“以学生为主体”模式在医学生“问诊”见习课的应用研究

以学生为主体”教学模式在临床医学教学中已得到充分推广,但其在实践中的效果仍不理想。在医学本科生“问诊”见习课中,通过“早期临床实践”、“以症状学知识为载体的问诊教学”和“多重角色扮演”等一系列教学改革措施,为完善“以学生为主体”教学模式进行积极尝试与探索。     

下肢多功能枕的设计与应用

<正>目前,髋关节脱位是髋关节置换术后常见的并发症之一,初次置换术后脱位发生率为3.2%~6.5%,全髋关节翻修术后脱位发生率为7.4%~11.4%[1],早期脱位因髋关节周围肌肉、关节囊的力量没有恢复正常,而病人又将下肢放置在容易发生关节脱位的危险体位所致。目前应用最多的是梯形枕和三角枕,但此类枕头不利于侧卧时使用,病人常因患肢过度悬空而     

2010年湖北地区三级医院成人细菌耐药性分析

细菌耐药监测可以观察细菌耐药的特点、细菌耐药的变迁,并且对抗生素的临床应用具有指导意义。为了解湖北地区成人细菌耐药情况,对全省16家三甲医院成人细菌感染的临床分离菌进行了耐药性分析,现报告如下。1材料与方法     

心理压力是如何产生的

正首先是个别差异每个人由于体质不同,所以对疾病的抵抗力也不一样。同样,人对心理、感情上的压力也有不同的反应。事实证明,无法适应挑战的人通常较容易生病。当然,压力的来源并不只在身体方面,心理问题也会引起压力。因此,如果说压力引发沮丧,焦虑的情绪也同样会造成压力。压力问题是恶性循环的,过度的压力会引起身心衰弱,而身心衰弱则使人不能应付挑战,这样就又造成了压力。     

经颅磁刺激对海马原代神经元突起生长的影响

目的 观察经颅磁刺激(transcranial magnetic stimulation,TMS)对体外培养的海马原代神经元突起生长及形态的影响,并初步探讨磁刺激对细胞生长发育的影响机制.方法 体外培养的海马原代神经元分为正常培养组(C组),假刺激组(S组),40%最大刺激强度组(M1组),60%最大刺激强度组(M2组),培养细胞24 h后开始磁刺激,每天固定时间刺激,刺激的频率为1 Hz,磁刺激最大输出强度为1.9 T,每天刺激3次,每次20序列,每个序列间隔1 s,每次间隔1 min,连续刺激5 d,刺激源距离细胞1.0 cm.刺激结束后进行免疫荧光染色,观察原代神经元突起形态学改变,比较突起生长数目的 改变及SYN-I表达的改变.结果 TMS 5 d后观察细胞生长状态良好,细胞与细胞间联系较多,部分细胞表现为多突起生长.M1、M2组2个突起的神经元占总神经元的比例分别为(45.6±14.9)%和(45.2±15.6)%,较C组和S组明显增多,差异有统计学意义(P＜0.05);3个及3个以上突起的神经元占总神经元的比例分别为(30.3±10.8)%和(29.3±11.5)%,较C组和S组亦明显增多,差异有统计学意义(P＜0.05).M2组的SYN-I mRNA的表达较C、S两组增高,差异有统计学意义(P＜0.05).结论 TMS可以促进体外培养的海马原代神经元突起的生长.     

呼吸内科住院患者痰培养和药敏结果临床分析

为了控制感染,临床上广泛使用抗生素,因而细菌的耐药性问题日益受到重视.我们对2003～2006年呼吸内科院内感染569例次痰培养阳性标本进行了细菌分布和耐药率分析.     

讲话瓣膜在气管造口患者中的应用

讲话瓣膜（Passy-Muir tracheostomy speaking valve，PMV）在国外的呼吸科、耳鼻喉科、神经内外科、儿科等已应用十几年，主要针对气管切开术后需长期保留气管造口的患者；但我国目前尚少报道。现将我科应用PMV情况报道如下。     

益心舒胶囊对X综合征临床症状及焦虑状态的观察

目的：观察益心舒胶囊（YXSC）治疗心脏 X 综合征焦虑状态的临床疗效。方法232例入选患者随机分为治疗组（120例）和对照组（112例）。两组患者均给予X综合征的常规治疗,在此基础上,治疗组加服YXSC,每次3粒,每日3次,疗程12周。结果治疗组临床总有效率为87.50%,对照组为83.04%（P〉0.05）;两组均有改善心绞痛发作次数、持续时间的作用（P〈0.01）;治疗组对改善临床心悸、乏力、头晕目眩症候,以及焦虑情绪评分等方面疗效明显好于对照组（P〈0.01）。结论 YXSC 治疗 X综合征焦虑状态有较好的疗效。     

入院前电话通知对中老年ST段抬高心肌梗死患者进急诊室至球囊扩张时间的影响

目的 探讨入院前心电图采集和电话通知对ST段抬高心肌梗死(STEMI)患者进入急诊室至球囊扩张时间[进门至球囊扩张(door to balloon,D2B)时间]的影响. 方法 对2006年1月至2007年12月就诊于北京安贞医院抢救中心并接受直接经皮冠状动脉介入治疗(PCI)的STEMI患者的临床资料进行分析.将患者分为3组:无入院前心电图(无心电图)组、有入院前心电图(有心电图)组和依据入院前心电图进行电话通知(电话通知)组.主要分析指标为D2B时间.次要分析指标为住院期间患者病死率. 结果 纳入研究患者402例,其中无心电图组137例(34.1%),有心电图组176例(43.8%),电话通知组89例(22.1%).3组患者年龄、性别、既往病史及心肌梗死部位比较,差异无统计学意义(P0.05).与无心电图组比较,有心电图组和电话通知组患者D2B时间缩短,3组分别为113 min、96 min和86 min(均P<0.01).3组患者住院期间病死率[分别为4例(2.9%)、4例(2.3%)和3例(2.2%)]比较,差异无统计学意义(均P0.05). 结论 入院前心电图采集和早期电话通知能缩短STEMI患者D2B时间,使更多的患者D2B时间<90 min.入院前与医院建立电话联系可缩短再灌注时间.     

急性心肌梗死冠状动脉内抽吸物的病理分析

Objective To analyze the components of retrieved materials from the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients by manual aspiration during primary percutaneous coronary intervention (PCI). Methods Visible retrieved materials were collected, fixed in formalin and processed for paraffin embedding, sectioned and stained with hematoxylin and eosin (HE). The retrieved materials were microscopically divided into erythrocyte-rich thrombi, platelet/fibrin-rich thrombi, combined thrombi (similar proportions of erythrocytes and platelet/fibrin components), atherosclerotic plaque materials and edematous components. Based on pathological findings, thrombus materials were classified into fresh (< 1 d), lytic (1-5 d), frash/lytic and organized thrombi(>5 d) after formation. All patients were further classified into plaque positive and plaque negative groups. Clinical and angiographic data were also obtained for analyzing possible association between pathological findings and surrogates of myocardial reperfusion, including myocardial blush grade (MBG), enzymatic estimated infarction size (peak CK and CK-MB levels), left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) which were assessed 16 h after procedure. Results Visible samples were collected from 49 patients by manual catheter aspiration (thrombus components in 46 patients, atherosclerotic plaque only in 3 patients). Frequency of erythrocyte-rich thrombi, platelet/fibrin-rich thrombi and combined thrombi were 41.3% (19/46), 30.4% (14/46) and 28.2% (13/46), respectively. The incidence of fresh, lyric, fresh/lytic and organized thrombi were 47. 8% (22/46), 32. 6% (15/46), 10.9% (5/46) and 8.7% (4/46), respectively. Plaque materials were found in 57.1% (28/49) patients, including ruptured plaque accompanied by thrombus formation [8.2% (4/49)], fibrous plaque [6.1% (3/ 49)] and thickened intima [2.0% (1/49)]. Baseline characteristics did not differ between plaque positive (n=28) and plaque negative (n=21) groups. Ratios of MBG 3 were higher in plaque positive group than in plaque negative group [82.1% (23/28) vs. 52. 4% ( 11/21 ), P=0.025]. Peak CK and CK-MB levels were lower in the former than in the later [(1705±1647)U/L vs. (2629±2013)U/L, P=0. 042; (146± 136) μg/L vs. (258±215) μg/L, P=0.016; respectively]. Furthermore, LVEF were higher in plaque positive group than in plaque negative group (0.59±0. 10 vs. 0.52±0.08, P=0.012). Conclusion Manual catheter aspiration during primary PCI in STEMI patients is an effective way for removing thrombus and plaque materials, and plaque debulking before stenting or pre-dilation and this procedure might probably improve myocardial reperfusion, limit infarction size and improve cardiac function.