手术室新护士三年阶梯式培训模式探讨

目的探讨手术室新护士三年培训模式和方法。方法采用三年阶梯式培养模式,建立完整的系统培训架构,包括培训对象的界定、培训原则及目的、培训目标师资队伍的培养、阶段培养计划、使用培训手册、培训考核体系的建立、培训评价体系的建立等。结果新护士培训系统、科学。结论新护士三年阶梯式培养值得深入研究和推广应用。     

土耳其斯坦东毕吸虫磷酸丙糖异构酶基因的克隆及其序列分析

目的 克隆土耳其斯坦东毕吸虫磷酸丙糖异构酶的全长基因。方法 根据日本血吸虫和曼氏血吸虫磷酸丙糖异构酶基因的保守区设计引物，利用RT—PCR扩增出土耳其斯坦东毕吸虫磷酸丙糖异构酶基闪的大片段，再结合RACE技术分别得到磷酸丙糖异构酶基因的3’端和5’端，将3部分序列拼接后获得磷酸丙糖异构酶基因全长cDNA序列，并提交GenBank。结果 成功克隆了土耳其斯坦东毕吸虫磷酸丙糖异构酶基因全长cDNA序列并提交GenBank，登录号为DQ092331。结论 土耳其斯坦东毕吸虫磷酸丙糖异构酶基因全长cDNA的克隆为进一步表达及其生物学性能的分析提供了理论基础。     

Sex‐related Disparity in Surgical Mortality among Pediatric Patients

Background. It has been reported that gender differences in cardiovascular outcomes found in adults also are present in children who undergo surgical repair for congenital heart disease. Methods. California statewide hospital discharge data 1989–99 were used to study outcomes in children <18 years undergoing cardiac surgery. Hospital discharge data were linked to death registry data to study postdischarge death within 30 days of discharge. We used logistic regression to evaluate the effect of gender on mortality controlling for age, race and ethnicity, type of insurance, household income, date and month of surgery, type of admission, hospital case volume, and various types of procedures. Results. There were 25 402 cardiac surgery cases with 1505 in‐hospital deaths (mortality rate of 5.92%). An additional 37 deaths occurred within 30 days after hospital discharge. Crude mortality rates for males (5.99%) and females (5.84%) were not significantly different. However, fewer neonates were female and females underwent a higher proportion of low‐risk procedures than males. Logistic regression revealed that females, compared with males, had a significantly higher odds ratio (OR) for in‐hospital mortality (OR = 1.18, P < .01) and overall (up to 30 days post discharge) mortality (OR = 1.18, P < .01). The risk‐adjusted length of hospital stay was similar between females and males while charges per hospital day were slightly higher in females than males. The prevalence of Down syndrome, pulmonary hypertension, and failure to thrive were higher in females. Conclusions. Female gender is associated with an 18% higher in‐hospital and 30‐day postdischarge mortality as compared with male gender. There was no difference in length of hospital stay between males and females. The mechanism by which female gender acts as a risk factor requires further investigation.     

大鼠脑血肿周围组织半胱氨酸天冬氨酸蛋白酶3表达变化与尼莫地平的影响

目的：观察脑出血后血肿周围半胱氨酸天冬氨酸蛋白酶3的表达。及尼莫地平对其的影响。方法：实验于2004—07在大连医科大学中心实验室进行。取120只SD雄性大鼠随机分为3组：①尼莫地平组（n=50）：尾壳核注射自体股动脉血50μL复制脑出血模型，造模即刻腹腔注射尼莫地平1．6mg／kg（即8μL／g），以后每天1次。②模型组（n=50）：同前造模，术后腹腔注射等量生理盐水。③假手术组（n=20）：手术，但进针人尾壳核后不注血。各组分为术后6，24，48，72h、5d 5个时间点。造模动物醒后进行Bederson评分，评估其行为和神经功能缺陷（0—3分。评分越高，神经功能缺陷越重，评分≥2分为造模成功）。人组动物在以上5个时间点进行Bederson评分后，麻醉状态下处死取脑，经尾壳核行冠状切片，行免疫组化测定半胱氨酸天冬氨酸蛋白酶3表达。结果：80只大鼠进入结果分析。①Bederson评分：模型组、尼莫地平组大鼠醒后迅速出现偏瘫，24h后评分趋于稳定，至72h之间评分最高，然后逐渐下降，5d时仍有体征。模型组、尼莫地平组各时间点评分均高于对照组（P〈0．01），尼莫地平组术后48，72h评分低于模型组（P〈0.05）。②血肿周围组织半胱氨酸天冬氨酸蛋白酶3表达：假手术组进针侧脑组织表达很少，模型组6h后即有表达，24h达高峰，持续72h后逐渐下降，5d后仅有少量表达；尼莫地平组动态变化趋势与模型组相同，但各时间点的数值均较低，尤其是术后24～72h（P〈0．01）。结论：①脑出血后血肿周围组织中半胱氨酸天冬氨酸蛋白酶3表达升高，提示其与脑出血血肿周围组织损伤有一定关系。②尼莫地平降低脑出血后血肿周围组织中半胱氨酸天冬氨酸蛋白酶3表达，从而减轻细胞凋亡程度，对神经细胞起到保护作用，降低神经功能缺陷。     

影响颅脑外伤术后颅内感染的危险因素分析

目的探讨影响颅脑外伤开颅术后颅内感染的危险因素。方法采用回顾性研究比较分析了912例颅脑损伤术后出现颅内感染与未出现颅内感染组间的差异因素。结果非感染 770例,颅内感染142例(15．6％)。感染类型有无菌性脑膜炎、细菌性脑膜炎、脑室炎及脑室积脓、脑脓肿、硬膜下腔积脓、术区皮下或(和)骨瓣下化脓或合并骨髓炎、切口感染。细菌检出率占感染的27．5％。颅脑外伤术后感染与高温季节、高龄、重度以上损伤、短期内两次以上手术、连续两侧开颅术、长时间 (>5 h)手术、显微外科手术、颅底与后颅凹手术、脑室外引流、皮下或硬膜外积液以及急诊手术等因素相关(P<0．05)。结论对具有上述危险冈素的易感患者应给予更密切的关注和预防性的处理。     

Interdisciplinary approach to abdominal Burkitt’s lymphoma

Burkitt’s lymphoma is a high-grade, rapidly growing B-cell neoplasm. It is recognized by its aggressive course, brief median survival, and low rates of long-term survival. The authors discuss the case of a patient who acutely presented with intraabdominal complications from a new onset of Burkitt’s lymphoma. The clinical and pathological features, staging, treatment options, and survival data are reviewed. In addition, the role of surgical intervention is carefully analyzed.     

Study on relationship of acute left main coronary artery occlusion and ST segment elevation in lead aVR

Objective We sought to evaluate the relationship between the ST-segment elevation in lead aVR in the acute myocardial infarction and the acute left main coronary artery obstruction.     

动脉栓塞对骨盆肿瘤手术疗效的影响

[目的]探讨供血动脉栓塞对骨盆肿瘤手术疗效的影响。[方法]本组16例，脊索瘤7例，骨巨细胞瘤3例，骨转移瘤3例，骨肉瘤2例，神经纤维瘤1例。术前1d行肿瘤血管造影并用明胶海绵进行供血动脉栓塞。与对照组（结扎双侧髂内动脉骨盆肿瘤切除术）比较，观察其对术中出血量、手术时间、住院时间、术后下床时间、伤口愈合时间及术后各种功能恢复的影响。[结果]骨盆肿瘤切除术前肿瘤供血动脉栓塞与结扎双侧髂内动脉比较，除术中出血量外（P〉0．05），手术、住院、术后下床及伤口愈合时间在统计学上均有非常显著性差异（P〈0．001），而且结扎双侧髂内动脉可能对患者的性功能、排便功能等存在着不良的影响。[结论]肿瘤供血动脉栓塞骨盆肿瘤切除术可大大缩短手术、住院、术后下床、伤口愈合时间，且能更好地保护盆腔内外各组织器官的血运，从而避免其功能的损害。