基于临床流程功能需求的生理监测仪配置评估

病人生理监测仪是临床医学的主要仪器之一，由于所涉及的技术流程定位不同，功能需求也就不同，其功能配置也应有所不同。本文从分解分析生理监测仪相关应用领域的技术定位功能需求出发，讨论卫生技术装备管理的功能配置评估。     

遗传性小脑型共济失调症(附55例报告)

本文分析了55例小脑型遗传性共济失调的临床资料，男女之比为4：1，2/3患者年龄在37～50之间，并发症状多为行走不稳。主要临床表现为兼有躯干和肢体共济失调（78.2％），眼震（56.4），构音障碍（69.l％），约1/4病人有病理征及家族史。讨论了本病与其他疾病所致共济失调的鉴别诊断，以及本病的病理学基础。     

电视传媒在健康知识传播中的作用

电视传媒已成为人类生活中不可缺少的一部分，承担着传播知识与文化的重要任务。电视传媒对一个民族的思想文化影响力、提高该民族在国际社会中的整体形象，都具有不可替代的作用。20世纪80年代，许多健康教育机构就已经开始利用影视传媒手段为健康教育服务，并取得了明显成效。     

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。     

子宫内膜息肉中雌、孕激素受体的表达

目的检测子宫内膜息肉雌激素受体(ER)、孕激素受体(PR)的表达,探索子宫内膜息肉形成的原因及机制。方法子宫内膜息肉48例为观察组,正常子宫内膜36例为对照组,采用免疫组化SP法,行半定量分析,检测ER、PR的表达。结果增殖期的息肉组织中PR表达的评分结果为(2.89±2.16),低于增殖内膜的评分(4.04±1.73),差异有统计学意义(P<0.05);分泌期的内膜息肉中ER表达的评分结果为(3.80±1.64),高于分泌期内膜中的评分(2.64±1.45),差异有统计学意义(P<0.05)。结论增殖期的子宫内膜息肉中PR的表达降低及分泌期的息肉中ER表达增高可能参与了子宫内膜息肉的形成及发展。     

中医药治疗感染性发热病84例

感染性发热病是细菌或病毒等病原微生物侵入人体而引起的急性热病,在临床上一般包括细菌性感染和病毒性感染.临证以发热恶寒、口苦头晕、胸腕痞闷、恶心纳呆、大便不畅或便秘、舌苔黄厚而腻、脉弦滑为主证,属湿热病邪侵入人体所引起的湿温病范畴.我院中医门诊自2000年以来,采用中医药辨证治疗湿热郁遏型感染性疾病获得了较好的疗效,现将资料完整的126例分析如下.     

上颌第一磨牙近中颊根第二根管的治疗体会

目的 探讨在临床上上颌第一磨牙近中颊根第二根管（MB2）的发现及扩通。方法 在25例需要进行根管治疗的上颌第一磨牙上寻找MB2，若无法找到，使用超声根管异物清除工作尖10P清理髓底及慢速圆钻去除预计位置部分牙本质，再次寻找。找到后通畅根管，若无法扩通，使用慢速圆钻在MB2根管口处向根方去除少量牙本质。结合使用EDTA再次通畅根管。结果 25颗治疗齿中有13颗找到MB2（52％），其中2颗是在超声根管锉清理髓室底后发现的，4颗在进一步去除MB2根管口位置的牙本质后发现。8颗治疗齿的MB2通畅（32％），其中3颗自然扩通，5颗在去除MB2根管口处部分矛本质并使用EDTA后通畅。结论 临床上上颌第一磨牙MB2发现率为52％。扩通率为32％。掌握MB2的解剖位置，使用超声方法以及EDTA可提高MB2的发现率和扩通率。     

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal.OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method.DESIGN: 1:1 paired grouping according to gender and controlled observation.SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University.PARTICIPANTS Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items.According to 1:1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45)and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82years, and hospitalized at the 16th to 72th hours after onset.METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy.200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function effect were observed at the same time.effect of drug.RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died ulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9),(41.8±2.1), (19.7±1.7)s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9)s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P ＜ 0.05] ;Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L;After therapy in control group:(4.0±0.6) g/L; P ＜ 0.05]. Platelet aggregation rate decreased from (37.92of total cholesterol (TC), triacylglycerol(TG) and Iow density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,after therapy than before therapy [Before therapy: (43.84±4.55)% ;After therapy: (40.48±4.02)% ;P ＜ 0.05].cantly lower than of control group 14 days after therapy. The total effective rate after therapy was signifiadverse effect.CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit,increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal.OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method.DESIGN: 1:1 paired grouping according to gender and controlled observation.SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University.PARTICIPANTS:Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items.According to 1:1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45)and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82years, and hospitalized at the 16th to 72th hours after onset.METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy.200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index: Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5th, 7th and 14th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time.MAIN OUTCOME MEASURES: ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug.RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9),(41.8±2.1), (19.7±1.7)s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9)s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P ＜ 0.05] ;Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L;After therapy in control group:(4.0±0.6) g/L; P ＜ 0.05]. Platelet aggregation rate decreased from (37.92±0.85)% before therapy to (26.42±1.01)% after therapy (P ＜ 0.01). ②Change of blood lipid level: Levels of total cholesterol (TC), triacylglycerol(TG) and Iow density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,P ＜ 0.05]. ③ Change of hemorheology index: Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy: (43.84±4.55)% ;After therapy: (40.48±4.02)% ;P ＜ 0.05].④ Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [(90±1.2), (97±2.1) cm/s,P ＜ 0.01]. ⑤ NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group (93%,78%, P ＜ 0.05). ⑥There was no obvious adverse effect.CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit,increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.     

人工肱骨头置换术治疗高龄复杂肱骨近端骨折

目的探讨和分析采用人工肱骨头置换术治疗复杂肱骨近端骨折的适应证、手术技术要点和早期疗效。方法对12例肱骨近端四部分骨折伴肱骨头脱位的高龄患者,早期手术行人工肱骨头置换。手术采用三角肌胸肌间入路,先复位大小结节,确定假体高度,骨水泥固定假体保持30°左右的后倾,大小结节再复位固定,必要时取骨折的肱骨头自体骨植骨,术后早期功能锻炼。结果术后平均随访16．6个月,术后未发生感染、神经损伤、关节脱位和假体周围骨折。采用Neer评分系统评定人工关节功能,平均为84．4分,90分以上(优)3例,80～89分(满意)7例,70～79分(不满意)2例,满意率为83．3%。12例患者疼痛方面平均得分为33．5分,功能方面为25．6分,运动方面为16．5分,解剖重建方面为8．8分。结论在正确选择手术适应证、掌握手术技术以及合理的术后康复等前提下,人工肱骨头置换术是治疗高龄患者复杂肱骨近端骨折的有效方法,尤其在减轻创伤后肩关节疼痛方面效果最为显著。但在恢复肩关节活动度方面仍欠满意,需加强对患者术后关节康复训练的指导工作。     

兔关节软骨细胞的分离、培养和形态学特征

[目的]探讨兔关节软骨细胞的分离、培养方法,观察单层高浓度培养时细胞表型表达情况.[方法]无菌条件下,从 2周龄新西兰白兔的颞颌关节及四肢关节髁突面削取软骨片,采用机械-酶消化法分离软骨细胞,经台盼蓝拒染计数,将细胞按 1× 106个 /孔接种于 6孔培养板,传代培养,描绘生长曲线.利用相差显微镜及透射电镜观察细胞形态.应用甲苯胺蓝及Ⅱ型胶原免疫组化对细胞进行鉴定.[结果]每克软骨能获取 1 5× 106个软骨细胞,活性率为 95%.培养 2～ 3 d,细胞贴壁、变形,呈多角形; 8 d左右,细胞融合成层.透射电镜观察显示细胞核圆形,有丰富的粗面内质网、高尔基体及分泌的基质成分.甲苯胺蓝及Ⅱ型胶原染色阳性.细胞传至 5代后,出现"成纤维细胞样".[结论]本研究建立了简单易行的软骨细胞分离、培养方法;初代、第 2代细胞生长良好,适合于实验研究;软骨细胞 5代培养后,细胞表型发生改变.