开颅手术患者术后颅内感染的病原菌分布与耐药性分析

目的调查开颅手术患者术后颅内感染的病原菌分布及耐药性,为临床合理选用抗菌药物提供依据。方法回顾性分析医院2010年1月-2014年6月行开颅术治疗的278例患者临床资料,统计分析颅内感染发生率、感染病原菌分布及其耐药率,使用Microsoft office Excel 2003对调查数据进行统计分析。结果 278例开颅手术患者术后发生颅内感染25例,感染率为9.0%;共分离鉴定出39株病原菌,其中革兰阴性菌24株占61.5%,革兰阳性菌15株占38.5%;肺炎克雷伯菌对庆大霉素、头孢他啶和头孢曲松耐药率分别为25.0%、25.0%和37.5%,对美罗培南耐药率为0,鲍氏不动杆菌对环丙沙星、妥布霉素、氨曲南、亚胺培南和哌拉西林/他唑巴坦的耐药率分别为25.0%、25.0%、37.5%、37.5%和12.5%;表皮葡萄球菌对青霉素G、克林霉素、红霉素、亚胺培南、头孢唑林和磺胺甲噁唑/甲氧苄啶等抗菌药物具有较强耐药性,耐药率为55.6%~100.0%。结论开颅手术患者颅内感染率较高,感染病原菌以革兰阴性菌为主,具有耐多药特点,临床应加强病原菌监测,掌握病原菌特点,指导临床用药。     

医疗改革前后患者就诊消费情况调查分析

采用了自行设计的医疗改革前后患者的就诊消费情况问卷调查表，于2004年4月至5月间对杭州市内省市级综合性医院和社区医院的门诊就诊者进行了问卷调查。调查结果显示：医疗改革前后患者在就诊感冒一类较轻疾病或病情较稳定的慢性病时的消费选择发生了明显改变，医改后得此类疾病的患者选择社区医院的频数增长显著；而在就诊花费较大或病情严重的疾病时惠者的消费选择频数分布改变并不明显。结果还显示近一半患者认为医改后医疗费用有所上升，30％的患者认为无变化，20％的患者认为有所下降。医改后也有55％的患者曾有在医院开药方，再到平价药房买药的经历。建议各级医院要审时度势，分析自身的情况，扬长避短，合理定位，调整自身的服务方式和服务结构，发挥各自的优势，为患者服好务。     

外伤性脑脊液鼻漏术前漏口的影像学定位

外伤性脑脊液鼻漏是颅脑损伤常见的并发症之一,特别是在合并前颅底骨折的患者中,其发生率可达39%[1].脑脊液漏手术修补前通过神经影像学技术对漏口进行精确的定位,不仅能够提高手术探查修补的成功率,减少不必要的暴露,同时也为开展微侵袭神经外科技术进行脑脊液鼻漏的修补手术创造了条件.笔者将MR脑池造影术(MRC,magnetic resonance cisternography)与高分辨率CT(HRCT,high-resolution com-puter tomorgraphy)检查结果结合,作为脑脊液鼻漏术前定位检查技术;同时根据检查结果,对具体患者选择相应的手术方式,取得了良好的效果.现报告如下.     

中西医结合治疗心绞痛78例

心绞痛是内科学常见病,严重地影响人民的健康和生命.笔者自1978-2001年以中药补肾为主,结合西药治疗冠心病78例,并与单纯西药治疗23例相比,疗效满意.     

Efficacy of large decompressive craniectomy in severe traumatic brain injury

Objective： To investigate the role of large decompres- sive craniectomy （LDC） in the management of severe and very severe traumatic brain injury （TBI） and compare it with routine decompressive craniectomy （RDC）.
Methods： The clinical data of 263 patients with severe TBI （GCS~8） treated by either LDC or RDC in our department were studied retrospectively in this article. One hundred and thirty-five patients with severe TBI, including 54 patients with very severe TBI （GCS ≤ 5）, underwent LDC （LDC group）. The other 128 patients with severe TBI, including 49 patients with very severe TBI, underwent RDC （RDC group）. The treatment outcome and postoperative complications of the two treatment methods were compared and analyzed in a 6-month follow-up period.
Results： Ninety-six patients （71.7 %） obtained satisfactory treatment outcome in the LDC group, while only 75 cases （58.6 %） obtained satisfactory outcome in the RDC group （P〈 0.05）. Moreover, the efficacy of LDC in treating very severe TBI was higher than that of RDC （63.0 % vs. 36.7 %, P 〈 0.01）. The chance of reoperation due to refractory intracranial pressure （ICP） in the LDC group was significantly lower than that of the RDC group （P 〈 0.05）, while the incidences of delayed intracranial hematoma and subdural effusion were significantly higher than those of the RDC group （ P 〈 0.05）.
Conclusions： LDC is superior to RDC in improving the treatment outcome of severe TBI, especially the very severe ones. LDC can also efficiently reduce the chances of reoperation due to refractory ICP. However, it increases the incidences of delayed intracranial hematoma and contralateral subdural effusion.     

Surgery for posttraumatic syringomyelia： a retrospective study of seven patients

Objective： To analyze retrospectively the clinical symptoms, signs, radiological findings and results of treatment of posttraumatic syringomyelia. Methods： The data of 7 patients with posttraumatic syringomyelia confirmed by computerized tomography （CT） and magnetic resonance imaging （MRI） in our hospital between 1999 and 2004 were reviewed retrospectively. The patients underwent decompressive laminectomy or syringo-subarachnoid （S-S） shunting with microsurgery. Long-term follow-up was available （range： 13-65 months）. Results： The major dinical manifestations of posttraumatic syringomyelia usually included the onset of increasing signs and the development of new symptoms after an apparently stable period. The clinical symptoms included pain, sensory disturbance, weakness, and problems in autonomic nerves. Syrinx existed merely at the cervical level in 4 cases and extended downward to the thoracic levels in the other 3 cases. One case underwent decompressive laminectomy, 6 cases were treated by S-S shunting. During the early postoperative period, all the patients showed an improvement of symptoms of syrinx without major complication or death. The decreased size or collapse of the syrinx was demonstrated by postoperative MRI. Conclusions ： Posttraumatic syringomyelia is a disabling sequela of spinal cord injury, developing months to years after spinal injury. MRI is the standard diagnostic technique for syringomyelia. The patients with posttraunmtic syringomyelia combined with progressive neurological deterioration should be treated with operations. S-S shunting procedure is effective in some patients with posttraumatic syringomyelia. Decompressive procedure may be an alternative primary surgical treatment for patients with kyphosis and cord compression.     

甘海胃康治疗慢性萎缩性胃炎随机平行对照研究

[目的]观察甘海胃康治疗慢性萎缩性胃炎疗效。[方法]使用随机平行对照方法,将214例住院患者按掷骰子法简单随机分为两组。对照组118例胃复春,1.436g/次,3次/d。治疗组118例甘海胃康,2.4g/次,3次/d。观测临床症状、症状积分、X线钡餐造影、胃镜、不良反应。连续治疗90d为1疗程。连续治疗2疗程,判定疗效。[结果]治疗组痊愈11例,有效96例,无效11例,总有效率90.68%。对照组痊愈12例,有效71例,无效13例,总有效率86.46%。治疗组疗效优于对照组(P0.05)。症状积分两组均有改善(P0.05),治疗组改善优于对照组(P0.05)。[结论]甘海胃康治疗慢性萎缩性胃炎效果显著,值得推广。     

A20基因对大鼠颅脑损伤的治疗作用

目的 研究A20基因在创伤性颅脑损伤(traumatic brain injury,TBI))中的抗凋亡脑保护作用.方法 实验组与对照组各35只SD大鼠,制作重度TBI模型后,实验组与对照组分别在伤后30 min,在立体定向仪下向损伤灶周边皮质及损伤灶内多点注射脂质体-pcDNA3.1-A20和脂质体-pcDNA3.1空质粒.两组分别于术后12,24,48,72,168 h各取5只大鼠取脑制作切片,免疫组化法检测A20基因的表达和损伤后细胞凋亡的情况;每组剩余的另10只大鼠于TBI后第1,2,3,4周,进行斜板试验测试其神经功能.结果 (1)实验组损伤灶周边A20表达显著高于对照组(P<0.01).(2)TBI后可见损伤侧皮质、海马分布有不同数量的凋亡细胞,以损伤灶周围皮质最为集中;两组的细胞凋亡均在TBI后72 h达到高峰.实验组TBI后12,24,48及72 h神经凋亡数量较对照组明显降低(P<0.01或0.05).(3)伤后第4周,实验组临界角度大于对照组(P<0.05).结论脂质体介导的A20基因治疗能够起到抗损伤后细胞凋亡的神经保护作用.     

复方防己黄芪汤治疗肾病综合征

笔者以复方防己黄芪汤为主,治疗54例肾病综合征病人,报告如下:1　一般资料54例均符合肾病综合征诊断标准。其中男性34例,女性20例;年龄15～65岁,多为18～40岁;最长病程者15年,最短者1年;气虚型23例,阳虚型11例,湿热型16例,瘀水交阻型5例。2　治疗方法2.1　一般治疗　均予低盐,低脂饮食,无明显氮质血症者,嘱进高蛋白饮食加服鲫鱼汤(鲫鱼一尾3～5两,砂仁、草果仁各10克,陈皮15克,生姜5克,浮肿明显而顽固者或血压颇高者,可以少量西药作相应处理。2.2　中药治疗　　方剂组成:黄芪、黄精、白术、汉防己、赤芍、虎杖、丹参、僵蚕、肉艹丛蓉、桑椹…