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存留于右侧中间支气管长达14年的支气管异物一例

支气管乳突状瘤一例并文献复习

目的探讨支气管乳突状瘤的临床表现、病理学特征，诊断要点及治疗方式。方法分析 1 例呼吸道乳头状瘤的临床特征、影像及病理学资料，同时进行文献复习对该病进行分析总结。结果患者男性，73 岁，务农。因“呼吸困难半年”入院。本例患者胸部增强 CT 提示左主支气管起始部内见软组织密度影，支气管镜下行病理活检提示为支气管鳞状上皮乳头状瘤，人乳头状瘤病毒（HPV）阴性，Ki67（MIB-1）阳性。行纤维支气管镜下切除并给予重组人干扰素 α2b 注射液（假单胞菌）300 万 IU 皮下注射，治疗 7 d 后再次行纤维支气管镜下治疗好转后出院。通过以“乳头状瘤”与“支气管、气管、肺”为关键词检索查阅 CNKI、万方、维普等数据库，截止 2019 年 3 月。文献报道 93 例，患者年龄 19～80 岁，表现为咳嗽咳痰 60 例，咯血 38 例，胸闷或呼吸困难 31 例；位于气管、主气管 48 例；外科手术 43 例，支气管镜治疗 32 例；65 例患者有病理分型，其中鳞状细胞乳头状瘤 35 例、腺性乳头状瘤 10 例、混合型乳头状瘤 20 例。结论支气管乳突状瘤好发于中老年男性，与吸烟、HPV 感染相关。临床表现可无特异性，表现为咳嗽、咯血及呼吸困难等，容易误诊，诊断主要依据活组织病理检查，鳞状细胞乳头状瘤相对较多。支气管镜下介入治疗或手术治疗是有效的治疗手段，预后好，但易复发，需长期随访。

右心声学造影协助诊断肺动静脉瘘一例

Investigation of the Student-patient Relationship in Diagnostic Bedside Teaching

目的　探讨诊断学床旁见习教学中学患关系现状，为提高诊断学床旁教学质量提供应对策略。 方法　采用自行设计问卷，于2010年5月-2011年6月对80名临床医学专业三年级本科生以及同期在内科住院的100例患者分别进行不署名学患关系问卷调查（有效问卷率分别为91.3%和67%），同时对8名带教教师和7名临床主管医生进行个别访谈。 结果　学生问卷调查显示，79.5%的学生曾在床旁教学中遭遇患者不同程度的拒绝或不配合，大多数学生认为有被拒的心理准备和承受力。患者调查显示，82.1%的患者不愿意接受学生问诊查体，58.2%的患者表示即便给予一定经济补偿，也不愿配合教学。而对带教教师及临床主管医师访谈结果显示，当前床旁带教难度大大增加，学患关系紧张。 结论　现阶段学患关系紧张，根据其涉及原因，提出提升医务人员及医学生人文观念，推进医疗、教育体制改革，建立媒体监督机制，开展公众教育等多层面的应对策略，同时提出课程设置、教学模式、师资培养等具体教学应对举措。Objective　To explore the present status of the relationship between students and patients in diagnostic bedside teaching, in order to promote the teaching quality. Methods　From May 2010 to June 2011, self-made questionnaires were adopted to carry out an anonymous survey among 80 medical students in grade three or above and 100 inpatients to investigate the relationship between the students and the patients(with an effective questionnaire rate of 91.3% and 67% respectively). Eight tutors and 7 physicians concerned were taken in the individual interview. Results　The survey showed that 79.5% of the students encountered refusal from patients in bedside teaching, and most of them believed that they had psychological preparation and endurance for the refusal. A total of 82.1% of the patients expressed their unwillingness to accept examination by clinical students, and 58.2% of the patients were unwilling to cooperate in the teaching even with an amount of economic compensation. The tutors and physicians concerned stated that the student-patient relationship was undesirable at present. Conclusions　The relationship between students and patients in bedside teaching is strained at present. Based on the complicated reasons, we propose such coping strategies as promoting humanism among medical workers and students, pushing forward the medical and educational reform, building media supervision, developing public education, perfecting course design, teaching style, and cultivation of teachers, and so on.