通州市1970～1999年病毒性肝炎流行特征及防制对策

病毒性肝炎在通州市的传染病中一直位居首位,严重影响了城乡人民的身体健康,为了探讨其发病和流行规律,现将通州市1970～1999年病毒性肝炎的流行资料进行分析,并提出科学的防制对策。     

经治疗后妊高征孕妇子宫胎盘床螺旋动脉血流速率变化

妊高征 (ＰＩＨ)是产科重要疾病之一 ,病因极其复杂 ,其致病因素可导致子宫胎盘床螺旋动脉ＰＩ、ＲＩ改变 ,使子宫胎盘血流障碍 ,对ＰＩＨ的预测、防治是产科学术界共同关心的问题 ,它严重危及胎儿生命[1] 。本文用彩色多普勒检查跟踪随防治疗后的妊高征孕妇 ,探讨子宫胎盘床螺旋动脉ＰＩ、ＲＩ的变化 ,进一步说明检测子宫胎盘床螺旋动脉血流速率变化预测妊高征的临床价值。1　资料与方法1.1　资料来源 :1998年 8月至 2 0 0 0年 6月经彩色多普勒预测出的妊高征孕妇 2 6例 (ＰＩＨ组 )随机抽取 ,正常孕妇 12 2例 (正常组 ) ,所有病例均为单胎…     

公立和私立医疗机构的效率与质量

在塞内加尔进行的对公立和私立机构的研究通过病例组成，投入，保健检查提供卫生服务的相对效率。结果显示私立机构倾向于提供较高质量的保健服务，但其内部差异很大，天主教诊所显示比公立和其他私立机构更有效。     

农村医院的联合战略

农村医院的联合策略与卫生机构的所有制或管理有关，服务内容以及其他的协调活动对于很多农村医院的生存是重要的。本文论述应用于农村医院的一系列联合策略，是宾夕法尼亚州立大学Ｌａｒｒｙ Ｄ．Ｇａｍｍ等人以该州４６个农村医院为样本的调查结果，研究了这些策略与其环境和组织的关系。文章发表于１９９６年第２期的Ｈｏｓｐｉｔａｌ ＆ ｈｅａｌｔｈ Ｓｅｒｕｉｃｅｓ Ａｄｍｉｎｉｓｔａｔｉｏｎ杂志。     

浅谈县血防专业队的组织管理

血防查螺一般都要进行村组自查、乡镇互查和县级抽查三个回合。县血防办每年都要组织规模很大的血防专业队,对血防重点乡镇反复进行查螺。这是血防工作中的重要环节,对保证螺情见底起到了不可忽视的作用。但是,近几年来,随着农村经济责任制的变化和搞活、开放的不断深化,县血防专业队在组织管理上出现了一些新情况,乡镇基层对专业队的反映也比较多。主要是组织工作比较困难,临时抽调的队员素质和查螺技术     

限制性液体复苏对肝脏缺血-再灌注损伤的影响

Objective To investigate the effects of limited resuscitation on hepatic ischernia-reperfusion in-jury in rots with hemorrhagic shock. Method Uncontrolled hemorrhagic shock was induced in 54 rats by transect-ing the middle branch of the splenic artery to produce standardized massive splenic injury. Resuscitation started when the mean arterial pressure (MAP) reached 40 mmHg. The rats were randomly divided (n = 9per group) in-to sham-operated group (SS), or one of five treatment groups in which infusion of Ringer' s solution was continually administrated to maintain MAP at 40 (RS40), 50 (RS50), 60 (RS60), 80 (RS80) or 100 mmHg (RS100) for 45 minutes (T45 point). After the bleeding was controlled, resuscitation was continued with Ringer's solution and whole blood (2:1) to increase the MAP to 100 mmHg for 120 minutes (T165 point), which was followed by obser-vation for 240 minutes (T405 point). All animals were observed for 240 minutes or until death. Blood specimens were collected at TO, T45, T165 and T405 for determination of blood lactate levels. At the end of the experiment,a small amount of hepatic tissue was collected to measure tissue blood perfusion, total antioxidative capacity (TAOC), Na+K+ ATPase activity and malondialdehyde (MDA) levels. Results At T405, the blood lactate lev-els in the RS80 and RS100 groups [(3.60±0.68) and (3.84 ± 1.09) mmol/L, respectively] were significantly higher than those in the SS, RS40, RS50 and RS60 groups [(2.00±0.66),(2.74±1.45),(2.43 +0.94) and (2.07±0.95) mmol/L, respectively;all:P < 0.05]. The MDA levels were significantly higher in the RS80 and RS100[(7.32±0.31) and (7.71±0.23) nmol/mg,respectively] than those in the SS, RS40, RS50 and RS60 groups[(4.95±0.80),(6.14±0.94),(6.42±0.48) and (6.84±0.36) nmol/mg, respeetively;all: P <0.05]. The Na+ K+ ATPase and TAOC levels were significantly lower in all of the RS groups than those in the SS group (all: P < 0.05), and those in the RS80 and RS100 groups was significantly lower than those in the RS40,RS50 and RS60 groups (all: P <0.05). Blood perfusion in the RS80 and RS100 groups was significantly lower than that in the other groups (all: P < 0.05). Conclusions If hemorrhage is uncontrolled, limited resuscitation appears to balance the needs for organ perfusion, improve the microcircttlation and decrease lactate levels. Fur-thermore, limited resuscitation could decrease ischemia-reperfusion injury in liver tissue.     

限制性液体复苏对肝脏缺血-再灌注损伤的影响

Objective To investigate the effects of limited resuscitation on hepatic ischernia-reperfusion in-jury in rots with hemorrhagic shock. Method Uncontrolled hemorrhagic shock was induced in 54 rats by transect-ing the middle branch of the splenic artery to produce standardized massive splenic injury. Resuscitation started when the mean arterial pressure (MAP) reached 40 mmHg. The rats were randomly divided (n = 9per group) in-to sham-operated group (SS), or one of five treatment groups in which infusion of Ringer' s solution was continually administrated to maintain MAP at 40 (RS40), 50 (RS50), 60 (RS60), 80 (RS80) or 100 mmHg (RS100) for 45 minutes (T45 point). After the bleeding was controlled, resuscitation was continued with Ringer's solution and whole blood (2:1) to increase the MAP to 100 mmHg for 120 minutes (T165 point), which was followed by obser-vation for 240 minutes (T405 point). All animals were observed for 240 minutes or until death. Blood specimens were collected at TO, T45, T165 and T405 for determination of blood lactate levels. At the end of the experiment,a small amount of hepatic tissue was collected to measure tissue blood perfusion, total antioxidative capacity (TAOC), Na+K+ ATPase activity and malondialdehyde (MDA) levels. Results At T405, the blood lactate lev-els in the RS80 and RS100 groups [(3.60±0.68) and (3.84 ± 1.09) mmol/L, respectively] were significantly higher than those in the SS, RS40, RS50 and RS60 groups [(2.00±0.66),(2.74±1.45),(2.43 +0.94) and (2.07±0.95) mmol/L, respectively;all:P < 0.05]. The MDA levels were significantly higher in the RS80 and RS100[(7.32±0.31) and (7.71±0.23) nmol/mg,respectively] than those in the SS, RS40, RS50 and RS60 groups[(4.95±0.80),(6.14±0.94),(6.42±0.48) and (6.84±0.36) nmol/mg, respeetively;all: P <0.05]. The Na+ K+ ATPase and TAOC levels were significantly lower in all of the RS groups than those in the SS group (all: P < 0.05), and those in the RS80 and RS100 groups was significantly lower than those in the RS40,RS50 and RS60 groups (all: P <0.05). Blood perfusion in the RS80 and RS100 groups was significantly lower than that in the other groups (all: P < 0.05). Conclusions If hemorrhage is uncontrolled, limited resuscitation appears to balance the needs for organ perfusion, improve the microcircttlation and decrease lactate levels. Fur-thermore, limited resuscitation could decrease ischemia-reperfusion injury in liver tissue.     

非酒精性脂肪性肝病痰瘀证与颈动脉内膜中层厚度的关系探讨

目的探讨非酒精性脂肪性肝病痰瘀证与颈动脉内膜中层厚度(IMT)的关系,为非酒精性脂肪性肝病痰瘀证提供有益的辨证参数。方法对80例经B超诊断的非酒精性脂肪性肝病患者进行中医痰瘀辨证分型,并行颈动脉内膜中层厚度检测。结果痰证30例,瘀证30例,无证可辨20例;54例IMT增厚者中,中/重度脂肪肝患者占88.9%,痰瘀证占83.3%,显著高于IMT正常组者的38.5%和57.8%(P0.01);非酒精性脂肪性肝病组和40例健康对照组腰围分别为[(93.34±8.43)cm和(78.51±6.73)cm,P0.01];BMI分别为[(26.48±3.52)和(22.67±2.34),P0.01];DBP分别为[(79.29±9.14)mm Hg和(74.74±9.13)mm Hg,P0.01];FBG分别为[(5.80±1.51)mmol/l和(4.98±0.51)mmol/l,P0.01];HOMA-IR分别为[(3.60±2.26)和(1.80±1.56),P0.01];TG分别为[(2.71±2.97)mmol/l和(0.93±0.4)mmol/l,P0.01];TC分别为[(5.20±1.27)mmol/l和(4.84±0.6)mmol/l,P0.01];UA分别为[(399.76±89.35)mmol/l和(326.3±67.09)mmol/l,P0.01];ALT分别为[(83.77±82.76)U/l和(18.0±7.72)U/l,P0.01];AST分别为[(50.30±39.34)U/l和(21.88±4.47)U/l,P0.01];GGT分别为[(73.76±104.34)U/l和(18.63±13.55)U/l,P0.01];IMT分别为[(1.19±0.75)mm和(0.71±0.25)mm,P0.01];非酒精性脂肪性肝病瘀证组和无证可辨组TG分别为[(4.79±3.97)mmol/l和(0.84±0.23)mmol/l,P0.05];TC分别为[(5.63±1.4)mmol/l和(4.35±1.33)mmol/l,P0.05];IMT分别为[(1.25±0.14)mm和(0.84±0.12)mm,P0.05];LDL-C分别为[(2.9±0.84)mmol/l和(2.51±0.89)mmol/l,P0.05],痰证组TG分别为[(1.66±0.29)mmol/l和(0.84±0.23)mmol/l,P0.05];TC分别为[(5.19±0.92)mmol/l和(4.35±1.33)mmol/l,P0.05];LDL-C分别为[(3.21±0.74)mmol/l和(2.51±0.89)mmol/l,P0.05];多因素回归分析提示FBG(OR:5.48,95%CI:1.39~21.61)、TG(OR:1.14,95%CI:1.14~12.82)、BMI(OR:1.20,95%CI:1.02~1.42)、年龄(OR:1.02,95%CI:1.01~1.03)、痰瘀证(OR:1.10,95%CI:1.03~1.17)是非酒精性脂肪性肝病患者动脉IMT增厚或斑块形成的独立危险因素。结论颈动脉内膜中层厚度与脂肪肝中医痰瘀证型及脂肪肝程度有关,可作为脂肪肝中医痰瘀辨证分型的一种辅助客观指标。     

高频电刀热凝治疗口腔颌面部海绵状血管瘤

目的探讨高频电刀热凝治疗口腔海绵状血管瘤的疗效.方法随机选择口腔海绵状血管瘤患者59例,其中上唇16例,下唇13例,颊部10例,舌部26例,牙龈4例,采用CV-2000电脑高频电刀治疗机治疗,观察疗效并随访1～3年.结果 59例患者中49例有效,1次治疗后痊愈;8例显效,1次治疗后痊愈;2例无效.结论高频电刀热凝治疗口腔海绵状血管瘤简单、疗效好、时间短.     

血管化前臂皮瓣移植在口腔颌面外科的应用

目的探讨血管化前臂皮瓣移植在口腔颌面外科的应用特点.方法 44例口腔颌面部肿瘤患者,切除肿瘤后所致的缺损, 以血管化前臂皮瓣进行修复,对局部外形及功能重建进行分析.结果 44例患者中43例成功,1例失败,成功率97.7%.结论血管化前臂皮瓣在口腔颌面外科的组织缺损的修复中具有很大的灵活性,其制备简便,安全可靠,明显优于传统的带蒂组织移植,值得推广和应用.