目的 了解全市私营口腔诊疗机构口腔器械处理能力和处理质量,为卫生行政部门制定行政决策提供数据支持.方法 2018年11月采用横断面调查和随机抽样的方法,对全市范围内口腔诊疗机构总量的20％ 进行抽样督查,填写调查表,统计各被查单位的器械处理能力和处理质量.结果 在各行政区范围内共抽检私营口腔诊疗机构157家,器械以自行处理为主占94.27％(148/157);清洗流程完全符合规范的比例为79.73％(118/148);器械处理所必需的清洗设备配置率为52.03％(77/148);各行政区间配置率差异有统计学意义(P=0.001);末次冲洗用水以自来水为主;各行政区之间在末次冲洗用水的选择上差异有统计学意义(P<0.001);选择的灭菌设备以小型灭菌器为主.化学监测和物理监测执行率为85.81％,75.00％(127/148,111/148),生物监测和清洗效果监测执行率较低为55.41％,50.68％(82/148,75/148);各行政区内的私营口腔诊疗机构在四项监测项目中执行率差异均有统计学意义(P<0.001);清洗质量合格率最高为80.76％(634/785),包装质量和灭菌质量的合格率分别为76.56％(601/785)和75.16％(590/785),各行政区口腔诊疗机构诊疗器械处理质量差异有统计学意义(P<0.001).结论 私营口腔诊疗机构是全市口腔诊疗的重要力量;其器械处理质量是保证民众健康的重要一环;卫生行政部门需要加强对私营口腔诊疗机构的监管.

Objective To analyze the effects of ezetimibe combined with atorvastatin on the levels of blood lipid, lipoprotein associated phospholipase ( LP-PLA2) and high-sensitivity C-reactive protein (hs-CRP) in the elderly patients with acute coronary syndrome. Methods Ninety cases with acute coronary syndrome, which were admitted in our hospital during January 2013 to December 2015, were enrolled in this study and divided into the experimental group and the control group randomly, with 45 cases in each group. The control group was given atorvastatin treatment, while the experimental group was given ezetimibe combined with atorvastatin treatment. The indicators of blood lipid, LP-PLA2 and hs-CRP of two groups before and after treatment were detected and compared. Results There were no significant differences in total cholesterol ( TC ) , triglyceride ( TG ) , high-density lipoprotein cholesterol( HDL-C) , low-density lipoprotein cholesterol ( LDL-C ) , LP-PLA2 and hs-CRP between two groups before treatment ( P>0.05) . And after treatment, the levels of TC, TG, HDL-C, LDL-C, LP-PLA2 and hs-CRP showed significant differences between the two groups ( P<0.05 ) . There were significant differences in TC, TG, HDL-C, LDL-C, LP-PLA2 and hs-CRP in the two groups after treatment, compared with those before treatment ( P<0.05 ) . The total incidence rate of adverse reactions in experimental group was 4.4%, compared with 6.7% in the control group with no significant difference ( P>0.05) . Conclusions Ezetimibe combined with atorvastatin shows remarkable curative effect on acute coronary syndrome in the elderly patients, which can decrease the levels of LP-PLA2, blood lipids and hs-CRP with lower incidence rate of adverse reactions.

目的 分析阿司匹林持续服用对急诊下行阑尾切除术中和术后出血及其他并发症的影响.方法 急性阑尾炎患者66例,其中持续应用阿司匹林组25例,未服用阿司匹林组41例.均急诊行阑尾切除术.比较两组术中出血量、手术时间、放置腹腔引流管率(引流量)、术后出血(再手术)率、术后输血率、切口感染率、血栓栓塞事件率住院时间及病理类型.结果 两组患者在术中出血量、手术时间、放置腹腔引流管率、术后出血(再手术)率、术后输血率、切口感染率、血栓栓塞事件率、住院时间、病理类型等方面比较,差异无统计学意义(P＞0.05).结论 在细致的操作及妥善的止血下,急诊下行阑尾切除患者围手术期持续服用低剂量阿司匹林是安全的,并不增加术中和术后出血风险.所以不建议拖延手术.

目的:研究复方聚乙二醇电解质散在肝性脑病(Hepatic encephalopathy,HE)治疗中的疗效.方法:将73例HE患者随机分为乳果糖治疗组(n=24)、大黄治疗组(n=24)以及复方聚乙二醇电解质散治疗组(n=25).所有患者常规行持续低流量吸氧、低蛋白饮食、维持水电解质平衡、保肝等综合治疗.观察患者24h后West Haven分级下降程度、血氨水平及总住院天数的差别.结果:治疗前三组患者基线资料比较无明显差异.治疗24h后复方聚乙二醇电解质散治疗组West Haven分级明显低于其余两组,其疗效与其余两组比较具有显著差异(P＜0.05);乳果糖治疗组与复方聚乙二醇电解质散治疗组血氨水平下降较明显,两组间比较无明显差异(P＞0.05),上述两种治疗方法降血氨作用优于大黄治疗,比较具有明显差异(P＜0.05).复方聚乙二醇电解质散治疗组总住院天数明显少于其余两组(P＜0.05).结论:复方聚乙二醇电解质散作为一种治疗HE的新方法,值得临床进一步研究、推广及应用.

目的 研究无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效.方法 选取2012年1月至2014年12月昆山市第一人民医院急诊医学科收治的AECOPD合并Ⅱ型呼吸衰竭患者47例.根据随机、对照的原则分为观察组(n=24)和NIPPV组(n=23),其中观察组给予常规抗感染、祛痰、平喘、持续低流量吸氧等治疗;NIPPV组在常规治疗的基础上加用NIPPV治疗.对比治疗24h、72h后患者的血气分析、心率及呼吸次数等指标.结果 与治疗前相比,两组患者在治疗后的第24小时和72小时,呼吸次数、心率、动脉血二氧化碳分压(PaCO2)和乳酸(Lac)显著降低(P＜0.05),动脉血氧分压(PaO2)和pH显著上升(P＜0.05);而且与第24小时相比,第72小时的各值改善更为明显(P＜0.05).两组患者在治疗后第72小时的N末端前脑钠肽(NT-proBNP)值也有显著下降(P＜0.05).与观察组相比,NIPPV组患者的呼吸次数、心率、PaCO2、Lac、pH、PaO2和NT-proBNP均有更为显著的改善(P＜0.05).此外,NIPPV组较观察组住院天数与住院费用明显减少(P＜0.05).结论 NIPPV在治疗AECOPD合并Ⅱ型呼吸衰竭患者中疗效显著,值得临床推广应用.

Objective: To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC), and to explore the role of nuclear factor-kappa B (NF-κB) and interleukin-6 (IL-6) in mechanism of hepatocarcinogenesis.Methods: Mice were divided into vacuity contrast group, normal diet group and high fat diet group. After feeding for 15 weeks, diethylnitrosamine (DEN, 45mg/kg) was weekly administrated by intraperitoneal injection into mice in both normal diet and high fat diet groups to gradually establish a model of HCC. The mice in blank control group were not treated with any drugs through the whole experiment. Livers and serum were individually collected from five mice in normal diet and high fat diet groups, respectively, and three mice in the blank control group in week 15, 20, 25 and 30. All the remaining mice were executed in week 36, and serum and liver pathologic gross were collected. The pathological changes of liver tissues were observed with HE staining. The differences in hepatocarcinogenesis among three groups were also analyzed. The levels of serum triglyceride (TG), cholesterol (TC), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected. The levels of serum NF-κB and IL-6 were assayed by ELISA.Results: Animal models of NAFLD were successfully established after 15 weeks of high-fat diet feeding. In the week 36, no mice in the blank control group developed HCC. Eight of 20 (40.0%) mice in normal diet group developed HCC. Thirteen of 18 (83.3%) mice in high fat diet group developed HCC. The levels of serum NF-κB and IL-6 in high fat diet group were significantly higher than those in the normal diet group in each period during study (all P < 0.01).Conclusion: The results suggest that NAFLD can promote hepatocarcinogenesis in the presence of DEN. The abnormal levels of NF-κB and IL-6 play important roles during the development of HCC. DOI:10.3781/j.issn.1000-7431.2015.11.140

OBJECTIVE To investigate the germicultures results and drug resistance of fester pathogens in patients with acute appendicitis ,so as to provide a reference for clinical treatment .METHODS From Jan .2011 to Dec . 2013 ,624 cases of acute appendicitis patients in our hospital were selected as study objects .The fester samples were collected during appendectomy .Pathogenic culture and drug resistance analysis were conducted to the 624 samples and all data were analyzed by WHONET 5 .4 .RESULTS Totally 408 samples were cultured to detect 438 strains of pathogens ,dominating by gram‐negative bacteria with 428 strains ,accounting for 97 .7% .The top four bacteria detected were E .coli(72 .6% ) , Pseudomonas aeruginosa (10 .5% ) , K lebsiella pneumoniae (5 .7% ) , and Enterobacter aerogenes (2 .5% );and the E .coli had high drug resistance to ticarcillin (94 .7% ) ,ampicillin (83 .0% ) ,ciprofloxacin (82 .7% ) ,cephalothin (82 .1% ) ,and gentamicin (74 .8% );P .aeruginosa were serious‐ly resistant to ampicillin (100 .0% ) ,cefalotin (100 .0% ) ,ticarcillin(86 .5% ) ,and ceftazidime(64 .3% );Kleb‐siella were highly resistant to ticarcillin (98 .3% ) , ampicillin (96 .3% ) , and cephalothin (73 .6% ) . CONCLUSION Infections in patients with acute appendicitis are mainly caused by gram‐negative bacteria ,common‐ly E .coli .Different pathogens showed differences in drug resistance to various antibiotics Rational antibiotic ther‐apy should be carefully selected clinically .

目的:探讨美罗培南不同输注方案治疗老年ICU获得性重症肺炎的临床效果.方法:选取2011年6月至2014年1月我院的92例老年ICU获得性重症肺炎患者,随机分为传统组和改良组,每组各46例,分别采用不同的输注速度给予美罗培南治疗,并且对其总有效率、细菌学疗效进行评定,观察记录患者的不良反应情况、住院时间及抗菌药物的治疗费用.结果:改良组患者的总有效率为82.61％,显著高于传统组的67.39％ (P＜0.05);改良组患者的细菌学疗效明显优于传统组(P＜0.05);改良组患者的治疗时间为(5.94± 1.21)d,明显低于传统组的(7.52±1.47)d(P＜0.05);改良组患者的治疗费用为(3412.7±992.4)元,相比于传统组的(3983.5±1022.6)元明显降低,差异均有统计学意义(P＜0.05).两组患者分别有3例出现不良反应,其中,4例出现腹泻,2例出现恶心,但患者均能够耐受,停药后腹泻、恶心症状消失,差异无统计学意义(P＞0.05).结论:美罗培南治疗ICU获得性重症肺炎在提高临床治疗效果、减轻患者的炎症反应、缩短治疗时间,在一定程度上能够降低患者的经济负担方面具有显著的优越性.

目的:研究并分析血液净化治疗方案在应用于急诊重度有机磷中毒中的临床疗效。方法:选择28例重度有机磷中毒患者为研究对象,按照随机抽取的方式将其划分为观察组与对照组,每组14例。观察组患者行血液净化治疗方案,对照组患者行常规治疗方案。针对两组患者临床治疗效果进行比较与分析。结果:观察组患者自主呼吸时间、意识恢复时间、胆碱酯酶恢复时间、住院时间指标均明显低于对照组患者,两组数据组间比较,差异有统计学意义(P<0.05)。结论:急诊中针对重度有机磷中毒患者采取血液净化方式进行治疗有疗效确切、安全性高、患者预后水平高等特点,优势显著,值得临床应用与推广。

目的:观察急诊使用高渗氯化钠注射液治疗多发伤伴休克的救治效果。方法:对48例严重多发伤合并休克患者立即给予开放气道、维持呼吸、控制出血、感染、常规抗休克治疗和加用高渗氯化钠注射液进行液体复苏,并记录开始输液即刻、输液后10min、30min、lh、2h时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和尿量、心率、无创血氧饱和度(指脉氧)。结果:输液l0min后SBP即开始升高,输液30min后SBP、DBP、MAP明显升高(P<0.05);同时心率减慢,尿量增加,与开始输液即刻比较差异均有统计学意义(P<0.05),且作用维持在2h以上。结论:高渗氯化钠注射液能有效地扩充血容量,提高血压,改善组织器官血流灌注,改善休克患者的全身状况,对于多发伤并休克患者的早期复苏是经济安全有效的。

目的探讨无创双水平正压通气(BiPAP)用于急性左心衰竭的可行性。方法将68例急性左心衰竭患者随机分为观察组38例和对照组30例,两组均予常规治疗,观察组加用BiPAP。结果观察组有效率明显高于对照组(P<0.05);两组治疗后血气指标改善,脑型钠尿肽(BNP)水平下降,观察组更明显(P<0.05)。结论BiPAP通气辅助治疗急性左心衰竭安全有效,其机制可能是改善血气指标、降低血浆BNP水平。

目的评价绿色通道卡、章在急诊患者应用的作用,探讨抢救急诊患者新的管理模式,以提高急诊抢救成功率。方法对我院急诊科使用绿色通道卡和绿色通道专用章护送和转运危重及特殊急诊患者情况进行回顾性分析。结果急诊患者使用绿色通道卡、章后病人的满意度由90%上升到95%,没有因费用,延误等问题造成病人家属不满和投诉。大大缩短了病人就诊及等候时间,为提高抢救效果赢得时间。结论急诊患者应用绿色通道卡、章,能及时、安全护送病人进行检查、手术及住院,夺取抢救病人的最佳时机。确保以最快的速度使病人得到及时救治,提高抢救成功率。

目的:探讨无创双水平正压通气治疗急性左心功能不全的疗效。方法:比较常规和无创通气治疗急性左心功能不全的有效率,治疗前后的血气指标、BNP水平。结果:无创通气组有效率84.20%,常规组有效率63.33%;两组治疗后血气指标改善,BNP水平下降,前后比较有统计学差异;无创通气组治疗后上述指标改善更明显,与常规组比较有统计学差异。结论:无创双水平正压通气治疗急性左心功能不全时可提高成功率。

目的通过对3年来救治的危重患者的诊治过程、行之有效的抢救方法和管理程序进行探讨,以提高急诊救治危重患者的成功率,提高急诊应急处理。方法统计3年来抢救各种危急重症患者共622例,总结救治方法程序和管理模式。结果成功救治587例,死亡35例,急诊抢救成功率为94.37%。结论在危重患者的抢救工作中要成功地对患者实施救治,就需要熟练掌握各种疾病的抢救程序,同时在抢救过程中健全而又有指挥力的抢救管理是抢救实施的重要保证。

目的探讨低钾性周期性瘫痪导致房室传导阻滞的临床和心电图特点。方法回顾性分析我院2004年-2008年收治的12例低钾性周期性瘫痪引起的房室传导阻滞患者的临床资料。结果12例患者血钾平均(2.07±0.69)mmol/L,发生Ⅰ度房室传导阻滞9例,Ⅱ度房室传导阻滞3例,合并其他心律失常4例。结论低钾性周期性瘫痪致房室传导阻滞与血钾浓度无明显关系,补钾治疗后,心律失常消失,心电图恢复正常。

Objective To investigate the diagnosis and treatment of the post-traumatic fat embolism syndrome. Methods Analysing the clinic datas of 12 patients with post-traumatic fat embolism syndrome.Results 12 patients with fat embolism syndrome are classifid to 3 types by Sevitt classification including 3 patients to explosive type,4 patients to total type are 5 patients to subclinical type.3 patients of explosive type died,the other patients were cured with early and right diagnosis and treatment.Conclusions The right cognition for clinic characters and diagnosis standard,early and right treatment can enhance the clinic treatment result.The effective therapy methods for post-traumatic patient decrease the incidence of fat embolism syndrome.

选择年龄大于65岁的肝炎患者共90例,随机分为A、B二组,A组为综合护肝、退黄疸、维持水电介质平衡、防治并发症、控制感染等治疗;B组在A组基础上加用促肝细胞生长素.结果B组其临床症状缓解、黄疸消退时间、病情预后均显著优于A组.结论,促肝细胞生长素在治疗老年人病毒性肝炎可使病程缩短、提高生存率方面取得较满意的效果.

分析286例麻疹患者的流行病学特征及临床特点.结果:麻疹一年四季均有发病,高峰为2月下旬～6月份,发病年龄跨度较大,发病的最高人群为外来打工的流动人口,有麻疹疫苗接种史者占21.03%(53/252),有明确麻疹接触史者196例(68.53%),典型、轻型典型、轻型非典型麻疹患者分别为203例(70.98%)、62例(21.68%)、21例(7.34%),有各种并发症者占55.59%.成人患者以典型麻疹为主,中毒症状重,并发症发生率达49.17%.麻疹IgM抗体阳性占84.48%(49/58).提示麻疹发病未得到完全控制,有上升趋势;成人发病率高,病情重,并发症多;需强化麻疹疫苗接种