终池闭式引流置换脑脊液治疗蛛网膜下腔出血患者的护理

对30例蛛网膜下腔出血患者采用深静脉导管终池置入进行闭式循环引流置换脑脊液.结果 置管时间为4～8d,无1例发生继发性颅内感染及脑疝等并发症.治愈20例,好转6例,无效4例,其中1例因再出血病情加重死亡,总有效率86.7%.提出术前做好患者心理护理,术中准确传递所需用物,术后密切观察病情变化,严格控制脑脊液引流速度和置换速度,做好引流管护理,可促进颅内积血消散,改善患者预后.     

终池闭式引流置换脑脊液治疗蛛网膜下腔出血患者的护理

对30例蛛网膜下腔出血患者采用深静脉导管终池置入进行闭式循环引流置换脑脊液。结果置管时间为4～8d，无1例发生继发性颅内感染及脑疝等并发症。治愈20例，好转6例，无效4例，其中1例因再出血病情加重死亡，总有效率86．7％。提出术前做好患者心理护理，术中准确传递所需用物，术后密切观察病情变化，严格控制脑脊液引流速度和置换速度，做好引流管护理，可促进颅内积血消散，改善患者预后。     

脑脊液置换治疗颅脑手术后严重颅内感染的护理

对１５例颅脑术后严重颅内感染患者行脑室、脑室－蛛网膜下腔、蛛网膜下腔脑脊液置换治疗。置换过程中通过密切观察病情变化，严格无菌操作，保持引流通畅，正确控制滴速，保持引流量与注入量相等的措施，无并发症，均痊愈出应注意每日留取脑脊液标本行生化检查，及发现神经系统内环境系乱和电解质失衡。     

以脑室出血为首发表现烟雾病患者的护理

对16例以脑室出血为首发表现的烟雾病患者行侧脑室引流术,结果患者手术均获成功,无并发症发生.平均住院13.6 d出院.提出术前进行心理护理,做好充分术前准备;术后密切观察病情变化,正确掌握脑室引流袋的高度,观察引流液的量和颜色,保持脑室引流通畅;做好腰穿置管后脑脊液置换的护理,及时观察并发症的发生,予以出院指导等,对巩固手术疗效,促进患者康复至关重要.     

创伤性蛛网膜下腔出血临床分析

目的分析创伤性蛛网膜下腔出血的治疗方法及效果。方法随机将70例创伤性蛛网膜下腔出血患者分为2组,每组35例。对照组行脑脊液置换治疗,观察组实施持续腰大池脑脊液引流治疗。对比2组治疗效果。结果观察组并发症发生率、病死率、植物生存率、残疾率均明显低于对照组,良好率及预后优于对照组,差异具有统计学意义(P0.05)。结论应用续腰大池脑脊液引流治疗外伤性蛛网膜下腔出血,可明显改善患者临床症状,降低并发症发生率,效果满意。     

鞘内置管脑脊液置换与反复腰穿放脑脊液分别鞘内注药治疗结核性脑膜炎的疗效比较

目的探讨鞘内置管脑脊液置换与反复腰穿放脑脊液分别鞘内注药治疗结核性脑膜炎的疗效。方法在常规综合治疗的基础上,对照组采用反复腰穿放脑脊液并鞘内注药,观察组采用鞘内置管脑脊液置换加鞘内注药。结果观察组总有效率（93.1%）明显高于对照组（73.0%）（P〈0.01）;观察组脑脊液压力恢复正常和住院时间均明显短于对照组（P〈0.01）;对照组不良反应（5例）明显多于观察组（0例）（P〈0.05）。结论相比反复腰穿放脑脊液,鞘内置管脑脊液置换疗效高,疗程短,不良反应少,值得临床推广应用。     

高血压脑室出血置管引流36例体会

目的探讨高血压脑室出血的有效治疗方法。方法采用脑室外引流加血肿冲洗剂、液化液或腰穿脑脊液置换的方法治疗高血压脑室出血36例。结果36例手术患者,死亡4例,3例效果不良,24例效果良好。结论脑室外引流加血肿冲洗剂,液化剂或配合腰穿脑脊液置换治疗脑室出血效果确切,值得推广。     

脑脊液持续引流治疗蛛网膜下腔出血的临床观察

目的探讨腰穿置管脑脊液持续引流治疗蛛网膜下腔出血(SAH)的临床价值。方法 对60例SAH患者在内科常规治疗的基础上,用16号硬膜外穿刺针于L3、L4间隙穿刺置入硬膜外导管,接一次性输液管及引流袋,持续引流,引流速度1～4滴/min,平均3滴/min,引流量度100～400 mL/d,平均250 mL/d,引流3～7(平均5、6)d后拔管。结果腰穿置管脑脊液持续外引流患者的头痛缓解时间、意识清醒时间、头颅CT示积血清除时间和颅高压恢复正常时间明显缩短,治疗过程中发生脑积水、再次脑出血、继发性脑血管痉挛等并发症发生率及治疗无效和死亡病例明显减少。结论脑脊液持续引流为SAH病人提供了一种安全、有效、方便的治疗方法。     

脊柱手术后脑脊液漏的治疗

目的:评价单纯更换切口敷料、术区持续引流和经皮蛛网膜下腔引流对脊柱术后脑脊液漏的治疗效果.方法:2003年1月～2008年6月我科实施脊柱手术2481例,术后44例出现脑脊液漏,其中男29例,女15例,年龄25～65岁,平均49.1岁.在切口愈合前应用抗生素预防感染,同时分别进行单纯更换切口敷料(A组,19例)、延长术区引流时间(B组,19例)、腰部经皮蛛网膜下腔脑脊液引流(C组,6例),对3种治疗方法的疗效和并发症进行评价.结果:A组中9例(47.4%)切口愈合,术后平均16.8d脑脊液漏消失,其中3例合并假性硬膜囊肿;10例(52.6%)治疗失败,其中4例1周内脑脊液漏出无减少趋势,3例行单纯硬膜修补,脑脊液漏于术后14d消失,1例行蛛网膜下腔引流后当日脑脊液漏消失,5例(26.3%)合并脊膜炎,经蛛网膜下腔引流和注入抗生素,脑脊液漏于置管当日消失,3d后治愈,1例(5.3%)合并切口感染.假性硬膜囊肿和切口感染者采用直接硬膜修补和经皮蛛网膜下腔引流均获得治愈,蛛网膜下腔引流后第1日脑脊液漏消失.B组脑脊液漏的消失及引流的平均时间为7.2d,切口均Ⅰ期愈合,未出现脊膜炎和切口感染.C组引流后平均1.8d脑脊液漏消失,平均引流时间为6.9d,切口均Ⅰ期愈合,无感染等并发症.结论:延长术区引流时间和经皮蛛网膜下腔引流是治疗脊柱手术后脑脊液漏的有效方法,单纯更换切口敷料效果较差、并发症较多.     

蛛网膜下腔出血腰大池脑脊液持续引流术护理体会

目的探讨腰大池脑脊液持续引流术治疗蛛网膜下腔出血的护理方法及效果。方法对32例接受腰大池脑脊液持续引流治疗的蛛网膜下腔出血患者给予健康教育、病情观察、并发症的预防及管道管理等措施。结果 32例患者血性脑脊液消失时间4~11 d,平均6.1 d。引流管置管时间为5~13 d,平均7.5 d。引流后头痛、意识障碍等明显改善或消失。术后颅内感染1例(3.1%),经抗生素治疗后痊愈,未发生脑脊液漏等并发症。住院时间9~16 d,平均13.8 d。结论对接受腰大池脑脊液持续引流的蛛网膜下腔出血患者,治疗期间精心实施系统化护理,能提高引流效果,降低并发症发生率,缩短康复时间。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.