创伤性支气管断裂的诊断与治疗

目的，报告创伤性支气管断裂２０例病的诊断和治疗，总结创伤生支气管断裂的早期诊断依据，分析延误诊断的原因，评价手术治疗效果。方法：本组２０例手术治疗１８例。伤后一周内手术１４例，其中１０例行支气管断端吻合术，４例修补成形术。     

创伤性支气管断裂的诊断与治疗

目的；报告创伤性支气管断裂20例病人的诊断和治疗，总结创伤性支气管断裂的早期诊断依据，分析延误诊断的原因，评价手术治疗效果。方法：本组20例手术治疗18例。伤后一周内手术14例，其中10例行支气管断端吻合术，4例修补成形术。全肺切除及肺叶切除各2例。结果：早期手术的14例病人，术后均痊愈；延迟手术的4例中2例肺功能明显减退，1例吻合口感染并发脓气胸；2例伤后术前突然死于并发症。结论：只有早期正确诊断才能及时手术治疗，早期手术，并发症少，治愈率高，肺功能恢复满意。伤后一周内为最佳手术时机。     

外伤性支气管断裂7例诊断和治疗分析

目的:报告7例外伤性支气管断裂患者的诊断与治疗,评价其早期诊断和手术治疗效果以及延误诊断造成的后果。方法:本组7例早期行支气管修补术6例,1例于伤后3个月行支气管重建术。结果:本组7例手术后全部痊愈,其中1例延误诊断患者手术效果不如早期好。结论:外伤性支气管断裂容易误诊,纤维支气管镜及影像检查是诊断支气管断裂的可靠方法。早期诊断和手术治疗可减少肺和胸腔感染机会,及时挽救患者生命和恢复呼吸功能。     

创伤性主支气管断裂的观察与护理

对我院1989-10～2001-07收治创伤性主支气管断裂12例观察与护理体会如下. 1 临床资料 本组均为胸部闭合伤,其中男10例,女2例,年龄4～43岁,平均26.4岁.交通事故伤7例,高处坠落伤1例,煤井下被煤石砸伤4例.右侧7例,左侧5例.合并肋骨骨折7例,锁骨骨折2例,血气胸11例,肺挫伤4例,无合并伤1例.主要症状胸闷、气短12例,皮下气肿15例,咯血痰4例,紫绀2例.仅1例受伤当日剖胸确诊,其余确诊时间2～90d.本组均经手术治愈.行支气管断裂修补、吻合术9例,一期全肺切除1例,二期全肺切除2例,其中1例为支气管造瘘.术后50 d二期行全肺切除.随访2个月～10 a,2例伤侧胸壁稍塌陷,均恢复正常生活.     

26例外伤性支气管断裂的外科治疗

我们 1985～ 2 0 0 1年共收治外伤性支气管断裂 2 6例 ,取得满意的临床效果 ,现报道如下。1　临床资料本组男 18例 ,女 8例 ;年龄 11～ 5 2岁 ,平均 2 6岁 ;坠落伤 4例 ,交通事故所致闭合伤 2 2例。手术时间为伤后 4ｈ～10个月。支气管完全断裂 2 1例 ,部分断裂 5例 ;发生在左侧15例 ,右侧 11例。合并肋骨骨折 2 2例 ,锁骨骨折 6例 ,颅脑损伤 4例 ,四肢骨折 5例。Ｘ线检查见早期有血气胸 ,晚期均有肺不张征象 ,肺坠落于心膈角。胸部ＣＴ扫描 12例 ,均明确诊断支气管断裂。气管镜检查 2 3例 ,7例急性损伤可见断裂处黏膜及软骨环中断 ,16例陈…     

创伤性支气管断裂X线平片的特征

支气管断裂在胸部闭合伤中并非少见,我们观察3例胸部闭合伤患者,X线诊断并经手术证实为右主支气管断裂。现将X线平片上观察到的主支气管断裂的特征表现报道如下: 例1:男,21岁。因砖墙倒塌压伤右侧胸部3小时急诊入院。仰卧位胸片,右侧第2前肋和第3、4后肋骨折;右侧气胸,肺组织压缩约80％,压缩的肺组织靠近右肺门周围,上部向外侧偏移并与纵隔之间可     

纤维支气管镜对外伤性气管支气管不完全断裂的诊断价值

目的：探讨纤维支气管镜对多发性复合伤和单纯的闭合性胸部外伤合并气管、支气管不完全及完全断裂的诊断时机及其价值。方法：采用0lympus 1T30纤维支气管镜检查并诊断多发性复合伤和单纯的闭合性胸部外伤合并气管、支气管不完全及完全断裂6例。结果：早期诊断，定位准确，及时手术，术后肺复张率高，失去诊断治疗时机，则肺组织不能复生。结论：纤维支气管镜对多发性复合伤和单纯的闭合性胸部外伤合并气管、支气管不完全及完全断裂诊断明确、定位准确，为手术治疗提供可靠依据。     

钝性创伤性支气管断裂的晚期诊治特点

钝性创伤性支气管断裂是一种少见而严重的疾病 ,早期有些患者常因各种原因被延误诊治。我们自１９８０年２月～１９９５年３月共遇到９例 ,均在晚期获确诊手术治疗 ,效果满意。临床资料一、一般资料本组９例 ,男６例 ,女３例 ,年龄９～５１岁 ,平均２６．４岁。１例急诊入院 ,８例伤后１月半～１８个月由外院转入。车祸伤６例 ,重物压伤２例 ,高处坠伤１例。左侧５例、右侧４例。主支气管断裂６例 ,上叶或中间支气管断裂３例。完全断裂６例 ,部分断裂３例。７例伤后即有呼吸困难、气胸、咯血或纵隔气肿等症状 ;２例无明确肺部症状 ,伤后５天…     

创伤性支气管断裂的诊断与治疗

本组２０例，手术治疗１８例。伤后一周内手术１４例，其中１０例行支乞管断端吻合术，４例修补成形术。全肺切除及肺叶切除各２例。结果：早期手术的１４例病人，术后均痊愈；延迟手术的４例中２例肺功能明显减退，１例吻合感染并发脓气胸；２例伤后术前突然死于并发症。本组分析表明：只有早期正确诊断才能及时手术治疗，早期手术，并发症少，治愈率高，肺功能恢复满意。     

外伤性支气管断裂9例分析

我院自 1982 - 0 6～ 2 0 0 1- 0 8收治外伤性支气管断裂 9例 ,分析如下。1　临床资料本组男 7例 ,女 2例 ,年龄 17～ 6 2岁 ,平均 34.5岁。 9例均为闭合性损伤 ,其中车祸伤 7例 ,坠落伤 1例 ,砸伤 1例。发生在左侧 5例 ,右侧 4例。主支气管断裂 6例 ,叶支气管断裂 3例 ;完全断裂 6例 ,部分断裂 3例。 9例伤后均有胸痛、呼吸困难 ,7例有皮下气肿。 9例均有多发性肋骨骨折 ,合并脑挫伤 2例 ,四肢骨折 1例 ,腹外伤 1例。本组伤后早期行 X线检查示液气胸 6例 ,气胸 2例 ,其中 3例有典型肺坠落征表现 ,无气胸表现 1例 ,皮下气肿 7例 ,纵隔气肿 …     

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.