老年PCI术后迟发性腹膜后血肿1例

患者男,82岁。因胸痛4d于2006年4月10日入院。既往有脑梗死病史。入院诊断为急性广泛前壁 下壁心肌梗死,KillipⅢ级;陈旧性脑梗死。于2006年5月11日经右侧股动脉穿刺行经皮冠状动脉介入治疗(PCI),于左前降支近段及     

全膝置换术后的持续性冷冻疗法

进行全膝置换手术的患者与日俱增,术后肿胀和疼痛仍未很好的解决。冷冻疗法具有悠久的历史,可以降低细胞代谢、血流速度、炎症反应、水肿、疼痛、痉挛、皮肤肌肉关节内的温度、渗透性、神经传导速度。因此,全膝置换手术后进行冷冻疗法具有广阔的前景。冷冻疗法包括冰袋、化学冰袋、可充气式臂带装置(包含冰水和具有压迫性)、制冷器和套袖连接的循环装置。运用冷冻疗法的时间从创伤后立即到伤后1￣3d,持续时间和频率各异。其中持续性冷冻疗法(制冷器和套袖连接的循环装置)可以较好地减轻肿胀,减少出血量及止痛药的用量,同时能改善关节活动度。持续性冷冻疗法的皮肤温度应控制在10￣15℃,根据敷料的厚薄适当调整机器温度。     

MSCT后处理重建技术在肾移植后肺部感染中的应用

目的 探讨MSCT后处理重建技术在肾移植后肺部感染诊断中的应用价值.方法 回顾性分析52例临床证实的肾移植后肺部感染患者的常规CT、HRCT以及后处理重建图像资料(MPR、MIP、MinIP、VR)胸部CT征象的显示及分布.结果 39例患者明确病原体,其中以混合感染(18/52)最多,细菌感染(13/52)次之,真菌(4/52)与CMV感染(4/52)较少.后处理重建图像的小结节显示率明显高于常规CT、HRCT(P均＜0.05),对于其他征象的显示差异无统计学意义(P均＞0.05),但有助于病灶范围显示.结论 MSCT各种后处理重建有助于显示肾移植后肺部感染所致实质、气管、血管改变;增强后血管重建有助于曲霉菌早期诊断.     

脾切除术后门静脉血栓形成的早期预防

目的:研究门静脉高压症患者脾切除术后早期接受抗血栓治疗对预防门静脉血栓形成的效果及安全性.方法:将2002年4月至2006年4月肝硬化门脉高压症欲接受脾切除术的患者67例分为两组,同期常规用药组为对照与早期使用抗凝、祛聚药物预防组进行对比研究,利用彩超监测门静脉血栓形成情况.结果:62例完成随访6个月以上,随访率92.5%,其中预防组39例,对照组23例.术后对照组发生门静脉血栓6例(26.1%),1例为复发血栓.预防组发生门静脉血栓3例(7.7%),发生率明显低于对照组(P=0.047),无严重出血并发症.结论:门静脉高压症患者脾切除术后早期接受抗血栓治疗是防治门静脉血栓形成的安全、有效方法.     

盐酸纳洛酮治疗醉酒后重型脑外伤临床疗效分析

目的:探讨应用盐酸纳洛酮治疗醉酒后重型脑外伤的临床疗效.方法:将醉酒后重型脑外伤73例患者分成常规治疗对照组和纳洛酮治疗组,观察患者早期颅内压、脑水肿、头颅CT及意识变化、预后转归情况.结果:治疗1周后,纳洛酮组与对照组颅内压(≥251 mmH2O)、重度脑水肿改善分别为8/14例、7/16例,P＜0.01;纳洛酮组治疗10 d后意识转清率(53.8%)及伤后3个月恢复良好率(43.6%)显著高于对照组(P＜0.05),病死率及致残率(35.9%)明显减少.结论:盐酸纳洛酮能很好降低醉酒后重型脑外伤病人颅内压及脑水肿,能很快使意识转清,降低病死率及致残率,促进病人的脑神经功能恢复,改善病人预后.     

慢性乙肝病毒感染后的婚育问题探讨

乙肝病毒感染很常见，其中相当一部分人处于婚育期，由此产生很多临床问题，本文结合该病临床特点，就婚育期乙肝病毒感染者关心的一些实际问题从以下几方面进行讨论。     

肾移植术后巨细胞病毒肺炎23例临床分析

目的:探讨肾移植术后巨细胞病毒(CMV)肺炎的临床特点、治疗和转归.方法:对肾移植患者术后23例并发CMV肺炎患者的临床资料进行回顾性分析.通过检测外周血中CMV-IgM和(或)CMV-DNA,结合临床症状及胸片明确诊断.以更昔洛韦治疗,同时防治混合感染,加强营养支持,并根据动脉血氧分压,尽早使用呼吸机.结果:11例(47.8%)治疗有效,其中9例治愈,死亡12例.结论:对肾移植术后CMV肺炎应尽早诊断、及时应用以更昔洛韦为主的综合治疗.     

曲马多在不同术后镇痛方法中的临床效果

目的:比较曲马多在几种常用术后镇痛方法中的临床效果和不良反应,为其在临床上的应用提供一定的参考.方法:80例ASAⅠ、Ⅱ级下腹部和下肢手术全麻病人随机分为4组,每组20例,采用病人自控静脉镇痛(Ⅰ组)和病人自控硬膜外镇痛(Ⅱ、Ⅲ、Ⅳ组)两种镇痛方式,镇痛配方为:Ⅰ、Ⅱ组曲马多600mg;Ⅲ组曲马多600mg+0.75%耐乐品75 mg;Ⅳ组曲马多600 mg+0.75%耐乐品75 mg+欧贝8 mg.记录术后6、12、24和48 h 4组曲马多用药量,不良反应的发生情况,镇静、镇痛及下肢运动评分并进行比较.结果:4组病人在各时段的曲马多用药量及镇痛、镇静效果差异无显著性(P＞0.05),Ⅱ、Ⅲ和Ⅳ组的下肢运动评分差异无显著性(P＞0.05),Ⅳ组的恶心、呕吐发生率明显少于其他3组,差异有显著性(P＜0.05).结论:曲马多可安全、有效地用于术后镇痛,镇痛液中加入抗呕吐药能明显减轻其恶心、呕吐的副作用.     

PCI术后105例出院后电话回访分析

2008-07-2009-08笔者对心血管内科105例PCI术患者出院后进行电话回访,对PCI术后用药情况、饮食控制、危险因素等进行指导,效果满意,现报道如下。1临床资料1.1一般资料本组男72例,女33例,年龄36~85岁。其中30~49岁8例,50~79岁87例,80~89岁10例。学历:大学12例,初高中45例,小学及以下48例;患高血压病54例,糖     

鼻后滴漏并发慢性咳嗽72例临床分析

目的:探讨以慢性咳嗽为主要表现的鼻后滴漏的病因诊断和治疗方案.方法:回顾性分析2001年1月至2005年6月本院收治的72例以鼻后滴漏为主要临床特点而并发慢性咳嗽的鼻-鼻窦疾病病人的资料,总结诊断与治疗经验.结果:本组病人均以慢性咳嗽为主诉,平均咳嗽时间达9个月.虽然咽、喉、气管、支气管、肺、胃检查均无明显病变,但鼻-鼻窦则均存在相关性原发疾病,包括慢性化脓性鼻窦炎36例(50.0%)、变应性鼻炎20例(27.8%)、慢性鼻炎13例(18.1%)、鼻腔乳头状瘤3例(4.2%).经过积极的抗炎与抗变态反应治疗和必要的手术治疗,48例(66.7%)咳嗽症状消失,24例(33.3%)症状明显减轻.结论:以鼻后滴漏为主要临床特点的鼻-鼻窦疾病可以并发慢性咳嗽,且可以此症状为主要临床特点,却不表现典型、明确的鼻-鼻窦疾病症状.积极治疗鼻-鼻窦疾病,可以有效地消除继发性肺部症状.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.