带锁髓内钉治疗股骨干骨折并发症原因分析及防治

目的提高带锁髓内钉的治疗效果,减少术中术后的并发症。方法自1998年10月～2001年10月用带锁髓内钉治疗的160例股骨干骨折,随访6～18个月。结果股骨颈骨折2例,主钉折断2例,锁钉折断2例,锁钉松动退出3例,术后感染4例,骨折延迟愈合6例。结论带锁髓内钉是治疗股骨干骨折较好的治疗方法,分析产生合并症的原因后采取各种防治措施可明显降低并发症的发生率。     

短肠综合征并肠外瘘的诊治(附32例分析)

目的研究短肠综合征合并肠外瘘的诊断与治疗方法的特点与规律。方法1995~2005年共收治剩余小肠<100 cm的肠外瘘病人32例,就肠外瘘发生原因、部位、治疗方法和肠康复方法进行分析。结果治愈20例,死亡6例,6例好转后中断治疗出院。病人残存的肠管平均(58.03±28.30)cm。28例接受了肠内营养,其中9例未进行肠康复治疗,肠管平均长度为(52.8±31.5)cm,肠内营养平均恢复时间为(129.6±89.8)d;19例接受了肠康复治疗,肠管平均长度(64.1±19.2)cm,肠内营养平均恢复时间为(61.8±54.0)d。结论短肠综合征合并肠外瘘的主要疾病为肠扭转,部位多在吻合口,原因是坏死范围较大,切除界限不易判断。早期使用生长抑素有减少肠液分泌的作用,还可减少短肠综合征急性期的腹泻症状。后期使用生长激素有促进肠外瘘自愈和肠康复的双重作用。     

Reduced hip bone mineral density is related to physical fitness and leg lean mass in ambulatory individuals with chronic stroke

Following a stroke, the reduced level of physical activity and functional use of the paretic leg may lead to bone loss and muscle atrophy. These factors and the high incidence of falls may contribute to hip fractures in the stroke population. This study was the first to examine total proximal femur bone mineral content (BMC) and bone mineral density (BMD) and their relationship to stroke-specific impairments in ambulatory individuals with chronic stroke (onset >1 year). We utilized dual-energy X-ray absorptiometry (DXA) to acquire proximal femur and total body scans on 58 (23 women) community-dwelling individuals with chronic stroke. We reported total proximal femur BMC (g) and BMD (g/cm²) derived from the proximal femur scans, and lean mass (g) and fat mass (g) for each leg derived from the total body scans. Each subject was evaluated for ambulatory capacity (Six-Minute Walk Test), knee extension strength (hand-held dynamometry), physical fitness [maximal oxygen uptake (VO₂max)] and spasticity (Modified Ashworth Scale). Results showed that the paretic leg had significantly lower proximal femur BMD, lean mass and percent lean mass, but higher fat mass than the non-paretic leg for both men and women. Proximal femur BMD of the paretic leg was significantly related to ambulatory capacity ( r =0.33, P =0.011), muscle strength ( r =0.39, P =0.002), physical fitness ( r =0.57, P <0.001), but not related to spasticity ( r =–0.23, P =0.080). Multiple regression analysis showed that lean mass in the paretic leg was a major predictor ( r ²=0.371, P <0.001) of the paretic proximal femur BMD. VO₂max was a significant predictor of both paretic proximal femur BMD ( r ²=0.325, P <0.001) and lean mass in the paretic leg ( r ²=0.700, P <0.001). Further study is required to determine whether increasing physical fitness and lean mass are important to improve hip bone health in chronic stroke.     

肺炎支原体肺炎患儿急性期和恢复期血浆H-ficolin和L-ficolin水平分析

目的了解肺炎支原体肺炎患儿急性期和恢复期血浆中H-ficolin、L-ficolin水平的变化。方法采用ELISA法检测85例肺炎支原体肺炎患儿急性期和恢复期血浆H-ficolin、L-ficolin水平,并进行相关性分析。结果急性期H-ficolin水平1.8~25.2μg/ml,平均（11.9±5.9）μg/ml,恢复期H-ficolin水平0.3~26.5μg/ml,平均（10.1±5.7）μg/ml,急性期明显高于恢复期（Z=2.161,P=0.031）。急性期L-ficolin水平0.2~10.6μg/ml,平均（4.5±2.3）μg/ml,恢复期L-ficolin水平0.03~10.2μg/ml,平均（4.6±2.2）μg/ml,急性期和恢复期无统计学差异（t=0.245,P=0.807）。患儿急性期血浆H-ficolin水平与L-ficolin水平明显相关（r=0.22,P=0.039）。结论H-ficolin可能参与儿童肺炎支原体肺炎疾病过程。     

歧义病案产生的影响因素分析

目的 分析歧义病案产生的影响因素,为医院开展相关DRGs管理提供决策依据.方法 回顾性调查2019年1月1日-2019年12月31日广州市某三甲医院45856份手术病案,利用国家版DRGs分组器筛查出518份歧义病案.采用单因素卡方检验及多因素Logistic回归分析歧义病案产生的影响因素.结果 45856份手术患者住...     

SAAHECG对冠心病的诊断价值及与冠状动脉狭窄程度的关系探讨

目的 探讨尼沙赫心电图(SAAHECG)在冠心病诊断中的应用及其与不同冠状动脉狭窄程度的关系。方法 回顾性分析2016年10月至2020年12月有胸闷、胸痛的临床症状且在该院施行冠状动脉造影术(CAG)的患者209例,所有患者术前均同步行SAAHECG及常规心电图(ECG)检查。根据冠状动脉造影结果,分为非冠心病组即对照组(冠状动脉狭窄<50%),冠心病组(冠状动脉狭窄≥50%)。将冠心病组分为轻度狭窄组(冠状动脉狭窄50%～69%)、中度狭窄组(冠状动脉狭窄70%～89%)和重度狭窄组(冠状动脉狭窄≥90%)3组。观察SAAHECG与ECG对冠心病诊断的灵敏度、特异性,以及SAAHECG与ECG在冠状动脉不同狭窄程度时的灵敏度。结果 SAAHECG与ECG诊断冠心病的灵敏度分别为82.56%、49.42%,差异有统计学意义(P<0.05),特异性分别为48.65%、43.24%,差异无统计学意义(P>0.05)。从轻度狭窄组到重度狭窄组SAAHECG与ECG的诊断灵敏度依次为：63.16%/26.32%、74.51%/43.14%、90.20%/56.86%,其中,...     

国产与进口吲哚美辛缓释胶囊生物等效性评价

比较国产与进口吲哚美辛缓释胶囊在人体内的生物利用度和生物等效性.18名健康男性志愿者双周期随机交叉口服吲哚美辛缓释胶囊75 mg,用反相高效液相色谱法测定达稳态后的血药浓度.受试制剂与参比制剂的达峰时间(Tpeak)分别为(3.78±1. 00)h和(3.50±1.29)h;达峰浓度(Cmax)分别为(7.51±2.74)ug/ml和(8.05±2.58)ug/ml;药时曲线面积(AUC)分别为(66.41±30.12)和(63.90±26.50)ug@ml-1@h-1.多次给药达稳态条件下,国产的吲哚美辛缓释胶囊与进口制剂的相对生物利用度为(103.20±21.90)%.双单侧检验表明,国产与进口吲哚美辛缓释胶囊具有生物等效性.     

Externalization and internalization of cardiac endothelin receptors during different phases of sepsis in rat.

Objective. To study the redistribution ofendothelin- 1 (ET- 1 ) receptors in two subcellular organelles, the sarcolemreal membrane and the light vesicle, of rat heart during the progression of sepsis. Methods. Sepsis was induced by cecal ligation and puncture (CLP). ET1 receptor was assayed by using[125I]-ET1 binding. Marker enzyme activities, protein yield, and dry-to-wet weight ratio of cardiac membraneswere measured. Results. Septic rat heart exhibited two distinct phases: an initial hyperdynamic phase( 9h after CLP; early stage of sepsis) followed by a hypodynamic ( 18h after CLP, late stage of sepsis) phase. [125I]-ET1 binding study showed that during early stage of sepsis, the Bmax of ET1 receptors was increased by 30% in sarcolemma but decreased by 19% in light vesicles, while during late stage of sepsis, the Bmax was decreased by 24% in sarcolem-ma but increased by 38% in light vesicles. The total binding of sarcolemma and light vesicles was increased by 25% during early stage of sepsis but decreased by 17% during late stage of sepsis. Conclusions. These data indicated that ET1 receptors in the rat heart were externalized from light vesicles to sarcolemmal membranes during early hyperdynamic phase while internalized from surface membranes to intracellu-lar compartment during late hypodynamic phase of sepsis.     

病人知情同意权的几个辩证法问题

以知情同意为核心的病人自主权是医疗服务和现代医患关系新的支撑点。在人体实验、放弃治疗等领域,充分尊重病人的知情同意权具有极大的现实意义。然而,医生的解释说明、医疗干预和亲属代理同意则构成了对知情同意的限制。因此,必须辩证理解和知情同意的内涵,以最大限度地保障病人利益。