肝硬化合并上消化道出血98例病因分析

目的探讨肝硬化合并上消化道出血的病因.方法回顾性分析1998～2003年舞钢职工医院98例肝硬化合并上消化道出血患者的病因.结果 98例上消化道出血患者的病因中,食管胃底静脉曲张破裂出血占50.0% (49/98);门脉高压性胃病占26.53%(26/98),消化性溃疡占21.43%(21/98).结论肝硬化合并上消化道出血病因中,非曲张静脉出血(包括门脉高压性胃病、消化性溃疡)占有相当高的比例,应引起足够的重视.     

态度接种对青少年态度改变的影响

目的:检验态度接种对青少年态度改变的影响。方法:整群抽取某校初二4个班的学生225名,测查安乐死态度,筛选113名对安乐死持反对态度的初二学生,按班级分为4组,每组约30人,分别接受不同的态度干预处理,两周后再次测查安乐死态度,探讨态度干预对青少年安乐死态度改变的影响。结果:在对待安乐死的态度上,干预后的各组被试存在显著的组间差异(F=26.180,P0.001),事后检验表明,态度接种组与对照组的差异显著,态度接种组比对照组更倾向于保持原有态度;强烈攻击组与对照组存在显著差异,对照组更倾向于保持原有态度;对照组与组合干预组差异不显著。结论:态度接种有助于青少年维护原有态度、抵制态度改变,态度接种组更加坚信自己原有态度的正确性,而且,这种影响效应具有一定的持续性。     

A conservative surgical approach for management of iatrogenic pulmonary artery perforation

Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.     

大面积脑梗死后出血性转化的CT诊断新认识

目的 提高对大面积脑梗死后出血性转化的CT诊断水平及新认识.方法 对60例大面积脑梗死后出血性转化的CT资料进行回顾性分析.结果 大面积脑梗死后复查头部CT,常规扫描37例,薄层扫描23例.出血性转化在梗死后1d检出3例,2～3 d检出16例,4～7 d检出9例,8～14 d检出32例.CT表现分3型：中心型（13例）、边缘型（21例）、混合型（26例）.结论“出血性转化”已代替“出血性脑梗死”和“梗死后出血”,大面积脑梗死最易发生出血性转化,影像学检查是诊断出血性转化的金标准,CT为首选的主要检查方法,薄层扫描更利于病变早期检出,对指导临床选择治疗方案及预后判断具有重要意义.     

双气囊小肠镜诊断不明原因消化道出血的临床研究

背景:双气囊小肠镜(DBE)是诊断不明原因消化道出血(OGIB)的常用方法,不同地区OGIB病因有所差异。目的:评价DBE诊断OGIB的有效性和安全性,分析湖北地区OGIB患者的病因特点。方法:收集2006年12月～2012年1月武汉大学人民医院诊断为OGIB的216例患者,并接受DBE检查,对诊断结果、治疗、随访、并发症等进行回顾性分析。结果:DBE的诊断率为80.6%(174/216),并发症发生率为1.9%(4/216),DBE对76.8%(166/216)患者的治疗策略产生影响。湖北地区常见的OGIB病因依次为憩室/重复畸形(23.1%)、肿瘤(21.8%)、溃疡/糜烂(21.8%)、息肉(5.6%)等。结论:DBE是一种安全、有效的OGIB诊断方法。湖北地区OGIB病因以憩室/重复畸形、肿瘤、溃疡/糜烂较为常见。     

剖宫产合并子宫肌瘤切除术40例临床分析

目的探讨剖宫产时行子宫肌瘤切除术的安全性及可行性。方法 40例妊娠合并子宫肌瘤患者(治疗组)行剖宫产合并子宫肌瘤切除术;对42例妊娠无子宫肌瘤患者(对照组)行剖宫产术。比较2组手术时间及术中出血情况。结果治疗组手术时间为(59.12±6.29)min长于对照组的(31.24±5.21)min,差异有统计学意义(P<0.05);2组术中出血量比较差异无统计学意义(P>0.05)。结论对于经验丰富的医师,恰当把握适应证,对于妊娠合并子宫肌瘤患者在剖宫产术时行子宫肌瘤切除术是安全可行的。     

基于海量视频存储技术的超声动态影像工作站系统

针对当前超声影像面临的问题及制约因素，详细介绍了基于海量存储技术的超声影像工作站系统构成及特点，并全面分析了该新型工作站系统的主要功能和应用效果。     

ACD - A solution as anticoagulant during continuous renal replacement therapy in high risk bleeding patients

Objective To assess the efficacy and safety of ACD-A solution as anticoagulant during continuous renal replacement therapy (CRRT) in high risk of bleeding patients. MethodsForty high risk bleeding patients on continuous veno - venous hemofiltration (CVVH) were randomly divided into two groups: ACD-A group (22 patients, 61 cases) and heparin-free group (18 patients, 47 cases). Serum creatinine, function of the coagulation system, electrolyte and acid-base were monitored pre - and post - CVVH. The vital signs of the patients during treatment, dialyser clotting and the incidence of bleeding episodes were recorded. Results(1) The serum level of creatinine decreased significantly after treatment in both groups, but the rate of decrease was obviously higher in ACD-A group than that in heparin - free group[(55.4±10.2)% vs (42.0±5.2)%, P＝0.031]. (2) The average duration of CVVH treatment was (17.3±3.8) h in ACD-A group and (9.7±4.5) h in heparin-free group. There was significant difference between them (P＝0.019). The frequency of dialyzer clotting was much higher in heparin-free group than that in ACD-A group (88% vs 4.9%, P＜0.001). (3) There was no significant difference in the function of the coagulation system between pre- and post-CVVH in either group (P＞0.05). (4) Electrolyte, acid-base and glucose tended to be stable during the treatment in ACD -A group. (5) The vital signs were kept stable and no bleeding episodes were found in all patients of two groups. ConclusionsAnticoagulation with ACD-A is safe, effective and convenient for CRRT in critically ill patients at high risk of bleeding. The occurrence of complications can be reduced by configurating appropriate replacement fluid and close laboratory monitoring.