双侧额叶脑挫裂伤42例诊治体会

我院于2005年1月至2007年12月收治双侧额叶脑挫裂伤患者42例，占同期颅脑损伤病人的4．2％，现将诊治体会报告如下。     

脑出血合并神经源性肺水肿相关危险因素分析

目的:探讨脑出血合并神经源性肺水肿(NPE)的相关危险因素.方法:收集脑出血无合并NPE患者和脑出血合并NPE患者各45例,对两组患者的年龄、性别、格拉斯哥昏迷评分、心率、脑钠肽、氧合指数和血清高教C-反应蛋白行对照分析和Logistic回归分析.结果:两组比较,年龄、性别、GCS评分和血清高敏C-反应蛋白差异无统计学意义(P>0.05),心率、脑钠肤和氧合指数差异有统计学意义(P<0.05);Logistic回归分析结果显示心率增快(OR:1.053,P<0.05)和脑钠肽升高(OR:1.002,P<0.05)为脑出血合并NPE的独立危险因素.氧合指数是脑出血合并NPE的保护因素(OR:0.965,P<0.05).结论:心率增快和脑钠肽升高是脑出血合并NPE的独立危险因素,而氧合指数是脑出血合并NPE的保护因素.     

不同浓度罗哌卡因术后臂丛神经镇痛的效果观察

Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.     

不同浓度罗哌卡因术后臂丛神经镇痛的效果观察

Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.     

血肌酐水平对急诊室急性 ST 段抬高型心肌梗死患者死亡的预测价值

目的：探讨血肌酐水平对急诊室急性ST段抬高型心肌梗死（ STEMI ）患者30 d死亡的预测价值。方法收集急诊室首诊的年龄≥18岁确诊的119例STEMI患者。记录患者临床资料、血肌酐结果，并对患者进行30 d的随访，随访内容为30 d的全因死亡。结果30 d随访中，有17例（14．3％）发生死亡。血肌酐＞112μmol／L预测患者发生死亡的敏感度为70．59％，特异度为82．35％，其预测STEMI患者30 d发生死亡的ROC曲线下面积为0．796（95％CI 0．713～0．865）。结论当急诊首次血肌酐＞112μmol／L时，对STEMI患者30 d后死亡有较好的预测价值。     

血清神经元烯醇化酶水平对急性脑梗死患者转归的预测价值

目的 探讨血清神经元烯醇化酶（NSE）水平与急性脑梗死患者短期预后的相关性.方法 选择急性脑梗死患者100例,出院时根据评定改良Rankin量表评分（mRS评分）对患者进行分组,mRS评分0～2分为预后良好组,mRS评分3～6分为预后不良组.比较两组血清NSE水平以及临床资料.结果 预后良好组62例,预后不良组38例.两组年龄、性别、高血压病、2型糖尿病、高脂血症、缺血性心脏病、TIA、既往卒中、吸烟和喝酒史比较,差异无统计学意义（P均＞0.05）.预后不良组患者入院NIHSS为10.0分,NSE水平13.8 mg/L,预后良好组分别为4.0分和10.8 mg/L,P均＜0.01.多因素Logistic回归分析显示,NSE水平为预后不良患者的独立危险因素（OR=1.180,95％CI：1.029 ～ 1.351,P=0.017）.以血清NSE水平预测患者预后不良的Cutoff值为＞11.87 mg/L,其曲线下面积为0.732（P ＜0.001）.结论 血清NSE水平是判断急性脑梗死患者预后的良好生物指标.     

急诊监护室患者流行病学特征分析

目的 探讨急诊监护室的疾病谱、季节、时间、年龄及死亡原因分布等流行病学特点。 方法 回顾性分析2013-2014年广州医科大学附属第二医院急诊监护室的1 320名病人的诊疗资料,对患者的性别、年龄、就诊时间、急诊诊断、去向等进行调查统计分析。 结果 就诊患者中男性749例,女性571例,男女比例为1.31:1,年龄(70.48 ±17.20)岁。高发年龄组为61~85岁,1、3、5月为就诊高峰月份,前3位疾病是呼吸系统疾病(28.7%)、循环系统疾病(24.7%)、神经系统疾病(21.2%);入院率56.2%;死亡患者中以神经系统疾病病死率最高,为27.50%,其次为呼吸系统疾病(23.75%)、泌尿系统疾病(15.00%)。 结论 广州地区急诊监护室患者主要为老年呼吸系统、循环系统及神经系统疾病,应合理地进行急诊资源配置,提高抢救成功率。