重症监护室医护人员实施早期康复行为意向问卷的编制及信效度检验

目的 编制重症监护室(intensive care unit, ICU)医护人员实施早期康复行为意向问卷并检验其信效度,为展开相关研究提供测评工具。方法 基于计划行为理论,通过文献分析、专家咨询、小组讨论形成初始问卷。采用便利抽样法对上海市3所三级甲等医院的202名ICU医护人员进行调查。通过项目分析筛选条目,探索性因子分析评估结构效度,最终确定问卷条目。计算Cronbach’α系数和重测信度对问卷信度进行评价。结果 最终形成了包含5个维度26个条目的问卷。探索性因子分析共提取了5个公因子,累积方差贡献率为70.51%。问卷各条目水平的内容效度为0.800～1.000,问卷水平的内容效度为0.813。问卷总的Cronbach’s α系数为0.941,各维度Cronbach’s α系数均>0.7。问卷总重测信度为0.995,各维度的重测信度为0.932～1.000。结论 ICU医护人员实施早期康复行为意向问卷具有良好的信度和效度,值得推广应用。     

拉米夫定治疗慢性乙型肝炎46例分析

1资料与方法1.1病历资料慢性乙型肝炎住院及肝病门诊患者46例,男性41例,女性5例,年龄19～56岁。诊断标准均符合2002年全国传染病寄生虫病学术会议修订的病毒性肝炎诊断标     

重症急性胰腺炎护理质量评价指标体系的构建

[目的]构建重症急性胰腺炎护理质量评价指标体系。[方法]以Donabedian的三维质量结构模式为理论框架,结合文献研究拟定重症急性胰腺炎护理质量评价指标初稿,形成专家咨询问卷,采用德尔菲法和层次分析法相结合,确定各指标权重,构建重症急性胰腺炎护理质量评价指标体系。[结果]构建的重症急性胰腺炎护理质量评价指标包括3个一级指标、15个二级指标、53个三级指标。两轮专家函询问卷的有效回收率分别为87. 0%和100. 0%,专家权威系数分别为0. 88和0. 92;协调系数分别为0. 268和0. 203(P0. 001),各级指标的层级单排序及总排序一致性均0. 1,具有满意的一致性检验结果,咨询结果和权重设置比较可靠。[结论]重症急性胰腺炎护理质量评价指标体系构建过程科学严谨,评价指标明确,层次分明,指标体系客观可靠,为临床实践的进一步验证提供了理论基础。     

腔镜微创食管癌切除术的学习过程分析

目的总结腔镜微创食管癌切除术（MIE）的学习过程。方法选取同一组医生连续完成的MIE手术100例,按手术时间顺序分为3组：第1、2组各25例行胸腔镜并常规开腹手术,第3组50例行胸腹腔镜手术．分别记录手术时间、出血量、正常结构保护及并发症发生情况、术后ICU观察时间、住院时间、术后肿瘤病理及淋巴结清扫情况等临床资料,比较各组之间的差异。结果全组中96例患者顺利完成MIE,4例患者中转开胸,无中转开腹。中位手术时间310min,中位失血量200ml,中位清扫淋巴结22枚,总体并发症发生率50％。第1组与第2组比较,在保留奇静脉弓（P=0．010）、保留支气管动静脉（P=0．038）及左侧喉返神经胸段术中暴露率（P=0．048）方面的差异有统计学意义。前50例与后50例比较,在胸部手术时间（P=0．000）、失血量（P=0．025）、保留奇静脉弓（P=0．001）、保留支气管动静脉（P=0．000）、胸野淋巴结清扫（P=0．022）、左喉返神经链淋巴结清扫（P=0．000）及该神经起始部术中暴露率（P=0．002）方面的差异有统计学意义。结论MIE学习过程较长．应循序渐进。随着经验的积累和手术技巧的提升．MIE将逐渐显示其独特的优势并替代传统开胸食管癌切除术。     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

云南省洱源县血吸虫病流行区农村卫生厕所现况及粪便无害化效果分析

目的 目的 了解云南省血吸虫病流行区农村卫生厕所建设和管理状况, 评价粪便无害化处理的效果。 方法 方法 在云南省洱源县选取3个血吸虫病流行村, 每村随机抽取30户, 现场调查改厕相关基本情况, 按照国家标准采集和检测厕所粪便样品。 结果 结果 抽查的永乐、 前甸和新庄等3个流行村卫生厕所普及率分别达83.19%、 83.12%和81.63%。共现场调查90座户厕, 仅32.22%的户厕建在庭院以内, 91.67%的卫生厕所和70.00%的非卫生厕所厕屋完整, 33.33%的卫生厕所和所有的非卫生厕所内有蛆/蛹/成蝇, 平均数量分别为1.05只/厕和3.40只/厕。卫生厕所粪大肠菌平均去除率为 90.00%, 寄生虫卵平均沉降率为80.61%, 蛔虫卵平均死亡率为95.20%。出粪液粪大肠菌值合格率为41.67%, 蛔虫卵死亡率合格率为78.13%, 未检出活血吸虫卵。卫生厕所与非卫生厕所无害化效果差异有统计学意义。 结论 结论 云南省血防改厕起到了较好的粪便无害化效果, 但仍要加强卫生厕所的建设、 使用和管理。     

丙硫咪唑治疗华支睾吸虫病90例临床观察

丙硫咪唑是一种广谱抗寄生虫药物,经动物实验和临床应用无明显毒副作用。对多种寄生虫病(线虫病、绦虫病、囊虫病及一些吸虫病)有较好效果。我们于1986年应用该药治疗华支睾吸虫病90例,现将观察结果报道如下。 1 对象与方法 1.1 治疗对象:在90例患者中,住院患者6例,门诊患者84例。男78例,女12例。年龄8～62岁,15岁以下者3例。诊断依据:①食生鱼史(尤其是麦穗鱼和其它种类的小鱼);②华支睾吸虫抗原皮试阳性;③嗜酸粒细胞直接计数在0.4×10~9/L以上;④消化系统症状:右季肋部及心窝部疼痛、消化不良等;⑤粪便中查到虫卵者即可确诊。如     

舒血宁合并抗精神病药物治疗慢性精神分裂症的对照研究

评价舒血宁对于慢性精神分裂症的疗效。采用双盲对照多中心协作的方法，共纳入５４５例慢性精神分裂症患者，在原抗精神病药物治疗稳定３个月的基础上，被随机分为舒血宁治疗组或对照组，治疗时间为１６周。从治疗的第６周起，舒血宁治疗组的简明精神病评定量表和阴性症状评定量表评分的降低显著大于对照组；舒血宁组对于ＢＰＲＳ的迟滞因子和思维障碍因子的疗效显著优于对照组；根据传统疗效评定标准分析，舒血宁组治疗的显效率显著     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.