在深静脉血栓—肺栓塞病程中腔静脉滤器的应用价值分析

目的：探讨腔静脉滤器(Vena cava filter VCF)在深静脉血栓(Deep venous thrombosis DVT)—肺栓塞(Pulmonary embolism PE)病程中的应用价值。方法：结合本组25例高危深静脉血栓一肺栓塞患者，对其中24例置放5种构型的永久型或临时型下腔静脉滤器(IVCF)26枚的临床疗效、影响病程与预后因素及病生理改变，复习文献分析讨论。结果：DVT有可能脱落导致PE或致死性肺栓塞；置放IVCF可有效预防肺栓塞，早期进行溶栓治疗，改变预后。结论：严格按适应证植入IVCF，对DVT—PE的早期治疗和预防致死性肺栓塞有重要意义，但其应用价值需进行综合评价和进一步探讨。     

胰岛素样生长因子-Ⅰ和胰岛素样生长因子结合蛋白-1与妊高征的关系

目的：探讨胰岛素样生长因子 I(IGF-Ⅰ)和胰岛素样生长因子结合蛋白 1(IGFBP—1)与妊高征(PIH)的关系。方法：采用免疫放射法测定50例妊高征孕妇(PIH组)和108例正常孕妇(对照组)的血清 IGF-Ⅰ、IGFBP-1水平，并对其结果进行相关性分析。结果：①妊高征孕妇血清 IGF-Ⅰ水平低于正常孕妇(P<0.05)，且重度妊高征孕妇血清 IGF-Ⅰ水平低于中度和轻度孕妇(P＜0.05，P＜0.01)。②妊高征孕妇血清 IGFBP-1水平高于正常孕妇(P＜0.05)，且重度妊高征孕妇血清 IGFBP-1水平高于中度和轻度孕妇(P＜0.05，P＜0.01)。③两组孕妇血清 IGF-Ⅰ水平与血清 IGFBP-1水平呈负相关(r=-0.386，P＜0.05)。④妊高征孕妇血清 IGF-Ⅰ水平与舒张压呈负相关(r=-0.386，P＜0.05)，血清 IGFBP-1水平与舒张压呈正相关(r=0.632，P＜0.01)。结论：妊高征孕妇血清 IGF-Ⅰ、IGFBP-1水平的高低可反映妊高征的严重程度。     

后腹腔镜治疗肾上腺肿瘤35例临床分析

目的总结后腹腔镜技术治疗肾上腺肿瘤的临床经验.方法采用后腹腔镜切除肾上腺肿瘤35例,男12例,女23例.年龄25岁～72岁,平均49.8岁.左侧15例,右侧20例.其中嗜铬细胞瘤5例,原发性醛固酮增多症10,柯兴氏病2例,神经节细胞瘤2例,无功能性腺瘤16例.腰部取3个套管针穿刺入路,用自制的水囊扩张器扩张后腹腔,用超声刀将肿瘤切除.结果 35例手术均成功,无中转开放手术病例.术中出血量10～500 ml,平均74 ml.病人均未输血.手术时间45～200 min,平均90 min.结论后腹腔镜手术切除肾上腺肿瘤手术效果确切,手术时间短,术中出血少,损伤小,术后恢复快,可以替代绝大多数肾上腺肿瘤开放手术.     

回盲部恶性肿瘤的诊治

目的：分析回盲部恶性肿瘤的诊断和治疗过程，总结经验．以期提高早期确诊率和患者生存率。方法：回顾性分析近5年53例住院治疗的回盲部恶性肿瘤患者的临床资料。结果：53例患者中腺癌、黏液腺癌50例，恶性淋巴瘤3例。首次确诊率为75．5％。误诊或延迟诊断的疾病主要为阑尾炎、阑尾脓肿，胆囊炎、胆石症、下消化道出血、贫血待查等。结论：60岁以上的老年患者为回盲部恶性肿瘤的主要人群，肿瘤类型主要为腺癌。尽管首发症状缺乏特异性，但提高警觉性，详细询问病史，通过大便隐血试验、钡灌肠或气钡双重造影、纤维结肠镜检查仍能有效的提高首次确诊率，积极手术冶疗，可显著改善患者的预后。     

EASY医院固定资产信息管理系统的应用体会

随着医疗设备的不断增加 ,对其进行科学的管理显得愈加重要.为次,我们设备处管理人员引进了 EASY医院固定资产信息管理系统.     

感染科护理人员负性情绪的调查

目的探讨压疮管理的方法和路径。方法制订并应用皮肤评估表、难免压疮报告表及压疮督查表,对入院患者进行评估和对难免压疮患者实施针对性预防干预。结果141例难免压疮患者住院期间实际发生压疮11例,占7.80%,显著低于常规管理法15.09%的压疮发生率（P〈0.05）。结论表格化管理可最大限度地明确各级人员职责,保证护理措施的落实,降低难免压疮发生率。     

双J管临床应用及美蓝在置管术中的作用

目的探讨双J管(双J输尿管支架管)在泌尿系疾病治疗中的应用效果以及美蓝在置放术中的作用。方法对215例患者采用放置双J管作内支架和内引流治疗,近期48例术中以美蓝协助定位。结果术后留置尿管5~7d,无切口感染、尿瘘等并发症。术后1~3个月拔除双J管,随访3~6个月,肾功能、肾积水明显好转,吻合口通畅。以美蓝协助定位者无双J管上移致拔管困难。结论双J管具有内支架和内引流作用,操作简单,引流效果好,并发症少,缩短住院时间。以美蓝协助定位,值得推广应用。     

严重脊柱侧凸矫形患者围术期的舒适护理

对28例严重脊柱侧凸患者行矫形手术，结果手术均获成功，松解术后1周行后路矫形内固定加植骨融合术，术后Cobb角平均为40．8°，侧弯矫正率平均为52．0％。术后随访6～30个月，均无并发症发生。提出在做好脊柱侧凸矫形手术常规护理的同时，加强患者心理、体位、呼吸、镇痛、排便等方面的舒适护理，可增强患者舒适感，为手术获得成功和患者顺利康复提供有力保障。     

Lithium and haloperidol differentially alter the dynorphin A (1-8) and enkephalin levels in the neurointermediate lobe of rat pituitary

Repeated administration of the antimanic drug lithium (4 mEq/kg/day for 2, 4 or 6 days, i.p.) to rats produced a progressive decline and eventual depletion of dynorphin-A (1-8) (DYN) concentration whereas Met5-enkephalin (ENK) was only marginally decreased in the neurointermediate lobe of the pituitary (NIL). Administration of a neuroleptic haloperidol neither affected ENK and DYN levels nor influenced lithium-induced changes. The study reveals that lithium produces a preferential perturbation in the dynorphin system relative to the enkephalin system. These results taken together with other evidence, indicate that dynorphin is possibly coreleased with vasopressin following lithium administration and provide a pharmacological support to the previously described colocalization and corelease of these endogenous peptides in the NIL.     

Liver and lung resection for colorectal metastasis

Aim: To examine the survival benefit of liver and lung resection for colorectal metastasis and the potential prognostic factors that affect patient survival. Methods: All patients who had resection of lung or liver metastasis for colorectal metastasis in Queen Elizabeth Hospital, Hong Kong from 1995 to 2004 were retrospectively reviewed. The overall and disease‐free survival was analysed, in particularly between liver and lung metastasis. All factors that may have affected the survival were entered into Cox's proportional hazards regression model to identify significant variables associated with survival. Results: At 5 years, the overall survival of patients who had resection of lung and liver metastasis was 44% and 38%, respectively; the disease‐free survival was 26% and 24%, respectively. Overall and disease‐free survival of patients with resection of lung metastasis was comparable to those with resection of liver metastasis. The differentiations of primary tumour and time to metastasis were shown to be significant prognostic factors influencing overall survival. Those patients with systemic chemotherapy after resection of colorectal metastasis demonstrated a significantly higher probability of overall survival. Conclusion: Resection of lung and liver metastases from colorectal origin was safe and both procedures improved survival. The use of chemotherapy after resection of metastasis significantly improved the overall survival.