急诊创伤性脊柱损伤患者致残程度的相关因素

目的 探讨急诊创伤性脊柱损伤患者致残程度的相关因素.方法 自行设计《创伤性脊柱损伤致残因素调查表》并结合《脊柱脊髓损伤评分》,对创伤性脊柱损伤患者285例进行调查评估.结果 创伤性脊柱损伤患者中有昏迷情况患者A级57例,B级37例,C级44例,D级17例,E级18例,与无昏迷患者损伤程度比较差异有统计学意义（Z=20.055,P＜0.01）;不同运送方式、创伤原因、脊柱手术时间患者脊髓损伤程度不同,差异均有统计学意义（P＜0.05）;在创伤性脊柱损伤中主要是车祸、打砸和坠落伤.结论 除创伤直接因素外,影响创伤性脊柱损伤患者损伤水平还包括现场及运送患者保护不当、昏迷患者救治措施以抢救生命为主、转运增加二次运送风险、延误早期手术时间.     

脊柱骨折脱位合并脊髓损伤早期应用甘露醇的体会

脊柱骨折脱位合并脊髓损伤早期应用甘露醇的体会２６４４００山东省文登市整骨医院徐东霞２６４２００山东省威海市疗养院徐东红凡直接暴力或间接暴力作用在正常脊柱和脊髓组织，均可造成脊髓损伤。各种急性脊髓损伤都会产生不同程度的脊髓水肿，水肿可使脊髓所受到的压迫...     

地震中脊柱脊髓损伤伤员的急救

地震会造成大量脊柱脊髓损伤伤员。脊柱骨折影响脊柱稳定性,给现场急救带来困难。对怀疑有脊髓损伤的伤员在救治过程中应注意保持脊柱稳定并妥善制动。7岁以下的儿童有其自身的解剖特点,在现场救援时应特别注意。现场医学急救除常规的ABC原则外,还应注意与脊髓损伤密切相关的呼吸功能和血流动力学方面的问题。现场急救的主要目的是降低脊柱脊髓损伤伤员的残疾程度,提高存活率和救治效果。     

低场磁共振诊断脊柱创伤50例

回顾性分析50例脊柱损伤患者的临床资料和MRI影像片。50例脊柱损伤患者主要表现为脊柱损伤、脊柱软组织损伤和脊髓损伤,MRI表现不同。低场MRI能全方位反映脊柱损伤的程度和病理变化,可对脊髓、椎间盘、韧带以及其它软组织损伤做出较为准确的判断,可作为临床诊断、治疗评价及改善预后的最好检查方法,对X线、CT扫描未发现的骨挫伤也有重要诊断意义,但对附件骨折仍有一定的局限性。     

脊柱骨折脊髓损伤-后路钉棒复位内固定术患者系统健康教育方式的效果

目的 探讨系统健康教育对脊柱骨折脊髓损伤病人的效果及影响.方法 将进行脊柱骨折脊髓损伤-后路钉棒复位内固定术病人64例随即分为实验组和对照组,每组32例.对照组实施常规健康教育.观察组运用系统健康教育方法.分别在实施健康教育前后,用问卷进行测评,了解两组病人对相关知识的掌握情况、焦虑程度、对护士工作满意度.结果 系统健康教育提高了脊柱骨折脊髓损伤病人对疾病认知和护理知识的掌握配合降低了焦虑心理,提高了满意度.结论 对脊柱骨折脊髓损伤-后路钉棒复位内固定术患者实施系统的健康教育能够加强护患间的沟通与交流,优化护患关系,增强了患者对医护人员的信任.     

急性脊柱脊髓损伤患者并发症的相关因素分析与早期康复

目的 探讨急性脊柱脊髓损伤患者并发症的临床发病情况、发病危险因素、治疗措施.方法 对543例急性脊柱脊髓损伤患者的临床资料进行回顾性分析.结果 543例患者中242例(44.6%)发生并发症;发生率最高的前三位并发症为:低钠血症(202例,37.2%)、泌尿系感染(150例,27.6%)、肺部感染(54例,9.9%).完全性颈脊髓损伤患者低钠血症和肺炎的发生率明显增高.结论 积极的早期预防和早期康复训练是预防急性脊柱脊髓损伤并发症的有效方法.     

外周血pNF-H、S100B水平与脊柱骨折伴脊髓损伤患者病情程度的相关性

目的探讨外周血神经丝蛋白H磷酸化亚型(p NF-H)、S100B钙结合蛋白(S100B)水平与脊柱骨折伴脊髓损伤患者病情程度的相关性。方法选择238例脊柱骨折患者,根据其是否伴脊髓损伤分为脊髓损伤组71例与脊髓未损伤组167例,采用ELISA检测血清p NF-H、S100B水平,比较2组血清p NF-H、S100B水平,对比病情不同严重程度的脊柱骨折伴脊髓损伤患者血清p NF-H、S100B水平,绘制受试者工作特征(ROC)曲线分析血清p NF-H、S100B水平对脊柱骨折伴脊髓损伤的诊断价值。结果脊髓损伤组血清p NF-H、S100B水平高于脊髓未损伤组(P均<0.05)。脊髓完全损伤的脊柱骨折患者血清p NF-H、S100B水平高于脊髓不完全损伤的脊柱骨折患者(P均<0.05)。血清p NF-H、S100B水平联合检测对脊柱骨折伴脊髓损伤的ROC曲线下面积均高于单独检测(P均<0.05)。结论 p NF-H、S100B水平在脊柱骨折伴脊髓损伤患者外周血中高表达,并与脊柱骨折伴脊髓损伤患者病情严重程度相关,检测血清p NF-H、S100B水平有助于脊柱骨折伴脊髓损伤...     

国际脊髓损伤脊柱损伤基础数据集

收集脊柱损伤的信息对于脊髓损伤患者的诊断和治疗非常重要,设立脊髓损伤患者脊柱损伤基础数据集是为了规范脊柱损伤相关信息的收集方式和报告内容,学习并使用国际脊髓损伤脊柱损伤基础数据集,有助于规范和统一我国脊髓损伤患者脊柱损伤信息的收集,为相关治疗提供依据。本文将介绍国际脊髓损伤脊柱损伤基础数据集的研发过程,数据元素的内容以及数据编码的应用实例。     

胸腰段脊柱爆裂骨折伴脊髓损伤的治疗

目的　评价不同经后路内固定方法治疗胸腰段脊柱骨折伴脊髓损伤的疗效。方法　回顾性分析 96例经后路长、短节段内固定治疗胸腰段脊柱骨折伴脊髓损伤患者术后神经功能恢复程度、骨折复位愈合效果和并发症的发生情况。结果　短节段组在神经功能恢复程度上与长节段组无显著差异 (P >0 .0 5 ) ,但短节段组的脊柱后凸术后矫正丢失角度明显 <长节段组 ,而且并发症少。结论　后路短节段内固定治疗胸腰段脊柱骨折伴脊髓损伤的效果明显优于后路长节段内固定     

脊柱脊髓损伤的现场急救与护理体会

脊柱、脊髓受直接或间接机械外力作用时,可引起各种类型的脊柱骨折、脱位,造成稳定性的破坏,而脊柱不稳定是造成脊髓损伤的主要原因.一部分病人因此造成难以恢复的终生残疾甚至死亡.颈、腰椎骨折是院前现场急救中经常遇到的外伤性疾病.因此,对于疑有脊椎骨折、脱位、脊髓损伤的患者,均应予以高度重视,必须在现场给予合理的救护,以保证搬运病人的过程中不加重脊髓损伤.我科2002～2010年成功救治25例脊柱脊髓损伤病人,现将抢救与护理体会报告如下.     

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.