因人而异的系统健康教育对脑出血并发症发生率的影响

目的 探讨因人而异的系统健康教育对脑出血并发症发生率的影响.方法 将151例脑出血住院患者随机分为观察组78例和对照组7 3例,对照组进行常规健康宣教,观察组采用因人而异的系统健康教育.对两种健康教育模式的效果进行比较.结果 离出血并发便秘、坠积性肺炎等并发症发生率对照组均显著高于观察组(P<0.01),且观察组住院时间明显缩短(P<0.01).结论 因人而异的系统健康教育对脑出血患者的康复具有重要意义.     

Rare and fatal complications of tonsillectomy: sudden pneumothorax and extensive subcutaneous emphysema

Tonsillectomy is a common, minimally invasive, and relatively safe surgical operation. Although the surgical technology for such minor operations is mature and widely available in most countries worldwide, postoperative adverse complications occur and may be hazardous and fatal. Our article presents the details of a 4-year-old boy who suddenly developed pneumothorax and systemic extensive subcutaneous emphysema after tonsillectomy. He received professional treatment from a multi-disciplinary team (MDT) and timely rescue in our hospital; however, he died tragically. To this end, there is an urgent need to raise clinicians’ awareness of the potentially fatal and rare complications that can occur after tonsillectomy.     

利伐沙班与低分子肝素对髋关节置换术后并发症的影响

目的 比较利伐沙班和低分子肝素在预防全髋关节置换术术后对患者深静脉血栓(DVT)形成的影响及疗效。方法 126例行全髋关节置换术的患者随机分为利伐沙班组和低分子肝素组。低分子肝素组(n=70)术前12 h或术后24 h给予低分子肝素注射液,皮下注射,40 mg,1 次·d^-1,连续给药14 d。利伐沙班组(n=56)术后6~8 h给予利伐沙班口服,10 mg,1次·d^-1,连续给药35 d。观察2组术中出血量和术后引流量,比较2组的安全性指标以及术后DVT的发生率。结果 2组术中出血量、术后引流量、术后下肢DVT发生率比较差异无统计学意义(P>0.05)。利伐沙班组增加了患者术后出血、切口感染、切口不愈合或延期愈合等不良事件的风险,与低分子肝素组比较差异有统计学意义(P<0.05)。结论 在全髋关节置换术后预防DVT方面,利伐沙班和低分子肝素的疗效相似,但术后伤口并发症发生率明显高于低分子肝素,使用利伐沙班的安全性需要进一步验证。     

Cardiac catheterization in children with pulmonary arterial hypertension

Cardiac catheterization of childhood pulmonary arterial hypertension (PAH) is used to assess the severity of the disease as well as prognosis, selection of the most adequate pulmonary vasodilators, and evaluation of effectiveness. Sudden deterioration of cardiovascular hemodynamics, however, can be easily induced by pain, patient agitation, catheter manipulation, and by vasodilator provocation tests; these could trigger a pulmonary hypertension crisis, vagotony, respiratory distress, and hemoptysis resulting in critical complications, including death. Those patients with New York Heart Association functional class IV are at an especially high risk. It is noteworthy that pulmonary arteriography is a contraindication in patients with PAH. In a review of 7218 adult patients, 76 (1.1%) serious complications, including four deaths, were reported; with regard to the pediatric patients, 29 (10.7%) out of 270 patients with complications, including one with cardiogenic shock requiring cardiopulmonary resuscitation in addition to minor complications, were reported. To prevent serious complications, basic and routine precautions, such as oxygen and concomitant transcutaneous oxygen saturation and electrocardiogram monitoring during transportation to and from the catheter laboratory, are mandatory. Furthermore, the cooperation of experienced physicians and well informed medical staff in addition to meticulous preparation, for example, calculation of prior doses of catecholamine and confirmation of the presence of emergency equipment, is required.     

EX-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼

目的 探讨EX-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼的近远期疗效.方法 收集2011年2月到2015年1月选择在我院眼科就诊的新生血管性青光眼患者160例,随机分为试验组与对照组各80例,两组在术前都给予雷珠单抗玻璃体内注射,试验组选择EX-Press植入手术,对照组选择小梁切除术.对比2组治疗后手术成功率、最佳矫正视力、眼压等.结果 试验组的手术成功率为98.8％,对照组为91.3％,试验组的手术成功率明显高于对照组(P＜0.05),手术失败的患者二次手术都成功了.术后6个月两组患者的最佳矫正视力都明显高于术前(均为P ＜0.05),术后6个月试验组的最佳矫正视力明显高于对照组(P＜0.05).试验组与对照组的眼压分别为(11.20±6.32) mmHg(1 kPa =7.5 mmHg)和(18.34 ±7.13) mmHg,都明显低于术前的(35.33±10.04) mmHg和(35.12±9.24) mmHg(均为P＜0.05),同时组间差异也均有统计学意义(均为P＜0.05).术后6个月试验组术后恶性青光眼、引流管阻塞、前房出血、脉络膜脱离、视网膜脱离等并发症发生情况都明显低于对照组(均为P ＜0.05),所有并发症经对症处理后好转.结论 EX-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼能提高手术成功率,促进视力的恢复与眼压的降低,减少术后远期并发症的发生,有很好的临床应用价值.     

糖尿病患者白内障手术的相关风险

白内障是糖尿病患者常见眼部并发症之一.与非糖尿病患者相比,糖尿病患者白内障发病年龄更早,进展更迅速.虽然超声乳化白内障手术和传统白内障囊外摘除手术相比手术时间短,视力恢复快,但对于糖尿病患者,白内障手术风险仍远远高于非糖尿病患者.术中小瞳孔的出现概率较大,手术可导致糖尿病视网膜病变加重,术后更易发生黄斑水肿、眼内炎、角...     

血府逐瘀汤治疗肋骨骨折并发症分层对照临床研究

目的探讨血府逐瘀汤治疗肋骨骨折并发症的临床效果。方法 120例钝性胸部损伤合并肋骨骨折胸部简明损伤分级(abbreviated injury scale,AIS)1～3分的患者,根据胸部AIS分值分为3层,每层分为对照组及治疗组,每组20例。两组均采用常规治疗法,治疗组加用血府逐瘀汤。比较两组患者肺不张、胸腔积液、肺挫伤发生率及需行胸腔穿刺或胸腔闭式引流率等。结果治疗组胸部AIS为1、2分的患者中胸腔积液发生率分别为20%、45%,低于对照组的55%、85%,胸部AIS为3分的患者中胸腔闭式引流率为10%,低于对照组的60%,差异有统计学意义(P0.05)。结论血府逐瘀汤能显著降低AIS1、2分的肋骨骨折患者胸腔积液发生率及AIS3分肋骨骨折患者胸腔闭式引流率,有临床应用价值。     

加长柄双动半髋关节置换治疗高龄股骨粗隆间不稳定骨折

目的:探讨加长柄双动半髋关节置换治疗高龄股骨粗隆间不稳定骨折的临床疗效。方法:2007年8月—2011年12月采用加长柄双动半髋关节置换治疗75岁以上股骨粗隆间不稳定骨折55例,平均随访20.3个月,观察术后并发症、下地时间及髋关节功能。结果:55例均获随访,无一例死于术后并发症,无深静脉血栓及脑型脂肪栓塞并发症,无髋关节脱位,平均下地时间7.5d,术后12个月Harris髋关节评分:优16例,良32例,可3例,差4例。结论:加长柄双动半髋关节置换术是治疗高龄股骨粗隆间不稳定骨折的一种安全有效的方法,术后恢复快,可早期负重,避免卧床并发症。