阑尾切除术美容切口与麦氏切口术后恢复效果的对比

目的 对阑尾切除术美容切口与麦氏切口的术后观察与护理进行比较分析.方法 将接受阑尾切除术的患者按手术切口的选择分成2组对照组(MC组86例)为进行传统的经麦氏口阑尾切除术的患者;实验组(MR组76例)为进行经美容切口(改良腹直肌外缘切口)的阑尾切除术的患者.对2组患者术后切口愈合情况、使用止痛剂的次数、下床活动时间、肛门排气时间进行比较分析,并通过单盲法的问卷形式比较2组患者对其切口的满意程度.结果 2组患者的切口愈合情况差别无显著性意义(P＞0.05),MR组患者术后使用止痛剂的次数少于MC组、下床活动时间及肛门排气时间早于MC组,差别有非常显著性意义(P＜0.01),问卷结果差别有显著性意义(P＜0.01).结论 阑尾切除术采用美容的改良式腹直肌外缘切口具有美观、经济、术后恢复快、患者满意,并且为临床护理带来了诸多便利.     

Prevalence of Thrombocytopenia among Chinese Adult Antiretroviral-na?ve HIV-positive Patients

Background:

The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults.

Methods:

We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression.

Results:

A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30–39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200–349 cells/mm³ (3.3%) and >350 cells/mm³ (2.8%) compared with patients with CD4+ counts of 50–199 cells/mm³ (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥50 years, HCV-Ab positivity and having a CD4+ cell count of 50–199 cells/mm³ were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively.

Conclusions:

Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.     

鞍区非垂体瘤病变的临床研究

目的探讨鞍区非垂体瘤病变的临床诊治特征。方法回顾性分析156例鞍区非垂体瘤病变的临床资料,囊性病变86例、炎性病变4例、良性肿瘤56例和恶性肿瘤10例。临床表现以头痛(50.6%)和视野缺损(41.7%)最常见,内分泌改变以皮质醇增高(32.7%)和泌乳素增高(20.5%)最常见。均行手术治疗。结果术后新发一过性尿崩13例,电解质紊乱8例,垂体功能改变3例。术后头痛与视觉症状缓解率分别为84%和73%,皮质醇增高和泌乳素增高缓解率分别为100%和77%。平均随访35个月,总体复发率为8.2%(13/156),病死率为0.6%(1/156)。结论鞍区非垂体瘤病变,术前鉴别诊断较困难,有一定误诊率。治疗手段以手术治疗为主,术后症状缓解明显,并发症少;术后复发率低,预后好。     

免疫性肝纤维化大鼠血浆氨基酸浓度与肝纤维化程度的相关性研究

目的探讨血浆氨基酸浓度与肝纤维化程度的相关性。方法通过注射猪血清构建不同分期大鼠肝纤维化模型。采用Agilent 1100,通过高效液相色谱法(high performance liquid chromatograph,HPLC)测定大鼠血浆中的氨基酸浓度。利用统计学方法分析血浆氨基酸浓度与肝纤维化程度之间的相关性。结果根据柱前衍生高效液相色谱法测定的大鼠血浆中16种游离氨基酸含量及Spearman等级相关分析和方差分析发现:血浆组氨酸(histidine,His)、苯丙氨酸(phenylalanine,Phe)、苏氨酸(threonine,Thr)、酪氨酸(tyrosine,Tyr)、缬氨酸(valine,Val)等与肝纤维化程度具有相关性(His:rs=0.512,P=0.015;Phe:rs=0.713,P<0.01;Thr:rs=0.567,P=0.006;Tyr:rs=0.753,P<0.01;Val:rs=0.508,P=0.016);His、Phe和Tyr在不同肝纤维化病理分期中的浓度均与正常组有统计学差异,但在不同病理分期间无统计学差异。结论血浆中His、Phe和Tyr浓度与肝纤维化程度正相关,但对肝纤维化病理分期无判别意义。     

Transmission Risk from Imported Plasmodium vivax Malaria in the China–Myanmar Border Region

Malaria importation and local vector susceptibility to imported Plasmodium vivax infection are a continuing risk along the China–Myanmar border. Malaria transmission has been prevented in 3 border villages in Tengchong County, Yunnan Province, China, by use of active fever surveillance, integrated vector control measures, and intensified surveillance and response.     

产褥期可能罹患的罕见疾病

探讨产褥期可能罹患的罕见疾病,产褥期是指从胎盘娩出至产妇全身各器官(除乳腺外)恢复至未孕状态所需要的时期,一般为42d。在产褥期内发生的常见疾病表现为阴道出血、子宫复旧欠佳、阴道炎、会阴切口愈合欠佳、骨质疏松、贫血等,虽然滋养细胞疾病、产后溶血性尿毒症综合征、栓塞等罕见病的发病率较低,但也要提高警惕,避免医疗差错的发生。当遇到疑难病例一定要联系患者实际进行分析,要把不同症状发病时间顺序搞清楚,综合分析病情变化。当某个诊断出现无法解释的情况时,要对诊断提出质疑,考虑罹患其他科室疾病和罕见疾病的可能。如果上述罕见疾病在产后未能得到及时诊治,将会导致相应并发症的发生危及患者生命,严重危害女性的身心健康。     

脂肪乳对PT、APTT和Fib凝血结果的影响与对策

目的探讨减少脂肪乳对凝血酶原(PT)、部分凝活酶时间(APTT)和纤维蛋白原(Fib)干扰的方法。方法制备正常新鲜混合血浆并检测PT、APTT、Fib;在正常新鲜混合血浆中加入不同浓度的脂肪乳并检测其PT、APTT和Fib,取均值计算干扰物影响度,同时在强生干化学分析仪VITRO FS5.1上检测血浆指数,并分析血浆指数与脂肪乳干扰之间的关系。通过CS2000i自带的稀释功能,寻找最佳的稀释倍数,减少脂肪乳对Fib的干扰。结果当添加干扰物脂肪乳4.76%体积分数时,对PT、APTT和国际标准化比值(INR)影响均7.5%,未超过1/2 CLIA’88规定的允许误差;脂肪乳添加的体积与血浆指数存在良好的线性相关:y=18.284x+4.557 9,R2=0.993 3;脂肪乳添加的体积与衍算纤维蛋白原(PT-der fibrinogen,PT-DFbg)添加前后的差值也存在良好的线性相关:y=0.146 9x-0.891 4(x≥6),R2=0.961 7;标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。结论利用血浆指数,可以减少一定浓度内脂肪乳对PT、APTT和Fib的干扰,标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。     

三拗汤对病毒性肺炎的辅助治疗疗效分析

目的探讨三拗汤对病毒性肺炎的辅助治疗效果,以降低不良反应发生率。方法选取2010年3月-2013年3月收治的病毒性肺炎患者168例,按照患者就诊时间顺序均分为对照组及观察组,各84例,对照组患者在使用止咳药物、化痰药物情况下给予利巴韦林静脉滴注,观察组在对照组基础上服用三拗汤,对比两组患者的各项指标。结果对照组患者发热、咳嗽时间显著长于观察组,差异有统计学意义(P<0.05),肺部啰音消失时间、肺部影像恢复时间对照组高于观察组,但差异无统计学意义;观察组治疗总有效率为88.10%,不良反应发生率为1.19%,对照组分别为73.81%、8.33%,两组比较差异有统计学意义(P<0.05)。结论三拗汤辅助治疗病毒性肺炎患者,能够缩短患者临床症状恢复时间、降低患者不良反应发生率、提高患者临床治疗效果,值得临床推广使用。     

改良侧位纵切横缝术治疗对慢性肛裂的疗效分析

目的探讨改良侧位纵切横缝术在慢性肛裂治疗中的临床实际疗效。方法选取2011年1月至2013年11月期间我院收治的120例慢性肛裂治疗患者为研究对象,将其随机分为常规组和实验组,每组各60例。常规组患者给予常规手术治疗,实验组患者则给予改良侧位纵切横缝术。术后对患者进行随访,对比两组患者的临床治疗效果、伤口愈合时间和并发症发生情况。结果治疗后,实验组患者的总有效率为98.3%,显著高于常规组的76.7%,差异具有统计学意义(P<0.01)。实验组患者的伤口愈合时间明显短于常规组患者,差异具有统计学意义(P<0.01);实验组患者的并发症发生情况明显少于常规组患者,差异具有统计学意义(P<0.01)。结论改良侧位纵切横缝术在慢性肛裂的治疗中疗效显著,且患者术后恢复好,值得临床推广应用。