211例脑出血死亡时间与死因分析

目的：分析脑出血死亡时间及死因,找出脑出血不同死亡时间的主要死因,为制定脑出血不同时间的相应救治措施提供依据。方法：回顾性总结分析211例脑出血死亡病例的死亡时间、主要死因,找出不同死亡时间对应的主要死因。结果：（1）死亡时间：≤3天91例、4～7天52例、8～14天42例、15～21天18例、22～28天7例、≥29天1例。（2）死亡原因：169例死于脑疝及中枢性呼吸、循环衰竭;20例死于肺部感染;10例死于消化道出血;4例死于多器官功能衰竭;4例死于心脏病变（如心脏猝死、心肌梗塞、心功能衰竭）;其它4例（痰窒息、肾功能衰竭、肝功能衰竭）。（3）不同死亡时间主要死亡原因：≤3天90例死于脑疝及中枢性呼吸、循环衰竭,仅1例死于消化道出血;4～7天47例死于脑疝及中枢性呼吸、循环衰竭,3例死于肺部感染,死于心脏病变及其它各1例;8～14天29例死于脑疝及中枢性呼吸、循环衰竭,8例死于肺部感染,2例死于消化道出血,死于心脏病变、多器官功能衰竭、其它各1例;15～21天7例死于肺部感染,5例死于消化道出血,3例死于脑疝及中枢性呼吸、循环衰竭,死于心脏病变、多器官功能衰竭、其它各1例;22～28天死于消化道出血、肺部感染各2例,死于心脏病变、多器官功能衰竭、其它各1例,已无死于脑疝及中枢性呼吸、循环衰竭者;29天后死于多器官功能衰竭1例。结论：脑出血死亡时间不同,其主要死亡原因不同。临床应该针对不同死亡时间的主要死因制定相应救治方案,以降低死亡率。     

The evaluation of thymus function on the basis of circular DNA estimation technique

The production of T-lymphocytes by thymus is an important indicator of functioning of immune system. The article discusses one of the actual techniques of evaluation of productive function of thymus i.e. qualitative analysis of intracellular circular DNA of T-cells of peripheral blood (TREC). The stages of adaptation of technique on the basis of nationally produced reagents and instruments. To assure the implementation of qualitative polymerase chain reaction a pair of primers with specific sequence of marker of recent thymus emigrants was selected. The optimization of temperature regimen of amplification was made. To ensure the transition to the qualitative analysis on the basis of polymerase chain reaction technic in real-time a fluorescent probe complementary to amplicone nucleotide sequence was developed. The following analytic characteristics of technique were established: sensitivity 4 ng/ml, reproducibility 1.8%. The valid discrepancy of TREC concentrations in patients of different age groups is demonstrated.     

Status of microcirculation and rheological properties of blood in patients with cerebral circulatory disorders

Microcirculation and rheological properties of blood were investigated over time on the basis of the findings of biomicroscopy of the bulbar conjunctiva in 61 patients with different stages of circulatory encephalopathy in the presence of arterial hypertension and atherosclerosis. Rheological properties of blood were changed at all stages of disease. Correlations between the ability of erythrocytes to aggregation and the degree of their intravascular aggregation by the findings of biomicroscopy of the bulbar conjunctiva were not found. The importance of investigation of the intravascular aggregation of erythrocytes and theological properties of blood for assessment of the cerebral vascular microcirculation, control of therapy, and verification of some aspects of the mechanism of action of various drugs was shown.     

免疫抑制法测定血清CK-MB致结果偏高的原因分析

目的：探讨免疫抑制法测定血清肌酸激酶同工酶（CK-MB）值高于总肌酸激酶（CK）的原因及解决方法。方法选择陕西省人民医院心内科已经确诊心肌梗死的住院病人68例,肿瘤内科恶性肿瘤病人32名,其中肝癌8例、肺癌6例、胃癌6例、神经母细胞瘤5例、乳腺癌4例、卵巢癌3例以及来源于消化内科肝硬化患者16例。另选取门诊体检中心健康体检者100例作为对照组。于罗氏 MODUALR 全自动生化分析仪上采用免疫抑制法测定 CK-MB,酶偶联速率法测定总CK活性。结果在68例心肌梗死病人血清中CK-MB单项升高21例,总 CK单项升高39例,二项指标同时升高30例;在32例恶性肿瘤患者中血清CK-MB单项升高11例,总活性升高3例,二项同时升高3例;16例肝硬化患者2例 CK-MB单项升高。结论采用免疫抑制法检测CK-MB作为心肌梗死诊断指标存在一定缺陷,且CK-MB结果升高与某些重度炎症、恶性肿瘤等有密切关系。     

The pathology of the foot in the atherosclerotic damage of lower extremities vessels in patients with type 2 diabetes mellitus

The results of examination of 116 patients with atherosclerotic damage of lower extremities arteries caused by type 2 diabetes mellitus are presented. At the base of data of X-Ray examination the character, frequency and localization of damage of osteoarticular apparatus of the feet were been analyzed in disorders of main blood flow in cases with diabetes mellitus. Pathologic changes were recorded in 89.9% of cases with prevalence of isolated or combined hypertrophic processes. Destructive alterations, typical for osteoarticular apparatus of the feet in diabetes mellitus (diabetic osteoarthropathy), were absent. X-Ray signs of deformating osteoarthrosis of foot articulations were revealed in 48.4% of cases with maximal rate of damage of metatarsophalangeal joints. No relationship of osteoarticular apparatus lesions rate and a grade of circulation disorder in atherosclerotic vascular disturbances in type 2 diabetes mellitus was revealed (p > 0.05). The frequency of a set of X-Ray signs of osteoarthrosis--narrowing of joint space, subchondral osteosclerosis is associated with duration of diabetes mellitus more than 10 years. The relationship between frequency of development of atrophic processes (osteoporosis) of osteoarticular apparatus of the feet in cases with main vascular disorders and severity of course of diabetes mellitus (p < 0.01). Statistically confident prevalence of rate of osteoarticular apparatus of the foot was recorded in aggravation of metabolic disturbances.     

Ankylosing hyperostosis of the spine (Forestier's disease). A study of its clinical picture based on the data from a mail questionnaire

Postal questionnaires were used to study the incidence and intensity of complaints of the spine and peripheral skeleton in patients with ankylosing hyperostosis of the spine. Selection of persons to fill in questionnaires was carried out by means of a preliminary non-randomized analysis of the records of the spinal fluorograms in patients of one of the outpatient clinics of Moscow. Criteria for ankylosing hyperostosis of the spine were the presence of continuous ossification of the anterior longitudinal ligament over a length of not less than 4 successive segments of the spine and the lack of other x-ray alterations in the given part of the spine. It has been established that as compared to the control group (n = 41) without any x-ray alteration in the thoracic part of the spine, the patients with ankylosing hyperostosis of the spine (n = 146) complained of the lumber part and shoulder joints more frequently. The incidence of complaints of other 6 out of 8 parts of the skeleton under analysis was not high in ankylosing hyperostosis of the spine.     

Quality of life in schizophrenia: a review of the literature from 1995 to 2000

The measurement of the quality of life of patients diagnosed with psychiatric disorders has become central to evaluating the effectiveness of treatments offered by Australian mental health services. The importance of quality of life as an indicator of the outcomes of interventions has been reflected by a large body of research seeking to measure the impact of variables such as gender, ethnicity and duration of illness on the measurable quality of life of an individual diagnosed with schizophrenia. This study aims to review and synthesize the recent literature in which quality of life has been measured by the use of at least one quality of life instrument. It is concludes that while the measurement of quality of life is valuable as a measure of outcomes, it should be treated as only one means of doing so .     

社区老年人护理需求及生活质量的相关性研究

目的 了解社区老年人对社区护理服务的需求情况及对生活质量的影响因素,提出改进社区护理的对策,以提高老年人生活质量.方法 选择深圳市2个社区的388名老人作为研究对象,用自制的社区护理需求调查问卷及生活质量综合评定表(GQOLI-74),对其生活质量状况、社区护理需求情况及影响因素进行调查.结果 老年人生活质量得分为61.71±9.85;对社区护理需求得分为2.52±1.03,对健康促进需求最高(2.88±1.09)分.影响社区护理需求的主要因素是对社区护理的认识、患病数目、年龄等;影响老人生活质量的主要因素是患病情况、经济状况、文化程度、职业、婚姻状况、年龄等.老年人对社区护理各领域需求与生活质量的躯体功能、心理功能呈负相关关系(P＜0.05,P＜0.01);对疾病护理方面和护理需求总分与社会功能呈负相关关系(P＜0.05,P＜0.01).结论 社区老年人生活质量偏低,对社区护理需求较高,其生活质量和社区护理需求呈负相关关系,需针对老年人需求特点开展社区护理工作,提高其生活质量.     

Enhanced Toxicity for Mice of Combinations of Bacterial Endotoxin with Antitumor Drugs

The toxicity of Salmonella typhosa 0901W endotoxin to mice was potentiated by (per kilogram) 1 mg of colchicine, 20 mg of emetine, 100 mg of 6-mercaptopurine, 100 mg of 6-methylmercaptopurine riboside, 75 mg of methotrexate, 2 mg of sparsomycin, or 2.5 mg of vinblastine. No potentiation of endotoxin lethality was evident with simultaneously administered (per kilogram): 200 mg of cytosine arabinoside, 450 mg of dibromomannitol, 100 mg of 5-fluorouracil, 125 mg of 5-fluorouracil deoxyriboside, 8 mg of mitomycin C, 1 mg of nitrogen mustard, or 10 mg of tris(1-aziridinyl)-phosphine sulfide. With the exception of colchicine, all drugs prolonged the duration of sleep after the administration of 80 mg of hexobarbital per kg. Simultaneous injection of endotoxin with 100 mg of 6-mercaptopurine per kg, 75 mg of methotrexate per kg, or 1 mg of vincristine per kg resulted in significantly greater lethality than administration either prior to or after the drug. However when endotoxin was administered prior to 100 mg of 5-fluorouracil per kg, lethality was significantly increased. The route of administration of endotoxin and 5-fluorouracil, 6-mercaptopurine, methotrexate, or vincristine did not influence overall lethality. Pretreatment of mice with multiple doses of Escherichia coli endotoxin resulted in a significant reduction in the lethality of 6-mercaptopurine- or vincristine-endotoxin combinations, but had no influence on 5-fluorouracil- or methotrexate-endotoxin combinations. Endotoxin-pretreated mice were more susceptible to vincristine alone and more resistant to high doses of 5-fluorouracil. The lethality of 6-mercaptopurine was increased by simultaneous administration of gram-negative isolates from feces of human patients with neoplastic disease.     

二级医院护士职业获益感对职业发展的影响

目的探讨二级医院护士职业获益感与职业发展的关系,说明职业获益感对职业发展的积极作用。方法采用护士职业获益感问卷和职业发展现状问卷对521名二级医院护士进行问卷调查。结果二级医院护士职业获益感处于中等水平;职业发展现状处于中等水平;职业获益感各维度与职业发展现状各维度均呈现正相关(P<0.01);文化程度、职称和职业获益感能够影响二级医院护士的职业发展现状。结论职业获益感与职业发展存在密切关系,应采取适当的认知干预措施,提高护士职业获益感,促进个人职业发展。     

Definitions of quality of life: a taxonomy

Quality of life is of central concern in evaluative research, improved quality of life is probably the most desirable outcome of all health care policies However, definitions of quality of life are as numerous and inconsistent as the methods of assessing it Stemming from a larger piece of work looking at the definition and measurement of quality of life, this paper highlights the lack of a consensus definition of quality of life by means of a taxonomy of definitions that emerge from the literature The paper describes and gives examples of four main types of definition which make up the taxonomy global (type I), component (type II), focused (type III), and combination definitions (type IV) In addition, an outline of factors influencing the definition of quality of life is given, and an alternative strategy for both defining and measuring the concept (the use of lay definitions) is suggested     

不同放尿方法对剖宫产术后病人膀胱功能的影响

目的 :探讨剖宫产术后不同放尿方法对病人膀胱功能的恢复、子宫复旧及产后出血的影响。方法 :将 12 0例剖宫产术后病人随机分为3组 ,甲组采用开放式引流法 ,乙组采用自主性放尿法 ,丙组采用定时性放尿与自主性放尿相结合的方法。结果 :开放式引流法对剖宫产术后病人膀胱功能的恢复有影响 ,对子宫复旧、产后出血无影响 ;自主性放尿法对剖宫产术后病人膀胱功能的恢复、子宫复旧、产后出血均有影响 ;定时性放尿与自主性放尿相结合的方法可促进剖宫产术后病人膀胱功能的恢复 ,不影响子宫复旧及产后出血。结论 :定时性放尿与自主性放尿相结合的方法优于开放式引流法和单纯自主性放尿法 ,适用于剖宫产术后病人。     

The activity of peroxidation of lipids in biologic samples of patients with recurrent diseases of upper respiratory tracts

The parameters of peroxidation of lipids in blood and saliva were analyzed on sampling of 60 patients with recurrent diseases of upper respiratory tracts during period of remission. It is established that the content of primary and secondary products of peroxidation of neutral lipids in blood plasma is lower as compared with healthy persons. The content of end products of peroxidation of neutral lipids and products of oxidation of phospholipids in blood plasma is higher as compared with healthy persons. The characteristics of alterations of intermediates of peroxidation of lipids in various biologic samples depend on the localization of inflammatory process.     

The diagnosis and possibilities for the anti-arrhythmia treatment of malignant ventricular disorders of the heart rhythm]

Altogether 130 patients with malignant ventricular disorders of cardiac rhythm were examined to demonstrate a possibility of obtaining the diagnostically significant data with the aid of Holter's monitoring of the ECG in 89.2%, with the aid of bicycle ergometry exercise tests in 72.3%, and by means of an electrophysiological examination of the heart in 82.5% of the above-indicated group of patients. The drug testing with the use of invasive and noninvasive techniques of monitoring the action of antiarrhythmic drugs given per os makes it possible to choose effective therapy on an individual basis. The long-term use of such therapy may prevent ventricular tachycardia relapses and noticeably enhance the patients' survival. Severe organic pathology of the heart associated with a decrease of its pump function seen in the majority of patients with malignant ventricular disorders of cardiac rhythm refractory to pharmacotherapy restricts, in a considerable number of cases, the potentialities of drastic surgical treatment because of the risk of operative death. To improve the disease prognosis of these patients, it is necessary that other methods of nonmedicamentous treatment may be used, requiring a less scope of surgical intervention, such as implantation of a cardioverter-defibrillator.     

慢性阻塞性肺病患者血浆B-型钠尿肽水平及临床意义

目的通过观察不同严重程度分级的COPD患者急性发作期与稳定期血浆BNP水平的分布以及不同时期的差异来探讨其变化的规律和临床意义。方法病人就诊时或入院后当天测定血浆BNP水平作为急性发作期的值,病情稳定后评定严重程度分级并在一月后复诊时再次测定血浆BNP水平作为稳定期的值。分别比较不同严重程度分级的COPD患者急性发作期与稳定期血浆BNP水平的分布位置以及COPD患者急性加重期与稳定期血浆BNP水平的差异。结果①急性加重期时不同严重程度分级患者的血浆BNP水平分布的位置是不同的,严重程度分级越高,分布位置越高(P<0.0001)。②稳定期时不同严重程度分级患者的血浆BNP水平分布的位置是也不同的,严重程度分级越高,分布位置越高(P<0.0001)。③急性加重期血浆BNP水平高于稳定期时的水平(P<0.0001)。但在分组比较中,严重程度Ⅰ级的患者急性加重期与稳定期血浆BNP水平的差异无统计学意义(P=0.4407);严重程度Ⅱ级、Ⅲ级和Ⅳ级的患者急性加重期血浆BNP水平高于稳定期时的水平(P均<0.0001)。结论对于COPD患者,血浆BNP水平可以作为判断病情严重程度的一个指标,而血浆BNP水平的变化也有助于评估急性加重患者的治疗效果。     

Bringing criteria for external assessment of the quality of biochemical studies within the framework of the Federal System for External Evaluation of the Quality of Clinical Laboratory Studies, in conformity with requirements of the Order No. 45 of the Ministry of Health of Russia, 2/7/2000

Criteria for external assessment of the quality of evaluation of 23 biochemical parameters of the blood, meeting the standards of accuracy determined by the Order No. 45 of Ministry of Health of Russia of February 7, 2000 for intralaboratory quality control have been estimated. According to the data of the Federal System for External Evaluation of the Quality of Clinical Laboratory Studies, the percentage of results of analyses of test sera meeting these criteria has been estimated. Introduction of new criteria for external assessment of the quality of biochemical tests into the practice of the Federal System will not notably modify the currently used criteria with regard to the majority of biochemical parameters, except introduction of more stringent criteria for albumin and magnesium and less stringent for creatine kinase.     

STANDARDIZATION OF THE ANTIMENINGITIS SERUM

The high variability in infectivity of Diplococcus intracellularis makes it impracticable to standardize the antimeningitis serum on the basis of the virulence of the diplococcus. The irregularity of reaction of small animals to the poison or endotoxin of Diplococcus intracellularis makes it impracticable to standardize the antimeningitis serum on the basis of endotoxic value. The want of uniformity in the complement-binding power of the antimeningitis serum, and the absence of established relation between complement-binding power and therapeutic activity make the employment of this method of standardization impracticable. The part taken by specific opsonins in promoting recovery from infection with Diplococcus intracellularis suggests their employment as a measure of the therapeutic activity of the antiserum. Methods of quantitative estimation of opsonic content of the antimeningitis serum being available, it would seem advantageous to adopt for the present as a standard of value a definite and suitable strength in opsonins of the antimeningitis serum. As a definite and suitable standard of strength a minimum dilution activity of a 1 to 5,000 dilution of the antiserum is proposed. Since the immune opsonins of the antimeningitis serum appear to be highly durable under proper conditions of refrigeration of the antiserum, the test proposed will be applicable when the antimeningitis serum shall have become an article of commerce.     

人性化护理在儿科病房中的应用效果分析

目的通过人性化护理在儿科病房中的实施,探讨人性化服务的实施效果,以进一步改进我科护理工作。方法护理部记录备案的患者及家属满意度调查问卷及每月护理质量评估资料,收集我科实施人性化护理前后住院患儿家属的满意度问卷。抽取人性化护理实施前后问卷各500份进行分析,并比较实施前后护理质量。结果实施人性化护理前后患儿家属满意度有显著性差异（P〈0．01）;人性化护理实施前后,护理质量差异也有统计学意义（P〈0．05）,护理质量明显提高。结论我科对住院患儿实施人性化护理后,提高了患者及家属满意度,提高了护理质量,提升了护理人员形象,保证了护理安全,减少了护理纠纷发生。     

三种皮神经营养血管及筋膜蒂逆行岛状瓣的应用及康复

1MATERIALSANDMETHODS1.1Materials14malecaseslivedinourhospitalfromJanuary1999toMay2002,withagerange24-74,average35.8,inwhich3casesofcombiningcutaneousdeficiencywithboneexposureaftertrauma;1casesofcutaneousdeficiencyofinternalankle;1caseofcutaneousdeficiencyoflateralankle2casesofcombiningos-teomyelitisofcalcaneumboneandcutaneousdeficiency,1caseofboneexposureofcalcaneumboneaftertrauma,2casesofdegreeIIIburnofdorsumoffootcombiningwithexposureofdeeptissue,1caseoftuberculosisulcerofwristbacka…