病人自控镇静镇痛在玻璃体和斜视手术的应用研究

[目的]探讨病人自控镇静镇痛（PCSA）在玻璃体和斜视手术中应用。[方法]玻璃体切割术和斜视矫正术病人共68例,随机分入舒芬太尼联合异丙酚PCSA组（P组）和单纯局麻组（C组）。每组34例,其中两类手术各占17例。P组局麻并以PCSA辅助。术中观察收缩压、心率、呼吸、镇静评分、病人合作度评分、满意度评分、疼痛评分及术中眼心反射和术后恶心呕吐等不良反应。[结果]与基础值比较,P组仅术中10min的收缩压、心率升高;C组术中各时点均显著升高;P组呼吸频率下降。术中P组镇静评分、合作度和满意度评分显著高于C组,而疼痛评分、躁动、呻吟发生率显著低于C组。两组眼心反射和恶心呕吐发生率无差异。术后4h疼痛评分P组显著低于C组,术后8h两组疼痛评分无差异。[结论]舒芬太尼联合异丙酚PCSA应用于玻璃体及斜视手术能提高病人术中术后镇痛的满意度,安全有效。     

病人自控镇静镇痛在玻璃体和斜视手术的应用研究

 [目的]探讨病人自控镇静镇痛（PCSA）在玻璃体和斜视手术中应用。[方法]玻璃体切割术和斜视矫正术病人共68例,随机分入舒芬太尼联合异丙酚PCSA组（P组）和单纯局麻组（C组）。每组34例,其中两类手术各占17例。P组局麻并以PCSA辅助。术中观察收缩压、心率、呼吸、镇静评分、病人合作度评分、满意度评分、疼痛评分及术中眼心反射和术后恶心呕吐等不良反应。[结果]与基础值比较,P组仅术中10min的收缩压、心率升高;C组术中各时点均显著升高;P组呼吸频率下降。术中P组镇静评分、合作度和满意度评分显著高于C组,而疼痛评分、躁动、呻吟发生率显著低于C组。两组眼心反射和恶心呕吐发生率无差异。术后4h疼痛评分P组显著低于C组,术后8h两组疼痛评分无差异。[结论]舒芬太尼联合异丙酚PCSA应用于玻璃体及斜视手术能提高病人术中术后镇痛的满意度,安全有效。     

儿童斜视手术的临床分析

目的 对儿童斜视进行分析,提出儿童斜视早期手术的必要性及手术时机的选择。方法 对248例儿童斜视的手术年龄,适应证,手术方法及手术量的估计进行分析。对调节性内斜视根据AC／A（调节性集合和调节的比率）比值、融合力的大小及戴全矫远视镜后出现的内斜度数来确定手术方法;间歇性外斜视和恒定性外斜视,根据外斜视的三种类型选择手术方法。并对其效果做出评定。结果 在随访观察中,Ⅰ级治愈171例,占68．95％,其中内斜视63例（包括部分调节性内斜视）,外斜视53例,A-V征18例,麻痹性29例,上斜视8例。Ⅱ级良好53例,占21．37％。Ⅲ级差24例,占9．68％。总有效率90．32％。结论 儿童斜视应当尽早手术矫正,这不仅有助于儿童立体视觉的恢复,而且还可防止弱视的发生。建立和维护正常立体视功能是儿童斜视早期手术的根本目的。     

七氟醚和氟烷麻醉对小儿斜视矫正术中眼心、眼呼吸反射程度的比较

目的比较七氟醚(Sevoflurane)和氟烷(Halothane)对小儿斜视矫正术眼心、眼呼吸反射程度的影响.方法60例2～8岁拟在吸入全麻下行斜视矫正术的小儿随机分为七氟醚-N2O-O2麻醉组(S组,n=30)和氟烷-N2O-O2麻醉组(H组,n=30),所有小儿均使用喉罩并保留自主呼吸.分别于手术野消毒铺单后和牵拉眼肌期间记录眼心反射(oculocardiac reflex,OCR)指标(HR,心律失常、MAP)和眼呼吸反射(oculorespiratory reflex,ORR)指标(RR,SpO2,PET CO2).以消毒铺单后的数值作基础值.结果S组基础HR高于H组[S vs H:(119±23)vs(108±20),P＜0.05];与基础值比较,牵拉眼肌期间两组病人HR急剧降低[S:(119±23)vs(95±13),P＜0.01;H:(108±20)vs(75±15,P＜0.01],但OCR期间S组最低HR明显高于H组[S vs H:(95±13)vs(75±15),P＜0.01];S组OCR发生率和OCR期间心律失常发生率均明显低于H组(OCR发生率:S vs H:41%vs 79% P＜0.01,心律失常发生率:S vs H:4%vs 20%,P＜0.01).两组病人OCR期间P R明显低于基础值[S:(32.3±3.0)vs(38.0±2.2),P＜0.05,H:(28.0±3.7)vs(34.5±3.0),P＜0.05],但S组基础RR和OCR期间最低RR均高于H组(P＜0.05).结论小儿斜视矫正术中,部分小儿经历了急剧的眼心、眼呼吸反射.七氟醚组眼心、眼呼吸反射程度明显低于氟烷组,七氟醚是用于小儿斜视矫正术较安全的一种新型吸入麻醉剂.     

大型综合性医院手术部建设的思考

手术部的建设不能违背科学发展观的总体要求,需要把握的主要原则：一是规模适度,按需建设;二是布局合理,路径便捷;三是功能配套,适应医疗;四是视屏示教,智能控制;五是以人为本,体现关怀;六是节能先导,绿色运行;七是规范装饰,环保安全;八是打包施工,统一验收。     

Epidemiology of pelvic and acetabular trauma in a Dublin tertiary hospital: a 10-year experience

Background

Pelvic fractures are usually the result of high-energy trauma and may have associated soft tissue and organ damage resulting in significant morbidity and mortality in these patients. Currently, there is little data from Ireland regarding these injuries.

Objective

To study the epidemiology of pelvic fractures presenting to a tertiary referral centre in Dublin.

Methods

Patients referred with a pelvic fracture were identified using the Hospital Inpatient Enquiry System (HIPE) from 1998 to 2008. The patient??s medical notes were reviewed for demographic data, type and mechanism of fracture and associated injuries.

Results

A total of 509 patients were identified over the 10-year period. 466 patients were included in the study. There was a significant male preponderance 76% (n?=?354) as compared to females 24% (n?=?112). Mean age was 36.5?years (range 16?C83). Road traffic accidents (RTA) were the cause in 74% (n?=?346) of the cases.

Conclusion

From our study, the typical patient profile is one of a male in his 30??s involved in an RTA requiring acetabular surgery. This is in accordance with previously published international data and highlights the need for specialised units, training in this subspecialty and allocation of resources.     

学龄前儿童及婴幼儿弱视斜视的早期筛查及干预

弱视、斜视会严重影响儿童双眼视功能发育，早期发现有利于早期治疗，在幼儿园常规开展视力普查及在入托体验时进行屈光状态检查，发现病例及时治疗，可提高儿童身体素质。     

斜视手术parks切口临床应用32例分析

使用parks切口行斜视手术32例，使手术时间缩短，恢复期缩短，术后无并发症、切口小、不影响外观及术后反应轻，疗效满意。因此，笔者认为parks切口与传统的肌止端切口（swan氏切口）及角膜缘切口（limbus切口）相比具有明显的优越性，值得推广。     

Outcome of early surgery in infantile esotropia: Our experience in tertiary care hospital

BackgroundInfantile esotropia is a convergent strabismus presenting before 6 months of age and is the most common strabismus disorder presenting in the ophthalmology OPD. The dilemma of whether to go for early surgery and how early has been a matter of research for the last 50 years. We describe our results of surgery in infantile esotropia at variable age groups, as well as with different reoperation rates and compare with the results in western literature.MethodsA prospective study was carried out through a review of 113 cases operated for infantile esotropia between February 2013 and August 2014. The variables studied were: age at surgery, type of fixation, refractive error, associated nystagmus, inferior oblique overaction or dissociated vertical deviation (DVD), type of surgery performed and pre- and postoperative deviation angles.ResultsThere were 67 male and 46 female cases of infantile esotropia. The age group of patients varied from 6 months to 12 years. Latent nystagmus was seen in 22 cases, inferior oblique overaction in 49 cases and DVD (mild) in 14 cases. Bimedial rectus recession was done in 78 cases and recession–resection in non-dominant eye in remaining 35 cases. The postoperative residual deviation was <10 PD in 102 cases, between 10 and 16 PD in 5 cases and more than 16 PD in 6 cases. Only 6 cases (5.3%) required reoperation for correction of residual deviation.ConclusionThe authors recommend surgery before 12 months in all cases of infantile esotropia. The reoperation rates in the current study were considerably low.     

临床护理路径在心脏外科围术期医院感染管理中的效果

目的：探讨应用临床护理路径实施心脏外科围术期医院感染管理的临床效果。方法：将72例心脏外科手术患者随机分为观察组和对照组,各36例。观察组应用临床护理路径进行医院感染管理,对照组则按常规工作模式进行管理。结果：观察组患者的平均住院天数较对照组明显减少（P〈0.05）,患者对心脏外科医院感染相关知识掌握情况及对护理工作满意度明显高于对照组（P〈0.05）。结论：应用临床护理路径实施心脏外科围术期医院感染管理,可以减少住院时间,提高护理质量,提高患者对护理工作满意度和对医院感染管理知识的认识。     

共同性斜视手术治疗的临床探讨

目的探讨眼外肌悬吊徙后术治疗共同性斜视的临床效果;方法将眼肌断端缝线根据所测徙后手术量悬吊后徙后术的临床观察,术后眼位正位或偏斜5度以内88例,与对照组有显差异（P<0.05）,6-10度残余斜视度8例,作部病例矫正眼位满意,无并发症发生;结论手术方法简单,效果可靠,避免了眼心反射,巩膜穿孔,玻璃体脱出及垂直性斜视的发生。     

斜视术后立体视功能修复及重建的影响因素

斜视会导致远、近立体视功能不同程度的破坏,不同类型的斜视对立体视功能破坏程度不一致。手术是目前改善立体视功能的有效办法,故选择合适的手术时机非常重要,术后也应关注患者双眼立体视功能的修复及重建情况,争取达到功能性治愈。而斜视患者术后立体视功能受斜视类型、患者年龄、病程、术前及术后早期的立体视功能、术后眼位、视功能训练等因素影响。该文就其影响因素进行综述,为选择合适的手术时机及评估立体视功能预后提供参考。     

Pulmonary angiography in a non-teaching hospital over a 12-year period.

OBJECTIVE: To report the safety of pulmonary angiography in a non-teaching hospital and discuss the place of this investigation in the diagnosis of pulmonary embolism. DESIGN AND SETTING: A retrospective review of all patients undergoing pulmonary angiography over a 12-year period, November 1979 to October 1991, at Dandenong Hospital, Melbourne. A protocol was established whereby each procedure was performed with the assistance of staff and equipment from the intensive care unit to provide haemodynamic monitoring and measurement of pulmonary artery pressures. PATIENTS: During the review period 114 patients underwent pulmonary angiography, most (108) for suspected pulmonary embolism. RESULTS: One hundred and fifteen pulmonary angiograms were performed, and no deaths related to the procedure occurred. Complications included perforation of the right atrium in three patients, with no sequelae. Cardiac arrhythmias were common but self-limiting. CONCLUSION: In our series, pulmonary angiography was a safe procedure if undertaken with the appropriate monitoring measures. A protocol which includes the participation of the intensive care unit has proved helpful. In addition, it was found that clinical symptoms and signs were unreliable and in 24 patients who also had ventilation-perfusion (V/Q) scans, only seven scans were accurate. A review of the literature indicates that V/Q scans lack specificity and that pulmonary angiography may be performed safely. The latter investigation should be more frequently performed.     

共同性斜视双眼视觉重建的研究进展

共同性斜视是眼科常见病,是临床上造成双眼视觉功能异常的常见原因。目前手术是主要的治疗方法,国内外多数学者都认为斜视手术矫正眼位后双眼视觉功能有不同程度的提高,但关于斜视手术仍有很多值得探讨的地方,如手术时机。视觉训练能改善双眼视觉,但它的有效性、规范性等需进一步研究。现就共同性斜视双眼视觉恢复或重建的治疗予以综述。     

66例水平斜视患者肌止端距离测量分析

目的:评价水平斜视患者内直肌肌止端及外直肌肌止端距角膜缘距离是否为发病影响因素之一.方法:手术中测量66例水平斜视患者132条内、外直肌肌止端距角膜缘距离,并进行统计分析后与正常人群比较是否具有差异性.结果:测量组内直肌66条,距离(4 -7)mm,平均(5.3±0.6)mm,正常参考值为5.5mm,二者间差异具有统计...     

汶川地震后亚急期灾区前沿综合性医院疾病谱分析

 目的 研究汶川地震灾区亚急期疾病发生的变化规律,为准确配置救灾医疗资源提供依据。方法 回顾性调查汶川地震灾区的中德红十字会野战医院2008年5月25日至6月13日就诊病人的病史资料,分析灾后疾病谱的构成及其变化。结果 从2008年5月25日起,共收集6 708例病人就诊资料。病种以呼吸道感染、胃肠道感染、外伤为主,有相当部分的慢性病患者。外伤在后期有所减少。结论 汶川地震后第3周起灾区地震相关性外伤疾病减少,呼吸系统、消化系统感染性疾病最为常见。     

Tuberculosis trends over a five-year period at a tertiary care university-affiliated hospital in Singapore

INTRODUCTION

Tuberculosis (TB), a potentially fatal infectious disease, poses significant health problems. The objective of this study was to analyse trends among newly diagnosed TB patients seen at the Singapore General Hospital (SGH).

METHODS

This study was a retrospective case record review of notified TB patients at SGH between 2006 and 2010 (inclusive).

RESULTS

A total of 1,979 cases of TB were notified over the five years. The number increased from 368 in 2006 to 407 in 2010 (p = 0.51), in tandem with the increasing number of patients seen at the hospital and the rising population in Singapore. Singaporean residents accounted for 82.8% of the cases, while non-Singaporean residents and non-residents made up the remainder. The year-to-year percentage of non-Singaporean residents and non-residents notified remained stable throughout the five years (p = 0.783). The number of male Singaporean residents (70.7%) notified was more than twice that of female Singaporean residents (29.3%). The majority of patients infected with TB (31.9%) were elderly patients aged > 65 years. Although testing for the human immunodeficiency virus increased from 43.8% (2006) to 64.2% (2010), the number detected with coinfection remained stable (14 and 12 patients in 2006 and 2010, respectively). Mortality rates also remained stable at 12.0%.

CONCLUSION

We cannot afford complacency, as there was no downward trend in the number of notified TB cases at SGH from 2006 to 2010. As the elderly contribute significantly to the TB burden, increased efforts are required to manage this vulnerable population.     

儿童白内障手术治疗的临床观察

目的评价儿童白内障手术治疗的效果并探讨其影响因素。方法回顾性研究年龄3~12岁行白内障摘除联合Ⅰ期人工晶体植入术的25例(41眼)儿童白内障,其中双眼16例,单眼9例,观察其术后视力及合并症情况。结果10例(18眼)BCVA≥0.5,其中双眼患儿8例,单眼2例;13例(20眼)合并斜视;不合并斜视的患儿较合并斜视的患儿视力好(P<0.05)。结论儿童白内障术后部分患者可以获得较好视力;晶状体混浊类型和是否合并斜视是影响视力预后的重要因素。     

针灸治疗麻痹性斜视系统评价

目的:评价针灸治疗麻痹性斜视的临床疗效及安全性。方法:计算机检索Cochrane Library(Issue 1,2011)、PubMed(1980—2011.7)、MEDLINE(1966—2011)、Ovid循证医学数据库(1991—2011),中国生物医学文献数据库(CBMdisc,1978—2011.7)、中国期刊全文数据库(CNKI,1979—2011.7)、维普期刊全文数据库(VIP,1989—2011.7)和万方数据资源系统(1983—2011.7),同时手工检索4种中医杂志,检索时间均为2010.1—2011.8,语言限于中英文,收集针灸治疗麻痹性斜视的临床随机对照试验(RCT),参照Cochrane系统评价员手册5.1.0推荐的对偏倚风险的评价工具进行文献质量评价,并采用RevMan 5.0软件进行Meta分析。结果:最终纳入5个RCT,均为低质量研究,共301例患者,Meta分析结果显示,两组有效率的差异有统计学意义[RR=1.30,95%C(I1.09,1.54)],针灸配合药物治疗麻痹性斜视的疗效优于单纯使用药物。结论:针灸治疗麻痹性斜视有一定疗效,但由于纳入试验质量均较低,仍需高质量的随机对照试验来确定针灸治疗麻痹性斜视的疗效。     

三种下斜肌转位术治疗分离性垂直斜视的手术疗效分析

目的：探讨三种不同下斜肌转位术治疗分离性垂直斜视患者的临床治疗效果,以提高患者临床疗效与生活质量。方法：对分离性垂直斜视患者进行回顾性临床分组研究,单纯下斜肌转位术为A组,下斜肌截除联合转位术为B组,下斜肌截除联合转位并前徙术为C组。三组患者在常规局部麻醉下,以不同的手术方法进行治疗。术后对患者进行垂直斜度及下斜肌亢进改善程度检查,随访六个月,对检查结果进行统计学分析。结果：A、B、C三组分离性垂直斜视患者经治疗后,总有效率分别为88.46%、89.47%、93.33%,组间比较差异无统计学意义（P〉0.05）。结论：对于分离性垂直斜视患者进行临床手术治疗时,应根据患者实际情况选择手术方法,从而达到更为有效的治疗效果,提高患者生活质量。