硬膜外术后镇痛对胃肠动力的影响

本文从胸段和腰段硬膜外局麻药对胃肠动力影响的差异以及硬膜外局麻药或阿片类药物对胃肠动力的不同作用等方面综述硬膜外术后镇痛对胃肠动力的影响。结果显示胸段硬膜外镇痛有利于术后胃肠动力的恢复,硬膜外应用局麻药或局麻药复合阿片类药物术后镇痛较单纯应用阿片类药物对胃肠动力影响小。     

新时期军队医院卫生人力资源管理初探

通过对军队医院卫生人力资源管理现状的分析,提出新时期军队医院卫生人力资源管理的应对策略:树立正确的用人观念;引入竞争的用人机制;建立有机的学习型医院;树立长效的激励机制;进行科学的绩效评估;做好员工职业生涯的规划。从而为军队医院卫生人力资源管理提供有力保障。     

Clinical observation of kaixin capsule in treating type 2 diabetes mellitus complicated with abnormal lipidemia

Objective

To observe the clinical efficacy of Kaixin Capsule (KXC), a Chinese compound preparation, in treating type 2 diabetes mellitus (DM) complicated with abnormal lipidemia.

Methods

Seventy-two DM inpatients were medicated on the basis of administering conventional hypoglycemics, and KXC was orally taken. They were compared with those patients only taking hypoglycemics to observe the change of blood lipid before and after treatment.

Results

The total cholesterol of KXC combined with hypoglycemics group had their blood lipid lowered by 14% after treatment and triglyceride lowered by 36%, HDL-C raised by 11 % , and LDL-C lowered by 24% . Compared with only hypoglycemics treatment, there was significant difference (p <0.01).

Conclusion

KXC has good blood lipid regulating effect on DM complicated with abnormal lipidemia.     

巨细胞病毒在慢性乙型肝炎患者肝组织中的表达

目的探讨巨细胞病毒(CMV)在慢性乙型肝炎(CHB)患者肝组织中表达意义。方法采用免疫组化以抗-CMV单克隆抗体对76例CHB患者肝组织进行检测,然后用抗-HBcAg多克隆抗体和抗-CMV单克隆抗体双标记技术在CHB患者同一张肝组织切片上显示两种病毒分布特点。结果轻度和重度慢性肝炎患者CMV检出率无显著差异(P=0.444),而重度CHB患者中CMV表达阳性细胞明显多于轻度患者(P=0.012)。双标记染色显示CMVAg和HBcAg多数表达于肝小叶内同一区域肝细胞甚至同一肝细胞内,也可见于肝小叶中不同部位。结论CHB患者更易重叠CMV感染,并且其感染程度与肝组织的活动性病变密切相关。     

甲状腺癌中CD44V6和基质金属蛋白酶-2的表达

目的研究黏附分子CD44V6、基质金属蛋白酶-2（MMP-2）在甲状腺癌中的表达、相互关系及其与甲状腺癌侵袭转移的相关性。方法应用S—P免疫组化染色法检测82例甲状腺乳头状癌（PTC）中CD44V6和MMP-2表达。结果82例甲状腺乳头状癌（PTC）中CD44V6和MMP-2阳性表达率为67．1％和68．3％，均高于甲袱腺腺瘤周围正常甲状腺组织，P〈0．01。CD44V6和MMP-2阳性表达与淋巴结转移呈正相关，P〈0．05，且随侵袭程度增加而升高。结论CD44V6、MMP-2在促进甲状腺癌的浸润与转移中呈协同效应。CD44V6和MMP-2表达的综合检测对甲状腺癌转移趋势和预后评估具有重要的参考价值，可能是甲状腺癌侵袭转移、预后判断的分子标志。     

怎样做一名优秀的内镜医生

怎样做一名优秀的妇科内镜医生？我想主要有五个方面的问题。第一个是妇科内镜，作为一个微创外科，是二十一世纪外科医生和妇产科医生必备的技术。无论是在县级医院，还是在省级医院，这是一项基本技术。第二个是如何选择手术的适应证。就像我们做任何手术一样，要选择一个最适合的手术方式。实际上就是要选择什么样的病人适合做腹腔镜手术。第三个就是用这样一个手术方式来诊断治疗病人，要掌握这个病诊断治疗的基本原则。第四个就是要掌握一些基本的要领来预防或者避免并发症的发生。最后一个就是讲怎样培训自己成为一个合格的、优秀的妇科内镜医生。     

不同部位和不同生长年限白芍中的芍药苷含量测定

目的采用高效液相色谱法检测不同部位和不同生长年限白芍中的芍药苷含量。方法以C18化学键合硅胶柱分离芍药苷,甲醇-0.05mol/L磷酸二氢钾溶液-醋酸-异丙醇(67∶173∶4∶4)为流动相,UV检测波长为230nm进行测定。结果不同部位和不同生长年限白芍中的芍药苷含量差异较大。结论生长年限越长其芍药苷含量相对较高,根茎中的芍药苷含量比根相对高。     

小瞳孔白内障摘出人工晶状体植入术

目的探讨小瞳孔下白内障摘出人工晶状体植入术。方法用前房维持器及黏弹剂分离虹膜，采用非切开瞳孔扩张术，对86例（96眼）伴有葡萄膜炎等并发白内障行白内障摘出人工晶状体植入术。结果96眼术后76眼瞳孔恢复原状20眼瞳孔椭圆形。术后1周视力：0．1～0．3者26眼，0．4～0．6者62眼，0．8-1．0者8眼。结论小瞳孔白内障采用本手术方法，能获得较好视力，无严重并发症。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

产褥期上矢状窦及脑静脉血栓形成的CT诊断

目的 探讨CT对产褥期脑静脉血栓（CVT)的诊断价值。方法 对13例临床怀疑或随诊CVT的患者行CT检查。患者23～25岁，产后3～17天发病，主要临床表现为头痛、呕吐、视乳头水肿等高颅压症状，局灶性神经功能缺损，偏瘫、失语、抽搐发作及意识障碍等。结果 CVT在CT上表现为脑水肿低密度区内小片状高密度出血灶，特征性变化为平扫时可见硬膜窦内异常高密度及脑实质静脉增高即“条索征”，强化后硬膜窦内呈“空三角征”。结论 CT可准确地显示CVT的图像学改变，与MRI、MRV、DSA技术相结合，是诊断脑静脉病变可靠、有效和快捷的检查方法。x