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Evaluation Studies of Low-Field MRI and Arthroscopy Imaging in Diagnosis of Meniscus Tears

【摘要】　目的　评价低场MRI对膝关节半月板撕裂的诊断准确性。　方法　2009年9月-2010年4月经关节镜检或手术确诊的膝关节损伤患者69例，其中35例41个半月板撕裂，回顾性分析、整理其临床、关节镜及MRI表现，以传统Reicher诊断的改良分级标准确定半月板撕裂的级别、形态并记录，同时对关节内其它伴随征象作统计。　结果　35例41个撕裂半月板中，17个为盘状半月板，MRI显示Ⅲa级撕裂信号24个，Ⅲb级撕裂信号5个，Ⅲc级撕裂信号4个，Ⅳ级撕裂信号1个，桶柄状撕裂信号7个。本组低场MRI诊断半月板撕裂的敏感度、特异度、准确度分别为93.18%、92.11%、92.68%。　结论　低场MRI诊断膝关节半月板撕裂与关节镜结果差异不大，是一种诊断半月板撕裂的可靠、无创性检查方法。【Abstract】　Objective　To evaluate the accuracy of low-field MRI in the diagnosis of meniscus tears.　Methods　We collected the clinical data of 69 patients with knee joint injuries confirmed by surgical operation or arthroscopy from Septembe 2009 to April 2010. Among them, 35 patients had 41 cases of meniscus tears. We retrospectively analyzed their clinical symptoms, and their manifestations on low-field MRI and arthroscopy. According to the modified diagnostic criteria based on Reicher’s diagnosis, the grade and the shape of meniscus tears were determined and recorded, and other accompanying signs inside the joint were also analyzed statistically.　Results　Among the 41 cases of meniscus tears of 35 patients, 17 were discoid meniscus. MRI showed that there were 24 signals of Ⅲa tears, 5 of Ⅲb tears, 4 of Ⅲc tears, 1 of Ⅳ tears and 7 of bucket-handle tears. The sensitivity, specificity and accuracy of low-field MRI in the diagnosis of meniscus tears were 93.18%, 92.11%, and 92.68%, respectively.　Conclusions　There is no significant difference between the results of arthroscopy and low-field MRI in diagnosing meniscus tears. Consequently, MRI is a reliable and non-invasive method in the diagnosis of meniscus tears.

急诊科护士轮岗周期与护理不良事件的关系

【摘要】　目的　观察急诊科护士轮岗周期与护理不良事件发生的关系，为护士轮岗周期确定提供依据。　方法　2009年1月-2010年6月，对科内参加轮岗的护理人员统一发放自制表格，采用匿名形式，对各组实施不同的轮岗周期，并对轮岗期内各组发生的不良事件分别进行统计。　结果　轮岗周期为5个月时，不良事件发生数最少。　结论　急诊科护士轮岗周期应定在5个月较合适。

老年血液透析患者低血压的护理

两种不同院前急救物品管理法对急救效果的影响

目的　探讨优化院前急救物品的配置方法，降低不良事件发生率。 方法　针对院前急救物品使用中存在的问题，采用每班配备抢救箱，实行抢救药品失效预警制，抢救仪器标识管理等改进措施，弥补救治工作中的疏漏，并就2009年、2010年院前急救物品配置优化前后状况进行比较。 结果　仪器完好率、物品准备齐全率明显好转，患者不满意度发生率、医护配合矛盾发生率，均较优化配置前下降（P＜0.05）。 结论　优化院前急救物品配置可有效减少不良事件的发生。

自体血管移植内瘘护理一例

Application of Risk Assessment in Compulsory Gastric Lavage

目的　总结风险评估和预警措施在中毒患者洗胃救治中的作用，以减少洗胃并发症发生，保证救治安全。方法　抽取2009年1月－2010年12月在急诊科实施强制洗胃患者90例，2009年中毒洗胃患者45例为对照组，2010年中毒洗胃患者45例为观察组。对照组实施常规护理，观察组在常规护理的基础上实施风险评估，比较两组患者洗胃并发症发生情况。结果　观察组洗胃并发症较对照组明显减少，两组比较差异有统计学意义（χ2=10.601，P＜0.01）。结论　风险评估可提高护理人员对洗胃风险的预见性，有效减少并发症的发生。

血透回血时两种时段拔除动脉穿刺针的方法比较

目的：比较血透回血时两种时段拔除动脉穿刺针对针刺伤及操作并发症影响。方法：对38名维持性透析患者3000例次内瘘穿刺回血随机分成观察组和对照组，分别行回输血液后和回输血液前拔出动脉穿刺针方法回血，观察患者穿刺处渗血、血肿、回血充分性及操作失败或针刺伤等并发症。结果：观察到单人操作时应用改进后的回输血液后一并拔出动静脉穿刺针回血优点明显，并发症少，两组比较统计学有显著性差异(P＜0.05)。结论：单人操作时应用改进后的回输血液后一并拔除动静脉穿刺针回血安全有效，切实可行。

Establishment of Arterialized Small-for-Size Liver Transplantation Model and Investigation of Histopathologic Changes of Grafts in Rats

　Objective　To establish and modify a rat model of arterialized small-for-size orthotopic liver transplantation and investigate the histopathologic changes of the grafts after transplantation. 　Methods　Modified two-cuff technique was applied to establish a rat model of 40% small-for-size orthotopic liver transplantation with a modified microvascular “sleeve” anastomosis between the celiac trunk of donors and the stump of right kidney artery of recipients. Seven days survival rate was observed, main indices of liver function, histopathologic changes of the grafts were detected on the 1st, 2nd, 4th and 7th day after transplantation, respectively. 　Results　The successful rate of operation was 93.3%. Seven days survival rate was 60.0%. The mean time of nonhepatic time was (12.0±2.5) min. Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate on the first day and peaked on the second day after operation. Histological findings indicated that hepatic sinusoidal and central vein dilation, monocytes infiltration in partial area were found on the 1st day after operation, more diploid and polyploid hepatocytes could be observed on the 4th day after operation. 　Conclusion　The model is easily available and highly reproducible, and the stability of the model is improved by modifying the technique. The histological changes of the grafts are mainly caused by ischemia-reperfusion injury.

Significance of Hepatic Arterial Reconstruction on Model of Small-for-Size Orthotopic Liver Transplantation in Rats

Objective　To investigate the significance of hepatic arterial reconstruction on the model of 40% small-for-size orthotopic liver transplantation in rats. Methods　Modified two-cuff technique was applied to establish a rat model of 40% orthotopic liver transplantation. A total of 240 Sprague Dawley (SD) rats were randomly divided into 2 groups: reconstructive artery group and non-reconstructive artery group. One week survival rate was observed. Main indexes of liver function, histology and the expression of proliferative cell nuclear antigen (PCNA) of liver graft （by immunohistochemical method） were detected on day 1, 2, 4 and 7 after transplantation, respectively. Results　One week survival rates of reconstructive artery group and non-reconstructive artery group were 65.0% (13/20) and 50.0% (10/20) respectively (Pgt;0.05). Alanine aminotransferase (ALT) and total bilirubin (TB) began to elevate from day 1 and peaked on day 2 after surgery in two groups. ALT in non-reconstructive artery group on day 2 and 4 were significantly higher than that in reconstructive artery group (P＜0.05). TB in non-reconstructive artery group on day 2 and 7 were significantly higher than that in reconstructive artery group (P＜0.05). Histological findings indicated that more diploid and polyploid hepatocytes and more gently dilation of central veins and hepatic sinusoids could be seen postoperatively in reconstructive artery group. The expression of PCNA of liver graft peaked on day 2 after surgery. The expression of PCNA of reconstructive artery group was higher on day 1 (P＜0.01) and lower on day 7 than that of non-reconstructive artery group after operation (P＜0.05).　Conclusions　Arterial reconstruction can improve liver function of liver grafts after small-for-size orthotopic liver transplantation, alleviate the histological changes and promote the regeneration of liver grafts quickly.

自身残余血预处理透析器在预防血液透析患者首次使用综合征中的应用及效果

目的　讨论自身残余血预处理透析器对降低血液透析患者首次使用综合征（FUS）发生率的效果。 方法　对2008年10月－2011年5月20例原采用传统法处理新复用透析器发生FUS血液透析患者，改用自身残余血预处理新复用透析器，并就传统法和自身残余血预处理法对新复用透析器处置后在患者透析过程中的临床症状进行观察比较。 结果　采用自身残余血预处理透析器后，透析患者FUS发生率明显降低，两种方法所致FUS比较差异有统计学意义（P＜0.05）。 结论　自身残余血预处理新复用透析器法能有效降低FUS的发生率，减轻维持性血液透析患者的痛苦。