母婴保健实行医院社区联合管理模式的研究

Objective To explore the feasible management mode of maternal and infant care in order to improve the level of maternal and infant health. Methods The "love maternal and infant project" was constructed to carry out maternal health for the whole period of management seamlessly by the mode of combining hospital and eommunity. Result Adding "love maternal and infant project" increased maternal self-health awareness and health care, the complications during pregnancy was prevented, the birth defects was also effective prevented, and maternal and neonatal mortality were significantly reduced (from 7.4‰ to 0.8‰).Conclusion The management model of hospital-based, community as a supplement can improve maternal health and increase, puerperant and family mem-bers' awareness of consciously obeying the demands of inspection and monitoring. The health care system should be rigorous, long-term and continuing, and suitable for a certain size and equipment general hospital.     

遗忘型轻度认知损害患者海马三维磁共振影像特点

Objective To identify the characteristics of hippocampal 3-dimensional MRI in patients diagnosed as having subtypes of amnestic mild cognitive impairment(aMCI)using hippocampal surfacebased analytic technique.Methods Fifry aMCI patients and 16 healthy controls who were equivalent in age and education(NC)were recruited.Every subiect carried out a 3-dimensional MRI scan.After the imaging data were acquired.the borders of the hippocampus were manually traced in coronal vlew using the software of InsightSNAP1.4.1. Hippocampal volume was computed automatically and statistically analysed.Hippocampal 3-dimension MRI were transformed into 3-dimension parametric surface mesh models of 400×200 prids.Hippocampal radial distance measures which was the distance from the surface point to the central axis were statistically compared between two groups.The radial atrophy significance maps were acquired and adjusted for multiple comparisons.Hippocampal morphological difference maps of aMCI in contrast with NC were acquired.Results The average normalized volume of left hippocampus were(3247.5±600.2)mm3 in aMCI patients and(3467.9±451.3)mm3 in NC subjects.The average normalized volume of right hippocampus were(3416.8±699.1)mm3 in aMCI patients and(3469.1±358.9)mm3 in NC subjects.Comparison of hippocampal volume did not differ significantly between aMCI patients and NC subjects(t=1.161,P=0.255;U=0.178,P=0.859).By using hippocampal surface-based morphologic analytic technique,3-dimension hippocampal morphological difference maps between two groups were acquired,showing significant atrophy on the lateral and inferior hippocampal surface which corresponded to CA1 and subiculum hippocampal subfields bilaterally in aMCI patients compared with NC subjects. Conclusions aMCI patients do not have significant volume loss in the hippocampus. Through hippocampal surface-based morphologic analyses, partial regional atrophy of hippocampus at some degree is found, mainly localizing in the lateral and inferior hippocampal regions which correspond to CA1 and subiculum hippocampal subfields bilaterally in aMCI compared with NC. These results may reflect the early image marker in aMCI.     

人脐血单个核细胞静脉移植心肌梗死模型兔心肌组织肿瘤坏死因子α的表达

背景：有报道指出心肌梗死部位及其周围区域炎性细胞浸润和炎性因子渗出,参与心室重构、心功能损害的发生和发展,干细胞移植治疗心肌梗死与移植干细胞抑制心肌梗死后局部炎症反应相关。 目的：探讨静脉移植人脐血单个核细胞对兔心肌梗死后心肌组织炎症反应及炎性因子肿瘤坏死因子α表达的影响。 设计、时间及地点：随机对照动物实验,于2008-02/12在中南大学湘雅医院医学实验研究中心和中南大学实验动物学部完成。 材料：6份脐血来自中南大学湘雅医院产科身体健康足月分娩的产妇。健康纯种中国家兔45只,随机分为细胞移植组、模型组、假手术组,15只/组。 方法：Ficoll法分离培养人脐血单个核细胞,传至第2代用于移植,移植前24 h行BrdU标记,调整浓度至0.04×1013 L-1。细胞移植组、模型组兔结扎冠状动脉左前降支建立急性心肌梗死模型,假手术组兔左前降支穿线不结扎。造模后24 h,细胞移植组经耳缘静脉注入0.5 mL人脐血单个核细胞悬液,含2×107个人脐血单个核细胞;模型组、假手术组同法注入等量生理盐水。分别于细胞移植后1,2,4周取材。 主要观察指标：超声心动图测量结果,心肌组织切片白细胞计数,免疫组化检测心肌BrdU阳性细胞及肿瘤坏死因子α的表达水平,RT-PCR法检测心肌肿瘤坏死因子αmRNA的表达。 结果：与模型组比较,移植后1,2,4周细胞移植组心功能明显改善,左室短轴缩短率及左室射血分数均明显升高(P < 0.05);各时间点细胞移植组白细胞数均明显降低(P < 0.05)。移植后第4周,假手术组心肌细胞无肿瘤坏死因子α表达;模型组可见明显肿瘤坏死因子α表达;细胞移植组肿瘤坏死因子α表达程度明显减弱,且呈黄褐色的BrdU阳性细胞散在分布于梗死周边区域。与模型组比较,移植后1,2,4周细胞移植组肿瘤坏死因子αmRNA的表达水平均明显降低(P < 0.05)。 结论：静脉移植人脐血单个核细胞可改善兔心肌梗死后心功能,抑制心肌组织肿瘤坏死因子α表达,减轻心肌梗死后局灶性炎症反应。     

宋立群教授从气化理论辨治水肿病经验介绍

宋立群是黑龙江中医药大学附属第一医院教授,主任医师,肾内科主任、中医内科教研室副主任,医学博士,博士研究生导师。宋教授精研中医学经典,对现代肾脏病研究又有较深造诣。对水肿病的辨治认识独到,提出气化是水液运化的动力,气机的升降出入是水液在体内的运动形式,     

急性肠梗阻病因及手术时机探讨

目的探讨急性肠梗阻的发病原因及手术时机。方法回顾性分析怀化市第二人民医院2。04年7月～2。09年2月入院治疗的162例急性肠梗阻患者的临床资料。结果粘连性肠梗阻占42．6％;恶性肿瘤性肠梗阻占32．1％;嵌顿疝性肠梗阻占1o6％;其他147％。3例因手术后多器官功能衰竭死亡,8例放弃治疗出院,5例好转出院．其余的146例均治愈出院。结论粘连和恶性肿瘤性肠梗阻是位居前两位的肠梗阻类型,采取一些措施以降低腹部手术后肠粘连的发生率是有必要的。单纯性肠梗阻发展为绞窄性肠梗阻死亡率会急剧上升,加强病因分析、选择合适的手术时机是降低肠梗阻死亡率的关键。绞窄性肠梗阻不是肠梗阻手术治疗的唯一适应证,当急性肠梗阻保守治疗72h仍无效,应积极手术,早期及时手术处理是最有效的治疗手段。     

多层螺旋CT血管成像诊断主动脉夹层的临床应用研究

目的探讨多层螺旋CT血管成像（MSCTA）在主动脉夹层中的应用价值。方法回顾性分析56例主动脉夹层的CT表现,后处理方法采用容积再现法（VR）、表面覆盖法（SSD）、最大密度投影（MIP）、多平面重组（MPR）及曲面重建等处理技术,以VR作为诊断的主要依据,其他重组方法作为补充。结果56例主动脉夹层中,主动脉增宽28例（50％）,观察到内膜钙化移位22例（39．3％）,心包纵隔积血18例（32．1％）,胸腔积液12例（21．4％）。结论多层螺旋CT血管成像对主动脉夹层有较高的诊断价值,能较好的显示真假腔、内膜及受累血管的范围,为手术提供重要信息。     

历代医家运用导引吐纳治疗头痛的经验

古代气功大多集中在道教著作中,中医古籍文献记载的气功较为分散,难于查找。我们在建立“导引吐纳类气功中医古籍文献数据库”的基础上,总结了历代医家运用导引吐纳治疗头痛的27条功法,除去动作、功效完全相同者,共计17种。     

医疗纠纷对医学生实习的影响及对策

近几年,医疗纠纷的发生率不断上升,这给医学生的实习带来了新困难、新阻力、新课题,直接影响实习效果。如何排除干扰、克服困难、引导医学生顺利完成实习任务并打下坚实的基础值得医学教育界重视和积极应对。     

加味血府逐瘀汤对冠心病稳定型心绞痛的临床疗效

目的 观察加味血府逐瘀汤对冠心痛稳定型心绞痛的临床疗效.方法 将纳入的60例患者随机分为治疗组与对照组,每组30例,对照组予以常规西药治疗,对照组在此基础上予以加味血府逐瘀汤口服,观察两组患者治疗前后临床证候.结果 结论     

经脐入路腹壁无疤痕腹腔镜胆囊切除术的临床观察

目的:探析经脐入路腹壁无疤痕腹腔镜胆囊切除术的临床疗效。方法:入选我院2010年5月～2012年5月间收治的60例具有胆囊疾患的患者,按随机原则分为治疗组和对照组各30例,分别进行单孔腹腔镜胆囊切除术和传统三孔法腹腔镜胆囊切除术,观察分析两组手术有效率、手术时间、出血情况、出院时间、并发症以及有无可见疤痕等。结果:治疗组30例患者有1例中转开腹手术手术成功,对照组30例患者全部手术成功,差异无统计学意义。治疗组平均手术时间2.1(h 1.75～2.67h),术中平均出血量5ml(2～8ml),术后无出血,术后1～3天出院,均未有胆总管损伤等并发症发生,平均随访2月(1.5～3月),未有腹壁可见疤痕;对照组平均手术时间1小时(0.5～1.5h),术中平均出血量4ml(2～6ml),术后1～3天出院,无并发症发生,平均随访2月(1.5～3月),上腹部腹壁有明显疤痕。结论:针对有胆囊疾患的患者实施经脐入路腹壁无疤痕腹腔镜胆囊切除术安全有效,无可见疤痕。