强直性脊柱炎并发葡萄膜炎的诊断及治疗(附16例报告)

[目的]探讨强直性脊柱炎并发葡萄膜炎的诊断和治疗。[方法]对16例确诊强直性脊柱炎并发葡萄膜炎患者的症状、X线表现、实验室检查结果进行分析,总结其临床特征和治疗方法。[结果]16例患者（16只眼）均为急性前葡萄膜炎,葡萄膜炎的平均发病年龄为32岁,均有葡萄膜炎复发史,双眼受累者10例（62.5%）,均为单眼交替发病。所有患眼均表现为急性非肉芽肿性前葡萄膜炎;葡萄膜炎平均持续时间为4周。X线检查均有轻重不等的骶髂关节炎改变,13例患者HLA-B27阳性（81.3%）,经睫状肌麻痹剂和糖皮质激素眼液治疗后14只眼最佳矫正视力≥1.0。[结论]对于合并有腰骶痛及关节症状的急性前葡萄膜炎患者进行X线及HLA-B27检查,有助于早期确诊强直性脊柱炎。强直性脊柱炎并发葡萄膜炎经睫状肌麻痹剂和糖皮质激素滴眼等综合治疗预后良好。     

强直性脊柱炎伴发前葡萄膜炎23例临床分析

目的:研究分析强直性脊柱炎(ankylosingspondylitis,AS)伴发前葡萄膜炎患者的临床特征,以提高对本病的诊断水平,降低误诊、漏诊率。方法:选取符合标准的23例前葡萄膜炎患者(共27眼),对其临床表现、实验室检查及诊疗经过进行统计分析。结果:①该23例患者中,男性18例,女性5例,男性患者占比明显高于女性患者;②AS发病年龄为(36±12)岁;葡萄膜炎发病年龄为(30±10)岁;③23例(100%)影像学检查均显示有骶髂关节不同程度的异常改变;15例(65%)HLA-B27检査阳性,12例(52%)血沉升高,5例(22%)C反应蛋自>10mg/L;④治疗上,予糖皮质激素滴眼液局部抗炎、睫状肌麻痹剂扩瞳以防止虹膜后粘连;病情严重者,予全身激素治疗;配合中药汤剂及药物熨敷等中医特色治疗,共治愈患者23例,预后良好。结论:AS伴发前葡萄膜炎发病人群中,青年男性居多,可造成多系统功能受损。根据典型的临床症状、体征及辅助检查可明确诊断。中西医结合治疗可取得良好疗效。     

强直性脊柱炎并发葡萄膜炎临床分析

目的:探讨强直性脊柱炎(AS)并发葡萄膜炎的临床特点、诊断和治疗,提高对该病的认识。方法:回顾性分析近3年江苏省苏北人民医院风湿免疫科门诊及住院部301例AS患者的临床资料,将AS并发葡萄膜炎的患者及未并发葡萄膜炎的患者分别定义为葡萄膜炎组及非葡萄膜炎组,进行统计学分析。结果:301例AS患者中,男性218例,女性83例,男女比约2.6∶1;曾经或就诊时有葡萄膜炎的患者为36例(11.96%)。葡萄膜炎组及非葡萄膜炎组患者的性别(P=0.119)、发病年龄(P=0.563)、HLA-B27阳性率(P=1.000)以及疾病活动度方面差异均无统计学意义。而葡萄膜炎组平均病程[(7.84±7.45)年]长于非葡萄膜炎组[(4.14±4.43)年,P=0.006];葡萄膜炎组患者中CD25升高的患者比例(55.56%)高于非葡萄膜炎组(36.60%,P=0.029);Bath AS功能指数(BASFI)评分在葡萄膜炎组(2.29±2.36)高于非葡萄膜炎组(0.96±1.53,P=0.003);葡萄膜炎组中77.78%患者有外周关节受累,高于非葡萄膜炎组(47.55%,P=0.001)。治疗方面,葡萄膜炎组生物制剂使用率为41.67%,高于非葡萄膜炎组(24.53%,P=0.029)。结论:AS患者的葡萄膜炎发病与病程相关,随着病程的延长葡萄膜炎发病率升高。葡萄膜炎组中有较多患者CD25升高,提示CD25可能与葡萄膜炎相关。伴发葡萄膜炎的AS患者更易有躯体功能受损和外周关节受累。AS病程中若出现葡萄膜炎,需积极进行局部及全身治疗;若疗效不佳,可建议患者使用生物制剂。     

HLA-B27阳性急性前葡萄膜炎的危险因素分析

目的分析白细胞抗原(HLA)-B27阳性急性前葡萄膜炎(AAU)的可能危险因素。方法收集2013年11月至2019年12月单眼发作的急性非感染性前葡萄膜炎患者的临床资料,按照HLA-B27是否阳性,分为HLA-B27阳性AAU组和HLA-B27阴性AAU组,进行单因素方差分析,筛选出危险因素。再对筛选出的有统计学意义的因素进行二元Logsic回归分析。结果112例患者中HLA-B27阳性AAU组72例,HLA-B27阴性AAU组40例。单因素方差分析显示,是否有强直性脊柱炎(AS)、类风湿因子、治疗前眼压、发病至开始治疗的间隔时间,差异有统计学意义(P<0.05)。二元Logisuc回归分析显示,是否有AS、治疗前眼压为其独立危险因素。结论HLA-B27阳性AAU的独立危险因素可能是治疗前眼压、合并有AS。因此,临床应重视眼压监测、加强AS多学科治疗。     

糖皮质激素治疗角膜葡萄膜炎的疗效和安全性

目的探讨糖皮质激素治疗角膜葡萄膜炎的疗效并评价其安全性。方法对2002～2010年期间应用小量糖皮质激素治疗的86例角膜葡萄膜炎患者(102患眼),进行分析。结果应用激素治疗前后患者平均视力分别为0.45±0.120、.64±0.35,差异有统计学意义(P<0.05)。治疗中无药物不良反应发生。结论应用小量糖皮质激素治疗角膜葡萄膜炎,可迅速控制炎症,安全性好。     

获得性梅毒的葡萄膜炎临床特征和治疗

目的：分析获得性梅毒患者的葡萄膜炎（梅毒性葡萄膜炎）临床特征,观察其治疗效果。方法回顾性分析15例（22只眼）经临床及血清学检查确诊的梅毒性葡萄膜炎患者临床资料,确诊后均行驱梅治疗,并随诊观察6个月以上。结果15例（22只眼）患者中,男9例,女6例。发病年龄为（47．3±5．2）岁。7例患者为双眼发病,8例为单眼发病。病程2 d ～1．5年,平均病程2．2±1．6月。患者均以视力下降或眼前黑影飘动等为主诉就诊。初诊平均视力0．15±0．21;9例患者（14只眼,63．6％）表现为全葡萄膜炎,6例（8只眼,36．4％）表现为后葡萄膜炎、视神经视网膜炎。玻璃体均有尘状混浊,眼底检查视网膜色泽污浊灰暗,黄斑中心凹反射消失,13例（20只眼,90．9％）可见视盘充血或水肿,21只眼行眼底血管造影检查显示,所有患眼均有程度不等的斑驳状背景荧光增强改变,20只眼的视乳头有荧光素着染或渗漏,16只眼的视网膜静脉有荧光素渗漏,4只眼出现黄斑囊样水肿。经驱梅治疗半年后随访时,视力提高19只眼（86．4％）,所有患眼炎症消退。结论梅毒性葡萄膜炎是一种可以治愈的疾病,早期诊断、正规治疗后患者的预后较好。     

糖皮质激素滴眼与球结膜下注射治疗葡萄膜炎疗效分析

目的：比较糖皮质激素滴眼液滴眼与糖皮质激素球结膜下注射对特发性前葡萄膜炎的治疗效果。方法：对共48例（63只眼）特发性前葡萄膜炎患者，其中24例32只眼用塘皮质激素滴眼液滴眼，根据炎症程度选择滴眼频率，每次1滴，24例31只眼用糖皮质激素球结膜下注射。根据炎症程度每日一次或隔日一次注射，两组均用药至炎症消退，并同时使用非甾体类消炎药滴眼及睫状肌麻痹药治疗。结果：糖皮质激素滴眼组及球结膜下注射组治疗6w后炎症全部消退，差异没有显著性（P〉0．05），结膜下注射组有球结膜充血、水肿、疼痛等副作用。结论：糖皮质激素滴眼与球结膜下注射对特发性前葡萄膜炎有相同的治疗效果。     

急性视网膜坏死临床分析

急性视网膜坏死是由疱疹类病毒引起的以急性前葡萄膜炎、玻璃体炎、闭塞性视网膜血管炎、视网膜坏死、视网膜脱离为主要特征的眼部综合征 ,误诊率较高。现将我院 1999年 1月～ 2 0 0 3年 10月收治的急性视网膜坏死 11例 13眼报告如下。1　临床资料1 1　一般资料　本组 11例中男 7例 ,女 4例 ;年龄2 1～ 5 0岁 ,平均 35岁。单眼发病 9例 ,双眼发病 2例。表现为眼红、疼痛伴视物模糊 10眼 ,眼前黑伴视力下降 2眼 ,无痛性视力下降 1眼。1 2　误诊及确诊情况　本组误诊为葡萄膜炎 7眼 ,其中前葡萄膜炎 4眼 ,全葡萄膜炎并玻璃体炎 3眼 ;视网膜…     

眶内电针治疗Fisher综合征所致眼肌麻痹临床观察

目的:回顾分析眶内电针(IEA)治疗Fisher综合征(MFS)眼肌麻痹疗效及MFS眼肌麻痹患者的临床特点。方法:收集接受IEA治疗的MFS患者27例的资料,对一般资料、受累颅神经、感染情况、治疗前后最大复视角度、治疗及恢复情况等进行回顾分析。结果:患者从发病到开始接受IEA治疗的平均时间为(31.04±46.23)d,接受治疗后达到临床痊愈的平均天数为(33.67±21.96)d。临床痊愈(无复视致残)24例(88.9%)。治疗后,左眼和右眼的最大复视角度均较治疗前显著降低(P0.01)。MFS眼肌麻痹特点:100%患者有外展神经病变,其中11.1%为单侧病变,88.9%为双侧受累;37.0%合并III、VI对颅神经麻痹,无孤立的III或IV对颅神经麻痹患者。70.3%有感染史;11.1%伴发高血压、7.4%伴发高脂血症、3.7%伴发2型糖尿病。22.2%伴有Bell征,双侧受累4例,单侧受累2例。25.9%眼睑下垂,双侧受累5例,单侧受累2例。3.7%伴有双侧瞳孔散大。结论:IEA治疗可加快MFS眼肌麻痹症状恢复,MFS眼肌麻痹的临床特点可提示临床诊断。     

白内障超声乳化及人工晶体植入术治疗葡萄膜炎并发白内障54例围术期护理

目的:探讨白内障超声乳化及人工晶体植入术治疗葡萄膜炎并发白内障的临床效果和护理经验。方法:给予54例(57眼)葡萄膜炎并发白内障患者白内障超声乳化及人工晶体植入手术治疗,实施细致的围术期护理,观察手术效果。结果:所有患者均顺利完成手术,人工晶状体植入囊袋内;术后52眼(91.2%)视力较术前有明显提高,4眼(7.0%)因继发性青光眼和视神经萎缩视力无提高,1眼(1.8%)因黄斑囊样水肿而导致视力低下。术前矫正视力0.05~0.30(0.15±0.08),术后1个月矫正视力0.3~1.0(0.50±0.25),比较差异有统计学意义(t=9.97,P=0.000);术后40眼(70.2%)出现不同程度葡萄膜炎反应,经局部及全身糖皮质激素和非甾体抗炎剂治疗后炎症消退,2例患者(2眼)分别在术后6、10个月葡萄膜炎复发,经局部糖皮质激素和散瞳剂治疗后炎症得以控制,视力恢复。结论:白内障超声乳化及人工晶体植入术治疗葡萄膜炎并发白内障疗效确切,并发症少,围术期细致的护理干预是保障手术顺利进行和术后视力改善的重要环节。     

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.