Changes in platelet parameters and secondary brain injury in acute craniocerebral trauma

Changes in platelet parameters are important in secondary brain injury in acute craniocerebral trauma We selected 163 patients with craniocerebral trauma who were admitted within 24 hours with nonoperative therapy. Platelet parameters of 40 healthy subjects served as controls. Platelet number was decreased, while mean platelet volume and platelet distribution width values were increased, at 1 and 3 days after injury. Platelet number was lower and mean platelet volume and platelet distribution width were larger in patients with traumatic cerebral infarction and those in Glasgow Coma Scale score 〈 8 group. Platelet number was negatively correlated to volume of cerebral edema, but positively correlated to Glasgow Outcome Scale score. These data indicate that changes in platelet parameters may be utilized to indicate the state of central nervous system injury and patient prognosis .

First Reported Incidence of Delayed Secondary Abdominal Compartment Syndrome in a Trauma Patient with Scleroderma: A Case Report and Review of the Literature

Background: Scleroderma is a complex immune-mediated rheumatic disease that is characterized by fibrosis of the skin, internal organs, and vasculopathy. Extensive fibrosis, especially in the limited compartment, has been reported to induce acute compartment syndrome frequently reported involving the upper and lower extremities. Case Presentation: We present a rare case of a 54-year-old Caucasian female who underwent surgery for abdominal compartment syndrome in the setting of scleroderma. Upon arrival, at the hospital, the patient’s health status showed signs of improvement with no indicators of abdominal compartment syndrome until the tenth hospital day. A CT scan showed a new intra-abdominal fluid collection with total lower abdominal anasarca and a stable retroperitoneal hematoma. Following emergency surgery, significant bowel edema without other intra-abdominal injuries was noted. Conclusion: Secondary abdominal compartment syndrome may occur in patients with scleroderma without evidence of intra-abdominal trauma or emergent abdominal surgery. Further research is warranted to investigate the relationship between scleroderma and secondary abdominal compartment syndrome.

Secondary Spontaneous Rupture of the Diaphragm in a Child after Blunt Chest Trauma

Traumatic diaphragmatic rupture (TDR) is very rare in the pediatric age group. Because of its rarity and its coexistence with more injuries, the diagnosis is often delayed. Very little has been written about this condition in the pediatric age group. TDR, while uncommon, should be considered in cases of blunt thoracic trauma. All patients should undergo meticulous examination preoperatively. The clinical presentation and importance of making an accurate diagnosis and surgery is highlighted. We report a case of secondary spontaneous traumatic left-sided diaphragmatic rupture in a child that was managed by delayed surgical repair.

Sclerosing cholangitis following severe trauma: Description of a remarkable disease entity with emphasis on possible pathophysiologic mechanisms

MM： Persistent cholestasis is a rare complication of severe trauma or infections. Little is known about the possible pathomechanisms and the clinical course.METHODS： Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma （one burn injury, three accidents, one power current injury）. Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.RESULTS： Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis （PSC）-Iike destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up 〉2 years. Therapeutic possibilities were limited.CONCLUSION： Posttraumatic sderosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension.Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.

Secondary damage in trauma and limited access dressing: a review

Secondary damage in trauma may increase morbidity,mortality and the cost of treatment considerably.This article reviews the literature of 46 relevant articles on this topic.We hope to provide a better understanding of the various mechanisms that can lead to secondary damage following major trauma and aim to improve the management of such in trauma patients.We also explore the utility of limited access dressing and its ability to minimize and treat secondary musculoskeletal trauma.Four interdependent cellular mechanisms have been described that contribute and perpetuate secondary tissue damage-lysosomal,protein/enzyme denaturation,membrane permeability and mitochondrial.Systemic changes are mainly due to systemic hypoxia and the systemic inflammatory response syndrome.Limited access dressing appears to be an efficient and cost-effective method for the management of secondary damage,as evidenced by the reduced number of debridements,shorter wound coverage time,and reduction in total length of hospital stay while lowering treatment costs and improving quality of care.

Outcomes of secondary sulcus intraocular lens implantation in unilateral anterior persistent fetal vasculature

AIM: To evaluate the surgical results of sulcus intraocular lens(IOL) implantation in children with unilateral anterior persistent fetal vasculature(PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule.METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity(BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution(logMAR) after IOL implantation(P<0.001) with a mean follow-up was 16.55±5.86 mo. Average age at secondary IOL implantation was 41.05±15.41 mo. Three eyes(13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise(4 eyes; 18.18%), postoperative increased inflammation(3 eyes; 13.64%) and postoperative hypotony(2 eyes; 9.09%) were common complications.CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.

Ciliary body detachment after secondary intraocular lens implantation in childhood

Dear Sir,Iam Dr.Li-Na Meng,from the Qingdao Eye Hospital,Shandong Eye Institute,Shandong Academy of Medical Sciences,Qingdao,China.I want to present a rare case of secondary intraocular lens(IOL)implantation in an11-year-old boy who developed the complication of ciliary body detachment.When he was 2 years old,the boy underwent bilateral cataract extraction for congenital cataract in the other

Transradial vs transfemoral secondary access outcomes in transcatheter aortic valve implantation:A systematic review and meta-analysis

BACKGROUND Complications of transcatheter aortic valve implantation(TAVI)procedures include bleeding,vascular complications,and strokes.These complications are often associated with the type of access used.The two types of access in TAVI procedures are primary and secondary.The main use of the primary access is for valve delivery,while secondary access is used for angiography and hemodynamic monitoring.While there are many options for primary access,those for secondary access are transfemoral and transradial.AIM To compare outcomes between transradial vs transfemoral secondary access(TFSA).METHODS A systematic search was conducted using major databases(EMBASE,PubMed,Cochrane Central,Google Scholar),which resulted in 5 studies that met the criteria for study selection.Outcomes of interest were 30-d rates each of major/life-threatening bleeding,vascular complications,strokes,and mortality.All 5 studies were observational.Only adjusted or matched data were used when available in this meta-analysis.RESULTS A total of 5065 patients underwent TAVI,with 1453 patients(28.7%)having undergone transradial secondary access(TRSA)and 3612 patients(71.3%)TFSA.Irrespective of the site of primary access,the odds of having major or lifethreatening bleeding were 60%lower in the TRSA group than the TFSA group(P<0.00001).The odds of having major vascular complications were 52%lower in the TRSA group(P<0.0001)with no difference in minor vascular complications between the 2 groups.Similarly,the odds of mortality in 30-d after the procedure were 41%lower(P=0.006)and the odds of stroke were 54%lower(P=0.001)in the TRSA group than the TFSA group.CONCLUSION The transradial secondary approach appears to be a safer alternative to the transfemoral secondary approach in TAVI procedures.

The use of virtual surgical planning and navigation in the treatment of orbital trauma

Virtual surgical planning （VSP） has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three- dimensional （3D） printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

PMN apoptosis and its relationship with the lung injury after chest impact trauma

Background Polymorphonuclear neutrophil (PMN),one of the most important inflammatory cells,functions throughout the initiation,progression and resolution of inflammation. This study aimed at investigating the relationship between PMN apoptosis and the lung injury after chest impact trauma. Methods PMNs were purified from rabbits subjected to the chest impact trauma and their apoptosis,necrosis,survival and respiratory burst were detected by flow cytometry. Meanwhile,lactate dehydrogenase and (LDH) [Ca 2+ ]i were measured. Results The delayed apoptosis of PMNs in bronchoalveolar lavage fluid was observed from 2 hours to 12 hours after trauma,and viable cells increased. Respiratory burst of PMNs in bronchoalveolar lavage fluid was increased significantly from 2 hours with the peak at 8 hours. Meanwhile,lactate dehydrogenase in bronchoalveolar lavage fluid was higher than that in control ( P <0.05) from 4 hours to 24 hours,and intracellular free Ca 2+ in PMN was increased temporarilly. Conclusions Retention of PMN in tissues and the abnormality in apoptotic pathway inevitably generate persistent activation of PMN and excessive release of toxic substances,resulting in tissue injury. The temporary increase of intracellular free Ca 2+ may be responsible for the delayed apoptosis of PMN.

Secondary glaucoma after pediatric cataract surgery

AIM: To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery.METHODS: Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011. The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes.RESULTS: The mean follow-up periods of group 1 and 2 were (60.86 ±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8% ) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50 ±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycinC surgery.Onepatientunderwent a second trabeculectomy+mitomycin C operation for both of his eyes.CONCLUSION:The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.

继发性甲状旁腺功能亢进病人甲状旁腺全切+胸腺舌叶切除+前臂皮下种植法应用效果及经济效益分析

目的分析继发性甲状旁腺功能亢进(SHPT)病人甲状旁腺全切(TPTX)+前臂皮下种植(AT)+胸腺舌叶切除的应用效果及经济效益。方法分析2018年3月~2021年1月于本院接受治疗的SHPT病人110例,按不同治疗方案分为药物组(50例,接受西那卡塞联合小剂量骨化三醇),手术组(60例,采取TPTX+AT+胸腺舌叶切除)。对比两组治疗前、治疗24个月后的生化指标、心脏结构与功能、临床症状与生活质量,并统计两组并发症、成本效益、24个月复发率。结果手术组治疗后24个月血清iPTH[(206.45±152.59)pg/ml]、钙[(2.05±0.26)mmol/L]、磷[(1.48±0.21)mmol/L]、钙磷乘积(3.02±0.69)、ALP水平[(102.03±30.25)U/L]均低于药物组[(721.32±325.36)pg/ml、(2.22±0.18)mmol/L、(1.91±0.22)mmol/L、(4.22±0.74)、(140.62±27.15)U/L](P<0.05);手术组治疗后24个月LVEF[(60.85±4.02)%]高于药物组[(55.58±3.84)%],LVED[(48.03±2.58)mm]、LVST[(9.85±0.76)mm]低于药物组[(51.02±3.65)mm、(11.12±0.86)mm](P<0.05);手术组治疗后24个月骨痛、皮肤瘙痒、不宁腿综合征评分比药物组低,KDTA评分比药物组高(P<0.05);手术组治疗总费用[(4.06±1.42)万元]相比药物组[(3.46±1.85)万元],差异无统计学意义(P>0.05);手术组iPTH下降有效率为90.00%(54/60),高于药物组的48.00%(24/50)(P<0.05);成本效果分析发现,药物组、手术组CER分别为7.21、4.51,手术治疗更具成本效果优势;增量成本效果分析显示,相比药物组,手术组用于治疗SHPT每多有效治疗1例病人相对需增加1.48万元成本;手术组、药物组并发症发生率(13.33%VS 12.00%)、治疗后24个月复发率(8.33%VS 4.00%)对比,差异无统计学意义(P>0.05)。结论TPTX+AT+胸腺舌叶切除术可减轻SHPT病人骨痛,降低iPTH水平,纠正钙磷代谢紊乱,改善心脏功能与结构,提高生活质量,且成本效益高于药物治疗。

人工晶状体屈光力计算公式在儿童Ⅱ期植入的研究进展

Ⅱ期人工晶状体(intraocular lens,IOL)植入常用于矫正先天性白内障摘除术后无晶状体眼状态。IOL屈光力计算是影响儿童Ⅱ期IOL植入术后视功能发育和改善的关键因素之一。现有IOL屈光力计算公式是基于成人有晶状体眼的数据研发,能准确预测成人眼IOL植入的屈光力,但是对儿童Ⅱ期IOL植入的屈光力预测准确性欠佳,主要原因包括:1)儿童II期植入术前为无晶状体眼,缺乏部分公式定义中的有晶状体眼的前房深度(是指从角膜前表面中央顶点到晶状体前表面的距离)和晶状体厚度。2)公式根据囊袋内植入IOL预测屈光力,但儿童Ⅱ期IOL睫状沟植入术在临床上应用更为广泛。当IOL植入睫状沟时有效晶状体位置发生前移,可能引起屈光预测误差。3)成人眼的发育已完成,目标屈光度多为正视或近视眼(-3.00~+1.00 D),但是儿童眼仍在发育,需针对其特性测算合适的远视目标屈光度(+0.50~+12.00D)以适应眼球发育引起的屈光变化。为使Ⅱ期IOL植入患儿达到术前预设的目标屈光度,对现有公式进行选择与优化至关重要。

儿童Ⅱ期人工晶状体植入术后青光眼相关不良事件影响因素与预测的研究进展

儿童白内障是全球范围内可治疗儿童盲症的主要原因之一。对于这些患儿而言,手术是恢复或保护视力的主要方法。然而,手术后的并发症,特别是青光眼相关不良事件(glaucoma-related adverse events,GRAEs),常常成为导致儿童二次致盲的主要原因,这引起了眼科医疗领域的广泛关注。文章综述了儿童Ⅱ期人工晶状体植入术后GRAEs的影响因素,包括手术设计、眼部解剖特征、其他眼部发育异常和全身疾病等。手术设计中是否植入人工晶状体(intraocular lens,IOL)以及植入的时机和位置都对GRAEs的发生有显著影响。此外,眼部解剖特征如角膜直径、眼轴长度、前房深度、中央角膜厚度和术前晶状体厚度等,也是影响GRAEs发生的重要因素。同时,其他眼部发育异常和全身疾病,如先天性无虹膜、先天性风疹综合征等,也会增加儿童白内障术后青光眼的发生率。文章还总结了预测GRAEs的方法,并推荐使用Cox回归模型建立预测模型。这种模型可以有效地预测儿童Ⅱ期IOL植入术后在特定时间段内发展为GRAEs的概率,从而为早期识别GRAEs高危儿童提供了重要的借鉴。通过对GRAEs影响因素的深入分析和预测模型的建立,文章旨在帮助眼科医生更好地理解GRAEs的发生机制,并在手术前对患儿进行风险评估,从而选择最佳的手术方案和预防措施。这对于改善患儿的术后恢复、减少并发症、保护视功能具有重要的临床意义。

双侧无晶状体患儿采用改良切口Ⅱ期睫状沟IOL植入术后的屈光度误差及安全性评估

目的:评估双侧无晶状体儿童采用改良切口Ⅱ期睫状沟人工晶状体(IOL)植入术的屈光度误差及安全性。方法:回顾性分析2020/2021接受改良切口Ⅱ期睫状沟折叠式IOL植入术的12例24眼双侧无晶状体儿童资料。分析术中、术后1 d及术后1 mo切口相关并发症的发生情况,记录最佳矫正视力(BCVA),眼轴长度(AL),水平角膜直径(WTW),以及术前预留屈光度(PRD)和实际等效球镜屈光度(AESD)的屈光结果。将患者按年龄(≤7岁和>7岁)、AL(<23和≥23 mm)和WTW(≤11.5和>11.5 mm)分为两组,比较根据测量结果预测的AESD和PRD之间屈光度误差。结果:在所有患儿中,男孩9例(75%),女孩3例(25%),其中2例(17%)为前囊下白内障,4例(33%)为后极性白内障,6例(50%)为核性白内障。白内障摘除时的平均年龄为6.4±1.61(3.4-8.9)mo,白内障摘除至Ⅱ期IOL植入术的平均时间间隔为6.8±1.82(4.4-11.5)a。术前平均BCVA为0.49±0.33(1.0-0.1)LogMAR,术后平均BCVA为0.38±0.32(1.0-0.0)LogMAR。平均AL为23.56±1.96(19.00-26.38)mm,平均WTW为11.5±0.92(9.3-13.9)mm,平均PRD为1.57±0.60(0.73-2.77)D,平均AESD为0.57±0.55(-0.50-1.75)D,AESD与PRD的平均差值为-0.99±0.52(-2.22-0.32)D。按年龄、AL、WTW分组的AESD、PRD差异无统计学意义(P=0.59、0.56、0.53)。结论:无晶状体儿童采用改良切口Ⅱ期睫状沟IOL植入安全可行。在睫状沟植入IOL时,需要从公式选择的IOL度数中减去约1 D。年龄、AL和WTW对差异无显著影响。

即刻种植与延期种植在牙齿外伤修复患者中的应用效果比较

目的:比较即刻种植与延期种植在牙齿外伤修复患者中的应用效果。方法:选取2022年1月至2023年1月于该院接受种植治疗的179例牙齿外伤患者进行前瞻性研究,按随机数字表法将其分为研究组(n=89)和对照组(n=90)。研究组实施即刻种植,对照组实施延期种植,比较两组种植体稳定程度[种植体稳定系数(ISQ)]、治疗周期、修复前后牙周相关指标[探诊深度(PD)、菌斑指数(PLI)、龈沟出血指标(SBI)]水平、美观度[红色美学指数(PES)、白色美学指数(WES)]评分和临床疗效。结果:两组ISQ评分比较,差异无统计学意义(P>0.05);研究组治疗周期短于对照组,差异有统计学意义(P<0.05);修复后,两组PD、PLI、SBI水平均低于修复前,且研究组低于对照组,差异有统计学意义(P<0.05);修复后3个月,两组PES、WES评分均高于修复前,且研究组高于对照组,差异有统计学意义(P<0.05);两组治疗总有效率比较,差异无统计学意义(P>0.05)。结论:即刻种植应用于牙齿外伤修复患者中可提高美观度评分,缩短治疗周期,降低牙周指标水平,其效果优于延期种植。

美国高校学生事务工作者继发性创伤及其干预

高校学生的心理问题及频发的校园危机给高校教育工作者带来了继发性创伤的挑战。本文通过对美国学生事务工作者“继发性创伤”相关文献的挖掘与分析,梳理了继发性创伤概念的演进,发现大学校园创伤种类和频次增加、大量校园边缘人群、突发的全球疫情等诱因正在加剧学生事务工作者继发性创伤现象的蔓延。针对此问题,美国从政府、行业、高校等多个层面实施了干预措施。美国高校学生事务工作者继发性创伤及其干预的探索可以提高我国对高校辅导员乃至整个教师群体继发性创伤问题的关注,以保障他们的心理健康和持续发展。

接受植入型心律转复除颤器二级预防的缺血性心肌病患者复发性室性快速心律失常的临床预测因素

目的:分析接受植入型心律转复除颤器(implantable cardioverter defibrillator,ICD)二级预防的缺血性心肌病(ischemic cardiomyopathy,ICM)患者复发性室性快速心律失常(ventricular tachyarrhythmia,VTA)的临床预测因素。方法:回顾性纳入我院2013年1月至2018年12月期间,接受ICD二级预防的88例ICM幸存患者。收集患者基线资料,观察患者随访5年内复发性室性心动过速(ventricular tachycardia,VT)/心室颤动(ventricular fibrillation,VF)的发生情况。结果:单因素Cox回归分析结果显示,患者随访5年时发生复发性VT/VF的影响因素包括血管紧张素转换酶抑制剂/血管紧张素受体阻滞药的使用情况(HR=0.334,95%CI:0.159~0.705,P=0.004)以及左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)(HR=1.006,95%CI:1.002~1.011,P=0.006)。多因素Cox回归分析结果显示ACEI/ARB的使用情况以及LVEDV是影响患者随访5年时发生复发性VT/VF的独立临床因素(P<0.05)。LVEDV预测患者随访5年时发生复发性VT/VF的受试者工作特征曲线下面积为0.771(95%CI:0.672~0.869),在最佳截断值为163.5 mL。Kaplan-Meier生存曲线分析,LVEDV≤163.5 mL的患者随访1年(100.0%vs.76.7%,Log Rankχ^(2)=11.723,P=0.001)、3年(93.3%vs.58.1%,Log Rankχ^(2)=15.398,P<0.001)、5年(88.9%vs.46.5%,Log Rankχ^(2)=19.188,P<0.001)的无复发性VT/VF生存率明显更高。此外,57例患者在至少半年的医疗治疗后接受了随访超声心动图检查,LVEDV>163.5 mL的患者1年内复发性VTA发生率较高[LVEDV>163.5 mL vs.≤163.5 mL;37.9%(11/29)vs.7.1%(2/28);χ^(2)=7.670,P=0.006]。结论:LVEDV扩大可作为ICM患者随访5年内发生复发性VT/VF的独立预测因素。

重症颅脑损伤患者气管切开术后继发肺部真菌感染的危险因素分析

目的:探讨重症颅脑损伤患者气管切开术后继发肺部真菌感染的危险因素,为临床预防和治疗提供参考。方法:采用回顾性研究方法,选择2014年1月-2017年6月鄂州市中心医院(以下简称"我院")收治的气管切开术后继发肺部真菌感染的重症颅脑损伤患者87例,作为观察组;选择同期住院且术后未继发肺部真菌感染的重症颅脑损伤患者87例,作为对照组。分析观察组患者感染真菌的分布及耐药情况,采用χ2检验和二分类Logistic分析对重症颅脑损伤患者气管切开术后继发肺部真菌感染的危险因素进行探讨。结果:我院观察组患者送检临床标本174份,检出真菌7种共87株,检出率较高的菌种为白色假丝酵母菌(41株,47.13%)和光滑假丝酵母菌(23株,26.44%)。白色假丝酵母菌和热带假丝酵母菌对氟康唑、伊曲康唑、氟胞嘧啶等常用抗真菌药的耐药率低于20%;光滑假丝酵母菌对氟康唑、伊曲康唑、氟胞嘧啶的耐药率超过25%,对两性霉素B和制霉素的耐药率低于20%。χ2检验和二分类Logistic分析结果显示,低蛋白血症、入院时格拉斯哥昏迷评分(GCS)(<8分)、入院时肌酐清除率(<30m L/min)、气管切开辅助通气时间(≥7 d)、抗菌药物使用时间(≥14 d)、抗菌药物联合应用、使用碳青霉烯类药物、使用全身糖皮质激素均为继发肺部真菌感染的独立危险因素[比值比分别为3.02、2.98、2.21、2.05、2.48、2.35、4.74、5.97,95%置信区间分别为(1.59,5.74)、(1.58,5.63)、(1.18,4.41)、(1.11,3.78)、(1.34,4.59)、(1.27,4.34)、(2.49,8.35)、(3.08,11.49),P<0.05]。结论:我院重症颅脑损伤患者气管切开术后继发肺部感染的真菌以白色假丝酵母菌和光滑假丝酵母菌为主,对常用抗真菌药普遍较为敏感。低蛋白血症、入院时GCS评分、入院时肌酐清除率、气管切开辅助通气时间、抗菌药物联合应用、使用碳青霉烯类药物、使用全身糖皮质激素是重症颅脑患者气管切开术后继发肺部真菌感染的独立危险因素。临床应重视上述危险因素的预测价值,提高诊疗的敏感性和特异性,并根据药敏试验结果合理选用抗真菌药;同时,对于存在上述因素的高危患者,临床应及时给予早期预防性或经验性抗真菌治疗。

创伤性牙缺失伴骨缺损的种植修复临床探讨

目的:观察口腔颌面部严重创伤后牙缺失伴骨缺损的种植修复临床效果。方法:颌面部严重创伤后牙缺失伴骨缺损患者20例,其中多颗牙连续缺失者12例,共植入ITI Straumann等常用牙种植体65枚,其中5例行骨劈开+骨挤压+骨引导再生(guided bone regeneration,GBR)技术。2～6个月后行上部结构修复,定期随访,检查种植体骨结合情况、种植体周围软组织与修复体情况。结果:本组病例修复后经1～5年的临床观察,除1例所植入的5枚种植体中的1枚,在修复后3年脱落,其余患者各项评价指标均良好,种植体存留率为98%。结论:颌面部严重创伤后的牙列缺损,尤其多颗牙的连续缺失,很难采用其他固定修复方法来完成。种植修复具有不损伤余留牙、美观舒适、咀嚼效果好等优点,是一种良好的修复方法。