NT-proBNP和hs-CTNI联合检测在急性非ST段抬高型冠状动脉综合征危险分层及治疗中的意义

目的研究联合检测N末端脑钠肽前体(NT-proBNP)及超敏肌钙蛋白(hs-CTNI)对急性非ST段抬高型冠状动脉综合征(NSTE-ACS)患者早期介入治疗以及危险分层的临床意义。方法选择245例NSTE-ACS行冠脉造影的患者,入院后即刻测定NT-proBNP及hs-CTNI,据此分为Aa、Ab、Ba、Bb 4组。分别行冠脉介入治疗、冠脉搭桥手术及药物保守治疗,并进行6个月随访。结果 Aa组心功能大于1级患者明显高于Ba组,差异有统计学意义(P<0.05)。Aa组发生左主干病变或左主干并3支病变共6例,明显高于其他3组。Bb组患者行冠脉介入手术率高于Aa组,差异有统计学意义(P<0.05)。Bb组患者介入时间早于其他3组,差异无统计学意义(P>0.05)。半年随访,5例患者发生死亡,10例因顽固性心绞痛及心肌梗死再次行靶血管血运重建术。结论 NSTE-ACS患者NT-proBNP及hs-CTNI升高,与发生严重冠脉病变、临床预后差有密切关系,建议尽早行冠脉介入手术。     

公立医院改革中门诊服务中心工作探讨

我院在推行北京市公立医院改革中,按照北京市医院管理局统一安排,设置门诊服务中心。门诊服务中心通过统一标识、统一服务内容、统一服务规范,落实便民举措,优化服务流程等方法,使门诊服务得到规范化管理。门诊服务中心对初次到医院就诊的患者起到直接的指导作用,能够提高服务质量和服务水平,展现医院良好服务形象,提升患者就医感受。     

青少年特发性脊柱侧弯患者影像学锁骨水平的临床意义

目的评估青少年特发性脊柱侧弯（adolescent idiopathic scoliosis,AIS）患者肩部影像学锁骨水平的临床意义。方法选取2010年6月-2011年12月在我院接受治疗的连续120例主胸弯AIS患者,取自然站立位脊柱全长后前位X线片及背部外观照,分别量取锁骨水平参数（包括锁骨角、锁骨差）和外观肩高。将锁骨水平参数与外观肩高分别进行相关分析及参数间差值比较,并应用受试者工作特征曲线（ROC曲线）对锁骨水平参数进行肩部平衡诊断价值的评估。结果锁骨差与外观肩高相关,r=0.86（P〈0.05）;锁骨角与外观肩高相关,r=0.73（P〈0.05）;10%患者锁骨差与外观肩高存在差别;应用锁骨角和锁骨差进行肩部平衡诊断的ROC曲线下面积（area under curve,AUC）均〈0.9,提示不具有较高的诊断价值。结论锁骨水平与外观肩高显著相关,但不能准确反映患者肩部平衡情况,医师需通过其他资料全面了解患者肩部畸形情况。     

Clinical experience with modified Miccoli’s endoscopic thyroidectomy for treatment of thyroid carcinoma in 86 cases

Background

The main purpose of this study was to assess the feasibility and relevant applying techniques of total thyroidectomy for thyroid carcinoma with a modified Miccoli’s approach.

Methods

Eighty-six patients with thyroid carcinoma consecutively received radical operation from October 2007 to June 2012. A cavity above the gland was constructed by a modified suspension method using the suspension retractor with suction catheter after the pathway making. Eighty-six cases underwent the modified Miccoli’s endoscopic thyroidectomy using the ultrasonic scalpel and the space maintain-regulating device. Level VI lymph node dissection was performed using the method of inspection pit.

Results

All the procedures were completed successfully. The average detection rate of level VI lymph nodes, the average time of thyroidectomy and lymph nodes dissection were 7.27 ± 3.99 pieces per case, 51.32 ± 13.35 min, and 38.43 ± 15.24 min, respectively. With regard to postoperative complications, there were three cases of delayed transient hoarseness, two patients with transient numbness of hands and feet, one subject with chylous fistula, and no hemorrhage.

Conclusion

Total thyroidectomy for thyroid carcinoma can be safely performed with the modified Miccoli’s approach by using ultrasonic scalpel and the space maintain-regulating device. Application of these adaptive reforms can obviously reduce the difficulties in manipulation and have the advantages of minimal incisions, good cosmetic results, less bleeding, shorter hospital stay, and fewer complications.     

纤溶酶对心房颤动患者血栓前体蛋白、纤维蛋白原的影响

目的探讨心房颤动患者血栓前体蛋白、纤维蛋白原水平变化及纤溶酶对其的影响。方法心房颤动患者50例,随机分为常规药物治疗组（A组）26例,常规药物联合纤溶酶治疗组（B组）24例,分别观察治疗前、后血栓前体蛋白、纤雏蛋白原含量,并以23例健康人作对照。结果心房颤动患者血浆血栓前体蛋白、纤维蛋白原水平显著高于健康人（P〈0．01）,纤溶酶治疗后显著低于治疗前（P〈0．01）,治疗后B组显著低于A组（P〈0．01）。结论心房颤动患者血栓前体蛋白、纤维蛋白原水平对其血栓形成有一定影响,纤溶酶能有效降低血栓前体蛋白、纤维蛋白原含量。     

中医药治疗重症胰腺炎机制探讨及实验研究进展

重症急性胰腺炎（sever acute pancreatitis,SAP）起病急,病情危重,病死率高,并发症严重,预后较差。现治疗方面取得很大进步,近年来已有大量研究表明中医药治疗也是SAP治疗的重要组成部分,能明显提高疗效。该文将近年来中医药下调胰腺核因子的活化、降低炎性细胞因子水平、改善微循环、抑制自由基等SAP治疗机制的实验研究作一综述。     

大型灾害及事故紧急医疗救援研究内容的思考

本文介绍了对大型灾难及事故紧急医疗救援的研究内容和开展研究的意义.研究内容分为两部分,第一部分是对我国既往对灾难事故救援的现状研究,包括现场救援的总体性研究、救援缺陷研究以及救援法律法规研究.第二部分是对灾难事故的现场救援研究,包括灾难事故损失早期评估研究;建立高素质、高效率的专业救援队伍的研究;救援物资及装备研究;灾难事故导致伤害的原因、种类、性质、特征、概率、后果和最佳应对方案研究;人员和设备输送研究;现场救援的风险评估及对策研究;现场救援的组织指挥研究;受困人员生命探测搜索研究;受困人员解救脱险研究;检伤分类研究;伤员潜在致命情况评估研究;危重症患者现场生命支持研究;战伤自救基本技术研究;特殊情况导致的伤害救援研究;伤员分流及转运研究;停止救援及现场清理时机研究;疫情防控研究;院内强化治疗研究;群众现场避险逃生、自救互救及防灾减灾措施研究.     

脐部单孔腹腔镜技术治疗小儿急性阑尾炎临床观察

目的对用脐部单孔腹腔镜技术治疗小儿急性阑尾炎的临床优缺点进行探讨。方法对于2009年6月至2011年12月期间我院收治的70例小儿急性阑尾炎患者的手术情况进行总结分析。结果 70例患者中,有68例患者顺利完成手术。结论该方法操作简单、创伤小等众多优点,具有较高的临床价值。     

The Use of Condensational Growth Methods for Efficient Drug Delivery to the Lungs during Noninvasive Ventilation High Flow Therapy

Purpose

The objective of this study was to evaluate the delivery of nasally administered aerosols to the lungs during noninvasive ventilation using controlled condensational growth techniques.

Methods

An optimized mixer, combined with a mesh nebulizer, was used to generate submicrometer aerosol particles using drug alone (albuterol sulfate) and with mannitol or sodium chloride added as hygroscopic excipients. The deposition and growth of these particles were evaluated in an adult nose-mouth-throat (NMT) model using in vitro experimental methods and computational fluid dynamics simulations.

Results

Significant improvement in the lung dose (3–4× increase) was observed using excipient enhanced growth (EEG) and enhanced condensational growth (ECG) delivery modes compared to control studies performed with a conventional size aerosol (~5 μm). This was due to reduced device retention and minimal deposition in the NMT airways. Increased condensational growth of the initially submicrometer particles was observed using the ECG mode and in the presence of hygroscopic excipients. CFD predictions for regional drug deposition and aerosol size increase were in good agreement with the observed experimental results.

Conclusions

These controlled condensational growth techniques for the delivery of submicrometer aerosols were found to be highly efficient methods for delivering nasally-administered drugs to the lungs.