环境因素影响着部队的日常训练和军事行动,高温环境军事作业容易导致热损伤.高热环境对医护人员的工作、伤病员救治、药品储运和仪器性能、伤病员心理方面都有较明显的影响.根据驻地环境,同抓教育训练、筹备研究结合、精细规范环境、完善现有预案.降低高热环境对军事训练和卫勤保障的不良影响,切实服务热区部队,提高战斗力,对部队卫勤保障来说也是非常重要的工作.

队属医院突发公共卫生事件应急处置能力建设,关乎医院保障驻地及一线部队的平战时卫勤保障能力.从近年来武警部队处置腺病毒、流行性出血热、诺如病毒等重大突发公共卫生事件应急处置来看,还存在各级领导重视不够,落实组织领导机构定期会商、风险研判、检查督导等机制不够经常,没有真正形成防控合力.加之监测预警不够主动,对大型集训演训、季节气温变换、驻地发生疫情等风险警示不够及时.队属医院应针对突发公共卫生事件的特点规律,总结经验教训,不断调整完善现有卫勤保障对策,积极推进应急制度和机制创新,加强军地合作,及时高效应对重大突发公共事件.

水痘是由水痘-带状疱疹病毒(VZV)原发感染引起急性呼吸道传染病,潜伏期一般为12 ~21 d,平均14 d,是集体单位常见的传染病之一[1] .近年来,武警部队十分重视传染病防疫工作,但仍偶有部队传染病发病报道,不同程度地影响了部队的战斗力,严重危及官兵身体健康[2] .

"魔鬼周"极限训练是武警特种部队训练改革的成果,对牵引反恐特战力量建设、引领示范特战专业实战化训练深入发展具有重要意义[1]. 为增强驻疆武警部队的反恐维稳处突能力,武警驻疆某部官兵于2016年9月开赴西北戈壁腹地,进行了为期7d的"魔鬼周"训练. 为了解部队"魔鬼周"期间训练伤情的特点和规律,为防治伤病提供科学依据,更好地指导部队制定训练及卫勤保障计划[2] ,笔者对"魔鬼周"训练期间56名特战官兵的伤病情况进行了统计分析.

随着新一轮改革的推进,武警部队遂行任务越来越多样化,这也对基层部队的卫勤保障工作提出了更高的要求. 特别是武警部队着眼新疆任务实际,在南疆地区组建了一支山地反恐特战部队,从任务实际看,疆区部队驻地执勤点多、线长、面广,基层卫勤保障人员相对紧缺,现有编制内的军医力量远不能满足部队需要,为适应部队改革与发展,卫勤工作必须向实战化靠拢. 卫生员队伍作为卫勤保障的重要力量,处于一个更加突出的重要位置. 因此,提高卫生员的救治能力对降低伤员病死率和伤残率、增强卫勤保障能力、服务广大基层官兵,都具有重要的意义[1].

目的 了解武警驻南疆部队相关疾病谱,探讨总结部队平时发病规律,为部队疾病防治及科学施训提供必要参考.方法 对武警驻南疆某机动部队卫生队2012-2016年的收治情况进行统计分析,采用回顾性研究方法,对该部卫生队门诊、住院、外诊、转诊等记录在案的病例逐一进行统计,并采用图表结合的方式对统计结果进行描述.结果 该卫生队2012-01-01至2016-12-31累计收治官兵13 531人次,导致官兵患病前五位的系统疾病依次是呼吸系统疾病(7560例;55.9％)、运动系统疾病(2324例;17.2％)、消化系统疾病(1869例;13.8％)、皮肤病及其相关损伤(771例;5.7％)、五官疾病(438例;3.2％).其中呼吸系统疾病、消化系统疾病、皮肤病及其相关损伤和中暑及中毒四类疾病收治人数随月份呈现明显特点.从病种来看,有23种疾病5年来发病人次低于10例,每年患病人数最多的疾病均是上呼吸道感染(7324例;54.1％).结论 本研究初步分析出南疆基层部队卫生队的疾病谱特点和发病原因,为基层部队疾病的预防和规范化保障提供了依据,提高了为兵服务的效率,同时也为下一步做好部队卫勤保障及卫生资源的合理配置提供依据.

Objective To investigate the value of electronic bronchoscopy in the diagnosis of sputum bacteria resistant pulmonary tuberculosis in the elderly. Methods The clinical data of 60 elderly patients with suspected sputum negative bacterial tuberculosis treated in our hospital was analyzed retrospectively. Results Brush biopsy was positive in 37 cases (61.67％ ), lavage fluid in 32 cases (53.33％ ), biopsy in 34 cases (28.33％ ), including 19 cases (31.67％ ) whose biopsy and brush biopsy were both positive. There was no statistically significant difference (X2 = 3.01 = 0.07) between the positive rate of lavage fluid and that of brush lavage. The positive rate of brushing combined with BALF was higher than that of brushing or BALF alone, and the difference was statistically significant (X2 respectively 11.59 and 24.60,all P ＜0.05). Conclusions The clinical symptoms of senile pulmonary tuberculosis are not typical. Bronchoscopy and brushing tests are of diagnostic value for bacterial negative pulmonary tuberculosis, and bronchoscopy should be performed as early as possible.

结核性胸膜炎(tuberculous pleurisy,TP)是我国最常见的结核病类型之一[1],是结核分枝杆菌及其代谢产物进入处于高度过敏状态的胸膜引起的炎性反应[2].临床又分为干性胸膜炎和渗出性胸膜炎,表现为发热、干咳、胸痛和呼吸困难等症状,如治疗不及时,可形成慢性包裹性积液,导致压迫肺组织和胸廓变形[3].快速排除胸腔积液,可消除对胸膜的刺激,减轻胸膜肥厚和粘连[4].胸腔穿刺抽液是TP在正规抗结核药物治疗基础上的经典治疗方法,但胸腔中心静脉置管引流积液是近几年在临床实践中逐渐发展起来的一种新方法,有替代胸腔穿刺抽液的趋势[3].本研究旨在观察中心静脉导管引流联合异烟肼及甲强龙胸腔注射治疗结核渗出性胸膜炎的疗效.

目的 分析70例维吾尔族老年重症肺炎患者临床表现及诊治特点.方法 收集2013年1月1日至2016年12月31日武警新疆总队医院收治的300例肺部感染患者资料,从中选取符合重症肺炎诊断标准的70例维吾尔族老年患者资料,并回顾性分析其临床表现及诊治特点.结果 70例维吾尔族老年重症肺炎患者主要并发疾病为慢性阻塞性肺疾病(57.1％,40/70)、陈旧性肺结核(42.9％,30/70)、慢性支气管炎(30.0％,21/70)、高血压(28.6％,20/70)、2型糖尿病(37.1％,26/70)、脑梗死后遗症(12.9％,9/70).临床表现以发热和咳嗽咳痰(均为100.0％,70/70)、干湿性哕音(94.3％,66/70)、周身酸痛(65.7％,46/70)、意识模糊(55.7％,39/70)多见.影像学检查以双肺叶(28.6％,20/70)、三叶以上肺叶(42.9％,30/70)、单肺叶(28.6％,20/70)受累,单侧或双侧胸腔积液(32.9％,23/70)、双肺弥慢性病变(30.0％,21/70)多见.实验室检测以丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)异常(58.6％,41/70)、电解质紊乱(74.3％,52/70)、低蛋白血症(40.0％,28/70)、白细胞与血红细胞沉降率(ESR)及C反应蛋白(CRP)升高(77.1％,54/70)、中性粒细胞升高(81.4％,57/70),以及氧合指数[均低于300mmHg(1mmHg=0.133 kPa)]、血氧分压(均低于60 mm Hg)降低的Ⅱ型呼吸衰竭(65.7％,46/70)为多见.70例患者治疗早期均选择经验性病原菌全覆盖药物,其中40例及时参考痰涂片、痰培养及药物敏感性试验结果调整治疗敏感药物,17例患者能够耐受电子支气管镜检查并辅以电子支气管镜吸痰及药物灌洗治疗.临床治疗的总有效率为54.3％(38/70),14例临床治愈者均为只有1种基础疾病者,24例临床好转者均为并发1～2种基础疾病者,且包括全部17例接受灌洗治疗的患者;无效者32例(45.7％),其中26例(37.1％)因家属拒绝采用有创治疗而放弃治疗(多为并发3种基础疾病的患者),死亡6例(8.6％)均为并发3种以上基础疾病的患者.结论 维吾尔族老年重症肺炎患者并发疾病种类多、病情重,对症早期积极治疗是保证临床好转的关键,临床治疗转归(除放弃治疗者)与并发基础疾病的多少密切相关.

目的:分析免疫缺陷侵袭性肺曲霉菌病(IPA)的临床特征,以提高该病的临床诊疗水平.方法:对25例免疫缺陷IPA患者的基础病与合并症、临床特征、宿主因素、实验室检查、影像学检查,治疗及预后进行回顾性总结分析.结果:临床表现主要有发热、咳嗽、咳痰、咯血、气促和胸痛等.肺CT改变呈多样性,并呈动态演变.手术治愈5例(20%),药物治愈3例(12%),好转5例(20%),恶化1例(4%),死亡10例(40%),不能评价1例(4%).结论: 免疫缺陷IPA患者,临床表现缺乏特异性,肺CT结合宿主因素,可为早期经验性治疗提供诊断依据,从而改善预后.

非窒息性气道异物在成人和儿童均是较常见的病症[1],如不及时诊治,后果严重,对于气管异物的处理,儿童多可采用纤维支气管镜下取出异物,对于成人则多使用气管镜,在取出异物之前应选择合适的、与异物外形及大小匹配的异物钳[2],成人气管异物的临床症状往往不典型,缺乏特异性,有时与常见的呼吸道疾病难以鉴别,因此极易误诊[3],笔者结合1例近期诊治患者的经验进行总结,报告如下。

Kartagener's综合征(kartagener's syndrome,KS)由支气管扩张、慢性鼻窦炎或鼻息肉、内脏反位三联征组成.主要表现为反复发生呼吸道化脓性感染、咯血为特征的支气管扩张症状及副鼻窦炎和右位心[1].笔者结合1例近期诊治患者并文献复习,现报告如下.

Objective To discuss the clinical features of pulmonary cryptococcosis and improve the clinical diagnosis and treatment level.Methods The clinical data of hospitalized patients with pulmonary cryptococcosis were analyzed.Results In 32 cases of pulmonary cryptococcosis,non-immunodeficient patients were 17 cases and immunodeficient patients were 15 cases.The most common clinical symptoms were cough (18 cases,56.3％),expectoration (ten cases,31.3％),and chest pain (nine cases,28.1％).Imaging features were mainly isolated solitary nodules (18 cases,56.3％) and multiple nodules (12 cases,37.5％).According to the nodule size,10～50 mm nodules were the most common (19 cases,59.4 ％).In 18 cases of solitary nodules,11 cases occurred in the right lung,lower lobe,and lesions were limited.Curative effect:21 cases were cured (65.6 ％),seven cases were improved (21.9 ％),two cases were deteriorated (6.3％),one case had death (3.1％),and one case could not be evaluated (3.1％).Conclusions Pulmonary cryptococcosis is more common in middle-aged men,available in an immunocompetent and immunocompromised population.Clinical and imaging manifestations are lack of specificity,diagnosis depends on pathological biopsy,treatment includes operation excision and antifungal agents in pulmonary cryptococcosis.

<正>侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)是由曲霉菌侵入肺组织所引起的深部真菌感染性疾病,以发展成坏死性、出血性肺炎,形成多发性脓肿或肉芽肿,病灶边缘有小动脉栓塞为特征[1]。近年来,随着人口老龄化、广谱抗生素的广泛使用、恶性肿瘤放化疗的日益增加、器官移植的广泛开展及免疫抑制药的使用、糖皮质激素及各种导管侵

Objective To explore the cause and clinical features of elderly patients with aspiration pneumonia.Methods The clinical data of 36 elderly patients with aspiration pneumonia were retrospectively analyzed.Results 19 cases(52.77%) were cured,4 cases(11.11%) were improved,and 10 deaths(27.77%) reported.Besides,3 cases(8.33%) gave up the treatment.The clinical manifestations mainly were fever(25 cases),and cough and sputum(24 cases).Gram-negative bacilli included 14 strains of pseudomonas aeruginosa(38.9%),12 strains of escherichia coli(33.3%),and 6 strains of klebsiella pneumoniae(16.7%).Gram-positive coccus included 4 strains of staphylococcus aureus(11.1%) and 3 strains of streptococcus pneumoniae(8.3%).Fungi included 10 strains of candida albicans(27.8%) and 9 strains of aspergillus(25%).Conclusion Senile aspiration pneumonia is a common disease in clinic,mostly of whom are recessive inhaler.Its clinical manifestations have no specificity,but it has a relatively high mortality.

Objective To study changes in T lymphocyte subsets of features and cytokine interleukin hormone(IL)-6,IL 8,tumor necrosis factor(TNF-α) in patients with chronic obstructive pulmonary disease(COPD) and the clinical significance.Methods Peripheral blood T cell subsets and serum IL-6,IL-8,TNF-α level were detected in admitted 80 patients with acute exacerbation of COPD and a control group of 30 healthy subjects.Analysis and comparison of the differences,and correlation with forced expiratory volume in one second(FEVI) were made.Results In COPD group,total T cells(CD3+),Th cells,Th / Ts ratio,natural killer(NK) cells were lower than those in control group,the difference was statistically significant(P 0.05).COPD group at time of admission had significantly higher serum IL-8,IL-6 and TNF-α levels,the difference was statistically significant(P 0.05);there were negative correlation between IL-6,IL-8,TNF-α and FEV1(r =-0.74,-0.69,-0.76,P 0.05,respectively).Conclusion T lymphocyte subsets and cytokine are jointly involved in the inflammatory reaction in COPD,these changes play an important role in the development of COPD process,and can be used as an important indicator for monitoring of the disease.

[Objective]To improve the understanding of pulmonary cryptococcosis through studying the correlation and clinical characteristics of immunodeficiency. [Methods]60 patients were randomly divided into surgical treatment group(35 cases) and medical treatment group (25 cases). After treatment, the prognosis of patients in both groups was evaluated and statistical analysis was also conducted. The same is the case with the patients with immune deficiency and non-immune deficiency. [Results]As for the patients in medical treatment group, the effective rate was 76.0% , the cure rate was 32.0% and the mortality rate was 16.0%, while the rates for those in surgical treatment group were respectively 97.1%, 60.0% and 0% .There was significant difference between the above two groups(P 0.05). There was also marked difference between the two groups with non-immune deficiency and immune deficiency. The rates for the former group were respectively 97.1%, 75.0% and 0%, while the rates for the latter group were respectively 75.0%, 17.9% and 14.3%(P 0.05). [Conclusions]This research showed that the effect of surgical treatment for pulmonary cryptococcosisis was superior to that of medical treatment, and the prognosis of patients with non-immune deficiency was better than that of those with immune deficiency.

Objective Explore the clinical features of Wegener' s granulomatosis,in order to improve the understanding of the disease.Methods Retrospective analysis of 50 cases diagnosed in April 1992 to May 2012,the clinical data of patients with Wegener' s granulomatosis,including clinical manifestations,laboratory,radiological and pathological examination.Results 22 males,28 females,age of onset is 13 74 years old,with an average age of 43.8 years.Diagnosis time for 14 days 180 months,an average of 16.7 months.Clinical eyes (38％),ear (20％),nose (64％),oropharynx (26％),upper respiratory tract and lungs (58％) and renal (44％) is mainly involved.Cytoplasmic anti-neutrophil cytoplasmic antibodies (cANCA) positive rate of 96％,perinuclear anti-neutrophil cytoplasmic antibodies (pANCA)-positive rate of 12％.Pathological manifestations of necrotizing granulomatous inflammation,vasculitis,inflammatory cell infiltration.Treatment mainly glucocorticoids and immunosuppressants.Conclusions Complex and diverse clinical manifestations of Wegener's granulomatosis,lack of specific signs,target organ damage how the system or organ disease syndrome,especially over the most common lower respiratory tract and renal involvement,the pathological features of necrotizing granulomatous vasculitis.

针对胆囊结石现今多采用损伤小、恢复快的腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术式,由于需要采用全麻及CO2气腹,腹腔镜手术对呼吸功能有明显的影响,术中及术后可发生呼吸系统多种并发症[1,2].尤其是有慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)病史的老年患者,肺功能受到不同程度的损坏,更容易出现呼吸系统并发症.因此,术前对老年COPD进行手术耐受力的评估及呼吸系统并发症的预测尤显重要.能否耐受腹腔镜手术,要根据体检及手术前心肺功能等进行综合评估.本研究对560例老年COPD并胆石症手术治疗者术前进行肺功能测定,术后呼吸功能的病理生理改变及影响因素进行了综合性分析,报告如下.

【Objective】To survey diet intake of energy and macro nutrients and evaluate energy and glycolipid metabolism in different glycometabolic people.【Methods】Subjects of Han all above 30-year-old were recruited by diabetic history and oral glucose tolerance test in 103 formation corps of Xingjiang and respectively were there 147 pople in prediabetic state,177 new diagnosed diabetes,139 pre-diagnosed diabetes patients and 140 pople in normal glycometabolism state matched by gender and age with those in prediabetic state.Their diet intake of energy and macro nutrients were surveyed and their energy and glycolipid metabolism were evaluated.【Results】(1)The new and pre-diagnosed diabetes patients were older,in lower culture level and accompanied with more proportion of hypertention(P value were all less than 0.05).(2)Abnormal glycometabolic people had bigger waist circumference,waist to hip ratio,higer systolic and diastolic pressure,fasting and postprandial plasma glucose,total plasma cholesterol,but lower high-density lipoprotein cholesterol(P value were all less than 0.05).Especially the pre-diagnosed diabetes patients had higher systolic pressure.And in these abnormal glycometabolic people,there were more dietary energy,carbohydrate and fat intake,but less protein and fiber intake(P value were all less than 0.05).(3) In abnormal glycometabolic people,whether in male or female subgroup were there all bigger waist circumference,but only in male subgroup higher proportion of abdomenal obesity(P value was less than 0.05)【.Conclusion】Compared with normal glycometabolic adult people,abnormal glycometabolic people have much severe abdomenal obesity,accompanied with more proportion of hypertention,more dietary energy,carbohydrate,fat,but less protein and fiber intake.They have higher blood glucose,total plasma cholesterol,but lower high-density lipoprotein cholesterol.