骨筋膜室综合征38例诊治体会

<正> 骨筋膜室综合征是四肢骨筋膜室内的肌肉和神经因急性严重缺血而出现的早期的症状和体征。如不及时诊断和治疗可迅速发展为坏死或坏疽,使肢体残废甚至丧失生命,又名浮克曼(Volkman)缺血性肌挛缩、创伤性张力性肌肉缺血等。 本院近年来收治本病例38例,现报告如下:     

选择性翼管神经分支切断术对改善变应性鼻炎患者心理状态的分析

目的:探讨选择性翼管神经节后分支切断术改善成人持续性变应性鼻炎患者焦虑抑郁状态及生活质量的效果。方法:选取2022年1月至2022年12月就诊于宜春市人民医院80例成人持续性变应性鼻炎患者作为研究对象,按照随机数字表法分为对照组与实验组各40例。对照组患者接受药物治疗1月,实验组患者接受药物治疗的同时予以鼻内镜下选择性翼管神经节后分支切断术,治疗后均随访6个月。比较两组患者治疗前、治疗后1个月、6个月焦虑自评量表(SAS)、抑郁自评量表(SDS)及鼻炎相关生活质量问卷(RQLQ)得分情况。结果:随访期间实验组RQLQ平均得分及SAS、SDS评分在治疗后1个月、6个月均显著低于治疗前,且低于同时期对照组,差异有统计学意义,对照组除了SAS评分在治疗后1个月比治疗前显著降低,其他指标治疗后1个月、6个月与治疗前比较差异无统计学意义。结论:选择性翼管神经节后分支切断术能有效改善成人持续性变应性鼻炎患者焦虑抑郁状态,提高患者生活质量。     

天麻钩藤饮对肝阳上亢型高血压患者抗氧化及颈动脉硬化的影响

目的:探讨天麻钩藤饮对肝阳上亢型高血压患者抗氧化活性以及颈动脉硬化的影响.方法:选择肝阳上亢型高血压患者60例,随机分为天麻钩藤饮组(中药组)和非洛地平组(对照组)各30例,治疗6个月,分别检测治疗前后患者血压、血清SOD、MDA以及颈动脉内中膜厚度(IMT)的变化.结果:治疗后,2组血压均明显下降,组间比较差异无显著性(P>0.05),天麻钩藤饮组和非洛地平组的SOD活性在治疗前分别为(85.6±11.2)U/mL和(86.3±12,5)U/mL,在治疗后为(98.1±12.8)U/mL和(95.1±13.2)U/mL,治疗后比较差异有显著性(P<0.01);MDA在治疗前为(6.28±1.65)nmol/L和(6.23±1.58)nmol/L,治疗后为(4.08±1.30)nmol/L和(5.11±1.39)nmol/L,治疗后比较差异有显著性(P<0.01).天麻钩藤饮组IMT治疗前后分别为(1.16±0.14)mm和(0.75±0.08)mm,比较差异有显著性(P<0.01).结论:天麻钩藤饮对肝阳上亢型高血压病患者具有良好降压作用,并且能增加抗氧化活性,改善高血压患者颈动脉硬化.     

手背间隙感染并发前臂筋膜间室综合征1例报告

筋膜间室综合征,在骨科疾病中较为常见为骨、骨间膜、肌间膈和深筋膜形成的骨筋膜内的肌肉和神经因急性缺血而产生的一系列早期症状和体征。若能正确诊断,及时治疗,大多可获康复。反之,则预后较差,其多发生于肢体的挤压伤、石膏或夹板固定不当等。起病后进展快,并发症严重,我们曾在基层卫生     

小剂量雷公藤多甙治疗子宫肌瘤疗效观察

目的:观察小剂量雷公藤多甙(GTW)治疗子宫肌瘤的临床疗效及副作用.方法:随机将124例患者分为两组,对照组62例,治疗组62例.治疗组服用雷公藤多甙40mg/d,疗程3～6个月,对照组服用米非司酮25mg/d,疗程3个月.治疗前后均用B超测量子宫及其肌瘤大小,用放射免疫法(RIA)测血清雌二醇(E2)、孕酮(P)、促卵泡素(FSH)、促黄体生成素(LH)水平.结果:两组治疗后3～4个月、5～6个月子宫及肌瘤体积与治疗前比较均明显缩小,差异均有显著性(P＜0.05,P＜0 01).而且缩小呈时间依赖关系.治疗后3个月,治疗组E2、P较治疗前显著下降,FSH、LH水平较治疗前升高,差异均有显著性(P＜0.01),上述性激素水平在停药后1～3个月内均恢复正常.服药期间治疗组3.2%、对照组74.19%有不同程度的胃肠道反应及更年期症状.结论:小剂量雷公藤多甙治疗子宫肌瘤的临床疗效明显,副作用少.     

布地奈德联合沙丁胺醇雾化吸入治疗支气管哮喘的疗效及其对肺功能和免疫功能的影响

目的:探讨支气管哮喘患者给予布地奈德联合沙丁胺醇雾化吸入治疗的临床疗效.方法:将70例支气管哮喘病人随机分为观察组和对照组.观察组给予布地奈德联合沙丁胺醇雾化吸入治疗,对照组仅给予常规治疗,连续治疗2周.观察两组主要临床症状、肺功能及免疫功能改善情况,治疗结束后评价临床疗效,观察不良反应.结果:观察组临床疗效总有效率为91.4%,显著高于对照组(62.9%),相比较有显著性差异(x2=8.102,P0.01).观察组住院时间、咳嗽缓解时间、肺部哮鸣音和湿啰音消失时间低于对照组,两组相比较有显著性差异(t=9.886、7.668、10.546、9.993,P0.01).治疗后,观察组FEV1/FVC、FEF值显著下降,与治疗前比较有显著性差异(t=3.232、3.672,P0.01),且观察组FEV1/FVC、FEF值与对照组比较有显著性差异(t=2.187、2.517,P0.05).治疗后,观察组CD4~+、CD4~+/CD8~+表达水平上升、CD8~+表达下调,与治疗前比较有显著性差异(t=5.060、5.136、4.584,P0.01),且观察组CD4~+、CD8~+及和CD4~+/CD8~+表达水平与对照组比较有显著性差异(t=3.795、4.643、3.897,P0.01).两组患者均未出现严重不良反应.结论:支气管哮喘患者给予布地奈德联合沙丁胺醇雾化吸入治疗临床疗效好,可以有效改善患者肺功能和免疫功能,且安全可靠.     

倍他乐克治疗高血压合并窦性心动过速观察

对60例高血压合并窦性心动过速(其中10例为β受体反应亢进综合征β-亢)患者用倍他乐克50mg,每日2次口服,治疗观察2周,收缩压由治疗前23.1±2.0kPa降至19.8±2.9kP,舒张压由13.1±0.5kPa降至12.1±1.0kPa,平均心率由治疗前123.7±24.5次/分减慢到73.5±11.7次/分。治疗前后血压、心率差异均有显著性(P<0.05)。其中β-亢患者在治疗当日即显示明显疗效。治疗中未发现明显副作用。结果提示,倍他乐克是治疗高血压并窦性心动过速最理想的药物,而且对β-亢有明显的疗效。     

腹腔镜与开腹胰体尾切除术对胰腺导管腺癌的治疗经验（英文）

目的:评估腹腔镜(LDP)与开腹胰体尾切除术(ODP)的并发症发生率和肿瘤清除效果。创新点:本组病例的腹腔镜手术组采用endo-GIA缓慢压榨方法处理胰腺残端,并采用根治性顺行模块化胰脾切除术,获得了较低的术后胰漏发生率和良好的手术清除效果。方法:收集4年间实施胰体尾切除手术的胰腺导管腺癌病例资料,进行回顾性分析。结论:22例胰腺导管腺癌进行了LDP手术,76例病人进行了ODP手术。比较LDP和ODP组,两组在胰漏(P=0.62)、腹腔内脓肿(P=0.44)和术后出血(P=0.34)发生率无显著性差异。LDP组和ODP组术中获取的淋巴结数量(11.2±4.6 vs.14.4±5.5,P=0.44)和淋巴结阳性病例数(36%vs.41%,P=0.71)无显著性差异。切缘阳性发生率(9%vs.13%,P=0.61)也无显著性差异。LDP组平均生存期(29.6±3.7)月,ODP组为(27.6±2.1)月,无显著性差异(P=0.35)。综上所述,腹腔镜胰体尾切除术对早期的胰腺导管癌是安全有效的。采用endo-GIA缓慢压榨方法可以预防术后胰漏发生,腹腔镜下根治性顺行模块化胰腺切除有利于肿瘤清除。腹腔镜手术可以达到和传统开腹手术相似的肿瘤清除效果。     

126例首发住院精神分裂症患者的心理干预效果研究

为了观察心理干预对首发精神分裂症病人的疗效,抽取洛阳市精神卫生中心2013年2月至2014年1月住院的精神分裂症病人126例,平分为两组.实验组在服用常规抗精神药物的基础上实施为期3个月的心理干预.采用简明精神病评定量表(BPRS)和住院精神病人康复疗效评定量表(IPROS)对两组患者进行计分评定.研究结果表明,治疗前后,实验组BPRS分有显著性差异(P﹤0.01),两组的BPRS分比较也有显著性差异(P﹤0.01),实验组IPROS各因子分及总分均降低,与干预前相比有显著性差异(P﹤0.01),对照组只有工疗情况因子分有显著性差异(P﹤0.01),其它因子分和总分前后差异不显著(P>0.05).因此,对首发住院的精神分裂症患者施以必要的心理干预,可提高康复效果.     

如何创设充满活力的英语课堂气氛

目的:观察针药联合治疗气虚血瘀型中风的效果。方法:选择气虚血瘀型中风患者140例作为研究对象,随机分为对照组与观察组各70例,对照组给予常规治疗,观察组在对照组的基础上给予中医针灸治疗,两组治疗1个月后观察其疗效。结果:观察组有效率(97.1%)明显高于对照组有效率(80.0%)(P<0.05)。治疗后观察组与对照组的神经功能缺损评分分别为(15.82±12.09)分和(24.34±11.85)分,都明显低于治疗前的(37.16±12.55)分和(37.56±12.79)分(P<0.05),观察组治疗后的神经功能缺损评分也明显低于对照组,差异均有统计学意义(P<0.05)。结论:针药联合治疗气虚血瘀型中风能够促进恢复神经功能缺损状况,提高总体疗效的,值得临床推广。     

Evaluation of cilazapril in vasovagal syncope treatment

Objective: to evaluate cilazapril in vasovagal syncope treatment. Method: eighty-six cases of VVS patients found positive in TTT tilt were medicated with 2.5 mg cilazapril daily for three months and followed up by TTT. Results: seven cases quit due to cough or unexplained reason; 79 VVS patients had no more fainting spells; 75.95% of TTT results of patients changed to negative after 3 months therapy. The before and after cilazapril treatment average blood pressures (taken in lying position) were 121/73 mm Hg (1 mm Hg=0.133kPa) and 120/76 mm Hg respectively (P>0.05); and mean heart rates were 68.63±12.37/min and 70.13±13.15/min respectively with no significant changes (P>0.05). Conclusion: Cilazapril was effective in treatment of VVS; did not affect normal blood pressure and heart rate; was safe; and had little side effect.     

住院癌症患者的疼痛控制状况及疼痛对生活质量影响的调查

目的：调查住院肿瘤患者的疼痛控制情况,以及癌痛对肿瘤患者生活质量的影响,为癌痛护理实施提供依据。方法：对376例住院肿瘤患者进行了调查,调查采用癌痛患者疼痛调查表,其中包括疼痛部位调查,24 h疼痛的轻重程度调查,使用止疼药物的调查,24 h受疼痛影响的程度。结果：本组患者目前的癌痛评分（NRS评分）平均为（4.10±2.48）分;有过疼痛的患者为371例（98.67%）,既往使用口服药物止痛208例（89.27%）;使用过非药物止痛疗法的患者有189例（50.27%）。生活质量在24 h受疼痛影响的程度,影响最大的是日常生活（6.51±2.43）分,影响最小的是睡眠（3.46±2.62）分。结论：疼痛对癌症患者的生活质量产生影响,住院患者癌痛控制效果有待加强。     

Corneal relaxing incision combined with phacoemulsification and IOL implantation

Objective: To analyze the effectiveness and safety of corneal relaxing incisions (CRI) in correcting keratometric astigmatism during cataract surgery. Methods: A prospective study of two groups: control group and treatment group. A treatment group included 25 eyes of 25 patients who had combined clear corneal phacoemulsification, IOL implantation and CRI. A control group included 25 eyes of 25 patients who had clear corneal phacoemulsification and IOL implantation.Postoperative keratometric astigmatism was measured at 1 week, 1 month, 3 months and 6 months. Results: CRI significantly decreased keratometric astigmatism in patients with preexisting astigmatism compared with astigmatic changes in the control group. In eyes with CRI, the mean keratometric astigmatism was 0.29±0.17 D (range 0 to 0.5 D) at 1 week, 0.41±0.21 D (range 0 to 0.82 D) at 1 month, respectively reduced by 2.42 D and 2.30 D at 1 week and 1 month postoperatively (P=0.000, P=0.000), and postoperative astigmatism was stable until 6 months follow-up. The keratometric astigmatism of all patients decreased to less than 1.00 D postoperatively. Conclusions: CRI is a practical, simple, safe and effective method to reduce preexisting astigmatism during cataract surgery. A modified nomogram is proposed. The long-term effect of CRI should be investigated.     

格列美脲对老年2型糖尿病治疗的疗效观察

目的探讨格列美脲对老年2型糖尿病（T2DM）治疗的有效性及安全性。方法给予78例老年T2DM患者格列美脲1～4 mg降糖治疗,疗程3个月,比较治疗前后患者血糖指标变化情况。结果空腹血糖、餐后2 h血糖、糖化血红蛋白水平均较治疗前显著变化（P〈0.05）,血压、血脂水平较治疗前无显著变化（P〉0.05）,未对患者肝肾功能产生不良影响。结论格列美脲治疗老年T2DM临床疗效良好,安全性高,不良反应小,患者服药依从性高,可作为老年T2DM的首选降糖药。     

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.     

Dynamic measurements of serum inhibin B and estradiol: apredictive evaluation of ovarian response to gonadotrophin stimulation in the early stage of IVF treatment

Objective: We dynamically measured serum inhibin B and estradiol in the early stage of hormonal stimulation to predict the ovarian response in in vitro fertilization (IVF) treatment. Methods: A total of 57 patients (<40 years of age) who un-derwent the first cycle of long protocol IVF or introcytoplasmic sperm injection (ICSI) treatment were included. Serum inhibin B, estradioi, follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured four times: (i) on Day 3 of the menstrual cycle (basal); (2) on the day before the first administration of gonadotrophin (Gn) (Day 0); (3) on Day 1 of Gn therapy; and (4) on Day 5 of Gn therapy. Comparisons of these measurements with ovarian responses and pregnancy outcomes were made and analyzed statistically. Results: (1) On Day 1 and Day 5 of recombinant FSH (rFSH) stimulation, ovarian response, i.e., numbers of follicles, oocytes, fertilized oocytes, and embryos, had a positive correlation (rS=0.46～0.61, P=0.000) with raised inhibin B and estradiol concentrations, but a negative correlation (rS=-0.67～-0.38, P=0.000 or P<0.01) with total rFSH dose and total days ofrFSH stimulation. (2) No significant variation (P>0.05) between the pregnant and non-pregnant groups on the basis of mean age or on all hormone concentrations at four times of the IVF cycle was observed. However, all the seven patients aged >35 years did not reach pregnancy. Conclusions: (1) Serum inhibin B and estradiol concentrations obtained shortly after Gn therapy may offer an accurate and early prediction of ovarian response; (2) Low levels of serum inhibin B and estradiol obtained shortly after Gn stimulation indicate the need for a longer period of Gn treatment and a higher daily dosage; (3) No obvious pregnancy difference among patients of age <35 years was found; however, IVF pregnancy outcome is significantly lower in women of age >35 years.     

Elevated high sensitive C-reactive protein and apelin levels after percutaneous coronary intervention and drug-eluting stent implantation

Objective:Percutaneous coronary intervention(PCI) triggers an acute inflammatory response,while sirolimus is known to have anti-inflammatory properties;the inflammatory system response to PCI after sirolimus-eluting stent placement remains unclear.The purpose of this study is to determine the changes in high sensitive C-reactive protein(hs-CRP) and apelin after PCI procedure and drug-eluting stent implantation in patients with and without reduced left ventricular systolic function.Methods:Forty-eight consecutive patients undergoing PCI at the Beijing Anzhen Hospital between July and September 2006 were recruited.Sirolimus-eluting stents were employed in all patients.Blood samples were drawn immediately before and 24 h after the procedure.Plasma hs-CRP and apelin levels were determined by enzyme immunoassay.Results:Paired t-test revealed a significant increase in both hs-CRP and apelin post-procedure(P=0.006 and P0.0001,respectively).Patients with reduced left ventricular ejection fraction(LVEF) had significantly lower baseline apelin levels compared to those with normal ventricular function [(46.8±10.8) vs.(72.0±8.4) pg/ml,P0.001].However,apelin increased to a level similar to the level of those with normal left ventricular systolic function 24 h after the PCI procedure [(86.7±11.6) vs.(85.1±6.1) pg/ml,P=0.72].Conclusions:hs-CRP and apelin levels increased after PCI and sirolimus-eluting stent implantation.Patients with impaired left ventricular systolic function had significantly lower baseline apelin levels,which increased significantly after PCI.     

情境教学与床旁考试——值得推崇的临床课教考模式

目的:探讨适应高职医学教育临床课教考模式。方法:采用随机分组方法将2003级三年制临床医学专业03-1班与03-2班分为情境教学班(实验组)与传统教学班(对照组),比较两班学习成绩与综合学习素质的变化,调查分析床旁考试结果与反响。结果:实验组与对照组学生学习成绩有显著差异(E=-3.198P=0.000),实验组学习成绩较对照组平均提高11.39分,且实验组学习成绩标准差小,情境教学极大地提高了学生综合学习素质,床旁考试与学生实际能力的相关一致性高(r=0.94P<0.01)。结论:“情境教学、床旁考试”是培养高等技术应用性卫生专门人才的助动器与导向仪,是学生、老师、管理者所接受和倍加推崇的临床课教考模式。     

改良小夹板固定治疗桡骨远端伸直型骨折疗效观察

目的:比较改良小夹板与传统小夹板固定桡骨远端伸直型骨折复位后的临床疗效。方法:将选取的113例桡骨远端伸直型骨折患者,分成观察组55例和对照组58例,两组在手法整复后分别采用改良小夹板固定、传统小夹板固定,比较两组患者在治疗4周内夹板调整次数、疼痛缓解时间、手腕消退时间、骨折临床愈合时间及夹板固定后并发症情况,两组在治疗3个月后掌倾角和尺偏角的丢失值,Green和O’Brien腕关节功能评分,治疗后优良率。结果:观察组与对照组在4周内夹板调整次数分别为(2.58±0.78)次、(4.03±0.81)次。观察组与对照组疼痛缓解时间分别为(3.13±1.01)d、(5.23±1.25)d,手腕肿胀消退时间分别为(5.62±1.02)d、(7.24±2.12)d,骨折愈合时间分别为(36.17±3.12)d、(46.14±3.56)d,差异均有统计学意义(P<0.05)。观察组与对照组3月后的掌倾角丢失值分别为(1.2±1.46)°、(1.79±1.82)°,尺偏角丢失值(1.68±1.37)°、(1.52±2.16)°,两组比较差异无统计学意义(P>0.05),两组Green和O’Brien评分分别为(89.78±11.52)分、(80.39±13.28)分,两组比较差异有显著统计学意义(P<0.05)。观察组优良率90.9%,对照组优良率81.0%,观察组患者并发症发生率低于对照,差异有统计学意义(P<0.05)。结论:改良夹板固定桡骨远端伸直型骨折优于传统小夹板,具有良好实用效果,值得临床推广使用。     

Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion

Objective:The aim of this study is to investigate if dual-source computed tomography(DSCT) could guide the percutaneous coronary intervention(PCI) of chronic total occlusion(CTO).Methods:We enrolled patients who were confirmed to have at least one native coronary artery CTO by DSCT before they underwent selective PCI in the period from December 2007 to October 2008.A CTO was defined as an obstruction of a native coronary artery with no luminal continuity.The CT-guided PCI procedure involved placing CT and fluoroscopic images side-by-side on the screen.DSCT images were analyzed for location,segment,plaque characteristics,calcification,and proximal lumen diameter of the CTO before PCI.The guidewire was advanced and manipulated under CT guidance.The PCI was carried out and the results were compared.Results:Seventy-four CTOs were assessed.PCI was successful in 57 cases of CTOs(77.0%).According to the results,CTOs were divided into two groups:successful-PCI and failed-PCI.All coronary artery paths of CTOs were clearly recognized by DSCT.In the successful-PCI group,soft plaques were detected much more often than those in the failed-PCI group,but fibrous and calcified plaques were seen more often in the failed-PCI group.Calcification severity in CTO segments showed a significant difference between the groups(P=0.014).Calcified plaques were detected in 20(35.1%) lesions in the successful-PCI group.More than 70% of the failures were calcified plaques,of which there were two arc-calcified and one circular-calcified lesions.Occlusions were longer in the failed-PCI group than those in the successful-PCI group [(38.8±25.0) vs.(18.0±15.3) mm,respectively,P0.01].Fewer guidewires were used in the successful-PCI group compared with the failed-PCI group(1.7±1.0 vs.2.5±0.9,respectively,P0.01).The logistic regression analysis indicated that predictors of recanalization of CTOs included occlusion length(P=0.0035,risk ratio(RR)=0.93) and calcification severity(P=0.05,RR=0.27).Multi-linear trends analysis showed that the factors affecting procedural time were CTO location(P=0.0141) and occlusion length(P=0.0035).Conclusions:DSCT could delineate the path of CTOs and characterize plaques.The outcomes of PCI were related to thrombolysis in myocardial infarction(TIMI) flow grade,CTO characteristics,severity of calcified plaques,and the length of occlusive segments.Occlusion length and calcification severity were independent predictors of CTOs.Occlusion length and CTO segments could also help to estimate the duration of interventional procedures.