良性葡萄胎恶变时间的探讨

回顾１９６３～１９９２年我院１３２例末次妊娠为葡萄胎且经病理确诊的恶性滋养细胞肿瘤病例，并探讨葡萄胎恶变成恶性葡萄胎（恶葡）或绒毛膜上皮细胞癌（绒癌）的时间相关性。结果，距葡萄胎妊娠结束时间在６月以内、６～１２月、１２月以上确诊的绒癌分别占同期病例的９／８０、１４／１７、３４／３５，提示绒癌发生与距葡萄胎妊娠结束时间呈正相关。我们认为，在未获得病理证实的情况下，对于葡萄胎排出后６月之内发病的恶性滋养细胞肿瘤，临床应诊断为恶葡，６月以上者则应诊为绒癌。     

轴向运动指标评价冠心病左心功能的初步研究

目的应用实时三维超声技术探讨轴向运动的距离、时间评价心脏整体和局部功能的价值。 方法对20例正常人和30例冠心病患者进行了三维超声检查,定量分析室壁轴向运动的距离及所需时间,比较两组测量结果。 结果两组左室整体射血分数（EF）、左室局部射血分数（REF）之间的差异均无统计学意义（P〉0.05）;而冠心病组轴向运动平均距离的标准差（ESD）、最小距离（Emin）降低,平均距离所需时间（E%）增加,两组间的差异具有统计学意义（P〈0.05）。 结论轴向运动指标能够早期准确测定心脏整体和局部功能的异常,为临床诊断和治疗提供更完整的定量信息。     

先天性心脏病的左室功能变化特征

测定了103名先天性心血管病患者的STI,心内分流和心外分流者不同。动脉导管未闭(PDA)者的STI,其异常程度不象房、室缺(ASD,VSD)大,这可能与分流水平,分流量大小及分流持续时间等造成的病理改变有关。在修补术后,房、室缺患者的PEP/LVET及ICT/LVET比值减小;而动脉导管未闭患者则增加,这反映了PDA的后负荷在术后增大。另外,PEP/LVET和QP/QS呈正相关,心内分流量越大,PEP/LVET比值就越大。根据PEP/LVET比值,可以粗略估计心内分流量的大小。     

Ultrasonic study of venous patterns in the right hypochondrium: An anatomical approach to differential diagnosis of obstructive jaundice

Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused portal hypertension, systemic venous enlargement caused cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.     

造影剂在大肠癌CT诊断中的应用

目的 探讨术前胃肠造影在大肠癌CT诊断和分期中的价值，提高大肠肿瘤的CT诊断水平。方法 对28例经肠镜活检或手术病理证实的大肠癌，分析术前灌肠造影CT表现，与手术及病理分期对照，了解大肠癌的螺旋CT分期的敏感性及准确性。结果 胃肠造影后CT能显示肠腔及肠壁的改变、病灶与周围组织关系，并可显示周围组织器官的侵犯及有无远处转移。本组螺旋CT显示大肠癌的敏感性达100％（28／28），对大肠癌TNM分期的准确率为T分期82％（23／28），N分期75％（21／28），M分期100％（28／28）。结论 大肠癌术前胃肠造影CT检查对中晚期大肠癌诊断和分期具有重要意义，是目前临床评估大肠癌术前分期的最佳影像方法。     

悬浮红细胞储存时间对制备的洗涤红细胞钾离子和游离血红蛋白影响

[目的]探讨悬浮红细胞储存时间对制备的洗涤红细胞的钾离子(K+)浓度和游离血红蛋白(FHb)含量的影响.[方法]采用全自动离心制备法将储存0～7 d(0～7 d组,n=10)、8～15 d(8～15 d组,n=10)、16～23 d(16～23 d组,n=10),24～31 d(24～31 d组,n=9)的悬浮红细胞制备成洗涤红细胞,分别于制备前、制备后0、12、24 h取样测定其K+浓度和FHb含量,比较不同储存时间的洗涤红细胞的K+浓度和FHb含量.[结果]制备前,不同储存时间的悬浮红细胞的K+和FHb含量相比较差异均有显著性(P＜0.05),储存时间越长,K+和FHb含量越高.制备后24 h,0～7 d组、8～15 d组、16～23 d组、24～31 d组制备的洗涤红细胞的K+浓度分别为(3.23±0.52)、(3.31±0.87)、(2.98±0.63)和(3.21±0.86) mmol/L,均低于人体正常K+参考值上限.制备后12 h、24 h,各组FHb含量相比较差异均有显著性(P均＜0.05),储存时间越长,FHb含量越高.制备后24 h,四组FHb含量分别为(0.26±0.11)、(0.41±0.20)、(0.72±0.37)、(1.05±0.37)g/L,24～31 d组明显高于其他三组(P均＜0.05).[结论]悬浮红细胞的储存时间对制备的洗涤红细胞的K+浓度影响不大,在制备后24 h的保存期内K+浓度均低于人体正常参考值上限,但对FHb的影响较大,建议避免使用接近储存期末的悬浮红细胞进行洗涤红细胞的制备.     

血液透析患者低血压发生时间与季节分布特征及护理

目的 分析尿毒症患者血液透析中出现低血压的时间和季节分布特征,旨在提出相应的护理对策,以减少低血压的发生.方法 对2010年1月至2010年12月在本院进行血液透析的147例(1642例次)尿毒症患者进行回顾性分析,探讨在血液透析过程中发生低血压的时间与季节分布情况.结果 血液透析时第1个小时为低血压发生的第1个高峰期,血液透析最后1个小时为低血压发生的第2个高峰期,冬、春季低血压发生率明显高于夏、秋季,且冬季最高,春秋季其次,夏季最低,各季节比较差异有统计学意义(P＜0.05).结论 血液透析中低血压的发生时间和季节分布呈现规律性变化,应采取相应的护理措施,减少低血压的发生,提高血液透析患者的治疗效果.     

Anesthesia for children with pericardial effusion: a case series

Objectives and aims: To review the anesthetic management of children requiring surgical intervention for pericardial effusion, determine the nature and frequency of complications and define risk factors that predict perioperative risk. Background: Anesthesia in the presence of a pericardial effusion may be associated with significant hemodynamic compromise particularly during induction. However, the literature specifically concerning children is limited to a single‐case report. Methods: A retrospective case review of children undergoing general anesthesia for surgical treatment for pericardial effusion between 1999 and 2008 at a single institution. Results: Sixty‐five children underwent 79 general anesthetics for surgical treatment for pericardial effusion. Median age was 4 years (2 weeks–16 years), and median weight 15 kg (range, 2.5–96 kg). Fifty‐five children (84%) developed effusions following cardiac surgery. The commonest induction agent was ketamine (25/65, 38%), and the majority of children (52/65, 80%) were intubated and ventilated for the procedure. Seven children (11%) suffered from eight major complications, and 14 children (22%) suffered from a minor complication. Major complications were more common in children with preoperative tachypnoea (P = 0.01) and cardiac tamponade on preoperative echocardiogram (ECHO) (P = 0.001). Preoperative hypoxia had a sensitivity of 92% and a positive likelihood ratio of 5.2 (95% CI 1.5–17.5) for predicting all complications. Conclusions: Anesthesia for pericardial effusion in children was associated with an adverse physiological event in one‐third of children. Major complications may be predicted by preoperative tachypnoea and cardiac tamponade on preoperative ECHO, and all complications may be predicted by preoperative hypoxia. The anesthetic technique included a variety of induction agents, and we cannot recommend a particular approach.     

Wait time and satisfaction with care and service at a nurse practitioner managed clinic

PURPOSE: To examine the relationships among the various times patients wait for health care and patient satisfaction with nurse practitioner (NP) care and the service component of care in a NP developed and managed clinic. DATA SOURCES: Forty-seven patients (78% response rate) responded anonymously to a 15-item questionnaire that measured satisfaction with NP care and an additional 15 items that measured satisfaction with the service component of care. Actual clock times were recorded on a flow sheet that corresponded to the system of care at this clinic. CONCLUSIONS: Using Pearson Product-Moment Correlation, there were no statistically significant relationships among various wait times and the measures of satisfaction. IMPLICATIONS FOR PRACTICE: Patient satisfaction with NP care is an important indicator of quality of care. Although satisfaction was not related to wait times, NPs must be respectful of the amount of time that patients wait for health care.     

2004－2016年珠海市道路交通伤害时间序列分析

目的 建立珠海市道路交通伤害(road traffic injuries,RTIs)发生的时间序列模型,了解RTIs的时间变化规律。方法 对2004－2016年珠海市3家哨点监测医院RTIs病例发生时间进行描述性分析。以2004－2015年RTIs按发生年、月份建立自回归移动平均混合模型(ARIMA),以2016年资料进行验证;同时按RTIs发生星期、时点(24 h)建立ARIMA模型进行时间序列分析。结果 2004－2016年共监测到70 813例RTIs。1－2月份 RTIs较少,7月达高峰;星期一、六和日RTIs发生数量较多;18－21点RTIs呈现最高峰,7－9点、0－2点分别呈现次高峰。构建得到RTIs发生人数按年、月份的ARIMA(0,1,1)模型(Ljung-Box检验Q=16.586,P=0.413),预测2016年RTIs人数,预测值与实际观测结果较相符;随着预测时间延长,CI范围扩大。对RTIs发生星期及时点序列分析建模为ARIMA(1,0,0)(Ljung-Box检验Q=13.283,P=0.652),观测值与拟合值基本相符。结论 2004－2016年珠海市RTIs流行状态具有一定时间变化规律,ARIMA模型适合进行RTIs发生时间趋势拟合并进行短期预测分析。