两种透析方式患者经济负担与生活质量的比较

目的 探讨血液透析（HD）、腹膜透析（PD）两种肾脏替代治疗的患者经济负担和生活质量。方法 针对我中心维持透析≥6个月的HD、PD患者,回顾性调查其年平均经济负担及现阶段生活质量。结果HD组和PD组的年平均透析费用分别为（75619±42008）元、（53408±6667）元,2组比较有统计学差异（P〈0．05）;HD组和PD组总的经济负担分别为（100403±44419）元、（79859±22209）元,2组比较有统计学差异（P〈0．05）。PD组在生活质量方面（总体健康、精神健康、情感职能、躯体疼痛以及肾病负担、社交质量、症状与不适、肾病影响、满意度）得分优于PD组。结论HD患者疾病经济负担高于PD患者。PD在生活质量的某些维度上优于HD,应进一步推广使用PD。     

MR弹性成像及其临床应用

触诊是指医生通过触摸感觉组织在外力作用下的变形反应来探测肿瘤或其他异常组织的存在.触诊的应用常局限于人体表面的器官,是一种定性、主观的检查方法,受医生个体触觉敏感性的限制,应用范围较局限.弹力成像技术自1991年由Ophir提出以来,在超声和MRI领域得到广泛关注并迅猛发展,已经成为医学成像的一个研究热点[1].目前,MR弹性成像(MRE)是在常规MRI基础上发展起来的新技术,是一种机械化、定量化的触诊手段,具有客观、分辨率高、无创、不受诊断部位限制的优点,被称作"影像触诊".     

高原性红细胞增多症官兵睡眠质量和认知功能调查

2007年9月至2008年4月,作者调查了拉萨和日喀则两地的官兵230名,观察高原地区高原性红细胞增多症(高红症)官兵的睡眠质量和认知功能,报道如下.     

低分子右旋糖酐致大疱表皮松解型药疹1例

大疱表皮松解型药疹是1958年首次发现的一种严重的变态性药疹，较少见，初起致死率达47％，1993年降至25％．本科于2009年2月成功救治1例，现报告如下。     

牵引手法熏法治疗下颈椎失稳60例

目的:观察三联疗法(牵引、手法、中药熏药法)治疗轻中度下颈椎失稳的临床疗效。方法:治疗组采用三联疗法治疗,对照组采用牵引治疗。结果:治疗组治愈率和总有效率分别为40.0%和92.6%,对照组分别为16.3%和86.1%,两组比较差异均具有统计学意义(P<0.01)。两组治疗前后自身比较,功能量表评分均降低,X线摄片显示,其角位移和水平位移均减少,差异均有统计学意义(P<0.01),且治疗组优于对照组(P<0.01)。结论:对于轻中度下颈椎失稳的患者三联疗法的效果优于牵引治疗。     

重症高血压脑出血的外科干预治疗

目的探讨外科治疗重症高血压脑出血的效果。方法根据出血部位、出血量及血肿是否破入脑室,选择早期或超早期（出血后7h内）小骨窗开颅血肿清除术、开颅血肿清除并去骨瓣减压术、单侧或双侧脑室外引流手术治疗了154例重症高血压脑出血病人,平均随访2年,观察术后病人恢复情况和日常生活能力。结果按日常生活能力分级法（ADL）,Ⅰ级16例（10.4%）,Ⅱ级36例（23.4%）,Ⅲ级38例（24.7%）,Ⅳ级22例（14.3%）,Ⅴ级4例（2.6%）,死亡38例（24.7%）。结论对条件适合的重症高血压脑出血病人应早期或超早期手术治疗,可明显减少后遗症及降低病死率。     

下鼻甲手术适应证讨论

慢性鼻炎的鼻腔通气障碍主要是由于下鼻甲＂肥大＂引起的,但是下鼻甲肥大还是肿大目前尚未定论。下鼻甲肥大是指鼻甲黏膜结缔组织增生,用血管收缩剂后黏膜无明显反应;下鼻甲肿大则对血管收缩剂很敏感。     

小切口单侧固定的经椎间孔椎体间融合治疗下腰椎退行性疾病中期疗效评价

Objective To evaluate the mid-term clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw fixation for lower lumbar degenerative diseases. Methods From April 2004 to December 2005, minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation was performed in a consecutive series of 43 patients, including 24 male and 19 female, aging from 38 to 71 years, with an average age of 49 years. The length of surgical incision was 3 cm. The operation level at L3.4 were 3 cases, L4.5 27 cases,L5-S1 13 cases and no case was at multilevel. Clinical outcomes were assessed by ODI scores and JOA questionnaires before and after operation. Operation time, intraoperative blood loss, incision status and complications were recorded. Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and the degeneration of adjacent segments. Results The mean operation time was 110 minutes, the mean blood loss was 150 ml and all the incisions were healed primarily. The follow-up time ranged from 36 to 58 months. The ODI scores decreased significantly from 60 ± 10 preoperatively to 12 ±4 postoperatively(P < 0. 01). The JOA scores were improved remarkably from 9. 6±2. 2 preoperatively to 23. 8±2.0 postoperatively ( P < 0. 01 ) and the proportion with optimal effect was 86%. The ventral and dorsal heights of intervertebral disc were significantly higher than those before operation ( P < 0. 01). The fusion rate was 94%. The incidence of adjacent segment degeneration was 17%. There were no complications such as secondary scoliosis, screw loosening, internal fixation failure and cage slippage. Conclusions The minimally invasive TLIF through paramedian approach with unilateral pedicle screw fixation is an effective and convenient method with little surgical trauma. The mid-term follow up results showed favorable outcomes in patients receiving this surgery.