探究应用甲基强的松龙对 ARDS 患者的炎性因子的影响

目的：观察应用不同剂量的甲基强的松龙对ARDS患者的炎症因子的影响。方法选取2010至2013年住院接受治疗的ARDS患者60例，通过计算机随机分组的方式将其分为A、B、C组，每组均为20例，A、B、C三组每天给予甲基强的松龙剂量分别为1000、500、80 mg，比较这3组患者治疗第1、4、7天的TNF-α以及IL-6的含量变化以及机械通气时间、死亡率和住院时间。结果 A、B、C组患者在第1、4天的TNF-α以及IL-6的含量上无显著差异（ P＞0．05），但第7天时A、B组的TNF-α以及IL-6的含量显著小于C组（ P ＜0．05），且最终A、B组的机械通气时间显著短于C组（ P ＜0．05）。结论中等剂量以上剂量的甲基强的松龙对ARDS患者的炎症因子有显著的抑制作用，且近期疗效显著，但长远疗效仍需进一步观察。     

先心病患儿的“救心基地”——记上海交通大学医学院附属上海儿童医学中心心胸外科

“婴儿直接被抛弃在垃圾桶里，好心人发现并抱去医院检查发现，婴儿患有先心病。顿时明白了孩子被抛弃的理由。” “医院花园或街头路边放着一个襁褓中的婴儿，被好心人救回去后会在婴儿衣服里找到一封信，内容大概为：因家庭贫困无法负担孩子的心脏病医药费，望好心人能救救孩子。”     

腹部B超在筛查胎儿畸形100例临床分析

目的：探究腹部B超筛查胎儿畸形在临床上的价值。方法对行腹部B超检查的2000例患者，其中检查出胎儿畸形的100例患者的临床资料进行回顾性的分析总结。结果在2000例孕妇均进行腹部B超检查出胎儿畸形率为5%，孕早期检出畸形16例；孕中期检出畸形58例；晚孕期检出畸形26例。各系统畸形中，消化系统畸形9例，生殖泌尿系统畸形17例，神经系统畸形24例，心血管系统畸形26例，颜面部畸形5例，腹壁畸形4例。其他畸形合计15例，占总畸形人数的15%。在100例畸形胎儿中，严重畸形55例。孕早期检查出严重畸形15例；孕中期检查出严重畸形30例；孕晚期检查出严重畸形10例；其中畸形程度在各个孕期进行两两比较，严重畸形早中期比较，中晚期比较差异有统计学意义（P<0.05）；轻微畸形中晚期比较差异均有统计学意义（P<0.05）；严重畸形早晚期比较差异无统计学意义；轻微畸形早晚期比较，早中期比较差异均无统计学意义。结论腹部B超对于畸形胎儿的筛查具有安全、经济、高效、方便的特点，对临床诊断具有重要意义。     

2008年四川省阿坝州大骨节病相对活跃病区硒及T-2毒素水平调查

Objective To investigate the children's body environmental Se and T-2 toxin level in their staple food in Kaschin-Beck disease(KBD)relative active regions in Aba state of Sichuan province in 2008.Methods We took X-ray photograph of the right hand on children aged 7-13 years in 48 villages from 11 counties in Aba state.The relative active regions of KBD were chosen according to the X-ray result and historical status of KBD.The children's urine and hair,drinking water and their staple food werr sampled.Selenium contents in urine,hair,water and food samples were determined by naphthalene fluorescence,and T-2 toxin in staple food samples were detected by ELISA kits.Results In 2145 X-ray films,66 films were positive,and the children's KBD positive rate was 3.08%(66/2145).The KBD positive rate was respectively 10.98%(29/264)and 8.52%(19/223)in Maerkang county,Jinchuan county and it was 0.75%(3/400)in Rangtang county,historically serious endemic area.The selenium content in urine of children aged 7-13 years in Maerkang county,Jinchuan county and Rangtang county was (10.41±4.67), (10.11±3.65), (8.42±2.68)μg/g Cr, respectively, there was no statistical difference among three counties(F=0.901, P>0.05). The selenium content in hair of children aged 7-13 years in Maerkang county[(0.18±0.04)mg/kg] was lower than that in Jinchuan county[(0.21±0.04)mg/kg, P<0.05].The selenium content in water in Jinchuan county [(0.225±0.124 )μg/L ] was lower than that in Maerkang county and Rangtang county[(0.320±0.092), (0.339±0.105)μg/L, all P<0.05]. The selenium content in staple food in Jinchuan county(0.0033 mg/kg) was lower than that in Maerkang county and Rangtang county(0.0258,0.0137mg/kg, Z=-6.146,-3.042, all P<0.017). The T-2 toxin level in flour in three counties was 19.60,17.95,26.25 ng/g,respectively,there was no statistical difference among three counties(X2=5.623, P>0.05).The T-2 toxin level in grain Maerkang county (10.72 ng/g) was higher than that in Jinchuan county and Rangtang county (3.74,3.30 ng/g, Z=-6.315,-4.407,all P<0.017). T-2 toxin contamination in flour was more severe than that in grain (Z=-6.690,-5.493,-3.676, all P<0.05). Conclusions In 3 relative active KBD regions of Aba state,the children's selenium nutritional status and the T-2 toxin contamination level in their staple food is consistent with the distribution of KBD.     

内镜下同期放置双侧金属胆道支架的方法探讨

目的 探讨经内镜同期置入双侧可膨式金属胆道支架的方法。方法9例Ⅱ～Ⅳ型肝门部胆管恶性梗阻患者,平均血胆红素（162．8±193．8）μmol／L,内镜下插入双导丝分别留置在左、右侧胆管内,在充分扩张狭窄段后,逐一插入金属支架至双侧肝管予以释放。观察操作的便利性、成功率、控制黄疸有效性、早期并发症和近期的临床疗效。结果全组均一次成功置入双侧支架,分别采用“Y”型支架置入法2例、塑料支架过渡法1例和并行支架法6例,平均耗时（38．1±14．8）min,以并行法置入且留置支架末端在乳头外的方法最为便捷。9例患者术后除1例外其他黄疸均迅速消退,3周内均退至正常,无明显并发症发生。结论同期置人双侧金属支架是安全可行的,可迅速有效地控制肝门部肿瘤所致的黄疸和胆道感染;采用特殊设计的金属支架并行置入,并将支架末端留置在乳头外,是较为简便效佳的方法。     

2008年四川省阿坝州大骨节病相对活跃病区硒及T-2毒素水平调查

Objective To investigate the children's body environmental Se and T-2 toxin level in their staple food in Kaschin-Beck disease(KBD)relative active regions in Aba state of Sichuan province in 2008.Methods We took X-ray photograph of the right hand on children aged 7-13 years in 48 villages from 11 counties in Aba state.The relative active regions of KBD were chosen according to the X-ray result and historical status of KBD.The children's urine and hair,drinking water and their staple food werr sampled.Selenium contents in urine,hair,water and food samples were determined by naphthalene fluorescence,and T-2 toxin in staple food samples were detected by ELISA kits.Results In 2145 X-ray films,66 films were positive,and the children's KBD positive rate was 3.08%(66/2145).The KBD positive rate was respectively 10.98%(29/264)and 8.52%(19/223)in Maerkang county,Jinchuan county and it was 0.75%(3/400)in Rangtang county,historically serious endemic area.The selenium content in urine of children aged 7-13 years in Maerkang county,Jinchuan county and Rangtang county was (10.41±4.67), (10.11±3.65), (8.42±2.68)μg/g Cr, respectively, there was no statistical difference among three counties(F=0.901, P>0.05). The selenium content in hair of children aged 7-13 years in Maerkang county[(0.18±0.04)mg/kg] was lower than that in Jinchuan county[(0.21±0.04)mg/kg, P<0.05].The selenium content in water in Jinchuan county [(0.225±0.124 )μg/L ] was lower than that in Maerkang county and Rangtang county[(0.320±0.092), (0.339±0.105)μg/L, all P<0.05]. The selenium content in staple food in Jinchuan county(0.0033 mg/kg) was lower than that in Maerkang county and Rangtang county(0.0258,0.0137mg/kg, Z=-6.146,-3.042, all P<0.017). The T-2 toxin level in flour in three counties was 19.60,17.95,26.25 ng/g,respectively,there was no statistical difference among three counties(X2=5.623, P>0.05).The T-2 toxin level in grain Maerkang county (10.72 ng/g) was higher than that in Jinchuan county and Rangtang county (3.74,3.30 ng/g, Z=-6.315,-4.407,all P<0.017). T-2 toxin contamination in flour was more severe than that in grain (Z=-6.690,-5.493,-3.676, all P<0.05). Conclusions In 3 relative active KBD regions of Aba state,the children's selenium nutritional status and the T-2 toxin contamination level in their staple food is consistent with the distribution of KBD.     

胃癌术后空肠造口早期肠内营养的护理观察

目的分析空肠造口早期肠内营养的优越性及护理措施。方法将胃癌患者112例随机分为两组：空肠造口传统肠内营养组58例,空肠造口早期肠内营养组54例。对两组患者的血浆白蛋白含量、肛门排气时间、术后第3天切口疼痛分值、平均住院时间及费用进行观察比较。结果肛门排气时间、平均住院费用实验组较对照组均显著减少。结论胃癌术后空肠造口早期肠内营养符合生理需求,胃肠功能恢复及经济效益明显优于空肠造口传统肠内营养。     

经皮肝穿刺胆管引流和内支架置入术的护理要点分析

目的分析经皮肝穿刺胆管引流和内支架置入术的护理要点。方法选取本院2014年3月~2015年3月收治的行经皮肝穿刺胆道引流术和内支架置入术患者30例作为研究对象,对30例患者的临床资料进行回顾性分析。结果 30例患者均解除胆道内阻塞,患者的血清总胆红素下降到69.3~111.8μmol/L,患者皮肤黄染以及巩膜黄染明显消退,患者的食欲增加明显。结论为经皮肝穿刺胆管引流和内支架置入术患者提供全面、具有针对性的护理,掌握护理要点,具有良好的治疗效果。     

广西某县HIV现场监测与定点监测的流行病学特征研究

目的 探讨现场监测与定点监测发现人类免疫缺陷病毒（human immunodeficiency virus, HIV）阳性人群的流行病学特征,为有效发现HIV阳性病例提供防治依据。方法 在广西艾滋病高发区选择某县,获取2013年1月1日～2014年3月31日发现报告的HIV阳性数据（定点监测）,同期对当地常住人口进行现场HIV抗体检测同时收集相关信息（现场监测）。运用对应分析法分析两种疾病监测方式下发现的HIV阳性人群流行病学特征间的关联性。结果 现场监测214 586人,发现阳性1 195例,发现率0.56%（1 195/214 586）;定点监测151 365人,发现阳性584例,发现率0.39%（584/151 365）,现场监测发现率高于定点监测（χ²=53.69,P<0.001）;对应分析显示,现场监测更容易发现“年龄在55～岁、文盲/小学文化、农村、异性传播、HIV感染者和CD4细胞计数≥200（个/mm³）”的特征人群;定点监测更容易发现“30～岁、初中高中及以上文化、城镇、艾滋病、其他传播途径和CD4细胞计数<200（个/mm³）”的特征人群。结论 实施现场监测有利于发现非病症感染者,老年人群、低文化程度和农村人群是HIV感染的重点高危人群。