胸腔镜肺癌根治术对患者炎性介质及微循环的影响观察

目的：观察胸腔镜肺癌根治术对患者炎性介质及微循环的影响程度。方法选取根治术治疗的80例肺癌患者,将其分为对照组（传统开胸手术组）40例和观察组（胸腔镜手术组）40例,将两组患者术前1d和术后1d、3d及7d的血清炎性介质及血流变指标进行检测与比较。结果两组患者术前1d的血清炎性介质及血流变指标均无明显差异（P＞0.05）,而手术后1d、3d及7d观察组的检测水平均明显低于对照组,且两组术后3d的检测水平均高于其他时间段,差异有统计学意义（P＜0.05）。结论胸腔镜肺癌根治术对患者炎性介质及微循环的影响均小于传统开胸手术,患者对手术的应激程度较小,因此更适用于肺癌手术患者。     

全程疼痛管理对人工膝关节置换术术后患者疼痛及膝关节功能恢复的观察

目的探讨全程疼痛管理对人工膝关节置换（totalkneearthropiasty,TKA）术后患者疼痛及膝关节功能恢复的效果。方法采用配对的方法将行单侧TKA的50例患者分为观察组和对照组,每组各25例,对照组患者术后给予硬膜外自控镇痛,观察组患者给予实施全程疼痛管理。比较两组患者7d内（第1d、2d、3d、5d、7d）疼痛评分及术后10d内（第1d、3d、7d、10d）膝关节活动度,两组患者不良反应发生情况。结果观察组患者术后第1d、2d、3d、5d、7d疼痛评分明显低于对照组（均P〈0．05）;观察组患者术后第1d、3d、7d、10d膝关节活动度明显优于对照组（均P〈0．05）;观察组患者不良反应发生率明显低于对照组（P〈0．01o结论全程疼痛管理有助于TKA术后患者疼痛的控制和促进患者膝关节康复,提高患者生活质量。     

普伐他汀降脂治疗肝酶升高老年冠心病患者的临床疗效

【目的】了解普伐他汀对肝酶升高的老年冠心病患者降脂治疗的疗效及安全性。【方法】血清丙氨酸转氨酶(ALT)轻中度升高的老年冠心病患者47例,予普伐他汀20 mg/d治疗,并于给药后7 d、14 d、28 d及60 d检测血脂、肾功能及ALT的变化。【结果】入选患者在28 d及60 d时总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和甘油三酯(TG)明显降低(P<0.01),而ALT在7 d、14 d时无明显升高(P>0.05),在28d及60 d时有明显降低(P<0.05)。【结论】普伐他汀对ALT轻中度升高的老年冠心病患者降脂治疗效果确切、安全,不增加肝毒性。     

放松训练对围手术期颅内动脉瘤伴高血压患者的影响

目的观察放松训练对行血管内栓塞术的颅内动脉瘤伴高血压患者的影响。方法将60例颅内动脉瘤伴高血压需行颅内动脉瘤血管内栓塞术的患者,随机分为实验组与对照组各30例,对照组采用常规护理,实验组在常规护理基础上 放松训练,分别记录两组患者术前3 d及术前1 d,术后第1 d、第3 d的血压值、焦虑评分值。结果术前1 d、术后第1 d及术后第3 d两组患者血压比较,均P<0.05,差异有统计学意义,对照组血压高于实验组;术后第1 d及术后第3 d两组患者焦虑程度比较,均P<0.05,对照组高于实验组。结论放松训练可有效减轻颅内动脉瘤伴高血压患者围手术期焦虑程度、降低患者血压水平。     

36例重症胰腺炎患者的营养支持与护理

目的探讨急性重症胰腺炎患者的营养支持及护理。方法总结2000年7月～2008年3月36例急性重症胰腺炎患者营养支持的护理,并于患者营养支持前及支持后10d、20d及30d进行血清总蛋白测定和总淋巴细胞计数。结果血清白蛋白值术前(37.7±2.6)g/L,术后10d(29.8±3.5)g/L,术后20d(32.7±3.8)g/L,术后30d(38.1±3.5)g/L,其中术后10d,术后20d与术前比较差异有统计学意义(p<0.05);淋巴细胞总数术前1.45±0.14×109/L,术后10d1.07±0.18×109/L,术后20d1.21±0.17×109/L,术后30d1.43±0.22×109/L,其中术后10d,术后20d与术前比较差异有统计学意义(p<0.05)。结论加强重症胰腺炎患者营养支持的护理有利于患者的术后康复。     

乌司他丁联合大黄对重症急性胰腺炎患者腹内压及C-反应蛋白的影响

目的 通过研究乌司他丁加大黄治疗对重症急性胰腺炎(SAP)患者腹内压及血清C反应蛋白(CRP)水平的影响,探讨其在SAP中的临床应用价值.方法 通过随机分组的方法将42例SAP患者分成两组.对照组给予常规胃肠减压、抑制胰酶分泌等治疗.联合治疗组在上述治疗的基础上予以乌司他丁和大黄治疗.分别在治疗前、治疗3d、7d、10d监测患者的腹内压及CRP水平、APACHE-Ⅱ评分,以及观察两组患者的病死率(60d)、住院时间和住院费用,通过对比分析治疗效果.结果 联合治疗组患者与治疗前相比,联合治疗后7d、10d腹内压及CRP水平、APACHE-Ⅱ评分均有降低(P<0.05).对照组与治疗前相比,治疗至10d腹内压才开始明显降低(P<0.05),CRP水平及APACHE-Ⅱ评分治疗后7d、10d均有降低(P<0.05).联合治疗组与对照组治疗后同期相比,联合治疗组3d、7d、10d腹内压及CRP水平、APACHE-Ⅱ评分均明显降低(P<0.05).联合治疗组与对照组相比,联合治疗组平均住院时间及住院费用明显减少(P<0.05),病死率(60d)下降.结论 乌司他丁联合大黄对SAP患者腹内压、血浆CRP及APACHE-Ⅱ评分水平明显降低,并可降低SAP患者住院时间和住院费用,病死率降低,值得推广应用.     

超声引导下星状神经节脉冲射频联合电针治疗偏头痛患者的疗效观察

目的 观察超声引导下星状神经节脉冲射频联合电针治疗偏头痛患者的临床疗效。 方法 采用随机数字表法将72例偏头痛患者分为联合组、针刺组及对照组,每组24例。3组患者均给予依托考昔及佐米曲普坦分散片口服,电针组患者在此基础上辅以电针治疗（每天治疗1次,连续治疗7 d）,联合组患者则辅以超声引导下星状神经节脉冲射频（共治疗1次）及电针治疗（每天治疗1次,连续治疗7 d）。于治疗前、治疗后3 d、7 d、30 d及90 d时分别采用疼痛视觉模拟评分法（VAS）、偏头痛特异性生活质量问卷（MSQoL）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）及偏头痛失能程度问卷（MIDAS）对3组患者进行疗效评估。 结果 治疗后3 d、7 d、30 d、90 d时联合组、针刺组疼痛VAS、MSQoL、HAMA及HAMD评分均较治疗前明显改善（P<0.05）,治疗后30 d、90 d时联合组及针刺组MIDAS评分均较治疗前明显改善（P<0.05）。治疗后3 d时联合组疼痛VAS、MSQoL、HAMA及HAMD评分均显著优于针刺组（P<0.05）,治疗后30 d、90 d时联合组MIDAS评分均显著低于针刺组（P<0.05）。治疗后3 d、7 d、30 d、90 d时联合组疼痛VAS、HAMA、HAMD评分均显著低于对照组（P<0.05）,MSQoL评分显著高于对照组（P<0.05）,治疗后30 d及90 d时联合组MIDAS评分均显著低于对照组（P<0.05）。 结论 超声引导下星状神经节脉冲射频联合电针治疗能在短期内迅速缓解偏头痛患者症状,提高生活质量,且疗效持续时间至少达3个月。     

1.8mm和3.0mm透明角膜切口白内障超声乳化术后泪膜和眼表变化对比研究

目的对比观察临床应用1.8 mm和3.0 mm透明角膜切口白内障超声乳化术后泪膜和眼表变化情况。方法选取2013年9月至2015年2月进行诊治的94例白内障患者,按随机数字表法随机分为A、B两组各47例,A组患者给予1.8 mm透明角膜切口白内障超声乳化术,B组患者行3.0 mm透明角膜切口白内障超声乳化术,对比分析两组患者术后2 d、5 d、10 d、30 d时的泪膜和眼表变化情况。结果两组患者术前主观干燥异物感(DES)、Schirmer试验(SIt)、泪膜破裂时间(BUT)以及角膜荧光素染色积分(CFS)组间比较无显著差异(P0.05),术后2 d、5 d、10 d时两组患者的DES及SIt均较治疗前明显升高(P0.05),组间比较A组明显低于B组(P0.05),术后30 d时A组患者的DES及SIt恢复到术前水平,B组患者仍明显高于术前(P0.05);术后2 d、5 d、10 d时两组患者的BUT及CFS均较治疗前明显降低(P0.05),术后30 d时A组患者的BUT及CFS恢复到术前水平,B组患者仍较术前差异明显(P0.05)。结论相比3.0 mm透明角膜切口,1.8 mm透明角膜切口白内障超声乳化术对患者泪膜及眼表损伤较小,值得推广应用。     

经鼻高流量氧疗和无创正压通气对于肺源性中重度急性呼吸窘迫综合征患者初始治疗的效果评价

目的:对比及评价经鼻高流量氧疗(HFNC)和无创正压通气(NPPV)对于肺源性中重度急性呼吸窘迫综合征(ARDS)患者的初始治疗效果。方法:采用回顾观察性研究,选择2016-01-01—2018-08-01期间因肺源性中重度ARDS入住我院急诊ICU的患者,且给予常规氧疗后低氧不能缓解。根据患者入院后最高的无创氧疗方案将患者分为经鼻高流量(HFNC)组及无创通气(NPPV)组,所有患者的无创氧疗方案选择为随机进行。主要观察指标为90 d病死率,次要观察指标为患者28 d气管插管率。结果:41例患者纳入分析,患者来自中国11个省,入院原因均为重症肺炎,入住ICU时氧合指数(PaO_2/FiO_2)均≤200 mmHg。所有患者的90 d病死率为49%(20/41),28 d气管插管率为51%(21/41)。HFNC组26例患者,90 d病死率为42%(11/26),28 d气管插管率为42%(11/26);NPPV组15例患者,90 d病死率为60%(9/15),28 d气管插管率为67%(10/15)。HFNC组和NPPV组90 d病死率及28 d气管插管率差异无统计学意义。根据患者基础免疫功能将所有患者分为非免疫抑制患者及免疫抑制患者,非免疫抑制患者共23例,其中HFNC组14例,NPPV组9例,HFNC非免疫抑制组患者90 d病死率及28 d插管率显著低于NPPV组患者(14%vs.67%,P=0.008;14%vs.67%,P=0.01)。免疫抑制患者共18例,其中HFNC组12例,NPPV组6例,使用HFNC患者的90 d病死率及28 d插管率与NPPV组患者差异无统计学意义(75%vs.50%,P=0.46;75%vs.67%,P=0.71)。结论:与NPPV比较,对于非免疫抑制肺源性中重度ARDS患者采用HFNC初始治疗可显著降低病死率及气管插管率,是一种较为理想的无创氧疗方案。     

大剂量地塞米松冲击治疗慢性特发性血小板减少性紫癜的价值分析

目的探讨大剂量地塞米松冲击治疗慢性特发性血小板减少性紫癜的应用价值。方法选择慢性特发性血小板减少性紫癜患者150例,根据随机数字法将患者分为观察组和对照组,观察组患者应用地塞米松40 mg/d,静脉滴注,治疗时间4 d,不再维持治疗。对照组患者每日清晨顿服应用泼尼松l mg/kg,用药时间4周,根据患者血小板水平调整用药剂量。比较两组患者治疗效果及治疗后3 d及5 d血小板水平的变化。结果①观察组患者治疗总反应率为88.00%,对照组患者治疗总反应率为69.33%,观察组患者治疗总反应率显著高于对照组(P<0.05)。②治疗后3 d及5 d,两组患者血小板水平均显著升高,与对照组患者相比,观察组患者血小板改善更加显著(P<0.05)。结论大剂量地塞米松冲击治疗慢性特发性血小板减少性紫癜具有较高的应用价值。     

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.