改良式单孔锥颅置管引流术治疗慢性硬膜下血肿疗效分析

目的：探讨改良式单孔锥颅置管引流术治疗慢性硬膜下血肿的临床疗效。方法选取2011年1月至2013年1月于我院就诊的慢性硬膜下血肿患者共100例,按照入院编号,将患者随机分为两组,观察组和对照组各50例。对照组患者给予常规的钻孔手术治疗,观察组给予患者改良式单孔锥颅置管引流术治疗,观察患者接受治疗后的临床效果。结果观察组50例患者在接受具有针对性和科学性护理之后,其中痊愈患者30例（60.0%）,好转20例（40.0%）,总有效率为100%;对照组患者中痊愈患者26例（52.0%）,好转18（36.0%）,无效6例（12.0%）,总有效率为88.0%。观察组患者治疗总有效率和痊愈率要明显高于对照组患者,组间治疗效果差异有统计学意义（P＜0.05）。结论临床上在治疗慢性硬膜下血肿症时,可以采用改良式单孔锥颅置管引流术治疗方法,能有效改善患者治疗效果,提高预后质量,获得非常理想的治疗效果。     

Myocardial Hematoma Documented by Transthoracic Echocardiography After Sequential Coronary Artery Stenting

We report the case of a patient who deteriorated suddenly while undergoing endoluminal coronary artery reconstruction with multiple stents to the left anterior descending coronary artery. With the aid of transthoracic echocardiography, a pericardial effusion was noted; however, dissection of the ventricular wall due to a large myocardial hematoma was also identified. Emergency exploration with evacuation of the pericardial blood with coronary artery bypass graft surgery was successfully accomplished. We discuss the possible factors that could have been associated with this unforeseen complication and the potential benefit of transthoracic echocardiography in early recognition.     

急性脑出血患者血浆N端脑钠肽前体、和肽素的检测及其临床意义

目的：探讨急性脑出血患者血浆 N 端脑钠肽前体（NT-proBNP）及和肽素与病情严重程度及脑出血量之间的关系。方法选取该院2011年12月至2013年6月期间诊断为急性脑出血患者109例（脑出血组）和同期体检的健康者32例（对照组）,对脑出血组患者和对照组健康者血浆 NT-proBNP、和肽素水平与格拉斯哥昏迷评分（GCS）进行比较。结果脑出血组血浆NT-proBNP 及和肽素水平明显高于对照组,随病情严重程度及出血量增加呈显著升高,差异有统计学意义（P ＜0．05）。血浆 NT-proBNP、和肽素水平与脑出血量呈正相关（r＝0．63,r＝0．58,P ＜0．01）,与 GCS 呈负相关（r＝－0．52,r＝－0．46,P ＜0．01）。结论血浆 NT-proBNP、和肽素水平和急性脑出血关系密切,能反映急性脑出血患者病情严重程度。     

Traumatic Lingual Hematoma Resulting in Bilateral Temporal Mandibular Joint Dislocations

Background

Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction.

胸痛发作小于3 h的急性主动脉综合征与非ST段抬高型心肌梗死的差异化风险评估

目的研究在胸痛发作小于3 h的情况下,急性主动脉综合征(AAS)及非ST段抬高型心肌梗死(NSTEMI)的差异化风险评估。方法回顾性分析AAS患者69例,NSTEMI患者136例,对两组数据进行统计学分析,比较组间差异。利用单因素及多因素Logistic回归分析评估AAS及NSTEMI的差异化风险因素。比较各差异化风险因素的受试者工作特征曲线(ROC)下面积(AUC),分析各因素鉴别AAS及NSTEMI的价值,并确定部分差异风险因素的最佳截断值。结果多因素Logistic回归分析结果显示,相比于NSTEMI,D-二聚体(OR 8.872,95%CI 4.064~19.366)、血小板分布宽度(PDW)(OR 1.635,95%CI 1.253~2.133)、非结合胆红素(UCB)(OR 1.149,95%CI 1.003~1.317)、收缩压(SBP)(OR 1.025,95%CI 1.006~1.045)是AAS发生的高风险因素。ROC曲线分析显示,AUC_(D-二聚体)=0.944(95%CI 0.897~0.973),AUC_(PDW)=0.794(95%CI 0.724~0.853)。利用ROC曲线的约登指数确定D-二聚体及PDW从NSTEMI中鉴别AAS的最佳界值,D-二聚体的ROC曲线分界点为247.5μg/L,灵敏度为95.7%,特异度为83.8%;PDW的ROC曲线分界点为16.05%,灵敏度为58.8%,特异度为95.6%。结论D-二聚体、PDW、UCB、SBP是AAS及NSTEMI的差异化风险因素;当D-二聚体247.5μg/L时,可有效除外AAS;当PDW16.05%时,大概率发生AAS。     

Postbiopsy intramural hematoma of the duodenum in an adult with Noonan's syndrome

Intramural duodenal hematoma is a rare complication of endoscopic biopsy. It is usually seen in children with growth failure and in patients with bleeding disorders or who are anticoagulated. It is frequently associated with acute pancreatitis. We present a case of an adult patient with Noonan's syndrome who developed postbiopsy intraduodenal hematoma. Abdominal ultrasound and computed tomography scan established the diagnosis. Conservative treatment was successful. According to a brief review of the literature, patients with Noonan's syndrome may develop hematoma after sampling of the duodenum because they present all the main predisposing factors. Additionally, pulmonic valve stenosis may be another predisposing factor, but this may warrant further investigation.     

Femoral artery catheterization complications: A study of 503 consecutive patients

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.     

Traumatic Brain Injury in Patients Receiving Direct Oral Anticoagulants

BackgroundEmergency departments (EDs) are faced with a growing number of patients with traumatic brain injury (TBI) using direct oral anticoagulants (DOACs). However, there remains uncertainty about the bleeding risk, rate of hematoma expansion, and the efficacy of reversal strategies in these patients.ObjectiveThis study aims to identify the risk of traumatic hemorrhagic complications in patients with TBI using DOACs.MethodsIn this retrospective study we included patients with TBI. All TBI patients were using DOACs, attended one of the three EDs of our hospital between January 2016 and October 2019, and received a computed tomography (CT) scan of the brain. The primary outcome was any traumatic intracranial hemorrhage on CT. Secondary outcomes were the use of reversal agents, secondary neurological deterioration, a neurosurgical intervention within 30 days after the injury, length of stay (LOS), Glasgow Outcome Scale (GOS) at discharge, and mortality.ResultsOf the included patients (N = 316), 24 patients (7.6%, 95% confidence interval [CI] 4.2–9.8) presented with a traumatic intracranial hematoma (ICH). Seven patients (2.2%, 95% CI 0.6–3.8) received a reversal agent and 1 patient (0.3%, 95% CI ?0.3–0.9) underwent a neurosurgical intervention. Of the 24 patients with a traumatic ICH, progression of the lesion was seen in 6 patients (1.9%, 95% CI 0.4–3.4). The mean LOS was 6.5 days (95% CI 3.0–10.1) and the mean GOS at discharge was 4 (95% CI 3.6–4.6). Death occurred in 1 patient (0.3%, 95% CI ?0.3–0.9) suffering from an ICH.ConclusionBased on the present findings it can be postulated that TBI patients using DOACs have a low risk for ICH. Hematoma progression occurred, however, in a substantial number of patients. Considering the retrospective nature of the present study, future prospective trials are needed to confirm this finding.     

经胸超声心动图诊断A型主动脉壁间血肿

目的 观察经胸超声心动图诊断A型主动脉壁间血肿的价值。方法 回顾性分析40例经CT血管成像（CTA）确诊的A型主动脉壁间血肿患者的临床资料及超声心动图表现,评价经胸超声心动图诊断A型主动脉壁间血肿的价值。结果 40例A型主动脉壁间血肿患者,男25例（25/40,62.50%）,女15例,发病中位年龄55岁;以胸背部疼痛（36/40,90.00%）为主要症状;其中30例有高血压病史、15例有吸烟史。主动脉壁间血肿超声主要表现为主动脉壁内-中膜与外膜间存在厚薄不均匀低回声;主动脉窦部增宽与年龄、高血压病史相关（r=0.51,P=0.01;r=0.34,P=0.03）。25例（25/40,62.50%）合并主动脉瓣反流,其中21例（21/25,84.00%）为轻度反流;12例合并心包积液,其中10例（10/12,83.33%）为少量积液。结论 经胸超声心动图对诊断A型主动脉壁间血肿有一定价值,并可用于患者随访。     

血透患者右无名静脉损伤后超长时活动性出血一例

血液透析中心静脉导管插管导致静脉损伤继发局部血肿是常见并发症,但围插管期无症状、插管后数月出现气管压迫、危及生命的活动性出血少见。该文报道一例45岁男性患者,因右侧颈内静脉置管后4个月出现右侧无名静脉严重活动性出血、纵隔血肿压迫气管,经过控制血压、减少容量负荷、关闭同侧内瘘后出血停止、最后血肿吸收。该例提示应重视深静脉置管穿刺损伤引发纵隔血肿的可能性,尤其在穿刺不顺利时应当立即行胸片、CT或超声检查,以减少漏诊和误诊。