创伤性肝破裂42例临床诊治体会

目的探讨创伤性肝破裂的病情诊断及治疗方法的选择。方法回顾性分析近6年(2010~2016年)我院收治的42例创伤性肝破裂患者的临床资料。结果保守治疗适用于轻度肝损伤患者,介入后手术治疗组疗效明显优于手术治疗组。结论创伤性肝破裂早期诊断伤情并选择合适的治疗方式,是挽救患者生命和降低病死率的有效方法。     

腹腔镜规则性肝左外叶切除的临床体会

目的探讨该腹腔镜规则性肝左外叶切除的可行性和安全性。方法回顾性分析2009年3月至2011年6月该院为8例左肝内胆管结石、原发性肝癌、血管瘤患者行腹腔镜肝左外叶切除的临床资料。结果 8例均顺利完成手术,无中转开腹者。手术时间(266.63±21.65)min,术中出血(307.504±90.20)mL,病人术后平均住院日(8.754±1.83)d,无残石。发生胸腔积液1例,无切口感染、胆漏、腹腔感染等并发症,无死亡病例。结论腹腔镜规则性肝左外叶肝切除安全、可行,具有微创的优点。     

阴道生物黏附缓释制剂的研究进展

综述了近年来国内外阴道生物黏附缓释新型制剂的进展,包括生物黏附性缓释乳膏、生物黏附阴道片、缓释凝胶剂等。     

急性胆源性胰腺炎胆道手术干预疗效的临床分析

目的:探讨胆源性急性胰腺炎的治疗方法。方法:回顾性分析某院胆源性胰腺炎94例的临床资料。结果:轻症胰腺炎73例中,非手术治疗17例,手术治疗56例,均治愈。重症胰腺炎21例中,非手术治疗9例,治愈6例,死亡3例,死亡率为33.33%;手术治疗12例,治愈11例,死亡1例,死亡率为9.09%。重症急性胰腺炎手术治疗组的死亡率显著低于非手术治疗组(P<0.05)。结论:抉择好手术时机是治疗胆源性急性胰腺炎的重要环节。     

星点设计-效应面法优化硝酸布康唑缓释乳膏的制备

目的 采用星点设计-效应面法对硝酸布康唑缓释乳膏的处方进行优化。方法 以液体石蜡用量(X₁)、乳化剂用量(X₂)、助乳化剂占乳化剂比例(X₃)为考察因素,以24,48,72 h的累积释放度为考察指标,分别用多元线性模型、二次多项式模型描述考察指标和3个考察因素之间的数学关系,根据模型绘制效应面图和等高线图,通过重叠等高线图确定优化处方,最后进行验证。结果 二次多项式模型比多元线性模型置信度高;根据二次多项式模型,发现 3 个考察因素和 3个考察指标之间存在可信的定量关系;优化处方各设定指标的预测值和实际值非常接近。结论 星点设计-效应面法可用于硝酸布康唑缓释乳膏的处方优化,所建模型具有良好的预测能力。     

彩超实时引导下经皮肾穿刺活检的临床体会

目的总结彩超实时引导下经皮肾穿刺活检的经验。方法对2010年1月至2010年8月75例肾脏病患者实行彩超实时引导下肾穿刺活检的结果进行回顾性分析。结果肾活检成功率97.3%,镜下血尿75例（100%）,肉眼血尿1例（1.33%）,腰痛6例（8%）。术后均无严重并发症。结论该方法具有安全、准确、成功率高、并发症少等优点,值得广泛推广。     

Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture

Objective： To retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation （PFNA）.
Methods： From September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type Ⅰ fractures, 19 type Ⅱand 6 type Ⅲ according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists （ASA）, there were 9 grade Ⅰ, 14 grade Ⅱ, 8 grade Ⅲ, and 4 grade Ⅳ.
Results： The duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation （mean 3.5 days）. Hospital stay was 4-7 days （mean 5.3 days）. Full weight bearing time was 10-14 weeks （mean 12.8 weeks）. During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks （mean 16.6 weeks）. No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had troehanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.
Conclusion： The emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation, less blood loss, shorter length of stay, less complications, and the preliminary clinical effect is satisfactory.     

肝叶切除治疗肝内胆管结石256例的体会

目的 探讨肝叶切除治疗肝内胆管结石的疗效. 方法 回顾性总结1996-12～2006-12在我科行肝叶切除治疗肝内胆管结石256例的经验与体会. 结果 本组无手术死亡,术后并发症有胆漏12例（4.69%）,膈下感染7例（2.73%）,腹腔脓肿5例（1.95%）和肝功能衰竭2例（0.78%）.本组获随访者229例,随访时间4个月～10年,平均7年3个月.93.01%术后症状消失,工作生活正常;5.68%偶有轻度胆管炎发作;1.31%仍反复发作严重胆道感染. 结论 肝叶切除术是治疗肝内胆管结石最有效的手段之一.     

电子健康档案标准——CDA与openEHR

电子健康档案记录个人终生完整、准确的健康信息.针对目前常见的医疗档案标准,本文针对HL7 CDA与openEHR进行了详细阐述,并针对两者在适用范围、模型结构与安全性方面的不同进行比较.并针对中国电子健康档案发展的前景进行展望,并指出了可能存在的障碍.