Immediate changes in pupil size following Laser in situ keratomileusis (LASIK): Pupillometry study

Purpose

To investigate the impact of laser in situ keratomileusis (LASIK) on the change in pupil size immediately after the procedure.

Methods

In a prospective study, measurement of pupil size was assessed in 70 eyes of 35 consecutive patients using a hand-held pupillometer before and immediately after LASIK in mesopic condition at the refractive eye center, Riyadh, Saudi Arabia.

Results

The pupil showed mild dilation immediate after LASIK. Mean pupil size before LASIK was 4.10 ± 0.74 and immediate after was 4.74 ± 0.82, P value <0.0001. No association was found with age, sex, central corneal thickness or pre-operative refractive measurements (CCT).

Conclusion

There is a change in pupil size that immerses immediately after LASIK; postulations suggested for pupillary dilation include the effect of suction ring, post-operative steroid eye drops, dark room, pain and anxiety.     

CT监控下立体定向颅内血肿抽吸术的临床应用

目的 探讨在CT监控下立体定向脑内血肿清除术的临床应用价值。方法 将定向仪安装在CT床头侧并与CT坐标中心校验为同步，病人在手术室或直接在CT室钻孔，手术全过程在CT床上进行，至少行术前、术中和术毕3次监控扫描，并根据需要随时扫描观察动态效果或调整靶点。本组共860例，包括基底节血肿408例、丘脑－内囊后肢血肿136例、外囊血肿105例、脑叶血肿156例、脑干血肿40例、小脑血肿5例及脑室出血10例；抽吸术距发病时间自3h至14d。结果 血肿可随意抽出者586例，血肿较馥稠但可清除率大于50％者202例，可清除率在50％以下者68例，完全无法抽出4例；手术时间25－120min，平均45min；存活693例，死亡167例，对生存者进行日常生活能力测评（active day life,ADL),ADL 1-2级者378例，ADL3级者166例，ADL4级者107例，ADL5级者28例，失访14例。结论 CT监控下立体定向脑内血肿抽吸术，是1种值得推广的安全、精确和简捷的脑内血肿治疗方法。     

超早期脑室穿刺引流术治疗重型脑室出血

目的 探讨重型脑室出血的治疗方法。方法 11例重型脑室出血患者，原发性脑室系统出血7例，继发性脑室系统出血4例，脑实质损伤轻微。在超早期行脑室穿刺引流加脑室内注射尿激酶溶栓治疗。结果 经治疗后11例患者预后良好8例，中残1例，死亡2例，无植物生存状态，并发脑积水3例，行脑室腹腔分流术后好转。结论 在超早期行脑室穿刺引流加脑室内注射尿激酶溶栓可以解除或缓解四脑室血肿对脑干的压迫作用，降低四脑室内压力，提高治疗效果。     

Retinal colour duplex scanning during LASIK-ring suction with different keratomes

PURPOSE: The purpose was to measure the blood flow velocity during the suction phase of LASIK. SETTING: University Eye Hospital, Martin-Luther-University Halle-Wittenberg, Halle, Germany. METHODS: Papillary blood flow velocity was measured by colour Doppler sonography. Suction rings of four different manufacturers were applied in 30 healthy volunteers without eye diseases all of normal blood and eye pressure. The velocity of the blood flow in the central retinal artery was measured before, during and after suction. RESULTS: When Hansatome (Bausch & Lomb) and M2 (Moria) rings were used, no blood flow velocity was detected during suction in 90% of all cases. These rings were compared to the SKBM standard suction ring (Alcon) and the Krumeich non-IOP ring, in which no blood was present in only 56.67% (p < 0.05) and 10% (p < 0.001) of cases respectively. Moria, Alcon and Krumeich Lasitome rings performed equally well during the recovery phase compared with the original values. An exception is the Hansatome ring (Bausch & Lomb), with lower velocities when evaluated after 30 minutes (p < 0.01). CONCLUSIONS: During the ring suction phase of LASIK, the rings tested reduce velocity differently.     

Contouring of the midtrunk in overweight patients

Classical abdominoplasty primarily addresses the anterior abdominal wall. It involves a low transverse incision, extensive undermining in the supra-aponeurotic plane, correction of the musculofascial flaccidity, and resection of excessive skin and fat. The introduction of suction lipectomy into the armamentarium of the plastic surgeon has allowed a more thorough, yet safer, contouring of the entire midtrunk. When used in conjunction with a modified W-type abdominoplasty, circumferential suction lipectomy has yielded excellent results in contouring the midtrunk of overweight patients. It is the purpose of this article to present our technique for this procedure.     

密闭式吸痰管在机械通气病人气道护理中的应用

用循证医学的方法探索密闭式吸痰管应用在机械通气病人气道护理中的利弊。提出临床问题后,用主题“Endotracheal and Closed suction”检索Cochrane CDSR,ACP Journal Club,DARE,CCTR(OVID平台)、Medline、中国学术期刊全文数据库(CNKI)获得相关证据。吸痰时使用密闭式吸痰管,可明显减轻由吸痰引起的并发症症状,从而降低病人对吸痰的恐惧程度,避免由吸痰导致的不良事件的发生。     

控制性肺膨胀对急性肺损伤绵羊吸痰后肺复张容积的影响

目的　探讨控制性肺膨胀 (sustainedinflation ,SI)对急性肺损伤 (acutelunginjury ,ALI)绵羊吸痰后肺复张容积的影响。方法　内毒素静脉注射复制绵羊ALI模型 ,进行两组吸痰 ,SI组吸痰后立即予以一次SI,用P -V曲线法测定吸痰前后肺复张容积 ,同时观察吸痰前后动脉血氧合的变化。结果　非SI组吸痰前肺复张容积 (98 8± 77 6 )ml,吸痰后 3min显著降低 (6 4 3ml± 5 3 0ml,P <0 0 5 )。SI组吸痰后3min、 15min肺复张容积分别为 (12 8 1± 78 0 )ml和 (119 4± 6 1 5 )ml,均较吸痰前 (6 8 0± 5 0 3)ml显著增加 (P <0 0 5 )。非SI组动脉血氧分压 (PaO2 )在吸痰前为 (82 2± 4 6 9)mmHg ,叹痰后 15min显著降低为 (71 2± 30 3)mmHg (P <0 0 5 ) ;SI组吸痰前后PaO2 无明显变化。结论　吸痰可加重肺泡塌陷 ,SI可明显促进肺泡复张。     

2种吸痰方法的效果比较

目的比较密闭式吸痰与开放式吸痰的临床效果。方法将72例机械通气病人随机分为对照组和观察组，各36例，观察组采用密闭式吸痰，对照组采用开放式吸痰，比较2组肺部感染发生时间、感染发生率、痰液喷出情况及平均操作时间差异。结果观察组肺部感染发生时间延长（1周后），感染率低（P〈0．05），观察组工作量及喷出痰液明显少于对照组（P〈0．01），差异有显著意义。结论密闭式吸痰效果优于开放式吸痰，能降低肺部感染，减轻护理工作量，操作安全性强。     

血栓抽吸装置在经皮冠状动脉介入治疗中对心肌再灌注的影响

目的:评估血栓抽吸装置在急性心肌梗塞(AMI)急诊冠状动脉介入治疗(PCI)患者治疗中的临床应用。方法:86例行急诊PCI治疗的AMI患者被随机分为血栓抽吸组(41例,应用抽吸导管后再行PCI),直接PCI组(45例,直接行PCI),观察无复流发生率、术后ST段下降率及左心室射血分数等。结果:PCI后血栓抽吸组患者的无复流发生率明显低于直接PCI组(4.9%∶11.1%,P0.05),ST段回落率(66.67%、75.61%)、LVEF[(54.02±8.93)%∶(49.23±9.12)%]均优于直接PCI组(P均0.05)。结论:急诊冠脉介入治疗急性心肌梗塞患者时,应用血栓抽吸导管可以降低无复流发生率,改善心功能,且安全有效。     

人工气道吸痰引起黏膜损伤的原因分析及对策

目的探讨人工气道内吸痰引起气管黏膜损伤的原因及护理对策。方法回顾性分析24例次人工气道内吸痰引起气管黏膜损伤情况及其原因,并采取相应的护理对策。结果吸痰引起气管黏膜损伤的原因有：吸痰过频8例次（33.3%）,吸引负压调节不当6例次（25%）,吸痰管选择不当4例次（16.7%）,吸痰时间过长3例次（12.5%）,气道湿化不足3例次（12.5%）。结论预防人工气道内吸痰引起气管黏膜的损伤,必须正确区分吸痰引起气管黏膜损伤的原因,及时对症处理,保证人工气道患者的护理质量,提高抢救成功率。