腭咽环扎术后阻塞性睡眠呼吸暂停低通气综合征上气道形态的研究

目的：探讨腭咽环扎术（VRLP）后阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的上气道形态特征.方法：应用纤维鼻咽镜和头影测量技术检查了6例VRLP后并发OSAHS患者、6例VRLP后未发生OSAHS和6例未手术腭裂患者的上气道形态,测量了鼻咽腔直径、腭咽环扎处咽腔直径、口咽腔直径、舌根后咽腔直径、下咽腔直径、舌骨至下颌骨的距离等6个相关参数,并应用单因素方差分析进行组间比较.结果：未手术腭裂患者上气道形态光滑,VRLP后上气道在软腭后区和舌根后区出现2处狭窄,VRLP后OSAHS患者上气道鼻咽部明显狭窄变形,为腺样体肥大所致.结论：X线头影测量技术是一种简单实用的评估VRLP后OSAHS的方法,建议VRLP术前行此检查以排除腺样体严重增生患者.     

牛视网膜提取物对人-鼠杂合细胞抗体产生的影响

目的：探讨牛视网膜提取物对人－鼠杂合细胞抗体产生的影响。方法：在ＰＲＭＩ１６４０完全培养基（ＣＭ）中加入２０ｍｇ／Ｌ牛视网膜提取蛋白,配成牛视网膜培养基（ＢＲＥＭ）。用ＭＴＴ测定、细胞克隆技术、夹心ＥＬＩＳＡ方法和染色体分析,比较人－鼠杂合细胞Ｇ１２在两种培养条件下的细胞活力、克隆效率、人ＩｇＭ分泌和人染色体阳性细胞比率之间的差异。结果：用ＢＲＥＭ培养的Ｇ１２细胞活力高于用ＣＭ培养（Ｐ＜００５）。用ＢＲＥＭ培养的Ｇ１２细胞克隆中分泌人ＩｇＭ者占１２／２４,用ＣＭ培养的克隆只占２／４７。Ｇ１２细胞传代培养３个月后,用ＢＲＥＭ培养的上清人ＩｇＭ水平Ａ４９０为０３３５±００５０,用ＣＭ培养的上清为００７０±００２７（Ｐ＜００５）。前者含人染色体阳性的细胞为２０％,后者２５％,两者间没有差异（Ｐ＞００５）。结论：添加牛视网膜提取物的培养基可以提高人－鼠杂合细胞的活力和人ＩｇＭ抗体的分泌能力。维持人源性ＩｇＭ持续分泌的条件不仅取决于杂合细胞中人染色体的存在和稳定,还有其它未知因素在起作用,牛视网提取蛋白可以提供这方面的需要。     

Radiographic Analysis of Graft Dimensional Changes in Transcrestal Maxillary Sinus Augmentation: A Retrospective Study

Background. The maxillary sinus lift is a popular and predictable technique associated with implant-supported rehabilitation of the severely atrophic maxilla. The aim of the present retrospective study was to investigate the effectiveness of transcrestal maxillary sinus augmentation and the graft resorption pattern using different heterologous bone substitutes. Methods. A total of 75 sinus-grafting procedures were performed and 89 implants were placed in 66 patients, 24 males and 42 females, with mean age 67.9 ± 10.64 years (range 43–84 years). Nineteen subjects were smokers. The mean follow-up period was 93.33 ± 54.71 months (range 14–240 months). Clinical and radiographical evaluations were performed. Graft height and width were measured at baseline and at the latest follow-up. Results. Mesiodistal and vertical resorption averaged 9.3 ± 20.7% (standard deviation), and 5.04 ± 9.9% of the postoperative size, respectively, considering the graft as the unit. Linear regression analysis showed that graft resorption in both the vertical and the mesiodistal dimension is independent of the follow-up time. Conversely, there was a trend for greater resorption when increasing the postoperative graft size, in both vertical (p = 0.001) and horizontal (p = 0.007) dimensions. When grouping the dimensional changes by graft particle size (only small (<300 μm) particles, combination of small and medium (>500 μm)/large (>1000 μm) particles, and only medium/large particles), there was a trend for greater resorption associated with smaller particles, but it was not significant; neither in the mesiodistal nor in the vertical dimension (p = 0.17 and p = 0.25, respectively). No implant was lost during the observation period. In conclusion, the transcrestal technique for maxillary sinus augmentation documented a high level of predictability. The low clinical morbidity and the contextual dental implant positioning is clinically useful in relation to a significant reduction of the time required for implant restoration, a consistent decrease of the number of surgical phases, and a cost-effectiveness approach for the rehabilitation. The graft resorption pattern in all cases was compatible with persistent implant protection and support.     

膝关节手术后功能锻炼时机的实验研究

目的:探讨膝关节手术后最佳的功能锻炼时机。方法:采用新西兰兔制成膝关节创伤模型,然后按功能锻炼时机不同分为术后不固定组(A组);术后固定24 h组(B组);术后固定72 h组(C组)3组,30 d后测量膝关节活动度,观察滑膜上皮细胞以及细胞增生、胶原纤维增生情况。结果:A组膝关节活动范围更大,滑膜上皮细胞光滑细胞增生和胶原纤维增生均不明显,较B、C组有统计学差异(P<0.05)。结论:通过动物实验,我们发现:在膝关节手术后,麻醉消退后即刻开始功能锻炼,确能较术后24 h和72 h才开始锻炼在减轻膝关节的粘连,减少关节内瘢痕组织增生,最大限度地恢复膝关节的功能等方面有着明显的优点。     

杂合式肾脏替代治疗在急危重患者中的应用

目的探讨杂合式肾脏替代治疗(hybrid renal replacement therapy,HRRT)在急危重患者治疗中的临床疗效。方法回顾性研究2005年1月至2010年1月于我院行HRRT治疗的117例急危重患者,观察这些患者行HRRT治疗后的病情和临床转归情况。结果经HRRT治疗后患者体温、心率和呼吸频率降低,各项生命体征趋于平稳。并发急性肾损伤的22例患者中16例患者尿量逐渐增多,肾功能部分或完全恢复。117例患者经HRRT治疗,10例患者死亡,治愈好转率为91.5%,死亡率为8.5%。结论杂合式肾脏替代治疗对于急危重患者来说是一种有效的治疗措施。     

一种新的手术方式:声带外展下移术治疗双侧神经麻痹

目的探讨一种新的手术方式:声带外展下移术治疗双侧神经麻痹临床优势及特点。方法回顾性分析15例使用声带外展下移术治疗双侧神经麻痹的临床效果。结果所有患者术后伤口一期愈合。9例患者术后10天拔管,6例患者术后半月至1月时拔管。复查时间1年至2年不等,患者正常生活,均未见呼吸不畅情况发生。结论声带外展下移术疗效确切,具有能同时照顾到呼吸通畅度、发声及避免呛咳的作用。     

从护理收费过低现象看我国综合医疗服务项目价格调整的必要性

我国护理服务价格一直处于较低水平,难以真正体现护理人员的劳务价值.同样,其他综合医疗服务项目的价格也不尽合理,不利于医疗机构的经济运行和发展.文章基于对上述现象的分析提出调整综合服务项目收费价格的一些建议.     

一种新型混杂多官能团齐聚物的固化反应

以N,N,N′,N′-四缩水甘油基-4,4′-二氨基二苯甲烷(TGDDM)和丙烯酸(AA)为原料,合成了一种既含有环氧基又含有乙烯基酯基团的新型混杂多官能团齐聚物树脂(MEVO)。以过氧化甲乙酮(MEKP)为引发剂、甲基四氢苯酐(MeTHPA)为环氧固化剂与MEVO共混制备了MEVO-MEKP、MEVO-MeTHPA和MEVO-MEKP-MeTHPA 3种固化体系。通过非等温DSC和FT-IR研究了MEVO的固化反应,求得了各体系表观反应活化能。结果表明：在MEVO-MEKP固化体系中,乙烯基酯按照自由基聚合机理固化,对环氧基没有影响;在MEVO-MeTHPA固化体系中,环氧基固化过程中乙烯基酯会发生热固化;在MEVO-MEKP-MeTHPA固化体系中,乙烯基酯和环氧基按各自机理固化并互相影响。