医护人员自我防护意识培训与职业暴露关系的探讨

随着医学科学的发展和各种诊疗技术的推广,尤其是近几年新的化学药物和高新技术的临床应用,医务工作者常暴露于多种职业性危害因素之中[1].     

胎儿成人型多囊肾超声表现1例

孕妇23岁，孕2产0，停经22周来我院行常规超声检查。超声显示：胎儿头颅光环完整，双顶径5.3cm，脑中线居中，脊柱排列整齐，连续性好，胎盘附着于子宫后壁，四肢发育良好，股骨长3.6cm，胎心149次/min,胎儿肝回声均质。双肾体积明显肿长，     

产前超声诊断胎儿心内膜垫缺损

目的探讨胎儿心脏心内膜垫缺损的产前超声表现与诊断技巧,提高此类畸形的产前超声检出率.方法调节胎儿心脏检查条件,常规胎儿超声检查后进行胎儿超声心动图检查,获得胎儿四腔心切面、左右室流出道切面、三血管切面,大动脉短轴切面,采用彩色多普勒和频普多普勒检查.结果产前诊断出胎儿心内膜垫缺损13例,均经引产后尸解得到证实.其中部分性心内膜垫缺损4例,完全性心内膜垫缺损9例.结论超声心动图检查是产前诊断胎儿心内膜垫缺损的可靠方法与技术.     

剖宫产术后下肢活动对深静脉血栓形成的影响

目的:预防剖宫产产妇术后深静脉血栓形成(DVT).方法:筛选出符合条件且行剖宫产术的产妇60例,随机分为实验组和对照组各30例,实验组术后给予双下肢主被动活动,对照组进行术后早期活动宣教,并收集术前、术后第1日晨、术后第3日晨血常规及血凝4项数值,进行相关统计学比较.结果:两组产妇术后纤维蛋白原(Fbg)、红细胞比容(HCT)、凝血酶原时间(PT)统计学差异有显著性(P<0.01);实验组Fbg、HCT值明显低于对照组,PT较对照组显著延长.结论:对剖宫产产妇术后及时实施有效的双下肢主被动活动,可有效改善产妇血液高凝状态,降低深静脉血栓形成的危险,预防下肢深静脉血栓形成.     

彩色多普勒血流显像在胎儿脐带绕颈中的诊断价值

目的探讨彩色多普勒超声血流显像在胎儿脐带绕颈中的诊断价值。方法采用彩色多普勒超声诊断仪，检查135例孕妇，孕28-42周，常规先B型超声检查胎儿、胎盘、脐带、羊水等一般情况，再重点观察有无脐带绕颈征象，然后采用彩色多普勒超声血流显像，做进一步检查，确定有无脐带绕颈。结果135例孕妇B型超声检查发现129例脐带绕颈，符合率95．56％；彩色多普勒超声血流显像检查发现135例，符合率100％。结论彩色多普勒超声血流显像在胎儿脐带绕颈中有重要诊断价值。     

超声诊断胎儿左心室脂肪瘤1例

晰,右侧可见,左右心室流出道切面显示清楚,心室与大动脉连接正常,两条大动脉在心底呈交叉排列.超声提示:①宫内孕,单活胎,头位;②胎儿左心室占位(脂肪瘤).     

介入超声治疗卵巢囊肿69例分析

目的探讨介入超声对卵巢良性囊肿的治疗效果。方法采用SC-6000C型彩色多普勒超声诊断仪，探头频率2．0～5．0MHz,局部定位、消毒、引导穿刺、抽液、注药（无水乙醇），术后观察30～60min，离院。结果一次介入治疗治愈率86．96％（60／69），总治愈率97．10％。追踪随访3～18个月，未见明显不良反应。结论经腹壁超声引导介入治疗卵巢良性囊肿，患者痛苦少、疗效高、副作用少、可重复治疗，值得在临床推广。     

呼气保持法测定机械通气患者呼气末肺动脉楔压的方法研究

目的 联合应用呼吸机上的"呼气保持"功能与监护仪上的"肺动脉楔压(PAWP)回顾"软件,寻找一种既准确又方便快捷的测量呼气末PAWP(eePAWP)的方法.方法 采用前瞻性自身前后对照研究方法.选择放置肺动脉导管的机械通气患者12例,随机选取50例次的测量值,21例次为单纯正压通气,29例次为正压通气混有自主呼吸.先根据呼吸变异度(RV)分为＜8 mm Hg(1 mm Hg=0.133 kPa)或≥8 mm Hg两组,再根据PAWP测量方法分为监护仪自动显示组和呼气保持法测量组.比较每例次自动测量法和呼气保持法所测PAWP值的差异.结果 21例次单纯正压通气患者中,12例次RV＜8 mm Hg者中自动显示组PAWP(mm Hg)数值多高于呼气保持组(12～16比9～14),但两组数值差距较小,甚至偶有相等的情况;9例次RV≥8 mm Hg者中自动显示组PAWP(mm Hg)数值均高于呼气保持组(13～20比9～15),两组数据差距较大;但不论RV多少,两组间PAWP数值比较差异均有统计学意义(均P＜0.01).29例次正压通气混有自主呼吸的患者中,RV＜8 mm Hg者(13例次)和RV≥8 mm Hg者(16例次)中自动显示组大部分PAWP数值高于呼气保持组(11～18比10～17),4例次低于呼气保持组(11～20比14～23),但两组间各PAWP数值差异均无统计学意义(均P＞0.05).结论 无论单纯正压通气还是正压通气混有自主呼吸的患者,呼气保持法均能较好地识别eePAWP波形,更准确、快速地反映患者真实的血流动力学状态.

Abstract：

Objective To find an accurate and convenient method of measuring end-expiratory pulmonary artery wedge pressure (eePAWP) by "expiration holding" function of ventilator and "pulmonary artery wedge pressure (PAWP) Review" software of monitor. Methods Twelve patients with introduction of pulmonary artery catheter and undergoing mechanical ventilation were selected. Fifty measurements were randomly selected for the comparison of the differences between automatic measurement and expiration holding method in each patient. There were 21 cases underwent single positive pressure ventilation and 29 cases with positive pressure ventilation mixed with spontaneous breathing. All measurements were first divided into ＜8 mm Hg (1 mm Hg=0. 133 kPa) or ≥8 mm Hg groups according to respiratory variability (RV). They were then divided into automatic measurement group and expiration holding group according to PAWP measurement, and the difference in the results between two groups were recorded. Results In 21 cases with single positive pressure ventilation, in 12 cases PAWP (mm Hg) of automatic measurement group was higher than that of expiration holding group (12 - 16 vs. 9 - 14) when RV＜8 mm Hg, but the difference between two groups was not obvious, and measurements were similar occasionally. In automatic measurement group PAWP (mm Hg) was higher than that of expiration holding group (13 - 20 vs. 9 - 15) in 9 cases when RV≥8 mm Hg, the difference was obvious. Neither RV＜8 mm Hg nor RV≥8 mm Hg, the statistical difference was significant (all P＜0. 01). In 29 cases, when positive pressure ventilation was mixed with spontaneous breathing, RV＜ 8 mm Hg (n = 13), RV≥ 8 mm Hg (n=16), most of the results in automatic measurement group were higher than those of expiration holding group (11 - 18 vs. 10 - 17), and only 4 of them were lower than expiration holding group (11 - 20 vs. 14 - 23). There was no statistically significant difference between two groups (all P＞0. 05). Conclusion Expiration holding measurement is a better method that can identify the eePAWP, and it reflects the true hemodynamic status more accurately and quickly whether positive pressure ventilation only or positive pressure ventilation mixed with spontaneous breathing is given.     

血府逐瘀汤治疗脑梗塞60例

目的：观察活血逐瘀类中药配伍治疗进展脑梗塞的疗效。方法：采用血府逐瘀汤加减治疗本病60例。结果：总有效率91．67％,有5例脑梗塞临床表现进展加重,持续2～3天,余57例脑梗塞临床表现未进展加重,且治疗效果良好。结论：活血逐瘀汤治疗脑梗塞病人,显著降低进展型脑梗塞发病率,缩短进展持续时间,治疗效果良好,从而明显降低脑梗塞病人的认知、语言、肢体残疾程度。     

侧卧角度对骶尾部软组织压力的有限元分析

[目的]构建不同侧卧角度骶尾部三维有限元模型并进行力学分析，探讨预防深部压力性损伤的最佳侧卧翻身角度。[方法]选取健康成年男性志愿者俯卧位骶尾部CT数据，构建0°、15°、30°、45°侧卧翻身角度下包含皮肤脂肪组织、肌肉组织、骨骼支撑垫的三维有限元模型，设定边界条件、施加载荷，分析骶尾部深部组织压力性损伤模型Von Mises应力、剪切应力及分布特征。[结果]皮肤脂肪组织的Von Mises应力由小至大依次为：30°组<15°组<0°组<45°组，差异有统计学意义[(5.1±0.1) kPa,(5.6±0.2) kPa,(6.1±0.1) k Pa,(12.7±1.2) kPa, P<0.001]。肌肉组织中Von Mises应力由小至大依次为：30°组<45°组<15°组<0°组，差异有统计学意义[(17.6±0.8) k Pa,(19.3±1.4) kPa,(20.6±0.5) kPa,(22.6±1.4) kPa, P<0.001]。皮肤脂肪组织剪切应力由小至大依次为：30°组<15°组<0°组<45°组，差异有...