口腔冲洗法在预防呼吸机相关性肺炎中的应用

目的 探讨改良口腔冲洗法在预防呼吸机相关性肺炎(VAP)中的应用及效果,以便更好为人工气道行机械通气的患者提供护理.方法 将60例行经口气管插管并给予机械通气治疗＞48 h患者随机分为观察组和对照组,各30例,对照组采用传统生理盐水棉球顺序擦洗法行口腔护理,观察组采用生理盐水冲洗法行口腔护理,从患者口腔细菌繁殖状况、口腔感染、并发症发生率等方面进行统计分析,并观察两组机械通气后VAP发生率以及机械通气持续时间.结果 两组在进行口腔护理前细菌培养结果比较,观察组、对照组阳性例数均为26例,细菌种类均为4种,阳性例数和细菌种类差异无统计学意义;两组进行口腔护理后细菌培养结果比较,观察组阳性1例,细菌种类2种,对照组阳性4例,细菌种类4种,两组差异有统计学意义(P＜0.01);两组在进行口腔护理后,对口腔清洁度、口腔真菌、口腔溃疡进行了比较,观察组明显优于对照组,差异均有统计学意义(P＜0.05);两组在VAP发生率、呼吸机使用时间、病死率3个项目进行比较,观察组均明显优于对照组,VAP发生率观察组为16.67％、对照组为83.33％,两组差异有统计学意义(P＜0.05),呼吸机使用时间观察组(7±3.6)d、对照组(13±5.4)d、两组差异有统计学意义(P＜0.05),病死率观察组为3.33％、对照组为23.33％,两组差异有统计学意义(P＜0.05).结论 利用冲洗法进行口腔护理的效果明显优于传统口腔护理法.     

Effectiveness of glycerol as a rehydrating agent

On two occasions, 8 male subjects completed a dehydration protocol, immediately followed by a 180-min rehydration protocol, then a subsequent exercise bout. During each dehydration session, subjects lost 3.1 +/- 0.4% body weight (BW) following discontinuous exercise in the heat (40 degreesC, 33% rh). During the first 30 min of rehydration, subjects ingested either 1.0-g glycerol x kg body weight(-1) + 30% of the total rehydration water volume (GLY), or 30% of the total rehydration water volume without glycerol (CON). The five remaining ingestions (every 30 min) were equal to 14% of the remaining fluid volume and were identical in nature. Fluid volume ingested equaled fluid volume lost during dehydration. Following the 180 min rehydration period, subjects cycled (appoximately 50% VO2 peak) in the heat (40 degrees C, 33% rh) until volitional exhaustion. Three observations were made: (a) Following glycerol-induced rehydration, time to volitional exhaustion was greater during the subsequent exercise bout in the heat (CON: 38.0 +/- 2.0, GLY 42.8 +/- 1.0 min, p <.05); (b) glycerol-induced rehydration significantly increased plasma volume restoration within 60 min and at the end of the 180-min rehydration period; and (c) total urine volume was lower and percent rehydration was greater following GLY, but neither was significantly different.     

疑难修复前正畸的临床体会

目的:探讨疑难修复前先期进行正畸治疗为修复体提供条件的临床方法.方法:对15例前牙缺失不具备修复条件的患者先行正畸治疗调整间隙及咬<牙合>后再修复缺牙.结果:美观及功能效果满意.结论:针对一些缺牙修复条件不足的患者采用先期正畸治疗而后修复是一种较理想的治疗方法.     

高危型人乳头瘤病毒检测作为宫颈癌初筛手段的应用研究

目的探讨高危型人乳头瘤病毒(human papilloma virus,HPV)检测作为宫颈癌及癌前病变初筛手段的可行性。方法选取2011年5月至2012年5月深圳市香蜜湖街道1 000名自愿参加宫颈癌筛查的妇女作为观察组,以高危型HPV检测作为初筛方法,阳性者进一步行液基细胞学检查(liquid-based cytology test,LCT),结果≥非典型鳞状上皮细胞(atypical squamous cells of undetermined significance,ASCUS)者行阴道镜下宫颈活检,以病理诊断为确诊标准;以同期于深圳市计划生育服务中心就诊的行联合筛查(高危型HPV+LCT)的体检妇女600名为对照,进行高级别宫颈病变及宫颈癌的人群发病率的比较分析。结果1观察组高危型HPV感染率8.80%(88/1 000)。不同文化程度分组中小学及以下、大学及以上两组感染率较高,分别为12.99%(10/77)、14.21%(27/190),与其它两组比较差异有统计学意义(P0.05);不同年龄、职业及不同性生活年限分组中的各组感染率比较,差异无统计学意义(P0.05)。2高危型HPV初筛组高级别宫颈病变及宫颈癌的人群发病率为1.40%(14/1 000),联合筛查组的人群发病率为1.83%(11/600),差异无统计学意义(P0.05)。结论以高危型HPV检测作为宫颈癌人群普查的初筛手段高效、可行。     

Six-month open trial of haloperidol as an adjunctive treatment for anorexia nervosa: a preliminary report

OBJECTIVE: To evaluate the effectiveness of haloperidoll as an adjunctive treatment for resistant anorexia nervosa restricting subtype (AN-R). METHOD: Thirteen outpatients with treatment-resistant AN-R were treated for 6 months with haloperidol in addition to standard treatment. Treatment resistance was defined as persistent and resistant anorectic symptoms despite multiple standard therapies. Assessments were carried out at baseline and after 1, 3, and 6 months with the Eating Disorder Inventory (EAT), the Eating Attitude Test (EAT), and the Clinical Global Impression and Improvement Scale (CGI-I). RESULTS: Significant change from baseline to end point was observed on EDI total score (p =.02) and on the subscales Drive for Thinness (p =.009), Bulimia (p =.01), and Interoceptive Awareness (p =.02), as well as on the EAT (p =.009) and CGI scores (p =.001). Body mass index changed significantly from baseline (15.7 +/- 1.9) to end point (18.1 +/- 2.5; p =.03). DISCUSSION: These preliminary data suggest that low doses of haloperidol might be effective as an adjunctive treatment for patients with severe AN-R. Larger controlled studies are warranted to confirm these data.     

'Thinking aloud' as a method of analysing the treatment decisions of physicians

The feasibility of studying the decision-making process of physicianswith the ‘thinking aloud’ method was tested in astudy of 33 physicians. On 2 occasions 3 months apart the studysubjects were asked for their management of 2 duplicate setsof 5 patients. On 1 occasion they either had to think aloudwhen making their decision, or they had to give a retrospectivereport of their decision-making process. The verbalized thoughtsand retrospective reports were analysed to search for differentdecision-making strategies. In 2 relatively simple cases (womenwith urinary tract infections), the thinking aloud method showeda decision process with little deliberation about the treatment,suggesting the use of rules-of-thumb or routine behaviour. Thinkingaloud during more complex cases (stomach and reflux complaints)showed more comparative and absolute evaluations of possiblemanagement and treatment options. This differentiation in strategiesdid not emerge from the retrospective reports. The inconsistencyin the repeated treatment choices was about 27/. Thinking alouddid not significantly increase this inconsistency. It is concludedthat thinking aloud is a useful method of analysing treatmentdecisions.     

同轴双管持续性冲洗引流治疗腰椎间盘术后椎间隙感染的临床研究

目的探讨用同轴双管持续性冲洗引流方法治疗腰椎间盘术后椎间隙感染的临床疗效,以提高治愈率。方法 2009年10月-2012年10月医院收治的25例腰椎间盘术后椎间隙感染患者随机分成两组,其中治疗组13例采用同轴双管持续性冲洗引流术,对照组12例采用非手术治疗,使用石膏腰围固定,观察两组的治疗效果,病原菌种类、实验室常规检查结果变化,数据采用SPSS 12.0软件处理。结果治疗组和对照组感染的病原菌主要有金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌、阴沟肠杆菌,两组患者在感染病原菌差异无统计学意义;两组患者与术前比较,血沉增快、C-反应蛋白升高、体温升高、白细胞计数和分类升高差异均有统计学意义(P<0.05);治疗组有8例显效,4例好转,而对照组有5例显效,3例好转,治疗组总有效率为92.31%,与对照组66.67%相比,差异有统计学意义(P<0.05)。结论同轴双管持续性冲洗引流可有效清除病灶,缓解减压腰椎间盘压力,提高腰椎间盘术后患者间隙感染的治疗效果。