耳内镜下行鼓膜置管后合鼓室充气治疗梅尼埃病的临床疗效

目的:探讨耳内镜下行鼓膜置管后联合鼓室充气治疗梅尼埃病的临床疗效。方法:选取我院2014年1月~2016年12月收治的40例梅尼埃病患者为研究对象,随机分为观察组20例与对照组20例,所有患者均在耳内镜下行鼓膜置管,对照组患者经通气管注入甲泼尼龙治疗,观察组患者联合鼓室充气治疗,比较两组患者的临床疗效及听阈、耳鸣情况。结果:观察组治疗总有效率为90.0%,明显高于对照组的60.0%,听阈均值与耳鸣评分皆明显低于对照组,差异具有统计学意义,P0.05。结论:在耳内镜下行鼓膜置管后联合鼓室充气治疗可有效控制梅尼埃病的眩晕症状,降低听阈均值,改善耳鸣程度,具有较高临床应用价值。     

硬管耳内窥镜下鼓膜置管治疗分泌性中耳炎的术后护理

目的 探讨硬管耳内窥镜下鼓膜置管治疗分泌性中耳炎术后护理的要点.方法 对反复穿复刺不愈的分泌性中耳炎患者112例(125耳)行鼓膜切开鼓膜置管术,通过加强术后护理指导观察其疗效和并发症.结果 术后患者症状改善,听力提高,并发症有脱管16耳(12.8%),堵管6耳(4.8%),耳漏4耳(3.2%),拔管后鼓膜穿孔不愈合3耳(2.4%),鼓室硬化2耳(1.6%).结论 耳内窥镜下鼓膜置管创伤小、恢复快、并发症少,优质的术后护理指导和健康宣教对病情恢复、减少术后并发症有重要意义.     

硬管耳内窥镜下鼓膜置管治疗分泌性中耳炎的术后护理

目的探讨硬管耳内窥镜下鼓膜置管治疗分泌性中耳炎术后护理的要点。方法对反复穿复刺不愈的分泌性中耳炎患者112例(125耳)行鼓膜切开鼓膜置管术,通过加强术后护理指导观察其疗效和并发症。结果术后患者症状改善,听力提高,并发症有脱管16耳(12.8%),堵管6耳(4.8%),耳漏4耳(3.2%),拔管后鼓膜穿孔不愈合3耳(2.4%),鼓室硬化2耳(1.6%)。结论耳内窥镜下鼓膜置管创伤小、恢复快、并发症少,优质的术后护理指导和健康宣教对病情恢复、减少术后并发症有重要意义。     

中心静脉导管置入术治疗结核性胸腔积液的护理

总结了中心静脉导管置入术引流胸水治疗68例结核性胸腔积液患者的护理。主要包括术前准备、术中护理、术后中心静脉置管引流护理、清毒隔离、心理护理、饮食护理、体位指导、疼痛护理以及出院指导等。认为采取必要的护理措施,加强中心静脉置管的护理,可防止并发症发生,促进结核性胸腔积液患者早日康复,同时可提高患者生活质量。     

分泌性中耳炎患者鼓膜切开置管治疗护理中无缝隙护理对患者并发症发生的影响

目的探讨分泌性中耳炎患者鼓膜切开置管治疗护理中无缝隙护理对患者并发症发生的影响。方法选取2018年4月至2019年12月中南大学湘雅二医院收治的分泌性中耳炎患者92例, 所有入组患者均接受鼓膜切开置管治疗, 根据不同的护理方法将患者分为对照组和研究组各46例, 对照组患者围术期接受常规护理干预, 研究组患者在围术期接受无缝隙护理干预, 对两组患者手术效果、心理状态、听力恢复情况以及并发症发生情况进行比较分析。结果研究组疗效高于对照组, 差异有统计学意义(P<0.05);研究组术后各时间段患者ETDQ-7评分得分均低于对照组, 差异有统计学意义(P<0.05), 对照组在术后3个月出现评分回升情况;研究组术后各时间段患者SAS评分得分均低于对照组, 差异有统计学意义(P<0.05), 对照组在术后3个月出现评分回升情况;研究组术后并发症发生率低于对照组, 差异有统计学意义(P<0.05)。结论对于接受鼓膜切开置管治疗的分泌性中耳炎患者, 围术期采用无缝隙管理模式进行护理干预, 可有效降低患者术后并发症, 促进患者术后听力恢复, 从而有效避免患者焦虑情绪的发生。     

内镜直视下食管支架置入术治疗食管癌性狭窄100例围术期护理

目的:探讨内镜直视下食管支架置入术治疗食管癌性狭窄患者围术期的护理方法.方法:对100例食管癌性狭窄患者在内镜直视下行食管支架置入术,术前予以全面细致的准备,术中准确、快速、敏捷地配合,术后给予正确的体位指导、饮食指导、并发症的预防与处理、出院指导.结果:本组患者共置入138个支架,均一次性扩张并置管成功.术后1周患者吞咽困难改善,能经口进食.结论:食管支架置入术能较好地解决食管癌并发食管狭窄患者进食困难的问题,提高其生活质量,精心全面的护理是减少并发症、提高治疗效果的保证.     

介入置管溶栓治疗下肢动脉硬化闭塞症的观察与护理

总结了介入置管溶栓治疗83例下肢动脉硬化闭塞症的护理经验,包括术前健康教育和心理护理,术前检查与准备,患肢护理与下肢循环观察;术后基础护理,抗凝治疗护理与血运监测,留置导管护理,并发症预防和护理;出院指导与随访。认为强化介入置管溶栓治疗下肢动脉硬化闭塞症患者的围手术期护理,能够取得较为理想的溶栓介入治疗效果。     

内镜下经皮胃造瘘术在球麻痹患者的应用及护理

报告了11例脑梗死球麻痹患者施行内镜下经皮胃造瘘术的护理.认为术前必须做好患者心理护理,术后加强病情观察和营养支持,并预防和注意术后并发症.经过治疗和护理,3例能从口进食,出院前拔除胃管;1例带管死亡;7例病情稳定后带管出院,置管时间共16～456 d.     

腹腔镜肾折叠术治疗肾盂输尿管结石合并重度肾积水的围术期护理

总结腹腔镜下肾折叠术治疗 15 例肾盂、上段输尿管结石合并重度肾积水的护理.认为护理重点为术前完善相关检查,对患者做好心理护理,术后加强病情观察,做好肾周引流管护理、双 J 管护理、导尿管护理,重视出院指导,是防止并发症发生和患者康复的重要保证.     

妊娠合并肾绞痛患者经膀胱镜双J管置入术的护理

目的 研究妊娠合并肾绞痛患者行经膀胱镜双J管置人术的护理方法与效果.方法 通过膀胱镜将双J管置入15例妊娠合并肾绞痛患者的患侧输尿管行内引流,给予针对性护理.结果 13例患者成功置人双J管后肾绞痛症状消失,顺利度过围生期,并顺产健康新生儿.结论 密切监测患者及胎儿情况并做好术前心理护理、完善术前准备;术中密切监测患者生命体征;术后做好并发症护理;并完善出院指导在患者的康复及胎儿的顺产中起重要作用.     

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.