脊髓型颈椎病(cervical spondylotic myelopathy,CSM)以肢体活动、感觉障碍、麻木等为主要表现,中老年患者居多,大多需手术治疗.颈椎管扩大成形术联合微型钛板固定治疗是CSM创伤较小、疗效确切的手术方法,通过"脊髓漂移"原理进行减压治疗[1].但报道称,术后仍有部分患者因致压物体积过大、脊髓漂移距离过短、术前压迫率过高等影响脊髓功能恢复[2].既往高压氧已被证实用于脊髓损伤、颅脑损伤等具有良好的辅助康复效果,但用于CSM术后康复的报道较少[3].为此,本文比较高压氧对CSM术后功能恢复及弥散张量成像(diffusion tensor imaging,DTI)相关参数的影响,探讨其可能机制,报道如下.

目的 观察超声心动图联合血清心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白(cTnI)检测评估慢性心力衰竭(CHF)病人左心功能的效果.方法 选取2016年10月—2019年4月本院收治的72例确诊为CHF的住院病人,纽约心脏病协会(NYHA)心功能分级Ⅰ级17例,Ⅱ级22例,Ⅲ级18例,Ⅳ级15例.采用超声心动图检测受试者左心功能指标,主要包括左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、每搏输出量(SV)、心脏指数(CI)及二尖瓣舒张早期与舒张晚期血流峰值速度比值(E/A).采用酶联免疫吸附试验(ELISA)检测血清H-FABP、cTnI水平,采用Spearman法分析超声心动图参数、血清H-FABP、cTnI水平与心功能分级的相关性.采用多元回归分析超声心动图参数联合血清H-FABP、cTnI水平对CHF病人心功能分级的预测价值.结果 不同心功能分级病人LVEDV、SV、CI参数比较,差异无统计学意义(P>0.05).与心功能Ⅰ级、Ⅱ级比较,心功能Ⅲ级、Ⅳ级CHF病人LVEF降低,LVEDD、LVESD、LVESV、E/A水平升高(P<0.05).CHF病人血清H-FABP、cTnI水平随心功能分级增加升高(P<0.05).Spearman分析结果显示,LVEF与心功能分级呈负相关(P<0.05),LVEDD、LVESD、LVESV、E/A、血清H-FABP、cTnI水平与心功能分级呈正相关(P<0.05).LVEF、E/A、H-FABP、cTnI是预测CHF病人心功能分级的独立因素(P<0.05).结论 超声心动图可有效评估CHF病人左心功能,联合检测血清H-FABP、cTnI对CHF病人心脏分级有一定预测价值.

Objective:To explore the application effect of Furacilin solution to incision disinfection in elderly patients with tracheotomy.Methods:48 long-term bedridden elderly and skin sensitive patients who underwent tracheotomy were randomly divided into the Furacilin disinfection group(n=26) and Iodophor disinfection group(n=22).Furacilin solution and Iodophor were used for incision disinfection of tracheotomy based on the conventional dressing,and then swab sampling for bacterial and fungal culture was conducted.The local wound infection and the skin reactivity were observed and recorded and the collected data were comparatively analyzed.Results:The degree of the skin reactions was milder in the Furacilin disinfection group than Iodophor disinfection group(P<0.01);the infection rate of pseudomonas aeruginosa,stenotrophomonas maltophilia,Bauman acinetobacter was lower in the Furacilin disinfection group than Iodophor disinfection group(P<0.05);the difference in the comparison of the infection rate of streptococcus pneumoniae was not statistically significant between the two groups(P>0.05).Conclusion:Furacilin solution used for incision disinfection of tracheotomy has little skin irritation and can effectively prevent the common bacterial infection,it is suitable for the sensitive skin.

<正>我病区患者1例,男性,行尿道狭窄切开及尿道扩张术,术后需留置导尿管。因患者尿道口需尿管扩张1周,且术后需随时观察病情及时更换污染敷料,须充分暴露下半身。普通病号裤下床,留置的尿管不便于放置,且患处部位很快被渗出物污染,患者不得不卧床。为了不影响患者术后下床活动,又便于观察尿道口渗液及尿管固定情况,我科与泌尿外科医生共同研究对传统的病号裤进行改良,改良后的病号裤行尿道手术及插尿管可以下床的男性患者都可以应用,介绍如下。

Objective To make a comprehensive understanding of cervical MRI with the neck in neutral and flexion positions and investigate the mechanism of Hirayama disease. Methods A detailed neurological examination, cervical MRI in neck flexion and neutral positions were performed in 20 patients. Results Nonflexion cervical sagittal MR images revealed cord atrophy at the C5-T1 vertebral levels, especially at C6 in 10 patients. Sagittal and axial T1-and T2-weighted images showed anterior displacement of the posterior wall of the cervical dural canal in 14(70%) patients. An epidural mass, isointense with the cord on T1-weighted images and T2-weighted images, was noted at the posterior aspect of the lower cervical dural canal in 14 patients with some small flow void signals inside it. Intramedullary signal abnormalities were detected in 3 patients. Conclusions Hirayama disease was a nonprogressive juvenile spinal muscular atrophy of the distal upper limbs. Special MRI findings in neck flexion were remarkable. The dynamic changes and abnormal vascularity in neck flexion might make involvements in the pathogenesis of Hirayama disease.

Objective To evaluate the use of infant identification bands and falling off of the bands. Methods Infant iden- tification bands,i.e. wrist band and ankle band were put on every infant recruited in this trail. This bands were fastened in different ways: outside-to-outside and interside-to-outside. Conformable measurements of wrist circumference and ankle cir- cumference were implemented to make the bands fit the range of sizes of infants. Results More wrist bands fell off than an- kle bands(P0.05). Bands were more secure when outside-to-outside fastened. Conclusion Ankle bands fastened outside-to- outside were recommended.

Amyotrophic lateral sclerosis(ALS) involves upper neuron,lower neuron and corticospinal tract.Its early diagnosis remains a challenge for clinicians.MRI techniques including conventional MRI,MRS,DTI and BOLD have been applied in the clinical diagnosis and related studies in ALS.With non-invasive,sensitive and macroscopic advantages,MRI has great potentials in the diagnosis of ALS.

颈动脉位置表浅,可作为反映全身动脉粥样硬化情况的窗口.颈动脉粥样硬化与脑卒中密切相关,约23%的缺血性脑卒中是由颈动脉粥样硬化引起的[1],其中颈动脉不稳定粥样硬化斑块或"脆弱斑块"(vulnerable plaque)的破裂、脱落是致病的主要形式.Glagov等[2]发现,由于血管壁外界的代偿性扩张,即使粥样硬化斑块的容积有较大增加,管腔的截面积仍可以长时间保持不变.除非这种变化已经积累到相当程度,否则单纯测量狭窄程度有时不能检出动脉粥样硬化性病变.因此,在了解颈动脉狭窄程度的同时,更应该关注粥样硬化斑块形态学及其成分的变化.高分辨MRI弥补了经皮超声和DSA对斑块大小、形态及成分评价的不足,可从生物形态和组织成分两方面对颈动脉粥样斑块进行细致分析,以满足临床对颈动脉粥样硬化斑块稳定性判断的需求.

Purpose: To evaluate the value of MSCT in assessing the resectability of periampullary carcinoma. Materials and Methods: The MSCT films of 35 cases with periampullary carcinoma that had been proved by pathology were retrospectively reviewed and compared with the findings during operations or ERCP examinations. Results: On MSCT studies, tumors were found in the ampullary region in 35 cases and were enhanced in different degrees on the post-administration of iodine contrast iv, 16 of them were reconstructed. All these cases were shown definitely with neighbor tissues and vessles. By MSCT's assessment, 26 tumors were resectable, 9 tumors were unresectable because they had metastasized or invaded vessels. 19 tumors were resected. Conclusion: Using dynamic enhanced MSCT scan with 3D reconstruction, it can well display the tumors and the relationships with other tissues around them. MSCT plays an important role in assessing tumor resectability and predicting prognosis.

通过非侵袭性的方法观察中枢神经系统血管结构一直是影像技术关注的焦点.自上世纪90年代中期以来,磁共振血管成像 (magnetic resonance angiography,MRA) 和CT血管造影成像(computed tomographic angiography,CTA)技术已经在挑战传统的血管造影术.在血管性疾病诊断的许多方面,血管造影尽管是"金标准",但MRA及CTA在准确判断病变的性质、程度、与周围结构关系等方面具有无可替代的优势,而且不仅局限于脑和脊髓血管性疾病的诊断.近年来三维(3D)技术在MRA及CTA中的应用,可以更加直观、客观和清晰显示中枢神经系统的血管结构,有学者认为MRA和CTA可能取代有创的血管造影术.

目的:探讨女性垂体腺瘤发生卒中相关影响因素,建立可行的预测方程.方法:回顾性分析解放军总医院神经外科1999-01/2004-01由门诊连续收入院治疗的43例女性垂体腺瘤卒中患者的临床资料,以同期入院治疗的258例垂体腺瘤未卒中病例为对照,采用单因素比较以及logistic多元逐步回归方法,建立回归方程,分析与女性垂体腺瘤卒中相关的垂体腺瘤大小、病程、早期视力视野变化以及无功能性腺瘤影响女性垂体腺瘤卒中发生的关系.结果:按意向处理分析,两组患者均进入结果分析.按OR值大小依次是:早期视力、视野改变、病程、肿瘤大小和无功能腺瘤.建立回归方程:Logit y=-4.937 615+1.812 802x3+1.446 673x7+0.691 593 x8+2.002 303x11.结论:女性垂体腺瘤中的大腺瘤、巨大腺瘤及无功能腺瘤时易发生卒中,应在出现视力、视野改变时加以早期防治.