和平时期,心脏锐器伤发生较少,但临床情况危急,大多死于现场或伤后短时间内,存活病例中心包内主肺动脉穿透伤鲜有报道.笔者报道1例心脏大血管穿透伤患者,经急诊抢救恢复良好出院. 临床资料 1 一般资料 患者男性,37岁.因饮酒时与人发生斗殴被改锥刺伤左侧胸部20min入我院急诊科.伤后即出现意识淡漠、呼吸困难,来院时脉搏150 次/min,呼吸32 次/min,血压50/30mmHg,意识淡漠、躁动,呼气有酒味,双侧瞳孔6mm,直接、间接对光反射迟钝,左侧胸壁第1 肋间锁中线处见一伤口,长约8mm,伤口无明显出血.急诊科给予液体复苏、抗休克治疗的同时行头颅 CT、胸部 CT、腹部彩超等检查,3h后,患者休克仍未见明显改善,意识淡漠,脉搏>140次/min,呼吸30次/min左右,血压60/40mmHg,无尿.神经科会诊后除外神经系统损伤;胸外科会诊见患者面色苍白,肢体湿冷,低血压、颈静脉怒张、心音遥远"Beck三联征"( Beck ' s tri-ad) ,诊断为心脏大血管穿透伤,急性心脏压塞,创伤失血性休克,左侧开放性血气胸(积气极少).伤后3h15min行心包穿刺置管引流,伤后4h入麻醉科行剖胸手术.

Objective To study the change trend of main clonal strains of acinetobacter baumannii isolates in order to discover the molecular epidemiology characteristics. Methods Seventy-four different acinetobacter Baumannii strains isolated in clinical department during June 2010 and December 2012 were selected,and main clonal lineages were detected with multiplex polymerase chain reaction( PCR) based on sequence groups; strains of genome DNA were analyzed with endonuclease and pulsed field gradient gel electrophoresis( PFGE) based on restrictive endonucleases ApaI, and cluster analysis was carried out by BioNumerics software; 10 resistance genes of blaOXA-51-like,blaOXA-23-like, blaOXA-24-like,blaOXA-58-like,blaTEM,blaampC,armA,ISAba1,intI 1 and intI 2 isolates were detected with PCR and sequencing method. Results The main clonal lineages was sequence group 1( 77. 0%); band forms of PFGE were diversified,and were roughly classified into 13 genotypes,in which type A( n = 35) was the main group; the positive rates of resistance genes of blaOXA-51-like,blaOXA-23-like,blaTEM,blaampC,armA,ISAba1 and intI 1 were 100. 0%,54. 1%,86. 5%,66. 2%,89. 2%,90. 5% and 85. 1% respectively,but blaOXA-24-like,blaOXA-58-like and intI 2 were not detected. Conclusion The main prevalent clonal lineages exist in isolated Acinetobacter baumannii in the hospital,which may have high homology with European clonal lineage Ⅱ; detection rate of related genes of multidrug resistant is high; the same resistant gene exists within genotypically unrelated strains,therefore it is proven that antibiotic resistance genes are readily exchanged between cocirculating strains in genotypically distinguishable strains.

Objective To investigate the effect of ligustrazine on the transdifferentiation of primary culture human embryo renal proximal epithelial cells induced by TGF-β1.Methods The cortical tissue was digested with collagenase,and removed contaminating glomeruli and larger fragments by filtration,then further purified by isopycnic centrifugation using Percoll.The cultured cells were divided into five groups after subculture till passages: normal control group,10 ng/mL TGF-β1 group,5 ng/mL ligustrazine +10 ng/mL TGF-β1 group,10 ng/mL ligustrazine +10 ng/mL TGF-β1 group and 20 ng/mL ligustrazine +10 ng/mL TGF-β1 group.After stimulating for 48 h,the changes of the cells were observed by microscope and transmission electron microscope,and the transdifferentiation of the cells were detected by the histochemistry enzyme staining and immunocytochemistry.Results After the stimulation with transforming growth factor-β1,the cultured human embryo renal proximal tubular cells induced profound morphological changes,with cells developing marked hypertrophy,becoming elongated,and losing the cobblestone growth pattern,disassociated with neighboring cells.Electron microscopy showed that the transformed cells completely lost epithelial polarity and microvilli on the cell surface,histochemical enzyme staining negative and express of little cytokeratin-18,more vimentin and α-smooth muscle actin.These change were decreased by ligustrazine in a dose-dependent fashion.Conclusion Ligustrazine can partially prevent TGF-β1 inducing transdifferentiation of human embryo renal proximal tubular cells in a dose-dependent fashion.

花粉症是对花粉过敏,由IgE介导的Ⅰ型变态反应性疾病.临床表现分速发相:鼻痒、阵发性喷嚏、清涕及迟发相:鼻塞、哮喘同时合并中枢症状:嗜睡、疲倦、关节痛等.症状重者,可影响日常生活及军事训练,战时甚至影响作战.常见变应原依次为晚春花粉、蒿属花粉、早春花粉、夏秋花粉[1,2].军人因职业特殊,接触变应原的机会增多,如野外训练、山地训练、蹲山洞等,其患花粉症的机会较多,因此对军人花粉症进行合理治疗是很重要的[3].现将军人花粉症的治疗阐述如下.

Objective:To study the nursing on severe limb electrical injury plus abdominal electrical injury.Methods:To summarize the nursing experience of this kind patient.Results:After a full range of care to save the patients' lives with no care complications occurred.Conclusion:We have developed the appropriate care measures to the severe limb electrical injury patients:close observe the pateints' limb edema,abdominal exudate,renal function situation,give intensive care,rehydration care,life care,psychological care,fistula care.

Medical disputes have become hot topic of people,the focus of news media and the difficulties of medical institutions and health authorities.The hospital should build unified emergency prevention and control and monitoring and early warning systems,and set up specialized public relations crisis management team to rapid develop science contingency plans so that resolve the crisis in the bud.

Objective:To observe the more effective methods that can improve the success rate of vein puncture in elderly patients to relieve patients pain. Methods:To select 170 elderly patients which divided into observation group and control group by odd and even numbers of the last hosptial number, each group had 85 cases. In the observation group, wet applied with anisodamine before vein puncture, external apply potato slice after vein puncture. In the control group treated by conventional infusion therapy. Observing the puncture site pain intensity, phlebitis incidence, puncture success rate of two groups. Result:①After one week infusion there was no significant difference (P>0.05) of puncture site pain intensity and phlebitis incidence in two groups, while infusion two weeks, three weeks and four weeks later there was statistically significant difference (P<0.05). ②Venous puncture success rate of two groups were statistically significant difference (P<0.05) after infusion one week, two weeks, three weeks, four weeks. Conclusion:Before and after venipuncture applied with anisodamine plus potato slice had a better effect than conventional infusion therapy, can be widely used in elderly patients venous puncture.

剖宫产术是产科终止分娩的方法之一.手术是一种严重的心理应澈,患者可能对手术产生恐惧、焦虑抑郁等不良情绪,这些不良情绪可能会影响到手术效果.近年来,个性化护理干预在临床得到了广泛的应用,并取得了一定的疗效[1].为此,我院对剖宫产患者实施个性化围手术期护理干预,观察期护理效果,现报道如下.

By controlling the defect in clinical nursing,improving nursing quality.Methods:Analysis of the possible reasons for nursing defects in all aspects of nursing activities.Proposing appropriate management strategies on the reasons for nursing defects,thereby reducing the occurrence of errors,providing security for patients of high-quality care services orderly.Conclusion:Nursing care workers must rerecognize the complex factors that exist in nursing work,improve the services further,improve the nursing workflow and rules and regulations to avoid or reduce the incidence of nursing defects.

Choosing 498 cases of nurses in two hospitals,investigating their knowledge of dealing with pain and the application situation.To make them update new knowledge and skills,so that they could service the patients better.

In order to comply with the requirements of nurses reform,improved the quality of operating room new nurses,operated room work efficiency,improved satisfaction of doctors and patients.Operating room matron organized nurses learning before working,then fully understanded the purpose and necessity of standardized training.

Objective: To enhance the quality of care in operating room by PDCA circulation method. Methods: The PDCA cycle method quality control procedures used in the operating room before surgery, postoperative care phase to the feedback and evaluation stage. Result: Clinical practice through the PDCA cycle method has received good effects. Conclusion: PDCA cycle method used in perioperative nursing quality management, the quality control from a simple post into before, during and after the evaluation of the system management process, so that the quality of care continued to improve.

Improving the nursing quality of the operating room,emphasizing on lanning,implementation,inspection,handling four critical areas.

To investigate the problems and reasons in the operating room from the preoperative,intraoperative and postoperative. According to the problems propose solutions to improve quality of care in the operating room,reducing the pain of patient.

Objective:To understand the risk factors that lead to geriatric depression properly,reduce the incidence of geriatric depression.Method:Taking multivariate analysis to 124 cases of patients with depression treating in PLA 253 hospital during 2002～2010.Result:Social psychological factors and degenerative changes of brain tissue were the risk factors that lead to geriatric depression.Conc-lusion:It is the effective measures of early detecting,early treating geriatric depression that old people checking head CT,and central neu-rotransmitter and neuroendocrine periodically.

在医院中,手术是外科治疗和抢救患者的重要手段,手术医护人员在手术中直接接触患者血液、体液等污染的机会相对较多.随着经血液传染疾病的增多,手术医护人员在工作过程中意外被针刺伤、锐气割伤,而可能发生感染血液传染性疾病的危险性增大[1].因此,做好手术医护人员职业损伤的预防和处理工作,能更好地加强手术医护人员的自身防护,这也是医院感染管理的监控内容之一.为此我们对我院外科手术医生和手术室护理人员发生职业损伤情况进行调查,现报道如下.

对8例术后不能排尿患者采用开塞露纳肛,其能有效减少尿潴留的发生.

Through dealing with the conflict from everywhere in clinical nurses to create a harmonious relation atmosphere and improve the group cohesion.

The using of sealing tube and folding tube methods in intravenous catheter,its effects were good,it improved the using effect of intravenous catheter.

Objective: In order to relieve pain in patients with functional dyspepsia, on the causes of the disease-related factors were analyzed and develop nursing. Methods: According to clinical data, diagnosis is based and efficacy standards, analyzing of the related factors of July 2008～July 2010 to our hospital treating 76 cases of functional dyspepsia, and development of nursing. Result: There is not treatment program of functional dyspepsia in the organ of the conditioning and psychological adjustment measures conditioning development of nursing. Conclusion: Nursing care is simple, quick, good effect, reducing the burden on patients.