丝裂霉素胸膜腔灌注治疗肺癌恶性胸膜腔积液初报

目的 观察胸膜腔内灌注丝裂霉素治疗恶性胸膜腔积液的疗效。方法 对15例恶性胸膜腔积液病人采用胸膜腔闭式引流术，1-2d排空胸膜腔积液，后注入100mL生理盐水＋20mg丝裂霉素，夹闭引流管4h后开放，间隔1d再同样方法用1次，引流无液体后拔出引流管，4wk后评价疗效。结果 病人呼吸困难明显好转，生活质量明显改善。CR10例，PR3例，NC2例，总有效率86．7％（13／15）。结论 胸膜腔内灌注丝裂霉素能有效控制恶性胸膜腔积液，对晚期肿瘤所致恶性胸水的病人有重要意义。     

2型糖尿病患者糖尿病足41例临床特点及相关因素分析

目的 探讨影响2型糖尿病(T2DM)患者发生糖尿病足(DF)溃疡的相关因素.方法 对2005年1月至2006年12月北京市平谷区医院内分泌科收治的113例T2DM患者(DF溃疡者41例,无DF溃疡者72例)的临床资料进行回顾性分析.结果 DF组年龄、吸烟人数比例高于非DF组(P＜0.05);吸烟和年龄与DF的发生呈明显的正相关(r=0.256,P＜0.05;r=0.346,P＜0.001),多因素Logistic回归分析表明,年龄和吸烟是DF发生的独立危险因素;20例DF患者由于缺乏足护理常识而导致溃疡的发生.DF的分级与住院时间和SBP呈正相关(r=0.603,P＜0.001;r=0.401,P=0.01).结论 DF患者年龄与DF的发生呈正相关;高血压与DF的发生无明显的相关性;DF患者的血脂多在正常范围之内,与以往的文献报道有所不同.     

Hyperbaric Oxygen Treatment Improves Hearing Level via Attenuating TLR4/NF-κB Mediated Inflammation in Sudden Sensorineural Hearing Loss Patients

Objective Hyperbaric oxygen treatment(HBOT) has demonstrated efficacy in improving hearing levels of patients with idiopathic sudden sensorineural hearing loss(ISSHL); however, the underlying mechanisms are not well understood. HBOT alleviates the inflammatory response, which is mediated by Toll-like receptor(TLR) 4 and nuclear factor(NF)-κB. In this study we investigated whether HBOT attenuates inflammation in ISHHL patients via alteration of TLR4 and NF-κB expression.Methods ISHHL patients(n = 120) and healthy control subjects(n = 20) were enrolled in this study.Patients were randomly divided into medicine group treated with medicine only(n = 60) and HBO group receiving both HBOT and medicine(n = 60). Audiometric testing was performed pre-and posttreatment. TLR4, NF-кB, and TNF-α expression in peripheral blood of ISSHL patients and healthy control subjects was assessed by ELISA before and after treatment.Results TLR4, NF-κB, and TNF-α levels were upregulated in ISSHL patients relative to healthy control subjects; the levels were decreased following treatment and were lower in the HBO group than that in the medicine group post-treatment(P 0.05 and P 0.01).Conclusion HBOT alleviates hearing loss in ISSHL patients by suppressing the inflammatory response induced by TLR4 and NF-κB signaling.     

Search for clinical predictors of good glycemic control in patients starting or intensifying oral hypoglycemic pharmacological therapy: A multicenter prospective cohort study

AimsOur aim was to search for clinical predictors of good glycemic control in patients starting or intensifying oral hypoglycemic pharmacological therapy.MethodsA multicenter, prospective cohort of 499 diabetic subjects was enrolled in this study: patients with newly diagnosed diabetes (NDM group) or poor glycemic control with oral antidiabetic drugs (OADs) (PDM group). All subjects then started or intensified OADs therapy and followed up for 91 days. Glycemic control was determined according to HbA1c at day 91 with HbA1c <7% considered good.ResultsThe proportions of patients with good glycemic control after follow up for 91 days were 66.9% and 34.8% in NDM group and PDM group respectively. Logistic regression analysis showed that the change in GA at 28 days was the only predictor of good glycemic control in NDM patients (OR = 1.630, 95% CI 1.300–2.044, P < 0.001). In PDM patients, changes in GA at 28 days, CPI, baseline HbA1c, diabetic duration, and BMI were all independent predictors of good glycemic control (All P < 0.05).ConclusionsGA decline is a good predictor of future success in newly diagnosed patients. In patients intensifying therapy, beside GA decline, other individualized clinical characteristics should also be considered.     

实验动物麻醉的应用研究（附1000例报告）

目的：通过分析1 000例实验动物猪的麻醉情况,总结较实用的麻醉方法。方法：对4年共1 000例猪选用咪达唑仑0.1～0.2 mg/kg及速眠新0.25～0.3 ml/kg复合肌注诱导镇静,琥珀酰胆碱、地西泮注射液、利多卡因加入至平衡液内,配制成麻醉混合液,采用缓慢静滴维持的方法实现实验猪的各种手术麻醉。结果：6例猪在麻醉过程中由于操作不当,于气管插管前后死亡,1例死于氧气供给缺乏,9例死于术中大出血,余均顺利维持至手术结束。结论：速眠新与地西泮复合用药,用于猪的麻醉是经济、实用的,具有很高的应用价值。     

LigaSure在阴式子宫切除术中的应用

目的探讨LigaSure在阴式子宫切除术中的临床应用效果。方法2007年1月～2008年1月,应用LigaSure行阴式子宫全切术200例。子宫肌瘤86例,子宫增大如孕10～14周;子宫腺肌病73例,子宫增大如孕8～11周;宫颈上皮内瘤变Ⅲ级10例;子宫脱垂Ⅱ～Ⅲ度15例;子宫内膜不典型增生6例;功能失调性子宫出血10例。用LigaSure钳夹、电凝、切断骶韧带、主韧带、子宫血管、圆韧带、输卵管及卵巢固有韧带。结果200例手术全部顺利完成。手术时间20～50min,术中出血量15～150ml,术后住院时间3～5d,无严重并发症发生。200例均术后3个月复诊,检查阴道残端无线头及肉芽组织生成,愈合良好。结论应用LigaSure行阴式子宫切除术,手术操作步骤简化,手术难度系数降低,手术时间短,术中出血少。     

喉罩通气用于静脉麻醉下腹腔镜胆囊切除手术

目的：分析探讨喉罩通气替代气管内插管应用于静脉麻醉下腹腔镜胆囊切除手术的可行性和安全性。方法：68例ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除手术患者，采用全凭静脉麻醉。观察记录入室后、诱导后即刻、喉罩置入后即刻BP、HR、血氧饱合度（SpO2）；喉罩置入是否成功，手控呼吸和机械通气下检查有无漏气；记录气腹前后呼气末二氧化碳分压（PetCO2）、气道压力（Paw）、潮气量（Vt）的变化；麻醉后的恢复情况以及术后调查患者有无术中知晓。结果：有4例因喉罩周围漏气严重而致喉罩通气失败，其余64例患者喉罩置入顺利，手控呼吸和机械通气下无漏气现象，顺利完成手术；Paw气腹后较气腹前明显增加，Vt变化不明显，PetCO2仅轻度增加，调整呼吸参数后恢复；患者血流动力学变化不显著；麻醉后苏醒迅速恢复平稳，对手术过程无记忆，无术后不良反应。结论：应用喉罩通气全凭静脉麻醉在加强监测下可安全用于腹腔镜胆囊切除手术患者。     

乳腺导管原位癌38例诊治分析

目的探讨乳腺导管原位癌的诊治。方法对38例乳腺导管原位癌进行回顾性分析。结果钼靶、B超、乳腺核磁以及冰冻病理检查的诊断阳性率分别为81.82%（18/22）、66.67%（12/18）、100%（7/7）和70.0%（21/30）。治疗方式以乳房切除为主。本组无局部复发。结论保守性手术是乳腺导管原位癌的首选术式。     

胆囊合并胆总管结石的诊治体会

目的探讨现代外科对胆囊合并胆总管结石的诊治方法。方法13年来我院对262例病人在准备行腹腔镜胆囊切除术前行ERCP或MRCP检查。其指征为:近期有胰腺炎发生或黄疸史,肝功能异常,B超或CT示胆总管扩张或有结石者。结果在此262例中,有257例发现结石并行EST或网篮取石成功,待胆总管恢复正常后行腹腔镜胆囊切除术。23例发现乳头狭窄或胆总管肿瘤,行EST、支架内引流或手术治疗。12例ERCP失败。结论胆囊合并胆总管结石的治疗策略为术前先行ERCP或MRCP EST,取石成功后再行LC为最佳策略。     

平谷区2006年学校和幼儿园水痘疫情流行病学分析

目的了解平谷区水痘疫情流行情况,为制定水痘疫情防治措施提供科学依据。方法对2006年平谷区水痘疫情进行描述性流行病学分析。结果2006年平谷区共发生多发疫情8起,其中有1起达到国家突发公共卫生事件报告试行标准;散发132起,合计病例305例,全区平均罹患率为76.25/10万。其中平谷区学校、幼儿园病例占84.92%;主要以4～7岁和8～15岁儿童发病为主,男女发病比例为1.54∶1;对于病例的处理,全区采取隔离和应急接种水痘疫苗,2006年全区共接种17所学校和5所幼儿园,共1519人次。结论2006年平谷区水痘疫情主要发生在夏、冬两季,水痘是一种呼吸道传染病,易在学校、幼儿园集体单位引起流行,做好对患病学生的隔离和宣传工作是预防控制学校水痘流行和扩散的重要措施,应急接种对今后疫情发生起重要作用,而对当次疫情作用不明显,但当次疫情隔离措施落实至关重要。