综合治疗颈性眩晕的观察

颈性眩晕系指椎动脉或颈交感神经受到压迫和刺激导致椎-基底动脉供血不足所引起的眩晕综合征．是中老年人常见、多发病。1994年8月～1997年4月．我们对96例患采用综合治疗，收到较好疗效，现报告如下。     

颈性眩晕

颈性眩晕顾名思义就是因颈源性因素引起的眩晕综合征。其特点是头颈部前后屈伸及左右转动时突发眩晕，一般持续时间较短，可因颈椎小关节紊乱的纠正而得到缓解。颈源性眩晕的症状在临床十分多见，已引起学们的普遍重视。对于这种疾病的命名，曾有过颈后交感神经丛综合征、颈椎综合征、椎动脉压迫综合征、椎动脉供血不足、颈前庭综合征、颈性偏头痛、颈性眩晕等．反映出我们对于此病的认识不断深入，但仍有许多问题需要探讨。     

从瘀论治老年眩晕

目的 旨在探讨老年眩晕患者从瘀论治的理论与临床．方法 检查３４例老年眩晕患者和３０例健度体检老人的血液流变学指标，甲襞微循环以及有关项目进行对比分析．对眩晕患惠应用培它啶、蝮蛇抗栓酶静脉滴注，进行治疗前后血液流变，甲襞微循环变化对比分析．结果与时照组比较，老年眩晕组的血液流变与甲襞微循环均有明显异常，Ｐ＜０．０１．治疗前后两组比较，也有明显差异，以治疗后全血粘度、纤维蛋白原、红细胞聚集指数下降为明显，Ｐ＜０．０１，而甲襞微循环以流速增快，血细胞聚集降低为明显，Ｐ＜０．０１．结论：老年眩晕患者存在明显血瘀证候和实验室微观检查异常变化，应用培它啶和蝮蛇抗栓酶静滴治疗眩晕疗效肯定．对中医论治眩晕是一个新的补充．     

颈椎稳定性训练治疗颈性眩晕的临床研究

目的探讨颈椎稳定性训练治疗颈性眩晕的临床疗效。方法67例确诊颈性眩晕的患者分为治疗组34例和对照组33例,治疗组使用神经肌肉激活技术进行颈椎稳定性训练,对照组予以手法治疗。治疗前及治疗后14 d采用颈性眩晕症状与功能评估量表及Tetra平衡测定仪跌倒风险指数进行评定。结果治疗后,治疗组功能评价得分及跌倒风险指数均优于对照组（P＜0.05）。结论对基于颈椎失稳及本体感觉失调的颈性眩晕施以颈椎稳定性训练可以收到良好的治疗效果。     

颈椎病伴颈源性眩晕的临床分析

目的探讨伴颈源性眩晕的颈椎病发病机制和颈前路手术疗效。方法对2008年3月-2012年11月收治的293例颈椎病患者中83例伴有颈源性眩晕者进行手术治疗,其中神经根型颈椎病23例,脊髓型颈椎病60例。病变涉及单节段29例,2个节段50例,3个节段4例。对全部病变节段均行前路减压固定融合术。观察比较术前、术后3 d、及末次随访时眩晕缓解情况,采用颈性眩晕症状与功能评估量表30分法评定眩晕及主观满意情况,日本骨科学会评估治疗分数法评定神经脊髓功能改善情况。结果随访12～30个月,平均21个月。两种评分在术后3 d、末次随访与术前比较差异有统计学意义（P〈0.05）,末次随访与术后3 d比较差异无统计学意义（P〉0.05）。结论颈源性眩晕手术效果往往伴随脊髓和神经根症状改善而缓解,颈椎病伴颈源性眩晕采取手术治疗是一种有效的方法。     

针刺治疗肝肾阴虚型颈性眩晕的临床疗效观察

目的:通过针刺风池、天柱、L4~6夹脊、百会、太冲、太溪等穴与西医药物治疗肝肾阴虚型颈性眩晕的疗效比较,探讨其疗效。方法:将100例入选的肝肾阴虚型颈性眩晕患者,随机分成治疗组与对照组,每组50例。治疗组采用针刺治疗,对照组采用西医药物治疗。分别治疗3个疗程后,观察两组患者治疗前后右椎动脉(RVA)平均血流速度的变化及临床症状的变化。结果:与治疗前比较,治疗后两组的右椎动脉平均血流速度均有改善,有显著性差异(P0.01),治疗后组间比较,P0.05,差异具有统计学意义;两组治疗后疗效比较,治疗组优于对照组,差异具有统计学意义(P0.05)。结论:与西医药物治疗比较,针刺治疗疗效更好,血流供应更丰富,是治疗肝肾阴虚型颈性眩晕的优选方法。     

针刺治疗肝肾阴虚型颈性眩晕的临床疗效观察

目的 通过针刺风池、天柱、颈4-6夹脊、百会、太冲、太溪等穴与西医药物治疗肝肾阴虚型颈性眩晕的疗效比较,探讨其疗效。方法 将100例入选的肝肾阴虚型颈性眩晕患者,随机分成两组：试验组50人,对照组50人。实验组采用针刺治疗;对照组采用西医药物治疗。分别治疗3个周后,观察2组患者治疗前后右椎动脉（RVA）的平均血流速度的变化及临床症状的变化。结果 与治疗前比较,治疗后2组的右椎动脉（RVA）的平均血流速度均有改善,有显著性差异（p<0.01）,治疗后组间比较,P＜0.05,差异具有统计学意义;2组治疗前后疗效比较,针刺治疗组优于西医药物治疗组,差异具有统计学意义(P<0.05)。结论 与西医药物治疗比较,疗效更好（P＜0.05,差异具有统计学意义）,血流供应更丰富（P＜0.05,差异具有统计学意义）,是治疗肝肾阴虚型颈性眩晕的优选方法。     

胸部撞击时胸壁的动力学响应与胸部损伤

目的：探讨胸部准静态撞击时胸壁动力学响应过程及其与损伤的关系。方法：在犬胸壁肋骨、胸骨等部位布放加速度传感器,监测胸壁运动过程,结合撞击物理参数分析胸壁的动力学响应与损伤的关系。结果：胸壁的粘性标准是预测胸部伤情的可靠参数,变形量、压缩响应和变形速度与损伤程度有一定的相关性,当撞击速度较低而变形量较大时,损伤形式演变成“挤压型”;当撞击速度高而变形量较低时,则演变为“冲击型”损伤。撞击能量、速度和撞击力对损伤的预测是间接的,机体结构和生物力学特性上的差异影响了它们间的相关性。高速撞击时损伤的防护应以减小变形速度为主,选择一种能降低体壁运动加速度和变形速度的材料对损伤的防护是有益的。结论：胸壁的变形运动过程是影响胸部损伤的关键,粘性标准是预测胸部伤情的可靠参数。     

Giant hibernoma of the thoracic pleura and chest wall

Hibernoma is a rare tumor containing prominent brown adipocytes that resemble normal brown fat. Brown fat (versus white fat) is predominantly found in hibernating mammals and infants. Brown fat adipocytes contain a higher number of small lipid droplets and a much denser concentration of mitochondria. The tumor can occur in a variety of locations however the extremities, followed by the head and neck, have been the most common sights. All variants of hibernoma described have followed a benign course with the majority presenting as a small, lobulated, nontender lesions. We present a case of a giant hibernoma arising from the pleura which invaded the intra and extra-thoracic chest.     

Intrapleural anesthesia following thoracic surgery and in chest trauma

The analgesic effect of intrapleural administration of local anesthetics (lidocaine, trimecaine, azocaine) has been studied in 180 patients after thoracic surgery and with chest trauma. The effect was assessed on the basis of subjective (visual analogue 10-score scale) and objective findings (hemodynamic parameters, spirograms, ECG). In control patients analgesia was performed by intramuscular promedol administration. It has been shown that fractionated intrapleural administration of local anesthetics is an effective and safe analgesic technique after thoracic surgery and in chest trauma.     

A case of thoracic degloving injury with flail chest

A 75-year-old male patient suffered a chest degloving injury when he fell on his back and was run over by a small farm tractor he was pulling. At the time of patient admission, the paradoxical motion of the right chest wall was remarkable; and he had an open fracture of the right humerus, a dislocation of the right ankle, and a laceration of the right forearm. Chest computed tomography revealed fractures of the fifth to seventh ribs and detachment of both the right pectoralis major muscle and serratus anterior muscle from the chest wall, with a disconnected right thoracic cavity. Because the right flail chest was severe and there was a large amount of air leakage that continued under positive-pressure ventilation for pneumatic stabilization, we performed surgical fixation of the ribs and repaired the lung injury on the fifth hospital day. The patient's postoperative course was uneventful.     

胸痛管理培训对胸外科护士胸痛管理的效果分析

目的确定胸痛管理培训对护士胸痛管耻知识及认知的影响。方法采用前后自身对照的方法,选择本科室29名护士为培训对象,进行为期5个月的系统培训,在培训前后使用“护士对胸痛管理认知及护理测评表”进行测评,比较培训前后胸外科护士对胸痛管理知识及认知的掌握,比较得分差异有无统计学意义。结果通过胸痛管理知识规范化的培训,培训后护士对胸痛管理知识及认知的掌握程度明显高于培训前（P〈0.01）,差异有统计学意义。结论规范化的胸痛管理培训能有效地提高胸外科护士对胸痛管理知识及认知的掌握,对患者进行有效护理,减轻患者疼痛,提高患者生活质量。     

Suppression of the cardiopulmonary resuscitation artefacts using the instantaneous chest compression rate extracted from the thoracic impedance

Aim

To demonstrate that the instantaneous chest compression rate can be accurately estimated from the transthoracic impedance (TTI), and that this estimated rate can be used in a method to suppress cardiopulmonary resuscitation (CPR) artefacts.

Methods

A database of 372 records, 87 shockable and 285 non-shockable, from out-of-hospital cardiac arrest episodes, corrupted by CPR artefacts, was analysed. Each record contained the ECG and TTI obtained from the defibrillation pads and the compression depth (CD) obtained from a sternal CPR pad. The chest compression rates estimated using TTI and CD were compared. The CPR artefacts were then filtered using the instantaneous chest compression rates estimated from the TTI or CD signals. The filtering results were assessed in terms of the sensitivity and specificity of the shock advice algorithm of a commercial automated external defibrillator.

Results

The correlation between the mean chest compression rates estimated using TTI or CD was r = 0.98 (95% confidence interval, 0.97–0.98). The sensitivity and specificity after filtering using CD were 95.4% (88.4–98.6%) and 87.0% (82.6–90.5%), respectively. The sensitivity and specificity after filtering using TTI were 95.4% (88.4–98.6%) and 86.3% (81.8–89.9%), respectively.

Conclusions

The instantaneous chest compression rate can be accurately estimated from TTI. The sensitivity and specificity after filtering are similar to those obtained using the CD signal. Our CPR suppression method based exclusively on signals acquired through the defibrillation pads is as accurate as methods based on signals obtained from CPR feedback devices.     

Postoperative chest ultrasound findings and effectiveness after thoracic surgery: A pilot study

The aim of this study was to analyze the information from post-operative chest ultrasound (CU) to evaluate the possibility to use this method instead of chest X-ray (CXR) after thoracic surgery. Patients who underwent thoracic surgery were evaluated with CU blinded to CXR after surgery, deciding if it was useful or CU was exhaustive. Twenty-four patients were enrolled prospectively. The CU allowed a further discrimination of the lung abnormalities, discriminating between atelectasis, infections or hematoma. CXR was required in only 5 cases due to the presence of massive subcutaneous emphysema or absence of lung point. In the remaining 19 cases, CU was considered exhaustive and effective. In particular, CU was considered exhaustive in 67% of cases after open surgery and in 85% of cases after video-assisted thoracic surgery. In conclusion, CU appears to be effective in post-operative management after thoracic surgery and it can increase the diagnostic accuracy reducing any unnecessary X-ray exposure.     

Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury

Blunt thoracic trauma can result in significant morbidity in injured patients. Both chest wall and the intrathoracic visceral injuries can lead to life-threatening complications if not anticipated and treated. Pain control, aggressive pulmonary toilet, and mechanical ventilation when necessary are the mainstays of supportive treatment. The elderly with blunt chest trauma are especially at risk for pulmonary deterioration in the several days postinjury and should be monitored carefully regardless of their initial presentation. Blunt thoracic trauma is also a marker for associated injuries, including severe head and abdominal injuries.     

Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

Background

Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT.