医院机动卫勤分队模块化抽组实践

现代战争的作战形式多样化、作战手段高技术化及非作战军事行动保障需求增加，使传统卫勤组织模式受到挑战。本院采用模块化抽组方法，以模块化理论指导医院机动卫勤分队抽组，并于2005年和2006年通过了综合演练和完成各类保障任务的检验。     

某部114例军事训练伤调查分析

军队训练伤是部队军事劳动中最常见的损伤之一 ,直接影响军队训练和执勤 ,并损害指战员的健康。为此 ,我们对 1995年度收治的某部 114例军事训练伤进行了分析。结果报告如下。1　资料与方法　 (1)资料 :来源于某部 1995年发生军事训练伤的 114名战士 ,年龄 18～ 2 2岁 ,入伍年限 1～ 4年 ,分别来自该部工程、技术和后勤分队等。(2 )方法 :采取回顾性调查和跟踪调查相结合的方法 ,根据《全军军事训练伤诊断标准》 ,以医院门诊诊断为依据 ,确保调查结果的可靠性。2　结果与分析　 (1)训练伤发生与入伍年限分布 :在 114例训练伤人员中 ,入伍 1…     

多发伤患者早期血浆血管生成素2水平变化与内皮损伤和预后的关系

目的 探讨多发伤患者早期血浆血管生成素2(angiopoietin2,Ang2)的水平变化与血管内皮损伤和预后的关系及临床意义.方法 为前瞻性观察研究,选择2008年1月至2010年1月收入聊城市人民医院急诊科的多发伤患者59例,纳入标准:创伤至入院时间在1 h以内;年龄大于18周岁;既往身体健康,排除有心、脑、肝、肾等器质性疾病,糖尿病、高血压,肿瘤;急慢性感染性疾病;严重颅脑损伤(GCS<12分);两周前用过抗凝及溶栓类药物患者.共纳入59例患者包括男36例,女23例,年龄(32.3±11.5)岁.按创伤严重度评分(ISS)分为重伤组(ISS≥16分,29例),轻伤组(ISS<16分,30例)2组.另取30例健康人为健康对照组,均为接受体检的健康人.其中男19例,女11例,年龄均大于18周岁,年龄(33.5±10.6)岁.各组性别、年龄构成均具有可比性.患者到达急诊科后10 min内抽取外周静脉血 10 mL,分离血浆.应用酶联免疫吸附法(ELISA)测定血浆Ang2的水平.同时测定血浆冯·维勒布兰德因子(Von Willebrand factor,vWF)、血栓调节蛋白(thrembomodulin,TM)的水平.统计数据用均数±标准差(-x±s)表示,所有数据采用SPSS 13.0统计软件进行统计分析.应用单因素方差分析和两两比较的Q检验(Newman-Keuls法)比较分析各组Ang2的水平差异.采用成组资料t检验比较分析死亡和生存患者Ang2的水平.采用pearson相关分析法分析Ang2水平与血浆vWF,TM的相关性.以P<0.05为差异具有统计学意义.结果 重伤组(ISS≥16分)血浆Ang2水平明显高于轻伤组(ISS<16分)(P<0.05),两组均明显高于正常对照组(P<0.05).死亡组血浆Ang2水平明显高于生存组(P<0.05).创伤后Ang2水平变化与血浆vWF,TM水平均有明显相关性(P<0.05).结论 血浆Ang2水平在多发伤早期明显增高,和创伤严重程度相关,和创伤后内皮损伤相关,其对预后有重要的预测价值.

Abstract：

Objective To investigate the early changes of plasma levels of angiopoietin2 in patients with multiple trauma and the relationship between plasma levels of angiopoietin2 (Ang2) and endothelial injury as well as prognosis of patients in order to determine their clinical significance. Methods Patients with multiple trauma admitted to emergency department from January 2008 to January 2010 were enrolled. A total of 59 casualties met the criteria(admission within 1 h after trauma and age > 18 years), and were eligible for enrollment. Patients with heart, brain, liver, kidney and other organic diseases, diabetes, hypertension, tumor, acute and chronic infectious diseases , severe brain injury (CCS < 12 points) , anticoagulant and thrombolytic medicine used two weeks before trauma were excluded. Among 59 patients, 36 were males and 23 females. The average age was(32.3 ±11.5) years. Patients were divided into severe trauma group (ISS ≥16 points,n =29) , moderate trauma group (ISS < 16 points, n =30 ) judged by using injury severity score (1SS). Thirty healthy subjects were selected as controls, 19 male and 11 female, with age > 18 years and an average age of(33.5 ±10.6) years. All groups had comparable gender proportion and average age. The 10 mL peripheral blood sanple was collected within 10 minutes after arrival of patients to emergency department and the plasma was separated from blood. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of angiopoietin2, and the plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) were also detected. Data were expressed as mean ± standard deviation and were statistically analyzed by using SPSS version 13.0 statistical software. The differences in plasma levels of angiopoietin2 of patients in each group were analyzed by ANOVA and Newman-Keuls test. Levels of angiopoietin2 in fatal patients and survival patients were also compared by using t test. The relationships between angiopoietin2 and plasma levels of vWF as well as levels of TM were analyzed by Pearson correlation analysis. Changes were considered as statistically significant if P value was less than 0.05. Results The plasma levels of angiopoietin2 in severe trauma group (ISS scored 16 points) were significantly higher than those in moderate trauma group (ISS < 16 points) ( P < 0.05 ), and those in trauma patients of the two groups were both significantly higher than those in control group (P < 0.05). The plasma levels of angiopoietin2 in fatal patients were significantly higher than those in survivors (P < 0.05). Plasma levels of angiopoietin2 were significantly correlated with plasma levels of vWF and TM (P < 0.05). Conclusions The plasma levels of angiopoietin-2 significantly increase after multiple trauma, and correlate with the degree of trauma severity. The plasma levels of angiopoietin2 correlate with endothelial injury after multiple trauma, having important prognosis value in patients with multiple trauma.     

肿瘤抑制基因PTEN在乳腺癌中的表达及其临床意义

目的研究肿瘤抑制基因PTEN在乳腺癌组织中的表达及临床意义。方法采用免疫组化法检测83例乳腺癌组织PTEN蛋白的表达情况。结果83例乳腺癌组织的PTEN阳性表达率为61.4%（51/83）,PTEN阴性表达率为38.6%（32/83）。PTEN表达与乳腺癌原发肿瘤的大小（P〈0.05）、临床分期（P〈0.05）、淋巴结转移（P〈0.05）以及雌激素受体（ER）（P〈0.05）有关。PTEN高表达的乳腺癌患者5年总生存率明显高于低表达者（P〈005）。结论乳腺癌组织中存在肿瘤抑制基因PTEN的表达缺失或减弱,可能与乳腺癌的发生、发展有关。PTEN可以作为一个判断乳腺癌预后的指标。     

二炮后勤应急保障大队医疗分队组训实践

应急作战时效性强、作战样式复杂、立体协同、进攻防卫交织的特点凸显出机动卫勤力量的重要性,使其成为当前军事斗争卫勤保障的“拳头”和“尖兵”,因而建设一支适应当前军事斗争和意外灾害救援特点的机动卫勤分队,具有十分重要的意义。就本院医疗分队参加二炮后勤应急保障大队实兵实装综合演练前后的组训实践谈几点体会。     

军旅营体制下卫勤保障的难点与对策

1998年部队实行编制体制改革后，实行军旅营体制的部队变化比较大。如何搞好军旅营体制下卫勤保障是摆在我们面前的新情况、新课题。我们立足编制和现有条件，积极探索军旅营体制下卫勤保障的特点和规律，经过近5年的实践，取得了明显成效。现将我部5年来的实践体会总结如下。     

无线血压传感器压力遥测腹主动脉瘤覆膜支架腔内修复后内漏的可行性

背景：腹主动脉瘤覆膜支架腔内修复后内漏的检查方法主要有螺旋CT、动脉造影、核磁共振、多普勒超声等,但都是通过影像间接判断的,无法实现对内漏的直接有效检查,存在漏诊、操作复杂、检查成本高、对患者有一定创伤等缺点。 目的：采用植入式无线血压传感器长期监测腹主动脉瘤修复术后瘤腔内血压,用于诊断是否发生内漏。 方法：用于腹主动脉瘤修复后内漏诊断的压力无线检测系统由植入式无线血压传感器、能量发射线圈、数据读取器和数据处理平台组成。植入式无线血压传感器直接检测瘤腔内血压。无线血压传感器由无线能量接收模块、电源管理模块、传感器模块、信号调理模块、微控制器和射频通讯模块组成。 结果与结论：目前已经完成了样机的研制,并进行了体外模拟血压测试实验。通过模拟实验,初步验证了无线血压传感器进行压力遥测的可行性及有效性。 关键词：无线血压传感器;腹主动脉瘤;腔内修复;瘤压;数字化医学 doi:10.3969/j.issn.1673-8225.2012.13.016