小儿脑性瘫痪误诊241例分析

小儿脑性瘫痪 (cerebral palsy,CP)是指出生前到出生后 1个月内各种原因引起的脑损伤所致的非进行性中枢运动障碍及姿势异常 [1 ]。是导致小儿肢体残疾的常见原因之一 ,严重地影响着小儿的身心健康。 2 0 0 2 - 0 8～ 2 0 0 2 - 10我们在对湘潭地区进行 CP发病率及相关因素调查过程中发现 CP首诊误诊率较高 ,现报告如下。1　临床资料本组均符合 1988年佳木斯全国会议制定的小儿脑瘫诊断标准。调查儿童 179895人 ,确诊 CP为 385例 ,发病率为2 .14‰。首诊误诊 2 4 1例 ,误诊率 6 2 .5 9%。本调查城镇儿童 5 82 77人 ,确诊 CP人数为 94例 …     

常州市0—6岁残疾儿童的流行病学调查

目的：掌握目前常州市残疾儿童的患病率及致残原因。方法：参照2001年全国0－6岁残疾儿童抽样调查所采用的方法对市区5个街道0－6岁儿童5102人进行了各类残疾的流行病学调查。结果：确诊各类残疾共44人，患病率为8．62‰，各类残疾共57人次，残疾发生率为1．12％，其中智力残疾27人次，肢体残疾18人次，精神残疾7人次，视力残疾3人次，听力残疾2人次，残疾发生率分别5．29‰、3．53‰、1．37‰、0．59‰、0．39‰。结论：常州市残疾儿童的患病率较1987年有明显下降，但残疾儿童的康复现状仍不容乐观。     

常州市0～6岁残疾儿童的流行病学调查

目的掌握目前常州市残疾儿童的患病率及致残原因。方法参照2001年全国0～6岁残疾儿童抽样调查所采用的方法对市区5个街道0～6岁儿童5102人进行了各类残疾的流行病学调查。结果确诊各类残疾共44人,患病率为8.62‰,各类残疾共57人次,残疾发生率为1.12%,其中智力残疾27人次,肢体残疾18人次,精神残疾7人次,视力残疾3人次,听力残疾2人次,残疾发生率分别为5.29‰、3.53‰、1.37‰、0.59‰、0.39‰。结论常州市残疾儿童的患病率较1987年有明显下降,但残疾儿童的康复现状仍不容乐观。     

118例新生儿死亡原因分析及预防措施

作者对本院 1 0年间 1 1 8例新生儿死亡原因进行分析 ,并探讨其预防措施 ,报告如下。1　临床资料1 989年 1月～ 1 998年 1 2月在本院住院娩出的新生儿共 1 790 0例 ,其中 1 1 8例出生后 7ｄ内死亡 ,新生儿死亡率 6 59‰。1 1 8例新生儿死亡中早产儿 52例 (44 1 % ) ,孕 2 8～ 33 6周 32例 (61 5% ) ,孕周 34～ 35 6周2 0例 ,占 38 5%。体重 <2 50 0 ｇ 46例 (88 5% ) ,体重 >2 50 0 ｇ 6例 (1 1 5% )。窒息 36例 (30 5% ) ,其中轻度窒息 1 3例 ,重度窒息 2 3例。前置胎盘、胎盘早剥以及脐带绕颈、脐带打结、脱垂共 2 2例 (1 8 6% ) ,其中…     

238例小儿脑瘫的临床分析

小儿脑瘫 (ＣＰ) ,在我国发病率约为 1.8‰～4‰[1] ,应重视防治。现将我院近年来收治的ＣＰ病例分析报告如下。1　资料与方法1.1　一般资料　 1996年 4月— 2 0 0 1年 4月本院门诊及住院资料完整的ＣＰ患儿 2 38例 ,男 188例 ,女 5 0例 ;男∶女为 3.76∶1;年龄 2个月～ 6岁 ,其中≤ 3个月 37例 (15 .5 5 % ) ,4～ 6个月 85例(35 .71% ) ,6个月～ 1岁 5 2例 (2 1.85 % ) ,>1岁6 4例 (2 6 .89% ) ;早期 (<6个月 )确诊 12 2例(5 1.2 6 % ) ,其中超早期 (≤ 3个月 ) 37例 (15 .5 % ) ;2 38例均符合 1988年全国小儿脑瘫座谈会的诊断标准[2 ] 。1…     

糖尿病的主要危害是什么?

糖尿病是一种严重危害人体健康的常见慢性终身疾病 ,主要表现为慢性高血糖并伴有碳水化合物 (糖 )、脂肪和蛋白质代谢障碍。它在世界所有国家都已成为严重的社会公共卫生问题。据 1 993年 1 0月世界卫生组织 (ＷＨＯ)统计报告 ,全世界糖尿病患病人数已达1 .2亿之多 ,为 1 987年的 3倍 ,占成年人口的 6% ;根据我国的调查 ,我国糖尿病患病率约为 2 %～ 3% ,4 0岁以上的人群患病率占 5.3% ,而且每年还在以 1‰的惊人速度增长 ,据估计 ,我国现已有 30 0 0万糖尿病人 ,预测在本世纪末 ,糖尿病人数将达 4 0 0 0万。事实上患病数还不仅如此 ,按国际…     

定西县2-6岁精神残疾儿童流行病学调查

目的调查定西县 2— 6岁精神残疾儿童患病率并探讨其危险因素。方法使用克氏孤独症行为量表 (CAB) ,儿童孤独症评定量表 (CARS量表 ) ,PEP心理教育量表等调查定西县 2— 6岁儿童 3 776名。结果确诊精神残疾 13例 (男性 10例、女性 3例 ) ,CAB阳性率为 4.76‰ ,患病率为 3 .44‰ ;脑器质性疾病致精神残疾者所占比例最高 ,为 61.5 4% ,合并智力低下者占 84.62 % ;精神残疾的危险因素有母亲文化程度、父母婚姻状况及近亲婚配、儿童抚养人及经济收入等。结论定西县 2 -6岁儿童精神残疾患病率较高 ,家庭状况及经济收入是精神残疾形成的重要因素。     

安阳市近十年住院心脑血管疾病患病及死亡情况分析

目前心脑血管疾病已是主要的死亡原因 ,而近年我国心脑血管疾病也在死因构成中占首要地位。为了解我市住院心脑血管疾病患病及病死情况 ,我们统计分析了我市医院近 1 0年住院确诊为不同的心脑血管疾病患者共 5 0 5 0例 ,现报告如下。自 1 990年 1月至 2 0 0 0年 1月经住院确诊为不同的心脑血管疾病患者共 5 0 5 0例 ,其诊断均为入院第一诊断 ,其中男 2 86 3例( 5 6 7% ) ,女 2 1 87例 ( 43 3% )。随着年龄增长患病人数增加 ,40岁～组开始病例数明显增多共 75 8例 ( 1 5 % ) ,5 0岁～和 6 0岁～组病例最多共 30 1 9例( 5 9 3% )。男女患病人…     

海南省0—6岁脑性瘫痪儿童流行病学调查

目的:调查海南省0—6岁脑性瘫痪(CP)儿童的流行特征及康复现状,为脑瘫儿童的早期诊断和干预性治疗及政府和相关行政部门制定脑瘫儿童的预防、康复医疗救助政策提供理论依据。方法:2015年9月—2016年9月期间,采用分层整群抽样原则,以居委会(村)为最小单位抽取全省18个市县乡镇0—6岁全体常住儿童作为调查对象,每个市县随机抽取3—4个区(乡镇),所抽取的区(乡镇)中再随机抽取2—4个居委会(村),抽取到的居委会(村)中全部0—6岁儿童均纳入调查,由海南省妇幼保健院儿童康复科医师进行诊断分型,收集并整理数据,用SPSS17.0统计软件进行统计学分析。结果:共实际调查海南省18地区0—6岁儿童38267例,实际有效37862例,发现脑瘫患儿80例,脑瘫患病率为2.11‰;各地区的脑瘫患病率在0‰—9.33‰,各年龄组患病率分布在1.98‰—3.22‰;不同性别间男女患病率之比为4∶1;脑瘫分型以痉挛型为主(占61.29%);曾接受康复训练的比例为66.2%。结论:海南省0—6岁儿童脑瘫患病率为2.11‰,分型以痉挛型为主,围生期保健及早期随访工作尚待加强,康复干预现状有待进一步改善,可作为进一步研究脑瘫防治工作的基础性资料。     

高原地区60岁以上人群慢性病现状及其影响因素

为了解高原地区老年人慢性病患病现状及其影响因素 ,以改善本地区老年人生活质量及健康状况 ,并为高原地区老年人保健政策提供科学依据 ,我们于 1 997年 4～ 5月对西宁地区老年人慢性病状况进行了调查。共调查 6 0岁以上 1 36 2人 ,其中患慢性病者92 6人 ,患病率为 6 7 99% ;男性 76 9人 ,患病5 5 8人 ,患病率为 72 5 6 % ;女性 5 93人 ,患病36 8人 ,患病率为 6 2 0 6 %。男性患病率明显高于女性 (Ｐ <0 0 1 )。本次调查发现老年病人多患有 1种以上慢性病 ,最多者同时患 7种慢性病。患 1～ 4种病人数分别为 41 2人( 44 49% )、 2 81人 (…     

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.