本研究探讨脊柱结核不全瘫患者多层螺旋CT(MSCT)影像表现及临床意义.选取脊柱结核术前不全瘫患者72例作为观察组,其中Frankel脊髓损伤分级:B级24例,C级27例,D级21例,同时选取肌力正常的脊柱结核患者90例作为对照组,分析比较两组患者MSCT影像特征差异.观察组3个及以上椎体受损比例、病变椎体胸段以上分布比例明显高于对照组(P＜0.05);观察组骨性椎管不完整、椎体总高度丢失≥1个椎体、椎旁脓肿及致压物压迫椎管、压迫椎间孔比例及后凸Cobb角明显高于对照组(P＜0.05);观察组Frankel分级B级患者骨性椎管不完整比例为37.50％,显著高于C级和D级患者(P＜0.05);观察组Frankel分级B级患者椎旁脓肿及致压物压迫椎管比例、压迫椎间孔比例及后凸Cobb角高于D级患者(P＜0.05).与肌力正常的脊柱结核比较,脊柱结核术前不全瘫患者MSCT影像有所差异,在不同Frankel分级间同样有一定差异.

乙状结肠造口术是在乙状结肠和腹壁表面之间建立人工通道的手术. 适用于解除晚期直肠癌引起的肠梗阻,以及直肠阴道瘘、直肠膀胱瘘等直肠手术的术前准备. 粪水性皮炎是肠造口术后常见的并发症之一,占造口周围皮肤炎症的22％,主要是由于粪水刺激引起造口周围皮肤的糜烂[1-2].导致肠造口周围粪水性皮炎的因素包括:造口位置不理想[3]、造口乳头平坦或凹陷[4]、造口护理技术不正确[4]、粪水排泄物积聚[4]、造口周围皮肤不平[5]、出现造口并发症(如造口回缩、造口旁疝等). 患者一旦发生粪水性皮炎,在增加疼痛的同时还导致造口袋粘贴不牢反复出现渗漏,增加经济负担,严重影响患者的生活质量. 如何采取正确的护理方法,有效预防造口并发症的发生是值得护理人员思考的问题. 2018 年8 月7～20日,我们对1例永久性乙状结肠造口术后并发造口周围粪水性皮炎患者给予积极治疗与护理. 现报告如下.

目的:探讨机器人辅助腹腔镜肾部分切除术的围术期护理方法及效果.方法:回顾性分析141例行机器人辅助腹腔镜肾部分切除术患者的临床资料;术前重视心理护理,给予针对性情感支持,做好充分术前准备;术后做好病情观察、切口管道护理,积极预防并发症,做好康复期指导.结果:本组141例患者均顺利完成手术,无中转行标准腹腔镜和开放手术;手术时间90~180 min(平均120.0 min),热缺血时间16~30 min(平均21.5 min);术中出血量50~200 ml(平均94.2 ml),无围术期出血和输血;术后排气时间1~3 d(平均1.7 d),下地活动时间2~7 d(平均3.8 d),术后住院时间4~9 d(平均5.9 d),术后进食时间1~4 d(平均2.6 d),留置导尿管时间1~7 d(平均2.9 d),留置引流管时间1~7 d(平均2.8 d).均在术后7 d左右完成切口拆线,愈合满意,无手术切口并发症.随访2~24个月,肾功能无明显变化,无迟发性出血等不良事件,未见恶性肿瘤局部复发和远处转移.结论:机器人辅助腹腔镜肾部分切除术具有创伤小、出血少、恢复快等优势,能减轻患者痛苦,提高患者舒适度与满意度.精湛的手术技艺配合有效的护理是机器人辅助腹腔镜肾部分切除术取得成功和患者顺利康复的保障.

目的：探讨实施整体护理对血液病患者心理状况及治疗依从性的影响。方法选取中国人民解放军总医院血液科二病区行化疗治疗的血液病患者230例为研究对象，随机分为观察组和对照组。其中对照组112例，观察组118例，对照组患者实施常规护理，观察组患者实施整体护理。对两组患者的心理状况、恶心呕吐程度、治疗依从性以及生存质量进行调查和分析。结果两组患者经过治疗，SAS、SDS得分均较治疗前明显降低，且观察组患者降低更为明显；观察组患者恶心呕吐程度明显轻于对照组，治疗依从性明显高于对照组；观察组患者生活质量量表各因子得分均明显高于对照组。上述比较差异均有统计学意义（P＜0．05）。结论对血液病化疗患者实施整体护理，有利于改善患者的心理状况，提高患者治疗依从性和生活质量，是一种顺应医学发展及人文需要的科学护理模式。

Objective To analyze the effect of psychological intervention on depression in patients with lymphoma after chemotherapy.Methods To collect 82 cases of patients with lymphoma whom hospitalized form June 2009 to June 2012 in our hospital,82 patients were divided into two groups randomly,the observation group(41 cases) were given targeted psychological nursing,the control group was given routine nursing care,compared two groups of patients with chemotherapy interruption rate and depression score. Results The chemotherapy interruption rate of observation group patients was significantly lower than that of the control group(P < 0.05);after the treatment,the observation group SDS score,SAS score,VAS score was significantly lower than that of control group(P < 0.05).Conclusions Psychological intervention can effectively improve the patients compliance to the chemotherapy treatment,to avoid the bad emotion.

Objective To explore the effect of evidence-based nursing on urinary fistula after total cystectomy with ileal orthotopic neobladder.Methods 60 patients were divided into observation and control group (30 in each group); control group was treated with regular nursing,and observation group was treated with evidence-based nursing: first establishing evidence-based nursing group; propose evidence-based problem according the experience of nursing; then literature searching and obtaining support of evidence; application on the clinical.Results No urinary fistula occurred in the observation group,and the occurring rate was 16.67％ in the control group,and the difference was significant (x2 =5.45,P ＜0.05 ) ; total life quality of EORTCQLQ-C30 and other factors in observation group were higher than those in the control group,including(74.13 ± 11.32)in observation group and (61.56 ± 11.24) in control group,and the difference was significant (t =19.548,P ＜0.05).Conclusions Evidence-based nursing could prevent the urinary fistula after total cystectomy with ileal orthotopic neobladder,and improve the life quality and worth application in clinic.

Objective To explore the relationship between perfectionism and self-concept of patients with bladder cancer after operation.Methods Chinese version of Frost Multidimensional Perfectionism Scale and the Tennessee Self-Concept Scale were used to investigate 120 patients with bladder cancer in one week after operation.Results The score of perfectionism was(3.31±0.42).The score of self-concept was(2.12±0.33).The various dimensions of perfectionism were all negatively correlated with the various factors self-concept(P0.01 or P0.05).Three dimensions of perfectionism were the influencing factors of self-concept.Conclusion The scores of perfectionism are in the middle level.The scores of self-concept are in the low level.The level of self-concept of patients with bladder cancer can be predicted effectively by 3 factors of perfectionism.

Objective To explore the impact of selective psychological interventions on emotion of patients with orthotopic ileal neobladder.Methods Sixty-seven patients with bladder cancer receiving radical cystectomy and orthotopic ileal neobladder were divided into a control group(n=34) and an observation group(n=33) according to chronological order.All patients received routine nursing care,additionally patients in the observation group received selective psychological interventions,including such measures as cognitive-behavioral education,physical exercise,music therapy,and emotion management,ect.Results The scores of SAS and SDS showed significant differences between the two groups after intervention(P<0.01 for both).Conclusion Selective psychological intervention strengthens individuation of psychological intervention,and it can alleviate anxiety and depression of patients with bladder cancer receiving radical cystectomy and orthotopic ileal neobladder.

Objective:To develop the diagnostic level of bronchioloalveolar carcinoma(BAC) by analyzing the clinical fea-tures and CT presentations of BAC.Materials and Methods:All the cases of BAC comfirmed by operation and pathology were retrospectively analyzed from June 2002 to June 2007.These cases were review using the 2004 revised WHO classifica-tion of BAC and separated them into two groups,pure BAC and mixed subtype adenocarcinoma with BAC components.The CT presentations of pure BAC were analyzed.Evaluated findings included the number(solitary or multiple),size,morphous,contours,density and gas-containing space of lesions.Other CT findings such as air bronchogram,vascular converging and lymphadenopathy were also assessed.Results:145 surgically resected cases with thin-section CT images were histologically diagnosed as BAC from 2002 to 2007.Of these,32(22.1%) proved to be pure BAC using the 2004 revised WHO classifica-tion.There were 20 men(62.5%) and 12 women(37.5%).The positive rate of tumor markers CEA and CA125 was 10% and 5%,respectively.The mean diameter of BAC was less than 3cm and all of the cases presented pure ground glass opacity.82.9% of them showed inhomogeneous density,97.1% well-defined margin.The rate of lobulated shape,air bronchogram and gas-containing space were 62.9%,60%,57.1%,respectively and lymphadenopathy in none of these BAC.Conclusion:In the di-agnosis of early stage of BAC,some morphologic features of lesions on thin slice CT may be more important.

Purpose:To develop the diagnostic level of primary pulmonary lymphomas through reviewing the CT findings of primary pulmonary lymphomas confirmed pathologically.Materials and Methods:The CT examinations of 8 patients with pathologically proven primary pulmonary lymphoma were retrospectively reviewed.Results:Pulmonary lesions were depicted as solitary mass in 3 patients,nodules in 4 and multiple patchy opacities in 1 patient.Air bronchogram was present in 5 patients,interstitial infiltrates in 5.The lesions showed obvious enhancement in 6 cases who received contrasted CT scan and CT value increased 42.7 Hu.Conclusions:Primary pulmonary lymphoma is a rare disease and CT appearance can be quite variable.More common imaging features include air bronchogram,interstitial infiltrates and no hilar and mediastinal lymphadenopathy.Biopsy is recommended to obtain pathologic diagnosis of primary pulmonary lymphoma.

Objective To investigate the application of respiratory navigator echo triggered black blood contrast FSE in cardiac MRI. Methods The respiratory navigator echo trigger technique combining with black blood FSE (NAV-FSE) was tested on 11 volunteers and 5 patients in free breathing,using breath-hold FSE (BH-FSE) with the same imaging protocals as control. The imaging efficiency and the image sharpness were compared between NAV-FSE and BH-FSE and t-test was used for the statistics. Results All NAV-FSE acquisitions were completed in sixteen subjects while 4 BH-FSE acquisitions failed because of poor breath holding. The efficiencies of NAV-FSE were (42. 95±11.50)%, (56. 14±11.40)% and (55.25± 14. 70)% when echo train length (ETL) were 24, 16 and 8, respectively. When ETL were 16 and 24, the sharpness of NAV-FSE ( 0. 43±0. 02 vs 0. 36±0. 02 ) and BH-FSE ( 0. 36±0. 03 vs 0. 35±0. 02 ) were statistically different (t =4. 26, 5. 53 ,respectively; P <0. 05). NAV-FSE could have a shorter ETL setting without consideration of breath holding. Conclusion The navigator echo trigger technique could be compatible with black blood contrast FSE to image the heart without the restriction of breath holding and it allows to optimize the parameters to improve the image quality.

<正> 近年来,随着冠状动脉造影(coronary arteriongraphy,CAG)的普及和对冠状动脉储备能力的不断探讨,一种特殊的血流动力学现象逐渐引起了临床的重视,这就是冠状动脉慢血流现象(coronary slow flow phenomenon,CSFP)。Tambe于1972年首先报道了6例有胸痛症状的患者,CAG没有发现血管病变,但发现血流速度减慢这一特殊现象。此后,

<正>磁共振成像(MRI)使用多种组织对比显示心肌的解剖形态、功能和组织结构,比较成熟的成像方式包括亮血对比平衡稳态进动电影成像(SSFP-CINE)、黑血对比FSET2WI成像(BB-FSE)、钆(Gd)造影

胰腺实性假乳头状瘤(SPTP)是一种少见的胰腺肿瘤.该病于1959年由Frantz首次报道[1],1996年WHO正式命名为实性假乳头状瘤.对2005-12/2007-08我院经手术及病理证实的SPTP 14例分析如下.

Objective To improve the nursing safety of taking oral drugs in the elderly,in an attempt to prevent the adverse drug events and secondary drug-caused diseases.Methods The illness types,the types and amounts of the drugs taken orally,and the situation of drugs taking were investigated in elderly of different age intervals.Results The types and amounts of drugs taken orally in elderly increased significantly with the increase of age and diseases with poor doctor supervision.The healthy education in the elderly taking drugs was insufficient.Conclusion The keys to improve the nursing security of taking drugs orally in the elderly are the cooperation between various parties and a joint effort of them.