外周静脉置入中心静脉导管并发症的护理要点

经外周静脉置入中心静脉导管（PICC）术,简称PICC置管术,是目前护理开展的创新技术,为临床护理工作带来了许多益处,也减轻了因反复静脉穿刺给患者带来的不适与痛苦。     

腹腔镜胆囊切除术的围手术期护理

目的 探讨腹腔镜胆囊切除术（LC）围手术期的护理.方法 对411例腹腔镜胆囊切除的患者在术前做好健康指导和心理护理,充分进行术前准备,术中、术后生命体征和各种并发症的观察与护理.结果 术前、术后采取有效的护理措施,保证了患者手术顺利及术后早日康复,所有患者均痊愈出院,术后无一例发生感染等并发症.结论 周密细致的围手术期护理,是减少术后并发症、提高手术成功率、促进早日康复的有力保障.     

兔高胆固醇-动脉粥样硬化模型心肌血管紧张素Ⅱ的表达及阿托伐他汀的干预效果

目的:建立兔高胆固醇-动脉粥样硬化模型,观察心肌组织血管紧张素Ⅱ(AngⅡ)的表达,探讨阿托伐他汀对心肌组织AngⅡ表达的影响。方法:22只健康雄性新西兰白兔随机分为3组:正常对照组(n=6),高胆固醇饲养组(n=8),高胆固醇饲养加阿托伐他汀(2.5mg·kg-1.d-1)组(n=8)。喂饲8周后,经兔中央动脉取空腹血标本测定血清总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)的浓度。取主动脉组织肉眼观察形态学改变;取心肌组织用免疫组化方法测定各组AngⅡ的阳性表达,结果采用阳性单位(PU)表示。结果:高胆固醇饲养组心肌组织AngⅡ的阳性表达显著高于对照组[(21.65±4.20)PU对(4.58±1.20)PU,P<0.05],高胆固醇饲养加阿托伐他汀组AngⅡ的阳性表达(16.50±1.53)PU较高胆固醇饲养组明显降低,但仍显著高于对照组,P<0.05。结论:高胆固醇血症时心肌组织肾素-血管紧张素醛固酮系统(RAAS)处于高度激活状态,阿托伐他汀具有明显的抑制心肌组织RAAS激活的作用。     

SCOUTⅡ半自动生化分析仪在酶联免疫检测方面的应用

ＳＣＯＵＴⅡ半自动生化分析仪是意大利ＭＥＮＡＲＩＮＩ公司研制的 ,具有操作简便、测量稳定、重复性好等优点。我院自 1996年购入以来 ,不仅是对生化项目进行检测 ,而且在酶联免疫试验 (简称酶免 )的定量和半定量及质控方面也有很大帮助。现简要概述一下ＳＣＯＵＴⅡ在酶免上的应用体会。1　吸光度测量如检测甲肝、乙肝系列、丙肝、结核抗体等用酶免检测的项目 ,在操作步骤的最后阶段 ,先加底物液Ａ和底物液Ｂ各 5 0 μｌ,显色后加终止液 2 5 0 μｌ,振荡器上混匀。仪器的参数设置为 :ＭＯＤＥ (Ｎ .) :ＡＢＳ ;ＦＩＬＴＥＲ :取与检测项…     

尿毒症81例首发症状与误诊分析

目的：了解尿毒症首发症状,减少误诊率。方法：对81例尿毒症患者首发症状及误诊情况进行分析。结果：本组中尿路梗阻2例经手术治疗后痊愈;其余症状体征好转,血肌酐、尿素氮不同程度下降,长期进行血液透析。结论：尿毒症涉及各器官系统,首发症状无特异性,只有掌握尿毒症的临床特点,详细询问病史,重视血常规、尿常规、肾功能、肾脏B超检查,减少误诊率。     

兔高胆固醇-动脉粥样硬化模型心肌血管紧张素Ⅱ的表达及阿托伐他汀的干预效果

目的:建立兔高胆固醇-动脉粥样硬化模型,观察心肌组织血管紧张素Ⅱ(AngⅡ)的表达,探讨阿托伐他汀对心肌组织AngⅡ表达的影响。方法:22只健康雄性新西兰白兔随机分为3组:正常对照组(n=6),高胆固醇饲养组(n=8),高胆固醇饲养加阿托伐他汀(2.5mg·kg-1.d-1)组(n=8)。喂饲8周后,经兔中央动脉取空腹血标本测定血清总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)的浓度。取主动脉组织肉眼观察形态学改变;取心肌组织用免疫组化方法测定各组AngⅡ的阳性表达,结果采用阳性单位(PU)表示。结果:高胆固醇饲养组心肌组织AngⅡ的阳性表达显著高于对照组[(21.65±4.20)PU对(4.58±1.20)PU,P<0.05],高胆固醇饲养加阿托伐他汀组AngⅡ的阳性表达(16.50±1.53)PU较高胆固醇饲养组明显降低,但仍显著高于对照组,P<0.05。结论:高胆固醇血症时心肌组织肾素-血管紧张素醛固酮系统(RAAS)处于高度激活状态,阿托伐他汀具有明显的抑制心肌组织RAAS激活的作用。     

微创胸腔镜心外膜电极同步化技术治疗心肌病心力衰竭十例

目的探讨微创胸腔镜心外膜电极技术完成心力衰竭(简称心衰)同步化治疗的效果。方法 10例心肌病心衰患者经心电图和组织多普勒技术明确诊断心衰伴心脏不同步运动。患者在全麻双腔气管插管放射线引导下行左锁骨下静脉穿刺放置右房和右室心内膜电极。然后利用微创胸腔镜和心外膜电极技术,在术中组织多普勒食管监测下测试左室侧壁不同位置,寻找同步化效果最理想的位置,并使用无损伤缝线固定左室心外膜电极。围术期监测心脏结构、功能和同步化效果。结果所有患者术中电极放置顺利,一般心外膜电极尝试贴附3～4次可以找到合适的位置,位置均在左室的侧后面。右房和右室电极起搏阈值为0.5～0.8V,左室心外膜电极阈值为0.5～1.5V,术后顺利拔除气管插管。除1例发生肺炎外,无膈肌刺激、电极脱位等并发症。术后临床症状改善顺利出院。术后随访3～24个月,左室最大收缩延迟时间缩短,左室不同步指数降低,心室间机械延迟。左室射血分数升高,左室舒张末径降低(P均0.05)。结论应用微创胸腔镜心外膜电极技术完成心衰同步化治疗安全可行,可获得良好的同步化效果。     

中西医结合治疗慢性肾功能不全疗效观察

目的：观察中药内服及保留灌肠治疗慢性肾功能不全的疗效。方法：选择慢性肾功能不全患者62例,分成治疗组32例及对照组30例。对照组低盐、优质低蛋白、低磷饮食,控制血压、降血糖、抗炎及对症治疗,治疗组在对照组的基础上用传统中药内服配合中药保留灌肠治疗。结果：对照组总有效率46.67%,治疗组总有效率为68.75%,两组血肌酐、尿素氮在治疗前后比较有统计学差异（P〈0.05）。结论：中西医结合治疗慢性肾功能不全疗效较好。     

微创胸腔镜心脏同步化技术治疗心肌病心力衰竭

目的 探讨利用放射线和胸腔镜的Hybrid技术完成心肌病心力衰竭同步化治疗的效果.方法 2007年4月至2009年9月,经心电图和组织多普勒技术明确诊断心衰伴心脏不同步运动的病人11例.在杂交手术室中,全麻双腔气管插管后先在放射线引导下左锁骨下静脉穿刺放置右心房和右心室心内膜电极;然后利用微创胸腔镜和心外膜电极技术,在术中组织多普勒食管监测下测试左心室侧壁不同位置,寻找同步化效果最理想的位置,并使用无损伤缝线固定左心室心外膜电极.围术期监测心脏结构、功能和同步化效果.结果 术中电极放置均顺利,术后顺利拔除气管插管,除1例发生肺炎外无膈肌刺激、电极脱位等并发症.术后临床症状改善出院.术后随访5～24个月.左心室最大收缩延迟时间由术前(393.4±40.2)ms缩短为(102.1±34.6)ms,左心室不同步指数(Ts-SD)由术前的(145.2±29.3)ms降为(51.0±21.4)ms,心室间机械延迟(IVMD)由术前(59.1±23.4)ms降为(31.2±11.5)ms.左心室射血分数由术前0.32±0.04升到0.41±0.07,左心室舒张末径由术前(73.1±13.4)mm降低为术后(63.2±6.7)mm.结论 联合利用放射线和微创胸腔镜心外膜电极的Hybrid技术完成心力衰竭同步化治疗安全、可行,可获得良好的临床治疗效果.

Abstract：

Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiac conduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed, such as difficulty of sinus electrode implantation, coronary sinus injury and bleeding, still one third CRT cases remain unchanged cardiac function.Recently the epicardial lead CRT therapy by the cardiac surgeons appears promising to provide better clinic resynchronization.The aim of this research is to explore the clinical value of surgical epicardial lead CRT for the cardiomyopathy heart failure with micro-invasive thoracoscopy techniques. Methods During April 2007 to Sep 2009 eleven patients were diagnosed as advanced heart failure with cardiac dysynchronization proven by the ECG and tissue Doppler echo examination. The dysynchronization parameters of tissue Doppler echo includes left ventricle maximize delay time , the left dysynchronization index (Ts-SD), the inter-ventricle mechanical delay time (IVMD), left ventricle end-dilation diameters (LVEDD) and the left ventricle ejection fraction (LVEF). All the patients got the consent agreement before the surgery. In the hybrid operation room the right atrial and ventricle endocardial electrodes were placed firs guided by X ray under the general anesthesia and double lumnen incubation. Then the thoracoscope techniques were used to explore the left ventricle lateral wall. The right atrial and ventricle electrodes were connected into the three chamber pacemaker. The Tissue Doppler Echo TEE technique was used to check which part of the left ventricle lateral wall is suitable for the idea CRT therapy. Usually the latest activated part of the left ventricle wall is the goal place. Then the epicardial electrode was fixed with 4-0 prolene suture at the idea place. All the cases were performed by the same surgeons group in the same medical center. The resynchronization features were examined after surgery and during the follow up. Results The endocardial and epicardial electrodes were implanted successfully without any serious complication. All patients were weaned and discharged without any adverse cardiac episodes. There is no mortality during the follow up period. All the patients received the β-blokers, diuretics, ACEI/ARB and other traditional medicine for the heart failure.The Tissue Doppler showed the E peak wave separated form the A peak which means the good resynchronization between the atrium and the ventricle. After surgery during the follow up the left ventricle maximize delay time decreased from (393.4 ±40.2 ) ms to ( 102.1 ± 34.6) ms, the left dysynchronization index (Ts-SD) decreased from (145.2±29.3)ms to(51.0±21.4) ms, the inter-ventricle mechanical delay time (IVMD) decreased from (59.1 ±23.4) ms to (31.2 ± 11.5 ) ms, left ventricle end-dilation diameters increased from (73.1 ± 13.4) mm to (63.2 ± 6.7) mn and the left ventricle ejection fraction increased from 0.32 ±0.04 to 0.41 ±0.07. Conclusion The micro-invasive surgical synchronization therapy could get good CRT result for the cardiomyopathy heart failure patients. Some patients traditionally in the waiting list for the heart transplant could be considered for the CRT therapy candidates.     

国境口岸应对突发公共卫生事件立法探析

〔目的〕探析完善我国国境口岸应对突发公共卫生事件立法体系,提供国境卫生检疫部门应对突发公共卫生事件处置的法律依据,提高口岸卫生核心能力。〔方法〕分析我国目前应对公共卫生突发事件体制的现状和《国际卫生条例(2005)》对口岸核心能力的要求,提出国境卫生检疫部门在应对口岸突发公共卫生事件方面的立法建议。〔结果〕有利于充分发挥卫生检疫部门的技术指导和快速应对的作用,提高口岸处置突发公共卫生事件的能力,更有效保障人民的生命和财产安全。〔结论〕通过立法赋予国境卫生检疫部门参与甚至主导国境口岸突发公共卫生事件的足够权责,更有利于发挥国境卫生检疫部门在处置口岸突发公共卫生事件的作用,提高口岸卫生检疫核心能力。