抗凝治疗肺心病血栓前状态的临床研究

目的探讨肺心病患者的血栓前状态，观察并分析低分子肝素抗凝干预的疗效。方法将54倒肺心病患者分为低分子肝素治疗组和常规治疗组各27例。分别检测治疗前后血浆血管性假血友病因子(VWF)、血浆凝血酶片段1 2(F1 2)、纤堆蛋白原(Fg)、血小板颗粒膜蛋白(GMP-140)和D-二聚体(DD)。结果肺心病患者VWF、F1 2、Fg、GMP-140、DD血浆浓度显著高于对照组；肺心病治疗组经LMWH治疗后上述各凝血分子标记物及PaCO2明显降低。而PaO2显著增高。常规组虽血气指标略有改善。但凝血分子标记物未见改善。结论尽早检测肺心病血栓前状态，及时给予低分子肝素抗凝干预，有望从根本上改善肺心病惠性加重期患者的不良预后。     

Wounding,shock and stress lesions of the upper gastrointestinal tract

This retrospective study included 2532 wounded, of whom 354 (14 per cent) were treated in surgical intensive care units. In 32 patients, 1.3 per cent of all admissions, upper gastrointestinal bleeding was detected. It occurred on average 8.9 days (3–21 days) after the wounding or surgical procedure in severely injured patients and those treated in intensive care units, respectively (32 of 354 patients, 9.0 per cent). All patients received different analgesic drugs and 17 of a group that presented with bleeding were given psychotropic agents as well. The majority of patients (96.3 per cent) were administered H₂-receptor antagonists as prophylaxis against stress ulcer disease. There was a statistically significant difference between these patients treated with H₂-receptor antagonists and those on no prophylactic therapy. No statistically significant difference was found between cimetidine and ranitidine in terms of their efficacy. Endoscopic examination revealed multiple bleeding gastric and duodenal erosions. The lesions were most commonly located in the corpus of the stomach. In the majority of patients (56.25 per cent), the haemorrhage stopped spontaneously and rebleeding presented in four of 32 (12.5 per cent) patients. Of 354 patients treated in intensive care units, five (1.4 per cent) had to be operated on because of bleeding arrest. Despite all therapeutic and surgical procedures undertaken, five of 32 (15.6 per cent) patients died.     

孕妇配偶的心理压力研究

目的描述孕妇配偶的压力水平 ,找出引起孕妇配偶压力的主要压力源。方法对 167例孕妇配偶用妊娠压力量表测量其压力水平及压力源。结果孕妇配偶的妊娠压力水平总分为 1.5 3 ,引起孕妇配偶压力的最主要的压力源是“为确保母子健康和安全而引发的压力 ( 1.88)”。结论护士的服务对象不应局限于孕妇 ,还应包括其配偶 ,根据孕妇配偶具体的压力源给予有针对性的护理 ,以利于有效地降低其压力水平。使孕妇配偶能顺利地度过角色转变期 ,在妊娠和分娩的应激下保持心身健康 ,更好地完成照顾孕妇和婴儿的任务。     

Information Fusing Recognition of Traditional Chinese Medicine （TCM） Pulse State Based on Stochastic Fuzzy Neural Network

Based on the fuzzy characteristic of the pulse state and syndromes differentiation thinking mode of TCM, an information fusing recognition method of pulse states based on SFNN （Stochastic Fuzzy Neural Network） is presented in this paper. With the learning ability in parameters and structure, SFNN fuses the measurement information of three pulse-state sensors distributed in Cun, Guan, and Chi location of body for the pulse state recognition. The experimental results show that the percentage of correct recognition with new method is higher than that by single-data recognition one, with fewer off-line train numbers.     

皮肤病患者焦虑水平评估及对策

目的正确评估皮肤疾病患者的焦虑水平，为制定有针对性的护理对策提供依据。方法对136例皮肤病患者采用状态-特质量表（STAI-FormY）进行心理状态评估。结果133例患者状态焦虑阳性47例，总阳性率35％，其中神经性皮炎阳性数23例，阳性率59％（23／39），天疤疮阳性数7例，阳性率58％（7／12），慢性荨麻疹阳性数8例，阳性率53％（8／15），湿疹阳性数2例，阳性率20％（2／10），带状疱疹阳性数5例，阳性率14％（5／36），过敏性紫癜阳性数2例，阳性率12％（2／16）。患者总体状态与特质焦虑评分相关性分析显示两者之间关系密切，呈直线正相关关系（r=0．81，P〈0．001）。结论住院皮肤疾病患者存在较多的焦虑状态，通过量表评估患者的焦虑程度，能较准确的找出焦虑者。     

Water- and fat-suppressed proton projection MRI (WASPI) of rat femur bone.

Investigators often study rats by microCT to investigate the pathogenesis and treatment of skeletal disorders in humans. However, microCT measurements provide information only on bone mineral content and not the solid matrix. CT scans are often carried out on cancellous bone, which contains a significant volume of marrow cells, stroma, water, and fat, and thus the apparent bone mineral density (BMD) does not reflect the mineral density within the matrix, where the mineral crystals are localized. Water- and fat-suppressed solid-state proton projection imaging (WASPI) was utilized in this study to image the solid matrix content (collagen, tightly bound water, and other immobile molecules) of rat femur specimens, and meet the challenges of small sample size and demanding submillimeter resolution. A method is introduced to recover the central region of k-space, which is always lost in the receiver dead time when free induction decays (FIDs) are acquired. With this approach, points near the k-space origin are sampled under a small number of radial projections at reduced gradient strength. The typical scan time for the current WASPI experiments was 2 hr. Proton solid-matrix images of rat femurs with 0.4-mm resolution and 12-mm field of view (FOV) were obtained. This method provides a noninvasive means of studying bone matrix in small animals.     

Bilateral Mid-Diaphyseal Femoral Stress Fractures in the Elderly

Abstract Background: Osteoporosis is characterized by low bone density and poor bone mineralization. Mid-diaphyseal stress (insufficiency) fractures of the femur caused by osteoporosis are rare. The symptoms of these lesions are vague and confusing. The physician must be alert to the possibility of femoral shaft stress fractures when evaluating an elderly patient complaining of back, hip or leg pain. Case Study: A 72-year-old osteoporotic female patient with bilateral mid-diaphyseal stress fractures of the femur is reported. The diagnosis of femoral shaft stress fracture in the elderly is very difficult when based on physical findings and plain radiography only. A magnetic resonance imaging (MRI) scan or nuclear scintigraphy is necessary for early diagnosis. In the described case, the patient had an excellent result after surgical treatment with intramedullary nails. Conclusion: MRI or nuclear scintigraphy must be obtained to exclude the possibility of femoral shaft stress fractures in the elderly. In the absence of contraindications, surgery is the best solution for this kind of lesion.     

蛇毒抗高凝状态酶、氟尿嘧啶对BEL-7404细胞作用的实验研究

目的通过蛇毒抗高凝状态酶（AHCSE）、氟尿嘧啶（5-FU）对人肝癌细胞BEL-7404（简称7404细胞）、正常LO2肝细胞（简称LO2细胞）作用的比较，研究AHCSE对肝癌的作用以及探讨其可能的作用机制。方法应用光学显微镜、透射电镜、MTT法、TUNEL、FCM等方法观察7404细胞、LO2细胞经过AHCSE、5-FU处理后，细胞形态学、生物化学等方面的变化。结果7404细胞、LO2细胞经过AHCSE、52FU处理后，发生了形态学改变；小剂量AHCSE对7404细胞具有很强的抑制作用，但对LO2细胞几乎无影响；随着剂量的加大，AHCSE对7404细胞抑制率上升不明显，但是出现对LO2细胞的抑制作用。经AHCSE作用后，7404细胞发生了凋亡，凋亡率随AHCSE浓度的增加而增加；与5-FU对7404细胞作用相似，但5-FU对LO2细胞抑制作用明显增强。结论AHCSE、5-FU对BEL-7404细胞均有很强的抑制作用，诱导细胞凋亡是其作用机制之一，AHCSE可能成为一种新的肝癌细胞凋亡的诱导剂。     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁

目的探讨经闭孔无张力尿道中段悬吊术(trans-obturator tension free vaginal tape,TVT-O)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的临床疗效。方法2006年1月~2007年9月,对15例SUI行TVT-O,取阴道前壁纵行切口1cm,组织剪分离尿道旁阴道黏膜下间隙至闭孔膜,放入蝶形导引杆,将螺旋形穿刺针沿导引杆紧贴耻骨下支穿过闭孔膜,从大腿根部皮肤穿出,将吊带无张力放置于尿道中段下方。结果手术时间15~40min,平均30min。术中出血量10~40ml,平均20ml。术中无并发症。1例术后尿潴留,留置尿管5d后缓解。10例术后大腿根部疼痛,术后3~10d消失。15例随访2~19个月,平均8个月,均治愈,无复发。结论TVT-O操作简单、安全有效。     

不同麻醉方式对儿童腹腔镜疝囊高位结扎术应激反应的影响

目的探讨两种麻醉方法对儿童腹腔镜疝高位结扎术（lapamscopic hernia sac high ligation）应激反应的影响。方法ASAⅠ-Ⅱ级择期行腹股疝疝囊高位结扎术患儿60例，年龄6—12岁，随机分为硬膜外麻醉组（E组）和单纯气管内全麻组（G组）各30例。检测术中不同时点血浆皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）、促肾上腺皮质激素（ACTH）浓度并观察平均动脉压（MAP）和心率（HR）的变化。结果E组各时点Cor、NE、E、ACHT浓度无明显变化（P〉0．05），G组气腹后上述各指标较气腹前明显增高（P〈0．05）且显著高于E组同时点（P〈0．05）（见表2）；E组气腹后平均动脉压及心率变化无统计学意义（P〉0．05），而G组的则显著升高（P〈0．05）；两组患儿气腹10min后PaC02均显著增加（P〈0．05），停气腹后渐恢复至正常，血PH值则变化不明显。结论硬膜外麻醉复合基础麻醉相对于单纯气管内全麻更能有效抑制儿童腹股疝疝囊高位结扎术的应激反应。