1例食管癌术后并落叶型天疱疮患者的护理

天疱疮是一种发生于皮肤、粘膜的自身免疫性大疱性疾病,其特点为不断出现极易破裂的水疱。发病机理复杂,发病原因不太清楚,有文献证实天疱疮的发生与内在肿瘤间存在一定的联系犤1犦,国内已有多例天疱疮与肿瘤并发的报告犤2,3,4犦。本例患者食管癌术后2个月,全身出现广泛红斑、水疱、糜烂、结痂、叶状脱屑伴瘙痒及疼痛,经病理证实为落叶型天疱疮,经过2周的积极治疗及精心护理,患者临床治愈出院。1临床资料患者男性,54岁,农民。因全身红斑、水疱、糜烂伴痒痛8个月,加重1月余于2004年5月28日入院。患者发病前2个月因“食管癌”在外院行“食管中段肿瘤切除术”,病理诊断为食管胸中段鳞癌(Ⅲ级,PT4N 1M 0),术后行放射治疗4周(每周5次),放疗后恢复尚可。入院体查:体温38.2℃,脉搏100次m/in,呼吸20次m/in,血压14/11K pa。一般情况差,消瘦,急性病容,全身浅表淋巴结无肿大,系统检查未见异常。皮肤科情况:头面部、颈部、躯干及四肢见泛发性暗红斑,散在分布黄豆至鸽蛋大小松弛性水疱,疱壁极薄、疱液混浊、部分为脓液、尼氏征( ),散在红色湿润糜烂面、结痂,当代护士2005年第12期学术版1例早产低体重儿留置PI...     

129例儿童眼外伤致伤原因分析及防范措施

本文对１２９例１３１眼儿童眼外伤致伤原因进行分析，其中有４８．０９％的受伤眼睛造成盲目，揭示社会各界应根据儿童各个发育时期的特点，进行照、管、教，确保儿童健康成长；同时全社会应对儿童卫生保健工作及卫生宣教工作加大力度。     

六安市基层医药卫生体制综合改革实践

自2009年11月24日全省基层医药卫生体制综合改革试点工作会议以来,在省卫生厅的正确指导和市委、市政府的坚强领导下,我市卫生系统广大干部职工认真践行科学发展观,牢固树立“卫生部门是改革的主战场、医疗卫生人员是改革的主力军”思想,开拓进取,勇于拼搏,以建立基本药物制度为突破口,全力推进基层医疗卫生机构管理体制、人事制度、分配制度、基本药物制度和保障制度改革,圆满完成了各项改革任务并取得了初步成效.     

九江市放射工作人员健康检查结果的动态观察

目的了解长期低剂量电离辐射接触对放射工作人员身体健康影响及动态变化情况。方法按照放射工作人员职业健康检查规范要求,结合个人放射剂量监测结果对1989—2009年连续21年1072人次放射工作人员检查结果进行动态变化分析。结果九江市放射工作人员人均年剂量当量有逐年下降趋势。放射工作人员的内科检查、淋巴细胞微核、血小板、血红蛋白阳性检出率有逐年下降趋势,市县乡之间无明显差异,其余项目无明显变化。结论随着放射防护水平提高,放射工作人员身体健康状况有一定好转,但是还需进一步加强防护。     

九江市不同地质环境农村生活饮用水水质分析

目的了解九江市农村生活饮用水水质情况,科学确定农村饮水不安全人口数,为落实《2010—2013年全国农村饮水安全工程规划人口调查复核工作大纲》提供依据。方法对九江市含有农村的12个县(市、区)的水质进行监测,得到水样1 359份,均为分散式供水,依据《生活饮用水卫生标准》(GB 5749-2006)按不同地质环境进行分析评价。结果九江市农村生活饮用水合格率分别为:山区地表水为57.4%,山区地下水为82.19%、鄱阳湖区地表水为50.64%,鄱阳湖区地下水为78.24%;平原区地表水为51.18%,平原区地下水为65.03%,各种水的合格率差异有统计学意义(χ2=61.84,P<0.01)。不合格指标主要为大肠菌群、细菌总数、浑浊度、氨氮和锰。结论九江市农村生活饮用水水质不佳,卫生防护差,微生物污染是主要存在问题。     

狼疮肾炎患者血清晚期蛋白氧化产物水平与疾病活动的相关性

目的：探讨氧化应激标志物晚期蛋白氧化产物（ AOPP）在狼疮肾炎（ LN）患者血清水平变化及其与LN疾病活动的相关性。方法 LN患者29例,根据肾小球滤过率（eGFR）水平分为eGFR≥60 mL／（min·1.73 m2）组16例、eGFR＜60 mL／（ min·1.73 m2）组13例。同期选择性别、年龄、体重匹配的健康对照者21例（对照组）,测定各组血肌酐（Scr）、尿素氮（BUN）、血白蛋白（ALB）、血沉（ESR）、C反应蛋白（CRP）、补体C3、C4以及24 h尿蛋白定量（24hUPQ）、eGFR;ELISA法测定各组患者的AOPP、丙二醛（ MDA）、抗dsDNA抗体;运用系统性红斑狼疮（SLE）疾病活动指数（SLEDAI）积分表对LN患者的疾病活动性进行评分。结果 LN组患者CRP、ESR、24hUPQ、抗dsDNA抗体、AOPP、MDA均较对照组明显升高,差异有统计学意义（P＜0.05）,C3、C4、eGFR较对照组降低,差异有统计学意义（P＜0.05）;LN患者eGFR＜60组ESR、MDA较eGFR≥60组明显升高,差异有统计学意义（P＜0.05）;而CRP、AOPP、抗dsDNA抗体、SLEDAI积分、24hUPQ均较eGFR≥60组升高,但差异无统计学意义（P＞0.05）;血清AOPP与MDA呈显著正相关（r＝0.942,P＜0.05）,与抗dsDNA抗体呈显著正相关（r＝0.982,P＜0.05）,与SLEDAI积分呈正相关（r＝0.653,P＜0.05）,与eGFR呈负相关（r＝－0.298,P＜0.05）。结论 LN患者血清AOPP水平明显升高,且随着肾功能损害而进一步升高,可作为一种评估LN氧化应激状态的指标。 AOPP与LN疾病活动性密切相关。     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.     

3～6岁儿童人工晶体测量中的沟通技巧

目的对人工晶体测量患儿实施有效的沟通技巧,免除服用水合氯醛的痛苦,同时使患儿消除紧张、恐惧心理,能主动配合检查.方法将沟通技巧贯穿于整个过程中,根据患儿的性格特点,实施具体疏导.结果良好的沟通能保证检查的顺利进行,避免了服用水合氯醛的痛苦,可提高检查的安全性.结论灵活应用沟通技巧,使患儿积极主动配合检查,可避免服用水合氯醛,提高检查安全性.