Management of adult patients with a left ventricular assist device.

The number of left ventricular assist device (LVAD) implantations is growing as a result of increased waiting periods for cardiac transplantation and the decreased availability of organ donors. Furthermore, the Food and Drug Administration (FDA) has approved permanent LVAD support. After an acute hospitalization, patients with LVADs may need prolonged convalescence in a healthcare facility because they have complex medical needs and are physically disabled. Admission criteria need to be developed as essential patient and nursing competencies need to be defined as a part of a successful LVAD program in an acute rehabilitation center. Acute rehabilitation centers can help patients with LVADs transition to a home setting.     

改良《颈性眩晕症状与功能评估量表》在椎动脉型颈椎病中医临床中的应用及评价

目的探讨改良《颈性眩晕症状与功能评估量表》在椎动脉型颈椎病(CSA)的中医临床中的应用可行性。方法151例CSA患者随机分为针灸推拿治疗组和单针灸对照组,治疗前后采用改良《颈性眩晕症状与功能评估量表》进行量化评估,并对该量表在本次中医临床中的效度及信度进行初步检验。结果治疗组治疗后症状与功能评分比治疗前有显著提高(p<0.01),治疗组改善指数明显高于对照组(p<0.05)。经检验,该量表也有可以接受的准则效度(r在0.8-0.9之间,p<0.01)和再测信度(r在0.6-0.9之间,p<0.01)。结论针灸推拿结合治疗CSA具有确切的临床疗效,能明显改善患者症状、颈椎功能和生活质量。改良《颈性眩晕症状与功能评估量表》在CSA中医临床中具有可信性、有效性。     

应用MRCP对63例肝移植术后胆道并发症的临床分析

目的评价MRCP在诊断原位肝移植术后胆道并发症中的临床应用价值。方法分析63例肝移植术后怀疑有胆道并发症患者的MRCP图像,并与手术、胆道造影、临床随访证实结果进行对照。所有病例均在高场强1.5T磁共振上进行。MRCP采用两种不同的成像方法:厚层块T2加权成像和薄层块多层T2加权成像。结果MRCP诊断移植术后胆道并发症的敏感性为95.3%(41/43),阳性预测值97.6(41/42),假阴性率为4.54%(2/44),假阳性率为2.27%(1/44)。总诊断准确率为95.2%(60/63)。MRCP作为唯一的诊断方法能为96.8%(61/63)的患者提供特异性诊断结果,仅2例患者需要ERCP和PTHC检查3.2%(2/63)。直接胆道造影作为一项治疗手段应用于22.2%(14/63)的患者中。结论MRCP是评价肝移植术后胆道并发症的有效影像学方法。     

芬太尼透皮贴剂预防脾栓塞后疼痛的临床观察

目的 观察芬太尼透皮贴剂预防脾栓塞术后疼痛的疗效. 方法 29例接受脾栓塞治疗的血液病患者（治疗组）,在术前10～12 h应用芬太尼透皮贴剂5 mg,观察其镇痛效果［采用视觉模拟评分（VAS）评分］及不良反应.同时回顾性分析14例接受脾栓塞治疗而未应用芬太尼透皮贴剂（对照组）的情况.结果 治疗组疼痛完全缓解9例(31.03%),疼痛部分缓解16例(55.17%),疼痛未缓解4例（13.8%）,镇痛满意率86.2%,VAS评分（1.93±1.77）分;对照组VAS评分（6.43±2.90）分,两组间差异有极显著性 (P<0.01).芬太尼透皮贴剂不良反应发生率低,主要有恶心、呕吐、食欲减退、便秘等,1例发生了肠麻痹及腹胀. 结论 芬太尼透皮贴剂预防脾栓塞术后疼痛的效果好,使用方便,不良反应发生率低，建议作为脾栓塞治疗前的常规用药.     

单中心18726例腹腔镜胆囊切除术并发症分析及预防处理对策探讨

目的 分析腹腔镜胆囊切除术(LC)的并发症及其影响因素，探讨并发症防治策略。方法 采用回顾性分析法，对自1992年3月至2001年7月在我腹腔镜中心行LC的18726例病人，术中、术后并发症及其发生因素进行分析。结果 术中胆总管损害28例(0.15％)，术后胆漏62例(0．33％)，腹腔出血6例(0．03％)，术后腹腔内脓肿及切口疝7例(0．03％)，总计103例，并发症发生率为0．55％。分析其原因与比适应证选择不当及术者对胆道解剖变异等缺乏足够认识等因素有关。结论 胆漏以及胆管损伤是比的主要并发症，精确操作可避免其损伤，术中及时发现和处理，一般预后是良好的。     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.     

盐酸托烷思琼预防脑动脉瘤栓塞术后恶心呕吐的观察

目的:观察盐酸托烷思琼对预防脑动脉瘤栓塞术患者术后恶心呕吐(PONV)的有效性和安全性。方法:选择行颅内动脉瘤栓塞术患者45例,随机分为3组,每组15例,于手术结束前30分钟A组患者缓慢静注盐酸托烷思琼5mg,B组患者缓慢静注盐酸托烷思琼3mg,C组患者给予生理盐水。术后观察并记录以下指标:(1)术后24h内恶心呕吐发生率及强度;(2)术后2、8h镇静评分(OAA/S);(3)术后2、8h平均动脉压(MAP),心率(HR);(4)各组不良反应的发生情况。结果:术后24h内两治疗组恶心呕吐发生率显著低于对照组,差异有统计学意义(P<0.05或P<0.01)。托烷思琼5mg组恶心呕吐发生率略低于3mg组,但差异无统计学意义(P>0.05)。结论:托烷思琼可降低脑动脉瘤栓塞术患者术后恶心呕吐的发生率。托烷思琼3mg不仅可以减少药物用量,而且能减少副作用的发生,是一种经济、有效、安全的止吐方法。     

全面康复:勃起功能障碍治疗的新目标

5型磷酸二酯酶(PDE5)抑制剂有效改善勃起功能障碍(ED)患者的勃起功能。枸橼酸西地那非的应用范围不断扩展,肺动脉高压已成为新的适应证。临床研究发现,西地那非能改善多种血管性疾病患者的内皮功能。在ED领域的研究进展包括:动物实验发现,西地那非可以改善海绵体内皮功能,增强磷酸化内皮型一氧化氮合酶(eNOS)蛋白表达,逆转缺血或缺氧导致的海绵体内压(ICP)降低。临床研究证实,西地那非可以使50%以上ED患者阴茎勃起恢复到最充分的硬度(4级勃起);使50%以上保留神经的根治性前列腺切除术后患者勃起功能康复,自发产生足以性交的勃起;使ED患者的自尊心、自信心和性关系满意度等社会心理功能恢复正常。从勃起功能到社会心理功能的全面恢复可能成为今后ED治疗的新目标。     

Postoperative analgesia: pain by choice? The influence of patient attitudes and patient education

Postoperative pain control can be unsatisfactory for a variety of reasons, including patients' attitudes towards pain treatment itself. To assess patients' expectations and their influence on postoperative analgesia, as well as the prevalence of pain following common gynaecological surgery, a prospective study was performed in 166 patients with either adbominal hysterectomy, mastectomy, laparoscopy or uterine curettage. After a first postoperative period with routine on-demand analgesia, a nurse specialised in pain treatment discussed the purposes and risks of pain treatment with the patients and cared for these patients in the second, subsequent study period. Following this discussion, 30 of 40 patients refusing analgesics in the first study period agreed to be given pain medication. In the groups with hysterectomy or mastectomy, pain control improved in the second postoperative period, even though the doses of analgesics administered were generally lower. Education of patients regarding the aims and risks of pain therapy is an essential part of pain control and can lead to an improvement of postoperative analgesia.