冲击载荷作用下骨盆三维有限元分析及其生物力学意义

目的:探讨骨盆受到冲击载荷作用的力学行为特征,为临床分析及判断骨盆骨折类型、力学分布、冲击载荷影响提供力学基础。方法:采用计算机仿真模拟方法,将所构建骨盆三维实体模型导入三维有限元分析软件AN-SYS7.0,计算单侧髂前上棘和单侧髂骨正后方部位冲击载荷作用下骨盆的力学行为表现,冲击载荷为0～8000N,峰值8000N,时间自0～40ms,分析主应力值、应力分布情况以及主应力方向上骨盆单元的位移。结果:冲击载荷作用于单侧髂前上棘时,0～10ms主要的应力沿髂后上棘到髂前上棘分布,在冲击后期10ms以后,骶髂关节、髋臼和耻骨支都会产生较大的应力分布;作用于单侧髂骨正后方部位时,0～20ms主要的应力沿髂骨纵行传导,应力分布并没有在冲击峰值10ms时达到最大,而是从20ms之后,应力开始向骶髂关节、双侧耻骨支、坐骨支以及髋臼等部位传导并可见到明显的应力分布。结论:分析冲击载荷作用下骨盆各部位应力分布以及骨盆各个单元在应力作用下的位移变化,有助于临床上进行骨盆损伤内固定力点的选择以及进一步明确骨盆内在应力值分布。     

颈外静脉穿刺置管在大量输液中的应用

目的探讨静脉药物配置室内不同操作距离对空气微粒污染的影响程度。方法在配置室内模拟配液加药，分别在距离操作者不同位置，用空气粒子计数器对空气微粒数进行检测，以了解空气微粒的污染情况。结果操作距离不同位置5个点的空气微粒污染程度比较，差异有显著性意义（均P〈0.01）。配置室内操作时空气微粒污染程度与操作距离有关，近操作者较远离操作者污染明显；此外，空气微粒污染程度还与洁净室的空间位置有关，回风口微粒污染明显，而送风口污染最轻。结论在万级洁净室内进行配液操作时，操作者周围空气中微粒污染仍严重，必须使用层流台或生物安全柜，以保证配液的质量和增强职业防护。     

主动脉手术围术期脑损伤监测指标的变化及其临床意义

目的监测主动脉手术围术期脑损伤指标的变化分析，探讨其在主动脉外科中应用的临床意义。方法30例主动脉手术病例，男23例，女7例，平均年龄43.7岁，深低温停循环下行主动脉弓部替换术22例，全胸降主动脉或胸腹主动脉替换术8例。术后出现暂时性神经系统功能紊乱（transient neurological dysfunction，TND）者8例（并发症组）；余22例无脑部并发症（非并发症组）。均于术前及术后72h内监测颅内压（intracranial pressure，ICP）并检测脑脊液（cerebral spinal fluid，CSF）乳酸及S100β的含量。结果两组ICP分别于术后24 h及12 h达峰值，并发症组于术后24～72 h显著高于非并发症组（P〈0.05）；两组CSF乳酸峰值分别出现于术后12 h及6 h，并发症组于术后12～72 h显著高于非并发症组（P〈0.05）；两组CSF中S100β均于术后12 h达到峰值，且组间72 h内各值均有显著差别（P〈0.05）。结论主动脉手术围术期ICP、CSF乳酸及S100β的异常升高与术后脑部并发症的发生有显著相关性，都是围术期敏感而可靠的脑损伤监测指标，具有较高的临床应用价值。     

阿托伐他汀改善对比剂对肾功能的短期影响

Objective To study the effects of atorvastatin on contrast induced renal function change and plasma hsCRP in patients undergoing coronary angiography. Methods 120 patients who underwent coronary angiography were randomized to receive atorvastatin (20 mg/qn, n = 60) or no atorvastatin (n =60) treatment 2 to 3 days before coronary angiography. Urinary α1-MG, TRF and mALB were checked for evidence of tubular or glomendar damage at start, 1 day and 2 days after the administration of a radiocontrast agent. Serum creatinine, BUN, cystatin C and hsCRP levels were also assessed at the same time. Ccr and GFR were calculated according to Cockcroft-Ganh and GFR(ml/min) = 74. 835/Cys C1.333formulas basing on serum creatinine or cystatin C concentration. Results (1) In control group, comparison with the value before coronary angiography,urinary α1-MG, TRF and mALB or serum cystatin C and hsCRP significantly increased at day 1 after angiography (P ＜ 0.01). In comparison to the levels at day 1 after angiography, urinary α1-MG, TRF, mALB, serum cystatin C significantly decreased at day 2 after angiography(P ＜ 0.01), but α1-MG, cystatin C still exceeded the values before coronary angiography, TRF and mALB levels at day 2 after angiography had no significant change compared to baseline(P ＞0.05), hsCRP LeveL at day 2 after angiography had no significant change compared to that at day 1 after angiography (P ＞ 0.05) too. (2) In comparison with the value before coronary angiography in atorvastatin-treated group, the levels of urinary α1-MG, TRF and mALB or serum cystatin C at day 1 and day 2 after angiography had no significant change compared to baseline(P ＞0.05). Serum hsCRP significantly increased at day 1 after angiography compared to baseline(P ＜ 0.01), but it had no significant change compared to day 2 after angiography (P ＞ 0.05). (3)To compare to the atorvastatin-treated group, the values of urinary α1-MG, TRF and mALB or Cys C and hsCRP significantly increased at day 1 after angiography in control group (P ＜ 0.01), the values of urinary α1 -MG, cystatin C and hsCRP still significantly increased at day 2 (P ＜ 0.01) too, but those of TRF and mALB had no significantly change at day 1 or day 2 after angiography between the two groups (P ＞ 0.05). There was no significant change in BUN, Cr, Ccr levels before and after angiography between the two groups. Conclusions Low dose contrast induces light renal function damage. Pretreatment with atorvastatin 20 mg/qn for 2 to 3 days could significantly reduce procedural inflammatory reaction, attenuate urinary protein and the effect of degrading GFR in coronary angiography patients.     

Effect of AVP on brain edema following traumatic brain injury

Objective: To evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema. Methods: A total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS≤8) and moderate traumatic brain injury group ( MTBI, GCS >8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group) and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan. Results: plasma AVP levels (ng/L) were (mean±SD): control, 3. 06±1. 49; MTBI, 38. 12±7. 25; and STBI, 66. 61±17. 10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P<0. 01). And the AVP level was correlated with the severity (STBI r =0.919, P < 0.01; MTBI r = 0.724, P < 0.01) and the duration of brain edema (STBI r = 0. 790, P < 0. 01; MTBI r = 0. 712, P<0.01). Conclusions: The plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.     

胆道镜在腹腔镜胆总管切开取石中的应用技巧

目的探讨胆道镜在腹腔镜胆总管切开取石术中的应用技巧。方法回顾性分析32例胆道镜在腹腔镜胆总管切开取石术中应用的临床资料。结果32例腹腔镜胆总管切开取石术均成功完成，无中转开腹。除胆道残余结石外没有其他并发症。结论胆道镜在腹腔镜下的应用技巧的掌握有利于提高胆道镜取石的效率和效果，有助于腹腔镜胆总管切开取石术的顺利开展。     

家族性特发性基底节钙化

家族性特发性基底节钙化（familial idiopathic basal ganglia calcification，FIBGC）是一种以影像学上有基底节及脑其他部位钙化为特征的神经系统变性疾病。大多数患在童年及青少年时期是健康的，而到了30-50岁时，典型患会逐渐出现神经精神以及运动障碍。首发症状通常包括动作笨拙、易疲劳、步态不稳、言语缓慢、吞咽困难、不自主运动、肌肉痉挛等，经常会有各种类型的癫痫发作。神经精神症状往往是首发或最突出的表现，轻仅仅为轻度注意力或记忆力的下降，重则会出现人格及行为改变，终致精神病或痴呆。[第一段]     

化疗药物性静脉炎及渗漏损伤的动物实验模型研究概况

化疗药物性静脉炎及渗漏损伤的动物实验模型是研究体内化疗药物性静脉炎及渗漏损伤的发病机制和评价各种治疗方法的重要条件。化疗药物性静脉炎及渗漏损伤的实验研究进展缓慢,其主要原因是缺乏理想的动物模型。依文献报道,化疗药物性静脉炎模型主要以大白兔耳缘静脉注射长春瑞滨等化疗药物为多见,化疗药物渗漏损伤模型主要以大鼠及大白兔背部皮下注射盐酸阿霉素等化疗药物为多见。文章就近年来常用的一些化疗药物性静脉炎及渗漏损伤的动物模型综述如下。     

整形外科原则和技术在面部软组织创伤急诊处理中的应用

目的：应用整形外科原则和技术急诊修复面部软组织创伤。方法：在面部软组织创伤急诊清创术中，遵循整形外科原则，用皮肤磨削、无张力缝合、植皮、皮瓣转移等技术进行修复。结果：460例患者中，术后1～2年中随访356例患者，均无瘢痕增生和错位畸形等并发症。结论：面部软组织创伤用整形外科原则和技术修复，能避免患者术后错位畸形，减少瘢痕。     

3种微创手术治疗复杂性输尿管上段结石的疗效比较

目的比较经尿道输尿管镜钬激光碎石(URSL)联合体外冲击波碎石(ESWL)、微创经皮肾镜取石(mini-PCNL)、后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石的疗效。方法153例复杂性输尿管上段结石患者按治疗方法分为三组:URSL联合ESWL(联合组)治疗60例,mini-PCNL治疗65例,RLU治疗28例。结果联合组有5例转开放手术取石,余50例患者平均手术时间(65.45±16.39)min,术后并发症发生率为23.64%(13/55),1个月后结石清除率为90.91%(50/55)。mini-PCNL组无中转,平均手术时间(50.38±12.91)min,术后并发症发生率为9.23%(6/65),1个月后结石清除率为100%。RLU组有2例转开放取石,平均手术时间(81.73±17.89)min,术后并发症发生率为15.38%(4/26),1个月后结石清除率为100%(26/26)。mini-PCNL组的手术时间、术后住院时间均显著短于联合组和RLU组;并发症发生率明显低于联合组;1个月后结石清除率明显高于联合组。结论mini-PCNL治疗复杂性输尿管上段结石具有手术时间短、结石清除率高、术后并发症少、恢复快的优点。