围分娩期胎死宫内的原因(上)

胎死宫内(intrauterinefetaldeath,IUFD)是围生儿死亡的重要原因。由于不同国家使用的死胎的起始孕周不同,胎死宫内率报道有很大的差异,在1‰～10‰之间。随着围产保健工作的加强,胎死宫内的发生率在近20年有了显著下降。预防妊娠晚期胎死宫内是降低围生儿死亡率的行之有效的措施和途径,本文对围分娩期胎死宫内的病因学研究现状作一介绍。晚期妊娠胎死宫内的原因包括以下     

马应龙麝香痔疮膏治疗糜烂型间擦疹35例

间擦疹是一种发生在皮肤皱襞部位的急性炎症性疾患，多由于皮肤皱襞处出汗潮湿，角质层被浸软加上局部皮肤随躯体活动不断摩擦导致充血糜烂而发生本病，而且常继发细菌和念珠菌感染，本病好发于婴幼儿和肥胖病人，多见于颈部、腋窝，腹股沟、臀沟和妇女乳房下，马应龙麝香痔疮膏对皮肤黏膜具有很好的消炎、镇痛、修复组织的作用，临床用其治疗间擦疹取得良好效果，现报告如下。     

1例妊娠合并急性脂肪肝的护理

妊娠合并急性脂肪肝为妊娠晚期特有的疾病，表现为急性肝细胞脂肪变性所引起的肝功能障碍。此病以双胎多见，病因不明，起病急、病情凶险，病死率为10％～100％，大多在产后数日内死亡，被产科专家称为妊娠晚期的灾难性疾病。我科于2007年11月5日收治了1例妊娠合并脂肪肝病人，现将其护理报告如下。     

FOLFOX4与替加氟替代方案对晚期胃癌疗效的对比研究

目的:对比观察FOLFOX4方案与替加氟替代方案治疗晚期胃癌的疗效和不良反应.方法:经病理或细胞学确诊的晚期胃癌患者75例,按收治的时间顺序交叉分入FOLFOX4组(A组)或替加氟替代组(B组),两方案均至少连用3周期评价疗效.A组:OXA 85mg/m2,静滴2h,第1天;LV 200mg/m2,静滴2h,第1、2天;5-FU 400mg/m2,静推,然后600mg/m2,22h静脉维持,第1、2天;2周重复,14天为1个周期.B组:OXA 130mg/m2,静滴2h,第1天;LV 200mg/m2,静滴2h,第1-5天;FT-207 800mg/m2,静滴3h,第1-5天;3周重复,21天为1个周期.结果:研究对象共75例.A组39例,总有效率(CR + PR)41.0%,其中初治患者总有效率55.6%;复治患者的总有效率28.6%.B组36例, 总有效率38.9%,其中初治患者总有效率 50.0%;复治患者的总有效率30.0%.两组总有效率比较均无统计学差异.不良反应主要是白细胞减少、恶心呕吐、神经感觉毒性等,A组白细胞下降发生率和消化系统不良反应发生率均明显高于B组(P均＜0.05).两组均无化疗相关死亡.结论:FOLFOX4方案与替加氟替代方案均为治疗晚期胃癌有效的方案,FOLFOX4方案总有效率稍高,不良反应较替加氟替代方案重,但可耐受.建议晚期胃癌初治可选用FOLFOX4方案,而其中年龄偏大,体质欠佳的患者宜选替加氟替代方案.     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

晚期肝癌——拿什么拯救你，我爱的人

20：34，夜幕早已降临，一台肝癌切除手术终于宣告结束了，手术还算成功。下完医嘱、交代好注意事项后，我拖着疲惫的身体回到了家。随便吃了晚餐后，想着明天还有个研究报告会，于是，我又抖了抖精神，打开电脑，查查邮件，看看最新的科研资料。     

对2例晚期肿瘤患者实施“临终关怀指导”的护理体会

临终关怀是为生命即将结束的患者及家属提供全面的身心照顾及支持，让临终患者在有限的时间内，有尊严而无遗憾安详度过人生旅途的最后一站。自1967年，英国SICELY SAUNDERS提出临终关怀理论以来人们依据生命科学的理论，对濒死的患者进行“临终关怀指导”。笔者自2000年末开始深入学习这一课题，逐渐在各类疾病晚期，特别是针对肿瘤患者开展起来，其目的是让患者安然接受死亡，其伦理学意义在于指导临终患者认知生命的价值及其弥留之际对生存的社会意义，使患者临终保持自己的尊严，减轻极度的死亡恐惧，     

7例侵犯左心房的晚期肺癌的手术治疗

1995年5月至2003年12月，我们手术治疗肺癌212例，其中7例肿瘤侵犯左心房而行肺切除并左心房部分切除术，现报告如下。     

主付钢丝固定法在外伤松动牙上的应用78例分析

目的：评价主付钢丝固定法在外伤松动牙上的临床应用价值。方法：利用主付钢丝固定法，操作简单快捷。固定可靠，对78例外伤所致牙齿松动的牙进行固定法修复。结果：主付钢丝固定法修复牙齿外伤78例，失败6例。结论：主付钢丝固定法临床性能可靠。     

奈达铂联合氟尿嘧啶治疗晚期食管癌临床观察

目的观察奈达铂联合氟尿嘧啶治疗晚期食管癌的疗效和毒性。方法奈达铂40mg/m^2·d静脉滴入d1、d8天;氟尿嘧啶200mg/m^2·d使用微量泵持续静脉滴注,连用2周。结果治疗组42例患者中,获CR3例,PR18例,总有效率（CR＋PR）49.95%;对照组42例患者中CR2例,PR14例,总有效率38.1%。毒副反应以骨髓抑制为主,表现为白细胞和血小板减少,恶心呕吐,感觉性神经毒性,口腔粘膜炎,腹泻,手足综合症等。结论奈达铂联合氟尿嘧啶方案治疗晚期食管癌疗效显著,且毒副作用小,值得临床进一步研究。