质量管理(Quality control,QC)小组是指运用质量管理理论和方法开展活动的小组[1].我院针对门、急诊病人输液的两大不满意因素,即不能一针见血及巡视不到位,专门成立门QC小组,把"消灭门、急诊输液病人的两大不满意"做为小组活动主题.经过一年多的活动,取得满意的效果,现将具体做法和收获总结如下.
“游泳”和“抚触”作为婴儿健康的辅助护理技术，产生于人类最基本的自然活动，具有悠久的历史。20世纪40年代即有“抚触”对婴儿影响正式的临床观察记录。1986年，美国迈阿密大学Field及其同事率先对早产儿抚触进行了临床观察，其后世界各国研究机构开始了对婴幼儿抚触的一系列临床研究。60年代末在许多国家兴起了游泳热，而国内将该技术运用于婴儿的各个时期，取得了良好的效果，本文就“游泳”和“抚触”的国内外研究进展作一综述。
目的 分析跟骨关节内骨折早期手术内固定的临床疗效.方法 2001年2月～2005年10月早期(伤后24 h内)采用切开复位、跟骨钛板内固定治疗跟骨关节内骨折24例(28足).骨折按Sanders分型:Ⅱ型3足,Ⅲ型24足,Ⅳ型1足,术后积极进行消肿等综合治疗.结果 所有患者均获随访,随访3～22个月,平均11个月.21例(25足)切口一期愈合,切口皮肤坏死2例2足,切口拆线后裂开1足,均经换药愈合.按Maryland Foot Score评分标准:优16足,良8足,可3足,差1足,优良率85.7%.结论 跟骨关节内骨折早期手术复位、钛板内固定,同时对复位后形成骨缺损较大者行自体骨移植,具有骨折复位满意、可早期进行功能锻炼、患者恢复快、住院费用低等优点.只要掌握好适应证并加强术后处理,可获得满意疗效.
Objective To evaluate the effect of adjuvant chemotherapy after radical surgery for stageⅠ,Ⅱnon-small cell lung cancer (NSCLC).Methods We analysed clinical data in 274 cases of stageⅠ,ⅡNSCLC undergone resectional surgery.102 patients received adjuvant chemotherapy after undergone radical surgery(adjuvant chemotherapy group).172 patients received surgery alone (surgery group).Results The relapse or metastasis rate was 42.2% in the adjuvant chemotherapy group and 49.4% in the surgery group.There was no significant difference between two groups(P＞0.05).The 5-year survival rate was 45.1% in the adjuvant chemotherapy group and 42.4% in the surgery group.There was no significant difference between two groups (P＞0.05) as well.Con- clusion Adjuvant chemotherapy is not a recommended therapy methods for patients with stageⅠ、ⅡNSCLC.
Objective To explore the changes of gastroduodenal mucous in children with allergic purpura and the relationship with helicobacter pylori infection.Methods To summarize the endoscopic features of 53 children with allergic purpura retrospectively.Helicobacter pylori was determined.Results The changes of gastroduodenal mucous included hyperemia,edema and erosions.The positive rate of helicobacter pylori was 67.9%(36 cases).Conclusion Gastricendoscopy can be useful to the diagnosis of allergic purpura.Helicobacter pylori may be one of the causes in allergic purpura,three combination protocal can be used in the basis of routine therapy.
Objective To investigate the clinical application of the sural neurocutaneous island vascular flap.Methods This method was applied to repair the soft tissue defect in dorsum of foot,malleolus,inferior part of shank,anterior tibia in 21 cases.The features of the nerve and the nutritional artery were observed.Results Twenty cases of flap transplanted were survived satisfactorily and one case was partial necrosis.Conclusion The sural neurocutaneous island vascular flap is easy to obtain and the rate of success is high.The farthest part of the flap can get to the intermedia of the anterior part of the foot.It is an ideal flap for repairing the soft tissue defect of the heels,dorsum,malleolus and the inferior part of the shank.
Objective To investigate the therapeutic effect of metformin combined pioglitazone on the newly diagnosed obesity type 2 diabetes(T2DM).Methods 71 patients with newly diagnosed obesity type 2 diabetes were randomly divided into two groups.25 patients in treatment group were treated by metformin(500 mg twice daily) and pioglitazone(30 mg once daily).The control group involved metformin group and pioglitazone group,24 patients in metformin group were given metformin(500 mg twice daily),22 patients in pioglitazone group were given pioglitazone(30 mg once daily).The treatment lasted for 12 weeks.The change of fasting plasma glucose(FPG),2 hour postprandial plasma glucose(2hPG),HbA_(1C),fasting plasma insulin(FINS) and 2 hour postprandial plasma insulin(P2hINS) levels were determined.Results After the treatment,the level of FPG,2hPG,HbA_(1C),FINS and P2hINS decreased significantly in three groups.The results showed that metformin group and pioglitazone group had similar curative effect,the treatment group was better in decreasing level of insulin and improving glucose metabolism disturbance as compared with metformin group and pioglitazone group.Conclusion Metformin combined pioglitazone is one of the choices in the newly diagnosed obesity T2DM patients whose glycemia was poorly controlled with single medication.
目的探讨影响住院肝性脑病患者死亡率的临床因素。方法回顾分析近4年来我院83例肝性脑病住院患者的情况。结果原发疾病为恶性肿瘤的肝性脑病患者其死亡率显著高于非恶性肿瘤患者(P<0.05),有合并症的肝性脑病患者其死亡率显著高于(P<0.05)无合并症的患者,电解质紊乱是导致肝性脑病患者死亡率增高(P<0.005)的重要因素。结论积极治疗各种合并症,控制电解质紊乱的发生,将有助于降低肝性脑病患者住院死亡率。
1临床资料 患者女,34岁.因全身疼痛、无力8个月,在各医院反复诊治无效,于2005年9月27日在我院行发射型计算机断层仪(ECT)锝-亚锡亚甲基二膦酸盐(99Tcm-MDP)全身骨显像,骨显像见患者全身骨骼放射性分布浓集,骨骼显示异常清晰,头颅骨放射性分布浓集呈"黑颅状",胸骨放射性分布浓集呈"领带状",双肾不显影,骨显像图表现为"Super Scan"(超级影像).
静脉给药是最好的途径之一.但由于老年人静脉穿刺困难,不易固定且容易滑脱,给病人增加痛苦,同时加大工作量.2003年12月至2005年12月.笔者对静脉穿刺困难病人30例进行静脉逆向穿刺,取得良好的效果,现总结如下.
1临床资料 患儿,男,11岁,因咯血入院.入院前一年半突然出现发作性面色苍白伴乏力,头晕、咳嗽、痰中带血丝,活动后气短、喘息、右胸针刺样疼痛,在外院按"支气管炎合并贫血"给予抗感染、铁剂治疗后咳喘稍缓解,苍白、乏力无变化.入院前1 d咯血约250 mL,苍白加重.
恶性肿瘤晚期常伴广泛骨转移,大多数有骨转移癌的患者会产生难以忍受的持续性骨痛.严重影响患者的生存质量.目前对其治疗手段虽多,但各种方法均有一定的局限性.放射性治疗(外照射、内照射)在缓解骨痛方面有着重要的临床价值.现就几种常用的放射性治疗方法及其毒性综述如下.
安氏Ⅱ类错(牙合)畸形(以下简称Ⅱ类错(牙合))发病率高,矫治难度大,其不仅严重影响患者颅颌牙面的正常发育,还可导致患者一定程度的心理障碍,故其治疗一直是口腔正畸临床研究的热点.
高血压脑出血是众所周知的三高(高发病率、高病残率、高死亡率)疾病,是神经外科常见病[1].在我国,脑出血患者占所有患者的21%～48%,发病后1个月内的病死率达30%～50%,超过30%的存活者遗留有功能缺损,因此一直以来是神经内、外科治疗的重点和难点,内科治疗好还是外科治疗好一直存在着争议[2].多年来,外科治疗优于内科治疗已达成共识[3].现就高血压脑出血外科治疗的历史进行回顾,并对外科治疗的现状进行综述.
1992～2005年,我院在体外循环直视下施行了心脏黏液瘤摘除术16例,麻醉诱导时有5例出现了低血压,其中1例出现了心跳骤停,经处理后好转,其它均平稳.现将麻醉处理的体会报告如下.
1病历摘要 患者女,25岁,未婚,3年前无意中发现右乳肿块,拇指大,伴有阵发性隐痛,以经期明显,无乳头溢液.B超:右乳实质性肿块,随后肿块增大明显.家族中无乳腺肿瘤病史.
急性胰腺炎是一种常见的急腹症,病情凶险,变化快,尤其是急性出血坏死性胰腺炎,常累及多个器官功能改变,死亡率高达30%～50%[1].2004年1月到2005年6月,我科收治急性胰腺炎39例,其中2例采取转外科行急症手术外,其余37例均采取内科治疗,无1例死亡,效果满意.现将护理体会报告如下.
甲状腺功能亢进症(简称甲亢)是以甲状腺激素(TH)分泌过多引起的一种临床综合征.甲亢患者常伴有不同程度的糖代谢紊乱,如糖耐量减低(IGT)甚至糖尿病.目前,对于甲状腺功能亢进症糖代谢紊乱的机制尚未完全明了,各家报道不一,主要有超生理量甲状腺激素的作用、胰岛素的抵抗(IR)、胰岛β功能的损害.
组织工程学是近年来发展起来的一门新学科,是材料学、工程学和生命科学共同发展并相互融合的产物,其最基本的思路是在体外分离、培养细胞,将一定量的细胞接种到具有一定空间结构的支架上,通过细胞之间的相互黏附、生长繁殖、分泌细胞外基质,从而形成具有一定结构和功能的组织或器官[1],因而,充足的种子细胞、合适的支架及促进种子细胞在支架上增殖分化的因子便成为组织工程的三大要素.
