论现代医院技术创新

创新是医院发展主题,本文采用综合分析、收集资料、对比方法,对技术创新内容、技术创新原则、技术创新趋势进行了较详细的分析研究.     

改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床观察

目的 :探讨改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床效果。方法 :用 7～ 9号腰脊穿刺针针头去尖 ,磨光后制成改良空管式泪道探针。为慢性泪囊炎 98例、10 2眼探通泪道后沿空管注入素高捷疗眼膏 ,使之布满泪道内壁 ,尽快修复探通的泪道内皮 ,达到扩张疏通的目的。以同一疾病 84例、85眼为对照组 ,以 1～ 3号银质泪道扩张针扩通泪道 ,留针 15min ,隔日 1次 ,共扩张 2～ 3次 ,扩张后用 0 .2 5 %氯氟液冲洗。结果 :术后随访 3个月 ,观察组治愈率为 97.0 5 %,对照组治愈率为 9.4 1%,差异有高度显著性 (P<0 .0 1)。 结论 :用改良的泪道探针探通泪道后注入素高捷疗眼膏 ,促使泪道修复 ,是治疗泪道阻塞或狭窄的有效方法。     

Victim Help Seeking: Differences Between Intimate Terrorism and Situational Couple Violence

Abstract: Research indicates that two major forms of partner violence exist, intimate terrorism (IT) and situational couple violence (SCV). The current study (N= 389) used a subgroup of women who responded to the Chicago Women’s Health Risk Study to examine whether type of violence experienced is differentially related to formal (e.g., police, medical agencies, counseling) and informal (e.g., family, friends/neighbors) help seeking. IT victims were more likely to seek each type of formal help but were equally or less likely to seek informal help. Findings can inform both family violence research and the development and implementation of social service programs.     

Investigation of Direct Causes of Drug Relapse and Abstainers’ Demands in a Compulsive Detoxification Center in Wuhan City of China

Objective To identify the direct causes of drug relapse and abstainers’ demand, and to develop programs for the prevention of drug relapse. Methods Abstainers in a Compulsive Detoxification Center in Wuhan City, capital of Hubei Province were randomly selected. An investigation on the direct causes of drug relapse and abstainers’ demands was conducted with multiple-choice questionnaires and face to face interviews. Data were analyzed with SPSS 12.0. Results The direct causes leading to drug relapse included: temptation to use drug again by themselves or by their drug mates, seeking pleasure and ecstasy from drug use, relatively well off living, mental stress, irritation, demoralization, family conflicts, unemployment, feeling distrusted by the family, lack of care and love from the family, and discrimination by others. abstainers’ demands after detoxification and returning to the society included: care and support from the family, employment assistance, changing living environment, understanding by others, support from the society, and keeping far away from drugs. Conclusions Environmental factors are the direct causes of drug relapse, and negative irritation is its predisposing causes. Leaving former residence, more care and help given by both the family and the society and raising their overall quality of life are the demands of abstainers.     

Comparison of the efficacy and safety of ciclesonide 160 μg once daily vs. budesonide 400 μg once daily in children with asthma

Ciclesonide is an onsite-activated inhaled corticosteroid (ICS) for the treatment of asthma. This study compared the efficacy, safety and effect on quality of life (QOL) of ciclesonide 160 microg (ex-actuator; nominal dose 200 microg) vs. budesonide 400 microg (nominal dose) in children with asthma. Six hundred and twenty-one children (aged 6-11 yr) with asthma were randomized to receive ciclesonide 160 microg (ex-actuator) once daily (via hydrofluoroalkane metered-dose inhaler and AeroChamber Plus spacer) or budesonide 400 microg once daily (via Turbohaler) both given in the evening for 12 wk. The primary efficacy end-point was change in forced expiratory volume in 1 s (FEV1). Additional measurements included change in daily peak expiratory flow (PEF), change in asthma symptom score sum, change in use of rescue medication, paediatric and caregiver asthma QOL questionnaire [PAQLQ(S) and PACQLQ, respectively] scores, change in body height assessed by stadiometry, change in 24-h urinary cortisol adjusted for creatinine and adverse events. Both ciclesonide and budesonide increased FEV1, morning PEF and PAQLQ(S) and PACQLQ scores, and improved asthma symptom score sums and the need for rescue medication after 12 wk vs. baseline. The non-inferiority of ciclesonide vs. budesonide was demonstrated for the change in FEV1 (95% confidence interval: -75, 10 ml, p = 0.0009, one-sided non-inferiority, per-protocol). In addition, ciclesonide and budesonide showed similar efficacy in improving asthma symptoms, morning PEF, use of rescue medication and QOL. Ciclesonide was superior to budesonide with regard to increases in body height (p = 0.003, two-sided). The effect on the hypothalamic-pituitary-adrenal axis was significantly different in favor of ciclesonide treatment (p < 0.001, one-sided). Both ciclesonide and budesonide were well tolerated. Ciclesonide 160 microg once daily and budesonide 400 microg once daily were effective in children with asthma. In addition, in children treated with ciclesonide there was significantly less reduction in body height and suppression of 24-h urinary cortisol excretion compared with children treated with budesonide after 12 wk.     

Unusual Delayed Manifestation of a Penetrating Chest Trauma

Abstract Pericardial tamponade remains a diagnostic challenge to the clinician especially when the patient is well compensated hemodynamically. We report an unusual case who sought medical help 1 month after having been stabbed in his chest. An investigation revealed a perforation of the myocardium and a pericardial tamponade. The patient survived thanks to a large organized clot that plugged the perforation. The patient was exposed to increased risk due to delayed onset, recognition, and therapy of the tamponade. Most reports on this subject deal with acute pericardial tamponade. Only few cases of delayed pericardial tamponade have been reported. A review of the relevant literature and the therapeutic approaches are discussed.     

次侧切术治疗期肛裂前后肛门直肠压力对比分析

目的 :探讨次侧切开内括约肌治疗肛裂术前、术后肛门直肌压力的变化。方法 :采用自行设计的次侧方内括约肌切开加双缘结扎术治疗 期肛裂 6 0例 ,测定手术前后肛门直肠压力 ,并与 6 0例正常人肛压比较 ,评价新术式治疗 期肛裂的临床疗效及其对肛门功能的影响。结果 :显示术后患者肛管静息压显著降低 ,与术前比较有显著性差异 (P <0 .0 1) ,与正常人比较无显著性差异 (P>0 .0 5 ) ;肛管最大收缩压与术前及正常人比较无显著性差异 (P>0 .0 5 )。结论 :次侧方内括约肌切开加双缘结扎术能有效地解除内括约肌痉挛 ,从根本上消除高肛压 ,从而彻底治愈肛裂 ,而且不影响肛门功能。     

抑郁障碍患者人格特征与发病关系的研究

目的探讨抑郁障碍患者的人格特征与其疾病发病间的关系。方法采用自评抑郁量表(SDS)、艾森克人格问卷 (EPQ)、应对方式评定量表 (WCRS)和归因方式问卷 (ASQ)对 76名抑郁障碍患者进行测试 ,同时选取 84名健康被试进行对照研究。结果①抑郁组患者在EPQ中神经质 (N)与精神质 (P)的得分显著高于健康组。②WCRS的结果显示在“宣泄接纳”、“退避调节”两个因子上 ,抑郁组的平均得分低于健康组。③在ASQ的得分中 ,抑郁组在负性事件归因的自身性、持久性和整体性均显著高于健康组。④抑郁障碍患者的“神经质”人格特质与应对方式的“宣泄接纳”和“退避调节”因子呈负相关 (r = 0 .474)。结论抑郁障碍患者的人格特征可表现为较强的神经质及孤僻、交往障碍 ,他们这种人格特征及应对和归因方式在其发病过程中起着重要作用。     

分娩期子宫破裂64例分析

目的 分析分娩期子宫破裂的发病原因及预防措施。方法 回顾分析1985年8月至2001年12月，16a间64例分娩期子宫破裂的临床资料。结果 子宫收缩剂使用不当3l例，占48．4％；胎先露下降受阻13例，占20．3％；子宫疤痕16例，占25％；阴道助产4例，占6．3％。初产妇10例(10．9％)；经产妇54例(89．1％)。结论 降低分娩期子宫破裂发生率关键在于加强计划生育工作及围生期保健，严格掌握子宫收缩剂的适应证及剂量；严格首次剖宫产指征；严密观察产程，及时处理异常分娩。     

咳嗽从肾论治

基于中医有关古代文献和个人的临床经验，作者举例说明咳嗽不仅能从肺治疗，从肾治疗也是行之有效的方法。