千万点击量就是我的“军容镜”——访解放军总医院第一附属医院皮肤性病科主任邹先彪教授

在很多人眼里,解放军总医院第一附属医院皮肤科诊治中心主任邹先彪教授无异于一个“大明星”,因为他在患者中的知名度太高了——这缘于他5年前开通的个人网站和他在中央电视台、     

“三方联动”构建实施就业导向的药学专业课程体系

为适应医药产业发展需求,满足医药企业对人才多样化的要求,学校、行业、企业"三方联动",以提高学生综合职业能力和服务终身发展为目标,共同确定药学专业人才培养定位与人才规格,构建与实施就业导向的药学专业课程体系。     

静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的应用

目的 探讨静脉留置针行股静脉穿刺输液在神经外科脑疝患者术前抢救中的意义.方法 将我科334 例单侧瞳孔散大的脑疝患者采用随机数字表法随机分为三组.A 组(外周静脉输液组):静脉留置针行外周静脉穿刺输液120 例.B组(中心静脉输液组):中心静脉穿刺置管输液102 例.C 组(静脉留置针行股静脉输液组):静脉留置针行股静脉穿刺输液112 例.比较三组患者穿刺成功所需时间(T1 )、输注20%甘露醇250 ml 所需时间(T2 )、术前瞳孔回缩例数.结果 T1 :A 组为(2.16 ±0.82)min,B 组为(11.73 ±4.43)min,C 组为(2.29 ±0.92)min.经t 检验:PAB ＜0.05,PBC ＜0.05,PAC ＞0.05.T2 :A 组为(35.78 ±1.69)min ,B 组为(19.74 ±1.97)min,C 组为(19.81 ±2.03)min.经t 检验:PAB ＜0.05,PBC ＞0.05,PAC＜0.05.瞳孔回缩例数:A 组为18 例,B 组为20 例,C 组为36 例.经χ2 检验:χ2 ＝0.825,PAB ＞0.05,χ2 ＝4.341,PBC ＜0.05,χ2 ＝9.533,PAC ＜0.01.结论 静脉留置针行股静脉穿刺置管输液能快速建立输液通道,且输液速度快,能够快速有效输注20%甘露醇等高渗脱水降颅内压抢救药物,迅速降低颅内压,缓解脑疝,为进一步手术治疗赢得时间,效果优于外周静脉输液及中心静脉输液,且并发症低,在神经外科脑疝患者的抢救中意义明显.     

早期肠内营养联合益生菌对重型颅脑损伤患者营养状况的影响

目的 观察早期肠内营养联合益生菌对重型颅脑损伤患者营养状况的影响.方法 将35例重型颅脑损伤患者按随机数字表法分入研究组(17例)及对照组(18例);两组患者均在入院后24～48 h内即开始经鼻胃管进行肠内营养,研究组在此基础上同时联合给予益生菌.于肠内营养支持前及支持后第8,15,21天清晨监测血红蛋白、淋巴细胞计数、血浆总蛋白、白蛋白、前白蛋白、胆碱酯酶、空腹血糖等指标,并测量上臂围(AC)、三头肌皮褶厚度(TSF)、上臂肌围(AMC),观察患者胃肠道反应情况及首次排便时间,比较GCS评分.结果 两组患者血红蛋白、淋巴细胞计数、总蛋白、前白蛋白及GCS评分各时相点差异均无统计学意义(P＞0.05).研究组在营养支持第8天,空腹血糖明显低于对照组(P＜0.05);第15天,胆碱酯酶显著高于对照组(P＜0.05);第21天,白蛋白水平有高于对照组的趋势(P=0.054),AC及AMC较营养支持前下降程度明显低于对照组(P＜0.05).研究组发生反流、便秘例数明显少于对照组,首次排便时间显著提前于对照组(P＜0.05,0.01).结论 与单纯肠内营养相比,联合益生菌的肠内营养能更好纠正重型颅脑损伤后的代谢紊乱,改善患者的营养状况.

Abstract：

Objective To investigate the effect of early enteral nutrition combined with probiotics on the nutritional status of patients with severe head injury. Methods Thirty-five patients with severe head injury were randomized into early enteral nutrition group ( control group, n = 18 ) and early enteral nutrition combined with probiotics group (observational group, n = 17). All the patients received enteral nutrition via nasogastric tube within 24-48 hours following admission. Hemoglobin, lymphocyte count,plasma concentrations of total protein, albumin, prealbumin, cholinesterase, and fasting blood glucose were determined before enteral nutrition and at days 8, 15, 21 after enteral nutrition. Arm circumference (AC), triceps skinfold thickness (TSF) and ann muscle circumference ( AMC ) were measured at the same time points. Gastrointestinal reactions as well as the time to first defecation were recorded. Glasgow coma scale (GCS) was assessed. Results There was no difference in terms of hemoglobin, lymphocyte count, plasma concentrations of total protein, prealbumin, and GCS score at each time point between the two groups ( P ＞ 0. 05 ). At day 8 after enteral nutrition, the patients in the observational group exhibited significantly lower level of fasting blood glucose than those in the control group (P ＜ 0.05 ). At day 15,the concentration of plasma cholinesterase in the observational group was significantly higher than that in the control group ( P ＜ 0. 05 ). At day 21, the observational group showed a tendency in increase of plasma albumin level in comparison with the control group( P = 0. 054), and the decrease of AC and AMC was obviously lower than that in the control group ( P ＜0. 05 ) compared with pre-enteral nutrition. The observational group showed less gastro-oesophageal reflux and constipation as well as earlier time to first defecation compared with the control group ( P ＜ 0. 05,0. 01 ). Conclusion Compared with the ordinary enteral nutrition, the enteral nutrition combined with probiotics can attenuate metabolic disorders and improve the nutritional status of the patients with severe head injury.     

颅内动脉瘤术后早期高压氧治疗对患者恢复的影响

目的 探讨高压氧(HBO)对颅内动脉瘤术后患者的治疗作用.方法 将120例前循环动脉瘤术后患者分为HBO治疗组和对照组,各60例.HBO治疗组在对照组治疗的基础上,早期应用HBO治疗,分别于术后1、3、7、14、21 d测定两组患者手术入路侧大脑中动脉平均血流速度;于术后1、7、14、21 d复查头颅CT,计算入路侧及术区异常密度体积;于术后3、7、14 d统计两组患者伴有"症状性脑血管痉挛"例数;术后3、21 d统计两组患者的机能状态(KPS评分),并做统计学分析.结果 两组术后3 d内大脑中动脉平均血流速度、伴有"症状性脑血管痉挛"例数、KPS评分均无统计学意义(P>0.05);术后7、14 d HBO治疗组血流速度较对照组低(P<0.05或P<0.01);术后14、21 d,HBO治疗组患者异常密度体积较对照组小(P<0.05);术后7、14 d HBO治疗组表现有"症状性脑血管痉挛"较对照组少(x2=4.18,P<0.05);术后21 d HBO治疗组KPS评分高于对照组(P<0.05).结论 颅内动脉瘤术后早期应用HBO治疗效果较好,其作用机制之一可能是HBO能够尽快地解除脑血管痉挛状态.

Abstract：

Objective To explore the effects of early hyperbaric oxygenation ( HBO ) on postoperative recovery of intracranial aneurysms patients.Methods The clinical data of 120 postoperative intracranial aneurysms patients were divided into HBO group and control group.The determination of average blood stream speed of middle cerebral artery( MCA) of operation side were recorded at the 1st,3th,7th, 14th and 21st day after operation.The operative regional abnormity density volume of CT re-examination were calculated at the 1st, 7th, 14th and 21st day.The number of cases associated with "symptomatic cerebral vasospasm" was counted at the 3st, 7th and 14st day.The functional state (KPS score) was evaluated at the 3th and 21st day.Result There was no significant difference of MCA average blood stream speed, number of cases associated with "symptomatic cerebral vasospasm" and KPS score between two groups at 3rd day after operation ( P > 0.05).The MCA average blood stream speed of HBO group was lower than that of control group at the 7th and 14th day after operation ( P < 0.05 and P <0.01).The abnormity density volume of HBO group was less than that of control group at the 14th and 21st day after operation ( P <0.05 ).The number of cases associated with "symptomatic cerebral vasospasm" of HBO group was smaller than that of control group at the 7th and 14th day after operation ( P < 0.05).The KPS score of HBO group was higher than that of control group at the 21st day after operation ( P <0.05).Conclusion The effects of early hyperbaric oxygenation therapy on postoperative intracranial aneurysms patients are good.One of the possible mechanism is release of cerebral vasospasm.     

缺血缺氧性脑病患儿的护理要点

目的研究分析临床护理缺血缺氧性脑病患儿的办法与效果.方法选择2009年12月~2011年12月我院收治的59例确诊为缺血缺氧性脑病的患儿作为临床观察对象.将全部患儿随机均分为观察组和对照组,其中观察组30例,对照组29例.观察组给予进行针对性的早期护理干预;对照组只给予常规的护理干预.结果观察组护理的总有效率为100%,对照组为89.66%,两组的总有效率比较差异具有显著性(P<0.05).结论对缺血缺氧性脑病患儿实施针对性的早期护理干预,能够有效改善其脑功能障碍,发育智力.     

噪声作业人员职业健康体检结果分析

目的：对1200例噪声作业人员职业健康体检结果分析,预防与早期发现职业禁忌症与职业病。方法：选取2012年广东省深圳市龙华新区（某五金厂、某电子厂等）共20家企业的1200名在噪声环境下工作的工人的职业健康体检资料进行对比分析。结果：1细例噪声环境下工作的工人,530人次检出1115项异常,异常人数检出率44．17％,工龄越长异常检出人数越多,听力损失检出率为17．08％,年龄越大听力损失越严重,性别比男性高于与女性,与接触噪音的工作年限无关。结论：噪声环境工作可造成噪声。     

TCDD和B[a]P诱导大鼠肺癌变过程CYPIA1表达变化的研究

目的:利用四氧二苯二氧杂环己二烯(TCDD,二噁英)和苯并(a)芘(B[a]P)致大鼠肺癌的动物模型,研究肺癌变过程中CYPIA1基因mRNA和蛋白水平的表达。方法:应用RT-PCR方法及荧光免疫法检测大鼠正常肺组织、癌前病变组织和肺癌组织中CYPIA1基因mRNA的表达及CYPIA1基因在肺组织蛋白水平的表达,评价CYPIA1基因在肺癌变过程的作用。结果:CYPIA1 mRNA/β-actin比值在TCDD、TCDD+B[a]P、B[a]P致癌组及对照组分别为0.956 4±0.328 2、1.153 3±0.432 6、0.252 4±0.103 2和0.093 6±0.032 7;在大鼠正常肺组织、正常增生、癌前病变和肺癌组织中分别为0.105±0.098、0.235±0.108、1.127±0.295和1.564±0.421。结果表明,CYPIA1mRNA在TCDD+B[a]P、TCDD致癌组有较强表达,在肺癌前病变和肺癌组织中有较强表达;CYP1A1蛋白表达灰度值在TCDD、TC-DD+B[a]P、B[a]P致癌组及对照组分别为41.76±4.82、46.28±4.32、31.02±3.16和18.75±2.27,在大鼠肺正常组织、正常增生、癌前病变和肺癌组织中分别为19.77±2.74、26.71±3.32、43.95±3.98和47.38±4.96。结果表明,CYP1A1蛋白在TCDD+B[a]P和TCDD致癌组有较强表达,在肺癌前病变和肺癌组织中有较强表达。结论:TCDD和B[a]P对CYPIA1有较好的诱导作用,CYPIA1高表达与肺癌的发生有着密切的关系,其在肺癌前病变和肺癌组织中的高表达,可能是肺癌前病变、肺癌发生的一个标志。     

小儿气道异物术后首次进食时间探讨

目的探讨小儿气道异物在全身麻醉下行气管、支气管镜检术后首次进食时间,为临床护理提供依据。方法 2010年9月-2011年5月,将213例气管异物患儿根据入院的先后顺序编号分组,对照组患儿按常规在全身麻醉清醒后6 h首次进食流质,观察组患儿在麻醉完全清醒、意识完全恢复后先给予20～30 mL温开水饮用,30 min后即给予流质饮食。比较两组患儿首次进食后呕吐、误吸的发生率,术后哭闹或自诉口渴、饥饿感发生率的差异。结果两组患儿首次进食后呛咳、呕吐的发生率无明显差异(P>0.05),观察组患儿术后哭闹或自诉口渴、饥饿感的发生率明显低于对照组。结论小儿气道异物在全身麻醉下行气管、支气管镜检术后首次进食可在患儿麻醉完全清醒、意识恢复后半小时给予。     

桂枝茯苓丸辅助化疗治疗卵巢癌患者28 例临床观察

目的观察桂枝茯苓丸联合化疗治疗卵巢癌的近期疗效。方法选择收治的56例卵巢癌患者为研究对象。所有患者均经病检确诊为卵巢癌,随机分为观察组28例和对照组28例,对照组给予顺铂＋环磷酰胺联合化疗,观察组在对照组的基础上加服桂枝茯苓丸。3个周期后评价其疗效及毒性反应。结果 3个周期后,观察组近期疗效为75.0%,对照组近期疗效为57.14%,差异有统计学意义（P〈0.05）;观察组有23例（82.14%）患者治疗后血清CA125降低至正常水平以下,而对照组仅13例（46.43%）,有统计学差异（P〈0.05）;观察组在过敏反应、血液学毒性、皮疹、肌痛以及胃肠道反应方面均明显低于对照组,差异有统计学意义（P〈0.05）。结论桂枝茯苓丸联合化疗治疗卵巢癌能取得较好的疗效,副作用明显低于单独的化疗方案。