自制分根器在分根法拔牙中的应用

目的:总结自行设计制作一分根器的临床应用效果。方法:选取200例需要拔除的复杂多根牙随机分为2组,研究组采用自制刃部四凹槽结构的分根器分根后拔除患牙,对照组采用传统的劈凿法拔除患牙。记录手术时间、患者的损伤情况和术后病人反应。结果:观察组手术时间和术后并发症均明显少于对照组(P<0.05),自制分根器在分根、挺根的使用效果良好。结论:自制分根器用于分根拔牙中具有安全、组织损伤小、病人痛苦小等优点。     

米非司酮用于子宫肌瘤临床观察

子宫肌瘤是生育期年龄妇女最常见的良性肿瘤。30岁以上妇女发病率高达20%。虽然全子宫切除是治疗该病的有效方法，但是由于各种原因，许多病人难以接受。近年来的研究表明，孕激素对肌瘤增生起重要作用，孕激素拮抗剂米非司酮可使肌瘤萎缩．我们用小剂量米非司酮治疗子宫肌瘤25例．现将结果报告如下。     

保定市学龄前儿童体重指数与血红蛋白、体内必需元素调查分析

<正>学龄前期是儿童生长发育的关键时期。血红蛋白(hemoglobin,Hb)、体内必需元素是体质发育重要的影响因素,并与儿童免疫功能、智力发育和疾病发生有着密切的联系。体重指数(body mass index,BMI)是反映整体肥胖的指标。BMI与肥胖的并发症和疾病死亡率有关。研究BMI、Hb和体内必需元素之间关系有重要的临床意义。为此,我们对保定市城区幼儿园不同年龄学龄前儿童进行血常规、体内必需元素和BMI检测,以探讨三者之间的关系。     

中分子羟乙基淀粉注射液辅助治疗急性脑梗死的临床疗效观察

目的探讨中分子羟乙基淀粉注射液辅助治疗急性脑梗死的临床疗效。方法回顾性分析笔者所在医院自2011年1～12月收治的82例急性脑梗死患者的临床资料。结果观察组和对照组治疗后神经功能缺损程度评分较治疗前差异有统计学意义(P<0.01);观察组治疗后7d、14d神经功能评分与对照组比较差异有统计学意义(P<0.05),观察组治疗总有效率为92.86%,对照组治疗总有效率为82.50%,二者比较差异有统计学意义(P<0.05)。结论中分子羟乙基淀粉注射液辅助治疗急性脑梗死治疗效果显著,值得临床推广应用。     

乡镇医院护理科研现状调查

[目的]了解乡镇医院护理人员对护理科研知识的认知与需求.[方法]采用自行设计的护理科研知识问卷对广东省佛山市某区三所乡镇医院共259名护士进行问卷调查;并结合区卫生局2009年、2010年护理科研立项情况进行分析.[结果]乡镇医院护理人员护理科研知识缺乏,对护理科研步骤、护理科研种类及护理科研选题知晓率分别为15.06%、16.60%、13.51%;缺乏系统的知识学习及相应的技能培训,参加培训者仅占30.12%;对护理科研知识需求强烈,愿意参加科研者占87.64%,而对护理科研的选题及设计、撰写论文的需求更强烈.[结论]上级护理行政部门应加大对乡镇医院护理人员科研知识的培训及指导;医院内成立护理科研小组,组织对护理科研知识的学习及技能的培训、护理科研课题的指导及评审.     

不同流式细胞分析系统对外周血淋巴细胞亚群分析结果的影响

目的 探讨部分临床实验室FCM淋巴细胞亚群分析参考范围应用的合理性及不同生产厂家的流式细胞仪和试剂组合对淋巴细胞亚群分析结果的影响.方法 根据国内临床实验室常用的3个流式细胞仪型号(Beckman Coulter Epics XL、Beckman Coulter Cytomics FC500、BD FACS Calibur),分别选取3家北京地区临床流式细胞室(A、B、c室),按照各室的实际检测方案分别测定50份健康人静脉血标本,以验证各室淋巴细胞亚群分析参考范围是否合理.调查3家实验室室内全血质控品使用情况,并将商品化全血质控品分发各室,按照各自的实际实验方案在20个工作日内与常规标本平行处理、检测和分析.针对不同生产厂家的试剂,在同一流式细胞仪(型号为Beckman Coulter Epics XL)上用a、b、c、d 4种不同的试剂组合对20份患者标本进行检测,其中试剂组合a为美国Beckman Coulter公司同厂配套试剂和仪器,试剂组合b、c、d的检测结果分别与试剂组合a比较,计算b、c、d试剂组合偏倚>10%的概率.采用相同试剂和溶血素(美国Beckman Coulter公司)对24份患者标本进行前处理,分别在2台不同厂家和型号的流式细胞仪(型号为Beckman Coulter Epics XL和BD FACS Calibur)上检测,比较相同试剂处理标本后不同仪器对淋巴细胞亚群分析结果的影响.采用同厂配套试剂和仪器,比较Beckman Coulter Epics XL和BD FACS Calibur两个流式细胞检测系统对20份患者标本检测结果的影响.结果 A室的自然杀伤(NK)细胞及CD+4 T淋巴细胞/CD+8 T淋巴细胞(T4/T8),B、c两室的T4均有大于10%的结果落在相应的参考范围之外,超出相应参考范围的概率分别为16%(9/50)、24%(12/50)、22%(11/50)、12%(6/50).3家实验室20个工作日内的室内质控均在参考范围内.与试剂组合a比较,试剂组合b、c的所有项目偏倚均较大,其中偏倚>10%的概率最低为试剂组合b的T8,为70%(14/20);最高为试剂组合b、c的T淋巴细胞(T3)、T4,均达到100%(20/20).试剂组合d的T3、T8和B淋巴细胞(B)偏倚较大,偏倚>10%的概率分别为35%(7/20)、85%(17/20)、75%(15/20).不同生产厂家的试剂、仪器处理和分析标本的结果,与采用同一生产厂家的试剂、仪器处理和分析的结果相比,T3、T4、T8、B、NK均存在较大偏倚,偏倚>10%的概率分别为71%(17/24)、80%(19/24)、38%(9/24)、33%(8/24)、92%(22/24).Beckman Coulter Epics XL和BD FACS Calibur两个流式细胞检测系统相比较,T8、NK和B的偏倚均较大,偏倚>10%的概率分别为55%(11/20)、70%(14/20)、55%(11/20).结论 流式细胞实验室需要建立自己的参考范围并定期验证,以便合理进行调整.建议定期采用全血质控品,并累计质控数据.各实验室应选择同厂配套试剂处理标本.

Abstract：

Objective To investigate the appropriate setting up of normal reference ranges of lymphocyte subsets in some flow cytometry laboratories and to study the effects of different flow cytometers and various reagents by different manufacturers on the analysis of peripheral blood lymphocyte subsets. Methods Three FCM labs (named A, B and C) in Beijing region were selected representing 3 commonly used flow cytometers (Beckman Coulter Epics XL, Beckman Coulter Cytomics FC500, BD FACS Calibur). 50 samples from healthy donors were distributed to 3 labs and tested according to individual lab's standard operating procedure to verify whether the normal reference ranges of peripheral blood lymphocyte subsets established were appropriate. The application of internal quality control was also investigated. Commercial blood quality control reagents were given to the 3 FCM labs and tested within 20 working days paralleled with routine samples. In addition, 20 patients' samples were prepared using 4 different combinations of reagents ( a , b , c and d). The results from combination a, which used the Beckman Coulter reagents and instrument, were compared to the results from combination b, c and d, which used reagents from different manufacturers. Then the prepared samples were tested on Beckman Coulter Epics XL to evaluate the effects of different combinations of reagents on the results of peripheral blood lymphocyte subsets analyzed by the same instrument. Furthermore, 24 patients' samples prepared by same reagents from Beckman Coulter company were tested on both Beckman Coulter Epics XL and BD FACS Calibur respectively to assess the effects of different instruments on peripheral blood lymphocyte subsets. 20 patients' samples prepared by same reagents and instruments were analyzed by Beckman Coulter Epics XL analytic system and BD FACS Calibur analytic system respectively to assess the effects of the two analytic systems on the lymphocyte subsets. Results Over 10% of the results for NK and T4/T8 in lab A as well as T4 in labs B and C fell outside of their normal reference ranges. The probabilities exceeding corresponding normal reference ranges were 16% ( 9/50 ), 24% ( 12/50 ), 22% (11/50) and 12% ( 6/50 ), respectively. The results using internal blood quality control in 3 FCM labs within 20 working days were all within the reference ranges of the quality control provided by the kit. The biases from b and c reagent combinations were substantial compared with that of reagent a combination. Among the biases from b and c reagent combinations, the lowest probability of bias exceeding 10% was T8 of combination b, which had probability of 70% (14/20). The highest probabilities of hias exceeding 10% were T3 and T4 of b and c reagent combinations, which reached 100% (20/20) . Furthermore, the biases of T3, T8 and B of d reagent combination compared with that of reagent a combination were also substantial. The probabilities of bias exceeding 10% were 35% (7/20) ,85% (17/20) and 75% (15/20), respectively. Comparing the results of samples prepared and analyzed by reagents and instruments from different manufacturers to that of samples prepared and analyzed by the same company's reagents and instruments showed that there were great discrepancies in T3, T4 , T8 , B and NK. The probabilities of bias exceeding 10% were 71% ( 17/24), 80% (19/24) ,38% (9/24), 33% (8/24) and 92% (22/24), respectively. The biases of T8, NK and B were substantial when compared the results from Beckman Coulter Epics XL analytic systems and BD FACS Calibur analytic systems. The probabilities of bias exceeding 10% were 55% (11/20 ), 70% ( 14/20 ) and 55% (11/20), respectively. Conclusions FCM labs should set up their own normal reference range for peripheral blood lymphocyte subsets. The normal reference range should be verified periodically. It is important to apply internal blood quality control regularly and accumulate the quality control results. The reagents and instrument for preparing peripheral blood samples should be from the same manufacturers.     

男性手术患者全身麻醉留置导尿的时机与护理

全身麻醉后行留置导尿的男性患者,在舒适度上优于麻醉前导尿[1],但在麻醉清醒期对导尿管的耐受性差,尿道刺激症状明显,甚至无法忍受,导致强烈躁动[2].而术前留置导尿可以引起患者的疼痛和不适感,但患者麻醉清醒后对导尿管刺激的耐受性好,增加手术后较长留置期间的舒适度[3-4].根据术后留置尿管时间的长短,我们对85例男性留置导尿患者全身麻醉前后插管时机及舒适度进行了研究.现将结果报告如下.     

白介素-2局部封闭加红光照射治疗外阴白色病变疗效观察

目的探讨白介素-2局部封闭加红光局部照射治疗外阴白色病变的临床疗效。方法 69例外阴白色病变患者,分为治疗组41例和对照组28例,治疗组,采取重组人白介素-2 20万U、2%利多卡因2～5ml推注病变周围,1次/3d,10d为1疗程;涂抹奇白消软膏加红光局部照射每日1次,10d为1疗程,疗程间隔20d,治疗1～3疗程。对照组采用传统保守治疗方法,对鳞状细胞增生型患者外阴涂抹哌瑞松软膏,对硬化苔癣型患者外阴涂抹0.5的丙酸睾丸酮鱼肝油软膏,每天1次,1周为1疗程,治疗6～8疗程。结果治疗组41例,治愈10例,显效27例,好转3例,无效1例,总有效率97.56%。对照组28例,治愈5例,显效14例,好转4例,无效5例,总有效率82.14%。结论白介素局部封闭加红光局部照射治疗外阴白色病变效果明显。     

白细胞介素-2联合紫杉醇及卡铂治疗晚期卵巢癌疗效观察

目的 观察白细胞介素-2（IL-2）与紫杉醇、卡铂联合治疗晚期卵巢癌的近期疗效及不良反应.方法 对29例初治或复发的晚期卵巢癌患者使用IL-2联合紫杉醇、卡铂化疗方案进行治疗.IL-2 2500 IU静脉滴注,第1天;紫杉醇175 mg/m2,静脉滴注3h,第2天,卡铂曲线下面积=5静脉滴注,第2天.用紫杉醇之前常规进行预防性抗过敏处理.3周为1个周期,至少化疗3个周期,3个周期后评定疗效及不良反应.结果 29例均可评价疗效,有效率为62.07％（18/29）,其中完全缓解3例（10.34％）,部分缓解15例（51.72％）,稳定9例（31.03％）,进展2例（6.89％）.主要不良反应为恶心、呕吐、腹泻腹痛、中性粒细胞减少、乙酰胆碱综合征等,多为1～2级.结论 IL-2联合紫杉醇、卡铂是治疗晚期卵巢癌的有效方案,且不良反应可耐受,值得临床进一步研究.     

二甲双胍分别联合西格列汀及吡格列酮对2型糖尿病患者血糖、胰岛β细胞功能和胰岛素抵抗的影响

目的:探讨二甲双胍联合西格列汀及二甲双胍联合吡格列酮分别治疗2型糖尿病对血糖及胰岛素的影响。方法:选取2016年8月—2019年1月于我院内分泌科治疗的2型糖尿病患者90例,随机分为两组(西格列汀组和吡格列酮组),每组45例。西格列汀组行二甲双胍和西格列汀联合治疗,吡格列酮组行二甲双胍和吡格列酮联合治疗,两组均连续治疗6个月。比较分析两组治疗前后空腹血糖、糖化血红蛋白、空腹胰岛素、餐后2 h胰岛素、胰岛素抵抗指数及胰岛β细胞功能指数。结果:治疗后,两组空腹血糖、糖化血红蛋白及胰岛素抵抗指数均降低,且西格列汀组低于吡格列酮组(P<0.05);两组空腹胰岛素、餐后2 h胰岛素及胰岛β细胞功能指数均升高,且西格列汀组高于吡格列酮组(P<0.05)。结论:联合二甲双胍用药,西格列汀治疗2型糖尿病对血糖及胰岛素水平的改善优于吡格列酮。