目的 评价磁共振扩散加权成像(DWI)感兴趣区(ROI)的选择在评估直肠癌术前分化程度和淋巴结转移中的应用价值.方法 搜集在本院经病理组织学检查确诊为直肠癌患者56例.所有患者均使用Siemens Aera1.5T磁共振扫描仪行常规扫描序列及DWI序列检查.根据术后病理分期,将肿瘤分为高、中、低分化三组;按淋巴结是否转移分为两组.由2名不同年资影像诊断医师在直肠癌DWI图像上采用三种ROI法(小ROI、面积ROI、容积ROI)独立测量病灶的表观扩散系数(ADC)值.不同组间定量资料采用方差分析或t检验;运用受试者工作特征曲线(ROC)将存在显著差异的参数进行分析,获得相应的最佳临界值、曲线下面积(AUC)和诊断效能.结果 三种ROI法获得的ADC值差异有统计学意义(P＜0.05),其中容积ROI法测得的ADC值更高、重复性最好.三种ROI法测得的ADC值在直肠癌病理分化、有无淋巴结转移中差异有统计学意义(P＜0.05).绘制ROC曲线,高、中分化组容积ROI法AUC =0.901,最佳临界值为1.125×10-3mm2/s;中、低分化组容积ROI法AUC=0.848,最佳临界值为0.965×10-3mm2/s;淋巴结转移阳性与阴性组容积ROI法AUC=0.915,最佳临界值为0.975×10-3mm2/s.结论 三种ROI法中容积ROI法测得直肠癌的ADC值可重复性最好.ADC值可用于区分高、中分化和中、低分化以及淋巴结转移阳性与阴性的直肠癌,而容积ROI法测得的ADC值预测价值最好.

Objective:Fast track surgery in patients with colorectal improve ambulation first level of application. Methods:The row over the same period 126 cases of colorectal surgery in hospital 64 cases were randomly divided into experimental group and a control group of 62 patients. The control group received usual care, the experimental group followed the concept of rapid rehabilitation perioperative care, using a self-designed questionnaire case of two groups of patients were compared first ambulation. Results:First ambulation independence test group than the control group, the experimental group, the average time patients get out of bed for the first time after the activity was 55 ± 1.5 hours, the average walking distance for the first time for 37 ± 8.6 m level than the control group, Also the incidence of postoperative symptoms than the control group (P<0.05).Conclusion:Application of the concept of fast track surgery in patients with colorectal surgery perioperative nursing, helps to reduce postoperative shivering, nausea, vomiting, pain and other symptoms after the occurrence of the first patients to improve ambulation level,, promote patient rehabilitation.

根据我国儿童健康流行病学专家组(CHERG)的研究显示:1990～2008年,中国新生儿、婴儿和儿童的活产儿死亡率已有明显下降,已经提前实现了联合国千年发展目标4(MDG4);从死因别构成比例来看,意外伤害死亡的比例显著增加,占总死因的10%[1] .

Objective To investigate the relationship between the height of liquid containers and the height of liquid level at terminal phase of intravenous injection to evaluate the safety of intravenous injection and best time for withdrawal of needles after intravenous transfusion.Methods A total of 48 patients were randomly divided into 3 groups(60~79cm/80~99cm/100~120cm).At terminal phase of intravenous injection,we measured the height of liquid level when the liquid automatic stopped in infusion apparatus.Results There was no significant difference between the 3 groups in the height of liquid level(P 0.05) and no linear correlation between the height of liquid containers and the height of liquid level in infusion apparatus(P 0.05).Conclusion Auto stop of infusion apparatus is not affected by the height of liquid containers.Withdrawal of needles at terminal phase of intravenous injection is safe and effective.

Objective To evaluate the safety and efficacy of intermittent pneumatic compression in prevention of deep venous thrombosis after major orthopedic operation. Methods We searched MEDLINE (1966 to January 2008),The Cochrane Library (Issue 2,2008),CBM (1996 to January 2008),CNKI (1998 to January 2008),VIP (1998 to January 2008),and retrieved clinical controlled trials (CCTs) or randomized controlled trials (RCTs) in which IPC was used as an intervention to prevent DVT,and all the trials were published in English or Chinese. The methodological quality of the included studies was assessed according to the standard of Cochrane systematic review. RevMan 4.2 software was used for meta-analysis. Results Seven RCTs and 1 CCT were included. Their methodological quality was poor. The results of Meta–analyses showed:(1) The incidence of DVT in the IPC group was lower than that in the control group (RR=0.20,95%CI 0.11 to 0.35,P0.000 01); (2) There was no difference in the incidence of DVT between the IPC group and the LMWH group (RR=0.70,95%CI 0.28 to 1.74,P=0.44); (3) The incidence of DVT in the IPC plus LMWH group was lower than that in the LMWH-alone group (RR=0.23,95%CI 0.10 to 0.52,P=0.000 4). Furthermore,the incidence of DVT in the IPC plus LMWH group was lower than that in the GCS plus LMWH group (P0.000 1). No severe adverse reaction of IPC in DVT prevention was reported. Conclusion IPC shows an effective tendency in DVT prevention,but because of the low quality and the small sample of the included studies,this conclusion needs to be verifi ed by protocols of more samples and high quality.

自行设计并制作全喉气管造口生理功能维护器(下称维护器),维护器由柔性造口盖、弹性挂绳以及过滤膜夹持结构三部分组成。将其应用于32例全喉气管造口术后患者,效果理想,且具有材质柔软、结构小巧、固定稳妥、通气性能良好等优点。

目的 调查四川省各级医院医疗废物管理现状.方法 采用自制问卷对四川省113所二、三级医院的医疗废物管理情况进行横断面调查.结果 68%的三级医院对一次性医疗器械毁形浸泡后交于地区建立的垃圾场所进行无害化处理,94%的二级医院对毁形浸泡后的一次性医疗器械只能做焚烧处理.结论 四川省各级医疗卫生机构医疗管理工作的开展进行,不仅需要政府和各级医疗卫生机构加大资金投入和监管力度,而且还需要各级医院进一步完善组织和管理,并重视全员培训。

近10年来,静脉输液治疗得到快速发展,特别是中心静脉导管置管[1].我科从2005年开始广泛开展中心静脉置管(CVC)和经外周中心静脉置管(PICC).在使用CVC、PICC置管化疗的过程中出现了一些罕见的并发症,报告如下.