改良早期更换气囊漏气的气管切开套管对患者的影响

目的:研究采用改良方法早期更换气囊漏气的气管切开套管对患者的影响。方法:随机将72例早期气囊漏气的气管切开患者分为常规换管组(A组)和改良早期换管组(B组),B组采用无气囊气管导管作为支架在发现气管切开套管漏气时即予更换,观察一次性换管成功率、换管时间、漏气期间与换管后3d内平均每天发生气促次数、发现气囊漏气时及发现漏气后5d取痰行细菌培养并行床边胸部X线拍片以了解肺部感染情况、漏气期间及换管后均抽取动脉血气分析、气囊漏后的机械通气时间及发现气囊漏气后ICU停留时间等指标。结果:改良早期更换组一次性换管成功率高于常规组(P<0.05),换管时间亦短于常规组、换管期间SpO2下降发生率低于常规组、局部出血少于常规组(均P<0.05)。换管后肺部细菌感染发生率、漏气后机械通气时间与ICU停留时间,B组均明显少于A组(均P<0.05)。结论:采用无气囊气管导管为支架更换早期气囊漏气的气管切开套管安全、可靠、有效,有利于改善氧合,可减少人机对抗,可更有效地控制肺部感染、缩短机械通气时间及ICU停留时间,值得临床推广。     

注射用染料木素胶束的体外释药研究

目的:考察以单甲氧醚聚乙二醇-聚乳酸羟基乙酸共聚物为载体制备的注射用染料木素胶束的体外释药规律。方法:以加入2%吐温80的磷酸盐缓冲溶液(pH7.4)为释放介质,采用动态膜透析技术考察注射用染料木素胶束释药行为;采用高效液相色谱法测定含量并计算累积释药率;应用6种数学模型对其释药规律进行拟合;同时与染料木素原料药比较。结果:染料木素原料药在2 h内释放完全,而注射用染料木素胶束前期释药较快,后期释药较慢,并可持续释药48 h以上,释药行为符合Weibull模型。结论:注射用染料木素胶束体外释放具有一定的缓释特性。     

Coping and acceptance: The greatest challenge for veterans with intestinal stomas

Objective

Intestinal stomas (ostomies) create challenges for veterans. The goal of this qualitative analysis was to understand better patients' perspectives regarding their greatest challenge.

Methods

Ostomates at three Veterans Affairs locations were surveyed using the modified City of Hope Quality of Life—Ostomy questionnaire that contained an open-ended request for respondents to describe their greatest challenge. The response rate was 51% (239 of 467); 68% (163 of 239) completed the open-ended item. Content analysis was performed by an experienced qualitative research team.

Results

Coping and acceptance were the most commonly addressed themes. The most frequently expressed issues and advice were related to a need for positive thinking and insight regarding adjustment over time. Coping strategies included the use of humor, recognition of positive changes resulting from the stoma, and normalization of life with an ostomy.

Conclusions

Coping and acceptance are common themes described by veterans with an intestinal stoma. Health-care providers can assist veterans by utilizing ostomate self-management strategies, experience, and advice.     

睑袋的分型与手术方式的选择

目的探讨睑袋分型与手术方式选择的关系,以及临床效果。方法根据临床表现将216例睑袋分为3型和7个亚型,I型以先天结构异常为主要原因,Ⅱ型以长期用眼疲劳为主要原因,Ⅲ型以组织及骨的退行性变化为主要原因。按分型进行手术,手术方法按亚型设定7种。结果216例中159例获得随访3～12个月,均取得较好的临床效果。结论此分型简单,对临床手术方法的选择有很好的指导意义。     

Comorbidities play a larger role in predicting health-related quality of life compared to having an ostomy

BACKGROUND: Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL. METHODS: Eligible patients had abdominal operation with ostomy (cases) or similar procedure without ostomy (controls). Patients were recruited for this case-control study from 3 Veterans Affairs hospital medical and pharmacy records. Comorbidities were assessed with Charlson-Deyo Comorbidity Index. Multinomial logistic regression evaluated the impact of comorbidities and having an ostomy on HR-QOL, measured using the Medical Outcomes Study Short Form 36 for Veterans. RESULTS: A total of 237 ostomates (cases) and 268 controls were studied. Average age was 69 years; 64% of cases had colostomy, 36% ileostomy. Twenty-nine percent of patients had a high level of comorbidities. Cases and controls were similar except for reasons for undergoing surgery. High comorbidity was a significant predictor of low HR-QOL in 6 domains of the Short Form 36 for Veterans; having an ostomy was a significant predictor in 4. CONCLUSIONS: High comorbidity significantly influences low HR-QOL and impacted more domains than having an ostomy.     

一次性脑科袋式手术薄膜在会阴部微创电切手术中的应用

目的探讨一次性脑科袋式手术薄膜在会阴部微创电切手术中的应用。方法252例会阴部平诊前列腺电切和经宫腔镜电切手术患者随机分为观察组178例和常规组74例,常规组使用无菌巾铺巾,观察组使用脑科袋式手术薄膜铺巾;对患者会阴部手术部位有无污染及其程度作记录,评价两组铺巾的手术效果。结果使用脑科袋式手术薄膜较常规使用无菌巾缩短了手术时间,减少了手术感染,两组差异有统计学意义（P〈0．01）。结论一次性脑科袋式手术薄膜在会阴部微创电切手术中的疗效优于常规使用无菌巾。     

非PVC膜软袋大容量注射剂生产设备影响药品包装质量的因素探讨

通过输液药品包装质量不合格的表现形式,分析影响药品包装质量的设备因素,与供需双方及设备专家探讨交流,以利设计结构及制造技术的改进提高。     

普贝生配合水囊用于中晚期妊娠引产效果观察

目的观察普贝生配合水囊用于中晚期妊娠引产的效果。方法抽取100例中晚期妊娠引产病例,随机分为2组,分别应用水囊引产及阴道内置普贝生与水囊引产配合。结果普贝生与水囊引产配合后,引产时间明显缩短,出血少。两种引产方法比较,差异有统计学意义(P<0.01)。结论普贝生与水囊引产配合,方法简便、效果良好,与单纯水囊引产相比,疗效显著,引产时间短,不良反应少,具有较广泛的应用前景。     

真空定位袋在放疗临床应用中的剂量学研究

目的探讨真空定位袋在放疗中的质量保证与质量控制。方法把真空定位袋抽成真空．并使其厚度分别为1cm．3cm,5cm,10cm不等,将其置放于加速器治疗床的固体水模上,固体水模内放置剂量测量仪探头,分别用6MV和15MV高能x线进行照射,得到一组剂量仪读数,然后拿掉真空定位袋,其它条件不变,再去照射。用两组数据进行比较可求出真空定位袋的穿透因子。结果对于不同型号,不同厚度的真空定位袋,穿透因子不同。结论相同能量x线照射下,穿透因子随着真空定位袋厚度的增加而减小;相同型号和厚度的真空定位袋,穿透因子随着x射线能量的增加而增加．因此有必要对真空定位袋进行质量保证和质量控制．确保放射治疗定位和剂量计算的精度。     

Digital artery occlusion secondary to plastic shopping bag trauma

Upper limb digital arterial occlusion is uncommon. We present the case of a 47-year-old man with an ischaemic right middle finger (dominant hand) due to trauma from carrying a heavy plastic shopping bag. Duplex scanning revealed no proximal source of emboli. An angiogram demonstrated occlusions in the medial and lateral digital arteries of the middle digit at the level of the proximal phalanx. Treatment with heparin and warfarin resulted in complete resolution of symptoms.