剃毛与不剃毛备皮对食道癌术后感染率的影响

目的 研究术前不同备皮方法(剃毛与不剃毛)对手术切口感染的影响;方法将96例食道癌手术患者随机分为剃毛组和未剃毛组,统计分析两组手术切口感染率情况;结果剃毛组发生切口感染6.67%;未剃毛组发生切口感染率7.84%;两组切口感染率比较,差异无显著性.(P>0.05);结论不剃毛备皮法和代传统的剃毛备皮法对手术切口感染无影响.     

两种备皮方法在骨科手术中的效果观察

目的探讨两种备皮方法对骨科手术愈合效果的影响。方法选取本院骨科病房符合入选标准的患者264例,对照组和观察组各132例。对照组采用常规剃毛备皮,观察组采用脱毛剂备皮,比较两组切口感染率、切口愈合与患者满意度。结果观察组切口感染率、切口愈合与患者满意度均优于对照组,差异均具有统计学意义（均P〈0.05）。结论脱毛剂备皮法可以有效降低骨科手术患者切口的感染率,改善切口愈合情况,提高患者满意度,是一种科学、有效的备皮方法。     

不剃毛备皮在普外科腹部手术前的应用分析

目的探讨不剃毛备皮法在普外科腹部手术中的应用方法 选择我院自2011年6月—2012年6月普外科腹部手术病人共1085例患者,分为两组,常规剃毛备皮组(常规组)和不剃毛备皮组(试验组),通过分析两组切口愈合情况及感染率,以此评价不剃毛备皮法在腹部手术中的应用.结果 研究结果显示两组术后的切口愈合率与感染率无统计学意义(P>0.05).护士和患者倾向不剃毛备皮法.结论 两种备皮法在预防切口感染上无明显差异,护士及患者均倾向于不剃毛备皮法,值得推广应用.     

含碘手术薄膜在预防手术切口感染中的应用

目的探讨含碘手术薄膜预防Ⅰ类手术切口感染发生率。方法将180例Ⅰ类手术切口随机分成试验组与对照组各90例,试验组手术部位采用含碘手术薄膜,对照组手术部位采用普通不含碘手术薄膜,分别在消毒后及手术结束缝合皮肤前取样做细菌培养,观察两组细茵培养及切口愈合情况。结果试验组手术切口甲级愈合100%,细菌培养无细菌生长;对照组手术切口甲级愈合87%,细菌培养阳性率35%。两组比较差异有统计学意义(P<0.05)。结论含碘手术薄膜能显著降低Ⅰ类手术切口感染率,值得临床推广。     

术前营养免疫状态调整在预防骨科Ⅰ类切口感染中的作用

目的 探讨术前营养免疫状态的调整方法对骨科Ⅰ类切口感染率的影响.方法 术前营养不良患者120例,随机分为改良营养状态调整组(治疗组)和常规营养状态调整组(观察组),治疗组术前检测患者的白蛋白、淋巴细胞数,白蛋白数值低于正常的则给与高蛋白营养食物和(或)人血白蛋白进行补充,使白蛋白数值大于35g·L-1,淋巴细胞总数大于1.5×109·L-1,检测患者的嗜中性粒细胞数、免疫球蛋白,调节机体免疫状态,使嗜中性粒细胞数值、免疫球蛋白的数值达到正常;观察组术前只调整营养状态,使白蛋白数值大于35 g·L-1.结果 治疗组围手术期感染2例,全部为浅表感染,切口感染率2.90%;观察组围手术期感染4例,其中浅表感染2例,深部感染2例,切口感染率7.84%(两组比较P＜0.01).治疗组出现迟发感染1例,迟发感染率1.45%;观察组出现迟发感染2例,迟发感染率3.92%(两组比较P＜0.05).结论 术前免疫状态的调整对骨科Ⅰ类切口感染率有显著影响,改良术前营养免疫状态调整方法可以降低Ⅰ类切口感染率.     

手术前备皮方法和备皮时间的研究

目的 研究术前备皮与不备皮对术后感染有何影响.方法 将我院260例手术患者随机分为观察组与对照组,观察组只清洁皮肤不备皮,对照组剃除手术野所有毛发,将两组数据进行统计学分析.结果 两组切口感染率比较无显著性差异(P＞0.05).结论 术前术区备皮不能降低术口切口感染率.     

预防性应用抗生素在I类手术切口病人中的作用

目的　 探讨Ⅰ类手术切口感染发生的危险因素及其预防性应用抗生素是否必要。方法 　 随机抽取实验组 54例 ,在围手术期不用抗生素 ,与使用抗生素的 56例对照组比较 ,并对有关因素进行多元回归分析。结果　 两组的切口感染率无明显差异 (P >0 0 5) ;经多元回归分析 ,切口感染与预防性应用抗生素、性别、麻醉方式无相关性 ,但与年龄、手术时间长、营养差、糖尿病史、手术并发症呈正相关性。结论 　 年龄、手术时间、糖尿病史、营养差、手术并发症是Ⅰ类手术切口感染的危险因素 ,如出现两个或两个以上的危险因素 ,可酌情预防性应用抗生素 ,否则 ,不主张Ⅰ类手术切口预防性应用抗生素     

三联微创切口与传统"L"外侧切口治疗跟骨骨折疗效对比

目的:通过回顾性分析,对两种切口在治疗跟骨骨折中多个指标进行对比,为临床治疗提供新思路。方法:选择跟骨骨折患足48例,SandersⅠ型9例,SandersⅡ型15例,SandersⅢ型18例;SandersⅣ型6例,随机分为微创组和传统组进行治疗,并随访12个月。对比平均术前等待时间、平均手术时间、术后功能恢复情况及并发症发生率。结果:两组患者平均术前等待时间有显著统计学差异(P<0.001),微创组等待时间(133±66)h,较传统组(247±52)h短。两组患者术后B9lher角和Gissane角的恢复无显著差异。虽然两组患者在皮瓣坏死率(微创组0%,传统组17.65%)和感染率(微创组0%,传统组5.88%)无统计学差异,但微创组较传统组发生率低。两组患者术后功能恢复情况无显著性差异(P=0.986),但传统组有1例患者因皮瓣坏死后进行皮瓣修复而抱怨美观受到影响。结论:三联微创切口在治疗跟骨骨折上总体优于传统"L"型外侧切口,是一种可以推广的新入路。     

预防性应用抗生素在Ⅰ类手术切口病人中的作用

目的：探讨Ⅰ类手术切口感染发生的危险因素及其预防性应用抗生素是否必要。方法：随机抽取实验组54例,在围手术期不用抗生素,与使用抗生素的56例对照组比较,并对有关因素进行多元回归分析。结果：两组的切口感染率无明显差异（P＜0．05）。经多元回归分析,切口感染与预防性应用抗生素,性别,麻醉方式无相关性,但与年龄,手术时间长,营养差,糖尿病史,手术并发症呈正相关性。结论：年龄,手术时间,糖尿病史,营养差,手术并发症是Ⅰ类手术切口感染的危险因素,如出现两个或两个以上的危险因素,可酌情预防性应用抗生素,否则,不主张Ⅰ类手术切口预防性应用抗生素。Ⅰ     

SHEL模型在降低手术室术后切口感染中的应用研究

目的：评价SHEL模型在手术室术后切口感染控制中的应用价值。方法：选择2021年1—6月完成Ⅰ、Ⅱ类手术的10 312例患者作为对照组,2021年7—12月完成Ⅰ、Ⅱ类手术的10 432例患者作为观察组,对照组采用常规方法控制,观察组采用SHEL模型实施手术切口感染控制管理,比较两组患者手术室卫生学监测结果及护理质量和切口感染率。结果：观察组手术室空气卫生学监测合格率、物体表面卫生学监测合格率及医务人员手消毒合格率(99.21%、98.33%、98.89%)均高于对照组(94.44%、83.33%、89.44%,均P<0.05);干预后手术室各项护理质量评分均高于对照组(均P<0.05);Ⅰ、Ⅱ类手术切口感染率及总感染率(0.07%、2.27%、0.99%)均低于对照组(0.28%、7.92%、3.47%,均P<0.05)。结论：应用SHEL模型实施手术室切口感染控制管理,有利于降低手术切口感染率,提高手术室管理质量,值得临床推广。     

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.