不同时期临床教学有关问题的分析比较

临床见习和实习是课堂理论教学的必要补充和延续。作者为七十年代末入学的医学本科生，现为医学院校临床教师。在十余年的临床工作及教学工作中发现一些对教学很不利的因素及现象，提供大家参考，共同探讨，以利今后的临床医学教学。另外，还比较了教学生和教师的体会。     

抗菌药物在小儿呼吸道疾病治疗中的应用

目的探讨抗菌药物在小儿呼吸道疾病治疗中的应用情况。方法选取2012年本院儿科收治的小儿呼吸道疾病患者500例的病历资料,观察抗菌药物使用情况。结果500例患者中使用抗菌药物293例,占58．6％,以头孢类抗菌药物为主的联合用药12例（4．1％）;220例发热患儿抗菌药物使用率为64．1％,280例体温正常患儿抗菌药物使用率为54．3％;90例白细胞升高患儿抗菌药物使用率为100．0％。410例白细胞计数正常患儿抗菌药物使用率为49．5％;头孢类DDDs占46．7％,使用率最高;头孢哌酮DUI值最高,有7种抗菌药物DUI值均〉1。结论抗菌药物在小儿呼吸道疾病治疗中存在给药频率过多、联合用药指征不正确等情况,会增加细菌的耐药性,因而需要加强对抗菌药物的规范管理,促进抗菌药物的合理使用。     

阿奇霉素序贯治疗小儿大叶性肺炎的效果观察

目的探讨阿奇霉素序贯治疗小儿大叶性肺炎的效果。方法选取2010年6月-2012年5月本院收治的小儿大叶性肺炎患者60例,按照治疗方法分为观察组和对照组。每组30例,观察组采用阿奇霉素序贯治疗,对照组采用阿奇霉素静脉滴注治疗,观察两组临床症状消失时间、住院时间、住院费用和不良反应情况。结果观察组治疗总有效率明显高于对照组（P〈0．05）,退热时间、咳嗽消失时间、肺哕音消失时间、住院时间和住院费用明显少于对照组（P〈0．05）,不良反应发生率明显低于对照组（P〈0．05）。结论阿奇霉素序贯治疗小儿大叶性肺炎,能够有效改善患儿的临床症状,提高治愈率,减少治疗费用,减少不良反应,效果显著,值得临床推广。     

Change of alveolar epithelial type Ⅱ cells and pulmonary surfactant protein A in young rats with acute lung injury

Objective To study the temporal changes of alveolar epithelial type Ⅱ cells and surfactant pro-tein A in young rats with acute lung injury induced by lipopolysaecharide. Method Totally 110 SD young rats (male:53, female : 57) were randomly divided into ALI and normal control groups (six subgroups in each group).LPS(4 mg/kg) was given intraperitoneally in ALI group. The same amount of normal saline was given in the con-trol groups. Eight rats in each subgroup were sacrificed at 6, 12, 24, 36, 48 and 72 hours after the injection.Lung samples were taken for transmission electron microscope examination. RT-PCR was epmloyed for the mea-surement of SP-A mRNA. Western blot was used for the detection of SP-A in the lung tissue. ANOVA and homo-geneity of variance test were performed by SPSS 12.0. Results The microvilli disappeared at 24 hours after the injection of LPS. The number of lamellar body (LBs) was provisionality increased at 24 hours and 48 hours. The ring-like an'angement of LBs around nucleus and the giant LB with vacuole-like deformity were found as the main characteristics of AEC- Ⅱ in ALI at 48 hours. The number of LBs reduced and broken and residual LB remained at 72 hours. SP-A elevated greatly from 24 to 48 hours (P < 0.01), reached peak at 36 hours (6.94 ± 0.80, P <0.01),reached the lowest level(3.87 ±0.50, P <0.01)at 72 hours. Conclusions The pathological changes of AEC-Ⅱ and SP-A in lung tissue wiht ALI are time-dependent. The typical alterations of AEC- Ⅱ occurs at 48 hours accompanied by the compensatory increase of SP-A. AEC- Ⅱ is seriously injuried with the typical changes of LBs and the diminishing of SP-A in lung tissue.     

Change of alveolar epithelial type Ⅱ cells and pulmonary surfactant protein A in young rats with acute lung injury

Objective To study the temporal changes of alveolar epithelial type Ⅱ cells and surfactant pro-tein A in young rats with acute lung injury induced by lipopolysaecharide. Method Totally 110 SD young rats (male:53, female : 57) were randomly divided into ALI and normal control groups (six subgroups in each group).LPS(4 mg/kg) was given intraperitoneally in ALI group. The same amount of normal saline was given in the con-trol groups. Eight rats in each subgroup were sacrificed at 6, 12, 24, 36, 48 and 72 hours after the injection.Lung samples were taken for transmission electron microscope examination. RT-PCR was epmloyed for the mea-surement of SP-A mRNA. Western blot was used for the detection of SP-A in the lung tissue. ANOVA and homo-geneity of variance test were performed by SPSS 12.0. Results The microvilli disappeared at 24 hours after the injection of LPS. The number of lamellar body (LBs) was provisionality increased at 24 hours and 48 hours. The ring-like an'angement of LBs around nucleus and the giant LB with vacuole-like deformity were found as the main characteristics of AEC- Ⅱ in ALI at 48 hours. The number of LBs reduced and broken and residual LB remained at 72 hours. SP-A elevated greatly from 24 to 48 hours (P < 0.01), reached peak at 36 hours (6.94 ± 0.80, P <0.01),reached the lowest level(3.87 ±0.50, P <0.01)at 72 hours. Conclusions The pathological changes of AEC-Ⅱ and SP-A in lung tissue wiht ALI are time-dependent. The typical alterations of AEC- Ⅱ occurs at 48 hours accompanied by the compensatory increase of SP-A. AEC- Ⅱ is seriously injuried with the typical changes of LBs and the diminishing of SP-A in lung tissue.     

糖皮质激素联合阿司匹林和丙种球蛋白治疗小儿川崎病的临床效果

目的 观察糖皮质激素联合阿司匹林和丙种球蛋白治疗小儿川崎病的临床效果。方法 选取2019年1月—2022年1月长江大学附属潜江市中心医院收治的川崎病患儿40例,采用随机数字表法分为观察组和对照组各20例。对照组患儿给予阿司匹林联合丙种球蛋白治疗,观察组在对照组治疗基础联合糖皮质激素治疗,2组均治疗14 d。比较2组患儿临床治疗效果、临床症状消失时间,治疗前后白细胞计数(WBC)、C反应蛋白(CRP)、红细胞沉降率(ESR)、血小板计数(PLT),以及并发症和不良反应发生率。结果 观察组治疗总有效率为95.00%,高于对照组的65.00%(χ²=3.906,P=0.048);观察组退热时间与黏膜充血、淋巴结肿大、四肢肿胀消失时间均短于对照组(P<0.01);治疗14 d后,2组WBC、CRP、ESR、PLT均低于治疗前,且观察组低于对照组(P<0.05或P<0.01);观察组与对照组并发症和不良反应总发生率比较差异无统计学意义(10.00%vs. 5.00%,P=1.000)。结论 糖皮质激素联合阿司匹林和丙种球蛋白治疗小儿川崎病,可有效提升临床效...     

浅谈电子期刊与纸质期刊的综合利用

电子期刊是图书馆的新型信息资源,以其传递速度快,检索功能强,信息存储量大等特点在教学科研工作中起着越来越大的作用,但目前各图书馆都存在电子期刊与纸质期刊重复收藏现象。如何正确处理好二者的关系,使有限的经费发挥出最大的效能,是一个值得深入研究的问题。本文通过对电子期刊和纸质期刊优缺点的分析比较,提出了如何加强期刊综合利用,提高期刊利用率。