非高密度脂蛋白胆固醇水平与冠心病患者冠状动脉病变Gensini评分的相关性研究

目的 探讨非高密度脂蛋白胆固醇水平(non-HDL-C)与冠心病(CHD)患者冠状动脉病变Gensini评分的关系及临床意义。方法 对225例疑诊或既往临床诊断CHD患者予以冠状动脉造影(CAG),将造影阴性的39例作为对照组(HC组),造影阳性的186例患者诊断为CHD,结合临床特点分为心绞痛组(AP组)122例和心肌梗死组(AMI组)64例。采用Gensini评分对冠状动脉病变程度评分,测定患者全套血脂水平,探讨non-HDL-C及相关脂质成分与冠状动脉病变程度Gensini评分的相关性;同时对他汀类药物强化降脂达标,低密度脂蛋白胆固醇(LDL-C)<1.80 mmol/L的AP组患者进行non-HDL-C与冠状动脉病变程度Gensini评分的亚组分析。结果 AMI组non-HDL-C水平高于AP组及HC组,AP组non-HDL-C水平高于HC组,差异均有统计学意义(P<0.05);CHD患者non-HDL-C水平与Gensini评分呈正相关(r=0.562,P<0.05);LDL-C控制达标的AP组患者,高non-HDL-C组(≥2.60 mmol/L)比低non-HDL-C组(<2.60 mmol/L)Gensini评分明显升高,差异均有统计学意义(P<0.05)。结论 non-HDL-C与冠状动脉病变程度密切相关,non-HDL-C在评估LDL-C控制达标患者的冠状动脉病变程度及再发心血管事件风险上有一定价值,可作为LDL-C达标后心血管残余风险新的观察指标。     

我院人才流失情况调查分析及对策

目前全国的各大医院都面临着人才流失的问题。加入WTO后,民营医院和中外合资医疗机构不断增多,他们会以“本土化”策略猎取人才,致使公立医院的高级专业人才和管理人才大量流失。为了解我院1990年以来调离人员的情况,探索防范措施,我们进行了此次调查研究。1.资料与方法:资料来源于自1990年1月1日～2 0 0 2年12月31日共13年来我院调出人员填写的《调离人员情况表》,共计调出人员2 5 0人,其中医务人员2 13人,占85 %。我们重点分析了调离的2 13名医务人员。2 .调查结果:(1)年龄结构:调离的医务人员中,小于30岁有6 9人,占32 % ;30岁～4 0岁有…     

生长抑素治疗食道胃底静脉曲张破裂出血分析

食道胃底静脉曲张破裂出血是肝硬化门脉高压的严重并发症，也是肝硬化患者的主要死因。我院于2000年3月～2005年3月应用生长抑紊治疗肝硬化食道胃底静脉曲张破裂出血36例，疗效满意，现报告如下。     

多层螺旋CT及多平面重组诊断嗜铬细胞瘤的价值

随着多层螺旋CT及三维后处理技术在临床的应用,对肾上腺嗜铬细胞瘤(adrenal pheochromocytomas)的诊断及鉴别诊断有很大的进步。回顾性分析我院自2000年6月~2006年6月期间收集的经手术及病理证实的14例嗜铬细胞瘤患者,探讨多层螺旋CT及多平面重组对嗜铬细胞瘤的诊断价值。1材料与方法1.1一般材料本组14例中,男性11例,女性3例,年龄22~55岁,平均年龄38.5岁。临床表现有腰痛头晕、头痛、心悸、多汗,有阵发性或持续性高血压症状者11例,发作时血压均在190/120~220/170mmHg,无明显临床症状,体检时发现3例。实验室检查24h尿中香草扁桃酸(VMA)1.…     

腹部手术后早期肠内营养支持临床应用体会

目的 观察肠内营养在腹部手术后患者中应用的时机及其作用。方法 将2001年6月到2003年6月收治的88例上腹部手术患者随机分为肠内营养组(n=48)和肠外营养组(n=40)，观察两组患者营养支持前后体重、白蛋白、前白蛋白、肝功酶谱、并发症、营养支持费用情况，了解肠内营养实施时机。结果两组患者术后营养均可较好维持，肠内营养组对肝功能无影响，较肠外营养组并发症明显减少，且费用明显降低。结论 肠内营养对腹部手术后患者营养支持有益且可尽早实施于上腹部手术后患者。     

膀胱癌基底膜层粘蛋白,胶原蛋白Ⅳ与纤维连接蛋白分布表达的？…

目的 探讨膀胱癌基底膜中层粘蛋白，胶原蛋白Ⅳ与纤维连接蛋白分布表达的相关性。方法 用免疫组织化学方法测定３５例膀胱移行上皮癌和３例低分化鳞状上皮癌肿瘤组织基底膜层粘蛋白（ＬＮ），胶原蛋白Ⅳ（ＣｏｌⅣ）和纤维连接蛋白（ＦＮ）含量与分布，结果病理级别高，浸润性生长的膀胱移行上皮癌，基底膜ＬＮ，ＣｏｌⅣ和ＦＮ一样，阳性染色少，分布不连续，反之，病理级别低，非浸润性生长的肿瘤，基底膜ＬＮ，ＣｏｌⅣ也和Ｆ     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

二氧化碳血液净化仪实验研究

目的探讨气体传输型二氧化碳血液净化仪在呼吸衰竭(RF)治疗中实施体外膜肺氧合(ECMO)部分循环支持的实验研究。方法建立实验犬的RF模型,用BaxterEF-550血管路连接二氧化碳血液净化仪,股静脉置入双腔单针导管行V-V转流,转流过程中维持血流量200mL/min,氧入通入量4L/min~6L/min,转流开始10min后,分别采集动脉血及膜式人工肺出入端血标本,以后每转流60min分别采集血标本进行血气分析。结果人工肺出入端PCO2可由50.93mmHg±1.62mmHg~63.27mmHg±0.46mmHg下降为1.27mmHg±0.05mmHg~14.07mmHg±1.86mmHg,PO2上升值为371.6mmHg±42.67mmHg~614.6mmHg±50.35mmHg,人工肺出入端PCO2、TCO2、PO2、SO2、O2-C变化均有显著性差异(P<0.01)。转流60min,实验犬体动脉血PaO2从39.6mmHg,升高为56.7mmHg±2.36mmHg,PCO2由52.8mmHg下降为50.4mmHg±0.53mmHg。结论二氧化碳血液净化仪有良好的二氧化碳血液净化和氧传输双重性能;二氧化碳血液净化仪的气体传输性能,在0.2L/min流量时,可以使活体实验动物血气发生改变———氧摄入和二氧化碳排出增多,从而简化了ECMO技术并实现呼吸支持的作用,为呼吸衰竭的救治提供一项新的技术和途径。