“医生走穴”与城市区域卫生规划

近年，“医生走穴”的问题被新闻媒体炒的沸沸扬扬，其实，这个问题并非今日才有。医院施行人事制度和分配制度改革后促进了人力资源的合理配置，“医生走穴”再一次提到议事日程。目前，一些医院和卫生主管部门大多看到“医生走穴”的积极一面，结合城市区域卫生规划考虑的甚少。根据以往经验，“医生走穴”是一面“双刃剑”，管理有序，可以利用我国有限的医疗卫生人力资源造福社会和病人；     

聚丙烯网片修补巨大造口旁疝8例体会

造口旁疝是结肠造口术后最常见的并发症，发生率5%-50%。虽然造口旁疝有很多手术方法，但术后复发率较高，尤其巨大造口旁疝，仍然是疝外科的一个难点。目前，人工材料（聚丙烯或聚四氟乙烯网片）已被广泛应用于疝的修补，但造口旁疝的网片修补相对较少。现将我们1999年1月至2006年2月应用聚丙烯网片修补8例巨大造口旁疝的体会介绍如下。     

肝癌经皮局部消融治疗

手术切除是目前肝癌治疗的最佳手段,但仅有9%-27%的患者适合手术.手术后的局部复发也十分常见,再手术的机会也不多.目前的化疗及放疗均不能达到较理想的目的.近年来国内外学者先后开展了许多微创性的局部消融方法,本文就肝癌经皮局部消融治疗(percutaneous localablative therapy,PLAT)的方法和疗效作一综述.     

腹腔压力与重症急性胰腺炎严重程度的关系

Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.     

曲马多治疗腰硬联合麻醉期间寒战的临床观察

目的 观察曲马多治疗腰硬联合麻醉期间寒战的临床疗效。方法 通过对60例寒战患者的临床观察对比，最后用统计学处理。结果 效果确切，如加用氟哌利多效果会更好，它可克服曲马多引起的恶心、呕吐等副作用，且对生命体征变化影响不大（无明显差异P〉0．05）。结论 曲马多治疗腰硬联合麻醉期间寒战非常实用，有推广价值。     

中药熏洗联合微创经筋刀治疗膝骨性关节炎临床疗效及护理体会

目的:观察中药熏洗联合微创经筋刀治疗膝骨性关节炎临床疗效及护理体会。方法:66例膝骨性关节炎患者随机分为2组,各34例,治疗组采用中药熏洗联合微创经筋刀治疗,对照组采用一般常规药物治疗。结果:总有效率治疗组93.75%,对照组44.12%,2组比较,差异有统计学意义(P<0.01)。各证型疗效风寒湿痹型100%、风湿热痹型100%、肝肾两虚型87.5%、痰瘀痹阻型75.5%,均优于对照组(P<0.05)。结论:中药熏洗联合微创经筋刀治疗膝骨性关节炎在缓解症状和恢复功能方面效果明显,同时做好治疗前后护理及宣教,对提高患者疗效有重要意义。     

全身麻醉用于二次剖宫产术对新生儿的影响

目的分析二次剖宫产术实施全身麻醉对新生儿的影响。方法采用回顾性分析的方法,对本院2009年1月～2011年6月76例因血小板减少、脊柱畸形、硬膜外麻醉失败接受全麻行剖宫产术的临床资料进行分析。结果二次剖宫产从麻醉诱导到胎儿娩出时间（I-D时间）明显长于首次剖宫产,新生儿1minApgar评分二次剖宫产组（S组）明显低于首次剖宫产组（F组）,5minApgar评分两组无差异。结论由于二次剖宫产I-D时间较长,全身麻醉用于二次剖宫产术可导致新生儿窒息,但不影响预后。     

硝酸甘油用于高血压致脑出血手术患者的效果观察

目的观察高血压致脑出血行颅内血肿清除术中硝酸甘油能否起到与硝普钠相同的效果以及是否加重脑损伤。方法将60例高血压致脑出血需行颅内血肿清除术的患者随机分为两组,硝普钠组（n=30）和硝酸甘油组（n=30）,于手术开始后,平均动脉压高于120mmHg时,两组分别给予硝普钠和硝酸甘油泵入,并依据血压变化调整泵速,观察两组患者麻醉诱导前（T0）、切皮时（T1）、钻孔开颅时（T2）、降压平稳维持15min后（T3）、手术结束缝皮时（T4）、拔管时刻（T5）的平均动脉压的变化,并于T0、T5时间点抽取远端静脉血检查SB100蛋白的变化。结果硝普钠组和硝酸甘油组平均动脉压组间比较差异无统计学意义（P〉0.05）,SB100蛋白两组比较不能证实硝酸甘油加重脑损害。结论硝酸甘油可以用于高血压致脑出血行颅内血肿清除术的患者,可以起到与硝普钠同样的效果,并且不加重脑损害。     

血压正常高值340例监测3年进展及相关因素分析

目的探讨血压正常高值进展成高血压的时间关系和影响因素。提醒临床医生关注血压正常高值人群。方法选择2009年抚顺石化公司在职职工健康体检时符合血压正常高值标准的体检者340例,连续3年体检时进行血压监测,并同时测量血脂、血糖、血尿酸等因素。结果监测1年后有25.29%进展成为高血压,2年后有28.82%进展成为高血压,3年后有33.53%进展成为高血压。