直肠癌围手术期直肠给药联合化疗效果分析

作者回顾 1996年至 2 0 0 2年我院治疗的直肠癌 68例 ,对比分析单纯手术与围手术期静脉、口服及直肠给药联合化疗对病人肿瘤局部病理及术后 1、3、5年存活率的影响 ,现报告如下。1　资料与方法1·1　临床资料　 68例患者均来自我院 ,分为两组。Ⅰ组 :术前未化疗单纯Miles直肠癌手术 ,共 2 8例 ,其中男 2 0例 ,女 8例 ,年龄 3 0～ 65岁 ,平均 42 0岁 ;Ⅱ组 :术前 3d开始静脉、口服及直肠给药联合化疗 ,共 40例 ,其中男 3 2例 ,女 8例 ,年龄 3 1～ 67岁 ,平均 45 2岁。两组病人肿瘤均距肛门 7cm以内 ,均采用Miles手术。两组年龄、病理 (Du…     

腹腔镜手术围手术期的护理

腹腔镜手术具有创伤小、痛苦轻、对腹腔脏器干扰小、术后恢复快等优点。我院自2007年5月至2008年8月共开展腹腔镜手术68例。通过围手术期的精心护理，病人均痊愈出院，现将护理体会介绍如下。1临床资料本组68例，男30例，女38例，年龄最小17岁，最大78岁，平均年龄32．5岁。其中阑尾炎25例，胆石性胆囊炎3例，消化道穿孔6例；异位妊娠17例，卵巢囊肿15例，子宫肌瘤2例。所有患者手术顺利。术后有6例切口疼痛，肩部疼痛2例，腹胀3例，     

婴儿左向右分流先心病伴肺动脉高压的围术期处理（附35例报告）

目的:探讨婴儿左向右分流先心病(CHD)合并肺动脉高压(PH)的围术期处理.方法:本组35例左向右分流CHD合并PH患儿,年龄2～12个月,其中心脏直视手术28例.手术前、中、后积极采用各项治疗措施,合理运用呼吸机、扩张肺血管药、膜肺、超滤,动态监测肺动脉压、加强呼吸道管理等.结果:34例顺利度过手术危险期,恢复良好.死亡1例,占2.9%.结论:早期手术,围术期注重综合处理,保护肺等重要器官的功能,防治PH及危象可获得满意的疗效.     

人工全髋关节置换术的临床护理

我院从1994年2月开始对59例股骨头无菌性坏死病人行全髋关节置换术,均收到满意效果。现将护理体会报告如下。 1 临床资料本组病人50例,男30例,女20例,左侧21例,右侧26例,双侧3例。年龄23岁～68岁。病期2个月～14年。均为Ⅱ期以上病人.随访期最长4年。术后功能良好。 2 术前准备 2.1 人工全髋关节置换术,是骨科较大手术,病人往往顾虑     

38例心脏病患者妇科手术的围手术期护理

心脏病 ,尤其是心功能不全的妇科患者在行大手术时 ,手术和麻醉等因素均有可能进一步增加患者的心脏负担 ,如缺乏科学的围手术期护理 ,极有可能因此诱发心力衰竭而导致死亡。本院自 1999年 3月～ 2 0 0 1年 11月共收治各类型的心脏病妇科手术患者 38例。期间 ,因采取了术前、术中和术后的心脏监护和加强了围手术期的护理 ,使所有患者均顺利渡过手术关 ,且无并发症发生。经术后随访 ,均康复良好 ,现报告如下。临床资料本组 38例 ,年龄 19～ 72岁 ,平均 4 3 6岁。经临床诊断其中患子宫内膜癌 5例 ,子宫内膜增生 3例 ,卵巢恶性肿瘤 3例 ,子宫肌…     

101例全肺切除治疗体会

全肺切除由于手术创伤大 ,肺功能丧失多 ,手术并发症和死亡率高。而正确选择手术病人 ,加强围术期处理和提高手术技巧是降低手术并发症和死亡率的关键。现就我院自 1973年 3月至 2 0 0 1年 6月 10 1例全肺切除的体会介绍如下。1　资料与方法1·1　一般资料　本组 10 1例 ,男性 72例 ,女性 2 9例 ,年龄 2 1～ 6 6岁 ,平均年龄 4 1岁。中央型肺癌 33例 ,其中肿瘤直径 3～ 5cm 2 2例 ,>5cm 11例。依照 1997年TNM分期均为ⅢA期。结核性毁损肺 30例 ,脓胸合并毁损肺 2 1例 ,1侧全肺支气管扩张 16例 ,右全肺大疱 1例。1·2　手术方法　行左全肺…     

全肠外营养在恶性肿瘤病人围手术期的应用

近 3年来 ,我院在肝、胃癌、大肠癌等恶性肿瘤病人围手术期应用 TPN,积累了一定的经验。1　临床资料1 .1　一般临床资料　 1肝癌 1 0例 ,均为男性 ,年龄38～ 60岁。轻度营养不良 5例 ,中度营养不良 3例 ,重度营养不良 1例 ,营养状况正常 1例。 2胃癌 1 2例 ,男 8例 ,年龄 40～ 60岁 ;女 4例 ,年龄 40～ 55岁。轻度营养不良 8例 ,中度营养不良 2例 ,另 2例营养状况在正常范围。 3大肠癌 8例 ,其中直肠癌 6例 ,结肠癌 2例 ,轻度营养不良 2例 ,中度营养不良1例 ,其余病例营养状况基本正常。1 .2　 TPN治疗　术前 3天和术后 3～ 5天进行TPN,…     

子宫动脉栓塞术治疗子宫肌瘤的护理和临床观察

目的:总结子宫动脉栓塞术治疗子宫肌瘤的护理方法和技巧以及临床疗效观察.材料及方法:回顾分析 13例子宫肌 瘤临床和护理资料,病人均行双侧子宫动脉超选择性栓塞术,围手术期进行相应的临床观察处理和护理.结果: 13 例病人均成功栓塞,无严重不良反应和并发症发生.术后随访 3～ 6个月,显效占 53.9%,有效占 30.8%,无效占 15.3%.结论:子宫动脉栓塞术是子宫肌瘤安全、有效和微创的治疗方法,围手术期对患者进行认真的临床观察和 护理可显著减轻患者的身心负担.     

声带小结、小息肉应用纤维喉镜下Nd:YAG激光治疗的效果观察

1999年1月～2001年6月我院对269例声带小结、小息肉病人行纤维喉镜下Nd:YAG激光治疗,现报告如下。 1 资料与方法 1.1 临床资料本组随访的217例均为门诊病人,均仅限病变直径小于3.5mm者。男96例,女121例;年龄11～57岁;病程2个月～21a;既往无手术史者184例,有1～3次手术史者33例;小结94例,小息肉123例(双侧者41例,广基者46例)。     

高龄腹部疾病患者术后并发症32例分析

目的 探讨高龄腹部疾病患者围手术期并发症的各项处理,进一步完善手术后并发症的处理原则.方法 分析32例68岁以上手术患者围手术期的临床资料.结果 本组术后并发症发生在:心血管系统12例,呼吸系统5例,脑血管意外3例,肾功能衰竭1例,刀口感染4例,感染中毒性休克3例,胃粘膜损害性出血2例.共死亡4例.结论 高龄患者术后并发症的主要危险因素是心肺疾病,其次是免疫力低下、手术创伤、急诊手术等.应根据老年人生理特点,完善手术前后的检查、监测和各项支持,降低术后并发症的发生.     

"Back to sleep": parents compliance with the recommendation on the most appropriate sleeping position of infants, Haifa District, Israel, 2001

BACKGROUND: In 1993, the Israel Ministry of Health issued a formal recommendation to avoid placing healthy infants to sleep in the prone position in order to prevent sudden infant death. The objective of the study was to study parents' compliance with this recommendation and to identify characteristics of noncompliant parents of infants aged less than 6 months old. METHODS: The study population consisted of 1912 parents of infants aged 0-12 months who visited the Haifa District primary preventive health centers during the study week and answered the self-administered questionnaire. RESULTS: 15.6% of infants younger than 1 year were placed to sleep in the prone position: 12.4% among infants younger than 3 months, and 17.6% among infants 3-6 months old. Surprisingly, multiple logistic regression analysis demonstrated that Israeli-born Jewish mothers were more likely to place their babies prone than Israeli-born Arab mothers or mothers born in the former Soviet Union who had immigrated to Israel after 1990. CONCLUSIONS: At-risk behaviors are usually associated with minority and immigrant populations. Culture specific and other possible reasons for our unusual findings are discussed.     

PGD9 Outcomes and Cost-Benefit of Inhaled Corticosteroid Therapy Introduction in Medicaid-Enrolled Asthmatic Children

OBJECTIVE: The purpose of this study was to assess the clinical and economic impact of the introduction of inhaled corticosteroid therapy for asthma in a cohort of children 12 years and younger who were North Carolina Medicaid enrollees.
METHODS: The North Carolina Medicaid claims database was used to retrieve clinical and economic variables for the purpose of this study. The case group, which was comprised of 84 children who started corticosteroid inhaler therapy between March 1994 and March 1995, was followed up for 1 year before and 1 year after the start of the therapy. The control group was comprised of 72 children with similar severity of asthma who remained on any other therapy other than corticosteroids for a continuous 2-year period. Paired t-tests were used to compare differences, and multiple regression analysis was used to adjust for potential confounders.
RESULTS: There was a 58% reduction in hospital visits, and a 19% reduction in physician visits in the case group after initiation of inhaled corticosteroids. In the control group, an increase of 34% in the number of outpatient visits occurred in the second year. All the decreases and increases were statistically significant. Children with regular patterns of inhaled corticosteroid refills were found to be significantly lower costing for Medicaid. However, after adjusting for potential confounders, no significant change in health care costs per asthmatic child occurred as a result of the introduction of inhaled corticosteroid therapy.
CONCLUSION: Overall, the study found that introduction of inhaled corticosteroids in a cohort of asthmatic children enrolled in Medicaid was beneficial to Medicaid because it brought about dramatic decreases in health care utilization without additionally increasing costs.     

The epidemiology of necrotizing enterocolitis infant mortality in the United States.

OBJECTIVES: This study examined trends and risk factors for infant mortality associated with necrotizing enterocolitis in the United States. METHODS: Necrotizing enterocolitis-associated deaths and infant mortality rates from 1979 through 1992 were determined by means of US multiple cause-of-death and linked birth/infant death data. RESULTS: Annual necrotizing enterocolitis infant mortality rates decreased from 1979 through 1986 but increased thereafter and were lower during the 3-year period before (1983 through 1985;11.5 per 100,000 live births) the introduction of surfactants than after (1990 through 1992; 12.3 per 100,000). Low-birthweight singleton infants who were Black male, or born to mothers younger than 17 had increased risk for necrotizing enterocolitis-associated death. CONCLUSIONS: As mortality among low-birth weight infants continues to decline and smaller newborns survive early causes of death, necrotizing enterocolitis-associated infant mortality may increase.     

沈阳地区127例住院婴儿麻疹的流行病学及临床分析

目的 分析2006年沈阳地区127例住院婴儿麻疹患者的临床特征,以利于更好地防治要儿麻疹.方法 对沈阳市传染病院2006年收治的127例住院婴儿麻疹临床资料进行回顾性分析.结果 ①3-7月份为发病高峰,占全年发病的86.61%;②发病年龄主要为5～10月龄,占83.46%;③外来流动人口(主要为农村到城市务工者)子女发病率高,占64.57%;④全身中毒症状明显,皮疹典型,为充血性斑丘疹,口腔麻疹黏膜斑明显可见.结论 本次小月龄婴儿麻疹发病数增加,发病季节后移,临床症状典型,并发症多,以肺炎、喉炎、肝脏损伤、心肌损伤常见.建议提高基础免疫覆盖率、及时性以及接种质量;适当提前婴儿的初免年龄;对育龄妇女可适时进行麻疹疫苗复种.     

不同年龄社区获得性肺炎住院儿童的病原学及临床特征研究

目的 了解盐城地区住院儿童社区获得性肺炎(CAP)感染的病原学及临床特征,为盐城地区儿童CAP的防治提供参考依据。方法 回顾性分析2014年10月-2015年9月在盐城市妇幼保健院住院的CAP患儿541例的临床资料。住院期间多病原检测包括:痰常见7种呼吸道病毒抗原、血肺炎支原体(MP)- IgM抗体、血EB四项抗体、痰培养或血培养。结果 病原体阳性检出率为62.8%。MP28.7%,病毒21.8%,细菌16.8%。从单一病原来看,以MP感染率最高(28.7%),其次为呼吸道合胞病毒、肺炎链球菌。>1~5岁龄组及>5~14岁龄组CAP患儿,MP检出阳性率均较高。病毒感染主要发生于1岁以内婴儿。年龄与发热的发生比及高低程度呈正相关,1岁以内年龄组发热比例低(41.6%)且以低热及中等度发热为主,1岁以上年龄组发热比例高(55.6%)以高热为主。CAP患儿5岁以下年龄组咳嗽、喘息气促的发生率明显高于5岁以上儿童;年龄越小肺部体征越明显。1月~1岁龄组CAP胸部影像学主要表现为小斑片影,多为单侧肺受累;>5~14岁龄组患儿则多为大叶受累阴影,多为单侧肺受累。结论 盐城地区住院儿童CAP病原依次为支原体、病毒、细菌。不同年龄段CAP患儿病原体检出率不同。不同年龄和不同病原学感染的儿童CAP的影像学表现各有特点。     

Adaptation of parents in relation to their 6-month-old infant''s type of disability

The adaptation of parents to a disabled infant was studied in relation to the type of disability presented by the baby. Participants were divided according to three types of disability and one control group: patents of infants with (1) Down's syndrome (DS), (2) congenital heart disease (CHD), (3) a cleft lip and/or palate (CLP), and (4) no disability (ND). The data were collected using a self-administered questionnaire given to each parent 6 months after the birth of their baby. The measures included parenting stress, stress appraisal, and psychological distress. Overall, the results indicate that parents of infants with DS and parents of infants with CHD report greater levels of parenting stress and psychological distress than parents of babies with CLP or non-disabled infants. Mothers were found to report greater levels of stress and distress overall, but differences across diagnostic groups were similar for mothers and fathers. The implications of the findings for theory and clinical intervention are discussed.     

广州市4200例婴幼儿全血锌检测结果分析

目的探讨缺锌对婴幼儿健康的影响。方法使用原子吸收光谱法对广东省妇幼保健院医院门诊4200例0-3岁婴幼儿进行全血锌的测定。结果婴幼儿缺锌率为30．26％,〈1岁组高于1～3岁组,女高于男,体弱儿高于正常儿,体弱儿夏季缺锌率最高（P〈0．001）。结论婴幼儿生长发育期易缺乏锌元素。缺锌会影响儿童健康,故应重视儿童期低血锌的综合防治．加强监测,注重营养平衡。     

婴幼儿先天性心脏病外科治疗的临床特点

目的:分析婴幼儿先天性心脏病外科治疗的临床特点。方法:总结婴幼儿先天性心脏病手术1276例的外科治疗情况。结果:男605例,女671例;年龄6天~3岁,平均13.6个月;体重2.2~18.0 kg,平均8.8 kg。1193例在全麻低温体外循环下行心脏畸形纠正术,83例采用深低温低流量体外循环。620例术中采用超滤技术。术后死亡17例(1.3%),死亡原因为低心排血综合征10例、肺动脉高压危象4例和肺部感染3例。结论:提高手术和体外循环技巧以及术后预防和治疗低心排血综合征和呼吸系统并发症的能力,是婴幼儿心脏手术成功的关键。     

先天性心脏病儿童围手术期营养风险评估及影响因素分析

目的 评估先天性心脏病（CHD）儿童病例围手术期营养风险,并进一步分析其影响因素。方法 以2018年1月至2022年1月在海南省妇女儿童医学中心进行手术治疗的CHD儿童病例为研究对象,收集病史资料并采用STRONGkid完成围手术期营养风险评估。采用单、多因素分析方法分析影响CHD儿童病例围手术期发生营养风险的相关因素。结果 共1 006例CHD儿童完成围手术期营养风险评估。STRONGkid评估结果显示,CHD儿童病例围手术期中高营养风险发生率为43.94%。多因素Logistic回归分析结果显示,孕周<37周（OR=3.706）、家庭月均收入<5 000元（OR=2.875）、有肺动脉高压（OR=2.892）、有心力衰竭（OR=3.216）、复杂病种（OR=1.881）、前白蛋白<250 mg/L（OR=1.990）、25-（OH）D<30 nmol/L（OR=1.611）是CHD儿童围手术期发生营养风险的危险因素。结论 CHD儿童围手术期营养风险应引起重视,孕周、家庭经济情况、肺动脉高压、心力衰竭、复杂病种等成为该类儿童围手术期发生营养风险的可能影响因素。     

The Usefulness of Information Gathered from Parents in the Identification of Young Children with Handicaps: A Review and Discussion

ABC checklists (Adults Behaviors in Caregiving) have been created in three versions to assess caregivers of younger and older infants and caregivers of preschoolers. Two master teachers of younger infants were observed with ABC I during 46 half‐hours of observation, across daycare settings, time of day and day of week. Two master caregivers of toddlers were observed with ABC II during 59 half‐hours of observation. Piagetian activities were provided for younger infants during 1/5 of times sampled, and for older infants during 1/10 of times sampled. Master teachers practically never ignored babies who needed attention. Verbal criticisms or scolds were emitted in fewer than 1% of the times sampled. Isolation as a behavior modification technique was very rare with younger babies but occurred in 1/6 of sampled intervals with toddlers. Positive socioemotional interaction comprised 1/4 of teacher repertoire with younger babies. Language interactions represented 1/3 of the teachers’ repertoire with younger babies and almost 1/2 of the toddler teachers’ repertoire. ABC inputs varied somewhat as a function of time of day. There were no indications that caregivers became more negative later in the week. Thus, ABC proved to be a sensitive, easy to use instrument that is useful in monitoring the transactions of infant/ toddler caregivers and the effects of any inservice training procedures.