重症手足口病的诊治体会

手足口病(HFMD)是由多种肠道病毒引起的常见传染病,以婴幼儿发病为主.普通病例主要表现为发热和手、足、口、臀等部位斑丘疹、疱疹,重症病例则出现神经系统、循环系统、呼吸系统并发症,个别病例病情进展快,往往突然出现外周微循环衰竭、神经源性肺水肿,最终导致死亡[1].本文将我院339例手足口病患儿分为两组(A、B),采用权威病情监测法,使手足口危重症发生率及死亡率显著下降.现概述如下:     

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??Laparoscopic repair for giant hiatal hernia??A clinical analysis of 75 patients SUN Xiang-yu, QIN Ming-fang, ZHAO Hong-zhi, et al. Department of Mini-invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
Corresponding author: SUN Xiang-yu, E-mail: xiangyusun79@126.com
Abstract Objective To investigate the safety and effectiveness of laparoscopic repair for giant hiatal hernia. Methods The clinical data of 75 patients with giant hiatal hernia performed laparoscopic repair between January 2006 and August 2012 in Tianjin Nankai Hospital were analyzed retrospectively. The operation time, hospitalization time, intraoperative and postoperative complications, postoperative improvement of symptoms and upper gastrointestinal imaging were studied. Results All the patients were treated by laparoscopy successfully. Fifty-one patients were reinforced with meshes. Twenty-four patients were reinforced without mesh. Hiatal pillars in 40 patients were partly contracted and closed with meshes. Hiatal pillars in 35 patients were directly closed up to normal diameter by interrupted stitches. Among them, 11 patients were placed with meshes. Laparoscopic repair complicated with fundoplication was performed in 64 patients with average operation time of (97.2±2.1)min, average operative blood loss of (82.0±1.7)mL and average hospital stay of (5.0±1.2)d. No conversion and death occurred. Seventeen patients (22.7%) had short-term or long-term complications. Seventy-five patients were followed up for 3 months to 62 months with average of (31.0±2.1)months. Main symptoms of 66 patients (88%) were disappeared. Nine patients ??12%??had recurrence of symptoms. Four patients??5.3%??were found recurrence by barium swallow. Conclusion Laparoscopic repair for giant hiatal hernia is safe and reliable. Mesh repair can reduce the recurrence rate but accompanied with risk of complication.     

镉染毒对大鼠骨生物力学性能的影响

目的: 探讨镉对大鼠股骨和腰椎生物力学性能的影响。方法: 24只8周龄雄性SD大鼠随机分成4组，分别背部皮下注射生理盐水0.5ml（对照组）和0.1mg/kg bw(低剂量组)，0.5mg/kg bw（中剂量组），1.5mg/kg bw（高剂量组）CdCl2，每周称体重，并根据体重调整注射量。染毒后第12周，收集全血、腰椎及股骨，分别用于血镉测定、骨镉测定、骨密度测定及生物力学测定。结果: 染毒组大鼠体内血镉及骨镉水平明显高于对照组，差异有统计学意义（P < 0.05）；中、高剂量染毒组大鼠骨密度较对照组显著下降（P < 0.05）；染毒组大鼠股骨和腰椎生物力学性能较对照组有不同程度的的降低，其中高剂量染毒组大鼠股骨生物力学性能的下降和对照组相比有显著差异（P < 0.01）；中剂量和高剂量染毒组大鼠腰椎生物力学性能和对照组相比差异有统计学意义（P < 0.01）。结论: 镉能影响大鼠股骨和腰椎的生物力学性能，并且腰椎生物力学性能的改变要早于股骨。     

综合护理干预预防ICU失禁性皮炎的临床观察

目的 分析综合护理干预在预防ICU失禁性皮炎(IAD)的应用效果。方法 68例18岁以上失禁患者随机分为对照组和干预组,对照组给以常规护理,干预组在常规护理基础上采取综合护理干预,比较两组IAD发生率。结果 干预组IAD发生率为18.9%,对照组IAD发生率是51.6%,两组差异有统计学意义(P<0.05)。结论 综合护理干预能降低ICU的IAD发生率,提高ICU护理质量。对护理人员IAD进行培训、规范失禁患者护理流程、采用合适的保护皮肤材料,可以降低ICU的IAD发生率。     

锌制剂、肠道微生态调节剂对迁延性腹泻患儿的作用

目的研究锌制剂联合肠道微生态调节剂对于小儿迁延性腹泻患儿的作用与效果。方法选取我院在2018年1—12月采用肠道微生态调节剂的50例小儿迁延性腹泻患儿,将其作为A组;另选出在此基础上采用锌制剂联合肠道微生态调节剂的50例小儿迁延性腹泻患儿,将其作为B组,观察比较两组患者的治疗效果。结果 B组患者的治疗有效率为98.00%,高于A组(84.00%),差异具有统计学意义(P0.05);治疗前,A组与B组其免疫功能指标对比,差异无统计学意义(P 0.05);治疗后,B组其免疫功能指标均优于A组,差异具有统计学意义(P 0.05)。结论肠道微生态调节剂联合锌制剂能够极大地提升小儿迁延性腹泻患儿其自身的血锌水平与免疫能力,减少各类氧化应激反应的产生。