护工自行管理在住院肿瘤患者中的应用价值研究

目的：探讨护工管理模式在肿瘤患者中的应用价值。方法我院2013年以肿瘤科为试点,签订工作合同护工42人。执行规范的招聘条件,由医院后勤保障部、护理部、医院感染管理科自行管理培训,明确各项规章制度,建立完善的护工考核和奖励机制。观察执行护工自我管理后1年护工的流失率、病房患者陪人率、护工雇请率、患者及家属满意度、护工与患者纠纷发生情况。结果实行护工自行管理后,护工人员流失率较执行该项政策前3年均明显降低（均P＜0.05）,患者及家属、其他医务人员对护工的满意度均明显提高（均P＜0.05）,护工的雇请率较之前明显增加（P＜0.05）,病房陪人率、护工与患者纠纷发生数均明显下降（均P＜0.05）。结论护工管理模式能够降低护工人员流失率、病房陪人率、护工与患者纠纷,提高患者及家属对医院的满意度。     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

倾斜试验中加用异丙肾静点诊断神经心源性晕厥(附10例报告)

晕厥是突然发生的一过性意识丧失,伴有肌张力减退、导致病人摔伤,临床不少见.在除外神经科的疾病后,如癫痫、TIA,过去常认为晕厥大部分由严重心律失常引起,然而很多晕厥病人的心脏结构是正常的.经过动态心电图及心内电生理检查经常不能发现室速或严重心动过缓等造成晕厥的原因.所以又把这一类晕厥称为不明原因的晕厥.因为表现为低血压和心动过缓,所以过去又称为血管速走性早厥.近年来研究发现这一类不明原因的晕厥与自身内源性儿茶酚胺引起心肌的异常收缩有关,故又称为神经心源性晕厥(Neurocardiogenic syncope)、利用倾斜试验可以诱发表现为血管迷定反应的晕厥,为临床诊断提供了新的手段.我们用倾斜试验加用异丙肾诱发诊断了一组不明原因晕厥的病人,报告如下.     

肝细胞核因子3β的研究进展

肝细胞核因子3β(hepatoeyte nuclear factor-3β,HNF-3β)是目前分子生物学研究领域的新亮点,HNF-3β参与许多脏器重要功能基因的调控.它不仅在肝细胞的成熟、分化中起重要的调控作用,还参与胚胎的发育过程和胰岛素作用的调节.HNF-3β及其家族成员(如HNF-3α)与肺呼吸有关,它们是气道上皮细胞分化所必需的成份,可能与肺癌的发生、发展和预后密切相关.本文就HNF-3β对脏器基因的调控作一综述.     

经皮冠状动脉介入术前阿托伐他汀强化治疗对预后的影响

目的评价经皮冠状动脉介入术前患者行阿托伐他汀强化治疗对预后的影响。方法60例入选患者术前被随机分为两组,强化治疗组29例患者,术前12小时内服用阿托伐他汀80mg;对照组31例患者,术前12小时内服用阿托伐他汀20mg,所有患者术后均以阿托伐他汀每日20mg,每日1次长期维持。观察两组患者术前及术后24小时的肌酸激酶同工酶、肌钙蛋白I、C反应蛋白等指标的变化,比较两组在出院3个月时主要不良心血管事件发生率。结果强化治疗组主要不良心血管事件发生率为3．4％,对照组为22．6％（P〈0．05）;与对照组相比,强化治疗组患者术后肌酸激酶同工酶、肌钙蛋白I升高幅度显著减低（P〈0．05）;C反应蛋白升高的幅度低于对照组,但两组比较差异无统计学意义（P〉0．05）。结论PCI术前使用80mg阿托伐他汀同常规使用20mg的剂量相比,强化治疗的患者在短期预后方面获益大。     

铜藻总萜提取物抗抑郁活性及作用机制

目的探讨铜藻总萜提取物抗抑郁活性及作用机制。方法采用乙醇浸提,借助超声波萃取得到铜藻总萜类提取物。采用经典的小鼠强迫游泳实验和小鼠悬尾实验进行抗抑郁模型,以小鼠行为绝望的不动时间作为指标,考察铜藻总萜类物质的抗抑郁活性。高效液相-电化学法检测小鼠小脑中5-羟色胺(HT)水平。结果小鼠悬尾实验结果显示,与空白组比较,铜藻总萜提取物低、中、高剂量均能减少小鼠悬尾不动时间,且不同剂量抗抑郁活性有差异(P<0.05或P<0.01);铜藻总萜提取物各剂量组能够不同程度提高小鼠小脑5-HT含量(P<0.05或P<0.01),并呈剂量依赖性。结论铜藻总萜提取物具有抗小鼠实验性抑郁作用,其作用机制可能与提高下丘脑5-HT含量有关。     

胰腺癌早期误诊原因分析

目的探讨早期胰腺癌误诊原因. 方法对27例胰腺癌进行临床分析,其中对22例入院诊断与出院诊断不符者统计列表,就临床症状、病史、入院诊断、确诊方法进行比较.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

目的 应用光学相干断层成像(OCT)技术比较不稳定性心绞痛(UAP)和稳定性心绞痛(SAP)患者冠状动脉粥样硬化斑块特征.方法 对临床诊断的23例UAP和24例SAP患者,在完成冠状动脉造影并确诊冠心病后进行OCT检查.根据OCT结果 回顾性比较分析UAP和SAP患者冠状动脉粥样硬化斑块特征,包括富含脂质斑块(≥2个象限的脂质斑块)、斑块纤维帽厚度、薄纤维帽粥样斑块(TCFA)、斑块破裂、钙化和血栓等.结果 47例患者中有44例成功进行OCT检查,包括22例UAP和22例SAP患者.UAP患者冠状动脉富含脂质斑块为91%(20/22),多于SAP患者的73%(16/22),但差异无统计学意义(P=0.741).UAP患者冠状动脉脂质斑块表面纤维帽厚度明显小于SAP患者[(69.5±34.7)μm比(141.1±68.5)μm,P=0.000],纤维帽侵蚀比例为59%(13/22),明显多于SAP患者的9%(2/22,P=0.000);TCFA[73%(16/22)比14%(3/22),P=0.000]和斑块破裂[50%(11/22)比9%(2/22),P=0.003]多于SAP患者.UAP患者冠状动脉斑块表而可见血栓形成多于SAP患者,但差异无统计学意义[27%(6/22)比9%(2/22),P=0.761].在斑块钙化方面,UAP与SAP患者之间差异无统计学意义.结论 OCT技术可清晰显示冠状动脉粥样斑块特征.与SAP患者比较,UAP患者冠状动脉粥样硬化斑块表现为纤维帽更薄、更多的纤维帽侵蚀、更多的破裂斑块和TCFA.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

光学相干断层成像评价冠状动脉内支架术后即刻支架周围组织结构改变

目的:应用光学相干断层成像(OCT)评价冠状动脉内支架术后即刻支架周围组织结构改变。方法:对21例临床诊断冠心病准备介入治疗患者,在冠状动脉内置入支架后即刻进行OCT成像检查。21例患者中共有22支冠状动脉置入25个支架,其中前降支11支13个支架,回旋支8支9个支架,右冠状动脉3支3个支架。OCT评价支架贴壁不良、血管夹层及撕裂、组织脱垂等。支架贴壁不良定义为支架支撑杆与血管壁距离大于0.20mm,组织脱垂定义为血管壁组织通过支架网眼突入管腔。结果:21例患者均成功进行OCT检查,22支靶血管25个支架均成功获得清晰OCT图像。通过OCT发现置入的25个支架中有12个支架可以看到部分支架支撑杆未能完全封闭血管壁上的夹层及撕裂;所置入的支架中有50个支架支撑杆贴壁不良,平均支架支撑杆与血管壁的距离为0.39±0.20(0.20~1.16)mm。通过OCT检出置入的25个支架中有20个支架可见到不同程度组织脱垂,共检出85个组织脱垂,平均最大组织脱垂面积为0.55±0.64(0.04~2.81)mm2。结论:OCT成像技术可清晰显示冠心病冠状动脉支架后血管夹层、撕裂组织脱垂及支架贴壁情况,其临床意义有待于进一步研究。