健康教育路径对葡萄胎患者认知水平与抑郁状况的影响

目的 探讨葡萄胎患者实施健康教育路径的护理效果.方法 将我院收治的120例葡萄胎患者随机分为对照组和观察组各60例.对照组采取常规健康教育 ,观察组实施健康教育路径 ,比较两组患者经不同护理措施干预后的认知水平及抑郁状况.结果 护理前两组患者认知水平及抑郁自评量表(S D S评分)比较差异无统计学意义 (P>0 .05);实施健康教育临床路径护理后 ,观察组患者认知水平与SDS评分均明显提高 ,组内前后比较差异有统计学意义(P<0 .05).对照组认知水平较护理前有所改善(P> 0 .05) ,护理后组间比较差异有统计学意义(P<0 .05).结论 实施健康教育路径 ,能提高葡萄胎患者对疾病的认知程度 ,降低抑郁水平.     

美容缝合法在门诊乳腺良性肿瘤切除术中的应用及效果观察

目的:探讨美容缝合法在门诊乳腺良性肿瘤切除术患者中的应用效果.方法:将104例行门诊乳腺良性肿瘤切除术患者随机分为对照组64例和观察组40例,对照组手术切口采用常规缝合法即单纯间断缝合,观察组手术切口采用美容缝合法即皮内连续缝合,比较两组术后切口各项观察指标,切口疼痛与拆线疼痛程度,切口愈合分级、瘢痕增生及色素沉积情况.结果:两组术后切口各项观察指标、切口疼痛与拆线疼痛程度、瘢痕增生与色素沉积比较,观察组均优于对照组(P＜0.01).结论:对门诊乳腺良性肿瘤切除术患者采用美容缝合法,可减轻术后切口及拆线疼痛,减少瘢痕增生和色素沉积,有较好美容效果.     

复合脉冲磁性治疗仪辅助治疗小儿肺炎50例

目的:评价复合脉冲磁性治疗仪辅助治疗小儿肺炎的疗效。方法:将小儿肺炎121例,随机分为治疗组50例和对照组71例,其中又按年龄阶段不同分为3组,除常规抗感染、抗病毒、扩张血管、雾化吸入、对症等治疗外,治疗组予复合脉冲磁性治疗仪辅助治疗。对两组咳嗽、咳痰、气促、肺部罗音消失时间进行比较。结果:治疗组患儿症状及体征好转情况优于对照组,住院时间短,经统计学检验婴幼儿组、学龄前儿童组有非常显著性差异(P<0.01)。学龄儿童组有显著性差异(P<0.05)。结论:复合脉冲磁性治疗仪辅助治疗小儿肺炎疗效显著,方法简便。     

静脉注射胺碘酮转复性房颤的疗效

慢性心房颤动 (ＣＡＦ)是一种严重病症 ,近年来它的发病率日趋上升 ,据报道 ,静脉注射胺碘酮治疗房颤 (ＣＡＦ)12ｈ转复率 5 5 .5 % ,总转复率也高于其它方法 ,且静脉注射胺碘酮副作用明显小于口服者。本文旨在研究静脉注射胺碘酮 (又名可达龙 ,由ＳｏｎｏｆｉＷｉｎｔｈｒｏｐＩｎｄｕｓｔｒｉｃ生产 )的价值及安全性。对象与方法一、对象选择ＣＡＦ住院患者 2 0例 ,病程 >3周 ,男 13例 ,女 7例 ,平均年龄 (6 8± 4)岁 ,高血压病合并冠心病 12例 ,冠心病 5例 ,风心 2例 ,特发性 1例 ,平均 2 4ｈ室率 >70次 /ｍｉｎ ,收缩压 >90ｍｍＨｇ ,心…     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

疼痛学教学的体会

疼痛学从1931年Dogliotti将乙醇注入患者的蛛网膜下腔并获得癌痛患者的长期止痛效果开始，世界发达国家即开展了顽粤性痛症的姑息治疗研究，不过临床实际工作的进展非常缓慢。1975年成立了国际疼痛学会，疼痛治疗作为一个新兴的专业才在世界各国陆续开展起来。     

抗生素对结直肠息肉氩离子凝固术及电凝电切术后炎性指标的影响

  目的 探讨抗生素对结直肠息肉氩离子凝固术及电凝电切术后炎性指标的影响。 方法 采取前瞻性随机对照研究方法,选择2014-01至2015-12医院消化内科收治的58例结直肠息肉治疗患者,随机分为抗生素组(28例)及非抗生素组(30例)。于术前,术后1、3 d测定血浆内毒素、降钙素原及C-反应蛋白水平。 结果 58例治疗后均未出血及穿孔,术后9例出现腹痛、腹胀不适(15.5%),12~24 h症状基本消失。抗生素组患者治疗后出现低热1例(3.6%),发热时间为术后8 h左右,非抗生素组患者治疗后出现发热4例(13.3%),均为低热,发热时间为术后7~14 h,两组发热率差异有统计学意义(P<0.05)。两组治疗后1、3 d与术前比较,血浆内毒素、血浆降钙素原、C-反应蛋白水平变化差异均无统计学意义。 结论 结直肠息肉氩离子凝固术及电凝电切术治疗在整体上是安全的,治疗后炎性指标基本正常,不支持应用抗生素。     

颈内静脉留置导管引发对侧臂丛神经卡压性损伤一例

患者,女,51岁,因胆囊切除后持续腹胀、食欲减退、上腹隐痛于2003年6月人院。入院当天于右侧颈内静脉穿刺留置双腔导管(7Fr×20 cm,内置15 cm深,深圳市宜心达医学新技术有限公司)行高价静脉营养,症状缓慢减轻。第6天开始出现左前臂尺侧隐痛,症状持续加重;第7天开始整个左上肢及左肩胛周围持续疼痛,阵发性放电样巨痛,以左