27家医院孕产妇围产期健康教育现状的调查

目的 了解孕产妇围产期的健康教育现状.方法 便利抽取全国7个省2个直辖市中27家医院,请入选各医院产科护士长,填写自行设计的围产期护理服务现状问卷.结果 调查的27家医院中59.3%为综合医院,40.7%为妇产专科医院;从医院等级上40.7%为三级医院,40.7%为二级医院,18.6%为一级医院.参加产前教育的孕妇占在医院分娩孕产妇比例的11%～100%.80.8%医院提供产前教育是免费的,但23.1%的医院无经费来源.65.4%的医院对产前教育的效果进行评价.27家医院在待产过程中均及时告知产妇产程进展,在分娩后均及时告知产妇新生儿健康状况,产后均对产妇进行了母乳喂养指导、产后自身护理、新生儿护理的教育.结论 调查的27家医院围产期服务现状,围产期健康教育形式多样,内容丰富,为孕产妇提供了重要的信息,在开展基本的产前、产时、产后健康教育的同时,部分医院提供一些特色服务如助产士门诊,产后访视等,也为以后全面开展产科特色服务打下研究基础,对于产前教育是否应当收费以及教育经费的来源,产前教育师资要求、课程安排、如何对产前教育的效果进行评价等需要进一步考虑.     

超声弹性成像对甲状腺实性结节的鉴别诊断价值

目的 探讨超声弹性成像弹性评分法及顺应性比值法在甲状腺实性结节鉴别诊断中的应用价值.方法 对69例患者的86个甲状腺实性结节根据术后病理结果分为良性组及恶性组,分别对两组的超声弹性图像评分及顺应性比值进行回顾性分析,与术后病理结果对比,计算弹性评分法及顺应性比值法诊断的敏感性、特异性及准确性;绘制弹性评分法及顺应性比值法的受试者工作特征曲线(ROC曲线),选取最佳诊断界点.结果 86个甲状腺结节中,良性组甲状腺结节共67个,结节直径(2.05±0.21)cm;恶性组甲状腺结节共19个,结节直径(1.62±0.12)cm.良性组及恶性组结节直径比较,差异无统计学意义(t=-1.736,P＞0.05).良性组与恶性组间弹性评分(中位数分别为2、3分)及顺应性比值(中位数分别为1.66、3.97)比较,差异有统计学意义(Z值分别为-5.290、-5.450,P均＜0.05).以弹性评分≥3分为鉴别甲状腺良、恶性的诊断界点,诊断敏感性、特异性及准确性分别为84.2%(16/19)、86.6%(58/67)和86.0%(74/86),ROC曲线下面积为0.854;以顺应性比值≥2.50为鉴别甲状腺良、恶性的诊断界点,诊断敏感性、特异性及准确性分别为89.4%(17/19)、86.6%(58/67)和87.2%(75/86),ROC曲线下面积为0.911.结论 超声弹性成像弹性评分法及顺应性比值法均有助于甲状腺良、恶性结节的鉴别诊断,在临床具有较高的应用价值.

Abstract：

Objective To evaluate the value of ultrasound elastography score and strain ratio index in the differential diagnosis of thyroid solid nodules. Methods Eighty-six thyroid solid nodules of 69 patients were divided into 2 groups based on their pathologic results: benign nodules group and malignant nodules group.Compared with pathological results, each thyroid solid nodules' elastographic scores and strain ratio index were respectively analyzed. The sensitivity, specificity and accuracy of elasticity score and strain ratio index were calctlated.The receiver operator characteristic (ROC) curves were drawn according to the results, to choose the best cut-off value.Results There were 67 nodules in benign nodules group and 19 nodules in malignant nodules group. The diameter of benign nodules was (2.05 ± 0.21)cm, malignant nodules was (1.62 ± 0.12)cm. There were no significant differences in the elasticity score and strain ratio index between benign and malignant nodules(t= - 1.736, P ＞ 0.05). Malignant lesions had a higher score and strain ratio index(median 3, 3.97, respectively) than benign ones(median 2, 1.66,respectively, Z = - 5.290, - 5.450, all P ＜ 0.05). If the cut-off value of the elastographic scores was equal or more than 3, the sensitivity, specificity and accuracy were 84.2%(16/19) ,86.6%(58/67) and 86.0%(74/86), respectively,with an area under ROC curve of 0.854. If the cut-off value of the strain ratio index was equal or more than 2.50,the sensitivity, specificity and accuracy were 89.4%(17/19),86.6%(58/67) and 87.2%(75/86), respectively, with an area under ROC curve of 0.911. Conclusion Elasticity score and strain ratio index are helpful in differentiating benign and malignant lesions of thyroid with high clinical value.     

甘草酸对TNBS诱导的大鼠胰腺纤维化的干预作用

背景甘草酸具有保护细胞膜,调节免疫反应等作用,可减轻肝脏、肾脏等组织中的纤维化程度.     

内镜黏膜下剥离术治疗消化道早期癌及癌前病变

随着消化内镜技术的发展,越来越多的早期消化道癌及癌前病变被发现,淋巴结转移风险低的早期癌可通过内镜下切除,其效果等同于外科手术.内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)是在内镜黏膜切除术基础上发展而来,其优势在于可以整块切除较大病变.本研究采用ESD治疗符合内镜切除原则的早期消化道癌、癌前病变以及胃肠道类癌,取得较好效果,现报道如下.     

冠脉造影、血管内超声成像及虚拟组织学检测易损斑块的研究进展

全球每年约有2 000多万人出现突发性心脏事件,包括急性冠状动脉综合征(ACS)和(或)心脏性猝死。ACS的主要启动机制是罪犯血管动脉粥样斑块破裂和伴随的血栓形成。近几年来提出"易损斑块(vulnerable plaque)"这一概念,即将导致急性心血管事件的斑块统一命名为易损斑块。     

大肠侧向发育型肿瘤的内镜诊治41例分析

大肠侧向发育型肿瘤(laterrally spreading tumor,LST)与大肠癌密切相关,早期发现,早期内镜处理,可降低大肠癌发生率.我们通过黏膜染色加放大结肠镜观察共发现LST患者41例,经内镜黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗,取得较好疗效,报道如下.     

早孕期单绒毛膜囊双胎的超声诊断分析

临床研究发现,单绒毛膜囊双胎产后畸形率、围生期死亡率均较高。2008年7月～2014年3月,我们采用彩色多普勒超声诊断出单绒毛膜囊双胎妊娠69例,其中孕早期诊断出66例,及时进行了临床干预,避免了不良妊娠结局。 临床资料：本组单绒毛膜囊双胎妊娠孕妇69例,年龄20～37岁、平均28岁,其中自然受孕67例、人工受精2例,均无家族遗传病史。     

固定矫治对错(牙合)患者口腔健康相关生活质量的影响

Objective To assess oral health-related quality of life in patients with fixed appliances.Methods Orthodontic patients were asked to complete the scale of general conditions(Chinese version,questionnaire 1)and oral health impact profile(OHIP)-14(Chinese version,questionnaire 2).Baseline data were collected at first visit and thereafter.The subjects finished questionnaire 2 at the 1st week,4th week,12th week and 24th week,respectively,after the fixed appliance was bonded.Data were analyzed to evaluate the various sample groups with different personal information and clinical parameters.Results were collated and analyzed using software package SPSS version 15.0.Results The most common negative effect was physical pain[55/222(27.8%)]and psychological discomfort[40/222(18.0%)],mainly in the first month.The total scores at five time points were 3,10,7,5 and 4,respectively.No difference was found in quality of life in patients between sixth month with fixed appliance and without appliance(P＞0.05).Age and education status affected the quality of life(P＜0.001).Conclusions Fixed orthodontic appliance therapy affected patients' oral health-related quality of life during treatment.The quality of life in the first month of treatment was mostly compromised and was improved later.     

脑干诱发电位在超早期脑瘫诊断中的价值

小儿脑瘫 (ＣＰ)是一种常见致残性疾病 ,早期 (指 6个月内 )甚至超早期 (3个月内 )发现并早干预 ,将大大改善患儿的生存质量。脑干诱发电位 (ＢＡＥＰ)已成为小儿ＣＰ诊断的重要手段 ,对超早期ＣＰ诊断同样重要 ,1996年 1月至 1998年 12月我院收治超早期ＣＰ并接受ＢＡＥＰ检查 130例 ,现报告如下 :1　临床资料与方法130例均系 3个月龄前经我院康复中心诊断的住院病人 ,部分延至 3 12 前入院。诊断采用山富太郎新生儿期六大症状结合Ｖｏｊｔａ姿势反射检查法[1] 。ＢＡＥＰ检查由我院脑干测听室采用意大利产ＰＨＳＩＳ -Ⅱ型神经肌肉电生理…     

呕必亭预防高剂量顺铂腹腔热灌注所致呕吐的临床研究

目的 :探讨呕必亭预防高剂量顺铂腹腔热灌注所致恶心呕吐。方法 :57例患者接受DDP100mg/m2 43℃生理盐水2500～3000ml腹腔灌注 ,腹灌第1周期用呕必亭或用对照药物胃复安 地塞米松或恩丹西酮 ,第2周期交换应用。结果 :预防急性呕吐的有效率 ,呕必亭为88.9 % ,恩丹西酮为85.7% ,胃复安 地塞米松为66.7 %(P<0.025)。其中完全缓解率为63.9 %、61.9 %、38.9 %(P<0.05) ,对慢性呕吐的预防(2～5天)的有效率分别为 :72.2 %～91.9 %、61.9%～90.4%、27.8 %～69.4 %(P<0.05)。结论 :呕必亭能有效地预防高剂量顺铂腹腔热灌注所致的呕吐 ,与恩丹西酮相仿 ,明显优于胃复安 地塞米松 ,且给药方便。