纤维喉镜下门诊改良手柄YAG激光揭盖术治疗会厌囊肿的临床观察

目的探讨纤维喉镜下经门诊改良手柄YAG激光揭盖术治疗会厌囊肿相较传统治疗方法的优势。方法将门诊确诊的118例会厌囊肿患者随机分为两组,实验组59例在纤维喉镜下经门诊改良手柄YAG激光施行揭盖术,传统组59例经过纤维喉镜活检通道导入YAG激光手术。手术后随访6个月以上,观察比较两组的治疗效果、会厌部的生理功能恢复时间和治疗的总时间及囊肿复发率。结果对比结果,实验组较传统组在治疗效果、会厌部生理功能恢复时间、治疗时间及囊肿复发率方面均有优势,差异有显著性(P0.05)。结论纤维喉镜下经门诊改良手柄YAG激光揭盖术治疗会厌囊肿较传统治疗方法更有效、更方便、更安全。     

会厌囊肿摘除治疗效果分析

目的观察会厌囊肿摘除术治疗会厌囊肿的手术效果。方法将24例患有会厌囊肿的患者随机分为对照组和治疗组,各12例。对照组采用表面麻醉下射频治疗,治疗组采用全麻下会厌囊肿摘除术治疗。结果治疗组疗效明显优于对照组,喉部生理功能恢复时间和治疗总时间明显短于对照组,治疗后病情复发率明显低于对照组。结论应用会厌囊肿摘除术对患有会厌囊肿的患者实施治疗的临床效果非常明显。     

支撑喉镜电视内镜下低温等离子射频治疗会厌囊肿的疗效及其对术后近期复发率的影响

目的对比研究支撑喉镜电视内镜下低温等离子射频治疗会厌囊肿的临床疗效及其对术后近期复发率的影响。方法将2014年1～12月于我院行会厌囊肿手术治疗的76例患者随机分为两组：观察组（n=38）行支撑喉镜电视内镜下低温等离子射频治疗;对照组（n=38）行常规手术治疗。对比两组手术效果及术后12个月复发情况。结果（1）所有患者均手术成功,观察组术中出血量、手术时间、术后模糊视觉疼痛评分（VAS）、术后咽痛时间、住院时间均明显优于对照组,组间差异有统计学意义（P〈0.05）;（2）两组术后均未见严重并发症,其它并发症出现率无明显差异（P〉0.05）;（3）观察组复发率明显低于对照组（P〈0.05）。结论支撑喉镜电视内镜下低温等离子射频治疗会厌囊肿疗效显著、复发率低,值得推广。     

鼻前庭囊肿揭盖术与传统唇龈沟径路鼻前庭囊肿切除术的比较

目的:比较鼻前庭囊肿揭盖术与传统唇龈沟径路鼻前庭囊肿切除术的优缺点.方法:对2007年5月至201 1年9月我科69例鼻前庭囊肿手术患者的临床资料进行回顾性分析,其中33例行鼻前庭囊肿揭盖术(揭盖组),36例行唇龈沟径路鼻前庭囊肿切除术(唇龈沟组).结果:唇龈沟组有2例术后复发,揭盖组有3例术后复发,两组比较差异无统计学意义(P＞0.05),揭盖组在手术时间、出血量、伤口愈合时间及术后患者反应、伤口疼痛程度方面明显优于唇龈沟组,两组比较差异具有统计学意义(P＜ 0.05或P＜0.01).结论:鼻前庭囊肿揭盖术具有手术时间短、出血少、术后恢复快、患者痛苦轻等优点,且复发率与唇龈沟径路手术相当,故可作为鼻前庭囊肿治疗的首选.     

三种方法治疗鼻前庭囊肿的疗效比较

目的比较3种方法治疗鼻前庭囊肿的优缺点,探讨鼻前庭囊肿的最佳治疗方法。方法 2002年1月-2008年6月收治鼻前庭囊肿患者84例,随机分为3组,分别采用微波、鼻前庭揭盖术和唇龈沟切口径路鼻前庭囊肿切除术治疗。结果 84例患者均治愈。3组治疗时间和出血量比较均有统计学意义（P〈0.05）。术后4例发生感染,分别为鼻前庭揭盖术组1例（3.57%）,唇龈沟切口径路鼻前庭囊肿切除术组3例（10.71%）。随访1年,仅微波治疗组3例患者（10.71%）因囊肿壁残留复发,行鼻内镜下鼻前庭囊肿揭盖术后治愈。结论鼻内镜下鼻前庭囊肿;揭盖术具有精确、微创、手术时间短、并发症少、复发率低等优点。     

鼻前庭囊肿鼻内镜下电动切割揭盖术与唇龈沟径路切除术的临床分析

目的比较鼻内镜下鼻前庭囊肿电动切割揭盖术及唇龈沟径路鼻前庭囊肿切除治疗鼻前庭囊肿的效果。方法回顾性分析2009年8月至2015年12月在扬州市第一人民医院行手术治疗的58例鼻前庭囊肿患者,26例接受鼻内镜下鼻前庭囊肿电动切割揭盖术(观察组),32例接受唇龈沟径路鼻前庭囊肿切除术(对照组),依据不同术式分成2组,对2组手术出血量、手术时间、术后疼痛评分、囊肿复发率等方面进行比较,采用SPSS 19.0软件进行统计学分析。结果观察组和对照组在手术出血量、手术时间、术后患者疼痛评分方面行统计学比较,差异均有统计学意义(P<0.05)。观察组患者术后经术后3个月~2年的随访观察均未复发,对照组患者经术后3个月~2年的随访观察3例复发。结论鼻内镜下鼻前庭囊肿电动切割揭盖术具有以下优点:复发率低、手术损伤小、出血少、时间短、术后患者舒适度好等,是治疗鼻前庭囊肿的确切方法。     

鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿的疗效观察

目的:观察鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿的临床疗效。方法:选取2017年4月～2019年4月治疗的70例鼻前庭囊肿患者为研究对象,随机分为对照组和观察组,每组35例。对照组使用唇齿沟径路切除术治疗,观察组使用鼻内镜前庭囊肿揭盖术治疗,对比两组手术相关指标、术后并发症发生情况及炎症介质水平变化。结果:观察组手术用时、住院时间及创口愈合时间均短于对照组,术中出血量低于对照组(P0.05);治疗后,观察组白细胞介素-8、白细胞介素-6、C反应蛋白及肿瘤坏死因子-α水平均低于对照组,差异有统计学意义(P0.05);观察组术后并发症发生率低于对照组,但差异无统计学意义(P0.05)。结论:使用鼻内镜前庭囊肿揭盖术治疗鼻前庭囊肿具有损伤小、恢复快等优势,机体炎症反应较轻,利于术后康复。     

低温等离子射频与高频电刀切除会厌囊肿的疗效观察

【目的】探讨低温等离子射频与高频电刀治疗会厌囊肿的临床疗效。【方法】全麻状态支撑喉镜引导下,采用低温等离子射频或高频电刀对40例会厌囊肿患者手术治疗,观察并比较两种方法疗效。【结果】低温等离子射频对比高频电刀切除会厌囊肿具有出血量少、术后疼痛及不适时间短等优点,但费用偏高。【结论】低温等离子治疗会厌囊肿临床疗效确切,安全可靠,容易操作,但费用偏高,适合在大中型城市推广。     

二氧化碳激光、低温等离子及电刀治疗会厌囊肿的临床效果分析

目的探讨显微喉镜下二氧化碳激光、低温等离子及电刀3种方法治疗会厌囊肿的临床效果。方法选择60例会厌囊肿患者,按照术式分成激光组、等离子组和电刀组,每组20例。比较3组患者术后疼痛、恢复进度、复发率、并发症、术中操作出血等。结果等离子组术后疼痛最轻,激光组次之,电刀组最重。术后恢复进度,激光组与等离子组类似,电刀组恢复较前2组延迟。术中出血方面,激光组、等离子组较少,电刀组出血较多。随访0.5~3年,激光组、等离子组均无复发,电刀组1例复发。电刀组术后出现少量出血1例,会厌缺损并发症1例。结论 3种手术方法均是治疗会厌囊肿的主要方法,均能取得比较好的治疗效果,但显微喉镜下二氧化碳激光、低温等离子治疗会厌囊肿更有优势。     

腹腔镜治疗52例卵巢子宫内膜异位囊肿治疗的临床疗效观察

选取104例需手术治疗的卵巢子宫内膜异位囊肿患者,分别采用腹腔镜手术和开腹手术治疗。结果与开腹手术相比,腹腔镜手术组手术时间短,术中出血量少,术后排气时间短,术后下床时间短,平均住院时间短,各项指标比较差异显著,具有统计学意义(P0.05)。腹腔镜手术组总治疗有效率为100.0%,明显高于传统开腹手术组(88.5%),两组比较差异显著(P0.05);腹腔镜手术组术后1年复发率为0,低于传统开腹手术组(7.69%),两组比较差异显著(P0.05)。腹腔镜手术治疗卵巢子宫内膜异位囊肿疗效确切,创伤小、疼痛轻、恢复快、术后并发症少,是治疗该病的理想术式。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.