云南白药对全髋关节置换术出血量的影响

目的研究云南白药在围术期对全髋关节置换术术中出血量及术后引流量的影响。方法2006至2008年我科收治的股骨颈骨折行全髋关节置换术60例,随机分成两组,分别服用云南白药胶囊和空胶囊;术前术后测定凝血酶原时间(PT),记录全部病人术中出血量及术后24 h引流量。结果实验组和对照组病人的凝血酶原时间(PT)差异有统计学意义(P<0.01);试验组的术中出血量、术后24 h引流量分别为(380±78)ml(、336±77)ml,较对照组(481±77)ml(、418±68)ml明显减少,差异具有统计学意义(P<0.01)。结论云南白药胶囊能够明显减少全髋关节置换术围术期出血量。     

Assessing ethical problem solving by reasoning rather than decision making

Context The assessment of ethical problem solving in medicine has been controversial and challenging. The purposes of this study were: (i) to create a new instrument to measure doctors’ decisions on and reasoning approach towards resolving ethical problems; (ii) to evaluate the scores generated by the new instrument for their reliability and validity, and (iii) to compare doctors’ ethical reasoning abilities between countries and among medical students, residents and experts. Methods This study used 15 clinical vignettes and the think‐aloud method to identify the processes and components involved in ethical problem solving. Subjects included volunteer ethics experts, postgraduate Year 2 residents and pre‐clerkship medical students. The interview data were coded using the instruments of the decision score and Ethical Reasoning Inventory (ERI). The ERI assessed the quality of ethical reasoning for a particular case (Part I) and for an individual globally across all the vignettes (Part II). Results There were 17 Canadian and 32 Taiwanese subjects. Based on the Canadian standard, the decision scores between Taiwanese and Canadian subjects differed significantly, but made no discrimination among the three levels of expertise. Scores on the ERI Parts I and II, which reflect doctors’ reasoning quality, differed between countries and among different levels of expertise in Taiwan, providing evidence of construct validity. In addition, experts had a greater organised knowledge structure and considered more relevant variables in the process of arriving at ethical decisions than did residents or students. The reliability of ERI scores was 0.70–0.99 on Part I and 0.75–0.80 on Part II. Conclusions Expertise in solving ethical problems could not be differentiated by the decisions made, but could be differentiated according to the reasoning used to make those decisions. The difference between Taiwanese and Canadian experts suggests that cultural considerations come into play in the decisions that are made in the course of providing humane care to patients.     

完全性胸腹腔内脏反位合并十二指肠壶腹周围癌一例报告与文献复习

目的总结完全性胸腹腔内脏反位合并十二指肠壶腹周围癌的临床诊治方法。方法报道2006年3月收治的1例极为罕见的完全性胸腹腔内脏反位合并十二指肠壶腹周围癌行胰十二指肠切除术的病例,并复习国内外相关文献。结果本例患者病理诊断为十二指肠乳头及壶腹部腺癌Ⅰ-Ⅱ级。术后1周胆红素降至正常;但2周后出现胃-空肠吻合输出袢粘连性不完全性梗阻,经内镜下置管、鼻饲、营养支持、针灸等处理,40d后痊愈出院。经检索,全球自1936-2006年间报道的全胸腹腔内脏反位合并恶性肿瘤的患者仅15例;其中只有5例全胸腹腔内脏反位合并胰头与壶腹周围癌的报道。结论完全性胸腹腔内脏反位合并肿瘤时,若无明显禁忌证,应同样予以积极的外科治疗,术中操作应注意完全相反的解剖学结构。     

皮下环精索封闭疗法治疗急性附睾-睾丸炎疗效观察

目的评价急性附睾-睾丸炎皮下环精索封闭疗法的疗效.方法对80例急性附睾-睾丸炎病例随机分为两组,对照组给予传统治疗方法,而治疗组除了传统疗法外,加用皮下环精索封闭治疗.结果治疗组所有患者1～3d内发热、疼痛症状缓解,4～6 d内附睾睾丸肿胀明显减退,97.5%的病例2周内治愈;而对照组40%的患者1～3d内发热、疼痛症状缓解,75%的患者4～6d内附睾睾丸肿胀减退,80%患者2周内治愈,治疗组疗效优于对照组.结论皮下环精索封闭疗法可以迅速缓解临床症状,缩短病程,提高治愈率,是治疗急性附睾-睾丸炎的有效方法.     

后腹腔镜下肾肿瘤剜除术的临床疗效观察(附5例报告)

目的：探讨后腹腔镜下肾肿瘤剜除术的操作要点及临床价值。方法：采用后腹腔镜下肾肿瘤剜除术治疗肾肿瘤5例，其中肾癌3例，肾错钩瘤2例，瘤体直径1．5～4．0cm。具体方法是：①暴露瘤体和肾动脉；②采用硅胶管牵拉肾动脉，必要时可暂时阻断肾动脉；③于瘤体1cm正常肾组织处用电钩切除瘤体；④采用生物蛋白胶、止血纱布缝合加压处理创面出血。结果：手术均获成功。手术时间150～210min，术中出血80～350ml。术后1～2天肠道功能恢复并可床上活动，1～4天可下床活动。术后住院5～9天，平均7天。结论：后腹腔镜下肾肿瘤剜除术具有创伤小、康复快、安全、住院时间短等优点；对外生性生长、直径小于4cm瘤体，该法可作为首选手术方法。     

创伤性复发性腓骨肌腱脱位的手术治疗

目的研究创伤性复发性腓骨肌腱脱位的手术方法. 方法回顾分析1986年1月～2003年12月手术治疗的21例创伤性复发性腓骨肌腱脱位的病例,所有病例均应用Watson Jones手术. 结果 15例得到随访,随访时间1～15年,平均4.9年.1例因外伤再次脱位,其余14例未再出现脱位,均恢复正常运动或训练,比赛. 结论 Watson Jones手术治疗复发性脱位操作简单,损伤小,效果满意.     

改良开放性手术治疗巨大良性前列腺增生症

目的探讨巨大良性前列腺增生症的开放性手术治疗方法及效果。方法回顾分析16例巨大良性前列腺增生症,年龄61~88岁,平均74岁。作耻骨上经膀胱前列腺切除术。结果手术均成功;手术时间35~65min,出血量100~200mL,术后前列腺重量为200~520g,平均215g;膀胱冲洗2~3d,拔导尿管5~7d;术后3d再出血1例,经DSA同侧髂内血管栓塞止血成功,排尿困难1例,短期尿失禁1例,其余患者术后均排尿通畅,控尿良好。结论开放性手术治疗巨大良性前列腺增生症,其梗阻解除彻底,是一种合理的治疗方法。恰当的手术方法是提高疗效及降低并发症的关键。     

弥漫性轴索损伤病人的护理

弥漫性轴索损伤 (DAI) ,在脑损伤中发生率高 ,病死率高 ,占脑外伤死亡病人总数的 3 5 %。全部DAI病人中植物生存率为 15 % ,重残 14 % [1] 。为了降低病死率 ,提高病人的生存质量 ,现将 1999年 1月— 2 0 0 2年 1月我院收治的 5 5例DAI昏迷病人的护理体会总结如下。1　临床资料　　本组 5 5例 ,男 3 8例 ,女 17例 ,年龄 6岁～ 68岁 ,平均 40 .9岁。格拉斯哥 (GLS)计分均 <8分 ,其中评分为 3分～ 5分的特重型病人 3 2例。致伤原因 :车祸 44例 ,高处坠落 8例 ,打击伤 3例。 5 5例病人中有 17例因合并颅内血肿而行开颅手术 ,其他病人为保…     

医疗监护技术的现状和发展趋势

本文介绍了医疗监护技术的现状、存在问题和当前的新进展及发展趋势.