背景与目的:微血管侵犯(MVI)是肝细胞癌(HCC)患者术后早期复发的重要危险因素,对合并有MVI的HCC行解剖性肝切除或较宽切缘的肝切除可能切除更多的MVI,从而减少复发率,改善患者的无瘤生存率和总生存率.但MVI是基于术后组织病理学的诊断,因此术前准确预测MVI对HCC个体化治疗方案的制定有着重要价值.普美显(Gd-EOB-DTPA)最大优势在于肝胆期的特异性影像表现,因此,在肝胆期行普美显增强磁共振(EOB-MRI)能清晰显示病灶的边界,大大提高了对病灶的显示及诊断能力.本研究通过分析术前EOB-MRI影像学特征,探讨其对HCC患者MVI的预测价值.方法:回顾2014年7月-2017年6月南京大学医学院附属鼓楼医院肝胆外科147例术前行EOB-MRI检查并接受根治性肝切除的HCC患者临床病理及影像资料.分析预测MVI的危险因素,并检测EOB-MRI的预测效能.结果:在147例患者中,MVI阳性49例,MVI阴性98例.单因素分析显示,肿瘤直径(P=0.001)、肝胆期非结节型肿瘤(P＜0.001)、动脉期瘤周强化(P=0.016)、动脉期瘤周高信号环(P=0.014)、肝胆期肿瘤混杂信号(P=0.001)和肝胆期瘤周低信号(P＜0.001)是MVI的预测因素.多因素分析显示,肝胆期非结节型肿瘤(OR=5.075,95％CI=1.587～16.223,P=0.006)、肝胆期肿瘤混杂信号(OR=2.750,95％CI=1.102～6.866,P=0.030)和肝胆期瘤周低信号(OR=7.130,95％CI=2.679～18.977,P＜0.001)是 MVI 的独立预测因素.3种EOB-MRI影像学特征(肿瘤大体分型、肝胆期肿瘤混杂信号、肝胆期瘤周低信号)预测MVI的敏感度分别为89.8％,57.1％和61.2％;特异度分别为51.0％,72.4％和89.8％.当3种EOB-MRI影像学特征同时具备时,其特异度高达98.0％.结论:肝胆期非结节型肿瘤、肿瘤混杂信号和瘤周低信号是预测MVI的独立危险因素.当同时具备3种EOB-MRI影像学特征时,预测MVI具有较高的特异度.

A total of 218 outpatients with first-episode and high-risk ischemic strokes were randomly divided into management and control groups.Management group received multidisciplinary disease care mode while control group common disease care mode.The results showed that the functional independent measures (FIM) score of management group improved dramatically (89 ± 28 vs.81 ± 26,P =0.04).The National Institutes of Health Stroke Scale (NIHSS) score changed significantly (13.9 ± 5.6 vs.16.1 ± 6.9,P =0.02).Systolic blood pressure significantly changed [(131 ± 17) vs.(137 ±23) mmHg(1 mmHg =0.133kPa),P=0.04].Diastolic blood pressure significantly changed [(81 ± 10) vs.(85 ± 15) mmHg,P =0.03] ; Low density lipoprotein decreased [(2.54 ± 0.75) vs.(2.81 ± 0.65) mmol/L,P =0.01].The number of readmitted patients also decreased significantly (P =0.04).Thus muhidisciplinary disease care mode could enhance the qualityof-life,control risk factors and improve patient prognosis.

Objective To evaluate the effectiveness of multidisciplinary care pattern on elderly stroke outpatients.Methods Multidisciplinary care pattern provided elderly stroke outpatients with half-day clinic follow-up,including interdisciplinary evaluation and care.The evaluation index included the effect of nursing,satisfaction of patients as well as satisfaction of caretakers.Results Both systolic and diastolic blood pressure had been improved in the last follow-up compared with the first [(127.2 ± 17.8) mm Hg vs (139.2 ± 19.7)mm Hg and (72.3 ± 10.4)mm Hg vs (78.2 ± 12.3)mm Hg].Low density lipoprotein reduced from (102.9 ±20.4) mg/dl to (87.6 ± 18.0) mg/dl,and FIM score also improved from (103.11 ± 18.67) to (117.37 ±17.47).Among recommended nursing contents,at least one subject had significant change for one patient.Both patients and caretakers were satisfied with the care pattern.Conclusions Multidisciplinary care pattern can obviously improve the quality of nursing for elderly stroke outpatients.

分析86例脑梗死病人并发肩部并发症的原因,探讨其护理对策,认为并发肩部并发症的原因主要有疾病因素、心理因素、环境因素、知识缺乏等;提出康复训练、健康教育、技能培训、心理疏导等护理对策。