两种皮瓣游离方式对乳腺癌根治术后皮下积液的影响

目的 探讨皮瓣游离方式对乳腺癌根治术后皮下积液的影响.方法 将148例乳腺癌患者按皮瓣游离方式分为两组,A组(75例)采用皮下注射肾上腺素生理盐水后用手术刀游离皮瓣,B组(73例)用电刀游离皮瓣,比较两组术中出血量、术后5d总引流量及皮下积液的情况.结果 A、B两组术中出血量分别为(210.6±79.3)ml、(193.7±103.5)ml,差异无统计学意义(P＞0.05),术后5d总引流量分别为(178.2±103.1)ml、(307.0±214.8)ml,差异有统计学意义(P＜0.01);皮下积液发生率B组(19.2%)明显高于A组(6.7%)P＜0.05.结论 在乳腺癌根治术中皮下注射肾上腺素生理盐水,用手术刀直接游离皮瓣,术后皮下积液发生率低,是一种较好的皮瓣游离方法.     

手术刀对乳腺癌根治术后皮瓣坏死发生的影响

目的探讨几种手术刀对乳腺癌根治术后皮瓣坏死发生的影响。方法所有患者均采用乳腺癌改良根治术,按所用手术刀不同分为三组,一般手术刀组40例,为A组;电切及电凝输出功率35W的59例,为B组;电切及电凝功率输出功率60W的59例,为C组。结果 A组40例中坏死4例（10.0%）,完全坏死1例;B组59例中坏死5例（8.5%）,完全坏死2例;C组55例中坏死16例（27.1%）,完全坏死5例。三组皮瓣坏死发生率比较差异有统计学意义（χ2=5.87,P〈0.05）。结论乳腺癌皮瓣根治术后皮瓣坏死的原因是多方面的,电刀的不正确使用可增加乳腺癌的并发症,输出功率小于35W的电刀安全,易于操作,术中出血少,皮下积液和皮瓣坏死发生率低。     

乳腺癌根治术皮瓣处理体会

目的探讨乳腺癌根治术皮瓣坏死,皮下积液的原因与对策。方法行乳腺癌根治术游离皮瓣时电刀应用小频率,皮缘3．Ocm以内不用电凝,术后随机分成硅胶胃管小负压吸引组（甲组）,皮瓣戳孔加压包扎组（乙组）,皮下置常规引流管负压吸引组（丙组）。结果在预防皮瓣坏死,皮下积液方面甲组明显优于乙组,乙组优于丙组。结论乳腺癌根治术后皮瓣坏死,皮下积液淋巴漏是可以预防的。     

皮瓣外加压补丁预防乳腺癌改良根治术后皮下积液

目的:探讨乳腺癌改良根治术后皮下积液的防治方法。方法:回顾2000年1月～2009年1月收治女性乳腺癌患者265例,比较皮瓣外加压补丁(A组)与传统纱布加压(B组)乳腺癌改良根治术后皮下积液的发生率。结果:A组130例患者皮下积液12例,发生率9.2%;B组135例患者皮下积液30例,发生率22.2%;A组与B组比较皮下积液发生率差异有统计学意义(P<0.05)。结论:皮瓣外加压补丁有助于乳腺癌改良根治术后减少皮下积液的发生率。     

哭泣 给心灵做个解压SPA

目的探讨阿司匹林（Asp）与高血压脑出血术后再出血的相关性。方法开颅手术治疗的高血压脑出血患者612例，按发病前长期应用Asp与否分为未应用Asp（A）组和应用Asp（B）组。比较两组术后再出血率、再出血量、死亡率及随访6个月时日常生活活动能力（ADL）分级。结果术后再出血率A组为12．1％，B组为39．7％；再出血量A组为（41．3&#177;20．6）ml，B组为（53．2&#177;20．1）ml；死亡率A组为13．4％，B组为38．4％；6个月后ADL评分A组为（67．05&#177;26．2）分，B组为（55．17&#177;2914）分；两组间差异有统计学意义（均P〈0.01）。结论长期服用Asp增加高血压脑出血患者术后再出血机会，增加致残车及死亡率。     

尿激酶治疗结核性包裹性胸腔积液30例的疗效探讨

目的探讨分析尿激酶胸腔注入治疗结核性包裹性胸腔积液疗效。方法将50例结核性包裹性胸腔积液病人随机分为治疗组和对照组，治疗组30例在常规治疗的基础上，每次柚液后向胸腔内注入尿激酶，对照组20例常规治疗。比较两组胸腔积液引流量、胸膜厚度及肺功能的改变。结果注药组胸腔积液引流量平均为（1937&#177;196）ml，显著多于对照组的（1278&#177;220）ml，（t=2．43，P〈0．05）；注药后胸膜厚度为（2．51&#177;0．28）mm，显著低于对照组（3．50&#177;0．33）mm，（t=2．56，P〈0．05）；肺功能改善。结论尿激酶胸腔注入治疗结核性包裹性胸腔积液疗效显著。     

腹腔镜结直肠癌根治术与同期开腹手术的回顾性研究

目的回顾性分析比较腹腔镜结直肠癌根治术与同期开腹手术患者的临床资料,探讨应用腹腔镜技术行结直肠癌根治术的可行性。方法2004年8月至2009年4月腹腔镜辅助下结直肠手术184例,右半结肠癌根治术37例,横结肠癌根治术11例,左半结肠癌根治术31例,直肠癌Dixon手术53例、Miles手术49例、Hartmann手术3例;开腹结直肠癌根治术718例（开腹组）,其中右半结肠癌根治术107例,横结肠癌根治术54例,左半结肠癌根治术131例,直肠癌Dixon手术288例、Miles手术117例、Hartmann手术21例,对照比较2组患者的术中及术后情况。结果2组均无术中、术后严重并发症和手术死亡病例,腹腔镜组有4例中转开腹手术。腹腔镜组与开腹组的平均手术时间分别为（210．5&#177;26．5）min和（95．5&#177;12．5）min,差异有统计学意义（P〈0．05）.腹腔镜组术中失血量（85．5&#177;12．5）ml明显少于开腹组（200．5&#177;22．5）ml．P〈0．05。清除的淋巴结数量,直肠前切除肿瘤远端切缘长度2组间差异无统计学意义。腹腔镜组术后胃肠功能恢复时间（4．5&#177;0．5）d明显旱于开腹组（5．5&#177;0．5）P〈0．05.腹腔镜组住院时间（9．5&#177;0．5）d明显短于开腹组（12．5&#177;0.5）d,P〈0．05,2组的3、5年生存率差异无统计学意义。结论腹腔镜结直肠癌切除术安全、有效,具有可行性。     

经不同途径行CAG及PCI的对比剂用量和手术时间的对比分析

目的比较经桡动脉和股动脉途径行冠状动脉造影（coronary artery angiography,CAG）及经皮冠状动脉介入治疗（Dercutaneous coronary intervention,PCI）所用的对比剂用量和手术时间。方法同期525例行CAG和PCI治疗的患者,经股动脉途径325例,经桡动脉途径200例,分为3组：仅行CAG组（A组）、简单单支病变PCI组（B组）和二支、三支、复杂或慢性闭塞病变PCI组（C组）,比较经股动脉和经桡动脉途径各组所用对比剂用量和手术时间。结果经股动脉途径A、B、C组患者所用对比剂用量与经桡动脉途径各组相比无统计学差异（85．1&#177;41．5ml vs 86．6&#177;36．6ml,P=0．822;175．8&#177;57．5ml vs160．0&#177;48.5ml,P=0．764;228．2&#177;70．5ml vs 222．8&#177;55．9ml,P=0．816）,经桡动脉途径A、B、C组手术时间明显长于经股动脉途径各组（21．5&#177;17．6min vs 10．5&#177;8．6min,P=0．000;41．5&#177;34．4min vs 29．0&#177;16．8min,P=0．000;64．4&#177;18．1min vs46．7&#177;15．5min,P=0．007）。结论经股动脉和经桡动脉途径行CAG和PCI时所用对比剂用量相似,但经桡动脉途径行手术时间长于经股动脉途径。     

芳香维甲酸乙酯治疗32例银屑病临床分析

目的探讨异丙酚、依托咪酯用于老年食管癌患者全麻诱导插管时效果及对循环系统的影响。方法选择65岁以上择期行食管癌根治术患者150例，ASAⅠ～Ⅲ级，随机将其分为异丙酚组（A组）、依托咪酯组（B组）、异丙酚合用依托咪酯组（C组），每组50例。麻醉诱导：A组采用异丙酚2mg／kg；B组使用依托咪酯0．3mg／kg；C组是依托咪酯0．1mg／kg和异丙酚1．0mg／kg。持续监测和记录麻醉诱导显效时间及循环系统的变化。结果（1）C组麻醉诱导意识消失时间（46．6±7．2）s，睫毛反射消失时间（51．6±6．2）s，眼球固定时间（60．2±14．1）8，均明显小于B组[分别为（66．2±11．4）s、（70．3±10．6）s、（82．3±11．5）s]，P〈0．05；与A组比较差异无统计学意义（P〉0．05）；A组与B组比较，差异有统计学意义（P〈0．05）。（2）在循环系统方面与注药前比较，B组在插管即刻血压和心率（HR）明显上升（P〈0．05），A组在诱导后血压和HR明显下降（P〈0．05），C组循环变化不明显（P〉0．05）。脉搏氧饱和度（SpO2）均保持在97％～100％。结论依托咪酯和异丙酚伍用是老年食管癌患者麻醉诱导较为理想的方法。     

间质化疗在乳腺癌术中应用的临床意义

目的探讨乳腺癌术中放置氟尿嘧啶植入剂间质化疗的临床意义。方法60例行乳腺癌改良根治术患者按术中是否使用氟尿嘧啶植入剂分为治疗组（40例）和对照组（20例）。对照组常规手术治疗,治疗组在常规手术后,蒸馏水冲洗创面,分别在肿瘤区域下方、胸大小肌间、腋窝血管下0．5cm均匀放置氟尿嘧啶植入剂（剂量0．4g）。观察两组术后骨髓抑制、肝肾功能、胃肠道反应、皮瓣坏死、皮下积液、局部复发等情况。结果两组骨髓抑制、肝肾功能异常、皮瓣坏死、皮下积液及胃肠道反应发生率比较差异无统计学意义（P〉0．05）。治疗组局部复发率低于对照组[0比20．0％（4／20）],差异有统计学意义（P〈0．05）。结论乳腺癌改良根治术中应用氟尿嘧啶植入剂是安全有效的。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。