红细胞容积分布宽度与肾移植术后ARDS患者病死率的相关性分析

目的  探讨红细胞容积分布宽度（RDW）与肾移植术后急性呼吸窘迫综合征（ARDS）患者病死率的相关性。方法  回顾性分析106例肾移植术后ARDS患者的临床资料, 根据RDW的高低分为RDW正常组（≤15.0%, 68例）和RDW升高组（ > 15.0%, 38例）。比较两组患者的基本情况和不良事件发生情况, 绘制Kaplan-Meier曲线比较两组的50 d病死率, 采用Cox比例风险回归分析ARDS患者死亡的风险因素。结果  106例患者中, 50 d内死亡总例数为46例（43.4%）。两组在序贯器官衰竭评估（SOFA）评分、血清肌酐、血红蛋白及血小板计数的差异有统计学意义（均为P < 0.05）。RDW升高组患者的50 d病死率及感染性休克发生率明显高于RDW正常组, 差异均有统计学意义（均为P < 0.05）, Kaplan-Meier生存曲线分析表明, RDW升高组与正常组患者的50 d病死率差异有统计学意义（P < 0.01）。Cox比例风险回归法单因素分析发现, 血红蛋白 < 100 g/L、血清肌酐 > 133 μmol/L、血小板计数 < 100×10⁹/L、重度ARDS、RDW > 15.0%均为ARDS患者50 d内死亡的潜在危险因素（均为P < 0.05）。多因素分析发现, 重度ARDS[比值比（OR）=12.77, 95%可信区间（CI）11.63~15.39, P < 0.001]和RDW > 15.0%（OR=2.01, 95%CI 1.02~3.94, P < 0.043）为ARDS患者50 d内死亡的独立危险因素。结论  RDW升高与肾移植术后ARDS患者疾病严重程度和50 d病死率相关, 可以作为一项较有意义的预测肾移植术后ARDS患者预后的临床指标。     

蛋白A免疫吸附治疗肺移植术后新生DSA介导的急性排斥反应

目的  探讨肺移植术后新生供者特异性抗体(dnDSA)介导的急性排斥反应的治疗方法。方法  回顾性分析1例肺移植术后早期出现抗体介导的急性排斥反应(AMR)受者的资料,分析其诊疗经过。结果  受者因系统性硬化症相关性终末期间质性肺病接受右肺移植,术前群体反应性抗体(PRA)Ⅰ类阳性(11%),术前未行特殊预处理,手术当日及术后予以抗胸腺细胞球蛋白诱导治疗。术后早期受者康复顺利,术后13 d出现胸闷、气促,并呈进行性加重,迅速进展为Ⅰ型呼吸衰竭,PRA Ⅰ类上升为58%,并出现dnDSA,其位点为A24：02,平均荧光强度(MFI)值为2 110,据国际心肺移植学会指南,拟诊为(可能)AMR。予血浆置换、蛋白A免疫吸附、糖皮质激素冲击、利妥昔单抗及免疫球蛋白静脉滴注等综合治疗后,PRA及DSA水平逐渐下降,术后20 d DSA MFI值为0,受者临床情况逐渐好转,呼吸困难消失,气促逐渐缓解,呼吸衰竭纠正,肺部渗出影逐渐吸收;术后45 d,受者完全康复出院。随访1年,受者状态良好,生活质量与同龄健康人相同,PRA Ⅰ类为5%,Ⅱ类为阴性,未出现DSA。结论  在传统药物治疗基础上加用蛋白A免疫吸附治疗,能有效去除受者循环血液中的DSA,减轻靶器官损害,近期及远期治疗效果理想。针对肺移植术后AMR,采用传统药物治疗联合免疫吸附,可以达到理想治疗效果。     

Pre and postoperative nurse-guided incentive spirometry versus physiotherapist-guided pre and postoperative breathing exercises in patients undergoing cardiac surgery: An evaluation of postoperative complications and length of hospital stay

Atelectasis is the most occurring postoperative complication after cardiac surgeries. Postoperative respiratory exercises and incentive spirometry led to decrease in postoperative complications, especially atelectasis and hospital stay. The objectives of the study were to evaluate postoperative complications and length of hospital stay of patients who received pre and postoperative nurse-guided incentive spirometry against those of patients who received pre and postoperative breathing exercises by the physiotherapist in patients who underwent cardiac surgery. Data of patients who received 2 days preoperative and 2 days postoperative nurse-guided incentive spirometry with a spirometer (PPN cohort, n = 102) or received 2 days preoperative and 2 days postoperative breathing exercises by physiotherapist without spirometer (PPP cohort, n = 105), or 2 days postoperative physiotherapist-guided breathing exercises only without spirometer (PPB cohort, n = 114) were collected and analyzed. The acute or chronic collapse of part or entire lung was defined as atelectasis. The length of stay in the hospital was from the day of admission to discharge. Patients of the PPN cohort had fewer numbers of incidences of atelectasis, dyspnea, and sweating >1 day after operations compared to those of the PPB and the PPP cohorts (P < .05 for all). The partial pressure of oxygen and oxygen saturation of arterial blood ≥6 hours after operations reported higher, the duration of ventilation was shorter, and numbers of re-intubation processes reported fewer for patients of the PPN cohort than those of the PPB and the PPP cohorts (P < .05 for all). The hospital length of the stay of patients in the PPN cohort was fewer than those of the PPB and the PPP (P < .0001 for both) cohorts. Pre and postoperative nurse-guided incentive spirometry with a spirometer following cardiac surgeries would have better postoperative pulmonary outcomes and fewer hospital stays than those of postoperative-only or pre and postoperative physiotherapist-guided breathing exercises (level of evidence: IV; technical efficacy stage: 5).     

中国10~15岁少儿抑郁情况及影响因素分析

目的 了解中国10~15岁少儿抑郁情况,为完善儿童保健政策提供基础资料。方法 采用多阶段分层抽样的方法抽取全国少儿样本2257人,采用流行病调查中心抑郁自评量表(CES-D)进行调查。结果 少儿抑郁平均得分为27.17分;单因素分析显示,年龄、母亲学历、过去一个月父母间争吵、过去一个月因病旷课及学校寄宿等因素对少儿抑郁得分有影响,差异均有统计学意义(P<0.05);二分类logistic回归分析结果显示,母亲学历较低(OR=11.761,95%CI=2.052~67.418)、不与父亲同住(OR=1.224,95%CI=1.020~1.468)、父母吵架(OR=1.017,95%CI=1.004~1.030)是少儿抑郁的危险因素(P<0.05),过去一个月没有因身体不适而旷课(OR=0.517,95%CI=0.337~0.793)是少儿抑郁的保护性因素(P<0.05)。结论 应对母亲学历较低、不与父亲同住、父母吵架及具有身体健康问题的少儿给予更多关注。     

冰淇淋暗示法对儿童腺样体术后依从性探究

目的探讨患儿采用冰淇淋心理护理慰法对腺样体患儿术后的依从性。方法选取笔者所在科室2019年2月到2020年2月住院行小儿腺样体切除术患儿78名,随机分为实验组和对照组各39名。两组患儿在年龄无差异(P>0.05)。实验组患儿在术前宣教及术后宣教均告知家属给患儿备好冰淇淋,待全麻术后清醒食用,并让患儿自己选择冰淇淋种类,对照组则是采取一般小儿术后饮食。结果从患儿术后哭闹情况进行评估,实验组患儿术后依从性明显高于对照组(P<0.05),结果有统计学意义。结论儿童对疼痛、饥饿耐受性差,加上手术导致的术后持续平卧位及心电监护、氧气吸入。使得患儿在术后哭闹,不配合术后护理。采用冰淇淋心理护理安慰法,可以有效的对患儿起到积极的暗示作用。     

Enzymatic hydrolysis of low temperature alkali pretreated wheat straw using immobilized β-xylanase nanoparticles

A low temperature alkali (LTA) pretreatment method was used to treat wheat straw. In order to obtain good results, different factors like temperature, incubation time, NaOH concentration and solid to liquid ratio for the pretreatment process were optimized. Wheat straw is a potential biomass for the production of monomeric sugars. The objective of the current study was to observe the saccharification (%) of wheat straw with immobilized magnetic nanoparticles (MNPs). For this purpose, immobilized MNPs of purified β-xylanase enzyme was used for hydrolysis of pretreated wheat straw. Wheat straw was pretreated using the LTA method and analyzed by SEM analysis. After completion of the saccharification process, saccharification% was calculated by using a DNS method. Scanning electron micrographs revealed that the hemicellulose, cellulose and lignin were partially removed and changes in the cell wall structure of the wheat straw had caused it to become deformed, increasing the specific surface area, so more fibers of the wheat straw were exposed to the immobilized β-xylanase enzyme after alkali pretreatment. The maximum saccharification potential of wheat straw was about 20.61% obtained after pretreatment with optimized conditions of 6% NaOH, 1/10 S/L, 30 °C and 72 hours. Our results indicate the reusability of the β-xylanase enzyme immobilized magnetic nanoparticles and showed a 15% residual activity after the 11th cycle. HPLC analysis of the enzyme-hydrolyzed filtrate also revealed the presence of sugars like xylose, arabinose, xylobiose, xylotriose and xylotetrose. The time duration of the pretreatment has an important effect on thermal energy consumption for the low-temperature alkali method.

A low temperature alkali (LTA) pretreatment method was used to treat wheat straw.     

锦州铁路地区2~6岁儿童营养状况分析

目的 了解锦州铁路地区儿童生长发育和营养状况,保护儿童的身体健康。方法 对2010年锦州铁路地区市内及沿线6所幼儿园的2 367名2~6岁儿童体检资料进行分析。结果 锦州铁路地区2~6岁儿童营养不良检出率为3.25%,其中生长迟缓率、低体重和消瘦率分别为1.56%、0.68%和1.01%;儿童超重率和肥胖率分别为6.39%和5.83%;市内组与沿线组进行比较,低体重率、消瘦率和肥胖率差异均有统计学意义（P<0.05）;儿童贫血检出率为3.76%,2岁组儿童贫血率明显高于其他年龄组;市内与沿线2组贫血检出率比较有统计学意义（χ²=7.85,P<0.01）。结论 锦州铁路地区儿童营养状况较好,但少数年龄组的肥胖和贫血检出率较高。     

一例特大听神经瘤患者术后伴多种并发症的护理

目的通过对一例特大听神经瘤术后伴多种并发症的患者的护理体会,分析总结其有效的护理方法。方法我科在2016年至2018年期间采用微创技术通过在全麻下经迷路径路听神经瘤的方式,对听神经瘤患者进行了肿瘤切除术,均康复出院。其中一例听神经瘤大小为5CM的特大听神经瘤患者,肿瘤位于左侧内听道、桥小脑角区,术后出现了颅内感染,颅内积气、积血,颅内压增高;肺部感染;面瘫引起的暴露性角膜炎;肝功异常(药物性肝损伤)等多个并发症。本文通过回顾的方式针对这一病例术后治疗护理涉及的感染高热,皮肤,眼部,腰池等多个方面的护理过程予以分析总结。结果虽然患者术后并发症涉及多个方面,病情较重,但对其有针对性的,积极有效的护理使其恢复较好,住院30天后康复出院。结论听神经瘤经迷路径路手术切除后虽然创伤较小,但就其部位解剖结构的特殊性和大小差异,尤其特大听神经瘤情况,易引发较多并发症,在术后护理中实时关注病人病情变化,同步采取有效措施,可有效地预防和治疗并发症,提高手术的成功率和病人愈后的生活质量。     

负压吸引法在内镜下经十二指肠乳头保胆取石术中的应用研究

为探究采用内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）联合单人经口胆道镜（SpyGlass）行经十二指肠乳头保胆取石术的有效性和安全性,并观察负压吸引法在取净胆囊结石及防止结石复发中可行性,回顾性分析2022年8月至2023年8月于北京友谊医院内镜中心采用负压吸引法行内镜下经十二指肠乳头保胆取石术的4例胆囊结石患者的临床资料,记录手术成功率和结石清除率、胆囊管超选时间、胆囊取石时间、术后并发症发生率等指标。手术成功率和结石清除率均为100%。胆囊管超选时间为6~30 min,其中2例患者在X线引导下进行胆囊管超选,超选时间分别为20 min和30 min;另2例患者为单人经口胆道镜引导下胆囊管超选,超选时间为6 min和8 min。胆囊取石时间为8~20 min,其中1例患者胆囊结石最大径为1 cm,激光碎石后使用取石网篮将结石取出;4例患者术中均使用网篮取石及负压吸引法取净结石。无严重并发症发生。术后随访8.5~24.0个月,无结石复发。本研究初步认为,内镜下经十二指肠乳头保胆取石术由于其超级微创的优势,技术上相对安全有效,值得临床进一步开展应用。