腰背部皮肤大面积纤维组织瘤样增生一例

患者女,21岁.7年前即发现腰部有一约2cm大小的肿物,但无疼痛及瘙痒等症状,未做特殊治疗.逐渐发展呈片状,经多家医院治疗,均无效果.其后渐蔓延分布于整个背部及臀部,于2006年7月经活检后考虑为纤维瘤,行腰部纤维瘤切除及自体皮片移植术,术后创面无复发.现患者自感未切除的瘤体有进一步扩展,并有向头颈部延伸趋势(图1),遂入院.检查:全身发育正常,背部可见明显的肿物呈菜花状突起,瘤体全部分布在背侧面,呈散在或片状.     

严重延迟复苏烧伤休克患者血浆脑钠肽的变化

Objective To observe the early change in plasma brain natriuretic peptide (BNP) level in burn patients with long delayed fluid resuscitation of burn shock and its clinical significance.Methods Thirty-six burn patients with second and third degree of burn covering 32%- 92% total body surface area were enrolled for the study, among them 10 patients were complicated with serious heart failure (heart failure group), and 26 patients rallied from shock after delayed fluid resuscitation without heart failure (stable group).The level of plasma BNP, lactate dehydrogenase (LDH), MB isoenzyme of creatine kinase (CK-MB), and left ventricle ejection fraction (LVEF) were determined at admission and 3 hours after hospitalization, and 24, 48, 72, 168 hours after the injury in both groups with electrochemiluminescence (ECL).Results Compared with stable group, the plasma BNP level (ng/L) of heart failure group at 3 hours after hospitalization, and 24, 48, 72 hours after the burn injury increased significantly (3 hours after hospitalization: 1 521.38±121.11 vs.391.36±63.27, 24 hours after burn: 2 516.86±193.25 vs.360.79±146.56, 48 hours after burn: 1 587.76±169.23 vs.398.92±77.46, 72 hours after burn: 974.45±166.33vs.283.43 ± 68.15, all P＜ 0.01), the level of LVEF lowered significantly (3 hours after hospitalization;0.33±0.03 vs.0.58±0.09, 24 hours after burn: 0.36±0.09 vs.0.60±0.10, 48 hours after burn: 0.35±0.08 vs.0.62±0.11, 72 hours after burn: 0.39±0.10 vs.0.64±0.10, all P＜0.05).The levels of LDH (μmol·s-1·L-1)in stable group were 2.87±0.50 at admission,3.02±0.43 3hours after hospitalization,4.02±0.87 24 hours after burn, 6.90±0.87 48 hours after burn, 3.64±0.75 72 hours after burn, 2.670.45 168 hours after burn while in heart failure group, they were 2.97±1.40, 3.84±0.37, 4.29±0.45,8.50±0.38, 3.84±0.62, 2.30±0.38, respectively;and CK-MB (U/L) in stable group were 59.12±13.75at admission, 70.39 ±10.72 3 hours after hospitalization, 79.29 ±17.27 24 hours after burn, 67.44 ±12.7748 hours after burn, 30.28± 7.13 72 hours after burn, 21.44 ±3.15 168 hours after burn while in heart failure group, they were 65.76 ± 16.38, 81.46 ± 7.92, 86.43 ± 14.19, 72.53 ± 11.27, 36.39 ± 6.18,22.85±7.26, respectively.No statistically significant difference was found in changes in both LDH and CK-MB between two groups (all P＞0.05).Conclusion Determination of the plasma BNP is a simple and useful method in detecting heart failure during resuscitation of shock after a serious burn injury.     

严重延迟复苏烧伤休克患者血浆脑钠肽的变化

Objective To observe the early change in plasma brain natriuretic peptide (BNP) level in burn patients with long delayed fluid resuscitation of burn shock and its clinical significance.Methods Thirty-six burn patients with second and third degree of burn covering 32%- 92% total body surface area were enrolled for the study, among them 10 patients were complicated with serious heart failure (heart failure group), and 26 patients rallied from shock after delayed fluid resuscitation without heart failure (stable group).The level of plasma BNP, lactate dehydrogenase (LDH), MB isoenzyme of creatine kinase (CK-MB), and left ventricle ejection fraction (LVEF) were determined at admission and 3 hours after hospitalization, and 24, 48, 72, 168 hours after the injury in both groups with electrochemiluminescence (ECL).Results Compared with stable group, the plasma BNP level (ng/L) of heart failure group at 3 hours after hospitalization, and 24, 48, 72 hours after the burn injury increased significantly (3 hours after hospitalization: 1 521.38±121.11 vs.391.36±63.27, 24 hours after burn: 2 516.86±193.25 vs.360.79±146.56, 48 hours after burn: 1 587.76±169.23 vs.398.92±77.46, 72 hours after burn: 974.45±166.33vs.283.43 ± 68.15, all P＜ 0.01), the level of LVEF lowered significantly (3 hours after hospitalization;0.33±0.03 vs.0.58±0.09, 24 hours after burn: 0.36±0.09 vs.0.60±0.10, 48 hours after burn: 0.35±0.08 vs.0.62±0.11, 72 hours after burn: 0.39±0.10 vs.0.64±0.10, all P＜0.05).The levels of LDH (μmol·s-1·L-1)in stable group were 2.87±0.50 at admission,3.02±0.43 3hours after hospitalization,4.02±0.87 24 hours after burn, 6.90±0.87 48 hours after burn, 3.64±0.75 72 hours after burn, 2.670.45 168 hours after burn while in heart failure group, they were 2.97±1.40, 3.84±0.37, 4.29±0.45,8.50±0.38, 3.84±0.62, 2.30±0.38, respectively;and CK-MB (U/L) in stable group were 59.12±13.75at admission, 70.39 ±10.72 3 hours after hospitalization, 79.29 ±17.27 24 hours after burn, 67.44 ±12.7748 hours after burn, 30.28± 7.13 72 hours after burn, 21.44 ±3.15 168 hours after burn while in heart failure group, they were 65.76 ± 16.38, 81.46 ± 7.92, 86.43 ± 14.19, 72.53 ± 11.27, 36.39 ± 6.18,22.85±7.26, respectively.No statistically significant difference was found in changes in both LDH and CK-MB between two groups (all P＞0.05).Conclusion Determination of the plasma BNP is a simple and useful method in detecting heart failure during resuscitation of shock after a serious burn injury.     

还原型谷胱甘肽对严重延迟复苏烧伤患者肝功能损害的治疗作用

目的 探讨还原型谷胱甘肽(GSH)对严重延迟复苏烧伤患者肝功能损害的影响.方法 选择40例严重延迟复苏烧伤患者,随机分为两组,治疗组20例静脉滴注GSH;对照组20例给予能量合剂,均连续治疗7～14 d.于治疗前及治疗后7 d、14 d抽取患者静脉血,检测血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、r-谷氨酰转肽酶(r-GT)、碱性磷酸酶(ALP)、总胆红素(TBIL)及直接胆红素(DBIL),并进行对比分析.结果 治疗组治疗后7 d各指标即显著下降,14 d时进一步下降,与治疗前比较差异均有统计学意义(P＜0.05或P＜0.01);对照组治疗后7 d虽较治疗前有所下降,但差异无统计学意义,14 d时各指标均显著下降(P均＜0.05).与对照组14 d时比较,治疗组ALT、AST、7-GT、TBIL、DBIL下降显著(P均＜0.05),而ALP差异无统计学意义.结论 早期给予GSH对改善严重延迟复苏烧伤患者肝功能损害的疗效显著.     

母婴同室新生儿院内感染的原因及预防

<正> 母婴同室是促进母乳喂养成功的一项重要措施,是创建爱婴医院的基础。新生儿因自身免疫功能尚未健全,抵抗力低下,易发生感染,所以母婴同室中新生儿院内感染问题也是当前医院管理工作中的一个重要课题。本文就1999年1月～2001年12月,母婴同室病房内新生儿发生院内感染的因素进行了分析,并提出几点预防措施。     

易性别癖1例报告

易性别癖１例报告黄永新（桂林市人民医院）关键词易性别癖；性变态ＲｅｐｏｒｔｏｆＯｎｅＣａｓｅｏｆＴｒａｎｓｓｅｘｕａｌｉｓｍ￥／／易性别癖国内临床较少见，现就临床工作中发现１例报告如下：患者，男，１９岁，工人，初中文化。８岁起就觉得自己应该是女孩，１...     

超短波电疗烧伤创面促进上皮再生

超短波电疗多被用于治疗各种急慢性炎症或软组织损伤,而用于治疗烧伤创面促进表皮再生则少有报道。1990年1月至1993年12月我院对159例需行植皮处理的创面应用了超短波电疗。现报道如下。1 临床资料1.1 一般资料 超短波治疗组(80例,男51例,女29例;年龄:4个月～65岁,其中15岁以下54例)。创面的部位:上肢26例,下肢15例,躯干29例,臀部10例。火焰烧伤27     

桂林地区1159名高中学生心理健康状况调查分析

目的 探讨桂林地区高中生心理卫生状况及个性特点,了解桂林地区青少年心理健康水平,为改善其心理健康教育提供科学依据.方法 应用心理健康测查表(PHI),以整群分层抽样方法对桂林地区6所中学的1159名高中生进行统一心理健康问卷调查.结果 (1)桂林地区高中男生、女生SOM[男生(8.12±4.31)分;女生(8.71±4.42)分]、DEP[男生(10.48±3.09)分;女生(11.58±3.05)分]、ANX[男生(9.47±4.84)分;女生(9.31±4.51)分]、PSD[男生(8.36±3.45)分,女生(7.21±3.29)分]、UNR[男生(7.87±3.63)分,女生(7.12±3.45)分]和HMP[男生(8.96±3.21)分,女生(8.70±3.18)分]因子分以及男生的HYP因子分[(7.55±3.61)分]均高于全国常模;男生PSD、HYP和UNR因子分均比女生高,SOM和DEP因子分低于女生.(2)市级中学高中生SOM、DEP、ANX、HYP、UNR和HMP分数低于县级中学;市级中学男生SOM、DEP、ANX、PSD、HYP、UNR和HMP因子分也比县级中学低;市级和县级中学男生SOM、DEP、ANX、PSD、UNR和HMP因子分均比常模高,县级中学男生HYP因子分也高于常模.市级中学女生SOM、DEP、ANX、HYP、UNR和HMP因子分均低于县级中学;市级中学女生除HYP因子分低于常模外,DEP、PSD和HMP因子分均比常模高;县级中学女生SOM、DEP、ANX、PSD、UNR和HMP因子分均高于常模.(3)男生SOM和DEP的T分低于女生,PSD、HYP和UNR的T分比女生高;市级中学男生和女生的T分正常比例均高于县级中学,T分＞60和T分＞70比例均比县级中学低,县级中学男生2个以上T分＞70比例高于市级中学;男生T分正常比例低于女生,T分＞60比例高于女生.结论 桂林地区高中生的心理状况不容乐观,尤其是县级中学高中生,应采取干预措施,改善和提高他们的心理素质.