北京市2010年麻疹减毒活疫苗补充免疫活动前后麻疹流行病学特征变化

目的分析北京市2010年麻疹减毒活疫苗(Measles Attenuated LiveVaccine,MV)补充免疫活动(Supplem entary Immunization Activities,SIAs)前后麻疹流行病学特征,评价控制麻疹效果,为消除麻疹提供参考。方法利用2005～2010年麻疹逐月发病数据建立自动回归滑动平均混合模型(Autoregressive Integrated MovingAverage,ARIMA),预测2011年发病水平,采用描述流行病学方法,对北京市实施MVSIA前后麻疹监测数据进行分析。结果预测实施MVSIA前麻疹发病率为49.5/100万,实施MVSIA后麻疹发病率为5/100万,较预测水平下降89.9%。各年龄组麻疹发病率均有大幅下降,削平了季节性流行高峰。实施MVSIA后,≤4岁和15～39岁人群麻疹发病仍占较大的构成比,分别为37.8%和53.1%。结论北京市2010年实施MVSIA后,麻疹发病大幅下降。为进一步降低麻疹发病水平,应维持高水平常规免疫,提高MV及时接种率,加强学龄前散居儿童和成人查漏补种,最大程度提高免疫水平。     

基于渗透压原理实现尼莫地平可控释药系统的研究

目的 制备基于渗透压原理的尼莫地平渗透泵胶囊,考察影响其释药行为的因素,优化处方并考察其释放机制。方法 根据尼莫地平渗透泵胶囊在体外累积释放度与零级方程拟合度,对囊壳、含药层、助推层的辅料种类和用量进行单因素考察,选出释放主要影响因素为致孔剂用量、含药层并检测其渗透压活性物质用量和膨胀剂用量,利用Box-Behnken设计法对其进一步优化,确定最优处方。制备3批尼莫地平渗透泵胶囊体外释放度与零级方程拟合考察其释药特性,再使用相似因子法(f₂)进行释放机制研究。结果 尼莫地平渗透泵胶囊最优处方为致孔剂(PEG 6000)用量14 mg、含药层渗透压活性物质(NaCl)用量33.7 mg、膨胀剂(PEO 800万)用量33.2 mg,制备的尼莫地平渗透泵胶囊在12 h内药物释放较完全,致孔剂为药物提供释药途径,渗透压活性物质为释药动力。结论 尼莫地平渗透泵胶囊控释效果良好,累积释放度大于90%,并且接近零级释放方程,符合预期。     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.     

30例心肌梗塞的护理体会

目的:探讨有效抢救心肌梗塞的方法及护理.方法:及时改善缺氧、止痛、溶栓.在30例急性心梗患者中,抢救成功25例,死亡5例.结论:系列及时的内科治疗可提高心肌梗塞的治愈率,降低死亡率,严密观察病情及细心的护理是抢救成功的关键.     

全身热疗联合艾迪注射液改善晚期癌症患者生存质量的研究

目的观察在热增强效应下抗癌中药艾迪注射液改善晚期癌症患者生存质量的临床疗效。方法观察组35例采用全身热疗联合艾迪注射液,对照组36例单独运用艾迪注射液,观察两组患者生存质量、止痛效果、肿瘤进展时间等变化。结果观察组的卡氏评分值平均提高36．51分,对照组提高25．69分,观察组提高尤为明显,二组相比有显著性差异（P〈0．05）;观察组止痛总有效率达57．14％;对照组总有效率为52．77％,二组均有一定的止痛效果,但观察组止痛效果稍好。观察组肿瘤进展时间为（62．33±8．25）d,对照组为（60．27±6．84）d,无显著性差异。结论全身热疗联合艾迪注射液能有效地提高晚期癌症患者的生活质量,同时有较好的止痛作用,并且在控制肿瘤进展方面也有一定的优势。     

紫杉醇治疗晚期非小细胞肺癌的护理

随着医学的发展 ,越来越多的抗癌药物应用于临床 ,并取得了一定疗效。我科自 1998年起应用紫杉醇治疗晚期非小细胞肺癌 8例 ,疗效满意。由于紫杉醇的毒副反应 ,在护理上与其他抗肿瘤药相比有特殊之处 ,因此 ,在使用紫杉醇药物治疗时 ,做好临床护理是必要的。1　临床资料1.1　一般资料8例患者均为晚期非小细胞肺癌住院患者 ,男 7例 ,女 1例 ;平均年龄为 48岁 (34～ 6 0岁 )。经病理组织学或细胞学检查确诊 ,肝肾功能及血常规正常。1.2　药物用法紫杉醇剂量为 135～ 2 10 mg/ m2 ,溶于生理盐水或 5 %葡萄糖生理盐水 5 0 0 ml。用聚乙烯输液器…     

多院区医院行政总值班制度建设和管理实践

针对多院区行政总值班管理难点,采取值班搭配特色化,岗位职责差异化,值班要求标准化,管理培训统一化,停班管理严格化,值班保障人性化等措施,通过加强管理,保证医院非办公时间问题处置的高效率、标准化、同质化。     

依洛尤单抗短期快速调脂在高危急性冠状动脉 综合征患者中应用价值

目的探讨依洛尤单抗的调脂疗效、安全性以及在极高危急性冠状动脉综合征(ACS)患者中的应用价值。方法选取2019年2—7月北部战区总医院心血管内科收治的35例高脂血症合并ACS的患者为研究对象。所有患者均在他汀类药物治疗的基础上加用依洛尤单抗140 mg皮下注射(他汀类药物不耐受患者单用依洛尤单抗),7～10 d后复查血脂指标,比较用药前后血脂指标的变化情况。结果应用依洛尤单抗后,患者的总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇(LDL-C)均较用药前明显下降,差异有统计学意义(P<0.05)。其中,LDL-C较用药前降幅达59.84%,LDL-C降至1.80 mmol/L者达28例(80.00%)。结论依洛尤单抗可快速降低患者的胆固醇和LDL-C水平,对甘油三酯也有明显改善效果,有望成为降脂治疗领域一个新的里程碑式的药物。     

合并心力衰竭ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗临床疗效分析

目的探讨心力衰竭对直接经皮冠状动脉介入术(PPCI)治疗急性ST段抬高型心肌梗死(STEMI)患者院内疗效的影响。方法回顾性分析全军心血管介入诊疗管理系统中接受PPCI治疗的8 760例STEMI患者的临床资料。根据有无合并心力衰竭将STEMI患者分为常规组(KILLIPⅠ级,n=7 787)与观察组(KILLIPⅡ～Ⅳ级,n=973)。比较两组患者的救治时间指标、临床各项主要指标、院内死亡事件及其他临床心脏不良事件发生情况等。结果观察组患者发病年龄以及女性、高脂血症、既往陈旧性心肌梗死病史、入院诊断为前壁心肌梗死患者比例明显高于常规组,两组比较,差异均有统计学意义(P<0.05)。观察组介入术中主动脉内囊反搏术应用比例、D2B时间、三支血管病变比例明显高于常规组,而单支血管病变比例低于常规组,两组比较,差异均有统计学意义(P<0.05)。观察组院内病死率明显高于常规组,其中,观察组术中、术后病死率均高于常规组,两组比较,差异均有统计学意义(P<0.05)。二元Logistic逐步回归分析发现,年龄、前壁心肌梗死及D2B时间是STEMI患者发生心力衰竭的独立危险因素(P<0.05)。结论合并心力衰竭的STEMI患者PPCI院内病死率增高,针对发生心力衰竭的独立预测因子,应尽量缩短D2B时间,积极优化围术期救治策略,减少心力衰竭的发生,以期降低患者院内病死率,改善长期预后。