Cranial subdural haematoma after spinal anaesthesia

Intracranial subdural haematoma is an exceptionally rare complicationof spinal anaesthesia. A 20-yr-old male underwent appendicectomyunder partial spinal and subsequent general anaesthesia. A weeklater, he presented with severe headache and vomiting not respondingto bed rest and analgesia. Magnetic resonance imaging showeda small acute subdural haematoma in the right temporo-occipitalregion. The patient improved without surgical decompression.The pathogenesis of headache and subdural haematoma formationafter dural puncture is discussed and the literature brieflyreviewed. Severe and prolonged post-dural puncture headacheshould be regarded as a warning sign of an intracranial complication. Br J Anaesth 2001; 86: 893–5     

经皮穿刺空心钉张力带固定选择性治疗髌骨骨折

2000年1月～2005年1月,我们采用经皮穿刺空心拉力螺丝钉＋钢丝张力带微创技术治疗62例髌骨骨折,治疗效果良好,骨折全部愈合,功能恢复满意。     

Management of persistent post-dural puncture headache after repeated epidural blood patch

We report a case of persistent post-dural puncture headache (PDPH) in a patient despite two epidural blood patches (EBPs). Successful resolution of headache was achieved with a third EBP performed under computed tomography (CT) guidance. A 38-year-old female had a total abdominal hysterectomy under combined spinal-epidural anesthesia with no complications. After surgery, she developed a postural headache consistent with PDPH. The first EBP was performed by injecting autologous blood through the epidural catheter that was in situ. The second EBP was performed under fluoroscopy. The patient continued to have a persistent headache. A computed tomography (CT) myelogram demonstrated cerebrospinal fluid (CSF) leak at L3-4 level. A "directed" CT-guided blood patch was then performed successfully with resolution of the headache.     

局麻与硬膜外麻醉下聚丙烯材料补片应用腹股沟疝修补术效果及慢性疼痛调查——基层医院经验

目的对比分析局麻与硬外麻醉下无张力修补术治疗腹股沟疝疗效,探讨基层医院在有限条件下治疗腹股沟疝更适宜的麻醉方式。方法采用前瞻性研究方法,纳入研究的患者为2016年7月至2017年1月半年来收治的102例腹股沟疝所有患者分成局麻组与硬外麻组,两组均采用疝囊高位结扎+平片无张力修补术,比较两组手术时间、术后伤口疼痛时间、术后不良反应和并发症的发生和差异;记录术后患者对麻醉效果的满意度;出院后嘱病人1周后回院复查1次,1个月、6个月、12个月、24个月电话随访1次。结果两组皮下血肿、术后伤口感染、阴囊肿胀、腹股沟神经与腹腔脏器损伤、术后伤口疼痛时间差异无统计学意义(P0.05),局麻组住院时间、住院费用、恶心/呕吐、头昏/头痛、尿潴留并发症发生率均比硬外麻组低或少,两组差异有统计学意义(P0.05)。两组患者在2年随访中各有2例出现腹股沟区疼痛,服用NSAIDs类药物好转。两组术后1月、6月、12月和24月VAS评分结果,其差异没有统计学意义(表3)。两组患者对手术中麻醉满意情况见表4,硬膜外组满意患者多于局麻组。结论基层医院实施局麻下开放式腹股沟疝平片无张力修补术可行,也不增加慢性疼痛的发生。     

SP-C对重组肺表面活性物质活性的影响

目的 探讨不同浓度的肺表面活性物质(PS)相关蛋白C(SP-C)与合成脂质构成的重组PS活性的变化。方法 从新鲜猪肺的灌洗液中提取PS,从PS中分离出SP-C。将二棕榈酰磷脂酰胆碱、二油酰磷脂酰胆碱和棕榈酰油酰磷脂酰甘油按60:20:20的重量比混合,即为合成脂质(SL),将SP-C按1％、2％、3％(与脂质的重量比)加入SL中,制成三种重组PS:RS-1、RS-2和RS-3。将上述物质溶于生理盐水中即为实验液体。用气泡型表面张力计测定各实验液体的表面张力。将PS缺如的未成熟胎兔随机分为4组:PS、SL、RS-3和对照组。分别向PS、SL和RS-3组气道内注入PS、SL、RS-3液;对照组未注入任何物质。然后进行人工通气,通气后5、10、15、20min测定各组潮气量。结果 PS的最小表面张力(γmin)为(0.9±0.3)mN/m,SL的γmin为(22.6±1.3)mN/m,明显高于PS(P<0.01);随SP-C浓度的增加γmin逐渐降低,RS-3的γmin降至(0.7±0.1)mN/m(与PS相比,P>0.05)。通气20min时,PS组、RS-3动物的潮气量分别达到(25±7)ml/kg、(25±4)ml/kg,明显高于对照组和SL组(P<0.01)。结论 不含SP-C的合成脂质表面活性低,加入SP-C后构成的重组PS表面活性明显增强。     

Myocardial catecholamine responsiveness of spontaneously hypertensive rats as influenced by swimming training

Summary Alterations of myocardial mechanical catecholamine responsiveness by swimming training (2×90 min/day, 4 weeks) were examined in 13-week-old spontaneously hypertensive male rats (SHR). The relationships between myocardial mechanical catecholamine responsiveness and ventricular -adrenoceptors as well as myosin isoenzyme pattern were also examined. Compared with sedentary controls, trained rats showed a greater responsiveness to isoproterenol (10^–6 mol/l) on isometric tension (T) and its first derivative (dT/dt) (T:0.45±0.55 vs. –0.15±0.11 10^–2 N/mm², p<0.01, dT/dt: 17.1±10.1 vs. 8.3±3.6 10^–2 N/mm²·s, p<0.05). In sedentary SHR, dT/dt_max increased significantly, whereas developed tension decreased slightly, coupled with a decrease of time to peak tension by high dose (10^–6 mol/l) isoproterenol. Therefore, it can be stated that dT/dt is a better indicator for catecholamine sensitivity than isometric tension. -adrenoceptor density ([³H]-dihydroalprenolol binding) decreased significantly in trained rats (68.7±7.62 vs. 102.4±4.37 fmol/mg protein, p<0.01) with no significant difference in K_D values (4.61±2.26 vs. 6.11±1.94 nM, ns). In addition, myosin isoenzyme pattern revealed by pyrophosphate gel electrophoresis shifted towards VM-1 after swimming training. The increased catecholamine sensitivity of fast contracting myocardium is, in principle, compatible with the assumption of cAMP-dependent regulation of myofibrillar ATPase activity (21) or cross bridge kinetics (9), although other postreceptor processes should also be taken into consideration for the increased catecholamine sensitivity.Supported by the Deutsche Forschungsgemeinschaft     

Intracellular pH and contraction of isolated rabbit and cat papillary muscle: effect of superfusate buffering

The influence of external buffering on surface pH (pHs), intracellular pH (pHi) and developed twitch tension was investigated in rabbit and cat papillary muscle. pHs and pHi were measured using single and double-barreled microelectrodes respectively. In 20 mM HEPES buffered solution, steady state pHi is close to that in control CO2/HCO-3 (25 mM HCO-3, 5% CO2) solution. pHs and developed tension also do not differ greatly from their control values. Decreasing the HEPES concentration to 5 mM, at constant external pH, lowers pHs considerably. The surface acidosis is associated with a small intracellular acidification; steady state pHi in 5 mM HEPES is always more acid than that in control CO2/HCO-3. A significant decrease in developed tension is also seen in 5 mM HEPES. Alteration of the superfusion velocity influences pHs only slightly. Stimulation of the muscle at high frequency is shown to increase surface acidification, the extent of which is dependent on the buffer concentration. The conclusion from the present experiments is that in papillary muscle external buffering influences intracellular pH and contraction via its effect on pHs.     

定量磁化率图在脑微出血中的研究进展

脑微出血（CMB）常见于脑小血管病和神经退行性疾病。在病理上,CMB区域存在含铁血黄素沉积。定量磁化率图（QSM）可对这类超顺磁性物质精准定量,从而为CMB相关疾病的早期诊断提供有力工具,且在疾病严重程度分级和预后判断方面发挥重要作用。综述QSM用于诊断脑淀粉样血管病（CAA）、阿尔茨海默病（AD）、血管性痴呆（VaD）、多发性硬化（MS）、前哨性头痛（SH）、创伤性脑损伤（TBI）等中枢神经系统疾病CMB的研究现状及其进展。     

尺骨上段合并鹰嘴骨折内固定的生物力学研究

目的比较克氏针张力带、重建钢板联合张力带及鹰嘴解剖钢板固定尺骨上段合并鹰嘴骨折3种方式的生物力学稳定性,为临床选择内固定提供理论依据。方法 8个自愿捐献的新鲜成人尸体肘关节标本,均为男性;年龄26～43岁,平均34.8岁。于尺骨上段及尺骨鹰嘴分别截骨制作尺骨上段合并鹰嘴骨折模型。每个标本分别采用克氏针张力带(A组)、重建钢板联合张力带(B组)及鹰嘴解剖钢板(C组)3种方式对骨折端固定。采用生物力学测试系统进行单轴压缩试验,记录载荷-位移曲线,内固定系统的稳定性采用骨折端压缩位移为2 mm时所加的载荷值进行评价。结果实验过程中未出现克氏针退出、钢板螺钉断裂、标本破坏,标本与夹具固定无松动。3组标本均表现为位移随载荷增加而逐渐增长,但B、C组的载荷-位移曲线斜率明显高于A组。当骨折端压缩位移为2 mm时,A、B、C组的所加载荷值分别为(218.6±66.9)、(560.3±116.1)、(577.2±137.6)N,B、C组所加载荷值均显著高于A组,差异有统计学意义(P<0.05);B、C组间差异无统计学意义(t=0.305,P=0.763)。结论尺骨上段合并鹰嘴骨折多为不稳定骨折,重建钢板联合张力带、鹰嘴解剖钢板固定均能满足要求,临床上可根据患者情况合理选用。克氏针张力带固定不够牢固,临床上应避免单独使用。     

克氏针张力带治疗髌骨骨折

2001年3月～2010年12月,我科采用克氏针张力带治疗髌骨骨折45例,均取得满意效果。1材料与方法1.1病例资料本组45例,男33例,女12例,年龄24～73岁。横断形骨折35例,粉碎性骨折10例;新鲜闭合骨折39例、陈旧性骨折2例,开放骨折4例。1.2手术方法腰麻或连硬外麻醉。髌前纵形切口,长45～55 cm,复位较大