星状神经节阻滞对肺癌患者免疫功能的影响？

目的探讨星状神经节阻滞（SGB）对肺癌患者免疫功能的影响。方法选取2013年1~6月在本院行胸腔镜肺叶切除术治疗的40例非小细胞肺癌患者,按照随机数字表法将其分为Ⅰ组和Ⅱ组各20例。Ⅰ组患者行右侧SGB,Ⅱ组不行SGB。检测两组肺癌患者术前（T0）、术毕（T1）、术后1 d（T2）、术后3 d（T3）外周血清中的转化生长因子-β（TGF-β）、白细胞介素-4（IL-4）、白细胞介素-6（IL-6）的表达。结果Ⅱ组患者血清TGF-β、IL-4、IL-6在T1、T2、T3明显升高,与Ⅰ组比较其差异有统计学意义（P ＜ 0.05）。结论 SGB能缓解肺癌患者的近期免疫抑制。     

星状神经节阻滞治疗围绝经期综合征患者的激素水平变化及疗效分析

目的 观察星状神经节阻滞(SGB)治疗妇女围绝经期综合征的临床疗效.方法 选择我院2007年2月至2008年12月经妇科门诊确诊为围绝经期患者30例,均进行阴道细胞学检查,并检查血雌二醇(E2),促卵泡生成素(FSH),黄体生成素(LH),符合围绝经期综合征而无其他慢性疾病,且近3个月均未服用过激素类药物.采用前入路SGB,每日1次,左右交替进行,每10次为1疗程,均治疗2个疗程.记录患者治疗前后血FSH、LH、E2的变化.结果 血中E2由治疗前的(31.29±19.36)pmol/L升高至(159.47±88.21)pmol/L(t=-24.976,P<0.01),FSH由治疗前的(54.67±19.24)U/L下降至(38.15±13.50)U/L(t=13.872,P<0.01),LH由治疗前的(36.1±15.6)U/L下降至(26.7±8.7)U/L(t=9.188,P<0.01).围绝经期综合征的主要症状潮热出汗、失眠、心悸、关节痛、肌痛、阴道干涩的改善总有效率为91%、92%、85%、87%、88%.方法 SGB可调整围绝经期自主神经平衡失调,使已紊乱的自主神经和内分泌功能达到新平衡,是消除围绝经期综合征的有效治疗方法 .     

Fast block flow tracking of atrial septal defects in 4D echocardiography

We are working to develop beating-heart atrial septal defect (ASD) closure techniques using real-time 3D ultrasound guidance. The major image processing challenges are the low-image quality and the processing of information at high-frame rate. This paper presents comparative results for ASD tracking in time sequences of 3D volumes of cardiac ultrasound. We introduce a block flow technique, which combines the velocity computation from optical flow for an entire block with template matching. Enforcing adapted similarity constraints to both the previous and first frames ensures optimal and unique solutions. We compare the performance of the proposed algorithm with that of block matching and region-based optical flow on eight in vivo 4D datasets acquired from porcine beating-heart procedures. Results show that our technique is more stable and has higher sensitivity than both optical flow and block matching in tracking ASDs. Computing velocity at the block level, our technique tracks ASD motion at 2 frames/s, much faster than optical flow and comparable in computation cost to block matching, and shows promise for real-time (30 frames/s). We report consistent results on clinical intra-operative images and retrieve the cardiac cycle (in ungated images) from error analysis. Quantitative results are evaluated on synthetic data with maximum tracking errors of 1 voxel.     

甲磺酸罗哌卡因在腋路远端臂丛神经阻滞显微手外科中的应用效果观察

目的观察0.5%甲磺酸罗哌卡因和0.375%左旋布比卡因行腋路远端臂丛神经阻滞的效果。方法 50例手外科肘部以下手术患者,分为观察组和对照组各25例,观察组给予0.5%甲磺酸罗哌卡因,对照组给予0.375%左旋布比卡因,两组均采用相同麻醉方法。比较两组患者麻醉效果评级、感觉和运动阻滞完善时间及消退时间、不良反应情况。结果两组患者麻醉效果评级比较,差异无统计学意义(P>0.05);感觉阻滞完善时间及消退时间观察组明显长于对照组,差异有显著统计学意义(P<0.01);运动阻滞完善时间及消退时间观察组明显短于对照组,差异有统计学意义(P<0.05)。两组均未发生蛛网膜下腔或硬膜外阻滞、喉返神经或膈神经阻滞、霍纳综合征、气胸、局麻药中毒等并发症。结论 0.5%甲磺酸罗哌卡因的麻醉效果优于0.375%左旋布比卡因,更适合较长时间手术的显微手外科手术患者。     

反向斜引进针行肌间沟臂丛神经阻滞的疗效观察

目的观察反向斜引进针法行肌间沟臂丛神经阻滞在肩部及上臂手术中的麻醉效果和安全性。方法90例肩部和上臂手术的患者,随机分为A、B两组,A组采用反向斜引进针阻滞法,B组采用传统的肌间沟阻滞法。观察比较两组的一次穿刺成功率、麻醉显效时间、麻醉起效时间、麻醉维持时间、运动阻滞起效时间及麻醉效果和有无并发症。结果A组的麻醉显效及起效时间明显短于B组（P〈0．05）,A组的运动阻滞起效时间明显长于B组（P〈0．05）,麻醉效果及一次穿刺成功率明显优于和高于B组,效果确切、安全、无并发症。结论反向斜引进针法行肌间沟臂丛神经阻滞操作简便,较传统肌间沟臂丛神经阻滞法麻醉起效时间快,麻醉效果也更加确切,并发症少,并且有区域阻滞选择性,值得临床推广和应用。     

舌咽神经阻滞入路的解剖基础

目的:为舌咽神经阻滞入路和预防并发症的发生提供解剖学资料.方法:应用35具成人头、颈部标本,逐层解剖,显露舌咽神经并追溯到颈静脉孔外口,仔细观察舌咽神经与周围诸结构的位置及毗邻关系并测量相关数据.结果:舌咽神经与迷走神经、副神经、岩下窦及颈内静脉一起自颈静脉孔出颅,出颅后与颈内动脉、颈内静脉、舌下神经、副神经、迷走神经等结构关系密切.舌咽神经阻滞进针的深度即下颌角与外耳门连线的中点至颈静脉孔的距离,左侧为22.33±1.98 mm,右侧为22.45±2.03 mm,进针方向为斜向内上方稍偏前,与正中矢状面呈45～60°.结论:本研究可为舌咽神经阻滞入路和预防并发症的发生提供可靠的解剖学资料.     

Evaluation of a Kalman-based block matching method to assess the bi-dimensional motion of the carotid artery wall in B-mode ultrasound sequences

We aim at investigating arterial diseases at early stage, by assessing the longitudinal (i.e. in the same direction as the blood flow) motion of the intima-media complex. This recently evidenced phenomenon has been shown to provide relevant and complementary information about vascular health.Our method assesses the longitudinal and radial motion from clinical in vivo B-mode ultrasound sequences. To estimate the trajectory of a selected point during the cardiac cycle, we introduce a block matching method that involves a temporal update of the reference block using a pixel-wise Kalman filter. The filter uses the initial gray-level of the pixel as control signal to avoid divergence due to cumulating errors. The block and search-window sizes are adapted to the tissue of interest.The method was evaluated on image sequences of the common carotid artery, acquired in 57 healthy volunteers and in 25 patients at high cardiovascular risk. Reference trajectories were generated for each sequence by averaging the tracings performed by three observers. Six different computerized techniques were also compared to our method.With a pixel size of 30 μm, the average absolute motion estimation errors were 84 ± 107 μm and 20 ± 19 μm for the longitudinal and radial directions, respectively. This accuracy was of the same order of magnitude as the inter- and intra-observers variability, and smaller than for the other methods. The estimated longitudinal motion amplitude was significantly reduced in at-risk patients compared with healthy volunteers (408 ± 281 μm vs. 643 ± 274 μm, p < 0.0001).Our method can constitute a reliable and time-saving technique to investigate the arterial stiffness in clinical studies, in the objective to detect early-stage atherosclerosis.     

局部封闭在阻生齿拔牙中的应用体会

目的：探讨局部封闭的同时拔除阻生齿，可减少术后炎症反应的临床疗效。方法：拔除阻生齿前10′用庆大霉素8万μ,DXm5mg，利多卡因1ml行远中盲袋封闭，常规局麻拔除患牙，观察24－48h后的炎症反应。结果：24h后无明显出血，张口受限，48h后无干槽症的为98％，轻度张口受限的为2％。结论：局部封闭的同时拔除阻生齿，可有效的减少术后炎症反应。