经皮椎体成形骨水泥注入治疗老年脊椎骨质疏松压缩性骨折的疗效

目的观察经皮椎体成形骨水泥注入治疗老年脊椎骨质疏松压缩性骨折的疗效。方法选取我院2014年3月至2016年3月收治的40例老年脊椎骨质疏松压缩性骨折患者作为研究对象,在确定所有患者或家属均已经如实掌握此次研究方案内容并签署知情同意书后随机分为对照组及研究组各20例,对照组采取开放手术治疗,研究组采取经皮椎体成形骨水泥注入治疗,比较两组患者临床疗效。结果两组患者围术期指标、VAS评分、BMD、椎体高度、Cobb角相比较,差异有统计学意义(P<0.05)。结论经皮椎体成形骨水泥注入治疗老年脊椎骨质疏松压缩性骨折疗效确切,可作为临床治疗的优选方案加以推广使用。     

经皮椎成型术治疗骨质疏松性椎体压缩性骨折临床体会

目的:探讨经皮椎成型术治疗骨质疏松性椎体压缩性骨折临床体会。方法:将2013年12月~2016年12月在某院骨科治疗的60例骨质疏松性椎体压缩性骨折患者随机分为两组,对照组采用经皮椎体后凸成形术(PKP),观察组采用经皮椎体成形术(PVP),比较两组患者的治疗效果、手术情况、术后疼痛及脊柱功能情况。结果:观察组治疗有效率为93.33%,对照组的治疗有效率为96.67%,差异无统计学意义(P>0.05);观察组手术时间及骨水泥注入量少于对照组,差异有统计学意义(P<0.05);观察组术后VAS疼痛评分、ODI指数、病椎椎体高度、Cobb角与对照组相比无明显差异(P>0.05)。结论:经皮椎成型术治疗骨质疏松性椎体压缩性骨折效果显著,能有效缓解患者腰部疼痛,改善腰部功能,手术操作安全可靠,具有积极的临床意义。     

不同方法治疗老年骨质疏松性椎体压缩骨折的疗效分析

目的探讨不同方法治疗老年骨质疏松性椎体压缩骨折的疗效。方法选择2016年6月至2017年3月老年骨质疏松性椎体压缩骨折患者90例根据治疗方法分组。对照组给予经皮椎体成形手术治疗,观察组则给予经皮椎体后凸成形手术治疗。比较两组老年骨质疏松性椎体压缩骨折治疗效果;手术出血、骨水泥用量;治疗前后患者疼痛、Cobb角、腰椎功能障碍指数、椎体前壁高度、椎体中间高度;骨水泥渗漏发生率。结果观察组老年骨质疏松性椎体压缩骨折治疗效果和对照组无明显差异,P> 0.05;观察组手术出血、骨水泥用量和对照组无明显差异,P> 0.05;治疗前两组疼痛、Cobb角、腰椎功能障碍指数、椎体前壁高度、椎体中间高度相近,P> 0.05;治疗后观察组疼痛、Cobb角、腰椎功能障碍指数、椎体前壁高度、椎体中间高度优于对照组,P <0.05。观察组骨水泥渗漏发生率显著低于对照组,P <0.05。结论经皮椎体后凸成形手术治疗老年骨质疏松性椎体压缩骨折的应用效果确切,可更好恢复椎体结构和功能,减轻疼痛,减少骨水泥渗漏,值得推广应用。     

单侧及双侧穿刺治疗骨质疏松椎体压缩性骨折的效果比较观察

目的比较观察单侧与双侧穿刺疗法对骨质疏松椎体压缩性骨折的临床效果。方法将骨质疏松椎体压缩性骨折患者110例随机分成试验组和对照组各55例。2组均采取经皮穿刺后凸成形术进行治疗,试验组经单侧穿刺后注入骨水泥,对照组经双侧穿刺后注入骨水泥。观察2组骨水泥注入量、手术时间、穿刺时的透视次数及Cobb角。结果试验组骨水泥注入量少于对照组,手术时间短于对照组,透视次数少于对照组,差异均有统计学意义(P<0.05)。全部患者均顺利完成手术,手术过程中均未发生脊髓损伤、神经损伤和球囊破裂。结论单侧穿刺疗法治疗骨质疏松椎体压缩性骨折效果更佳,而且创伤小、射线暴露时间短、操作时间较短,优于双侧穿刺治疗,值得临床推广应用。     

经皮椎体后凸成形术联合唑来磷酸治疗骨质疏松椎体压缩性骨折的临床研究

目的 观察骨质疏松椎体压缩性骨折采用经皮椎体后凸成形术联合唑来磷酸治疗的效果.方法 选择本院2013年8月~2015年8月收治的骨质疏松椎体压缩性骨折患者37例,回顾性分析其临床资料,观察治疗效果.结果 37例患者手术时间(44.1±2.6)min;骨水泥注入量(4.1±0.9)mL.术后12个月时,疼痛评分、Beck值低于术后1周,Cobb角高于术后1周,差异具有统计学意义(P<0.05).结论 应用经皮椎体后凸成形术联合唑来磷酸治疗骨质疏松椎体压缩性骨折患者时,具有良好的治疗效果,可提升患者的生活质量.     

PKP 与 PVP 治疗骨质疏松性椎体压缩骨折的临床效果比较

目的：探讨经皮椎体后凸成形术（ PKP）治疗椎体骨质疏松致椎体压缩骨折的临床效果。方法按照入院顺序将2011年1月至2013年7月收治的91例椎体骨质疏松致椎体压缩性骨折患者分为PKP组（45例）和PVP组（46例）,PKP组采用经皮椎体后凸成形术治疗,PVP组采用经皮椎体成形术治疗,比较2组患者治疗后的VAS评分、Cobb角、椎体高度、ODI评分等指标的变化情况。结果 PKP组患者的评价2手术时间（38\．4±8．2）min、骨水泥注入量（6．1±1．8）ml均显著大于PVP组,但骨水泥渗漏椎体数显著的低于PVP组（ P <0．05）。术前PKP组和PVP组的VAS评分、Cobb角、椎体高度、ODI评分差异无统计学意义（ P >0．05）;术后1周、术后6个月2组患者的VAS评分较治疗前均显著的降低（ P <0．05）,2组间差异无统计学意义（ P >0．05）;术后6个月,PKP组的Cobb角（17．1±1．6）度、椎体高度（78．9±7．2） mm、ODI评分（14．2±2．5）分均显著的优于同期PVP组患者（ P <0．05）。结论对于椎体骨质疏松致椎体压缩性骨折患者采用PVP与PKP均能够取得较好的疗效,但PKP对于术后椎体高度恢复、Cobb角恢复、功能恢复等效果更加显著。     

高粘度骨水泥PVP治疗老年骨质疏松椎体压缩骨折的疗效分析

目的探讨高粘度骨水泥经皮椎体成形术(PVP)治疗老年骨质疏松椎体压缩骨折的疗效。方法选取2016年6月～2018年6月间到我院行PVP治疗的骨质疏松椎体压缩骨折的老年患者共120例,按照随机原则分为两组,观察组60例患者采用高粘度骨水泥,对照组60例患者采用低粘度骨水泥,比较两组患者疗效。结果两组患者术前各项指标、术中骨水泥灌注量比较,差异无统计学意义(P 0.05),术后观察组患者VAS评分、ODI评分比较,差异有统计学意义(P 0.05),Cobb角比较,差异有统计学意义(P 0.05),椎体前缘、中线高度比较,差异有统计学意义(P 0.05),骨水泥静脉渗漏率、椎间渗漏率、椎旁渗漏率比较,差异有统计学意义(P 0.05)。结论高粘度骨水泥PVP治疗老年骨质疏松椎体压缩骨折较低粘度骨水泥疗效更为确切,骨水泥渗漏率更低,建议临床推广应用。     

经皮椎体成形术治疗脊椎压缩性骨折的效果评价

目的探究经皮椎体成形术治疗脊椎压缩性骨折的效果评价。方法选取2013年10月1日～2017年12月26日本院收治的脊椎压缩性骨折患者64例的临床资料,对其进行随机分组,观察组采取经皮椎体后凸成形术治疗;对照组实施经皮椎体成形术治疗,对两组术后疼痛、临床指标和治疗效果进行观察和分析。结果观察组脊椎压缩性骨折患者治疗后疼痛评分、手术时间、骨水泥注入量与对照组比较,差异无统计学意义(P> 0.05)。观察组脊椎压缩性骨折患者手术后伤椎增加高度、伤椎丢失高度均优于对照组,差异有统计学意义(P <0.05);观察组脊椎压缩性骨折患者治疗有效率为93.8%显著高于对照组,差异有统计学意义(P <0.05)。结论骨质疏松性椎体压缩骨折应用PVP治疗或是PKP治疗均有显著效果,但是PKP术后对伤椎增加高度、伤椎丢失高度均优于对照组。     

探讨经皮椎体成形术治疗老年骨质疏松性胸腰椎压缩性骨折的疗效

目的探究经皮椎体成形术治疗老年骨质疏松性胸腰椎压缩性骨折患者的临床效果。方法 60例老年骨质疏松性胸腰椎压缩性骨折患者,采用随机分组法分为对照组和实验组,各30例。对照组采用保守疗法进行治疗,实验组采用经皮椎体成形术进行治疗。比较两组患者治疗效果、视觉模拟评分法(VAS)评分及Cobb角。结果实验组患者治疗总有效率为93.33%,其中显效17例,有效11例,无效2例;对照组患者治疗总有效率为60.00%,其中显效10例,有效8例,无效12例。实验组患者治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。对照组患者VAS评分为(5.6±1.3)分, Cobb角为(17.4±4.2)°;实验组患者VAS评分为(2.1±0.6)分, Cobb角为(10.6±3.0)°;实验组患者VAS评分明显低于对照组, Cobb角明显小于对照组,差异有统计学意义(P<0.05)。结论采用经皮椎体成形术对老年骨质疏松性胸腰椎压缩性骨折患者进行治疗,其临床效果显著,可有效改善患者的疼痛状况,降低骨水泥渗漏风险,具有较好的临床应用价值,值得推广使用。     

经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折的效果及对VAS评分的影响研究

目的研究经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折的效果及对VAS评分的影响。方法本次研究选取的研究对象为2014年7月至2016年7月在我院进行治疗的骨质疏松性胸腰椎压缩性骨折患者,将36例患者计算机随机分为2组,18例/组。一组患者实施保守治疗(对照组),另一组采用经皮椎体成形术治疗(观察组)。对比两组的VAS评分、椎体前缘高度、椎体后缘高度以及Cobb角。结果观察组骨质疏松性胸腰椎压缩性骨折患者治疗后的VAS评分、椎体前缘高度和Cobb角均优于对照组患者(P<0.05),两组患者的椎体后缘高度对比无统计学意义。结论在治疗骨质疏松性胸腰椎压缩性骨折中应用经皮椎体成形术的效果显著,可减轻患者的疼痛程度。     

上海市社区卫生服务中心医务人员伦理学知识调查及建议

目的:调查上海社区卫生服务中心医务人员的伦理学知识认知情况.方法:采取分层抽样方式,于2016年6—8月对上海市245家社区卫生服务中心的7552名医务人员进行问卷调查.结果:医务人员对伦理学知识非常了解、基本了解、了解很少和完全不了解的人数分别为536人(7.1%)、5411人(71.7%)、1536人(20.3%)和69人(0.9%).不同岗位、职称、学历的医务人员之间存在着明显的伦理学知识认知差距.结论:上海社区卫生服务中心医务人员的伦理学知识了解程度仍有待提高,需加强伦理学知识的学习和应用.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Studies on the receptors involved in the action of the various agents in the phenylbenzoquinone analgesic assay in mice

1. Tolerance to the activity of several narcotic analgesics (morphine, levorphanol, and methadone) and several narcotic-antagonist analgesics (pentazocine, cyclazocine, and nalorphine) was studied in the mouse phenylbenzoquinone stretching test. Virtually complete tolerance was induced by chronic treatment with each of the narcotic agents, while no apparent tolerance was induced by the narcotic antagonists.2. In morphine-tolerant mice there was a high degree of cross-tolerance to the effects of not only the other narcotic drugs but also to those of the narcotic antagonists, acetylsalicylic acid, and physostigmine.3. The effects of morphine and pentazocine were antagonized by naloxone but not by atropine, while the effects of physostigmine were antagonized by atropine but not by naloxone. Neither atropine nor naloxone antagonized the effect of acetylsalicylic acid.4. The results of the tolerance study suggest that there is a fundamental difference in the consequences of receptor interaction for the narcotic and the narcotic-antagonist analgesics. Morphine-tolerant mice exhibit cross-tolerance non-specifically. The selectivity of naloxone and atropine differentiates the narcotic and narcotic-analgesics from the other two agents used in this analgesic test.     

Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

Neurotensin causes a greater increase in the metabolism of dopamine in the accumbens than in the striatum in vivo

Differential pulse voltammetry with carbon fibre electrodes was used to study the effect of central administration of neurotensin on the extracellular level of 3,4-dihydroxyphenylacetic acid (DOPAC) in the nucleus accumbens and the striatum in anaesthetised rats. Intracerebroventricular injection of neurotensin (10 micrograms) increased the peak height for DOPAC 20 min after administration in the nucleus accumbens but only after 40 min in the striatum. The maximum increase was similar in both regions, with 30% and 27% above the pre-injection basal level, respectively. Neurotensin (1 micrograms) however increased the extracellular level of DOPAC in the nucleus accumbens alone. Neurotensin (0.1, 1.0 and 3.0 micrograms/0.5 microliter), injected into the ventral tegmental area, induced a potent and long-lasting elevation of the peak height for DOPAC in the nucleus accumbens, while the same doses in the substantia nigra produced effects on the metabolism of dopamine in the striatum of smaller amplitude and shorter duration. The maximum effect of each dose was about 2.5 times greater in the mesolimbic, compared to the nigrostriatal system. Amphetamine (2 mg/kg, s.c.) decreased the extracellular level of DOPAC with a similar magnitude, both in the nucleus accumbens (52%) and the striatum (47%). Intracerebroventricular administration of neurotensin (1 micrograms), 5 min after amphetamine, did not alter the effect of amphetamine on the extracellular level of DOPAC either in the nucleus accumbens or the striatum. However, neurotensin (10 micrograms) partially reversed the effect of amphetamine in the nucleus accumbens and had a similar but smaller and delayed effect in the striatum. The results from the present study, together with previous neurobehavioural studies, suggest that neurotensin has a relatively selective action on the mesolimbic dopaminergic system in the rat.     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

抗生素在预防普外科手术切口感染中的价值分析及其预防

目的:分析抗生素在预防普外手术切口感染中的临床价值.方法:选择我院收治的100例普外科手术患者作为观察对象(2015年2～11月),采用随机分组的方式将100例普外科手术患者分成对照组与实验组,分别在术后使用抗生素及术前1h使用抗生素,观察两组手术切口感染率及患者的疼痛评分.结果:对照组切口感染率(16.00％)明显高于实验组(4.00％),两组之间对比疼痛评分存在显著差异(P＜0.05),有统计学意义.结论:针对普外科手术患者根据患者的切口类型科学、合理选择抗生素及选择适当的使用时间能有效减少术后手术切口感染,有效改善患者预后.     

女性医务人员健康状况的研究

目的探讨女性医务人员健康状况的特点。方法对2877例医院工作人员健康查体资料进行统计学分析。结果①女性医务人员中,41.0%的人员患有不同类型的疾病,略高于男性患病率（36.8%）,二者差异有统计学意义（P=0.029）;②女性医务人员高脂血症为31.9%（212/665）,低于男性（65.9%,274/416）;③脂肪肝患病率女性（32.6%,181/556）,亦低于男性（45.9%,151/329）;④女性相关疾病中,乳腺疾病和子宫肌瘤的患病率分别为4.8%和3.4%;而宫颈糜烂为20.2%;⑤女性医务人员高血糖为11.0%（77/702）,高血压为4.6%（56/1229）。结论女性医务人员中妇科与乳腺疾病是健康体检的重点,代谢性疾病也应加以关注。