呼吸功能锻炼降低脊柱侧凸患者术后肺部并发症

为探讨青少年脊柱侧凸患者术前进行呼吸功能锻炼的可行性和有效性。对77例脊柱侧凸肺功能受限的患者进行系统的呼吸功能锻炼，与80例脊柱侧凸肺功能受限未进行锻炼的患者比较，比较其锻炼前后肺功能的变化，肺部并发症的发生率。结果显示呼吸功能锻炼后．肺功能明显改善（P〈0．01），肺部并发症均明显降低。     

不同时机后路胸廓成形对KingⅡ型脊柱侧凸胸弯顶椎及邻近节段去旋转效果的影响

背景：随着脊柱三维矫形理论的提出，胸廓成形术日益受到重视，其中后路凸侧胸廓成形可在脊柱侧凸矫形之前或之后进行，目前临床尚无统一时机要求。 目的：观察不同时机行后路凸侧胸廓成形对KingⅡ型脊柱侧凸胸弯顶椎及邻近节段去旋转效果的影响。 设计、时间及地点：病例对比观察，于2000－01／2007－07在中山大学附属第二医院完成。 对象：选择中山大学附属第二医院收治的应用全椎弓根钉技术＋凸侧胸廓成形治疗的KingⅡ型脊柱侧凸患者26例，KingⅡA型10例，KingⅡB型16例。 方法：根据术中胸廓成形时机分为2组，去旋转前组12例于去旋转前先行凸侧胸廓成形术，去旋转后组14例于去旋转后再行凸侧胸廓成形术。手术方式均为后路全椎弓根钉矫形固定，顶椎及邻近节段采用万向钉固定，术中去旋转采用CD技术，全部病例均未行前路松解。 主要观察指标：利用秩和检验比较两组患者的胸弯Cobb角矫正率、顶椎及邻近脊椎去旋转率。 结果：①两组患者胸弯Cobb角矫正率差异无显著性意义（P=0．17）。②去旋转前组患者的项椎及邻近脊椎去旋转率高于去旋转后组（21．4％，15．1％，P=0．026）。 结论：后路去旋转前切除项椎及附近脊椎凸侧肋骨（胸廓成形）可提高KingⅡ型脊柱侧凸患者胸弯项椎及邻近节段的去旋转效果。     

呼吸功能锻炼降低脊柱侧凸患者术后肺部并发症

为探讨青少年脊柱侧凸患者术前进行呼吸功能锻炼的可行性和有效性。对77例脊柱侧凸肺功能受限的患者进行系统的呼吸功能锻炼,与80例脊柱侧凸肺功能受限未进行锻炼的患者比较,比较其锻炼前后肺功能的变化,肺部并发症的发生率。结果显示呼吸功能锻炼后,肺功能明显改善(P<0.01),肺部并发症均明显降低。     

中文版SRS-22问卷评估青少年特发性脊柱侧凸患者生活质量的研究

目的研究未经治疗的青少年特发性脊柱侧凸（AIS）患者的健康相关的生活质量。 方法对62例未经治疗的女性AIS患者采用中文版脊柱侧凸研究学会患者问卷表（SRS-22）进行问卷评估。根据Cobb角大小分为轻度脊柱侧凸组14例（Cobb角＜30°）、中度脊柱侧凸组42例（Cobb角30°~50°）、重度脊柱侧凸组6例（Cobb角＞50°）。 结果重度脊柱侧凸组自我形象维度得分均低于轻度脊柱侧凸组和中度脊柱侧凸组,差异有统计学意义（P＜0.05）。3组功能活动、疼痛、心理健康三个维度的得分差异均无统计学意义（P&rt;0.05）。 结论中文版SRS-22问卷可提供AIS患者与健康相关的生活质量信息。Cobb角＞50°的AIS患者自我形象维度得分较低。     

1例应用可撑开型人工假体钛肋治疗胸廓发育不良综合征合并脊柱侧凸的护理

患者 男性，14岁。胸廓发育不良综合征合并脊柱侧凸矫形术后8年，于2001年4月13日首次入院，Cobb’s角95°，在全麻下行前路开胸脊柱融合（T5-11），脊柱后路融合术（T1-L1），术后恢复顺利，出院后给予石膏外固定6周，佩戴支具2年，     

极重度脊柱侧凸矫形手术的护理干预

目的探讨极重度脊柱侧凸矫形手术的护理干预。方法对2007年1月至2008年3月收住的11例极重度脊柱侧凸患者施行一、二期矫形手术,术前进行肺功能、体位、牵引、唤醒训练等护理干预,术后严密观察脊髓神经功能、积极防治各种并发症和加强康复训练。结果经过2次手术,患者达到50％的矫形效果,消化、泌尿系统功能明显改善,肺活量明显增加,无一例患者出现严重护理并发症,术后3周痊愈出院。结论有效的护理于预有助于降低极重度脊柱侧凸矫形术后并发症的发生,提高临床治疗效果,促进患者早日康复。     

特发性脊柱侧凸手术治疗后肺功能变化的研究现状

<正>特发性脊柱侧凸(idiopathic scoliosis,IS)是最为常见的一类脊柱侧凸,发病原因通常不明,会造成胸廓和/或脊柱畸形,导致肺扩张受限、膈肌运动减少、呼吸不对称,从而影响患者的心肺功能甚至并发肺源性心脏病^[1-2]。严重的脊柱侧凸需要进行手术治疗,能够显著矫正患者的Cobb角,从而改善患者的外观^[3-4],但是手术治疗本身也会影响患者的肺功能,而且矫形术后肺功能变化的研究结论也不相同。本文系统综述了IS手术治疗的适应证、手术治疗后肺功能的变化以及影响因素,包括手术路径、术前肺功能水平、年龄、随访时间、是否行康复治疗等。     

脊柱侧凸患者术前采用脊柱侧凸牵引床牵引的效果评价及护理

目的评价脊柱侧凸患者术前采用自行设计牵引床牵引的效果、舒适度、术后并发症,并提出牵引过程的护理重点。方法统计分析22例脊桂侧凸患者牵引前后脊柱柔韧度相关指标的变化及与术后正位Cobb角的相关性,牵引舒适度情况、牵引相关并发症以及术后并发症。结果所有患者均完成牵引牵引前后脊柱柔韧度改变明显（P〈O．05）,术后正位Cobb角改变值与牵引前后各体位Cobb角度差值有关系（P〈O．05）,牵引过程及术后相关并发症少。结论脊柱侧凸患者术前采用自行设计牵引床进行牵引舒适度高、效果显著、牵引相关并发症少,护理人员相关工作量减少,但牵引床占用空间比较大,床架结构有待进一步改进。     

脊柱侧凸矫形术围术期护理干预

[目的]探讨脊柱侧凸矫形术围手术期的护理干预要点.[方法]总结168例脊柱侧凸矫形术患者术前心理护理、饮食指导、肺功能锻炼、脊柱柔韧性功能锻炼和牵引护理及术后生命体征、脊髓神经功能观察以及胃肠道、体位管理和功能康复要点.[结果]168例脊柱侧凸矫形术患者手术疗效显著,均安全度过围手术期,无护理并发症发生.[结论]对脊柱侧凸患者围手术期进行正确综合护理干预,是保证手术安全、避免术后并发症、促使患者术后早日康复的重要举措.     

两种椎体成形术对脊柱骨折患者Cobb角及伤椎前缘高度的影响

目的比较经皮椎体后凸成形术和经皮椎体成形术对脊柱骨折患者Cobb角及伤椎前缘高度的影响。方法选取2017年1月至2019年6月在北京老年医院治疗的脊柱骨折患者150例,根据治疗方法分为经皮椎体后凸成形术组70例和经皮椎体成形术组80例,采用Oswestry功能障碍指数(Oswestry disability index,ODI)比较术后1个月和6个月的脊柱功能障碍程度,观察两组Cobb角、伤椎前缘高度等。结果两组手术时间、术中出血量和术后住院时间比较差异无显著性(P>0.05);两组术后Cobb角较术前降低、伤椎前缘高度较术前升高,差异有显著性(P<0.05);经皮椎体后凸成形术组术后1、6个月时Cobb角明显低于经皮椎体成形术组,伤椎前缘高度高于经皮椎体成形术组,差异有显著性(P<0.05);两组术后6个月ODI指数较术前降低,差异有显著性(P<0.05);两组术后1、6个月ODI指数比较,差异无显著性(P>0.05);两组并发症发生率差异无显著性(χ2=0.063,P=0.802)。结论经皮椎体后凸成形术能明显改善Cobb角及伤椎前缘高度。     

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.