微创手术结合中药治疗开放性Pilon骨折疗效观察

目的:观察微创手术结合中药治疗开放性Pilon骨折的临床疗效。方法:32例Pilon骨折采用微创手术治疗,并有限切开内固定结合外固定支架固定,中药内服与熏洗。结果:32例均骨性愈合,优良率84.3%。结论:微创手术结合中药治疗开放性Pilon骨折对骨折端有效固定,保护软组织血运,促进骨折愈合和功能恢复效果较好。     

小心，宝宝尿尿见红

有一天,一位年轻的妈妈带着孩子来看病,孩子叫佳杰,四岁半,正在幼儿园上大班。因为孩子小便有血尿,经化验后确定佳杰的尿路感染已较为严重。听到检查结果,这位妈妈直怨自己太粗心才让孩子病成这样。原来几周前的一天,佳杰妈妈就发现孩子的尿尿里有一点红红的血色了,因为儿子身体一向都很棒,只是顺便问了一下佳杰在幼儿园都吃些什么东西,听佳杰说吃了西红柿炒鸡蛋,还有大西瓜,也没有太在意。可几周过去了,佳杰妈妈看到孩子的小便还是带红,而且颜色还加深了,再问,孩子才说他们几天都没吃大西瓜了,这时佳杰妈妈才着了     

输尿管镜下气压弹道碎石治疗鹿角形肾结石38例

目的：探讨肾窦内。肾盂切开输尿管镜下气压弹道碎石治疗鹿角形肾结石的疗效。方法：对38例鹿角形肾结石采用肾窦内。肾盂切开输尿管镜下气压弹道碎石,将结石分解成数块,再逐一取出。结果：38例鹿角形肾结石均较顺利取出,无粘膜撕脱、出血等并发症,其中16例肾功能不全者均显著改善。结论：。肾窦内肾盂切开输尿管镜下气压弹道碎石是治疗鹿角形肾结石的较好方法。     

Neodymium：Yttrium Aluminum Garnet Laser for Mini-Percutaneous Treatment of Upper Urinary Tract Stones

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodym- ium:Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access (F14-F18) was successfully established under B-ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase Ⅱ lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 min with an av- erage time of 100±15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65±11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases (89.5 %). All ureteral stones were completely removed in 15 cases (100 %). It was concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.     

扩张型心肌病患者窦性心率震荡现象

目的研究窦性心率震荡(HRT)在扩张型心肌病(DCM)患者中的变化,以及与心率变异性时阈指标(SDNN)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)的关系。方法选择DCM患者30例,正常健康对照者20例,根据24 h动态心电图(Holter)记录资料,计算HRT的两个参数震荡初始(TO)和震荡斜率(TS),比较两组之间的差别,并计算TO、TS与SDNN、LVEF、LVEDD之间的相关性。结果DCM组TO值显著高于对照组(3.18%±6.25%vs-6.22%±3.68%,P<0.001);DCM组TS值显著低于对照组(6.06±6.13 ms/RR间期vs 13.08±5.54ms/RR间期,P<0.01)。TO与SDNN、LVEF、LVEDD之间明显相关。结论DCM患者室性早搏后的HRT现象减弱,HRT可能成为评价DCM患者自主神经功能状态的新指标。     

机械通气抢救急性左心衰竭的临床疗效观察

目的探讨机械通气抢救急性左心衰竭的疗效及临床应用价值。方法30例重症急性左心衰竭伴呼吸衰竭患者在传统常规治疗的基础上加用机械通气治疗,观察通气前后心率、呼吸频率、平均动脉压、动脉血气分析(pH、PaO2、SaO2、PaCO2)的变化及临床症状的改善情况。结果机械通气治疗后,30例患者中26例病情好转,4例死亡。通气后患者的呼吸困难明显改善,肺部罗音明显减少。通气1h后呼吸频率由(34.2±7.3)次/min降至(22.1±4.3)次/min(P<0.05),心率由(118.7±16.4)次/min降至(88.6±12.5)次/min(P<0.05),平均动脉压由(95.5±6.4)mmHg降至(84.7±5.2)mmHg(P<0.05)。通气前及通气后1h查血气,SaO2由(76.3±8.6)%升高至(95.8±4.4)%(P<0.01),PaO2由(48.5±7.6)mmHg升高至(85.4±5.2)mmHg(P<0.01),pH、PaCO2变化无显著差异。结论对各种不同原因引起的急性左心衰竭伴呼吸衰竭患者,机械通气治疗能及时有效的改善患者的临床症状及低氧血症,是抢救急性左心衰竭的有效辅助措施。