胫骨应力骨折(附30例临床X线诊断分析)

本文对30例(31个)胫骨应力骨折进行了临床、X线征象分析。并对其发生机制,诊断及鉴别诊断中的一些问题进行了讨论。     

泌尿系感染者病原菌及耐药性分析

目的：了解近年来泌尿系细菌感染致病菌及耐药性，为合理应用抗生素，提供临床根据。方法：对泌尿系感染患者298株病原菌进行药物敏感试验。结果：大肠埃希菌仍是引发泌尿系感染的主要病原菌，占53％，其次是葡萄球菌属，占19．40％，肠杆菌属占10．06％，肠球菌属占4．70％等，各类菌属耐药情况。结论：临床医师必须关注本地病原菌分布及耐药情况，合理应用抗生素，减少耐药性播散。     

可控盲结肠膀胱术19例

目的 :探讨膀胱全切术后可控盲结肠膀胱术的选择及应用。方法 :回顾性分析我科 1 9例可控盲结肠膀胱术患者的临床资料。结果 :1 9例患者术后恢复较好 ,储尿囊平均容量 4 80ml,平均压力 (1 .96± 0 .4 9)kPa ,排尿控制较好 ,插管容易 ,无尿失禁及输尿管反流。结论 :可控盲结肠膀胱术具高容量、低内压、控制排尿等特点 ,可极大提高患者的生活质量 ,其中以可控去带盲结肠膀胱术最为简单、有效 ,值得临床应用     

The epidemiology of urinary dysfunction in Chinese women

The epidemiology of urinary dysfunction in a Chinese population living in Hong Kong was investigated. Fifteen hundred ethnic Chinese women answered a telephone questionnaire including symptoms of urinary dysfunction, anthropometric measurements, obstetric history and place of birth. The relative predictive value of these factors was analyzed using logistic regression. The prevalence of urinary dysfunction was 13%. Ten percent reported stress incontinence, and 4% had urgency or urge incontinence. The strongest predictor was place of birth, with women born in mainland China having the highest prevalence of pure stress incontinence (OR 1.33, CI 1.1–1.6). For the symptoms of detrusor instability age was the strongest predictor, with women over 50 years being at greater risk (OR 2.8, CI 1.6–5.0). Contrary to earlier beliefs, urinary dysfunction in Chinese women is as common as in Caucasian women. Place of birth is the strongest predictor for pure stress incontinence, with women born in mainland China being at greater risk. This suggests that environmental factors in early life have a differential effect on the development of urinary incontinence. EDITORIAL COMMENT: Taiwan Chinese women have a comparable prevalence of urinary dysfunction with Hong Kong Chinese women. A survey representing a multistage sample of 82 678 women aged 18 years or older was conducted in the Taipei area from January to June 1993. A total of 818 cases were interviewed by trained students. One hundred and eighty-nine (23.1%) of the respondents reported having had some degree of incontinence in the preceding 12 months, 28 (3.4%) reporting regular incontinence. Most presented with stress urinary incontinence, whereas urge incontinence and mixed incontinence were more commonly seen in the elderly group (aged 60 years or older). The risk factors for urinary incontinence included age, number of vaginal deliveries (>3), number of abortions (>2) and maternal history of incontinence. Voiding symptoms (irritative or obstructive) and constipation were significantly more prevalent among respondents with incontinence than those without (P<0.001). This evidence also indicates that the long-held belief that Chinese women have a much lower prevalence of urinary dysfunction than western women has all but ended.     

重型颅脑损伤后应激性溃疡防治与胃肠道感染的相关性及对策

目的探讨重型颅脑损伤患者应用洛赛克对应激性溃疡进行防治与胃肠道感染几率增加之间的关系及治疗对策。方法回顾近3年来我院收治的重型颅脑损伤并存活30 d以上病人176例,测定不同时间胃液pH值并分析防治应激性溃疡与发生胃肠道感染的相关性以及相应对策。结果在126例持续应用洛赛克的患者中,持续应用＞7 d的患者胃肠道感染发生率明显高于持续应用≤7 d的病人。其余50例间隔应用洛赛克患者与126例持续应用洛赛克患者相比,应激性溃疡发生率无明显差别,但间隔应用洛赛克患者胃肠道感染发生率较持续应用洛赛克＞7 d的患者明显下降。结论重型颅脑损伤患者应激性溃疡防治＞7 d者,由于胃酸分泌严重抑制,增加胃肠道感染发生率。间隔性应用洛赛克治疗在抑制胃酸分泌,减少应激性溃疡发生的同时,可明显减少胃肠道感染的发生。     

无张力阴道吊带术治疗女性压力性尿失禁

目的：探讨无张力阴道吊带术(TVT)治疗女性压力性尿失禁的初步疗效和手术安全性。方法：对20例经过临床和尿动力学检查诊断为压力性或混合性尿失禁的女性患者进行TVT手术治疗，并对手术效果和并发症进行初步的随访研究。结果：平均手术时间40min(25—100min)，平均术后住院3．2d(1—28d)。18例单纯性压力性尿失禁患者16例治愈，治愈率为88．89％(16／18)，另2例显效(11．1％)。2例混合性尿失禁患者中1例显效，另1例无效。术后发生尿潴留3例，2例作松解术，1例延长导尿管留置时间后缓解。发生局部血肿1例经保守治疗后康复。结论：TVT手术是一种治疗压力性尿失禁的安全有效的方法，具有手术简单、创伤小、并发症少、患者康复快等优点。     

Abscess formation after transobturator sling placement: a case report

New techniques of sling placement may be associated with infectious complications. Slings through the obturator foramen and thigh can lead to a significant abscess formation within the thigh adductor muscles. A large thigh abscess associated with a transobturator sling was diagnosed and treated. The authors report the evaluation and treatment of a unique infectious complication of transobturator slings.     

应激相关因素对护士生活质量作用模型的理论构建和结构方程分析

目的应用结构方程分析研究应激相关因素对护士生活质量的影响机制。方法通过随机抽样,采用生活质量综合评定问卷、压力反应问卷、生活事件量表、特质应对方式问卷、领悟社会支持量表、艾森克人格问卷对405名护士进行调查,并应用结构方程分析方法对其作用机制进行探索。结果在5个理论可行的竞争模型中获取了最佳模型(CMINDF2.344;GFI0.928;AGFI0.891;CFI0.945;RMSEA0.060),即应激相关5因素(压力反应、生活事件、社会支持、应对方式和个性特征)中除应对方式外均能直接影响生活质量,而应对方式则以其他应激相关因素为中介对生活质量产生间接影响,这5个因素均可互为中介对护士生活质量产生间接作用。结论结构方程分析方法证实应激对护士生活质量的影响是一个交叉作用系统,在干预应激对护士生活质量的影响时应综合运用直接和间接方法。     

Preterm Birth: Implications for Family Stress and Coping

The event of preterm birth represents a significant risk to the equilibrium of the family, often placing the family under significant stress. This paper is intended to assist neonatal nurses in understanding factors related to a family's appraisal of stress and strategies used for coping. Such factors are an important consideration in planning the most effective interventions to support optimal family adaptation to their preterm infant's birth. In identifying the best clinical approaches to supporting a family coping with the event of a preterm birth, nurses need to consider levels of the evidence that supports adoption of clinical intervention strategies. Working to reduce family stress and improve family coping ensures the most optimal home environment for the preterm infant to grow and thrive in after discharge.     

Effects of chronic stress on plasma corticosterone, ACTH and prolactin

Rats were placed in a stressful environment for 24 hr per day and levels of plasma hormones were measured after varying numbers of days in the environment. Rats were habituated to operant chambers placed in sound-attenuated enclosures. Food pellets were available by lever press on a FR1 schedule. After 3 days of habituation, rats in the “stressed” group were trained to pull a ceiling chain to avoid or escape shock. Following training, stress trials, consisting of a consecutive sequence of 5 sec each of a warning light, warning tone and 0.16, 0.32, 0.65, 1.3 and 2.6 mA of footshock, occurred approximately once per 5 min around-the-clock. For the first day, the sequence was terminated when the ceiling chain was pulled. On subsequent days, 90% of all shock presentations could be avoided or escaped by chain pull; the remaining 10% of trials were inescapable and the entire sequence was presented. Control rats lived in identical chambers without presentation of shock. Rats were sacrificed after 1, 2, 3, 4, 7 or 14 days in this environment and levels of plasma corticosterone, ACTH and prolactin were determined. Levels of plasma corticosterone were elevated during the first 7 days in the stressful environment, but returned to control values by day 14. Levels of plasma ACTH and prolactin were similar in stressed and control rats at all time points measured. These data suggest that stress-induced changes in glucocorticoids but not in ACTH or prolactin might mediate some of the physiological changes that occur as the result of chronic stress.