老年胆道外科疾病100例围手术期护理

目的:探讨老年胆道外科疾病患者的围手术期护理方法。方法:对100例老年胆道外科疾病患者术前做好全面检查,积极治疗伴随疾病,术后密切观察病情,做好管道护理,重视健康指导。结果:本组治愈97例,病情危重自动放弃治疗2例,死亡1例。结论:术前做好充分准备,积极治疗伴随疾病,术后密切观察病情,做好健康指导,是提高手术安全性和减少并发症的关键。     

微白蛋白尿与危重患者预后

微白蛋白尿被认为是反映全身毛细血管渗透性增加的一个重要指标.目前,已经发现许多常见的内科疾病如:糖尿病、肾脏疾病和心血管疾病,都会出现微白蛋白尿,且有文献报道微白蛋白尿与危重患者的预后相关.本文就微白蛋白尿与危重患者预后的关系、预测危重患者疾病严重程度的价值进行简要综述.     

丹参胶囊的系统稳定性考察

目的:制备丹参提取物和丹参胶囊,研究二者在高湿、高温和光照条件下的稳定性,并考察丹参胶囊及相关物料的吸湿特性。方法:采用UPLC测定丹参素、迷迭香酸、紫草酸和丹酚酸B的含量,流动相0. 05%磷酸水溶液(A)-乙腈(B)梯度洗脱(0～2 min,93%～79. 2%A; 2～6 min,79. 2%～75%A; 6～9 min,75%～65%A; 9～10. 5 min,65%～10%A; 10. 5～11 min,10%～93%A),流速0. 4 mL·min~(-1),检测波长280 nm。通过测定丹参胶囊及相关物料的吸湿增重,绘制吸湿等温曲线,测算临界相对湿度(CRH)。结果:丹参提取物和丹参胶囊分别在温度40℃,相对湿度75%和92. 5%,光照强度(4 500±500) Lx条件下放置10 d后,4个酚酸成分含量波动均在±10%以内,无明显变化趋势;高温60℃条件,二者中的丹参素变化率分别为47. 45%和32. 24%,丹酚酸B变化率分别为-6. 39%和-9. 64%。吸湿性考察显示,淀粉基丸CRH=58. 5%,丹参提取物CRH=72. 34%,包衣丸CRH=72. 85%,丹参胶囊CRH=73. 55%。结论:高温环境会影响丹参提取物和丹参胶囊中酚酸类指标成分的稳定性,为确保丹参提取物及丹参胶囊质量稳定,应避免高温环境。为防止丹参胶囊及其相关物料过度吸湿,淀粉基丸、丹参提取物、丹参包衣丸和丹参胶囊的生产、贮存环境中相对湿度应控制在相应CRH以下。     

参附注射液治疗内科疾病

参附注射液提取于人参黑附片,包含乌头生物碱、人参皂苷类成分,现代工艺精制而成。中草药成分复杂,药理疗效通过多靶点、多层面作用于人体组织器官。临床实践验证,参附注射液补气、温阳。虚证表现为细胞免疫功能下降,参附注射液能提高免疫功能,改善机体免疫力,内科疾病应用价值明显。     

Pulmonary edema in man: Comparison of capillary filtration pressure, quantification by means of the double indicator-dilution method, and clinical observations

In three groups of patients, one with no signs of pulmonaryedema (n = 11), one with acute myocardial infarction but withoutpulmonary edema (n = 6) and one with recent myocardial infarctionand clinical signs of pulmonary edema (n = 13), investigationswere performed to determine the degree of pulmonary edema: Pulmonary capillary wedge pressure (PC W), plasma colloid osmoticpressure (COP), and critical pressure (CrP) defined as CrP =PCW – COP. The double indicator dilution method with ¹³¹/ albumin as anintravascular indicator and tritiated water (THO) as a diffusingindicator. Clinical estimates such as radiological and auscultatory criteria. Monitoring of PCW and plasma COP appears to give valuable informationon whether or not pulmonary edema fluid is being generated atthe moment when these measurements are being made. On the otherhand, the information obtained by the double indicator-dilutionmethod proved insufficient to warrant its adoption for routineclinical use. Even the difference in mean transit limes of thetwo indicators was found to be a better measurement of the degreeof pulmonary edema.     

济宁地区21-三体综合征患儿致家庭负担情况调查

目的 调查济宁地区21-三体综合征患儿致家庭经济负担及精神负担情况。方法 2013年1-8月对济宁市78例21-三体综合征患儿的170名陪护人（试验组）及同期济宁市年龄与患儿相仿的、近期无任何重大疾病的100例健康儿童的190名陪护人（对照组）进行问卷调查。采用生活满意度评定量表（LSR）及生活满意度指数A（LSIA）评定两组陪护人生活满意度,采用症状自评量表（SCL-90）评定两组家庭负担情况。结果 试验组农村地区和城镇地区患儿治疗支出占家庭收入的68.56%、55.91%。试验组陪护人LSR、LSIA评分均低于对照组（P＜0.05）|试验组农村地区陪护人LSIA评分低于城镇地区,差异有统计学意义（P＜0.05）|试验组陪护人SCL-90中躯体化、人际关系、抑郁、焦虑及精神病性5个因子评分均低于对照组,差异均有统计学意义（P＜0.05）|试验组农村地区陪护人SCL-90中仅人际关系因子评分高于城镇地区,差异有统计学意义（P＜0.05）。结论 21-三体综合征患儿不仅会给家庭带来经济负担,更影响陪护人的生活质量及精神健康状况,应该引起足够的重视。     

人体寄生虫学教学中学生批判性思维能力的培养

为提高医学生在寄生虫学学习阶段的批判性思维能力,以CTDI-CV量表为标准,对本校60名学生随机分成两组进行批判性思维能力培养的对照研究。结果显示实验组学生的批判性思维能力有所提高,两组存在显著性差异(P<0.05)。当前医学教育应改进教学方法与评估体系,建立和完善医学生批判性思维能力的培养模式。     

Scrub typhus strikes back: Are we ready?

Scrub typhus has struck back, albeit with renewed vigour, impacting areas with previously known endemicity as also impressing newer expanses. It is not surprising, therefore, that Scrub typhus has emerged as a leading cause of public health concern globally as well as in India, but are we ready to take on the challenge?Over the last decade, there has been a global increase in the number of outbreaks of Scrub typhus, be it the military occupied areas or the civil population at large. The innumerable outbreaks of Scrub typhus, although disconcerting, have nonetheless contributed phenomenally towards better understanding of the dynamics of scrub typhus. There have been significant contributions to awareness of the disease amongst medical professionals, scrub typhus as a cause of Acute Undifferentiated Febrile Illness (AUFI) and newer clinical manifestation – Acute Encephalitis Syndrome (AES), availability and advances in diagnostics and management, man-vector-pathogen interactions, new records of Leptotrombidium species, newer vectors and Orientia species.Antigenic diversity and the varied clinical presentation of scrub typhus, absence of scrub typhus surveillance system and a lack of political will to recognize the disease as one of the important reemerging public health problem are areas seeking concerted deliberations and actions so that the challenges posed by scrub typhus can be addressed.     

糖代谢紊乱对危重病人预后的影响

目的探讨危重病人的糖代谢紊乱与病情严重程度、预后的关系。方法应用APACHEⅢ评分系统对206例危重患者的危重程度进行评估,并观察患者病死率。结果糖尿病组、应激性高血糖组的APACHEⅢ评分均明显高于血糖正常组(P<0.01);ICU住院时间、呼吸机使用时间均较血糖正常组明显延长(P<0.01);肾功能受损害程度、发热情况均较血糖正常组严重(P<0.01)。而三组患者的TBil值和每日摄取食物的热卡差异均无显著性(P>0.05)。糖尿病组、应激性高血糖组的病死率均明显高于血糖正常组(P<0.01)。以应激性高血糖组最高(45.57%),血糖正常组最低(18.28%)。结论糖代谢紊乱可加重病情,存在糖代谢紊乱的危重患者病死率明显增高,是影响危重患者预后的危险因子之一。     

Multisystem Inflammatory Syndrome after Breakthrough SARS-CoV-2 Infection in 2 Immunized Adolescents,United States

Eight weeks after having laboratory-confirmed SARS-CoV-2 breakthrough infections, 2 otherwise healthy, fully immunized adolescent patients in the United States who were experiencing related signs and symptoms were diagnosed with multisystem inflammatory syndrome in children. Our findings indicate that COVID-19 vaccination does not completely protect adolescents against multisystem inflammatory syndrome.