斜卧体位与俯卧体位在微创经皮肾镜取石手术中的比较

目的: 比较斜卧位、俯卧位在微创经皮肾镜取石术中应用的安全性和疗效。方法: 2组上尿路结石患者共62例, 其中斜卧位27例, 俯卧位35例, 术前2组患者在年龄、性别、合并症等方面比较,差异均无统计学意义(P>0.05),记录手术时间、出血量、围手术期并发症及术后住院天数等,并进行统计学分析。结果: 2组共62例手术均获成功,无穿刺失败和中转开放手术者。斜卧位组手术时间(85.1±25.3) min;术中出血量为(117.5±49.7) mL;未发生严重的并发症。俯卧位组手术时间为(97.2±30.6) min;术中出血量为(149.3±53.1) mL;术中发现气胸1例,术后发生大出血2例。2组病人在术中出血量、手术并发症及术后住院天数等方面比较,差异均有统计学意义(P<0.05)。结论: 改良斜卧位经皮肾镜取石术疗效与俯卧位相似, 但改良斜卧位手术患者较易耐受,且并发症少,安全性高,在临床上有良好的推广前景。     

ICU患者不同体位对肺功能的影响及住院时间相关性分析

【目的】探讨ICU患者半卧位和平卧位对肺功能的影响,以及患者肺功能和住院时间的相关性。【方法】 收集42例在我院呼吸与危重症学科ICU,心内科ICU,外科ICU,和急诊ICU住院患者,问卷调查患者在半卧位和平卧位的舒适度。床边测定用力肺活量(FVC)、第一秒用力呼气容积(FEV1)和第一秒用力呼气容积和用力肺活量的比率(FEV1%)。同时观察不同体位手指氧饱和度（SpO2%）。分析肺功能以及手指氧饱和度和患者住院时间的相关性。【结果】 在半卧位体位下, 35/42患者自觉症状好于平卧位。ICU患者半卧位的FVC, FEV1比较平卧位明显改善(FVC：2.90±1.00 VS 2.22±0.85,P=0.0017;FEV1：1.95±0.89 VS 1.38±0.70,P=0.0035),ICU患者半卧位比较平卧位SpO2明显改善（95.74±1.64% VS 93.14±3.34%,P=0.0015）,但ICU患者半卧位肺功能,SpO2和住院时间无相关性。【结论】ICU患者半卧位自主感觉好于平卧位,不同体位肺功能存在明显差异,患者SpO2%亦能得到明显改善,患者肺功能和SpO2与住院时间无相关性。     

俯卧位通气在急性呼吸窘迫综合征治疗中的研究进展

俯卧位通气(prone position ventilation,PPV)是急性呼吸窘迫综合征(acute respiratory distress syn-drome,ARDS)肺保护性通气的有效治疗措施之一,具有改善氧合、减少呼吸机相关性肺损伤等优点,但由于临床医师对PPV认识不足及顾虑其并发症,目前在临床上并未得...     

准分子激光角膜屈光术后皮质类固醇性高眼压临床相关因素分析

目的:探讨准分子激光角膜屈光术后皮质类固醇性高眼压的发生率、临床相关凶素及预后.方法:对2005-12/2006-12间行LASIK或LASEK的2060例4060眼滴糖皮质激素眼液(1g/L地塞米松及1g/L氟米龙)2～3mo,术后1wk;1,2,3,6mo及1α观察眼压变化,对高眼压者进行治疗,并采用Logistic方法分析高眼压与年龄、性别、眼别、最大径线屈光度、最大径线角膜曲率、角膜切削深度和眼底垂直径杯/盘比值的相关性.结果:有88例143眼发生了高眼压,发生率为3.5%,所有高眼压患者经药物治疗眼压均降至正常.Logistic回归分析结果显示,眼底杯/盘比值与高眼压相关性P值为0.015,OR值为3.071,其他因素P值均大于0.1.眼底垂直径杯/盘比值大于等于0.4者发生皮质类固醇性高眼压的几率是小于0.4者的3.071倍.结论:准分子激光角膜屈光术后应用糖皮质激素眼液可引起部分患者发生皮质类固醇性高眼压,眼底垂直径杯/盘比值与皮质类固醇性高眼压有较强相关性,大于等于0.4是皮质类固醇性高眼压的高危因素,对眼底杯/盘比值大于等于0-4者术后可酌情减少激素用量和/或加用降眼压药物.     

舌骨位置与多导睡眠监测指标及腭咽成形术后疗效的相关性分析

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者舌骨位置与多导睡眠监测(PSG)参数指标以及腭咽成形手术疗效相关性,探讨舌骨位置对OSAHS患者疾病程度及腭咽成形手术预后的影响。方法收集2020年6月—2021年10月47例不同程度OSAHS行改良悬雍垂腭咽成形术(H-UPPP)患者术前上气道CT影像及术前、术后3个月PSG数据资料,回顾性分析颏下点至舌骨下缘的垂直距离(MH-v)、下颌骨颏棘至舌骨水平距离(MH-h)以及Friedman舌位(FTP)与阻塞性睡眠呼吸暂停低通气指数(AHI)、平均血氧饱和度(AvSpO₂)、最低血氧饱和度(LSpO₂)及血氧饱和度低于90%累积时间占总睡眠时间比(CT90)相关性,并进一步分析FTP、MH-v与H-UPPP手术疗效的相关性。结果MH-v与AHI、LSpO₂和AvSpO₂均呈中等程度相关(r=0.540, P=0.000;r=-0.523, P=0.000;r=-0.514, P=0.000),MH-v与CT90呈弱相关(r=0.495,P=0.000);MH-h与上述PSG指标均无相关性(P＞0.05);FTP与AHI、LSpO₂、AvSpO₂及CT90均呈弱相关(ρ=0.329, P=0.024;ρ=-0.309, P=0.034;ρ=-0.370, P=0.01;ρ=0.325, P=0.026)。在H-UPPP手术有效组与无效组的MH-h比较差异无统计学意义(t=-0.448,P=0.656),MH-v差异具有统计学意义(t=-5.908, P=0.000),而两组之间FTP比较差异无统计学意义(χ²=1.540,P=0.215),MH-v受试者工作特征ROC曲线下面积为0.884,在预测H-UPPP手术有效性方面具有中等诊断价值。结论作为影响OSAHS患者病情的解剖学因素,CT影像中的舌骨位置MH-v相比FTP与PSG诸多指标具有更好的相关性,对预测H-UPPP手术有效性具有一定的价值。     

Evaluation of the Impact of Body Position on Primary Central Sleep Apnea Syndrome

ObjectiveTo evaluate the impact of the body position on primary central sleep apnea syndrome.MethodsFifty-five subjects diagnosed with central sleep apnea (CSA) through polysomnographic examinations were prospectively enrolled in the study. All patients underwent cardiologic and neurologic examinations. Primary positional central sleep apnea (PCSA) was determined when the supine Apnea–Hypopnea Index (AHI) was greater than two times the non-supine AHI. The primary PCSA and non-PCSA groups were compared in terms of demographic characteristics, sleep parameters, and treatment approaches.ResultsOverall, 39 subjects diagnosed with primary CSA were included in the study; 61.5% of the subjects had primary PCSA. There were no differences between the primary PCSA and non-PCSA groups regarding age, sex, body mass index (BMI), co-morbidities, and history of septoplasty. In terms of polysomnography parameters, AHI (P = .001), oxygen desaturation index (P = .002), the time spent under 88% saturation during sleep (P = .003), number of obstructive apnea (P = .011), mixed apnea (P = .009), and central apnea (P = .007) was lower in the primary PCSA group than in the non-PCSA group. Twenty-nine percent of the patients in the primary PCSA group were recommended position treatment and 71% were recommended positive airway pressure (PAP) therapy; all patients in the non-PCSA group were recommended PAP therapy.ConclusionsOur results demonstrated that the rate of primary PCSA was high (61.5%) and primary PCSA was associated with milder disease severity compared with non-PCSA. The classification of patients with primary CSA regarding positional dependency may be helpful in terms of developing clinical approaches and treatment recommendations.     

Is Going Beyond Rasch Analysis Necessary to Assess the Construct Validity of a Motor Function Scale?

Objective

To examine whether a Rasch analysis is sufficient to establish the construct validity of the Motor Function Measure (MFM) and discuss whether weighting the MFM item scores would improve the MFM construct validity.