外周中心静脉置管长度探讨

目的 探讨外周中心静脉置管术(PICC)中简便、准确估计最佳置管长度的测量方法.方法 将58例行PICC置管的患者分为实验组和对照组各29例.实验组采用从穿刺点沿静脉走向至锁骨头下缘距离+右侧4 cm或左侧7 cm为置管长度的测量法,对照组按照PICC常规操作步骤,采用从穿刺点至右胸锁关节再向下反折至第3肋间为置管长度的测量法,置管到达测量长度后,经胸部X射线摄片定位,比较两组PICC导管置入上腔静脉的成功率、置管长度.结果 实验组PICC导管置入上腔静脉的成功率显著高于对照组(P<0.05),实验组、对照组测得置管长度分别为(48±3.5)cm、(50.5±3.5)cm,与实际置管长度比较,差异无显著性意义(P>0.05).结论 采用体外测量法测量准确,可提高PICC导管置入上腔静脉的成功率,且测量方法 简便,置管比较安全.     

Fetal transverse cerebellar diameter measurements in normal and reduced fetal growth.

OBJECTIVES: To establish the increase in fetal transverse cerebellar diameter (TCD) relative to gestational age during normal and restricted fetal growth; to determine the significance of TCD and TCD/AC relationship in predicting fetal outcome as expressed by perinatal mortality. DESIGN: A retrospective cross-sectional study. SUBJECTS: Three hundred and sixty normally developing fetuses between 17 and 34 weeks of gestation and 73 growth-restricted fetuses between 24 and 34 weeks of gestation. METHODS: Ultrasonographic measurements included head circumference (mm), abdominal circumference (mm) and transverse cerebellar diameter (mm). A gestational age-related normal reference chart was produced for TCD. RESULTS: Statistically significant relationships between transverse cerebellar diameter and gestational age, abdominal circumference and head circumference were found. The normal fetal TCD exhibited a more than twofold increase in size during the second half of pregnancy. Twenty-six per cent of the small-for-gestational age (SGA) fetuses displayed a reduced TCD and 82% of the SGA fetuses demonstrated raised TCD/AC values. No statistically significant difference in perinatal mortality or birth weight was found between the subsets of growth-restricted fetuses with reduced or normal TCD; or between the subsets with normal or raised TCD/AC values. CONCLUSIONS: In the normally developing fetus the TCD increases with advancing gestational age. Increased TCD/AC values are suspicious of fetal growth restriction. The perinatal mortality in growth-restricted fetuses with a small cerebellum is increased twofold over that of other fetuses.     

腹腔镜下两种手术方式子宫肌瘤剔除的比较

目的 探讨腹腔镜下子宫肌瘤剔除使用双极电凝法及锐性分离两种不同剥离方式的区别.方法 腹腔镜下子宫肌瘤剔除术中,采用双极电凝钳电凝剥离55例(研究组),同期单片剪锐性剥离48例(对照组),在肌瘤剔除手术时间、出血量、术中并发症及术后住院日等情况进行比较.结果 研究组与对照组比较,出血量减少(P＜0.05),手术时间缩短(P＜0.05),而术中并发症及术后住院日差异无统计学意义(P＞0.05).结论 腹腔镜下子宫肌瘤剔除术采用双极电凝边电凝边剥离肌瘤的方法优于直接剪刀锐性剥离法.     

Comparison of two different techniques of electrotherapy on myofascial pain

This study was designed to compare the effects of Transcutaneus Electrical Nerve Stimulation (TENS) and Electrical Muscle Stimulation (EMS) on myofascial trigger point (MTrP) of the upper trapezius muscle. A total of 40 patients were randomly divided into three groups. All patients had active MTrP in one side of the upper trapezius muscles. Group I was treated with TENS and trapezius-stretching exercises; Group II was treated with EMS and trapezius-stretching exercises and Group III, the control group, had only trapezius-stretching exercises. Subjective pain intensity with VAS, range of motion (ROM), and pain threshold (PT) were assessed before, immediately after two week treatment and 3 months after treatment. Group I had a statistically significant reduction in VAS (P<0.01), increase in PT and ROM (p<0.05) at end of the treatment when compared with the control group. Only VAS was significantly improved (p<0.05) in the Group II patients. At the end of the third month, both groups showed highly significant improvement (p<0.01) in VAS and PT (but not ROM). There was no statistical difference in none of parameters between EMS and TENS groups in any time (p>0.05). In conclusion, TENS seem to be more effective immediately after treatment but in long term evaluation there is no significant superiority of two electrotherapy techniques on each other.     

Comparison of two breast self-examination palpation techniques.

In this randomized clinical trial, we compared the vertical strip (VS) and the concentric circle (CC) patterns of breast palpation in order to determine which pattern provided the most thorough self-examination and the best lump detection in breast models. The sample consisted of 34 adult women from a Veterans Outpatient Clinic in the Northwest who were assigned according to breast size (large or small) to one of two groups. Subjects were pretested and randomly taught one method of palpation. Proficiency in the palpation technique, area covered, and number of lumps detected were evaluated. Interrater reliability for proficiency evaluation was 86%. During breast self-examination, the VS group covered significantly more area than the CC group (t = 2.72, p = 0.01). Breast size did not affect breast area covered. Lump detection using breast models did not differ between the two groups. Though this study did not support the conclusion that increased thoroughness leads to increased lump detection, there is support in the literature. Lack of difference in lump detection in this study may have been due to the constraints of the breast models used. However, further research is needed.     

两种剖宫产腹部切口选择对其腹部切口子宫内膜异位症发生率比较

目的通过观察新式剖宫产术与子宫下段剖宫产术两种剖宫产腹壁切口不同选择对其术后并发症腹部切口子宫内膜异位症发生率情况,探讨减少剖宫产术后腹部切口子宫内膜异位症发生率的有效方法。方法 1998年9月~2008年9月在本院仅行1次剖宫产及选择两种不同腹壁切口、随访3年内诊断患有腹部切口子宫内膜异位症的产妇,对两者发生率进行比较。结果 3 150例采用子宫下段剖宫产术产妇3年内患有腹部切口子宫内膜异位症患者为24例;2 942例采用新式剖宫产术产妇3年内患有腹部切口子宫内膜异位症患者为56例,两者发生率有明显统计学差别（P〈0.01）。结论在减少腹部切口子宫内膜异位症发生率,选择子宫下段剖宫产术（纵切口）为一种有效的方法。     

Comparison of abdominal circumference measurements by real-time and b-scan techniques

In an effort to evaluate the efficacy of measuring abdominal circumference with real-time ultrasound, 53 patients were scanned with both contact scanning and linear array real time. Image measurements were made blindly from both types of equipment. Abdominal circumference measurements with real time compared favorably with those obtained from contact images (r = +0.984).     

Normal fetal cardiac measurements derived by cross-sectional echocardiography.

Cardiac structures have been measured in normal fetuses by cross-sectional echocardiography to establish a range of normal values. Gestational ages varied from 16 weeks to term. The cardiac structures measured were left and right ventricular width (n = 337), aortic root diameter (n = 296), pulmonary artery diameter (n = 312), mitral valve orifice (n = 159), and tricuspid valve orifice (n = 161). The lengths of the left and right ventricles were measured in 100 fetuses. Normal ranges were constructed using real-time ultrasound images which can be readily used in routine practice. Measurement of cardiac structures is an aid to the study of cardiac abnormalities and the availability of normal ranges of measurements of fetal cardiac structures may help to confirm and define suspected cardiac malformation during routine screening.     

Comparison of the effect of two different types of dry-needling techniques on subacromial impingement syndrome

IntroductionInfraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined.Designrandomized controlled clinical trial, single-blind study.MethodSixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups.InterventionsIn 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy.Main outcome measure(s)Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured.ResultsThe findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups.ConclusionPain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.     

不同无菌技术操作方法效果的比较研究

目的 探讨不同无菌技术操作方法的效果。方法①选择进行头皮静脉穿刺患儿61例,随机分为实验组33例用0.1％安多福消毒皮肤,对照组28例用75％酒精消毒皮肤,分别做局部皮肤细菌培养;②将配药瓶口分别用0.5％安多福与2％碘酒、75％酒精消毒,比较其效果;③比较无菌持物镊和无菌罐开启2、4、6、8h的细菌培养结果,并对监测结果进行统计学处理。结果①0.1％安多福与75％酒精消毒效果比较,P<0.05,差异有显著性;②0.5％安多福与2％碘酒、75％酒精消毒瓶口无论何种情况,P>0.05,差异无显著性;③无菌持物镊和无菌罐保存时间6h仍可无菌生长。结论 0.1％安多福皮肤消毒效果好;使用1根棉签消毒无论用0.5％安多福或2％碘酒、75％酒精消毒1个药瓶口均是安全的;无菌持物镊和无菌罐有效保存时间最长6h。     

Sodium measurements in multiple myeloma: two techniques compared

Sodium was determined by flame photometry and by direct potentiometry in 56 serum or plasma samples from 24 patients with multiple myeloma or macroglobulinemia. We observed differences between the two techniques as large as 17 mmol/L (12%). The flame-photometric values decreased relative to the direct-potentiometric values as protein increased or water content decreased. Moreover, the two sodium measurements could not be interconverted simply on the basis of correcting for protein or water content. There was significantly lower residual variance (p less than 0.005) when the direct-potentiometric sodium values were compared with the osmolality (corrected for the influence of glucose and urea nitrogen) than when the flame-photometric values for sodium were so compared. We conclude that direct potentiometric measurements of sodium in patients with multiple myeloma gives clinically relevant results but flame photometry does not. Clearly, the method by which sodium is measured in patients with multiple myeloma must be considered if results are to be interpreted correctly.     

两种体温计测量结果的比较

目的：了解液晶体温计与玻璃体温计体温测量结果有无差异。方法：用液晶体温计与玻璃体温计同时测量20位健康成年女性的口腔温度，对结果进行统计学处理。结果：两组测量数值无统计学意义(P＞0．05)。结论：液晶体温计在测量体温中与体温计同样有效，并且使用更安全、简便。     

Comparison of two different CPAP systems by tidal breathing parameters

OBJECTIVE: Comparison of tidal breathing and pressure fluctuation of the continuous positive airway pressure (CPAP) associated with the use of the valveless Infant Flow System versus the conventional constant-flow CPAP (Babylog 8000) in preterm infants. DESIGN: Randomized cross-over trial. SETTING: Neonatal intensive care unit level III. PATIENTS: Twenty infants; median (range): birth weight 1,035 g (640-4,110 g), actual weight 1,165 g (820-4,250 g), gestational age at birth 27 (26-40) weeks. INTERVENTIONS: After extubation two CPAP devices (Infant Flow System vs Babylog 8000) were applied in a random order to the same infant. Fluctuations of the applied pressure during the breathing cycle and tidal breathing parameters were measured by the flow-through technique. MAIN RESULTS: Using the Infant Flow System the mean (standard deviation) inspiratory flow [1.5 (0.1) vs 1.3 (0.1) l.min(-1).kg(-1), P<0.05] and tidal volume were significantly increased [5.3 (1.3) vs 4.7 (1.3) ml/kg(-1), P<0.05] compared to Babylog 8000. The fluctuations of the applied pressure of the Infant Flow System during the breathing cycle were significantly lower [0.1 (0.03) kPa vs 0.15 (0.08) kPa, P<0.05] compared to Babylog 8000. No differences were seen in the duration of inspiration and expiration and the time to peak tidal flow. In the Infant Flow System pressures during expiration remained stable whereas they increased during the use of Babylog 8000. CONCLUSIONS: Within-subject comparisons of tidal breathing parameters of the two CPAP devices Infant Flow System and Babylog 8000 show: (1) a significant influence of the system used; and (2) that the valveless Infant Flow System increases air flow and tidal volume with less fluctuations in CPAP pressures during the breathing cycle.     

两种麻醉方法用于脊柱神经外科手术的效果比较

目的 比较脊柱神经外科手术中吸入麻醉与全凭静脉麻醉的效果差异.方法 选取神经外科进行脊柱神经外科手术的100例患者,随机分为吸入麻醉组（50例）和全凭静脉麻醉组（50例）,吸入麻醉组采用七氟醚吸入麻醉,静脉麻醉组使用丙泊酚维持麻醉,比较两组患者围手术期的血液生理学指标平均动脉压（MAP）,心率（HR）,血氧饱和度（SpO2）,呼末二氧化碳分压 （PETCO2）和脑氧供指标颈静脉氧饱和度（SjvO2）和体感诱发电位（SEP）.结果 静脉麻醉组平均动脉压高于吸入麻醉组（P〈0.05）.两组患者心率均低于麻醉前数值,静脉麻醉组诱导后10 min心率下降,低于吸入麻醉组（P〈0.05）.静脉麻醉组患者脑氧供指标与麻醉前无显著差异,吸入麻醉组SjvO2明显升高,说明脑耗氧量下降.吸入组与静脉组SEP出现波幅或者潜伏期异常的发生率差异无显著性.结论 两种麻醉方法仅能维持脊柱神经外科手术中血流动力学稳定,吸入麻醉可降低脑耗氧量,静脉麻醉可维持正常体感诱发电位.     

Ultrasound measurements of fetal limb bones.

In order to establish the growth patterns of fetal limbs, measurements of femur, humerus, tibia, fibula, radius and ulna were made by ultrasound and related to gestational age. To this end, 2317 normal singleton pregnant women were studied cross-sectionally at 13-40 weeks of gestation. Patients were selected on the basis of a certain last menstrual period, history of regular cycles and at least one ultrasound scan before 16 weeks confirming gestational age. Linear growth of all limb measurements was observed between 13 and 28 weeks of gestation. From this gestational age onwards, a flattening of the growth curve was seen. A second-degree polynomial equation turned out to be the best model to describe this phenomenon. The measurements of all six fetal long bones showed a high correlation with menstrual age (r >or= 0.99). The femur displayed the largest mean weekly increments (2.8 mm per week from 13 to 28 weeks and 1.7 mm per week from 29 to 40 weeks of gestation) and the radius had the smallest (2.08 mm per week from 13 to 28 weeks and 1.25 mm per week from 29 to 40 weeks' gestation). Considering inter and intraoperator variations and the weekly increment of fetal long bone length, a correct evaluation of limb growth is possible for the femur every week before 28 weeks and every 2 weeks after 28 weeks. For the remaining limb bones, a correct evaluation is possible every 2 weeks at all gestational ages.     

Severe fetal cytomegalovirus infection associated with cerebellar hemorrhage.

Cytomegalovirus (CMV) is the most common cause of congenital infection worldwide. We report on a fatal fetal manifestation of primary maternal CMV infection including cerebellar hemorrhage and hydrops. The diagnosis was established by maternal serological tests, culture and polymerase chain reaction testing of amniotic fluid and fetal blood. The pregnancy was terminated. Postmortem examination confirmed the diagnosis.     

Sonographic detection of fetal cerebellar cavernous hemangioma with in-utero hemorrhage leading to cerebellar hemihypoplasia.

We report the prenatal diagnosis of cerebellar cavernous angioma. Ultrasound examination at 21 weeks' gestation showed a hyperechogenic lesion measuring 12 mm in diameter, occupying most of the right cerebellar hemisphere. At 24 weeks' gestation, significant hypoplasia of the right hemisphere was diagnosed, and the pregnancy was terminated. Pathological evaluation of the lesion revealed extensive hemorrhaging and a rich network of dilated vessels and small capillaries. The right cerebellar lobe was hypoplastic and covered with blood clots. Cerebral cavernous malformation should be considered in the differential diagnosis of hyperechogenic lesions in the fetal cerebellum.     

不同麻醉方法用于腹腔镜胆囊切除术的比较

目的 比较不同麻醉方法对腹腔镜胆囊切除术(Lc)患者应激反应的影响.方法 择期行LC患者40例,随机分为全麻组(Ⅰ组,n=20)和全麻复合硬膜外组(Ⅱ组,n=20),监测两组患者的血流动力学变化,分别于麻醉前、插管时、术中及拔管时抽取静脉血测定血浆肾素活性(PRA)、血管紧张素Ⅱ(AT-Ⅱ)及醛固酮值(ALD)的浓度.结果 Ⅰ组出现明显的心血管反应,尤以插管及拔管时显著高于基础值(P＜0.05-0.01),Ⅱ组各时间点血液动力学稳定,与Ⅰ组比较有显著差异(P＜0.05-0.01);Ⅱ组麻醉前后内分泌各测定值无显著变化,而Ⅰ组则显著增高(P＜0.05-0.01),与Ⅱ组比较有显著差异(P＜0.05-0.01).结论 全麻复合硬膜外阻滞用于LC可减轻应激反应,循环状态稳定,是较理想的麻醉方法.