腹腔镜治疗老年胆囊结石并发胆囊炎的疗效及对炎症因子的影响

目的探讨腹腔镜微创与开腹手术治疗老年胆囊结石并发胆囊炎患者的临床疗效及对肿瘤坏死因子(TNF)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)的影响。方法选取2015年3月至2016年9月入住该院的胆囊结石并发胆囊炎患者140例,按手术方法不同分为观察组(n=70)和对照组(n=70)。观察组采用腹腔镜手术治疗,对照组采用传统开腹手术治疗,比较两组患者术中出血量、切口长度及手术时间;术后的疼痛评分、术后排气时间、下床活动时间、住院时间及并发症发生情况;比较两组患者TNF、IL-6、IL-10水平变化。结果观察组患者的术中出血量、切口长度及手术时间均明显少于对照组,差异有统计学意义(P0.05);观察组患者的疼痛评分(2.43±0.18)分,明显低于对照组的(5.06±0.87)分,差异有统计学意义(P0.05);观察组术后排气时间、下床活动时间及住院时间均明显短于对照组,差异有统计学意义(P0.05);观察组患者总并发症发生率为4.29%,明显低于对照组的21.43%,差异有统计学意义(P0.05);与治疗前相比,两组患者血清TNF、IL-6及IL-10水平均明显上升,差异有统计学意义(P0.05);观察组治疗后血清TNF、IL-6及IL-10水平均低于对照组,差异有统计学意义(P0.05)。结论采用腹腔镜治疗老年胆囊结石并发胆囊炎能显著提高治疗效果,降低炎性反应,值得在临床上推广。     

前列腺癌腹腔镜手术与经典手术的比较

目的探讨前列腺癌腹腔镜手术与经典手术的不同。方法回顾性分析该院确诊为前列腺癌的患者100例,采用传统前列腺癌根治术患者50例作为对照组,使用腹腔镜下前列腺癌根治术患者50例作为观察组。比较2组患者的手术时间、住院时间、出血量,同时比较尿失禁、术后勃起等并发症发生率。结果观察组患者住院时间低于对照组,差异有统计学意义(t=0.538,P0.05);观察组手术时间大于对照组,差异有统计学意义(t=0.673,P0.05);观察组出血量低于对照组,差异有统计学意义(t=0.832,P0.05);观察组患有术后勃起功能障碍等并发症发生率低于对照组,差异有统计学意义(χ~2=6.819,P0.05);观察组尿失禁、尿道狭窄等并发症发生率与对照组比较,差异无统计学意义(χ~2=0.03,P0.05);观察组尿道狭窄等并发症发生率与对照组比较,差异无统计学意义(χ~2=0.08,P0.05)。结论腹腔镜前列腺癌手术可减少患者的住院时间,降低术中出血量,减少术后并发症发生率,但手术时间大于传统手术。     

急性结石性胆囊炎行腹腔镜手术治疗时机选择对康复效果的影响

目的探究急性结石性胆囊炎行腹腔镜胆囊切除术的手术时机对康复效果的影响。方法选取收治的81例急性胆囊炎患者作为研究对象,按手术治疗时机分成对照组(n=41,晚期手术,即发病72h后行手术)和观察组(n=40,早期手术,即发病72h内行手术);比较两组术后疼痛时间、肛门排气时间、下床活动时间和总住院时间等时间指标,中转开腹、并发症和复发情况。结果观察组术后疼痛时间、肛门排气时间、下床活动时间和总住院时间分别为(33.76±2.56)h、(30.59±4.18)h、(5.18±1.50)d、(6.21±1.18)d,均显著低于对照组的(48.67±3.78)h、(40.17±7.95)h、(6.27±2.31)d、(8.80±2.61)d,差异有统计学意义(t=19.967、6.634、2.427、5.703,P0.05)。观察组中转开腹显著低于对照组,差异有统计学意义(χ2=4.105,P0.05);两组并发症和复发虽略有差异但无统计学意义(P0.05)。结论对急性结石性胆囊炎早期行腹腔镜胆囊切除术能显著缩短住院时间、减少中转开腹,并有利于患者康复。     

腹腔镜经脐部切口治疗与传统开腹手术治疗小儿先天性肠闭锁的疗效与安全性

目的 探究小儿先天性肠闭锁给予腹腔镜经脐部切口治疗与传统开腹手术治疗的疗效与安全性。方法选取2018年1月—2021年3月该院治疗的先天性肠闭锁患儿42例作为研究对象,按照随机数字表法分成观察组(n=21)和对照组(n=21),对照组给予传统开腹手术治疗,观察组给予腹腔镜经脐部切口治疗,比较两组患儿临床疗效、手术相关指标及并发症。结果 观察组治疗总有效率95.24%,较对照组明显更高,差异有统计学意义(χ²=4.286,P<0.05);观察组手术时间(2.55±0.64)h、术后进食时间(4.05±1.12)d、住院时间(12.14±3.05)d,明显短于对照组,差异有统计学意义(t=2.801、3.825、2.831,P<0.05),出血量(8.33±3.62)mL明显少于对照组,差异有统计学意义(t=14.203,P<0.05);观察组吻合口瘘、切口感染、尿潴留、腹腔脓肿并发症发生率为9.52%,较对照组明显更低,差异有统计学意义(χ²=6.035,P<0.05)。结论 小儿先天性肠闭锁给予腹腔镜经脐部切口治疗的疗...     

Trivex微创旋切术治疗下肢静脉曲张患者实施精细化护理效果及美学效果观察

目的 探讨精细化护理对Trivex微创旋切术治疗下肢静脉曲张患者的护理效果及美学效果。方法 选取2021年1月至2023年1月在我院接受Trivex微创旋切术治疗的124例下肢静脉曲张患者为研究对象,随机将其分为观察组和对照组,每组62例,对照组实施常规护理,观察组实施针对Trivex微创旋切术的精细化护理,比较两组患者术后并发症发生率、舒适度、疼痛评分及美学评分。结果 观察组术后并发症发生率为4.84%,低于对照组的16.13%,差异具有统计学意义(χ²=4.211,P=0.041);观察组术后舒适度评分较对照组高,疼痛评分较对照组低,差异具有统计学意义(P <0.05);观察组术后美学评分为(8.73±1.26)分,高于对照组(7.88±1.35)分,差异具有统计学意义(t=3.624,P <0.001)。结论 Trivex微创旋切术是治疗下肢静脉曲张的有效手段,在围手术期实施精细化护理可有效降低术后并发症发生率,提高患者舒适度,缓解疼痛,提升美学效果。     

腹腔镜微创手术治疗小儿腹股沟斜疝的临床应用

目的观察腹腔镜微创手术治疗小儿腹股沟斜疝的临床效果。方法选取我院2015年3月—2018年3月收治的342例小儿腹股沟斜疝,根据手术方式的不同分为腹腔镜组(n=174)与开放组(n=168)。腹腔镜组行腹腔镜微创手术,开放组经腹股沟行斜切口开放手术。比较两组术中情况、术后恢复情况及切口美观满意度,记录术后并发症发生情况及随访情况。结果与开放组比较,腹腔镜组切口长度、手术时间、排气时间、下床活动时间及住院时间均缩短,术中出血量减少,切口美观满意度评分升高,差异有统计学意义(P0.001)。腹腔镜组、开放组术后并发症发生率分别为2.3%(4/174)、24.4%(41/168),比较差异有统计学意义(χ~2=36.554、P0.001)。随访6～24个月,腹腔镜组1例(0.6%)病情复发,开放组4例(2.4%)病情复发,比较差异无统计学意义(P=0.208);腹腔镜组术后无对侧疝发生,开放组29例(17.3%)发生对侧疝,比较差异有统计学意义(χ~2=32.819、P0.001)。结论腹腔镜微创手术治疗小儿腹股沟斜疝安全性高,术后并发症少,病情恢复快,值得临床推广应用。     

腹腔镜手术治疗对宫外孕患者术后康复及远期预后的影响

目的:探析腹腔镜手术治疗对宫外孕患者术后康复及远期预后的影响。方法:选取2017年3月～2019年3月收治的86例宫外孕患者,按随机数字表法分为对照组和观察组,各43例。对照组采用开腹手术治疗,观察组采用腹腔镜手术治疗。比较两组围术期指标、输卵管再通情况、宫内妊娠情况及并发症发生情况。结果:观察组术后排气时间、术后下床活动时间短于对照组,术中出血量低于对照组,差异有统计学意义(P0.05);两组手术时间比较,差异无统计学意义(P0.05);观察组输卵管通畅率高于对照组,不通率低于对照组,差异有统计学意义(P0.05);两组输卵管通而不畅发生率比较,差异无统计学意义(P0.05);观察组宫内妊娠率高于对照组,并发症总发生率低于对照组,差异有统计学意义(P0.05)。结论:腹腔镜手术用于宫外孕治疗中具有微创、高效及安全等优点,患者术后恢复快速且并发症少,能够有效提升输卵管通畅率及宫内妊娠率,利于改善患者预后。     

腹腔镜下腹股沟疝修补术对手术效果及T淋巴细胞百分比的影响

目的探讨腹腔镜下腹股沟疝修补术对手术效果及T淋巴细胞百分比的影响。方法选取2017年1月-2019年1月腹股沟疝患者280例作为研究对象,随机分为对照组(n=140)和观察组(n=140)。对照组采用开放无张力疝修补术,观察组采用腹腔镜下无张力疝修补术,术后7 d对患者治疗效果进行评估,比较两组手术指标、疼痛视觉模拟评分(VAS)、T淋巴细胞百分比及术后并发症。结果观察组与对照组手术时间比较,差异无统计学意义(P 0.05);观察组出血量、术后自主活动时间及VAS评分少于对照组(P 0.05);观察组治疗费用多于对照组(P 0.05);观察组手术后7 d CD3~+、CD4~+和CD4~+/CD8~+百分比高于对照组(P 0.05);观察组手术后7 d CD8~+百分比低于对照组(P 0.05);观察组手术后切口疼痛、尿潴留、阴囊水肿及切口感染发生率与对照组比较,差异均无统计学意义(P 0.05)。结论将腹腔镜手术用于腹股沟疝患者中,手术创伤较小,能改善患者T淋巴细胞百分比,未增加术后并发症发生率,值得推广应用。     

腹腔镜手术与传统手术治疗中期妊娠合并卵巢囊肿的效果比较

探讨比较腹腔镜手术与传统手术治疗中期妊娠合并卵巢囊肿的效果。以采取术式不同将146例中期妊娠合并卵巢囊肿分为传统手术治疗组(n=65)和腹腔镜手术组(n=81),比较分析两组手术时间及手术成功率等。腹腔镜手术组手术时间、切口大小、术中出血量、术后排气时间及术后住院时间均优于传统手术治疗组,差异具有统计学意义(P0.05);腹腔镜手术组手术成功率显著高于传统手术治疗组,且前者术后宫缩率及术后并发症发生率均低于后者,差异具有统计学意义(P0.05)。腹腔镜手术较之于传统手术治疗中期妊娠合并卵巢囊肿更具安全性,且手术成功率高,具推广意义。     

腹腔镜诊治腹部创伤临床疗效评价

评价应用腹腔镜诊治腹部创伤的临床疗效。随机选取接诊的50例腹部创伤患者作为研究对象,将其随机分为对照组(n=25)及治疗组(n=25);对照组给予传统开腹手术治疗,治疗组应用腹腔镜手术治疗;对所有患者的临床资料进行回顾式分析,比较两组术后恢复速度及术后并发症的发生情况。治疗组术后恢复速度明显优于对照组,组间比较,差异具有统计学意义(P0.05);治疗组术后并发症的发生情况明显少于对照组,组间比较,差异具有统计学意义(P0.05)。将腹腔镜应用于腹部创伤的治疗中疗效确切且手术创口小、术后恢复快,值得临床推广应用。     

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.     

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.