风险分级护理模式对维持性血液透析患者内瘘功能的影响

动静脉内瘘是维持性血液透析患者使用时间最长的一种安全血管通路,内瘘的长期畅通影响着患者的血透治疗时间,如果护理不当则可导致内瘘局部异常,或者内瘘堵塞,出现血液返流,导致再循环发生,或者其他并发症发生导致内瘘失效,影响到血液透析的充分性,进而影响患者的生活质量及预后情况[1].多项研究显示[2]：年龄、原发病、合并症、内瘘使用时间等都是导致维持性血液透析患者内瘘失功的危险因素.根据这些研究结果,我中心从2013年开始采用分级护理模式,将患者内瘘危险分级,并给予针对性护理措施,加强对高危险度患者护理有可能降低内瘘失功的情况,报道如下.     

5044例电视腹腔镜胆囊切除术的临床分析

目的探讨腹腔镜胆囊切除术的手术原则及并发症的预防。方法收集我院1992～2002年完成的5044例腹腔镜胆囊切除术的临床资料，分析行腹腔镜胆囊切除病人的原发疾病种类，手术引起的近期及远期并发症。结果5044例腹腔镜胆囊切除术病人中最多的是慢性胆囊炎合并胆囊结石，占84．75％；急性胆囊炎伴胆囊结石186例，占3．69％。中转开腹手术93例，占1．84％。手术并发症中，最严重的为手术中胆管损伤，共9例，发生率0．18％；术后胆漏12例，发生率0．24％；术后出血5例，发生率0.10％。晚期并发症包括胆总管残余结石8例，胆管狭窄6例。无死亡病例。结论腹腔镜胆囊切除术是胆囊疾病的最佳选择，操作技术仍然较复杂，胆总管损伤的发生率较高。细致的操作及配合手术中胆道造影可以减少胆管损伤的发生。     

胆囊化学灭活的临床应用和远期疗效观察

目的探讨胆囊化学灭活的临床应用可行性和远期疗效.方法胆囊造瘘21人,微波热凝闭塞胆囊管后,向胆囊内注入95%酒精灭活胆囊粘膜,1次/4小时,连续6次.如灭活1周后造影胆囊腔闭合,胆囊管不显影;或引流量＜10ml,无胆汁,则为灭活成功.灭活前后分别测定血肝肾功能指标和心电图.结果1次微波热凝闭塞胆囊管的成功率为76%(16/21),2次为95%(19/20);95%酒粗完全灭活胆囊粘膜的成功率为85%(17/20),另3例灭活后胆囊区仍有小的液性暗区.所有病人无结石再生,灭活中及灭活后无严重并发症.灭活前后血生化和ECG无明显变化(P＞0.05).结论胆囊化学灭活临床应用安全有效,远期疗效满意.     

深圳市某医院手术室优质护理改革成效及经验探索

目的:通过了解深圳市某医院手术室开展"优质护理服务"活动的情况,探讨患者对护理服务满意度的变化。方法:经专家组研讨手术患者主要关心的8个主要问题制作调查问卷,选择2011-2012年24个月的手术患者开展问卷调查。结果:医院开展优质护理服务活动后手术患者满意度明显高于活动前。2012年大多数月份的手术患者对护理服务的满意度环比大幅提升,全年平均满意度大幅提升。但也存在患者对手术前手术后注意事项的宣教、服务过程中的操作及服务流程中对麻醉镇痛效果不满意等问题。结论:"优质护理服务"活动实施效果较好,患者满意度有了明显提高,医院可进一步完善并推广。     

酷似胆囊癌的黄色肉芽肿性胆囊炎的诊断策略

Background  Patients with xanthogranulomatous cholecystitis sometimes exhibit imaging and intraoperative findings that are similar to those of advanced gallbladder cancer, thus these patients are easily misdiagnosed. The present study aimed to investigate the characteristics of xanthogranulomatous cholecystitis masquerading as gallbladder cancer that could potentially aid in the correct diagnosis of this condition.

Methods  The clinical, serological, radiological and operative features of twelve patients with obviously wall-thickening or mass-forming xanthogranulomatous cholecystitis were retrospectively analyzed. Additionally, the patient preoperative features were compared to those of 36 patients with advanced gallbladder cancers.

Results  Twelve patients with xanthogranulomatous cholecystitis exhibited one to three episodes of acute cholecystitis within 0.5 to 7 months prior to admission to the hospital. Five of these patients exhibited concomitant choledocholithiasis, whereas no concomitant choledocholithiasis was identified in patients with advanced gallbladder cancer. The incidence of abdominal pain (χ²=6.588, P=0.010), acute cholecystitis (χ²=29.176, P=0.000), acute cholangitis (χ²=6.349, P=0.012), choledocholithiasis (χ²=16.744, P=0.000), carcinoembryonic antigen test (P=0.007), CA125 (P=0.001), and diffuse gallbladder wall thickening (χ²=6.031, P=0.014), continued mucosal line (χ²=15.745, P=0.000), homogeneous enhancement of mucosal line (χ²=19.947, P=0.000), submucosal hypoattenuated nodules or band (χ²=18.607, P=0.000) in computed tomography demonstrated statistically significant differences between cases of xanthogranulomatous cholecystitis and gallbladder cancer. Furthermore, all the twelve patients with xanthogranulomatous cholecystitis exhibited at least one positive computed tomography imaging feature aside from past acute cholecystitis episode, and no patient with advanced gallbladder cancer simultaneously exhibited past acute cholecystitis episode and at least one positive computed tomography imaging feature.

Conclusions  The accurate preoperative diagnosis of xanthogranulomatous cholecystitis includes an integrated review of past acute cholecystitis episode, choledocholithiasis, and positive computed tomography imaging features. Besides, we present an algorithm for intraoperative diagnosis.

     

Vasohibin免疫脂质体抑制小鼠肺纤维化的实验研究

目的制备Vasohibin免疫脂质体,并观察对小鼠肺纤维化的抑制作用。方法采用逆相蒸发法,首先制备含Vasohibin质粒的脂质体,并与山羊抗小鼠VWF单克隆抗体偶联,形成免疫脂质体,并用博莱霉素诱发肺纤维化小鼠模型。14 d后,处死小鼠,取出肺脏组织,用HE染色和免疫组化观察小鼠肺间质血管密度,比色法检测肺组织羟脯氨酸含量。结果与对照组相比,吸入Vasohibin免疫脂质体的小鼠的肺间质血管密度减少,CD31细胞数在模型组平均为（78±12）个,治疗组为（46±16）个,空白对照组为（9±2）个。肺组织羟脯氨酸含量降低,对照组为（1.39±0.23）μg/mg,治疗组为（0.84±0.12）μg/mg。结论 Vasohibin免疫脂质体能有效降低博莱霉素诱发的肺纤维化,为肺纤维化的早期治疗提供了理论基础。     

新冠病毒感染疫情期间全包制管理模式在血液透析中心的应用

目的 探讨新冠病毒感染疫情期间全包式管理模式在血液透析中心应用效果。方法 通过建立应急防控体系、开展全员全程培训、调整优化工作流程,实行全包制管理模式,将所有透析患者按透析时间和使用机器以每8～10人划分为1个小组,每名责任护士承包1组。通过防护用品使用、诊疗流程、应急处置流程考核,观察透析周期内患者及陪伴人员疫情防控措施落实的依从性,调查透析患者和员工满意度,评价实施效果。结果2020年2月1日—2022年4月1日共完成血液透析65520例次,未出现感染病例。实行全包制管理模式以来,各项考核合格率100%,疫情防控措施落实依从性明显提高（P<0.05）;员工满意度由75.8%提高到97.0%,患者满意度由97.0%提高到99.6%(P<0.05)。结论 实施全包制管理模式可有效提升医务人员新冠病毒感染疫情防范及应急处置能力。     

WT1基因突变与急性髓系白血病预后关系的Meta分析

目的分析总结WT1基因突变与急性髓系白血病(AML)预后的关系。方法检索PubMed、Google Scholar及Cochrane Library数据库截至2018年4月2日收录的相关文献,采用Review Manager 5.2软件进行Meta分析。结果共纳入9篇文献。Meta分析结果显示,对于儿童AML患者,WT1基因突变型组较野生型组总生存(OS)时间更短(HR=1.41,95% CI 1.07~1.87,P=0.01)。对于总体AML患者,WT1基因突变型组较野生型组无复发生存(RFS)时间更短(HR=2.21,95% CI 1.15~3.93,P=0.02),而两组OS及无病生存(DFS)时间差异均无统计学意义(HR=1.65,95% CI 0.97~2.80,P=0.06;HR=0.46,95% CI 0.08~2.57,P=0.38)。对于正常核型AML及成年AML患者,WT1基因突变型组与野生型组OS时间差异均无统计学意义(HR=2.66,95% CI 0.57~12.31,P=0.21;HR=2.10,95% CI 0.70~6.30,P=0.18)。结论WT1基因突变是影响儿童AML患者OS及总体AML患者RFS的危险因素。     

乳腺癌和乳腺良性肿物体表傅里叶变换红外光谱研究

目的 探讨利用傅里叶变换红外(FTIR)光谱技术鉴别乳腺癌和乳腺良性肿物的可行性.方法 联合运用衰减全反射(ATR)探头与中红外光纤、FTIR光谱分析仪,测定26例乳腺癌患者和34例乳腺良性肿物患者体表的FTIR光谱,比较两组光谱各个谱带的峰位(P)、相对峰强(I)及半高宽指标(F),总结乳腺癌体表光谱的特征.结果 与乳腺良性肿物体表光谱比较,乳腺癌体表光谱中(1)蛋白质酰胺Ⅱ带P1546发生明显地红移(向低波数移动,P＜0.05);(2)与核酸相关的相对峰强11256/I1460(P＜0.05)明显升高;(3)与C-H或C-O-H的变角振动的谱带峰位P1303发生明显地红移(向低波数移动)(P＜0.05).结论 乳腺癌体表FTIR光谱与乳腺良性肿物体表的光谱比较,在蛋白质、核酸和脂类相关谱带均有明显差异.

Abstract：

Objective To explore the feasibility of superficially differentiating breast cancer from the benign fourier transform infrared ( FTIR) spectroscopy. Methods Twenty-six cases of breast cancer and 34 cases of the benign were examined superficially by FTIR spectroscopy. For each FTIR spectrum,the peak positions (P), relative intensity (I) and full width at half maximum ( F) of the band were recorded and the relative intensity ratios were calculated. Results In the group of breast cancer, both the peaks of 1546 cm-1 and 1303 cm-1 shifted toward lower wave number (P ＜0. 05), as compared to those of the benign group. The relative intensity ratio of I1256/I1460) was increased significantly (P ＜ 0. 05). Conclusion There existed many significant differences in FTIR spectra between malignant and benign breast masses.     

基于“脾胃虚寒夹滞理论”的安胃清幽方治疗消化性溃疡的应用研究

目的 观察以“脾胃虚寒夹滞理论”指导,采用安胃清幽方治疗消化性溃疡(PU)的临床疗效.方法 选取我院收治的90例PU患者,随机分为对照组(采取三联疗法)与实验组(对照组治疗基础上加用安胃清幽方治疗),评估两组患者中医症候评分,溃疡面积、幽门螺旋杆菌(HP)根治情况,并测定溃疡愈合质量相关指标.结果 治疗后,实验组中医症...