控制性降压下俯卧位脊柱手术全麻患者眼内压及眼底动脉血液动力学的变化

目的实时监测控制性降压对俯卧位脊柱手术全麻患者眼内压及眼底动脉血液动力学的影响,以探讨其安全阈值。方法随机选取预行俯卧位脊柱全麻手术的60例外科患者为研究对象,麻醉过程中采用硝酸甘油控制性降压。选择诱导前10 min(T0)、诱导后10 min(T1)、俯卧位后10 min(T2)、控制性降压10%(T3)、20%(T4)、30%(T5)、恢复正常血压10 min(T6)、术毕平卧位后10 min(T7)、拔出气管导管后10 min(T8)9个时间点,使用笔式眼压计测量眼内压(IOP),使用彩色多普勒超声仪测定右眼视网膜中央动脉和睫状后动脉的血流动力学特征收缩期最高流速(PSV)、舒张末期最低流速(EDV)、阻力指数(RI)及搏动指数(PI)。结果患者诱导麻醉后,IOP、RI及PI随着麻醉时间的延长呈升高趋势,PSV及EDV呈降低趋势,T5时,各指标差异性最大,均较T0有显著差异(P0.05或0.001)。T6后,各指标有所恢复,T8各指标较T0无统计学差异(P0.05)。另外,T5时4例患者出现视网膜中央动脉闭塞(CRAO)征象,其MAP均低于患者该时段平均水平(64.8±8.66 mmHg)。结论控制性降压对俯卧位脊柱手术全麻患者的眼内压及眼底动脉血液动力学指征有所影响,血压降低水平控制在基线水平的30%以内,且保证目标MAP65 mmHg,可有效保护患者视神经。     

Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis

Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). However, the exact physiological effects of ARS are still unclear. This study investigated the short and long‐term effects of ARS on disc and condyle angles/positions by metric analysis. Twenty‐two subjects diagnosed with ADDwR were recruited. Maxillary full‐coverage ARS were fabricated, and MRI of TMJs was obtained before splint treatment, immediate post‐insertion and 6 months after splint treatment. Disc–condyle relationship was determined by disc–condyle angle measurement. Disc and condyle positions were described as X‐Y coordinates with the summit of glenoid fossa as the origin of the coordinates. Thirty‐two TMJs were classified as ADDwR and 12 were normal. Upon ARS insertion, all TMJs with ADDwR got normal disc–condyle relationships. The condyles moved significantly forward and downward, while the discs moved significantly backward and upward. MRI at 6 months after treatment (without ARS insertion) indicated that only 40·6% (13/32) of the joints were maintained in the normal disc–condyle relationship. The majority of condyles returned to their pre‐treatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc–condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short‐term clinical outcomes with ARS and their relatively lower efficacy in the long term.     

高位复杂性肛瘘的治疗进展

阐述了在治疗高位复杂性肛瘘方面的新方法和技术，介绍了改良的挂线术、保留括约肌的术式和封堵注入术的治疗方法和效果。改良的挂线引流术式仍是治疗高位复杂性肛瘘的主要方法；新近出现的保留括约肌的手术方法为减少肛门功能失禁、彻底治疗高位复杂性肛瘘提供了可能；封堵填充术因其操作简单、较好的治愈率等特点正成为非手术治疗的主要方法。     

64层螺旋CT在肿瘤调强放射治疗定位中的应用及分析

目的：探讨64层螺旋CT在肿瘤调强放射治疗定位中的临床应用及CT扫描床的误差分析。方法：收集我院2010年6月-2011年6月在TOSHIBA Aquiiion 64层螺旋CT机上进行肿瘤调强放疗定位CT扫描患者25例。其中，男13例，女10例，年龄35—73岁，平均年龄55岁。头颈部肿瘤10例，胸部肿瘤5例，腹部肿瘤6例，盆腔肿瘤4例。CT定位图像经DICOM3．0接口传输到XVI软件中，在Workstation上进行治疗床与定位床的误差分析。结果：组内数据符合统计学意义（P〈0．05），误差值X轴为（0．968±0．910）°，Y轴为（0．508±2．09）°，Z轴为（0．3±2．62）°。除X轴外，旋转误差均不符合国标GB／T17589—1998。结论：64层螺旋CT碳纤维平板床在肿瘤调强放疗定位中误差已超过阈值，不适合做精确调强放射治疗定位。     

不同体位下留置鼻肠管在老年痴呆患者中的应用效果

目的 探讨不同体位下留置鼻肠管在老年痴呆患者中的应用效果。方法 选取我院在2019 年2 月至2020年2 月确诊并治疗的老年痴呆患者100 例，依据置管时的不同体位分成两组，对照组（n=50）应用仰卧位（床头抬高＜30°），研究组（n=50）应用45°右侧卧位。观察比较两组的一次性成功置管比率水平差异；两组的置管平均耗时水平差异；两组置管过程中的相关反应发生比率水平差异。结果 研究组一次性成功置管比率水平为94.0%（47/50），对照组一次性成功置管比率水平为76.0%（38/50），研究组一次性成功置管比率水平高于对照组（P＜0.05）。研究组置管平均耗时为（131.6±10.1）s，对照组置管平均耗时为（284.1±13.4）s，研究组置管平均耗时水平短于对照组（P＜0.05）。研究组置管过程中发生相关反应的比率水平低于对照组（P＜0.05）。结论 给予老年痴呆患者在留置鼻肠管时使用45°右侧卧位可显著提高一次性成功置管比率，缩短置管耗时，降低患者发生相关置管反应的比率水平。     

Apport des panneaux Vichy dans l’acquisition de la station assise depuis son utilisation au CAMSP en 2011

The seated position is achieved by the integration of sensory systems and the use of muscle chains to ensure balance and maintenance of the posture against gravity. This position frees the mobility of the upper limbs. Based on the work of Prof. A. Büllinger and his colleagues, which explores the function of sensory flows, particularly peripheral visual flows, in the tonicopostural development of the child, we sought to highlight the importance of the sensory support with which the child with a neuromotor disorder readjusts himself and straightens his back. In a first experiment of specific therapeutic education with gingham panels, we found an immediate, but not permanent, effect of postural straightening when the child is surrounded by these panels, and a long-term effect when they are integrated in the child's physical therapy over a given period. The conclusions drawn from this experiment led us to use gingham panels as a complementary tool in neuromotor therapy within the CAMSP.     

减小后牙▉平面倾斜度对安氏Ⅱ类高角畸形髁突位置影响的研究

目的: 研究在安氏Ⅱ类高角畸形正畸治疗中,减小后牙平面倾斜度对髁突位置的影响。方法: 15例安氏Ⅱ类高角畸形患者,年龄15~30岁。治疗前ANB>5°,下颌平面角FH-MP>32°,磨牙关系为双侧远中关系。常规排齐整平及适当扩弓后,利用多曲唇弓导下颌向前,并使后牙平面平坦化。利用锥形束CT（cone-beam CT,CBCT）测量治疗前、后颞下颌关节前、上、后间隙及后牙平面的改变情况。采用SPSS19软件包对变化量进行t检验;并利用相关性分析,进一步探讨髁突位置改变量与后牙平面倾斜度减小量之间的相关性。结果: 所有患者磨牙尖牙关系均调整到中性,侧貌改善明显,髁突后间隙平均增加(0.88±0.17)mm,变化有统计学意义(P<0.001);髁突上间隙平均增加(0.45±0.20)mm,变化也具有统计学意义(P<0.05)。后牙平面变平坦,POP-SN及POP-FH平均减小3.59°±2.31°及2.31°±3.62°,变化具有统计学意义(P<0.001)。髁突前间隙变化量无统计学意义,髁突位置改变量与后牙平面倾角的变化量之间无显著相关性。结论: 在安氏Ⅱ类高角畸形患者的正畸治疗中,通过正畸减小后牙平面倾斜度,可使髁突的位置发生适当的前下改变,有利于关节症状的改善。