BACKGROUND Few data were known on surgical management of intracardiac-extending in patients with intravenous leiomyomatosis (IVL). METHODS From June 2007 to December 2014, six women (mean age, 39.3 ± 7.5 years; range, 24-55 years) with intracardiac-extending IVL were treated surgically at our hospital. Data were obtained from medical and pathological records, including characteristics of patients, surgical management, and follow-up. RESULTS Surgery was performed successfully in all patients. Of 6 patients, 4 underwent one-stage operation and 2 underwent two-stage procedures. Circulatory arrest with hypothermia was used for a cardiotomy combined with venotomy in 5 patients. Complete resection was done in 5 patients. There were no perioperative deaths or complications in any of the patients. Hospital stay was 11.2 ± 2.9 days (range 7-15 days). All patients were followed-up for a mean of 41.0 ± 19.1 months (range, 17-69 months) after surgery. A recurrence of pelvic mass was found in 1 patient, but no symptoms or intravenous mass were reported. No obstruction occurred in any patient with a venotomy. CONCLUSION Surgery is a better therapy for IVL and complete removal has favorable outcomes.

冠状动脉粥样硬化性心脏病（冠心病）是当今严重威胁生命和健康的主要疾病之一，在冠心病的诊断和治疗中，女性患者因其有雌激素保护作用，一直被视为冠心病低危人群，因此对女性患者的研究较少[1]。近20年来，随着医学科学的进步和冠心病常识的普及，男性患者的病死率不断下降，而女性却在上升[2]。因此，对女性冠心病患者进行科学的健康指导，提高女性健康水平是有意义的。针对女性冠心病患者这一特殊群体，既要重视疾病本身的治疗，又要针对不同致病危险因素及临床特点进行合理的健康指导。

Objective To investigate the effect of continuity of care outside the hospital for rehabilitation of military cadres of coronary artery bypass graft. Methods 83 military cadres of coronary artery bypass surgery were selected,continuity of care to carry out of observation group in 43 cases,and continuity of care not performed of control group in 40 cases.General discharge guidance and intermittent follow-up clinic were carried out in the control group.Information collected one year after hospital discharge of the two groups were compared. Results Higher appliance of medication,diet, exercise,and return visit rate in the observer group were higher than those of the control group,but the complication incidence of observer group was lower than that of the control group, the difference was statistically significant(P0.01 or P0.05). Conclusion The implementation of continuity of care after coronary artery bypass graft is better for rehabilitation.

Objective To observe the nursing effect of continuing nursing in the patients hospitalized in department of cardiovascular surgery. Methods The patients (n=100) were chosen from Jan. 2012 to Jun. 2013 and then randomly divided into observation group and control group (each n=50). After selecting excellent nursing backbones to act as full-time health educators, observation group was given appraisal by using the cognitive level measurement form of cardiovascular disease continuing nursing before nursing intervention. The control group was given routine nursing mode. Results After nursing intervention, in the familiarity appraisal of 4 level-1 dimension, knowledge related to diseases, treatments, rehabilitation and social life, the percentage of patients being very familiar with above-mentioned knowledge was 12.0%, relative familiar was 26.0%, and familiar was 46.0%in observation group. The percentage of patients being very familiar with above-mentioned knowledge was 6%, relative familiar was 14%, and familiar was 24%in control group. The difference had statistical significance between 2 groups (P<0.05). The patients’ satisfaction to nurses was 98.0%in observation group and 80.0%in control group (P<0.05). Conclusion Continuing nursing can improve the cognitive degree to the knowledge related to diseases, treatments and rehabilitation, and patients’ satisfaction to nurses in the patients hospitalized in department of cardiovascular surgery. The nursing efficacy is higher.

目的 研究连续护理对军队心脏瓣膜置换术后患者抗凝治疗依从性的影响.方法 根据是否实施连续护理服务,将心脏瓣膜置换术后患者分为对照组(2009年3月～2011年3月)34例和实验组(2011年4月～2013年4月)36例.通过调查问卷的方法,比较两组患者相关知识的掌握程度、国际化标准比值(INR)的水平和治疗依从性.结果 实验组对相关知识熟悉的占83％,对照组为38％;依从性较好(完全遵守),实验组占83％,对照组占73％,实验组的不遵守率为3％,对照组为15％; INR在2.5～3.5范围内的患者,实验组占86％,高于对照组的53％(P＜0.05).结论 连续护理可提高军队患者对心脏瓣膜置换术和抗凝治疗的认识度、用药的依从性,可使INR水平控制平稳,降低不良因素的影响,从而达到较好的抗凝治疗效果.

Objective To discuss more effective fixation methods of indwelling trocar in children patients. Methods Two hundred patients were divided into observation group and control group in random. In the observation group, the affected children were fixed with infusion paste in the handle of indwelling trocar, then excipient film, and finally with elastic bandage. In the control group, participants were fixed with infusion paste in the handle of indwelling trocar, then excepient film, and finally with small board and elastic bandage. Results The average time of indwelling trocar for retention was 4.3 days and parents' satisfaction reached up to 98% in the observation group, much higher than those in the control group that were 2.3 days and 74% respectively. Conclusion The fixation method applied in the observation group has some advantages of long retention time, high parents' satisfaction, comfort for children patients, and good cooperation between children patients and nurses, which reduces the nurses' workload. It is worthy of extension in clinic.

目的:总结体外膜肺氧合( ECMO)在危重复杂先天性心脏病(先心痛)手术中的应用经验.方法:从2006年10月至2011年12月,我院对6例危重复杂先心病手术患儿使用ECMO治疗.男4例,女2例,年龄2个月～14岁,体重6 5～29.5kg.采用自身前后对照,观察EMCO对预防手术意外及严重并发症的作用.结果:ECMO的支持时间为5h～24d,成功脱离ECMO 5例(83.3％,均病情好转后出院.1例因呼吸循环衰竭而未能脱离ECMO,并放弃治疗,出院后第二天死亡.出院后3个月随访,存活患儿未见严重并发症.结论:正确的采用ECMO可以有效治疗危重复杂先心病手术后严重并发症,降低住院死亡率.

Objective To explore the use of the continuum of care approach for patients with coronary artery bypass surgery and the effect of the continuum of care.Methods Collected from January 2009 to June 2010,112 cases of coronary artery bypass surgery patients in the observation group,June 2007 to December 2008,98 patients with coronary artery bypass surgery as the control group. The observation group with implement the continuum of care intervention,the implementation of routine care control group.Results and the nursing effects were compared in two groups.Results The patients care and job satisfaction was higher in observation group,and difference between groups was statistically significant ( x2 =15.38,P ＜ 0.01 ).The patients hospital stay was shorter than that in the control group,the difference between two groups was statistically significant (t =2.521,P ＜ 0.05).After intervention,health related knowledge level was significantly increased,the difference between the two groups was statistically significant (x2 =62.98,95.93,106.66,83.34,respectively;P ＜ 0.01 ).Conclusions Using the continuum of care approach for heart surgery patients with coronary artery bypass grafting help to increase patient understanding of health-related knowledge and improve patient outcomes,shorter hospital stay,increase nursing job satisfaction,and is worthy of reference.

Objective To explore cognitive level of continuous nursing for nurses to cardiovascular disease,so as to provide reference for developing continuous nursing widely.Method A total of 188 nurses were investigated with a survey scale of cognitive level on continuous nursing for patients with cardiovascular disease.Results The mean score of cognitive level of continuous nursing for nurses to cardiovascular disease was (3.44±0.36).The average scores of 4 aspects,including disease,treatment and rehabilitation related knowledge,and social knowledge were all between 3 to 4.Department and working time were the factors influencing cognitive level of continuous nursing for nurses to cardiovascular disease. Conclusions The cognitive of continuous nursing for nurses to cardiovascular disease is in a middle level and influenced by the factors of departments and work time.Some aspects should be improved,such as the popularity of continuous nursing education,strengthening academic exchanges,the use of high qualification nurses,and so on.

<正>随着社会生活方式的变化及计算机网络技术的迅猛发展,互联网用户日益增多,2009年,中国互联网络信息中心(CNN-IC)发布的《第23次中国互联网络发展状况统计报告》显示,截至2008年底,中国网民规模达到2.98亿人,其中10～19岁的青少年所占比重最大(35.2%),成为2008年中国互联网最大的用户群体。随之而生的青少年网络成瘾也逐渐成为一个

目的:检测血浆D—二聚体( DD)检测在急性主动脉夹层(AAD)血浆中的水平变化,并探索DD在Stanford A型AAD诊断中的应用价值.方法:2010年1月至2011年12月来我院急诊就诊的AAD患者36例,分为A组和B组:A组Stanford A型AAD患者19例,男12例,女7例,年龄21～70岁,平均年龄49.92±11.78岁;B组为Stanford B型AAD患者17例,男11例,女6例,年龄24 ～ 75岁,平均年龄51.02±12.14岁.对照组为同期的健康人群.抽血化验血浆中DD、C反应蛋白(CRP)、白细胞介素-6(IL-6)和肌钙蛋白I(cTnI),对比分析DD诊断的阳性率、敏感性和特异性.结果:与对照组相比,A组和B组中DD、CRP、IL-6和cTnI水平均升高,DD、CRP和IL-6三项指标具有统计学意义(P＜0.05),A组DD水平升高具有显著统计学意义(P＜0.01). A组DD诊断的阳性率63.1％、敏感性为93.8％和特异性为77.3％,均高于B组,具有显著统计学意义(p＜0.01).结论:血浆DD检测对于Stanford A型AAD诊断具有重要的参考价值.

Objective To explore the effects of preoperative visits of nurses in ICU applied in heart surgery clients.Methods A total of 140 clients who had heart surgery from October 2009 to October 2010 were recruited as the experimental group and received preoperative visits from nurses in ICU.And 140 clients who had heart surgery from September 2008 to September 2009 were enrolled as the control group.The patients' satisfaction with nursing services and nursing effects of the two groups were compared.Results The patients satisfaction with nursing services and nursing effects of the experimental group were higher than the control group,the patients' days of experimental group in ICU was less than the control group,the difference was statistically significant(P0.01 or P0.05).Conclusion Preoperative visits can enhance the specialist knowledge of ICU nurses and improve patients satisfaction with nursing services,and shorten the days of hospitalization.

Objective To explore the cognitive levels of continuous nursing of convalescence in community for discharging patients with cardiovascular disease so as to provide basis for continuous nursing after their social reintegration.Methods From January to August 2009,101 discharging patients with cardiovacular disease were investigated with a self-designed questionnaire concerning four aspects of cognitive knowledge and capacities on disease,treatment,rehabilitation,and social life.Results The overall cognitive level of continuous nursing knowledge in patients with cardiovascular disease was low.After the treatment and care in the hospital,the patients might fail to achieve continuous self-care after returning to community.Conclusion Patients with cardiovacular disease are lack of knowledge and capacities on continuous nursing.Hospital health education should be strengthened to raise patients' cognitive levels on continuous nursing and awareness of self-management for patients' early rehabilitation.

With the promulgation and implement of Medical Accident Treatment Regulations and Basic Norms of Medical Records Writing from the State Council and the law consciousness of seeking medical advice people gradual strengthening,the standard writing of nursing records has become an indepreciable key point of clinical nursing work.According to quality management experience of nursing records for years and related document report in resent years,the author emphatically analyzes universal problems that might lead to medical tangle of nursing records,putting forward concrete evasion measures which aim at caution and reference for clinical nursing staffs and manager.

To provide some information about low temperature plasma related technique and operational notes for nursing staff engaged in disinfection and sterilization work,this paper reviewed the technique principle,application status,and sterilization effect monitoring of low temperature plasma sterilization technology,and concluded the influential factors,and put forward the relevant notes.

创伤后应激障碍(post-traumatic stress disorder, PTSD)是指经历了强烈的创伤性应激事件后出现的一种反应性精神障碍,主要表现在心理、生理上的一系列临床综合征.其特征性的症状为病理性重现创伤体验、持续性警觉增高、持续性回避、对创伤经历的选择性遗忘以及对未来失去信心等.随着近年来自然灾害及各种意外事故的频繁发生,对PTSD的研究越来越受到医学界的重视.本文对我国有关PTSD研究进展进行归纳总结,以期为从事该研究的相关人员提供参考依据.

BACKGROUND: After myocardial infarction, inflammatory reaction and myocardial fibrosis can be detected in myocardium. During this process, differentiation and survival of transplanted bone marrow stem cells can be affected. OBJECTIVE: To study the optimal time for bone marrow stem cell transplantation in rabbits after myocardial infarction by analyzing histological changes in cardiac lesion region. DESIGN, TIME AND SETTING: A randomized control cell investigation was performed at the Experimental Animal Center of Central South University from June 2005 to April 2006. MATERIALS: Totally 36 clean male pigmented rabbits were divided into model control group and cell transplantation group. Each group was divided into 3 subgroups according to time points (immediately, 2 weeks and 4 weeks after establishing models), 6 rabbits in each time point. METHODS: Rabbit models of myocardial infarction were established by liquid nitrogen frozen in both groups. Bone marrow was extracted from bilateral iliac bone in the cell transplantation group. Mononuclear cells were harvested from bone marrow by FICOLL method, induced by 5-aza and labeled by Brdu. Subsequently, bone marrow stem cell suspension (number of cells 1.0×107) was injected into the juncture between infracted region and normal myocardium at 4 points immediately, 2 weeks and 4 weeks after establishing models. Using the same methods, DMEM of the same volume was injected into rabbits of the model control group at the corresponding time points. MAIN OUTCOME MEASURE: Pathological changes in myocardium 4 weeks after transplantation. RESULTS: Immunohistochemical staining demonstrated that Brdu-labeled cells were detected in the cell transplantation group 2 weeks and 4 weeks after establishing models, whereas Brdu-labeled cells were negative in the cell transplantation group immediately after establishing models. Hematoxylin and eosin staining confirmed that myocardium-like cells were found in the cell transplantation group 2 weeks after establishing models, whereas negative in the cell transplantation group immediately and 4 weeks after establishing models. Only scar and fibrous tissues were detected, but no specific structure was presented in the model control group at each time point. CONCLUSION: The optimal time for bone marrow cell transplantation is at week 2 after myocardial infarction in rabbit models. Autologous bone marrow stem cells can differentiate into myocardium-like cells after transplantation.

目的 自体骨髓干细胞移植在观察心肌梗死(心梗)后不同时期的组织学及心脏功能的变化,探讨骨髓干细胞移植的最佳时机.方法 将36只雄性青紫兰兔随机分成6组,每组6只:即时移植组(A组),即时对照组(A1),2周后移植组(B组),2周后对照组(B1组),4周后移植组(C组),4周后对照组(C1组).用液氮冷冻法制成心梗模型.将经5-氮杂胞苷(5-aza)诱导过的骨髓干细胞,于心梗形成后的即时、2周和4周,注射入心梗区.4周后.分别使用M型超声心动图和在体心功能检测系统,检测左心室射血分数(EF)、左室短轴缩短率(FS)、左室收缩压最大变化速率(dp/dt max)、收缩末期内径(LVSD)、左室舒张末期内径(LVDD).结果 即时移植的治疗组与对照组比较,左心室射血分数(EF)、左室短轴缩短率(FS)、左室收缩压最大变化速率(dp/dt max)、左室收缩末期内径(LVSD)、左室舒张末期内径(LVDD)在治疗组与对照组相比无明显的变化(P＞0.05).4周后治疗组与对照组相比, EF、FS、dp/dt max、LVSD、LVDD也无明显变化(P＞0.05).2周后治疗组与对照组、即时治疗组、4周后治疗组相比, EF、 FS、dp/dt max、LVSD、LVDD有明显的改善(P＜0.05).结论 心梗后第2周进行骨髓干细胞移植,可有效的减轻心室扩张,改善心功能。

患者 男,14岁.发现心脏杂音14年入院.患者出生后体检发现心脏杂音.查体:胸骨左缘第3肋间闻及Ⅲ级收缩期杂音.心电图示窦性心律,异常Q波,左心室高电压.胸部X线片示心胸比率0.42.超声心动图示室间隔中上部探及实质性肿块,约4.4cm×3.3cm×2.7cm,前部于左右心室交界处边缘不清,其他部位均可见较完整的包膜,肿块内似见分叶,其回声不均,可见不规则钙化,右心室流出道狭窄.

1 病例报告 患者男,60岁,铁匠.被金属异物击中左胸20天入院.20天前工作时被铁屑击中左胸,当时有短暂的意识丧失,大小便失禁.3天后出现呼吸困难,双下肢水肿及发热,当地医院以左胸异物开胸探查,未找到异物而转我院.查体:心前区可闻及Ⅱ级收缩期杂音及心包磨擦音,双下肢水肿.X线胸片可见相当左心室处有一1.2 cm×0.6 cm金属异物影,CT扫描及超声心动图均发现左心室金属异物及有血栓形成(图1,2).在全麻、低温体外循环下手术.待心脏停跳后,切开心尖无血管区2 cm,可见约1.6 cm×0.6 cm×0.4 cm一铁屑嵌于左心室内壁,其突入心腔部分已被血栓包裹、并有一索条样机化附壁血栓,心包和左心室原手术切口粘连.取出异物和血栓,反复冲洗心腔,"三明治"缝合心脏切口.金属异物重1.0 g.术后无并发症,20天后痊愈.随访1年6个月,可参加一般体力劳动.