OBJECTIVE To understand the prevalence of hospitalization of community residents in Tianjin so as to propose references for allocating health resources and offer medical services effectively and smoothly. METHODS Sample population was obtained by multistage cluster random sampling and the data was collected by means of questionnaire from one door to the next. RESULTS The cumulative prevalence of hospitalization (CPH) was 42.67‰. The group (age﹤18) got a lower CPH (9.44‰) than the adults group (45.04‰)with a statistical differene (P = 0.000). The first 5 sorts of causes to the hospitalization were coronary heart disease, diabetes mellitus, cerebrovascular disease, hypertension and cataract. CONCLUSION Community residents have a relative high prevalence of hospitalization. With the development of aging , chronic and non-communicable diseases have become the principal problems. As the current medical system bears a moderate burden , more attention should be paid to the primary medical service and institution to optimize limited medical source so as to get optimal productivity.

目的探讨抗结核药物致肝损伤的治疗及护理方法。方法 2009年至2013年期间,本院诊治的40例初治肺结核患者,经过抗结核治疗后出现肝功能损伤,针对性给予相应的治疗和护理措施,对其临床资料进行回顾性分析。结果 40例患者中,经过保肝对症治疗和有效护理后,36例肝功有所改善,待肝功恢复正常或基本恢复正常后,更改抗结核治疗方案,完成抗结核治疗,另外2例放弃治疗,2例由于过敏反应和严重肝损伤,而未能完成抗结核治疗。结论针对高危人群,密切观察强化期抗结核治疗患者的肝功损伤情况,做到早期诊断、早期治疗。

OBJECTIVE To analyse pulmonary tuberculosis suspected patients with sputum smear and sputum culture and mycobacterium tuberculosis drug resistance,and guide clinical diagnosis and rational drug use.METHODS Used direct sputum smear microscopy,acid Lowenstein culture and drug susceptibility testing of absolute concentration method with tuberculosis suspected patients,and detected patient's sputum,the results were statistically analysed.RESULTS The smear positive rate of 1 976 copies of instant sputum was 26.47 percent;The positive rate of mycobacterium tuberculosis culture was 38.01 percent,included the humanoid detection rate was 25.56 percent,the bovine detection rate was 6.93 percent,and the nontuberculosis mycobacterium detection rate was 2.63 percent.The sputum smear positive and sputum culture positive rate was 78.20 percent(409 / 523),the sputum smear negative and sputum culture positive rate was 23.47 percent(341 / 1 453),the sputum culture positive rate of mycobacterium tuberculosis in sputum smear positive specimens was significantly higher than in sputum smear negative specimens.The 751 mycobacterium tuberculosis with isoniazid,rifampicin,streptomycin,aminosalicylic acid and ethambutol single drug were resistant,the total single-resistance rate were 20.11 percent,15.98 percent,14.78 percent,12.78 percent and 9.19 percent respectively.The resistance rate of initial treated patients resistant to isoniazid was 64.25 percent,followed by resistant to streptomycin was 50.78 percent,followed by rifampicin,aminosalicylic acid and ethambutol were 48.19 percent,44.04 percent and 35.75 percent respectively.The resistance rate of retreatment patients resistant to isoniazid and rifampicin were 71.05 percent,followed by resistant to streptomycin was 39.47 percent,followed by amino acid and ethambutol were 31.58 percent,21.05 percent respectively.The resistance rate of initial treated patients with non-tuberculous mycobacteria resistant to isoniazid was up to 95.25 percent,followed by human type was 56.92 percent and bovine type 45.00 percent;the resistance rate of retreatment patients with non-tuberculosis mycobacteria resistant to isoniazid was strain up to 100.00 percent,followed by human type was 70.00 percent and the bovine was 0.00 percent.There was a higher resistance for isoniazid,rifampicin,streptomycin,aminosalicylic acid and ethambutol five single drug with non-tuberculosis mycobacteria,the resistance rate of retreatment patients with isoniazid and ehtylaminebutanol were 100.00 percent.The isolated of bacteria present multi-drug resistance and resistance strains,the multi-drug resistance rate was 16.78 percent,the resistance rate of initial treatment peipositive patients was 17.40 percent(111 / 638),the resistance rate of retreatment pei-positive patients was 13.27 percent(15 / 113);the multi-drug resistance rate was 11.19 percent,the resistance rate of initial treatment pei-positive patients was 10.50 percent(67 / 638),the resistance rate of retreatment pei-positive patients was 15.04 percent(17 / 113).CONCLUSION The culture positive of mycobacterium tuberculosis in pulmonary tuberculosis patients with sputum smear positive specimens is significantly higher than sputum smear negative specimens,the culture positive strains of mycobacterium tuberculosis for five drugs are resistant to single drug,multi-drug and multi-drug strains,and different types of the resistance rate and the resistance spectrum of strain are different.

目的探讨抗病毒治疗慢性乙型肝炎和并艾滋病病毒感染患者的护理体会。方法 2010年3月至2013年2月期间,我院诊治的44例慢性乙型肝炎和并艾滋病病毒感染患者,给予拉米夫定、替诺福韦联合治疗,随机将其分为对照组(常规护理)和观察组(护理干预),每组各22例,对两组临床疗效和护理满意度,进行观察和比较。结果与对照组相比,观察组治疗的总有效率、护理满意度均明显升高,P<0.05,差异有统计学意义。结论对于慢性乙型肝炎和并艾滋病病毒感染患者,有效的护理干预能够明显提高临床疗效,值得临床推广。

Objective To investigate the correlation between the systemic inflammation and arterial elasticity with chronic obstructive pulmonary disease (COPD).Methods A case-control study,subjects were divided into two groups:case group:102 patients with stable COPD patients,control group:83 cases of healthy persons over the same period.Two groups of subjects using the same method applied automatic pulse wave velocity determined by measuring carotid-femoral pulse wave velocity (C-FPWV) and cervicaldorsal arterial pulse wave velocity (C-DPWV) as the main artery elastic parameters.Serum tumor necrosis faetor-α (TNF-α) measured by immunoturbidimetry and serum interleukin-1(IL-1),IL-6,TNF-α measured by radioimmunoassay.Determination of these inflammatory mediators as parameters of systemic inflammation,compared with normal control group.Results ① Case group C-FPWV,C-DPWV,IL-1,IL-6,TNF- α,hs-CRP higher than the control group,the difference was statistically significant P ＜0.05.②Case group C-FPWV with age,smoking index,systolic blood pressure,IL-1,IL-6,TNF-α,hs-CRP was positively correlated with P ＜0.05.C-DPWV with age,smoking index,IL-1,IL-6,TNF-α,hs-CRP was positively correlated with P ＜0.05.③IL-6,smoking index (years of support),TNF-α is an independent factors of C-FPWV and IL-6 is an independent factors of C-DPWV.Conclusions Systemic inflammation associated with arterial elasticity in patients with COPD.Systemic inflammation may be involved in the pathogenesis of decreased arterial elasticity in COPD patients.Systemic inflammation is a risk factor for cardiovascular disease in patients with COPD.

目的 分析(足母)外翻患者的临床病理变化特点及术后并发症的原因.方法 选择我院自2005年1月至2010年7月,采用小切口、跖骨颈梯形截骨致嵌插骨折、辅以软性外固定治疗(足母)外翻106例(182足),均为女性；年龄18～50岁,平均42岁.术前负重位X线检查(足母)外翻角为20°～40°,平均28.6°；第1、2跖骨间(intermetatarsal angle,IM)角为9°～15°,平均11 °.均合并有(足母)囊炎.结果 本组(足母)外翻的病理改变主要为以下几种类型:即第1跖骨内收、IM角增大;第1跖内翻、(足母)囊炎及第1跖趾关节半脱位；第2、3跖骨头处胼胝；第2趾呈锤状趾；第1跖趾关节骨关节炎.术后随访6～36个月,其中(足母)外翻复发1足,(足母)内翻1足,转移性跖骨痛2足.结论 根据(足母)外翻患者的临床病理改变特点,制定个体化手术方案,可明显提高矫形手术的成功率,降低主要并发症的发生率.

(趾)外翻是成年女性常见足病,严重影响患者生活质量.虽然治疗的方法有130多种,但是还没有哪一种方法可以作为通用方法使用.我们自2005年1月至2010年7月,采用小切口、跖骨颈梯形截骨致嵌插骨折,并辅以软性外固定治疗(趾)外翻106例(182足),疗效满意.

<正>拇趾外翻是成年女性常见足病,严重影响病人生活质量。被推荐用于拇外翻治疗的手术有130多种,但无一是结论性的观点,还没有哪一种方法可以作为通用方法使用。我院2005年1月—2010年7月,采用小切口、跖骨颈梯形截骨致嵌插骨折、

Objective To investigate the distribution and influencing factors of two subgroups of obesity,metabolically obese normal-weight(MONW) and metabolically normal obese(MNO),in the community of Chongqing University.Methods Totally 3,543 subjects aged 22-95 years old(56.20% males and 43.80% females,mean age [58.32±0.21] years) in community of Chongqing University were investigated during March 2008 to June 2008.Questionnaire survey,physical examination and biochemical test were used in our study.Results The prevalence rates of MONW and MNO were 4.90% and 5.09%,respectively.Totally 13.15% of normal weight subjects were metabolically abnormal,whereas 14.15% of obese subjects were metabolically healthy.The prevalence of MONW increased with age in both men and women,while the prevalence of MNO was decreased with age in men.The highest prevalence of MNO was found in women of middle-age(6.17%),and it decreased after the age of 60(3.25%).Multivariable logistic regression model showed that older age(OR=10.378,P=0.035),smoking history(OR=3.035,P=0.006),current smoking(OR=3.058,P=0.011),alcohol drinking history(OR=3.080,P=0.012),and family history of type 2 diabetes mellitus(OR=2.683,P=0.046) were the factors of MONW,while younger age(OR=0.056,P<0.001),middle age(OR=0.096,P<0.001),waist circumference(OR=0.813,P<0.001),slight physical activity(OR=1.914,P=0.029),moderate physical activity(OR=3.607,P<0.001) and family history of hypertension(OR=0.417,P<0.001) were the factors for MNO.Conclusion MONW and MNO obesity are commonly seen in the community of Chongqing University.Demography information,life style,diseases and family history may help to identify the subjects with high risk of MONW.Early diagnoses and treatment are important to prevent the cardiometabolic disease,and identification of the MNO subgroup is important to give different treatments to patients with different subgroups of obesity.(Shanghai Med J,2011,34: 345-350)

目的完善门诊电子处方系统、加快其合法性。方法阐述电子处方与传统手写处方相比的优越性及存在的问题。结论电子处方提高了医生和药师的工作效率,降低了错误处方发生率,改善了服务质量,协调了医生和患者之间的关系。结论尽快确认电子处方的合法性,加快建立完善的电子处方系统,这将是医院管理的一大进步,值得发展和推广。

目的探讨高龄髋部骨折患者急症手术治疗经验。方法对2006-01-2008-12河北廊坊整形外科医院手术治疗的72例年龄≥75岁髋部骨折患者进行回顾性分析。结果患者伤后至手术的时间平均为1 d,术后有并发症者0例,平均住院16 d,72例均得到随访。功能评定优良率89%。结论高龄患者术前合并症和术后并发症的发生率高,认真的围手术期准备和急症手术治疗能减少患者并发症的发生。

<正>Cardiac paraganglioma is an extremely rare clinical entities of the heart.The usual investigations for pheochromocytoma are necessary,however the most useful,specific to primary cardiac tumors,are coronary angiography and echocardiography.While complete surgical excision is the standard treatment of mainstay.We report a case of a 55-year-old woman with cardiac paraganglioma located in right atriaoventricular groove of the heart.As we know,this is the first case that cardiac paraganglioma located in right atriaoventricular groove of the heart in English literature.

Objective:To study the method and technology of the percutaneous lung biopsy guided by multi-slice spiral CT.Methods: There were 185 patients which were performed percutaneous lung biopsy.Before the operation,the CT scan was done and the point,depth and angle of the needle were made sure on the display.And then the biopsy needle was used for biopsy.Results: The success operations were 168(91.2%) one-time success operations were 156(84.2%), two-time were 12(6.4%).The pneumothrorax were 53 cases (28.6%),and bleeding were 35 cases (19%).Conclusion: The percutaneous lung biopsy guided by multi-slice spiral CT is important diagnosis way for the lung nodule mass.The success operation is depended on the right methods and techniques.

Objective To discuss the clinical features, effect and the prognosis of the primary lung clear cell carcinoma.Methods The data were retrospectively analyzed the clinical materials of the 11 cases of the primary lung clear cell carcinoma were reviewed.Results 9 cases were men and 2 cases were women in totaling 11 cases. The age of onset of symptom ranged 39~73-year-old, with an average age of 58-year-old. All 9 male patients smoking, average smoking index ≥500/year. Time of obtaining diagnosis was between 2 weeks and 11 months with an average of 4.5 months. The main clinical menifestations included cough, hemoptysis and chest pain so on. Chest X plain film illustrated uniform density of the shadow of the massive, the edge of the tumors was not smooth, with an average diameter≥7 cm, and the biggest diameter of the tumor>13 cm; All cases had been performed fiber bronchoscopy preoperatively, 3 patients found a neoplasm intra-bronchial cavity, and brushed pathology report malignant lesions, 2 cases were misdiagnosed as squamous cell carcinoma, 1 case was considered clear cell carcinoma of the lung. All patients with chest CT scans showed that the feature of the tumor including the shape was round or elliptic, the density was uniformal and high, non-cavity, shallow sub-leaf, short glitch and pleural indentation sign so on.Conclusion There are no specific clinical manifestations for the diagnosis of primary lung clear cell carcinoma. Pathology examination is needed for the diagnosing.

Objective:To explore the clinical characteristics of the diagnosis and therapy of esophageal tuberculosis.Methods:A case was reported and the relative literature was reviewed.Results:We reported a case of esophageal tuberculosis of a 48-year-old male with symptoms of dysphagia and pectoralgia for one month.Our primary diagnosis was established as esophageal carcinoma and the patient underwent surgical therapy.Histological examination of the excisional lesion and lymph nodes showed epithelioid granulomas,Langhans′giant cells,caseous necrosis,with no evidence of malignancy.Antituberculous treatment was given for the patient after operation.The patient recovered well without any complaints and still had no recurrence after 6 months following up.Conclusion:Clinicians should aware the features of ET and this rare disease should be considered in the differential diagnosis of esophageal lesions.

2008-02我科收治了1例肺癌病例,经手术切除后病理检查证实为肺真菌病(隐球菌感染),现报告如下.

笔者收治自发性食管破裂1例,分析如下. 1 病历摘要 男,52岁.2008-01-19因19 d黑便一次,恶心、呕吐半月,突发左胸痛0.5 d急诊入院,为当日清晨5:00许呕吐胃内容物10ml后突发左侧胸痛,伴心慌、胸闷、气促.既往胃病史20 a余,自服药物后好转.入院时查体:T 37.7 C,P 132次/min,BP 114/86 mm Hg.胸廓无畸形;左侧呼吸运动减弱;左侧触诊语颤减弱;左上叩诊稍呈鼓音,左下叩诊呈浊音;左侧呼吸音消失,右侧呼吸音粗糙.腹平软,无压痛及反跳痛,肝脾肋下未及,肠鸣音正常.入院时辅助检查x线胸腹片提示左侧液气胸,左肺压缩10%～20%,并部分包裹性胸腔积液,左下肺感染;右中上腹宽大液平.心脏超声提示心脏向右明显移位,房室大小正常.心肌酶谱显示肌红蛋白升高,为163.80 ng/ml(参考值0.00～70.00 ng/m1).血生化显示:Cl-93.0 mmol/L,Ca2+1.50 mmol/L,P 1.78 mmol/L,MR2+1.09 mmol/L,BUN 12.16 mmol/L,Cr 118.7 μmol/L.

Objective To evaluate value of CT perfusion imaging in diagnosing the solitary pulmonary nodule(SPN).Methods Forty-five patients with SPN(2~4 cm in diameter) were study with CT perfusion imaging using 6-slice spiral CT.The CT perfusion imaging features were analysed with tumor’s perfusion software.The blood volume(BV),blood flow(BF),time to peak (TTP),peak enhancement intensity(PEI) and time-density curve(TDC) of the lesions were measured.And the enhanced values and SPN/aorta in PEI(S/A) of lesions were also calculated.Results There were statistically significant differences between malignant and benign nodules in BF, BV and PEI. There were no differences between malignant, benign and inflammatory nodule in perfusion values and TTP. The TDC were of different shapes among malignant, benign and inflammatory nodules. The enhanced values and S/A of malignant and inflammatory nodules were higher than that of benign nodules, and there were significant differences. Conclusion MSCT perfusion is valuable for diagnosis and differentiating diagnosis of SPN.

目的通过比索洛尔(Bisoprolol)在冠心病(CHD)合并慢性阻塞性肺疾病(COPD)并支气管哮喘治疗中的运用,了解比索洛尔(Bisoprolol)在治疗中对缺血负荷值和一秒钟用力呼气容积(FEV1)的影响.方法确诊为无症状心肌缺血型心脏病,合并COPD并支气管哮喘缓解期患者34例均予比索洛尔片0.625mg-2.5mg,每日一次口服,观察一月,比较服药前后的心肌缺血负荷值和FEV1值.结果比较服药前后心肌缺血负荷值,P＜0.01,有显著性差异;比较服药前后FEV1值,P＞0.05,无显著性差异.结论比索洛尔在治疗冠心病中,对心脏有保护作用;在治疗COPD并支气管哮喘缓解期患者中,对小气道无明显致痉挛作用.