目的 研究SD大鼠反复暴露于84消毒液对多种器官的伤害情况.方法 SD大鼠30只,雌雄各半,在密闭空间内分别按100 mL/m2喷洒含0(对照组)、400、10000 mg/L次氯酸钠的84消毒液,大鼠暴露2次/d,每次1 h,持续28 d,腹主动脉穿刺收集血样,用于血液学和血液生化指标检测,于第29天,所有大鼠麻醉后实施安乐死,采集肝、肾、心、脾、肺、气管、眼球和皮肤等重要脏器进行进一步检查.结果 高剂量组大鼠重复染毒28 d后,气管、肺、肝、肾、血液系统出现病变,眼和呼吸道出现急性刺激症状,血细胞增多和凝血功能障碍,气管、肺、肝和肾发生病理学改变.低剂量组和对照组无异常改变.结论 长期大剂量接触84消毒液可能对动物机体健康造成不良影响,在使用中应加强个人防护.

目的 比较高龄(≥80岁)终末期肾衰竭病人采取不同治疗方式的临床疗效,探讨适合高龄终末期肾衰竭病人的治疗方式.方法 收集本院5年间诊治的高龄终末期肾衰竭病人59例,其中18例采取单纯药物治疗,22例行常规血液透析(HD)治疗,19例以保留残余肾功能为目的进行低剂量透析治疗,比较3组间生命体征、血液生化指标、预后等指标的差异.结果 治疗初期(6个月),常规透析剂量组和低透析剂量组在贫血、酸中毒、心功能的纠正和部分生活质量的改善方面优于单纯药物组(P<0.05),常规透析剂量组和低透析剂量组在残余尿量方面差异有统计学意义(P<0.05).在治疗后期(24个月),低透析剂量组在残余尿量、生活质量方面优于单纯药物组和常规透析剂量组(P<0.05).多脏器功能衰竭发生率及生存率3组间差异无统计学意义(P>0.05).结论 高龄终末期肾衰竭病人选择HD治疗应尽量保留残余肾功能,这有利于提高病人的生活质量.

目的 探讨尿毒症患者高通量血液透析(HFHD)治疗期间经基于沟通反馈的持续改进干预效果.方法 选取2018年1月—2020年1月中国人民解放军总医院第六医学中心血液透析室接受HFHD治疗的124例尿毒症患者,根据随机数宇表法分为对照组与观察组,各62例.对照组接受常规干预,观察组接受基于沟通反馈的持续改进干预,均干预6个月.分别于干预前及干预6个月,使用焦虑自评量表(SAS)及抑郁自评量表(SDS)评估两组心理状态并比较.干预6个月,使用自制满意度调查表调查两组满意度;评估两组患者的瘙痒程度并比较;记录两组干预期间并发症发生情况.结果 干预6个月,两组SAS、SDS评分均较干预前降低,且观察组低于对照组(P<0.05);观察组护理满意度调查表中各调查项得分均高于对照组(P<0.05);观察组皮肤瘙痒程度轻于对照组(P<0.05);观察组过敏、出血发生率低于对照组(P<0.05).结论 尿毒症患者HFHD治疗期间经基于沟通反馈的持续改进干预效果确切,有利于改善患者的心理状态,减轻皮肤瘙痒程度,且易于患者接受,满意度高.

目的 探究维持性血液透析(MHD)患者甲状旁腺切除术(PTx)后血压昼夜节律的变化及其与心功能的关系.方法 选择2016年10月至2020年12月于中国人民解放军总医院第六医学中心进行MHD并接受PTx治疗的200例继发性甲状旁腺功能亢进(SHPT)患者作为PTx组,另选取同期于本院进行MHD患者122例作为对照组.PTx组患者于手术前后检测甲状旁腺功能、超声心动图及24 h动态血压,对照组同期在血液透析前进行检测.依据术后血压昼夜节律情况将PTx组患者分为血压节律正常组和血压节律异常组,分析血压昼夜节律变化与心功能间的关系.结果 PTx组术前全天收缩压及舒张压、夜间收缩压及舒张压均高于对照组,而夜间收缩压下降百分率(ΔSBP％)、舒张压下降百分率(ΔDBP％)均低于对照组;PTx组术后全天收缩压及舒张压、夜间收缩压及舒张压均较术前降低,夜间ΔSBP％、ΔDBP％均较术前升高[(10.6±2.2)％比(3.1±4.0)％、(10.8±2.6)％比(3.8±4.9)％],差异均有统计学意义(均P<0.05).PTx组术前左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)均高于对照组,左心室射血分数(LVEF)显著低于对照组,差异均有统计学意义(均P<0.05);PTx组术后LVESD、LVEDD、IVST、LVPWT、LVMI均较术前降低,LVEF较术前升高[(55±7)％比(47±9)％](均P<0.05).依据患者PTx术后动态血压检测结果,分为血压节律正常组(132例)和血压节律异常组(68例).血压节律异常组夜间收缩压、舒张压均高于血压节律正常组,夜间ΔSBP％、ΔDBP％均低于血压节律正常组,LVEDD、IVST、LVPWT及LVMI均高于血压节律正常组,LVEF低于血压节律正常组,差异均有统计学意义(均P<0.05).逐步多重线性回归分析结果显示,MHD患者PTx术后LVMI与全天收缩压呈正相关,与夜间ΔSBP％呈负相关(均P<0.05).结论 PTx可有效控制MHD并发SHPT患者的甲状旁腺功能,术后血压明显下降,心功能有所改善,术后LVMI与全天收缩压呈正相关,与夜间ΔSBP％呈负相关,术后血压昼夜节律异常将加重MHD患者的心功能损害.

Objective To investigate the influences of laser treatment on the expressions of the plasma vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF) in children cutaneous hemangioma.Methods 109 infant hemangioma patients with laser treatment from October 2009 to August 2012 were engaged in this study,including 74 proliferative phase patients,20 involuting phase patients and 15 involuted phase patients.10 non-hemangioma patients were selected as the control.The blood plasma of all the patients were collected for the further test.The plasma levels of VEGF and bFGF were measured with the enzyme-linked immunosorbent assay(ELISA).The plasma levels of VEGF and bFGF of 23 proliferative phase patients were dynamically observed before and after the treatment.The data were analyzed with SPSS 16.0 software package.Results The plasma VEGF levels in the proliferating group were significantly higher compared with the involuting,involuted group and the negative control.The plasma bFGF levels of the proliferating group were significantly higher compared with the left three groups.The plasma VEGF and bFGF levels significantly decreased after the laser treatment.Conclusion The plasma VEGF and bFGF concentrations decrease after the laser treatment in infant hemangiomas.VEGF and bFGF may be the objective index to judge the effect of the laser treatment on infant hemangiomas.

Objective To study the analysis of elderly patients during hemodialysis hypotension causes and nursing interventions.Methods From 2011 February ～2012 year in June in our hospital for hemodialysis in 120 cases of elderly patients,in the hemodialysis process closely observed the occurrence of hypotension and analysis of its causes,and to take timely nursing intervention,observed on measures of effectiveness.Results 120 cases of patients with hemodialysis 3621 times in the process,a total of 835 times the incidence of hypotension,23.1%.The positive nursing intervention measures,792 hypotension is reversed,returned to normal,to continue hemodialysis treatment,the success rate is 94.9%;43 time to give intervention after failed to correct hypotension and termination of blood dialysis,accounted for 5.1%;no deaths.Conclusion In elderly patients undergoing hemodialysis,should actively prevent hypotension risk factors,and to take timely treatment of hypotension in elderly hemodialysis patients,improve the survival rate and quality of life.

Objective To discuss the Hypopigmentation and its Risk factors of Ota patients treated with QS Nd∶YAG and QS Ruby laser. Methods 266 patients with Ota treated with Q-switched Ruby laser and Q-switched Nd∶YAG laser were followed up and all clinical data were gathered and analyzed by SPSS.A piece of pathology organization was incised and HE staining chemical immunohistochemical staining were adopted. Results 15.0% of the patients appeared hypopigmentation.The fluence of lasers,the first treatment age,the size of the injury and the gender may be risk factors related to hypopigmentation.Chemical immunohistochemical staining showed that melanin granule disappeared in spots of the hypopigmentation. Conclusions Hypopigmentation was one of the most common complication.The fluence of lasers,the first treatment age and the size of the injury which may play important roles in the occurrence of hypopigmentation should be paid more attention during the treatment of Ota.The Ota should be treated as soon as the size of the injury is stable after the diagnosis ensures.

Objective To explore the effect of repairing technique on facial trauma healing.Methods 49 patients with facial trauma treated with aesthetic repairing technique such as dermabrasion,local skin flap transposition,and laser therapy,divididly or together,when they had had the acute operations to debride the wound and to repair the defect of tissue.Treatment for scar after operation should also be emphasized.Results All wounds on the faces of 49 patients treated with aesthetic repairing technique healed very well without dust staining and hypertrophic scar.Second plastic operation was avoided in 48 patients.Conclusions The application of aesthetic repairing technique in the acute treatment of facial trauma can effectively reduce secondary deformity,relieve the patients' financial burden.It is worth to introduce widely and will have good prospects.

目的观察皮肤扩张术治疗面部巨大疣状痣的疗效。方法9例面部巨大疣状痣患者,根据皮损形态和大小,选择合适的扩张器和扩张部位进行扩张;手术切除疣状痣组织后用扩张皮瓣修复创面。结果本组9例皮损完全回复,无继发畸形。结论应用皮肤软扩张术治疗面部巨大疣状痣,既能彻底去除皮损组织,又无继发畸形,是一种比较理想的治疗方法。

随着经济的发展,人们的物质生活水平不断提高,但是新的健康问题也在不断地出现.由于不合理膳食和不良生活习惯,人群中高血糖、高血脂的比率不断扩大[1-2].对人群的血糖、血脂水平进行动态观察,有利于发现高血糖、高血脂的发病趋势,进一步做好有针对性的防病治病工作.为了进一步做好宾馆从业人员中糖尿病和心血管疾病的预防工作,自2001-2006年我们对北京某宾馆从业人员进行了连续6年的血糖、血脂水平动态观察,现将结果总结如下.

2004年2月至2005年6月,我们采用结膜入路眼袋矫正术治疗眼袋24例,并进行了临床观察.现报告如下. 临床资料:本组24例皆为女性,年龄28～41岁.临床表现为局限性下睑外突,双侧同时存在,皮肤弹性尚好,上睑松垂和面部皱纹不太严重.

2002年6月至2003年12月,我们对31例有焦虑、抑郁症状的烧伤手术患者实施心理干预.现报告如下.

1999～200年,我们使用离子流治疗仪照射创面,取得良好效果.现报告如下. 临床资料:本文102例患者,随机分为两组,治疗组51例,男41例,女10例;年龄5～59岁,平均(35±13.5)岁;烧伤面积12%～75%,平均(35.5±12.2)%.对照组51例,男44例,女7例;年龄6～55岁,平均(32±14.1)岁;烧伤面积10%～73%,平均(33.6±10.8)%.两组临床资料有可比性.

1病例介绍 李×,女,13岁,因双小腿起黑褐色斑,触痛6天收入院.体检:体温37.5℃,脉搏84次/分,呼吸21次/分,血压16/10 kPa;双小腿及足背可见对称性、形状不规则且界线清楚的黑褐色斑片,同时左髋部可见融合性黑色斑片,边界清楚.试验室检查:WBC23.6×109/L,以中性粒细胞为主,可见中毒颗粒.入院后创面加深为片状蜂窝状液化坏死灶,体温渐升到39℃以上.经多次细菌培养,菌种为金黄色葡萄球菌,绿脓杆菌、鲍氏不动杆菌、嗜麦芽寡养食单胞菌、浅黄金色单胞菌等致病菌.病理诊断为大量炎性细胞浸润.创面经6次坏死组织清除,自体皮移植,应用抗生素,全身支持疗法等,住院74天治愈.