目的 观察品管圈在降低硬式内镜器械损坏发生率的应用效果.方法 通过品管圈活动方式,分析其对降低硬式内镜器械损坏中的应用效果.结果 品管圈活动后,硬式内镜器械损坏的发生率由开展前的0.51％下降到开展后的0.12％,活动前后比较,差异有统计学意义(P＜0.05).影响因素主要有圈员在工作责任感、积极性、解决问题的能力、团队凝聚力、沟通协调、操作手法方面的能力显著提高.结论 开展品管圈活动有利于降低硬式内镜器械损坏发生率.

文身是指外源不容性的色素机械地引入真皮而使皮肤产生的一种永久性色素斑[1].外源性文身包括修饰性文身和外伤件文身两种,如文眉、文眼线、文唇等修饰性文身,以及车祸、爆炸等意外伤害引起的异常色素沉着[2].自1998年1月至2010年1月,笔者采用MedliteⅡ型Q开关Nd:YAG激光仪(美国康奥公司生产)对5856例外源性文身患者进行治疗,获得了较满意疗效.现报道如下.

目的 观察应用Q开关Nd:YAG激光治疗色素沉着-息肉综合征中色素沉着的临床疗效及不良反应.方法 自2001年1月至2008年12月,采用波长1064 nm,光斑直径2～4mn,能量密度4.8-6.4 J/cm2,脉宽10ns的Q开关Nd:YAG激光,对19例色素沉着-息肉综合征患者的色素沉着进行1-6次的治疗,每次治疗间隔3个月,并根据治疗前后的对比照片判定疗效,判定标准分为Ⅳ级.结果 治疗后随访所有患者3～6个月,治愈者13例,占68.4%;显效者5例,占26.3%;有效者1例,占5.3%.总有效率达100%,而且治疗效果与治疗次数成正相关;无瘢痕及皮肤质地、唇红色素的改变等并发症出现.结论 Q开关Nd:YAG激光治疗色素沉着-息肉综合征中的色素沉着具有疗效满意率高、不良反应少等优点,值得临床使用.

完全胃肠外营养(TPN)是近20年发展起来的一种起着 "人工胃肠"作用的治疗措施.胃肠外营养支持在临床中起着重要的作用,特别是对一些如消化道瘘、急性重症胰腺炎等,以禁食、水为主要治疗手段的疾病.建立1条有效的静脉通路是实施TPN的首要条件.传统的方法有外周静脉营养和锁骨下静脉穿刺中心静脉营养,两者均有一些不足,如并发症多、易破坏静脉、输入困难等,而影响TPN的实施.我科应用外周静脉穿刺中心静脉置管(简称PICC)进行TPN,取得了较好的疗效.此方法操作简单、血管损伤小、管道保留时间长,利于保护外周静脉,又避免了传统锁骨下静脉穿刺行中心静脉营养的并发症.现将PICC护理体会介绍如下.

目的 观察GentleLASE plus激光脱毛治疗的临床疗效.方法 对898例患者治疗1079个部位,选择波长755 nm,光斑直径10 mm,能量密度为16～24 J/cm2;一般治疗3～6次,每次间隔6～8周.结果 本组患者共898例(1079个部位),均获随访6个月,治疗后无水泡、感染及瘢痕形成.其中500个部位治疗1～3次,432个部位治疗4～6次,其余147个部位均治疗6次以上.四肢和腋窝的疗效较其他部位好.结论 采用755 nm翠绿宝石激光脱毛治疗,疗效持久、微创,无不良反应发生.

Objective To observe the therapeutic effect and side effect of Q-switched Nd:YAG laser irradiation on naevus fuscocaeruleus zygomaticus(NFZ). Methods A total of 280 cases were treated with 1 064nm wave length laser.The diameter of therapy spot was 3～4mm, pulse duration was 10ns,and energy density was 9～11 J/cm2. The therapeutic effect was judged according photograph took before treatment and 3～6 months after treatment. The judgment standards of therapeutic effect were classified into Ⅳ grades. Results The therapeutic times ranged from 1～5.The interval of therapy was 3～12 months.107 cases(38.2%) were cured, and the average times of cure were 2.7.The total effective rate was 77.9%, and the therapeutic effect was positively related with therapeutic times.Hyperpigmentation was observed in 152 cases(54.3%). Conclusion Q-switched Nd:YAG laser has fairly good therapeutic effect on naevus fuscocaeruleus zygomaticus.There is almost no other side effect except the high occurring of hyperpigmentaion,and it is cleaned up slowly.

Objective To observe the clinical effect of facial scars were treated with Er:YAG laser. Methods We treated 472 patients of facial scars were treated with Er:YAG laser machine (wave length, 2940nm) made in USA. The handle shaft should focus on the treatment locations when we treated the patients. The skin eruption turned white and bleeded after laser irradiation. The scars could be cured after 3 times. The treatment interval was 1～2 months. Results In all of the 472 cases of scars, the curative rate was 55% . The skin reaction was slight. 20% of the patients showed hyperpigmentation, which could disappear after 1-6 months. Conclusion Er:YAG laser is a better way to treat scars, especially to superficial pitted scars.

目的探讨Vbeam血管激光治疗仪治疗鲜红斑痣及草莓状血管瘤的临床效果。方法应用美国生产的Vbeam血管激光治疗仪(波长595nm)治疗鲜红斑痣及草莓状血管瘤患者714例。根据血管的粗细适当选择脉宽及能量密度。观察皮肤反应,以皮肤变灰色为准。一般需多次治疗,每次间隔1个月,治愈为止。结果治疗效果满意,显效率88%以上。无色素减退及增生性瘢痕形成。结论Vbeam血管激光治疗仪是目前治疗血管性疾病的理想选择。治疗后反应轻微,无瘢痕及色素减退等副作用。

<正>1998年1月～2008年1月,我们采用MedliteⅡ型Q开关Nd:YAG激光仪治疗外源性文身5215例,取得了显著效果,现报道如下。

Objective Observing therapeutic effect and safety property of oral acitretin combing with NB-UVB phototherapy for psoriasis.Methods The cure term:Oral acitretin combing with NB-UVB phototherapy on three times a week to treat 53 cases patients of psoriasis,for 6 weeks.The contrast team: monotherapy with NB-UVB,three times a week to treat 50 cases patients of psoriasis.Results The present study showed that oral acitretin combing with NB-UVB was more effective than monotherapy with NB-UVB.Compared with UVB alone,the combination therapy can shorten the treatment frepuency and reduced total UVB exposure dose.Conclusion The combination therapy is a recommendable methed for treating psoriasis.

Objective: To observe the dynamic change of the proliferative activity of fibroblasts in the hypertrophic scarring models in rabbit ears and investigate the influence of 595nm Vbeam laser on them.Methods: 20 white rabbits were used to establish the models of hypertrophic scar in ears,the material was taken on different time,studying the changes of fibroblasts with 595nm Vbeam laser irradiation and comparing with the controls during the process of forming hypertrophic scars,and the expression of proliferation cell nuclear antigen(PCNA) protein was detected by immunohistochemical method.Results: The expression of PCNA increased gradually after re-epithelization,and the peak of the expression of PCNA was at 4th week.The expression of PCNA in the 595nm Vbeam laser irradiation group was obviously weaker than that in the control group since one week after re-epithelization(P0.05).There was significant difference between the two groups(P0.01).Conclusion: 595nm Vbeam laser irradiation can inhibit the proliferative activity of fibroblasts in hypertrophic scars of rabbit ears,which has obvious effect on preventing and treating hypertrophic scars.

目的:观察595nmVbeam激光照射对增生性瘢痕动物模型伤口愈合中成纤维细胞增殖的抑制作用。方法:实验于2004-10/2005-06在哈尔滨医科大学附属第二医院激光美容中心完成。成年大耳白兔20只,建立兔耳腹侧面增生性瘢痕模型,上皮化后切取一组瘢痕8处,然后将瘢痕随机分为激光治疗组和对照组,激光治疗组在创面上皮化后按一定参数进行激光照射,开始时每周照射1次,1个月后改为每两周照射1次,共两个月。对照组不进行治疗。在上皮化后1,2,4,6,8周分别切除两组增生性瘢痕各8处,每次取材前用游标卡尺测量瘢痕厚度,对切取组织进行苏木精-伊红和Masson染色,并对上皮化后4周组织进行电镜观察,对上皮化和上皮化后4周组织进行增殖细胞核抗原蛋白测定,对比研究在瘢痕形成过程中595nmVbeam激光照射对兔耳增生性瘢痕成纤维细胞的影响,观察成纤维细胞超微结构的改变,检测增殖细胞核抗原蛋白表达变化。结果:实验大耳白兔20只全部进入结果分析。兔耳增生性瘢痕经595nmVbeam激光照射后,按不同时间段取材与对照组比较,①瘢痕厚度明显变薄:创面上皮化后即出现增生块高出于皮面,且不断增厚,在上皮化后4周时最高,以后逐渐下降。激光照射（即上皮化后）2,4,6周后激光治疗组瘢痕增生厚度显著小于对照组激光治疗组:（1.95±0.08）,（2.16±0.09）,（1.53±0.08）mm;对照组:（2.04±0.09）,（2.37±0.11）,（1.68±0.09）mm,P＜0.05。②苏木精-伊红染色显示不同时间取材的兔耳增生性瘢痕组织对照组真皮层明显增厚,为周围正常真皮厚度的三四倍。而激光治疗组真皮层较对照组变薄。Masson染色显示瘢痕胶原纤维呈蓝色,对照组可见蓝染较深的胶原纤维,外形粗大,排列杂乱无章。而经激光照射的瘢痕虽然也可见蓝染的胶原纤维,但与对照组比较蓝染变浅且纤细,胶原排列也趋于一致。③高倍镜下成纤维细胞计数在上皮化后随时间逐渐增多,在上皮化后4周时达到高峰,以后又下降,但在上皮化后1,2,4,6,8周激光治疗组成纤维细胞数量与对照组比较未见明显减少（P＞0.05）。④透射电镜观察显示经595nmVbeam激光照射4周后成纤维细胞核变小、畸变,胞质中细胞器减少,细胞功能不活跃,线粒体空泡变性,细胞周围的胶原呈溶解状态。⑤增殖细胞核抗原蛋白表达激光治疗组较对照组明显减弱（增殖细胞核抗原阳性细胞反应率上皮化后为18.33%,上皮化后4周,激光治疗组为41.93%,对照组为64.26%,P＜0.05）。结论:595nmVbeam激光照射可抑制兔耳增生性瘢痕成纤维细胞的增殖过程,应用595nmVbeam激光预防和治疗瘢痕可行。

患者女,50岁.因间断性咯血2个月余于2005-04-04入院.该患入院前2个月起无明显诱因出现间断性咯血,无发热,无咳嗽、咳痰,无胸闷、胸痛、心悸.1个月后出现咽部异物感,无明显体重下降.

【Objective】 To evaluate the value of fibrobronchoscope in locating for surgical hemostasis of massive hemoptysic patients.【Methods】 Eleven patients who had been suffered from massive hemoptysis were collected.In order to judge the hemorrhagic sites,6 patients were given tracheal intubation via fibrobronchoscope or thoracotomy and lateral incision of trachea to enter the trachea;while the rest(5 patients) were based on lung CT and clinical sign.Then all of them were given segmentectomy or lobectomy.【Results】 The 6 patients who were locating via fibrobronchoscope did not relapse,while among the 5 patients locating via lung CT and clinical signs,1 patient died from another massive hemoptysis and 2 patients were given second operation because of second hemoptysis.【Conclusions】 Fibrobronchoscope can confirm the location of the massive hemoptysis accurately.It plays an important auxiliary role in ascertaining the scheme of surgical therapy.

<正>患者男性,61岁,2005年11月12日入院。该患者2年前无明显诱因出现声音嘶哑,舌痛,舌体肿大,呛咳及吞咽困难。曾于当地医院经喉镜检查,结果不详。症状逐渐加重。1年前又出现胸闷,双下肢水肿,以“心包积液”收入我院心内科治疗,后症状缓解出院。10个月前上述症状进一步加

我科于1998年1月-2004年1月应用Q开关Nd:YAG 激光治疗太田痣819例,取得了满意疗效,现总结如下.

目的总结31例经腹腔镜灌洗治疗重症急性胰腺炎的护理体会.方法对31例经腹腔镜灌洗引流治疗SAP患者术后施行心理护理,引流护理,营养护理以及各种基础护理.结果除1例患者因术后并发MOF、DIC死亡外,其余30例均痊愈出院,随访6个月无复发.结论加强腹腔镜灌洗引流治疗重症急性胰腺炎术后的护理,可有效地降低SAP的死亡率,减少并发症.

Objective To explore the effect of cosmetics on patients who have facial telangiectasis. Methods We treated 252 cases of facial and nasal telangiectasis with Vbeam laser machine made in USA. The wavelength is 595 nm. We chose proper pulse width and energy output according to the vascular diameter. The handle shaft should focus on the treatment locations when we treated the patients. The skin eruption turned grey and the telangiectasis disappeared after laser irradiation. The stellate telangiectasis and nasal telangiectasis could be cured after 1～7 times of laser irradiation. The puactate or filamentous telangiectasis and erythema, heliotrope patchy telangiecatasis could be cured after 1～3 times. The treatment interval was 1～2 months. Results All of the 252 cases of facial telangiectasis were cured. The cure rate was 100 %. The skin reaction to the laser irradiation was slight. 30 % of the patients showed hyperpigmentation, which could disappear spontaneously after 1～6 months. In addition, we found patients' faces become more smooth and less wrinkles. Conclusion Satisfied effects are archieved in facial telangiectasis with Vbeam laser machine. This treatment has no scar and no recurrence with only slight skin reaction. And the skin becomes smooth and less wrinkles. Therefore, it is a good choice to treat facial telangiectasis with Vbeam laser irradiation.

Aim: To investigate the effect of laser with 595 nm wave-length choosing various energy and pulse on the superficial vessels and the change of peripheral tissues of vascular diseases by using blood vessel of ear in rabbits. Methods: V-Beam laser treatmontor with 595 nm wave-length produced by American Candela Company and 12 female big-ear white rabbits were used. The rabbits were divided into four groups, with three in each group. Group one: energy 13 J, pulse 40 ms; Group two: energy 13 J, pulse 20 ms; Group three: energy 13 J, pulse 10 ms; Group four: control group without treatment. Results: After one-day treatment, number of big and medium vessels decreased obviously in group one, number of medium vessels decreased obviously in groups one, two and three. After 3 weeks, the number of vessels increased. Conclusion: Using proper (but not too high) energy on the basis of suitable pulse has the selective effect on different caliber vessels, and cannot cause the injury of skin, and can shorten the course of treatment through controlling the cycle of treatment severely.

V-Beam激光治疗机,是595 nm波长的长脉冲激光治疗机,在治疗过程中可能产生一过性的色素沉着,但不损伤皮肤,不留瘢痕,是目前较为理想的集治疗与美容为一体的激光治疗机.从激光的治疗原理中可以看到,595 nm波长是血红蛋白吸收能量较好的一个波长,因此主要用于血管性疾病的治疗.此外,周围组织也会吸收一定的能量,这部分能量会使组织产生什么样的变化,达到什么样的治疗效果,是本研究所要探讨的问题.