脊柱后路内固定术后迟发性感染患者行外科治疗的护理

目的 探讨脊柱后路内固定术后迟发性感染患者进行外科治疗时的护理要点.方法 对骨科行脊柱后内固定术后并发迟发性感染的27例患者采用手术清创及双套管置管冲洗灌注引流,同时行抗生素治疗,对护理要点进行总结.结果 患者平均住院时间为18 d,所有患者在相应的外科处理和抗生素治疗后伤口均未出现窦道和不愈合.结论 伤口清创、双套管冲洗引流同时配合药物治疗是治疗脊柱后路内固定术后迟发性感染的一种安全有效的治疗方法;术前心理护理、饮食护理,术后体位护理、管道护理及药物不良反应的观察,及细致的出院指导是患者顺利康复的重要保证.     

胸腰椎后路内固定术后早期伤口深部感染的护理

目的探讨胸腰椎后路内固定术后早期深部感染的护理措施。方法对15例胸腰椎后路内固定术后早期伤口深部感染患者,在彻底手术清创的基础上,采用保持伤口有效对位冲洗,引流通畅,保持抗生素的有效输入,加强营养,正确指导功能锻炼等护理措施。结果15例早期伤口感染患者均恢复良好,随访6～36个月无复发。结论对胸腰椎后路内固定术后早期伤口深部感染的患者,有效的护理措施有利于感染伤口的顺利愈合。     

腰椎后路融合内固定术后早期深部感染的因素分析及治疗

目的探讨腰椎后路融合内固定术后早期深部感染的发生率、影响因素及治疗策略。方法回顾性分析我院2013—2011年1492例行腰椎后路融合内固定术患者术后早期深部感染的发生率,根据是否发生感染将患者分为两组：感染组11例,非感染组1481例,进行感染风险因素评分（infectionriskfactorscore,RFS）,比较两组是否存在统计学差异,分析保留内置物情况下彻底清创、持续冲洗负压引流结合静脉滴注抗菌药物治疗的成功率、分析失败因素及处理策略,探讨何种状况下需清创同期取出内固定。结果1492例腰椎后路融合内固定术后早期深部切口感染11例（0．74％）,感染组与非感染组RFS分别为2．64±0．24和0．78±0．55,差异有统计学意义（P=0．032）。9例保留内置物情况下采用彻底清创、持续冲洗负压引流,结合静脉滴注抗菌药物,治疗成功6例。另3例2次清创取出内固定后继续冲洗引流：2例感染彻底控制、1例伤口愈合后1个月血液感染继发颅内感染、感染性休克死亡;2例术前长期口服激素同时RFS≥3分患者,采用彻底清创、持续冲洗负压引流,结合静脉滴注抗菌药物同时取出内固定,感染彻底控制。结论腰椎后路融合内固定术后早期深部感染发生率相对较低,保留内置物情况下彻底清创后持续冲洗负压引流结合静脉滴注应用抗菌药物是一种有效的治疗方法,对于术前长期口服激素同时RFS≥3分患者,彻底清创同时取出内固定有利于感染彻底控制。     

脊柱后路迟发性感染并窦道形成注入碘海醇及亚甲蓝的作用：与内固定的关系

背景：脊柱后路术后迟发性感染有一定的发生率,各家报道不一,多见于有内植入物存在,无内植入物者发生率较低.当感染发生时,感染与内固定是否一定有相关性,术前无法有效的通过临床症状判断,影像学检查亦不能给予完全肯定.术中处理方法常见报道为切开清创,置管冲洗.目的：探讨碘海醇及亚甲蓝在脊柱后路迟发性感染并窦道形成患者中的临床应用效果,并分析其与内固定的关系.方法：选择佛山市第六人民医院收治的30例脊柱后路迟发性感染并窦道形成患者,起病时间为初次术后3个月,其中有内固定者21例,无内固定者9例.30例患者随机分为两组,观察组患者术前常规窦道内注入碘海醇造影拍片,明确窦道的深度及基底部宽度,指导术中麻醉方式及手术范围,消毒铺巾完毕后伤口内注入亚甲蓝2 mL,对窦道壁组织进行染色,术中清除亚甲蓝染色组织,清创后放置引流,Ⅰ期缝合;对照组按常规切开清创、置管冲洗引流.比较两组患者手术时间、出血量、术后目测类比评分及再感染率等指标的差异.结果与结论：观察组手术时间为（45.26±7.66） min,出血量为（50.61±11.11） mL,显著低于对照组的（60.46±9.22） min,（80.48±11.47） mL,差异均有显著性意义（P均＜0.05）.两组患者伤口均完全愈合,术后随访1,3,6,12个月,患者均未再出现伤口再感染症状.两组术后目测类比评分随着时间推移均逐渐减少,差异有显著性意义（P＜0.05）;两组相同时间点比较差异无显著性意义.提示碘海醇及亚甲蓝可以有效的应用于脊柱后路迟发性感染并窦道形成患者,无论有无内固定,均有利于术前评估选择麻醉方式,缩短手术时间,减少术中出血.     

含抗生素骨水泥间隔物在椎弓根钉内固定术后迟发性感染翻修术中的应用

目的:探讨在腰椎弓根钉内固定术后,钉道迟发性感染翻修术中使用自制的含抗生素骨水泥间隔物的方法及有效性.方法:对2007年4月至2009年4月期间7例椎弓根钉内固定术后发生钉道迟发性感染的患者采用手术切开清创,自制抗生素骨水泥间隔物治疗,感染治愈后行Ⅱ期椎弓根内固定术.结果:7例患者钉道迟发性感染均获治愈.行Ⅱ期翻修术后症状明显缓解,无感染复发迹象.结论:抗生素骨水泥间隔物能有效治愈钉道迟发性感染,维持原螺钉孔道,为Ⅱ期翻修手术创造良好条件.     

胸腰椎后路内固定术后感染的分析与治疗

目的通过临床病例探讨胸腰椎后路内固定术后感染的治疗策略。方法对收治的9例胸腰椎后路内固定术后感染患者的病因、临床表现、诊断依据及治疗方法进行回顾性分析。结果手术操作、器械消毒、患者身体健康状态差等是感染的主要病因。临床表现主要为局部红、肿、热、痛、压痛、渗液,伤口裂开,窦道形成。血沉、C反应蛋白是诊断术后感染的敏感化指标,细菌培养是金标准。敏感抗生素＋病灶清创灌洗引流是治疗的主要方法。结论围术期提高对感染的重视程度是预防感染的重点;敏感抗生素＋病灶清创灌洗引流是治疗胸腰椎后路内固定术后感染的主要方法。     

负压封闭引流术在治疗脊柱术后早期深部感染中的应用

目的探讨负压封闭引流术治疗脊柱后路内固定术后早期深部感染的临床疗效。方法回顾性分析2009年3月-2012年3月采用负压封闭引流术治疗脊柱后路内固定术后早期深部感染患者9例,其中男5例,女4例;年龄21～64岁,平均44．6岁。所有患者均行手术清创,保留原有内固定,并采用负压封闭引流的治疗方式。结果患者经负压封闭引流术治疗1～3次,平均2．1次,每次3～7d;所有患者接受6～38个月的随访,平均18个月,伤口均愈合,无腰痛、切口疼痛、红肿、渗出及窦道形成等;再次行影像学检查未见骨质破坏;复查血沉、C反应蛋白、白细胞总数及分类明显下降或降至正常。结论负压封闭引流术是治疗脊柱后路内固定术后早期深部感染的有效方法。     

脊柱内固定手术后感染的治疗分析

目的探讨胸腰椎疾患脊柱内固定术后感染的原因及防治措施。方法对18例胸腰椎疾患行脊柱内固定术后并发迟发性感染患者进行内固定物取出、病灶清除、灌洗引流、抗感染等治疗。结果18例患者随访12—28个月,均无窦道再形成,2例除腰部残留轻微疼痛外,其他病理性疼痛消失,X线片及ESR、CRP均正常。术前及术中脓液取样行细菌培养,培养时间延长至7d以上,其中10例培养出表皮葡萄球菌、3例微球菌、2例粪链球菌、3例无菌生长。结论脊柱内固定术后迟发性感染由致病菌弱细菌所引起,发展慢且较局限。通过内固定物取出、病灶清除、持续灌洗引流、抗感染等治疗可获得满意疗效。     

持续腹腔双套管冲洗负压引流治疗胰腺脓肿的护理

目的：总结腹腔双套管持续冲洗负压引流治疗胰腺脓肿的护理经验和体会。方法对10例行腹腔双套管持续冲洗负压引流治疗的胰腺脓肿患者行心理护理，引流管的护理，持续冲洗负压引流的观察及预防感染。结果3例治愈顺利拔管；6例脓肿缩小，感染得以控制，带管出院；1例死于败血症，感染性休克。结论腹腔双套管持续冲洗负压引流是治疗急性重症胰腺炎中后期胰腺囊肿的重要措施，而引流管的护理，持续负压冲洗的观察及预防感染是保障腹腔双套管持续冲洗引流的重要条件。     

腰椎后路椎间融合术后伤口深部感染的护理

目的：探讨腰椎后路椎间融合术后伤口深部感染的护理措施。方法：选择7例腰椎后路椎间融合术后伤口深部感染患者,在彻底手术清创的基础上,采取保持伤口冲洗引流通畅,做好病情观察、心理及生活护理,加强感染管理及监控,加强营养,积极预防卧床并发症等护理措施。结果：7例伤口感染患者均恢复良好,无复发。结论：对腰椎后路椎间融合术后伤口深部感染的患者,有效的护理措施利于感染伤口的顺利愈合。     

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.