病毒性肝炎血清Ⅳ型胶原和层粘连蛋白水平与门静脉管径的相关性

采用放射免疫方法检测１０２例各型病毒性肝炎血清Ⅳ型胶原（ⅣＣ）、层粘连蛋白（ＬＮ）的变化,并与Ｂ型超声仪检测的门静脉主干管径比较。结果发现：在慢性重度肝炎及重症肝炎血清ⅣＣ,ＬＮ水平升高,在门静脉管径＞１２ｍｍ时,其血清ⅣＣ,ＬＮ值明显上升,且与门静脉管径呈正相关。表明血清ⅣＣ,ＬＮ的检测对肝纤维化的诊断有重要参考价值。     

冠心病患者红细胞膜ATP酶活性及血脂水平的变化

观察２１例冠心病患者及正常对照组的空腹血浆甘油三酯（ＴＧ）、总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、高密度脂蛋白胆固醇（ＨＤＬＣ）,红细胞膜Ｎａ＋Ｋ＋ＡＴＰ酶、Ｃａ２＋ＡＴＰ酶,Ｍｇ２＋ＡＴＰ酶及红细胞内Ｃａ２＋浓度（［Ｃａ２＋］）的变化。发现冠心病组ＴＧ,ＴＣ,ＬＤＬＣ及红细胞内［Ｃａ２＋］高于对照组;而血浆ＨＤＬＣ,红细胞膜Ｎａ＋Ｋ＋ＡＴＰ酶与Ｃａ２＋ＡＴＰ酶活性低于后者;Ｍｇ２＋ＡＴＰ酶无变化;Ｎａ２＋Ｋ＋ＡＴＰ酶,Ｃａ２＋ＡＴＰ酶分别与血浆ＴＧ,ＴＣ和ＬＤＬＣ呈负相关,与血浆ＨＤＬＣ呈正相关。根据测定结果,对其发病机制进行了讨论     

3D全腔镜下双侧改良Mini-Maze手术治疗心房颤动的护理配合

目的总结3D全腔镜下双侧改良Mini-Maze手术治疗心房颤动的护理配合。方法对33例房颤患者施行3D全腔镜下双侧改良Mini-Maze手术,术前做好患者的评估,确保腔镜设备及射频系统完好,掌握射频原理,具备熟练的操作及应急能力,主动密切配合手术,加强团队互相协作。结果 33例房颤患者顺利完成3D全腔镜下双侧改良Mini-Maze手术,效果满意,术中无并发症,无围术期死亡,出院时30例患者为窦性心律。结论术前充分准备,正确摆放手术体位,熟练掌握3D腔镜手术操作技能,术中密切主动的配合及有效的团队协作是顺利完成3D全腔镜双侧改良Mini-Maze手术的重要保障。     

先天性心脏病围术期血流动力学监测方法

血流动力学监测是先天性心脏病围术期的重要监测手段,对于指导临床治疗非常重要.目前,监测血流动力学的方法有多种,有创性的方法包括直接Fick法、Swan-Ganz导管的热稀释法及脉搏波形法;无创性的方法包括部分二氧化碳重复吸收法、生物阻抗法等方法.本文将对几种监测方法各自的原理,优缺点进行综述.     

肿瘤患者PICC置管赋能教育研究

目的探讨赋能教育在PICC健康教育中的应用效果。方法选取首次行PICC置管治疗的101例肿瘤患者,随机分为常规组(n=51)和赋能组(n=50),分别实施常规健康教育和赋能教育,干预后比较两组自我效能评分、自我管理能力评分及并发症发生率。结果赋能组干预后自我效能总分及自我减压、正性态度维度评分显著高于常规组(P0.05,P0.01);PICC自我管理能力及各维度评分显著高于常规组(P0.05,P0.01);并发症发生率显著低于常规组(P0.01)。结论赋能教育较常规健康教育更有助于患者掌握PICC相关知识,提高患者自我效能和自我管理能力,减少PICC置管后并发症的发生。     

尿道板纵切卷管尿道成形术在儿童尿道下裂治疗中的应用效果观察

目的 探讨尿道板纵切卷管尿道成形术在儿童尿道下裂治疗中的应用效果.方法 选择2014年5月至2016年5月我院收治的140例尿道下裂患儿作为研究对象,以随机数字表将其平均分为研究组与对照组.对照组行加盖岛状皮瓣尿道成形术,研究组行尿道板纵切卷管尿道成形术.结果 两组总有效率对比中,研究组(97.12％)与对照组(92.29％)差异无统计学意义(P>0.05).研究组尿道狭窄1例(1.43％),对照组尿道狭窄8例(11.43％);两组术后尿道狭窄的发生率比较中,研究组1.43％低于对照组11.43％(P<0.05).结论 尿道板纵切卷管尿道成形术在儿童尿道下裂治疗中具有显著的治疗效果,有效降低了术后尿道狭窄的发生概率,适于临床推广.     

Antihyperlipidaemic effect of triterpenic acid-enriched fraction from Cyclocarya paliurus leaves in hyperlipidaemic rats

Context: Cyclocarya paliurus (Batal) Iljinskaja (Juglandaceae) is an edible and medicinal plant; the leaves are used in Chinese folkloric medicine to treat dyslipidaemia and diabetes.

Objective: This study evaluates the antihyperlipidaemic potential of the triterpenic acid-enriched fraction (TAE) from C. paliurus and the underlying mechanism.

Materials and methods: The hyperlipidaemic rats were induced by high fat diet for 6 weeks. After oral administration of TAE (200 and 400?mg/kg), the neutral fraction (150 and 300?mg/kg) and statin (4?mg/kg) to the hyperlipidaemic rats for 4 weeks, lipid profile and apolipoprotein (apoB48) level in plasma, and the expression levels of apoB48, microsomal triglyceride transfer protein (MTP), phosphorylation of mitogen-activated protein kinase (MAPK) and tumour necrosis factor α (TNF-α) in intestine were examined. The main constituents in the TAE were identified by HPLC-MS.

Results: TAE administration (400?mg/kg) decreased the levels of atherogenic lipids in serum and liver (p?p?Conclusion and discussion: These findings suggested that TAE possessed antihyperlipidaemic activity partially involved in the inhibitory effect on apoB48 overproduction, which may provide evidence about its potential role in ameliorating dyslipidaemia.     

Fat‐Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter,Single‐Blind,Randomized Controlled Trial

Background: Improvement of fat digestion and absorption was supposed to relieve feeding intolerance. This trial aimed to evaluate the effect of a fat‐modified enteral formula on feeding tolerance in critically ill patients. Materials and Methods: This trial was conducted in 7 hospitals in China. In total, 144 intensive care unit (ICU) patients with estimated need of enteral nutrition (EN) for at least 5 days were randomly given fat‐modified enteral formula containing medium‐chain triglycerides (MCT), carnitine, and taurine (interventional feed group, n = 71) or standard enteral formula (control feed group, n = 73). EN intake, feeding intolerance (diarrhea, vomiting, gastric retention, and abdominal distension) and outcomes (mechanical ventilator‐free days of 28 days, length of ICU stay, length of hospital stay, and in‐hospital mortality) were collected. Results: Daily calories and protein intake were increased in the interventional feed group compared with the control feed group (P < .01). Total incidence of feeding intolerance was 42.3% in the interventional feed group and 65.7% in the control feed group (P < .001). Daily incidence of feeding intolerance was 11.3%, 18.3%, 14.1%, 25.4%, and 26.1% in the interventional feed group and 31.5%, 32.9%, 34.2%, 34.2%, and 30.4% in the control feed group from study days 1–5 (P = .0083). Incidence of feeding intolerance without abdominal distention was 32.9% in the interventional feed group and 49.3% in the control feed group (P = .047), while the incidence of abdominal distension was 26.8% in the interventional feed group and 43.8% in the control feed group (P = .03). No significant differences existed in outcomes between the 2 groups. Conclusions: The fat‐modified enteral formula containing MCT, carnitine, and taurine may improve feeding tolerance in critically ill patients.     

卵巢过度刺激综合征合并单纯型呼吸性碱中毒的处理方法及注意事项

目的 探讨卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)合并单纯型呼吸性碱中毒患者的处理方法及注意事项,并简述血气分析在OHSS患者中应用的临床意义.方法 选取本院2016年1月至9月收治的中重度OHSS患者,入院后均立即行动脉血气分析,50例患者合并有单纯型呼吸性碱中毒,给予患者面罩吸氧及胸腔或腹腔穿刺术,于6h后再次行动脉血气分析,比较患者呼吸频率及pH、PaCO2的值.结果 经吸氧及穿刺术等对症治疗,患者呼吸困难、腹胀不适等症状明显好转,呼吸频率减慢,pH值下降、PaCO2升高,穿刺术前后比较差异有统计学意义(P＜0.05).结论 对于OHSS合并单纯型呼吸性碱中毒的患者应尽早给予吸氧及穿刺术等对症治疗,OHSS患者入院后应常规行血气分析.     

大量输血方案在大出血和凝血病早期的应用研究

目的 探讨大量输血方案在早期大量输血和预防凝血病效果.方法 在临床收集50例大量输血病例,依照大量输血方案(MTP),对干涉前和干涉后进行统计分析处理,用干涉前和干涉后数据进行统计学比较.结果 输注红细胞越多血小板下降越严重.输注15 U后,凝血酶原时间(PT)试验、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)均明显升高(P＜0.05).输注20 U后,纤维蛋白原(Fib)明显降低(P＜0.05).两组患者MTP干涉前与干涉后比较,差异有统计学意义(P＜0.01).结论 应用MTP对预防血凝病的发生,评估凝血状态具有重要意义.