Richard钉内固定治疗老年粗隆间骨折手术并发症原因分析

目的：探讨Richard钉内固定治疗老年股骨粗隆间骨折手术并发症的原因。方法：回顾Richard钉内固定治疗老年粗隆间骨折146例临床资料，分析其中25例手术并发症的相关因素。结果：加压钉位置不良9例，髋内翻7例，Richard钉板松动3例，深部血肿、脂肪液化、局部骨吸收各2例。手术并发症相关因素还包括年龄、骨质量、骨折程度、手术适应证选择、手术技术等。结论：骨质疏松、骨折局部骨缺损是老年粗隆间骨折主要病理特征。选择Richard钉内固定须注意患者年龄、骨折类型、骨质量等。手术技术的优劣是避免手术并发症决定性因素。     

腰椎间盘突出症术后并发症原因分析

腰椎间盘突出症(lumber disc herniation，LDH)是一种常见病，随着现代影像技术的发展，LDH诊断水平明显提高，很多基层医院都能进行椎间盘髓核摘除术，然而术后失败率高达5％～20％。我院1996年2月～2003年2月，共手术治疗腰椎间盘突出432例，本文重点分析LDH术后并发症和失败的原因。     

氯丙米嗪促进局灶性脑缺血损伤大鼠运动功能恢复的特点

背景：去甲肾上腺素能药物苯丙胺可提高脑缺血后动物运动功能的恢复。氯丙米嗪抑制5-羟色胺和去甲肾上腺素再摄取，提高脑内去甲肾上腺素和5-羟色胺水平。目的：观察氯丙米嗪对局灶性脑缺血损伤后大鼠运动功能的作用。设计：随机分组设计，对照动物实验。单位：解放军第四军医大学航空临床医学教研室神经精神病学组。材料：实验在第四军医大学航空航天医学系形态学实验室完成。选择SD大鼠24只随机分为假手术组、缺血组、缺血用药组，每组8只。缺血用药组动物于缺血后24h经口灌注2．5g／L氯丙米嗪溶液（10mg／kg），1次／d。假手术组、缺血组动物经口灌注相应容量的蒸馏水。方法：采用插线法制作大脑中动脉缺血／再灌注大鼠模型，造模成功后进行①网屏握持试验：将网屏水平放置，将鼠放于其上，然后缓慢地将其一端抬高，在2s内将此网屏翻转成125&;#176;位，并保持于该位，记录大白鼠在网屏上握持的时间。②胶布撕脱试验：将0．5cm^2的医用胶布粘于大鼠两前爪腹侧商后，送其入观察箱中，记录其撕去胶布所使用的时间。各组实验动物在术后1，3，7，14，28d为观察时间点。主要观察指标：大鼠局灶性脑缺血后网屏握持时间和胶布撕脱时间。结果：①与假手术组比较，缺血组和缺血用药组大鼠网屏肌力测试时间缩短，差异非常显著[以术后3d为例，假手术组、缺血组、缺血用药组分别为（54&;#177;4），（20&;#177;5），（21&;#177;4）s，P〈0．01]。缺血用药组与缺血组比较网屏握持时间延长，差异显著[以术后28d为例，缺血组、缺血用药组分别为（51&;#177;5），（54&;#177;5）s，P〈0．05]。②缺血组和缺血用药组大鼠胶布撕脱时间均比假手术组长，差异非常显著[以术后3d为例，假手术组、缺血组、缺血用药组分别为（47&;#177;9），（188&;#177;20），（172&;#177;22）s，P〈0．01]。缺血用药组比缺血组大鼠胶布撕脱时间略短．差异无显著性（P〉0．05）。结论：氯丙米嗪对局灶性脑缺血后肌力恢复作用明显，而对感觉和精细运动功能作用不明显，此与偏瘫后肢体精细功能恢复差的特点相符。     

癌症患者亲属的焦虑、抑郁状况及相关因素研究

Objective The purpose of the study was to examine anxiety and depression in primary family caregivers of patients with cancer and to examine related factors that are associated with anxiety and depression of family caregivers.Methods The anxiety was rated with the Serf-Rating Anxiety Scale (SAS) and the depression rated with the Center for Epidemiological Survey,Depression Scale ( CES-D ).The general conditions of the caregivers were collected with questionnaires designed by authors among the 106 primary family earegivers for inpatients having cancer.Results The mean depression scores of caregivers rated by the 106 earegivers themselve for the cancer patients on the CES-D was ( 18.75±9.06),which was significandy higher than that of the normal samples in our country and exhibited a statistical difference (P＜0.01).55.7% of caregivers reported depression symptoms.In 106 caregivers,the score from self-rating anxiety scale is ( 33.94±7.09),which was higher than that of the normal samples in our country,having a statistical difference (P＜0.01).22.6% of the caregivers reported their SAS scores exceeded thresholds for clinical anxiety.The high anxiety index was significandy associated with the caregivers reported more patients symptoms,and the spouses of the patients were also at the high risk of anxiety.Conclusions A high level of severe anxiety and depression existed in primary family caregivers of cancer patients.The psychological status of caregivers was influenced by many kinds of factors.Health care personnel should actively provide corresponding interventions to improve the level of mental health in family caregivers of patients.     

合并冠心病的老年人的胆道手术问题

本文通过总结１８１例合并冠心病的老年人的胆道外科手术，指出老年人心血管系统有着特殊的解剖生理变化，而胆道疾患与心血管疾患在临床表现上有某些相似之处，因此在临床工作中应明确两者之间的关系，重视冠心病病人的手术问题，牢固掌握适应证，使他们安全渡过手术期，降低手术死亡率。     

血管性痴呆患者认知与非认知功能及尼莫地平联合甲磺酸二氢麦角碱的干预效应

目的:观察尼莫地平联合甲磺酸二氢麦角碱对血管性痴呆患者认知及非认知功能的改善及其应用的安全性。方法:选择2002-01/2004-05解放军第四军医大学西京医院收治的血管性痴呆患者80例,采用随机法分为两组。单用尼莫地平为对照组(n=40,口服尼莫地平片30mg,3次/d),尼莫地平联合甲磺酸二氢麦角碱为治疗组(n=40,口服尼莫地平片30mg,3次/d,甲磺酸二氢麦角碱2.5mg,2次/d),分别在入组前、治疗后45d和90d进行效果评定。①采用简易智能量表(总分30分)和长谷川痴呆量表(总分30分)评定认知功能。②采用日常生活能力量表(总分100分,分值越高,改善效果越好)、社会功能活动调查表(≤5分为正常,分值越低,改善效果越好)评定非认知功能。③采用简易智能量表评定智能改善效果(显效:治疗前后评分提高≥6分;有效:评分提高≥4分;无效:评分提高<4分)。④同时记录药物的副作用。结果:按实际处理分析,治疗组38例(95%)与对照组37例(93%)进入结果分析。①治疗前及治疗后45d:两组间各量表分值差异无显著性(P>0.05)。②治疗90d后两组认知功能评分比较:治疗组显著高于对照组犤简易智能量表评分(24,2±5.5,18.2±4.9);长谷川痴呆量表评分(23.8±6.2,18.9±4.2)(P<0.05)犦。③治疗90d后两组非认知功能评分比较:治疗组日常生活能力量表评分显著高于对照组(76.8±14.7,61.7±12.9)(P<0.05);治疗组社会功能活动调查表评分显著低于对照组(6.2±3.1,8.6±2.9)(P<0.05)。④治疗90d后两组智能改善效果比较:治疗组显著高于对照组(81.6%,59.5%)(P<0.05)。⑤两组治疗期间无明显的不良反应。结论:尼莫地平与甲磺酸二氢麦角碱的联合治疗血管性痴呆,与单独应用尼莫地平相比,可明显改善认知功能,提高日常生活能力,且具有良好的安全性,可作为血管性痴呆的一种治疗方案。     

神经衰弱患者的重心平衡功能障碍与氟桂利嗪的治疗作用

目的：观察神经衰弱患者平衡功能障碍的情况，比较氟桂利嗪和三环类药物的疗效。方法：将80例神经衰弱患者随机分为氟桂利嗪和三环类药物治疗组，用EAB-100重心平衡测定仪进行治疗前后平衡功能的观察。结果：神经衰弱患者平衡功能障碍主要表现在重心弥散，经氟桂利嗪治疗后重心轨迹图显示重心集中于中心。氟桂利嗪治疗组治疗后力学波谱(Freq)睁眼(0．32&;#177;0．06)Hz和闭眼(0．39&;#177;0．08)Hz状态下均较治疗前[(0．43&;#177;0．07)，(0．53&;#177;0．08)Hz]好转(t=8．940，9．037，P&;lt;0．05)。身体重心距坐标系中心的最大偏移距离(ARD)治疗后睁眼(3．20&;#177;1．47)mm，闭眼(4．80&;#177;1．86)mm较治疗前[(6．60&;#177;1．32)，(8.41&;#177;1．73)mm]好转(t=4．468，t=6．455，P&;lt;0．05)。三环类药物治疗组与氟桂利嗪组治疗效果相似，Freq与ARD均较前好转(t=7．127～12．352，P&;lt;0．05)。结论：氟桂利嗪是一种具有抗组胺、抗5-羟色胺和抗多巴胺活性的选择性钙离子内流阻滞剂，对神经衰弱患者的平衡功能障碍有明显的改善作用。     

癌症患者亲属的焦虑、抑郁状况及相关因素研究

Objective The purpose of the study was to examine anxiety and depression in primary family caregivers of patients with cancer and to examine related factors that are associated with anxiety and depression of family caregivers.Methods The anxiety was rated with the Serf-Rating Anxiety Scale (SAS) and the depression rated with the Center for Epidemiological Survey,Depression Scale ( CES-D ).The general conditions of the caregivers were collected with questionnaires designed by authors among the 106 primary family earegivers for inpatients having cancer.Results The mean depression scores of caregivers rated by the 106 earegivers themselve for the cancer patients on the CES-D was ( 18.75±9.06),which was significandy higher than that of the normal samples in our country and exhibited a statistical difference (P＜0.01).55.7% of caregivers reported depression symptoms.In 106 caregivers,the score from self-rating anxiety scale is ( 33.94±7.09),which was higher than that of the normal samples in our country,having a statistical difference (P＜0.01).22.6% of the caregivers reported their SAS scores exceeded thresholds for clinical anxiety.The high anxiety index was significandy associated with the caregivers reported more patients symptoms,and the spouses of the patients were also at the high risk of anxiety.Conclusions A high level of severe anxiety and depression existed in primary family caregivers of cancer patients.The psychological status of caregivers was influenced by many kinds of factors.Health care personnel should actively provide corresponding interventions to improve the level of mental health in family caregivers of patients.     

机化性肺炎2例

1病例报告 例1：男，57岁。胸闷、咳嗽1个月余，痰中带血2d入院。查、体；全身情况良好，化验检查正常。影像检查：胸部平片示左下肺有密度增高的块状阴影，边缘毛糙，拟有分叶，近胸膜处病灶边缘模糊不清。X线考虑左下肺占位性病变，建议CT进一步检查。CT检查：肺窗示左肺下叶前内基底段见不规则高密度块影，边缘见分叶，与左侧胸壁粘连，左下肺支气管分支管腔显示狭窄。纵隔窗示块状呈中等软组织影，密度较均匀，邻近后胸壁胸膜增厚。CT诊断：左下肺占位性病变（左下肺肺癌）。术前诊断：左下肺占位性病变（左下肺肺癌）。在全麻下行左下肺肿瘤切除术，术中、术后生命征稳定。病理报告：左下肺机化性肺炎。