不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

乳头上开窗术在内镜括约肌切开困难时的应用

目的：探讨应用乳头开窗术治疗ＥＳＴ困难的胆胰疾病。方法：使用球状微波刀或柱状高频电凝器,在乳头上１１～１２点隆起部或在乳头上基部开窗以引流胆汁。结果：开窗成功１０１例,失败１例。胆总管结石,胆管炎,括约肌狭窄,胆源性胰腺炎,开窗后效果与ＥＳＴ同。壶腹周围癌梗阻性黄疸,术前开窗胆汁引流减黄后择期手术２１例。结论：乳头开窗术是ＥＳＴ困难病例的一种可取的替代方法,对壶腹周围癌致梗阻性黄疸能达到术前减黄,改善全身情况,晚期或放弃手术者,乳头上开窗可减轻症状和提高生活质量。     

碘仿自固化磷酸钙根管糊剂封闭性的体外研究

目的:观察注射型碘仿自固化磷酸钙(CPC)根管糊剂在体外充填根管的封闭性能。方法:62颗离体单根管牙用K锉常规法预备至40#,其中58颗随机分为2个实验组,分别用注射型碘仿CPC糊剂和氧化锌丁香油碘仿糊剂作为根管封闭剂,牙胶尖侧压法充填根管。另外4颗作为对照组。根充材料凝固后,将牙的根尖部分浸泡于2%亚甲蓝染料中6d,沿牙体长轴纵向劈开,测量根管内壁染料渗漏长度。采用团体t检验进行统计学分析。结果:注射型碘仿CPC充填组平均渗漏8.400mm,氧化锌丁香油碘仿糊剂组平均渗漏5.300mm,2组的渗漏值有显著性差异(P<0.05)。结论:碘仿CPC的体外根管封闭性不及氧化锌丁香油碘仿糊剂。     

原发性甲状旁腺功能亢进的诊断及治疗

该文概述了原发性甲状旁腺功能亢进(PHPT)的诊断和治疗。PHPT是高钙血症最常见的原因。在欧洲和北美地区,随着血清生化自动分析仪的出现,无症状型PHPT被诊断出来的病例越来越多。目前主要根据患者血钙及甲状旁腺激素(PTH)水平判定其是否有甲状旁腺功能亢进。术前准确定位有助于甲状旁腺病灶完整切除。术前定位常用的是超声检查和~(99m)Tc-MIBI核素显像。术中快速检测PTH水平可评估是否已准确、彻底切除了病变腺体,从而保证手术治疗的成功率。PHPT手术适应证包括:血清钙浓度高于正常上限超过1 mg/dl;骨折;肾结石;任何部位Z评分≤-2. 5;年龄50岁。对于不能手术、不接受手术及无症状的PHPT患者可选择药物治疗。     

银杏叶提取物合舍曲林治疗抑郁症临床观察

选择性5-羟色胺再摄取抑制剂(SSRIs)已成为一线抗抑郁药,治疗抑郁症起效时间和总体疗效与传统的抗抑郁剂(TCAs)相当,没有重大的突破.有研究报道,银杏叶提取物舒血宁(Ginkgo biloba Extract 761,EGb 761)与TCAs合并治疗抑郁症可提高疗效、减少不良反应[1].目前此类报道甚少,我院对住院的抑郁症患者进行了合并治疗的对照观察.     

血浆D-二聚体在颅脑损伤患者早期诊断中的意义

目的探讨血浆D-二聚体的检测在颅脑损伤患者早期诊断中的意义。方法对选取的61例颅脑损伤患者和59例健康人的血浆D-二聚体水平进行分析,分为观察组和对照组,分析两组患者的血浆D-二聚体水平;再根据损伤的不同程度将观察组患者分为轻型组、中型组合重型组,分别为21例、20例和20例,观察三组患者的血浆D-二聚体水平。结果观察组患者于4 h、6 h及12 h的D-二聚体水平分别为(2.79±0.58)mg/L、(3.07±1.01)mg/L、(4.11±1.09)mg/L,明显高于对照组[(0.46±0.15)mg/L](P<0.05);重型损伤组和中型损伤组患者明显较轻型损伤组患者高,且重型损伤组患者明显高于中型组均差异有统计学意义(P<0.05)。结论血浆D-二聚体可以作为判断病情严重程度的有效指标。     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

目的 前瞻性评价早期VSD治疗深Ⅱ度烧伤创面的临床疗效,为其临床应用提供依据.方法 选择笔者单位2009年5月-2010年3月收治的双下肢烧伤后3 h内入院、总面积小于10%且各下肢深Ⅱ度面积大于1%TBSA的患者22例.依照部位对称、深度相同、面积相近等同体对照原则,将每例患者创面分为VSD治疗组(应用VSD治疗)与对照组(应用10 g/L磺胺嘧啶银霜换药).观察2组患者创面的水分蒸发量、肿胀程度、细菌定植情况、疼痛程度、愈合时间及愈合质量并进行比较分析.数据行t检验与秩和检验.结果 21例患者完成试验,均在伤后4 h内完成创面处理.VSD治疗组正常皮肤及覆盖敷料前创面的水分蒸发量与对照组相近(t值分别为1.310、-0.911,P值均大于0.05);创面覆盖敷料2 h后,敷料表面的水分蒸发量[(44.3±3.9)mL·h-1·m-2]明显少于对照组[(66.1±6.4)mL·h-1·m-2,t=-11.39,P<0.01].伤后3、7 d,VSD治疗组大腿周径较伤后5 h分别增加了(3.48±0.35)、(2.51±0.21)cm,明显小于对照组的(8.02±0.41)、(3.99±0.32)cm(t值分别为4.110、3.569,P值均小于0.01).2组创面入院时及伤后10 d细菌培养阳性率组间比较,差异均无统计学意义(Z值分别为-0.894、0.000,P值均大于0.05);2组伤后10 d细菌培养阳性率均较各组入院时显著降低(Z值分别为-3.220、-3.870,P值均小于0.01).VSD治疗组创面伤后10 d的pH值(7.12±0.06)呈现弱酸性,对照组(7.41±0.13)则为中性.VSD治疗组伤后1、3、7 d创面疼痛程度轻于对照组(t值分别为-16.132、-21.230、-16.453,P值均小于0.01).2组创面愈合时间比较,差异无统计学意义(t=1.186,P>0.05).伤后2、3个月VSD治疗组创面愈合质量评价为佳(100.00%、100.00%),明显优于对照组(19.05%、85.71%,Z值分别为-11.638、-3.870,P值均小于0.01).结论 早期VSD治疗不能使深Ⅱ度烧伤创面愈合时间提前,但能显著提高其愈合质量,是处理深Ⅱ度烧伤创面的有效方法之一,值得临床关注与进一步研究.     

肾上腺肿瘤多层螺旋CT诊断

目的总结肾上腺肿瘤螺旋CT扫描的表现、特征,提高对肾上腺肿瘤的影像诊断与鉴别诊断水平。方法对26例资料完整、经手术或病理证实的肾上腺肿瘤的CT图像进行回顾性分析,总结肿瘤大小、密度、形态、边缘及强化程度、CT值等特征。结果 12例肾上腺皮质腺瘤,其体积以小到中等大小为主,密度均匀,边界清楚,有包膜,增强扫描可见轻微强化。1例嗜铬细胞瘤体积偏小,形态规则,边界清楚,密度欠均匀,增强扫描明显不均匀强化。1例髓质脂肪瘤体积巨大,呈混杂密度,边界清楚,实性部分轻微强化,脂性成分不强化。12例转移瘤中有9例体积较小,密度均匀,边界清,强化明显;1例体积大,强化不均匀,呈环状强化,中心部分强化不明显。12例转移瘤中有11例有其他部位原发癌或多脏器转移征象。结论肾上腺肿瘤的CT表现有一定特点,结合临床表现、病史及化验检查,可以作出影像学诊断,而且诊断准确率较高,对肿瘤良恶性鉴别有一定价值。