迟发性外伤性颅内血肿26例治疗体会

我院１２５０例颅脑损伤中迟发性外伤性颅内血肿２６例（占２０８％）。本文就迟发性外伤性颅内血肿加以讨论。１临床资料本组男性１６例，女性１０例，年龄２２～７２岁。２６例中交通肇事１６例，摔伤４例，打伤３例，坠落伤３例。伤后有原发性意识障碍１６例。发生迟...     

外伤性颅内迟发性血肿的诊断和治疗

目的：探讨外伤性颅内迟发性血肿的早期诊断及治疗。方法：回顾性分析我院1993年至2003年3月收治的81例外伤性颅内迟发性血肿的临床资料。结果：颅脑外伤病人2983例，并外伤性颅内血肿1133例，其中并外伤性颅内迟发性血肿81例，占颅脑损伤的2．7％(81／2983)，占颅内血肿的7．1％(81／1133)，病死率18．5％。81例均行开颅血肿清除术，去骨瓣减压49例。痊愈55例，轻残7例，重残3例，死亡15例，植物生存1例。并脑积水行分流术7例。结论：降低外伤性颅内迟发性血肿病死率和致残率的关键在于早期诊断和治疗，早期诊断取决于对本病的早期临床征象及检查的正确认识。     

迟发性外伤性颅内血肿113例临床特点及影像学特征分析

目的：对外伤性迟发性颅内血肿113例临床特点及其影像学特征进行分析。方法：对1995-01～2003-03期间住院治疗的外伤性迟发性颅内血肿患病历资料进行回顾性分析。结果：在同期住院治疗的1574例颅脑损伤患中，有113例(7.2％)患出现迟发性颅内血肿或因迟发性颅内血肿入院手术治疗．术后恢复良好18例(15．9％)．中残29例(25．7％)，重残25例(22．1％)，植物生存17例(15．1％)，死亡24例(21．2％)。结论：外伤性迟发性颅内血肿有其明确的临床特点和典型的影像学特征，及早发现，及时手术抢救治疗，能显改善外伤性迟发性颅内血肿的预后。     

外伤性迟发性颅内血肿的诊治体会

目的：探讨外伤性迟发性颅内血肿的临床特点、发病机制、诊断和治疗方法。方法：回顾性分析孝义市人民医院神经外科2005年1月—2010年12月32例外伤性迟发性颅内血肿患者的临床资料。结果：手术治疗28例,保守治疗4例,死亡2例,死亡率6.25%。结论：外伤性迟发性血肿多出现于原发颅脑损伤或清除其他颅内血肿后72 h内,高峰期为24 h内,所以对于颅脑损伤患者应密切观察病情变化,进行性意识障碍、头痛、呕吐和生命体征不稳定是迟发性血肿临床特征,需高度警惕,动态或定时头颅CT复查,早期诊断并掌握保守和手术治疗指证是提高预后的关键。     

外伤性迟发性颅内血肿48例临床分析

目的：探讨外伤性迟发性颅内血肿的发病规律，以提高该类患者的治疗效果。方法：对经CT监测及临床观察确诊的48例外伤性迟发性颅内血肿病人，就迟发性血肿与原发性损伤的关系、致伤原因、迟发血肿部位、血肿形成时间及急性颅内血肿清除术的关系与治疗资料进行分析。结果：经2次CT检查发现迟发性血肿38例，经3次CT检查确诊10例。迟发性血肿多发生于伤后72h内(83．3％)，往往出现首次CT证实有脑挫裂伤的部位，且多为额颞部(64．6％)，手术治疗43例次，保守治疗7例，死亡11例。结论：中老年人，减速伤及造成的对冲伤，颅内血肿清除减压，低血压，强力脱水等是迟发性颅内血肿形成的高危因素，早期诊断和治疗是关键。     

外伤性迟发性颅内血肿42例诊治分析

我院2000-2006年外伤性迟发性颅内血肿的患者42例分析如下。 1临床资料 1．1一般资料 本组占同期颅脑损伤患者的8．3％。其中男30例，女12例，年龄最小6岁，最大77岁，平均（43．8±9．7）岁。受伤方式：对冲伤21例，加速伤10例，复合伤11例。症状与体征：伤后不同程度意识障碍25例，意识障碍进行性加重者28例，     

外伤性迟发性颅内血肿的早期观察

外伤性迟发性颅内血肿是指头部外伤后，首次CT检查未发现颅内血肿，经过一段时间后再次检查时发现颅内血肿，或清除颅内血肿一段时间后又在颅内其他部位发现血肿。外伤性迟发性颅内血肿是常见的继发性颅脑损伤，好发于伤后或术后24h至72h，不易早期发现，如未能及时诊治常危及患生命。本院自1998年5月至2005年5月共收治外伤性迟发性颅内血肿68例，现总结报告如下。     

迟发性外伤颅内血肿的观察及护理

迟发性外伤性颅内血肿指伤后首次CT检查无血肿，而在以后CT检查中发现了血肿。或清除外伤性颅内血肿后在不同部位又出现了血肿。其发生率占颅脑外伤病例的0．3％～3．5％，约占重型颅脑外伤病例的6．5％-8．7％。本病预后较差，死亡率和致残率高达25％～75％。临床观察和护理对降低本病死亡率和致残率尤为重要，通过CCS昏迷评分可发现意识的微小变化，观察头痛、恶心、呕吐、瞳孔变化及肢体活动情况，及时发现病情的微小变化，及时复查CT，使本病早期明确诊断，早期治疗，以提高本病的治愈率。     

CT诊断外伤性迟发性颅内血肿30例分析

目的探讨CT诊断外伤性迟发性颅内血肿的特点和临床应用价值。方法回顾分析30例外伤性迟发性颅内血肿患者的临床资料,分析迟发性血肿的CT表现特点,包括血肿的发生时间、类型、部位等。结果伤后2~3 d或术后72 h内出现进行性意识障碍或临床症状无明显改善,血肿类型主要是硬膜外血肿、硬膜下血肿、脑内血肿,发生部位主要为颅骨骨折线区下方,颅骨受力处及其对冲部位等。结论 CT能够及时诊断外伤性迟发性颅内血肿的发生,为临床治疗提供可靠参考。     

外伤性迟发性颅内血肿的临床观察及护理

外伤性迟发性颅内血肿占颅内血肿的５％左右,其死亡率较高,轻型颅脑损伤恶化的最主要原因多由迟发性血肿引起。改善该类病人的预后的关键在于及早诊断和治疗。本文结合我科收治的２６例外伤性迟发性颅内血肿的诊治经验,重点介绍其临床观察要点和护理体会。１临床资料１...     

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.