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find Keyword "困难" 41 results
  • PROCESSING STRATEGY OF DIFFICULT REMOVAL OF SCREWS IN PLATE

    ObjectiveTo investigate the countermeasures for difficult removal of screws in the plate. MethodsThe clinical data were retrospectively analyzed from 47 patients having difficult removal of screws in the plate between January 2004 and May 2014. There were 30 males and 17 females, aged 16-58 years (mean, 34 years). The time from internal fixation to removal of internal fixation was 10 months to 20 years (mean, 22 months). The locations of internal fixation were upper extremity in 25 cases and lower extremity in 22 cases. The number of difficult removal screws in the plate was 1 in 18 cases, 2 in 15 cases, 3 in 9 cases, and 4 in 5 cases. The plate types included general plate in 15 cases and locking plate in 32 cases; stainless steel plate in 10 cases and titanium plate in 37 cases. The reason for difficult removal, plate, screw, incision, and bone quality of patient were comprehensively analyzed, and different methods for difficult removal were chosen according to the principle that first simply then complicated. ResultsAll plates and screws were removed, and no iatrogenic fracture or nerve and vascular injuries occurred. The operation time was 65-270 minutes (mean, 125 minutes). The blood loss was 80-775 mL (mean, 157 mL). The postoperative drainage was 20-250 mL (mean, 92 mL). The incision healing by first intention was obtained in 39 cases, and delayed healing in 8 cases. The patients were followed up 3-24 months (mean, 10 months). No infection or re-fracture was observed. ConclusionThere are many countermeasures for difficult removal of screws in the plate, but each has indication. As long as a well arranged preoperative condition, mastering a variety of methods, and being familiar with its indication, as well as reasonably choosing method based on the specific situations, the plate and screw maybe smoothly removed.

    Release date:2016-08-25 10:18 Export PDF Favorites Scan
  • Diagnostic Accuracy of Wilson Score for Predicating Difficult Intubation: A Meta-Analysis

    Objective To evaluate the diagnostic accuracy of Wilson score for predicating difficult intubation. Methods Such databases as PubMed, EMbase, CNKI, WanFang Data and VIP were searched to collect the studies about Wilson score for predicating difficult intubation published from inception to January 2013. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality by QUADAS. The analysis was conducted by using Meta-Disc 1.4 software, and the random effect model was chosen to calculate the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the 95%CI. The summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated in order to comprehensively assess the total diagnostic accuracy of Wilson score for predicating difficult intubation. Results A total of 9 studies involving 6 506 subjects were included. The results of meta-analysis showed that: the pooled sensitivity was 0.57 (95%CI 0.53 to 0.62), specificity was 0.89 (95%CI 0.88 to 0.90), positive likelihood ratio was 6.11 (95%CI 4.63 to 8.07), negative likelihood ratio was 0.52 (95%CI 0.41 to 0.66), diagnostic odds ratio was 12.76 (95%CI 8.60 to 18.93), and the AUC of SROC was 0.84. Conclusion Wilson score plays a role in predicating difficult intubation, while some other clinical indicators also need to be taken into consideration in its application.

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  • Effects of Pulmonary Rehabilitation on Patients with Stable COPD of Different Severity

    ObjectiveTo investigate the effect of pulmonary rehabilitation on pulmonary function,perception of dyspnea and quality of life in stable COPD patients of different severity. Methods300 patients with COPD in stable stage were divided into a moderate COPD group (n=120),a severe COPD group (n=100) and a very severe COPD group (n=80). Each group was randomly subdivided into a control group and a treatment group. The treatment groups received pulmonary rehabilitation for 6 months in addition to usual care,and the control groups received usual care without pulmonary rehabilitation. Pulmonary function(FEV1),6 minute walking distance (6MWD),modified medical research council (mMRC) scale,and acute exacerbation frequency of COPD were compared before and after intervention and among groups. ResultsAfter pulmonary rehabilitation for 6 months,the quality of life score and 6MWD were significantly improved in the treatment groups with moderate,severe,very severe COPD,and the increscent of 6MWD was greatest in the severe COPD patients. The mMRC of the patients with very severe COPD improved significantly after pulmonary rehabilitation(P<0.05). Lung function before and after the intervention in three groups all showed no significant difference (P>0.05). The acute exacerbation frequency of the severe COPD patients was significantly reduced by pulmonary rehabilitation (P<0.05), while there was no significant change in the moderate and very severe groups (P>0.05). ConclusionPulmonary rehabilitation can improve exercise tolerance and quality of life of COPD patients with different severity,reduce acute exacerbation frequency in severe COPD,reduce the dyspnea degree in very severe COPD. Pulmonary rehabilitation is a cost-effective treatment for stable COPD.

    Release date:2016-08-30 11:31 Export PDF Favorites Scan
  • 噻托溴铵在慢性阻塞性肺疾病急性加重期治疗的临床观察

    目的 观察噻托溴铵治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效。 方法 将2010年5月-2012年4月住院的100 例年龄50~80岁的中重度AECOPD患者随机分为治疗组(50例)和对照组(50例)。对照组给予吸氧、止咳、祛痰、雾化吸入布地奈德4 mL+硫酸特布他林4 mL(2次/d)抗炎,氨茶碱扩张气道,以及静脉使用抗生素抗感染、支持等常规治疗,治疗组在常规治疗基础上给予噻托溴铵干粉剂(18 μg,1次/d)吸入,疗程14 d。观察两组用药前后肺功能指标,呼吸困难评分以及血气分析指标的变化。 结果 两组患者用药后肺功能、呼吸困难评分及血气分析均较治疗前有明显改善,用药后与用药前比较差异有统计学意义(P<0.05);治疗组改善更明显,与对照组比较差异有统计学意义(P<0.05)。 结论 噻托溴铵能明显改善中重度AECOPD患者的呼吸困难,肺功能及血气分析指标。

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  • Bedside Assessment of Swallow in Stroke

    摘要:目的:探索可靠的卒中患者床旁吞咽评估方法。方法:61例住院卒中患者均进行各种床旁吞咽评估筛查及电视透视检查,以后者为金标准探讨各方法的敏感度、特异度及阳性、阴性预测值。结果:六种独立床旁吞咽评估方法与金标准相比较的敏感度在60%~87%之间,特异度在76%~89%之间,阳性预测值在50%~69%之间,阴性预测值在86%~95%之间;几种评估方法作为平行试验联合应用时的敏感度在89%~98%之间,阴性预测值在94%~99%之间;几种方法作为序列试验应用时的特异度在97%~99%之间,阳性预测值在82%~90%之间。结论:根据不同方法的预测特点,可得到针对不同患者的、有效的床旁评估方法。床旁吞咽评估简单、有效、便捷,是临床工作中适宜的评估方法。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • Mental Health Survey of Children and Adolescents after 5·12 Wenchuan Earthquake

    目的:探讨5·12地震灾区11~16岁少年儿童的心理健康状况及其影响因素,为下一步开展创伤后心理危机干预提供依据。方法:在地震发生后一个月,使用长处与困难问卷(SDQ)学生版,调查了1268名来自于灾区的少年儿童(平均年龄14.20±1.02岁,男女比例1:1.02)的心理健康状况及其影响因素。结果:(1)灾区少年儿童SDQ总困难因子平均得分为13.66±5.75,74.9%的人报告自身存在主观困难;(2)女性的总困难因子、情绪因子、亲社会因子得分高于男性(z=-4.317,-7.963,-3.717;Pslt;0.001);(3)困难对少年儿童社会功能的影响程度随年龄增加(χ2=7.684,P=0.021)。年龄越大,多动因子得分有增加的趋势(χ2=13.881,P=0.001);(4)重度暴露组其总困难因子、情绪因子、影响因子得分高于轻度暴露组(z=-2.374,-4.279,-2.114;Pslt;0.05),困难造成的主观精神困扰程度前组高于后组(z=-2.920,P=0.004);(5)女性、高年龄者、教师/同学伤亡较重者、震后被转移至安全的帐篷或房屋的间隔时间越长者,SDQ总困难因子异常的危险性越高。结论:震后灾区少年儿童的心理健康状况受到暴露水平、性别、年龄以及震后被转移至安全地点的时间的影响,心理干预应综合考虑相关因素。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • 学龄儿童注意力缺陷多动障碍及抽动秽语综合征与智商及学习困难的关系

    摘要:目的:探讨注意缺陷多动障碍(ADHD)和抽动秽语综合征(TD)患儿的智商及学习困难关系。方法:采用韦氏儿童智力量表(C WISC)对ADHD和TD病组及正常学龄儿童(对照组)各100例进行智力测验, 分别计算各分测验的量表分、 言语智商(VIQ)、操作智商(PIQ)和总智商(FIQ), 进行对比分析。结果:ADHD组言语量表中的知识、词汇、理解分测验及操作量表中的填图、积木分测验及PIQ、FIQ均显著低于正常对照组(Plt;0.01)。TD组中言语量表中的算 术、词汇、理解分测验以及PIQ、FIQ均低于正常对照组(Plt;0.05)。结论:ADHD和TD病组儿童智商均在正常范围或处于边缘水平, 但均存在智力发展不平衡的现象。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • Diagnostic significance of brain natriuretic peptide in cardiac dyspnea

    Objective To evaluate the diagnostic value of brain natriuretic peptide (BNP) for cardiac dyspnea.Methods Plasma BNP levels were measured by radioimmunoassay in dyspnea patients with chronic heart failure (CHF) (n=52) or without CHF (n=30) and normal control group (n=28).Results The BNP level in dyspnea patients with CHF was significantly higher than that of dyspnea patients without CHF and normal control group [(649.80±141.72) pg/mL vs (59.08±18.60) pg/mL and (65.20±16.32) pg/mL,respectively,Plt;0.05].There was no significant difference of BNP level between dyspnea patients without CHF and normal group (Pgt;0.05).The plasma BNP level elevated with the worsening of heart failure (NYHA Classiffication).The BNP level in dyspnea patients with CHF was negatively correlated with left ventricle ejection fraction (r=-0.673,Plt;0.001).The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) is 0.91(0.88-0.98,Plt;0.001) with a sensitivity of 87.2% and a specificity of 86.8% at the cutoff value of 206 pg/mL.Conclusion Measurement of plasma BNP is a rapid diagnostic method for cardiac dyspnea.

    Release date:2016-08-30 11:35 Export PDF Favorites Scan
  • Effects of curosurf on ventilation weaning and respiratory mechanics in infants with acute lung injury after cardiopulmonary bypass

    Objective To investigate the effects of exogenous pulmonary surfactant (PS) on ventilation weaning and respiratory mechanics in infants with acute lung injury(ALI) after cardiopulmonary bypass (CPB).Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas,respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration,spontaneous breath remained steady;spontaneous respiratory rate significantly decreased from,tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure(PIP) decreased from (36.18±10.25)cm H2O to (25.11±5.14)cm H2O (Plt;0.01).Static lung compliance (Cstat) increased from (1.49±0.65)mL·cm H2O-1·kg-1 before treatment to (1.95±0.50) mL·cm H2O-1·kg-1 6 h after treatment (Plt;0.01);and airway resistance (Rstat)decreased from (128.17±26.34) cm H2O·L-1·s-1 before treatment to (78.56±18.22) cm H2O·L-1·s-1 6 h after treatment (Plt;0.01).All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment,lung protective ventilation strategy can significantly improve parameters of respiratory mechanics,increase dynamic lung compliance,decrease airway resistance,which can decrease the breathing effort of the infants and make it easy to wean from ventilator.

    Release date:2016-09-14 11:53 Export PDF Favorites Scan
  • 隧道式胸腔引流管在恶性胸腔积液患者中的应用

    摘要: 目的 介绍隧道式胸腔引流管(tunnelled pleural catheter,TPC)治疗恶性胸腔积液(MPE)的方法,探讨其临床应用价值。 方法 分析美国西南医学中心St.Paul医院自2002年10月至2005年11月共对112例MPE患者植入TPC的临床资料,其中男69例,女43例;年龄58.5±6.7岁。主要原发病为原发性肺癌、转移性肺肿瘤(原发癌为淋巴瘤、乳腺癌、卵巢癌)、胸膜间皮瘤;分析MPE患者TPC植入的效果。 结果 在3年观察期内,112例MPE患者共应用125例次TPC治疗,其中10例为对侧植入TPC,4例为同侧再次植入TPC。随访2周后有48例次症状完全缓解,62例次症状部分缓解,5例次症状未缓解,有5例次植管失败,5例次TPC植入术后2周内失去随访。 120例次成功植入TPC患者中有51例发生继发性胸膜炎,仅5例在管道拔除后需要再次胸腔治疗。随访2周中单胸腔积液量lt;20%。导管留置时间平均为56 d。所有TPC植入术后患者随访期的生存时间平均为144 d,随访1个月和1年的病死率分别为128%和836%。 结论 对具有门诊治疗条件、需要姑息治疗的MPE患者,TPC是有效的方法之一。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
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