边疆地区创伤患者院前急救的护理研究

目的 对基层医院创伤患者院前急救的护理进行探讨。方法 选择我院2016年1月~12月862例有救护车出车记录创伤患者成立观察组,选择2015年1月~12月725例有救护车出车记录创伤患者成立对照组,对比两组院前急救护理患者预后情况。结果 对照组725例患者中,成功转入院内救治637例,其中收入本院治疗316例,请外院专家及转入上级医院治疗321例,转入院内救治率87.86%;观察组725例患者中,成功转入院内救治842例,其中收入本院治疗378例,请外院专家及转入上级医院治疗464例,转入院内救治率97.68%;观察组转入院内救治率高于对照组,差异有统计学意义（P＜0.05）。观察组死亡20例,死亡率为2.32%,对照组死亡88例,死亡率为12.14%;观察组死亡率低于对照组,差异有统计学意义（P＜0.05）。结论 开展创伤患者院前急救护理过程中,应确保患者呼吸通畅和有效止血,并对生命体征进行严格检测,一旦发现异常立即采取处理措施。     

严重创伤病人到院前急救护理

目的 提高创伤病人急救护理技术。方法 分析了７３例严重创伤病人院前急救护理。措施包括伤情的判断、保持呼吸道通畅、伤口处理、迅速建立静脉通道及安全运送伤员等。结果 院前急救脱险７０例（９５．７％），死亡３例（４．１％）。结论 在急救现场准确判断伤情及恰当的救护是抢救成功的基础，运送途中恰当的护理是抢救成功的保证，熟练掌握规范的急救护理技术是抢救成功的关键。     

严重多发性创伤患者的急救护理

目的：对严重多发性创伤的急救护理措施进行探讨分析。方法选择于2012年1月~2013年8月到我院进行治疗的120例多发性创伤患者作为研究对象，对其行急救护理措施。结果30例死亡,62例痊愈,28例存活但有伤残或并发症。结论医护人员要加强业务技能训练，快速、敏捷的应对各种伤者，做到急诊急救能力精湛全面，提高对伤者的重视程度，以最短的时间确定患者的伤情并抢救，提高抢救成功率。     

多发性创伤的急诊抢救与护理

多发伤是指同一致伤因子引起的,涉及两处或两处以上部位,并且至少有一处损伤是危及病人生命的创伤。如不能在短时间内获得确切治疗,将会给患者增加很大的痛苦,甚至带来严重后果。为此,对我院从1998年1月至2000年9月收治的78例多发性创伤性患者的抢救与护理体会报告如下。     

多发性创伤病因分析与急救护理

目的 探讨多发性创伤病因析与急救护理.方法 分析了47例多发性创伤患者临床资料,分析多发性创伤患者的病因与急救护理,并提快速伤情评估、优先处理致命伤、准确执行急救程序等急救护理措施.结果 治愈25例,致残5例,死亡10例,好转7例.结论 护士增加急救护理意识,多发性创伤患者急救时,迅速分析病因、预见性的病情观察,及时有效的救治,从而降低致残和死亡的发生.     

严重创伤病人到院前急救护理

目的提高创伤病人急救护理技术.方法分析了73例严重创伤病人院前急救护理.措施包括伤情的判断、保持呼吸道通畅、伤口处理、迅速建立静脉通道及安全运送伤员等.结果院前急救脱险70例(95.7%),死亡3例(4.1%).结论在急救现场准确判断伤情及恰当的救护是抢救成功的基础,运送途中恰当的护理是抢救成功的保证,熟练掌握规范的急救护理技术是抢救成功的关键．     

院前急救患者心理护理的效果观察

目的探讨院前急救患者的心理特点和相应的心理护理对策。方法搜集我院2009年6月～2009年12月院前急救的清醒患者268例,并随机分为观察组和对照组,每组各134例。对照组给予常规急救护理,观察组在对照组护理的基础上给予患者、家属综合干预措施,并比较两组的护理效果。结果观察组和对照组护理效果比较差异有统计学意义（P〈0.05）。结论快速高效的急救干预护理措施是院前急救的重要保证,掌握患者的应激反应,护士采用语言、动作等方法使患者顺利过渡配合治疗。     

多发性创伤患者急性应激障碍的联合干预

目的:联合临床心理科与创伤外科对外科多发性创伤伴发急性应激障碍(ASD)患者进行研究,探寻综合医院ASD患者合理有效易操作的联合干预方法。方法:对多发性创伤后符合美国精神疾病诊断标准(DSM-IV-TR)ASD诊断的60例患者随机将30名设为联合干预组,30名设为对照组。联合干预组采用药物治疗加心理联合干预,心理联合干预方法有:情绪管理训练、自助小册子、认知疗法,针对家属的团体辅导,心理联合干预时间共4周,对照组仅采用药物治疗和一般支持治疗,在治疗前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、事件影响量表(IES-R)进行检测。结果:经治疗后联合干预组的HAMD量表分低于对照组,差异均有统计学意义(t=-2.780,P=0.007);HAMD减分率高于对照组,差异均有统计学意义(t=-2.833,P=0.006);联合干预组的HAMD量表分低于对照组,差异均有统计学意义(t=-3.670,P=0.001);HAMD减分率高于对照组,差异均有统计学意义(t=3.776,P=0.000);联合干预组的IES-R量表总分低于对照组,差异均有统计学意义(t=-2.120,P=0.038)。结论 :药物治疗加心理治疗联合干预更能改善多发性创伤ASD患者的情绪状态及应激症状。     

基层医院孕产妇的院前急救与护理

目的回顾分析我院产妇院前急救与护理的方法和效果，探讨院前急救中护理措施。方法对我院2008年1月-2009年6月期间院外接诊的384例孕产妇采取有效的救治，实施规范的治疗与护理，然后总结分析效果与意义。结果全部384例病例，院外救护成功。结论及时有效的院前急救与护理，在保证患者生命安全、降低母婴死亡率，减少产妇并发症方面有重要意义。     

56例心脏肿瘤外科治疗

目的 本文总结了56例心脏肿瘤外科治疗经验及体会。方法 所有患者均在体外循环下进行肿瘤切除，心肌保护方法采用温血心麻液连续灌注，如果肿瘤侵犯心脏重要的组织结构应该做姑息切除，以免出现严重的并发症。结果 心脏良性肿瘤54例，其中53例为心脏黏液瘤，1例为心脏脂肪瘤，心脏恶性肿瘤2例，均为肉瘤。良性肿瘤均能彻底切除。术后心功能能迅速恢复，长期随访无复发，有良好的临床效果。恶性肿瘤不能彻底切除，手术效果差，术后并发症多。结论 心脏肿瘤是性黏液瘤多见，手术效果好。心脏恶性肿瘤以肉瘤多见，因广泛侵润难以彻底切除。     

Clinicopathologic differences between 22 cases of CD56-negative and CD56-positive subcutaneous panniculitis-like lymphoma in Japan

CD56 is an important marker for prospecting clinicopathologic features of cytotoxic T-cell and natural killer (NK)/T-cell lymphomas. We examined 22 cases of subcutaneous panniculitis-like lymphoma and classified these into CD56-positive and CD56-negative groups. The 11 CD56-negative cases were mainly in the younger age group and had systemic subcutaneous nodules without ulceration. They exhibited subcutaneous invasion by medium-sized lymphoma cells, scattered erythrophagocytosis, patchy necrosis, and little tumor invasion in the superficial dermis. Their lymphoma cells had characteristics of CD3 epsilon-, CD8-, TcR beta F1-, T-cell intracellular antigen (TIA)1-, and granenzyme B-positive cytotoxic T cells and were negative for apoptosis-promoting proteins CD95 (Fas), Bax, CPP32 (caspase 3), and p53 (DO7). Ten patients were alive despite clinical signs of hemophagocytic syndrome and relapses in 7 cases. The 11 CD56-positive cases had systemic ulcerative skin tumors composed of pleomorphic lymphoma cells with massive necrosis and little erythrophagocytosis involving the subcutis and also often the whole dermis. Their tumor cells were positive for CD3 epsilon, TIA1, granenzyme B, CD95, CD95L (Fas ligand), Bax, and CPP32. Three cases were of the TcR beta F1-positive phenotype, 1 was of the TcR gamma/delta-positive T-cell phenotype, and 6 were of the TcR beta F1- and TcR gamma/delta-negative NK/T-cell phenotype. Six cases were p53 (DO7) positive. Seven cases had complications of liver dysfunction and cytopenia, and 8 died of disease. One CD56-negative case and 3 CD56-positive cases had nuclear signals of Epstein-Barr virus-encoded RNA in their lymphoma cells. The 2 groups had significantly (P <0.01) different prognoses by Kaplan-Meier and log-rank methods. Patients with CD56-negative and CD56-positive groups had statistically different clinicopathologic, immunohistologic, and functional findings and prognoses.     

42例肾外伤的诊治体会

肾外伤在泌尿生殖器损伤中较为常见，轻者仅表现为镜下血尿，重者大出血并发休克，危及生命。本院自。1995年至2003年间共收治42例，约占同期外伤的6％，结合文献复习，现将肾外伤的诊治体会报告如下。     

Clinicopathologic analysis of 22 cases of subcutaneous panniculitis-like CD56- or CD56+ lymphoma and review of 44 other reported cases

In 22 histologic cases of subcutaneous panniculitis-like lymphoma, we studied the clinicopathologic differences between CD56- and CD56+ cases (11 each). CD56- cases had skin ulcers (1 [9%]); tumor invasion in the superficial dermis (1 [9%]); erythrophagocytosis (10 [91%]); and medium-sized (11 [100%]), CD8+ (10 [91%]), T-cell receptor (TcR)betaF1+ (10 [91%]), and CD95 (Fas)- tumor cells. CD56+ cases had skin ulcers (9 [82%]); tumor invasion in the superficial dermis (8 [73%]); erythrophagocytosis (1 [9%]); and pleomorphic large (10 [91%]), CD8+ (2/10 [20%]), TcRbetaF1 + (3/10 [30%]), and CD95 (Fas)+ (7/10 [70%]) tumor cells. These 7 factors were significantly different between groups (P < .01). Median survival rates were 96 and 12 months for the CD56- and CD56+ groups, respectively. Age younger than 40 years, no skin ulcers, no tumor invasion in the superficial dermis, and CD8+, TcRbetaF1 +, CD95 (Fas)-, and CD56- tumor cells were significantly better prognostic factors (P < .01). The CD56- and CD56+ groups showed different tumor cell characteristics, clinicopathologic findings, and prognosis. In the CD56+ group, 1 was gamma/delta T-cell phenotype, 3 were alpha/beta T-cell, and 6 were TcRbetaF1- and gamma/delta- NK/T-cell, and 3 NK/T-cell cases had nuclear signals of Epstein-Barr virus-encoded RNA. Cases of CD56+ T- and NK/T-cell lymphoma had similar clinicopathologic findings and prognosis.     

输尿管镜在尿道损伤诊断和治疗中的应用（附56例报告）

目的探讨输尿管镜技术在尿道损伤诊断和治疗中的应用。方法回顾性分析输尿管镜直视下诊断和经尿道留置导尿管治疗56例尿道损伤患者的临床效果。结果 56例患者中,诊断前尿道破裂26例,后尿道破裂11例,均成功留置导尿管;诊断前尿道断裂13例,改行尿道损伤段切除加端端吻合术;诊断后尿道断裂6例,行膀胱造瘘术。前尿道损伤患者术后3周、后尿道损伤患者术后4周拔除尿管,随访6~12个月。37例尿道破裂的患者排尿通畅,尿流率在正常范围;后尿道断裂行膀胱造瘘术的患者术后第4个月行尿道造影检查明确尿道狭窄部位后行尿道狭窄段切除加端端吻合术。结论尿道损伤患者,输尿管镜检查可简单、快速地明确损伤类型;在输尿管镜直视下留置导尿管,具有视野清楚、创伤小、并发症少的特点,是尿道破裂理想和有效的治疗方法。     

Multicentric osteosarcoma: clinicopathologic and radiographic study of 56 cases

Multicentric osteosarcoma (M-OGS) is characterized by multicentricity of osseous osteosarcomas, either synchronous or metachronous, without visceral involvement. The study's purpose was to clinicopathologically and radiographically analyze 56 cases of M-OGS (22 synchronous and 34 metachronous). The distal femur was the most common site. Histologically, all tumors were high grade. Of 22 patients with synchronous M-OGS, 16 had 3 or more simultaneous tumors; the axial skeleton was involved in 14 (64%) of 22 cases. In metachronous M-OGS, the second malignancy occurred after a median of 22 months. Treatment was surgery, chemotherapy, radiotherapy, or a combination of these. Patients with metachronous osteosarcoma had a median survival longer than did patients with synchronous tumors. Overall, 8 long-term survivors were treated by aggressive surgery with wide margins (plus chemotherapy and/or radiotherapy). M-OGS combines multiple skeletal locations of high-grade conventional osteosarcomas and has a poor prognosis. Aggressive surgery may result in improved long-term survival, particularly in patients with metachronous disease.     

严重创伤急救与护理研究进展

严重创伤患者伤情复杂、变化快．在24h后出现多器官功能障碍及并发症。各器官生理功能严重紊乱．如急救与护理不及时将危及患者生命。特别是早期救治．即伤后1h内正确判断伤情及处理各种危重症，保护器官功能，是降低伤残率和病死率的重要环节。现就严重创伤的急救与护理作一综述。     

儿童腹膜后神经母细胞瘤56例临床分析

目的总结儿童腹膜后神经母细胞瘤（NB）的Ⅰ临床特征和预后,提高对儿童腹膜后NB的认识。方法回顾性分析首都医科大学附属北京儿童医院血液中心2008年1月至2011年1月收治的腹膜后NB患儿的临床表现、实验室检查、治疗和随访等资料,评价近期和远期疗效,评估2年无病生存率（EFS）。结果56例确诊腹膜后NB患儿纳入分析,男34例,女22例。发病中位年龄41．5（7～147）个月。病程中位数为1．7个月（6d至60个月）。Ⅱ期1例,Ⅲ期2例,Ⅳ期52例,1Vs期1例。高危53例,中危2例,低危1例。①起病时发热24例（42．8％）,肢体疼痛18例（32．1％）,腹部包块14例（25．0％）,腹痛12例（21．4％）,下肢无力3例（5．4％）。（2）49／56例（87．5％）LDH〉240U·L^-1,47／51例（92．2％）NSE〉16．3ng·mL^-1,44／53例（83．0％）24h尿VMA〉30μmol,14／30例（46．7％）SF〉1500ng·mL^-1。③肿瘤原发于肾上腺23例（41．1％）,原发于腹膜后25例（44．6％）,同时原发于肾上腺和腹膜后2例（3．6％）,胸腹联合6例（10．7％）。肿瘤包绕腹部大血管29／49例（59．2％）。27／53例（50．9％）瘤灶直径〉10cm,瘤灶包绕腹部大血管的发生率显著增高（P=0．002）。LDH在瘤灶包绕腹部大血管患儿中显著升高（P=0．021）,在瘤灶直径〉10cm患儿中亦显著升高（P=0．017）。④47例（83．9％）伴骨髓受累,46例（82．1％）有不同程度的骨骼转移,6例（10．7％）伴有腹腔其他脏器转移,3例（5．4％）伴有远处淋巴结受累。⑤40例行原发或转移瘤病理活检,其中神经节母细胞瘤10例（25．0％）,NB30例（75．0％）。⑥1例Ⅳs随诊观察,13例失访,42例采用BCH-NB高危方案规律化疗,16例治疗中肿瘤进展,其余26例完全缓解,继续随访中,中位随访时间19．5（3—52）个月,2年EFS为57．4％。结论儿童腹膜后NB发病年龄较大,临床多表现为发热、肢体疼痛和腹部包块。LDH在巨大瘤灶及瘤灶包绕腹部大血管的患儿中明显升高。病理学检查以NB多见,2年EFS为57．4％。     

新生儿心律失常56例临床分析

本文报道经临床表现和心电图确诊新生儿心律失常56例,其中房性早搏15例(26.7%),室性早搏12例(21.4%),室上性阵发性心动过速10例(17.8%),先天性房室传导阻滞6例(10.6%),窦性心动过缓6例(10. 6%),右束支阻滞6例(10.6%),新生儿心律失常类型以房性早搏最多:其次是室性早搏、室上性阵发性心动过速、房室传导阻滞.新生儿心律失常的病因以感染为主,本文感染29例(51.7%),其次心脏结构异常,先天性房室传导阻滞6例(10.6%),文中讨论了新生儿心律失常的治疗及其结果.