微创青光眼手术（MIGS）创伤小,术后并发症少,恢复快。本文评论了国内MIGS的变革及其理论机制、手术技术、手术设备的创新成果,提出了MIGS目前面临的挑战、现有问题及未来发展方向。（眼科,2023,32:81-83）

目的 观察早期小肠喂养管注入中药治疗重症急性胰腺炎的临床疗效.方法 选择2014年1月—2016年5月期间的40例重症急性胰腺炎患者,随机分为对照组和治疗组,各20例.对照组给予西医治疗,治疗组在西医治疗基础上,采用早期小肠喂养管注入中药治疗.比较两组的治疗效果.结果 治疗后治疗组总有效率95％(19/20),对照组总有效率75％(15/20),两组比较差异无统计学意义(P>0.05).治疗组腹痛缓解时间(2.45±0.89)d、腹胀缓解时间(3.40±1.35)d、首次排便时间2(2,3)d、全身炎症反应缓解时间3(3,4.00)d,均明显优于对照组[(4.00±0.79)d、(5.95±1.15)d、4(4,5)d、5(4,5.75)d];治疗7 d后,治疗组腹腔压力(6.40±2.51)cm H2O较对照组(8.95±2.50)cm H2O低,差异有统计学意义(P<0.05).预后指标比较,治疗组患者的住ICU时间较短(P<0.05);胰腺假性囊肿发生率、中转手术率、机械通气使用率/机械通气应用时间、CRRT使用率/CRRT应用时间、住院28 d病死率均较对照组低,但差异无统计学意义(P>0.05).结论 早期经小肠喂养管注入中药治疗重症急性胰腺炎,能够缩短全身炎症反应时间、腹痛腹胀时间.

目的 探讨动脉粥样硬化性烟雾综合征的临床特征和手术疗效.方法 回顾性分析21例动脉粥样硬化性烟雾综合征病人的临床资料,对比手术前后mRS评分、卒中发生率及症状改善等情况,判断手术疗效.结果 所有病人术中荧光造影提示搭桥血管通畅性良好.术后搭桥血管闭塞1例,脑梗死3例,脑过度灌注1例,伤口浅表部位感染1例,均给予对症处理.影像学随访3～14个月,13例行MRA或CTA检查,搭桥血管通畅性良好6例,不通畅7例.10例行CT灌注(CT perfusion,CTP)或MRI动脉自旋标记灌注技术(arterial spin labeling,ASL)检查,大脑灌注改善7例,无明显改善3例.临床随访7～52个月,病人mRS评分降低13例,无变化6例,升高2例;随访期间未发生缺血性或出血性卒中等严重不良事件,无死亡病例.结论 有吸烟史、合并高血压且超重的中老年人群应警惕动脉粥样硬化性烟雾综合征的发生.颅内外搭桥手术可以显著改善病人预后,降低卒中发生率.

Objective:To investigate the clinical factors affecting the deep venous thrombosis (DVT) in neurosurgical patients during the perioperative period.Methods:A retrospective analysis was conducted on the clinical data of 298 patients admitted to the Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from January to December 2019. We documented suspicious DVT risk factors including general clinical data, important laboratory test results, and surgical data. Based on whether there was DVT revealed by preoperative and postoperative intravenous ultrasound examination, the patients were divided into preoperative DVT group ( n=24) and preoperative non-DVT group ( n=274), postoperative DVT group ( n=125) and postoperative non-DVT group ( n=173). Univariate and multivariate logistic regression analysis were used to determine the risk factors that affected the formation of DVT before and after surgery. Results:No patient developed disability or died due to DVT during the perioperative period. Univariate logistic regression analysis showed that preoperative D-dimer and age were the clinical factors that affected the occurrence of preoperative DVT(all P<0.05); age, bed rest, postoperative dehydration ≥3 d and increase of postoperative D-dimer were the clinical factors that affected the occurrence of DVT post operation(all P<0.05). Multivariate logistic regression analysis showed that increase of preoperative D-dimer ( OR=1.725, 95% CI: 1.149-2.590, P=0.009) and age ( OR=1.055, 95% CI: 1.005-1.107, P=0.029) were independent risk factors for preoperative DVT; age ( OR=1.065, 95% CI: 1.040-1.092, P<0.001) and increase of postoperative D-dimer ( OR=1.091, 95% CI: 1.019-1.168, P=0.013) were independent risk factors for postoperative DVT. Conclusion:The risk of perioperative DVT seems higher in neurosurgical patients with older age or elevated D-dimer.

目的 评估ATP生物荧光检测试剂用于评价医疗器械清洗效果的可行性.方法 采用ATP水样检测拭子和检测试剂盒,分别对三类医疗器械清洗效果进行检测与评价.结果 采用ATP水样检测拭子和检测试剂盒分别检测超声清洗的医疗器械,去除率分别为99.80％和99.91％;两种ATP荧光检测试剂对三类(复杂结构、管腔和实体)医疗器械清洗后的测试结果对数值的相关系数依次分别为0.962、0.973、0.955(P ＜0.01).结论 两种ATP荧光检测试剂测试结果相关性较好,ATP水样检测拭子更适用于清洗现场ATP测试.

目的探讨中国人群眼颅压力梯度参考区间,为建立基于眼颅压力梯度的开角型青光眼诊疗新体系提供理论标准。方法横断面研究。对2010年8月至2019年8月首都医科大学附属北京同仁医院神经内科需行腰椎穿刺的受试者共200例。其中,男性97例,女性103例,年龄区间12～79岁,平均（47.0±14.7）岁。对受试者进行眼压、颅压及全身基本参数测量。性别资料采用频数和百分比描述;年龄、身高、体重、眼压、颅内压、平均动脉压、体质指数及眼颅压力梯度等连续定量资料采用■描述。对于少量缺失数据,采用马尔科夫链蒙特卡洛模拟（MCMC）对缺失数据进行多重插补。采用95%分位数法确定参考值范围,对于连续定量资料的多组间比较采用单因素方差分析,两两比较采用两独立样本t检验。结果根据全体受试者测定人群眼压参考区间为9.015 mmHg～20.265 mmHg（1 mmHg=0.133 kPa）。人群颅压参考区间为6.179 mmHg～14.921 mmHg。人群眼颅压力梯度参考区间为-2.987 mmHg～11.047 mmHg。眼颅压力梯度临床诊疗参考区间为0.423 mmHg～10.508 mmHg。以年龄进行分组,＜30岁人群眼颅压力梯度参考区间为-2.968 mmHg～9.028 mmHg;30岁～50岁人群眼颅压力梯度参考区间为-2.466 mmHg～11.606 mmHg;＞50岁人群眼颅压力梯度参考区间为-2.466 mmHg～11.606 mmHg。三组间眼颅压力梯度差异无统计学意义（F=2.041,P＞0.05）。以性别进行分组,男性眼颅压力梯度参考区间为-2.769 mmHg～10.089 mmHg;女性眼颅压力梯度参考区间为-3.137 mmHg～11.877 mmHg。两组间眼颅压力梯度的差异无统计学意义（t=-1.413,P＞0.05）。以体质指数（BMI）进行分组,BMI＜21 kg/m~2的人群眼颅压力梯度参考区间为-1.437 mmHg～11.577 mmHg;21 kg/m~2＜BMI＜23 kg/m~2的人群眼颅压力梯度参考区间为-3.046 mmHg～11.026 mmHg;BMI＞23 kg/m~2的人群眼颅压力梯度参考区间为-3.947 mmHg～10.087 mmHg。不同BMI分组间,眼颅压力梯度差异有统计学意义（F=6.109,P＜0.05）。结论眼颅压力梯度临床诊疗参考区间为0.423 mmHg～10.508 mmHg,可作为开角型青光眼临床诊疗的新指标。同时,还为开角型青光眼病因学诊断及个体化治疗的进一步深入研究,提供新的实践基础与研究方向。

目的 评价真空超声清洗器对心脏微创手术器械的清洗效果.方法 采用目测法和ATP生物荧光法以及活菌计数法,对该清洗器的清洗微创手术器械的效果进行评价.结果 经目测法观察,真空超声清洗器清洗后的微创手术器械干燥效果合格率为96.32％,清洗效果合格率为97.37％;经ATP法检测显示,该方法清洗后的微创手术器械上污染物去除率为99.91％,对细菌去除率为99.86％.结论 真空超声清洗器对心脏微创手术器械的清洗效果可达到合格要求.

目的 探讨慢性非特异性下背痛患者应用悬吊式核心稳定训练治疗的临床效果.方法 选取2016年1月～2017年1月首都医科大学附属北京康复医院诊治的慢性非特异性下背痛患者96例,按照随机数字表法分为观察组和对照组,每组各48例.观察组在体外冲击波治疗的基础上给予悬吊式核心稳定训练治疗,对照组仅进行体外冲击波治疗,两组均连续治疗2个月.分别于治疗前、治疗2个月、治疗后6个月采用视觉模拟评分法(VAS)评估患者疼痛程度,Oswestry功能障碍指数(ODI)评估腰椎功能,采用生活质量评价量表(SF-36)评估患者整体健康状况,计算治疗2个月后有效率,并记录治疗过程中不良反应发生情况,治疗结束后随访1年,观察两组复发情况.结果 两组治疗前VAS、ODI及SF-36评分比较差异均无统计学意义(P>0.05),治疗2个月、治疗后6个月时,两组VAS、ODI评分均低于治疗前,SF-36评分均高于治疗前(P<0.05或P<0.01),且观察组较对照组变化明显(P<0.05或P<0.01);治疗2个月时,观察组治疗有效率(83.33％)明显高于对照组(60.42％)(P<0.05);治疗结束后1年,观察组复发率(2.08％)明显低于对照组(18.75％)(P<0.05);治疗过程中两组均未发生严重不良反应.结论 慢性非特异性下腰痛患者应用悬吊式核心稳定训练治疗可明显减轻腰部疼痛,增强腰椎功能,且安全、疗效稳定.

目的:评价癫(癎)病人对于心跳骤停复苏后接受亚低温治疗对预后的影响.方法:回顾首都医科大学大兴医院重症医学科于2012年1月～2014年1月收治的心脏骤停复苏成功后给予亚低温治疗并进行连续脑电监测的成年患者42例.其中男性22例(52％),女性20例(48％),年龄31～62岁,平均47岁.既往有癫(癎)病史的4例(10％).通过医院电子病历信息系统查阅病历资料收集所需数据信息.结果:在纳入的42例患者中,有15例(36％,95％置信区间为21％～50％)发生了癫(癎),其中7例(17％)发生在亚低温治疗过程中;34例(81％)死亡,其中26例死于医院内,8例存活出院但仍在心脏骤停发生后的28 d内死亡.15例发生癫(癎)的患者均死亡,其中13例(87％)死于院内,2例(13％)存活出院但28 d内死亡;未发生癫(癎)的27例患者中有11例(41％)死亡,16例(59％)存活超过28 d.发生癫(癎)组的患者死亡率显著高于未发生癫(癎)者(P＜0.001).结论:提示有癫(癎)发作症状的患者心肺复苏后接受亚低温治疗预后不良.应用连续脑电监测技术可能有利于早期发现癫(癎)并采取有效的措施改善患者预后.

目的:确定医院内侵袭性真菌感染发生的危险因素,为防治侵袭性真菌感染提供依据.方法:采用回顾研究的方法,收集2009年1月-2013年12月在首都医科大学大兴教学医院重症医学科治疗超过10天的患者的病例资料.采用单因素分析对可能的发生侵袭性真菌感染危险因素进行筛查,对筛查的阳性结果采用多元逻辑回归的方法进行分析.结果:共纳入患者2042例,其中发生侵袭性真菌感染的患者182(8.9％)例.研究确定了3个侵袭性真菌感染的危险因素:应用免疫抑制剂(相对危险度3.26; 95％置信区间,2.98-3.60; p＜0.01)、联合应用抗生素超过14天(相对危险度2.63; 95％置信区间,2.11-3.05; p＜0.01)和恶性肿瘤(相对危险度1.98; 95％置信区间,1.62-2.43; p＜0.05).结论:重症医学科侵袭性真菌感染危险因素是应用免疫抑制剂、联合应用抗生素超过14天、恶性肿瘤,对于具有以上危险因素的患者可以更积极的实施抗生素抢先治疗.

OBJECTIVE To evaluate the effect of OptiPro solid detergent on cleaning and disinfection of the infant respirators,and to determine the chemical compatibility of OptiPro solid detergent with infant respirators.METHODS The infant respirators after clinical use were disassembled into small parts and loaded in automatic washer to clean and disinfect according to the cleaning procedure.After cleaning and disinfection,the samples,which were collected from 160 parts of the collection tank,humidification tank,tee pipe,and threaded pipe,were conducted for the ATP bioluminescence assay,residual protein assay and bacteriological assay.RESULTS The bacterial colony count was less than ≤5CFU/cm2 after the cleaning of the inner surface of the collection tank,mental core surface of humidification tank,the inner surface of the tee pipe,and the inner surface of the threaded pipe with OptiPro solid detergent,and there were no pathogenic bacteria detected.The RLU values were decreased above 90.0% for testing the cleaned respirators with ATP bioluminescence assay.The qualified rates of the cleaning of the various parts were all 100.0% with 5μg residual protein test for the inner surface of the collection tank,mental core surface of humidification tank,the inner surface of the tee pipe,and the inner surface of the threaded pipe.CONCLUSION OptiPro solid detergent is one of the ideal medical detergents applied in the cleaning and disinfection of the infant respirators.

Objective To study the effect of multienzyme automatic rinser in cleaning the tourniquet. Methods The 600 medium-polluted tourniquets were equally randomized into the control group and the experiment group:The former were disinfected by the conventional method and the latter by multienzyme automatic rinser. Then the cleanliness and positive rate of bacterial culture were compared between the two groups. Results The cleanliness and positive rates in the experiment group and the control group were 99.67% and 0,84.33% and 28.67%,respectively. The experiment group was significantly superior to the control group(all P < 0.01) . Conclusion The multienzyme automatic rinser is effective in cleaning tourniquets and thus worth clinical popularization.

常见的乳腺疾病包括乳腺小叶增生、乳腺囊性增生、纤维腺瘤、乳腺炎、导管内乳头状瘤、乳腺癌等,其中乳腺增生、乳腺纤维瘤、乳腺癌较为常见.乳腺疾病中绝大部分是乳腺增生性病变(在乳腺专科中占50%～70%)为良性乳腺疾病,乳腺癌是世界范围内女性最常见、最多发的恶性肿瘤,其严重威胁着妇女的生命和健康.近年来研究表明[1]乳腺疾病的发病与社会、经济、精神心理因素有关.随着医学模式的转变,社会、心理等因素对乳腺疾病尤其是乳腺增生性病变的病因及对乳腺癌的治疗效果及预后等的影响越来越被人们所重视.

[目的]探讨婴幼儿RetCam检查工作中护理的问题与对策。[方法]将133名进行RetCam检查的婴幼儿分为对照组和干预组,对干预组的每个患儿进行护理干预,记录每例患儿的相关临床资料,并总结护理问题与对策。[结果]干预组67例患者中62例情绪平稳,积极配合医生,能够顺利、安全完成RetCam眼底检查;对照组中51例情绪平稳,能够顺利、安全完成检查,两组完成检查的患儿例数差异有显著性意义(2χ=4.13,P<0.05)。[结论]完成眼底检查需要护士进行科学的护理配合,尤其是家长缺乏相关的医疗知识的患儿,以保证检查的顺利进行。

目的观察氯沙坦早期联合美托洛尔治疗老年重症心力衰竭的疗效。方法65例年龄（72.5±6.9）岁、NY-HA心功能分级的重症充血性心力衰竭（CHF）患者分为三组,即氯沙坦联合美托洛尔治疗组（22例）、氯沙坦治疗组（23例）和对照组（20例）,随访1 a,以NYHA心功能分级、超声心动图所示左室射血分数（LVEF）、年住院次数、年住院日和死亡例数来评估治疗效果,并探讨B型利钠肽（BNP）在心力衰竭处理中的价值。结果0.5 a时联合治疗组与氯沙坦组间BNP存在统计学意义（P＜0.05）,心功能分级、LVEF无统计学意义;而联合治疗组及氯沙坦组的心功能分级、LVEF、BNP较对照组存在统计学意义（P＜0.05或P＜0.01）。1 a时联合治疗组较氯沙坦组的心功能分级、LVEF、BNP存在统计学意义（P＜0.05或P＜0.01）;而氯沙坦组及联合治疗组的心功能分级、BNP、LVEF较对照组存在统计学意义（P＜0.01）,联合治疗组年住院次数及住院日最少。结论早期氯沙坦联合美托洛尔治疗老年重症CHF比单独应用氯沙坦有更好的临床疗效,其疗效在0.5 a后开始出现,且很好地提高患者生活质量。

为探讨纤溶酶原激活抑制剂-1(PAI-1)基因调节区-675 bp位点4G/5G多态性与2型糖尿病、2型糖尿病合并冠心病(CAD)的关系,采用特异性引物聚合酶链反应(PCR)方法,测定4G/5G基因型,并检测PAI-1抗原水平,共观察了121例单纯2型糖尿病(type Ⅱ diab etes)患者、87例2型糖尿病合并CAD患者和100例对照者.结果:合并CAD组的4G/4G基因型携带者明显高于对照组(49.4%比 37.0%,P<0.05),CAD组中PAI-1与三酰甘油(TG)呈正相关,并与4G/5G多态性有关, 表现为4G/4G基因型携带者的PAI-1质量浓度明显高于5G/5G基因型携带者[(39.82×10-3±3.11×10-3)ng/L比(38.04×10-3± 2.73 ×10-3)ng/L,P<0.05].提示:PAI-1基因4G/5G多态性与TG的联合作用与PA I-1抗原水平相关,并与2型糖尿病合并CAD的发病过程有关.

Objective:To assess the relationship between the plasminogen activator inhibitor (PAI) activity and coronary heart disease (CHD).Method:Blood plasma PAI activity, plasminogen activator (PA) activity, serum levels of cholesterol and triglyceride were measured from 145 patients with CHD and 130 controls using immunochemical assay method.Result:The PAI to PA ratio was significantly higher in CHD patients than that in control subjects〔( 1.83 ± 0.52 ) vs ( 1.17 ± 0.48 ),P 0.05 〕. Plasma PAI activity was correlated positively with levels of triglycerides(r= 0.45 ,P 0.05 ).Conclusion:Significantly high activity of PAI is associated with hypertriglyceridemia and high age may be of importance in the pathogenesis of CHD.

Objective To investigate the therapeutic effect on patients with worse chronic congestive heart failure. Methods 105 patients with worse congestive heart failure were initially received Sodium Nitroprusside or Urapidil micropumped with low dose of Dopamine.Those patients transferred to long- term combined use of triamterene and hydrochlorothiazide with tolerant dose of enalapril and metoprolol individually after improvement of their clinical situation and were followed- up for two years. Result The cardiac function of patients with worse heart failure were significantly improved( P ＜ 0.001 )with lowed hospitalization and reduced fatality rate. The combinied use of triamterene and enalapril was well tolerant. Conclusion The well performed emergent and long therapeutic methods can effectively improved cardiac function and the quality of life.

目的　通过临床对比研究结合细菌学检测，找出并证实发生真菌二重感染的易患因素，指导临床重症细菌感染治疗。方法　对52例重症细菌感染患者应用亚胺培南20 mg／kg治疗，平均5 d，治疗前、后5 d行细菌培养+药敏；治疗前及后3、5、7 d行真菌培养+药敏，按病种分组对其临床资料及细菌学资料进行分析。结果　52例患者中20例并发真菌二重感染(占38.5%)，并用糖皮质激素治疗的患者21例中，11例出现真菌二重感染(占52.4%)，P=0.029；糖尿病患者17例中，10例出现真菌二重感染(占58.8%)，P=0.035；恶性肿瘤患者2例均发生真菌二重感染，P=0.023；29例曾应用过其他广谱抗生素者(其中三代头孢21例、左旋氧氟沙星8例)，有13例出现真菌感染(占39.1%)(三代头孢11例，左旋氧氟沙星2例)，P=0.289。结论　恶性肿瘤及糖尿病患者在重症细菌感染治疗过程中易发生真菌二重感染；亚胺培南治疗同时并用糖皮质激素或治疗前长期大量应用广谱抗生素，尤其是三代头孢菌素是并发真菌二重感染的易患因素。

我院急诊科自1997年6月至2000年5月静脉应用硝普钠合并小剂量多巴胺治疗多种病因引起的重症充血性心力衰竭病人71例,取得良好的治疗效果.现报告如下. 1 临床资料