肾综合征出血热多尿期肾图的变化及意义

目的 :研究肾综合征出血热 (HFRS)多尿期肾图的变化及其意义。方法 :静脉注射 1 31 I-邻碘马尿酸钠 (1 31 I- OIH) 3.7×10 9Bq(10 μCi) ,用闪烁照相法描记 15 min,通过电子计算机自动处理 ,得出肾图的各项参数。结果 :2 0例受检者均已进入多尿期 ,2 4h尿量在 2 0 0 0 ml以上 ,血尿素氮 (BUN)已正常或接近正常 ,但肾图却明显异常 ,表现为半排时间 (TC1 /2 )延长 (>8min) ,15min残留率 (C1 5 /b)超过 5 0 % ,肾脏指数大多低于 45 % ;同期作尿β2 -微球蛋白 (β2 - m )测定 ,也明显高于正常 ;8例作发射型电子计算机扫描 (ECT)检查 ,肾小球滤过率 (GFR)和有效肾血浆流量 (ERPF)分别为 (4 0 .8± 2 1.2 ) ml/min和 (35 0 .8± 10 2 .1) ml/min,均明显低于正常 (P<0 .0 1)。结论 :HFRS患者多尿期肾图大多呈排出不良和功能受损的图形 ,表明该期肾功能以及肾血流量尚未恢复正常 ,对症治疗仍需继续。     

硅油取出联合白内障超声乳化术的临床探讨

目的 评估通过透明角膜切口完成白内障超声乳化及折叠式人工晶体植入联合经瞳孔前路硅油取出改良术的安全性及有效性。方法 对57例硅油充填眼完成白内障超声乳化后经瞳孔前路硅油取出联合折叠式人工晶体植入。结果 术后未发生明显角膜并发症,89.4%的病人（51例）未发生视网膜再脱离,复发性视网膜脱离6例（11.6%）,再次手术后成功复位。41例患者的术后视力改善。结论 白内障超声乳化及折叠式人工晶体植入联合硅油奴出改良术安全有效,可以最大限度地减少手术损伤。     

Prediction of lethal pulmonary hypoplasia and chorioamnionitis by assessment of fetal breathing

Summary. Twenty-three pregnancies with fetuses at risk for pulmonary hypoplasia were studied weekly until delivery. The amount of time spent in fetal breathing activity was recorded under controlled conditions during 1 h using real-time ultrasound. An amniotic fluid index was determined. The clinicians and the pathologist were unaware of the ultrasound findings. Eight of 23 fetuses did not breathe at the last ultrasound examination. Three babies died of pulmonary hypoplasia and two of these showed fetal breathing before birth. The three deaths were associated with rupture of the membranes at <20 weeks gestation and of ≥44 days duration. One infant developed bronchopulmonary dysplasia. The amniotic fluid index in these four pregnancies was low and the newborn infants had limb contractures. Chorioamnionitis/funisitis was noted in 13 placentas. Eight fetuses were assessed for fetal breathing within 2 days of birth. The lack of fetal breathing had sensitivity, specificity, positive and negative predictive values of 0.75 for chorioamnionitis/funisitis. In this pilot study the absence of fetal breathing was of no value in predicting lethal pulmonary hypoplasia, but was related to chorioamnionitis/funisitis. We recommend further studies of fetal breathing in relation to fetal/neonatal infections.     

A national survey of computerized decision support systems available to nurses in England

Aim  To examine the characteristics of computerized decision support systems (CDSS) currently available to nurses working in the National Health Service (NHS) in England.
Method  A questionnaire survey sent to a stratified random sample of 50% of all NHS care providers (Trusts) in England, asking respondents to provide information on CDSS currently used by nurses.
Results  Responses were received from 108 of the 277 Trusts included in the sample. Electronic patient record systems were the most common type of CDSS reported by Trusts ( n  = 61) but they were least likely to have features that have been associated with improved clinical outcomes.
Conclusions  The availability of CDSS with features that have been associated with improved patient outcomes for nurses in the NHS in England is limited. There is some evidence that the nature of the Trust affects whether or not nurses have access to CDSS to assist their decision making.
Implications for nursing management  The implementation of CDSS is increasing throughout the NHS. Many CDSS are introduced without adequate evidence to support its introduction and there is little evaluation of the benefits once they are implemented. Policy makers and nursing management should consider whether the introduction of CDSS aids nurse decision making and benefits patient outcomes.     

髋关节置换术后注意点及康复功能锻炼方法

本文介绍了髋关节置换术后的注意点及康复功能锻炼方法。包括卧床时的练习，起床练习，助步器站立练习，步态训练，起坐练习，具体操作有图片显示。