不典型性结核性脑膜炎7例误诊分析

本组7例，男性2例，女性5例，年龄6～54岁，病程20天～4月，其中起病缓慢5例，急性2例。7例均有不同程度的发热和头痛尤以午后为著，体温波动于37．2℃～38℃．意识不清4例。颅神经损害3例，脑膜刺激症4例。化验检查：血沉〉20mm／h、PPD-IgG皮肤实验（丘疹〉5mm）4例。     

胰岛素抵抗综合征的护理进展

体温是临床医护人员采集病史和资料过程中最重要的客观指标之一，其准确性和精确性直接影响到疾病的诊断和治疗。近年来，有关体温的测量及其与临床的研究日渐增多，现将其测量方法与临床疾病的关系等进行综述，现介绍如下。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

老年人测量腹股沟温度40例分析

我们2003—05-2003—08及2004—03-2004—05分别对40例随机抽取的已康复老年人进行了口温、腋温、腹股沟温的自身对照测量，现报告如下。     

加温措施对腹腔镜卵巢囊肿切除患者体温的影响（附60例报告）

腹腔镜卵巢囊肿切除术是微创外科手术，具有切口小、痛苦小、出血少、愈合快等优点，腹腔镜手术极易发生低体温。手术过程中由于麻醉、身体暴露、输入冷液体、腹腔冲洗液、CO2气体等因素作用，病人普遍存在体温下降现象。而术后低体温与患者术后多种并发症的发生有关，对机体多个系统产生影响，从而影响患者的术后康复。因此，保持患者术中正常体温非常重要，笔者选取60例2008年1月～2009年10月在我院进行腹腔镜卵巢囊肿切除术患者，     

联机血液透析滤过抢救肝破裂并多器官功能障碍综合征一例

患者，女，53岁，因“车祸致右侧腹外伤伴神志不清3h余”入院。体检：体温不升，脉搏未扪及，呼吸28次／min，血压为0。神志不清，重度贫血；胸廓挤压征不配合、右下肺呼吸音减弱，双肺可闻及湿性罗音；心率120次／min、律齐、心音低，未闻杂音；腹部明显膨隆，腹肌紧张，压痛，反跳痛不配合；移动性浊音阳性。     

丹参注射液治疗新生儿硬肿症50例体会

新生儿硬肿征是指患儿由于早产、受寒、感染、窒息等多种原因引起皮肤和皮下组织变硬与水肿的一种病症，多发生在出生后一周内，尤以早产儿为多见，且多伴体温不升、不哭、拒乳或呼吸微弱，反应低下，硬肿先发生在小腿，大腿外侧，渐至全身，预后多较差。我科自98～99年之间共收治本病患儿50例，在应用保暖、补液、控制感染的同时，配合应用丹参注射液治疗受到满意的疗效。     

新生儿臀部皮肤温度测量可行性研究

目的 探讨臀部皮肤温度测量临床应用的科学性与可行性.方法 对124例新生儿进行不同部位体温观测,比较不同情况下臀部皮温与腋温和肛温的关系.结果 同一环境温度下,腋温与肛温、臀温与肛温比较,差异有显著性意义(P＜0.01);臀温与腋温比较,差异无显著性意义(均P＞0.05).不同环境温度下相同部位体温比较,腋温、肛温及臀温差异有显著性意义(均P＜0.01).结论 臀部皮肤测温法可替代腋温测量法,能客观地反映新生儿体温的实际情况.     

68例极低出生体重儿的护理

<正> 胎龄小于36周,出生体重≤1500g的早产儿称为极低出生体重儿.孕母妊娠毒血症、外伤、跌跤和负重以及多胎和双胎等因素,是造成早产的主要原因.由于他们身体各器官发育较差,生活能力低下,死亡率极高,所以护理尤为重要.我院自1994年8月～1996年8月,共收治早产儿286例,现就其中的极低出生体重儿68例谈谈护理体会.1 临床资料68例中男42例,女26例,日龄小于24小时12例,1～3天19例,3～7天22例,7～14天11例,14天以上4例.死亡11例.     

书写护理记录应注意的几个问题

护理记录是护理人员对病人的病情观察和实施护理措施的原始文字记载，是医生诊断和治疗过程中的重要理论依据，它是临床护理工作中的重要医疗文件，也是在新的《医疗事故处理条例》实施的今天，病人接受治疗、护理的唯一法律证据。护理记录在一定程度上可以反映出一个医院的护理服务质量、学术及技术水平。因此，及时、准确、规范地书写护理记录能确保医院各项规章制度落到实处，减少或避免医疗护理纠纷的发生。