应用多层螺旋CT多方位重建技术诊断急性阑尾炎的价值

目的探讨多层螺旋CT多方位重建(MPVR)诊断急性阑尾炎的价值。方法2002年2月至2003年9月临床疑诊阑尾炎收治入院手术患者39例,术前均作了常规扫描和MPVR重建2种CT检查,术后31例确诊为阑尾炎,从阑尾充血、水肿至阑尾脓肿共分5级(正常阑尾为0级)。结果对照手术病理,MPVR重建诊断急性阑尾炎准确率872%,敏感度903%,特异度75%,阳性预测值933%,阴性预测值667%。常规CT检查诊断急性阑尾炎准确度385%,敏感度387%,特异度375%,阳性预测值706%,阴性预测值136%。28例确诊急性阑尾炎的MPVR重建片所示5种主要征象及出现频率如下阑尾肿大(管腔直径>6mm)(964%),阑尾结石(267%),回盲部肥厚(367%),阑尾周围炎(714%),脓肿(107%)。结论多层螺旋CTMPVR重建技术显著提高了CT对临床症状模棱两可、临床疑诊急性阑尾炎患者的术前诊断能力,并可减少重型阑尾炎病例的发生。     

中国原发性肝癌临床分期预测肝癌肝移植预后的临床研究

目的评价“中国原发性肝癌临床分期”对肝癌肝移植疗效的预测价值。方法对1993年4月至2003年1月我科59例采用肝移植治疗的肝癌病人临床资料进行回顾性分析,按中国原发性肝癌临床分期原则进行分期,比较各期间肝癌肝移植疗效。结果Ⅰb、Ⅱa、Ⅱb、Ⅲa和Ⅲb期移植术后1年生存率分别为83·33%、66·67%、50·00%、35·71%和16·67%,各期间术后累计生存率有统计学差异(P<0·01);Ⅰb~Ⅱb和Ⅲa~Ⅲb期移植术后1年生存率分别为66·67%和25·00%,2年生存率分别为45·71%和25·00%,两组间术后累计生存率有统计学差异(P<0·05)。结论中国原发性肝癌临床分期适用于肝癌肝移植术前分期。     

阿托伐他汀对冠心病患者肱动脉内皮依赖性舒张功能的影响

目的：应用高频超声观察冠心病（CAD）患者，经阿托伐他汀治疗后对肱动脉内皮依赖性舒张功能（EDD）的改善作用。方法：经冠脉造影（CAG）确诊为CAD患者59例，利用高频超声血管技术检测阿托伐他汀对CAD患者治疗前后肱动脉EDD的疗效。结果：阿托伐他汀治疗2年后，EDD比治疗前有明显改善（P〈0．05），与对照组相比无显著性差异（P〉0．05）。常规治疗组治疗2年后，EDD无明显改善（P〉0．05），与阿托伐他汀组治疗后及对照组相比差异有显著性（P〈0．05）。结论：阿托伐他汀具有改善EDD的作用。     

耐药性癫(癎)患者颞叶中细胞周期依赖性蛋白激酶5的表达

目的 研究细胞周期依赖性蛋白激酶5(cyclin dependent kinases 5,CDK5)在耐药性癫(癎)患者颞叶中的表达,探索其在耐药性癫(癎)发病机制中的作用.方法 收集耐药性癫(癎)患者术后脑组织,用荧光定量PCR、免疫组化和Western blot 3种检测方法从基因和蛋白水平分别测定CDK5在耐药性癫(癎)患者颞叶中的表达,并与对照组进行比较.结果 荧光定量PCR发现CDK5 mRAN比对照组明显增加,免疫组化检测显示这种基因的蛋白表达产物主要分布在神经元轴突和胶质细胞中,Western blot检测在相对分子质量35 000处有一蛋白条带,并且可见实验组(颞叶和海马中分别为1.4293±0.1839和2.0733±0.4738)高于对照组(颞叶和海马中分别为0.9680±0.4147和1.403±0.6163,P＜0.05).结论 CDK5在耐药性癫(癎)患者颞叶中表达增强,提示他们可能参与了耐药性癫(癎)的形成.     

缺血性脑血管病患者血清基质金属蛋白酶水平及影响因素分析

目的 比较急性脑梗死、短暂脑缺血发作(TIA)和陈旧脑梗死患者血清基质金属蛋白酶-9(MMP-9)水平并分析其影响因素.方法 缺血性脑血管病患者136例,分为急性脑梗死组57例,TIA组22例,陈旧脑梗死组57例,进行神经功能评分及血压、血常规、血脂、血糖检查.依据ELISA法进行血MMP-9测定.结果 MMP-9水平分别为急性脑梗死患者(444.13±418.46)ng/ml,TIA患者(374.36±278.31)ng/ml,陈旧脑梗死患者(231.11±367.43)ng/ml.急性脑梗死和TIA患者血MMP-9水平明显高于陈旧脑梗死患者(P＜0.05).MMP-9水平与血白细胞水平(r=0.192,P=0.025)、低密度脂蛋白(r=0.261,P=0.002)、收缩压(r=0.232,P=0.006)呈正相关;与高密度脂蛋白(r=-0.219,P=0.011)和血糖(r=-0.254,P=0.003)呈负相关.MMP-9与收缩压(β=0.259,P=0.001)、血白细胞(β=0.209,P=0.008)、低密度脂蛋白(β=0.586,P=0.000)、胆固醇(β=-0.458,P=0.007)和血糖(β=-0.200,P=0.014)具有线性关系.结论 MMP-9水平在急性脑梗死及TIA时升高,收缩压、血白细胞和低密度脂蛋白均可能为其影响因素.     

医疗设备维护管理信息系统的开发与研究

本文基于C Builder和SQLServer开发平台,介绍了设备维护管理信息系统的开发设计,实施及应用拓展,为医院对医疗设备的维护管理及科学决策作出积极探索。     

Comparison of Minimum Alveolar Concentration between Intravenous Isoflurane Lipid Emulsion and Inhaled Isoflurane in Dogs

Background: As in inhaled isoflurane anesthesia, when isoflurane lipid emulsion (ILE; 8%, vol/vol) is intravenously administered, the primary elimination route is through the lungs. This study was designed to determine the minimum alveolar concentration (MAC) and the time course of washout of isoflurane for intravenously infused ILE by monitoring end-tidal isoflurane concentration.

Methods: Twelve healthy adult mongrel dogs were assigned randomly to an intravenous anesthesia group with 8% ILE or to an inhalation anesthesia group with isoflurane vapor. An up-and-down method and stimulation of tail clamping were used to determine MAC of 8% ILE by intravenous injection in the intravenous anesthesia group and MAC by the inhaled approach in the inhalation anesthesia group, respectively. Isoflurane concentration and partial pressure in end-tidal gas, femoral arterial blood, and jugular venous blood were measured simultaneously just before each tail clamping and during washout.

Results: The induction time in the intravenous anesthesia group (105 +/- 24 s) was shorter than that in the inhalation anesthesia group (378 +/- 102 s; P < 0.01). MAC of 8% ILE by intravenous injection (1.12 +/- 0.18%) was significantly less than MAC by the inhaled approach (1.38 +/- 0.16%; P < 0.05). No significant difference was found between the two groups in the time course of washout of isoflurane.     

分步骤法维护三向瓣膜式PICC导管留置效果观察

目的预防外周中心静脉导管置管(PICC)后滑脱及体外部分非人为移入体内,减少局部炎症反应,防止导管性静脉炎发生.方法将42例接受PICC的肿瘤化疗患者随机分为观察组(n=22)和对照组(n=20),观察组采用分步骤法维护,即分步骤地更换透明贴膜及肝素帽(或先换肝素帽,再换透明贴膜),并将导管体外部分直形固定;对照组采用传统法维护,即同时更换透明贴膜及肝素帽,导管体外部分S形固定.结果观察组静脉炎,穿刺点渗液、硬结,导管移位发生率显著低于对照组(P<0.05,P<0.01).结论行PICC导管维护时,分步骤更换透明贴膜及肝素帽,将导管体外部分直形固定,可有效防止导管滑脱及体外部分进出体内,减少局部炎症反应,预防导管性静脉炎.     

MRI测量颈胸角在选择颈胸段脊柱手术入路中的临床应用

目的 :探讨在颈胸段脊柱术前应结合患者的颈胸段MRI的个体特征和疾病情况 ,选择手术创伤最小的手术入路。方法 :共 76例患者 ,其中 2 6例为颈胸段脊柱损伤 ,35例为颈胸段脊柱肿瘤 ,脊髓型颈椎病 12例 ,以及 3例颈胸段椎板减压术后后凸畸形。男 4 7例 ,女 2 9例。平均年龄 4 5 5岁 ,年龄范围 19～ 6 5岁。同时抽取 95套颈胸段MRI片。作胸骨上切迹向后水平延长线和胸骨上切迹向后上方至C7T1椎间盘前缘中点的连线 ,测量两线之夹角 ,称为颈胸角 (cervicothoracicangle ,CTA)。结果 :CTA平均为 4 7 6 4°(范围 2 5°～ 73°)。大于此平均角度且病灶在胸骨切迹水平线以上时可考虑低位下颈椎入路 ,5 0例 ;CTA较小 ,且病灶范围广 ,或尚累及T3 、T4,可以考虑经胸骨柄入路 ,13例 ;病灶范围广泛 ,经全胸骨入路 3例 ;Ⅰ期或Ⅱ期前后联合入路 5例 ;经右侧肩胛下后外侧胸腔入路 5例。结论 :颈胸段脊柱手术应尽量选择低位下颈椎入路等创伤较小的入路 ,其次考虑经胸骨柄入路。长节段脊柱受累的患者才考虑经右侧肩胛下后外侧胸腔或经全胸骨等创伤较大的入路。术前可以结合患者的病灶累及范围和颈胸手术角等MRI影像学表现 ,从而利于选择最合适的手术入路 ,减少手术风险、手术创伤和并发症 ,利于患者早日康复     

Health-related quality of life in Taiwanese patients with bronchial asthma.

BACKGROUND AND PURPOSE: Health-related quality of life (HRQOL) is primarily an assessment of how domains of life are affected by health. This study investigated the factors influencing HRQOL of Taiwanese patients with bronchial asthma. METHODS: A cross-sectional study was conducted to assess the factors influencing HRQOL. The sample consisted of 242 outpatients with bronchial asthma. The Chinese language version of the St. George's Respiratory Questionnaire was used to measure HRQOL. Data were analyzed using simple regression and multiple regression. RESULTS: Age, marital status, level of education, asthma severity, peak expiratory flow, and previous hospital admissions were found to be predictors of HRQOL. Gender, duration of disease, and history of emergency visits were not correlated with HRQOL. The variables entered in the HRQOL model accounted for 17.4% of the total variance (adjusted R(2)). The regression coefficients indicated that the mean scores increased 7.68 in patients with moderate to severe disease severity, and increased 7.34 in patients with a history of hospital admissions. The mean scores decreased 7.60 in married patients. CONCLUSION: This study found that marital status, asthma severity, and history of hospital admissions were major predictors of HRQOL in Taiwanese patients with bronchial asthma.