缺血性脑卒中患者抗血小板药物服药依从性及影响因素分析

目的:对缺血性脑卒中患者抗血小板药物服药依从行为的现状进行调查,探讨药物依从性的影响因素.方法:选取2017年6月至12月期间在本院住院的缺血性脑卒中患者585例,根据服药依从性情况,将研究对象分为依从性好的患者280例,依从性差的患者305例,通过Logistic回归分析影响缺血性脑卒中患者抗血小板药物服药依从性的影响因素.结果:A组患者的文化程度、家庭收入、有医保、居住在城市、合并糖尿病、合并高血脂症复诊的比例均显著高于B组,多因素Logistic回归结果显示,患者抗血小板药物服药依从性的影响因素有年龄、文化程度、家庭年收入、医保、合并糖尿病、合并高脂血症、复诊(P＜0.05).结论:缺血性脑卒中患者服用抗血小板药物的服药依从性有待进一步提高,应重点针对低年龄、文化程度不高、无医保、无合并其他慢性病的人群进行个性化干预,加强宣传缺血性脑卒中患者的二级预防,提高患者的服药依从性.     

缺血性脑卒中患者抗血小板药物服药依从性及影响因素

目的:对缺血性脑卒中患者抗血小板药物服药依从行为的现状进行调查,探讨药物依从性的影响因素.方法 选取2017年6月至12月期间在本院住院的缺血性脑卒中患者585例,根据服药依从性情况,将研究对象分为依从性好的患者280例,依从性差的患者305例,通过Logistic回归分析影响缺血性脑卒中患者抗血小板药物服药依从性的影响因素.结果 A组患者的文化程度、家庭收入、有医保、居住在城市、合并糖尿病、合并高血脂症复诊的比例均显著高于B组,多因素Logistic回归结果显示,患者抗血小板药物服药依从性的影响因素有年龄、文化程度、家庭年收入、医保、合并糖尿病、合并高脂血症、复诊(P＜0.05).结论 缺血性脑卒中患者服用抗血小板药物的服药依从性有待进一步提高,应重点针对低年龄、文化程度不高、无医保、无合并其他慢性病的人群进行个性化干预,加强宣传缺血性脑卒中患者的二级预防,提高患者的服药依从性.     

煤矿矿区高血压患者383例干预效果分析

目的探讨治疗和生活方式的干预对煤矿矿区高血压病控制效果。方法对丰矿八一社区全体居民建立健康档案,发现该社区高血压患者383例,将383例高血压患者进行统一建档管理。比较干预前后患者对高血压相关知识的知晓率、治疗率、血压控制率的变化情况。结果管理、干预前社区高血压患者对高血压相关知识的知晓率、治疗率、控制率分别为71.02%、80.15%、33.15%。管理干预一年后患者对高血压相关知识的知晓率、治疗率、控制率分别为100%、100%、96.08%。比较管理前后患者对高血压相关知识的知晓率、治疗率、控制率的差异有统计学意义。结论以社区为单位对高血压患者进行建档、管理、对生活方式进行干预等手段,能提高患者对高血压病相关知识的知晓率、治疗率、控制率。从而控制血压、预防心脑血管疾病的发生。     

初发和再发脑梗死相关影响因素比较分析

目的探讨60岁以上缺血性再发脑梗死患者危险因素。方法采用平行对照的方法,将发生脑梗死患者分为脑梗死再发组和非再发组,观察研究两组患者一般情况、合并疾病与颈动脉斑块变化特点。结果两组患者在体质量、饮酒方面无明显差异,脑梗死再发组患者血压、血糖、血脂等方面明显高于非再发组患者(P<0.05),颈动脉内膜中层厚度(IMT)、斑块发生率等高于对照组(P<0.05)。结论老年人缺血性脑梗死再发与颈动脉斑块关系密切。积极降压、调脂、降糖治疗,稳定颈动脉斑块在缺血性脑梗死二级预防中有重要意义。     

武警部队军人及家属紧急避孕知识和使用状况调查

 目的了解武警部队中女性紧急避孕知识的掌握和使用状况.方法以保密问卷或电话交流方式进行调查.结果在172名有效被调查者中,紧急避孕知晓率为43.6%,但应用率仅为2.9%.若知道更多有关知识,愿意使用率为37.2%,其中高龄女性(＞35岁)的愿意使用率将达49.3%.现役或退伍女军人、干部和年轻女性(＜25岁)的知晓率较高.年轻女性更希望紧急避孕药丸为免费或非处方药.结论对部队中女性有必要进行紧急避孕知识的宣教,积极推广紧急避孕药丸的使用是十分重要的.     

葡萄糖调节受损患者对口服葡萄糖耐量试验知晓率调查分析

目的：了解四川某三甲医院葡萄糖调节受损患者对口服葡萄糖耐量试验的掌握程度,分析相关影响因素,探讨相应的对策,提高口服葡萄糖耐量试验的准确性。方法采用自行设计的口服葡萄糖耐量试验相关知识问卷,问卷包括：一般资料问卷和OGTT知识调查。OGTT知识调查由试验目的、试验前准备、试验中注意事项、试验后标本处理、结果判读等组成,通过半结构式面对面调查葡萄糖调节受损患者对OGTT试验的知晓率并进行分析。结果对OGTT试验目的知晓率为71.4%,对试验前准备知晓率为54.0%,对试验中注意事项知晓率为52.0%,对试验后标本的正确处理知晓率为35.7%,对试验结果判断正确的知晓率为28.5%,综合以上分析平均知晓率为48.3%。接受过OGTT试验相关知识教育的患者为60.0%。接受相关知识主要来自医生和护士,较少从陪伴、家属、健康教育宣传资料处了解。结论葡萄糖调节受损患者对OGTT试验知晓率较差,需加大对OGTT试验相关知识的宣传,提高患者对OGTT试验的掌握度,从而保证OGTT试验的准确率。     

4D-CT血管造影在急性缺血性脑卒中中的应用价值

目的:探讨采用256层CT全脑灌注成像重建的4D-CT血管造影在急性缺血性脑卒中中的价值。方法:自2011年12月至2012年9月,共收集52例急性缺血性脑卒中病患的临床及影像学资料。所有患者均接受入院CT平扫、256层全脑CTP和头颈部CTA检查。CTP动态扫描获得全脑的血流灌注信息,通过灌注原始数据重建获得12cm扫描覆盖范围内的动态4D-CTA,观察其检测大血管管腔状况的能力。结果:CTA共检测11位患者中存在12处颅内血管闭塞。4D-CTA显示颅内11处大血管闭塞,敏感性、特异性及阳性预测值分别为91.7%、100%、100%。结论:256层CT全脑灌注成像重建的4D-CT血管造影可作为检测急性缺血性脑卒中大血管闭塞的一种可行方法。     

络泰治疗高胆固醇血症70例临床观察

高胆固醇血症是冠心病的重要危险因素，在疾病的发生发展过程中起着重要作用，目前缺血性心血管疾病发病率非常高，采用积极有效的措施治疗高胆固醇血症，对于延长生命和提高生活质量十分重要，调脂治疗能够预防动脉粥样硬化和冠心病的发生发展，有益于冠心病的二级预防。普伐他汀是他汀类血脂药物，络泰由中药三七根提取的三七总甙。于2002年1月-2003年1月应用络泰与普伐他汀治疗原发性高胆固醇血症共70例，观察其临床疗效及安全性。     

高压氧综合治疗进展型缺血性脑卒中的临床观察

近年来，对急性缺血性脑卒中的发病机制、病理生理及预防和治疗进行了大量的研究，脑卒中的早期溶栓治疗也取得了较好的效果，但对进展型缺血性脑卒中的治疗效果和预防的报道不多。笔者采用高压氧（HBO）综合治疗的方法对46例进展型脑卒中患者进行了治疗，现将治疗情况和效果报告如下。     

品管圈在缩短急性缺血性脑卒中患者静脉溶栓诊疗时间的应用

目的 探讨品管圈在急性缺血性脑卒中患者诊疗流程中缩短患者到院至接受静脉溶栓时间(door to needle time,DNT)的应用.方法 组建护理组品管圈,通过对急性缺血性脑卒中患者的静脉溶栓情况进行现状调查,分析DNT过长的原因,设定DNT目标值为60 min,并有针对性地进行整改、进行效果确认.结果 通过本次品管圈活动,DNT由原来(78.14±12.41) min缩短至(59.81±11.43) min,差异有统计学意义(P＜0.01).结论 通过开展品管圈活动,有效地缩短急性缺血性脑卒中患者的诊疗流程中DNT,为急性缺血性脑卒中患者治疗赢得了时间.     

Case report: therapeutic bronchial artery embolization in a case of Takayasu's arteritis.

The pulmonary arteries are frequently involved in Takayasu's arteritis with a reported incidence of 41-100% in affected individuals. Patients are usually asymptomatic, however, often despite extensive pulmonary involvement. We describe a patient with Takayasu's arteritis who presented with haemoptysis caused by bronchial artery hypertrophy secondary to occlusive pulmonary arterial disease, who was treated by bronchial artery embolization. This is, to our knowledge, the first reported case of haemoptysis secondary to Takayasu's arteritis successfully treated by embolization.     

Radiologic review of total elbow, radial head, and capitellar resurfacing arthroplasty

The use of metal and pyrolytic carbon radial head implants, capitellar resurfacing, and total elbow arthroplasty has become common in contemporary orthopedic surgery practice. The goal of total elbow arthroplasty is to decrease pain and restore an acceptable range of motion to the elbow joint. Rheumatoid arthritis is the primary indication for total elbow arthroplasty; newer indications include primary or posttraumatic osteoarthritis, fracture nonunion, acute comminuted fractures of the elbow, and postoperative resection of a neoplasm. Unlike total elbow arthroplasty, radial head replacement is most commonly performed in patients with trauma. Radial head fractures account for 33% of all elbow fractures in adults and are often associated with ligament disruption and valgus instability at the elbow. The goals of capitellar resurfacing arthroplasty include prevention of secondary osteoarthritis of the radiocapitellar joint and erosion in patients with radial head arthroplasty. Effective postoperative radiologic assessment of these different types of elbow reconstructions requires an understanding of their basic component design, physiologic purpose, and normal postoperative appearance, as well as the appearance of complications. Radiologists may have little training and experience with these new orthopedic devices.     

西安市航天六院职工脑卒中危险因素知识、信念、行为调查研究

目的 了解西安市航天六院职工（≥18岁）脑卒中防治知识、信念、行为现状,分析其相关影响因素,为脑卒中的防治提供科学依据。方法 选取2013年1-12月在西安市航天总医院体检的航天六院职工,采用整群随机抽取300人（年龄≥18岁）为研究对象,实际完成调查人员为284人,应答率为94.67%,由西安航天总医院体检中心医生经过培训后进行面对面调查并填写统计问卷调查表。调查内容包括一般情况和脑卒中防治知识、信念、行为等有关内容。结果 平均年龄（44.68±16.25）岁,其中以40-59岁年龄组人数最多,占45.42%。大专以上文化程度者最多,占46.13%。被调查人群脑卒中防治知识与行为、信念评分的相关系数分别为0.201（0.000）、0.663（0.000）,行为和信念评分的相关系数为0.239（0.000）。知识、信念和行为3者相互之间均有联系。结论 脑卒中防治知识、行为和信念3项评分具有一致性。     

北京市核医学2019年基本情况调查分析

目的:全面了解北京市医疗机构核医学发展现状,为国家相关主管部门合理配置医疗资源和制定相关医疗政策提供参考数据。方法:采用问卷调查形式,对2019年北京市拥有核医学相关科室的医疗单位进行调查。调查问卷的发放采用现场当面呈送与电子邮件相结合的方式。调查内容包括医疗机构或科室的概况、业务设置、影像设备规模、科室人员、诊疗工作...     

海洋石油职工复发性脑卒中情况分析

目的：了解海洋石油职工复发性脑卒中情况及影响因素。方法：采用病历回顾性调查法。结果：调查海洋石油职工脑卒中596例（男419，女177），首发484例，复发112例占18．8％。男性病人中复发82例，复发率为19．6％，女性病人中复发30例为17．0％，缺血性脑卒中显著高于出血性脑卒中，复发1次者61例占54．5％，复发次数最多为7次。复发性脑卒中患者有高血压、糖尿病、高血脂、TIA、高粘血症的百分率明显高于首发脑卒中病例。结论：海洋石油职工复发性脑卒中有较高的发生率且以缺血性脑卒中为多见，并有随年龄增加而升高的趋势。其所患各危险因素亦较高，故而必须采取一切干预措施，降低危险因素，减少脑卒中的复发，减轻家庭及社会负担。     

湖区武警部队官兵血吸虫病防治认知调查

目的了解湖区武警部队官兵血吸虫病认知现状,为制定武警部队血吸虫病防治措施提供参考依据。方法采用分层整群抽样的方法,对湖南、湖北、江西、安徽及江苏5省武警部队官兵进行问卷调查,调查内容包括官兵社会人口学信息、血吸虫病防治知识、防治态度和接触疫水行为方式,根据答题结果将防治知识判定为及格和不及格,防治态度分为积极和消极。结果 201个调查点22 606份有效问卷中,血防知识总及格率43.2%,其中年龄≤20岁组及格率41.7%,21～29岁组45.1%,≥30岁组42.1%;干部、战士及格率分别为42.5%、43.3%;入伍地为血吸虫病流行疫区官兵的及格率为48.2%,非疫区为39.7%;69.9%的官兵防治态度积极,30.1%消极;接触疫水的行为方式中,湖水浇菜地行为12 188人（53.9%）,参加疫区抗洪抢险8 139人（36.0%）;防治知识及格组与防治态度积极组在接触疫水的行为上明显低于不及格组和消极组。结论湖区武警部队官兵血吸虫病防治知识整体水平有待提高,加强血吸虫病健康教育及推行行为干预是部队血吸虫病防治工作的关键之一。     

Radiation doses for barium enema and barium meal examinations in Ireland: potential diagnostic reference levels

Wide variations in patient dose for the same examinations have been demonstrated by several studies throughout Europe. By investigating patient dose, variations can be acknowledged, causal agents sought and the necessary adjustments made. Diagnostic reference levels (DRLs) provide a framework with which dose levels from individual hospitals are compared, and when exceeded, corrective actions can be taken where appropriate. This study aimed to establish DRLs for barium enema and barium meal examinations in Ireland. Measurements were recorded using a dose-area product meter in 12 hospitals representing 33% of relevant hospitals. Results demonstrated wide mean hospital dose variation, by up to a factor of 7.8 and 4.2 for barium enema and barium meal examinations, respectively. Minimum and maximum individual patient dose values varied by a factor of 45 for barium enemas and 90 for barium meal examinations. Reasons for dose variations were complex, but major factors for both examinations were fluoroscopy time, secondary radiation grid type and level of filtration. Some examination-specific factors were also noted. DRLs, established using the quantity dose-area product, were calculated to be 47 Gy cm(2) for barium enemas and 17 Gy cm(2) for barium meal examinations. Although the DRL value for barium meals was the same as the reference value established in the UK for that examination in 1996, the barium enema DRL in this study was 45% higher than the relevant UK value.     

Nuclear medicine practice in Japan: A report of the 5th nationwide survey in 2002

The Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every five years since 1982 to provide detailed information on its current status. METHODS: Questionnaires were sent to every institution known to the Japan Radioisotope Association to provide nuclear medicine examinations. The questionnaires address the number and kind of nuclear medicine examinations performed as well as the kind and dose of the radiopharmaceuticals used during the month of June 2002. The annual number of total or specific examinations was then estimated. RESULTS: Of the institutions sent questionnaires, 1,204 were for in vivo study, 124 were for in vitro study, and 36 were for positron emission tomography (PET) study. Out of these, 95.8% answered them. A total of 1,697 gamma cameras were installed in 1,160 facilities, of which 50% were dual-head cameras. The estimated total annual number of examinations expressed by the number of administered radiopharmaceuticals was 1.60 million, similar to that of the previous survey (1997). The frequency of study with single photon emission computed tomography (SPECT) increased to 40%, from 30% in the previous survey. The scintigraphy most frequently performed was bone (35%), followed by myocardium (24%) and brain perfusion (12%). All showed a continuous increase over the past 20 years. Tumor imaging, however, fell from third to fourth place. The most commonly used radiopharmaceutical for each scintigraphy was 99mTc-HMDP for bone, 201Tl-chloride for myocardium, 67Ga-citrate for tumor, and 123I-IMP for brain. A total of 29,376 PET studies were performed yearly. Among them, 18F-FDG rapidly increased 3.7-fold. 131I therapy for thyroid cancer and hyperthyroidism was conducted yearly in 1,647 and 3,347 patients, respectively. A total of 31.35 million in vitro radioassays were carried out yearly, the number of which has been decreasing continuously since 1992. CONCLUSIONS: It was proved that the content of nuclear medicine practice in Japan has changed in the past five years. This report might be useful for understanding the current trends of nuclear medicine practice in Japan.     

长期服用华法林冠心病患者冠状动脉介入治疗围术期抗栓策略的探讨

目的 探讨长期服用华法林冠心病患者接受经皮冠状动脉介入治疗(PCI)围术期的抗栓策略,评价其安全性及近期疗效.方法 分析2002年1月-2007年12月在沈阳军区总医院住院的76例长期服用华法林不稳定型心绞痛患者行PCI的临床资料.服用华法林的原因为:心脏金属瓣膜置换术51例(67.1%),半年内的肺栓塞6例(7.9%),永久性房颤伴血栓高危因素19例(25%).PCI术前停华法林用常规剂量低分子肝素(LMWH)替代,当国际标准化比率(INR)≤1.3时行PCI.术后在应用小剂量阿司匹林(ASA)100mg/d及氯吡格雷75mg/d的基础上联用LMWH,并恢复华法林,INR达到1.8以上停用LMWH,调整华法林用量使INR维持在1.8～2.3之间,1个月后停用氯吡格雷.继续用ASA(75～100rng/d),华法林恢复至支架术前剂量.观察住院期间缺血事件、主要不良心脏事件(MACE)、支架内亚急性血栓形成(SAT)及出血的发生率.结果 出血事件5.3%(4/76),其中次要出血1例1.3%(1/76),MACE发生率1.3%(1/76),未因调整抗栓治疗方案而发生主要出血及SAT.结论 长期服用华法林的冠心病患者接受PCI术前用LMWH替代华法林,术后短时间内联用小剂量ASA、氯吡格雷、LMWH及华法林,根据INR精确调整华法林剂量并适时停用LMWH,这一特殊抗栓策略安全、有效,且可行性较好.     

Heat illness in children

With an increasing number of children and adolescents involved in competitive athletics throughout the calendar year, the sports medicine team must be familiar with preventing and treating heat-related illness. Heat illness is a spectrum of illnesses from heat cramps to heat stroke. Mortality for heat stroke ranges from 17% to 70%, depending on severity and age of the patient. Children are more susceptible to heat illness than adults for many reasons, including a greater surface area to body mass ratio, lower rate of sweating, and slower rate of acclimatization. The prevention of heat illness is based on recognizing and modifying risk factors, which include environmental conditions, clothing, hydration, and acclimatization. Once heat illness is suspected, treatment should begin immediately with rapid cooling procedures started on the field.