有限剥离骨膜对老年人股骨干骨折愈合的影响

闭合性皮肤剥脱伤临床并不多见,常因重物压砸、车祸等损伤引起,由于大多没有严重影响功能或为其他病痛所掩盖,患者及医生均不够重视,就诊时仅以皮下积液为惟一主诉,往往仅以简单穿刺抽液、加压包扎等治疗,迁延日久而不能治愈。自1993年2月-2006年4月共治疗此类患者31例,获满意结果,报告如下。1临床资料本组31例,男19例,女12例;年龄30~63岁,平均为41岁。均有外伤史,其中车祸伤18例,压砸伤6例,挤轧5例,摔伤2例。损伤部位:腰骶8例,髂嵴6例,腹股沟5例,大腿前外侧10例,小腿外侧2例。伤后至就诊时间1~55 d,平均31 d。早期损伤9例,晚期22例。剥脱面…     

肝细胞肝癌肺转移灶FDG摄取的假阴性分析

目的评价18^F-FDG PET／CT探测原发性肝细胞肝癌（HCC）肺转移的价值，并分析肺转移灶FDG摄取假阴性的原因。方法32例经手术病理或临床随访证实为HCC肺转移的患者行18^F-FDG PET／CT检查，根据FDG摄取阳性或阴性分为2组：A组18例，肺转移灶表现为FDG摄取增高；B组14例，肺转移灶表现为无FDG摄取。结果32例HCC肺转移患者中，27例18^F-FDG PET／CT显像发现肝内高代谢病灶，12例伴发其他肝外转移，其中包括腹膜后淋巴结、肺门或纵隔淋巴结、骨骼转移。PET对最大径〈10mm的肺转移灶探测灵敏度为35．6％，对最大径≥10mm的肺转移灶探测灵敏度为63．6％，两者比较，差异有统计学意义（χ^2=4．712，P=0．03）。肺转移灶的FDG摄取变异较大，从无FDG摄取到少数病灶的显著FDG摄取，83．3％（25／30）摄取阳性的转移灶最大SUV（SUVmax）≤3。结论HCC肺转移灶FDG摄取假阴性率较高，除与病灶大小有关外，可能与原发病灶的病理特点有关。呼吸控制的薄层CT图像以及必要时增强CT对肺部小结节的检出非常重要，对CT显示小的肺结节病灶应严密随访。     

口腔门诊治疗并发晕厥106例回顾分析

目的：通过对1983年以来，孝感市中心医院口腔中心门诊治疗并发晕厥106例的回顾性分析，探讨口腔门诊治疗并发单纯性晕厥的原因及一些相关因素，增强医患双方的防治意识，安全顺利的进行口腔门诊治疗。方法：对106例单纯性晕厥反应，采取现场询问式调查的方法，对其一般情况，口腔门诊治疗经历，治疗时的心态，口腔门诊治疗的了解，以及不同口腔治疗晕厥发生情况等进行调查、归纳、分析。结果：1)晕厥的发生与患者的年龄有关，12～40岁口腔门诊治疗经历欠缺的患者是口腔门诊治疗并发晕厥的高危人群。2)口腔患者进行治疗前心理准备充足与否对并发晕厥反应的影响较大。3)晕厥在口腔门诊某些治疗中发生率较高，拔牙术最多，其次为脓肿切排。86％(92例)属因畏惧疼痛导致紧张而诱发的血管抑制性晕厥。4)晕厥多发生于治疗初期(93：13)。结论：口腔门诊治疗并发晕厥临床表现多不严重，但对患者就诊和医师的治疗影响明显，切实做好口腔治疗错误信息，消除和减轻他们的疑虑和畏惧的紧张心情，对保障口腔门诊治疗安全尤为重要。     

安瓿类药液抽取过程中微粒控制的研究进展

针对护士在抽吸安瓿类药液过程中存在的微粒污染问题，搜集教材和有关的研究成果，对安瓿类药液抽吸过程中微粒的种类、来源及目前微粒控制技术的研究进展进行综述，旨在规范配药技术，提高工作效率和用药安全。     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

手部热压伤的早期修复(附43例报告)

目的 探讨早期清创、组织修复在热压伤治疗中的临床疗效。方法 分析43例不同程度手部热压伤患的病损特点并行临床分度，以便准确诊治、判断预后；全部病例采用早期手术治疗，轻度热压伤(即浅Ⅲ度烧伤)早期行切痂全厚或中厚皮片修复，中度和重度热压伤早期彻底清创保留间生态组织，应用血循环丰富的组织瓣修复创面。结果 42例创面一期修复，手功能和外形恢复满意：1例创面二期修复，手功能恢复差。结论 手部热压伤应早期手术清创，据病损程度选择良好的方法及时修复组织缺损，可最大限度地恢复手功能和外形，减少致残率，缩短疗程，获得较好的临床疗效。     

CO作用后大鼠肺血管细胞增殖和凋亡状况的研究

目的：通过研究CO和低氧作用后大鼠肺血管细胞增殖和凋亡状况，探讨低氧肺动脉高压的发病机制及防治措施。方法：应用免疫组织化学，原位末端标记及Western杂交等方法检测常压低氧大鼠肺血管壁细胞增殖，凋亡及c-myc基因的表达状况。结果：正常组，低氧和锡原卟啉组，低浓度CO和血晶素组大鼠肺动脉均存在增殖和凋亡的阳性细胞，两类细胞在肺内呈不均匀散在分布，低氧和锡原卟啉组大鼠肺血管增殖细胞数显著升高而凋亡细胞数显著减少，细胞增殖凋亡比值分别为对照组的5倍或4倍，而低浓度CO和血晶素组肺血管增殖细胞和凋亡细胞系数均显著增加，细胞增殖凋亡比值均为1．2，c-myc在低氧和锡原卟啉组大鼠肺内表达显著增加，在低浓度CO和血晶素组大鼠肺内表达减少。结论：增殖和凋亡现象共存在于正常和处理大鼠的肺血管细胞中，也许c-myc等基因的异常表达导致了细胞增殖和凋亡的失衡，进而调节了慢性低氧肺血管结构的改建。     

先天性心脏病患儿术后多脏器功能障碍的预后分析

目的 探讨小儿先天性心脏病(先心病)术后多脏器功能障碍(MODS)预后情况及其影响因素,为对此类患儿进行针对性护理提供依据.方法 收集先心病术后并发MODS 77例患儿的临床资料.结果 11例放弃治疗出院,66例中44例救治存活,22例死亡.出现时间最早、累及最多的脏器为心脏;病死率最高的为累及中枢神经系统的患儿(57.69%),其次是累及血液系统的患儿(55.56%);患儿的病死率与累及脏器的数量呈显著正相关(P＜0.01).死亡患儿手术体外循环时间和主动脉阻断时间显著长于存活患儿(均P＜0.05),术中意外及术后心肺复苏发生率显著高于存活患儿(均P＜0.05).结论 先心病术后患儿应加强心功能监护,特别是体外循环时间＞120 min,主动脉阻断时间＞60 min及术中发生过意外情况、术后采取过心肺复苏术的患儿;尽早采取有利措施避免其他脏器功能受损是提高患儿存活率的关键.     

硬膜外混合不同浓度舒芬太尼分娩镇痛时罗哌卡因的半数有效浓度

目的测定产妇硬膜外分娩镇痛时不同浓度舒芬太尼混合罗哌卡因的半数有效浓度(EC50),寻找舒芬太尼混合罗哌卡因的适宜浓度。方法100例ASAⅠ或Ⅱ级的足月初产妇,妊娠37～42周,随机分为2组:0.4μg/ml舒芬太尼混合罗哌卡因组(A组)(n=45)和0.6μg/ml舒芬太尼混合罗哌卡因组(B组)(n=55)。2组均在宫口扩张至2～3 cm时行硬膜外穿刺,置管。2组第1例产妇罗哌卡因浓度均为0.12%,随后的罗哌卡因浓度按序贯法确定:即前1例若镇痛有效(注药后30 min时VAS评分≤3分)。则下1例接受的药物降低一个浓度梯度,若镇痛无效,则上升一个浓度梯度,浓度梯度0.01%。若镇痛效果可疑,则下1例接受的药物维持原浓度,计算罗哌卡因的EC50及其95%可信区间。观察镇痛期间发生的不良反应。结果A组、B组皮肤瘙痒发生率分别为11.9%、29.4%(P< 0.05),A组、B组各有1例发生恶心呕吐(P>0.05)。A组罗哌卡因的EC50为0.059%(95%可信区间为0.056%～0.062%),B组罗哌卡因的EC50为0.054%(95%可信区间为0.053%～0.055%)。结论硬膜外混合0.4、0.6μg/ml舒芬太尼分娩镇痛时,罗哌卡因的EC50分别为0.059%、0.054%;舒芬太尼的推荐浓度为0.4μg/ml。     

Subcutaneously administered recombinant human β-interferon in the treatment of chronic hepatitis B virus infection

Background: Treatment of chronic replicative hepatitis B virus (HBV) infection is aimed at stopping viral replication and preventing the development of chronic liver disease. β-Interferon treatment has been less well studied than α-interferon. Methods: The efficacy and tolerability of a 6-month course of subcutaneously administered human recombinant β-interferon (rINF-β_ser) was studied and the results of a low-dose regime compared with a high-dose regime. Twenty patients (17 men and three women), aged 24–54 years, with chronic hepatitis B virus infection (all hepatitis B surface antigen-positive with detectable HBV-DNA in their sera for at least 3 months prior to therapy) were randomized into two treatment groups of 10 patients each. The low-dose group received 6×10⁶ U/dose and the high-dose group received 30×10⁶ U/dose, both groups receiving their respective doses three times a week initially for 1 month and continuing for a total of 6 months. Results: The treatment was well tolerated in both groups. None of the patients required dosage reduction or cessation of treatment because of side-effects. HBV-DNA decreased in all patients during treatment, demonstrating the anti-viral efficacy of rINF-β_ser, and was undetectable in 20 and 40% of patients receiving low-dose and high-dose regimes, respectively, at the end of 6 months treatment (P=N.S.). One year after completion of treatment, HBV-DNA was undetectable in 50 and 30% of patients in the low-dose and high-dose groups, respectively (P=N.S.). However, only one patient achieved seroconversion with loss of the hepatitis B surface antigen and appearance of an anti-hepatitis B ‘e’ antigen at the end of 18 months. Conclusion: This study shows that subcutaneously administered rINF-β_ser is well tolerated, but the optimal dose and duration of treatment still needs to be defined by further studies.