目的 分析神经外科手术患者医院感染特点与影响因素.方法 选取2015年1月至2018年3月在我院行神经外科手术且发生医院感染的36例患者作为研究对象,对其资料进行回顾性分析,详细记录患者资料及感染发生情况,进行医院感染特点与影响分析.结果 在36例患者中,呼吸道感染86.11%,切口感染8.33%,泌尿道感染5.56%.对所选患者医院感染影响因素进行分析,差异显著(P<0.05).结论 神经外科手术患者医院感染中以呼吸道感染较为常见.具体影响因素包括手术时间、类型及高血压疾病.上述因素需引起医师及相关人员注意,以降低医院感染发生率.

Objective To investigate the significance of early diagnosis and prognosis for severe traumatic cerebral injury combined with cerebral salt wasting and abnormal secretion of antidiuretic hormone syndrome.Method 47 cases of severe traumatic cerebral injury were divided into syndrome of inappropriate antidiuretic hormone secretion (SIADH) group and cerebral salt wasting (CSWS) group according to CSWS, SIADH diagnostic criteria. Laboratory tests were compared between groups. Prognosis and hazards factors were analyzed by Cox proportional analysis. Results ① Atrial natriuretic peptide (ANP), brain Natriuretic Peptide (BNP) of CSWS group reduced after treatment, which had a significant difference compared to the treatment (P<0.05 orP<0.01).②After treatment, GCS score<3 and 5 point in CSWS, SIADH patients were significantly lower than four point group (P<0.05).④Cox proportional hazards model analysis showed that skull fracture, cerebral hematoma, blood osmolality, sodium, hydrocortisone (HC), aldosterone (AL) were hazard factors for CSWS, SIADH. ANP, BNP had obvious relevance with CSWS.Conclusion CSWS, SIADH can be identified by CVP, ADH, ANP and BNP after severe traumatic cerebral injury, which have a major impact on the prognosis.

目的:探讨鞍区肿瘤术后合并脑性盐耗综合征(CSwS)的预后相关影响因素.方法:鞍区肿瘤术后患者49例,按照是否发生CSWS分为单纯肿瘤术后组(SS)29例和术后合并CSWS(SC组)20例.随访1年,采用格拉斯哥预后量表(GOS)评价患者预后,Kaplan Meier法进行生存分析,Cox模型分析患者预后危险因素.结果:入院时,SC组血钠、血渗透压低于SS组(P＜0.05),而24h尿钠、24h尿量、血清中心钠素(ANP)、脑钠肽(BNP)、皮质醇(HC)、醛固酮(AL)均高于该组(P＜0.05).随访1年后,SS组无死亡;SC组死亡5例,差异有统计学意义(P＜0.05);GOS4分组BNP、HC、AL含量均低于＜3分组(P＜0.05);5分组ANP、BNP、HC、AL含量均低于＜3分组、4分组(P＜0.05).Cox模型分析显示,鞍区肿瘤手术方式、肿瘤类型、血钠降低程度、中心静脉压(CVP)、ANP、BNP、HC、AL水平为鞍区肿瘤术后影响患者预后的危险因素(P＜0.05或0.01).结论:鞍区肿瘤术后合并CSWS患者ANP、BNP、HC、AL在治疗初期明显增高,肿瘤手术入路方式、肿瘤类型、血钠降低程度、CVP、ANP、BNP、HC和AL含量对患者的预后有着明显的影响.

目的 探讨鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症的早期临床诊断意义及预后分析.方法 选取在我院就诊的48例鞍区肿瘤术后或重度颅脑损伤合并中枢性尿崩症患者,按照诊断类型分为短暂性尿崩症组(A组),持续性尿崩症组(B组),三相性尿崩症组(C组),检测患者治疗前后实验室指标,同时分析患者预后情况.结果 ①治疗结束后,A组、C组在血钠、血渗透压、24尿钠及24h尿量均降低,同治疗时比较,差异具有显著性意义(P＜0.05或P＜0.01);治疗后A组、C组血渗透压,24h尿钠均低于B、C组(P＜0.05);②治疗后经GOS评分,B组、C组4分及以下患者所占比例明显高于A组(P＜0.05),而5分者均低于A组(P＜0.05);③患者随访1年,A组患者生存状况良好,与B组死亡3例、C组死亡3例相比较,差异有统计学差异(P＜0.05);④B、C组ADH术后先下降后上升,但未能达到正常水平,A组先升高后下降,后恢复至正常水平.结论 鞍区肿瘤术后、重度颅脑损伤合并CDI患者的预后与血ADH水平、24小时尿量有一定的相关性,不同类型CDI预后生存状况存在一定差异.

Objective It is to explore the protecting effect of ischemic precondition(IPC) on liver tissue,and to explore the secure time limit of liver tissue tolerance for ischemia after IPC.Methods 42 SD rats were randomly divided into sham operation group,control group and experimental group.The control group and experimental group were both divided into 3 groups according to different time limit.The contents of SOD,TNF-α,MDA and ALT of each group were determined.The liver tissue was observed under light microscope and electric microscope.Results After reperfusion for 60 min,there were significant differences in the contents of SOD,MDA and ALT in every time limit between experimental group and control group.But there was no significant difference in the content of TNF-α in 60?min between experimental group and control group.The examination results of morphology under light microscope were corresponded with that under electric microscope.Conclusion IPC can obviously relieve liver injury induced by ischemic-reperfusion in liver tissue.After IPC,50?min after porta hepatic been blocked may be the safe time limit for tolerating ischemia in liver tissue in SD rats.

目的:通过实验了解缺血预处理对肝组织的保护作用,并探讨缺血预处理后肝组织耐受较安全缺血的时限。方法:42只SD大鼠分为假手术组(SO组)、缺血再灌注组(IR组)和预处理+缺血再灌注组(IPC+IR组)3个大组,IR组及IPC+IR组根据肝缺血时间40、50、60min时限不同又各分为IR40、IR50、IR60组及IPC+IR40、IPC+IR50、IPC+IR60组,再灌注时间均为60min,各组均为6只。观察指标为超氧化物歧化酶(SOD)、肿瘤坏死因子(TNF-α)的含量,并行肝组织光镜、电镜观察。结果:再灌注60min后,IPC+IR各组SOD与IR组比较差异有统计学意义(P<0.05)。IPC+IR60组TNF-α与IR60组比较差异无统计学意义(P>0.05)。形态学上,病理切片及透射电镜结果与实验结果相符合。结论:缺血预处理可以明显减轻肝组织缺血再灌注所致肝损伤,延长阻断时间,本实验的研究结果提示预处理后肝门阻断50min可能是SD大鼠肝组织能够耐受缺血的较安全时限。

对34例嵌顿痔采取急诊手术切除加注射安氏化痔液,取得满意疗效.

我们用安氏化痔液灌肠治疗溃疡性结肠炎28例,效果理想,报告如下.