单腔与双腔内镜下闭合内镜黏膜下剥离术 相关创面或穿孔的疗效比较*

目的观察比较单腔内镜(SCE)与双腔内镜(DCE)下荷包缝合内镜黏膜下剥离术(ESD)相关手术创面或穿孔的临床效果。方法胃黏膜或黏膜下肿块患者38例,随机分成A、B两组,并行ESD术。其中SCE组予以SCE下闭合创面或穿孔,DCE组予以DCE下闭合。结果 38例行ESD术后,创面或穿孔均予以SCE或DCE下尼龙绳成功闭合。结论应用SCE或DCE下尼龙绳和钛夹成功闭合ESD创面或大穿孔,两者疗效相当,但SCE应用更加广泛。SCE有望取代DCE用于ESD创面或大穿孔的闭合,这为内镜下闭合大面积胃肠穿孔或ESD创面提供了新的途径。     

内隐外显协同教学法在基础护理教学中的应用

目的 探讨内隐外显协同教学法在护理专业教学中的可行性.方法 将120名学生随机分成实验组（60例）和对照组（60例）.在基础护理的教学中对照组采用传统的教学方法,实验组采用以协同教学法为主的教学方法.结果 除护理仪表得分两组比较差异无统计学意义（P＞0.05）外,实验组学生的考核成绩、对基础护理的教学方法评价、实验教师对实验组学生的综合素质评价都明显高于对照组,两组比较差异均有统计学意义（P＜0.01）.同时,实验组对专业学习的兴趣程度也明显高于对照组.结论 协同教学法能够提高基础护理的教学效果和学习成绩,激发学生的专业兴趣,同时,也是素质培养的有效途径.     

内蒙古呼伦贝尔地区成人慢性肾脏病流行病学调查

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in the general adult population in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region where many minorities of north China live. Methods Sampling surveywas performed in the residents aged 20 years and older in the Hulunbeir Prefecture. All the investigated subjects were tested for urinary albumin to creatinine ratio (ACR); hematuria by microscopy of urinary sediment; and GFR estimated by modified MDRD equation for Chinese adults (eGFR). The related risk factors of CKD were also investigated. Results A total of 4522 subjects were enrolled in the study. The prevalence of albuminuria was 7.11％, hematuria was 2.64％ and reduced eGFR [60 ml-min-1·(1.73 m2)-1] was 2.75％. The prevalence of hypertension was 38.90％; hyperglycemia 6.61％; hyperlipidemia 2.72％; increased waist 24.79％ and metabolic syndrome 15.02％. After the subjects with combined microalbuminuria, hematuria and reduced eGFR were excluded, the prevalence of CKD was 12.95％. Logistic regression analysis and stratified analysis showed increased age, increased waist, elevated systolic pressure, hyperglycemia,hypertriglyceridemia and metabolic syndrome were independently associated with albuminuria;increased age, elevated systolic pressure and hyperglycemia were independently associated with reduced eGFR; increased age was independently associated with hematuria. Conclusions The prevalence of adult CKD is 12.95％ in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region. Independent risk factors of CKD include increased age, increased waist, hypertension,abnormal blood glucose or lipid, and metabolic syndrome.     

内蒙古呼伦贝尔地区成人慢性肾脏病流行病学调查

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in the general adult population in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region where many minorities of north China live. Methods Sampling surveywas performed in the residents aged 20 years and older in the Hulunbeir Prefecture. All the investigated subjects were tested for urinary albumin to creatinine ratio (ACR); hematuria by microscopy of urinary sediment; and GFR estimated by modified MDRD equation for Chinese adults (eGFR). The related risk factors of CKD were also investigated. Results A total of 4522 subjects were enrolled in the study. The prevalence of albuminuria was 7.11％, hematuria was 2.64％ and reduced eGFR [60 ml-min-1·(1.73 m2)-1] was 2.75％. The prevalence of hypertension was 38.90％; hyperglycemia 6.61％; hyperlipidemia 2.72％; increased waist 24.79％ and metabolic syndrome 15.02％. After the subjects with combined microalbuminuria, hematuria and reduced eGFR were excluded, the prevalence of CKD was 12.95％. Logistic regression analysis and stratified analysis showed increased age, increased waist, elevated systolic pressure, hyperglycemia,hypertriglyceridemia and metabolic syndrome were independently associated with albuminuria;increased age, elevated systolic pressure and hyperglycemia were independently associated with reduced eGFR; increased age was independently associated with hematuria. Conclusions The prevalence of adult CKD is 12.95％ in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region. Independent risk factors of CKD include increased age, increased waist, hypertension,abnormal blood glucose or lipid, and metabolic syndrome.     

肾病综合征并发腹主动脉血栓一例

急性腹主动脉血栓栓塞是血管外科急重症,其并发症凶险,病死率为35%～80%[1].本病少见,部分医师对此病缺乏认识,极易误诊[2].我院最近收治1例肾病综合征并发腹主动脉血栓患者,报告如下. 男性,67岁,因反复水肿1年、腰痛3 d、双下肢无力7 h,于2009年12月16日入本院.患者1年前出现眼睑水肿,渐及全身,自购利尿药(药名及量不详)间断服用,未到医院就诊.     

内蒙古呼伦贝尔地区成人慢性肾脏病流行病学调查

目的 探讨我国内蒙古自治区呼伦贝尔少数民族聚居区成年人群中慢性肾脏病（CKD）患病率及其危险因素。 方法 对该地区20岁以上常住居民进行CKD抽样调查,被调查者均检测了尿白蛋白/肌酐比率、血尿（离心后尿沉渣显微镜检查）及估计肾小球滤过率（eGFR,检验血清肌酐后用国人校正的简化MDRD公式计算）;并同时调查了CKD的相关危险因素。 结果 符合入选条件的被调查者共4522例,白蛋白尿阳性率为7.11%;血尿阳性率为2.64%;eGFR低于60 ml•min-1•(1.73 m2)-1者为2.75%;去除白蛋白尿、血尿及eGFR下降共同存在造成的重复,该地区CKD患病率为12.95%。高血压患病率38.90%,糖代谢异常6.61%,脂代谢异常34.60%,腰围增大24.79%,代谢综合征15.02%。多因素Logistic回归分析及分层分析显示,年龄增加、腰围增大、收缩压升高、空腹血糖升高、血清三酰甘油增高及患代谢综合征与白蛋白尿发生相关;年龄增加、收缩压升高及空腹血糖升高与肾功能下降相关;年龄增加与血尿发生相关。 结论 内蒙古自治区呼伦贝尔地区CKD患病率为12.95%。相关危险因素包括年龄增加、腰围增大、高血压、血糖或血脂异常、及代谢综合征。     

胃镜下切除胃肌层肿块69例分析

目的 探讨内镜下黏膜剥离术(ESD)治疗胃肌层肿块的疗效及安全性.方法 分析2008年6月～2011年6月于南昌大学第一附属医院消化内科行ESD治疗胃肌层肿块患者,术前均经超声胃镜诊断,行ESD,术后切除组织均送病理切片检查,并内镜随访.结果 共69例,肿块直径0.5～ 2.0 cm;完整切除54例(78 3％),尼龙绳套扎+活检10例(14.5％);术后病理诊断平滑肌瘤39例,间质瘤23例,血管瘤3例,其他4例.出血16例,均行内镜下治疗好转;穿孔7例,均行钛夹闭合和胃肠减压后6例痊愈,1例术后第3天出现明显腹膜炎行外科手术治疗.结论 ESD治疗胃肌层直径小于2.0cm肿块是安全可行的,主要并发症是出血和穿孔,大多可通过内镜下治疗解决.     

高通量滤器F50复用对血透患者生存质量的改善

目的：探讨使用复用高通量滤器F50对血透患者生存质量的影响。方法：回顾性分析我院60例血透患者,复用高通量滤器F50治疗,3年前后血肌肝、尿素氮、血红蛋白、促红细胞生成素的使用量、体重及血压情况等资料。除血液透析治疗外,根据血钙、磷情况部分病人应用罗钙全或碳酸钙,根据血压情况使用降压药,根据血红蛋白（Hb）、红细胞压积（Hct）情况应用促红细胞生成素皮下注射,Hb 110～130 g/L,为靶目标值。结果：复用高通量滤器F50 3年后病人体重、血红蛋白及血浆白蛋白均较3年前有明显升高,85%病人血红蛋白达到靶目标值,促红细胞生成素使用量降低,患者的血压、干体重达到治疗目标;患者的生化指标如白蛋白、血钙、磷均纠正在正常值范围内。结论：复用高通量滤器F50治疗可使病人营养状态指标包括体重、血红蛋白及血浆白蛋白均较前有明显改善,促红细胞生成素用量减少,生存质量得到明显改善。     

人文关怀护理在老年患者中的应用

目的探讨在老年患者中开展人文关怀护理的方法及效果。方法回顾性分析2005年1月至2009年1月采用人文关怀护理老年患者300例与2005年1月前未采用人文关怀护理的患者300例,对比两者护理工作满意情况。结果观察组和对照组对护理工作的满意度分别为97．8％和90．9％,观察组均显著高于对照组。（P〈0．05）差异有统计学意义。结论人文关怀护理可以促进老年患者康复,提高患者对护理工作的满意度。