急性三氯化磷中毒误诊病例分析

作者曾遇到一例急性三氯化磷中毒误诊致死病例,为引起同道注意,兹报告如下。 病例摘要 患者××,女性,22岁,为某药厂甲胺磷车间三氯硫磷合成工序操作工.既往体健,该患于就诊前1小时,因三氯硫磷合成釜爆炸,致使以生产原料三氯化磷为主的蒸气弥散于车间空气中,慌乱中患者跌倒在下风向,约经8～9分钟后被人救出。当时患者神志清醒,自觉胸闷、呼吸困难、呛咳,眼睁不开。现场未做任何处置,急送×院急诊室就诊后入院。查体:神清合作,口唇无紫绀,瞳孔等大整圆。心脏听诊无杂音,心率、呼吸频率正常,双肺下部有少量干性罗音,腹软,肝脾未触及。生理反射存在,病理反射未引出。实验室检查:白细胞10.8 ×10~9/L,中性74％,淋巴24％,单核2％。血液胆硷     

物质的量浓度

物质的量浓度是用以表示含量的单位 ,是医学领域常用的计量单位。以前常用“质量浓度” ,单位是“ｍｇ/ｄｌ” ;后来引进各反应物的相对分子质量 ,出现了“克分子浓度”(单位为“Ｍ”)和“当量浓度”(单位为“Ｎ”) ;现在发展到“物质的量浓度” ,单位为“ｍｏｌ/Ｌ” ,ＷＨＯ建议尽可能采用物质的量浓度。其换算式如下。1　质量浓度的换算将质量浓度 (ｍｇ/ｄｌ)换算成量浓度 (ｍｏｌ/Ｌ)时 ,须依据特定的换算系数 ,如血糖的换算系数为 0 .555,尿素氮为 0 .357。换算系数 =1÷该物质的相对分子质量× 10 (因Ｌ =10×ｄｌ)。2　克分子浓度的…     

化学元素与核素符号的书写规范

１　化学元素符号均为正体,且首字母大写,如Ｆｅ、Ｍｇ、Ｃｕ、Ｃｏ。２　核素的核子数（质量数）必须标注在元素符号的左上角,如１３１Ｉ,不得写成１３１碘或Ｉ１３１。３　分子中核素的原子数应标注在核素符号的右下角,如Ｈ２、Ｏ２。４　质子数（原子序数）可在左下角注明,如８２Ｐｂ。５　对于离子态,离子价数和符号“＋”或“－”标在右上角,如Ｍｇ２＋和ＰＯ３－４,不应写成Ｍｇ＋２和ＰＯ－３４或Ｍｇ＋＋和ＰＯ－－－４。６　对于电子受激态和核受激态,可用符号“＊”标于右上角,如ＮＯ＊和１１０Ａｇ＊。化学元素与核素…     

“升”加词头后符号用“L”不用“l”

单位升是我国法定单位,其符号为“L,(l)”。我国推荐采用“L”,“l”为备用符号。目前出版的科技书刊中升的符号几乎均选用“L”,因此加词头后其符号也应用“L”,即毫升应写作“mL”,不用“ml”;微升应写作“μL”,不用“μl”。“升”加词头后符号用“L”不用“l”@吴淑芬     

妇科超声影像报告和数据系统联合三维超声造影鉴别诊断卵巢良恶性肿块

Objective To evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and 3D contrast-enhanced ultrasonography (3D-CEUS) in identifying malignant lesions from benign ovarian masses. Methods Both of 2D ultrasound (2D-US) and 3D-CEUS were performed on 102 patients with ovarian masses. The perfusion characteristics of ovarian masses were observed with 3D-CEUS,and the 2D-US features of ovarian masses were analyzed based on GI-RADS. Simple and multiple Logistic regression analysis were used to investigate whether the independent risk predictors in differential diagnosis of benign and malignant ovarian could be confirmed. In addition, ROC curves were drawn. The diagnostic efficacy of GI-RADS combined with 3D-CEUS scoring system was evaluated and compared with that of only GI-RADS. Results Simple and multiple Logistic regression analysis confirmed that there were 8 independent predictors of malignant masses, including large papillary projections (≥ 7 mm), separated or wall thickness ≥ 3 mm, central blood flow, the proportion of solid part ≥ 50%, combination of ascites, high level enhancement, uneven distribution of contrast media in enhanced solid part and the vascular with characteristics as dense, tortuous and anfractuous. When using 4 points as the cut-off, the area under the curve (AUC) of GI-RADS combined with 3D-CEUS scoring system in identifying malignant ovarian masses was 0.969, higher than that of only GI-RADS (0.839; Z=1.64, P=0.029). Furthermore, the scoring system showed higher sensitivity, specificity, positive predictive value, negative predictive value and accuracy (all P<0.001). Conclusion The combination of GI-RADS with 3D-CEUS can be more effective to distinguish malignant lesions from benign ovarian masses.     

槐杞黄颗粒治疗儿童紫癜性肾炎临床疗效及对免疫功能的影响

目的 观察槐杞黄颗粒治疗儿童紫癜性肾炎的临床疗效及其对患儿免疫功能的影响.方法 选取山西省儿童医院肾内科收治的紫癜性肾炎患儿120例为研究对象,按照随机数字表法分为常规综合治疗的对照组和联合槐杞黄颗粒治疗的观察组,每组各60例.2组均连续治疗随访6个月,并于治疗后1年进行回访.观察2组患儿临床治疗效果,治疗前后血白蛋白...     

多b值DWI-MRI在宫颈癌放化疗效果评价中应用价值

目的:探讨磁共振多b值弥散加权成像对宫颈癌放化疗效果的应用价值。方法:选取51例经临床证实为IIa期以上宫颈癌患者,并接受放化疗的治疗,在治疗前、治疗后2~3周及治疗结束后行常规MRI及多b值DWI检查,测量治疗前、后肿瘤ADC值及最大径,分析放化疗前后ADC值差异性以及与肿瘤最大径退缩率的相关性。结果:宫颈癌于放化疗后ADC值升高,放化疗前、放化疗后2~3周及结束时ADC值分别是（0.81±0.13）×10-3 mm2/s、（1.18±0.14）×10-3 mm2/s、（1.47±0.22）×10-3 mm2/s,两两之间差异具有统计学意义(P＜0.01);放化疗前与放化疗2~3周的ADC值差值(T值)为（0.37 ±0.13)×10-3 mm2/s,放化疗前后肿瘤最大径退缩率为0.78±0.12,放化疗前、放化疗后2~3周及结束时ADC值与肿瘤最大径退缩率均无相关性,T值与肿瘤最大径退缩率有正相关性(P＜0.05)。结论:宫颈癌病灶ADC值放化疗后升高,放化疗后ADC值早期升高幅度与肿瘤最大径退缩率具有正相关性,可作为预测宫颈癌化疗治疗效果的理想手段之一。     

拔除人工气道后应用无创呼吸机的护理体会

建立人工气道,行有创机械通气,是慢性阻塞性肺疾病(COPD)患者在病情危重关头首选的呼吸支持手段.一旦病情好转,即需及时撤离有创呼吸机,拔除气管插管.     

“症”、“证”、“征”的用法应规范

“症”用于“症状”、“并发症”、“病症”。“证”用于“适应证”、“禁忌证”、“证候”。“征”用于“综合征”、“体征”、“指征”、“征象”。