封闭式负压引流治疗难愈性压疮的护理探讨

目的探讨封闭式负压引流治疗Ⅲ-Ⅳ期压疮的效果。方法应用封闭式负压引流技术治疗Ⅲ～Ⅳ期压疮,随机将40例Ⅲ-Ⅳ期压疮的患者分为治疗组及对照组各20例,治疗组采用封闭式负压引流治疗创面,对照组采用安尔碘湿敷创面,观察两组治疗的效果。结果治疗组总有效率92％,对照组总有效率86．36％,两组比较,差异有统计学意义（P〈0．05）。结论对于Ⅲ-Ⅳ期压疮的患者使用封闭式负压引流治疗时间明显缩短、治愈率明显提高,同时减少病人痛苦、减轻医务人员工作量、减少抗生素使用及患者经济负担。     

Role of pilocarpine use following laser peripheral iridotomy in eyes with refractory acute angle closure glaucoma: A case report and literature review

Rationale:Angle closure glaucoma (ACG) is one of the most emergent types of glaucoma in clinical practice. Laser peripheral iridotomy (LPI) could minimize pupillary block and prevent ACG from an acute attack. However, recurrent increase in intraocular pressure (IOP) may still occur despite successful LPI. The aim of this study is to highlight the importance of postLPI pilocarpine use and larger LPI size as well as to share some experiences of cataract surgery in patients with ACG.Patient concerns:A 63-year-old female was referred to our hospital for headache, and poor control of IOP in the right eye for 3 hours.Diagnoses:The patient was diagnosed ACG in the right eye. Recurrence of ACG in the right eye and new-onset and recurrent ACG in the left eye were noted during follow-up, despite successful LPI. The diagnosis was confirmed through slit lamp and gonioscope examination.Interventions:The LPI size was enlarged and pilocarpine use was maintained at 2% (1 drop 4 times a day) in both the eyes. Finally, cataract surgery was performed in both the eyes.Outcomes:No recurrence of ACG was noted during postLPI pilocarpine use in both the eyes. The postoperative IOP was stable for >6 months after cataract surgery without any surgical intervention or antiglaucoma medication use. No discomfort or major complication was observed.Conclusion:This report highlights the importance of postLPI pilocarpine use and larger LPI size in patients with refractory ACG.     

经导管Amplatzer封堵器和外科手术治疗动脉导管未闭对照试验的Meta分析

目的评估经导管Amplatzer封堵器治疗动脉导管未闭(PDA)的疗效,为临床应用提供指导。方法采用Meta分析方法,对国内外有关经导管Amplatzer封堵器和外科手术治疗PDA的对比临床研究进行综合定量分析,采用RevMan4.2.2软件进行数据处理,计算各组技术失败率、并发症及严重并发症发生率、残余分流率等的相对危险度(RR)及其95%可信区间(CI)。结果符合纳入标准共5篇文献,总样本量349例。经导管Amplatzer封堵器组技术失败率高于外科手术组[5组对照试验(CT),349例,3.0%vs0,RR=4.29,95%CI(0.77,23.95)],但无显著性差异(P=0.10);并发症发生率低于外科手术[5组CT,343例,3.1%vs38.0%,RR=0.11,95%CI(0.05,0.23)](P<0.00001);严重并发症发生率显著低于手术组[5组CT,343例,0.5%vs6.0%,RR=0.23,95%CI(0.06,0.90)](P=0.03);Amplatzer封堵器组治疗后即时残余分流率高于手术组[4组CT,304例,16.3%vs0,RR=16.06,95%CI(3.0,86.12)](P=0.001);出院时残余分流率虽高于手术组,但无显著性差异(2.5%vs0,P=0.33)。结论经导管Amplatzer封堵器治疗PDA尽管成功率低于外科手术,但其创伤小、并发症发生率低、疗效与手术相仿,随着封堵器及其输送系统的不断改进和完善,在适应证范围内经导管Amplatzer封堵器治疗可作为PDA外科手术治疗的替代方法。     

Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery

OBJECTIVESTo evaluate the feasibility of open chest management with our modified negative pressure wound therapy immediately after cardiac surgery as a therapy for atypical tamponade.METHODSOpen chest with modified negative pressure wound therapy was performed immediately after cardiac surgery. The surface of the heart and the vessels were covered with non-adherent siliconized gauze. The sternal halves were stented using edge-cut disposable syringes to maintain a larger mediastinal cavity. Approximately 45 mm of distance was kept between the sternal edges. A trimmed sterile polyvinyl foam sponge was inserted into the mediastinum, the entire wound was sealed and negative pressure (−50 to −75 mmHg) was applied using a suction generator. Delayed chest closure was performed in a standard manner once the haemodynamic status was stabilizsed.RESULTSThe mortality rate was 3/15 (20%) patients. Deep sternal wound infection occurred in 1/15 (6.7%) patients. Five patients were extubated during the open chest management. Sternal closure was delayed for median of 3 days after the initial surgery. There was no incidence of bleeding complications or need for additional haemostatic procedures.CONCLUSIONSNegative pressure wound therapy performed immediately after cardiac surgery was feasible in our small number of patients.Clinical registration numberStudy ID: 2020-149.     

乳腺癌患者术后认知闭合需要与坚韧性人格的关系研究

目的探讨乳腺癌患者认知闭合需要与坚韧性人格的关系,为护士对患者开展针对性健康教育提供参考。方法对319例乳腺癌患者运用中文版认知闭合需要量表和坚韧人格量表进行调查。结果乳腺癌患者认知闭合需要得分为206.94±28.91,坚韧性人格得分为46.61±8.25;认知闭合需要和坚韧性人格呈显著负相关,认知闭合需要的决断性及对结构的需求能预测坚韧性人格(均P0.01)。结论乳腺癌患者认知闭合需要程度较高,坚韧性程度较低,认知闭合需要能预测坚韧性人格。护士可针对乳腺癌患者的决断性与对结构的需求给予相应引导,以增强其坚韧性人格。     

经导管封堵外科术后心脏瓣周漏的初步经验

目的评估经导管封堵外科术后心脏瓣周漏（PVL）的有效性及安全性。方法对本中心2009～2012年行经导管试封堵的PVL病例进行总结分析。结果共入选12例患者,包括7例主动脉瓣PVL及5例二尖瓣PVL。其中,9例男性和3例女性,平均年龄（60±10）岁;9例有1个PVL,3例有2个PVL;7例PVL（最大的）为新月形,3例为椭圆形,2例为类圆形。操作成功率为83.3%,临床成功率为66.7%,10例操作成功的患者中有8例病例纽约心脏学会（NYHA）分级提高1级以上。术后1个月,操作成功的患者PVL程度由术前平均3.1级降为1.3级（P＝0.007）,NYHA分级由平均2.9级降为1.8级（P＝0.007）,左室舒张末内径由56 mm降为52 mm（P＝0.005）,左房前后内径由69 mm降为60 mm（P＝0.005）,肺动脉收缩压由58 mm Hg降为43 mm Hg（P＝0.01）, NT-proBNP由1697 ng/L降至1066 ng/L（P＝0.02）,左室射血分数改变未达到统计学意义（P＝0.25）。病例8术前有慢性肾功能不全,术后出现造影剂肾病,给予床旁血液透析1周,肾功能无明显改善,后出现心功能恶化,最后死亡。病例6出现溶血,及肾功能一过性损害（肌酐最高至136 mmol/L）。结论初步结果显示,经导管介入封堵外科术后PVL虽然有一定并发症发生风险,但成功率及效果可以接受,可以在有经验的中心开展。     

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow‐up of patients undergoing these structural heart interventions is vital. Multi‐detector computed tomography (MDCT) has emerged as a key imaging modality in the peri‐procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence‐based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri‐procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.     

Anatomical status of the human musculus uvulae and its functional implications

In our ongoing series of anatomical studies to determine the three‐dimensional architecture of the human velar muscles, we have previously reported on the palatopharyngeus. The present study deals with the musculus uvulae (MU), in which the positional relationships of its origin to the posterior nasal spine and the palatine aponeurosis, as well as the interrelation between its anatomical status and functions, have yet to be clarified. Macroscopic and microscopic examinations were performed on 25 and 2 cadavers, respectively. In the former, bilateral MUs and their adjacent structures were exposed mainly from the nasal aspect. In the latter, the soft palates embedded in paraffin were cut into frontal and sagittal sections and alternately processed with HE and Azan stains. The left and right MUs adjacent to each other were found to run longitudinally along the midline beneath the nasal aspect of velum. It was overlaid by glandular tissue that increased in amount as it coursed distally. After originating from the oral surface of palatine aponeurosis, it ran backward to cross above the sling formed by the levator veli palatini muscles of both sides and reached the tip of uvula with its muscle fibers intermingled with glandular tissue. Past studies have proposed three functions of MU to enhance the efficiency of velopharyngeal closure: space occupier, stiffness modifier, and velar extensor. All of the above‐described anatomical characteristics of MU could be explained as being adapted for these functions. This implies that MU is actively responsible for maintaining the velopharyngeal closure efficiency. Clin. Anat. 27:1009–1015, 2014. © 2014 Wiley Periodicals, Inc.     

Scanning electron microscopic investigations of the human umbilical artery intima

Summary Umbilical cord arteries were investigated using a scanning electron microscope using different methods of preparation: Perfusion of one artery under pressure from a 100 cm water column caused artefacts and the preparatory work took at least 10 min after delivery. To shorten this time fully patent umbilical cords were double clamped and fixed immediately after birth. However, the removal of blood after fixation caused the endothelial layer to be lost. Therefore umbilical cords were double clamped, snap frozen and stored in liquid nitrogen until preparation. The endothelial lining of the fully patent umbilical artery at birth is composed of longitudinally arranged, spindleshaped cells, connected by cellular junctions. The basement membrane contains numerous gaps. Because of these gaps postnatal vasoconstriction causes herniation of the subendothelial myofibroblasts forming subendothelial vacuoles. The vacuoles produce displacement of the endothelial cell cytoplasm towards the vascular lumina resulting in protuberances and blebs on the endothelial cells. Rupture of vacuoles leads to crater-like injuries.Beneath the basement membrane a thin layer of myofibroblasts is arranged longitudinally. Oblique or transversely ordered bundles of myofibroblasts are interposed at wide and irregular intervals. These transverse bundles are able to trigger localized contraction rings called folds of Hoboken, the initial stage of postnatal arterial closure.     

Are patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia satisfied with nostril closure surgery?

Objective

Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation.

Methods

Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities.

Results

Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery.

Conclusion

Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required.