H5N1亚型人禽流感性肺炎一例

患者女,24岁.因"畏寒、发热6 d,咳嗽3 d,呼吸困难1 d"于2005年11月7日入院.发病前2周家中饲养的鸡、鸭陆续死亡,曾多次参与宰杀并食用.6 d前在无明显诱因下出现畏寒、低热,3 d后体温渐升至38～39 ℃,伴干咳和全身肌肉酸痛.因抗感染3 d无效,出现呼吸困难及发绀来本院就诊.     

社区卫生服务机构在传染病疫情控制中的作用

社区卫生服务作为基层预防保健网的网底，以其独特的“多面手”功能，特别是在2009年甲型H1N1流感流行防控过程中，对疑似病例、轻症病例、密切接触者进行医学观察及对居民的健康教育等方面发挥了重要作用。     

妊娠期肝内胆汁淤积症胎儿胆汁酸水平与肺表面活性物质的相关性研究

Objective To explore the relationship between total bile acid(TBA)concentration and fetal pulmonary surfactant in intrahepatic cholestasis of pregnancy(ICP).Methods Fifry five patients with ICP(ICP group)who received cesarean section from April 2008 to February 2010 in Second Xiangya Hospital,Central South University,were recruited.The general conditions of the neonates within 7 days after birth in ICP group were recorded.Those with fetal distress,neonatal asphyxia,or neonatal respiratory distress syndrome were referred as pathological neonates, others were referred as normal neonates. Over the same period, 23 healthy gravidas were recruited as control group. Enzymatic method was used to detect the TBA concentrations in maternal blood, cord blood and amniotic fluid. ELISA was employed to measure the urfactant protein A (SP-A) concentration in cord blood. High performance liquid chromatography system was used to detect the concentrations of phesphatidylcholine (PC),phosphatidylinositol (PI),lysophosphatidylcholine ( LPC), and sphingomyelin(SM) in amniotic fluid. Results ( 1 ) The concentrations of TBA in maternal blood, cord blood and amniotic fluid were ( 30. 1 ± 7.9 ), (9. 3± 3. 3 ) and (4. 4 ± 1.5 ) mmol/L in ICP group, (4. 8 ± 2. 2), (4. 9 ± 0. 9) and ( 1.4 v 1.1 ) mmol/L in control group, respectively. The differences between the two groups were significant ( P ＜ 0. 05 ). ( 2 ) The SP-A concentration in cord blood in ICP group was ( 29. 5 ± 6. 4 ) μg/L, significantly higher than that in control group, which was ( 22. 6 ± 7. 4 )μg/L ( P＜ 0. 05 ). ( 3 ) There were 20 pathological neonates and 35 normal neonates in ICP group. In pathological neonates, the concentrations of TBA and SP-A in cord blood were (10.9 ± 2.2) mmol/L,(37.0 ± 5.9 ) μg/L, respectively; and were ( 8.0 ± 2. 8 ) mmol/L, ( 26. 7 ± 4. 8 ) μg/L in normal neonates. The differences were significant (P＜ 0. 05 ). (4) There was a positive correlation between TBA concentration in cord blood and in maternal blood ( r1 = 0. 706, P＜0. 05 ). The TBA concentration in cord blood was positively correlated with SP-A concentration as well ( r3 = 0. 494,P ＜ 0. 05 ). (5) The PC and PI concentrations in amniotic fluid were (65.4 ± 7.2) mg/L and ( 3. 8 ± 0. 6 ) mg/L in ICP group, ( 69. 7 ±3.7) mg/L and (4. 3 ± 0. 7 ) mg/L in control group, respectively. The differences were significant (P ＜0. 05 ). The concentration of LPC in amniotic fluid in ICP group was (4. 8 ±0. 9) mg/L, significantly higher than that in control group (P＜0. 05), which was (4. 2 ±0. 6) mg/L. The concentration of SM in amniotic fluid was (3.5±0. 8) mg/L in ICP group, (4. 0 ± 0. 5 ) mg/L in control group, with no significant difference ( P＞0. 05 ). (6) The ratio of PC/LPC in ICP group ( 14. 2± 3. 2 ) was significantly lower than that in control group ( 16. 9 ± 2. 5 ) ( P＜ 0. 05 ). ( 7 ) The TBA concentration in cord blood was negatively correlated with PC and PI concentrations (r1 = -0. 561, r2 = -0. 407, P ＜ 0. 05 ), and had no correlation with LPC concentration (r3 = 0. 260, P＞ 0. 05). Conclusions ( 1 ) The fetal TBA concentrations in both cord blood and amniotic fluid of patients with ICP was higher than those of healthy gravidas, they were also positively correlated with maternal TBA concentration. (2) ICP resulted in the change of fetal pulmonary surfactant and this change was associated with TBA concentrations in both cord blood and amniotic fluid.     

浅谈学习兴趣在《营养与食品卫生学》教学中的重要性

探讨如何使学生明确学习目的,激发学习兴趣;实现教学方法多样化,培养学习兴趣;进一步创设教学情趣,开设第二课堂,提高学习兴趣.     

综合性医院突发公共卫生事件应急管理的探讨

<正>医院作为突发公共卫生事件中提供医疗和心理服务的关键场所,在突发公共卫生事件的应对中起着举足轻重的作用。2005年11月铜陵市人民医院收治大陆首例人感染高致病性禽流感病毒病例,继之经历"三聚氰胺"奶粉事件、手足口病、甲型H1N1     

妊娠期肝内胆汁淤积症胎儿胆汁酸水平与肺表面活性物质的相关性研究

Objective To explore the relationship between total bile acid(TBA)concentration and fetal pulmonary surfactant in intrahepatic cholestasis of pregnancy(ICP).Methods Fifry five patients with ICP(ICP group)who received cesarean section from April 2008 to February 2010 in Second Xiangya Hospital,Central South University,were recruited.The general conditions of the neonates within 7 days after birth in ICP group were recorded.Those with fetal distress,neonatal asphyxia,or neonatal respiratory distress syndrome were referred as pathological neonates, others were referred as normal neonates. Over the same period, 23 healthy gravidas were recruited as control group. Enzymatic method was used to detect the TBA concentrations in maternal blood, cord blood and amniotic fluid. ELISA was employed to measure the urfactant protein A (SP-A) concentration in cord blood. High performance liquid chromatography system was used to detect the concentrations of phesphatidylcholine (PC),phosphatidylinositol (PI),lysophosphatidylcholine ( LPC), and sphingomyelin(SM) in amniotic fluid. Results ( 1 ) The concentrations of TBA in maternal blood, cord blood and amniotic fluid were ( 30. 1 ± 7.9 ), (9. 3± 3. 3 ) and (4. 4 ± 1.5 ) mmol/L in ICP group, (4. 8 ± 2. 2), (4. 9 ± 0. 9) and ( 1.4 v 1.1 ) mmol/L in control group, respectively. The differences between the two groups were significant ( P ＜ 0. 05 ). ( 2 ) The SP-A concentration in cord blood in ICP group was ( 29. 5 ± 6. 4 ) μg/L, significantly higher than that in control group, which was ( 22. 6 ± 7. 4 )μg/L ( P＜ 0. 05 ). ( 3 ) There were 20 pathological neonates and 35 normal neonates in ICP group. In pathological neonates, the concentrations of TBA and SP-A in cord blood were (10.9 ± 2.2) mmol/L,(37.0 ± 5.9 ) μg/L, respectively; and were ( 8.0 ± 2. 8 ) mmol/L, ( 26. 7 ± 4. 8 ) μg/L in normal neonates. The differences were significant (P＜ 0. 05 ). (4) There was a positive correlation between TBA concentration in cord blood and in maternal blood ( r1 = 0. 706, P＜0. 05 ). The TBA concentration in cord blood was positively correlated with SP-A concentration as well ( r3 = 0. 494,P ＜ 0. 05 ). (5) The PC and PI concentrations in amniotic fluid were (65.4 ± 7.2) mg/L and ( 3. 8 ± 0. 6 ) mg/L in ICP group, ( 69. 7 ±3.7) mg/L and (4. 3 ± 0. 7 ) mg/L in control group, respectively. The differences were significant (P ＜0. 05 ). The concentration of LPC in amniotic fluid in ICP group was (4. 8 ±0. 9) mg/L, significantly higher than that in control group (P＜0. 05), which was (4. 2 ±0. 6) mg/L. The concentration of SM in amniotic fluid was (3.5±0. 8) mg/L in ICP group, (4. 0 ± 0. 5 ) mg/L in control group, with no significant difference ( P＞0. 05 ). (6) The ratio of PC/LPC in ICP group ( 14. 2± 3. 2 ) was significantly lower than that in control group ( 16. 9 ± 2. 5 ) ( P＜ 0. 05 ). ( 7 ) The TBA concentration in cord blood was negatively correlated with PC and PI concentrations (r1 = -0. 561, r2 = -0. 407, P ＜ 0. 05 ), and had no correlation with LPC concentration (r3 = 0. 260, P＞ 0. 05). Conclusions ( 1 ) The fetal TBA concentrations in both cord blood and amniotic fluid of patients with ICP was higher than those of healthy gravidas, they were also positively correlated with maternal TBA concentration. (2) ICP resulted in the change of fetal pulmonary surfactant and this change was associated with TBA concentrations in both cord blood and amniotic fluid.     

残疾居民的康复护理及社区关怀

目的:了解我社区残疾人康复服务的需求现状,探讨影响其接受康复服务的因素.方法:对我社区99例残疾病患者开展康复护理工作.结果:有针对性的干预治疗可以使残疾人在活动能力、日常生活、健康感受、生活感受明显改善,有效地减轻了患者焦虑、抑郁程度,提高了残疾患者的生活质量,减轻了家庭及社会的负担.结论:针对我社区开展的残疾人康复护理工作效果显著,值得推广.     

护理专业《临床营养学》教学改革的探讨与实践

目的探讨能适应今后临床实践需要的护理专业学生的《临床营养学》教学方法。方法以2005级护理专业320名本科生为研究对象,提高其学习积极性和主动性、优化教学内容,采用自我营养评价、病例模拟训练、案例分析等教学方法加强实践技能培养。结果学生认识到临床营养的重要性,提高了综合运用知识水平,加强了临床实践动手操作能力。结论《临床营养学》教学改革有利于培养适应现代临床综合治疗的护理专业人才。     

人性化护理对哮喘吸入治疗患者依从性和疗效的影响

目的探讨人性化护理对哮喘吸入患者依从性和疗效的影响。方法选择2012年6月至2013年6月收治的哮喘吸入治疗的患者100例,随机分为观察组和对照组各50例,对照组采用常规护理,观察组加强人性化护理干预,比较两组患者的依从率及疗效。结果观察组总有效率为98％,依从率为100％,对照组分别为80％、82％,两组差异均有统计学意义（P〈0．05）。两组治疗前最大呼气流量、第1秒用力呼气容积、血氧饱和度差异无统计学意义（P〉0．05）,治疗后均有好转,但观察组改善情况明显高于对照组,差异有统计学意义（P〈0．05）。结论加强哮喘吸入患者人性化护理干预,可显著提高治疗依从性及临床效果,改善预后,具有非常积极的临床意义。     

垫片式减张缝合用于腹部手术纵形切口的减张关闭

目的 介绍腹部手术新式减张缝合装置及使用方法.方法 采用Tension suture补片为42例各种纵形开腹手术结束手术前减张缝合.关腹前经腹膜外腹壁全层褥式缝合减张线,暂时不结扎.常规关闭腹壁各层,减张线穿过专用垫片结扎.结果 39例患者为一期术中放置减张缝合.3例为一期手术未放置减张缝合,伤口裂开后二期缝合腹壁伤口时加用减张缝合.除1例系统性红斑狼疮长期使用激素的肠破裂患者术后两周拆除减张缝合线后伤口裂开外,其余患者治疗成功,未发生切口裂开和缝线断裂.结论 新型减张缝合装置用于普通外科腹部手术纵形切口缝合可以有效地避免伤口裂开.对于有特殊愈合困难因素的病例,应该延长拆除减张线的时间直至确认切口完全愈合为止.新型垫片式减张缝合装置使用安全、方便.