重型颅脑损伤术后并发肾功能衰竭的预防

 目的 探讨重型颅脑损伤术后并发肾功能衰竭的预防措施。方法 选取GCS 3～8分患者121例随机分为治疗组(62例)和对照组(59例),治疗组除采用脑外科常规方法治疗外,特别采用了早期不限制补液、大剂量静点白蛋白及微量泵持续泵入小剂量多巴胺的方法,运用统计学X~2检验的方法进行比较。结果 治疗组并发肾功能衰竭3例(4.8％),对照组并发14例(23.7％),两组相比较有非常显著意义(X~2=8.93,P＜0.01)。结论 颅脑损伤术后不限制补液、早期静点大剂量白蛋白及微量泵持续泵入小剂量多巴胺能有效地预防肾功能衰竭。     

胸部爆炸伤紧急救治临床指南（2022年）

胸部爆炸伤是现代战伤和恐怖袭击中最常见的损伤类型之一,也是爆炸伤中致死率最高的伤类之一,大部分严重胸部爆炸伤患者死于受伤早期和院前转运途中,故对其紧急救治特别重要。目前普遍存在治疗不规范、疗效差异大等问题,且临床上缺乏胸部爆炸伤救治规范。中华医学会创伤学分会遵循科学性、实用性和先进性的原则,针对胸部爆炸伤的分型、院前急...     

住院患者对护理操作告知需求的调查

目的了解住院患者对护理操作告知的需求状况,为临床护士履行护理操作告知义务提供指导。方法采用自行设计的问卷对桂林市4所三级甲等医院774例住院患者进行调查。结果85.0%以上的住院患者对其中11项告知内容有需求;67.8%的患者选择护士作为告知人,口头告知方式最受患者欢迎(85.3%);不同年龄、文化程度及付费方式的住院患者对部分或全部护理操作告知内容需求差异有统计学意义(P<0.05,P<0.01)。结论住院患者对护理操作告知需求高,不同特征患者对护理操作告知需求有差异。护士需在履行告知前充分评估患者年龄、文化程度及医疗费用支付方式等因素,探索个性化、全程、优质的护理操作告知程序,以维护患者的知情同意权,满足其对护理操作告知的需求。     

结直肠癌患者血清可溶性CD26增高及其意义

目的评价血清可溶性CD2(6sCD26)对结直肠癌的诊断价值。方法收集我院59例结直肠癌患者、51例结直肠良性疾病患者和41例健康对照患者的血清,采用ELISA法检测血清中sCD26浓度。采用受试者工作曲线(ROC)法评价血清sCD26对结直肠癌的诊断价值,并采用logistic回归分析其对结直肠癌的关系是否独立于癌胚抗原(CEA)。结果结直肠癌患者血清sCD26水平较健康对照组和结直肠良性疾病组患者增高(P<0.01),但sCD26在Dukes不同分期间的差异无统计学意义(P=0.78)。sCD26诊断结直肠癌的曲线下面积为0.72〔95%可信区间(CI)为0.63～0.82,P<0.01〕,最佳诊断界值为526μg/L。sCD26的诊断敏感度和特异度分别为0.59(95%CI为0.48～0.72)和0.80(95%CI为0.67～0.90)。在包含了CEA的logistic回归模型中,sCD26阳性(≥526μg/L)的优势比为5.17(95%CI为1.72～15.53,P<0.01)。DukesA期结直肠癌患者sCD26较CEA具有更高的阳性率(P=0.03),但Dukes B、C和D期结直肠癌患者sCD26的阳性率均低于CEA(P<0.05)。结论sCD26对结直肠癌具有较高且独立于CEA的诊断价值。与CEA相比,sCD26更具有成为结直肠癌早期标志物的潜质。     

saRNA在转录水平激活人膀胱癌细胞p21WAF1/CIP1的表达研究

目的 探讨小激活RNA-dsP21-322上调人膀胱癌细胞系T24中抑癌基因p21WAF1/CIP1(p21)表达的效应.进一步分析dsP21-322是否还可上调p21前体mRNA的表达,以及增强RNA聚合酶Ⅱ蛋白与dsP21-322靶向的p21启动子区的联系.方法 合成靶向p21启动子区的小激活RNA序列dsP21-322及阴性对照(dsControl),并分别转染至T24细胞,RT-qPCR和Western Blot分别检测p21 mRNA、前体mRNA和蛋白表达的变化.ChIP检测RNA聚合酶Ⅱ蛋白与dsP21-322靶向的p21启动子富集的改变.结果 RT-qPCR和Western Blot结果显示,dsP21-322可以明显上调T24细胞系中p21成熟mRNA、前体mRNA及p21蛋白的表达,且与dsControl相比,差异均有统计学意义(P<0.001).此外,dsP21-322的转染可以明显增强RNA聚合酶Ⅱ蛋白与dsP21-322靶向的p21启动子区的联系.结论 dsP21-322上调抑癌基因p21表达是发生在转录水平的基因调控过程,这一特征的发现为后续RNA激活机制的研究提供了部分理论依据.     

聚焦解决模式在新护士情绪工作能力培训中的应用

目的探讨运用聚焦解决模式培训对提升新护士情绪工作能力的效果。方法选择新护士43名。按编号双号分为观察组(21人),采用聚焦解决模式培训,以医疗纠纷案例为特定情景,进行角色扮演,学习情绪控制、沟通交流、处理纠纷的技巧;单号为对照组(22人),按常规模式培训。结果培训后观察组护士的情绪工作各维度得分与总分显著高于对照组(均P<0.05)。结论运用聚焦解决模式培训可以提升新护士情绪工作能力。     

Discovery of a new waveform for intraoperative monitoring of hemifacial spasms

Background

Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated.

Methods

Thirty-two patients with typical hemifacial spasm and 12 with trigeminal neuralgia as a control were included. The facial muscle response was recorded during microvascular decompression surgery while the offending artery wall was stimulated (2?mA?×?0.2?ms). The latency, amplitude, and effective refractory period were analyzed.

Results

A waveform was recorded from the facial muscles of patients with hemifacial spasm when the offending artery wall was stimulated and was named the “Z-L response.” The latency was 7.3?±?0.8?ms, the amplitude was 0.08?±?0.02?mV, and the effective refractory period was 3.5–4?ms. The Z-L response disappeared immediately after microvascular decompression. No waveform was recorded from the facial muscles of patients with trigeminal neuralgia while the anterior inferior cerebellar artery, which adheres to the facial nerve, was stimulated (2?mA?×?0.2?ms).

Conclusion

We found a new waveform for intraoperative monitoring of hemifacial spasm. The Z-L response was useful when the abnormal muscle response was absent before decompression or persisted after all vascular compressions were properly treated. Particularly, the Z-L response may help neurosurgeons determine the real culprit when multiple offending vessels exist.