Objective To explore the appropriate time for the application of suspended bed in the treatment of severely burned children.Methods A retrospective analysis was performed based on the clinical data of 107 cases of severely burned children who were admitted to the Military Burn Center of the 990th (formerly 159th) Hospital of Joint Service Support Force of People's Liberation Army from January 2000 to December 2017.Cases were divided into two groups according to the time of the application of suspended bed.In control group (n =49),patients started to use suspended bed within 3 days after injury,while suspended beds were put into use from 4 to 6 days after injury in experimental group (n =58).The following indicators were collected and analyzed:total amount of fluid infusion,amount of colloid liquid,crystal liquid and water,urine volume,resuscitation index in shock stage,visceral complications after injury,hypernatremia,mortality;time of scab formation,time of scab removal,time of wound healing,positive rate of bacterial culture and the incidence of sepsis;time of sand bonding in suspended bed and positive rate of bacterial culture of bed sediment.Date were compared with t test and X2 test.Results In experimental group,the amount of crystal liquid,colloid liquid,water and total amount of fluid infusion in first24 hours were (0.97 ±0.10) mL · kg-1 · ％TBSA-1,(0.67 ±0.13) mL · kg-1 · ％TBSA-1,(1 233.00 ± 254.00) mL,(2 265.00 ± 958.00) mL,and these indicators in first 24 hours in control group were (1.18 ±0.13) mL· kg-1 ·％TBSA-1,(0.97±0.10) mL· kg-1 · ％TBSA-1,(1 635.00 ±283.00) mL,(2 979.00 ± 973.00) mL,the difference between the two groups was statistically significant (t =9.585,13.617,7.736,3.811,with P values below 0.01).The amount of crystal liquid,colloid liquid,water and total amount of fluid infusion in the second 24 hours in experimental group were (0.53 ±0.07) mL· kg-1 ·％TBSA-1,(0.49 ±0.06) mL · kg-1 · ％TBSA-1,(1 110.00 ±229.00) mL,(1 755.00± 649.00) mL;in control group,these indicators in the second 24 hours were (0.74±0.10) mL·kg-1 ·％ TBSA-1,(0.75± 0.12) mL·kg-1· ％TBSA-1,(1 542.00 ±288.00) mL,(2 479.00 ± 771.00) mL.The amount of fluid in experimental group was significantly lower than that in control group,the difference was statistically significant (t =12.529,13.653,9.635,5.279,with P values below 0.01).The indexes of resuscitation in experimental group were listed following:heart rate (115.00 ± 5.00) beats/min,mean arterial pressure (MAP) (53.00 ± 2.70) mmHg,central venous pressure (CVP) (8.00 ± 0.80) cmH2 O,lactic acid (2.00 ± 0.60) mmol/L,residual base (-2.10 ±0.70) mmol/L,hematocrit (HT) (0.42 ± 0.02) and albumin (35.00 ± 1.40) g/L.The indexes of resuscitation in control group were listed following:heart rate (126.00 ± 5.00) beats/min,MAP (56.00 ±3.30) mmHg,CVP (9.80 ± 1.50) cmH2O,lactic acid (3.80 ± 0.60) mmol/L,residual base (-4.40 ±0.60)mmol/L,HT (0.53 ±0.03) and albumin (33.00±2.10) g/L.These indicators in experimental group were better than those in control group except urine volume,the difference was statistically significant (t =10.234,5.585,8.214,16.117,-17.451,20.448,-3.989,with P values below 0.01).The incidence of hypernatremia and visceral complications in experimental group were 3.4％ and 10.3％ respectively,which were significantly lower than those in control group (18.4％ and 26.5％)(x2 =6.410,4.765,with P values below 0.05),mortality in control group was 4.1％ and 1.7％ in experimental group,there was no significant difference (P ＞ 0.05).There was no significant difference in the positive rate of bacterial culture and the incidence of sepsis between the two groups(with P values above 0.05).Scab formation in control group was earlier than experimental group,the difference was statistically significant (t =-5.579,P ＜ 0.01),however,the time of scab removal and wound healing in experimental group was obviously earlier than control group,the difference was statistically significant (t =-6.760,4.212,with P values below 0.01).In control group,the time of sand bonding was significantly earlier than experimental group,the difference was statistically significant (t =-15.010,P ＜ 0.05),and the positive rate of bacterial culture of bed sediment was higher than experimental group,the difference was statistically significant (x2 =4.356,P ＜ 0.05).Conclusions The appropriate time for the first application of suspended bed in the treatment of severely burned children should be from 4 to 6 days after injury,which can help the patients get through the shock period successfully and promote wound healing with lower mortality,wound injury and complications.Meanwhile,this timing also can increase the service life and utilization rate of suspended bed.

对于功能部位的深Ⅱ度烧伤创面以手术植皮封闭为主,这在目前已经形成共识.而对于肢体非功能部位的深Ⅱ度烧伤创面,目前治疗主要的手段往往是保守创面换药,但弊端较多:换药时疼痛不适感明显;患者配合度差,出血多,新生上皮很容易受损,甚至导致创面加深;包扎困难;创面感染发生率较高;愈后瘢痕较重等.另外,患者创面一旦发生感染,往往就会加深,后期需要植皮修复,而手术带来的影响是终身的,不仅原有创面的产生瘢痕,而且供皮区也较容易形成增生瘢痕,甚至后期影响肢体功能.这不仅是外观和功能问题,而且还会产生心理问题,严重者甚至可出现自卑感和抑郁症,以致难以回归社会.为此,我们一直在寻找一种积极有效的方法,来解决此问题.现遴选我科从2015年9月份至2017年2月份已出院患者60例,其中实验组和对照组各30例,从创面感染发生率、愈合时间和瘢痕增生程度三个方面进行对比,观察负压封闭引流治疗的优越性.研究结果表明,实验组创面感染发生率较低,愈合时间较常规换药缩短,瘢痕增生程度较轻,患者及家属满意率增加.因此,我们认为早期修复小儿四肢非功能部位深Ⅱ度烧伤创面时,采用负压持续吸引疗法,安全、方便,疗效确切、显著.

Objective To explore the epidemiological characteristics and prevention strategy of neonatal burns in southern Henan province.Methods From February 1967 to May 2018,a total of 49 cases of neonatal burns were admitted to the burn center of the 159th Hospital of People's Liberation Army,aged 0-28 (3.57 ± 7.35) days,28 cases of male and 21 cases of female,with total 1％-46％(8.66 ± 7.29) ％ total body surface area (TBSA) burns including superficial Ⅱ degree (4.23 ± 3.79) ％TBSA,deep partial-thickness burn (7.29 ± 6.71)％ TBSA,and full thickness burn (5.73 ± 5.05)％TBSA.The average time from injury to admission was (2.79 ± 4.40) days.While admission,there were 4 cases with moderate shock and 6 cases with inhalation injury.There were 7 cases of neonatal asphyxia,2 cases of neonatal hard swelling and 1 case of hydrocephalus.All of the cases were collected and retrospectively analyzed.According to the admission time,the cases were divided into 3 groups,1960s-1970 s,1980s-1990 s,and 2000s-2010 s.And their causes,injured body parts,burn area,the times of operation,hospitalization time,complications and prognosis were comparatively analyzed.Data were processed with one-way analysis of variance,chi-square test and Fisher's exact test.Results Hot liquid scald accounted for 57.14％ of the total number of cases,26.53％ of burns caused by flame,and 6.12％ of cases by neonatal thermostat.Compared with the ages,the number of thermal scald increased,and the nunber of flame burns decreased (with P values below 0.05).The proportion of iatrogenic factors increased year by year (P ＜ 0.05).Neonatal burns were mostly injured in head,neck,trunk and limbs,while hip,perineal,digestive tract and inhalation injuries were rare,with no significant difference in the different ages (with P values above 0.05).There were no remarkable differences in burn area and burn areas of different degrees of burn among the newborns of the different ages (with P values above 0.05).The total number of operations were close,but the number of hospitalization days was gradually reduced (P ＜ 0.05).Hypoalbuminemia,electrolyte imbalance disorder and diarrhea were the most common complications in neonates.Sepsis and death rate were significantly reduced (with P values below 0.05).The total cure rate was 91.84％.Conclusions To improve the national awareness of burn prevention and first aid,standardize the nursing process of newborn babies,and reduce iatrogenic burns are the fundamental solving ways.The application of new technologies such as hemodynamic monitoring,multidisciplinary cooperation,NPWT and MEEK skin grafting are key measures for the treatments of severely burned neonates.

目的 探讨降钙素原(pro-calcitonin,PCT)监测对老年烧伤患者抗感染治疗的临床意义.方法 回顾性分析笔者所在医院近3年收治烧伤面积在50％以下、Ⅲ度面积在30％以下、不合并吸入性损伤的193例老年烧伤患者,按PCT不同水平统计分析其抗生素使用、创面细菌培养、血细菌培养、手术治疗及预后情况.结果 PCT水平越高,对应抗生素治疗档次越高;血细菌培养阳性率与PCT水平相关(P=0.007),病死率与PCT水平相关(P=0.004);创面细菌培养阳性率、手术治疗率与PCT水平不相关(P＞0.05).结论 PCT监测是评估老烧伤患者感染严重程度、转归与预后的良好指标,对合理应用抗生素、及时采取措施控制初期感染及判断预后具有重要指导作用.

目的 对严重烧伤患者液体复苏过程中早期心力扶持的效果进行评估分析.方法 将笔者所在中心近期收治的83例严重烧伤患者随机分为心力扶持组(42例)和对照组(41例),心力扶持组在伤后48 h内除静脉应用西地兰和乌司他丁外,其他液体复苏治疗同对照组常规.伤后48 h检测心率、血压、中心静脉压、每小时尿量等休克复苏指标,抽取静脉血栓测肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肌钙蛋白I(cTnI)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆汁酸(TBA)、尿素氮(BUN)、肌酐(Cr)、β2-微球蛋白(β2-MG)等脏器损害指标.结果 在达到相同复苏效果的基础上,心力扶持组所需的补液量[(2.56±0.76)ml/kg·I％TBSA]较对照组[(3.24±0.93)ml/kg·1％TBSA]明显减少,心肌损害、肝肾功能损害显著减轻,而且心力衰竭、肾衰竭、脓毒症等远期并发症减少,预后较好.结论 烧伤休克期液体复苏过程中进行心力扶持,能有效减少补液量,减轻心、肝、肾等脏器损害,提高严重烧伤的救治成功率.

1例重度烧伤合并急性肾衰患者在采用抗休克、 抗感染、 营养支持、 连续血液净化、 口服中药及创面处理等治疗14 d后,胸部CT检查显示有胸腔积液,未予特殊处理;治疗16 d,患者出现呼吸困难,予以面罩吸氧等治疗后症状缓解;治疗24 d,患者再次出现呼吸困难,给予加大吸氧流量后症状未见缓解,遂予以氟康唑注射液100 mL,每日2次静脉滴注;治疗26 d,患者呼吸困难等症状未见好转,专家会诊,确诊为肺部真菌感染,建议给予大扶康治疗.大扶康治疗2 d,患者呼吸困难等症状明显缓解,肺部感染得到控制.

Objective To evaluate cervical cytology smear in the screening of cervical cancer and precancerous lesions. Methods Analyzed the results of 13 751 cases of cervical smear cell detection by TBS classification, then compared the abnormal results with the pathological diagnosis of cervical biopsy. Results There were 515 positive in 13 751 cas-es. The positive rate was 3.78%. Among the 515 cases, 349 cases underwent cervical biopsy. There were 217 cases up-per than CIN, the positive rate was 62.18%. The coincidence rate was 79.50% between the cervical smear and cervical biopsy. Conclusion Cervical smear is a simple and effective method in screening of cervical cancer, it facilitates basic hospital in rural areas.

Objective To investigate the structure and application of remote pathology consultation system.Methods The basic user terminal platform of the system was built up,and the communication with upper hospital specialist consultation platform was realized by Internet and the server.The information of the cases was prepared,uploaded,consulted,transmitted back and printed as designed.Results The system came into being by Internet linking basic user terminal platform,central server and hospital specialist consultation platform,which proved its stability and convenience by the trial operation.Conclusion The remote pathology consultation system can play an important role in primary military hospitals.

为适应军队数字化卫勤建设的需要[1-2],我院根据上级要求,于2011年5月用6个月的时间试点应用了远程数字化病理诊断系统,共利用该系统与多家上级医院完成了远程病理会诊242例次,显著提高了病理诊断水平.现将其应用情况报告如下. 1基层医院病理诊断现状 目前,军队基层医院医疗资源相对匮乏,病理资源更是严重缺乏.表现为从业人员少、专业水平较低、诊断设备简陋等[3].病理诊断对确诊疾病,特别疑难病例尤为重要[4].

Objective To improve the unsatisfactory situation of endoscope disinfection and develop endoscopic anti-cross- infection security protection sheath. Methods The protective sheath was processed by using tube and cylinder of medical flexible rubber that was non -toxic, harmless, tasteless and transparent, which size was coincide with the shank of endoscopic fore-end. The openings of fore-end and back-end were designed by immerse extra-strong circle. Every sheath was molded into barrel roll based on the midline axis of twist and bagging standby after disinfection and sterilization. Results The instruction of sheath was streamlined that could be unwound smoothly from back-end and accreted tightly to endoscopic mirror. Conclusion The sheath can be reduced effectively the risk of cross-infection in endoscope examination.

患者,男,61岁,农民.因咽痛伴吞咽困难及双侧颌下肿痛3个月余,于2008年6月10日来我院就诊.

1 病例资料 女,71岁.因左中腹肿块伴不适20余天入院.20余天前患者无意中发现左中腹一鸡蛋大小肿块,按压时疼痛明显,病程中无发热、盗汗、恶心、呕吐、心悸及泌尿系刺激症状,饮食、睡眠、尿便及日常生活未受明显影响.

我们根据需要研制成功了医院病理科经常使用的简易可控恒温电烤箱,用于融熔组织切片上的石蜡、快速染色、加温阿拉伯树胶等.该器材依常规电学原理、产热散平衡原理设计制成.经实际检验,性能稳定,使用方便.