股骨干骨折患者围手术期血液相关性指标变化的临床意义

目的探讨股骨干骨折患者围手术期血液指标变化及其与下肢静脉血栓的相关性。方法将该院30例股骨干患者于手术前、术后1、3、7d采集空腹静脉血,检测其凝血4项功能、血小板计数(PLT)、D-二聚体(DD)、血液流变学指标、动脉血气分析,并进行比较分析。结果患者术后1、3d凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APTT),均较术前延长,差异有统计学意义(P0.05);纤维蛋白原(FIB)和D-D在整个围手术期呈进行性升高,术后第3天达峰值,与术前比较差异有统计学意义(P0.01);PLT在术后呈进行性降低,与术前比较差异有统计学意义(P0.05),且术后第1天降到最低,差异有统计学意义(P0.01);患者术后血液流变学各项指标、动脉氧饱和度等与术前比较,差异均有统计学意义(P0.05);术后第7天,各项指标接近术前。结论股骨干骨折患者围手术期的血液相关性指标变化,对预防和早期发现下肢深静脉血栓有一定的临床意义。     

D-二聚体在脊柱退行性变患者围术期深静脉血栓栓塞症中检测的意义

目的探析血浆D-二聚体(D-D)在脊柱退行性变患者围术期深静脉血栓栓塞症(DVT)中的临床检测价值。方法分析2015年1月至2016年12月在我院接受治疗的200例脊柱退行性变患者的临床资料。根据围术期有无DVT,分成DVT组和无DVT组,每组100例。比较两组患者的一般资料、手术前与手术后1、3、7d的血浆D-D水平。分析血浆D-D在脊柱退行性变者围术期DVT中的诊断价值。结果两组患者的一般资料无明显统计学差异(P0.05)。术前两组患者的血浆D-D水平无明显统计学差异(P0.05);术后1、3、7dDVT组患者的血浆D-D水平均明显高于无DVT组(P0.01)。术后两组患者血浆D-D水平均较术前明显上升(P0.05)。血浆D-D在脊柱退行性变围术期DVT者中的诊断分界点为1.18μg/ml,敏感性为93.0%,特异性为79.0%,阴性预测值为98.0%,阳性预测值为42.0%,假阳性率为21.0%。结论血浆D-D可以在一定程度上预测脊柱退行性变者围术期是否出现DVT,但只能作为初筛指标之一。     

高龄髋部骨折患者围手术期并发症的原因分析及护理

目的：探讨预防高龄髋部骨折患围手术期并发症的护理。方法：对1992年5月至2002年5月12例高龄髋部骨折患发生的围术期并发症进行分析，并提出相应的护理措施。结果：要减少围手术期并发症的发生，必须：(1)对手术耐受性、风险性做出估计，适当选择手术时机；(2)积极控制并存病；(3)防止呼吸、泌尿系感染及褥疮；(4)防止深静脉血栓；(5)防止人工股骨头脱位；(6)维持营养、电解质及酸碱平衡；(7)功能锻炼。结论：做好围手术期的护理，是预防并发症和提高治疗效果的重要措施。     

血清Lp-PLA2、cTnT联合检测对老年髋部骨折患者围术期发生MACE的预测价值

【目的】探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)和肌钙蛋白T(cTnT)联合检测对老年髋部骨折患者围术期发生主要不良心血管事件(MACE)的预测价值。【方法】选取2015年1月至2021年6月在本院接受手术治疗的1267例老年髋部骨折患者,所有患者均在入院后2~5 d进行内固定术或人工髋关节置换术治疗,将术后30 d发生MACE的84例患者纳入MACE组,另采用随机数字表法在未发生MACE的患者中随机选取127例为对照组,采集两组一般资料、术前检查结果、围术期指标及血清Lp-PLA2和cTnT水平并比较,采用受试者工作特征(ROC)曲线分析血清Lp-PLA2和cTnT水平对老年髋部骨折患者围术期发生MACE的预测价值。【结果】MACE组年龄、冠心病占比和合并2种及2种以上基础疾病患者明显高于对照组(P<0.05);两组术后1 d、3 d和7 d血清Lp-PLA2和cTnT水平较术前1 d明显升高,且MACE组术后1 d、3 d和7 d时血清Lp-PLA2和cTnT水平高于对照组,差异均有统计学意义(P<0.05);ROC曲线分析结果显示:术后1 d血清Lp-PLA2、cTnT水平及两者联合预测老年髋部骨折患者围术期发生MACE的曲线下面积(AUC)分别为0.665、0.703和0.755,术后3 d血清Lp-PLA2、cTnT水平及两者联合预测的AUC分别为0.765、0.792和0.853,术后7 d血清Lp-PLA2、cTnT水平及两者联合预测的AUC分别为0.825、0.852和0.932。【结论】老年髋部骨折患者术后血清Lp-PLA2和cTnT水平明显升高,两者联合检测对围术期发生MACE具有较好的预测价值。     

高龄髋部骨折伴糖尿病患者的围手术期护理

目的 总结高龄髋部骨折伴糖尿病患者的围手术期护理体会.方法 选择79例高龄髋部骨折伴糖尿病患者,术前做好患者的心理护理、饮食指导、牵引护理、控制血糖,术后给予正确体位,加强并发症的预防及护理,指导功能锻炼,以提高手术成功率,促进患者早日康复.结果 术后1例因并发大面积脑梗死、多脏器功能衰竭死亡.78例患者出院后随访3～20个月均达到骨折临床愈合标准,患者生活可以自理.结论 对高龄髋部骨折伴糖尿病患者给予精心的围手术期护理可以减少并发症的发生,改善患者预后.     

股骨干骨折围术期并发深静脉血栓血液标志物相关性研究

目的观察股骨干骨折患者围术期血液标志物的变化与下肢静脉血栓的相关性。方法收集四川省骨科医院住院治疗的30例股骨干患者作为试验组,26例门诊健康体检者作为健康对照组,采集空腹静脉血检测手术前第1天、术后第1、3、7天凝血4项、D-二聚体(D-D)、组织型纤溶酶原激活剂(t-PA)、纤维酶原活化物抑制物(PAI-1)、血管性血友病因子抗原(vWF:Ag)、P-选择素(P-sel)、白细胞介素-10(IL-10)、血小板计数(PLT)各项拟定指标。结果同健康对照组比较,试验组术前凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)无明显变化;纤维蛋白原(FIB)、D-D术后较健康对照组明显升高,PLT明显降低,差异均有统计学意义(P0.05);同术前比较,D-D、t-PA、PAI-1、vWF:Ag、P-sel、IL-10、FIB均有增高,差异有统计学意义(P0.05);术后PT、TT及APTT与术前比较差异无统计学意义(P0.05);FIB和D-D在整个围术期呈进行性升高,术后第3天达最高值,较术前差异有统计学意义(P0.05);PLT术后进行性下降,差异有统计学意义(P0.05),术后第1天降到最低。结论股骨干骨折患者围术期存在创伤、手术、大量失血等刺激,机体处于高凝状态。监测围术期D-D、t-PA、PAI-1、vWF:Ag、PS、IL-10、FIB动态变化,对早期发现患者是否处于血栓前状态有一定指导意义。     

手术室协同激励护理干预模式联合损害控制在高龄髋部骨折手术患者中的应用

目的:探讨手术室协同激励护理干预模式联合损害控制在高龄髋部骨折手术患者中的应用方法及效果。方法:将80例高龄髋部骨折手术患者按护理方法不同分为观察组和对照组各40例,对照组给予术前常规护理和损害控制处理,观察组在此基础上实施手术室协同激励护理干预模式,比较两组护理效果。结果:两组手术时间、术中出血量及并发症发生率比较差异有统计学意义(P0.05,P0.01)。观察组术前、术后3 d、术后1周视觉模拟评分法(VAS)评分低于对照组(P0.01)。观察组术前、术后1 d、术后1周焦虑自评量表(SAS)评分低于对照组(P0.05,P0.01)。结论:手术室协同激励护理干预模式联合损害控制能有效缓解高龄髋部骨折手术患者的疼痛程度和焦虑情绪,缩短手术时间,减少术中出血量,降低围术期并发症发生率,改善患者预后。     

高龄髋部骨折患者的围手术期康复治疗

通过对高龄髋部骨折患者围手术期康复治疗的回顾性分析,为此类患者得到更好的康复治疗提供依据。248例高龄髋部骨折患者中有204例进行了手术治疗,手术治疗率82.3％。手术治疗者平均年龄77.8岁。包括股骨颈骨折行人工关节置换和空心钉内固定治疗,以及股骨粗隆间骨折行加压滑动鹅头钉内固定治疗。经积极的手术和围手术期康复治疗,大多患者恢复良好。对高龄髋部骨折患者采取积极的手术和围手术期康复治疗方法,提高康复水平和生活质量。     

老年髋部骨折患者的康复护理计划实施效果分析

目的：探讨高龄患者髋部手术后的康复效果。方法：2004--2005年对82例老年髋部骨折术后患者，护理上根据老年患者的生理及心理特点，全面评估患者的健康状况，制订并实施有针对性的护理计划。结果：患者均持双拐或手杖出院。平均随访18个月，68例康复结果判断为优，8例为良，可4例，差2例，优良率达92．3％。结论：髋部手术的高龄患者并发症多，免疫力弱．手术并发症多，加强围手术期康复护理是提高手术成功率、减少并发症和降低病死率的重要保证。‘     

老年髋部骨折患者围术期输血影响因素的研究

目的了解影响老年髋部骨折围术期输血的相关因素,为临床制定个体化输血方案提供参考依据。方法收集本院2018年3月—2019年2月1年的骨科住院老年髋部骨折手术围术期输血患者的病历882(人)份,纳入患者的性别、年龄、体质指数(BMI)、骨折类型、合并基础疾病、受伤至就诊时间、入院首次血红蛋白(Hb)、抗凝药物服药史、手术方式、美国麻醉医师协会(ASA)麻醉分级、术中出血量、术后引流量、术后Hb等指标做与输血的单因素分析;将其中各指标(P<0.05与P≥0.05)汇拢做多因素Logistic回归分析,确定老年髋部骨折手术患者围术期输血的高危因素。结果 1)围术期输血率:股骨颈骨折手术为33.20%(166/500),股骨粗隆间骨折手术为70.16%(268/382)。2)单因素分析:患者的年龄、BMI、骨折类型、入院首次Hb、合并其他心脑血管疾病(除高血压外,如冠心病、脑卒中等)、合并糖尿病、有抗凝药物服药史、手术方式、ASA麻醉分级、术中出血量、术后引流量及术后Hb皆可能影响围术期输血(均为P<0.05)。3)多因素Logistic回归分析:患者的性别、年龄、骨折类型、合其他...     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.