经皮脊柱内镜清创灌洗在骶髂关节结核中的临床应用

目的：探讨经皮脊柱内镜清创灌洗治疗骶髂关节结核的可行性及临床疗效。方法：对2007年1月至2009年4月采用皮脊柱内镜清创灌洗治疗的7例骶髂关节结核患者进行回顾性分析。其中男2例,女5例;年龄29~69岁;病变部位右侧4例,左侧3例;病程8~144个月;按Kim分型,Ⅲ型5例,Ⅳ型2例。患者术前均应用HRZE四联抗结核药物治疗2~6周。比较手术前后的视觉模拟评分（visual analogue scale,VAS）,红细胞沉降率（erythrocyte sedimentation rate,ESR）,C-反应蛋白（C-reactive protein,CRP）,Oswestry功能障碍指数（Oswestry Disability Index,ODI）。结果：7例患者手术顺利,术中平均出血量<50 ml,无血肿、感染等并发症发生。7例患者的随访时间为18~40个月。疼痛缓解明显,术后1、3、6、12、18个月VAS、ESR、CRP、ODI与治疗前比较,均有改善,末次随访时临床、影像学及实验室检查显示感染消除,并恢复正常生活和工作。结论：经皮脊柱内镜清创灌洗其组织创伤小、靶向操作、疗效肯定、术后恢复快,为骶髂关节结核的微创治疗探索出了新的选择。     

不同产地“乔诺英－哈尔马格”中花青素的含量测定及分析比较研究

目的：分析比较不同地区所产乔诺英－哈尔马格中花青素的含量，为其合理开发利用花青素提供科 学依据。方法：采用高效液相色谱法对不同产地乔诺英－哈尔马格中主要特征性成分及活性成分花青素的含量 进行分析比较研究。结果：从内蒙古巴盟地区采摘的乔诺英－哈尔马格中提取花青素的含量较高。结论：本文首 次对同一植物不同产地的乔诺英－哈尔马格中主要活性成分（花青素）的含量进行分析比较研究，利用前期研究 的最佳提取工艺方法，操作简便且重复性良好，为扩大茄科植物药源及提高质量控制标准提供科学依据。     

长期留置中心静脉导管患者经颈内静脉穿刺皮下潜行固定的效果

留置中心静脉导管在急症、重症的抢救、术中和ICU中已广泛应用.有研究表明,经外周静脉或锁骨下静脉穿刺皮下隧道法留置中心静脉导管不仅可降低导管相关性血流感染(CRBSI)的发生,且可延长中心静脉导管留置时间[1-2],但该项操作复杂且对机体损伤较大.颈部皮下组织少,组织较松弛,导管经皮下潜行时,操作简便,对机体损伤小,成功机率高.本院于2008年8月至2010年8月对需长期留置中心静脉导管患者,颈内静脉穿刺后采用皮下潜行固定导管,取得了一定的经验,现总结如下.     

探讨盐酸利托君对前置胎盘的治疗效果

目的：：因前置胎盘是妊娠晚期的一种严重并发症,增加母儿围产期死亡率,严重威胁母儿生命。盐酸利托君可以治疗前置胎盘引起的阴道流血及宫缩。通过本次实验探讨盐酸利托君对前置胎盘的治疗效果及其不良反应。方法：选择在我院住院治疗的无盐酸利托君使用禁忌证的前置胎盘孕妇386例,予盐酸利托君静脉滴注,在用药期间观察阴道流血量及宫缩情况、孕妇心慌、胎心率增快、呼吸困难等药物不良反应,以及386例患者的产后出血量、新生儿Apgar评分。结果：386例研究对象在用药后,192例在用药后宫缩缓解,阴道出血逐渐停止,有效率达86.9%;平均孕周延长23天。386例孕妇均采用剖宫产结束分娩。产后出血量在200~1600ml左右,其中295例新生儿出生后1分钟、5分钟Apgar评分为8~10分,新生儿均成活。母婴预后良好。结论：盐酸利托君对治疗前置胎盘引起阴道流血及宫缩有较为明显的治疗效果。     

清肠栓对三硝基苯磺酸诱导结肠炎大鼠结肠黏膜地址素细胞黏附分子-1表达的影响

目的:探讨黏膜地址素细胞黏附分子-1(MAdCAM-1)在三硝基苯磺酸(TNBS)诱导大鼠结肠炎发病过程中的作用:研究清肠栓是否通过抑制MAdCAM-1在结肠黏膜的表达,而发挥其抗炎愈疡作用.方法:用TNBS制备实验性大鼠结肠炎模型,大鼠随机分为清肠栓高剂量组、清肠栓低剂量组、柳氮磺胺吡啶组(SASP)、模型Ⅰ组、模型Ⅱ组及正常组.模型Ⅰ组造模3 d时,其余5组在给药7 d时处死大鼠.取大鼠结肠病变部位标本,进行组织病理学评价,用双抗体夹心酶联免疫吸附法检测结肠组织中LTB4和TNF-α水平,免疫组化染色法和Western blot分析法检测结肠黏膜MAdCAM-1蛋白表达.结果:造模3 d时,模型Ⅰ组大鼠结肠黏膜出现明显组织损伤;经过7 d处理后,清肠栓组大鼠黏膜组织损伤减轻.模型组结肠黏膜LTB4和TNF-α水平比正常组上升(436.38±66.56,396.81±69.43 vs 203.76±42.84;394.78±61.53,413.43±47.39 vs 233.84±55.24,均P<0.01);与模型Ⅱ组比较,各治疗组LTB4和TNF-α水平均下降,尤以清肠栓高剂量组下降明显(275.74±36.35,282.72±47.94,P<0.01).正常组大鼠结肠黏膜固有层MAdCAM-1可见少量表达,模型Ⅰ组大鼠结肠黏膜阳性染色细胞数明显增多:与模型Ⅱ组比较,清肠栓高剂量组、低剂量组和SASP组MAdCAM-1表达均明显下调,尤其在清肠栓高剂量组下调更为显著.结论:清肠栓通过抑制结肠黏膜促炎症因子LTB4和TNF-α释放,以及下调MAdCAM-1表达.而发挥其抗炎愈疡作用.     

癌症患者医院感染病原菌菌谱及耐药性分析

目的 探讨癌症患者医院感染病原菌的分布及其耐药状况.方法 回顾分析癌症患者医院感染1451例病例,采用WHONET-5软件进行统计处理.结果 1451株病原菌中革兰阴性(G-)杆菌492株,占33.9%,革兰阳性(G+)球菌411株,占28.3%,真菌548株,占37.8%;痰标本955株中G-杆菌为25.5%,G+球菌为31.2%,真菌为43.3%;大便标本284株中检出G-杆菌为64.4%,G+球菌为10.2%,真菌为25.5%;血液72株中检出G-杆菌为62.5%,G+球菌为30.5%,真菌为7.0%;咽拭子140株中检出G-杆菌为15.0%,G+球菌为43.0%,真菌为42.0%;药敏试验结果提示,G-杆菌对亚胺培南高度敏感对一代、二代头孢菌素、氨苄西林、哌拉西林等有较高耐药性,G+球菌对万古霉素高度敏感,对苯唑西林、青霉素、红霉素等耐药率很高,真菌对唑类抗菌药呈明显耐药.结论 由于产超广谱β-内酰胺酶菌(ESBLs)和耐甲氧西林葡萄球菌(MRS)检出率较高,临床用药应依据药敏试验结果选择和合理使用抗菌药物,控制病原菌的耐药性.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

米非司酮配伍米索前列醇终止孕8～16周妊娠100例效果观察

自 1 997年 9月～ 1 999年 9月 ,我院采用米非司酮配伍米索前列醇用于终止孕 8～ 1 6周妊娠 1 0 0例 ,效果满意 ,现对其有效性及安全性分析如下。1　资料与方法1 .1　对象 :1 0 0例孕 8～ 1 6周要求终止妊娠的健康妇女 ,无急、慢性病史 ,无肝炎、血液病史 ,无心脏病史 ,无药物过敏史。经妇科及 B超检查确诊宫内妊娠 ,常规化验白带 ,如有阴道炎 ,先治疗。1 .2　孕产史 :经产妇 75例 (包括剖宫产 5例 ) ,占75%。未产妇 2 5例 ,占 2 5% ,其中有人流史 1 5例。1 .3　给药及观察方法 :患者勿需住院。第 1天上午7时空腹顿服米非司酮 2 5mg× 6片 …     

糖尿病并发脑血管病66例临床分析

目的：探讨脑血管病患者常见的危险因素。方法：对66例老年糖尿病并发脑血管病患者与同期60例未合并糖尿病的脑血管病患者的临床表现及CT、血脂、血流变学等改变进行对比分析。结果：DM、血脂水平、血液高凝状态、高血压均是CVD病常见的危险因素。结论：对DM患者,不但要控制血糖,还要同时进行控制血压、降低血脂、控制血液高凝状态的综合治疗,才能降低CVD的发生。     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.