对聘用合同护士的思考和建议

20世纪90年代军队医院由于受编制所限，首先聘用合同护士。进入21世纪，面对激烈的医疗市场竞争，大部分公立医院为减少人力成本，也开始以低薪聘用合同护士。由于专业所限及就业难度加大，使越来越多合同护士走上医院的护理岗位。合同护士的地位、待遇和使用与正式护士存在较大差别。据《健康报》报道，安徽省卫生厅医政处对该省60家医院合同护士调查显示：仅有1．66％的合同护士和正式护士享有同样的待遇。[第一段]     

腹腔镜手术治疗卵巢良性肿瘤的护理

目的探讨腹腔镜手术治疗卵巢良性肿瘤的护理要点。方法全组患者56例,术前心理支持,皮肤、阴道准备,胃肠道准备,常规检查;术后加强病情观察,做好伤口护理,管道护理,术后8～24小时给病人进食,10～24小时离床活动,识别及处理腹腔镜手术的特殊并发症(泌尿系并发症,胃肠道并发症,切口周围皮下瘀血、瘀斑,皮下气肿及肩胛部酸痛)。结果56例患者手术均获成功,术后24小时内恢复正常饮食和活动,并发症少,术后平均住院3.5天。结论加强专科护理是手术成功的重要保证。     

Oral manifestation of chronic mucocutaneous candidiasis: seven case reports

BACKGROUND: Chronic mucocutaneous candidiasis (CMC) is a rare disorder characterized by persistent or recurrent candidal infections of the skin, nails and mucous membranes or by a variable combination of endocrine failure as well as immunodeficiency. Oral clinicopathological features of CMC have seldom been described in detail. METHODS: Seven patients with CMC were reported in the study. The clinical and histological findings, etiological Candida species, immunological evaluation, and therapeutic pattern of oral lesions, were analyzed. RESULTS: Long-standing whitish hyperplastic and nodule-like lesions with exaggerated deep fissure were the typical and characteristic oral manifestations presented by all patients. The tongue was the most common site affected. Histologically, no obvious distinction was found between CMC and other forms of candidal infection. Abnormal proportions of T-lymphocyte subsets and positive titers of autoantibody were observed in three subjects (42.9%) and one patient (14.3%) respectively. Meanwhile, four subjects (57.1%) showed decreased albumin and increased globulin, three cases (42.9%) had high levels of ESR. But no iron deficiency was found. Candida albicans was the microorganism isolated from these patients. CONCLUSIONS: Multiple and widespread candidal infectious lesions can be observed on the oral cavity of CMC patients. Hyperplastic and nodule-like lesion with irremovable whitish patches and deep fissure are the most common oral manifestations of these patients. Dentists, otolaryngologists and pediatricians should be familiar with the clinical appearances of CMC to make an accurate diagnosis. Potential systemic disorders should be concerned to avoid the reoccurrence of oral candidiasis.     

隐动脉筋膜蒂的交腿皮瓣修复小腿严重软组织缺损

目的探讨一种小腿严重软组织缺损的修复方法。方法以健侧隐动脉为蒂的顺行或逆行交腿皮瓣修复患侧小腿软组织缺损。结果本组8例均有效地覆盖受区创面,随访三个月,皮瓣全部成活。结论该皮瓣不牺牲小腿的重要血管,质地与受区相似,方法简单易行,血运可靠,血管蒂长,是修复小腿严重软组织缺损的较好方法。     

喉部CT仿真内窥镜成像技术的探讨

目的：探讨喉部CT仿真内窥镜(CT virtual endoscopy，CTVE)的成像质量及其影响因素。方法：对84例喉部螺旋CT扫描者行CTVE成像，根据喉腔内部结构、病灶、黏膜皱襞的显示情况和有无伪影将CTVE图像分为3级，分别比较CTVE技术在不同的扫描层厚、重建层厚及阈值的情况下图像质量的优劣。结果：CT原始扫描层厚为2mm、3mm分别与5mm、8mm的CTVE图像质量相比较，有显著性差异(P＜0．05)；重建层厚为2mm、3mm与5mm相比较，均有显著性差异(P＜0．05)；阈值为 -800— -600HU与阈值为-300HU相比较，有显著性差异(P＜0．05)。结论：不同的CT原始扫描层厚、重建层厚及阈值对CTVE图像的质量影响有明显差异。选用合适的原始扫描参数及重建参数，可以提高CTVE图像的质量，对喉部疾病的诊断很有帮助。     

贯众提取液对革兰氏阳性球菌的抑菌作用

目的：了解贯众(Dryopteris crossirhizomz)不同提取液对革兰氏阳性球菌的抑菌作用。方法：分别用水以及3种不同pH值的70％乙醇为溶媒提取贯众干品以制备贯众提取液，利用打孔法和试管稀释法测定提取液对13种微生物的抑制效果。结果：每1ml含生药1g的贯众醇提液、水提液对革兰氏阳性菌有较强的抑制作用，尤其是革兰氏阳性球菌如金黄色葡萄球菌和甲型溶血性链球菌等。对革兰氏阴性菌和真菌的抑制作用较弱，但对普通变形杆菌则有较强的抑制作用。不同pH值的抽提溶剂对药物的有效抑菌成份的提出效果不同，抽提溶剂pH越小，有效成份的提出效果越好。结论：贯众醇提液、水提液对革兰氏阳性菌有较强的抑制作用，尤其是对革兰氏阳性球菌，而对革兰氏阴性菌和真菌的抑制作用则较弱。贯众的抗菌成份易溶于水，抽提效果随pH减小而增加。     

血管紧张素Ⅱ对雄性大鼠下丘脑GGT活性的影响

目的观察脑室微量注射血管紧张素Ⅱ(AngⅡ)对雄性大鼠下丘脑γ-谷氨酰转肽酶(GGT)活性变化的影响.方法应用速率法分析测定下丘脑组织GGT活性. 结果脑室微量注射血管紧张素Ⅱ(0.12μg/20μl)使下丘脑GGT活性明显增加(P<0.05),此作用可被AngⅡ受体拮抗剂Saralasin所阻断.结论 AngⅡ可能通过兴奋AT1受体增强下丘脑组织GGT的活性,促进氨基酸转运至下丘脑促性腺激素释放激素(GnRH)神经元内,参与GnRH蛋白质的合成,从而使下丘脑GnRH肽含量增加.     

胸腺肽α1联合前列地尔治疗早中期慢性重症肝炎疗效观察

目的 :观察胸腺肽α1联合前列地尔治疗慢性重症肝炎的疗效。方法 :慢性重症肝炎 70例 ,分成治疗组 35例 ,对照组 35例。对照组用前列地尔待支持、保肝疗法 ;治疗组在此基础上加胸腺肽α1治疗 ,3m后检测血清胆红素、谷丙转氨酶、凝血酶原活动度等水平。结果 :治疗组总有效率为 80 0 % ,对照组总有效率为4 5 1% ,两组比较差异有显著意义 (P <0 0 5 ) ;治疗组与对照组治疗前各项生化指标比较无显著性意义 (P <0 0 5 ) ;治疗后两组的生化指标均有所下降 ,两组比较差异有非常显著性意义 (P <0 0 1)。结论 :胸腺肽α1联合前列地尔能显著减轻肝脏的损伤程度 ,而且患者耐受性好 ,无不良反应     

胸腰椎骨折伴脊髓损伤前后路手术适应证的选择

目的 通过107例胸腰椎骨折伴脊髓损伤病例的治疗,探讨前、后路手术适应证的选择。方法 31例经前路减压植骨,采用Z-Plate等内固定。76例经后路采用短节段椎弓根钉内固定。结果 两组均获得了满意的疗效。结论 选择前或后路手术,应综合考虑脊髓损伤程度、手术时机与技巧、骨折的部位、骨折类型和影像结果等,才能确实做到减压、恢复脊柱序列和坚强固定的目的。     

舰船员慢性荨麻疹与马拉色菌相关性研究

OBJECTIVE: To investigate the association of Malassezia furfur with chronic urticaria in the crew members of ships. METHODS: A comparative mycological study of 126 crew members of ships with chronic urticaria and 45 normal control subjects was carried out. The 82 urticaria patients identified as positive for Malassezia furfur were divided into groups A and B to receive treatment with antihistaminics (group A) and antihistaminics combined with 2% ketoconazole shampoo(group A). RESULTS: The carrier rates of Malassezia furfur were significantly higher in urticaria patients than in the normal control subjects (P<0.01), but in view of the case ratios of the final cure or improvement, no significant difference was observed between the two groups by the end of the treatment courses (P>0.05). But 6 to 8 weeks from the end of the treatment course, better therapeutic effect was noted in group B (P<0.01), with higher rate of negative Malassezia furfur findings (P<0.01). CONCLUSION: Malassezia furfur may play an important role in the prevalence of chronic urticaria among the crew members, and anti-fungal treatment may produce better long-term therapeutic effect.