早期乳腺癌前哨淋巴结活检手术中示踪方法的临床应用研究

目的对比分析核素联合亚甲蓝与亚甲蓝单示踪法在早期乳腺癌前哨淋巴结活检术中应用效果。方法收集我院385例行前哨淋巴结活检术的乳腺癌患者的临床资料,其中109例由高年资医生应用亚甲蓝单示踪法,276例由高年资和低年资两组医生应用核素联合亚甲蓝示踪法,对比分析行联合示踪法与单示踪法前哨淋巴结活检结果的差异。并分析不同年资手术医生在联合示踪法前哨淋巴结活检结果的差异。结果联合示踪法与亚甲蓝单示踪法在前哨淋巴结活检的检出率、假阴性率、准确率、灵敏率无统计学意义(P>0.05),在联合示踪法下,高年资手术医生与低年资手术医生的前哨淋巴结活检的检出率、假阴性率、准确率无显著差异(P>0.05)。结论高年资外科医生使用亚甲蓝单示踪法行前哨淋巴结活检,是安全可靠又经济的方法。联合示踪法有助于帮助年轻的乳腺外科医生快速掌握熟悉前哨淋巴结活检技术。     

康复计划对腹膜透析病人社会回归的影响

目的:通过对腹膜透析患者实施以五“E”为中心的康复计划,提高其生活质量,最终达到社会回归。方法:对腹膜透析患者进行包括体液控制、饮食指导、运动康复、心理辅导4个方面的康复治疗,观察治疗12周前后患者的生活状态变化,将患者分为3级。结果:实施康复治疗前后患者生活状态等级构成比分别为:治疗前1级:50%,2级:40.6%,3级:9.4%;治疗后1级:14.1%,2级:28.1%,3级:57.8%,经检验差异有显著性意义(P<0.001)。治疗后有37例患者达到3级,其中6例重新参加工作,2例从事志愿者活动,其余患者能象同年龄的正常人一样生活。结论:以五“E”为中心的康复计划可提高腹膜透析患者的生活质量,促进社会回归。     

临床护士的心理状况分析

目的了解综合医院护士心理健康水平状况，探索改进方法。方法对551名护士采用症状自评量表(SCL—90)进行问卷测试，使用SPSS1O．0软件统计分析。结果被测总体心理健康状况尚好，被测群体的依从性较强；工作6-10年的护士身心健康状况明显差于5年以下工龄的护士。结论提示管理者注意管理方法，关心10年内工龄的护士，提高其心理适应能力，调动10年以上工龄护士的工作积极性，增强群体活力。     

家兔颈淋巴引流阻断后脑组织含水量、Ca2+及SOD的变化

目的探讨家兔颈淋巴引流阻断后，脑组织含水量、钙及超氧化物歧化酶含量的变化及其意义。方法将50只新西兰白兔随机分为实验组和对照组，实验组行颈淋巴管结扎、淋巴结清扫术，对照组行假手术。两组分别于术后24h，48h，72h，96h，168h等五个时间点，进行脑组织含水量、钙及超氧化物歧化酶含量测定。结果家兔颈淋巴引流阻断后，脑组织含水量、钙含量明显增高，超氧化物歧化酶含量明显下降。结论家兔颈淋巴引流阻断后，引起脑淋巴回流阻滞，产生淋巴滞留性脑水肿。     

企业员工心肺复苏知识的认知现状及技能培训的探讨

目的了解企业员工对心肺复苏（cardiopulmonary resuscitation，CPR）知识的认知及需求状况，探讨对企业员工进行CPR知识与技能培训的方法和意义。方法通过整群抽样的方法，对111名参加CPR培训的企业员工进行问卷调查，了解企业员工对CPR知识的认知现状及需求情况，并比较不同年龄及学历层次者和受过专门CPR培训员工的CPR知识得分情况。结果企业员工心肺复苏知识缺乏，平均得分为（3．36±1．82）分；不同年龄及学历层次的企业员工对CPR知识的掌握情况，无统计学差异；曾接受过培训的企业员工CPR知识测评得分较高（P〈0．01）；企业员工有强烈的学习需求，99．09％的员工认为有必要举办相关培训班。结论企业员工需要通过专门的CPR培训以提高CPR知识和技能，培训形式应多样化，且有必要进行定期的重复培训；企业员工参加CPR培训是普及CPR知识与技能、提高我国现场急救水平、降低院前病死率的一条有效途径。     

Determinants of post-intensive care mortality in high-level treated critically ill patients

Objective To assess the predictive ability of preillness and illness variables, impact of care, and discharge variables on the post-intensive care mortality.Setting and patients 5,805 patients treated with high intensity of care in 89 ICUs in 12 European countries (EURICUS-I study) surviving ICU stay.Methods Case-mix was split in training sample (logistic regression model for post-ICU mortality: discrimination assessed by area under ROC curve) and in testing sample. Time to death was studied by Cox regression model validated with bootstrap sampling on the unsplit case-mix.Results There were 5,805 high-intensity patients discharged to ward and 423 who died in hospital. Significant odds ratios were observed for source of admission, medical/surgical unscheduled admission, each year age, each SAPSII point, each consecutive day in high-intensity treatment, and each NEMS point on the last ICU day. Time to death in ward was significantly shortened by different source of admission; age over 78 years, medical/unscheduled surgical admission; SAPSII score without age, comorbidity and type of admission over 16 points; more than 2 days in high-intensity treatment; all days spent in high treatment; respiratory, cardiovascular, and renal support at discharge; and last ICU day NEMS higher than 27 pointsConclusions Worse outcome is associated with the physiological reserve before admission in the ICU, type of illness, intensity of care required, and the clinical stability and/or the grade of nursing dependence at discharge.This study was supported in part, by the Foundation for Research on Intensive Care in Europe (FRICE) and by a grant from the Commission of the European communities (BMH1-CT93-1340)     

Well-being of institutionalized elders after Yang-style Tai Chi practice

Aims and objectives. The purpose of this study was to examine the effects of Tai Chi on the physical and psychological well‐being of elders who resided in long‐term care facilities. Background. The beneficial effects of Tai Chi on elders’ well‐being have been well‐documented; however, most of the studies focused on community‐dwelling or healthier elders. Design and methods. In this longitudinal, time‐series, quasi‐experimental study, a convenience sample of 28 institutionalized elders was recruited. A six‐month Yang‐style Tai Chi intervention was administered twice a week for 60 minutes per practice. The well‐being outcome variables, including physical and mental health status, blood pressure, quality of sleep, occurrence of falls and fear of falling, were measured before the intervention and then at one‐month, two‐month, three‐month and six‐month intervals. Results. Results indicated that the physical health status and social functioning of frail elders were significantly improved after Tai Chi practice [F(4,24) = 3·42, p = 0·038; F(4,24) = 9·66, p = 0·001 respectively]. Conclusions. Tai Chi practice is beneficial for frail older people. Relevance to clinical practice. The findings provide a basis for using Yang‐style Tai Chi as a floor activity in long‐term care facilities to promote the well‐being of the older residents.     

105名性服务小姐艾滋病相关知识、行为及艾滋病、梅毒感染状况调查

目的　了解北京市大兴区性服务小姐艾滋病知识、 相关行为及艾滋病、 梅毒的感染情况。方法　对娱乐场所的性服务小姐进行一对一匿名调查，并采血进行艾滋病、梅毒检测。结果　105名性服务小姐大多数为未婚，文化程度比较低，对艾滋病的预防及传播途径有一定了解，但蚊虫叮咬能否传播艾滋病回答正确率很低（36.19%），而且安全套使用率不高。检出HIV抗体阳性1例，阳性率0.95%；梅毒RPR阳性3例，阳性率2.86%。结论　大兴区性服务小姐人群中艾滋病、梅毒感染率较低，对该人群加强宣传教育和加大预防干预力度，是控制艾滋病蔓延和流行的重要措施。     

颈部淋巴结的超声诊断

本研究使用彩色多普勒观察７０例患者的８０个颈部良性及恶性淋巴结的血管类型。发现良性淋巴结（３０个）多在门部有一支和／或有小的分支；而恶性淋巴结（５０个）血流主要是外周型和／或中央血流型。这一特征，加上淋巴结形态及病史，有助于淋巴结良性及恶性病变的鉴别诊断     

重症脑梗死患者的早期肠内营养支持的应用

目的:研究重症脑梗死患者早期应用肠内营养支持对机体营养指标及胃肠道功能的临床效果。方法:对确诊为重症脑梗死的患者62例,以抽签法随机分为治疗组与对照组,分别用改良与传统方法实施鼻饲。结果:治疗组患者治疗前后血清白蛋白、非瘫痪侧上臂三头肌肌围(moveablearmmuscularcirculation,MAMC)和三头肌皮褶厚度(tricepsskinfold,TSF)等营养指标值在14d与1d比较时有统计学意义(t=2.32～11.75,P<0.05),各营养指标变化值在14d时治疗组较对照组差异有显著性意义犤血清白蛋白:(33.3±2.5)比(29.5±2.3)g/L;TSF:(13.51±2.27)比(12.35±2.13)mm;MAMC:(21.35±2.43)比(18.89±1.78)cm犦(P<0.05)。治疗组的上消化道出血、呕吐反流、腹胀和拒食等胃肠胃功能障碍的发生率均显著低于对照组(P<0.05)。结论:早期肠内营养支持可减轻重症脑梗死患者的营养状况恶化程度,有助于胃肠道功能的改善。