急性中风溶栓治疗相关的非对称性血管神经性水肿

本文报告一例使用重组组织型纤维蛋白溶酶激活剂(rtPA)治疗急性缺血性中风相关的非对称性血管神经性水肿。曾有报道使用rtPA治疗急性心肌梗塞可以出现不典型的过敏样反应,但据作者所知,这是首例使用rtPA治疗急性缺血性中风所致的非对称性血管神经性水肿。 患者女,51岁,急性发病,出现左侧肢体轻瘫。     

特发性黄斑裂孔的黄斑裂孔直径、被破坏的光感受器细胞内外节直径及其与视力的相关性研究

Objective To observe the diameters of macular hole and destroyed boundary line between inner and outer segment (IS/OS) of the photoreceptors and the correlation with the visual acuity in patients with idiopathic macular hole(IMH). Methods The clinical data of 39 eyes (37 patients) with IMH were retrospective analyzed. All the patients had undergone the examinations of visual acuity (Snellen chart), intra-acular pressure, ocular fundus (indirect ophthalmoscope), and Fourier-domain optical coherence tomography (FD-OCT) whose speed was 27 000 A scan/s, area was 6.0 mm×6.0 mm, and the mode was 512×128. The diametres of macular hole and destroyed IS/OS, and the correlations with visual acuity were detected. Results The mean IogMAR was 0.99±0. 44 (ranged from 0. 15 to 2.00), the mean diameter of macular holes was (942.0± 348. 4)μm(ranged from 171 to 1491 μm), and the mean diameter of IS/OS disruption was (1870. 35±673.2) μm(range from 463 to 3176 μm). There was a significant correlation among the diameter of the macular hole, the diameter of the IS/OS disruption, and IogMAR in IMH (P= 0. 038, 0. 002, 0. 000). In eyes with closed macular hole after surgery, the IogMAR and the diameter of the IS/OS disruption had a significant decrease. Conclusion Using FD-OCT the photoreceptor changes can be visualized in vivo. The abnormality in the IS-OS boundary line appears to be involved for a much larger area beyond the macular hole itself, and persists there with small size even after the maeular hole closure surgery.     

玻璃体切割联合内界膜移植、气体填充手术治疗美容激光致双眼黄斑裂孔一例

患者男,21岁.职业为激光器操作美容师.2012年6月28日因激光损伤致右眼黄斑裂孔,手术后裂孔未愈合近1年来我院就诊.2011年2月25日患者被固体美容激光晃眼后即感觉双眼轻度疼痛,视力下降,视物发暗.激光波长1604 nm,能量500 mJ.损伤后1h到当地医院就诊,经眼底照相及光相干断层扫描(OCTT)检查,发现双眼黄斑裂孔(图1).4个月后分别行双眼气体填充和玻璃体切割联合气体填充2次手术,未行视网膜内界膜剥离.     

血清C-反应蛋白、降钙素原及乳酸在脑外伤患者术后颅内感染诊断意义研究

目的 探讨血清C-反应蛋白(CPR)、降钙素原(PCT)及乳酸在脑外伤患者术后颅内感染的诊断价值.方法 选取87例神经外科脑外伤术后患者,按照颅内感染标准,将患者分为感染组(n=47)和非感染组(n=40),感染组患者根据预后又分为治愈组、好转组和加重、无效组.检测血清CPR、PCT及乳酸水平的变化情况,比较各指标受试者工作特征(ROC)曲线下面积.结果 感染组患者血清CPR、PCT及乳酸水平明显增加(P<0.05);与治愈组和好转组相比,加重、无效组CPR、PCT明显升高(P<0.05),治愈组血清CPR及PCT水平明显低于好转组(P<0.05);血清CPR、PCT及乳酸ROC曲线下面积分别为0.876,0.966,0.717(P<0.05),血清PCT在8.10μg·L-1时为最佳截断点,诊断的敏感度为89.4％,特异度为92.5％,优于其他两项血清指标.结论 血清CPR、PCT及乳酸的检测,有望成为鉴别诊断颅内感染的新型标志物.     

智能化病人自控镇痛复合PDCA循环管理在术后镇痛中的临床效果及对患者满意度的影响

目的 评价智能化病人自控镇痛（Ai-PCA）复合PDCA循环管理在术后镇痛中的临床效果。方法 选择2022年6月至2023年5月进行择期手术并自愿使用术后镇痛泵的4 560例患者,按照镇痛管理办法将其分为对照组和观察组。对照组为2022年6月至11月使用PCA镇痛的2 145例患者,观察组为2022年12月至2023年5月使用Ai-PCA复合PDCA循环管理的2 415例患者。比较两组的中重度疼痛发生率、随访率、不良反应发生情况、镇痛满意度及术后镇痛泵的有效单次按压率。结果 观察组的中重度疼痛发生率低于对照组,随访率高于对照组（P<0.05）。观察组的恶心呕吐、头晕乏力、过度镇静发生率均低于对照组,镇痛满意度高于对照组（P<0.05）。观察组术后镇痛泵的有效单次按压率高于对照组（P<0.01）。结论 Ai-PCA复合PDCA循环管理应用在术后镇痛中不仅提高了术后镇痛泵的有效单次按压率及随访率,还提高了患者的镇痛满意度和术后镇痛效果,降低了不良反应发生率。     

应用谱域OCT观察LASIK对黄斑区视网膜厚度的影响

目的使用谱域OCT（SD-OCT）观察LASIK对手术患者黄斑区视网膜厚度的影响。方法系列病例研究。使用随机数字表选择2012年10月至2013年5月接受LASIK的30例（60眼）屈光不正患者,采用SD-OCT观察患者术前、术后10 d以及术后30 d的黄斑总容积（TMV）和中央视网膜厚度（CRT）的变化。数据分析采用重复测量设计和Pearson相关分析法。结果30例（60眼）患者术前BCVA（logMAR）为-0.063±0.041,TMV为（7.31±0.31）mm3,CRT为（220.3±21.1）μm,术后10 d时相应的指标分别为-0.043±0.081、（7.32±0.26）mm3、（221.6±20.8）μm,术后30 d时相应的指标分别为-0.074±0.061、（7.35±0.29）mm3、（219.8±22.9）μm。患者术后视力满意,术后10 d的CRT较之术前、术后30 d的差异均有统计学意义（P＜0.05）,而术后10 d的TMV仅与术后30 d的差异有统计学意义（P＜0.05）,同时术前术后的TMV、CRT的改变程度与术前等效球镜度不相关。结论LASIK术后短时间内黄斑区存在一定程度的视网膜水肿,程度与等效球镜度无关,并且不影响预后视力。     

特发性黄斑裂孔的黄斑裂孔直径、被破坏的光感受器细胞内外节直径及其与视力的相关性研究

目的 观察特发性黄斑裂孔（IMH）的频域光相干断层扫描（OCT）特征以及与视力的相互关系。方法 回顾性分析IMH患者37例39只眼的临床资料;其中11只眼接受了玻璃体切割手术治疗。所有患者均接受Snellen视力表检查、眼压、裂隙灯、间接检眼镜及OCT检查,OCT扫描速度为27 000A扫描/s,扫描区域6.0 mm×6.0 mm,扫描模式为512×128;测量黄斑裂孔直径及被破坏的光感受器细胞内外节(IS/OS)直径。采用SPSS 14.0统计软件进行统计学处理,分析黄班裂孔直径、IS/OS直径与视力的相关性。结果 最小可分辨视角的对数值（logMAR）为0.15～2.00,平均对数值0.99±0.44;黄斑裂孔直径171～1491 μm, 平均直径(942.0±348.4) μm;被破坏的IS/OS直径463～3176 μm,平均直径(1870.3±673.2) μm。logMAR、裂孔直径、被破坏的IS/OS直径三者间均具有相关性（P=0.038,0.002,P=0.000）。接受手术治疗前后裂孔闭合的9只眼中,logMAR和被破坏的IS/OS直径差异均有统计学意义（P=0.022,0.020）。结论 IMH光感受器层的破坏大于裂孔直径,视力情况与裂孔直径、被破坏的IS/OS直径相关。经手术治疗后,视力提高且裂孔闭合,被破坏的IS/OS直径也相应缩小,但在裂孔闭合的情况下仍持续存在。     

锁骨下静脉穿刺安装永久心内膜心脏起搏器的经验

本文报告７１例经锁骨下静脉穿刺植入起搏电极安装永久起搏器的经验体会及操作过程。７１例全部成功，由穿刺到电极达右房平均３～４ｍｉｎ，２例误穿入动脉未发生并发症。对如何预防锁骨下静脉穿刺的常见并发症进行了讨论，并提出经锁骨下静脉穿刺安放起搏电极的适应证     

特发性黄斑裂孔的黄斑裂孔直径、被破坏的光感受器细胞内外节直径及其与视力的相关性研究

Objective To observe the diameters of macular hole and destroyed boundary line between inner and outer segment (IS/OS) of the photoreceptors and the correlation with the visual acuity in patients with idiopathic macular hole(IMH). Methods The clinical data of 39 eyes (37 patients) with IMH were retrospective analyzed. All the patients had undergone the examinations of visual acuity (Snellen chart), intra-acular pressure, ocular fundus (indirect ophthalmoscope), and Fourier-domain optical coherence tomography (FD-OCT) whose speed was 27 000 A scan/s, area was 6.0 mm×6.0 mm, and the mode was 512×128. The diametres of macular hole and destroyed IS/OS, and the correlations with visual acuity were detected. Results The mean IogMAR was 0.99±0. 44 (ranged from 0. 15 to 2.00), the mean diameter of macular holes was (942.0± 348. 4)μm(ranged from 171 to 1491 μm), and the mean diameter of IS/OS disruption was (1870. 35±673.2) μm(range from 463 to 3176 μm). There was a significant correlation among the diameter of the macular hole, the diameter of the IS/OS disruption, and IogMAR in IMH (P= 0. 038, 0. 002, 0. 000). In eyes with closed macular hole after surgery, the IogMAR and the diameter of the IS/OS disruption had a significant decrease. Conclusion Using FD-OCT the photoreceptor changes can be visualized in vivo. The abnormality in the IS-OS boundary line appears to be involved for a much larger area beyond the macular hole itself, and persists there with small size even after the maeular hole closure surgery.