全手皮肤脱套伤的分型和治疗

目的总结全手皮肤脱套伤的伤情特点,探讨全手皮肤脱套伤的分型标准及治疗方法。方法 1999年12月-2010年5月,收治41例全手皮肤脱套伤。男28例,女13例;年龄18～58岁,平均35岁。致伤原因:碾压伤28例,挤压伤13例。受伤至手术时间1～10 h,平均3 h。根据自定全手皮肤脱套伤分型标准:Ⅰ型11例,Ⅱ型5例,Ⅲ型4例,Ⅳ型8例,Ⅴ型13例。Ⅰ型采用吻合血管回植术;Ⅱ型采用带足背皮瓣的甲瓣、第2趾甲瓣再造术;Ⅲ型采用双足带足背皮瓣的第2趾甲瓣再造术;Ⅳ型采用吻合血管回植术;Ⅴ型采用带足背皮瓣的甲瓣再造(8例)或腹部皮瓣修复术(5例)。足背皮瓣切取范围为9 cm×6 cm～17 cm×11 cm,足背供区游离植皮修复。结果术后Ⅰ型6例发生部分手指坏死,Ⅳ型6例发生部分手指及手掌皮肤坏死;其余患者皮瓣、再造指及回植皮肤均成活。足背供区及腹部供区均顺利愈合。40例患者获随访,随访时间6个月～7年,平均14个月。采用吻合血管回植治疗者,手部皮肤颜色、质地接近正常,功能恢复佳,感觉恢复至S2～S4;采用甲瓣及趾甲瓣再造手指者,手功能基本恢复,再造指感觉恢复至S2～S3;采用腹部皮瓣者,手功能恢复欠佳,手部感觉恢复至S1～S2。结论采用自定标准对全手皮肤脱套伤程度进行分型,并指导临床治疗方案的选择,可获得较好临床疗效。     

医学数字资源长期保存标准体系研究

针对医学数字资源构建长期保存标准体系,结合研究现状,设计体系框架,为具有长期保存价值的医学数字资源提供保存标准,以期指导后续保存系统应用实践。     

优质护理在慢性乙型病毒性肝炎患者护理中的应用分析

目的分析优质护理在慢性乙型病毒性肝炎患者护理中的应用分析。方法选取2015年8月～2018年7月期间,我院收治的慢性乙型病毒性肝炎患者92例,随机分为对照组(46例)和观察组(46例),对照组患者行常规护理,观察组患者行优质护理,观察两组患者的生活质量评分、生活质量达标率和治疗依从性。结果观察组患者的消毒隔离达标率、病室管理达标率、护理能力合格达标率与对照组比较,差异有统计学意义(P0.05);观察组患者的物质生活评分、社会功能评分、心理功能评分、躯体功能评分与对照组比较,差异有统计学意义(P0.05);观察组患者的规律服药率、坚持疗程率、家属监督率、保持乐观率与对照组比较,差异有统计学意义(P0.05)。结论给予慢性乙型病毒性肝炎患者优质护理,可以提升护理效果,并提高患者的治疗依从性和生活质量,值得推广应用。     

Nationwide outcomes of newborns with rectosigmoid versus long-segment Hirschsprung disease

PurposeHirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns with rectosigmoid and long-segment HD.MethodsThe Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Newborns were stratified into those with rectosigmoid or long-segment HD. Those who received no rectal biopsy or pull-through procedure during their newborn hospitalization were excluded. A propensity score-matched analysis (PSMA) of newborns with either type of HD was constructed utilizing 17 covariates including demographics, comorbidities, and congenital-perinatal conditions.ResultsThere were 1280 newborns identified with HD (82% rectosigmoid HD, 18% long-segment HD). Patients with rectosigmoid HD had higher rates of laparoscopic resections (35% vs. 12%) and less frequently received a concomitant ostomy (14% vs. 84%), both p < 0.001. Patients with long-segment HD were more likely to have a delayed diagnosis (12% vs. 5%) and require multiple bowel operations (19% vs. 4%), both p < 0.001. They experienced higher rates of complications, including small bowel obstructions (10% vs. 1%), infections (45% vs. 20%), and Hirschsprung-associated enterocolitis (11% vs. 5%), all p < 0.001. After PSMA, newborns with long-segment HD were found to have a longer length of stay and higher hospitalization costs.ConclusionNewborns with long-segment HD experience significant delays in diagnosis, surgery, and complications compared to those with rectosigmoid HD. This information should be utilized to improve healthcare delivery for this patient population.Type of StudyRetrospective comparative study.Level of EvidenceIII.     

招收飞行学员听力检查标准探讨

目的 探讨修改空军招收飞行学员听力检查标准的可行性. 方法 ①收集招收飞行学员听力检查资料5673份,按现行的空军招收飞行学员听力检查标准(标准1)统计听力合格例数及合格率.②将低中频(0.25、0.5、1、2、3 kHz)听力损失不超标准1且双耳高频(4、6、8 kHz)听力损失总和≤270 dB者,按双耳高频听力损失之和的大小分为3组:A组(≤210 dB),B组(＞210 dB且≤240 dB)及C组(＞240 dB且≤270 dB).按5 dB档差统计A组听力较差耳4 kHz听力损失＞45 dB的例数,以及B组和C组听力较差耳4 kHz听力损失≤45 dB的例数.③将标准1高频部分修改为4 kHz听力损失≤45 dB,且双耳高频听力损失总和≤240 dB(标准2),或4 kHz听力损失≤45 dB且双耳高频听力损失总和≤270 dB(标准3).按标准2和标准3统计合格例数及合格率;分别统计符合3个标准的合格者中的0.5、1、2、4 kHz平均听阈＞25 dB的例数及所占百分比.比较3个标准的合格率及合格者中有听力障碍的百分比. 结果 ①按标准1统计,合格5310例.②A组4 kHz听力损失＞45 dB的63例,B组4 kHz听力损失≤45 dB的30例,C组4 kHz听力损失≤45 dB的25例.③按标准1、标准2及标准3统计的合格率分别为93.60％(5310/5673)、93.02％(5277/5673)及93.46％(5302/5673),差异无统计学意义;按标准1、标准2及标准3统计的合格者中0.5、1、2、4 kHz平均听阈＞25 dB的比率分别是2.56％(136/5310)、1.57％(83/5277)及1.77％(94/5302),按标准1统计的比率比标准2、标准3统计均高(x2=12.76、7.77,P＜0.01),而标准2与标准3之间差异无统计学意义. 结论 将现行空军招收飞行学员听力检查标准的高频修改为4 kHz听力损失≤45 dB,双耳高频听力损失之和≤240 dB是科学合理的,既降低了合格者中轻度听力障碍的比例,又对合格率没有明显影响.     

Criterion-related validity and test–retest reliability of the 20 m Square Shuttle Test

We assessed validity and reliability of the new 20m square shuttle run test (SST) for predicting maximal oxygen uptake (V O(2max)) and compared it with its predecessor, the 20m Multistage Shuttle Run Test (MST). In a repeated-measures randomised-block design, 74 healthy adult males performed the SST, the MST and a treadmill test (TT). To assess reliability, 40 of the total 74 volunteers were randomly-selected to perform the SST and MST twice. Unlike the SST (p>0.05), mean predicted V O(2max)(V predO(2max)) from the MST was significantly increased from that measured during the TT (p<0.05). The V predO(2max) from SST and MST correlated with TT V O(2max) at r=0.95 (p<0.001) and r=0.63 (p<0.001), respectively. Prediction error of SST was -0.3+/-3.3mlkg(-1)min(-1) with a coefficient of variation of +/-3.5%, while the equivalent values for MST were 4.2+/-7.3mlkg(-1)min(-1) and +/-7.4%. Mean test-retest V predO(2max) did not differ for both SST and MST (p>0.05), while the corresponding test-retest correlation coefficients were r=0.85 (p<0.001) and r=0.72 (p<0.001). Reliability errors in 95% limits of agreement were 0.3+/-4.8 and 0.6+/-6.8mlkg(-1)min(-1) while coefficients of variation were +/-5.2% and +/-6.8% for the SST and MST, respectively. It is concluded that SST is a more valid proxy than MST for predicting laboratory V O(2max) based on the current procedures, while both tests are sufficiently reliable in healthy male adults.     

改良标准化疗方案治疗脊柱结核的疗效分析

目的评价改良标准化疗方案治疗脊柱结核的临床疗效和药物安全性,明确常见副作用及其处理措施.方法收集2008年1月至2012年12月期间在昆明医科大学第一附属医院明确诊断为"脊柱结核"、接受改良标准化疗方案(2HRZE/4HRE/12-18HR;剂量为H 300 mg,R 450 mg,Z 750 mg,E 750 mg,晨起顿服)并完成至少2 a随访的患者资料,采用临床治愈率和复发率评估该化疗方案的疗效;通过药物副作用发生率和严重程度评估该化疗方案的安全性.对药物常见的副作用,按发生的类型、时间、严重程度、处理措施等进行统计和分析.结果共67例患者纳入本研究,其中男性32例,女性35例;年龄15~68岁,平均40.6岁.其中21例患者仅采用改良标准化疗方案,其余46例采用术前化疗+手术+术后化疗方案进行治疗.2 a临床愈合率95.52%,2 a内结核复发率1.50%.在整个化疗期间,药物副作用主要发生在前2个月的四联强化治疗期,主要涉及胃肠道反应(约为28.36%)、高尿酸血症(约为31.34%)、肝功能异常(约为31.34%)等;多数药物副作用较轻,部分较严重病例加用Vit B6、护肝药(如多烯磷脂酰胆碱、草甘酸二钠或还原性谷胱甘肽等)、碳酸氢钠和多饮水等措施得到控制;吡嗪酰胺的撤除可明显减少高尿酸血症的发生率.结论运用改良标准化疗方案治疗脊柱结核可获得良好的临床疗效并具有较高的安全性.