颈部外伤的诊治体会

目的回顾性分析颈部外伤患者的临床资料，对其发病原因、诊断及治疗过程进行分析，总结经验与体会。方法收集南京市第一医院耳鼻咽喉科2008年9月～2017年9月收治的颈部外伤患者19例，其中男15例，女4例；年龄18～87岁，平均年龄46.4岁，病程0.5 h至2个月。１９例患者中颈部异物9例（6例金属异物、3例玻璃异物）、开放性颈部外伤8例、闭合性颈部外伤2例。根据患者不同的发病原因及病情，选择不同的麻醉方式及治疗方法。结果19例患者伤口均愈合良好，随访6个月，无死亡病例，无气管及食管瘘，仅1例并发一定程度的声音嘶哑。结论在颈部外伤的诊治中，保持呼吸道通畅、止血、纠正失血性休克是关键，其次进行异物清除、喉气管功能重建及血管、神经吻合，减少术后功能损失。     

Multivariable analysis of factors affecting length of stay and hospital charges after single-level corpectomy

Anterior cervical corpectomy and fusion (ACCF) is commonly employed for treating myelopathy, deformity, and a variety of other cervical pathologies. Limited data are available on factors associated with longer hospitalization and higher hospital charges following ACCF. The purpose of this study was to evaluate the pre-, intra-, and postoperative variables that are associated with length of hospital stay and hospital charges for patients undergoing single-level anterior cervical corpectomy and fusion in a retrospective case series. We retrospectively identified from a clinical database 69 patients who underwent single-level ACCF at a single institution from 2010 through 2014. Demographic variables, clinical information, and intraoperative data were analyzed with respect to length of hospitalization and hospital charges. T-test and Chi-squared testing as well as univariate and multivariable analysis were performed with p < 0.05 considered significant. On multivariable analysis, polytrauma, postoperative complications, lower postoperative hematocrit, and two-staged procedures were significantly associated with longer lengths of stay. Length of stay, postoperative complications, and two-staged procedures were significantly associated with higher hospital charges. Patients undergoing a two-staged procedure and those having postoperative complications experience a longer postoperative length of stay and incur higher hospital charges. Avoidance of postoperative anemia may help to reduce length of stay following ACCF.     

Hb Kalavasos [HBA2: c.275T > A; p.Leu92His]: a Novel α Chain Hemoglobin Variant

We present a case of a novel pathogenic variant, Hb Kalavasos [α91(FG3)Leu→His (α2); HBA2: c.275T?>?A; p.Leu92His (NM_000517.4)]; this codon was previously numbered 91 on the α2-globin gene that was discovered following routine Hb A_1c testing on a 65-year-old female of Cypriot origin. The band, seen by high performance liquid chromatography (HPLC) but not capillary zone electrophoresis (CZE), was confirmed as a hitherto undescribed a chain variant, that we have named Hb Kalavasos for the Cypriot village of family origin of the proband.     

个体化护理干预对颈椎骨折伴高位截瘫患者压疮预防管理的影响

目的探讨个体化护理干预对颈椎骨折伴高位截瘫患者压疮预防的作用。方法将84例颈椎骨折伴高位截瘫患者随机分成观察组和对照组,每组各42例。对照组给予常规压疮护理,观察组在常规护理基础上以整体护理模式为理论框架,采用"Barden压疮风险评估表"进行评估,并对评分结果给予个体化针对性护理干预。出院前评价两组患者压疮发生情况。结果对照组42例患者中发生压疮8例,压疮发生率为19%,观察组发生压疮2例,压疮发生率为4.8%,差异有统计学意义(x~2=4.725,P0.05)。结论个体化护理干预能有效降低颈椎骨折伴高位截瘫患者的压疮发生,改善患者生活质量。