目的:分析探讨终末期慢性肾衰竭(CRF)并急性左心衰的发病机制及救治措施。方法:对36例各种原因所致的终末期CRF患者并急性左心衰采用药物控制血压,降低外周血管阻力,减轻心脏后负荷及采用血液透析等方法,减轻心脏前负荷,控制心衰。结果:36例患者2286次来院救治并发急性左心衰1144次,抢救成功1138次,成功率99.5%。结论:终末期CRF并急性左心衰据发病机理不同,给予不同处理,关键是尽快控制血压,脱水,降低外周血管阻力和控制血容量,降低心输出量。
Objective To explore the effect of deep muscle stimulation (DMS) combined with exercise therapy on morphological changes of the trapezius muscle assessed by musculoskeletal ultrasound and the function for patients with neck and shoulder myofascial pain syndrome (MPS). Methods One hundred and twenty patients with neck and shoulder MPS admitted to the First People’s Hospital of Shuangliu District, Chengdu between August 2021 and December 2022 were randomly selected and divided into 4 groups. There were 30 cases in each group. Group A received modulated middle frequency electrotherapy, group B received modulated middle frequency electrotherapy combined with DMS, group C received modulated middle frequency electrotherapy combined with exercise therapy, and group D received modulated middle frequency electrotherapy, DMS combined with exercise therapy. Before treatment and after 4 weeks of treatment, shear wave elastography was used to detect the shear wave velocity (SWV) of the four groups, high frequency ultrasound was used to detect the muscle thickness of the trapezius muscle. The Visual Analogue Scale (VAS) scores, Neck Disability Index (NDI), modified Barthel Index (MBI), Instrumental Activities of Daily Living Scale (IADL), World Health Organization Quality of Life-BREF (WHOQOL-BREF), Self-rating Anxiety Scale (SAS), and Self-rating Anxiety Scale (SDS) were also assessed to compare the therapeutic effects among the four groups of patients under different intervention methods. Results Before treatment, there was no significant difference in trapezius muscle SWV, trapezius muscle thickness, VAS, NDI, MBI, IADL, WHOQOL-BREF, SAS or SDS among the four groups (P>0.05). After 4 weeks of treatment, there were significant differences in trapezius muscle SWV, VAS, NDI, WHOQOL-BREF in the physiological domain and psychological domain, SAS and SDS among the four groups (P<0.05), and the improvements of trapezius muscle SWV, WHOQOL-BREF in the physiological domain and psychological domain, and SDS in group D were more obvious than those in other groups (P<0.05). After 4 weeks of treatment, there was no significant difference in MBI, IADL, or WHOQOL-BREF in the society domain and environmental domain among the four groups (P>0.05). Conclusion DMS combined with exercise therapy can significantly improve trapezius muscle elasticity, psychological state and quality of life of patients with neck and shoulder MPS.
ObjectiveTo discuss the clinical effects of T-tube with side holes in the gallbladder-common hepatic duct anastomosis. MethodsThe clinical data of 60 cases that performed gallbladder-common hepatic duct anastomosis from Jul. 2009 to Jul. 2012 were retrospectively analyzed. The contractile functions and mucosal recovery of gallbladder were compared between the conventional T-tube and T-tube with side holes. ResultsTwenty-four cases of gallbladder-common hepatic duct anastomosis used conventional T-tube, the gallbladder were not developing in 6-8 weeks after operation by T-tube cholangiography, the gallbladder mucosa of 17 cases were normal without edema, congestion and edema were observed in 6 cases, and the normal gallbladder mucosa structure disappeared in 1 case. The gallbladder were developing in 6-8 weeks after operation by T-tube cholangiography in 36 cases that used T-tube with side holes, the gallbladder mucosa structure had not congestion, edema, and erosion. The gallbladder contractile function were normal. ConclusionsThe floc, blood clots, and inflammatory substances in gallbladder can be discharged into the intestine or drainage in vitro, and the bile can go into gallbladder and can be concentrated through the T-tube with side holes. Physiological flow of bile can return to normal and the function of gallbladder can recover early.
目的总结1例非肝移植胆管铸型患者的诊治过程。 方法对1例非肝移植胆管铸型患者的临床资料、辅助检查资料及治疗效果进行分析，并进行文献复习。 结果1例非肝移植胆管铸型患者经生化检查、胆胰管水成像（MRCP）、上腹部CT等检查诊断为胆囊结石伴胆囊炎、胆总管结石伴低位胆管梗阻。采取开腹胆道探查、胆道镜检查取石、胆囊切除、T管引流手术治疗。术中见胆囊缩小，与周围大网膜膜性粘连，肝十二指肠韧带水肿，胆总管扩张呈充盈状态。胆道镜下见肝内外胆管轻度扩张，肝外胆管壁炎性水肿较重，大量纤维素附着；胆总管末端通畅，可见胰管开口，进而诊断为胆胰合流异常。以胆道镜从胆总管内取出1枚结石，约2.0 cm×1.5 cm×1.0 cm大，质硬，表面光滑；另取出1枚胆管铸型，约3.5 cm×0.3 cm×0.3 cm大，质脆易碎，表面粗糙。该患者的手术顺利，切除胆囊术后病理学检查示慢性胆囊炎改变。术后恢复良好，未出现胆汁漏、出血等并发症。术后随访1年，复查上腹部CT提示无结石复发，肝功能各项指标均正常。 结论非肝移植胆管铸型较少见，胆胰合流异常是非肝移植胆管铸型和胆管结石形成的原因之一。胆道镜是清除胆管铸型和观察胆管内结构的重要工具。
As an important component of the healthcare system reform, the regional rehabilitation medical alliance aims to integrate medical resources within the region, promote standardization, specialization, and accessibility of rehabilitation medical services, and achieve efficient collaboration and resource sharing among medical institutions at all levels. This article comprehensively and systematically reviews and analyzes the current situation of the construction of regional rehabilitation medical alliance in China. At the same time, combined with the construction practice of West China Airport Hospital of Sichuan University, it summarizes experience and puts forward suggestions, providing a reference for the development of regional rehabilitation medical alliance.