军医大学卫生装备教学的实践与思考

在明确了军队院校教育由学历教育向任职教育为主转变、实践性教学的比重逐渐加大这一现实需求的基础上,从适应军队院校教育改革、适应部队未来人民军医的任职需要等方面对军医大学开展卫生装备教学面临的形势进行分析,提出了＂三段式＂卫生装备教学模式,并指出作为卫勤实践教学新的增长点,卫生装备教学应该重视院校卫生装备与部队新装备相衔接并成为医学生军事医学综合演习和应对非战争军事行动卫勤保障的实验平台。     

Ultrasound Imaging Transducer Motion during Clinical Maneuvers: Respiration,Active Straight Leg Raise Test and Abdominal Drawing In

Clinical use of ultrasound imaging by physiotherapists is increasing; however, the clinical setting may be problematic due to variability inherent in the environment. As transducer motion interferes with accurate measurement, this study aimed to measure handheld transducer motion, relative to the pelvis, during a clinical simulation involving typical maneuvers employed in a physiotherapy assessment of the lumbopelvic region. Transducer motion about three axes and through one plane was measured (Vicon, Oxford, UK) on 12 participants during three clinical maneuvers at four abdominal imaging sites. Data were grouped and means used to determine discrepancies in transducer and pelvic motion for each imaging site/maneuver combination. None of the conditions produced large transducer motions relative to the pelvis and all findings were within previously established guidelines for acceptable amounts of transducer motion. These findings suggest that an ultrasound transducer can be held relatively stationary in a clinical setting, for the maneuvers tested. (E-mail: j.l.whittaker@soton.ac.uk)     

Effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia

ObjectiveWe investigated the effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia.MethodsWe randomly classified 214 patients with senile vascular dementia and swallowing dysfunction into a control group (CG, n = 106) and observation group (OG, n = 108). Both groups underwent health education, psychological intervention, and training of the oral muscle group. The OG additionally underwent the Mendelsohn maneuver and swallowing training. The Hasegawa Dementia Scale (HDS), China Stroke Scale (CSS), and Neurobehavioral Cognitive Status Examination (NCSE) were used to evaluate dementia, neurological impairment, and cognitive dysfunction, respectively.ResultsThe OG had a higher rate of effective therapy than the CG. After intervention, the OG showed better swallowing function than the CG. At 15 days and 1 month after intervention, the OG had higher video fluoroscopic swallowing exam scores than the CG. The OG had lower serum interleukin (IL)-1, IL-6, and tumor necrosis factor-α levels than the CG. After intervention, the OG had higher HDS and NCSE scores and lower CSS scores than the CG.ConclusionsThe Mendelsohn maneuver and swallowing training can improve swallowing function in patients with senile vascular dementia complicated with dysphagia and help to ameliorate the inflammatory response.     

Unexpected death in a young child associated with anomalous aortic origin of the left main coronary artery without physical exertion: A case of an anomalous coronary artery with highly abundant elastic fibers

Sudden death due to anomalous aortic origin of a coronary artery is far less common among young children in the absence of exercise stress. This report describes the case of a 2-year-old boy with a lower respiratory tract infection who suffered sudden cardiac arrest in his bed at home. The autopsy revealed that the left coronary artery (LCA) originated from the right sinus of Valsalva with an acute angle takeoff and traveled between the aorta and the pulmonary trunk (an interarterial course). Upon histological examination, the LCA, before reaching its major branches, was located adjacent to the outside of the aortic wall without an intramural passage, and the arterial wall was composed almost exclusively of elastic fibers without media containing smooth muscle cells throughout the entire length of the abnormal running. Screening tests for respiratory virus infection detected enterovirus in the lung tissue. In association with an acute angle takeoff and interarterial course, the wall structure with highly abundant elastic fibers that are more flexible tissues among blood vessel components might suggest their vulnerability to compression during the great vessels’ systolic expansion in the sympathetic activation induced by the viral infection, leading to fatal myocardial ischemia without physical exertion.     

Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante

Case reportA 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure.DiscussionTo the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy.     

陈氏绕肝双悬吊法联合右半肝血流阻断行右后叶肝肿瘤切除术

目的 评价右半肝阻断技术结合陈氏绕肝双悬吊法在右后叶肝肿瘤切除术中的应用价值.方法 2011年1月至2015年1月,在37例解剖性肝脏右后叶切除术中应用持续右半肝及陈氏绕肝双悬吊法辅助肝切除.右后叶肝肿瘤行右后叶切除时,采取持续右半肝阻断技术并结合陈氏绕肝双悬吊法经下腔静脉右侧放置2根提肝带,离断肝实质的过程中通过牵拉提肝带辅助肝切除.结果 全组共37例肝右后叶肿瘤病人行肝右后叶肿瘤切除术.术中均成功分离出右半肝肝蒂和右后叶肝蒂,游离右肝后均成功放置绕肝提拉带,断肝时行右半肝持续肝门阻断,术中无胆管损伤、肝短静脉、肝右静脉撕裂和大出血等相关操作并发症.肝实质离断时间17～28 min,阻断时间约20～30min,术中出血量60～330 ml.术后第1天丙氨酸转氨酶(ALT) 183～352 U/L,生化指标均在1周内恢复正常,无围手术期死亡.结论 右半肝持续阻断结合陈氏绕肝双悬吊法有助于减少右后叶肝切除术中出血量以及改善手术野,缩短肝实质离断时间,减轻肝脏缺血再灌注损伤,其操作简单、使用安全、适用范围广泛.     

Epidemiological evidence of increased waist circumference,but not body mass index,associated with impaired baroreflex sensitivity

Although an inverse relationship between body mass index (BMI) and baroreflex sensitivity (BRS) was found, the effect of waist circumference (WC) on BRS is still inconclusive. The contradictory results of previous studies may be related to the heterogeneity and relatively small sample size of the subjects examined. The aim of this population-based study was to investigate whether the influence of increased WC is more detrimental to BRS than BMI. A total of 760 community dwellers were recruited and they were classified into Q1 (n = 189), Q2 (n = 183), Q3 (n = 192) and Q4 (n = 196) groups, based on WC quartiles. Spontaneous BRS was determined by spectral α coefficient method. Valsalva ratio was the longest RR interval after release of Valsalva maneuver divided by the shortest RR interval during maneuver. Cardiac autonomic function was calculated by power spectrum of heart rate in low and high frequency (LF, 0.04–0.15 Hz; HF, 0.15–0.40 Hz), and LF/HF ratio in supine position for five minutes. There were significant differences in spontaneous BRS and Valsalva ratio among different WC groups. In multivariate analysis, obesity was inversely associated with spontaneous BRS and Valsalva ratio. However, these inverse relationships became insignificant after further adjustment for WC quartiles. In contrast, Q4 vs. Q1, Q3 vs. Q1 and Q2 vs. Q1 of WC were inversely related to spontaneous BRS. Q4 vs. Q1 and Q3 vs. Q1 of WC were negatively associated with the Valsalva ratio. In conclusion, increased and even high-normal WC had a stronger adverse effect on BRS than BMI, independent of cardio-metabolic risk factors.     

Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure

Background and aims  Bleeding from the hepatic vein is closely related to central venous pressure (CVP). To evaluate the effect of low central venous pressure during a hepatectomy, the infrahepatic inferior vena cava (IVC) was half clamped. Patients and methods  Between 2006 and 2007, 20 patients undergoing major hepatectomy with the IVC half clamping (half-clamping group) were compared with 58 patients undergoing hepatectomy without IVC half clamping between 2003 and 2005 (control group). The types of liver resection, amount of blood loss during the hepatectomy, volume of blood transfusion, length of hospital stay, and complications were compared between the two groups. Results  In the half-clamping group, blood loss was decreased in comparison to the control group (p = 0.041) and the suprahepatic CVP was low (2.4 ± 1.8 mmHg; p = 0.0002). The diameter at the root of the right hepatic vein was reduced in comparison to before clamping (5.8 ± 1.6 mm; p < 0.001). There were no complications of half clamping on any hemodynamic and blood electrolytic parameters. Conclusion  Using the half clamping technique of the IVC, intra-operative CVP was maintained below 3 mmHg without any side effects, and the low CVP significantly reduced the bleeding from hepatic veins during a major hepatectomy.