消化内镜废液积漏袋的设计和使用效果评价

目的 设计消化内镜废液积漏袋，以期为减少术中废液污染情况提供有效工具。方法 2020年设计消化内镜废液积漏袋，采用便利抽样法选取2021年10月至2022年1月某院消化内镜中心行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)操作的80例患者为研究对象，并依据随机数字法将其分为对照组和观察组，每组40例。对照组术中使用一次性PE手套收集阀门口废液，而观察组使用手术废液积漏袋。比较两组单位时间内收集废液量及废液污染情况评分。结果 对照组与观察组单位时间内收集废液量分别为3.55(3.2,4.3)ml/h和5.5(4.5,5.8)ml/h,差异有统计学意义(P<0.001)。观察组废液污染评分以0～1分为主，约占92.5%,其废液污染情况明显优于对照组，差异亦有统计学意义(Z=-5.763,P<0.001)。结论 手术废液积漏袋的使用可有效收集ERCP中产生的废液，减少术中废液手术室环境污染情况的发生，值得推广应用。     

感染病房负压水平对物体表面新型冠状病毒核酸污染影响的调查

目的 了解新型冠状病毒感染病房不同负压水平对物体表面该病毒核酸污染的影响。方法 选取某医疗机构新型冠状病毒感染负压病房作为调查对象,检测病房内外气压差,对病房内的床扶栏、地板、水槽和马桶等表面进行新冠病毒核酸采样,并检测病毒核酸污染情况。结果 2个层楼的感染病房负压差分别为(20.96±0.57)和(6.49±0.90)Pa(t=113.348,P<0.001),均符合GB/T 35428—2017要求(负压差≥5 Pa);相应层楼阳性样本检出率分别为16.41%和16.97%(χ²=0.020,P=0.887)。低负压病房起居室内阳性样本检出率为23.23%,高于洗手间阳性样本检出率(7.58%)(χ²=6.889,P=0.009);高负压病房两区域检出率差异无统计学意义(P>0.05)。低负压病房地面阳性样本检出率高于高负压病房(27.27%vs 7.69%;χ²=4.934,P<0.05)。结论 负压差大小对感染病房内新型冠状病毒的污染整体分布影响不明显,低负压病房应注重洗手间的清洁消毒,尤其应加...     

胆囊结石对肝硬化食管胃静脉曲张内镜术后再出血的影响

目的 探讨胆囊结石对肝硬化门静脉高压食管胃静脉曲张内镜术后再出血的影响。方法 回顾性分析2014年1月至2021年1月杭州市西溪医院肝硬化合并胆囊结石食管胃静脉曲张(GOV)内镜术患者122例(PGOV组),并以1:1对比分析在此期间肝硬化无胆囊结石GOV内镜术患者122例(NGOV组),比较两组患者5 d内、6周内、3个月内、6个月内、1年内再出血率及GOV消除率、并发症发生率。并予Logistic回归探讨肝硬化GOV内镜术后再出血的危险因素。结果 5 d内再出血:PGOV:2/122,NGOV:1/122 (RD=0.82%,95%CI=-2.0%～3.6%)(χ²=0.000,P=1.000)。6周内再出血:PGOV:11/122;NGOV:8/122 (RD=2.5%,95%CI=-4.3%～9.2%)(χ²=0.514,P=0.474)。3个月内再出血:PGOV:17/122;NGOV:18/122,(RD=-0.82%,95%CI=-9.6%～8.0%)(χ²=0.033,P=0.855)。6个月内再出血:P...     

鼻窦药物支架在复发性鼻窦炎中的短期疗效

目的 评估复发性鼻窦炎(RRS)患者行修正性内镜鼻窦手术(ESS)术中植入全降解鼻窦药物支架(SES)对术区创面恢复的短期疗效。方法 选择由同一术者完成手术的复发性鼻窦炎患者，自身对照方法在ESS术中随机分为支架侧(支架组)和对照侧(对照组)。术后30、90 d，由独立评估小组根据内镜检查结果评估支架侧和对照侧术区恢复情况，进行内镜评分和确定是否需要进行术后干预(手术和口服激素干预)。结果 共计纳入的30例复发性鼻窦炎患者，术后30 d，支架组相比对照组术后需要干预的比例降低了50%(χ²=5.514,P=0.007 0)，其中手术干预下降50%(χ²=4.921,P=0.043 9)，口服激素干预下降了50%(χ²=5.292,P=0.022 7)，额窦口通畅度提高60%(χ²=5.343,P=0.034)；术后90 d，支架组相比对照组术后需要干预的比例下降50%(χ²=5.414,P=0.024 5)，其中手术干预下降42.8%(χ²=4.887,P...     

临床实验室早期诊断ABO-HDN三种增强试验应用比较研究

目的 探讨《HDN产后免疫血液学试验推荐方案》中增强试验在临床实验室早期诊断ABO系统新生儿溶血病(HDN)中的应用效果。方法 可疑ABO-HDN患儿274例,检测母亲ABO,RhD血型和IgG抗-A/B效价及患儿ABO,RhD血型和三项溶血试验,采用经典抗球蛋白试验(对照组)和《HDN产后免疫血液学试验推荐方案》中的三种增强试验分别是酶处理细胞增强试验(试验组1)、添加低离子强度(LISS)溶液(试验组2)、添加聚乙二醇(PEG)溶液(试验组3)检测游离抗体和放散液抗体,比较四种方法的临床诊断效果。结果 274例患儿确诊ABO-HDN 161例(58.8%),其中A型87例(54.0%),B型74例(46.0%),不同血型患儿HDN患病率差异无统计学意义(χ² =0.089,P>0.05)。161例ABO-HDN患儿中直抗阳性25例(15.5%)。对照组放散试验漏检率为5.8%(16/274)。试验组游离试验和放散试验检出率均高于对照组,其中试验组1检出率最高,试验组3次之,试验组2低于1,3组(χ² _游离=46.438,χ²_放散 =37.534,均P<0.05)。HDN发病例数和总胆红素水平随着酶处理细胞增强试验放散液抗体效价增高而增加(χ² =18.931,F=12.624,P<0.05)。结论 酶处理细胞增强试验检出效果最佳,能为实验室早期诊断ABO-HDN提供可靠的依据。     

2016-2022年云南省市售禽畜肉中弯曲菌污染状况调查分析

目的 了解云南省市售禽畜肉中弯曲菌的污染状况,为食源性疾病的防控提供依据。方法 对2016—2022年云南省16个地(州、市)市售禽畜肉进行随机采样和弯曲菌检测,根据肉类别、样品采集年份、地区、采样环节和季度,对样品中弯曲菌的污染状况进行分析。结果 弯曲菌总检出率为9.21%(178/1 932),空肠和结肠弯曲菌检出率分别为5.75%(111/1 932)和3.47%(67/1 932)。禽肉中弯曲菌的检出率(11.42%,160/1401)高于畜肉(3.39%,18/531),两者差异有统计学意义(χ²=31.521,P<0.001)。弯曲菌在鲜肉、冷却肉和冻肉中的检出率差异有统计学意义(χ²=38.975,P<0.001),冷却肉中检出率最高,为16.67%(39/234),冻肉中检出率最低,为1.89%(5/264)。不同年份采集的样本弯曲菌检出率差异有统计学意义(χ²=26.597,P<0.001;空肠弯曲菌χ²=33.466,P<0.001;结肠弯曲菌χ^...     

口腔与胃内幽门螺杆菌感染的相关性

目的 探讨口腔幽门螺杆菌(Hp)感染与胃Hp感染的相关性,及口腔Hp感染对Hp根除治疗的影响。方法 选择216例上消化道不适患者,均给予幽门螺杆菌唾液测试板(HPS),¹³C-UBT检测,以¹³C-UBT为金标准,对HPS法检测结果用贝叶斯定理方法进行评价。选择¹³C-UBT阳性患者168例,经PPI三联或四联7天疗法规范的抗Hp治疗后4周和3个月,复查¹³C-UBT,并对两者结果进行对比研究。结果 ①利用贝叶斯定理计算得出:在口腔感染Hp发生的条件下胃感染Hp发生的概率为84.1%。HPS的灵敏度为66.1%,特异度为56.3%,阳性预测值为84.1%,阴性预测值为32.1%。②216例上消化道不适患者中,HPS阳性率为61.1%,¹³C-UBT阳性率为77.8%,两种检测方法比较,差异有统计学意义(χ²=14.138,P<0.01).¹³C-UBT阳性者,HPS阳性率为66.1%; ¹³C-UBT阴性者,HPS阳性率为43.8%,两者比较差异有统计学意义(χ²=7.827,P<0.01)。③治疗后4周,HPS阳性者(n=75),胃Hp根除率为93.3%; HPS阴性者(n=27),胃Hp根除率为92.6%,两者比较差异无统计学意义(χ²=0.000,P>0.05).3个月后,HPS阴性者(n=42)胃Hp根除率(63.2%),明显高于HPS阳性者(n=19)(33.3%),两者比较差异有统计学意义(χ²=4.758,P<0.05))。结论 口腔Hp感染与胃内Hp感染密切相关,胃Hp的感染复发率受口腔Hp存在的影响。     

454份流感样病例咽拭子标本病毒分离情况分析

目的 了解抚州市流感病毒分离情况,为进一步提高流感病毒分离率提供科学方法。方法 收集2019年1至4月份流感样病例咽拭子标本,Real-time PCR方法检测流感病毒核酸,MDCK细胞对核酸阳性标本进行病毒分离。结果 454份咽拭子标本分离出流感病毒11株,病毒分离率为7.64%(11/144),其中新甲1 10株,季H3 1株。抚州市第一人民医院监测标本病毒分离率为6.36%(7/110),抚州市疾病预防控制中心(抚州CDC)疫情标本、金溪县疾病预防控制中心(金溪CDC)疫情标本和广昌县疾病预防控制中心(广昌CDC)疫情标本病毒分离率分别为44.44%(4/9), 0%(0/7)和0%(0/18)。抚州CDC疫情标本与抚州市第一人民医院监测标本核酸阳性率和病毒分离率均有统计学意义(χ²=16.20,P<0.01;χ²=10.20,P<0.01)。抚州CDC疫情标本与金溪CDC、广昌CDC疫情标本核酸阳性率无统计学意义(χ²=1.45,P> 0.05),病毒分离率有统计学意义(χ²     

改良式手-膝位分娩对初产妇分娩结局和舒适度的影响

目的评价第二产程中采用改良式手-膝位分娩对初产妇分娩结局和舒适度的影响。方法选取2019年10月1日—2020年3月31日在西安市某三级甲等医院产房中心分娩的290名初产妇为研究对象,采用随机数字表法分为试验组(n=145)和对照组(n=145),试验组在第二产程采用改良式手-膝位分娩,对照组采用屈膝半卧位分娩,比较两组分娩结局和舒适度的差异。结果试验组自然分娩率高于对照组(χ²=12.590)、会阴侧切率低于对照组(χ²=48.019)、第二产程时间短于对照组(t=-2.579)、产时及产后2 h出血量少于对照组(t=-2.134)、分娩舒适度问卷得分高于对照组(t=-10.775),差异具有统计学意义(均P<0.05);两组新生儿窒息率比较,差异无统计学意义(χ²=0.344,P=0.995)。结论改良式手-膝位分娩可提高产妇自然分娩率,缩短第二产程时间,降低会阴侧切率,减少产后出血,提高产妇分娩舒适度。     

眼眶淋巴瘤和炎性假瘤的临床表现及MRI特征

目的 探讨眼眶淋巴瘤及炎性假瘤患者的临床表现及MRI特征,以提高二者的诊断水平。方法 眼眶淋巴瘤患者17例为淋巴瘤组,炎性假瘤患者18例为炎性假瘤组,均行MRI平扫及脂肪抑制-T₁WI序列增强扫描。比较2组临床表现、MRI平扫及增强扫描影像特征。结果 (1)眼眶淋巴瘤组年龄[(49.5±10.6)岁]大于炎性假瘤组[(45.1±14.2)岁](t=14.213,P=0.001),男性及眶周肿物可扪及比率(70.59%、58.82%)均高于炎性假瘤组(33.33%、22.22%)(χ²=4.858,P=0.028;χ²=4.880,P=0.027),病变部位、眼球突出、眼睑肿胀、结膜充血水肿、眼球运动障碍、视力下降比率与炎性假瘤组比较差异均无统计学意义(P>0.05)。(2)淋巴瘤组病灶边界清晰(52.94%)、“铸型”生长(41.18%)、信号均匀比率(64.71%)均高于炎性假瘤组(16.67%、0、22.22%)(χ²=5.106,P=0.024;χ²=9.265,P...     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.