面神经根显微血管减压术治疗面肌痉挛21例临床分析

目的探讨面神经根显微血管减压术治疗面肌痉挛的手术效果。方法采用显微血管减压术对21例面肌痉挛患者进行手术治疗。术后随访6mo，根据临床症状评定临床疗效。结果21例患者术后症状即刻消失，有效率100%。1例患者术后3d有轻度抽搐，随诊3mo末症状消失；术后出现耳呜、听力障碍1例，随诊3mo末症状好转；4例轻度面瘫，随诊6mo末好转；无脑脊液漏、颅内感染发生，无死亡和致残病例发生。结论显微血管减压术是面肌痉挛最有效的治疗方法，治愈率高，创伤小，面神经功能可完好保留，远期并发症少。     

微血管减压术治疗面肌痉挛213例的护理

目的总结分析微血管减压术治疗面肌痉挛213例的术前、术后护理。方法回顾性分析采用微血管减压术治疗的213例原发性面肌痉挛患者的临床资料,探讨术前、术后护理。结果术后症状即刻消失者185例,术后1个月内症状消失者14例,术后3个月症状消失者23例,优秀率97%。术后低颅压85例,脑脊液鼻漏3例,周围性面瘫3例,术侧听力障碍5例。结论微血管减压术治疗面肌痉挛疗效确切,重点是术后及时发现并发症并给予对症治疗及护理。     

内镜微血管术治疗面肌痉挛的临床疗效分析

[目的]评价神经内镜辅助下微血管减压术治疗原发性面肌痉挛的临床疗效.[方法]回顾性分析本科15例神经内镜辅助下微血管减压术治疗的原发性面肌痉挛患者的临床疗效和术后跟踪随访情况.[结果]15例患者中12例患者术后症状完全缓解;3例患者术后症状明显减轻,其中2例在2周内症状完全缓解,1例1个月内症状完全缓解.随访1～24个月未见明显并发症.[结论]神经内镜辅助下微血管减压术治疗原发性面肌痉挛是一种临床疗效显著、并发症少的手术方法.     

微血管减压术治疗面肌痉挛术后并发症的观察及护理

面肌痉挛是面神经受到异常血管压迫后,反复发生短时间的异常兴奋,表现为面部表情肌无痛、无意识的不自主抽动。随着显微神经外科技术的发展,面神经微血管减压术因其具有治愈率高、复发率低等优点,已成为治疗面肌痉挛的首选。微血管减压术涉及后颅窝桥小脑角区,该区包含复杂的神经血管结构,术后可出现颅内出血、感染、面瘫、     

面肌痉挛显微血管减压手术探讨

目的：探讨显微血管减压术治疗面肌痉挛的手术方法和效果。方法：34例面肌痉挛患者行显微血管减压术,记录手术效果和并发症,出院后进行电话随访1～2年。结果：27例患者术后面肌痉挛完全停止;4例1月内逐渐停止;其余3例明显减轻,无面肌痉挛复发者,无脑脊液漏。术后随访1～6年,远期并发症有轻度面瘫2例,轻度听力下降1例。结论：显微血管减压术治疗面肌痉挛要注意责任血管的准确辨认和采用适当的手术方法,治愈率高、创伤小,远期并发症少。     

锁孔手术微血管减压治疗面肌痉挛临床研究

目的:探讨锁孔手术微血管减压治疗面肌痉挛患者的疗效与安全性.方法:对100例面肌痉挛患者行锁孔手术微血管减压治疗.手术前后采用Cohen评分评价面肌痉挛程度,统计并发症及不良反应发生状况.结果:本组患者手术前Cohen评分均≥2分,平均(2.5±0.7)分;手术后Cohen评分均≤2分,平均(1.1±0.4)分.手术后Cohen评分较手术前显著下降(t=16.75,P＜0.01).不良反应主要表现为头痛、呕吐、面部麻木,发生率为47.0％;并发症发生率为13.0％,其中手术侧口唇疱疹9.0％、耳鸣4.0％.结论锁孔手术微血管减压治疗面肌痉挛患者效果显著,痉挛症状得到大幅度缓解,不良反应轻微,并发症少,安全性高.     

微侵袭技术治疗230例面肌痉挛患者的效果

目的探讨微侵袭技术在面肌痉挛微血管减压治疗中的应用效果。方法回顾性分析本院230例面肌痉挛经微血管减压治疗的病例资料。结果本组患者术中均发现存在责任血管。术后161例抽搐立刻消失,57例抽搐显著减轻,12例无效,其中10例3个月至1年内证实为延迟治愈。治疗总有效率99. 1%,听力下降发生率1. 3%,面瘫发生率为5. 2%。结论微侵袭技术在微血管减压术的应用可有效提高治疗面肌痉挛的有效率,降低面瘫率及听力下降发生率。     

面肌痉挛微血管减压术后并发症206例分析

目的:探讨显微血管减压术治疗面肌痉挛手术术后并发症发生的因素。方法:回顾性分析206例经显微血管减压术治疗的面肌痉挛临床资料。结果:本组中抽搐完全消失156例,减轻47例,无效3例,总有效率为98.5%。并发听力障碍10例,暂时性面瘫9例,脑脊液漏4例,共济失调2例。结论:显微血管减压术是面肌痉挛最有效的治疗方法;术中严格的显微操作、避免颅神经和细小穿支血管损伤等,能有效减少等并发症发生。     

22例原发性三叉神经痛病人行微血管减压术的术后并发症护理

[目的]总结原发性三叉神经痛病人行微血管减压术后并发症的观察及护理措施.[方法]回顾性分析22例原发性三叉神经痛病人行微血管减压术的临床资料.[结果]本组病人术后并发恶心、呕吐17例,眩晕10例,面部麻木20例,面瘫2例,吞咽障碍1例,口唇疱疹5例,高热2例,经积极对症处理均缓解或痊愈.[结论]加强原发性三叉神经痛病人行微血管减压术后并发症的观察及护理有利于预后.     

45例面肌痉挛显微血管减压术患者的护理

报告了45例面肌痉挛显微血管减压术患者的护理。术前做好心理护理和各项常规与电测听、肌电图等特殊检查;术后监测生命体征,及时评估面肌痉挛的频率、强度、持续时间,以及有无症状改善的征象,密切观察是否发生低颅压反应、脑脊液鼻漏、切口感染和颅内感染、面瘫、听力障碍等并发症。本组术后出现低颅压反应38例,脑脊液鼻漏2例,切口感染1例,一过性不完全面瘫1例,经治疗护理后均痊愈出院。本组治疗效果优良者29例(64.4%),部分缓解12例(26.7%),症状改善不明显4例(8.9%)。     

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.     

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.     

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.     

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.