晚期癌症患者的临终关怀及护理

癌症是严重危害人类健康的常见病和多发病。尽管现代医学技术已有了长足的进步，癌症的治疗仍是十分困难的课题。我国目前癌症的治愈率平均只有10％左右，其余90％的患者终将面临死亡…1。晚期癌症患者已成为临终关怀的主要服务对象，对晚期癌症患者实施临终关怀至关重要，也是社会对医学提出的迫切要求。     

重症急性胰腺炎预防非计划拔管53例的护理

总结53例重症急性胰腺炎患者预防非计划拔管的护理。通过多学科合作预防谵妄,识别重要管道,改进导管固定方式与约束工具,开展床边盲放鼻肠管新技术,翻身前Time Out,即翻身前暂时停止手中工作,检查所有管道的安全性等多种护理措施。53例患者无1例发生非计划拔管。     

2009年大理州血吸虫病疫情监测结果分析

目的了解大理州2009年血吸虫病疫情现状,为评价防治效果和做好下一步的防治工作提供参考。方法制定《大理州血吸虫病监测方案》,按要求开展疫情监测工作。结果全州共确定7个疫情监测点,分布于5个血吸虫病重点流行县(市),监测点的居民感染率0.47%;家畜平均感染率0.40%;钉螺面积119 574 m2,活螺平均密度0.280 2只/框(每框=0.11 m2),未发现感染性钉螺。结论大理州血吸虫病疫情总体上已处于较低水平,部分高原峡谷型流行地区的疫情还不太稳定,今后应重点加强这类地区的防治工作。     

CRRT治疗重症急性胰腺炎的护理体会

目的探讨及分享应用连续性血液净化(CRRT)方法治疗重症急性胰腺炎(SAP)的护理经验和体会.方法总结和分析我院近5年来应用CRRT方法治疗SAP的临床资料.结果治疗SAP共18例,病情好转出院16例,死亡2例.结论 CRRT在治疗SAP中是一种有效的具有广泛应用前景的方法,而做好CRRT治疗护理则是减少SAP并发症、提高其治愈率的关键因素之一.     

评价携氧抗休克液体的动物模型建立

目的 探讨一种可评价具有携氧功能的抗休克液体的实验动物模型.方法 SD大鼠在麻醉状态下做35%、45%、55%和65%放血失血性休克模型,以乳酸林格液(LR)、全血进行复苏,观察其对失血性休克大鼠平均动脉血压(mean arterial blood pressure,MAP)、左心室收缩压(left intraventricular systolic pressure,LVSP)、左心室压力上升或下降的最大速率(the maximal change rate of left intraventricular pressure,±dp/dtmax)的影响,同时观察血气指标变化和存活率的变化.结果 35%失血性休克后,输注LR和全血均可使MAP恢复到90～100 mmHg水平,同时LR和全血对恢复休克后动物血流动力学指标、血气指标以及对存活率的影响无显著性差异;45%和55%失血性休克后,单纯LR输注不能使MAP恢复到90～100 mmHg水平,且对休克动物的血流动力学指标和血气指标以及存活率的影响明显不及输注伞血以后效果好,在55%失血性休克时差异更大.65%放血后动物很快死亡,休克程度太重,不能作为评价模型.结论 55%失血性休克大鼠可作为评价具有携氧液体抗休克作用的实验动物模型.     

坐骨直肠窝脓肿误诊为睾丸炎导致坏死性筋膜炎伴感染性休克一例

报告坐骨直肠窝脓肿误诊为睾丸炎导致坏死性筋膜炎伴感染性休克一例。体会：对糖尿病病人肛周以及会阴部出现不适,疼痛应提高警惕,高度重视,避免误诊导致坏死性筋膜炎。一旦确诊为坏死性筋膜炎应立即切开,彻底清创,充分引流。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

血液分析仪与手工法计数儿童血小板误差原因分析

目的:分析血液分析仪与手工法对儿童血小板计数产生的误差.方法:用两种血液分析仪及手工显微镜计数法对600例血液标本进行血小板计数,并进行对比分析.结果:成人血小板值高于正常参考上限(300×109/L)的比率低于儿童,两种血细胞分析仪测的儿童血小板值无显著性差异(P＞0.05),血液分析仪分析时出现异常报警(URI),直方图尾部有异常升高的血小板值与显微镜计数的结果有显著性差异(P＜0.05).结论:使用血液分析仪计数儿童血小板时如出现,计数有警示信号(URI);MCV＜70 n,且RBC直方图显示有＜50 fl的小红细胞存在,血小板直方图出现尾部升高的表现或血小板直方图曲线呈齿状等以上情况时要进行手工显微镜计数仪得到准确的结果.     

临床药师在儿科培养的探索与体会

探索我国临床药师儿科专科培训的有效方法,分析药师队伍的现状,阐述临床儿科专科药师培训的方法与途径。目前药师从综合能力方面不能满足儿科临床对药学服务的需求,在儿科专科药师的培训中,应重视儿科临床知识、沟通技巧、团队合作意识的培训。