目的 调查新疆山地林区人群森林脑炎感染情况,为当地森林脑炎防控提供科学依据.方法 选择新疆北部山地林区5个不同的调查地区,采集林区人群血清,应用间接免疫荧光试验(IFA)方法,检测血清森林脑炎病毒IgG抗体.结果 共检测血清431份,阳性70份,阳性率16.24％;调查的5个地区中,阿拉套山南坡和天山北坡西段阳性率较高,分别为29.17％ (21/72)和28.77％ (21/73);其次为天山北坡中段,阳性率为14.86％ (22/148);阿尔泰山南坡北段较低,阳性率为5.26％(6/114);阿尔泰山南坡中段未检出阳性血清.结论 森林脑炎感染人群为边防军人和当地的农牧民,其中20 ～39岁的青壮年男性感染风险最高.

Objective To review the characteristics of coronary artery lesion and atherosclerotic plaque by applying coronary computed tomography angiography (CCTA) in elderly patients with chest pain and with or without diabetes mellitus (DM).Methods The patients with chest pain (n=488, aged over 60) undergone 64-row CCTA scanner were chosen from Jan. 2012 to Dec. 2014, including 221 with DM (DM group) and 267 without DM (non-DM group). The distribution and type characteristics of coronary plaque were compared in 2 groups. The survival rate and prognosis of acute coronary syndrome events were observed after followed up for 1 y.Results The incidences of multi-vessel lesion (75.1%) and diffuse lesion (43.9%) of coronary artery were significantly higher in DM group than those in non-DM group (37.8%, 16.1%), and incidence of mixed plaque was higher in DM group than that in non-DM group (82.4%vs. 39.7%). The occurring rate of coronary stenosis (over 50% and over 75%) was higher in DM group (61.5%, 31.2%) than that in non-DM group (36.0%, 19.9%). Kaplan-Meier survival curve showed that the survival rate of acute coronary syndrome events in patients with coronary stenosis over 50% was significantly lower in DM group than that in non-DM group (P<0.05) after followed up for 1 y.Conclusion CCTA can accurately reflect the difference in atherosclerotic plaques between patients with or without DM, which is helpful to review early risk of cardiovascular events.

目的 应用冠状动脉计算机断层血管摄影术(CCTA),探讨老年糖尿病患者血清胱抑素C与冠状动脉病变特点的相关性及与预后的关系.方法 回顾性分析新疆塔城地区2007年1月～ 2014年1月因疑似冠心病而接受CCTA检查,并抽血检测胱抑素C的老年2型糖尿病患者.结果 共入选568例患者,其中胱抑素C水平正常组216例,胱抑素C水平升高组352例.冠状动脉多支病变组胱抑素C增高的患者明显增多,差异具有统计学意义(P＜0.05);中-重度冠状动脉狭窄组血浆胱抑素C增高的患者明显增多,差异具有统计学意义(P＜ 0.05).Kaplan-Meier生存曲线显示,在冠状动脉狭窄＞50％的患者中随访1年,胱抑素C水平升高组无急性冠状动脉综合征事件,生存率明显低于胱抑素C水平正常组患者,差异有统计学意义(P＜0.05).结论 血清胱抑素C与老年糖尿病患者冠状动脉病变严重程度密切相关,并有利于进行早期危险评估.

Objective: In recent years, more and more medical disputes have happened to military hospital. Thus, we are writing to analyze the current situations on the management of medical risk in military hospital and prospect the countermeasures for hospital management by means of summing up the existing problems in order to enhance the preventive consciousness of clinical staff. Methods: A questionnaire was performed on the clinical staff who were working in the first-line of ten military hospitals to investigate and analyze the present situations about the management of medical risk. Results: The incidence of military risk was higher for those who were working less than five years when comparing with the experienced ones. The higher incidence of medical risk was found in the department of general surgery or the department of obstetrics and gynecology. The management system of medical risk was more improved in the first-class hospitals with level A than that of the hospitals with level B. The logistic regression analysis has showed that there was close relationships of the medical risks and several factors such as the hospital management system, the experience of working, the setting of departments, the risk education and the workload, etc. Conclusions: It is suggested that the military hospital should establish and improve a modified system of warning and evaluation for the medical risk. As the clinical staff, we should strengthen the consciousness of medical risk and the relative legality, turn over the standard ideas to communicate with patients, promote the harmonious relationship between doctors and patients so that the medical disputes would be decreased or avoided.

Objective: To analyze the clinical application of Lamaze childbirth method on early maternity process.Methods: 245 cases of primipara were divided into two groups,120 cases of parturition with conventional method of Midwifery(namely,control group),the other 125 cases were adopted the Lamaze childbirth method in the whole process of childbirth(namely,observation group).Then compared the labor time,pain degree,2h postpartum hemorrhage volume and complications of pregnant women between two groups.Results: The painess was lighter of observation group than that of control group,and 88 cases with mild painess(70.4%),it was better than the control group with 26 cases(21.7%).The total labor time of observation group was less than 513.23 minutes,2 h postpartum hemorrhage was 198.2 mL,postpartum complications were two cases(1.6%),the data was better than that of the control group.There was significantly statistical difference,P<0.05.Conclusion: It is suggested that the effect of Lamaze childbirth process for early maternity should be acquired by midwives and other clinical clients and be promoted on pregnancy.

Objective: To analyze the clinical effects of laparoscopic surgery technique on the treatment of gynecological diseases.Methods: 450 patients with all kinds of gynecological disease were treated by laparoscopic surgery,while another 284 cases were treated with open surgery.Then we compared the clinical curative effects between two groups,including the operation time,intraoperative blood loss,postoperative aerofluxus time,complications,the time of hospitalization and patients' satisfaction of operation.Results: The time of operation(73.4±54.3 min) and blood loss(107.4 ± 97.9 ml) of laparoscopy group were significantly less than that of open surgery group(121.8 ± 65.7 min and 65.7 ± 217.0 ml);the postoperative aerofluxus time(12.2±8.6 h) and the time of hospitalization after surgery(5.4 ±2.3 d) were shorter than that of open surgery group(16.8±12.1 h,12.1±4.8 d);the incidence of various complications(2.22%) of laparoscopic group was obviously lower than that of open surgery group(8.80%);and the satisfaction of patients of laparoscopic group(94.67%) was obviously better than that of open surgery group(82.39%).Conclusion: With the methods of laparoscopic surgery applied to gynecological diseases,we could take the advantages of it on the clinical surgery,such as shorter operation time,less blood loss,few days of postoperative hospitalization,slight complications,and better satisfaction from patients.

The main problems were analyzed existing in the medical support in the normalized maintaining stability actions,and then the measures were pointed out as following: Improve the level of situation education,develop the treatment system and anti-terrorism equipment,and enhance field training and disease prevention and psychological intervention.With these efforts,can we r improve the ability of medical support further.

目的探讨中国驻刚果（金）维和二级医院医务人员在执行国际维和卫勤保障任务中积极预防职业艾滋病的做法,为后续维和医务人员预防职业艾滋病提供参考。方法通过对维和队员们出国前进行艾滋病知识系统学习,并在实际工作中遵守职业安全防护规定和预防交叉感染规定,采取严格的防护措施。结果总结出预防职业艾滋病的4点基本做法:（1）全方位开展预防AIDS健康教育和宣传,提高维和队员防病知识;（2）建立科学实用的消毒隔离制度,严格落实各项消毒措施;（3）实际工作中落实预防措施,防止HIV职业感染;（4）尊重病人,避免过度的自我防护。结论集训期间着力提高AIDS的整体知晓水平,培养职业防护意识,工作中采取积极正确的防护措施,是预防职业性艾滋病感染的关键因素。

Objective:To study the protective effects of fentanyl delayed pretreatment on myocardial injury in patients undergoing heart valve replacement surgery.Methods:Sixty patients diagnosed with acquired heart valve diseases were randomly allocated to the fentanyl delayed pretreatment group(fentanyl group) or control group (n=30 each group).The detailed experimental protocols are as following:The pretreatment given fentanyl(0.3μg/kg·h continual intravenous injection by infusion pump) individualizedly based on patients sex,age,weight and felt before the heart valve replacement surgery.Anesthesia,cardiopulmonary bypass and surgery were performed as well between two groups.Results:The level of serum cTnI in fentanyl group was significant lower than that in control group,at the time points of 6h,12h and 24h after reperfusion,levels of serum cTnI were significantly decreased in the fentanyl group(P0.05 all).Length of ICU stay of fentanyl group was shorter than that of control group(P0.05).The cardiotonic agent scores of fentanyl group were lower than those in control group at 12h,24h and 48h after ICU arrival (P0.05 all).Conclusion:This study results showed that pretreatment fentanyl inhibited the elevation of troponin-I,reduced the cardiotonic agent use,and shortened the ICU stay time in the postoperative period of heart valve replacement surgery,suggesting a potential myocardial protective effect of pretreatment with fentanyl or opioid-peptide.

经鼻肓探气管插管是在保持患者自主呼吸的情况下,边倾听气管导管衔接管口气流声强弱边进行探插,不利于麻醉医师操作和判断气管导管的位置.我们从2009年1月至今采用小儿口哨连接气管导管后端,利用气流的强弱带动口哨声的有无、强弱,判断气管导管的前端是否对准声门及是否将气管导管插入气管内,取得了很好的效果.

患者,女,54岁,58 kg,双侧甲状腺Ⅲ度肿大,体温36.3℃、HR 72次/分、RR 13次/分、BP 140/70 mm Hg、ECG正常.在气管插管全身麻醉下行甲状腺双叶全切除术.术前30 min肌注东莨菪碱0.3 mg、地西泮10 mg.

医疗机构既是患者的诊治场所,又是传染性病原体流行传播的特殊场所,医院感染(以下简称院感)在严重威胁患者和医务人员健康安全的同时,也增加了患者和社会的经济负担,因此,院感控制已成为医疗机构日益关注的焦点.而有效的院感监测是预防、控制院感的主要措施之一 [1],真实、可靠、准确、实用的院感监测结果,对院感控制指导意义重大.笔者调研多家边疆医院,发现部分共性问题,并针对性提出浅见.

边疆地区军队医院为适应国家医疗改革,提高岗位练兵质量,促进医院发展,收治农牧区患者比例较大.如何顺应国家新型农牧区合作医疗(以下简称"新农合")政策,迎接医疗改革带来的机遇和挑战,克服困难,应对不利因素,是目前医院面临的新课题.

<正>有效的医患沟通能使患者产生良好的心理效应,缩短医患距离,确保医疗计划落实和诊疗方案实施[1]。特别是在国外执行维和任务,有效的医患沟通对特殊环境下的伤病员更是一种心灵抚慰。2007年6月～2008年3月,中国第七批维

2000年1月-2008年11月,我们在颅骨修补术中采用区域阻滞麻醉32例,效果满意.

2000年开始,我们采用区域神经阻滞麻醉行颅骨修补手术,取得良好的麻醉效果,现报道如下.

目的 观察高压氧舱内与一般环境中针刺治疗对中风偏瘫早期患者疗效差异.方法 70例患者随机分为治疗组和对照组.治疗1月后以简式Fugl-Meyer运动量表和修订的Barthel指数进行疗效评定.结果 治疗组患肢肢体运动功能及日常生活能力良好率明显高于对照组(P＜0.01,P＜0.05).结论 与一般环境中相比,高压氧舱内行针刺治疗更有利于中风患者运动功能和日常生活能力恢复.

Objective:To investigate the X-ray appearance of lungs in the patients with malaria to improve the knowledge of malaria.Methods: Twenty-seven malaria patients with fever,cough and expectoration were retrospectively studied.The malaria parasites in peripheral blood smear were all found in the 27 patients.The chest X-ray films were analyzed.Results: The lung marking became fuzzy in 14 cases,scattered spot and plaque-like shadows were found along lung marking in 8 cases,segmental consolidation in 3 cases and lobar consolidation in 2 cases.After 5 to 10 days of anti-malaria treatment,most focuses of infection in lungs were Absorbed.Conclusion: The changes of X-ray appearance of lung varied with the severity of malaria.In most cases,they were bronchitis or interstitial changes.The lobular,segmental or lobar pneumonia was found in the severe malaria patients.The lung lesions were Absorbed quickly after anti-malaria treatment.

目的:观察高压氧舱内针刺治疗对早期脑卒中偏瘫的疗效.方法:选择2004年1月～2008年12月确诊的早期脑卒中偏瘫110例,随机分为治疗组、对照一组和对照二组.治疗组35例,给予高压氧舱内针刺治疗;对照一组35例,在一般环境中针刺;对照二组40例,单纯行高压氧治疗.3组治疗周期均为1个月,疗程结束时以简式Fugl-Meyer运动量表和修订的Barthel指数评定疗效.结果:治疗组肢体运动功能及日常生活能力良好率明显高于对照组(P＜0.01,P＜0.05).结论:与一般环境中针刺治疗和高压氧治疗相比,高压氧舱内针刺治疗更有利于脑卒中早期偏瘫患者运动功能和日常生活能力的恢复.