急性梗阻性化脓性胆管炎临床治疗分析

目的探讨急诊内镜手术治疗急性梗阻性化脓性胆管炎的临床效果。方法选择80例急性梗阻性化脓性胆管炎(AOSC)患者,随机分为观察组(急诊内镜手术治疗)和对照组(外科手术治疗),对两组治疗效果进行分析比较。结果与对照组的治愈率相比(85.0%),观察组的治愈率明显增高(92.5%),差异有统计学意义(P<0.05)。与对照组的病死率相比(15.0%),观察组的病死率明显减少(0.0%),差异有统计学意义(P<0.05)。结论急诊内镜手术治疗AOSC具有微创性、操作简单、术后恢复快、术后并发症少等优点,尤其适用于老年及体质较弱、基础疾病较多的患者。     

急诊内镜手术治疗老年急性梗阻性化脓性胆管炎65例效果观察

目的:探讨急诊内镜手术治疗老年急性梗阻性化脓性胆管炎(AOSC)患者的临床效果。方法:将130例老年AOSC患者随机分为观察组和对照组各65例,观察组行急诊内镜手术治疗,对照组行外科手术治疗,观察、比较两组治疗效果。结果:观察组治愈率为96.9%、病死率为0.0%、并发症发生率为3.1%,对照组分别为86.2%、13.8%、12.3%,两组比较差异均有统计学意义(P<0.01)。结论:急诊内镜手术治疗AOSC效果理想,较开腹手术治疗具有微创、简便、术后并发症少、恢复快等优点,值得临床推广应用。     

桡动脉入路经皮冠状动脉介入术对老年冠心病患者术后康复及并发症的影响

目的探讨桡动脉入路经皮冠状动脉介入术(PCI)对老年冠心病患者术后康复及并发症的影响。方法选取97例老年冠心病患者,依据术式将其分为观察组(49例)与对照组(48例)。观察组患者采取桡动脉入路PCI治疗,对照组采取股动脉入路PCI治疗。比较两组手术情况、术后恢复情况、并发症发生情况,并术后进行1年随访,对比两组患者严重心脏不良事件发生率。结果两组X线暴露时间、穿刺时间、手术时间与穿刺成功率比较,差异未见统计学意义(P0.05);观察组术后卧床时间及住院时间分别为(15.39±3.26)h、(5.08±2.13)d,少于对照组(22.74±4.19)h、(7.79±2.46)d,且并发症发生率[6.12%(3/49)]低于对照组[25.00%(12/48)],差异有统计学意义(P0.05);术后随访1年,观察组患者严重心脏不良事件发生率为4.08%(2/49),与对照组[8.33%(4/48)]比较,差异未见统计学意义(P0.05)。结论桡动脉入路经皮冠状动脉介入术治疗老年冠心病可减少术后并发症发生率,疗效确切。     

微创内镜保胆术治疗胆囊息肉对术后恢复情况及远期并发症发生情况的影响

目的探讨微创内镜保胆术治疗胆囊息肉对术后恢复情况及远期并发症发生情况的影响。方法选择2015年8月至2016年8月在某院治疗的胆囊息肉患者50例,随机分为两组,每组各25例。对照组采用腹腔镜胆囊切除术,观察组采用微创内镜保胆术治疗,比较两组手术时间、术中出血量、肛门排气时间、恢复进食时间以及并发症发生情况。结果观察组手术时间、术中出血量、肛门排气时间、恢复进食时间分别为(57.61±3.29)min、(10.19±2.18)mL、(19.12±1.33)h、(1.63±0.52)d,均短于对照组的(62.59±2.17)min、(16.62±2.31)mL、(26.28±1.53)h、(3.59±0.64)d,差异有统计学意义(P0.05);观察组并发症总发生率为4.00%,低于对照组的32.00%,差异有统计学意义(P0.05)。结论采用微创内镜保胆术治疗胆囊息肉患者,利于其术后恢复,减少并发症的发生,是一种较为安全、有效的治疗方式。     

内镜切除联合等离子消融术治疗扁桃体肥大继发鼾症的疗效观察

目的探讨内镜切除联合等离子消融术治疗扁桃体肥大继发鼾症的疗效。方法回顾性分析该院2010年1月至2013年1月70例扁桃体肥大继发鼾症患者,随机分为观察组和对照组,观察组采用内镜切除联合等离子消融术,对照组采用传统扁桃体摘除术。分析比较治愈率、术中出血量、手术时间、疼痛指数、术后并发症发生率等相关指标。结果观察组总有效率为91.67%,明显大于对照组的73.51%,差异有统计学意义(P0.05)。观察组手术时间、出血量和疼痛指数分别是(23.34±2.21)min、(10.33±1.15)mL和(1.70±0.46)分,明显低于对照组的(35.00±2.70)min、(51.76±3.48)mL和(5.83±1.56)分,两组比较差异有统计学意义(P0.05)。治疗前两组患者呼吸暂停低通气指数(AHI)比较,差异无统计学意义(P0.05);治疗后观察组患者AHI明显低于对照组(P0.05);且观察组并发症发生率明显低于对照组,差异有统计学意义(P0.05)。结论内镜切除联合等离子消融术比传统手术疗效更佳,更适合扁桃体肥大继发鼾症患者,值得临床推广。     

腹腔镜微创技术在急诊普外手术中的应用效果

目的评价腹腔镜微创技术在急诊普外手术中的临床价值。方法选取2016年9月-2018年1月该院急诊普外科收治的手术患者80例作为研究对象,按照随机数字表法分为对照组(n=40)和治疗组(n=40),对照组采取开腹手术治疗,治疗组采取腔镜微创技术治疗,观察并比较两组手术情况、术后并发症及疼痛情况的差异。结果治疗组手术时间、排气时间和住院时间分别为(69.6±12.5)min、(25.8±2.8)h和(4.9±1.0)d,明显短于对照组,差异均有统计学意义(t=2.45、11.21和5.27,P0.05);治疗组术中出血量为(29.7±11.1)ml,明显少于对照组,差异有统计学意义(t=14.94,P0.05);治疗组患者术后并发症发生率为7.5%,明显低于对照组患者的25.0%,差异有统计学意义(χ2=4.50,P0.05);两组均无无痛病例,治疗组轻度疼痛率高于对照组,重度疼痛率低于对照组,差异均有统计学意义(χ2=6.55,5.16,P0.05);中度疼痛率两组比较,差异无统计学意义(P0.05)。结论腹腔镜微创技术应用于急诊普外科手术中,具有效果良好、创伤小、恢复快、疼痛程度轻和并发症发生率低等优点,值得在临床中进一步普及和推广。     

针刺联合全身麻醉对老年患者肠癌切除术后认知功能的影响

目的研究分析针刺联合全身麻醉对老年患者肠癌切除术后认知功能的影响。方法随机选取拟行肠癌切除术的老年患者112例,将其随机分为对照组与观察组,每组56例。对照组采用全身麻醉,观察组采用针刺联合全身麻醉,比较两组患者的术后认知功能。结果两组患者麻醉前、术前、术中30 min、术后的心率与血压比较,差异未见统计学意义(P0.05);观察组患者术后24 h MMSE评分(26.44±0.76)分低于对照组(27.18±0.72)分,差异有统计学意义(P0.05);两组患者麻醉前、术后6 h、术后24 h、术后72 h MMSE评分比较差异未见统计学意义(P0.05);观察组患者术后6 h(3.57%)、术后12 h(3.57%)认知功能障碍发生率低于对照组,差异有统计学意义(P0.05),但两组患者术后24 h、术后72 h认知功能障碍发生率比较差异未见统计学意义(P0.05);观察组患者术后苏醒时间显著早于对照组(P0.05)。结论在老年患者肠癌切除术中采用针刺联合全身麻醉能够缩短患者术后苏醒时间,减少患者的术后功能障碍。     

治疗性护理支持对内镜下胃黏膜剥离术患者依从性以及术后恢复情况的影响

目的探讨治疗性护理支持对内镜下胃黏膜剥离术患者依从性以及术后恢复情况的影响。方法以140例行内镜下胃黏膜剥离术治疗的胃间质瘤患者为研究对象,随机分为观察组和对照组各70例,观察组围术期给予治疗性护理支持,对照组采取常规护理支持,比较2组患者对手术的依从性及术后的恢复情况。结果观察组患者手术时间和住院时间分别为(0.77±0.25)h和(13.5±4.2)d,术中出血量为(36.3±0.65)m L,均少于对照组,差异有统计学意义(P0.05);观察组术后并发症发生率显著低于对照组(P0.05);观察组有45例完全依从,对照组有28例完全依从,观察组的依从性显著优于对照组(P0.05)。结论治疗性护理支持具有明显优势,更符合内镜治疗的护理需求。     

腹腔镜肾囊肿去顶术治疗肾囊肿16例疗效分析

目的探讨腹腔镜肾囊肿去顶术治疗肾囊肿的临床疗效。方法选取我院收治的单纯性肾囊肿患者32例,随机分为观察组和对照组各16例,观察组采用腹腔镜肾囊肿去顶术治疗,对照组采用开放手术治疗。比较两组患者术中出血量、手术时间、术后首次排气时间及术后并发症情况。结果观察组中术中出血量、手术时间及术后首次排气时间分别为(17.24±1.23)ml、(50.23±1.75)h和(36.12±1.74)h,均明显低于对照组的(53.14±5.11)ml、(71.89±3.58)h和(42.76±2.73)h,差异具有统计学意义(P0.05);两组患者拔除引流管时间差异无统计学意义(P0.05);观察组手术费用为(3045±1231)元,住院总费用为(7858±1752)元,明显高于对照组的(1964±559)元和(4122±751)元,差异具有统计学意义(P0.05);观察组术后并发症发生率为12.50%,明显低于对照组的31.25%,差异具有统计学意义(P0.05)。结论相比于开放手术,腹腔镜肾囊肿去顶术可有效较少患者术中出血,缩短手术时间和排气时间,降低术后并发症发生率,促进患者恢复,提高生活质量,临床疗效显著。     

临床护理路径对PCI术后冠心病患者的应用效果研究

目的探讨临床护理路径对PCI术后冠心病患者的应用效果。方法将本院90例PCI术后冠心病患者作为研究对象,按照随机数表法分为观察组和对照组各45例。对照组患者实施传统护理模式遵循医嘱给予护理,观察组患者实施临床护理路径。治疗后,分析比较两组患者的应用效果。结果观察组患者心律失常并发症发生率(2.22%)显著低于对照组(13.33%),比较差异具有统计学意义(P0.05);而观察组患者心衰、心源性休克并发症发生率虽有所降低,但与对照组比较差异无统计学意义(P0.05);观察组患者经治疗后的切口疼痛、腹胀、腰酸背痛评分分别为(1.56±1.32)分、(10.27±1.46)分、(1.34±0.97)分低于对照组(2.69±1.43)分、(16.18±2.25)分、(1.89±1.21)分,2组比较差异有统计学意义(P0.05);观察组患者治疗后满意度(95.56%)显著高于对照组(82.22%),比较差异具有统计学意义(P0.05);观察组患者的卧床时间、住院时间以及住院费用分别为(59.48±5.12)h、(6.43±2.26)d、(4.89±0.18)万元均短于或少于对照组(69.13±6.27)h、(9.15±2.68)d、(5.27±0.16)万元,比较差异有统计学意义(P0.05);观察组护理表格书写、基础护理、介入护理评分分别为(92.47±4.58)分、(93.49±3.91)分、(94.09±5.17)分均优于对照组(87.19±3.72)分、(88.62±4.29)分、(90.26±3.93)分,比较差异有统计学意义(P0.05)。结论临床护理路径疗对PCI术后冠心病患者的应用效果良好,能够减少术后并发症,缩短卧床时间和住院时间,提高患者满意度和综合护理质量。     

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.