人颈静脉孔区显微解剖研究

目的研究人颈静脉孔区显微解剖,为手术入路的选择提供形态学资料。方法手术显微镜(15倍)下对15个头颅标本,30侧颈静脉孔进行显微解剖和观察。结果颈静脉孔分为三部,即岩部、神经部、乙状部。岩部为接收岩下窦、舌下神经管静脉、岩斜裂静脉和椎静脉丛分支的静脉窦;神经部由位于结缔组织鞘中的舌咽、迷走、副神经所组成,行于颈静脉球上方的内侧,舌咽神经位于最前方,神经间被纤维或骨性结构隔开;乙状部接收乙状窦血流。结论颈静脉孔区结构复杂,熟悉颈静脉孔区的显微解剖有利于手术中保护重要的神经和血管。     

螺旋CT三维成像及曲面断层片对颏孔位置的研究

利用螺旋CT对正常年青人进行下颌骨的横断面连续薄层扫描,多平面重建后,测量并计算正常人颏孔在下颌骨中的实际位置。然后对上述人群拍摄X线曲面断层片,在曲面断层片上测量并计算颏孔在下颌骨中的实际位置,并比较差异。结果显示在垂直方向,颏孔距下颌骨下缘比距牙槽嵴顶近;在水平方向,颏孔主要位于第一磨牙及其近中的位置。曲面断层片的测量数据比螺旋CT的测量数据大0.93～2.94 mm,在比值方面与螺旋CT测量并计算的结果差异不大,二者之间差异无显著性。     

A rare complication of pre-Eisenmenger patent ductus arteriosus: Pulmonary artery dissection

INTRODUCTIONPulmonary artery dissection associated with patent ductus arteriosus is usually seen in patients with pulmonary hypertension and Eisenmenger's syndrome. This paper presents a case with pre-Eisenmenger patent ductus arteriosus complicated by pulmonary artery dissection, and explains how she was surgically treated.PRESENTATION OF CASEThe transthoracic echocardiography of a 21-year-old woman complaining of effort dyspnea revealed patent ductus arteriosus. Contrast-enhanced thoracic computed tomography scan showed patent ductus arteriosus and dissection in the main pulmonary artery extending from the edge of the patent ductus arteriosus orifice to the pulmonary valve. The patent ductus arteriosus was divided with pledgeted prolene suture and the dissected aneurysmal portion of the pulmonary artery was resected by surgery. Dacron graft interposition was applied to the main pulmonary artery.DISCUSSIONBecause rupture causes cardiogenic shock and sudden death, diagnosis is rare in the living subject and pulmonary artery dissection is frequently detected in autopsy. A case with pulmonary artery dissection as a result of patent ductus arteriosus has been reported in the literature, but the patient died in the preoperative period. In our study, the patient was not diagnosed to have Eisenmenger's syndrome, but had pulmonary artery dissection, a complication arising from patent ductus arteriosus. The patient underwent curative surgery that included pulmonary artery dissection repair and closure of the patent ductus arteriosus.CONCLUSIONIn addition to pulmonary artery aneurysm, pulmonary artery dissection must also be considered as a complication in cases of patent ductus arteriosus with high pulmonary artery pressure diagnosed in adulthood.     

BPD treatments: The never-ending smorgasbord

Despite important advances in neonatal care, rates of bronchopulmonary dysplasia (BPD) have remained persistently high. Numerous drugs and ventilator strategies are used for the prevention and treatment of BPD. Some, such as exogenous surfactant, volume targeted ventilation, caffeine, and non-invasive respiratory support, are associated with modest but important reductions in rates of BPD and long-term respiratory morbidities. Many other therapies, such as corticosteroids, diuretics, nitric oxide, bronchodilators and anti-reflux medications, are widely used despite conflicting, limited or no evidence of efficacy and safety.This paper examines the range of therapies used for the prevention or treatment of BPD. They are classified into those supported by evidence of effectiveness, and those which are widely used despite limited evidence or unclear risk to benefit ratios. Finally, the paper explores emerging therapies and approaches which aim to prevent or reduce BPD and long-term respiratory morbidity.     

正红花油不良反应文献分析

目的通过检索使用正红花油不良反应发生情况,为安全使用正红花油及非处方中成药提供参考。方法采用回顾性研究方法,通过检索CNKI中文数据库,收集使用正红花油的不良反应的相关文献,对资料进行整理和分析。结果经上述数据库报道,共遴选出相关文献66篇,文献中共报道了正红花油的相关不良反应个案339例。进一步遴选出不良反应相关文献共48篇,涉及56例不良反应个案。结论虽然正红花油的特点是药效确定、相对安全、使用方便,不良反应发生概率低,但药物安全性不容忽视,也需要考虑其不良反应并合理使用。     

经皮椎间孔镜下ULESS技术治疗老年退变性腰椎管狭窄症临床效果观察

目的:探讨老年退变性腰椎管狭窄症患者治疗中经皮椎间孔镜下ULESS技术的临床效果。方法:抽选42例2017年7月-2019年7月期间入我院进行经皮椎间孔镜下ULESS技术治疗的老年退变性腰椎管狭窄症患者作为本次研究的研究组,另选同时期入院进行开放性手术治疗的40例患者为对照组,对比两组患者手术操作时间、手术中出血量、手术后住院时间,手术前以及后1天、1周、3个月、6个月VAS评分以及ODI评分情况。结果:两组患者就手术操作时间、手术中出血量、手术后住院时间对比来看,研究组均低于对照组,研究组患者手术后1天、1周、3个月、6个月VAS评分以及ODI评分与对照组相比均较低,差异呈统计学意义(P<0.05)。结论:老年退变性腰椎管狭窄症患者治疗采取经皮椎间孔镜下ULESS技术能够安全有效提升患者的临床治疗效果,值得全方位推广应用。     

卵圆孔未闭介入封堵预防隐源性脑卒中复发

目的 探究卵圆孔未闭(PFO)封堵治疗的安全性、有效性,进一步讨论介入封堵治疗PFO的临床意义。方法 选取2019年1-7月我院行PFO介入封堵术的PFO患者90例,术前所有患者均行经胸超声心动图右心声学造影（cTTE）及经食道超声心动图（TEE）证实为卵圆孔未闭并存在右向左分流。封堵成功即刻予床旁经胸超声心动图（TTE）,观察封堵器及分流情况。术后3个月,行cTTE及颅脑CT。结果 所有患者均成功置入封堵器,即刻经胸超声心动图证实封堵器位置正常,二、三尖瓣功能正常,未见残余分流,均未出现术中、术后并发症。术后随访3个月,58.9%患者头痛症状完全消失,34.4%患者头痛症状明显改善,发作频率较前明显减少,总的有效率为93.3%。术前27例一侧肢体麻木乏力患者中19例术后肢体麻木乏力症状完全消失,8例肢体麻木乏力症状虽未完全消失但较前不同程度缓解;术前8例恶心呕吐患者,术后症状完全消失。术后3个月复查经胸壁超声心动图右心声学造影示阳性率为5.6%（5/90）。术后3个月复查颅脑CT,提示本研究中90例患者均未发现新发梗死灶,再发脑卒中发生率为0%。结论 介入封堵治疗PFO可明显缓解患者临床症状,解除患者痛苦,减少分流量,降低脑卒中的再发风险,是一种安全、有效的治疗方法,对PFO的治疗具有指导意义。     

文本挖掘探讨青风藤用药规律研究

目的:基于文本挖掘技术探讨青风藤用药规律。方法：在CBM数据库中检索、下载所有涉及青风藤的文献,通过清洗、降噪及关键词频统计的数据分层算法,挖掘青风藤治疗疾病的规律,症状、证型的分布规律,中药配伍、中成药、西药、汤剂、针灸联用规律,并进行规律的可视化展示。结果：青风藤主要治疗以疼痛、肿胀、强直、畸形为主的病证,中医病证要素涉及风、寒、湿、热、痰、瘀、虚。疾病以现代医学的类风湿关节炎为主,涉及多种风湿类疾病以及慢性肾炎、肝炎、心律失常等。中药应用方面,青风藤多与祛风除湿类、养血活血类、通络类、温经类及补肾类中药合用。此外,青风藤多与雷公藤多苷、活络丸等调节免疫、通络药物联用。结论：数据挖掘技术可以系统、全面、准确总结青风藤的用药规律,为拓展该药的临床应用及深入研究提供文献学依据。