曲安奈德配合金纳多治疗单侧急性低频下降型感音神经性聋

目的探讨耳后注射曲安奈德配合金纳多银杏叶提取物片治疗单侧急性低频下降型感音神经性聋(ALHL)临床疗效。方法选取2014-05—2016-09开封市祥符区中医院收治的78例单侧ALHL患者,通过随机数字表法分为研究组与对照组各39例。对照组采用舒血宁注射液+地塞米松注射液治疗,研究组采用曲安奈德+金纳多银杏叶提取物片治疗,2组均持续治疗10d。疗程结束后对比2组临床疗效、不良反应发生率,分析治疗前后血清免疫功能指标(IgM、IgG、CD3~+、CD4~+)水平变化。结果研究组总有效率为94.87%(37/39),高于对照组的74.36%(29/39),差异有统计学意义(P0.05);治疗前2组IgM、IgG、CD3~+、CD4~+水平比较差异无统计学意义(P0.05),治疗后研究组IgM、IgG、CD3~+、CD4~+水平高于对照组,差异有统计学意义(P0.05);研究组不良反应发生率7.69%(3/39),与对照组10.26%(4/39)比较,差异无统计学意义(P0.05)。结论耳后注射曲安奈德配合金纳多银杏叶提取物片治疗单侧ALHL效果显著,可有效提高患者听力水平,且对改善其免疫功能具有重要作用,安全性较高,值得推广。     

目标性培训在消毒供应中心培训中的应用

目的 探讨目标性培训方法在消毒供应中心岗位人员器械培训中的应用效果。方法 本研究为随机对照试验。选取2021年4月至7月在揭阳市人民医院消毒供应中心从事手术组工作的 20名 33～45岁女性岗位人员作为培训对象，采用随机数字表法将其分为对照组和观察组，各 10名。 对照组应用传统的培训方法，观察组应用目标性培训方法。培训后比较两组人员操作技能考核成绩、 培训满意度、负责清洗包装腹腔镜基础器械包的清洗质量和包装质量合格率。符合正态分布的计量资料采用均数±标准差（xˉ ± s）表示，组间比较采用独立样本t检验；计数资料采用例数或率（%）表示， 组间比较采用卡方检验；P＜0.05为差异有统计学意义。结果 观察组考核成绩、培训满意度及其负责清洗包装的腹腔镜基础器械包清洗质量、包装质量合格率明显高于对照组［（90.2±6.1）分比（77.0± 7.5）分、（90.0±6.0）分比（72.1±9.8）分、487（97.4%）比453（90.6%）、492（98.4%）比472（94.4%）］，差异有统计学意义（均P＜0.05）。结论 在消毒供应中心岗位人员器械培训时应用目标性培训方法，可有效提高岗位人员考核成绩及培训满意度及其负责清洗包装的腹腔镜基础器械包清洗质量、包装质量合 格率，保障患者安全。     

硝酸甘油注射液复合盐酸艾司洛尔注射液用于妊高征心衰的控制

目的寻找更有效控制妊高征产妇心衰的药物，为妊高征产妇心衰麻醉手术处理提供新方法。方法随机抽取广州市重症孕产妇救治中心妊高征心衰紧急剖宫产的产妇100例，采用双盲法随机分为A、B两组，每组50例。两组均进入手术室后先控制心衰后麻醉；A组硝酸甘油注射液5mg／ml以0．9％的氯化钠注射液稀释成10ml以0．05mg／kg快速单次静脉注射，同时复合盐酸艾司洛尔注射液1mg／kg快速单次静脉注射；B组单纯硝酸甘油注射液5mg／ml以0．9％的氯化钠注射液稀释10ml以0．05mg／kg快速单次静脉注射；4分钟、8分钟后观察各指标及相关症状并评判其有效性。结果A组产妇比B组控制心衰效果明显更好，用药后4分钟及8分钟A组SBP／DBP、HR、SPO2、RR、CVP、ECG等指标较B组明显改善俨〈0．05），端坐呼吸者可平卧接受气管插管麻醉。结论硝酸甘油注射液复合盐酸艾司洛尔注射液用于妊高征心衰比使用单纯硝酸甘油注射液更好，值得推广应用，硝酸甘油注射液与盐酸艾司洛尔注射液复合使用确能药效互补完全控制好心衰。     

Proposals for leflunomide use to avoid lung injury in patients with rheumatoid arthritis

Abstract

Among the 5,043 consecutive patients registered in the postmarketing surveillance for leflunomide, 61 were reported to have lung injury and 24 died from it. The adjusted multivariate logistic regression analysis of the risk factors showed that preexisting interstitial lung disease posed the greatest risk, as well as loading dose, smoking history, and low body weight of 40 kg or less with odds ratios of 8.17, 3.97, 3.12, and 2.91, respectively. In 12 patients, lung injury developed even 2 months after leflunomide withdrawal. When patients with (n = 9) and without (n = 13) fatal outcome were compared, eight out of the former, and six out of the latter had preexisting interstitial lung disease; the former showed severe hypoxemia, high serum C-reactive protein level, hypoalbuminemia, and continuous lymphocytopenia, and required mechanical ventilation. On the basis of these results and literature review, the committee proposes that leflunomide should only be recommended as a second-line drug, should not be administered to patients with preexisting interstitial lung disease, should also not be administered to patients with smoking history or those with low body weight, and should be administered without loading dose. Careful monitoring is necessary, and when lung injury develops, leflunomide elimination using colestyramine is mandatory.     

三级医院对口帮扶与大病专项救治实践

为进一步夯实三级医院对口帮扶贫困县县级医院工作,深化医药卫生体制改革,优化医疗资源配置,增强基层医疗卫生服务能力,更好满足群众的医疗健康服务需求,努力实现派出一支队伍、带好一所医院(卫生院)、服务一方群众、培训一批人才的目标,在喀什地区实施“项目帮带、团队帮带、整体帮带”等举措,制定大病救治计划,医共体建设等,使受帮扶医院诊治能力显著提高,有效推动了医共体工作的开展,是迅速提升贫困县县级医院服务水平的好方法。     

喷射心肌打孔移植骨髓间充质干细胞治疗心肌梗塞的实验研究

【摘要】 目的 探讨喷射心肌打孔移植骨髓间充质干细胞治疗缺血性心脏病的可行性。方法 将32只健康杂种犬随机分为单纯建模组（MI组），无针喷射生理盐水组（NS组），有针注射移植干细胞组（N+MSCs组），无针喷射移植干细胞组（NF+MSCs组）每组8只犬；建立急性心梗模型，分别采用直接关胸、无针喷射生理盐水、有针注射移植干细胞和无针喷射移植干细胞于梗死区进行操作。术后6周处死动物并检测血流动力学，取材行大体及组织学观察，计算心肌梗死面积及新生血管计数。结果 较其他组比较，NF+MSCs组左室舒张末压(900±32mmHg)下降、左室内压最大上升(84186±7285 mmHg/s)和下降速率( 78729±4508 mmHg/s)升高、梗死面积(1859±358%)缩小、新生小血管数量(957±223)增多（P＜005）。结论 喷射心肌打孔移植干细胞治疗缺血性心脏病是安全、有效的，可为临床研究提供参改。     

Potential health risks to adults and children in the UK from exposure to dietary lead in gamebirds shot with lead ammunition

We estimate potential risks to human health in the UK from dietary exposure to lead from wild gamebirds killed by shooting. The main source of exposure to lead in Europe is now dietary. We used data on lead concentrations in UK gamebirds, from which gunshot had been removed following cooking to simulate human exposure to lead. We used UK food consumption and lead concentration data to evaluate the number of gamebird meals consumed weekly that would be expected, based upon published studies, to result in changes, over and above those resulting from exposure to lead in the base diet, in intelligence quotient (IQ), Systolic Blood Pressure and chronic kidney disease (CKD) considered in a recent opinion of the European Food Safety Authority (EFSA) to be significant at a population level and also in SAT test scores and in rates of spontaneous abortion. We found the consumption of <1 meal of game a week may be associated with a one point reduction in IQ in children and 1.2–6.5 gamebird meals per week may be associated with the other effects. These results should help to inform the development of appropriate responses to the risks from ingesting lead from ammunition in game in the UK and European Union (EU).