脑室-腹腔分流术治疗正常压力脑积水的临床预后因素分析

目的研究影响正常压力脑积水（NPH）行脑室-腹腔分流手术预后的因素。方法从NPH患者的症状、病因、分流管的选择及腰穿放液试验、影像学表现、病程、年龄等因素分析手术效果。结果蛛网膜下腔出血、颅脑外伤、脑瘤术后引起的NPH手术效果好;临床以步态不稳为主要症状的手术效果好;选用低压分流管、腰穿放液试验症状改善的手术效果好;CT平扫脑室旁低密度区（PVL）和MRI检查室周、皮质下高信号的手术效果好;病程〈6个月、年龄〈60岁的手术效果好。结论影响NPH行脑室-腹腔分流手术预后的因素复杂,综合分析各因素对判断手术预后非常有益。     

脑室-腹腔分流术后并发症分析

脑室-腹腔（V-P）分流术是目前治疗各类脑积水的有效方法。虽然操作简单，但分流过度，分流不足，术后感染和分流管堵塞等并发症直接影响分流效果和手术成败。本总结17例脑室-腹腔分流失败资料分析如下。     

49例脑积水脑室—腹腔分流术术后并发症的护理

目的通过对49例脑积水行脑室-腹腔分流术的患者术后并发症发生情况原因进行分析总结,提出相应护理对策,以提高患者生活质量。方法对262例脑积水均采用Medtronic中分压脑室-腹腔分流装置行分流术的患者进行资料收集,对术后发生并发症及导致手术失败原因进行分析。结果 49例患者均出现不同程度的并发症,其中分流管堵塞者38例、感染4例,分流管、分流泵外露6例,分流过度3例,分流管断裂或位置不佳6例,通过有针对性的护理,所有患者并发症改善。结论通过对并发症原因的分析总结,并进行针对性的护理,可有效减轻并发症,缓解病情,促进术后恢复及患者预后。     

交通性脑积水分流术后并发症观察及护理

目的 总结交通性脑积水行脑室-腹腔分流(Ventriculoperitoneal,VP)术与腰大池-腹腔分流(Lumboperitoneal,LP)术治疗并发症发生情况及防治护理要点,提高治疗效果.方法 回顾性分析2018年10月一2019年3月收治的交通性脑积水患者86例,其中70例行VP治疗和16例行LP治疗.结果 VP组患者出现相关并发症14例,其中脑室内出血1例、穿刺道出血2例;颅内感染4例;分流管堵塞3例(脑室端1例、腹腔端2例);分流过度2例,出现癫痫2例.LP组患者出现分流管堵塞1例,未出现分流过度、颅内血肿、颅内或腹腔感染、癫痫等.结论 做好脑积水患者围手术期评估及术后并发症观察护理,有助于提高治疗效果.     

脑室-腹腔分流术后再手术原因及疗效分析

目的:探讨脑室-腹腔分流术后再手术的原因及治疗效果.方法:回顾性分析36例脑积水患者行脑室-腹腔分流术后需要再次手术的-临床资料,找出其再次手术的原因、并对再次治疗后的治疗效果进行分析.结果:36例患者的再手术原因包括:分流系统阻塞26例(其中脑室端阻塞12例,分流泵阻塞2例,腹腔端阻塞11例,三处均阻塞1例),感染5例(颅内感染4例,皮下感染1例).过度分流4例(其中硬膜下积液1例,硬膜下血肿1例,低颅压2例),腹腔分流管过短1例.经二次手术等治疗措施处理后总治愈31例,好转4例,死亡1例.结论:分流系统阻塞、感染、分流过度是脑室-腹腔分流手术后再手术的常见原因.术前脑脊液及腹部情况评估,分流装置的正确选择,严格无菌技术.正规操作是防止再次手术的关键,再次手术治疗仍可取得良好效果,改善患者的预后.     

脑室-腹腔分流术后患者并发症的观察及护理

笔者报道83例98次脑室-腹腔分流术术后患者并发症的观察及护理.认为分流管堵塞,患者出现消化道症状,术后感染是常见的手术并发症.早期消化道症状经对症处理自行消失,患者出现颅内高压症状、分流管处皮下积液形成,常表明有分流装置的堵塞,需进一步治疗;术中严格无菌操作、术后大剂量抗生素的应用及保持手术切口不受污染,对预防感染非常重要.     

脑积水病人脑室腹腔分流术围术期的护理

报道了26例脑室腹腔分流术病人围术期的护理体会,手术前做好充分的心理准备,增加营养.术后密切观察神经、瞳孔及生命体征的变化;定时按压分流泵,保持分流管的通畅;做好切口的护理;做好并发症观察及护理.所有病人分流植入后分流均获成功.2例因并发分流管腹腔端阻塞而再次手术.为提高脑室腹腔分流手术的成功率,重点是做好病情观察、切口的护理及引流管的护理.     

脑积水病人脑室腹腔分流术围术期的护理

报道了26例脑室腹腔分流术病人围术期的护理体会,手术前做好充分的心理准备,增加营养.术后密切观察神经、瞳孔及生命体征的变化;定时按压分流泵,保持分流管的通畅;做好切口的护理;做好并发症观察及护理.所有病人分流植入后分流均获成功.2例因并发分流管腹腔端阻塞而再次手术.为提高脑室腹腔分流手术的成功率,重点是做好病情观察、切口的护理及引流管的护理.     

小儿脑室腹腔分流术后并发症的分析及处理

目的分析小儿脑积水行脑室腹腔分流术术后并发症及处理方法。 方法对我院近10年实施的282例脑室腹腔分流术后疗效、并发症分析。 结果30例术后产生并发症,总并发症发生率为10.6%。其中分流管堵塞17例（腹腔端堵塞12例,脑室端堵塞4例,分流阀堵塞1例）。术后颅内感染4例,伤口感染3例。腹腔囊肿1例,肠穿孔2例,直肠内移位1例。脑室端脱出1例,硬膜下积液1例。 结论小儿脑室腹腔分流术治疗小儿脑积水是安全、有效的,需掌握手术技巧,采取措施预防并发症。       

8例脑室——膀胱分流术的护理

脑积水治疗方法很多,但目前较为实用的仅有脑室心房分流和脑室腹腔分流两种,但脑脊液有炎性改变时,或腹腔有过炎症病史时皆不能作分流术,而且两者都易堵塞分流管。我科1982年4月开始,应用脑室——膀胱分流术治疗8例脑积水效果尚佳,现就护理体会介绍如下: 一、临床资料 8例中,男性5例,女性3例,最小年龄8岁,最大年龄50岁,8例中,7例作CT检查均为脑室系统对称性扩大,其中交通性脑积水6例,颅缝再造并发脑积水1例,小脑蚓部肿瘤术后积水1例。二、临床护理工作几点体会 1.手术前一天给病人洗澡或擦澡,并备皮、下留置尿管,以备术中认清胱膀部位及预防术后尿潴留。     

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.