农村卫生人员继续教育的实践与思考

结合甘肃省农村卫生队伍的实际状况，坚持学历教育与岗位培训并举，分层次、分阶段培训的原则，建立农村卫生人员继续教育网络，构建“自学-培训-评价”三位一体的农村卫生人员继续教育体系。从中认识到：建立继续教育网络是农村卫生人员继续教育的基础工程；提高服务能力是农村卫生人员继续教育的主旋律；构建“自学-培训-评价”三位一体的继续教育体系是农村卫生人员继续教育的质量保证。     

Upper gastrointestinal burns by peroxyacetic acid in children- a review of seven cases

Objective： To study the clinical features of upper gastrointestinal burns by peroxyacetic acid （PA） in children and improve its treatment and outcome. Methods： The clinical materials of 7 cases with upper gastrointestinal burns by PA including clinical presentation, treatment and outcomes were reviewed. Results： There were six boys and one girl. The concentration of the swallowed PA was from 10% to 20% and the amount was 3-10 ml. The mainly bums were located in esophagus in one case, stomach in three cases, both esophagus and stomach in three cases. The gastrostomy and operation of dilating esophagus were performed in the cases with esophageal stricture. The pyloroplasty or gastroduodenostomy was performed in the cases with pyloric obstruction. All the cases were followed up for 12-18 months, dysfunction of esophagus or（and） cardia as well as stiffness and hypodynamia of the stomach was showed in most of the patients. Conclusion： The degree of upper gastrointestinal burns by PA varied according to different concentrations of PA which was swallowed. Correct emergent measures in the acute stage of the burns was very important, gastric tube should be inserted and go through esophagus and pylorus and must be retained for 5-8 weeks to prevent the stricture of esophagus and pylortts, otherwise the tube could act as a passage of nutriment. Prophylaxis of upper gastrointestinal bums by PA is very important because the treatment of the burns is difficulty and the outcomes are not always satisfactory.     

妊娠合并血小板减少112例临床分析

目的:探讨妊娠合并血小板减少的发病机制及围生期的处理方法。方法:回顾分析天津医科大学总医院1992年至2002年间112例妊娠合并血小板减少患者的病因及临床处理经验。结果:112例孕妇中特发性血小板减少性紫癜27例,占24.1%;子痫前期44例,占39.3%;妊娠期特发性血小板减少40例,占34.8%;血栓性血小板减少性紫癜1例,占0.89%。阴道分娩27例,剖宫产85例。产后出血13例,产褥感染1例。结论:多种原因可以导致妊娠妇女血小板减少。如无产科指征,以阴道分娩为宜;血小板<50×109/L时,在血源充足时行剖宫产。不主张采用侵入性检查方法确定胎儿血小板水平。     

急性中毒患者血液毒鼠强的GC/MS检测及临床应用

目的利用气相色谱-质谱（GC/MS）建立一种快速检测中毒患者血液毒鼠强的方法.方法考察5种有机溶剂液-液法提取血液毒鼠强的回收率,研究毒鼠强的线性方程、最低检测限及精密度.结果乙酸乙酯提取毒鼠强的回收率为90.40%,RSD=2.8%,n=5;毒鼠强线性方程为y=156.5x＋236.1,R=0.9988;最低检测限为4ng/ml;日内精密度为RSD为4.3%,日间精密度为RSD为6.7%.解析了毒鼠强质谱图的主要碎片归属.结论所建方法简单快速,灵敏度高,选择性好,可用于临床中毒患者血液毒鼠强的检测.     

硝苯地平制剂的溶出度测定方法

目的测定硝苯地平制剂的溶出度。方法在溶出介质中加入非离子表面活性剂吐温-80,使硝苯地平的溶解度增加至86μg·ml-1。结果及结论此方法完全符合溶出度测定的漏槽条件。     

益气除痰法延长非小细胞肺癌中位生存期的作用

目的:观察益气化痰法延长Ⅲ、Ⅳ期非小细胞肺癌(NSCLC)生存期的作用.方法:采用前瞻性、多中心、随机、对照的临床流行病学方法,将符合标准的病例按肺郁痰瘀型、脾虚痰湿型、阴虚痰热型及气阴两虚型四型辨证施治,辨病治疗以益气化痰法为主,辨证治疗分别以宣肺除痰、益气除痰、滋阴化痰、益气养阴法为主.用乘积极限(K-M)法分析不同证型的中位生存期及中位疾病进展时间.结果:肺郁痰瘀型、脾虚痰湿型、阴虚痰热型及气阴两虚型肿瘤总缓解率分别为9.1%、23.6%、11.5%、13.2%(P<0.05);瘤体总稳定率分别为69.7%、77.8%、69.2%、78.9%(P>0.05);中位生存期分别为308天、401天、300天和326天(P>0.05);1年累积生存率分别为45.63%、51.53%、41.95%、46.01%(P>0.05).结论:益气化痰法可使Ⅲ、Ⅳ期NSCLC的中位生存期达到9个月,与化疗配合应用可达到12个月,是晚期非小细胞肺癌的一种有效治法.其中,脾虚痰湿型患者中位生存期达到13个月,有可能进一步提高疗效.     

The association of XRCC1 haplotypes and chromosomal damage levels in peripheral blood lymphocyte among coke-oven workers.

Theoretically, a haplotype has a higher level of heterozygosity than individual single nucleotide polymorphism (SNP) and the association study based on the haplotype may have an increased power for detecting disease associations compared with SNP-based analysis. In this study, we investigated the effects of four haplotype-tagging SNPs (htSNP) and the inferred haplotype pairs of the X-ray cross-complementing group 1 (XRCC1) gene on chromosome damage detected by the cytokinesis-block micronucleus assay. The study included 141 coke-oven workers with exposure to a high level of polycyclic aromatic hydrocarbons and 66 nonexposed controls. The frequencies of total MN and MNed cells were borderline associated with the Arg(194)Trp polymorphism (P = 0.053 and P = 0.050, respectively) but not associated with the Arg(280)His, Arg(399)Gln and Gln(632)Gln polymorphisms among coke-oven workers. Five haplotypes, including CGGG, TGGG, CAGG, CGAG, and CGGA, were inferred based on the four htSNPs of XRCC1 gene. The haplotype CGGG was associated with the decreased frequencies of total MN and MNed cells, and the haplotypes TGGG and CGAG were associated with the increased frequencies of total MN and MNed cells with adjustment for covariates among coke-oven workers. This study showed that the haplotypes derived from htSNPs in the XRCC1 gene were more likely than single SNPs to correlate with the polycyclic aromatic hydrocarbon-induced chromosome damage among coke-oven workers.     

中西医结合治疗输卵管阻塞性不孕症

陈益昀主任中医师是全国第二、三批中医药专家学术经验继承指导老师，临床悬壶五十余载，治学严谨，注重实际。几十年的临床实践加之深厚扎实的理论功底，尤其能够结合现代医学知识，使其在治疗疾病，立法用药上独树一帜。笔者有幸随师学习，获益匪浅，兹将陈老师运用中西医结合治疗输卵管阻塞性不孕症的经验总结介绍如下：     

注射用对氨基水杨酸钠细菌内毒素检验探讨

用<中国药典>2000年版附录细菌内毒素检验法对PAS进行细菌内毒素检测并建立实验方法.实验结果表明用TAL试剂对PAS最大无干扰浓度为5mg/ml,无干扰作用,提示用细菌内毒素检查法检查PAS中的内毒素是可行的.     

高催乳素血症的临床分析

目的探讨女性高催乳素(PRL)血症的原因和治疗。方法对60例高催乳素血症患者临床资料进行回顾性分析。结果垂体腺瘤22例(36.7%),其中2例行手术治疗,20例予溴隐亭治疗。空蝶鞍l例(1.7%),予手术治疗。药物所致7例(11.7%),其中5例停止服药后3个月恢复正常月经。伴多囊卵巢综合症3例(5.0%),其中1例予促排卵治疗妊娠。甲状腺功能减退2例(3.3%),予口服甲状腺素治疗4月后月经恢复正常。特发性25例(41.7%),其中5例无临床症状者予定期观察,20例伴临床症状者予溴隐亭治疗。60例高催乳素血症患者采用溴隐亭治疗者40例,均取得良好效果。结论高催乳素血症应针对病因进行治疗。溴隐亭仍是治疗高催乳素血症的首选药物。