腹腔镜肾盂切开取石术与经皮肾镜碎石取石术在大于2.5cm肾盂结石处理中的临床效果比较

目的 比较研究腹腔镜肾盂切开取石术(LPL)和经皮肾镜碎石取石术(PCNL)在≥2.5 cm肾盂结石处理中的临床应用和价值.方法 回顾性收集我院2011～2016年肾盂结石患者64例.所有患者均为肾盂结石≥2.5 cm.分为2组,其中采用LPL手术32例(LPL组);采用PCNL手术32例(PCNL组).比较两种手术方式的患者基本参数和结石大小等.同时比较两组手术平均手术时间、估计失血量、输血率、术后住院时间、结石清除率、术后镇痛时间、术中并发症、术后早期和晚期并发症等.比较研究两种手术方式对肾盂结石的治疗效果.结果 两组之间在患者基本参数和结石大小方面无统计学意义(P＜0.01).LPL和PCNL手术时间分别为117±23.12、l18.16±25.45min(P＞0.01)、估计失血量分别为63±11.25、122±27.78mL(P＜0.01)、输血率分别为0％和6.2％(P＜0.01)、术后住院时间分别为4.5±1.34、4.8±2.2 d(P＞0.01)、结石清除率分别为93.1％和87.5％(P＞0.01)、术后镇痛时间分别为1.7±0.5、1.9±0.6 d(P＞0.01)、术中并发症分别为6.2％和25.0％(P＜0.01)、术后早期并发症分别为25.0和34.4％(P＞0.01)、术后晚期并发症分别为9.4％和12.5％(P＞0.01).结论 PCNL是肾盂结石目前标准的治疗方法,但对腹腔镜熟练的外科医师,LPL对部分肾盂结石的处理是一种可行、安全的治疗方法.     

Effect of two intensive insulin therapy regimens on perioperative glycemic control in bone fracture patients with type 2 diabetes mellitus

Background Currently,there are no uniform standards and methods for perioperative glycemic control in bone fracture patients with Type 2 diabetes mellitus (T2DM).We retrospectively analyzed the efficac...     

绿色通道建设提高高龄髋部骨折患者治疗的有效性与安全性

目的 观察绿色通道建设在高龄髋部骨折患者治疗中的应用效果,为高龄髋部骨折患者的规范化治疗提供依据.方法 回顾性分析2014年6月-2015年6月经治的115例高龄(≥75岁)髋部骨折患者的临床资料,根据诊治流程不同分为绿色通道组(58例)和常规处理组(57例).比较两组患者的手术等待时间、手术时间、出血量、住院时间及住院期间的术后全身并发症和局部并发症发生情况.结果 绿色通道组手术等待时间(中位数43.6 h)明显短于常规处理组(中位数136.8 h),差异具有统计学意义(P＜0.01);绿色通道组住院时间[(4.3±1.2)d]明显短于常规处理组[(8.5±2.5)d],差异具有统计学意义(P＜0.05);两组手术时间、出血量差异无统计学意义(P＞0.05).绿色通道组11例(19.0％)发生并发症,常规处理组29例(50.9％)发生并发症,常规处理组并发症发生率高于绿色通道组(P＜0.01);绿色通道组肺部感染和压疮的发生率明显低于常规处理组[3.4％(2/58) vs 14.0％(8/57),P＜0.05;3.4％(2/58) vs 15.8％(9/57),P＜0.05],两组患者肺栓塞、脑梗死、深静脉血栓、心肌梗死、切口感染发生率差异无统计学意义.结论 绿色通道建设应用于高龄髋部骨折的治疗,在条件允许的情况下早期手术有利于缩短高龄髋部骨折患者的住院时间、减少术后并发症,促进髋部功能的康复,对老年髋部骨折的规范化治疗具有重要和积极的意义.     

糖尿病周围神经病变患者足底压力与步态的变化

目的 了解2型糖尿病合并周围神经病变患者的足底压力与步态变化.方法 纳入住院的303例2型糖尿病患者,分为糖尿病无周围神经病变组(DC组)和糖尿病周围神经病变组(DPN组).收集患者一般资料、相关生化指标.使用FootScan系统收集足底压力及步态相关参数.采用独立样本t检验、Mann-Whitney U检验、Spearman秩相关进行数据分析.结果 与DC组相比,DPN组左足第3、4跖骨的峰值压力降低[(13.15±4.22)N/cm2 vs(11.96±3.94) N/cm2,P ＜0.05;(10.21±4.22) N/cm2 vs(9.14±3.66) N/cm2,P＜0.05],右足第1、2、3跖骨峰值压力降低[(6.02±2.79) N/cm2vs(5.04±2.87) N/cm2,P＜ 0.05;(9.95±2.69) N/cm2 vs(9.18±2.77) N/cm2,P ＜0.05;(10.90±3.23)N/cm2vs(9.93±3.09)N/cm2,P＜0.05],其余区域峰值压力、总应力、总接触面积、总应力-时间积分、各区域压力-时间积分的组间差异均无统计学意义(P＞0.05).与DC组相比,DPN组右足的整足接触阶段[56.8％(50.22％～62.45％) vs 59.5％(54.25％～64.15％),P＜0.05]延长,离地阶段[31.25％ (25.475％ ～ 35.775％)vs 29％(24.95％ ～33.65％),P＜0.05]缩短,总时间[(858±12)ms vs(900±127)ms,P＜0.05]延长,步行速度[(2.58±0.67) km/h vs(2.28±0.66) km/h,P＜0.05]减慢.步行速度与多个区域的足底压强呈正相关(P＜0.05),支撑相中的整足接触阶段与峰值压力呈负相关(P＜0.05),离地阶段与峰值压力呈正相关(P＜0.05).结论 糖尿病周围神经病变患者足底压力峰值、压力-时间积分未见升高,步行速度减慢,整足接触阶段延长,离地阶段缩短.对糖尿病患者足底压力进行评价同时需要对步行速度及步态进行矫正,使用压力-时间积分指标更能反映足底承受压力情况.     

糖尿病患者不同HbA1c控制水平的肺炎克雷伯菌肝脓肿的临床和影像学表现

目的 比较糖尿病(DM)患者不同血糖控制水平下肺炎克雷伯菌肝脓肿(KPLA)的临床和影像学表现.方法 146例糖尿病肺炎克雷伯菌肝脓肿(KPLA-DM)患者根据糖化血红蛋白(HbA1c)浓度分为3组(控制好,HbA1c≤7％;控制良好,7％＜HbA1c≤9;控制差,HbA1c＞9％).分别比较3组的一般情况、临床特点、影像学表现及并发症情况.结果 与血糖控制好和良好的患者相比,血糖控制差的患者发病年龄低[平均住院年龄(59.1±13.8)岁],住院时间更长[平均住院时间(23.1士7.6)d];更易合并高脂血症[49例(77.8％)],慢性肾功能不全[12例(19.2％)]等基础疾病;并发症及需积极抢救的临床危象多见;转移性感染多发.影像学表现中,血糖控制差的患者胆管系统积气[18例(28.6％)],肝静脉血栓性静脉炎[20例(31.8％)],肝脓肿产气[26例(28.6％)]发生率增高,差异有统计学意义(P＜0.05).结论 KPLA-DM患者血糖控制差与肝静脉血栓性静脉炎、气体形成和转移性脓肿并发症有关.     

Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients

heart failure with normal ejection fraction. Based on the previous studies, HFNEF has a significant morbidity and mortality and is associated with a similar prognosis to heart failure with reduced ejection fraction (HFREF). The present study aimed to investigate the clinical characteristics and prognosis of HFNEF in elderly patients.

Methods  Consecutive elderly patients (≥60 years old) hospitalized for the first episode of heart failure (HF) in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited. Three hundred and ten patients with HF were eligible for our study. As recently recommended, a cut-off value of 50% was used to distinguish HFNEF (LVEF≥50%) from HFREF (LVEF<50%). Data were retrospectively obtained from hospital records and databases. Follow-up data were obtained by telephone and from hospital records. For every eligible patient, the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups.

Results  Patients with HFNEF accounted for 54.5% of all cases of elderly patients with HF. Compared with HFREF, the elderly patients with HFNEF had a higher proportion of females (62.1% vs. 32.6%, P <0.001), higher body mass index (BMI) ((24.9±4.7) vs. (23.5±4.0) kg/m², P=0.011), higher systolic blood pressure at admission ((141.5±22.6) vs. (134.3±18.6) mmHg, P=0.002), but lower hemoglobin levels ((118.3±22.7) vs. (125.8±23.8) g/L, P=0.005). The incidence of coronary heart disease (43.2% vs. 65.2%, P <0.001) and myocardial infarction (16.6% vs. 46.1%, P <0.001) were significantly lower in elderly patients with HFNEF than in those with HFREF (P <0.001). With a mean follow-up of 33.5 (0.5–93) months, 120 patients (38.7%) died, including 94 (30.3%) cardiac deaths. The HFNEF group had fewer deaths than the HFREF group at the end of the first follow-up (46/169 (27.2%) vs. 58/141 (41.1%)) and at the end of the second follow-up (56/169 (33.1%) vs. 64/141 (45.4%)). Kaplan-Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF (P=0.021 for total mortality and P <0.001 for cardiac mortality). Multiple Logistic regression analysis showed that LVEF <50% was an independent risk factor for death in elderly patients with HF.

Conclusions  More than half of elderly patients with HF have a normal LVEF. The prognosis of the elderly patients with HFNEF is poor, though slightly better than the elderly patients with HFREF.

     

Impact of angina prior to acute ST-elevation myocardial infarction on short-term outcomes after primary percutaneous coronary intervention: results from the Shanghai Registry of Acute Coronary Syndrome (SRACE)

Background  The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction (STEMI) remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention (PCI). This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI.

Methods  Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI (PA group) and the remaining 583 were free of anginal symptoms (non-PA group). Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups.

Results  Diabetes was less common (17.5% vs. 23.3%, P=0.04) and symptom-to-door time was shortened ((191.6±96.8) minutes vs. (357.2±341.9) minutes, P <0.001) in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery (TIMI flow grade 0–1) at initial angiography (75.0% vs. 90.7%, P <0.001), and achieved more TIMI flow grade 3 after primary PCI (84.2% vs. 78.2%, P=0.04). These were associated with higher rates of overall procedural success (95.9% vs. 91.8%, P=0.02) and of complete ST-segment resolution at 90 minutes after the procedure (51.7% vs. 40.3%, P=0.001). During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved ((53.0±8.6)% vs. (51.1±9.7)%, P=0.002) and the primary endpoint of major adverse cardiac events was reduced in the PA group (7.2% vs. 12.7%, P=0.01).

Conclusion  Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.

     

中医养生运动干预2型糖尿病临床研究

目的:观察中医养生运动对2型糖尿病患者临床疗效、患者满意度及血糖恢复正常时间的影响。方法:88例2型糖尿病患者随机分为对照组和观察组,每组44例。对照组给予常规干预模式,观察组在对照组基础上给予中医养生运动干预模式。干预后,比较两组患者临床疗效、患者满意度、血糖恢复正常时间及糖尿病并发症发生率。结果:观察组有效率为90.9%,对照组有效率为70.5%,两组有效率比较,差异有统计学意义(P0.05)。观察组患者满意度为95.4%,对照组患者满意度为81.8%,两组患者满意度比较,差异有统计学意义(P0.05)。对照组患者血糖恢复正常时间为(23.96±5.48)d,观察组患者血糖恢复正常时间为(19.33±3.54)d,两组患者血糖恢复正常时间比较,差异有统计学意义(P0.05)。对照组糖尿病并发症发生率为15.9%,观察组糖尿病并发症发生率为2.3%,两组糖尿病并发症发生率比较,差异有统计学意义(P0.05)。结论:中医养生运动干预2型糖尿病临床疗效显著,可以提高患者满意度,缩短血糖恢复时间,降低糖尿病并发症发生率。     

心脏外科术后患者重返重症监护病房的原因及危险因素分析

目的 通过回顾性研究了解心脏外科术后再次返回心外科重症监护病房( ICU)患者的原因、结果和危险因素.方法 2008年1月至2010年8月,共4978例心外科手术后患者纳入本研究,在一次住院期间重返ICU的患者为重返组,没有重返ICU的患者为非重返组.搜集患者的围手术期资料包括术前心律、左室射血分数、肺动脉压力、NYHA心功能分级、体外循环时间、主动脉阻断时间、呼吸机辅助时间、术后第1天引流量、输血量、尿量、术后第1天肌酐、血红蛋白、ICU停留时间、住院时间、是否二次开胸和主动脉球囊反搏(IABP)植入等.通过单因素分析和多因素Logistic回归分析评估各种因素对重返ICU的影响.统计重返ICU患者的原因、治疗措施和病死率.结果 有139例(2.8％)患者重返ICU,其中男80例,女59例,年龄9～78岁,平均54.3岁,瓣膜病73例,冠心病36例,先心病18例,胸主动脉瘤10例,心脏肿瘤2例.重返ICU最常见的原因是呼吸系统因素(69例,49.6％),其次是心血管系统因素(33例,23.7％).第一次ICU停留时间为1.0 ～85.0 d,中位数2.00(1.00 ～4.00)d,第二次ICU停留时间为0.5 ～49.0 d,中位数3.00(1.00 ～5.00)d,间隔时间0.5 ～45.0 d,中位数3.00(2.00 ～6.75)d.重返ICU患者院内病死率为9.4％ (13/139),远高于非重返患者的0.4％ (20/4839)(P＜0.01).重返ICU的危险因素包括NYHA心功能分级、肺动脉压力、体外循环时间、主动脉阻断时间、气管插管辅助时间、术后第1天尿量和输血量、第一次监护室停留时间和二次开胸.其中心功能分级(95％CI:1.091 ～ 3.176,P=0.023)和第一次ICU停留时间(95％ CI:1.105 ～1.251,P＜0.01)是独立危险因素.结论 重返心外科ICU的患者有更高的病死率,心功能分级和第一次ICU停留时间长是重返ICU的独立危险因素,重返ICU最常见的原因是呼吸系统和心血管系统因素.     

COX-2抑制剂在腹腔镜胆囊切除术患者围术期疼痛管理中的应用效果研究

目的 探讨加速康复外科理念下选择性环氧化酶-2 (COX-2)在腹腔镜胆囊切除术患者围术期超前镇痛中的应用效果.方法 回顾性分析2016年6-12月该院胆道外科收治的应用选择性COX-2抑制剂超前镇痛的206例胆囊结石患者(新型镇痛组)和2015年6-12月收治的198例应用曲马多进行术后镇痛的胆囊结石患者(传统镇痛组)的临床资料.两组患者术中麻醉方案一致,术后采用相同的疼痛解救方案;对比分析两组患者围术期视觉模拟评分法(VAS)评分、疼痛解救药物使用率、不良反应、满意度及住院时间.结果 新型镇痛组患者术后2、6、12、24 h VAS评分均低于传统镇痛组,差异有统计学意义(P＜0.05);新型镇痛组患者的解救镇痛药物使用率低于传统镇痛组(14.56％ vs.44.95,P＜0.05),盐酸曲马多及盐酸哌替啶的使用率均低于传统镇痛组(P＜0.05).新型镇痛组患者不良反应总发生率更少(2.43％ vs.36.36％,P＜0.05),新型镇痛组患者恶心、呕吐发生率低于传统镇痛组(P＜0.05),其余各项并发症发生率差异无统计学意义(P＞0.05).新型镇痛组患者围术期的镇痛满意度高于传统镇痛组(P＜0.05),平均住院时间和术后住院时间差异无统计学意义(P＞0.05).结论 COX-2抑制剂能有效降低腹腔镜胆囊切除术患者围术期的疼痛程度,减少解救镇痛药物的使用频率,降低不良反应发生率,缩短住院时间,提升患者满意度.     

脑卒中后吞咽障碍患者经皮内镜下胃造瘘肠内营养的护理体会

目的 探讨脑卒中后吞咽障碍患者经皮内镜下胃造瘘(percutaneous endoscopic gastrostomy,PEG)行肠内营养的效果.方法 68例脑卒中后吞咽障碍患者根据肠内营养的方式不同分为PEG组(34例)和鼻胃管(nasogastric tube,NGT)组(34例).比较两种肠内营养途径的相关并发症及营养改善效果.结果 PEG组与NGT组比较,PEG组胃潴留(14.7％ vs.32.4％),反流性食管炎(11.8％ vs.23.5％),吸入性肺炎(17.6％ vs.38.2％)均较NGT组显著降低(P＜0.05);PEG组营养治疗3个月的BMI [(20.56±1.32) kg/m2 vs.(19.97±1.35) kg/m2],ALB [(40.45±2.12)g/L vs.(38.27±2.25) g/L],前白蛋白(PA)均高于NGT组[(302.12±30.28) mg/L vs.(280.27±28.17) mg/L],差异均有统计学意义(P＜0.05).结论 脑卒中后吞咽障碍患者PEG行肠内营养是一种安全、有效的营养支持方法,促进疾病康复,提高患者生活质量.     

股浅动脉重建对下肢动脉硬化闭塞症治疗的随机病例对照研究

目的： 评价忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症的安全性和有效性。方法： 应用前瞻性的随机病例对照研究方法对忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症的有效性和安全性进行评价,将北京大学第三医院2014年5月至2015年3月36例下肢动脉硬化闭塞症患者随机分为股浅动脉重建组（20 条患肢）和非重建组（16 条患肢）, 重建组均采用腔内治疗重建股浅动脉血运,非重建组均不重建股浅动脉,仅处理同时存在的髂动脉及股深动脉病变,比较两组患者临床疗效、并发症及治疗费用。结果： 两组患者的年龄、性别构成、治疗前踝肱指数、TASC（trans atlantic inter sociery consensus）分级及Rutherford分级均具有可比性（P>0.05）,术后1周内重建组显效率和总有效率均优于非重建组［75.0% vs.12.5%（P<0.001）; 90.0% vs. 37.5%（P=0.001）］,两组均无围手术期并发症及死亡病例。3个月随访时重建组显效率优于非重建组［65.0% vs. 25.0%（P=0.017）］,两组总有效率差异无统计学意义［85.0% vs.68.8%（P=0.422）］;6个月和12个月随访时两组显效率及总有效率差异均无统计学意义［显效率60.0% vs.37.5% （P=0.180）,80.0% vs.87.5%（P=0.672）;总有效率60.0% vs.43.8%（P=0.332）,85.0% vs.87.5%（P=1.000）］,重建组治疗费用高于非重建组［（53 367.4±24 518.3）元 vs.（30 397.5±15 354.4）元（P=0.011）］。重建组随访期间发现股浅动脉再狭窄/闭塞者8例,其中3例再次介入治疗,再次腔内治疗率为15.0%。结论： 忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症安全、有效、经济,可以作为部分外周动脉疾病患者的首选治疗方法。     

内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究

目的 评估内镜清创术与外科清创术两种方法治疗胰腺坏死感染的临床疗效.方法 回顾2009年6月至2016年6月新桥医院消化科内镜中心完成的胰腺坏死感染内镜清创术患者34例为内镜组,以同时期西南医院和大坪医院完成的胰腺坏死感染外科清创术的患者34例为外科组,分析比较其临床特征和治疗效果.结果 两组手术成功率均为100％;内镜组的病死率为8.82％(3/34),显著低于外科组41.18％ (14/34) (P ＜0.01);内镜组并发症发生率11.76％(4/34),显著低于外科组67.65％(23/34) (P＜0.01);两组并发症主要为出血、器官衰竭和休克,分别为2.94％(1/34)和61.76％(21/34)、0％(0/34)和41.18％(14/34)、2.94％ (1/34)和47.06％ (16/34),内镜组主要并发症发生率低于外科组(P＜0.01);两组复发率均为8.82％ (3/34);内镜组的手术次数、住院时间、住院费用均高于外科组,分别为2.62(1 ～10)次和1.06(1～2)次(P＜0.01)、83.5(7 ～175)d和54.2(2 ～ 154) d(P＜0.05)、35.18(2.81 ～147.61)万元和21.84(3.33 ～74.27)万元(P＜0.01).结论 胰腺坏死感染内镜清创术的并发症和病死率显著低于外科清创术,内镜清创术的手术次数、住院时间和住院费用均高于外科手术.     

Comparison of combined phacotrabeculectomy with trabeculectomy only in the treatment of primary angle-closure glaucoma

Background  Trabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.

Methods  This is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.

Results  After 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59±7.94) vs. (24.85±14.39) mmHg, P=0.614), complete success rate (88% vs. 71%, P=0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P=0.094), and complications (41% (7/17) vs. 57% (8/14), P=0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.

Conclusion  Phacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

     

Virtual reality simulator for training urologists on transurethral prostatectomy

Background A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields.They can simulate a variety of surgical scenarios to improve the overall skil...     

两种方式经瓣膜式PICC引导腔内心电图稳定性与准确性的对照研究

目的 观察自动泵入生理盐水和人工推注生理盐水对经瓣膜式外周置入中心静脉导管(peripherally inserted central catheter,pICC)引导腔内心电图稳定性和准确性的影响.方法 选择本院2016年1-5月恶性肿瘤拟行周期性输注化疗药物需置入瓣膜式PICC患者(≥20周岁),按照随机数字表法分为观察组和对照组,每组90例.观察组予自动泵入生理盐水法经瓣膜式PICC引导腔内心电图,对照组予人工推注生理盐水法.记录各组引导腔内心电图的稳定率、导管头端到位准确率、导管头端异位率、特征性P波出现率、盐水用量、术中出血量、术后24 h内穿刺点出血量、术后14 d内PICC致机械性静脉炎及PICC相关性上肢深静脉血栓发生率.结果 观察组引导腔内心电图的稳定率(92.22％)、导管到位准确率(94.44％)、特征性P波出现率(93.33％)明显高于对照组(74.44％、84.44％、80.00％,P＜0.05),观察组导管头端异位率(5.56％)、盐水用量(7.24±1.69) mL及术中出血量(2.39±1.01)mL明显少于对照组[15.56％、(26.78±10.52)、(5.34±1.36),P＜0.05],观察组术后穿刺点出血量(3.28±1.52)mL、PICC致机械性静脉炎发生率(3.33％)、PICC相关性上肢深静脉血栓的发生率(11.11％)明显少于对照组[(10.42 ±2.57) mL、11.11％、26.67％,P＜0.05].结论 自动泵入生理盐水经瓣膜式PICC引导腔内心电图的稳定性和准确性明显优于人工推注生理盐水,PICC置管术后并发症明显少于人工推注生理盐水.自动泵入生理盐水法更适用于瓣膜式PICC导管头端的定位.     

Endoscopic full-thickness resection of gastric stromal tumor arising from the muscularis propria

Background Gastric stromal tumors are the most common type of tumor originating from mesenchymal tissue.The traditional method for the treatment of gastric stromal tumor is surgical operation or therap...     

Comparison of the Outcomes of Monopolar and Bipolar Radiofrequency Ablation in Surgical Treatment of Atrial Fibrillation

Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency （RF） ablation used during cardiac surgery to treat atrial fibrillation. Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011. Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation, respectively. The sinus rhythm restoration rate, the procedural duration, the frequency of severe perioperative complications, and mortality were compared between the two groups. Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1±12.6 months （P=0.199）. The frequencies of severe perioperative complications and mortality were also similar in the two groups. The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation （19.7 ±4.6 minutes vs. 28.1 ± 8.5 minutes, P〈 0.001 ）. Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery, but bipolar RF ablation is more convenient in practice.     

临床药师干预普外科围手术期应用抗菌药物的临床效果及措施分析

目的 探讨临床药师干预普外科围手术期抗菌药物应用的效果及应对措施分析. 方法 回顾性分析我院2010-2012年收治的163例普外科手术患者的临床资料,根据临床药师是否参与普外科围手术期抗菌药物使用,将163例患者分为干预组和非干预组,观察两组患者抗菌药合理应用比例、手术切口感染率、平均使用时间、住院时间及治疗费用等指标. 结果 干预组抗菌药合理应用比例为83.5％ （71/85）,切口愈合优良率为95.3％ （81/85）,平均住院时间为（11.4±2.3）d,治疗费用为（3 784.5±211.8）元;非干预组抗菌药合理应用比例为57.6％ （45/78）,切口愈合优良率为82.1％ （64/78）,平均住院时间为（18.5 ±2.1）d,治疗费用为（5 329.7 ±115.6）元,两组间差异有统计学意义（P＜0.05）. 结论 临床药师参与普外科围手术期抗菌药物的应用指导,能显著提高抗菌药合理使用比例,缩短住院时间和减少医疗费用.     

Impaired brachial artery flow-mediated dilation and increased carotid intima-media thickness in rheumatoid arthritis patients

Background  Carotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation percentage (FMD%) are common parameters used for detecting subclinical atherosclerosis. This study compared subclinical atherosclerosis of the carotid and brachial arteries in rheumatoid arthritis (RA) patients and healthy controls using high resolution ultrasonography. We also investigated their correlation with clinical factors and the association between FMD% and CIMT.

Methods  One hundred and two RA patients and 46 age-gender matched healthy controls were included in the study. FMD of the brachial artery and CIMT were measured ultrasonographically. Patients with diabetes mellitus, hypertension, renal failure, history of cardiovascular or cerebrovascular disease were excluded. Subjects who were receiving or used high dose steroids were also excluded.

Results  The CIMT was significantly higher in patients than that in the control group ((0.697±0.053) vs. (0.554±0.051) mm, P <0.001), whereas brachial artery FMD% was lower in patients than that in the controls ((5.454±2.653)% vs. (8.477±2.851)%, P <0.001). CIMT was related to age, disease duration, tender and swollen joint score, C-reactive protein, systolic blood pressure and high-density lipoprotein. However, FMD% was only association with systolic blood pressure. There was no significant correlation between CIMT and FMD%.

Conclusions  Compared with the healthy control subjects, RA patients without clinically evident cardiovascular disease had subclinical atherosclerosis in terms of impaired FMD% and increased CIMT. FMD% and CIMT may measure a different stage of subclinical atherosclerosis in RA patients.