下尿路超声尿动力学研究:腹压大小和尿道膀胱连接部移动度之间的关系

目的　探讨当膀胱容量一定时 ,腹压大小和尿道膀胱连接部移动度的关系。方法　应用超声尿动力学方法对 40例患者进行检查 ,取膀胱容量一定时 ,同步记录腹压大小和连接部移动度 ,并比较两者的关系。结果　对40例患者共 12 0例次的同步测量结果表明 ,腹压和移动度呈正相关 (r =0 .6 1,P =0 .0 0 0 1)。结论　在一定腹压范围内 ,移动度随着腹压的变化而改变 ,这为今后移动度测定的标准化提供了依据。     

下尿路超声尿动力学研究:女性压力性尿失禁尿道膀胱连接部移动度和压力传导比关系的同步观察

目的 探讨超声尿动力学技术应用于女性压力性尿失禁诊断的初步结果。方法 对３０例压力性尿失禁患者和２２例正常人作超声尿动力学检查,测量连接部移动度和尿道膀胱压,计算压力传导比,并作统计学处理。结果 尿失禁组和正常组之间解剖参量连接部移动度和功能参量压力传导比存在显著的差异。尿失禁组阅移动度明显大于正常组。尿失禁组压力传导比明显低于正常组。连接部移动度和压力传导比存在负相关关系（ｒ＝－０．５８,Ｐ＝０     

下尿路超声尿动力学研究:女性压力性尿失禁尿道膀胱连接部移动度和压力传导比关系的同步观察

目的　探讨超声尿动力学技术应用于女性压力性尿失禁诊断的初步结果。方法　对 30例压力性尿失禁患者和 2 2例正常人作超声尿动力学检查 ,测量连接部移动度和尿道膀胱压 ,计算压力传导比 ,并作统计学处理。结果　尿失禁组和正常组之间解剖参量连接部移动度和功能参量压力传导比存在显著的差异。尿失禁组连接部移动度明显大于正常组。尿失禁组压力传导比明显低于正常组。连接部移动度和压力传导比存在负相关关系 (r =- 0 5 8,P =0 0 0 0 1)。结论　超声尿动力学研究结果支持压力性尿失禁膀胱尿道压传递障碍学说。     

超声尿动力学对尿道最大关闭压和腹压漏尿点压及膀胱颈移动度的研究

目的应用超声尿动力学技术研究静态和动态尿道关闭压及膀胱颈移动度的关系。方法对40例真性压力性尿失禁和22例正常入进行超声和尿动力学同步观察,标化测定静态最大尿道关闭压、腹压漏尿点压和膀胱颈移动度。结果真性压力性尿失禁腹压漏尿点压与尿道最大关闭压呈明显的线性相关(r=0.49,P=0.001),其回归方程y=21.90+0.88x。压力性尿失禁尿道最大关闭压、腹压漏尿点压均值显著低于正常组(P＜0.01)。膀胱颈部移动度显著高于正常组(P＜0.01)。腹压漏尿点压＞55cmH     

女性真性压力性尿失禁超声研究：尿道膀胱连接部位移线量参数分析

采用阴道探头经会阴超声显像研究真性压力性尿失禁（ｎ＝２５），通过设立正常组（ｎ＝４３）和无尿失禁盆底松弛组（ｎ＝１２），对反映尿道膀胱连接部位移的１０个线量指标进行了观察比较。结果发现压力性尿失禁连接部在静止期已处于低位，张力期呈过度移位。连接部移动度（ＵＶＪ－Ｍ）、张力期连接部垂直距离（ＵＶＪ－ＶＤ）及其增量△ＵＶＪ－ＶＤ）是研究压力性尿失禁连接部位移的三个特征性线量参数，而又以连接部移动度参数最具特征性。     

应用经食管超声肺静脉流速定量诊断左房压心脏手术中与心导管同步性研究

应用经食管脉冲多普勒超声在术中测定了７６例不同心脏病患者的左上肺静脉血流频谱。结果显示：Ｒｖ和ＳＦ％分别与同步测定的平均左房压间存在高度相关性（ｒ＝－０．８８和ｒ＝－０．８７）；以ＳＦ％小于５２％预测平均左房压大于２．０ＫＰａ时，其敏感性和特异性分别为９３％和８５％。结论认为，应用经食管脉冲多普勒测定肺静脉血流频谱能准确估测平均左房压，为定量评价左室舒张功能提供了新途径     

左室舒张末压与二尖瓣返流：频谱多普勒和心导管检查的同步性…

应用连续波多普勒测定了３６例二尖瓣返流患者的最大压差及左室舒张末压，并与同步心导管测定的同一测值对比。结果表明：两种技术测定的左室舒张末压之间存在高度相关（ｒ＝０．９４２，ｙ＝１．０４５ｘ－０．０１，ｐ〈０．００１，ＳＥＥ＝０．３９ｋＰａ）结论认为，频谱多普勒测定二法瓣返流压差为无创评价左室舒张功能提供了准确可靠的新途径。     

应用经食管超声肺静脉流速定量诊断左房压以及心脏手术中与心 …

应用经食管脉冲多普勒超声在术中测定了７６例不同心脏病患者的左上肺静脉血流频谱。结果显示：ＲＶ和ＳＦ％分别与同步测定的平均左房压间存在高度相关性（ｒ＝－０．８８和ｒ＝－０．８７）；以ＳＦ％小于５２％预测平均左房压大于２．０ＫＰａ时，其敏感性和特蜡性分别为９３％和８５％。结论认为，应用经食管脉冲多普勒测定肺静脉血流频谱能准确估测平均左房压，为定量评价左室舒张功能提供了新途径。     

脑血管病恢复期的护理侧重点

１对象与方法１．１对象１９９９～２００１年收住院１５例脑血管病患者，男１０例，女５例，年龄３６～７７岁，平均５３．３岁。其中高血压病史１０年以上１３例，脑血管瘤１例、脑出血７例、脑梗死６例，缺氧性脑病１例。１．２方法恢复早期的护理重点：（１）膀胱护理：针对患者尿失禁情况采取膀胱训练的方法。①容量训练：训练前应检测患者膀胱容量大小，如小于３００ml，为小容量膀胱，应进行夹管训练即每４h左右开放尿管１次，夜间持续开放，至膀胱容量恢复正常。检测膀胱容量的方法可用生理盐水或呋喃西林５００ml冲入膀胱内，至患…     

“瓶盖”法对脊髓损伤并截瘫病人压疮治疗的探讨

本科对收治的４８例压疮患者进行了治疗上的探讨，总结如下。１对象与方法１．１对象４８例压疮患者均为收治的脊髓损伤并截瘫病人。入院时随机分为Ａ、Ｂ两组，每组２４例。Ａ组为常规处理组：年龄２７．５±３岁；骶尾部压疮１４例，大粗隆部压疮９例，跟骨部压疮１例；压疮Ⅰ度２例，Ⅱ度９例，Ⅲ度１１例，Ⅳ度２例。Ｂ组为“瓶盖”法探讨组：年龄２６．２±３．０岁；骶尾部压疮１１例，大粗隆部压疮１３例；压疮Ⅰ度３例，Ⅱ度１３例，Ⅲ度７例，Ⅳ度１例。１．２方法常规处理组处理包括：定时翻身，免除受压，尤其应避免压迫已有压疮…     

The laparoscopic Burch procedure: Avoiding complications

Summary

Urinary stress incontinence affects approximately 29% of adult women. The primary cause of genuine stress incontinence is loss of support of the urethrovesical junction. The Burch procedure is the most effective technique for correcting the urethrovesical angle and resolving genuine stress incontinence. The performance of this procedure in the classic open manner is associated with complications of infection, haemorrhage and voiding dysfunction. Substitution of a laparoscopic approach to the space of Retzius results in less blood loss, fever, infections, and a decreased incidence of voiding dysfunction with improved results.     

Assessment of female urinary incontinence by introital sonography

By the use of a vaginal sector scanner, placed to the vaginal introitus (introital sonography), we studied the static and dynamic function of the urethrovesical region in patients with genuine stress incontinence and detrusor instability. Patients with genuine stress incontinence (n = 25) revealed either an increase of the retrovesical angle or the angle of inclination associated with a descent of the bladder neck during coughing. Opening of the bladder neck during cystometry, showing an increase of the detrusor pressure, was observed in patients with motor urge incontinence (n = 10). Application of the technique is recommended in patients with stress incontinence undergoing surgery for objective intraoperative assessment of successful reformation of the urethrovesical junction, irrespective of the surgical procedure. Compared with radiologic techniques, introital sonography has many advantages with no radiation exposure and with minimal inconvenience to the patient.     

MR血管成像血流动力学预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死

目的 评估基于MR血管成像(MRA)血流动力学预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的价值。方法 随机收集40例经头部MRA诊断的椎-基底动脉交界处裂隙型开窗患者，将其中20例伴后循环脑梗死归为脑梗死组，20例无脑梗死者纳入对照组。基于MRA建立椎-基底动脉模型，以开窗汇合处为A位，开窗左侧血管支为B位，开窗右侧血管支为C位，开窗起点处为D位，分别测量血流动力学参数，包括血流速度(V)、梯度振荡数(GON)、振荡剪应指数(OSI)、壁面压力(WP)、壁面切应力(WSS)及动脉瘤形成指数(AFI)。采用单因素及二元logistic逐步回归分析筛选椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的血流动力学参数相关独立危险因素，并以之建立回归模型；绘制受试者工作特征(ROC)曲线，计算曲线下面积(AUC),评估单一独立危险因素及回归模型预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的效能。结果 脑梗死组V(A)、V(B)及WSS(D)均高于对照组(P均<0.05),且三者均为椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的独立危险因素。以V(A)、V(B)及WS...     

胃镜协助气管插管在无痛内镜手术中的应用

目的 研究胃镜协助气管插管在无痛内镜手术全身麻醉气管插管中的临床应用效果和优势.方法 选取2018年1月-2019年12月该院收治的80例拟行内镜手术的全身麻醉气管插管患者,随机分成普通喉镜组(n=40)和胃镜协助组(n=40),普通喉镜组直接行气管插管,胃镜协助组采用胃镜协助的气管插管法.记录两组患者一次性插管成功率...     

Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design

IntroductionRoughly 17 million abdominal surgeries are performed annually in the U.S. Up to 17% of those may be readmitted for adhesion related problems. This study evaluated the effectiveness of soft tissue mobilization (STM) techniques at improving chronic pain, mobility restrictions and functional deficits following complex abdominal surgery.MethodsSubjects Two females aged 51 and 65.DesignSingle subject quasi-experimental A-B-A.InterventionFour 30-min treatment sessions of abdominal tissue mobilizations.Outcome measures Pain pressure threshold (PPT) and average scar mobility (ASM), Numeric Pain Rating Scale (NPRS), and the Oswestry Disability Index (ODI).ResultsSubject 1 ASM and PPT of the abdomen improved significantly and exceeded the established standard error of measurement (SEM). PPT of the scar decreased during the second baseline. This decrease exceeded the SEM for PPT but was not statistically significant. The changes in NPRS did not reach the minimal clinically important difference (MCID).Subject 2 abdominal PPT and ASM showed statistically significant improvements that exceeded their SEMs. Scar PPT showed improvement during the repeat baseline, however, this reached neither statistical significance nor the SEM.ConclusionsScar mobility and abdominal PPT improved both statistically and clinically in both subjects after only 4 sessions of STM. Scar pain measured by NPRS and PPT did not show significant improvement. This study demonstrated that STM can be an effective way to treat chronic abdominal scars by increasing scar mobility and reducing abdominal sensitivity to pressure. It is non-invasive, and is a less costly alternative to laparoscopic adhesiolysis.     

Keeping vulnerable elderly patients free from pressure ulcer is associated with high caregiver burden in informal caregivers

Rationale and objectives The effect of the presence of pressure ulcers on burden of caregivers is unknown. We investigated the relationship between the state of pressure ulcers in vulnerable elderly patients and the burden on their informal caregivers. Methods This cross‐sectional study enrolled 137 patients aged ≥40 years with limited activity and mobility at 10 home care service facilities in Japan. We assessed pressure ulcer status from medical records and caregiver burden using scores from both the Burden Index of Caregivers (BIC) and the Japanese short version of the Zarit Burden Interview (ZBI). Results Among patients, mean age was 80.9 years, 31.4% were men, and 83.9% were free from pressure ulcers. Multivariable analysis showed that caregivers whose patients were free from pressure ulcers had significantly higher caregiver burden as assessed by both the BIC [β‐coefficient = 3.18, 95% confidence interval (CI): 1.42–4.95, P = 0.003] and ZBI scores (β‐coefficient = 1.94; 95%CI = 0.30–3.58; P = 0.03). Conclusions Our results suggest that the continuous effort involved in keeping patients free from pressure ulcers may be associated with high caregiver burden in informal caregivers.     

经胸超声心动图诊断A型主动脉壁间血肿

目的 观察经胸超声心动图诊断A型主动脉壁间血肿的价值。方法 回顾性分析40例经CT血管成像（CTA）确诊的A型主动脉壁间血肿患者的临床资料及超声心动图表现,评价经胸超声心动图诊断A型主动脉壁间血肿的价值。结果 40例A型主动脉壁间血肿患者,男25例（25/40,62.50%）,女15例,发病中位年龄55岁;以胸背部疼痛（36/40,90.00%）为主要症状;其中30例有高血压病史、15例有吸烟史。主动脉壁间血肿超声主要表现为主动脉壁内-中膜与外膜间存在厚薄不均匀低回声;主动脉窦部增宽与年龄、高血压病史相关（r=0.51,P=0.01;r=0.34,P=0.03）。25例（25/40,62.50%）合并主动脉瓣反流,其中21例（21/25,84.00%）为轻度反流;12例合并心包积液,其中10例（10/12,83.33%）为少量积液。结论 经胸超声心动图对诊断A型主动脉壁间血肿有一定价值,并可用于患者随访。     

Chest Wall Mobility: Identification of Underlying Predictors

ObjectiveThe purpose of this study was to identify factors contributing to normal mobility or hypermobility of the chest wall.MethodsSeventy-eight young adults were divided into 2 groups: patients with normal mobility (group 1, n = 40) and hypermobility of the chest wall (group 2, n = 38). The mean mobility of the chest wall in groups 1 and 2 was 9.9 and 6.1 cm, respectively. The mean age of groups 1 and 2 was 22.2 and 21.5 years, respectively. The Brief Symptom Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory, and the Perceived Stress Scale were used to evaluate the psychometric properties. Quality of life was assessed using 12-Item Short Form Health Survey. Smoking status was determined via self-report of current smoking status. Chest wall mobility was measured using thoracic and axillary cirtometry. Pulmonary functions were evaluated using a Spirobank II device. Subsequently, forced vital capacity (FVC), forced expiratory volume in 1 second, peak expiratory flow, and forced expiratory flow 25% to 75% were verified. Carefusion Micro RPM and the 6-minute walk test were used to evaluate maximal respiratory pressures and functional capacity, respectively.ResultsWith backward linear regression models, FVC and obsessive-compulsive traits were significant predictors of chest wall mobility (R² = 0.27; P < .001 and P = .01, respectively). In logistic regression models, FVC, maximum inspiratory pressure, and obsessive-compulsive traits were significant predictors of normal mobility/hypermobility of the chest wall (R² = 0.42; P < .001, P = .01, and P = .03, respectively).ConclusionForced vital capacity, maximum inspiratory pressure, and obsessive-compulsive traits are significant predictors of chest wall mobility and normal mobility or hypermobility of the chest wall.     

Internal retraction in single-port laparoscopic cholecystectomy: Initial experience and learning curve

Abstract

Introduction: We report our experience and learning curve in single-port laparoscopic cholecystectomy (SPLC) using an internal anchored retraction system. Methods: Usefulness of the retraction system was analysed in 18 SPLC. The first eight, the following ten SPLC and 20 consecutive four-port laparoscopic cholecystectomies (4PLC) were compared. Duration of operation, burns on nontarget tissue and gallbladder perforations were assessed by reviewing videotapes recorded during the procedures. Results: Use of the retraction system failed in three out of five patients (60%) with intraoperative signs of chronic inflammation and in one out of 13 (7.1%) without such signs (p = 0.0441). Median operation time was 90 (45–120) in the first eight and 55 (40–180) minutes in the following ten SPLC (p = 0.0361). Whereas the first eight SPLC lasted longer compared to 4PLC (70 (40–140) minutes, p = 0.0435) the difference disappeared after eight procedures (p = 0.2076). Median number of burns to nontarget tissue was seven (1–16) in the first eight and one (0–8) in the following ten SPLC (p = 0.0049). There was no difference in perforation of the gallbladder. Discussion: Internal retraction enables a safe exposure of the Calot triangle avoiding bile spillage in cholecystectomies without intraoperative signs of inflammation. Familiarisation with SPLC was rapidly achieved. Operation time and dexterity were equal to 4PLC after eight SPLC.