湖南某三甲综合医院85例PICU儿童意外伤害临床分析

目的探讨儿童意外伤害的防范措施,为永州地区儿童意外伤害的有效干预提供一定的理论依据。方法回顾性研究2017年1月至2019年12月在本院PICU救治的85例儿童意外伤害病例,统计分析儿童意外伤害的不同影响因素及分布特点。结果儿童意外伤害病例中男童多于女童,农村多于城市;年龄分组中以幼儿期组最多见;种类分布以中毒(43.53%),尤其是以药物中毒最常见(28.24%);不同年龄组意外伤害种类分布不同。因意外伤害死亡的病例占同期死亡病例的41.38%。结论重症监护室意外伤害儿童死亡率高,具有性别、年龄及分布特点,对不同区域、不同年龄段儿童,尤其是男童,要有侧重地采取防范措施、加强监护、提高安全意识,可有效预防儿童意外伤害事件的发生。     

儿童意外伤害的家庭安全预防

儿童意外伤害是影响儿童健康成长和导致其死亡的主要因素之一。作为一个主要的公共安全和公共卫生问题，引起了广泛的关注和深入的研究。意外伤害的发生不是偶然的，有其自身的规律，了解这些易发因素，儿童意外伤害是可以预防的。儿童性别、性格特征、生活能力等因素均是影响儿童意外伤害发生的要素，伤害的发生会长期严重影响儿童的生理及心理健康。有必要建立系统的儿童意外伤害监测网络，籍以加强预防、减少伤害的发生。其中家庭安全预防方面的作用更为重要，我们认为应在以下几方面开展工作。     

0-4岁儿童意外伤害死亡的危险因素及干预

目的 探讨儿童意外伤害死亡的流行病学现状及危险因素。方法 以湖北省十堰市常住人口中,2000年1月1日-2003年12月31日期间，所有意外伤害致死的0-4岁儿童为调查对象，意外死亡参考《ICD-9损伤和中毒外因的补充分类》为本次调查的意外死亡分类标准。结果 O-4岁儿童年均意外死亡率为313．04／105，儿童意外死亡占0-4岁儿童死亡的14．36％，前5位主要原因为意外窒息、溺水、交通意外、中毒、跌落。结论 意外伤害危及儿童生命，应针对危险因素，采取有效的预防措施。     

125例5岁以下儿童意外死亡分析及干预对策

目的：为探讨5岁以下儿童意外死亡主要原因及相关因素，寻求切实可行的防范措施。方法：按国际疾病分类(ICD-10)进行死因分类，回顾性的对本市2001年和2002年978个医疗保健机构上报的5岁以下儿童死亡资料进行统计、分析处理。结果：2年内5岁以下儿童意外伤害死亡125例占同期内5岁以下儿童死亡总数的22．4％，居第一位，儿童意外死亡前四位主要原因为溺水、意外窒息、车祸、跌落；1岁以内意外死亡多见于意外窒息，2～5岁死亡则以溺水较多，车祸和跌落致死多见于3～5岁儿童。结论：意外伤害作为一组疾病是可以预防的，提高全社会的安全意识，伤害防治常识和自我保护能力，建立一套良好的运转急救体系是降低意外伤害死亡的有力措施。     

宁夏5岁以下儿童意外死亡现状分析

为探讨宁夏儿童意外伤害死亡的发生、形成、发展规律及危险因素,寻找相应干预措施,回顾分析宁夏1996-2005年5岁以下儿童意外死亡类别及相关因素。结果,儿童意外死亡主要原因为意外窒息、溺水及交通意外。5岁以下儿童意外死亡农村明显高于城市,川区农村明显高于山区;婴儿期主要意外死因为意外窒息;1~4岁儿童主要意外死因为溺水及交通意外;意外窒息、溺水有季节特点。意外死亡作为儿童期可避免的死亡指标,应加大宣传力度,提高防范意识,最大限度地降低儿童因意外造成死亡。     

儿童意外伤害的防范和紧急处理

儿童因为缺乏自我保护意识，容易发生意外伤害。全世界每年有上百万14岁以下的儿童死于意外伤害。在我国，意外伤害居儿童死亡原因的首位，其引起的儿童死亡率已经超过了最致命的肺炎、恶性肿瘤、先天畸形和心脏病死亡率的总和，占儿童总死亡率的26％以上。可见，意外伤害已成为儿童的第一健康“杀手”。     

谈儿童意外伤害的原因及预防

儿童意外伤害是一个公共卫生问题，是一种现代生活方式病，根据我市2003年的抽样调查，儿童意外死亡所占死亡的比例一直呈上升趋势，占调查死亡人数15．04％(111／738)。尤其对正处于生长发育期的儿童青少年，意外伤害已成为第一位死亡原因。     

2002～2005年意外伤害住院儿童调查

目的了解意外伤害住院儿童的特点，为开展意外伤害控制提供科学依据。方法复习2002年1月1日～2005年12月31日收住院的0～18岁2410例意外伤害儿童的临床资料，分析其伤害类别、构成、年龄分布及相关因素。结果意外伤害患儿占同期该院0～18岁住院总病例的9．77％。男童多见，平均年龄7．6岁。意外死亡率0．62％，占同期0～18岁儿童死亡顺位第3位，其中以创伤最多见，其次为中毒和烧伤。儿童意外伤害住院构成比排位前四位为外伤、烧伤和腐蚀伤、中毒、异物。意外伤害高峰年龄为12～18岁（34．94％），外伤以12～18岁最为多见（41．23％），烧伤和腐蚀伤以1～岁幼儿最多见（49．66％）。结论意外伤害严重威胁儿童健康，根据意外伤害的特点采取相应的措施以加强防范，减少其发病是完全可能的。     

5岁以下儿童意外死亡91例监测分析

采取回顾性研究的方法，对太仓市1993年至2003年的死亡监测资料进行统计分析。结果：太仓市5岁以下儿童意外死亡人数91例，死亡率平均为267．7／10^5，1～4岁是意外死亡的高发年龄段；溺水和意外窒息是意外死亡的第一、二位死因。认为根据该地区的环境特点、儿童的年龄特点，加强对家长的健康宣教及建立和完善意外伤害的社会急救体系等干预措施，可有效降低儿童意外伤害的死亡率。     

温州市2006年居民伤害死亡资料分析

目的探讨温州市居民伤害死亡分布特点，为开展伤害的预防提供科学依据。方法资料来源于温州市卫生监测区死亡报告数据，以ICD-10进行死因分类。结果2006年温州市伤害死亡率为49．59／10万。占全死因的9．45％，居第5位。伤害死亡前4位死因依次为意外跌落、机动车交通事故、自杀、淹死。结论伤害是温州市居民的主要死因，意外跌落、机动车交通事故、自杀、淹死是温州市城乡居民意外伤害死亡的主要原因。根据意外伤害死亡的流行特征，不同年龄、性别特点，采取相应的策略和措施开展伤害防治工作很有必要。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.