IVU、SCTU及MRU对梗阻性尿路疾病诊断能力比较

目的比较静脉肾盂造影(IVU)、多层螺旋CT尿路造影(SCTU)及磁共振泌尿系水成像(MRU)对梗阻性尿路疾病的诊断能力,为临床选择合理检查方案提供理论依据。方法对62例经手术病理或经临床治疗随访证实的梗阻性尿路疾病患者影像资料进行回顾性分析,本组病例均行IVU检查,25例患者行SCTU检查,49例患者行MRU检查,12例患者同时行上述3种方法检查。结果 8例肾盂-输尿管移行部狭窄,IVU显示2例,7例包括IVU未显示病例MRU可清晰显示,1例CTU显示不清,不能明确诊断;19例输尿管结石病例,IVU显示9例,10例IVU未显示梗阻原因患者行CTU检查均清晰显示,13例行MRU检查,7例显示;15例输尿管肿瘤,7例行CTU检查,12例行MRU检查均显示清晰;11例输尿管外源性压迫或侵犯病例,IVU表现为肾积水,3例行CTU检查,10例行MRU检查均可清晰显示;9例输尿管炎性病变,IVU表现为肾积水,4例行CTU检查,2例显示清晰,2例与肿瘤不易鉴别,7例行MRU检查,均显示清晰。结论 IVU在梗阻性尿路疾病中主要用来筛查,当怀疑梗阻原因是结石引起时,应首选CTU检查,当怀疑梗阻原因是先天狭窄或肿瘤性病变时应首选MRU。     

Does the proper intravenous immunoglobulin substitution in primary immunodeficiency protect against HBV infections?: a description of a case series

There are no recommendations concerning preoperative management of primary immunodeficiency patients in cases of emergency or planned surgery in relation to risk of hepatitis type B virus infection. To assess if immunodeficient patients regularly supplemented with immunoglobulins are protected against hepatitis B. IgG, IgM and IgA total levels and anti-HBs level were estimated in adult patients with primary humoral immunodeficiency before and after immunoglobulins supplementation according to a standardized schedule. Serum IgG and anti-HBs level significantly increased after immunoglobulin supplementation. Anti-HBs titer increased in all cases over 100 IU/L regardless of initial total IgG serum value, reaching a highly protective level. There was no correlation between increase in concentration of IgG (DeltaIgG) versus Deltaanti-HBs in the studied patients. Patients with primary hypogammaglobulinemia supplemented with immunoglobulin are protected against hepatitis type B.     

输液泵输液巡视卡的设计与应用

为加强输液泵输液的安全管理,自行设计了输液泵输液巡视卡并应用于临床。通过临床应用该巡视卡,纠正了护士在使用输液泵时依赖仪器报警的心理,规范了护理行为,加强了输液巡视的环节质控,护士主动发现问题的能力增强。应用1年来,未发生因使用输液泵输液引发的护理不良事件。     

Bias reduction in repeated-measures observational studies by the use of propensity score: The case of enteral sedation for critically ill patients

Purpose

Within the evidence-based medicine paradigm, randomized controlled trials represent the “gold standard” to produce reliable evidence. Indeed, planning and implementing randomized controlled trials in critical care medicine presents limitations because of intrinsic and structural problems. As a consequence, observational studies still occur frequently. In these cases, propensity score (PS) (probability of receiving a treatment conditional on observed covariates) is an increasingly used technique to adjust the results. Few studies addressed the specific issue of a PS correction of repeated-measures designs.

Materials and Methods

Three techniques for correcting the analysis of nonrandomized designs (matching, stratification, regression adjustment) are presented in a tutorial form and applied to a real case study: the comparison between intravenous and enteral sedative therapy in the intensive care unit setting.

Results

After showing the results before and after the use of PS, we suggest that such a tool allows to partially overcoming the bias associated with the observational nature of the study. It permits to correct the estimates for any observed covariate, while unobserved confounders cannot be controlled for.

Conclusions

Propensity score represents a useful additional tool to estimate the effects of treatments in nonrandomized studies. In the case study, an enteral sedation approach was equally effective to an intravenous regime, allowing for a lower level of sedation and spare of resources.     

静脉制剂Ⅰ期临床耐受性试验中的护理

目的总结静脉制剂Ⅰ期临床耐受性试验中的护理要点。方法 2011年10月-12月,采用随机、盲法、安慰剂平行对照试验设计,在健康志愿者中按剂量递增原则,逐组完成8个剂量单次静脉滴注给药耐受性试验。结果试验顺利完成。静脉制剂的Ⅰ期耐受性试验中,研究护士在临床试验前需认真学习试验方案,做好试验病房、监护急救设施设备的充分准备,针对可能出现的不良反应制定切实可行的处理预案,试验过程中密切监测,对出现的不良反应做好救治工作。特别针对静脉制剂,须做好受试者的心理疏导,保证静脉穿刺一次成功,减少受试者因情绪紧张、穿刺疼痛等因素干扰对试验药物耐受性的评价。结论Ⅰ期临床耐受性试验实施前准备充分,试验过程中为受试者提供良好的试验环境和心理护理,提高静脉穿刺一次成功率,密切监测,可使试验过程顺利,并获得客观、准确的试验结果。     

交叉法固定小儿四肢静脉留置针的效果观察

目的探讨一种更有效的固定留置针的方法,达到延长留置时间,减轻每日穿刺给患儿及家属带来的痛苦,保护血管,方便用药。方法将527例患儿按入院时的住院号分组,单号为观察组269例,双号为对照组258例,两组均采用美国BD公司生产的24GBDY型留置针。穿刺成功后观察组用普通医用布胶交叉法固定留置针,对照组用普通布胶环形缠绕法固定留置针。结果观察组留置针留置时间为(5.048±0.130)d,对照组留置针留置时间为(2.837±0.132)d。结论交叉法固定优于普通环绕法,固定牢固,不适反应少,留置时间明显延长,患儿及家属乐于接受,值得临床推广。     

责任包干工作制在静脉输液护理质量管理中的应用

目的:探讨责任包干工作制在静脉输液护理质量管理中的应用效果.方法:选取2010年10～12月神经内科住院需要静脉输液治疗患者50例为对照组,采用常规静脉输液护理;选取2011年1～3月同类患者50例为实验组,实施责任包干工作制静脉输液,观察、比较两组平均每日案例静脉输液完成时间、一针穿刺成功率及患者满意度情况.结果:实验组平均每日案例静脉输液完成时间、一针穿刺成功率及患者满意度均优于对照组(P＜0.01).结论:静脉输液实施责任包干工作制应用效果显著,可有效提高工作效率和护理质量,从而提高患者满意度.     

静脉滴注维生素C影响血糖测定的个案报道

目的探讨静脉滴注维生素C影响血糖测定的结果。方法通过个案方法分析静脉滴注维生素C影响血糖测定。结果血生化示谷丙转氨酶448U／L,谷草转氨酶1435U／L,肌酐153．9U／L,尿酸725U／L,磷酸肌酸激酶1842U／L,乳酸脱氢酶7333U／L,利用已糖激酶法复查原静脉血标本,测得血糖6．2mmol／L。结论GOD法作为血糖测定的常规方法之一,分析其广泛用于各国实验室的优点在于其结果稳定、特异和试剂价格低廉。     

丙戊酸钠预防脑肿瘤术后早期癫痫的系统评价

目的通过系统评价有关丙戊酸钠预防脑肿瘤术后癫痫的文献,评估丙戊酸钠预防开颅术后癫痫的有效性。方法以“（丙戊酸钠）与（术后癫痫）”为关键词,从CNKI数据库或参考文献里搜索1989。2009年发表的文献。结果通过术前及术后预防治疗能显著控制早期癫痫发生率,有2篇进行统计学分析表明治疗能显著减少脑肿瘤术后早期癫痫发生机会（OR=0．27;95％CI：0．12～0．58）,漏斗图未见显著不对称。结论丙戊酸钠也许能有效预防脑肿瘤开颅术后早期癫痫。     

The passive transfer of immunoglobulin G serum antibodies from patients with longstanding Complex Regional Pain Syndrome

Background: The aetiology of Complex Regional Pain Syndrome (CRPS) is unknown. Recent evidence suggests that there may be autoantibodies directed against peripheral nerves, but it is unclear whether such autoantibodies are merely biomarkers or whether they cause or contribute to the underlying pathology. The transfer of disease after injection of a patient's serum or IgG fraction into mice (‘passive transfer’) is the classic way to demonstrate a functional role of autoantibodies. Aims: Based on previous preliminary results, we wished to investigate whether the transfer of IgG antibodies affected mouse behaviour or produced signs of CRPS. Methods: We injected purified serum‐IgG from 12 patients and 12 controls into groups of 6–10 mice (～17 mg/mouse intraperitoneally) on 2 consecutive days and looked for any evidence for altered behaviour or signs of CRPS. The observer, blinded as to test or control group, measured behaviour in the open field, stimulus‐evoked pain and motor coordination, and inspected limbs for autonomic CRPS signs. Results: Stimulus‐evoked pain and autonomic signs were not detected, but CRPS‐IgG induced significant depression of rearing behaviour (17.9 rears/3 min (n =84) vs. 22.1 rears/3 min (n =83), p =0.0004), confirming previous observations in a single case study. Moreover, motor impairment, one of the four cardinal signs of CRPS, was evident in the three CRPS‐IgG injected groups tested with a sensitive rota‐rod protocol (p <0.0001 vs. control‐IgG injected groups). Conclusions: These results lend support to a pathophysiological role for IgG autoantibodies in CRPS.