1例因晕倒引发脊髓损伤的院外转运

脊髓损伤多见于房屋倒塌,高处坠落,重物打击头部或肩部,车祸等严重事故。可能发生闭合性脊柱压缩性骨折,椎骨骨折和椎骨脱位,伤情常常严重复杂,甚至发生不同部位的截瘫,严重者可造成死亡。目前对北京急救中心转运一名高度疑似脊髓损伤患者,现报道如下。     

脊髓损伤患者性功能障碍的心理干预（附12例报告）

分析脊髓损伤患者的性功能障碍,通过心理干预帮助患者改善性功能。对脊髓损伤患者而言,主要是让患者了解脊髓损伤对性功能的影响,教育患者增强自信心,以积极的态度进行治疗。脊髓损伤后患者性功能与脊髓损伤的平面高低、范围大小及损伤程度有关。胸椎损伤5例患者治疗后在直接刺激下有勃起反射出现,腰椎损伤患者治疗后勃起时间均较干预治疗前有所增长。心理干预治疗对脊髓损伤患者提高生活质量有重要意义。     

男性脊髓损伤患者性、功能障碍的治疗与康复训练

对于脊髓损伤患者的性功能情况,除药物治疗外,给予性功能障碍康复及性生活指导,可有效改善脊髓损伤患者的性功能障碍。     

急性颈髓损伤并发低钠血症临床分析

目的 探讨急性颈髓损伤后低钠血症的临床特点和有效的治疗方法.方法 回顾性分析急性颈髓损伤后低钠血症患者16例,男15例,女1例,年龄35.6(17～46)岁,高位颈髓(C4及C4以上)损伤4例,低位颈髓(C4以下)损伤12例,的临床资料.结果 平均出现低钠血症时间为伤后(5.3±1.6)d,出现低钠高峰时间为伤后(7.9±2.1)d,低钠持续时间(18.7±5.1)d,最低血清钠浓度为(112.7±3.8)mmol/L.所有患者均给予深静脉插管以补液及行中心静脉压监测,经限水、补钠等治疗后14例患者低钠血症纠正,2例患者自动出院.结论 低钠血症原因是颈髓损伤发常见的严重并发症.通过严密监测患者血钠并维持钠代谢正平衡可纠正患者的低钠血症.     

不同剂量甲基强的松龙联合神经节苷脂治疗大鼠急性脊髓损伤

目的比较两种不同剂量的甲基强的松龙（MP）与单唾液酸神经节苷脂（GM—1）联合应用治疗大鼠实验性脊髓损伤的效果。方法36只大鼠随机分为3组，复制挤压性脊髓损伤动物模型，分别应用大剂量MP和两种不同剂量MP与GM—1联合治疗，术后24h、7d分别采血测定各组血清丙二醛（MDA）含量和后肢运动功能改良Tarlov评分。结果术后24h各组血清MDA含量显著升高，改良Tarlov评分显著降低，术后7d以上指标均有不同程度恢复，联合用药组较单独应用大剂量MP组恢复明显。其中，以小剂量MP＋GM-1组恢复效果最明显。结论小剂量MP和GM-1联合应用治疗大鼠实验性脊髓损伤的效果优于另外两种药物疗法。     

两种间歇导尿消毒法对男性脊髓损伤性功能及排尿功能障碍患者尿路感染发生率影响的对比分析

目的:通过两种间歇导尿消毒法对男性脊髓损伤性功能及排尿功能障碍患者尿路感染发生率的对比分析,为脊髓损伤间歇导尿患者寻求更有效的消毒方法。方法:将64例脊髓损伤性功能及排尿功能障碍患者随机分为无菌间歇导尿消毒法(对照组)和改良无菌间歇导尿消毒法(观察组)两组,比较两组患者实施间歇导尿术第1d、15d、30d出现尿路感染的比率。结果:62例患者完成实验,对照组2例患者实验期间发烧,改为持续留置导尿,两组患者均无无睾丸、附睾炎发生。观察组与对照组第1d尿路感染率分别是65.6%和66.7%;第15d尿路感染率分别是26%和60%;第30d尿路感染率分别是28.1%和66.7%,两组患者发生尿路感染的差异有统计学意义(P0.05),改良无菌间歇导尿消毒法第1d和第15d、30d比较,尿路感染率均有统计学意义(P0.05)。结论:改良无菌间歇导尿消毒法间歇导尿术应用于脊髓损伤性功能及排尿功能障碍患者,明显降低了泌尿系感染的发生率,是一种安全、有效的尿道消毒方法,值得临床推广。     

生殖器溃疡性疾病的病因分析

为了解以生殖器溃疡为主要表现的疾病的病因及其与HIV感染的关系，根据病史、临床表现，结合暗视野显微镜检查、梅毒血清学试验，PCR检测HSV-DNA，HIV抗体检测等进行诊断。186例生殖器溃疡性疾病中，梅毒46例(24．7％)；生殖器疱疹62例(33．3％)；梅毒和生殖器疱疹混合感染2例(1％)；拟诊软下疳3例(1．6％)；58例未能明确诊断，占31．2％；HIV感染1例。显示生殖器溃疡性疾病中，以生殖器疱疹和梅毒居多，软下疳少见，已出现合并HIV感染者。     

2018-2019年昆明市191例登革热患者临床特征分析

目的 探讨登革热临床特征,为登革热防治提供参考依据.方法 收集昆明市第三人民医院2018-2019年收治的登革热病例相关资料,并进行描述性统计分析.结果 191例中,东南亚输入约87.96％(柬埔寨占69.64％、缅甸占11.90％);境内占12.04％(西双版纳占11.52％).均有发热,发热平均(5.09±2.10...     

镇江市院外救治797例脑卒中患者特征分析

目的分析镇江市急救中心救治的脑卒中患者的流行病学与院外救治规律,为院外更好救治脑卒中提供建议。方法采用回顾性研究方法,分析2011年1月1日~12月31日期间镇江市急救中心救治的脑卒中患者的院外急救病历资料。结果共救治脑卒中患者797例,占同期院外急救人数的10.42%,其中①男女比例=1.32：1;年龄20~101岁,男性平均（66.67±13.937）岁,女性平均（71.85±13.797）岁（P<0.01）;发病率随年龄增长,70~79岁是最高发年龄段;既往史以高血压病史多见,占394例（49.4%）。②发病者数在季节上无特征变化（P>0.05）;一天中7：00~12：00、16：00~20：00是两个高峰时间段,9：00~10：00最高发时段（共6共61例,占8.3%）,而凌晨4：00~5：00的发病率最低（共9例,占1.4%）。③全部病例中危重192例（24%）,重症359例（45%）,轻症246（31%）;送三甲医院患者人数共为552例,占总人数的69.3%,以患方自主择院为主（626例,78%）。④急救反应时间（接警至到达现场时间）平均12.63 min,其中10 min内共318例（39.9%）;急救总耗时平均38.11 min。结论①老年人是脑卒中发生的易患人群,应积极开展预防工作,特别是有高血压病的患者应注意监测和治疗高血压;②脑卒中的救治过于集中于大医院,应积极构建脑血管病的急救、防治与康复的高度组织化的管理体系;③急救中心应加强院外急救网络建设,建立卒中院外处理系统,优化急救流程,有效减少延迟因素,提高院外急救质量。     

182例红皮病病因与临床特征分析

目的 探讨红皮病的病因与临床特征的相关性。方法 回顾性分析182例红皮病患者的临床资料。结果 男女之比为2.8 ∶ 1;发病年龄（58.6 ± 14.6）岁。继发于原有皮肤病135例（74.2%）,药物过敏14例（7.7%）,恶性肿瘤8例（4.4%）,原因不明25例（13.7%）。红皮病诱发原因中系统用药诱发比例最高,共52例（28.6%）,其中最常见的药物为糖皮质激素。随访76例,58例痊愈后未再发红皮病,再发患者14例,死亡5例,2例不明原因红皮病患者经过多次组织病理检查确诊为蕈样肉芽肿。结论 继发于原有皮肤病是红皮病的最常见原因。原因不明红皮病患者易复发,有伴随恶性肿瘤可能,应密切随访。     

Adaptation of a MR imaging protocol into a real-time clinical biometric ultrasound protocol for persons with spinal cord injury at risk for deep tissue injury: A reliability study

BackgroundHigh strain in soft tissues that overly bony prominences are considered a risk factor for pressure ulcers (PUs) following spinal cord impairment (SCI) and have been computed using Finite Element methods (FEM). The aim of this study was to translate a MRI protocol into ultrasound (US) and determine between-operator reliability of expert sonographers measuring diameter of the inferior curvature of the ischial tuberosity (IT) and the thickness of the overlying soft tissue layers on able-bodied (AB) and SCI using real-time ultrasound.Material and methodsPart 1: Fourteen AB participants with a mean age of 36.7 ± 12.09 years with 7 males and 7 females had their 3 soft tissue layers in loaded and unloaded sitting measured independently by 2 sonographers: tendon/muscle, skin/fat and total soft tissue and the diameter of the IT in its short and long axis. Part 2: Nineteen participants with SCI were screened, three were excluded due to abnormal skin signs, and eight participants (42%) were excluded for abnormal US signs with normal skin. Eight SCI participants with a mean age of 31.6 ± 13.6 years and all male with 4 paraplegics and 4 tetraplegics were measured by the same sonographers for skin, fat, tendon, muscle and total. Skin/fat and tendon/muscle were computed.ResultsAB between-operator reliability was good (ICC = 0.81–0.90) for 3 soft tissues layers in unloaded and loaded sitting and poor for both IT short and long axis (ICC = −0.028 and −0.01). SCI between-operator reliability was good in unloaded and loaded for total, muscle, fat, skin/fat, tendon/muscle (ICC = 0.75–0.97) and poor for tendon (ICC = 0.26 unloaded and ICC = −0.71 loaded) and skin (ICC = 0.37 unloaded and ICC = 0.10).ConclusionA MRI protocol was successfully adapted for a reliable 3 soft tissue layer model and could be used in a 2-D FEM model designed to estimate soft tissue strain as a novel risk factor for the development of a PU.     

Skin self-management of community-dwelling patients with spinal cord injury: A cross-sectional study

Backgroundcommunity-acquired pressure injury is one of the most common and troublesome complications of discharged patients with spinal cord injury. Previous studies have shown that pressure injury can not only increase the financial burden and care burden of patients, but also seriously affect their quality of life.AimTo evaluate the skin self-management of community-dwelling patients with spinal cord injury and to explore the related independent influencing factors.MethodsThis was a cross-sectional survey study. A convenience sample of 110 community-dwelling patients with spinal cord injury recruited from three rehabilitation centers in Guangzhou and Chengdu in China completed the survey from September 2020 to June 2021. They were asked about their demographic data, skin self-management, knowledge about skin self-management, attitude to skin self-management, self-efficacy, and functional independence. Univariate analysis and multiple linear regression were performed to isolate the most important relationships.ResultsThe skin self-management of community-dwelling patients with spinal cord injury was relatively low, and they also performed poorly in the three categories of: skin check, preventing pressure ulcer, and preventing wounds. Skin self-management was found to be most often associated with level of knowledge about skin self-management, higher reimbursement and self-efficacy.ConclusionCommunity-dwelling patients with spinal cord injury with lower level of knowledge about skin self-management, with lower self-efficacy, and those with higher reimbursement have worse skin self-management.     

Effectiveness of repeated transplantations of hematopoietic stem cells in spinal cord injury

AIM: To evaluate the short and long-term effects of the complex cell therapy of 202 cases of spinal cord injury (SCI). METHODS: The main arm included 202 cases of SCI and the control arm included 20 SCI cases. For the therapy the hematopoietic stem cells (HSCs) and progenitor cells (PCs) were mobilized to peripheral blood by 8 subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) for 4 d and are harvested at day 5. The cells were administered to the main arm intrathecally every 3 mo for a long term (3-5 years) according to the internal research protocol international medical institute of tissue engineering. Magnetic resonance imaging of the site of injury and urodynamic tests were performed every 6 mo. Motor evoked potentials (MEP), somatosensory evoked potentials (SSEP) were evaluated every 3 mo. The patients were evaluated with american spianl injury association (ASIA) index, functional independence measure index, the Medical Research Council Scale, the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI-92) and specifically developed scales. The function of bladder was evaluated by a specifically developed clinical scale. The long-term clinical outcomes were assessed for the SCI patients who received no less than 20 intrathecal transplantations of HSCs and hematopoietic precursors (HPs). RESULTS: The restoration of neurologic deficit after HSCs and HPs transplantations was proved stable and evident in 57.4% of the cases. In 42.6% cases no neurologic improvement has been observed. In 50% of the cases the motor restoration began after the first transplantation, which is confirmed in average by 9.9 points improvement in neurologic impairment as compared to the baseline (P < 0.05). Repair of the urinary system was observed in 47.7% of the cases. The sensitivity improved from baseline 124.3 points to 138.4 after the first and to 153.5 points after the second transplantations of HSCs and HPs (P < 0.05, between the stages of research). The evaluation with ASIA index demonstrated regress of neurologic symptoms in 23 cases. Motor progress was also assessed with the ISCISCI-92 motor and sensory scores, and the data coincided with those received with the specifically developed scale. The number of the patients with the signs of locomotive repair was 56.9%. No life threatening complications or adverse effects have been observed. CONCLUSION: The method is safe, effective and considerably improves the life quality of SCI patients. The therapy is approved for clinical use as the treatment of choice.     

28例皮肤黑变病例临床、病理和诊断研究

目的明确皮肤黑变病例临床和组织病理特点,分析病因和发病机制。方法对28例皮肤黑变病例的发病年龄、累及部位、皮疹特点、诊断进行登记分析。其中8例患者进行组织病理检查、12例患者进行血清微量元素检查、7例患者进行斑贴试验检查。结果 12例患者有长期化工品、护肤品、药品等诱因,其余16例患者原因不明。累及部位以面颈部暴光部位为多,但其它部位也可发生。14例面部皮肤黑变病例中5例不符合Riehl黑变病特征性表现,只能笼统地诊断为皮肤黑变病。几乎所有患者组织病理改变基本相似,均表现为基底细胞灶性液化变性,真皮浅层色素失禁,噬色素细胞增多。结论本研究中各种皮肤黑变病例虽然发病诱因、伴随症状有所不同,但均表现为皮肤黑色斑片和真皮浅层色素失禁,这与褐色色素沉着伴随的表皮角朊细胞色素增加不同,表、真皮界面炎症反应可能是导致黑素细胞破坏的重要原因之一。     

Community acquired pressure injuries in a work-related spinal cord injury population: Problem characterization and assessment of a working solution

BackgroundTo characterize the problem of community-acquired pressure injuries (CAPIs) in a work-related spinal cord injury (SCI) population in Canada and assess the benefits of a person-centered solution. Characterization of the problem and a solution, albeit in an insured Worker's Compensation Board of British Columbia (WorkSafeBC) cohort, may inform the supply of solutions in the larger SCI population with disparate access to healthcare.MethodsFor this observational study, data on 244 WorkSafeBC clients, who received an intervention featuring pressure injury (PI) assessment between 2011 and 2015, were used to characterize the problem. Data on observed injuries, risk, referrals, and outcomes were linked to healthcare service claims. Employing an activity-based costing methodology, total expenditures on attributed services were calculated for clients with 1 or more PIs. Intervention cost and benefits from the insurer's perspective are considered.Results84 of 244 clients had 1 or more PIs at assessment, with attributed mean cost of $56,092 in 2015 Canadian dollars (CAD). Mean cost by PI severity range from $9580 to $238,736. At an intervention cost of $820,618, detection of less severe injuries provided an opportunity to prevent progression and achieve $3 million in cost avoidance. Follow-up data suggest reasonable returns. Reductions in the incidence, number, and risk of pressure injuries were also observed.ConclusionsThe analysis establishes the cost of CAPIs in a Canadian-based work-related SCI population and suggests preventative and early intervention is not only feasible but also practical. Results are relevant to decisions regarding the use of proactive prevention-based treatment models as opposed to reactive, solutions in the larger SCI population.     

Microclimate evaluation of strap-based wheelchair seating systems for persons with spinal cord injury: A pilot study

Study purposeThe purpose of this pilot study was to assess microclimate characteristics of two versions of a strap-based wheelchair seating system (perforated and solid straps) and to conduct preliminary microclimate comparisons of subjects' current wheelchair seating systems.Materials and methodsIn this pilot study, the microclimate properties of two variations (solid and perforated) of a strap-based seating system were compared with two commonly used seating systems. Six subjects sat on three different seating systems each for 100-min test periods, while temperature and relative humidity were measured with a single sensor adjacent to the skin-seat interface. Additionally, thermal images of the seat interface were collected before and after each test period.ResultsThe thermal images revealed that the maximum surface temperature of the solid-strap-based seating system was significantly lower than the other seating systems, −1.21 °C. (95% CI -2.11 to −0.30, p = 0.02), immediately following transfer out of the seat. Five minutes after transferring out of the seat, the perforated-strap seat was significantly cooler than the other seats −0.94 °C. (95% CI -1.59 to −0.30), p = 0.01, as was the solid-strap-based seat, −1.66 °C. (95% CI -2.69 to −0.63), p = 0.01. There were no significant differences in interface temperature or relative humidity measured with the single sensor near the skin-seat interface.ConclusionThis pilot study offers preliminary evidence regarding the microclimate of the strap-based seating systems compared with other common seating systems. Clinically, the strap-based seating system may offer another option for those who struggle with microclimate management.     

Development and preliminary validation of a tool measuring concordance and belief about performing pressure-relieving activities for pressure ulcer prevention in spinal cord injury

ObjectiveTo develop and examine the reliability, and validity of a questionnaire measuring concordance for performing pressure-relief for pressure ulcer (PrU) prevention in people with Spinal Cord Injury (SCI).MethodsPhase I included item development, content and face validity testing. In phase II, the questionnaire was evaluated for preliminary acceptability, reliability and validity among 48 wheelchair users with SCI.ResultsThirty-seven items were initially explored. Item and factor analysis resulted in a final 26-item questionnaire with four factors reflecting concordance, perceived benefits, perceived negative consequences, and personal practical barriers to performing pressure-relief activities. The internal consistency reliability for four domains were very good (Cronbach's α = 0.75-.89). Pearson correlation coefficient on a test-retest of the same subjects yielded significant correlations in concordance (r² = 0.91, p = .005), perceived benefit (r² = 0.71, p < .04), perceived negative consequences (r² = 0.98, p < .0001), personal barriers (r² = 0.93, p= .002). Participants with higher levels of concordance reported a greater amount of pressure-relieving performed. Individuals viewing PrU as a threatening illness were associated with higher scores of concordance and tended to report a greater amount of pressure-relieving performance which provides evidence of criterion related validity.ConclusionThe new questionnaire demonstrated good preliminary reliability and validity in people with SCI. Further evaluation is necessary to confirm these findings using larger samples with follow-up data for predictive validity. Such a questionnaire could be used by clinicians to identify high risk of patients and to design individualised education programme for PrU prevention.     

New parameter adjustment with spinal cord stimulation for postherpetic neuralgia treatment: A case report and literature review

Posterpetic neuralgia (PHN), a common and often severe painful condition, is a kind of refractory neuropathic pain (NP). Although the clinical treatment of PHN including pregabalin, nerve block and pulsed radiofrequency have been devoted with adequate and reasonable efforts, a proportion of people with PHN fail to obtain pain relief. Spinal cord stimulation (SCS) represents an adjustable and nondestructive procedure that considered electrical stimulation as the key mechanism for NP relief and offers an alternative treatment for PHN. SCS parameters, including amplitude, pulse width and frequency, influence the nervous system and the delivery of stimulation charge. Newly proposed stimulation methods such as high-frequency SCS and burst SCS, may offer alternative treatment for NP. In this paper, we reported a case of major pain successfully treated with SCS by adjusting the stimulation parameter and the electrode position using new stimulation method. The patient suffered from severe persistent PHN in the right upper limb area. The temporary SCS electrode was placed in the dorsal root entry zone (DREZ) area with a standard generator. Initially, we programmed the parameters at 360 Hz, 140 μs, and 1.5 V. After multiple setting adjustments with inadequate pain relief, the patient was finally programmed at 40 Hz, 120 μs, and 0.5 V. This parameter setting provided optimal pain alleviation and increased the quality of the patient's life. The visual analogue scale and Hamilton anxiety scores were decreased significantly. These scores showed no significant change during the six-month follow-up. SCS combined with dorsal root entry zone at relatively high frequency and low voltage offers a new method to treat PHN patients.     

Sacral interface pressure can be alleviated by repositioning with a small-angle change using an automated bed in patients with spinal cord injury

Aim of the studyThis study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal cord injury (SCI). Furthermore, we analyzed the clinical factors influencing pressure to identify the pressure injury (PI) high-risk group.Materials and methodsAn intervention was conducted for patients with paraplegia (n = 30) with SCI. In the first and second trials, interface pressure and total contact area of the sacral region were recorded from large- and small-angled positions using the automatic repositioning bed, which can change the angle of the back, lateral tilt, and knee.ResultsPositions with back raised ≥45° showed significantly higher pressure on the sacrum than most other positions. The pressure and contact area differences were statistically insignificant for combinations of small-angled changes <30°.Additionally, the duration of injury (β = 0.51, p = 0.010) and neurological level of injury (NLI) (β = −0.47, p = 0.020) were significant independent predictors of average pressure. Similarly, the duration of injury (β = 0.64, p = 0.001), the Korean version of the spinal cord independence measure-III (β = −0.52, p = 0.017), and body mass index (BMI; β = −0.34, p = 0.041) were significant independent predictors of peak pressure.ConclusionsFor repositioning, combinations of small-angle changes <30° effectively reduce pressure on the sacral region in patients with SCI. Lower BMI, longer duration of injury, lower functioning score, and NLI ≥ T7 are predictors of high sacral pressures, which increase the risk for PI. Therefore, patients with these predictors require strict management.