不孕不育者对人工授精技术的伦理态度调查研究

目的：研究不孕不育者对人工授精技术的伦理态度,促进该项技术更好地为患者服务.方法：自制问卷调查了223名不孕不育者.结果：不孕不育者对AIH、AID的态度存在显著差异（P＜0.05）;对婚姻家庭生活选择相对宽容;精子的商品化趋向值得关注;必须采取一定措施以保证精子和人工授精儿的质量.结论：AID会引发许多伦理问题,临床应用时更应遵循有利于患者、知情同意等伦理原则和相关法律规定,以减少纠纷,造福社会.     

脑外伤病人的临床伦理问题探讨

脑外伤病人占外科病人很大一部分比例,其治疗过程艰难而复杂,而且在治疗过程中涉及很多伦理学问题,值得探讨和研究.本文作者通过多年来诊治脑外伤病人的经验,从伦理学的角度对脑外伤治疗过程中的一些问题进行了探讨,以期更有利于保障患者和医务工作者的合法权益、减少医疗纠纷,摆正医生与患者位置关系,使脑外伤患者得到更好的治疗.     

如何解决临床实习与患者隐私权保护的予盾

针对当前临床实习与患者隐私权保护矛盾的日渐激烈现象,以临床实习医生365人为对象进行调查分析研究,提出解决矛盾的办法.     

重症患者失禁性皮炎预防管理的研究进展

阐述了重症患者失禁性皮炎的危险因素及预防管理措施。除一般危险因素外,危重疾病本身也是失禁性皮炎发展的风险因素。重症患者失禁性皮炎的预防管理主要包括基于信息化平台构建失禁性皮炎预防管理系统,基于循证制定预防管理干预措施,以及借助新型敷料与药物实现多元化皮肤干预。提出重症患者失禁性皮炎的预防管理较为复杂,需要临床护理人员进行持续深入探索。     

Thyroid dysfunction during PD-1 inhibitor treatment in patients with cancer: Incidence and association with progression-free survival

The use of programmed cell death-1 (PD-1) inhibitors has recently been approved in China. As a consequence, the identification of relevant prognostic markers that can assess the efficacy of these compounds is required. Therefore, the present study aimed to explore the incidence of thyroid dysfunction and its ability to predict progression-free survival (PFS) in Chinese patients with cancer who received PD-1 inhibitor treatment. Data from 72 patients with cancer who received treatment with PD-1 inhibitors alone or in combination with chemotherapy or targeted drugs were analyzed. Moreover, the expression levels of free triiodothyronine, thyroxine, and thyrotropin during treatment were assessed to evaluate thyroid dysfunction. A total of 26 (36.1%) patients who had received PD-1 inhibitors developed thyroid dysfunction. Specifically, the incidence of thyroid dysfunction was 35.6% in patients with lung cancer, 25.0% in patients with malignant melanoma, and 46.7% in patients with other types of cancer. In addition, the median PFS was 7.0 (95% confidence interval, 4.9-9.1) months, whereas the 1- and 2-year PFS rates were 35.1 and 26.2%, respectively. Generally, patients with thyroid dysfunction exhibited longer PFS compared with those without thyroid dysfunction (P=0.001). Subgroup analyses were subsequently performed, which demonstrated that thyroid dysfunction was associated with longer PFS in patients with malignant melanoma (P=0.039) and other types of cancer (P=0.002), but not in those with lung cancer (P=0.083). These findings were noted in patients who received PD-1 inhibitor monotherapy (P=0.003), but not PD-1 inhibitor plus chemotherapy (P=0.172) or PD-1 inhibitor plus targeted therapy (P=0.582). Finally, thyroid dysfunction [P=0.001; hazard ratio (HR)=0.260] and PD-1 inhibitor monotherapy (P=0.015; HR=2.231) were identified as independent factors that could predict PFS. In conclusion, the present study demonstrated that thyroid dysfunction during PD-1 inhibitor treatment could be used as a potential marker for the prognosis of favorable PFS in patients with cancer.     

危重症评分量表对急诊病人转入ICU及死亡的预测能力研究

目的:探讨危重症评分量表对急诊病人转入重症监护室(ICU)及死亡的预测能力。方法:采用方便抽样法选取2019年1月—2019年12月在我院急诊科就诊的250例病人作为研究对象,最终纳入228例病人,按转入科室分为ICU组(68例)及普通病房组(160例)。应用改良早期预警评分(MEWS)量表和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评估病人病情,记录病人ICU转入率及死亡率,并应用受试者工作特征曲线(ROC)分析MEWS量表、APACHEⅡ量表在急诊病人ICU转入率及死亡率中的预测价值。结果:与普通病房组相比,ICU组MEWS评分、APACHEⅡ评分更高(P<0.001)。死亡组MEWS评分、APACHEⅡ评分高于非死亡组(P<0.001)。经ROC曲线分析可知,MEWS评分、APACHEⅡ评分诊断急诊病人转入ICU的最佳截断值分别为4分和20分,两者联合诊断急诊病人转入ICU的敏感度及特异度明显高于MEWS评分、APACHEⅡ评分单项诊断。MEWS评分、APACHEⅡ评分诊断急诊病人死亡最佳截断值分别为6分和25分,两者联合诊断急诊病人死亡的敏感度及特异度高于...     

早产儿转运过程的监护

随着急诊转运医学及新生儿重症监护医学的发展,新生儿转运医学应运而生。转运工作是将危重新生儿从基层医院转往三级医院的NICU作进一步监护、诊断及治疗的过程。它不是一个简单的运送过程,而是一个连续的监护治疗过程。成功的转运对于降低危重新生儿的死亡率及伤残率有着积极的意义[1],而恰当的救护是成功转运的保证。2004年1月~2005年12月我科共转运早产儿57例,本文现将早产儿转运过程中救护措施报告如下。1对象选择2004年1月~2005年12月在我科住院的早产儿57例,男性39例,女性18例。日龄<24h 42例,24~72h 13例,4~7d 2例。胎龄<28周5例,2…     

细节管理在老年留置普通硅胶胃管患者鼻饲饮食中的应用

目的 研究细节管理减少老年留置普通硅胶胃管患者鼻饲饮食后并发症、减少感染及死亡率的作用.方法 选取80例老年留置普通硅胶胃管患者,随机分为对照组40例与干预组40例,对照组患者鼻饲饮食实施常规管理,干预组患者鼻饲饮食实施管理,比较两组干预效果.结果 干预组发生胃肠道并发症6例,无堵管现象,肺部感染2例;对照组发生胃肠道...     

应用随机双盲法评价补肾和脉方治疗老年单纯收缩期高血压的临床研究

目的探讨补肾和脉方联合规范化抗高血压药物治疗老年单纯收缩期高血压的疗效及安全性。方法采用随机双盲对照研究方法,将65例患者按照分层区组随机化分为试验组和对照组。试验组采用中药复方颗粒联合规范化抗高血压药物治疗,对照组采用安慰剂颗粒联合规范化抗高血压药物治疗。2组均治疗12周,研究分为导入期和随机化治疗期,观察疗效性指标。结果试验组降压有效率94．3％（33／35）,对照组87．5％（26／30）,组间比较差异无统计学意义（X^2=1．119,P〉0．05）。试验组降压达标率88．6％（31／35）,对照组80％（24／30）,组间比较差异有统计学意义（X^2=17．515,P〈0．01）。治疗前后脉压的降低幅度相比,2组间差异有统计学意义（t=3．248,P〈0．01）。结论补肾和脉方联合规范化抗高血压药物治疗可有效、平稳地控制老年单纯收缩期高血压患者的血压,改善其临床症状,具有良好的安全性和耐受性。     

Association of admission blood glucose level and clinical outcomes in elderly community‐acquired pneumonia patients with or without diabetes

IntroductionCommunity‐acquired pneumonia (CAP) is the major cause of infection‐related mortality worldwide. Patients with CAP frequently present with admission hyperglycemia.ObjectivesThe aim of this study was to evaluate the association between admission blood glucose (ABG) level and clinical outcomes in elderly CAP patients (≥80 years of age) with or without diabetes.MethodsIn this single center retrospective study, 290 elderly patients diagnosed with CAP were included. Demographic and clinical information were collected and compared. The associations between admission blood glucose level and the 30‐day mortality as well as intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) in elderly CAP patients with or without diabetes were assessed.ResultsOf the 290 eligible patients with CAP, 159 (66.5%) patients were male, and 64 (22.1%) had a known history of diabetes at hospital admission. After adjusting for age and sex, the logistic regression analysis had identified several risk factors that might be associated with clinical outcomes in elderly patients with CAP. Multivariable logistic regression analysis revealed that admission glucose level > 11.1 mmol/L was significant associated with ICU admission, IMV, and 30‐day mortality both in non‐diabetic and diabetic patients. Furthermore, Kaplan–Meier analysis indicated that patients with higher admission glucose level were correlated statistically significantly with 30‐day mortality in patients with CAP (P < 0.001).ConclusionAdmission blood glucose is correlated with 30‐day hospital mortality, ICU admission, and IMV of CAP in elderly patients with and without diabetes. Specially, admission glucose > 11.1 mmol/L was a significant risk factor for 30‐day hospital mortality.