脊柱侧弯患者术后腹胀的观察及其影响因素分析

目的动态观察脊柱侧弯患者术后腹胀的发生情况,并分析其影响因素。方法选取全麻下行后路矫形手术的脊柱侧弯患者200例,收集其术后返回病房、首次排气、进食、下床活动的时间,是否发生腹胀及腹胀程度。结果 42.0%的患者术后发生腹胀。术后12 h腹胀发生率为22.0%,之后逐渐上升,在术后36 h达高峰;术后12 h腹胀程度已较重,平均分达4分,之后逐步上升,在术后36 h达最高值。使用PCA镇痛泵组腹胀发生率显著高于未使用组(P<0.01)。结论脊柱侧弯术后患者腹胀发生率高且程度较重,症状出现早,应及早予以预防与处理。     

复合竖脊肌平面阻滞的多模式镇痛策略在腰椎后路手术中的应用

目的:探究复合竖脊肌平面阻滞(ESPB)的多模式镇痛策略在腰椎后路手术中应用的临床效果。方法:选取择期行后路腰椎手术患者80例,采用随机数字表法随机分为ESPB组和非ESPB组各40例。ESPB组患者在全身麻醉后以每侧0.25%罗哌卡因20 mL行双侧竖脊肌平面阻滞,非ESPB组患者不进行ESPB。记录术后2、12、24和48 h静息和运动(翻身)的疼痛视觉模拟评分(VAS);记录阿片类药物用量、补救镇痛情况、首次按压镇痛泵时间;记录围手术期应激指标、术后恢复情况及不良反应发生情况。结果:与非ESPB组比较,ESPB组患者术后2、12 h静息和运动(翻身)VAS评分降低,阿片类药物用量减少,补救镇痛情况降低,首次按压镇痛泵时间延迟,围手术期血糖、血清皮质醇浓度降低,术后首次排气时间和首次下床时间缩短,患者满意度提高(P均<0.05),不良反应发生率差异无统计学意义(P>0.05)。结论:复合ESPB的多模式镇痛策略可减少围手术期阿片类药物用量、降低患者应激反应,可安全有效地应用于腰椎后路手术患者,利于患者术后康复。     

颈椎前路手术患者围手术期死亡相关因素分析

目的探讨颈椎前路手术患者围手术期死亡的相关因素。方法颈椎前路手术412例,其中颈椎病258例,颈椎外伤138例,颈椎肿瘤8例,颈椎结核8例。选取性别、年龄、术式等指标进行统计分析。结果围手术期内8例患者死亡,统计分析显示病例死亡同并发症、瘫痪情况和病种三因素相关。结论颈椎前路手术患者围手术期死亡主要同患者自身病情有关,加强围手术期管理可能会降低病死率。     

塞来昔布对骨科围手术期镇痛的疗效评估

[目的]观察塞来昔布(西乐葆)对骨科围手术期患者术后镇痛的疗效及安全性。[方法]选择2004~2005年住院手术患者,共64例,随机分组,分别给予西乐葆或镇痛泵进行术后镇痛。西乐葆给药时间:一般于手术前8~12 h,即患者手术禁食前首次给药,手术后6 h患者可进食后再次给药,手术后3~5 d按手术大小及患者疼痛程度决定停药时间。给药剂量:西乐葆首次服用400 mg,大手术可加大剂量。观察患者疼痛VAS评分、药物不良反应及患者满意度。[结果]西乐葆的术后镇痛效果与镇痛泵相似,但发生不良反应比及患者总体满意度优于镇痛泵。[结论]西乐葆对手术后镇痛具有满意的疗效及安全性,适合于骨科围手术期术后镇痛。     

颈椎前路手术间接相关并发症的影响因素

目的探讨颈椎前路手术围手术期内手术间接相关并发症的影响因素。方法回顾1992年1月~2004年1月,颈椎前路手术412例,对年龄、性别、病史、病种、瘫痪情况等因素进行单因素筛选和多因素回归分析,获取颈椎前路手术围手术期手术间接相关并发症的可能影响因素。结果围手术期内发生手术间接相关并发症23例次(19例),统计分析显示间接相关并发症可能与患者的瘫痪情况有关。结论颈椎前路手术患者围手术期间接相关并发症主要同患者自身病情有关,根据病情特点加强围手术期管理可能会降低其发生率并改善患者预后。     

集束化护理预防泌尿外科机器人手术后腹胀

目的 探讨集束化方案预防泌尿外科机器人手术患者术后腹胀的效果。方法 将122例泌尿外科机器人手术患者按住院时间分为对照组和观察组各61例。对照组予以泌尿外科机器人手术后常规护理，观察组在常规护理基础上增加预防术后腹胀的集束化护理方案，包括疼痛干预、早期活动、早期饮水、嚼口香糖、腹部按摩、温水足浴等措施。结果 两组术后首次排气时间、首次排便时间、腹胀发生率及程度比较，差异有统计学意义（P＜0.05，P＜0.01）。结论 实施预防泌尿外科机器人手术的集束化护理方案能够有效预防患者术后腹胀发生，缩短患者术后排气排便时间以及减轻术后腹胀的程度。     

舒适护理促进腹部术后患者胃肠功能恢复的效果观察

目的观察舒适护理对促进腹部术后患者胃肠功能恢复的效果。方法随机将接受腹部手术的68例患者分为2组,每组34例。对照组围手术期给予常规护理干预,观察组在常规护理基础上应用舒适护理干预。比较2组术后肠鸣音恢复时间、肛门排气时间、胃管拔除时间及术后腹胀、便秘发生率和对护理工作的满意度。结果观察组患者术后肠鸣音恢复时间、肛门排气时间及腹胀、便秘发生率均少于对照组,对护理工作满意率高于对照组。2组比较,差异均有统计学意义(P0.05)。结论舒适护理可促进腹部手术患者术后胃肠蠕动功能的早期恢复,减少患者术后腹胀、便秘发生率,提高手术效果及对护理工作的满意度。     

缩肛运动对腹部术后老年患者肛门排气时间的影响

目的 了解缩肛运动时老年患者腹部手术后肛门排气时间的影响.方法 将83例60岁以上行腹部手术的患者随机分为观察组(42例)和对照组(41例),观察组术后6～12 h开始进行缩肛运动,每日3次,连续4 d;对照组术后行常规护理.观察两组术后肛门排气时间,腹胀情况.结果 观察组术后首次肛门排气时间、腹胀发生率与对照组比较,差异有显著性意义(P<0.01,P<0.05).结论 缩肛运动可促进老年患者腹部手术后肛门排气,减轻术后腹胀症状.     

剖宫产后腹胀及其影响因素的Logistic回归分析

目的 观察剖宫产产妇产后腹胀发生率及程度,探讨其影响因素.方法 收集100例剖宫产产妇的基本资料,记录产妇首次排气时间、进食时间以及早期下床活动时间；观察产妇腹胀发生情况以及腹胀程度.结果 腹胀发生率、程度随时间进展而变化:术后12h出现腹胀,腹胀程度评分为3.8分；12～h腹胀发生率和腹胀程度逐渐升高,术后36～96 h腹胀发生率和腹胀程度又逐渐下降.术后36 h腹胀发生率和程度达最高峰,腹胀程度评分为4.5分；共32例产妇出现不同程度腹胀；年龄、术前禁食、手术持续时间、术后是否使用PCA、下床活动时间5个因素与腹胀发生密切相关(P＜0.05、P＜0.01)；术后是否使用PCA、下床活动时间是术后腹胀的2个独立危险因素.结论 剖宫产产妇产后腹胀发生率较高,程度较重,腹胀持续时间长,护理人员应尽早采取干预措施促进产妇康复.     

腹部体型参数对腹腔镜远端胃癌D2根治术围术期并发症及术后恢复的影响

目的探讨腹部体型参数对腹腔镜辅助远端胃癌D2根治术(LADG)病人围术期并发症及术后恢复的影响。方法 LADG治疗的病人168例,术前4天计算体重指数(BMI)、腰臀比(WHR)。采用全腹部CT测定腹部体型参数[脐周腹壁脂肪厚度平均值(NMT)和腹部内脏脂肪厚度(VFT)]。统计术中及术后康复指标、并发症发生情况。结果 168例病人中,发生围手术期并发症32例,并发症发生率19.05%。Pearson相关性分析显示,NMT与术后肛门排气时间、进食时间及住院时间呈显著正相关(P0.05),VFT与淋巴结清扫数呈负相关(P0.05),与手术时间呈显著正相关(P0.05)。多因素Logistic回归分析显示,术前合并症是影响围手术期并发症的独立危险因素(P0.05)。结论腹部体型参数对LADG病人术中情况及术后康复具有一定影响,但对围手术期并发症发生的影响不明显。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.