喉癌术后人工气道的护理体会

目的探讨喉癌手术后人工气道的护理对降低呼吸道感染并发症的效果。方法对我科2000-2008年21例行喉癌喉切除术后患者人工气道护理进行回顾性分析。结果21例喉癌患者（其中有18例喉部分切除术,行喉成形术;3例全喉切除术,行气管造瘘术）住院期间均呼吸道通畅无感染,伤口均I期愈合。结论喉癌术后患者采取人工气道精心护理,对防止呼吸道感染等并发症的发生具有重要作用。     

老年喉癌患者术后气道管理探讨

目的：探讨老年喉癌患者最新气道管理方法。方法：对25例老年喉癌患者进行正确吸痰,气道湿化及预防局部感染。结果 ：25例老年喉癌患者无一例发生局部及呼吸道感染,无护理不当造成的合并症。结论：对老年喉癌患者进行精心、适宜、科学的护理,可显著提高其生活质量,降低医疗护理并发症。     

不同的麻醉方式与老年患者术后下呼吸道感染的相关性研究

目的研究不同的麻醉方式与老年患者术后下呼吸道感染的相关性方法将我院2008年12月-2013年4月老年手术患者240例按麻醉方式分为两组各120例。实验组采取气管插管全身麻醉,对照组采取硬膜外阻滞麻醉。分析比较两组患者的下呼吸道感染发生率。结果实验组共发生术后下呼吸道感染11例,感染率为9.2%;对照组共发生术后下呼吸道感染5例,感染率为4.2%,组间差异显著。结论麻醉方式的不同和老年患者术后下呼吸道感染发生率有相关性,气管插管全身麻醉的感染率要显著高于硬膜外阻滞麻醉。     

浅谈老年喉癌患者术后下呼吸道阻塞的观察及护理

目的 对老年喉癌患者术后下呼吸道分泌物潴留堵塞气道时适时正确的深部吸痰,按需进行气道护理,预防和减少并发症,保证气道通畅.方法 对49例老年喉癌患者术后及时观察是否出现下呼吸道阻塞并适时正确的深部吸痰及按需进行气道湿化,指导患者有效深呼吸及有效咳嗽.结果 49例老年喉癌患者术后尽管多数出现了下呼吸道阻塞,及时正确的深部吸痰同时按需进行气道护理,术后均未出现明显的并发症.结论 对老年喉癌患者术后及时观察及评估有无下呼吸道分泌物潴留堵塞气道,适时正确的深部吸痰,按需进行气道湿化,指导患者有效深呼吸及有效咳嗽,减少不必要的刺激可有效预防及减少气道并发症的发生,保证气道的通畅,提高手术成功率,为患者术后康复提供了有效保障.     

喉癌患者术后呼吸道的系统化安全管理

喉癌是耳鼻喉科常见的恶性肿瘤,目前中国对喉癌的治疗,仍以外科手术切除配合放、化疗为主,喉癌术后患者均行气管切开,而气管切开后改变了呼吸道黏膜的完整性,分泌物增加,痰液黏稠易形成干痂而阻塞呼吸道,加上吸痰、胃管的留置易发生呼吸道感染,影响预后甚至威胁患者生命,因此,预防喉癌术后呼吸道的阻塞及感染等并发症是关键,通过对本科收治的122例喉癌手术治疗患者进行系统化安全管理,收到较好的效果,现报道如下。     

喉癌术后医院感染危险因素分析及预防

目的:分析喉癌术后医院感染的危险因素,为预防喉癌术后感染提供参考依据。方法:采用回顾性分析方法,对2012年1月—2018年6月在我院耳鼻喉科收治的168例喉癌手术患者的临床资料进行统计,分析其发生医院感染的危险因素,提出预防措施。结果:高龄、长期吸烟、合并基础疾病、手术时间>4h、住院时间长、术中出血量≥20ml、低蛋白血症与喉癌术后感染有关(P<0.05)。结论:喉癌术后医院感染的发生是多因素协同作用的结果,需要进行全面综合的预防。     

喉癌术后手术部位感染情况调查及危险因素分析

目的探讨喉癌术后手术部位感染(SSI)及其发生的危险因素。方法回顾性调查我院2006年1月至2010年12月96例喉癌手术患者的临床资料,应用SPSS 13.0软件分析其发病相关因素。结果 96例喉癌患者发生SSI 15例,感染率为15.6%;单因素分析表明:临床分期、手术时间、术式及术前气管切开是SSI发生的危险因素(P<0.05);Logistic逐步回归分析表明:临床分期(OR=0.273)和全喉术式(OR=8.085)是喉癌术后SSI的独立危险因素。结论对临床分期较晚、手术范围较大的患者,应注意提高术中手术技巧、缩短手术时间、正确及时处理术后感染,以减少SSI的发生,降低咽瘘的发生率。     

喉癌术后咽瘘调查及影响因素分析

目的 探讨喉癌术后患者咽瘘发生情况和影响因素.方法 收集2000年3月至2002年3月在我科住院治疗的120例喉癌患者的临床资料,按照喉癌患者是否并发咽瘘分为对照组和观察组,对收集到的临床资料进行描述性分析和二分类Logistic回归分析,找出喉癌患者并发咽瘘的影响因素.结果 在120例患者中,有10例并发咽瘘,发生率为8.33％.二分类Logistic回归分析结果示,喉癌患者术后感染是喉癌患者并发咽瘘的危险因素,而部分切除手术方式和口腔冲洗是并发咽瘘的保护因素.结论 喉癌患者术后并发咽瘘较常见,尽可能的采用部分切除手术方式,加强术后感染的预防和做好口腔冲洗工作,预防术后并发咽瘘.     

喉癌术后并发咽瘘相关因素的探讨

目的探讨喉癌术后咽瘘发生的相关因素.方法对本院1993～2001年喉癌手术患者的临床资料进行回顾性分析,应用SAS软件进行统计学分析.结果98例患者中13例发生术后咽瘘(13.26%),其发生与肿瘤临床分期、手术方法、术前放疗、手术时间和术后感染有关.结论喉癌的早期诊断、治疗对于预防术后咽瘘的发生至关重要,而手术者技术的熟练、缩短手术时间、术后感染的及时预防和正确处理,有助于预防咽瘘的发生.     

浅谈用手术治疗老年妇科肿瘤的临床疗效

目的：探讨分析用手术治疗老年妇科肿瘤的临床疗效。方法：选取2011年5月至2012年5月间我院收治的老年妇科肿瘤患者120例作为研究对象,对其进行外科手术治疗,并对所有患者的临床资料进行回顾性分析。结果：通过治疗,有18例患者在术后并发肺部感染、切口感染、泌尿系统感染及呼吸道感染等并发症。在本次研究的120例患者中,无一例患者发生死亡,疗效显著。结论：用外科手术治疗老年妇科肿瘤,疗效显著。同时,在术前、术中及术后对患者加强护理,可有效降低患者发生并发症的几率,提高治疗的效果。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.