54例严重缓慢心律失常病人的起搏器治疗

1978年～1987年用永久起搏器治疗54例严重缓慢心律失常的病人,共进行103次手术。随访8年多,发现7例死亡,其中6例死亡原因与起搏器治疗无关,1例死于与起搏器并发感染密切相关。本文就严重缓慢心律失常的类型、病因、安装永久起搏器的指征、手术并发症等加以讨论。     

多希紫杉醇联合顺铂治疗晚期非小细胞肺癌疗效观察

目的观察和评价多希紫杉醇联合顺铂(DP方案)治疗晚期非小细胞肺癌的疗效和毒性。方法将我科近几年收治的48例晚期非小细胞肺癌患者随机分为治疗组和对照组。治疗组采用多希紫杉醇联合顺铂(DP方案),对照组采用长春瑞滨联合顺铂(NP方案)。2周期化疗后进行疗效、毒性对比研究。结果治疗组和对照组近期有效率分别为45.5%和37.5%,疾病进展时间(TTP)分别为6.3和5.9个月,中位生存期分别为10.1和9.0个月,1年生存率分别为45.8%和39.4%,两组间比较差异均无显著性(P>0.05)。治疗组在恶心呕吐、骨髓抑制等毒性反应发生率方面低于对照组,差异有显著性(P<0.05)。结论多希紫杉醇联合顺铂治疗晚期非小细胞肺癌与NP方案相比较,疗效相似,但毒性反应低于NP组,患者更易耐受,可广泛应用于临床。     

南通市居民健康知识水平现状及对策

为全面了解和准确掌握南通市各行各业、中小学校健康知识的知晓情况,对创建国家卫生城市健康教育工作进行效果评估。调查显示,南通市11个片区健康知识的总知晓率居民为93.42%,学生为91.08%。要真正提高全体市民的健康教育水平,下一步必须采取三大对策,即:形成“抓反复、反复抓”的常态机制;加大健康教育投入;教育部门加强全市学生的健康知识普及工作,对卫生部门列入学校卫生的指标加以考核。只有这样,南通市的健康教育工作才能跃上新台阶。     

无线通信在医疗领域的应用

本文介绍了无线通信在医院管理、病人移动观察、病例跟踪等方面的应用.     

A systematic review of resident‐as‐teacher programmes

Context Residents in all disciplines serve as clinical teachers for medical students. Since the 1970s, there has been increasing evidence to demonstrate that residents wish to teach and that they respond positively to formal teacher training. Effective resident‐as‐teacher (RaT) programmes have resulted in improved resident teaching skills. Current evidence, however, is not clear about the specific features of an effective RaT programme. Objectives This study was performed in order to investigate the effectiveness of RaT programmes on resident teaching abilities and to identify the features that ensure success. Methods of assessment used to ascertain the effectiveness of RaT programmes are also explored. Methods The literature search covered the period between 1971 and 2008. Articles focusing on improving resident teaching skills were included. Each study was reviewed by two reviewers and data were collected using a standard abstraction summary sheet. Study outcomes were graded according to a modified Kirkpatrick's model of educational outcomes. Results Twenty‐nine studies met review inclusion criteria. Interventions included workshops, seminars, lectures and teaching retreats. Twenty‐six studies used a pre‐ and post‐intervention outcome comparison method. Subjective outcome measures included resident self‐evaluation of teaching skills or evaluation by medical students, peers and faculty members. Objective outcome measures included written tests, evaluation of teaching performance by independent raters and utilisation of objective structured teaching examinations. One study objectively measured learning outcomes at the level of medical students, utilising the results of an objective structured clinical examination. Overall resident satisfaction with RaT programmes was high. Participants reported positive changes in attitudes towards teaching. Participant knowledge of educational principles improved. Study methodologies allowed for significant risks of bias. Conclusions More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.     

肾动脉狭窄支架植入术的临床疗效观察

目的探讨肾动脉狭窄支架植入术的临床疗效.方法1997年1月～2004年12月,我院行支架介入治疗肾动脉狭窄27例.对27例术前、术后及随访期内血压、肾功能以及生活质量进行评估,并与同期单纯药物治疗肾动脉狭窄27例进行比较.结果介入组27例植入支架40枚,手术成功24例(88.9%,24/27),失败3例(11.1%,3/27),手术并发症5例(18.5%,5/27).术后在血压下降(包括收缩压舒张压)肌酐下降,肾小球滤过率增加方面,介入组获益率明显优于药物组,两组比较差异均有显著性,术后随访6个月～8年6个月,中位数为1年9个月,介入组有19例能比较健康的生活和工作,药物组仅12例能维持生活和工作.结论支架介入治疗较单纯药物治疗肾动脉狭窄疗效显著.     

经尿道切除技术在下尿路疾病中的应用（附128例报告）

目的 探讨经尿道切除技术（TUR）治疗下尿路疾病的适应证、操作方法、术中术后处理及并发症预防的要点。方法 应用经尿道汽化电切术（TURVP）和双极等离子汽化电切术（TUPKVP），分别以5％葡萄糖液和生理盐水作冲洗介质，选择性耻骨上膀胱造瘘，持续低压灌洗，术后气囊导尿管留置5～7天拔管，自行排尿。结果 经尿道前列腺双极等离子汽化电切术7例，经尿道前列腺汽化电切术58例，合计前列腺手术65例；腺性膀胱炎汽化电切术43例；膀胱肿瘤汽化电切术15例；后尿道狭窄等离子汽化电切术3例；精阜腺瘤汽化电切术2例。全部病例均一次手术完成，有效率（126／128）98．4％。无膀胱穿孔、电切综合征、大出血、真性尿失禁发生。前列腺术后尿道狭窄、排尿困难再次手术者2例，占3．08％，排尿疼痛、不适感6例，占9．23％，逆行射精4例，占6．15％。结论 TUR技术是一种微创、安全、迅速、有效、恢复快、并发症较少的腔内泌尿外科治疗方法，特别适用于下尿路疾病的手术；术中持续低压灌注对确保切割视野清晰、预防并发症至关重要。     

下呼吸道感染鲍曼不动杆菌ESBLs表型及基因型检测

目的分析引起下呼吸道感染产超广谱β-内酰胺酶(ESBLs)鲍曼不动杆菌的耐药情况及其β-内酰胺酶(BLA)耐药基因类型。方法采用微量稀释法测定临床分离的35株鲍曼不动杆菌对21种抗菌药物的敏感性、三维试验法检测ESBLs采用聚合酶链反应(PCR)及序列分析的方法分析BLA基因型。结果29株(82.9%)ESBLs阳性,其中14株(40.0%)合并产AmpC酶。所有菌株均对亚胺培南、美洛培南、头孢哌酮/舒巴坦和多粘菌素E敏感,其余抗生素的耐药率在40.0～100.0%之间。35株TEM型扩增全部阳性,任选2株测序结果均为TEM-1型。有15株菌株扩增到SHV型BLA基因,经测序13株为SHV-12型ESBLs,另2株(HZ01株和HZ29株)为2种新发现的SHV型BLA,分别被命名为SHV-48和SHV-56。结论临床分离的引起下呼吸道感染鲍曼不动杆产ESBLs比例很高,多重耐药状况极其严重,至少存在4种不同类型的β内酰胺酶基因,基因型分别为TEM-1、SHV-12、SHV-48和SHV-56。