透巩膜睫状体光凝治疗难治性青光眼的疗效观察与护理

[目的]观察半导体激光透巩膜睫状体光凝的治疗效果，探讨围手术期的护理。[方法]对35例难治性青光眼患眼行810mm半导体激光透巩膜睫状体光凝治疗。使用能量1．5W～2．0W，时间每次2s，每次治疗3个象限，对治疗前后的眼压进行统计学分析。[结果]治疗前35例患眼眼压平均为52．8mmHg（1mmHg=0．133kPa），治疗后眼压平均为14．7mmHg。[结论]半导体激光透巩膜睫状体光凝是治疗难治性青光眼的围手术期护理对确保疗效，预防严重并发症具有重要意义。     

透巩膜睫状体光凝治疗难治性青光眼的疗效观察与护理

[目的]观察半导体激光透巩膜睫状体光凝的治疗效果,探讨围手术期的护理.[方法]对35例难治性青光眼患眼行810 nm半导体激光透巩膜睫状体光凝治疗,使用能量1.5 W～2.0 W,时间每次2 s,每次治疗3个象限,对治疗前后的眼压进行统计学分析.[结果]治疗前35例患眼眼压平均为52.8 mmHg(1 mmHg=0.133 kPa),治疗后眼压平均为14.7 mmHg.[结论]半导体激光透巩膜睫状体光凝是治疗难治性青光眼的围手术期护理对确保疗效,预防严重并发症具有重要意义.     

半导体激光经巩膜睫状体光凝治疗复杂性青光眼的护理

目的探讨半导体激光经巩膜睫状体光凝治疗复杂性青光眼的作用及有效的护理。方法对32例复杂性青光眼进行半导体激光睫状体光凝治疗,给予术前、术后的生理、心理及眼部护理,并制定相关的临床护理措施,使患者以最佳的状态完成手术。结果随访观察6~10个月,治疗前平均眼压为49.2±9.7 mmHg(33.8~63.7 mmHg),第1次治疗后为20.1±6.3 mmHg(12.1~36.2 mmHg),最后随诊为19.6±7.2 mmHg(10.6~33.4 mmHg),明显低于术前(P<0.01);24例眼压下降≥30%,手术成功率为75%,疼痛缓解率为90.6%。结论半导体激光经巩膜睫状体光凝是一种治疗复杂性青光眼的降低眼压疗效确切的方法,并发症少,可重复治疗,尤其适用于年龄较大、全身情况较差的病人及绝对期青光眼病人,配合相应的护理措施,可提高其生活质量。     

半导体激光经巩膜睫状体光凝治疗难治性青光眼的应用和护理

目的探讨半导体激光经巩膜睫状体光凝治疗难治性青光眼的作用及有效的护理。方法对32例难治性青光眼进行半导体激光睫状体光凝治疗,能量1.5～2.0W,时间0.5～1s,范围180°～360°,点数12～28点,给予术前、术后的生理、心理及眼部相关的临床护理,使患者以最佳的心态配合手术。结果观察6～10个月,治疗前眼压为6.54±1.29kPa,第一次治疗后眼压为2.67±0.84kPa,最后随诊眼压为2.6±0.96kPa,明显低于术前(P<0.01);24例眼压下降≥30%,手术成功率75%,疼痛缓解率90.6%。结论半导体激光经巩膜睫状体光凝是治疗难治性青光眼的一种降低眼压、疗效确切的方法,该方法可缓解疼痛,并发症少,可重复治疗,尤其适用于年龄较大、全身情况较差的病人及绝对期青光眼病人,同时配合相应的护理措施,帮助他们提高生活质量。     

810nm激光经巩膜睫状体光凝治疗难治性青光眼48例围术期护理

目的：探讨810nm激光经巩膜睫状体光凝治疗难治性青光眼患者围术期的护理方法。方法：对48例（48眼）难治性青光眼患者行810nm激光经巩膜睫状体光凝术,并给予精心围术期护理。结果：本组无光感者20眼,12眼经一次光凝术后眼压低于40mmHg（1mmHg=0．133kPa）,7眼经2次光凝术后眼压低于40mmHg,1眼经3次光凝术后眼压低于40mmHg;光感及以上者28眼,15眼经一次光凝术后眼压为5—21mmHg,13眼行2次或3次光凝术及滴眼液滴眼后眼压可控制在21mmHg。结论：810nm激光经巩膜睫状体光凝治疗难治性青光眼相对安全、简便有效,可缓解眼痛、保存眼球,做好围术期护理是手术成功的关键。     

经巩膜睫状体光凝治疗难治性青光眼患者并发症的护理

总结利用810 nm激光经巩膜睫状体光凝治疗难治性青光眼的各种并发症及其护理经验。对48例(48眼)难治性青光眼施行半导体经巩膜睫状体光凝术,对术中及术后并发症进行全面观察和护理。本组患者术中出现眼心反射1例;术后发生前房出血3例,前房闪辉及角膜后沉着物6例,结膜水肿12例,术后高眼压14例,眼球萎缩1例。认为术中密切观察生命体征变化,术后注意患者主诉,加强病情观察,及时发现各种并发症,及时处理,能有效预防或及时处理并发症,改善预后。     

半导体激光经巩膜睫状体光凝术的配合

激光烧灼睫状体是治疗重度、难治性青光眼的有效方法。半导体二极管激光系统的问世,为睫状体光凝提供了新型仪器。自1996年10月我院眼科开展了半导体激光经巩膜睫状体光凝术,现将此项新技术的配合介绍如下。 1 临床资料     

半导体激光睫状体光凝术治疗难治性青光眼的护理

难治性青光眼是青光眼中治疗效果差、对视功能影响严重的一类青光眼,应用半导体激光进行睫状体光凝是最近开展的一项手术方式,是利用波长为810nm激光通过接触的方式经巩膜选择性被睫状体色素上皮吸收,睫状体发生持续性的损害,房水分泌下降,达到控制眼压的目的。2000年12月至2002年12月本院对32例难治性青光眼进行了治疗,获得了满意效果,现将结果报告如下。     

经巩膜接触式Nd:YAG激光睫状体光凝术治疗晚期青光眼

目的：探讨Nd：YAG激光对晚期青光眼的治疗效果。方法：晚期青光眼30例31眼，行Nd：YAG激光睫状体光凝手术，根据治疗前眼压高低情况确定治疗点数，术后观察眼压，视力改变及并发症，随访4年。结果：新生血管性青光眼和其它类型青光眼治疗前后眼压下降均有显著意义，P〈0．01，但二者间眼压下降无显著性差异，P〉0．05。结论：Nd：YAG激光对晚期新生血管性青光眼和非新生血管性青光眼均有很好疗效，且操作简单，安全，值得在临床上推广应用。     

绝对期青光眼睫状体光凝术后并发症的预防及护理31例

我科 2 0 0 0年 1月～ 2 0 0 1年 10月 ,应用 810ｎｍ激光经巩膜睫状体光凝治疗晚期青光眼 31例 ,共 34眼 ,经积极预防、观察和护理 ,并发症明显减少 ,取得满意疗效。1　临床资料1 1　对象31例中 ,双眼 3例 ,单眼 2 8例 ,共 34例 ,男性 16例 ,女性15例 ,年龄 17～ 70岁。其中慢性闭角青光眼 11眼 ,新生血管型青光眼 10眼 ,急性闭角青光眼 5眼 ,其他继发性青光眼6眼 ,青少年型青光眼 2眼。视力 :无光感 11眼 ,有光感 2眼 ,手动 5眼 ,指数 16眼 ,所有患者均见视神经萎缩。眼压 :34眼中 ,最低眼压 34.5 2ｍｍＨｇ ,最高眼压 117.8ｍｍＨｇ ,平…     

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.