养老机构预立医疗照护计划研究进展

介绍预立医疗照护计划的概念内涵,综述养老机构开展预立医疗照护计划的必要性、实践现状（包括介入预立医疗照护计划讨论的时机、讨论牵涉人员及内容、干预策略及效果）、影响因素,以期为今后在我国养老机构中开展预立医疗照护计划提供参考。     

腹腔镜全子宫切除术中结扎束血管闭合系统的应用研究

目的评估结扎束血管闭合系统(LF1537 Blunt Tip)在腹腔镜全子宫切除术中应用的临床疗效,探讨其临床价值。 方法选取解放军总医院2014年1月至2016年1月期间收治并行腹腔镜全子宫切除术患者,根据术中是否使用结扎束血管闭合系统分为观察组(使用结扎束血管闭合系统)和对照组(常规手术),记录并比较两组的一般资料和手术相关指标。 结果两组的年龄、体质量指数、腹部手术史符合正态分布且差异无统计学意义(P＝0.625、0.287、0.664);两组的疾病构成差异无统计学意义(P＝0.808)。观察组的手术时间[(46.6 ± 19.1)min vs (65.8 ± 29.2)min]和术中出血量[(51.0 ± 21.9)ml vs (118.4 ± 50.7)ml]均少于对照组,差异有统计学意义(P< 0.001);两组的输血(2例 vs 6例)、住院时间[(6.3 ± 2.2)d vs (6.7 ± 2.8) d]、中转开腹(0例 vs 2例)、并发症发生(4例 vs 7例)比较,差异无统计学意义(P＝0.204、0.391、0.182、0.472)。 结论本研究中将结扎束血管闭合系统(LF1537 Blunt Tip)应用于腹腔镜全子宫切除术,能够更加安全有效的对血管和组织进行闭合和切割,缩短了手术时间,减少了出血量,使手术更加可靠、快捷,具有重要临床应用价值。     

Mammotome微创旋切系统在乳腺外科中的应用(附132例分析)

目的探讨B超引导下Mammotome微创旋切系统对乳腺肿块诊断与治疗的应用价值.方法132例221处乳腺肿块在B超引导下进行Mammotome微创旋切术.其中一侧单发肿块79例,单侧或双侧多发肿块53例,直径0.5～5.2cm,平均1.4 cm,149处肿块临床可扪及.结果所有肿块均完成Mammotome微创旋切切除,平均旋切24次,平均36 min (10～40 min).无一例操作失败.所有肿块均获得明确病理诊断,良性病变129例,乳腺浸润性导管癌3例均行乳腺癌改良根治术.皮肤伤口小,除10例有轻度皮下瘀血外无其它并发症.结论B超引导Mammotome微创旋切系统进行乳腺肿块切除,操作简易,切除彻底,创伤小.     

Nd∶YAG激光后发性白内障切开技术的探讨

为探讨Ｎｄ∶ＹＡＧ激光治疗后发性白内障的技术问题，回顾了３４例３５只眼Ｎｄ∶ＹＡＧ激光治疗后发性白内障的类型、击发能量与脉冲、切开方法和术后效果。从Ｎｄ∶ＹＡＧ激光的聚焦、能量和切开方法的选择、病人视轴区的确定与术后并发症的观察处理方面，探讨了Ｎｄ∶ＹＡＧ激光后发性白内障的切开技术问题。结果表明，Ｎｄ∶ＹＡＧ激光治疗后发性白内障安全有效。为了避免损伤焦点周围的光学界面组织，必须有足够的功率密度和准确的聚焦，从最小能量开始，逐渐增加，直到出现切割效果。由于后发性白内障厚薄、机化程度以及有无人工晶体、虹膜粘连、后囊破裂、玻璃体脱出和偏位激光孔等不同情况，手术时选用适当的切开方法也十分重要。     

血管内支架成型术治疗颈动脉狭窄21例

目的探讨血管内支架成型术治疗颈动脉狭窄的临床效果和安全性。方法对21例颈动脉狭窄患者,先行血管造影,然后根据血管狭窄情况,选择合适自膨式支架跨过狭窄部位,将支架送至预想的位置释放,覆盖狭窄部位。结果治疗狭窄动脉21支,狭窄程度均明显改善,狭窄程度由原来的(78.94±12.8)%下降至(3.19±3.04)%,无死亡病例,术后患者症状均明显改善,围术期无并发症。随访1~12个月,颈动脉超声检查治疗血管无再狭窄。结论只要适应证选择正确,围术期处理得当,血管内支架成型术治疗颈动脉狭窄,不仅临床效果好,而且安全性高。     

IL-2对精子顶体酶及一氧化氮合酶活性的影响

目的　探讨白细胞介素 2对正常人及白细胞精子症精子功能的影响。方法　精子顶体酶的活性检测采用BAEE/ADH联合法。结果　白细胞精子症及正常人精子顶体酶的活性分别为 (2 7.6 8± 10 .0 6mU/ml,n =18;4 3.6 3± 7.6 1mU/ml,n =18) (P <0 .0 1) ;白细胞精子症及正常人精子一氧化氮合酶分别为 (2 .74± 0 .39U/mg pr,n =18;2 .74± 0 .39U/mgpr,n =18) (P <0 .0 1)。结论　白细胞介素 2对精子顶体酶和一氧化氮合酶均有明显抑制作用 ,提示这可能是导致精子受精能力下降的原因。     

氧化酶拭子在男性急性尿道炎患者快速鉴别诊断中的临床应用

目的　评价一种氧化酶拭子检测技术在男性急性尿道炎临床快速鉴别诊断中的应用价值。方法　用氧化酶拭子直接蘸取 189例门诊男性急性尿道炎可疑病例尿道分泌物 ,并观察棉拭子上有无氧化酶反应 ,同时接种于TM培养基。比较两种检测手段的检测结果。结果　 189例标本中TM培养和氧化酶反应的阳性率分别为 78.8%和 79.9% ,两法总符合率为 91.5 % (31 14 2 /189)。与培养法比较 ,氧化酶拭子敏感性 95 .3% ,特异性 77.5 % ,阳性预测值 94 % ,阴性预测值 81.6 % ,两法无显著性差异 (P >0 .0 5 )。结论　氧化酶拭子检测技术能对淋菌性和非淋菌性尿道炎进行快速初步鉴别且有较高的敏感性和特异性 ,方法简便、成本效益性好。     

Bilateral Choroidal Occlusion in Antiphospholipid Syndrome Associated with Systemic Lupus Erythematosus

This article reports a rare case of bilateral choroidal occlusion that occurred in a 24-year-old woman with antiphospholipid syndrome (APS) associated with systemic lupus erythematosus (SLE). This young lady concurred with aorta ventralis thrombosis and bilateral iliac artery occlusion when presented, and experienced a rapid deterioration of vision. She also has a history of recurrent miscarriage. Corticosteroid, immunosuppression and anticoagulation therapy were administered. Patients with APS associated with SLE are at risk for thrombotic phenomena, which may affect the ocular vessels of all sizes, including choroidal vessel. Our case alerts ophthalmologists and rheumatologists that bilateral choroidal occlusion may indeed be developed in patients with APS associated with SLE, and is a potential cause of visual morbidity.     

Outpatient Mastectomy and Breast Reconstructive Surgery

Background In the United States, post-mastectomy breast reconstruction is a state (all 51 jurisdictions) and federally mandated benefit. Outpatient mastectomy, which could lower use of breast reconstruction, may raise concerns about whether patients receive adequate post-mastectomy care. Methods Using linked surveillance, epidemiology, and end results (SEER)–Medicare data, we identified Medicare fee-for-service women aged 65–69 years, diagnosed with early-stage breast cancer, and receiving unilateral mastectomy from 1998–2002. The corresponding surgery delivery settings were determined from claims data. The outcome of interest was reconstruction within 4 months of diagnosis. We used multivariable logistic regression models to examine the association of outpatient mastectomy with the likelihood of post-mastectomy reconstruction, controlling for patient’s characteristics. Results Among the 3,419 patients in the sample, 717 (21%) patients received outpatient mastectomy. The proportions of patients receiving reconstruction were 13% for inpatient mastectomy patients and 4% for outpatient mastectomy patients. Outpatient mastectomy patients were younger and had less comorbidities than inpatient mastectomy patients. Multivariable regression analysis suggested that outpatient mastectomy patients were less likely to receive reconstruction (odds ratio = 0.247; 95% confidence interval (CI): 0.166–0.368). Additional analysis suggests that African American patients were less likely than white patients to undergo reconstruction (odds ratio = 0.515; 95% CI: 0.293–0.906) and that this ethnic difference was more manifest among patients undergoing inpatient mastectomies. Conclusions This study shows that outpatient mastectomy was associated with lower use of breast reconstruction. A better understanding of choice of delivery setting of mastectomy with a focus on younger and minority breast cancer patients should be explored in future research.     

不同镇痛方法对胆囊切除术病人糖代谢和康复的影响

目的　观察比较多途径和单一方式镇痛方法对胆囊切除手术病人糖代谢和术后康复的影响。方法　 40例择期在硬膜外阻滞下行胆囊切除术的病人 ,随机分为多途径组 1(M1)、多途径组 2 (M2 )、对照组 1(C1)和对照组 2 (C2 )。C1组于术前从硬膜外腔给予吗啡 1mg +新斯的明 1mg。C2 组术后仅肌注哌替啶镇痛。M1和M2 组在C1基础上于术前至术后 2天口服双氯芬酸 ,M2 组于术毕在切口处采用 0 5 %布比卡因喷洒。结果　M1和M2 组血糖 (Glu)变化平稳。C1组血糖于术后第 1天上升 (P <0 0 5 ) ,C2 组血糖值则从术中至术后第 3天均明显上升 (P <0 0 5或P <0 0 1)。术后第 1天 ,四组胰岛素 (Ins)水平均明显上升 (P <0 0 5或P <0 0 1)。C1和C2 组胰岛素上升幅度明显高于M1和M2 组 (P <0 0 5 )。至术后第 3天 ,M1和M2 组胰岛素水平均恢复至正常水平 (P >0 0 5 ) ,而C1和C2 组胰岛素值仍高于麻醉前值 (P <0 0 5或P <0 0 1)。血浆皮质醇 (Cor)浓度均于术中 6 0分钟时明显上升 (P <0 0 1) ,与M1和M2 组相比 ,升高幅度以C1和C2 组显著 (P <0 0 5 )。IL 6水平在各组未见显著性改变 (P >0 0 5 )。结论　多途径镇痛方法对术后糖代谢和康复的影响小于单一途径镇痛术