摘要
Objective:To investigate the diagnostic value of pelvic floor ultrasound combined with electromyography physiological parameters for postpartum stress urinary incontinence(SUI)of different degrees and pelvic floor function of primipara.Methods:A total of 160 SUI patients who admitted to Yan'an hospital of Kunming City from January 2019 to January 2022 were selected,and they were divided into abnormal group(110 cases)and normal group(50 cases)according to pelvic floor function(the muscle voltage values of different muscle fibers).The SUI was graded according to the Chinese Guidelines for Diagnosis of Urological Diseases and the International Incontinence Advisory Committee's Incontinence Questionnaire(ICI-Q-SF).The posterior horn(α)of bladder and urethra at rest,the displacements of the bladder neck on y-axis(△y)and x-axis(△x)after the rest to the fatigue action,the proximal urethral rotation angle after the rest to the fatigue action(γ),the posterior horn of bladder and urethra(β)after the fatigue action were observed.The electromyography was used to draw and record the pelvic floor myoelectric activity signals of the patients of two groups at five stages(pre baseline rest period,class II muscle fiber systole period,class II and I muscle fiber systole period,class I muscle fiber systole period and post baseline rest period).And then,the muscle voltage values of different muscle fibers on the surface of pelvic floor were quantified.Results:There was no statistically significant difference in Δ x between patients with postpartum SUI of different degrees.There were significant differences in △y,α,β and γ between patients with postpartum SUI of different degrees(F=7.162,7.655,14.998,2.758,P<0.05).The differences of the means of muscle voltages of pre and post baseline rest period,and class I muscle fiber systole period among patients with postpartum SUI of different degrees were not significant.The differences of the means of muscle voltages of class II,and the class II and I muscle fiber systole period among patients with postpartum SUI of different degrees were significant(F=12.062,24.501,P<0.05),respectively.There was no statistically significant difference in △x between the two groups.The △y,α,β and γ of abnormal group were significantly higher than those of normal group(t=8.991,8.691,9.389,27.552,P<0.05),respectively.There were no statistically significant differences in the means of muscle voltage values of the pre and post baseline rest period,and class I muscle fibers systole period between the two groups.The means of muscle voltage values of class II,and class II and I muscle fibers systole period in the abnormal group was significantly higher than them in the normal group(t=9.613,14.452,P<0.05),respectively.The sensitivities of △y,α,β,γ,the means of class II muscle fibers systole period,and the means of class II and I muscle fibers systole period of pelvic floor ultrasound and electromyography physiological parameters were respectively 71.60%,79.40%,81.40%,91.20%,83.30%and 82.40%,and the specificities of them were respectively 41.40%,37.90%,37.90%,60.30%,41.40%,and 44.80%in diagnosing postpartum SUI of different degrees of primipara.The sensitivity and specificity of the combined diagnosis of them were respectively 92.20%and 82.80%in diagnosing postpartum SUI of different degrees of primipara.The sensitivities of △y,α,β,γ,the means of class II muscle fibers systole period,and the means of class II and I muscle fibers systole period of pelvic floor ultrasound and electromyography physiological parameters were respectively 79.10%,77.30%,88.20%,89.10%,77.30%,87.30%,and the specificities of them were respectively 64.00%,64.00%,52.00%,46.00%,70.00%and 66.00%in diagnosing pelvic floor function of primipara.The sensitivity and specificity of the combined diagnosis were respectively 98.20%and 80.00%in diagnosing pelvic floor function of primipara.Conclusion:Pelvic floor electromyography physiological parameters and pelvic floor ultrasonic parameters have a certain value in diagnosing postpartum SUI of different degrees and pelvic floor function,and the value of the combined diagnosis of them is higher.
摘要
Objective@#: The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis. @*Methods@#: A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis. @*Results@#: A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05). @*Conclusion@#: The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.
摘要
Objective To explore the effect of hypertonic saline combined with magnesium sulfate on severe craniocerebral injury.Methods Patients with severe craniocerebral injury admitted to our hospital from September 2017 to February 2019 were selected prospectively.With the informed consent of the patients' families,the patients were divided into control group and experimental group according to the random number table.Patients in the two groups accepted intracranial pressure monitoring;patients in the experimental group additionally accepted magnesium sulfate combined with hypertonic saline for a continuous use of 7 d.Incidences of high intracranial pressure,epilepsy,low intracranial perfusion,cerebral vasospasm,cerebral infarction,and intracranial pressure rebound,total mannitol dosages one week after injury,serum neuron specific enolase (NSE) level,and Glasgow outcome scale (GOS) scores and mortality rate 3 months after injury were analyzed and compared between the two groups.Results A total of 93 patients were enrolled;47 were into the control group and 46 into the experimental group.There were no significant differences in age,gender,Glasgow coma scale (GCS) scores and NSE levels at admission,and percentages of patients accepted craniotomy evacuation of hematoma or bone flap decompression between the two groups (P＞0.05).As compared with those in the control group,the total mannitol dosage one week after injury and serum NSE concentration were significantly lower,and GOS scores 3 months after injury in the experimental group were significantly higher(P＜0.05).Patients in the experimental group had significantly lower incidences of high intracranial pressure,cerebral vasospasm and intracranial pressure rebound as compared with patients in the control group (P＜0.05).Conclusion Hypertonic saline combined with magnesium sulfate can improve the prognoses of severe craniocerebral injury;it has few side effects and is cheap;it might be an effective cerebral protective agent.
摘要
Objective To explore the influence of minimally invasive puncture drainage on blood brain barrier (BBB) function and its mechanism.Methods Ninety-two patients with hypertensive intra-cerebral hemorrhage (HICH) in the Department of Neurosurgery of Jiaxing Affiliated Second Hospital of Zhejiang Province were divided into a control group and an observation group, according to random number table method, 46 cases in each group. In the control group, the conventional craniotomy was performed, while in the observation group, minimally invasive puncture drainage was carried out to remove the hematoma. The National Institute of Health Stroke Scale (NIHSS) were used to evaluate the neural function, the level of serum myelin basic protein (MBP) was detected by enzyme linked immunosorbent assay (ELISA), the central nervous specific serum protein S100 level was measured by electrochemical luminescence method, the albumin levels in serum and cerebrospinal fluid were determined by automatic biological analyzer, and the BBB index was calculated. After 14 days of surgery, the curative effect and incidence of complications of two groups were observed.Results After surgery, the NIHSS scores of two groups were obviously lower than those before surgery, and the degree of descent in observation group was more significant than that in the control group (score: 3.68±2.39 vs. 5.43±3.89,P < 0.05); after surgery, the levels of MBP, S100, albumin in cerebrospinal fluid and BBB in two groups were higher than those before surgery [MBP (μg/L): 3.02±0.28 vs. 3.81±0.29, S100 (μg/L): 0.95±0.24 vs. 1.34±0.27, cerebrospinal fluid albumin (μg/L): 9.89±0.78 vs. 21.43±1.14, BBB index: 0.22±0.04 vs. 0.48±0.05], the differences being statistically significant (allP < 0.05), but the change values in the observation group were less significant than those in the control group. The total effective rate in observation group was significantly higher than that in the control group [84.78% (39/46) vs. 65.22% (30/46),χ2 = 4.696,P = 0.030]. The incidence of wound infection, gastrointestinal bleeding in observation group was markedly lower than that in the control group [16.67% (6/46) vs. 36.96% (17/46), χ2 = 4.120,P = 0.042].Conclusion The minimally invasive puncture drainage has unequivocal clinical curative effect in treatment of patients with HICH, it can protect the nerve and BBB functions and reduce the incidence of complications.
摘要
Objective To investigate the correlation between serum S100B, IL-6 and intracranial pressure in patients with severe craniocerebral injury.Methods 81 cases of patients with severe brain injury in our hospital from August 2012 to April 2016 were selected,intracranial pressure was monitored immediately after admission to calculate the average daily ICP level ,and venous blood were collected after craniocerebral injury 6,12,24,48, 72 hours.Detection of serum S100B protein and IL-6 levels,and the correlation analysis with the level of intracranial pressure.Results Patients with severe craniocerebral injury S100B levels increased gradually after injury, reached the peak at 24 hours, then decreased gradually; while patients with IL-6 and intracranial pressure after injury gradually increased, the difference was statistically significant in different time points among the S100B,IL-6 and intracranial pressure levels (P<0.05).Conclusion The changes of intracranial pressure after severe craniocerebral injury were proportional to the levels of serum S100B and IL-6,S100B and IL-6 can reflect the changes of intracranial pressure,intracranial pressure changes predicted by S100B plasma concentration in 48 hours were more sensitive than those in the same concentration of IL-6.