胫后动脉内踝上皮支皮瓣修复足跟软组织缺损

目的探讨胫后动脉内踝上皮支皮瓣修复足跟皮肤软组织缺损的临床效果。方法2000年7月-2008年3月,我科采用胫后动脉内踝上皮支皮瓣修复各种原因所致足跟部皮肤软组织缺损12例。结果12例皮瓣全部成活,皮瓣面积：5cm×7cm～8cm×14cm。随访6～12月,效果满意。结论胫后动脉内踝上皮支皮瓣血运可靠,穿支点比较固定,手术操作简便安全,且不牺牲重要血管,是修复足跟部皮肤软组织缺损的较理想方法。     

白芨多糖的提取与除蛋白研究

目的考察中药白芨的多糖含量与提取工艺,为其开发利用奠定基础。方法运用水提醇沉法提取白芨粗多糖,三氯乙酸法除去粗多糖中的蛋白。分别运用苯酚-硫酸法和Bradford法测定多糖和蛋白的含量。结果测得白芨粗多糖提取率34.70%,所得提取物多糖含量为67.61%,三氯乙酸法的脱蛋白率为75.86%,多糖损失率为0.015%。结论白芨中含有大量多糖,值得深入研究开发。     

乳腺癌前哨淋巴结的超声造影检查及与乳腺癌组织ER、PR和HER-2表达的相关性

目的通过分析乳腺癌患者皮下注射超声造影剂(Sono Vue)后腋窝淋巴结的增强情况,检测乳腺癌组织中ER、PR及HER-2的表达,探讨乳腺癌前哨淋巴结超声造影检查的临床价值及其与乳腺癌组织中ER、PR及HER-2表达的相关性。方法选择女性乳腺癌患者89例,术前经肿块周围皮下注射超声造影剂探查前哨淋巴结并标记,与术后肿块免疫组织化学ER、PR及HER-2的结果做对照分析。结果本研究89例患者中,乳腺癌组织中ER、PR、HER-2同时为阳性者,超声造影发现其腋窝淋巴结转移率最高(73.3%),HER-2阳性且ER、PR有一者阴性或两者均为阴性者,超声造影发现其腋窝淋巴结转移率次之(57.1%),再次是ER、PR、HER-2均为阴性者(42.9%),超声造影发现其腋窝淋巴结转移率最低者是HER-2阴性且ER、PR有一者阳性或两者均为阳性者(28.0%)。结论乳腺癌前哨淋巴结的超声造影检查与乳腺癌组织ER、PR及HER-2表达对照研究发现,HER-2是乳腺癌腋窝淋巴结转移的危险因素。     

“火郁发之”的临床应用

“火郁发之”源于《素问·六元正纪大论篇》,在论述了风、寒、暑、湿、燥、火6种气候变化对人体的影响基础上提出了五郁理论.而“火郁发之”讲的是对于火郁的治疗原则,原指外邪侵袭人体,阻遏气机,火热不得发泄而成火郁,用发之之法进行治疗.王冰注曰：“发为汗之,令其疏散也.”火郁所引发的疾病在《素问·六元正纪大论篇》中也有论述：“火郁之发……故民病少气,疮疡痈肿,胁腹胸背……疡疿,呕逆,瘛疭骨痛,节乃有动,注下温疟,腹中暴痛,血溢流注,精液乃少,目赤心热,甚则瞀闷侬,善暴死.刻终大温,汗濡玄府,其乃发也,其气四.”后世医家对“火郁发之”也有不同见解.笔者试就近10年来临床对“火郁发之”的应用综述如下.     

右下腹精原细胞瘤1例

患者,男,36岁,以右下腹肿物伴下腹疼痛反复发作2年,加重并呕吐2d,由民航总医院于2008年10月13日转入我科。既往体健。查体：P94次／分,BP100／60mmHg,神情萎靡,消瘦貌,心肺（-）。右下腹局限性隆起,可触及15cm×12cm大小肿物,质硬,界清,活动差,无明显压痛,左下腹压痛,反跳痛（-）,肠鸣音活跃。     

社区高血压非药物治疗措施的执行情况分析

Objective To assess effectiveness of implementation of non-pharmaceutical treatment in a standardized community-based hypertension management program in China.Methods A protocol of standardized community-based hypertension management was developed based on current guidelines for prevention and treatment of hypertension in China.Physicians in community health-care service centers at the grassroots across China were trained in a standardized way using this protocol during 2005 to 2008,and then the trainees were required to manage hypertensive patients according to the protocol.Hypertensive patients eligible for criteria of inclusion and under management for more than one year were analyzed to observe changes in their behavioral risk factors,pharmaceutical and non-pharmaceutical treatment,and effectiveness of blood pressure lowering.Results By the end of 2008,a total of 29 411 hypertensive patients had been managed for one year according to the protocol and 20 077 patients with complete data (47.1％ for male)with mean age of 61±11 years were eligible for analysis.After standardized management of one year,prevalence of smoking,alcohol drinking and proportion of patients who preferred salty diet decreased from 17.7 percent,18.1 percent and 32.8 percent to 8.9 percent,8.7 percent and 15.8 percent,respectively(P＜0.01).Srstolic blood pressure(BP)decreased by 11.6[95％confidence interval(CI)10.8-12.4]mm Hg(1 mm Hg=0.133 kPa),13.7(95％CI 13.3-14.1)mm Hg and 15.2(95％CI14.8-15.6)mmHg in the patients with non-pharmaceutical therapy,pharmaceutical therapy and both,respectively;and diastolic BP decreased by 7.5(95％CI6.9-8.1)mm Hg,8.3(95％CI8.1-8.5)mmHg and 8.0(95％CI7.8-8.2)mm Hg in the three groups,respectively.During the one-year period of management,proportion of the patients with appropriate non-pharmaceutical therapy increased continuously.By the end of one-year management,59.5 percent of smoked patients were required to quit their smoking,55.5 percent of alcohol drinkers were required to limit their drinking,52.3 percent of overweight and obese patients were required to reduce their weight and 47.3 percent of patients with physical exercises less than three times a week were required to increase their regular physical activity.However,certain proportion of the patients with risk factors did not receive appropriate non-pharmaceutical therapy.Conclusion Guideline-oriented hypertension management succeeded in lifestyle changes among the patients,but it is a gradual process to its full implementation.     

ANA、抗ENA抗体联合检测对自身免疫病诊断的意义

目的 探讨抗核抗体(ANA)和抗可提取性核抗原(ENA)多肽抗体谱检测对自身免疫病诊断的意义.方法 对285例各种自身免疫病患者和30例健康人血清采用间接免疫荧光法检测ANA,免疫印迹法检测ENA多肽抗体.结果 ANA在SLE患者中最高,阳性率为97.1%;抗SSA、抗SSB 抗Sm、抗dsDNA、抗NUC和抗ulRNP抗体在SLE中检出率分别为85.6%,75.3%,37.4%,90.8%,83.3%和77.6%;抗SSA、抗SSB和抗ulRNP在SS中检出率分别为84.8%,78.8%和69.7%;抗Jo-1抗体在PM/DM中检出率为52.6%;抗ulRNP抗体在MCTD中检出率为90.5%;抗Scl-70抗体在PSS中检出率为46.7%.结论 ANA和ENA抗体谱阳性分布有明显的倾向性,不同的自身免疫病患者血清所含自身抗体有差异,因此ANA和ENA抗体联合检测对自身免疫病具有诊断意义.     

116例急性胆源性胰腺炎疗效分析

急性胆源性胰腺炎的治疗仍较为棘手,目前认为,急性胆源性胰腺炎先行非手术治疗,待患者全身情况改善后再行手术治疗,但不少患者未等病情稳定就出现加重,发展为重症胆源性胰腺炎而危及生命.本文通过分析总结我附院(宜宾一医院,为我教学医院)普通外科2002年12月至2007年12月收治的116例急性胆源性胰腺炎的临床资料,探讨不同病因的急性胆源性胰腺炎的治疗方式,现报道如下.     

吸烟对动脉粥样硬化的影响及其临床意义

目的观察吸烟对动脉粥样硬化的影响。方法60例高血压病患者,分为吸烟组和对照组,利用二维超声测量双侧颈总脉内膜-中层厚度及斑块数目。结果吸烟组与对照组比较,颈动脉内膜-中层厚度有显著性差异(P<0.01)。斑块数目较对照组增多,有显著性差异(P<0.01)。结论吸烟可使颈动脉内膜-中层厚度增厚,导致动脉粥样硬化。     

剖宫产术后切口感染监测分析

目的 调查剖宫产切口感染罹患率增高的关键因素,快速控制切口感染.方法 产科发生2例剖宫产切口感染后,立即做当日产科、外科罹患率与2周前15 d的回顾性调查及3个月的目标性监测,对剖宫产手术切口感染的相关因素特别是整个手术操作过程现场调查,分组进行干预对比.结果 2009年2月5日调查当日产科切口感染罹患率45.46%,11例手术中5例切口感染,1例检出金黄色葡萄球菌;外科术后98例,1例术后切口感染,罹患率1.03%;5例产科切口感染的手术医师均是妇科医师在急诊情况下行剖宫产术,在发现感染患者手术日期1月21日的前3 d妇科有1例切口金黄色葡萄球菌感染患者;1月21日-4月5日产科与外科同期的感染率比较差异有统计学意义(P<0.05);通过关注过程的目标性监测,采集手术相关的材料和手术环境生物检测113份,合格率100.00%,易感因素和用药与平时无差异;监测18例次手术医师术前外科手消毒时揉搓时间、力度和范围不够,均不合格,监测干预对比,干预组切口无感染,感染率比较差异有统计学意义(X~2-6.27,P<0.05).结论 剖官产术后切几感染,与手术医师术前外科手消毒密切相关,注重过程的目标监测及时有效.