结核病区医务人员医用防护口罩佩戴现状及影响因素分析

目的了解结核病区医务人员医用防护口罩佩戴状况及影响因素,为有针对性地做好职业防护提供参考。方法对广州军区5所三甲综合性医院的结核病区195名医务人员采用自行设计的问卷进行佩戴医用防护口罩行为现状调查,分析医务人员佩戴医用防护口罩行为的影响因素。结果结核病区医护人员佩戴医用防护口罩的行为得分为(17.93±3.37)分,结核病区医护人员佩戴医用防护口罩细节行为条目得分较低;职业、教育培训、监管机制、经济因素是结核病区医务人员佩戴医用防护口罩行为的主要影响因素(P0.05,P0.01)。结论结核病区医务人员佩戴医用防护口罩的主动意识较强,但较易忽视佩戴的细节行为。职业防护须重视细节行为,加大教育培训、双重监管和经济投入力度,以预防结核病医院感染,促进医务人员职业防护。     

Study of Surgical Emergencies of Tubercular Abdomen in Developing Countries

To study the various modes of presentation, diagnosis, and management of surgical emergencies of tubercular abdomen. This prospective study of surgical emergencies of tubercular abdomen was conducted in 50 patients who attended our surgical emergency from 2006 to 2008. Patients were evaluated thoroughly with history, physical examination, routine investigations, and special investigations such as ELISA, PCR, barium studies of gastrointestinal tract, and diagnostic laparoscopy as required and managed with medical and surgical treatment as necessary. The most of patients were from rural areas, in the third to sixth decades with slight male preponderance. Abdominal pain, vomiting, and constipation were commonest presenting symptoms. About 20 % patients had history of pulmonary tuberculosis and 16 % patients presented with ascites. PCR for blood and ascitic fluid was positive in 72 and 87.5 % patients, respectively. About 24 % patients were managed nonoperatively and responded to ATT. About 76 % patients needed surgery among which one-fifth of patients were operated in emergency. Procedures like adhesiolysis of gut (47.3 %), strictureplasty (10.5 %), resection anastomosis (5.2 %), right hemicolectomy (5.2 %), and ileotransverse anastomosis (7.8 %) were performed in 30 patients and peritoneal biopsy and lymph node biopsy in the remaining 8 patients. Both medically and surgically managed patients were put on antitubercular therapy. Abdominal tuberculosis is a disease of middle-aged rural people, presenting commonly with abdominal pain and vomiting with right lower abdominal tenderness. PCR (blood and ascites) for tuberculosis is much more sensitive than IgM ELISA (blood and ascites). The most of patients required surgical procedures and all patients responded dramatically to antitubercular therapy symptomatically with increase in the hemoglobin level and decrease in ESR.     

结核病专科医院临床护士营养知识态度现状调查分析

目的了解结核病专科医院护士的营养知识和态度的现状,分析其相关性,为针对性地进行营养知识培训提供依据。方法采用方便抽样的方法,对某三甲结核病专科医院的256名临床护士的营养知识和态度进行调查。结果护士营养知识正确率53.74%,得分(16.12±4.56)分,其中良好、一般、差者分别占1.2%、41.0%、57.8%;不同年龄、工作年限、学历、职务、编制、工作状况护士的营养知识掌握情况比较,差异有统计学意义(P0.05,P0.01);态度得分为(94.56±10.53)分,持正性、中性、负性态度者分别占64.5%、33.6%、1.9%,不同职称护士的营养态度得分差异有统计学意义(P0.01);营养知识与态度呈正相关(P0.01)。结论护理管理者应加强对护士营养知识的培训,端正其对营养的态度,从而提高营养护理质量。     

Xpert MTB/RIF在骨关节结核患者

【摘要】 目的：探讨Xpert MTB/RIF在骨关节结核患者快速诊断中的应用价值。方法：2014年2月~2014年11月使用Xpert MTB/RIF对49例骨关节结核患者及32例非结核性骨关节病患者的脓液标本进行检测,以临床诊断为金标准,计算Xpert MTB/RIF检测结核分枝杆菌的敏感性、特异性、阳性预测值、阴性预测值、一致率;同时对脓液标本行抗酸染色及结核分枝杆菌快速培养（BACTECT MGIT 960）,比较Xpert MTB/RIF与抗酸染色、结核分枝杆菌快速培养在敏感性及特异性上的差异;综合上述两方面因素评价Xpert MTB/RIF在骨关节结核患者快速诊断中的应用价值。结果：Xpert MTB/RIF检测单个脓液标本的时间为2.3±0.2h。49例骨关节结核患者脓液标本中,46例Xpert MTB/RIF检测结核分枝杆菌阳性,3例Xpert MTB/RIF阴性;32例非结核性骨关节病患者脓液标本中,1例Xpert MTB/RIF检测结核分枝杆菌阳性,31例Xpert MTB/RIF阴性;以临床诊断为金标准,Xpert MTB/RIF检测结核分枝杆菌的敏感性为93.87%、特异性为96.87%、阳性预测值为97.87%、阴性预测值为91.17%,一致率为95.06%。在46例Xpert MTB/RIF结核分枝杆菌阳性的骨关节结核患者中,10例存在利福平耐药突变基因,耐药突变率为21.73%。49例骨关节结核患者脓液标本中,抗酸染色阳性8例,阴性41例,敏感性为17.39%;结核分枝杆菌快速培养阳性患者11例,阴性38例,敏感性为23.91%;32例非结核性骨关节病患者脓液标本抗酸染色及结核分枝杆菌快速培养均为阴性,其特异性均为100%。Xpert MTB/RIF检测结核分枝杆菌的的敏感性优于抗酸染色及结核分枝杆菌快速培养（P<0.05）,特异性与抗酸染色及结核分枝杆菌快速培养无明显差异（P>0.05）。结论：Xpert MTB/RIF在骨关节结核患者的快速诊断中具有较高的诊断效能,其耗时短,敏感性高,特异性强,与抗酸染色及结核分枝杆菌快速培养比较具有明显优势。     

儿童胸腰椎结核手术治疗的效果及并发症分析

目的 :回顾性分析儿童胸腰椎结核病灶清除、矫形、植骨融合内固定手术治疗的效果和并发症的发生情况及其原因分析。方法:2002年1月~2012年12月收治31例12岁以下儿童胸腰椎脊柱结核患者,男20例,女11例,年龄8.1±2.3岁(4~12岁),胸椎结核14例,胸腰段结核9例,腰椎结核8例。术前Frankel瘫痪分级,B级3例,C级6例,D级11例,E级11例。对仅有1个椎体部分破坏或椎体周围冷脓肿,脊柱稳定者,行前路椎体结核病灶清除植骨融合内固定术,本组3例;对椎体破坏较重或椎体破坏数量2个以上伴较重的后凸畸形者,行经后路前柱结核病灶清除,截骨矫形,钛网/异体或自体骨前柱支撑+后路椎弓根螺钉固定,本组18例;对于结核病灶破坏椎体严重,椎体破坏3个以上,冷脓肿蔓延广泛,同时伴有严重的后凸畸形者,行联合前后路手术,本组5例;对于冷脓肿以及脊柱结核破坏病灶较少,以严重后凸畸形为主要表现者,行后路截骨矫形术,本组4例;对于仅有较大冷脓肿,椎体破坏轻微者,行单纯病灶清除术,本组1例。采用X线、三维CT扫描、MRI等影像学手段评估内固定情况、畸形矫正与丢失、植骨融合效果、邻近节段畸形发生情况以及应用VAS评分、ODI评分、Frankel神经功能分级评价手术效果。随访观察并发症发生情况并分析其相关因素。结果:平均随访时间38±11个月(12~52个月),所有患者均顺利完成手术,无神经功能障碍加重者,末次随访时Frankel分级提高1~2级以上,分别为C级2例,D级3例,E级26例。VAS从术前的7.6±1.1分改善至末次随访时的2.1±1.4分;ODI评分从术前的75.3±12.1改善至末次随访时的26.2±12.4;病椎平均后凸Cobb角从术前的56.0°±2.5°改善至末次随访时的35°±1.9°,上述指标均显著改善(P0.05),所有病例通过二维CT证实全部骨性融合,平均骨愈合时间为6.1±1.1个月。手术相关并发症发生率32%(10/31):其中后凸畸形加重3例,交界性后凸畸形5例,椎弓根切割1例,结核复发1例;并发症病例和无并发症病例比较,其平均年龄较小,病变节段数较多,病程较长。上述病例经延长固定节段和翻修手术全部治愈。结论:手术治疗儿童胸腰椎结核可取得较好效果,主要并发症是出现交界性后凸畸形以及原有固定节段后凸畸形加重,其发生的原因和患儿的年龄、病变节段和范围、病程长短等密切相关。     

半椎板切除减压植骨融合内固定治疗腰椎结核

[目的]评价后路半椎板切除全椎管减压、病灶清除、同种异体骨植骨融合内固定术治疗腰椎结核的临床效果。[方法]自2010年3月~2013年10月,本院采用经后路半椎板切除全椎管减压、病灶清除、同种异体骨植骨融合内固定术治疗腰椎结核患者32例。[结果]术后患者症状较前明显改善。术后VAS、ESR、CRP及Cobb’s角改善明显,JOA优良率为90.6%;ODI优良率为93.7%;术后1年X线片示融合率为90.6%。[结论]采用后路半椎板切除全椎管减压、病灶清除、同种异体骨植骨融合内固定术治疗腰椎结核是一种安全、有效的手术策略。     

Application of Thoracoscopic Hybrid Surgery in the Treatment of Stage III Tuberculous Empyema

Background: To investigate the efficacy and value of thoracoscopic hybrid surgery in the treatment of stage III chronic tuberculous empyema (CTE).Methods: 48 patients diagnosed as CTE with pleural thickening and encysted abscess cavity from were treated by hybrid operation (HO). Small incision operation was first used for resection of thickening pleural fibreboard and decortication of parietal pleura. Then, thoracoscopy was guided into chest to decorticate the visceral pleurali. Additional 25 patients with open operation of pleurectomy were set as control.Results: The average operation time of HO group was 70 ± 22 min compared to 130 ± 32 min of control. The amount of bleeding, hospitalization time and chest tube drainage of HO group (200 ± 55 ml, 18 ± 1.2 days, 3.5 ± 1.5 days) were significantly decreased compared to control (400 ± 45 ml, 28 ± 4.5 days, 6.5 ± 2.5 days). Post operation complications occurred in 5 (10.42%) and 3 (12%) cases for HO group and control, respectively.Conclusions: In stage III CTE, the small incision assisted thoracoscopic hybrid surgery help to remove thickening parietal pleura, promote the application of thoracoscopy, which has obvious advantages compared to traditional surgery.     

PCR直接测序法分析结核分枝杆菌katG基因突变

为了了解我国结核分枝杆菌耐异烟肼（ＩＮＨ）分离株ｋａｔＧ基因突变情况，研究其临床意义。本研究通过聚合酶链反应（ＰＣＲ）、ＰＣＲ－单链构象多态性（ＳＳＣＰ）和ＰＣＲ直测序法分析９２株结核分枝杆菌临床分离株的ｋａｔＧ基因。以Ｈ３７Ｒｖ标准株为对照，２３株药物敏感体中，２１株ｋａｔＧ基因ＳＳＣＰ分析正常，２株异常。３６株耐非ＩＮＨ药物的分离株中，２０株ｋａｔＧ基因ＳＳＣ正常，１６株异常。３３株耐ＩＮＨ分     

上腭黏膜长期不愈溃疡1例

1临床资料邹XX,男性,43岁,2004年9月发现左腭咽部溃疡伴疼痛,渐增大,疼痛加重,于外院就诊,取活检,病理示“黏膜肉芽肿性炎”。经一般抗炎治疗无效,症状进行性加重,2004年12月来我院就诊。患者平素体健,否认系统性疾病及传染病史。检查:患者面部对称,开口度一指半,口内25—28缺失,上腭见大面积溃疡,前起上颌硬区,后达软腭后缘,外侧越过左牙槽嵴达颊黏膜咬合线处,内侧越过中线约1 cm,右侧翼下颌皱襞处见散在溃疡,溃疡暗红色,无分泌物。右侧颌下区扪及数枚直径约0.5 cm淋巴结,质软,可活动,无压痛。实验室及特殊检查:白细胞4.1×109个/L,中性…     

口腔颌面部结核误诊原因临床分析

目的：分析口腔颌面部结核的误诊原因。方法：对13例口腔结核病误诊病例的误诊原因进行分析。结果：口腔颌面部结核病发病部位、临床表现多样化，容易导致误诊。结论：口腔颌面部结核病确诊主要靠病理检查，复杂病例需多种方法综合分析，必要时应进行抗结核诊断性治疗。