贲门失驰缓症介入治疗的疗效评价

目的：评价贲门失弛缓症球囊扩张介入治疗的疗效。方法：对20例贲门失驰缓症患者行球囊扩张术。结果：20例患者共进行了31次球囊扩张，人均1．5次（其中12例扩张1次，5例扩张2次，3例扩张3次）。术后患者吞咽困难明显缓解，主要并发症为疼痛和返流。术后随访无症状期为3－13个月。结论：球囊扩张术是治疗门失弛缓症的有效方法。     

沟通艺术在护理管理中的运用

现代管理理念已由单纯管理型向服务型转变。为了能更好地服务于临床护理人员，实现护理的科学管理，管理者必须学会运用有效的沟通技巧与护理人员进行信息及情感交流。[第一段]     

儿科临床带教老师综合素质调查分析

目的了解儿科带教老师综合素质方面存在的问题,为提高带教老师素质,训练一支作风严谨,具有务实、创新精神的临床教学队伍提供依据。方法采用自行设计的临床带教老师综合素质评价调查表对178名本院实习4周后的护生进行调查。结果带教老师综合素质总均分3.93±0.37,评分低于均分的条目有职业态度（3.80±0.60）分,交流沟通能力（3.83±0.56）分,生活护理（3.74±0.67）分,衡量护生操作合格程度能力（3.89±0.46）分,对护生思想、学习、生活关心（3.85±0.52）分。结论儿科临床带教老师综合素质总体较好,但亦存在不足,应及时采取适宜的方法和途径,优化带教老师队伍,提高带教老师的综合素质及临床教学质量。     

慢性肾脏病非透析患者脑钠素与动脉粥样硬化及心功能的关系

目的 研究脑钠素（BNP）与慢性肾脏病（CKD）非透析患者动脉粥样硬化及心功能不全的关系。 方法 采用双抗夹心免疫荧光法检测203例CKD非透析患者与16例高血压患者对照组全血BNP水平，分析其与颈动脉超声结果、心脏彩超结果及既往心血管疾病史的关系。 结果 CKD非透析患者BNP水平与对照组相比显著升高[M（范围）：54.40(15.10～ 173.00) ng/L比9.35(7.35～15.00) ng/L，P < 0.01]。Spearman相关分析显示CKD患者BNP与颈动脉内膜中层厚度（IMT）、左室心肌重量指数（LVMI）等呈正相关。存在颈动脉斑块、左室肥厚或既往发生过心血管事件的患者血BNP水平显著增高。多元回归分析显示LVMI、既往心血管事件均是影响BNP水平的独立因素。 结论 CKD非透析患者BNP水平和动脉粥样硬化性疾病、左室肥厚及心功能不全相关，提示BNP水平可作为一项评价CKD非透析患者心功能及动脉粥样硬化的敏感生物学指标。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

神经导航下经岩骨幕上下联合入路中面神经管的解剖研究

OBJECTIVE: To study the value of neuronavigation in the transpetroal approach, and to provide anatomic data for the protection of the nerves in the facial nerve canal (FNC) during surgeries. METHODS: Simulated surgery through the transpetroal approach was performed on 16 sides of 8 adult cadaver heads with the assistance by neuronavigation. The anatomy of the facial nerve and the relationship of related structures were observed and the distances from the utmost external edge of the mastoid to different segments of the FNC were measured. RESULTS: Neuronavigation was successful with all the FNC, with the mean error of less than 0.9 mm. The FNC could be divided into 3 segments, the labyrinthine, the tympanic and the mastoid segments, stretching 3.6+/-1.2 mm, 11.2+/-2.5 mm and 16.1+/-3.6 mm respectively and with diameters of 1.2+/-0.3 mm, 1.4+/-0.1 mm and 1.7+/-0.2 mm, respectively. CONCLUSION: Neuronavigation may help protect the FNC during surgical procedures, and a thorough knowledge of the anatomic features of the FNC can be significant for preservation of the facial nerves.     

腺性膀胱炎三种治疗方法治疗效果的随访观察

目的　比较腺性膀胱炎三种治疗方法的效果。方法　 86例腺性膀胱炎患者分别行膀胱药物灌注、经尿道电切、经尿道电切加膀胱药物灌注治疗。随访观察症状缓解程度和膀胱镜病检结果 1年。结果　 73例完成了随访调查 ,占 84.9%。三种方法治疗后症状缓解程度 ,差异无显著性意义 (P >0 .0 5 ) ;膀胱镜病检复查 ,灌注治疗效果好于电切治疗效果 ,综合治疗效果好于电切治疗效果 ,差异具有显著性意义 ;比较灌注治疗后膀胱镜病检阴性例数 ( 2 2 /2 8)与综合治疗后膀胱镜病检阴性例数 ( 3 0 /3 4) ,差异无显著性意义 ( χ2 =1.0 60 ,P =0 .3 0 3 )。结论　膀胱药物灌注和经尿道电切加膀胱药物灌注的膀胱镜病检复查 ,效果好于电切治疗的效果。     

短暂性脑缺血发作患者血浆中TXB2和PGF1α含量检测

本文用放射免疫法测定47例短暂性脑缺血发作(TIA)患者血浆中血栓素B_2(TXB_2)和6酮-前列腺F_(1α)(PGF_(1α))的含量。结果发现TIA患者血浆中TXB_2含量增高,PGF_(1α)降低;头颅CT或MRI示有小灶性梗塞者及TIA发作持续时间长于30min者TXB_2升高和PGF_(1α)降低更显著。治疗3个月后,血浆PGF_(1α)显著增高。TXB_2和PGF_(1α)在体内的失平衡是急性脑血管疾病发病的重要机理之一。     

应用聚合酶链反应（PCR）检测乙型肝炎患者的HBV一DNA

应用聚合酶链反应（ｐｏｌｙｍｅｒａｓｅｃｈａｉｎＲｅａｃｔｉｏｎ，ＰＣＲ）检测１０８例乙型肝炎患者血清中ＨＢＶ一ＤＮＡ，在不同类型的ＨＢＶ感染标志物（ＨＢＶＭ）的血清中结果有所不同：（１）在ＨＢｓＡｇ、ＨＢｅＡｇ和抗ＨＢｃ阳性血清中，ＰＣＲ阳性率８６．１１％（３１／３６）；（２）在ＨＢｓＡｇ、抗ＨＢｅ和抗ＨＢｃ阳性血清中，ＰＣＲ阳性率５５．８８％（１９／３４）；（３）在抗ＨＢｓ、抗ＨＢｅ和ＨＢｃ阳性血清中，ＰＣＲ阳性率为２０％（２／１０）；（４）在抗ＨＢｅ和抗ＨＢｃ阳性血清中，ＰＣＲ阳性率为２５％（２／８）；文中就ＰＣＲ检测的结果及临床意义作了扼要的讨论。