尿激酶胸腔内注射治疗外伤性凝固血胸

目的：观察尿激酶胸腔内注射治疗外伤性凝固血胸的疗效。方法：选择13例外伤性血胸患者，10例于伤后一周内应用本疗法，3例于伤后一周后应用本疗法。将尿激酶10万单位加入50ml生理盐水中，每日一次胸腔内注射，平均用药5天。同时放置胸腔闭式引流管引流胸腔积液。结果：本组病例13例，治愈率76．9％(10／13)，无并发症发生。结论：尿激酶胸腔内注射治疗外伤性凝固血胸，疗效确切、安全可靠，掌握恰当用药开始时间是治愈本病的关键。     

电视胸腔镜手术治疗凝固性血胸的荟萃分析

目的 探讨胸腔镜手术治疗凝固性血胸的临床疗效和安全性.方法 计算机检索Cochrane图书馆(2011年第3 期)、PubMed、EMBASE、CBM、CNKI、VIP、万方数据库(截至2011年9月).收集胸腔镜手术治疗血胸的随机或半随机对照试验,采用Cochrane系统评价的方法,提取数据并由2名评价者独立评价并交叉核对纳入研究的质量,对同质研究采用RevMan5.0软件进行Meta分析.结果 共纳入5个RCT包括310例患者.Meta分析结果显示:①胸腔镜组的手术后患者住院时间明显少于普通开胸手术[WMD=-4.55,95%CI( -6.07,-3.04)];②胸腔镜手术组的手术时间明显少于普通开胸手术[WMD=-65.68,95%CI( -71.88,-59.48)];③胸腔镜手术的术中出血量明显少于普通开胸组[WMD=-121.25,95%CI( -195.68,-46.82)];④胸腔镜术后胸管留置时间明显缩短[WMD=-2.00,95%CI( -2.90,-1.09)];⑤胸腔镜手术后胸腔引流量明显少于普通开胸组[WMD=-65.37,95%CI( -71.76,-58.98)].结论 胸腔镜手术可以明显缩短凝固性血胸治疗的手术时间,减少术中出血量,缩短血胸术后胸管留置时间,减少术后胸腔引流量及缩短住院时间.     

胸腔镜术式对凝固性血胸患者的临床疗效及安全性分析

目的研究胸腔镜术式对凝固性血胸患者的临床疗效及安全性。方法选取2014-01—2016-01于铁岭市中心医院进行治疗的凝固性血胸患者68例。根据患者治疗术式的不同分为观察组以及对照组各34例。其中观察组患者给予胸腔镜手术治疗,而对照组患者则给予传统开胸手术治疗,对比两组效果。结果观察组患者术中出血量、手术时间以及住院天数分别为(123.4±25.6)m L、(43.7±2.6)min、(7.6±2.4)d,均显著低于对照组的(157.5±27.8)m L、(57.9±3.7)min、(10.2±2.6)d,差异均有统计学意义(均P0.05)。观察组术后引流管留置时间、镇痛时间以及并发症发生率分别为(2.7±1.1)d、(2.4±1.2)d、2.94%(1/34),均显著低于对照组的(3.9±1.4)d、(4.1±1.5)d、20.59%(7/34),差异均有统计学意义(均P0.05)。结论胸腔镜术式治疗凝固性血胸的临床疗效显著,且能有效降低患者术后并发症发生率,减轻患者痛苦以及经济负担,有利于促进患者早日康复。     

局部麻醉下胸腔镜诊治胸部疾病58例

目的探讨电视胸腔镜(VATS)治疗胸部疾病时的麻醉配合方法和临床疗效。方法局部麻醉病人清醒下、不用气管双腔管插管,用胸腔镜诊治创伤性膈肌破裂、胸腔积液、胸膜病变、凝固性血胸58例。结果18例创伤性膈肌破裂、19例胸膜病变诊断率100%,胸腔积液、胸膜病变、外伤凝固性血胸得到诊治。结论局部麻醉胸腔镜诊治胸部疾病方法简便,创伤小、疗效好,安全可行。     

胸腔镜在创伤性血胸诊疗中的应用14例分析

目的探讨电视胸腔镜手术处理血胸的适应证与禁忌证。方法对14例创伤性血胸在电视胸腔镜下进行手术治疗。结果手术时间50~160(平均100)min。手术中从胸内清除的血量900~2 300(平均1 600)ml。术后留置胸腔闭式引流管4~7 d。全组无手术死亡。1例中转开胸手术,术后未发生并发症。结论电视胸腔镜手术适应于创伤后各期血胸。     

胸腔镜手术在创伤性血胸治疗中的体会

目的总结胸腔镜手术治疗创伤性血胸的临床经验。方法 2006年8月至2012年8月血胸患者39例,其中行胸腔镜治疗18例,行剖胸探查手术21例。结果胸腔镜组患者术后镇疼药物(吗啡)用量,术后胸腔引流管放置时间、引流量,住院时间均明显少于开胸组,且无并发症发生。结论胸腔镜手术治疗血胸具有创伤小、康复快、并发症少等优点,大部分创伤性血胸手术可由胸腔镜完成,是值得临床推广、安全有效的治疗方法。     

电视胸腔镜手术在血胸处理中的诊治体会

目的探讨和总结电视胸腔镜手术(VATS)在治疗血胸中的应用经验。方法回顾性分析5a来该院采用VATS治疗血胸38例与同期行开胸(TH)20例患者进行比较。结果VATS组手术时间、术后胸管放置时间和住院时间均较TH组明显缩短(P<0.01),住院费用差异无显著性(P>0.05),无并发症发生。结论合理应用电视胸腔镜治疗血胸具有创伤小、恢复快、并发症少和利于美容等优点,大部分血胸开胸手术可由胸腔镜手术完成,是一种安全、有效的方法,值得临床推广应用。     

凝固性血胸10例报告

我院近10年来共收治外伤性血胸283例,其中确诊为凝固性血胸者10例,现报告如下。 1 临床资料 本组10例,男8例,女2例,年龄18～45岁。交通事故伤6例,重物压砸伤2例,高处坠落伤2例。合并多发性肋骨骨折6例(链枷胸2例),肺挫伤4例;创伤性休克8例;合并腹腔脏器损伤3例(肝、脾、小肠破裂各1例)。 2 治疗方法及结果 本组10例确诊为凝固性血胸后均行开胸探查,清除胸腔内血凝块、积液及纤维蛋白,置胸腔闭式引流。对3例腹腔脏器损伤行肝修补、脾切除及肠修补处理。全组均治愈,肺功能恢复良好,无并发脓胸者。     

肺部疾病中电视胸腔镜手术与常规开胸手术的对比研究

目的 :在肺部疾病中应用电视胸腔镜手术 (VATS)与常规开胸手术比较显示其优越性。方法 :施行VATS40例 ,其中胸腔镜辅助小切口手术 (VAMT) 2 0例 (研究组 ) ;同期施行常规开胸手术 40例 (对照组 ) ,手术疾病均包括自发性气胸及肺部占位性病变等。比较两组病人围手术期情况。结果 :研究组与对照组比较 ,手术效果满意 ,无术后并发症及死亡。手术时间〔分别为 ( 140 .78± 6 0 .34) ,( 2 15 .76± 6 2 .34)min〕 ,失血量〔分别为( 2 6 0 .41± 16 5 .37) ,( 6 80 .38± 341.72 )ml〕及手术恢复、胸液量、胸管置留时间、术后住院天数等 ,均有显著性差异 (均为P <0 .0 1)。结论 :电视胸腔镜手术具有创伤小、出血少、疼痛轻、手术时间短、疗效可靠、恢复快、并发症少、住院时间短及符合美容要求等优点 ,结果令人满意。     

单孔电视胸腔镜手术治疗凝固性血胸的技巧探讨

正凝固性血胸(CH)是胸部外伤常见的并发症,其在钝性外伤和穿透伤中发生率分别为25%~75%和60%~80%,多由创伤本身引起,或受伤后长时间保持平卧位、被迫体位、胸部疼痛但未出现咳嗽等,导致胸引流不畅并进展而成[1-2]。传统开胸手术治疗CH存在创伤大、并发症多、术后恢复较慢等缺点。随着电视胸腔镜手术(VAST)在全球范围的开展[3-4],其在国内也得到了逐步     

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.     

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.