多发性子宫肌瘤伴大便失禁患者一例的护理

目的总结多发性子宫肌瘤合并大便失禁患者的护理经验。方法术前了解患者的护理需求及心理状态、手术方法及特点,提前制定护理计划,并在术后按计划实施护理。结果患者顺利度过围术期,未发生护理并发症。结论针对有护理难点的特殊病例,提前制定围术期特别护理计划,有助于提高护理质量,促进患者康复。     

评估以泮托拉唑为基础的三联和四联疗法根除幽门螺杆菌的疗效

目的 比较以泮托拉唑为基础的7d标准三联疗法与泮托拉唑+铋剂+甲硝唑+四环素的10 d四联疗法根除Hp的疗效和安全性.方法 170例非溃疡性消化不良的Hp感染者随机入选三联、四联治疗组.三联治疗组实行PAC方案:泮托拉唑40 mg(2次/d)+阿莫西林1.0 g(2次/d)+克拉霉素500 mg(2次/d),口服7 d.四联治疗组实行PBMT方案:泮托拉唑40 mg(2次/d)+胶体次枸橼酸铋220 mg(2次/d)+四环素750 mg(2次/d)+甲硝唑400 mg(2次/d),口服10 d.治疗结束后至少停药4周后复查13C-尿素呼气试验,结果≤4%.为Hp阴性,表示根除成功.同时评估疗效及安全性.结果 166例患者按方案完成治疗.三联治疗组按意图治疗分析(ITT)根除率为63.53%(54/85),较四联治疗组低[89.41%(76/85),x2=17.168,P=0.000].三联治疗组按实验方案分析(PP)根除率为65.06%(54/83),亦较四联治疗组低[91.57%(76/83),x2=13.588,P=0.000].从年龄段分析,年龄＞30岁者三联治疗组根除失败率为22.22%(4/18),较四联治疗组高[3.84%(1/26),x2=19.884,P=0.000].三联和四联治疗组不良反应发生率分别为60.00%(51/85)和42.35%(36/85).结论 在7 d标准三联疗法Hp根除疗效降低的情况下,含泮托拉唑、铋剂、四环素和甲硝唑的10 d四联方案可考虑为首选方案.

Abstract：

Objective Compare the efficacy and safety of pantoprazole-based 7-day standard triple therapy with 10-day quadruple therapy including pantoprazole, bismuth, metronidazole and tetracycline in Helicobacter pylori (H.pylori) eradication.Methods A total of 170 H.pylori positive patients with non-ulcer dyspepsia were recruited and randomly assigned into triple and quadruple therapy groups.The triple therapy group was implemented with PAC program which included orally taking pantoprazole 40 mg twice per day, amoxicillin 1.0 g twice per day and clarithromycin 500 mg twice per day for seven days.The quadruple therapy group was implemented with PBMT program which consisted of orally taking pantoprazole 40 mg twice per day, colloidal bismuth subcitrate 220 mg twice per day, metronidazole 400 mg three times per day and tetracycline 750 mg twice per day for ten days.The 13C -urea breathe test was re-examined at least 4 weeks after the completion of treatment, the result lower than 4%.was H.pylori negative which indicated the success of H.pylori eradication.The efficacy and safety were also evaluated.Results A total of 166 patients completed the treatment.With intention-to-treat (ITT) analysis, the H.pylori eradication rate in the triple therapy group was 63.5% (54/85), lower than that of the quadruple therapy group (89.41%(76/85) ,x2= 17.168,P=0.000).With per protocol (PP) analysis, the eradication rate in the triple therapy group was 65.06% (54/83), also lower than that of the quadruple therapy group (91.57 % (76/83) ,x2 = 13.588 ,P=0.000).Through the age analysis, in patients over 30 years old,the eradication failed rate in the triple therapy group was 22.22% (4/18), higher than that of the quadruple therapy group (3.84% (1 / 26), x2 = 19.884, P=0.000).The incidence of adverse reaction rates of the triple and quadruple therapy group were 60.00% (51/85) and 42.35 % (36/85) respectively.Conclusion Since the reduction of eradication rate with seven day standard triple therapy,the 10-day pantoprazole, bismuth, metronidazole and tetracycline quadruple therapy may be considered as the first choice.     

经阴道Prosima网片联合高位骶韧带悬吊术治疗重度盆腔器官脱垂的围术期护理

目的探讨经阴道Prosima网片联合高位骶韧带悬吊术(HUS)治疗重度盆腔器官脱垂的围术期护理方法。方法对86例重度盆腔器官脱垂(POP)患者实施精心护理,并对心理护理、饮食和肠道准备、阴道准备、术后生命体征监测、并发症护理等进行效果评价。结果 86例患者手术均顺利,平均随访时间13个月(2～19个月),术后生活质量明显改善。结论 Prosima网片联合HUS治疗重度POP的围术期护理重点是术前准备、术后护理、预防并发症护理及出院后的健康宣教。     

D-二聚体水平在狼疮性肠炎诊断中的临床意义

目的 探讨D-二聚体水平在狼疮性肠炎患者诊断中的临床意义.方法 89例系统性红斑狼疮(SLE)患者分为狼疮性肠炎组(10例)及狼疮无胃肠道病变组(79例),同期132例体检健康人群作为正常对照组.采用免疫比浊法检测不同组别血浆D-二聚体水平.结果 与正常对照组比较,SLE患者D-二聚体水平明显升高[(0.14 ±0.24) mg/L比(0.40±0.21) mg/L,P＜0.05];狼疮性肠炎组D-二聚体水平为(0.81±0.45) mg/L,与正常对照组比较,差异有统计学意义(P＜0.05);狼疮无胃肠道病变组D-二聚体水平为(0.19±0.20) mg/L,较正常对照组略有升高,但差异无统计学意义(P＞0.05);狼疮无胃肠道病变组与狼疮性肠炎组D-二聚体水平比较,差异有统计学意义(P＜0.01).79例无胃肠道病变组患者中,D-二聚体值升高者比例为43.0％ (34/79),其中76.5％(26/34)集中于合并神经精神性狼疮、狼疮性肾炎、肺动脉高压、心功能不全等重要脏器损伤患者.结论 D-二聚体水平在SLE患者中升高,与是否存在胃肠道病变如狼疮性肠炎相关.     

胃癌干细胞的研究进展

恶性肿瘤的克隆性增殖生长、维持及转移潜能取决于一群数量稀少、具有自我更新(self-renewal)潜力的细胞群体--肿瘤干细胞(cancer stem cell,CSC).     

剖宫产术后手术部位感染监测及干预研究

目的:掌握剖宫产术后手术部位感染(surgical site infection,SSI)的年发生率,分析综合干预措施开展以来年发生率的变化趋势。方法:采用前瞻性设计,以2008年1月至2013年12月在我院接受剖腹产手术的患者为对象,通过对患者住院期间的监测和出院后的电话随访掌握SSI发生情况。同时建立和开展了以人人参与、多学科结合、综合干预为原则的干预策略。结果:共纳入6 821例剖宫产患者,342例患者发生SSI,总发生率为5.01%。院内监测和院外随访分别为127例(37.2%)和215例(62.8%)。SSI易发生在年龄较大,孕前BMI和ASA评分较高,手术时间较长,及合并糖尿病的患者中。自综合干预措施开展以来,SSI年发生率分别为9.74%、7.28%、5.55%、4.12%、3.05%和2.12%,随时间呈明显的下降趋势(z=9.45,P<0.01)。结论:以人人参与、多学科结合、综合干预为原则建立干预策略,加强对患者出院前后的积极监测是预防SSI发生的关键措施。