缩宫素及米索前列醇预防产后出血的临床效果评价

目的探讨米索前列醇联合缩官素对预防产后出血的效果。方法选取我院2006年1月至2011年6月490例产妇,将其随机分成两组研究组和对照组,每组孕妇245例。对照组在分娩胎儿后立刻静脉注射10U缩宫素,研究组在分娩胎儿后在立刻注射缩宫素的时候,在肠壁处放0.4mg米索前列醇片。仔细记录两个小组第3产程所需要的时间、产后24h出血量及血压、脉搏的变化。结果研究组第3产程时间和24h出血量比对照组都少,差异都具有统计学意义（P〈0.05）;两组孕妇在使用药物前后测量的脉搏、血压发生的变化比较都没有统计学意义（P〉0.05）。结论缩宫素及米索前列醇联合使用可以预防产后出血,而这也是一种相对安全、有效和简便的临床方法。     

叶酸受体α在卵巢上皮性肿瘤中的表达

Objective To investigate the expression of folate receptor(FR) α in ovarian epithelial tumors and its clinopathological significance. Methods Tissue microarrays (TMAs) were constructed from 86 epithelial ovarian cancers and 29 borderline ovarian tumors, followed by the FRα expression evaluation by immunohistochemistry. FRα mRNA expression was investigated by quantitative real-time PCR using freshfrozen tissues from 40 cases of ovarian carcinoma and 14 cases of borderline tumor. FRα expression levels in ovarian tumors were also analyzed in correlation with tumor morphology, pathogenesis and FIGO stage.Results FRα expression was detected in 40 of 86 (46.5%) of ovarian cancers, with the highest rate of expression observed in serous carcinomas (62.7%, 32/51) compared with that of the other cancer types (P=0.000). Depending on pathogenesis type, FRα expressions in type Ⅱ ovarian carcinomas were significantly higher than those in type Ⅰ ovarian carcinomas (P = 0.001). Ovarian carcinomas had a tendency to express higher FRα than the borderline tumors (46.5% vs 27.6%), although statistically not significant (P = 0.074). FRα expressions in ovarian carcinomas showed no correlation with the FIGO stage (P =0.498). However, real-time PCR showed that FRα mRNA levels were significantly higher in ovarian carcinomas compared with that of the borderline tumors (P = 0.000) and also higher in serous ovarian borderline tumors compared with mucinous type (P = 0.007). Conclusion Higher level of FRα expression occurs frequently in ovarian epithelial tumors, especially in carcinomas and ovarian serous tumors.     

医院内感染的治疗与预防

医院内感染及其治疗是临床工作中经常遇到的问题。随着新的抗生素不断涌现，掌握医院内感染的特点，抗生素治疗的适应证、疗程及毒副作用成为广大医务人员的当务之急。现结合国内外最新的抗菌药物及治疗的新观念提出一些建议。     

顽固性心力衰竭的对策

顽固性心力衰竭亦称难治性心力衰竭，是指症状持续且对各种治疗反应较差的充血性心衰，它可能是心脏病终末期表现，但经过精心调整治疗方案可能挽救患者的生命而提高生活质量，变难治为可治。下面为对50例难治性心衰住院患者疗效观察而得出的疗效显著的治疗对策。     

颈伸位下头颈三维重建在甲状腺手术中的应用

目的  探究在颈伸位下三维重建头颈结构在甲状腺手术中的应用价值。方法  选择20例已经由病理结果证实的甲状腺疾病患者在颈伸位下的平扫CT图像,应用三维重建软件3DVWorks,对甲状腺、甲状腺结节、甲状软骨、下颌骨、锁骨、皮肤等组织进行三维重建,测量多个空间角度及径线以评估疾病及治疗方案。结果  通过在头颈三维重建模型中对下段气管所在的不同平面与甲状腺手术相关解剖结构的角度与距离测量,综合评估后在甲状腺结节 < 3 cm的11例患者中有3例患者不适合行经口腔镜术式,可行其他腔镜等术式;3例患者不适合行经口、经胸乳腔镜术式及经腋窝等腔镜手术,仅适合开放手术;1例患者因结节分期较高,不推荐行腔镜手术;另外4例患者各类手术均可施行。通过构建胸廓入口及以此平面准确分割巨大甲状腺体积,对6例含有结节 > 3 cm的巨大甲状腺进行预评估后发现均未达经颈胸联合切除甲状腺的指标要求,6例患者行传统单纯经颈切口即可完整切除甲状腺。对有残留甲状腺的3例患者,预评估显示3例残余甲状腺均可准确定位并能指导手术切除。结论  通过在颈伸位下三维重建头颈结构并建立评估指标,对腔镜手术方式选择、巨大甲状腺肿诊治、残余甲状腺术中定位有独特优势,有助于形成良好的手术策略,更有益于医患交流。