A型主动脉夹层术后脑部并发症危险因素分析

目的 对160例在深低温停循环(DHCA)结合脑灌下行A型主动脉夹层手术术后脑部并发症危险因素进行相关分析.方法 160例病人中男106例,女54例;年龄17～76岁,平均(56±13)岁.131例采用腋动脉插管选择性脑灌注(SCP),29例采用上腔静脉逆行性脑灌注(RCP).对所有术前、术中相关因素行单因素及多因素分析.结果 平均体外循环(CPB)(188±57)min,脑灌注(36±16)min.住院死亡16例.8例发生永久性神经功能障碍(PND),多因素分析示,与PND相关的危险因素有术前肾功能不全(OR=11.71,P=0.005)、伴有冠心病(CAD)(OR=7.35,P=0.035)、伴有脑血管病(CVD)OR=13.39,P=0.021)、术后低心排出量综合征(OR=22.21,P=0.008);32例发生暂时性神经功能障碍(TND),年龄>70岁(OR=1.17,P=0.042)是TND的相关危险因素.结论 安全时限内的脑灌注时间、脑灌注方式不影响神经系统并发症,神经系统并发症主要取决于病变本身的严重性和全身各器官功能状态.做好全身各器官的综合保护是脑保护的重要保障.     

59例等离子电极切割术治疗后尿道狭窄患者的临床观察

目的:探讨等离子电极切割术治疗后尿道狭窄的临床效果。方法:回顾性分析2002年5月—2011年5月就诊的59例后尿道狭窄患者采用等离子电极切割术治疗的临床疗效。结果:该治疗方法能够有效清除后尿道狭窄段瘢痕组织,患者术后能自行排尿。结论:等离子电极切割术治疗后尿道狭窄是一种简便、安全、有效的方法。     

犬的体外循环模型建立和管理

目的 总结22条犬的体外循环实验模型建立和管理的经验。方法 健康杂种家犬22条，雄性12条，雌性10条。建立中低温阻断停跳和常温不阻断不停跳的体外循环模型。并于体外循环开始前及转流中，进行激活全血凝固时间(ACT)、血细胞压积(Hct)和血气监测。结果 转流过程中Het、PaO2、PaCO2和BE均在正常范围。结论 建立一个正确的体外循环模型是该动物实验成功的必要因素。     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

TAVI术中紧急体外循环病例及规范修订

目的修订TAVI紧急体外循环规范。方法对完成经导管主动脉瓣植入术135例中, 5例术中因各种原因紧急建立体外循环行外科手术治疗。体外循环采用浅低温或者常温,中度血液稀释,使用Del Nido心脏停搏液行心肌保护。结果 5例患者平均体外循环时间为81.0±33.4 min,平均主动脉阻断时间为34.0±35.8 min,术后无相关并发症,均康复出院。根据体外循环中出现的相关问题建立并持续修订了相关规范。结论需要充分认识体外循环快速建立能力对TAVI手术的安全保障作用。     

心血管疾病患者并发医院感染的危险因素分析

目的探讨影响心血管疾病患者并发医院感染的危险因素。方法选取2013年5月至2014年5月浙江省湖州市中心医院心内科收治的388例心血管疾病患者为研究对象,对患者并发医院感染的危险因素进行单因素卡方检验以及多因素非条件Logistic回归分析。结果共有42例心血管疾病患者并发医院感染,感染率为10.8%,心血管疾病患者中发生感染最常见的部位为下呼吸道（40.5%）、上呼吸道（28.6%）、泌尿系统（14.3%）;多因素Logistic回归分析提示：年龄、合并糖尿病、慢性阻塞性肺疾病(COPD)、血清白蛋白水平、联合使用≥2周抗生素、心功能分级是心血管疾病患者并发医院感染的高危因素。结论心血管疾病患者并发医院感染受多种危险因素影响,临床应当针对性的对这些高危因素进行护理干预,降低医院感染率以改善患者的预后。     

三株从新生儿标本中分离的ST 1642型产NDM-5型碳青霉烯酶 大肠埃希菌

摘要：目的 分析新生儿科3株产NDM-5型碳青霉烯耐药大肠埃希菌的分子流行特征。方法 收集2017年8-9月新生儿科病房分离的3株碳青霉烯耐药大肠埃希菌（E1、E2、E3），Vitek2-Compact系统联合K-B法、E-test法进行药物敏感性试验，PCR扩增碳青霉烯耐药基因及其他相关耐药基因，检测质粒复制子分型并进行质粒接合转移试验，多位点序列分析（MLST）和脉冲场凝胶电泳（PFGE）分析菌株同源性。结果 药敏结果提示3株细菌对绝大多数β内酰胺类药物耐药，除外氨曲南（E1、E3敏感，E2耐药），对多粘菌素B、氨基糖苷类药物均敏感。PCR及测序结果提示3株细菌均检到blaNDM-5基因，同时检测到部分超广谱β内酰胺酶基因（blaSHV、blaTEM或blaCTX-M）；质粒复制子类型均为IncX3，E1质粒接合转移试验成功；MLST结果提示3株细菌均为ST1642型，PFGE结果显示3株细菌条带一致。结论 新生儿科3株碳青霉烯耐药的细菌均产NDM-5型碳青霉烯酶，同时携带超广谱β内酰胺酶基因，MLST和PFGE提示3株细菌为同一克隆来源。     

中医诊断学课程思政教学实践

课程思政是新时代适应新需求的课程观和教育理念,此文阐述目前课程思政教学的内在逻辑、存在的一些问题及对中医诊断学课程思政教学实践改革的探索。从教学大纲及目标、教学内容及课程设计、教学考核评价、教师课程思政能力建设4个方面,挖掘中医诊断学课程中的思政元素,提高教学质量,使中医诊断学课程思政发展充满活力与立德树人的魅力,使学生在课堂中受到潜移默化的影响,成为专业知识、专业技能、思想政治素质全面发展的对社会有用的人才。     

以短视频为例的用药科普新模式调查研究

目的 探讨短视频用药科普的效果.方法 统计并分析2020年5月至6月六院药师抖音短视频的观看量、点赞量等相关数据,以及相关短视频在微信公众号和微信视频号上的相应数据.结果 6个系列短视频中,抗凝药物华法林科普视频的观看量(4000余人次)和点赞量均最多,高血压、高血脂系列位居第2,观看量2500余人次;30期视频中,观...