TEP与改良Kugel术治疗双侧腹股沟疝的临床效果

目的分析比较TEP与改良Kugel术治疗双侧腹股沟疝的临床效果及患者生活质量。 方法选取2012年1月至2017年1月在上海交通大学医学院附属第九人民医院接受手术治疗双侧腹股沟疝患者157例。按照手术方式分为腹腔镜组（TEP组）和开放组（改良Kugel）组。其中，TEP组71例，改良Kugel组86例。分析比较包括2组患者的手术时间、术中出血量、住院时间、术后并发症、术后早期疼痛、慢性疼痛、复发情况和生活质量。采用SPSS 20.0统计学软件进行数据分析。 结果TEP组手术时间（93.5±10.9）min，改良Kugel组（102.6±9.8）min，差异有统计学意义（P<0.05）。TEP组住院时间（1.05±0.21）d，改良Kugel组（1.52±0.69）d，差异有统计学意义（P<0.05）。TEP组术中出血量（22.1±7.1）ml，改良Kugel组（23.4±6.8）ml，差异无统计学意义（P>0.05）。TEP组术后恢复正常活动时间（8.67±2.32）d，改良Kugel组（9.14±2.40）d，差异无统计学意义（P>0.05）。TEP组术后并发症5（7%），改良Kugel组10例（11.6%），差异无统计学意义（P>0.05）。并发症患者中身体质量指数>27 kg/m²，TEP组1例（20%），改良Kugel组6例（60%），差异无统计学意义（P>0.05）。TEP组慢性疼痛3例（4.2%），改良Kugel组14例（16%），差异有统计学意义（P<0.05）。截止至随访结束，TEP组术后复发0例，改良Kugel组术后复发1例，占约1%；2组无明显差异（P>0.05）。术后1及7 d，2组疼痛视觉模拟评分比较，差异有统计学意义（P<0.05）；术前、术后及12个月比较，差异无统计学意义（P>0.05）。术前、术后1、2、6及12个月2组生活质量量表评分比较，差异均无统计学意义（P>0.05）。 结论通过TEP治疗双侧腹股沟疝能有效地减少患者的手术时间、住院时间、术后疼痛。     

超脉冲CO2点阵激光辅助中药苦参油膏治疗增生性瘢痕的临床疗效观察

目的探讨超脉冲CO₂点阵激光辅助中药苦参油膏治疗增生性瘢痕的临床疗效。方法选取增生性瘢痕患者72例,随机分为对照组和研究组,每组各36例。对照组采用CO₂点阵激光治疗,冷敷冷疗后直接包扎,研究组在此基础上配合中药苦参油膏外敷,观察疗效和不良反应情况,比较两组患者疼痛指数、创面愈合时间、温哥华瘢痕量表(VSS)评分以及治疗后色沉发生率。结果每次治疗后研究组疼痛指数评分及创面愈合时间均低于对照组(P<0.05)。治疗前两组患者VSS评分无统计学差异(P>0.05);治疗后2个月和6个月时,研究组VSS评分均明显小于对照组(P<0.05)。研究组色沉发生率38.88%,明显低于对照组的72.22%,差异有统计学意义(P<0.05)。结论超脉冲CO₂点阵激光辅助中药苦参油膏治疗增生性瘢痕,可明显降低疼痛指数和VSS评分,缩短创面愈合时间,且不良反应较少,值得临床推广应用。     

Quantitative Ultrasound Imaging to Assess the Biceps Brachii Muscle in Chronic Post-Stroke Spasticity: Preliminary Observation

We prospectively investigated the feasibility of using quantitative ultrasound imaging (QUI) to assess the biceps brachii muscle (BBM) in individuals with chronic post-stroke spasticity. To quantify muscle echogenicity and stiffness, we measured QUI parameters (gray-scale pixel value and shear wave velocity [SWV, m/s]) of the BBM in three groups: 16 healthy BBMs; 12 post-stroke, non-spastic BBMs; and 12 post-stroke, spastic BBMs. The QUI results were compared with the Modified Ashworth Scale and Tardieu Scale. A total of 20 SWVs were measured in each BBM, once at elbow in 90° flexion and again at maximally achievable extension using acoustic radiation force impulse imaging. BBM pixel value was measured in gray-scale images captured at 90° elbow flexion using ImageJ software. Statistical analyses included analysis of variance for examining the difference in SWV and pixel values among the three groups; Bonferroni correction for testing the difference in SWV and pixel values in a paired group; t-test for examining the difference in SWV values measured at two elbow angles; and Pearson correlation coefficient for analyzing the correlation of QUI to Modified Ashworth Scale and Tardieu Scale. SWV significantly differed between spastic BBMs and non-spastic or healthy BBMs. For pixel values, each of the three groups significantly differed from the others at elbow 90° flexion. The difference in SWV measured between the two elbow angles was also significant (p?<0.01). A strong negative correlation was found between SWV and passive range of motion (R²?=??0.88, p?<0.0001) in spastic upper limbs. These results suggest that the use of QUI is feasible in quantitative assessment of spastic BBM.     

益智膏治疗小儿智力低下34例临床观察

[目的]观察应用益智膏配合针刺改善肾精不足型智力低下患儿智能水平的临床疗效。[方法]将68例入组患儿按照随机数字表法分成治疗组和对照组,治疗组34例给予服用益智膏、针刺、康复训练,对照组34例给予针刺、康复训练;采用中国韦氏幼儿、儿童智力量表进行评分,应用尼莫地平法计算智商(IQ)分值提高率。[结果]益智膏配合针刺治疗肾精不足型智力低下有效,临床总体疗效优于对照组,两组比较具有统计学意义(P0.05)。[结论]益智膏配合针刺治疗肾精不足型智力低下临床疗效确切。     

Long-term survival after chronic subdural haematoma

Outcome after chronic subdural haematoma (CSDH) is invariably assumed favourable: however, little data regarding long term survival (LTS) exists. One study reported excess mortality restricted to year 1, but with expected actuarial rates thereafter. We aimed to determine LTS after CSDH in a retrospective analysis relative to actuarial data from age-matched controls. Data was obtained in n = 155, (M:F 97:58, 69.3 ± 2.3 years). Follow-up maxima was 14.19 years (mean: 4.02 ± 3.07 years, median: 5.2 years). Mortality in-hospital, at 6 months, 1 year, 2 years and 5 years was n = 13 (8.39%), n = 22 (14.19%), n = 31 (20.35%), n = 42 (27.1%) and n = 54 (34.84%). LTS was significantly worse than controls (5.29 ± 0.59 years vs. 17.74 ± 1.8 years, hazard ratio [HR]: 3.52, P < 0.0001). Death most frequently related to pneumonia/sepsis and ischemic heart disease (IHD). Median modified Rankin score (mRS) in those discharged home (n = 94, 60.65%) was 2 [IQR: 1–3]. Discharge mRS in those who died at 6 months, 1 year, 2 years and 5 years was 5 [IQR: 3–6], 5 [IQR: 4–6], 3 [IQR: 1–3], 4 [IQR: 2–5]. Discharge mRS was significantly worse with year 1 mortality (P = 0.014). LTS related to discharge mRS (HR: 37.006, P < 0.001), post-operative motor-score (HR: 0.581, P = 0.0026), IHD (HR: 5.186, P = 0.005), warfarin-use (HR: 5.93, P = 0.036) and dementia (HR: 5.39, P = 0.031). No long term recurrences (LTR) were recorded. Although most were discharged home with mRS = 2, LTS was markedly less than previously reported: peers lived 12.4 years longer. Although greater in year 1, excess mortality was not restricted to year 1, but continued throughout prolonged follow-up. LTS related to discharge disability and dependence, and co-morbid risk factors for cerebral atrophy. No LTR suggests that, once ultimately closed, the ‘subdural space’ remains closed. CSDH patients represent a vulnerable group who require continued long-term medical surveillance.     

Characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae and in vitro synergy of the colistin–meropenem combination

Abstract

In this prospective study, consecutive isolates of Klebsiella pneumoniae were tested for different mechanisms of carbapenem resistance using the modified Hodge test (MHT), Rosco Neo-Sensitabs (ROSCO). Phenylalanine arginine beta-naphthylamide assay (PABN) inhibitor-based test was done on isolates in which the mechanism of resistance was not identifiable by the ROSCO. Among 105 selected isolates, carbapenemase production was noted in 100 (95%) by MHT and ROSCO showed 97 (92·4%) inhibition with dipicolinic acid signifying the production of MBL. PCR amplification was positive in 90 (86%) isolates for bla_NDM-1 and 46 (44%) isolates for bla_OXA-48. 54 (51%) isolates were positive for bla_CTX-M and all belonged to bla_CTX-M group 1. Isolates co produced bla_OXA-48 (31/105, 30%) and bla_CTX-M (40/105, 38%) in combination with the carbapenemase (bla_NDM-1) gene. Five colistin-resistant isolates were positive for bla_OXA-48. Eight isolates did not show inhibition with any of the inhibitor containing disks and found to be positive for bla_OXA-48. Isolates were tested for colistin-meropenem synergy and detection rate was higher by the checkerboard (48%) than E-test method (35%). Our study necessitates continuous surveillance to recognize the predominant machinery of resistance in a particular geographical region to formulate effective control measures.     

改良腹膜外剖宫产术和改良子宫下段剖宫产术比较

目的：探讨改良式腹膜外剖宫产术与改良式子宫下段剖宫产术的术后情况。方法对2009年1月~2012年12月河南省登封市中医院行两种术式剖宫产的患者，进行回顾性分析，比较其手术时间、术后情况。结果观察组和对照组体温升高再恢复至正常时间分别为（18.8±2.6）h、（20.6±3.0）h，差异有统计学意义（P＜0.01）；通气时间分别为（16.25±9.25）h、（22.32±10.50）h，显著缩短（P＜0.01）；术后外周血白细胞计数分别为（6.5±1.6）×109/L、（7.1±2.3）×109/L，差异有统计学意义（P＜0.05）；术后镇痛药物应用比例分别为20（20%）、60（60%），差异有统计学意义（P＜0.01）。结论改良式腹膜外剖宫产术术后情况优于改良式子宫下段剖宫产术，改良式腹膜外剖宫产术值得推广。     

改良超滤与零平衡超滤结合应用于婴幼儿体外循环手术59例的体会

目的总结改良超滤与零平衡超滤在59例婴幼儿体外循环手术中结合应用的经验、方法及临床效果。方法 59例婴幼儿,其中男40例,女19例,年龄4月～3岁之间,体重5～14kg,体外循环手术中均采用在体外循环过程中根据灌注压、红细胞压积给予零平衡超滤,停机后给予改良超滤。结果 59例患儿均顺利停机,无1例死亡,未出现超滤并发症,转中血球压积18～30(22.5±2)%,停机改良超滤后血球压积上升至32～38(35.8±1.4)%,在CCU住院时间为2～6d,皆顺利出院。结论在婴幼儿体外循环中将零平衡超滤与改良超滤的结合应用,零平衡超滤利于炎性介质的滤出,改良超滤可在CPB结束后快速排出多余的水分,提高红细胞压积,改善心肺功能,适用于低体重血液稀释度大的婴幼儿及体外循环时间长者。