目的:分析支气管热成形术治疗重症哮喘患者围手术期的临床资料,加强围手术期护理管理.方法:分析我院完成的支气管热成形术治疗109例重症哮喘患者,共计434例次的临床资料,总结预后及术后近期不良事件发生的原因.结果:常见的不良事件包括咳嗽、痰量增加、哮喘短暂加重、痰中带血、肺炎和痰栓形成等,其发生率分别为4.84％、8.99％、6.45％、3.92％、2.07％和1.38％.仅1例需要无创通气辅助,无自发性气胸、有创机械通气和死亡病例.结论:围手术期管理需要团队的协作.术前护理主要是评估病情和积极控制合并症,术后护理重点是观察并及时处理并发症.

Keloid is a kind of skin benign tumor with unexplained etiology,and various treatment methods for keloid have been reported in the literatures,this review focuses on recent advances about different treatment options for keloid.Intralesional injection of corticosteroid is still the first-line clinical treatment,and a variety of methods of comprehensive treatment can improve the efficiency and reduce the recurrence rate.According to the specific circumstances of patients,choosing the appropriate treatment method,may not only reduce the pain caused by the treatment but also improve the compliance of the patients,so as to achieve a good therapeutic effect.

中医养生以中医基础理论为指导,倡导人们注重修身养性以及情志、饮食、起居的调节.“驻颜美容”以中医养生理论为指导,是一种安全、持久、自然、健康、廉价的美容方法,养生理论的渗透是追求“内外兼修”的必经之路,最终才可达到阴阳平衡、气血调和的健康之美.

瘢痕疙瘩是皮肤科常见的良性皮肤肿瘤,目前发病机制尚不清楚,中医药治疗瘢痕疙瘩具有悠久的历史,本文通过对近年有关中医药治疗瘢痕疙瘩的方法及作用机制分类综述,认为中医药治疗瘢痕疙瘩简便易行,安全有效,采用中西医结合的方法不仅可以提高疗效,还能降低复发率.

A 53 years old female patient was presented here, who had been suffering from a large number of red papules and nodules in his left upper limb extensor side for 18 years. The histopathologic assessment revealed that mild epidermis thickening, the epidermal projections extend irregularly downward, the melanin in basal layer increased, spindle-shaped tumor cells infiltrated in the superficial and middle layer of dermis without clear realm. Masson trichrome staining: tumor cells were dyed red, mixed with a small amount of collagen fibers stained with blue, α-SMA staining was positive, KP-1 staining was negative. Diagnosis: piloleiomyoma. The patient had no obvious symptoms, so only follow-up was given without any treatment.

肺大泡(pulmonary bulla)是各种原因导致的肺泡内压力升高,肺泡壁破裂互相融合,最后形成巨大的囊泡状改变.肺大泡可单发或多发,其差距较大,大者可占据整个肺叶.多个小的肺大泡有融合成一个或更大的肺大泡趋势.肺大泡可占据一个肺叶甚至整个胸腔,压迫周围肺组织,造成余肺膨胀不全,影响肺功能.往往因剧烈咳嗽或运动,肺内压骤然升高,肺大泡突然破裂形成自发性气胸[1].慢性阻塞性肺疾病(COPD)伴有肺大泡病人常因正压通气致多发性肺大泡破裂,导致气胸,从而列为机械通气的相对禁忌证,因此护理此类疾病有一定难度,我科2016年3月28日收入1例肝癌术后突发肺大泡破裂的病人,在重症监护室(ICU)治疗及护理后于4月12日脱机拔管好转转出ICU.现将护理总结如下.

患者男性,48岁.因反复咯血、低热4个月,血尿、蛋白尿、双下肢浮肿半个月,少尿、无尿、胸闷5 d,2001年3月10日由外院转入我院.查体:T 38.2 ℃,Bp 110/70 mmHg(14.7/9.3 kPa).血常规:Hb 88 g/L, WBC 10.4×109/L,GRAN 80.2%,PLT 197×109/L.肝功能正常,总蛋白49 g/L,白蛋白27 g/L;肾功能: BUN 21.9mmol/L, Cr 804.5 umol/L;抗中性白细胞胞浆抗体(-),抗肾小球基底膜(glomerular basement membrane,GBM)抗体108%(参考值<16%);胸片报告:"双肺蝶翼状阴影"; B超示:双肾体积增大;肾穿刺活检报告:新月体性肾小球肾炎.诊断:急进性肾炎、Goodpasture综合征(Ⅰ型新月体性肾小球肾炎).