综合护理干预措施对2型糖尿病合并肺结核患者临床治疗的影响作用

目的:分析评价综合护理干预措施对2型糖尿病合并肺结核患者临床治疗的影响作用及促进患者尽快康复的价值。方法:选择2016年1月～2017年10月接受治疗的2型糖尿病合并肺结核患者128例作为研究对象,随机分为两组,各64例,对照组给予基础护理,观察组给予综合护理干预,对比两组护理效果。结果:经护理,观察组结核菌转阴、病灶缩小比率高于对照组,而FBG、2hPG指标水平则均明显低于对照组,两组数据差异有统计学意义(P0.05);在护理满意度上,观察组为96.88%,对照组为81.25%,明显低于观察组,两组数据差异有统计学意义(P0.05)。结论:综合护理干预应用于2型糖尿病合并肺结核患者中,可提升治疗效果,促进患者康复,值得在临床护理工作中应用。     

内江市妊娠期糖尿病孕妇对食疗与运动干预的认知调查分析

目的调查内江市妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇对食疗、运动干预的认知情况,为制订防治GDM策略提供依据。方法 2017-05/2018-07在内江市第一人民医院建卡行常规孕前糖耐量检测的孕妇中,对确诊GDM孕妇开展食疗、运动干预认知问卷调查,采用SPSS 20.0进行χ2检验、Logistic回归分析。结果 19.98%(374/1 871)确诊GDM,下发374份调查问卷,有效问卷回收率100%;GDM孕妇中,26～30岁年龄段(45.19%)、大专及本科以上学历(44.12%)、工人或公司职员(43.85%)、家庭人均月收入水平3 000～5 000元(36.63%)占比较高,仅18.98%GDM孕妇接受过食疗及运动干预相关知识;认知调查显示,仅29.14%的GDM孕妇知晓食疗、运动干预相关知识,工人或公司职员、家庭人均月收入水平1 000～2 999元的GDM孕妇对食疗、运动干预的知晓率差异有统计学意义(P0.05);职业、家庭人均月收入水平均是影响GDM孕妇食疗、运动干预知识知晓率的独立因素。结论内江市GDM孕妇对食疗、运动干预相关知识的知晓率不佳,或应加强本地区GDM健康知识宣教,改善上述不足之处,为GDM的防控提供基础。     

降钙素原在20例输入性疟疾诊治中的应用

目的评价血清降钙素原(PCT)在20例输入性疟疾诊治中的价值。方法回顾性分析该院2013年1月至2015年12月3年间输入性疟疾患者PCT检测结果与疟原虫分型、临床表现及预后的关系。结果本研究共有20例患者进行了PCT检测,其结果100%(20/20)有升高,范围在0.38~100.00ng/mL。间日疟PCT为(0.85±0.58)ng/mL,最高达正常值30倍;恶性疟PCT为(28.20±34.50)ng/mL,最高达2 000倍。白细胞总数升高者占20%(4/20),降低者占25%(5/20)。中性粒细胞比例升高者占95%(19/20),中性粒细胞(NEU)/淋巴细胞(LYM)4倍者占75%(15/20),PLT降低者占80%(16/20)。结论恶性疟患者PCT升高程度明显高于间日疟患者,PCT高低及NEU/LYM值的大小可能预示输入性疟疾患者疾病严重程度及预后。     

超声内镜的选择

1980年代早期,具有可弯曲结构的超声内镜发展迅速,并且很快成为胃肠病学及其相关领域的独立诊断工具.超声内镜主要用于胃肠肿瘤的术前定位,同时它也可以确定病变的起源以及黏膜下病变的类型.在这之后,就出现了标准的机械环扫超声内镜,频率为5～12 MHz,这些机型在以后10年的超声内镜应用中均占统治地位.超声内镜诊断的许多相关研究也是以这些仪器为基础的.     

RUNX3、RASSF1A启动子高甲基化与胃癌进展转移的关系

目的:探讨胃癌RUNX3、RASSF1A基因启动子甲基化在胃癌进展转移中的作用及意义.方法:RT-PCR和MSP检测62例胃癌标本及56例正常胃黏膜组织RUNX3、RASSF1A基因mRNA表达及甲基化状况,免疫组织化学检测VEGF在RUNX3、RASSF1A甲基化与非甲基化胃癌组织及20例正常组织中的表达,并分析RUNX3、RASSF1A甲基化与VEGF表达的关系.结果:胃癌组织RUNX3与RASSF1A表达较正常组织均明显降低(0.629±0.461 vs 0.893±0.543,0.653±0.476 vs 0.858±0.581,均P<0.05),且RUNX3与RASSF1A甲基化率均高于正常组织(69.4%VS 26.8%,66.1%vs 23.2%.均P<0.01).胃癌组织中RUNX3、RASSF1A甲基化组mRNA表达量较非甲基化组明显降低(0.545±0.299 vs 0.736±0.291,0.562±0.208 vs 0.674±0.185,均P<0.05).RASSF1A甲基化与肿瘤TNM分期及浸润深度相走RUNX3甲基化与肿瘤淋巴结转移、血管侵犯及TNM分期相关(P<0.05).RUNX3甲基化组胃癌组织VEGF蛋白表达高于非甲基化组(86.0%vs57.9%),RUNX3甲基化与VEGF表达相关(P<0.05).结论:RUNX3、RASSF1A启动子高甲基化可能是导致其表达降低的原因,并与胃癌进展演变相关.RUNX3甲基化可能参与胃癌血管、淋巴管转移.     

非酒精性脂肪性肝病患者基本特征及诊疗规范的调查研究

Objective To assess the characteristics and daily treatment compliance of non-alcoholic fatty liver disease (NAFLD) patients in China. Methods NAFLD adult patients from 21 clinics of 12 cities in China were enrolled in this registry. Physical examination such as demographic characteristics (height,weight, waist circumference measurement), blood pressure and clinical laboratory and ultrasonographic examination of liver were undertaken. Daily practice including life style and medication were recorded and assessed in accordance with 2006 Chinese NAFLD treatment guidelines. Results A total of 1656 patients were enrolled (1146 male and 510 female), mean of 45.8 ± 12.6 years old, mean duration of NAFLD history was (47.2 ± 47.7) months. 44.9% of NAFLD were suffering from metabolic syndromes. Patients with central obesity have higher incidence of hypertension and lower level of high-density lipoprotein cholesterol (HDL-C) than those without central obesity, P < 0.05. Body mass index (BMI), waist circumference, triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in ALT abnormal group were higher than those in ALT normal group (P < 0.05), HDL-C was lower in ALT abnormal group (P < 0.05). Significant differences existed between the BMI, female waist circumference, TG, fast insulin, HOMA index, ALT, AST and HDLC among subgroups with mild, moderate and severe steatosis. Majority of the patients did not follow recommendations of NAFLD treatment guidelines. Among targeted population only 15.3% of patients used insulin sensitizers and 23.8% took lipid lowering medicine according to the guideline. Conclusion Data indicated that nearly half of NAFLD patients co-morbid with metabolic disorders. Therapy compliance was unsatisfactory and the gap between current practice and Chinese NAFLD treatment guidelines was not optimal.     

孕妇肠套叠诊治一例

患者女,29岁,因中上腹胀痛1个月余,孕21+周入院,患者1个月来反复出现中上腹胀痛,呈阵发性绞痛,且偶感上腹部出现肠型蠕动波,伴有肛门排便排气逐渐减少,因连续3～4 d未解大便予以开塞露肛塞,排出较多量稀便后腹胀稍缓解,此后每大解2～3次稀便,无恶心、呕吐,消瘦明显,以"不全性肠梗阻"收入院.     

内镜下黏膜切除术后食管狭窄的危险因素分析

Objective To analyze the possible risk factors of esophageal stenosis after endoscopic mucosal resection (EMR). Methods From January 2008 to December 2009, a total of 219 procedures of esophageal EMR were performed to resect early esophageal squamous carcinoma and its precancerous lesions,and esophageal stenosis was observed in 9 cases. Data of these 9 patients ( stenosis group) were collected and compared with those of patients without stenosis ( control group, n = 202, 8 patients were excluded because of being diagnosed as squamous carcinoma with submucosal infiltration after EMR and being transfered to surgery). Results There was no significant difference between two groups in regard of gender, age, location of the lesion, length of the lesion or pathological diagnosis after EMR, while the rate of patients with mucosal defect larger than 3/4 circumference in stenosis group ( 8/9, 88.9% ) was significantly higher than that in control group (9/202, 4. 5%, P ＜ 0. 01 ). Conclusion In EMR for early esophageal squamous carcinoma and its precancerous lesions, post-EMR mucosal defect larger than 3/4 circumference is a risk factor for esophageal stenosis.     

内镜黏膜切除术对胃食管连接部病变的治疗价值

目的评价内镜黏膜切除术治疗胃食管连接部病变的疗效、安全性及应用价值。方法经术前内镜检查及黏膜活检证实后,采用内镜黏膜切除术切除51个胃食管连接部病变,其中低度异型增生39个,高度异型增生12个,病灶直径3～28mm,平均（10．9±4．0）mm。对手术前后病理结果进行对照,定期复查内镜进行随访。结果全组有44个病灶被完全切除,完全切除率为86．3％,手术前后病理结果相符的病灶仅26个（50．1％）,其余25个病灶中24个病灶术前活检病理级别偏低。并发症主要是出血,17例占33．3％,均经处理后停止出血,无一例发生穿孔或术后狭窄。51例患者随访中无1例复发或死亡。结论内镜黏膜切除术是治疗胃食管连接部病变安全、有效的方法,是阻断癌前病变和早期癌在体内进展的重要策略。     

尿样不同储存方式对氟含量测定值影响的研究

目的 研究尿液在不同条件的储存待检过程中氟含量值的变化。方法常规收集健康成人尿样,在不同条件下储存并分别于采样后3、7、15d、1、3、6个月采用氟离子选择电极法检测氟含量,比较时间、温度以及防腐对尿氟值的影响。结果尿氟含量从第3d至第6个月下降了0．156～1．266mg／L,尿样防腐保存与不防腐保存在-20℃,0～4℃下时有显著性差异,在室温下差异不显著;无防腐剂的尿样比加防腐的尿样氟含量值下降明显;尿氟含量值随保存时间延长均有下降,尤其是在保存1个月后下降明显。结论待检时间、防腐剂的使用、温度都是影响尿氟含量变化的因素,尿样保存的适宜条件应在-20℃、0～4℃下防腐保存,以15d内检测为宜。