社区护理人员灾害准备的研究进展

对国内外社区护理人员灾害准备模式、存在的问题、影响因素、培训现状及测量工具进行综述。提出应建立完善的社区护理人员灾害准备培训体系,建立适合我国国情的社区护理人员灾害应对准备模式并建立社区护理人员灾害准备测量工具的区域性常模,旨在为今后提高社区护理人员的灾害准备度提供参考依据。     

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients. Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study. According to the type of stent，the patients were divided into two groups, BMS group (n=46) and CS group (n=20). The demographic data, clinical signs and symptoms, and pre-procedure and post-procedure imaging data were followed up and recorded. The primary patency rates were calculated at 1, 3, 6, 9, and 12 months. Results The related symptoms were improved within 2 day post-procedure. The primary patency rates of BMS group in 1, 3, 6, 9 and 12 months were 97.83%, 95.65%, 69.56%, 41.3%, and 34.78% respectively. The rates of CS group were 100%, 100%, 95%, 65%, and 60% respectively. They did not reached statistical significance for primary patency rates between two groups in 1, 3, and 6 months (P＞0.05 respectively). However, from 9 months after procedure, it began to show the significant difference between two groups (P＜0.05). The median patency time of the CS group was (10.30±5.32) months, while BMS group was (8.52±0.49) months. The difference between the two groups was statistically significant (P=0.046). Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect. The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.     

腰椎终板Modic改变与椎间盘退变对应关系及二者与下腰痛关系的分析

目的：研究腰椎终板Modic改变类型与椎间盘退变的关系及二者与下腰痛（low back pain,LBP）的关系。方法：选取2016年10—12月间行腰椎MRI检查且合并Modic改变的患者200例。Pfirrmann分级评估腰椎间盘退变。通过电话随访,采用VAS法评估LBP。统计Modic改变及邻近椎间盘退变在下腰段（L4/5及L5/S1水平）的分布情况及关系,及二者与LBP的关系。结果：Modic Ⅱ型与Ⅱ?Ⅰ型均与轻度椎间盘退变相关（P < 0.05）。Modic Ⅰ?Ⅱ型与轻度及严重椎间盘均相关（P < 0.05）,而Modic Ⅰ型与严重椎间盘退变相关（P < 0.05）。Modic Ⅰ型、Ⅱ型及Ⅰ?Ⅱ型与LBP相关（P < 0.05）。多因素分析后,严重椎间盘退变（4级）与LBP相关性消失（P > 0.05）。结论：退变程度较高的腰椎间盘易合并Modic Ⅰ型,Modic Ⅱ型更常见于退变程度较低的腰椎间盘;退变初始阶段,Modic Ⅱ型可能向Ⅰ型转换。虽然Modic改变与腰椎间盘退变均与LBP相关,Modic改变的影响可能更直接,而腰椎间盘退变通过Modic改变间接产生影响,因此较弱。     

人工心脏瓣膜置换术后关节置换的围手术期抗凝治疗策略

背景:目前,对于人工心脏瓣膜置换术后关节置换患者围手术期的抗凝治疗尚无统一认识。目的:探讨人工心脏瓣膜置换术后关节置换患者围手术期使用低分子肝素(LMWH)替代华法林抗凝治疗的安全性和有效性。方法:回顾性分析2007年4月至2011年6月行人工心脏瓣膜置换术后关节置换患者19例。术前3天采用LMWH替代治疗。术后出现出血倾向时停用LMWH并输入血浆,补充凝血因子,同时给予夹闭引流,患肢加压包扎等对症治疗。术后鼓励下肢肌肉等长收缩训练,拔出引流后离床活动,并辅以下肢静脉泵和下肢弹力袜治疗。术后7 d开始加用术前用量的华法林,术后10 d左右停用LMWH。记录术中出血量和术后引流量,计算平均国际标准化比值(INR),评价术后出血和血栓情况。结果:19例患者的术中出血量为230～520 ml,平均(347±81)ml;术后引流量为480～820 ml,平均(607±103)ml。19例患者术后INR平均值为2.16±0.43。术后无一例出现重度出血,11例出现轻度出血,给予相应治疗后好转。无一例出现血栓征象。结论:人工心脏瓣膜置换术后关节置换患者围手术期使用LMWH替代华法林抗凝治疗可有效预防血栓形成。出现出血症状后及时停药、输入血浆、补充凝血因子以及对症治疗,同时给予术侧肢体加压包扎、夹闭引流可及时有效控制出血。术后鼓励早期功能锻炼、应用下肢静脉泵和抗血栓袜可协助预防血栓行成,有助于患者快速康复。     

青海省环境中氡及其子体浓度所致居民内照射剂量

本文对青藏高嫌北部的青海省室内外氡-222及其子体进行了测量。采用闪烁法测氡浓度, 托马斯三段法测氡子体α潜能浓度。测量了162个居室和161个室外的氡及其子体浓度。全省室内外氡的平均浓度分别为：20.94Bq·m^-3和8.01mq·m^-3。     

Hangman骨折伴椎间盘损伤的诊断与外科治疗

目的探讨Hangman骨折伴C2-3椎间盘损伤的病理特点及其外科治疗方法。方法21例Hangman骨折伴颈2-3椎间盘损伤患者,均进行颈椎前路C2-3椎间隙融合术,其中18例行颈前路钢板固定。分析其损伤类型、影像学特点和疗效。结果未出现神经症状加重、植骨块移位、吸收和切13感染等并发症,新鲜骨折的枢椎脱位和C2-3成角得到良好恢复,术后6个月C2-3植骨以及枢椎椎弓骨折都获得骨性融合。随访8个月至4年,平均随访2年7个月,绝大部分术前症状消失。结论Hangman骨折并不限定于枢椎椎弓根骨折,合并椎间盘损伤的Hangman骨折是一种特殊的骨折类型,颈椎前路融合手术是符合其病理生理特点的手术方法。     

单球囊与双球囊后凸成形术对椎体复位作用的研究

目的探讨单球囊与双球囊后凸成形术对椎体压缩骨折复位作用的差异,评价后凸成形术的临床疗效。方法对2000年5月～2004年5月应用球囊扩张后凸成形术(KP)施行椎体复位的58例胸腰椎椎体压缩性骨折(VCFs)患者(90个椎体)的临床资料进行了回顾性分析。58例患者90个椎体分为单球囊组(28个椎体)和双球囊组(62个椎体),两组均经双侧椎弓根穿刺,扩张后灌注骨水泥,分别采用单球囊双侧交替扩张和双球囊双侧同时扩张的方法。分别测量术前术后椎体高度和Cobb角,比较术前术后及两组之间的差异。结果患者术后疼痛均明显减轻或消失。椎体高度平均恢复率726%(229～100%);Cobb角由术前179°(31°～316°)矫正至术后96°(06°～282°),平均矫正87°(03°～272°),术前、术后相比差异有极显著性意义(P<0001)。单球囊组和双球囊组术后椎体高度平均恢复率分别为776%(553%～100%)和643%(229%～100%),术后平均矫正Cobb角分别为99°(03°～272°)和86°(06°～198°),两组相比差异无显著性意义(P>005)。结论后凸成形术可有效缓解椎体压缩骨折患者的疼痛,恢复椎体高度,改善后凸畸形;单球囊与双球囊后凸成形术同样能使压缩骨折的椎体获到较好复位。     

C1–2 transarticular screws combined with C1 laminar hooks fixation: a modified posterior atlantoaxial fixation technique and outcome in 72 patients

Purpose

To retrospectively evaluate the outcome of C1–2 transarticular screws combined with C1 laminar hooks fixation.

Methods

All patients underwent atlantoaxial fixation during a 5-year period. The surgical technique and treatment procedures were intensively reviewed and clinical symptoms, neurological function and imaging appearance were retrospectively evaluated.

Results

The clinical and radiology follow-up indicated a stable arthrodesis and clinical relief from symptoms for all patients. All patients with neurological defects improved an average of 1.33 grade at their most recent clinical assessment, P < 0.05; their average admission ASIA motor score, pin prick score and light touch score improved to an average follow-up ASIA score of 99.80 (99.83 ± 0.38), 111.83 (111.83 ± 0.45), and 111.89 (111.89 ± 0.32), respectively. No neurovascular impairment and case of implant failure were observed.

Conclusions

The C1–2 transarticular screws combined with C1 laminar hooks fixation is a reliable technique for atlantoaxial instability.     

中晚期肝癌化学免疫治疗与单纯TAE治疗疗效比较

本文采用肝动脉化学栓塞(TAE)后1～2周内行LAK/IL2的化学免疫治疗(Chemo-immu-notherapy CIT)中晚期肝癌(Mid-advanced HCC)42例(CIT组),TAE治疗2 7例为对照(TAE组)。结果:Ⅱ期HCC 2年生存率47.4％,Ⅱ期HCC部分缓解率(PR)和3个月、半年、1年生存率分别为39.1％、73.9％、56.5％和34.7％,显著高于TAE组Ⅱ期HCC二年生存率16.7％,(P<0.05)和Ⅱ期HCC部分缓解率为6.7％,三个月、半年、1年生存率40.0％,13.3％和6.7％,P<0.05;Ⅱ期HCC 1年内肝外转移率(25.5％)明显低于TAE组(66.7％,P<0.05)。表明化学免疫治疗能显著提高中晚期肝癌疗效。     

氧暴露剂量对人肺呼吸功能的影响

本文对８名受试者在０．２５～０．２７ＭＰａ下进行三种氧剂量暴露后的肺呼吸功能和Ｘ线胸片跟踪观察，目的在于验证整体实验功能结果对本室以往肺表面活性物质（ＰＳ）物理特性测定结果的符合性。结果表明，氧暴露剂量达到１０６０ＵＰＴＤ（肺型氧中毒剂量单位）时，对呼吸道粘膜、肺泡内皮细胞可产生一定程度影响，导致ＦＥＶ１、ＦＥＶ，％、ＭＭＦ、Ｖ１０（呼气流速）显著改变（Ｐ＜０．０５或Ｐ＜Ｏ．０１），但在停止暴露后４—１２ｈ内上述指标完全恢复。以上与本室以往ＰＳ物理特性测定结果相一致。本义肺活量降低程度较Ｗｒｉｇｈｔ（１９７２）报道的小，Ｘ线胸片无异常；因此，间断用氧要达到连续用氧的等效剂量，应对Ｗｒｉｇｈｔ计量法进行一些修正。