SARS前后医疗机构消毒质量状况分析

目的:了解SARS前后医疗机构在消毒隔离和医院感染管理上有何区别。结果:SARS前,监测30家医疗机构1757份样品,合格1344份,合格率为76.49％;SARS后,再次对30家单位进行监测,监测样品1800份,合格1501份,合格率为83.39％。SARS前后消毒质量合格率有显著性差异(X2=26.40,P<0.005),各级医疗机构消毒质量监测合格率之间也有显著性差异(2002年,X2=56.75.P<0.005;2003年,X2=98.78,P<0.005)。分析:SARS后,医疗机构在医院感染管理、发热门诊和收治传染病病区上的设施,以及临床医生自我保健上都有区别。     

2005年度南宁市区服务业人群梅毒感染情况调查

目的:了解服务业人群中梅毒感染情况。方法:对16 125例服务业人员进行梅毒检测,初筛阳性者以确认试验确认。结果:16 125例服务人员中,梅毒感染143例,其中男性3 575例,梅毒感染25例,感染率为0.70%;女性12550例,梅毒感染118例,感染率为0.94%;梅毒感染率无性别差异(χ2=1.84,P>0.100)。不同年龄段梅毒感染率有显著性差异(χ2=31.75,P<0.005)。不同职业梅毒感染率有显著差异(χ2=98.65,P<0.005)。结论:服务业人群中美容美发、宾馆客房服务、按摩娱乐业梅毒感染率显著高于其他服务业人群,有关部门应加强合作,加大对人该群梅毒感染的监测力度。     

天津市基层医院内科医护人员结核感染控制知晓情况调查分析

目的:了解天津市某辖区基层医院内科医护人员结核感染控制知晓情况。方法:采用"十一五"国家重大科技专项(2009ZX10004-714)医务人员结核病感染控制调查中的问题对天津市某辖区17家基层医院536名内科医护人员进行横断面问卷调查。结果:536名内科医护人员结核感染控制相关知识全部回答正确的仅占19.6%。在隔离(98.5%)、通风(98.1%)知晓率较好。而在分诊(72.6%)、消毒(53.5%)及与疑似或确诊肺结核患者接触时佩戴口罩类型(37.5%)的知晓率偏低。不同情况下使用何种类型口罩知晓率均偏低,仅有39.4%的医护人员知道在与疑似或确诊结核患者接触时佩戴N95医用口罩。在消毒(χ2=8.864,P<0.05)、与疑似或确诊肺结核患者接触时选择佩戴口罩的类型(χ2=7.348,P<0.05)及是否佩戴口罩(χ2=11.61,P<0.05)方面差异有统计学意义,且护士的应答率均高于医生。结论:被调查基层医院内科医护人员结核感染控制知晓情况有待提高,需不断加强对基层医院内科医护人员结核感染控制知识的培训。     

循证护理对ICU病人中心静脉导管相关性血流感染的预防应用

目的探讨循证护理在预防ICU病人中心静脉导管相关性血流感染中的应用效果。方法选取2011年6月—2012年7月入住我院ICU行中心静脉置管的病人181例,随机分为对照组(75例)和循证组(106例)。对照组采用传统护理方法,循证组采用循证护理方法。比较两组病人导管相关性血流感染发生情况。结果循证组导管相关性血流感染发生率(3.8%)低于对照组(12.0%),差异有显著性(χ2=4.46,P<0.05)。结论运用循证护理有效地预防了导管相关性血流感染的发生。     

脑出血病人吞咽功能评估

目的了解脑出血后吞咽困难的发生情况及不同程度吞咽困难与脑出血部位、出血量和肺部感染的关系。方法脑出血病人252例,入院后行颅脑CT或MRI检查,进行吞咽功能评估,根据吞咽障碍程度分为轻度、中度、重度3组,比较不同出血部位、不同出血量脑出血病人吞咽障碍发生率及肺部感染发生率。结果出现吞咽困难者125例,吞咽困难发生率为49.60%;小脑、脑干出血和幕上大脑半球出血量≥30mL病人吞咽困难发生率更高,差异有显著性(χ~2=23.967、40.072,P<0.01)。轻度吞咽障碍病人32例,并发肺部感染3例(9.38%);中度吞咽障碍病人47例,并发肺部感染9例(19.15%);重度吞咽障碍病人46例,并发肺部感染41例(89.13%),重度吞咽障碍病人并发肺部感染发生率显著高于中度、轻度病人,差异有显著性(χ~2=65.825,P<0.01)。结论吞咽困难是脑出血常见并发症之一,尽早诊断、及时治疗可改善病人预后。     

在ICU中重症SARS患者住院费用比较分析

为了解严重急性呼吸综合征(SARS)患者在ICU中的住院费用特点及其影响因素,探讨相应的控制措施;将我院2003年5月至6月住ICU的41例重症SARS患者与同期的179例住院SARS患者的住院费用及其影响因素进行比较分析,并将41例重症患者中分别住ICU1与住ICU2患者的住院费用及其影响因素进行比较分析。结果41例重症SARS患者中,男性21人,女性20人,年龄24～82岁,平均年龄(47.00±14.60)岁;其住院总费用为1902190元,平均(47117.51±33316.89)元;其中药费所占比例最高(48.27%),其他依次为治疗费、检查费、其他费用和床位费。ICU1组与ICU2组患者的平均住院总费用及5种费用的平均值的差异均无显著性(P>0.05)。41例重症患者的平均年龄明显高于179例患者(P<0.05);发生并发症的人数(占73.2%)明显增多(P<0.01);使用无创通气或有创通气治疗的分别占58.5%及17.1%,明显增多(P<0.01)。ICU1组患者中使用无创机械通气治疗的人数(占78.3%)明显多于ICU2组(P<0.01)。提示重症SARS患者的住院费用明显增高,药费所占比例最高,与多种因素有关,及时使用无创机械通气治疗,并积极探索更加有效的药物及合理的治疗措施,以提高治愈率,降低病死率,并能有效地控制SARS患者住院费用,降低药费比例。     

幽门螺杆菌感染与慢性胃炎相关性

目的探讨幽门螺杆菌(Hp)感染与慢性胃炎发生及发展相关性。方法对行胃镜检查2 789例慢性胃炎病人的胃镜及病理检查结果进行回顾性分析,研究慢性胃炎与Hp感染关系。结果中老年组(40～87岁)Hp感染发生率明显高于青年组(18～39岁),差异有显著性(χ2=46.60、29.08,P<0.01);不同性别组间Hp感染的发生率差异无显著性(P>0.05)。活动性胃炎组Hp感染率为99.0%,中重度感染占51.5%,均明显高于非活动性胃炎组(χ2=179.93,P<0.01)。慢性浅表性胃炎的Hp感染率为83.6%,慢性萎缩性胃炎为95.4%,二者比较差异有显著性(χ2=28.88,P<0.01)。Hp感染阳性组重度胃炎、肠上皮化生及异型增生的发生率均较Hp阴性组高,差异有显著性(uc=-30.19～-13.17,P<0.01)。结论慢性胃炎的发生和发展与Hp感染密切相关。     

儿童ALL治疗中骨髓细胞形态学动态监测及其意义

目的了解骨髓细胞形态学动态监测在儿童急性淋巴细胞白血病(ALL)治疗预后中的价值。方法采用回顾性研究方法,对我院2006年8月—2010年3月收治并获得系统治疗的70例ALL病儿进行Kaplan-Meier分析,监测完全缓解治疗第19、33天以及初次缓解后维持治疗过程中,骨髓原始+幼稚淋巴细胞比例,并采用COX比例风险回归模型对各影响因素进行分析。结果诱导完全缓解治疗第19天原始+幼稚淋巴细胞比例<5%组生存率高于5%～25%组,差异有统计学意义(χ2=25.320,P<0.001);第33天完全缓解组生存率显著高于部分缓解组(χ2=21.676,P<0.001)。维持治疗中原始+幼稚淋巴细胞比例5%组生存率高于5%～20%组(χ2=14.347,P<0.001);原始+幼稚淋巴细胞比例5%～20%病人按出现的时间距初次获得完全缓解时间分为3组,其中0.5～1.0年组与0.5年内组生存率差异无统计学意义(χ2=2.951,P>0.05),1.0年后组生存率显著高于1.0年内组(χ2=16.416,P<0.001);1年内出现频率≤3次组生存率高于>3次组(χ2=15.075,P<0.001)。原始+幼稚淋巴细胞比例5%～20%的标危、中危及高危病儿生存率依次降低(χ2=23.099,P<0.001),B细胞系ALL生存率高于T细胞系ALL(χ2=8.476,P<0.05)。多因素分析结果显示,1年内骨髓原始+幼稚淋巴细胞比例5%～20%出现频率>3次(RR8.180,95%CI 2.371～28.217,P=0.001)、高危型(RR3.013,95%CI 1.146～7.918,P=0.025)、T细胞系(RR7.064,95%CI 1.968～25.359,P=0.003)为预后影响因素。结论动态监测骨髓细胞形态学原始+幼稚淋巴细胞比例在ALL个体化施治中有极大临床指导意义。     

江阴市网络报告甲状腺疾病流行病学分析

目的了解江阴市甲状腺疾病患者的发病情况及流行特点,为下一步制定预防甲状腺疾病的对策及防治措施提供科学依据。方法对2012年江阴市网络报告的甲状腺疾病病人进行统计分析。结果通过统计得出41~70岁的病人占发病人数的73.04%,女性高于男性,差异有统计学意义(χ2=126.23,P<0.001);甲状腺结节病人占42.41%;发病有地区性,差异有统计学意义(χ2=408.63,P<0.001),其中夏港镇(χ2=132.41,P<0.001)和申港镇(χ2=318.25,P<0.001)发病率高于全市发病水平。结论甲状腺疾病患者以中老年女性为主,且以甲状腺结节和结节性肿大为主,有地区性差异。     

中心静脉导管相关血行感染46例观察

目的:研究ICU中心静脉导管相关血行感染(CRB-SI)细菌学情况及相关危险因素分析。方法:对我院ICU近3年临床诊断CRBSI的46例患者导管头培养病原菌特点及危险因素进行回顾性分析。结果:80例中心静脉导管插管病人有46例发生CRBSI(57.5%),共检出菌株49株,其中革兰阳性球菌10株;革兰阴性杆菌18株;真菌21株。感染组与未感染组比较年龄偏大(P<0.01);导管留置时间≥7 d,CRBSI发生率高(P<0.01);加强医护人员操作时的无菌程度后CRBSI发生率显著降低(P<0.01)。结论:ICU病区CRBSI发生率高,真菌感染构成比高。年龄、留管时间、医护人员操作时的无菌程度是CRBSI的相关危险因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.