老年食管贲门癌病人围手术期护理体会

目的总结71例老年食管贲门癌病人围手术期护理经验。方法回顾性分析71例食管贲门癌患者临床护理资料。术前护理重点在于稳定患者情绪,完善相关检查,使患者身体状况符合手术条件;术后护理重点在于密切监视各项生命体征,及时发现各类并发症早期征象并作相应处理。结果71例患者中发生并发症共15例（21．13％）,2例患者因突发心肺功能衰竭死亡（2．82％）,其余均安全度过围手术期。结论对老年食管贲门癌患者护理应注意术前术后护理重点,采取科学有效的护理措施,是促进患者安全度过围手术期重要保证。     

地佐辛用于鼻内窥镜手术的临床观察

目的：观察地佐辛用于鼻内窥镜手术患者全身麻醉的临床效果。方法：ASA（美国麻醉医师协会）I或Ⅱ级择期鼻内窥镜手术60例,随机分为地佐辛组（D组）和芬太尼组（F组）各30例。入手术室后,两组均用5 s时间经外周静脉分别静脉注射0.12 mg/kg地佐辛或1.2μg/kg芬太尼,60 s后复合相同药物进行诱导、插管。记录两组入室时（T0）、达到插管条件时（T1）、插管时（T2）、插管后1 min（T3）、插管后4 min（T4）、插管后7 min（T5）各时点MAP（平均动脉压）、HR（心率）和注药后60 s内有无呛咳发生及苏醒时间、苏醒期躁动评分。结果：与T0比较,两组组内T1 MAP、HR下降,两组组内T2、T3、T5 MAP、HR上升,两组组内T4 MAP下降有显著差异（P〈0.05）;与T1比较,两组组内T2、T3 MAP、HR上升有显著差异（P〈0.05）;组间比较,两组各时点MAP、HR无显著差异（P〉0.05）。两组患者注药后60 s内均无呛咳发生,两组患者苏醒期躁动评分0分比较有显著差异（P〈0.05）,两组患者苏醒时间无显著差异（P〉0.05）。结论：静脉注射0.12 mg/kg地佐辛或1.2μg/kg芬太尼均无呛咳发生,复合相同药物用于鼻内窥镜手术诱导两组插管前后血流动力学变化相似、术后苏醒均较快,但前者全麻苏醒期躁动较少。     

某医学院在校女大学生月经情况及原发性痛经的调查分析

目的了解女大学生月经及原发性痛经的发生情况,为针对性地对女大学生进行健康教育提供基础性资料。方法采用随机整群抽样的方法,对西安医学院护理学院394名大一、大二女生进行问卷调查、统计分析。结果被调查者中,初潮年龄在11～17岁之间,平均年龄为（13.62±1.26）岁。有309名原发性痛经者,占78.4%。其中轻度痛经的发生率为49.5%;中度痛经的发生率为41.7%,重度痛经的发生率为8.7%。结论尽管医学专业女大学生相对比较注意经期保健,但痛经发生率仍然很高,成为常见性多发病。关注女大学生痛经症状,采取积极有效的对策方式,加强月经保健知识的宣传教育,对于改善女大学生个体健康,提高学习生活质量,减轻痛经对女性的负面影响,有着重要的意义。     

经皮肾镜结合EMS四代碎石清石系统Ⅰ期治疗肾结石合并感染疗效分析

目的探讨经皮肾镜EMS四代碎石清石系统Ⅰ期治疗肾结石合并感染的安全性及临床分析。方法肾结石合并感染42例,均在超声定位及引导下穿刺,建立16F造瘘通道,将脓液引流后,使用EMS四代碎石清石系统负压洗出肾内脓液,建立24F标准经皮肾镜通道,进行超声联合弹道碎石和清石。结果本组在脓液引出后,均成功建立24F标准经皮肾镜通道行Ⅰ期碎石清石,手术时间45～65min,平均52.3min。本组未出现大出血、气胸、肠道损伤等严重并发症,术后血红蛋白下降4～20g,平均12g。2例术后出现寒战高热,体温〉39.5℃,其余病例术后体温〈38.0℃。各例患者均未出现全身炎症反应综合征（SIRS）。术后3天复查,38例结石取净,4例结石残留,结石清除率91.4%,术后住院时间5～11d,平均7.2d。结论经皮肾镜EMS四代碎石清石系统Ⅰ期治疗肾结石合并感染安全有效,并发症少,术后恢复快,值得推荐。     

超声刺激关元穴对自然围绝经期大鼠卵泡发育的影响

目的探讨超声刺激"关元穴"对围绝经期大鼠卵泡发育的影响。方法采用阴道涂片法筛选围绝经期雌性SD大鼠。选用输出声功率0.1 W,工作频率9 MHz,焦距4.5～5 mm,给予大鼠关元穴超声刺激。采用电化学发光免疫分析法检测大鼠血清雌激素(E)水平,组织学方法观察卵巢组织学结构变化,计数卵巢各级卵泡数。结果与对照组比较,超声刺激关元10 min/d、5min/d连续刺激10 d后显著提高围绝经期大鼠血中E水平(P<0.05),卵巢初级卵泡数、次级卵泡数增多,闭锁卵泡数减少(P<0.05)。结论超声刺激关元能改变围绝经期大鼠分泌雌激素的功能,影响卵巢卵泡发育。     

Prevalence of amino acid mutation in hepatitis C virus core region among Japanese volunteer blood donors

It is not known whether there is a trend of increasing or decreasing incidence of new hepatitis C virus (HCV) infections in Japan. From the treatment point of view, it is important to verify HCV genotypes and the prevalence of treatment-resistant clones of HCV. At the Japanese Red Cross blood centers, all blood samples obtained from blood donation have been screened using serological methods and the minipool nucleic acid amplification testing. One hundred and fourteen donors have been identified over the past 10 years to be HCV RNA-only positive without detectable anti-HCV and were considered to be in the acute phase of HCV infection. There was a trend of decreasing incidence of such new infections among the blood donors. HCV RNA-only-positive samples were examined further for genotyping and HCV RNA quantitation. Genotype 2 (2a plus 2b) was predominant (78.2%) among them followed by genotype 1b (21.2%). Direct sequencing was carried out to detect the possible treatment-resistant mutant clones 70Q and 91M, clones with amino acid substitutions at positions 70 and 91 of the HCV core protein, respectively. 70Q and 91M were found regularly in donors with genotype 1b, but not in those with other genotypes. No particular endemic areas for the mutant clones were identified. There was no significant difference in the mean viral titer between the 70Q mutant type and the non-70Q wild-type. Even in newly infected people, the mutant clone 70Q was detected frequently.     

A time-dependent effect of caffeine upon lesion-induced plasticity

During a critical period, unilateral retinal lesions induce rapid axonal sprouting of intact axons into denervated territories within the collicular visual layers. We investigated the effect of caffeine, a non-selective A₁ and A_2a antagonist, upon the lesion-induced plasticity of retinotectal axons. Pigmented rats submitted to a temporal retinal lesion received either caffeine (30 mg/kg, ip) or saline treatment. The anterograde tracing revealed that caffeine treatment during the critical period resulted in a clear reduction on the sprouting of ipsilateral fibers but to an amplification of the plasticity after PND21, thus revealing opposite effects depending on the developmental time window.     

Absence of reproductive and developmental toxicity in rats following exposure to a 20-kHz or 60-kHz magnetic field

The use of intermediate frequency (IF) magnetic fields (MFs) in occupational equipment and domestic appliances, such as inductive heating cookers, is increasing. The WHO indicated a lack of scientific evidence needed to assess the health risk of exposure to IF MFs. Male and female rats (24/group) were exposed to a 20 kHz, 0.2 mT(rms) or 60 kHz, 0.1 mT(rms) sinusoidal MF for 22 h/day from 14 days prior to and during mating. Copulated females were exposed until gestation day 7 and sacrificed thereafter. Mated males were sacrificed to examine MF exposure effects on spermatogenesis. Reproductive examinations were blinded, and experiments were duplicated per frequency to ensure reproducibility. No statistically significant, exposure-related changes were found in the estrous cycle, copulation and fertility indices, numbers of corpora lutea and implantation sites, or pre- and postimplantation loss. No reproducible changes were observed in sperm count, motility, or morphological abnormality, or in the weights of testes and epididymides after MF exposure. No significant abnormalities were observed in gross pathology or histopathology of the uterus, ovary, testis, and epididymis in the MF- or sham-exposed groups. MF exposure during the preimplantation period was not toxic to fertility or early embryogenesis under the experimental conditions.     

沐舒坦临床应用剂量规范化探讨

沐舒坦作为一种粘液溶解剂,临床应用广泛。然而,沐舒坦的临床应用剂量的选择跨度较大,疗程长短也存在差异,还未能达成共识。其疗效与剂量的相关性有待于临床实验探究。随着遗传药理学和药物基因组学的兴起,研究沐舒坦是否存在遗传和基因组因素的影响,可能为其临床应用剂量的选择及个体化用药开拓新的视野。     

无创机械通气治疗慢性阻塞性肺疾病呼吸衰竭的临床观察

目的 慢性阻塞性肺疾病合并呼吸衰竭病情危重,近年来发病率高,笔者旨在探讨有效的慢性阻塞性肺疾病急性加重期呼吸衰竭的临床治疗.方法 回顾性分析2006年9月至2011年9月笔者所在医院慢性阻塞性肺疾病急性加重期呼吸衰竭的60例患者的临床资料、动脉血气的变化.对照性研究所有患者机械通气治疗前后的临床表现、呼吸参数及动脉血气分析指标.结果 所有患者均能较好的耐受无创机械通气,且呼吸困难症状改善明显,机械通气后动脉血氧分压及二氧化碳分压得到明显改善(P＜0.05),而且也减慢了患者的呼吸频率,1周后所有患者病情缓解.结论 无创机械通气治疗能缓解呼吸肌疲劳、改善肺功能等,是慢性阻塞性肺疾病合并呼吸衰竭患者的一种安全有效的治疗方法,值得临床进一步的推广.