目的 分析某医院体检人群高尿酸血症(HUA)的检出情况.方法 2019年1月—2019年12月在某医院健康管理中心参加体检者共计2876例,其中男2558例,女318例,比较不同年龄、性别、BMI指数的人群血清尿酸水平.结果 2876例受试者中,共检出高尿酸血症881例,检出率为30.63％.其中男性2558例检出846例,检出率为33.07％;女性318例检出35例,检出率为11.01％.2876例受试者血清尿酸水平为(377.53±87.21)μmol/L,男性2558例受试者血清尿酸水平为(389.50±82.14)μmol/L,女性318例血清尿酸水平为(281.28±64.06)μmol/L;且高尿酸血症中肥胖的发生率(68.10％)显著高于非高尿酸血症肥胖发生率(11.98％).结论 某医院体检人群HUA患病率较高,且有年轻化趋势,应及时给予受试者相关的健康管理建议.

目的:探索一种关节镜下Latarjet手术的改良方法,并评估应用该术式治疗复发性肩关节前脱位的疗效.方法:选取2018年1月至2019年1月期间接受改良Latarjet手术治疗的11例患者,所有患者术前均诊断为复发性肩关节前脱位.术中采用改良方法预置导针,定位喙突移植物位置,并应用"旋转法"调整喙突高度,避免喙突骨量丢失.手术前、手术后第1天、术后1年行ASES评分、Rowe评分、VAS评分以及CT检查,评估疗效.结果:所有病例术后平均随访13.18个月(12～16个月),随访期间无复发脱位及半脱位,恐惧试验均为阴性.术后1年,ASES评分为98.18±2.17,Rowe评分为97.27±3.44,VAS评分为0.18±0.40,与术前ASES评分(70.61±7.35)、Rowe评分(39.09±7.35)、VAS评分(3.27±0.79)比较差异均具有统计学意义(P<0.05).术后CT检查结果显示:所有病例均无移植物外凸;9例患者的喙突骨块与关节盂完全平齐,2例患者喙突偏内侧,均<2 mm;10例患者的喙突骨块位于2:00～5:00位置,1例过低,超过5:00;喙突骨吸收率,其中0级5例,Ⅰ级6例,未见Ⅱ、Ⅲ级病例;6例患者骨吸收均发生于β螺钉附近.结论:改良关节镜下Latarjet手术治疗复发性肩关节前脱位是一种可靠且有效的术式,具有喙突移植物位置优良及骨吸收率低的优点.

急性肠系膜缺血( AMI)又称急性肠系膜血管缺血性疾病,是指肠道血液灌注突然减少,进而导致肠坏死,占急腹症的1％ ～2％,死亡率高达 50％ ～70％.其病程包括血供不足、炎性损伤及肠坏死3 个阶段.发病原因主要包括动脉血栓形成、动脉栓塞、静脉血栓形成及非闭塞性缺血等,其中急性肠系膜上动脉( SMA)栓塞( ASMAE)是最常见的病因,约占AMI的40％ ～50％[1-2].ASMAE一般表现为严重的急性单侧椎弓根性疼痛,缺乏明显的特异性体征,早期诊断存在困难,通常在晚期才能确诊.

Objective:To evaluate the application effect of mitomycin C in dacryocystorhinostomy for the treatment of chronic dacryocystitis.Methods:The clinical data of 45 eyes of 40 cases of chronic dacryocystitis who received dacryocystorhinostomy under nasal endoscope from Dec. 2013 to Dec. 2018 in the 988th Hospital of PLA were collected and analyzed retrospectively. All cases were divided into two groups.The treatment group, 22 eyes of 21 cases received dacryocystorhinostomy anastomosis applied with mitomycin C cotton for 5 minutes.The control group, 23 eyes of 19 cases received dacryocystorhinostomy without mitomycin C cotton. The followed-up time was 6 months. The efficacy of the two groups were observed and compared.Results:In the treatment group, 19 eyes were cured, 2 eyes were improved, and 1 eye was ineffective (relapsed). In the control group, 11 eyes were cured, 4 eyes were improved, and 8 eyes were ineffective (relapsed). The difference in effective rate between the two groups was statistically significant ( χ2=4.670, P=0.032). The intraoperative blood loss in the treatment group was (35±10) ml, which was less than the (40±15) ml in the control group. The difference was statistically significant between the two groups ( t=2.096, P=0.019). There was no significant difference in time of operation between the two groups ( t=1.548, P=0.065). The anastomotic formation time of dacryocystorhinostomy in the treatment group was shorter than that in the control group ( t=3.354, P=0.001). The anastomotic closure was found in 1 eye (4.55%, 1/22) of the treatment group, and 8 eyes (34.78%, 8/23) in the control group. Conclusion:Application of mitomycin C in nasal endoscopic dacryocystorhinostomy for the treatment of chronic dacryocystitis can significantly reduce the recurrence rate.

儿童鼻窦炎对儿童生长发育、身体健康影响较大,近年来颇受重视.但儿童鼻窦炎与成人鼻窦炎的发病原因、发病机制、发病特点有明显不同,且由于儿童鼻腔、鼻窦生理、免疫系统发育的不成熟,因此儿童鼻窦炎的诊治和成人相比差异较大,具有其特殊性.本文就儿童鼻窦炎的主要症状、体征、致病菌、致病机制、病因、诊断及治疗等给大家进行科普介绍,以更好地保证儿童的健康成长.

The diameter of femoral vessels was angiographically explored in pediatric patients with congenital heart disease (CHD) and compared with anthropometric and demographic indexes.A total of 153 pediatric patients younger than 3 years old were recruited. The sex, age, weight, and height of patients were recorded daily, and the body surface area (BSA) was calculated with the Mosteller formula.The values of mean left-right diameters were 3.13 (0.32) mm for the femoral artery (FA) and 5.14 (0.68) mm for the femoral vein (FV). The FA diameter (FA-Dm) and FV diameter (FV-Dm) were clearly related (R = 0.84, P < .001), and the FA-Dm/FV-Dm ratio ranged from 0.61 to 0.622. The diameters of femoral vessels were significantly correlated with age, height, weight and BSA (R = 0.63 to 0.73, P < .001). The FA-Dm and FV-Dm were most closely associated with the height of patients (FA-Dm: R = 0.73, P < .001; FV-Dm: R = 0.69, P < .001).The FV-Dm and FA-Dm were consistent with the weight, height, age and BSA in the surveyed pediatric patients. The FA-Dm and FV-Dm were closely associated with the height of pediatric patients. Furthermore, the FA-Dm/FV-Dm ratio was stable in these patients. Such estimations could help clinicians select the appropriate diameter of cannulation needles and catheters for interventional therapy pediatric patients with CHD.

目前军队医院新编制设置了统管全院训练的部门,如何按照新的训练标准和要求,解决年度训练计划不够全面,设置训练内容、场地不够科学,人员和装备与未来战争快速化、模块化不衔接是卫勤训练中心建设面临的挑战和难题.本文就我院近几年训练实际和创新方法进行了总结,旨在探索卫勤训练中心统筹指导、监督、保障军事训练的工作模式,以期提高军事训练整体质量.

目的 探讨现阶段团级医院战备训练组织中的问题,提出相应解决对策,提升现代战争条件下军队团级医院卫勤保障能力.方法 基于目前团级医院卫勤战备训练客观实际,逐步剥离表象,抓住训练根源问题,探寻解决问题的对策.结果 现阶段团级医院卫勤战备训练中最为突出的4大问题:部分官兵战斗意志薄弱,战备意识淡薄;战备训练内容方法陈旧,形式主义严重;卫生训练硬件设施落后,装备物资缺乏;医疗分队人员紧缺,骨干力量匮乏.解决对策:强化首战用我的战备观念;围绕保障需求,更新战备训练内容;灵活保障训练装备物资,确保组训高质量执行;配齐配强骨干队伍,注重人才培养保留.结论 基于团级医院卫勤战备训练存在的问题而提出的对策具有实用价值.

鼻出血对于儿童来说比较常见.但作为家长,遇到孩子鼻出血,往往不知所措,就此,笔者简单介绍了儿童鼻出血的发病原因、发病特点及如何预防和治疗,以飨读者,寄希有所帮助.

听诊器是临床医生常用的医疗工具, 为非一次性医疗器械. 医生在工作时听诊器头直接接触患者皮肤,由于需要先后诊治多名患者,因此同一个听诊器多重复使用,由此导致的听诊器头污染应该引起重视[1]. 姜建萍等介绍[2] 随机抽查临床医生应用的 60 个听诊器头进行菌培养,结果有 52 个(86.67％)发现有细菌污染. 我们曾经检测临床医生常用听诊器头(每天至少听诊 15 人次)48 个,全部有细菌污染.《医院消毒技术规范》第三版要求, 听诊器头在使用前必须消毒且消毒后细菌培养<10 cfu/cm2,不得检出任何致病菌.由于目前临床上医生工作时间紧张、消毒听诊器方法繁琐等原因,很难在实际工作中执行听诊器头一用一消毒[3]. 大多数时候听诊器头均未进行消毒而是直接用于下一个患者. 为了避免听诊器头污染及因此导致的交叉感染,我们设计制作了一次性听诊器头套.

目的:观察鼻内镜下中下双鼻道联合入路治疗真菌性上颌窦炎的临床效果及安全性.方法:选择真菌性上颌窦炎100例,随机分为观察组和对照组各50例.观察组采用鼻内镜下上颌窦中下鼻道联合开窗术治疗,对照组采用鼻内镜下泪前隐窝入路治疗.观察比较两组术中出血量、手术时间;术后随访1年,比较两组并发症发生情况,以及治愈和复发情况.结果:(1)观察组术中出血量(80±10)ml,非常显著少于对照组的(150±20)ml(P＜0.01);手术时间(30±5)min,非常显著短于对照组的(50±8)min(P＜0.01).(2)术后随访1年,观察组无一例发生溢泪及术侧鼻腔粘连、鼻腔狭窄、鼻腔过畅等并发症;对照组发生并发症16例(32.0％),其中,溢泪3例,术侧鼻腔粘连5例、鼻腔狭窄2例、鼻腔过畅6例.两组并发症发生率比较,差异非常显著(P＜0.01).观察组治愈48例(96.0％),复发2例(4.0％);对照组治愈49例(98.0％),复发1例(2.0％);两组治愈率、复发率比较,均差异不显著(P＞0.05).结论:鼻内镜下中下双鼻道联合入路治疗真菌性上颌窦炎,治愈率和复发率与鼻内镜下泪前隐窝入路治疗相当,而手术时间、术中出血量及术后并发症却较后者非常显著缩短或降低,值得临床推广应用.

Objective To investigate the efficacy of application of Norton in nasal endoscopic dacryocystorhinostomy.Methods The data of 100 eyes of 100 cases of chronic dacryocystitis who received dacryocystorhinostomy from Dec.2012 to Dec.2017 were analyzed retrospectively.All cases were divided into 2 groups randomly.The treatment group,50 cases,were treated with Norton cotton slice in nasal cavity before operation,and the control group,50 cases,were treated with adrenaline cotton slice before operation.The nasal mucosa was contracted by placing cotton slices twice,once per 5 minutes.in the nasal cavity 10 minutes before operation.All cases underwent endoscopic dacryocystorhinostomy.Results There were 49 cases cured,1 case improved and no case of ineffective in the treatment group,and in the control group 45 cases cured,3 cases improved and 2 cases ineffective.The difference of total effective rate was not statistically significant between the two groups (P =0.179).The treatment group had clear visual field,wide visual field and sustained operation.The blood pressure was stable,heart rate fluctuated slightly,less intraoperative hemorrhage.No bleeding occurred after operation.The operation time was shorter,and no obvious complication occurred during and after operation.Conclusion Application of Norton in dacryocystorhinostomy under nasal endoscope has advantages of quick onset,long curative effect and less adverse reactions.

目的 探索急性心肌梗死(acute myocardial infarction,AMI)住院幸存者预后的相关危险因素及出院时低钠血症对预后的预测价值.方法 选取2016年5月—2017年5月就诊于解放军总医院第六医学中心(原海军总医院)确诊为AMI的388例患者为研究对象,记录基线资料、入院时生命体征、实验室检查、诊疗记录和出院用药等资料.对所有患者进行为期1年的随访,对可能影响AMI患者预后的危险因素进行单因素分析,多因素COX回归进一步评价存在统计学意义的所有因素对AMI患者预后的影响程度.结果 单因素分析结果显示,与存活组比较,死亡组患者年龄大,心率高,LVEF低,Killip分级高,行PCI少,高脂血症和心梗史更常见;入院时血肌酐、hs-CRP和NT-ProBNP水平高,血红蛋白水平低,出院时血钠水平低;使用阿司匹林、β-受体阻断药和ACEI/ARB少,使用利尿药多.多因素COX比例风险模型结果显示,出院时低钠血症、Killip分级≥2、住院期间行急诊经皮冠脉介入治疗(percutaneous coronary intervention,PCI)、左心室射血分数(left ventricular ejection fraction,LVEF)和N端前脑钠肽(N-terminal pro-brain natriuretic peptide,NT-ProBNP)是12个月内患者死亡的独立预测因子,差异均具有统计学意义(P<0.05).结论 出院时低钠血症可作为预测AMI患者预后不良的独立危险因素,有助于临床医师对AMI患者进行危险分层,从而制定出合理的治疗方案,对改善AMI患者预后意义重大.

目的 评价埃索美拉唑治疗幽门螺旋杆菌(Hp)阳性胃溃疡的疗效.方法 入选78例患者,随机分为治疗组40例、对照组38例,两组患者治疗前的一般情况具有可比性.对照组给予奥美拉唑20mg,口服,每日2次,疗程2周;治疗组给予埃索美拉唑20 mg,口服,每日2次,疗程2周.同时两组均给予阿莫西林和克拉霉素治疗.结束时复查胃镜并检测幽门螺旋杆菌.结果 溃疡的愈合情况、症状缓解情况和Hp根除有效率,两组相比,差异均有统计学意义.结论 埃索美拉唑治疗Hp阳性胃溃疡疗效肯定,有临床应用价值.

进行高原地区卫勤保障是军队卫勤力量的重要职责.野战医疗方舱是较为成熟的野战机动医疗系统,可灵活机动地实施快速投送和全面高效的医疗救治;展开后与其他网架卫生帐篷组合,可组成野战方舱医院.本文分析了某军队医院组建的野战方舱医院在高原地区训练中的伤病员救治和后送情况,认为,伤病员后送原因主要有严重急性高原反应、卫勤保障机制单一、缺少专科设备和器械、消毒灭菌措施有待加强等;并探讨了方舱医院提高伤病员救治能力的对策.

Objective To explore the effect of newly developed XSTAT 30 hemostatic apparatus for US army TCCC. Methods The characteristics and application effects of XSTAT 30 were described from the aspects of design, indication and contraindication, operation and precautions, application safety and etc. Results In tactical echelons XSTAT 30 could be used for the hemostasis of penetrating fragment injuries at groin, armpit and etc. Conclusion XSTAT 30 behaves well in the hemostasis at the junction sites, and is worthy referencing for designing likely devices of the PLA.

The introduction of technical feature and medicinal material support of the US military fluid resuscitation in tactical combat casualty care (TCCC),including starting intravenous (Ⅳ) access or intraosseous (IO) route、resuscitation fluids of choice、management plan for resuscitation.In order to care casualty preferably in tactical area of the PLA,we put forward opinions and suggestions,mainly including:(①)Rational allocation of medicinal material support in tactical area.(②)Further improve capability of blood support in tactical area.(③)Further study the theory about tactical trauma recovery.

The application of four kinds of hemostatic tools in tactical combat casualty care (TCCC) of foreign armies was introduced,including extremity tourniquet,junctional tourniquet,hemostatic dressing.and elastic bandage as well as tranexamic acid.The above hemostatic tools were described from the aspects of structure,operating process,application range and technical points,and the histories of some tourniquet were also expounded.The problems of Chinese PLA were analyzed in designing and developing hemostatic tool.Some suggestions were put forward such as enhancing the practicability and portability of hemostatic tool,rational allocation of TCCC drugs and instruments and etc.

Objective To discuss the curative effect of nicorandil on angina pectoris (AP) in patients with coronary heart disease (CHD) complicated by type 2 diabetes mellitus (T2DM) after percutaneous coronary intervention (PCI). Methods CHD patients (n=92, male 52, female 40, aged from 59 to 82 and average age=67.3±10.5) were chosen from the Chinese PLA 153 Central Hospital from Jan. 2013 to July 2016. All patients with CHD complicated by T2DM had relapsed AP after received PCI. The patients were divided into test group and control group (each n=46) according to random digital table. On the base of class 2 preventive treatment of CHD, the test group was orally given nicorandil and control group, isosorbide mononitrate for 4 weeks. The attack times, duration and outcomes of electrocardiogram (ECG) of AP after PCI were recorded in all patients, and curative effect was reviewed in 2 groups. The adverse reactions were recorded during therapeutic period. Results There were 15 (32.6%) patients with significant curative effect, 25 (54.4%) with efficacy and 6 (13.0%) without curative effect in test group, and 7 (15.2%) with significant curative effect, 24 (52.2%) with efficacy and 15 (32.6%) without curative effect in control group. The total effective rate was higher in test group than that in control group (87.0% vs. 67.4%, P<0.05). During the therapeutic period, there were adverse reactions were observed but no hypotension and functional lesions of liver and kidney in 2 groups. The patients in control group had headache, nausea and facial blushing, and those in test group had headache, facial blushing and nodal bradyarrhythmia, and these symptoms were not treated specially and relieved by themselves. The comparison in incidence of adverse reactions showed that difference had no statistical significance between 2 groups (P>0.05). Conclusion Nicorandil can significantly relieve AP with higher safety in patients with CHD complicated by T2DM.

The technical feature,appliance support and different care stages of the US military airway management in tactical combat casualty care (TCCC) were introduced with the emphasis on three key technologies including nasopharyngeal airway, the best position to protect the airway and surgical cricothyroidotomy.In order to take better care of casualty in tactical area of the PLA, we propose that medicinal material support for airway management in tactical area should be allocated rationally and airway management plans on typical traumatic scenarios in tactical area should be designed scientifically.