糖尿病患者后房型人工晶体植入术临床观察

糖尿病患者发生白内障比正常人早 ,发病率较高。随着人工晶体技术的进展 ,糖尿病不再是人工晶体手术的禁忌症。我院自１９９７年以来 ,对３１例糖尿病患者白内障行ＥＣ ＣＥ +ＩＯＬ术。现将手术临床观察结果报告如下。１临床资料１．１一般资料３１例中男１２例 ,女１９例。年龄５０～８１岁 ,平均６６岁。术前均经内科确诊为Ⅱ型糖尿病 ,病史３个月～１６年 ,平均５年。４例胰岛素控制 ,７例饮食控制 ,２０例口服药物控制。术前空腹血糖≤６．１ｍｍｏｌ／Ｌ８例 ,６．１～８．９ｍｍｏｌ／Ｌ２３例。同时选３１例非糖尿病白内障患者作对…     

白内障超声乳化术中后囊破裂的处理及观察

白内障超声乳化术 (ＰｈａｃｏｅｍｕＬｓｉｆｉｃａｔｉｏｎ，简称Ｐｈａｃｏ)是白内障复明的理想手术 ,它的优越性已为眼科界所公认。在Ｐｈａｃｏ操作中会遇到种种困难 ,其中后囊破裂是早期最常出现的并发症 ［１］。现报告如下。１临床资料１．１一般资料１．１．１例数３５只眼中老年性白内障２０只眼 ,高度近视白内障８只眼 ,糖尿病性白内障７只眼。随访时间３～３６个月 ,平均１９个月。１．１．２后囊破裂部位中央破孔范围在１～４ｍｍ的１３只眼 ,５～６．５ｍｍ的７只眼 ,颞下边缘破裂７只眼 ,鼻下边缘破裂４只眼 ,下方边缘破裂３…     

白内障术中后囊破裂的临床分析

在白内障囊外摘出联合后房型人工晶体植入术中 ,发生后囊破裂致玻璃体脱出是常见并发症 ,作者对我院１９９７～２００２年开展现代白内障囊外摘除联合人工晶体植入术(ＥＣＣＥ +ＩＯＬ)３３２眼 ,术中发生后囊破裂１９眼 ,分析如下。１临床资料１．１一般资料本组３３２眼中男１７８眼 ,女１５４眼。年龄２０～８７岁 ,平均６４岁。术中发生后囊破裂１９眼 (其中玻璃体脱出１４眼 ) ,男１１眼 ,女８眼。发生在抽吸皮质时１１眼 ,娩出核时４眼 ,植入人工晶体时３眼 ,截囊时１眼。１．２手术方法常规ＥＣＣＥ术 ,角巩缘大切口 ,手法娩核及灌注…     

外伤性白内障两种治疗方法疗效比较

目的：比较晶体囊外摘除联合人工晶体植入术（ＥＣＣＥ＋ ＰＣ·ＩｏＬ） 与晶体切割联合前房型人工晶体植入术（晶切＋ ＡＣ·ＩｏＬ） 治疗外伤性白内障的疗效。方法：通过两种术式治疗４６ 例外伤性白内障。其中行ＥＣＣＥ＋ＰＣ·ＩｏＬ术２６ 眼，晶切＋ ＡＣ·ＩｏＬ２０ 眼。结果：矫正视力≥０．１ 者ＥＣＣＥ组２５ 眼，占９４．１％ ，晶切组１８ 眼，占９０％ ，矫正视力＞ ０．４ 者，ＥＣＣＥ组２２ 眼，占８４．６％ 。晶切组４ 眼占２０％ ，ＥＣＣＥ组明显高于晶切组，差异有显著性（Ｐ＜ ０．０５） ．结论：ＥＣＣＥ＋ ＰＣ·ＩｏＬ植入术及晶体切割ＡＣ·ＩｏＬ植入术均能有效治疗外伤性白内障， 但疗效以ＥＣＣＥ＋ ＰＣ·ＩｏＬ植入为优     

白内障超声乳化摘除及折叠式人工晶体植入术疗效观察

随着超声乳化设备的改进及手术技术的逐步完善,白内障手术质量及复明效果有了明显提高。作者自１９９７年９月～１９９８年１１月开展白内障超声乳化摘除及折叠式人工晶体植入术,报告如下。１资料与方法１．１一般资料５２例(５２眼),男３７例,女１５例。年龄４３～７４岁,平均(５６．５±１１．２)岁。老年性白内障４７例,先天性白内障３例,外伤性白内障２例。晶体核硬度:Ｉ度１１例,Ⅱ度１９例,Ⅲ度１７例,Ⅳ度５例。术前视力:眼前手动至０．３。术后１周、１个月记录检查结果。１．２手术方法超声乳化仪为ＡｌｃｏｎＵｎｉｖｅｒｓａｌⅡ…     

大批量白内障手术护理体会

我院 2 0 0 1年 10月采用弗雷德·霍洛基金会培训的白内障囊外摘除 人工晶体 (ＥＣＣＥ ＩＯＬ)植入的标准操作程序 ,开展了一次大批量的ＥＣＣＥ ＩＯＬ植入术 ,现将有关护理体会总结如下。1　临床资料本组共 110例 ,老年性白内障 10 5例 ,先天性白内障 3例 ,外伤性白内障     

LASIK治疗远视的临床观察

目的：评价准分子激光原位角膜磨镶术（ＬＡＳＩＫ）治疗远视的效果。方法：对１０例远视眼患者１９只眼（＋３．２５～＋１０．００）,采用ＬＡＳＩＫ进行治疗,术后随访半年以上。结果：术中术后无严重并发症,术后最佳矫正视力与术前相比,未见视力下降超过１行以上者,术后６个月７９％的患者裸眼视力达到０．５以上,１００％的患者裸眼近视力达到０．５以上,结论：ＬＡＳＩＫ治疗远视安全、有效、近期疗效满意,长期疗效尚待观察。     

小梁切除联合白内障囊外摘除人工晶体植入术35例的临床探讨

目的；探讨对白内障合并青光眼患者进行手术的术式和疗效。方法；对３５例３６眼进行了小梁切除联合白内障囊外摘除及人工晶体植入术，结果：对３２例随访１个月到５年１７眼视力达到０．５～１．０，１２眼视力达到０．３，３眼视力达到０．１，３２眼眼压的控制在正常范围，结论：结果显示这种联合手术对治疗白内障合并青光眼是一种安全，有效的方法。     

人工晶体植入术后屈光的动态分析

目的;研究人工晶体植入术后的屈光动态变化。方法：对４２眼施行白内障现代囊外摘除术,同期植入后房型人工晶体,测量术前,术后不同时期术眼的屈光变化。结果：术后１周平均眼视力０．２,３个月时视力为０．５。术后不同时期球镜度数变化不显著（Ｐ〉０．０５）。角膜的屈光变化以术后１个月内明显,手术后存在不同程度的散光。结论：常规切口术后散光术中可采取不同的对策 ,屈光状态在术后１个月内有明显变化,提示术后可选择     

小梁切除联合晶体囊外摘除人工晶体植入术

目的：提高青光眼伴白内障病人的手术效果和减少手术并发症。方法;对青光眼伴白内障病人４２例（４２眼）同时进行小梁切除术白内障囊外摘除和人工晶体植入术（即三联合术）术后平均随访１４．５个月。结果：视力,术前光感－０．１,术后０．０１－１．０,眼压,术后３７眼恢复正常,随访５－１８个月仍正常,５眼术后１周眼压为３．２５－３．８６ｋＰａ,经局部降眼压药作用１０天后恢复正常,随访８－２４个月的正常,结膜滤过     

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.