多途径介入治疗37例急性坏死性胰腺炎的临床分析

目的 :探讨经多途径介入治疗急性坏死性胰腺炎的效果。方法 :回顾性总结 6 7例用不同方法治疗的急性坏死性胰腺炎患者资料 ,其中介入组 (采用胰腺动脉插管灌注奥曲肽、抗生素、地塞米松、普鲁卡因四联药物 ) 37例 ,对照组 (四联药物静脉给药 ) 30例。结果 :介入组腹痛缓解、胰淀粉酶恢复正常及住院时间均短于对照组 (P<0 .0 5或 P<0 .0 1) ,两组严重并发症的发生率 (分别为 19.4 4 %和 4 1.93% )及病死率 (分别 2 .70 %和16 .6 7% )均有显著性差异 (P均 <0 .0 5 )。结论 :经多途径介入治疗急性坏死性胰腺炎较传统方法有效。     

Effect of Organizational Climate on Youth Outcomes in Residential Treatment

This study examined the association between organizational climate and changes in internalizing and externalizing behavior for youth in residential treatment centers (RTCs). The sample included 407 youth and 349 front-line residential treatment staff from 17 RTCs in Illinois. Youth behavior was measured using the Child Functional Assessment Rating Scale. Organizational climate was measured via the Areas of Worklife Survey. Using hierarchical linear modeling, results demonstrated that a higher perception of person-job match on community among front-line staff was associated with more improvement on youth externalizing behaviors. Counter-intuitively, higher person-job match on fairness and workload were each associated with less improvement on internalizing and externalizing behavior. These results offer several potential implications for residential treatment leadership, front line workers, policymakers, youth, and researchers.     

手术与非手术治疗胆源性胰腺炎的对比观察

目的：探讨手术与非手术两种治疗方式在胆源性胰腺炎中的临床疗效和安全性。方法92例胆源性胰腺炎患者,依据适应证以及家属意愿分为手术组和非手术组,每组各46例。手术组患者接受手术治疗,非手术组患者采用常规综合治疗。比较2组患者的临床指标恢复情况以及并发症、死亡率。结果与非手术组相比,手术组患者体温恢复时间、腹痛恢复时间短,肝功能正常恢复时间和血尿淀粉酶降至正常时间短（均P＜0．001）;手术组患者术后复发率、并发症总发生率、死亡率明显低于非手术组（均P＜0．05）。结论胆源性胰腺炎早期行手术治疗可以明显缩短患者病程,提高治愈率,减少并发症发生;治疗需要遵循个体化原则,明确的诊断和合适的手术时机是提高疗效的保证。     

CT引导下微创治疗颅内血肿

目的 探讨CT引导下微创治疗颅内血肿的价值。方法 62例颅内血肿患者经CT下直接定位，后经颅骨钻孔、引流行尿激酶溶解术，并进行定期CT随访观察。结果 术后1．4周CT复查血肿消失或大部分消失，脑内血肿者遗留脑软化灶。结论 CT引导下颅内血肿微创治疗是一种安全可靠、有实用价值的治疗方法。     

Treatment of impacted canines with aligners: An alternative and viable option

To recover impacted canines without esthetic issues, the aligners can be a resolutive tool allowing by pontics the camouflage of absent canines during orthodontic treatment. Knowledge of biomechanics, correct staging of dental movements, and surgery planification are strategic to achieve a good result.     

The Essence of Residential Treatment: III. Change and Adaptation

This paper examines four challenges facing residential treatment programs: Providing short-term treatment, increasing family involvement, preparing children for life in the community, and offering a “hospital level of care.” It shows that past problems in these areas have arisen from the social conditions and historical circumstances in which residential programs evolved rather than limitations inherent in the core concepts upon which the modality is based and that those concepts provide a basis for solving those problems.     

Acute Migraine Treatment With Rizatriptan in Real World Settings – Focusing on Treatment Strategy, Effectiveness, and Behavior

Although randomized controlled trials (RCTs) are the gold standard for assessing efficacy of a drug intervention, because they are conducted in a highly selected group of patients, they do not necessarily reflect normal customary or optimized patient care. Accordingly, information from RCTs must be supplemented by outcomes research and by nonexperimental or quasi-experimental study designs. Herein, we discuss information that supplements the rigorous but sometimes rigid nature of RCTs in an effort to better understand the clinical utility of drug treatment for migraine with patient-centered outcomes in mind. We start by discussing several lessons we learned from RCTs on comparative triptan studies, followed by presenting data on outcomes studies for rizatriptan. We then briefly discuss migraine treatment behavior issues, including early treatment and adherence to treatment.     

异位妊娠非手术治疗95例临床分析

目的：探讨非手术治疗异位妊娠的临床疗效。方法：95例异位妊娠患者中，用药组(n=63)采用MTX或米非司酮，期待治疗组(n=32)不予任何药物治疗，只定期复查血β-HCG，若出现腹膜刺激征及时复查B超。结果：用药组、期待治疗组β-HCG降至正常(小于或等于25IU／L)时间平均分别为27．4d、28．1d，在治疗过程中用药组7例、期待治疗组4例出现下腹痛加剧改行手术治疗，用药组、期待治疗组非手术治疗成功率分别为88．9％、87．5％。两组治疗失败后手术率和β-HCG降至正常时间无统计学差异。结论：临床上异位妊娠存在过度治疗趋势，部分患者可不用药物就能治愈，既可减轻患者痛苦、节省费用，又减少了药物的副反应。     

顽固性颈性眩晕不同治疗方案的前瞻性研究

Vertigoofcervicaloriginisrelatedofvertebralarterycom－pressionsyndromedevelopedbyprolapsedofintervertebraldisc，disorderofzygapophysialjoint，andmyofascitisintheneckre－gion．Somedatareporteditaccompaniedthechangeofmicrocir－culationandbloodviscosityalso．Itmaybemulti－agents．Inthistheprospectivestudy，１８３patientsofobstinatevertigocausedcervicalsyndromewiththechangeofmicrocirculationandbloodviscosityweretreatedwithoneofthreeprojectsdifferently．Agroup，acupotomentandmanipulativereduction；…     

药膳治疗对肝癌介入术后肝功能恢复的临床观察

为探讨药膳治疗对原发性肝癌介入术后肝功能恢复效果,对６０例原发性肝癌病人在药膳治疗原理的基础上,配合常规的治疗方法观察介入术后肝功能损害恢复的情况,并与５９例介入术后采用常规治疗方法的原发性肝癌病人进行对比。结果：治疗组对介入术后肝功能有恢复作用,恢复时间较对照组明显提前（Ｐ＜０．０５）,副反应明显减轻,生活质量得到提高。药膳治疗对于肝癌介入术后肝功能的恢复和减轻副反应是一种有价值的治疗方法,并可增进医、护、患之间合作与了解,体现了整体护理之所在     

The GRIM2005 study of migraine consultation in France II. Psychological factors associated with treatment response to acute headache therapy and satisfaction in migraine

The objective of this analysis was to identify variables associated with treatment response in subjects with migraine. Data were collected from a sample of 10 000 subjects. A battery of questionnaires assessing clinical and psychological variables was completed. Migraine diagnosis was attributed using an algorithm based on the IHS criteria and treatment response using the ANAES criteria. We identified 1534 subjects, of whom 1443 were treated. For 54.2%, at least one ANAES criterion for treatment response was unfulfilled. Non-response was associated with female gender, high HIT-6 impact scores and high HAD psychological distress scores. The strongest associations with non-response were identified for four psychological variables: elevated scores on the CSQ catastrophization subscale and the 'Consequences' and 'Acceptance' dimensions of the Brief COPE, and low scores on the 'Positive Reinterpretation' Brief COPE dimension. In conclusion, many individuals with migraine respond inadequately to treatment. Behavioural interventions aimed at modifying coping strategies may improve outcome.     

主髂动脉闭塞症介入治疗的进展

主髂动脉闭塞症是常见的外周血管疾病,治疗方法主要有两种:以经典的外科旁路术为代表的外科手术治疗及近年兴起的介入治疗。随着介入技术的不断进步及经验的积累,介入治疗的应用越来越多,对于复杂的主髂动脉闭塞症的治疗也取得了很好的效果。介入与手术杂交手术等各种新技术的发展,给主髂动脉闭塞症的治疗提供了更多的选择。介入治疗现已成为治疗主髂动脉闭塞症的首选治疗方案。本文对AIOD介入治疗的新进展进行综述。     

慢性颈动脉粥样硬化闭塞治疗的研究进展

慢性颈动脉粥样硬化闭塞会导致脑血流低灌注而增加卒中风险。无症状患者首选药物治疗,对于反复出现神经症状的患者可选择手术治疗。颅外-颅内动脉旁路术(extracranial-intracranial artery bypass,EIAB)治疗效果不优于药物治疗。颈动脉内膜剥脱术(carotid endarterectomy,CEA)、颈动脉支架成形术(carotidartery stent,CAS)手术风险高、成功率低,治疗效果尚待验证,故术前应严格筛选患者、把握适应证。本文就目前对于慢性颈动脉闭塞的治疗现状作一综述。     

剖宫产术后子宫瘢痕妊娠的诊断及急诊处理

目的:探讨剖宫产术后子宫瘢痕妊娠的诊断治疗方法及急诊处理措施。方法:回顾性分析2007-09-2011-09我科住院治疗的剖宫产术后子宫瘢痕妊娠患者临床资料25例。结果:25例患者均有剖宫产史,停经史,血HCG升高。其中10例患者在人流术前阴道超声诊断瘢痕妊娠;13例在人流时出血100～300ml,再经阴道超声诊断;2例人流术中出血800～1000ml休克,急行剖腹探查术中发现。术前明确诊断10例,用米非司酮+MTX+B超宫腔镜下清宫,效果满意;15例人流中出血较多者,其中5例经宫颈注射缩宫素,双合诊按压子宫下段30min后宫腔填塞纱布;另8例用22号Foleys尿管注液20～30ml压迫,术后24～48h取出,行双侧子宫动脉栓塞术,2d后行B超下清宫;2例出血过多伴休克剖腹探查时行子宫下段瘢痕处妊娠组织切除及子宫修补。25例患者均保全了子宫,保留了生育功能。结论:HCG、阴道超声在子宫瘢痕妊娠的诊断中的重要价值。应用米非司酮,MTX或子宫动脉栓塞,用B超或宫腔镜下清宫是治疗子宫瘢痕妊娠的有效方法。宫腔填塞纱布及Fo-leys尿管球囊注液局部压迫,对人流大出血时能取得很好的急诊止血作用,适合基层医院的紧急止血,为进一步及后续保留子宫治疗提供机会。     

重症急性胰腺炎的临床治疗

目的：探讨重症急性胰腺炎的临床治疗方法。方法：回顾性分析我院自1998.4～2006.7共收治的各类重症急性胰腺炎患者56例。结果：治疗上采取在内科治疗的基础上,选择适当手术干预,除2例并发多器官功能衰竭病死外,全部治愈出院。结论：重症急性胰腺炎的处理要根据患者的具体情况,应首先采取非手术治疗,并针对不同情况合理选择外科手术治疗。     

影响糖尿病药物治疗依从性的多因素分析及护理对策

[目的]探讨影响糖尿病药物治疗依从性的相关因素及护理对策。[方法]收集我院275例糖尿病病人的资料．采用多因素Logistic回归分析比较糖尿病病人用药依从性好与依从性不好组的影响因素。[结果]275例糖尿病病人中依从性好的76例,占27．6％,依从性不好的199例,占72．4%;将单因素分析有统计学意义的变量为自变量,引入逐步Logistic回归模型拟合,显示最终留在方程内的变量为年龄、糖尿病知识认知程度差、有药物不良反应、降糖药物多于3种。[结论]糖尿病病人药物治疗依从性较差,受诸多因素影响。     

中西医结合治疗脊柱结核伴布氏杆菌病临床研究

目的：观察中西医结合治疗脊柱结核伴布氏杆菌病的疗效和可行性。方法：自1998年2月—2008年2月共收治脊柱结核204例,其中68例伴有布氏杆菌病,随机设对照组与治疗组,其中对照组34例应用传统西医治疗方法,另34例采用中西医结合疗法,对两组治疗效果进行分析。结果：随访8个月-2年（平均16.5个月）,有59例获得随访,9例中途失访。根据骨结核病灶治愈标准及布氏杆菌病血清免疫学检验指标,对照组治愈时间5-16个月,平均12个月;治疗组治愈时间3-12个月,平均8个月。结论：虽然两种方法都可治疗脊柱结核伴布氏杆菌病,但中西医结合疗法更能进一步缩短疗程,促进愈合,且该方法简单、安全、有效,尤其值得在基层医院应用。     

静脉曲张的治疗进展

静脉曲张是血管外科常见疾病之一。曲张静脉主要位于下肢,且大隐静脉最常受累,其临床表现为下肢酸胀、灼烧感,久站后出现静脉血栓、腿部溃疡等并发症,严重影响生活质量。保守的治疗方法有压力治疗,改变生活方式,如避免久站立和劳累等。手术方法有传统大隐静脉高位结扎剥脱术、热肿胀消融术、血流动力学校正术（CHIVA）、非热能非肿胀技术（NTNTs）,本文就下肢静脉曲张的治疗现状进行总结归纳。     

Utilization of the Nurse Practitioner Role to Combat the Opioid Crisis

The opioid crisis has been deemed an epidemic given its catastrophic effects and dependence outcomes. Unfortunately, access to opioid use disorder (OUD) treatment for opioid dependence remains a significant barrier to effectively addressing this epidemic. The Comprehensive Addiction and Recovery Act granted buprenorphine-prescribing privileges to nurse practitioners with appropriate training. However, many state laws limit this practice, thereby preventing treatment for patients suffering from OUD. These regulations should be revised to allow nurse practitioners to care for patients with opioid dependency, reduce health care costs, and improve patients’ and their families’ quality of life.     

颅内动静脉畸形的治疗选择

目的总结颅内动静脉畸形的各种治疗措施及预后,探讨颅内动静脉畸形的合理治疗选择。方法 63例颅内动静脉畸形患者,手术治疗43例,保守治疗20例。患者有放射治疗史4例,后因合并症而手术切除。手术前曾行介入栓塞治疗者2例。结果手术治疗的43例中,经过造影检查证实全切除30例,不全切除13例,死亡5例,重残生存2例,轻度残疾或完全康复36例;保守治疗的20例中(12例为IV级病例),死亡5例,重残生存3例,轻度残疾或完全康复12例,随访提示再次出血3例,继发脑积水1例。结论手术全切除是颅内动静脉畸形最有效的治疗方法。对于无法手术的病例,建议患者行放射治疗或保守治疗和随访;介入栓塞治疗可作为巨大颅内动静脉畸形手术治疗前的辅助处理;对于放射治疗后出血或放射性脑病的病例,建议患者积极手术切除病灶。