降钙素对大白兔糖尿病骨质疏松模型假体骨密度及生物力学的影响

Objective To investigate the influence of calcitonin on bone mineral density and biomechanics around the artificial pros-thesis in ovariectomized diabetic rabbit model. Methods Fourteen femina New Zealand white rabbits at the age of 5 months old were select-ed, which weight 2.24 -2.65kg, averaging 2.26kg. First, the model of rabbit with diabetic osteoporosis was successfully established by the compound method of ovariectomy plus streptozotocin. Osteotomy in the middle part of femur was performed in both groups, fixation of artifi-cial prosthesis was done with 3.0 kirschner wire. After that, Rabbit models with diabetic osteoporosis were randomly divided into experimen-tal group and control group. Rabbits in the experimental group were treated with calcitonin 6U intramuscular injection once every other day. In control group, intramuscular injection of normal saline solution 1.5ml once every three days. Rabbit models of two groups were sacrificed in the 24th week. The BMD of the region of interest (ROI) around the prosthesis were detected before experiment and 8, 16 and 24 weeks after injection. After rabbits were killed, experimental femurs in both groups were complete removal and soft tissues were rejected. Determi-nation of the pull-out and torsion bone biomechanics experiments of prosthesis was done in both groups respectively. Results The BMD of ROI in the experimental group before operation was (0.1863±0.004)g/cm2 and (0.1753±0.005)g/cm2 in 24 weeks after operation, in control group before operation was (0.1865±0.002)g/cm2 and (0.1638±0.005)g/cm2 in 24 weeks after operation. There were significant difference between the two groups(P < 0.05). Biomechanical show that the pull-out strength in the experimental group was (312.68±8.73 )N/cm2 and (205.43±12.45 ) N/cm2 in control group. There were significant difference between the two groups(P < 0.05). The tor-sion strength in experimental group was (80.47±2.51) N/cm2 and (38.52±0.64) N/cm2 in control group. There were significant differ-ence between the two groups(P < 0.05). Conclusion Salmon calcitonin can reduce the bone turnover rate around prosthesis and decrease bone absorption in the rabbit of diabetic osteoporosis models, accelerate the bone formation around prosthesis, and increase the BMD. It can ameliorate the quality of bone around prosthesis, improve its biomechanics property, and increase the holding power between prosthesis and body mass. It is of clinical significance for the prevention and treatment of aseptic loosening artificial prosthesis.     

动态血压变异性与主观认知下降进展的相关性CSCD

Objective To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD). Methods In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD‑Q9 questionnaire was used to self‑evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow‑up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow‑up and were included in this study. According to the MoCA score at the end of follow‑up (<26 or ≥26), the patients were divided into progression group (39 cases) and non‑progression group (44 cases). The difference of MoCA score between baseline and last follow‑up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD‑Q9 score in the progression group were tested by multiple linear regression analysis. Results The 4‑year progression rate of SCD patients was 46.99% (39/ 83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD‑Q9 score and MoCA score between the progressive group and the non‑progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non‑progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P= 0.016]. There was no significant difference in 24 h DCV between the two groups (P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference (r=-0.368, P= 0.021). Conclusion There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value. © 2023 Chinese Journal of Health Management. All rights reserved.     

原位肝移植合并重症脓毒症病人的临床研究

Objective To improve the treat effect of the orthotopic liver transplantation patients with severe sepsis. Methods Fif-ty-six post-surgery patients were enrolled in this study. Patients were divided into two groups. One was non-OLT group (A group) and the other was OLT group (B group). Besides general data, the surveillance of blood lactate, the number of failure organs, APACHE Ⅱand MODS were recorded. 28-days survival rate and follow-up were checked. Results The mortality of hospitalization in non-OLT group was 30% and 57.6% in OLT group. The level of blood lactate in OLT group at the 1 st day increased significantly, which was statistically differ-ent with that in non-OLT group (P <0.01). It decreased but kept higher than that in non-group in following seven days. The numbers of failure organs in OLT group were more than in non-OLT group (P <0.01). The continuous APACHE Ⅱ score had no significant difference between two groups. But the continuous MODS score in OLT group was higher than in non-OLT group (P <0.01). Conclusions The 28-days mortality of OLT with severe sepsis is almost two times as much as that of non-OLT. It should cause more attention. The OLT with se-vere sepsis is more likely suffered from failure organs and difficult to recovery. To assess the condition of failure organs in OLT patients with severe sepsis, MODS score is better than APACHE Ⅱ score in this study. It is suggested that the standard of score system could be improved or come up with new score for organ transplantation. It will be better if blood lactate score is included.     

多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床研究

目的 探讨多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床疗效.方法 将86例复杂性肾结石患者分为两组,研究组(46例)采用多通道微创经皮肾镜结合钬激光碎石术,对照组(40例)行单通道微创经皮肾镜结合体外冲击波碎石术治疗.比较两组碎石取出时间、结石清除率、术后血红蛋白下降率、术中输血率、术后住院时间及并发症发生率.结果 研究组的碎石取出时间为(102±23)min,对照组为(121±28)min,两组比较差异无统计学意义(P＞0.05).研究组术后血红蛋白下降率为6.5%(3/46)、术中输血率为17.4%(8/46)、结石清除率为82.6%(38/46)、术后住院时间为(5.6±1.7)d,对照组分别为12.5%(5/40)、22.5%(9/40)、72.5%(29/40)、(7.4±1.8)d,两组比较差异均有统计学意义(P＜0.05).结论 多通道微创经皮肾镜结合钬激光治疗复杂性肾结石手术时间短、术中出血少、结石清除率高,且并发症相对较少,值得临床推广应用.

Abstract：

Objective To investigate the effect of multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in complex renal calculi operation. Methods Eighty six complex renal calculi patients were divided into two groups, study group (46 cases) was treated with multi-channel minimally invasive percutaneous nephrolithotomy combined with Yag laser, control group was treated with single-channel minimally invasive percutaneous nephrolithotomy combinated with extracorporeal shock wave treatment. Comparison of gravel removed time, stone clearance rate,postoperative hemoglobin decreasing rate, blood transfusion rate of surgery,length of stay time and operative complications were done between the two groups, the results were analysed statistically. Result The gravel removed time was (102±23) min in study group, and ( 121 ± 28) min in control group, there was no significant difference between the two groups(P ＞ 0.05 ). In study group, postoperative hemoglobin decreasing rate was 6.5%(3/46), blood transfusion rate of surgery was 17.4% (8/46), stone clearance rate was 82.6%( 38/46 ), length of stay time was (5.6 ± 1.7) d,while those in control group was 12.5%(5/40),22.5%(9/40),72.5%(29/40), (7.4 ± 1.8) d,respectively. There was statistical significance between the two groups(P＜ 0.05 ). Conclusion Multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in the treatment of complex renal calculi has the shorter operation time, less blood loss,less complications and higher stone clearance rate, and is worthy of promotion.     

胰岛素抵抗及血清瘦素异常与糖尿病合并脂肪肝的关系研究

Objective To study the relations among insulin resistance,abnormality of serum leptin level soluble leptin receptor(sLR) and the development of fatty liver in type 2 diabetes mellitue (DFL), so as to detect the partial pathogenesis. Methods 196 patients with type 2 diabetes mellitus were selected to retrospective study. The DFL group consisted of 96 patients who had already developed to fatty liver, while the NDFL group included 100 patients with no fatty liver. Biochemical test and insulin resistance were analysisd, and the level of serum leptin and sLR were also examined. Results The level of blood triglyceride(TG), high density lipoprotein(HDL), very low density lipoprotein( VLDL) between two groups were all statistical differences (t = - 8.124, 4.882, - 3.576, P < 0.01). The TG, HDL and VLDL level in DFL group were (3.25 ± 1.92), (1.11 ±0.28), (1.53 ± 0.60) mmol/L respectively. There was also a statistical difference in HOMA-IR level between the two groups (t = - 4.748, P < 0.01). HOMA-IR in DFL group was (4.82± 2.94), but no statistical difference in secretive function of beta cells (t = 0.123, P > 0.05). There was statistical difference in level of serum leptin and sLR between the two groups (t = - 7.435,13.332, P < 0.01); the leptin and sLR in DFL group were (4.34± 2.05) and (1.71 ± 0.53) fig/L respectively. Meanwhile, Pearson analysis showed that the blood TG level of the DFL group was positively correlated with HOMA-IR and leptin ( r = 0.845, P< 0.01; r = 0.742, P< 0.01); serum leptin level was positively correlated with HOMA-IR level (r = 0.852, P<0.01). However, serum sLR level showed negative correlation ( r = - 0.587, P < 0.01). Conclusions Insulin resistance and abnormality serum level of leptin and sLR might be one of the important causes for DFL, while abnormal lipid metabolism might be the secondary cause for this biochemical change.     

不同血浆靶浓度的普鲁泊福对鼻内镜手术应激反应的影响

Objective To observe the effect of propofol target controlled infusion with different blood plasma target concentration on stress reaction during the nasal endoscope operation. Methods Sixty patients with ASA Ⅰ - Ⅱ scheduled for the nasal endoscope operation were divided into three groups by random digits table: each group was 20 patients, group A, B, C was given propofol target controlled infusion with blood plasma target concentration 3,4,5 μ g/mi respectively. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), blood glucose, serum cortisol, bispectral index ( BIS ), extubation time were recorded before anesthesia,at 30 min after the operation starting and 60 min after the extubation.Results The descent degree of HR and MAP at 30 min after the operation starting were group C ＞ group B ＞ group A (P = 0.024,0.010 );the descent degree of MAP at 60 min after the extubation were group C ＞group B ＞ group A (P = 0.011 ). BIS and extubation time were 65 ± 8 and (25 ± 7) min in group A, 53 ± 11 and( 36 ± 13 ) min in group B, 45 ± 12 and(45 ± 9 ) min in group C, there were significant differences among three groups(t = 2.476,P= 0.023;t = 2.657,P= 0.012). The blood glucose was increased at 30 min after the operation starting and 60 min after the extubation, the ascensus degree were group A ＞ group B ＞ group C (P= 0.000、0.000);the serum cortisol was decreased at 30 min after the operation starting, the descent degree was group C ＞ group B ＞ group A (P= 0.000), increased at 60 min after the extubation, the ascensus degree was group A ＞ group B ＞ group C (P= 0.001 ). Conclusions Propofol target controlled infusion with blood plasma target concentration 4-5 μ g/ml can ensure eligible depth of anesthesia, decrease pain stimulus, remain stable vital sign,depress the stress reaction caused by nasal endoscope operation efficiently,with short extubation time. It is an eligible blood plasma target concentration.     

骨牵引和DHS治疗老年股骨粗隆骨间骨折的临床比较研究

Objective The purpose of this study is to observe the difference of the six-month mortality,complications and function recovery between the skeletal traction group and DHS group.Methods This retrospective study was undergone in the department of orthopaedics of Longhua hospital.According to the methods of tareatment,87 cases were divided into two groups:skeletal traction group and DHS group.To comapare the rate of six-month moaality,general complications(which include pulmonary infeetion,bed-sore,minary infection and deep venous thrombosis)and coxa yams between the two groups,while the Harris hip score in the third month and sixth month after injury were also compared.Reuslt ①About the rate of six-month momdity,there was one case(2.27%) in the skeletal traction group,and one ease also(2.33%) in the DHS group,there was no difference between the two groups.(P=1.0) ②About the rate of general complications,there were 15 cases(34.09%) in the skeletal traction group,and 14 cases(32.56%) in the DHS group,there was no difference between the two groups.(P=0.879) ③About the rate of coxa varus,there were seven eases (16.28%) in the skeletal traction group,and one ease(2.38%)in the DHS group,there was no difference between the two groups.(P=0.068).But for the unstable intertrochantefic fractures,there were seven cases out of 29(24.14%)in the skeletal traction group,and one case out of 31 (3.23%),these showed that the rate of coxa yams is higher in the skeletal traction group than in the DHS group.(P=0.045) ④In the third month after injury,the Harris hip score was 52.99±4.86 in the skeletal traction group,and 65.87±3.39 in the DHS group,these showed that the Harris hip score is higher in the DHS group than in the skeletal traction group(P<0.0001).While in the sixth month after injury,the Harris hip score was 84.44±5.79 in the skeletal traction group,and 85.69±4.07 in the DHS group,these showed that there was no difference between the two groups(P=0.254).Conclusion ① A low mortality and complications morbidity could be found in the treatment of intearochanteric fractures in aged patients by the skeletal traction associated with careful nursing.②For the unstable fratures,compared to the DHS fLxation the conservative method may get higher rate of the coxa varus.③Although the operative fixation is the first choice for the treatment of the intertreehanterie fractures in aged patients,the skeletal traction method are not to be out of date thoroughly.     

两种新型非生物型人工肝治疗慢性乙型重型肝炎疗效观察

Objective To explore the clinical effects of two new treatment methods of non-biologic artificial liver [slower plasma exchange (PE) combined with continuous veno-venous hemofiltration (CWH), and coupled plasma exchange filtration adsorption (CPEFA)] in treatment of chronic severe hepatitis B patients. Methods 130 patients with chronic severe hepatitis B were divided into three groups. 44 patients were treated with a parallel circuit of being combined slower PE and CWH based on the conservation medical therapy (group A). 43 patients were treated with CPEFA based on the conservation medical therapy (group B). 43 patients received PE with conservative medical therapy (group C). The clinical symptoms, signs, liver function, blood sodium concentration, effective rates and survival rates in three groups were surveyed before and after treatment. Results The symptom and signs of the majority in the above different groups improved. In group A and B, hyponatremia of patients were improved, the effective rates (within 6 months after the treatment) were 70.45% and 72.09% respectiverly. There was no statistical difference between the two groups (χ2=0.10,P>0.05), the survival rates(6 months) were 45.45% and 46.51% respectively and there was no statistical difference (χ2 = 0.08, P > 0.05). In group C, patients' hyponatremia did not change, the effective rate (51.16%)was obviously lower than those in group A and B (χ2 = 7.55,9.31, P < 0.01) and the total survival rate(6 months) was 30.23% also lower than those in group A, B (χ2 = 4.80,6.10, P < 0.05). Conclusions Being combined slower PE and CWH with a parallel circuit and CPEFA are two new, safe and effective methods of non-biologic artificial liver treatment.     

白内障小切口囊外摘出术与超声乳化吸出术的疗效比较

Objective To compare the effect of extracapsular cataract extraction and phacoemulsification. Methods Three hundred and twenty-six cases (360 eyes) of senile cataract were divided into two groups by random digits table with 163 cases (180 eyes) in each. One group underwent phacoemulsification (phacoemulsification group),and the other group underwent extracapsular cataract extraction with small incision(no-phacoemulsifieation group). A comparison was carried out between the two groups of the vision and complications after operation. Results In phacoemulsification group,7 d after operation 18.33%(33/180)had 0.4 or less in vision,66.11%( 119/180) were 0.5-0.9,15.56%(28/180) were 1.0 or better. In no-phacoemulsification group,7 d after operation, 18.89% (34/180) were 0.4 or less in vision,66.67% (120/180) were 0.5-0.9,14.44% (26/180) were 1.0 or better. During operation,posterior capsular ruptured and vitreous prolapsed in 4.44% (8/180) in phacoemulsification group and 3.33%(6/180) in no-phacoemulsification group. Corneal edema:there were 16.11%(29/180) in phacoemulsification group and 17.22%(31/180) in no-phacoemulsification group. The curative effect between the two kinds of operation mentioned above was almost the same and had no significant difference (P ＞0.05). Conclusion The no-phacoemulsification is simple and economical, wihch is suitable for basic hospitals.     

新疆地区两种循证医学教学方案效果的对比研究

Objective We compared the new teaching curriculum of evidence-based medicine (EBM) with the traditional one to explore a more effective one of EBM and provide reference for the popularization of EBM in Xinjiang.Methods From the fourteen regions in Xinjiang,we selected randomly four regions,and the trainees of the four regions were allocated randomly to the experimental group (169) and the control group (167).The new teaching curriculum was used in the experimental group and the raditional one in the control group.After training,we investigated all the trainees with questionnaires and compared the differences of the two groups.Results Compared with the control group,trainees of the experimental group were significantly enhanced in the abilities of cognition (χ2 =6.870,P=0.009),literature retrieval (χ2 =22.670,P=0.000),communication (χ2 =6.288,P =0.012)and scientific research (χ2=4.667,P = 0.031).However,the difference in the ability of diagnosis and treatment (χ2 =0.663,P=0.426) was not significant.On the other hand,the total examinational scores and the scores for the chapters of general introduction,etiological factor,diagnosis and system review of the experimental group were significantly higher than those of the control group,but there was not significant difference between the two groups in terms of the scores for the chapters of treatment and prognosis.Conclusion The new teaching curriculum of EBM is beneficial in developing the abilities of cognition,literature retrieval,communication,scientific research and apprehension of EBM theory and is more applicable for the popularization of EBM in Xinjiang.     

预存自体血回输在腰椎滑脱手术中的临床观察

目的：探讨预存自体血回输应用于腰椎滑脱手术的临床疗效、不良反应及应用价值。方法：选择80例因单节段腰椎滑脱接受腰椎后路减压、椎体复位、椎间植骨融合、椎弓根螺钉内固定手术并输血治疗的患者,其中预存自体血回输的患者40例作为A组,因拒绝术前预存自体血而输注异体血的40例患者作为B组,记录并比较两组患者的手术时间、术中失血量、术后引流量和输血量、血常规观察指标（红细胞、血红蛋白、红细胞比容）及输血相关不良反应。结果：两组的手术时间、术中失血量、术后引流量和输血量比较差异均无统计学意义（P〉0.05）;两组不良反应比较差异有统计学意义（P〈0.05）;两组输血后第1天血常规各观察指标降低,与输血前比较差异有统计学意义（P〈0.05）,两组间比较差异无统计学意义（P〉0.05）;两组输血后第7天血常规各观察指标比较差异均有统计学意义（P〈0.05）。结论：对腰椎滑脱手术患者来说,采用术前预存自体血回输及异体输血均能有效纠正术中术后失血性贫血,但术前预存自体血回输能降低输血不良反应发生率,输血后患者血常规各观察指标恢复更快,在当前异体血供血困难的前提下,术前预存自体血回输是一种值得临床推广的方法。     

自体输血和异体输血的临床应用比较

目的 比较自体输血和异体输血的临床应用效果.方法 选取2018年6月—2020年6月的100例输血患者,以双盲随机抽样法分组,每组样本容量50例,参照组采纳异体输血,试验组采纳自体输血,对比两组凝血功能指标、pH、电解质、输血量、输血费用、住院时间、不良反应发生率.结果 试验组术后24、72 h的TBIL、APTT、P...     

氨甲环酸对高龄伴多节段腰椎管狭窄患者围手术期失血量的影响及安全性评估

目的 探讨氨甲环酸对高龄伴多节段腰椎管狭窄患者围手术期失血量的影响及安全性.方法 2009年1月至2010年9月,对连续就诊的68例行多节段腰椎管减压的高龄腰椎管狭窄患者(年龄≥65岁)进行前瞻性随机对照研究.采用机械抽样法随机分为两组,每组34例,对照组采用常规治疗,试验组在常规治疗的基础上加用氨甲环酸.对两组术中失血量、术后引流量、输浓缩红细胞、输血例数、血红蛋白、凝血酶原时间等指标进行比较.观察患者术后是否出现下肢深静脉栓塞的临床症状.结果 试验组患者术中失血量、术后引流量、输浓缩红细胞和输血例数较对照组患者显著下降[分别为(641.1±128.4) ml比(780.1±107.3) ml,(228.80±52.07) ml比(345.50±42.16)ml,(1.02±1.56)U比(2.89±1.76)U,16例比28例](p＜0.05),术后血红蛋白[(104.00±4.87) g/L]明显高于对照组[ (92.20±5.47) g/L](P＜ 0.05).两组患者术前及术后凝血酶原时间和活化部分凝血活酶时间比较差异无统计学意义(P＞0.05).所有患者的手术切口均为Ⅰ期愈合,无明显深静脉栓塞的临床症状,术后7d彩色多普勒超声检查未见下肢深静脉血栓形成.结论 对高龄伴多节段腰椎管狭窄患者进行后路手术时,于术中及术后短期使用氨甲环酸能明显降低患者术中失血量及输血量,并且不增加静脉血栓形成的风险.     

血液保护在心脏手术中的应用

目的探讨血液保护在心外科围手术中的作用。方法回顾性分析60例接受心脏手术患者的临床资料,将其中采用常规血液保护进行手术的30例患者定义为对照组,将采用改进血液保护进行手术的30例患者定义为观察组,对两组患者手术后的血红细胞比容情况、输血情况及胸腔引流量等资料进行比较分析。结果观察组的人均输血量（0．89±1．12）U及人均胸腔引流量（303±85）mL均明显少于对照组的人均输血量（1．07±1．68）U及人均胸腔引流量（571±163）mL,差异有统计学意义（P〈0．05）;术后红细胞比容情况明显优于对照组,差异亦有统计学意义（P〈0．05）。结论在心外科围手术期中使用改进血液保护,可减少患者的围手术期输血量,降低术后胸腔引流量,提高红细胞比容,有利于促进患者术后康复。     

腰椎间融合单侧及双侧内固定术对腰椎间盘突出症的疗效对比探究

目的：对比腰椎间融合单侧及双侧内固定术对腰椎间盘突出症的疗效,探究更为有效、可靠的治疗方式。方法：选取腰椎间盘突出症患者112例,按照手术方式不同随机将其分为单侧组及双侧组,每组56例,分别采取腰椎间融合单侧或双侧内固定治疗,对比两组患者的手术情况及治疗效果。结果：单侧组手术时间、术中出血量及住院费用低于双侧组,差异有统计学意义（t=8.857,t=9.620,t=12.338;P〈0.05）;两组住院时间比较无明显差异;两组患者治疗后疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）均显著下降（t=28.223,t=24.899,t=25.013,t=20.475;P〈0.05）,其治疗前后VAS及ODI组间对比均无明显差异;两组患者均获得有效随访,单侧组末次随访椎间融合率为89.3%,双侧组椎间融合率为92.9%;单侧组随访未见明显并发症,双侧组随访发现1例椎间融合器内植骨部分吸收,1例出现突出对侧根性症状。结论：腰椎间单侧及双侧内固定均能够有效改善患者腰椎间盘突出症疼痛症状,且具有良好的椎间融合度,安全性较高;而单侧内固定手术时间更短、出血量更少且患者负担更小,对于需手术治疗的严重腰椎间盘突出症患者可使用腰椎间融合单侧内固定治疗。     

大量输血前后血钾浓度变化及高钾血症发生的影响因素

目的：研究大量输血前后血钾浓度的变化情况以及输血后高钾血症发生的影响因素。方法：将132例非挤压伤患者随机分为非输血治疗组（对照组）、大量输血治疗组（观察组）,比较两组患者输血前后的血钾变化情况,同时分析其相关的影响因素。结果：输血前、后及手术过程中两组患者的血钾水平未见明显差异,但术后12 h内,观察组患者的血钾水平明显高于对照组,差异具有统计学意义（t＝1.562,P＜0.05）,术后12 h之外两组患者的血钾水平比较未见明显差异。结论：临床上大量输血并不是引起患者高钾血症的主要原因,但某些患者在大量输血后会出现血钾升高,因此在进行输血过程中应对患者血钾水平进行密切监测和观察,且应注意肾功能变化,以排除由于肾功能受损导致的血钾升高,降低并发症的发生率。     

臭氧联合经皮髓核切割术治疗农村社区腰椎间盘突出症患者的临床研究

目的 探讨臭氧联合经皮髓核切割术治疗农村社区腰椎间盘突出症患者的临床疗效.方法 选择农村社区腰椎间盘突出症患者60例,将其分为三组,每组20例,研究组采用臭氧联合经皮髓核切割术治疗,实验组单纯经皮髓核切割术治疗,保守药物治疗组应用中西药保守治疗,对三组治疗后1个月、3个月及12个月进行随访,观察各组患者治疗前后腰椎间盘突出症的治疗总有效率、术后复发率、复发时间.结果 随访结果显示研究组的治疗总有效率高于单纯经皮髓核切割术的实验组（P＞0.05）,显著高于保守药物治疗组（P＜0.05）;研究组术后复发率也低于单纯经皮髓核切割术治疗的实验组（P＞0.05）,显著低于保守药物治疗组（P＜0.05）.结论 臭氧联合经皮髓核切割术治疗农村社区腰椎间盘突出症患者,方法简单,创伤小,疗效好,费用低,见效快,值得在农村社区推广应用.     

老年股骨转子间骨折防旋型股骨近端髓内钉内固定围手术期失血分析

目的 对采用防旋型股骨近端髓内钉（PFNA）治疗的老年股骨转子间骨折患者的围手术期失血量进行分析,探讨PFNA内固定围手术期失血的危险因素.方法 回顾性分析行PFNA内固定治疗的62例股骨转子间骨折老年患者的临床资料,对围手术期的显性失血量及隐性失血量进行统计分析,并依据性别、年龄、骨折类型进行分组,分析围手术期失血的影响因素.结果 62例患者总失血量为（775.8±129.6） ml,显性失血量为（120.6±42.0） ml,占总失血量的15.5％,隐性失血量为（655.2±109.1） ml,占总失血量的84.5％,隐性失血量显著高于显性失血量,差异有统计学意义（P＜0.01）.男性组（20例）总失血量、显性失血量、隐性失血量分别为（773.3±131.5）、（122.5±44.1）、（650.8±114.2） ml;女性组（42例）分别为（777.0±124.7）、（119.7±40.2）、（657.3±107.7） ml,两组比较差异无统计学意义（P＞0.05）.高龄组（35例）总失血量、显性失血量分别为（813.1±107.5）、（117.7±49.7）ml;非高龄组（27例）分别为（727.4±114.3）、（124.4±36.6） ml,两组比较差异无统计学意义（P＞0.05）;高龄组隐性失血量为（695.4±74.1） ml,高于非高龄组的（603.0±65.3） ml,差异有统计学意义（P＜0.05）.稳定组（14例）总失血量、显性失血量、隐性失血量分别为（578.1±82.3）、（68.5±23.1）、（509.6±63.1） ml,低于不稳定组（48例）的（833.5±84.1）、（135.8±35.0）、（697.7±79.3） ml,差异有统计学意义（P＜0.05）.结论 老年股骨转子间骨折PFNA内固定围手术期失血主要来自于隐性失血,年龄及骨折稳定性是影响隐性失血的危险因素.     

产前贮存式自体采血对妊娠结局的影响

目的：探讨产前贮存式自体采血（PABD）对孕妇妊娠结局的影响。方法：选取2015年1-12月在桂林医学院附属医院产科定期产检并分娩,同时符合PABD适应证的孕妇404例,其中进行自体采血者为研究组共203例,未进行自体采血者为对照组共201例,比较2组孕妇产后24 h出血量、新生儿出生体质量及Apgar评分、产后24 h血红蛋白（Hb）、血细胞比容（HCT）、血小板计数（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）情况;同时分析研究组采血前及采血后7 d,Hb、HCT、PLT、PT、APTT及FIB的变化情况。结果：2组孕妇的年龄,孕龄,产前Hb、PLT、HCT、PT、APTT及FIB比较,差异均无统计学意义（P＞0.05）。研究组与对照组的妊娠结局及各项血液指标比较显示,2组产后24 h出血量、新生儿出生体质量、1分钟Apgar评分、5分钟Apgar评分及Hb、PLT、HCT、PT、APTT、FIB情况比较,差异均无统计学意义（P＞0.05）。研究组采血后7 d的Hb、HCT、PLT、PT、APTT及FIB与采血前比较,差异均无统计学意义（P＞0.05）。结论：产前PABD对孕妇妊娠结局无不良影响,在产妇需要时能及时提供经济、有效的自体血液。     

护理干预在经皮椎间孔镜治疗腰椎间盘突出症中的应用

目的 探讨护理干预应用于经皮椎间孔镜治疗腰椎间盘突出症患者围术期中的临床效果.方法 选取2017年10月—2018年12月科室收治的80例经皮椎间孔镜技术治疗的腰椎间盘突出症患者作为研究对象,在遵照伦理学的基础上根据1:1的方式将对象分为试验组和对照组,每组40例;试验组实施围术期护理干预,对照组给予围术期常规护理,比...