单球囊与双球囊后凸成形术对椎体复位作用的研究

目的探讨单球囊与双球囊后凸成形术对椎体压缩骨折复位作用的差异,评价后凸成形术的临床疗效。方法对2000年5月～2004年5月应用球囊扩张后凸成形术(KP)施行椎体复位的58例胸腰椎椎体压缩性骨折(VCFs)患者(90个椎体)的临床资料进行了回顾性分析。58例患者90个椎体分为单球囊组(28个椎体)和双球囊组(62个椎体),两组均经双侧椎弓根穿刺,扩张后灌注骨水泥,分别采用单球囊双侧交替扩张和双球囊双侧同时扩张的方法。分别测量术前术后椎体高度和Cobb角,比较术前术后及两组之间的差异。结果患者术后疼痛均明显减轻或消失。椎体高度平均恢复率726%(229～100%);Cobb角由术前179°(31°～316°)矫正至术后96°(06°～282°),平均矫正87°(03°～272°),术前、术后相比差异有极显著性意义(P<0001)。单球囊组和双球囊组术后椎体高度平均恢复率分别为776%(553%～100%)和643%(229%～100%),术后平均矫正Cobb角分别为99°(03°～272°)和86°(06°～198°),两组相比差异无显著性意义(P>005)。结论后凸成形术可有效缓解椎体压缩骨折患者的疼痛,恢复椎体高度,改善后凸畸形;单球囊与双球囊后凸成形术同样能使压缩骨折的椎体获到较好复位。     

低频超声辐照载5-氟尿嘧啶的纳泡靶向治疗裸鼠射频消融后残留肝癌的效果

目的 探讨低频超声辐照载5-氟尿嘧啶(5-FU)的纳泡对射频消融治疗后裸鼠残留肝癌的治疗效果.方法 取6～8周龄BALB/c裸鼠60只,用人肝癌HepG2细胞构建裸鼠肝癌模型,经射频消融约80％后,将其随机分为生理盐水组、载5-FU的纳泡(5-FU)组、非低频超声辐照载5-FU的纳泡(非低频超声+5-FU)组、低频超声...     

基于《护理措施分类》的住院患者心脏功能相关护理措施与活动类目研究

目的 基于美国《护理措施分类》(NIC),初步确定不同心脏功能状态对应的护理措施与活动类目,以指导临床护理实践.方法 从NIC中初筛护理措施和活动类目,编制心脏专科护理人员咨询问卷;对29名心脏专科护理人员进行问卷咨询及评价.结果 初步筛选出心功能各级别所需护理措施与活动数分别为;Ⅳ级32条(451个)、Ⅲ级20条(237个)、Ⅱ级2条(23个)、Ⅰ级0条(0个).心脏专科护理人员对入选的护理措施条目的意见一致性为93.1％～100％;入选的护理活动条目的赋值均数为4.00～5.00分、变异系数为0～0.25.结论 初步确定的不同心脏功能状态对应的护理措施与活动类目,具有方便交流、系统性、有效性的特点,可作为指导临床护理实践的工具.     

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia

Objective

Laparoscopic simple prostatectomy for large volume benign prostatic hyperplasia (BPH) has been reported in the literature and may be a viable alternative to open surgery for large prostate glands. While previous publications have shown comparable outcomes between laparoscopic and open simple prostatectomy, there have been few publications describing improved laparoscopic operative technique to further improve these outcomes. The authors describe a novel technique of prostatic urethra preservation during laparoscopic simple prostatectomy.

Materials and methods

From January 2006 to September 2009, laparoscopic simple prostatectomy with prostatic urethra preservation was performed in 51 patients with symptomatic BPH. This technique included extraperitoneal insufflation of the retropubic space by balloon dilation, placement of five trocars in an inverted U shape, transverse prostatic capsular incision, development of a subcapsular plane, and removal of prostatic adenoma with preservation of the prostatic urethra followed by suturing of the prostatic capsule. Demographic, perioperative and outcome data were recorded.

Results

The mean operative time was 126±51.98 min and the estimated blood loss was 232.55±199.54 mL. Significant improvements were noted in the International Prostate Symptom Score (IPSS), quality of life (QOL) questionnaires and maximum flow rate (Q_max) of patients three months after surgery. No incontinence was reported in any patient. Moreover, there was no significant difference in the 5-Item International Index of Erectile Function (IIEF-5) score pre- and post- operatively in patients who had erectile function before surgery and no patient complained of retrograde ejaculation during the postoperative follow-up period.

Conclusions

Laparoscopic simple prostatectomy with prostatic urethra preservation for benign prostatic hyperplasia is feasible and reproducible. With this technique, postoperative morbidity can be reduced and antegrade ejaculation preserved.KEY WORDS : Benign prostatic hyperplasia, laparoscopy, prostate, prostatectomy     

住院患者护理相关《国际功能、残疾和健康分类》类目的初步研究

目的初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架。方法从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性>80%的标准筛选类目;按临床实用性原则对咨询结果再次筛选。结果初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目。结论初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架。     

应用皮瓣桥接治疗阴囊及下肢淋巴水肿的疗效观察

目的 探讨皮瓣桥接法治疗淋巴水肿的疗效。方法 对8例阴囊及下肢淋巴水肿所致严重皮肤病变应用轴型皮瓣和任意型皮瓣(胸腔联合皮管)治疗。切除病变组织、移转皮瓣、桥接引流淋巴液。结果 2年～7年术后随访观察，除1例外伤性小腿淋巴水肿术后3年复发外，其余各例淋巴水肿病变部位术后6月～12月逐渐显效，患肢肿胀均有不同程度的减轻且病情稳定，无丹毒及蜂窝织炎再发，手术效果满意。结论 利用皮瓣修复淋巴水肿所致的严重皮肤病变部位是治疗淋巴水肿的一种有效方法。     

Association between vitamin D receptor gene polymorphisms and intervertebral disc degeneration: A meta-analysis

Background

Studies that have investigated the association between vitamin D receptor (VDR) gene polymorphisms and intervertebral disc degeneration (IDD) have yielded inconsistent results.

Comparisons of the prevalence and correlation factors of chronic kidney disease between the old urban and rural residents in MinHang district of Shanghai

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population. Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai, respectively. Based on the over-60-year old people health examination program, 6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated. The prevalence of CKD in urban and rural areas was compared, and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis. Results (1) The survey objectives with an average age of (69.57±7.04) years, including 4345 cases of the city residents and 1806 cases of rural residents, were enrolled. The age structures of urban and rural showed differences, population over 80 years old account for 13.1% of the rural total, significantly higher than 7.4% in the urban population (P＜0.001). (2) The prevalence rates of diabetes, hyperuricemia, hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents, which were 26.4% vs 13.7%, 9.9% vs 2.3%, 53.7% vs 37.4%, 51.4% vs 15.6% (all P＜0.01). The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas, which were 32.9% vs 44.2%, 84.6% vs 62.8% (all P＜0.01). Compared with those in rural areas, the treatment rates of hypertension and high blood lipids in urban residents were increased (all P＜0.01). (3) The prevalence of CKD was 23.4%. Female CKD prevalence was higher than male, respectively 26.3% and 18.5% (P＜0.01). In urban CKD prevalence was 22.2%, lower than 25.2% in rural. The prevalence rate of hematuria in urban areas was lower than in rural areas, but the prevalence rate of decline in renal function was higher (all P＜0.05). With the increase of age, the prevalence rate of CKD was increased (P＜0.01). (4) Age (OR=1.072), smoking history (OR=1.543), previous history of kidney disease (OR=1.351), diabetes (OR=1.373), hyperuricemia (OR=2.498), obesity (OR=1.364), history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population, while the higher education (OR=0.676, OR=0.604) and drinking (OR=0.585) had negative correlation (all P＜0.05). Age (OR=1.032), female (OR=1.860) had positive correlation with CKD in rural elderly population (all P＜0.05). Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district. The prevalence of CKD is higher in urban areas than in rural. Age is a common factor for CKD in urban and rural. Previous smoking, history of kidney disease, diabetes, hyperuricemia, obesity, history of interventional therapy, education and drinking have correlation with urban CKD patients. Female has correlation with rural CKD population.     

急性创面无干扰伤口愈合的护理研究进展

介绍无干扰伤口愈合的概念及其在急性创面处理中的应用现状,分析无干扰伤口愈合在急性创面愈合中的促进因素及效果评价,以期为医护人员在临床实践中重视将急性创面处于无干扰愈合环境,结合患者情况,制定最佳的创面处理方案提供参考。