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呼吸机患者管理中橡胶手套的巧妙应用

The Experience of Clinical Application in Pancreaticoduodenectomy with Binding Pancreaticogastrostomy

Objective　To investigate the application value of the binding pancreaticogastrostomy in pancreatico-duodenectomy. Methods　The clinical data of 13 patients that performed pancreaticoduodenectomy with binding pancr-eaticogastrostomy from Jan. 2010 to Mar. 2013 in our hospital were retrospectively analyzed. The incidence of postoper-ative complications were counted. Results　There was 1 patient with pancreatic stump bleeding after operation， and then recovered after conservative treatment. There was no patient with pancreatic fistula， bile fistula， delayed gastric empt-ying， and other complications after operation in whole group. Peritoneal fluid and amylase level in peritoneal fluid were gradually reduced or degraded after operation. The gastrointestinal function was recovered better. All patients were compl-etely cured. Conclusion　The binding pancreaticogastrostomy in pancreaticoduodenectomy has its own unique advantage.It could be reduce the incidence of pancreatic fistula in postoperative patients by using binding pancreaticogastrostomy reasonably.

Differential Diagnosis and Treatment Strategies of Solitary Pulmonary Nodules

With widespread utilization of multi-slice helical computed tomography (CT) and low-dose CT in lung cancer screening, significantly greater incidence of patients with solitary pulmonary nodules (SPN) has been found. Once SPN is discovered, it is very difficult to immediately determine whether it is benign or malignant in clinical practice. In this review, SPN etiology, epidemiological characteristics of SPN patients, nodule size, morphology, location and growth rate, mathematical models for predicting malignancy of SPN, and diagnostic value of positron emission tomography (PET) and positron emission tomography-computed tomography (PET/CT) are summarized to provide reference for differential diagnosis of SPN. Current management strategies for SPN are also discussed in this review. According to whether SPN diameter is greater than 8 mm, whether SPN patients are advanced aged, have smoking or malignancy history, different follow-up and treatment strategies can be chosen. The diagnostic and treatment value of video-assisted thoracoscopic surgery for SPN is also discussed.

Detection of EGFR Exon 19 and 21 Mutations in Pleural Effusion from Non-Small-Cell Lung Cancer Patients by Mutant Enriched PCR Assay

Objective To investigate the feasibility of detection of epidermal growth factor receptor ( EGFR) exon 19 deletions and exon 21 L858R mutations in pleural effusion fromnon-small-cell lung cancer ( NSCLC) patients by mutant enriched PCR assay. Methods The mutations of exon 19 and 21 of EGFR gene in pleural samples fromthirty NSCLC patients were analyzed using both the mutant-enriched PCR assay and the non-enriched PCR assay. Results Ten ( 33. 3% , 10/ 30) exon 19 deletions and five ( 16. 7% , 5/30) exon 21 L858R mutation were detected by the mutant-enriched PCR assay, while only 6 cases ( 20. 0% ) and 1 case ( 3. 3% ) were detected by the non-enriched PCR assay respectively. The difference of mutation detection rate of EGFR gene between the two methods was statistically significant ( P = 0. 032) . Mutations were detected in all of partial responders ( 2 /4) among the four patients who received gefitinib therapy. Conclusions Mutant-enriched PCR assay can detect EGFR exon 19 deletions and exon 21 L858R mutation in pleural effusion from NSCLC patients effectively, economically and accurately. It may be a valuable biomarker for gefitinib therapy in advanced NSCLC.

Clinical Significance of Epidermal Growth Factor Receptor Mutations from Patients with Non-Small Cell Lung Cancer

Objective To evaluate the clinical significance of epidermal growth factor receptor EGFR) mutations in the treatment of non-small cell lung cancer ( NSCLC) . Methods Plasma DNAs solated fromblood specimens of 170 NSCLC patients, who were admitted in the First Affiliated Hospital of uangzhou Medical College from December 2005 to December 2007, were subjected to the test of EGFR utant-enriched PCR. The correlation of mutant detection with clinical characteristics was analyzed as well.Results Out of the total 170 patients, EGFR mutations were identified in 77 cases ( 77 /170, 45. 3% ) .EGFR mutations were more frequent in the patients with adenocarcinoma ( P lt; 0. 001) and in the nonsmokers P =0. 001) . In the 33 patients treated with gefitinib, those with mutations ( + ) showed a higher esponse rate and prolonged progression-free survival after the treatment compared with those with mutations( - ) ( P =0. 001 and 0. 001, respectively) . Conclusions EGFR active mutations can be specifically and ensitively detected by EGFR mutant enriched PCR assay. Plasma EGFR mutants detection is valuable in uiding clinical decision.

肺动静脉瘘的外科治疗

目的探讨肺动静脉瘘的临床特点、手术切除及治疗效果。　方法　回顾性分析自 1990年 1月至 2010年 12月同济大学附属上海市肺科医院手术治疗 23例肺动静脉瘘患者的临床资料，其中男 10例，女 13例；年龄 13～ 49（30.5±4.9）岁。行开胸手术 16例，电视胸腔镜手术 7例；肺楔形切除术 10例，肺叶切除术 13例。　结果围术期无死亡， 23例病灶彻底切除，术后无肺部感染、胸腔内出血、低血压、气胸、脓胸及支气管胸膜瘘等并发症。 23例患者手术后动脉血氧分压较术前明显改善［（93.5±2.8）mm Hg vs.（84.1±4.8）mm Hg，P＜ 0.05］。随访 23例，随访时间 5～ 56个月，肺动静脉瘘无复发。　结论　外科手术是治疗肺动静脉瘘非常有效的手段，对孤立性病变应优先考虑行电视胸腔镜手术，其具有创伤小、恢复快等特点。

人脱细胞生物羊膜治疗一例骨筋膜室综合征切开减压术后创面渗血

目的 总结1例人脱细胞生物羊膜（human acellular amniotic membrane，HAAM）治疗全身抗凝患者骨筋膜室综合征切开减压术后创面渗血的疗效。方法 2012年6月收治1例74岁经皮冠状动脉介入治疗后9 h发生右臂骨筋膜室综合征的女性患者，因需持续全身抗凝治疗，给予硝酸甘油对症治疗及切开减压术后创面持续广泛渗血。立即停用硝酸甘油，HAAM覆盖创面，塔形敷料加压包扎。切开减压术后9 d肿胀消退，行创面缝合及大腿皮片游离植皮修复。结果 HAAM覆盖创面48 h后创面渗血停止。术后随访4个月，患者右前臂植皮区创面愈合良好，右手功能正常，前臂及手部皮肤感觉无异常。结论 HAAM结合塔形敷料加压包扎对控制创面广泛渗血有良好效果，但尚需进一步积累病例观察。

EFFECTIVENESS OF DISCECTOMY COMBINED WITH Isobar NON-FUSION INTERNAL FIXATION IN TREATING LUMBAR DISC PROTRUSION

Objective To evaluate the short-term results of discectomy combined with Isobar non-fusion internal fixation. Methods Between May 2006 and May 2008, 65 cases of single segment lumbar disc protrusion were random surgically treated by discectomy combined with Isobar non-fusion internal fixation (34 cases, group A) and single discectomy (31 cases, group B), respectively. In group A, there were 18 males and 16 females with an average age of 38.8 years (range, 23-51 years); the involved segments were L2,3 (1 case), L3,4 (4 cases), L4,5 (20 cases), and L5, S1 (9 cases), including 11 cases of protrusion type, 16 cases of prolapsed-type, and 7 cases of sequestered type; and the mean disease duration was 7.2 months (range, 1-66 months). In group B, there were 19 males and 12 females with an average age of 39.2 years (range, 21-49 years); the involved segments were L3,4 (2 cases), L4,5 (24 cases), and L5, S1 (5 cases), including 13 cases of protrusion type, 15 cases of prolapsed-type, and 3 cases of sequestered type; and the mean disease duration was 6.5 months (range, 3 weeks to 72 months). There was no significant difference in the general data between 2 groups (P gt; 0.05). The surgical results were assessed by visual analogue scale (VAS) for back/leg pain and the Oswestry disabil ity index (ODI). The height of involved intervertebral space was measured dynamically after operation. Results The patients of two groups were followed up 32 months on average (range, 24-49 months). All cl inical symptoms of the patients were notably improved in 2 groups. One patient in group B experienced postoperative cerebral fluid leakage, and was cured after extubation, changing posture, and other measures. There was no implant failure, such as pedicle fracture, screw loosening, or screw malposition during the follow-up. The ODI and VAS were significantlyimproved after operation. The back and leg pain VAS scores at each time point were decreased significantly when compared with

生脉注射液对倍他洛克治疗冠心病慢性充血性心力衰竭疗效的影响

目的 评价生脉注射液对冠心病慢性中重度充血性心力衰竭（congestive heart failure，CHF）患者使用倍他洛克的影响。 方法 2004年1月-2009年6月住院的冠心病心功能NYHAⅢ~Ⅳ患者80例，随机分成两组，对照组在原抗心衰治疗基础上使用倍他洛克，治疗组在原抗心衰治疗基础上使用倍他洛克同时加用生脉注射液，观察两组使用倍他洛克能够达到的最大耐受剂量及其所需用的时间和安全性。 结果 治疗组与对照组对倍他洛克的平均最大耐受剂量分别为（82.1±15.6） mg/d和（81.6±15.2） mg/d，两组之间无差异；达到最大耐受剂量所需的平均时间分别为（4.98±0.87）周和（6.92±0.85）周，两组间比较有统计学意义；治疗过程中出现的不良反应，治疗组少于对照组。 结论 在中重度CHF患者使用倍他洛克治疗过程中加用生脉注射液治疗，可缩短倍他洛克达到最大剂量所需的时间，并可提高治疗过程中的安全性。

口服药发药盘应用于静脉采血中的护理体会

目的观察将废弃口服药发药盘应用于病房静脉采血管放置的效果。 方法2013年7月1日-28日采用前后对照的方法，比较静脉采血管放置盘改进前后对夜班护士当天整理、发放静脉采血管的时间和护士对采血流程满意度的影响。 结果改进后护士每天整理、发放采血管花费的平均时间由（112.38±7.73）s下降到（73.51±8.34）s，护士对采血流程的满意度由（1.40±0.81）分提高到（4.80±0.61）分，差异有统计学意义（P＜0.05）。 结论改良后的静脉采血管放置盘可以提高采血管整理和发放的效率，提高护士满意度。