不同麻醉方法对腹腔镜子宫切除术病人气腹应激的临床观察

目的观察全麻复合硬膜外麻醉与单纯气管内全麻对腹腔镜子宫切除手术病人气腹应激的影响。方法对44例腹腔镜子宫切除术患者应用单纯气管内全麻(A组),并与同期44例全麻复合硬膜外麻醉患者(B组)进行比较。观察其对子宫切除术患者循环和皮质醇与醛固酮水平的影响。结果两组年龄、体重、ASA分级、并发症比较差异均无统计学意义(P>0.05)。A组收缩压(SBP)、平均动脉压(DBP)、心率(HR)在气腹后明显高于入室麻醉后-术前稳定时水平(P<0.05),尤其DBP、HR均高于B组同一时段的水平(P<0.05)。而B组术中SBP、DBP、HR均稳定于入室麻醉后-术前稳定时水平。A组在腹腔镜子宫切除术气腹后皮质醇、醛固酮水平较入室麻醉后-术前稳定时显著升高(P<0.01),且显著高于B组(P<0.05)。B组两者改变不显著(P>0.05)。结论全麻复合硬膜外麻醉可通过有效阻断交感神经的传导通路,降低气腹对腹腔镜子宫切除术气腹应激的影响,保持皮质醇与醛固酮水平和循环功能稳定。     

下颌骨黏液纤维瘤1例报告

患者　男, 36岁。右下颌膨隆 2年。体检:右侧下颌咬肌区及颊部膨隆明显,边界不清,上界达颌下,后界达下颌骨后缘,前界达口角,约 10. 0cm×9. 0cm,皮肤颜色正常,无破溃,于膨隆范围内之皮下可触及一实性肿物,与皮肤无明显粘连,中等硬度,界限不清,压痛不明显。口内:右侧颊部黏膜见6. 0cm×4. 0cm肿物,上界及下界已达上、下颌前庭沟,前界达┼4,后界不清,为实性中等硬度,表面呈紫红色,可见血管增生及齿痕,部分黏膜糜烂,触之易出血。实验室检查无特殊。颧颌曲面断层示:右侧髁状突下至下颌骨正中见多个不规则囊状骨质密度减低区,右下颌体部见一…     

面部烧伤应用MEBO治疗的护理体会

目的：探讨面部烧伤创面在应用MEBO治疗的变化特点，总结观察护理体会。方法：本组156例病人全部采用外涂MEBO，按常规的护理技术处理创面，对烧伤创面进行观察护理。结果：本组156例面部烧伤病人全部愈合，仅有1例留有轻度疤痕，且不影响功能，有效率占100％。结论：MEBO治疗面部烧伤方法简单，疗效短，效果可靠。但必须按严格的操作程序涂药，护理是关键。     

Locoregional Failure Analysis in Head-and-Neck Cancer Patients Treated with IMRT

PURPOSE: Analysis of locoregional failure in head-and-neck cancer (HNC) following intensity-modulated radiation therapy (IMRT), with focus on the location of locoregional failures in relation to the chosen planning target volumes (PTVs) and dose distributions. PATIENTS AND METHODS: Between January 2002 and May 2006, 280 HNC patients were subjected to IMRT at the authors' institution. Mean follow-up was 23.2 months (3-59.3 months). Definitive IMRT was performed in 75% of all patients. In 71%, simultaneous cisplatin-based chemotherapy was given. 70% of patients presented with T3/4, T1-2 N2c/3 or recurred disease. Locoregional failure patterns were analyzed. RESULTS: 2-year local, nodal, distant, disease-free, and overall survival rates were 80%, 87%, 87%, 73%, and 82%, respectively. 46 local (16%) and 31 nodal (11%) failures have been observed so far. Local tumor persistence was seen in 23/46 cases (50%), and nodal persistence in 12/31 (39%), respectively. One marginal local failure developed in a patient referred for a recurred oral cavity tumor. Three nodal failures developed outside the PTVs at unexpected locations. All other failures have been confirmed "in field". No failure occurred in level Ib or upper level II. Local failure occurred mainly following definitive IMRT for large tumors, nodal failure only in nodally positive patients with nodal high-risk features. CONCLUSION: The dose-volume concept as used here has shown to be adequate, with disease failure developing at the site of the initial gross tumor manifestation inside the boost volume.     

透析患者心理健康状况临床分析

目的以症状自评量表(SCL-90)、艾森克人格问卷(EPQ)、抑郁自评量表(SDS)为指标,探讨腹膜透析和血液透析患者的心理健康状况。方法选我院随访的腹膜透析和血液透析患者各64例,健康体检人群中选取64例作为对照组,以SCL-90,EPQ,SDS为测量工具,研究3组人群的焦虑、抑郁等心理状态。结果透析患者躯体化、抑郁、焦虑因子分显著高于对照组,抑郁问卷标准分及抑郁指数显著高于对照组,其情绪不稳定,遇到刺激有强烈情绪反应。结论进行透析的同时,应兼顾患者的情感反应和情绪障碍的治疗,改善其心理健康状况,提高患者生活质量。     

Radiation Emission from Patients Treated with Holmium-166 Radioembolization

PurposeTo assess the radiation exposure to individuals coming from patients after treatment with holmium-166 (¹⁶⁶Ho) microspheres.Materials and MethodsHolmium-166 radioembolization (RE) with escalating whole-liver doses of 20 Gy, 40 Gy, 60 Gy, and 80 Gy was administered to 15 patients. Exposure rates (μSv/h) from patients were measured at 1.0 m distance from a lateral and frontal position at 0, 3, 6, 24, and 48 hours after infusion. The total effective dose equivalent (TEDE) to a maximally exposed contact was calculated in accordance with guidelines of the U.S. Nuclear Regulatory Commission (NRC). Results were extrapolated to a whole-liver dose of 60 Gy used in future treatments.ResultsThe median exposure rate at discharge, 48 hours after infusion, measured from a lateral position was 26 μSv/h (range, 7–45 μSv/h). Extrapolated to a whole-liver dose of 60 Gy, none of the exposure rates for the NRC contact scenario, at any time, frontal or lateral, would lead to a TEDE > 5 mSv; all patients may be released directly after treatment. Release after 6 hours is possible without contact restrictions for patients who received up to 7 GBq.ConclusionsThe TEDE to a contact of patients treated with ¹⁶⁶Ho RE would not exceed the NRC limit of 5 mSv. Contact restrictions 6 hours after treatment are unnecessary for infused activities < 7 GBq.     

MRS监测TIPS术后脑代谢改变的研究

目的 采用磁共振波谱(MRS)成像监测门静脉高压症患者行经颈静脉肝内门体分流(TIPS)术后脑代谢改变,分析与TIPS术后肝性脑病(hepatic encephalopathy,HE)发生有关的因素及其对术后脑代谢的影响.资料与方法 15例拟行TIPS的门静脉高压症患者为病例组,12名健康自愿者为对照组,均行MRS检查.病例组在TIPS术前及术后1周予以MRS、肝肾及凝血功能、血氨及彩色多普勒监测,并监测TIPS术中及术后1周的门体压力梯度(PSG).MRS定位右侧基底节,以肌酸(Cr)为参照计算各代谢物相对浓度.所有研究对象在MRS检查后行数字连接试验-A(NCT-A)和数字符号试验(DST).结果 15例患者TIPS术后有3例出现HE症状(Ⅰ～Ⅱ期,17～45天).术前病例组较对照组的NCT-A及谷氨酸盐复合物(Glx)/Cr升高,DST、胆碱(Cho)/Cr及肌醇(mI)/Cr降低.术前肝功能Child C级患者较A、B级患者在术后的Glx/Cr升高、mI/Cr降低.术后HE患者较非HE患者的mI/Cr降低,Glx/Cr升高.危险因素单因素分析发现病例组术后PSG降幅及分流道流速与TIPS术后HE发生有关;相关性分析显示术后PSG降幅与术后脑代谢中Glx/Cr呈正相关(r=0.693,P=0.004).结论 术前肝功能状态对TIPS术后脑代谢改变有明显影响.TIPS术后PSG降幅过大,与术后HE发生及脑代谢改变均具有相关性.MRS对确定TIPS术后PSG降幅的合理阈值具有重要意义.     

Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization

Purpose

To investigate the impact of the first transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) on health-related quality of life (HRQoL) and identify predictors for low HRQoL following TACE.

Materials and Methods

HRQoL was prospectively evaluated in 79 patients with standardized questionnaires (QlQ-C30 and HCC18) pre- and 2 weeks post-TACE. Treatment response was evaluated using common tumour response criteria. Clinical parameters [e.g. Eastern Cooperative Oncology Group (ECOG) performance status, Model of End Stage Liver Disease (MELD) score], tumour load and pre-TACE HRQoL scores were tested for predicting HRQoL after TACE.

Results

Patients showed a 12.1% decrease in global health score (GHS). Major decreases were observed for physical (?21.4%), role (?23.4%), and social (?21.5%) functioning and increases in symptom severity for fatigue (+30.1%), loss of appetite (+25.3%), pain (+19.4%) after TACE. ECOG performance status >1 was associated with increased nausea/vomiting (p = 0.002) and decreased GHS (p = 0.01). MELD score >10 was associated with increased fatigue (p = 0.021) and abdominal swelling (p < 0.001). Our study showed an increase in symptom severity in patients with no symptoms before TACE for pain (p = 0.005) and abdominal swelling (p < 0.001).

Conclusion

The first TACE for treatment of HCC does not result in a major loss of HRQoL in general. For TACE as a palliative therapy maintaining HRQoL is of critical importance and standardized HRQoL assessment can help to detect HRQoL problems.

     

未行肾替代治疗的尿毒症肺的CT征象分析

目的 探讨尿毒症肺的CT表现特征.方法 收集尿毒症伴呼吸道症状或胸部平片发现异常的患者34例,其中慢性肾小球肾炎合并尿毒症29例、糖尿病肾病合并尿毒症3例,多囊肾合并尿毒症2例.全部病例均行64排螺旋CT检查,总结尿毒症肺的CT表现.结果 34例患者肺部存在的病变主要有肺泡性肺水肿(28/34)、间质性肺水肿(23/34)、肺淤血(34/34)、胸腔积液(19/34)、肺动脉高压(12/34)以及肺钙化(2/34).结论 未行替代疗法的尿毒症肺患者的胸部CT表现具有一定特征性.     

经皮肝穿射频消融治疗肝脏肿瘤术CT随访扫描技术探讨

目的 评价超声引导经皮穿刺射频治疗肝癌术后CT随访的时机和扫描技术。方法 回顾性分析198例超声引导经皮穿刺射频治疗肝癌术中的盯例患者，在术后1周至6个月的CT扫描方法和CT表现。结果 超声引导经皮穿刺射频治疗肝癌术后毁损灶在不同时期的CT表现各不相同。毁损灶在早期（一个月内）CT表现呈混合密度，中央区以稍高密度为主，而周围则呈低密度，病灶边界不清。增强扫描时中央区大部无强化，而边缘则呈不均匀强化。半年后随访病灶则呈边界清楚不强化的低密度影。结论 早期CT随访判定局部是否存在出血，毁损灶大小，有着重要的作用。中后期强化扫描对病灶的残留和复发的诊断有着重要的意义。中后期CT随访时应常规进行螺旋双期扫描。     

湿润烧伤膏治疗肛周感染120例临床分析

目的 总结分析湿润烧伤膏（MEBO）治疗肛周感染创面的临床疗效.方法 对120例肛周感染创面外用湿润烧伤膏治疗,并根据病情予以局部或全身抗感染、营养支持等治疗,观察患者创面愈合时间及愈后效果.结果 120例肛周感染患者创面全部愈合,治愈率达100%,愈合时间最长1个月,最短7d,平均愈合时间为13d,愈后创面平整、无瘢痕、弹性好,随访观察复发率在2%以下.结论 湿润烧伤膏具有止痛、抗感染、预防瘢痕增生、促进创面愈合等作用,且应用简便、费用低廉,适合基层医院推广应用.     

湿润烧伤膏治疗不同深度烧伤创面的临床体会

目的:总结湿润烧伤膏(MEBO)治疗各种深度烧伤创面的临床疗效.方法:对198例烧烫伤患者创而实行MEBO治疗,观察治疗过程中创面所发生的变化和病人的预后.结果:MEBO控制创面感染疗效显著,愈合时间缩短,未发现瘢痕增生和致残病例.结论:MEBO可用于各种深度烧伤创面的治疗,能避免创面发生再损伤.     

锥颅治疗慢性硬膜下血肿47例分析

目的探讨锥颅治疗慢性硬膜下血肿的疗效。方法对47例慢性硬膜下血肿患者均根据颅脑CT定位,采用经头皮直接锥颅置管冲洗引流术治疗。结果47例病人中,意识障碍、偏瘫均在1~2 d内明显好转,2周后患者生活基本能自理,记忆力恢复正常,术后全部痊愈出院,随访半年无一例复发。结论经头皮行锥颅慢性硬膜下血肿冲洗引流术操作简单、手术时间短、创伤小、并发症少、疗效高。