多发伤的漏诊分析

目的分析多发伤患者漏诊的原因并探讨其预防对策,以降低漏诊的发生率。方法对2008年1月～2009年12月本院收治的207例多发伤患者进行回顾性分析,分为漏诊组（26例）和无漏诊组（181例）进行比较。结果 207例患者中有26例漏诊（12.56%）。与无漏诊组比较,漏诊组患者ICU治疗时间、住院时间长、创伤评分（ISS）、死亡率较高（P〈0.05）。造成漏诊的原因以患者意识障碍无法提供病史、医师评估不充分、患者生命体征不稳定无法进一步检查有关。结论对多发伤患者特别应防止发生脊柱、胸腹部等部位重大漏诊,而使患者致残或失去抢救机会。努力避免主观因素,规范、反复的创伤评估,是减少多发伤早期诊断时漏诊的关键。     

对非内分泌科护士胰岛素笔注射技术相关知识的调查

目的:调查非内分泌专科护士对胰岛素笔注射技术相关知识的掌握情况,为制定胰岛素笔注射技术相关知识培训计划提供依据.方法:采用自制调查问卷对132名非内分泌专科护士进行问卷调查.结果:非内分泌专科护士对胰岛素笔注射技术相关知识掌握较差,其中"预混胰岛素剂型""注射部位""拔针后是否需要干棉签按压注射部位"是非内分泌专科护士...     

替米沙坦与贝那普利治疗轻中度高血压的疗效比较

原发性高血压病（EH）是多种心血管疾病的重要危险因素,能引起血管重塑左室肥厚（LVH）。本研究选择血管紧张素Ⅱ受体拮抗剂（ARB）替米沙坦和血管紧张素转化酶抑制剂（ACEI）贝那普利,以比较两者的效果。     

Protective Effect of Sodium Tanshinone ⅡA Sulfonate on Injury of Small Intestine in Rats with Sepsis and Its Mechanism

Objective:To explore the protective effect of sodium tanshinoneⅡA sulfonate(STS) on small intestine injury in rats with sepsis and its possible mechanism.Methods:According to a random number table, 24 Tats were randomly divided into 3 groups:sham operation group(sham group),sepsis model group(model group) and STS treatment group(STS group),with 8 Tats in each group.A rat model of sepsis was induced by cecal ligation and puncture(CLP) for 5 h.STS(1 mg/kg) was slowly injected through the right external jugular vein after CLP.The histopathologic changes in the intestine tissue were observed under a light microscope,and the intestinal epithelial cell apoptosis was evaluated by terminal deoxynucleoddyl transferase(TdT)-mediated dUTP nick-end labeling(TUNEL) method.The expressions of Bcl-2,Bax and nuclear factorκB(NF-κB) p65 in the intestinal tissue was determined by Western blot.The levels of tumor necrosis factorα(TNF-α) and interleukin 6(IL-6) in the intestinal tissue were determined using enzyme-linked immuno-sorbent assay(ELISA). Results:Obvious injuries were observed in the intestinal tissue in the CLP group compared with the sham group. The expression of NF-κB p65 and the levels of TNF-αand IL-6 were up-regulated after CLP,the apoptosis of intestinal epithelial cells was increased after CLP,and the ratio of Bcl-2 to Bax was decreased.STS posttreatment could attenuate the injury on the intestinal tissue induced by CLP,decrease the apoptosis of intestinal epithelial cells and the levels of NF-κB p65,TNF-αand IL-6,and increase the ratio of Bcl-2 to Bax.Conclusion: STS can protect the small intestine in rats with sepsis,and the mechanism may be associated with the inhibition of intestinal epithelial apoptosis and the reduction of activation of inflammatory cytokines.     

Protective effect of diallyl trisulfide on liver in rats with sepsis and the mechanism

The protective effects of diallyl trisulfide on liver were examined in rats with sepsis. Sepsis was reproduced in rats by cecum ligation and puncture (CLP). Fifty-six male Wistar rats were randomly divided into sham-operated group (group S, n=8), sepsis model group (group C, n=24), diallyl trisulfide (DATS)-treated group (group D, n=24). Animals in groups C and D were further divided into three subgroups according to different observation time points, with 8 rats in each sub-group.Rats in group D and C were intravenously injected with normal saline or DATS respectively at a dose of 20 mg/kg after the establishment of sepsis model. Eight rats in groups C and D were sacrificed at 3, 6 and 24 h post-CLP and their livers were harvested for detection of interleukin (IL)-1 receptor associated kinase-4 (IRAK-4), nuclear factor-κB (NF-κB), c-fos, c-jun, malondialdehydethhe (MDA) and superoxide dismutase (SOD), tumor necrosis factor alpha (TNF-α) and for pathological examination. The results showed that the levels of serum IRAK-4, NF-κB and TNF-α in hepatic tissues were higher in group C than group S (control group) (P<0.05). After DATS treatment, the levels of IRAK-4 and NF-κB in the hepatic tissues and serum TNF-α in group D were lower than those in group C (P<0.05). The levels of c-fos and c-jun and MDA in the hepatic tissues were higher in group C than in group S (P<0.05). After DATS treatment, the levels of c-fos and c-jun and MDA in the hepatic tissues were significantly lower in group D than in group C (P<0.05). When compared with group S group, concentration of SOD in the hepatic tissues in group C was significantly lower (P<0.05). After DATS treatment, the concentration of SOD in the hepatic tissues was higher in group D than in group C (P<0.05). These findings suggested that treatment with DATS could ameliorate sepsis-induced liver injury in rats. The protective effect might be related to its ability to inhibit the signal pathway of IRAK-4 and NF-κB, thereby decreasing the production o     

PIGF及Maspin在结肠癌中的表达及意义

目的:探讨结肠癌组织中Maspin蛋白、PIGF的表达及其与肿瘤侵袭性的关系。方法:采用免疫组织化学方法检测60例结肠癌和30例癌旁正常组织中Maspin蛋白,PIGF的表达,并对其与结肠癌临床病理分期的关系进行统计学分析。结果:在正常结肠黏膜、结肠腺瘤和结肠癌组织中,Maspin表达的阳性率逐渐下降,而PIGF表达的阳性率逐渐上升。Maspin蛋白和PIGF在结肠癌组织中的表达均与浸润深度、淋巴结转移、Dukes分期有关,两者在结肠癌组织中的表达呈负相关。结论:结肠癌的发生、浸润和转移可能和Maspin蛋白表达下调及PIGF表达上调密切相关,联合检测可作为一组有效的结肠癌肿瘤标记和判断预后的指标。     

Apelin-APJ系统在心血管疾病研究进展

Apelin是最近发现的一种血管内皮源性肽,APJ是它的内源性配体。Apelin/APJ系统在体内系统广泛,它在心血管疾病的作用被日益重视,Apelin/APJ系统和心衰、高血压、急性冠脉综合征及心律失常等心血管疾病的相关性成为新近心血管研究的新方向和热点,现对Apelin/APJ系统在心血管疾病中研究作一阐述。     

超声弹性成像参数联合收缩期峰值流速、阻力指数以及血流分级对甲状腺良性、恶性结节鉴别诊断效能比较

目的 ：探究超声弹性成像参数联合收缩期峰值流速（PSV）、阻力指数（RI）、ADLER血流分级对甲状腺良性、恶性结节鉴别诊断效能比较。方法：选取2018年8月～2020年8月本院收治甲状腺实性结节患者100例,根据病理诊断结果分为甲状腺癌患者（n=65）为观察组及甲状腺良性结节患者（n=35）为对照组。比较不同组超声弹性成像参数、PSV、RI、ADLER血流分级评分,分析其对甲状腺良性、恶性结节鉴别诊断效能。结果：两组临床资料比较,发现两组年龄、性别、体质量指数、结节位置、慢性桥本甲状腺炎、甲状腺功能、结节数量、合并疾病等资料比较,差异无统计学意义（P>0.05）,具有可比性。观察组的弹性比值、PSV、RI和ADLER血流分级评分均显著高于对照组（P<0.05）。弹性比值、PSV、RI和ADLER血流分级评分评估甲状腺癌的诊断价值AUC分别为0.754、0.743、0.722、0.787,联合检测诊断甲状腺癌AUC为0.821,线下面积最大。结论：超声弹性成像参数联合PSV、RI、ADLER血流分级对甲状腺良性、恶性结节鉴别诊断具有重要的临床意义。     

前额皮瓣鼻再造术13例报告

目的：介绍应用额部皮瓣进行鼻再造的体会。方法：对8例外鼻皮肤癌术后缺损及5例鼻外伤后缺损患者采用额部皮瓣转移行鼻再造。结果：13例患者转移额部皮瓣全部成活,切口Ⅰ期愈合,无并发症发生。随访1～17年,鼻外形满意,肿瘤无复发。结论：应用额部皮瓣进行鼻再造,具有操作方便、血供可靠、成活率高、效果满意等优点,有临床应用价值。     

血浆脂联素对慢性心力衰竭诊断的临床价值

目的 探讨血浆脂联素(APN)对慢性心力衰竭(CHF)的临床诊断价值。方法 纳入2018年5月—2019年5月在安徽省立医院确诊CHF的患者48例为CHF组及40例健康志愿者为对照组。比较2组血浆APN和氨基末端脑钠肽前体(NT-proBNP)水平,获取CHF组左室射血分数(LVEF),分析CHF组血浆APN与NT-proBNP、LVEF的相关性。根据美国纽约心脏病协会(NYHA)心功能分级对CHF患者分组,比较不同亚组间血浆APN、NT-proBNP及LVEF。采集CHF组治疗前及治疗后3个月、6个月血浆APN、NT-proBNP及LVEF,分析APN对CHF的诊断价值。结果 CHF组年龄为45～91(60.98±13.98)岁,男性34例,女性14例;对照组年龄为51～93(57.88±13.76)岁,男性28例,女性12例。CHF组血浆APN、NT-proBNP分别为(23.08±9.39)μg/mL、5 455.00(1 256.00,8 552.25)pg/mL,高于对照组[(12.06±3.28)μg/mL、55.50(32.00,78.50)pg/mL],差异有统计学意义...