目的 了解带状疱疹后相关性疼痛(ZAP)的现况并探讨其相关因素,为制定针对性的干预措施提供依据.方法 采用自行设计的一般资料调查问卷和汉化版的PD-Q量表对荆州市某三级甲等综合医院皮肤科住院的85例带状疱疹患者进行调查.结果 本研究共纳入85例患者,有效完成问卷为83例,PD-Q量表得分为(10.71±2.53)分,单因素线性回归结果显示该得分与性别、年龄、职业、合并症和病程相关,多因素线性回归结果显示该得分与性别、职业、病程有关.结论 医护人员应该关注带状疱疹相关性疼痛,根据其影响因素寻找相关的护理措施和临床干预策略,以减轻患者疼痛.

目的 研究肾内科患者围透析期护理对凝血相关不良事件的预防作用.方法 选择2014年10月至2015年10月我院肾内科70例透析治疗患者作为研究对象,采用随机法分为两组,每组35例.观察组行围透析期护理,对照组行常规护理.观察两组患者凝血功能变化情况及凝血不良事件发生率.结果 观察组护理后凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)及纤维蛋白原(Fbg)分别为(9.85 ±0.87)s、(22.78±2.72)s、(10.19±1.43)s及(3.23±0.52)g/L,与护理前比较,差异无统计学意义(P＞0.05).观察组护理后心率(HR)、呼吸(R)、收缩压(SBP)及舒张压(DBP)分别为(81.38 ±7.79)次/min、(19.18±2.87)次/min、(128.40±10.24) mmHg及(80.52 ±8.14)mmHg,均显著低于对照组护理后,差异有统计学意义(P＜0.05).观察组不良事件发生率为2.86％,显著低于对照组的22.86％,差异有统计学意义(P＜0.05).结论 肾内科患者围透析期护理有助于维持患者生命体征和凝血功能的稳定,减少凝血相关不良事件发生率.

Objective To explore effects of predictive nursing intervention on hemoperfusion coagulation events in patients with maintenance hemodialysis.Methods 78 patients who received hemodialysis tadem hemoperfusion therapy in our hospital from September 2014 to June 2015 were selected as the study subjects,they were divided by random number table into the observation group and the control group (each 39 cases).The control group was given routine nursing,the observation group was given predictive nursing intervention,principal means were maintaining proper blood flow velocity,retaining a sufficient heparin dose,increasing operational proficiency.Prothrombin time (PT),partial prothrombin time (aPTT),thrombin time (TT),plasma D-dimer,fibrinogen (Fbg)and tissue plasminogen activator(t-PA) content in the two groups were measured before and after the dialysis,coagulation events in the two groups,division of coagulation status during the treatment were recorded,incidence of severe coagulation events were calculated.Results Compared with pre-dialysis,PT,aPTT and TT after the dialysis in the two groups were significantly decreased (P ＜ 0.05),but after the dialysis,indexes of the observation group were significantly higher than the control group (P ＜ 0.05);after the dialysis,content of D-dimer in the two groups were significantly increased,but the observation group ascending range was significantly lower than the control group (P ＜ 0.05),compared with pre-dialysis,after the dialysis,Fbg and t-PA in the two groups were significantly decreased,but content of the observation group were significantly higher than the control group (P ＜ 0.05);incidence of severe coagulation in the observation group was 2.56％,which was significantly lower than the control group (15.38％) (P ＜ 0.05).Conclusion Predictive nursing intervention for patients treated with maintenance hemodialysis tadem hemoperfusion therapy can improve abnormal conditions of coagulation function effectively,and reduce incidence of severe coagulation events.

目的：设计一种医学检验样本贮存柜在临床样本采集中的应用价值。方法选择我院体检中心健康志愿者捐献的凝血功能样本30份及本院肾内科红细胞、白细胞、管型及亚硝酸盐阳性尿沉渣样本30份。每份样本采集后均分为3份，分别归为即时组、室温2h组和贮存柜2h组。凝血功能样本评估指标为血浆凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间和血浆凝血酶时间，尿沉渣样本评估指标为红细胞、白细胞、管型和细菌，以即时组检测结果为基准对医学检验样本贮存柜的应用价值进行评价。结果与即时组相比，室温2 h组凝血功能血浆凝血酶时间结果显著上升（P<0.05），室温2 h组尿沉渣细菌计数显著升高（P<0.01），而血液和尿液贮存柜2 h组所有评估指标与及时组比较差异均无统计学意义（P>0.05）。结论该新型医学检验样本贮存柜可以很好的保存采集的血液和尿液样本，具有较好的临床应用价值。

目的 探讨血液透析永久性血管通道、临时通道护理对血栓发生风险的影响.方法 选取2014年4月至2015年2月在我院接受血液透析的患者84例为研究对象,采用随机数表法分为观察组和对照组各42例,观察组采取永久性血管通道护理,对照组采取临时通道护理,比较两组血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-a(TNF-a)水平,同时分析其凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)变化,应用生活质量评价量表(SF-36)、护理满意度评分表比较其预后情况与护理满意度,并记录血栓、感染等并发症发生率.结果 透析后观察组CRP、IL-6、TNF-a较对照组明显下降(P＜0.05);观察组PT、aPTT较对照组明显延长(P＜0.05),观察组Fbg低于对照组(P＜0.05);观察组SF-36评分、满意度评分高于对照组(P＜0.05);并发症发生率观察组4.8％ vs对照组19.0％ (P ＜0.05),血栓形成率观察组2.4％ vs对照组16.7％ (P ＜0.05).结论 血液透析永久性血管通道可降低血栓发生风险,明显降低炎症因子水平,改善生活质量.

Objective:To explore the value of combined detection of serum human epididymis protein 4 (HE4) and CA125 in the diagnosis of early ovarian carcinoma .Method:HE4 and CA125 were determined by Roche electri‐cal chemiluminescence immunoassay in 32 ovarian cancer patients ,79 pelvic benign tumors patients and 30 health controls .Results:The serum levels of HE4 and CA125 in ovarian cancer group were statistically significantly higher than those in benign pelvic masses group and healthy women (P< 0 .01) .The area under ROC curve of HE4 and CA125 to distinguish between malignant versus benign ovarian masses were 0 .935 and 0 .896 ,there was no statisti‐cally significant difference(P>0 .05) .The specificity of HE4 ,CA125 ,combined HE4 and CA125 were 84 .38% , 87 .50% and 81 .25% ,respectively .The sensitivity of HE4 and combined HE4 and CA125 were 96 .20% and 98 . 73% ,compared with single detection of CA125 ,there was a statistically significant rise(P< 0 .05) .Conclusion:HE4 is a useful marker for ovarian carcinoma with higher specificity ,combined detection of HE4 and CA125 can in‐crease the accuracy .

目的：根据CNAS-CL39的要求，探讨定性试验的性能验证方法。方法以 ELISA 法检测 HBsAg 为例，以厂家给定的性能指标为验证依据，根据空白检出限及样本检出限的验证方法对检出限进行验证，按照EP15-A2标准验证该方法的精密度，采用验证方法与公认方法比较的2×2列联表验证该方法的符合率，采用收集的 HBsAg阴性患者血清对cut off值进行验证。结果检出限、精密度（重复性和中间精密度）、符合率、诊断临界值的验证结果均符合要求。结论本研究按照 ISO15189和CNAS-CL39文件要求进行的免疫学定性试验性能验证方案是科学而适用的。

Objective:To evaluate the diagnostic value of N-terminal pro-brain type natriuretic peptide(NT-proBNP)for a-cute heart failure(HF)in elderly patients with renal insufficiency.Method:356 elderly patients with acute dyspnea and renal insufficiency were selected,including 151 patients with acute HF.Serum concentrations were measured for all patients.Estimated glomerular filtration rate(eGFR)values were calculated using the revised modification of diet in renal disease formula(MDRD).Patients were divided into three groups based on their eGFR:mild renal in-sufficiency group (n=104,eGFR≥60ml/min/1.73m2 ),moderate renal insufficiency group(n=159,eGFR30-59ml/min/1.73m2 )and severe renal insufficiency group(n=93,eGFR<30 ml/min/1.73m2 ).Serum NT-proBNP was measured for each group.Levels of NT-proBNP were compared between patients with acute HF and patients without acute HF in each group.The relationship between NT-proBNP and acute HF was analyzed.The diagnostic value of NT-proBNP was evaluated for acute HF in elderly patients with renal insufficiency.Results:Log(NT-proB-NP)in patients with acute HF was significantly higher than those without in different renal insufficiency groups(t=9.86,9.82,6.03,respectively,P<0.01).Increased NT-proBNP was independent predictor of acute HF in elderly patients with renal insufficiency(OR=18.54,P<0.01).From mild renal insufficiency group to severe renal insuffi-ciency group,AUC of NT-proBNP for acute HF were 0.915,0.874 and 0.787,optimal cut-points were 800,950 and 3000pg/ml,which yielded 84%,74% and 44% diagnostic specificity for acute HF,respectively.The AUC and diagnostic specificity of NT-proBNP for acute HF in mild or moderate renal insufficiency group were higher than in all patients′AUC(0.835)and diagnostic specificity(68%),and cut-points were lower than An cut-point of 970pg/ml identify acute HF for all patients.Conclusion:NT-proBNP is useful for diagnosis of acute heart failure in elderly pa-tients with renal insufficiency.eGFR grouping can improve diagnosis effectiveness of NT-proBNP in acute HF in pa-tients with mild and moderate renal insufficiency.

目的：探讨肾功能不全对应用氨基末端B型利钠肽前体（NT-ProBNP）诊断心力衰竭的影响。方法将240例心力衰竭患者作为心力衰竭组，按肾小球滤过率（GFR）将其分为肾功能正常组（GFR ：≥90 mL/min）和肾功能不全组（GFR ：＜90 mL/min）。根据GFR的降低程度将肾功能不全组再分为轻度组（GFR ：60～＜90 mL/min）、中度组（GFR ：30～＜60 mL/min）及重度组（GFR ：＜30 mL/min）。采集空腹静脉未抗凝血，分离血清。采用Roche Cobas E601型全自动电化学发光免疫分析仪检测血清NT-proBNP水平，Beckman Coulter LX20全自动生化分析仪检测血清肌酐、血糖和血脂水平；超声心动图仪检查测定心脏射血分数（EF）。结果肾功能不全组的血清NT-proBNP水平显著高于肾功能正常组（P＜0．01），组间年龄、身体质量指数（BMI）、EF、血糖、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇及三酰甘油水平的差异无统计学意义（P＞0．05）。轻度肾功能不全与肾功能正常组、中度肾功能不全组与重度肾功能不全组患者血清NT-proBNP水平的差异无统计学意义（P＞0．05），但轻度肾功能不全组和肾功能正常组患者血清NT-proBNP水平均显著低于中度和重度肾功能不全组（P＜0．01）；不同肾功能组患者EF值的差异无统计学意义（P＞0．05）。肾功能正常组和轻度肾功能不全组患者的EF值和LogNT-proBNP呈负相关（r值分别为-0．66、-0．54，P＜0．01）；中度和重度肾功能不全组的 EF值与 LogNT-proBNP无相关性（r值分别为-0．17、-0．36，P＞0．05）。结论应用血清NT-proBNP水平诊断心力衰竭必须考虑肾功能的影响，当患者肾功能处于中、重度损伤时，会严重影响NT-proBNP对心力衰竭诊断的准确性。

目的总结、分析应用全自动酶免疫分析系统检测乙型肝炎病毒血清标志物(HBVM)时出现需复检结果的常见原因和找出相应的处理及预防对策。方法收集349份需复检的临床标本。将初检HBsAg吸光度值/临界值(S/CO)0.8～1.2的"灰区"结果和S/CO1.2～2.0的弱反应性结果统一定义为"可疑"(以"±"表示),S/CO>2.0者直接判断为有反应性,即阳性:(1)对于HBsAg"可疑"标本用ELISA法对HBVM进行复检,同时用电化学发光免疫分析(ECLIA)法对HBsAg进行定量复检;(2)对于初检HBVM模式为少见模式者仅用ELISA法对HBVM进行复检。所有标本复检前均对其中有、无红细胞或纤维蛋白进行检查并重新3500r/min(离心半径13.5cm)离心5min,同时对该份标本所对应的前一份标本的性状及其结果进行分析,以明确是否有携带污染的可能。结果 HBsAg"可疑"标本ECLIA法复检阳性率(56.6%)显著高于ELISA法复检阳性率(40.3%),少见模式标本ELISA法复检与初检结果符合率为38.4%,由于初检时标本的前处理不合格直接引起的复检与初检结果不符者占所有不符标本的53.0%。结论对于ELISA法测定的HBsAg"可疑"结果,ECLIA法不失为一种方便、准确的复检方法。对于使用全自动酶免疫分析系统检测HBVM的实验室,标本的前处理是影响结果准确性的关键因素,应建立规范的标本前处理程序。

流行病学调查显示男性冠心病(coronary heart disease,CHD)发病率和死亡率均显著高于女性,因此传统观点认为雄性激素是冠心病发病的危险因素之一.但是近年来大量的研究发现,雄激素水平与男性冠心病的发病率呈负相关,生理水平的雄激素有抗动脉粥样硬化(atherosclerosis,AS)作用.本文就雄激素与男性冠心病的关系及其作用机制研究现状作一综述.

目的:对肝素锂抗凝血血浆测定HBsAg的适用性及血细胞对HBsAg测定的影响进行分析探讨。方法:随机收集申请乙型肝炎三系检查的94例门诊病人血清和肝素锂抗凝血血浆,并制备不同浓度的实验用RBC悬液和溶血样本,应用全自动酶标仪测定所有样本的HBsAg吸光度(A)值。结果:血清和血浆测定HBsAg的吸光度值差异无显著性(P>0.05);RBC对HBsAg的测定有较大影响,吸光度值明显高于阴性对照组(P<0.01),而溶血对HBsAg的测定没有明显影响(P>0.05)。结论:用肝素锂抗凝血浆测定HBsAg可以简化流程,减少干扰因素,具有较好的准确性。