不同手术方式治疗青光眼术后硬核白内障疗效观察

目的 观察巩膜隧道小切口超声劈核后手法娩出核与透明角膜切口超声乳化碎核治疗青光眼术后硬核白内障的疗效和安全性,为临床选择合适的手术方法提供依据.方法 将118例(130眼)青光眼术后硬核白内障患者按照随机数字表法分为两组,每组59例(65眼).A组采用巩膜隧道小切口超声劈核后手法娩出核治疗,B组采用透明角膜切口超声乳化碎核治疗.比较两组治疗前后的视力情况、前房深度分级、前后眼压及角膜内皮细胞密度,统计并发症发生情况.结果 治疗前两组各项指标比较差异均无显著性(P＞0.05);治疗后两组视力、前房深度分级、角膜内皮细胞计数均较治疗前显著改善(P＜0.01),眼压无显著变化(P＞0.05),两组间前房深度分级、角膜内皮细胞计数比较差异有显著性(P＜0.01),视力、眼压比较差异无显著性(P＞0.05).A组并发症发生率为32.3％,B组为26.2％,两组比较差异无显著性(P＞0.05).结论 采用巩膜隧道小切口超声劈核后手法娩出核与透明角膜切口超声乳化碎核治疗青光眼术后硬核白内障疗效显著,安全性高,但前者在改善前房深度分级方面具有明显优势.     

双刀水平面二次劈核与超声乳化治疗硬核白内障的对比研究

[目的]比较双刀水平面二次劈核折叠晶体植入与超声乳化手术治疗硬核白内障的疗效、并发症.[方法]97例118眼Ⅳ级以上硬核白内障患者,随机分成双刀水平面二次劈核手术(劈核组)47例56眼,超声乳化手术(超乳组)50例62眼.超乳组能量设定45%～60%,负压130～140 mmHg,平均超声能量(28.73±3.54)%,平均超声时间(127.35±51.46)s.两组术后随访时间6个月.[结果]术后3 d视力恢复,劈核组优于超乳组(P=0.04),90 d视力恢复两组间差异无显著性(P=0.69).术后角膜水肿发生率,劈核组轻度占8.29%(5/56),超乳组轻度8.06%(5/62),中度20.97%(13/62),两组总角膜水肿发生率比较差异有显著性(8.29% vs 33.87%,P＜0.05).两组术后3 d及90 d平均角膜散光度比较差异无显著性(P＞0.05).[结论]劈核组术后早期视力恢复快、角膜水肿发生率低,明显优于超乳组.提示双刀水平面二次劈核治疗硬核白内障疗效可靠、并发症少,值得推广.     

不同透明膜切口超声乳化术治疗急性闭角型青光眼合并白内障患者的临床效果分析

目的分析使用不同透明角膜切口长度超声乳化白内障人工晶状体植入术(Phaco+IOL)治疗急性闭角型青光眼合并白内障患者的临床应用效果。方法选取我院2016年2月～2018年3月进行手术治疗的急性闭角型青光眼合并白内障患者112例(132眼),随机分为对照组和观察组各56例。两组患者均采用Phaco+IOL手术治疗,对照组透明膜切口为2.2mm,观察组透明膜切口为2.8mm,术后随访患者3个月。观察两组患者超声乳化和手术时间,记录两组患者术前、术后1周、术后1个月及术后3个月的视力情况和手术源性散光情况。记录在治疗后不良反应发生情况。结果对照组患者Ⅳ级核超声乳化时间显著高于观察组,差异有统计学意义(P0.05),而两组其余级核超声乳化和手术时间比较差异无统计学意义(P0.05);两组患者术后1周、术后1个月及术后3个月的视力恢复情况及手术源性散光情况比较,差异均无统计学意义(P0.05);对照组不良反应发生率为17.85%,观察组不良反应发生率为5.36%,两组比较差异有统计学意义(P0.05)。结论使用2.2mm和2.8mm透明角膜切口超声乳化术治疗急性闭角型青光眼合并白内障,能够在短时间内恢复患者的视力,均能够恢复较好的临床效果,2.8mm切口具有较低的并发症发生率,预后较好,而对于硬核白内障患者,2.8mm角膜切口优于2.2mm切口。     

不同手术方式治疗青光眼术后硬核白内障的临床疗效观察

目的对不同手术方法治疗青光眼术后硬核白内障的临床疗效和安全性进行观察和分析。方法选取2009年9月-2013年4月曲靖市第二人民医院收治的青光眼手术后硬核白内障患者100例作为研究对象,按不同治疗方法分为观察组和对照组,其中观察组54例（75眼）,对照组46例（61眼）。观察组患者应用巩膜隧道小切口超声劈核后手法娩出核进行治疗,对照组患者应用透明角膜切口超声乳化碎核进行治疗。对所有患者随访3～6个月,观察和记录患者手术前、后视力,前房深度,眼压和角膜内皮细胞平均计数的变化及不良反应。结果2组患者视力均较治疗前显著改善（P〈0．05）,但2组间差异无统计学意义（P〉0．05）;2组患者前房深度分级显著优于治疗前（P〈0．05）,且治疗后观察组患者的前房深度分级显著优于对照组（P〈0．05）;2组患者治疗后的眼压与治疗前的差异无统计学意义（P〉0．05）,2组间的差异也无统计学意义（P〉0．05）;观察组患者角膜内皮细胞密度下降不显著（P〉0．05）,而对照组则下降显著（P〈0．05）,观察组患者治疗后的角膜内皮细胞密度显著高于对照组（P〈0．05）;2组患者术后的不良反应发生率分别为21．33％（16／75）和21．31％（13／61）,经对症治疗后均得到控制和恢复,2组患者不良反应情况差异无统计学意义（P〉0．05）。结论应用巩膜隧道小切口超声劈核后手法娩出核治疗青光眼术后硬核白内障,可有效改善患者视力和前房深度,安全性较高,且在改善前房深度和减少角膜细胞损伤方面优于超声乳化碎核术,值得临床推广应用。     

小梁切除术后硬核白内障冷超乳摘除对角膜的影响研究

目的 探讨小梁切除术后硬核白内障透明角膜切口冷超乳摘除时角膜切口、散光和角膜内皮细胞数量及形态的影响.方法 对连续小梁切除术后Ⅳ级硬核白内障手术患者随机分组,试验组采用透明角膜切口白内障冷超乳摘除,对照组采用透明角膜切口普通超声乳化技术.比较两组术后视力、角膜切口水肿、手术源性散光、角膜内皮细胞数量和形态改变.结果 两组术后视力恢复和手术源性散光差异无统计学意义(P＞0.05);角膜切口水肿和角膜内皮细胞数量减少对照组高于试验组,角膜内皮六角形细胞比例试验组好于对照组,差异有统计学意义(P＜0.05).结论 透明角膜切口冷超乳摘除小梁切除术后硬核白内障对角膜损伤较小,手术安全性较高,是小梁切除术后硬核白内障手术摘除较为理想的术式选择.     

小切口非超声乳化手术治疗硬核白内障的随访研究

目的探讨小切口非超声乳化手术治疗硬核白内障的临床效果和安全性。方法随机选择2016年1月～2018年1月将在我院诊治的硬核白内障患者150例,随机分为观察组76例和对照组74例。对照组给予超声乳化术治疗,观察组给予小切口非超声乳化术治疗,观察两组患者的视力恢复情况、角膜散光度、眼压和安全性。结果术后3个月观察组患者视力恢复率明显高于对照组,差异有统计学意义(P0.05)。术后3个月观察组患者角膜散光度、眼压明显低于对照组,差异有统计学意义(P0.05)。观察组患者角膜水肿、角膜内皮损伤并发症发生率及并发症总发生率明显低于对照组,差异有统计学意义(P0.05)。结论小切口非超声乳化白内障手术治疗硬核白内障具有明显优势,值得推广和使用。     

预劈核技术在硬核白内障超声乳化手术中的应用

目的 探讨预劈核技术在硬核白内障超声乳化手术中的应用.方法 将50例(50只眼)Ⅲ 级以上白内障随机分成二组,分别采用预劈核及拦截劈裂法模式,比较两组术中所用的有效超声时间、术后角膜水肿程度、手术并发症的发生情况.结果 预劈核组的有效超声时间短,术后角膜水肿程度亦明显轻于拦截劈裂组.术中后囊膜破裂眼数两组差异无统计学意义.结论 预劈核技术可缩短超声乳化白内障吸除术的有效超声时间,降低总体超声能量,减轻眼内组织损伤.     

青光眼滤过术后白内障超声乳化及人工晶体植入术分析

目的探讨青光眼滤过术后白内障超声乳化吸除及人工晶体植入术中手术方法、技巧,手术对眼压的影响及其疗效。方法选择青光眼滤过术后眼压正常的白内障患者44例（46眼）,行透明角膜切口,超声乳化白内障吸除及折叠式人工晶体植入术,观察术后视力及术后反应情况,术后随访3个月~3年。结果本组44例（46眼）中,术后所有患者视力均有不同程度的提高。8眼术后5 d内发生高眼压,经药物治疗,眼压恢复正常;其余38眼眼压均在正常范围。结论透明角膜切口、白内障超声乳化可有效地保护青光眼滤过泡,对眼压无特殊影响,并发症少,视力恢复快。     

3mm小切口手法劈核术治疗硬核白内障的疗效观察

目的观察3mm小切口手法劈核术治疗Ⅳ~Ⅴ级硬核白内障的临床疗效。方法选取2013年1月至2014年12月该院眼科收治的白内障患者221例共242眼,按照手术方式的不同分为试验组及对照组。试验组纳入患者143例157眼(其中Ⅳ级核119眼,Ⅴ级核38眼),行3mm带球结膜的角巩膜缘隧道式切口后,进行手法核周逐块劈开粉碎后将硬核旋转刨出,最后进行可折叠人工晶体植入;对照组纳入患者78例85眼(其中Ⅳ级核61眼,Ⅴ级核24眼),行4mm中央手法劈核摘除术后植入折叠人工晶体。比较2组术后并发症及术后视力变化情况。结果试验组术中后囊破裂2眼(1.27%),角膜水肿29眼(18.5%);对照组术中晶体后囊膜出现破裂3眼(3.5%),角膜水肿34眼(40.0%),2组术后并发症比较差异有统计学意义(P0.05)。试验组术后第一周视力优于或等于0.5的有106眼(67.5%),1个月复查视力光感优于或等于0.5的有139眼(88.5%);对照组术后第1周视力优于或等于0.5的有46眼(54.1%),1个月后复查视力优于或等于0.5的有69眼(81.2%),2组术后视力变化情况比较,差异有统计学意义(P0.05)。结论对Ⅳ~Ⅴ级硬核行核周手法劈核术可明显减少术中、术后并发症,且能提高手术效果。     

小切口非超声乳化白内障手术治疗硬核白内障的效果

目的探讨小切口非超声乳化白内障手术治疗硬核白内障的临床效果。方法选取2016年4月至2018年6月收治的硬核白内障患者98例(98眼),依据患者意愿分为对照组和试验组,每组49例(49眼)。对照组采用小切口超声乳化白内障手术治疗,试验组采用小切口非超声乳化白内障手术治疗,术后随访3个月,比较两组裸眼视力、角膜散光度、并发症发生情况。结果术后3个月,与对照组比较,试验组裸眼视力为0.1～0.3的比例、裸眼视力为0.4～0.8的比例较低,裸眼视力为0.8～1.0的比例较高,差异有统计学意义(P0.05)。术后3个月,试验组角膜散光度低于对照组,差异有统计学意义(P0.05)。与对照组比较,试验组并发症发生率较低,差异有统计学意义(P0.05)。结论硬核白内障患者采用小切口非超声乳化白内障手术治疗可提高裸眼视力,降低角膜散光度,降低术后并发症发生率,改善患者预后。     

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.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.