目的 讨论甲状腺患者围手术期护理措施及经验。 方法 对2004年6月－2012年12月收治的171例甲状腺手术患者的围手术期护理方法进行回顾性分析，并就护理要点进行经验总结。 结果 171例甲状腺手术患者均获治愈。术后并发症发生率1.8%～9.9%，包括切口内出血16例（9.9%），甲状腺机能减退11例（6.4%），单侧喉返神经损伤5例（2.9%），术后呼吸困难和窒息4例（2.3%），甲状腺危象4例（2.3%），喉上神经损伤3例（1.8%）。经及时对症处理，并发症得到有效控制，预后良好。 结论 术前细致的准备、术中积极的配合、术后密切观察并及早发现并发症、恰当处置，同时强化对患者的健康教育，对提高甲状腺围手术期护理质量与改善患者预后具有重要意义。
ObjectiveTo study the etiology, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of hemophagocytic syndrome (HPS). MethodsBetween February 2011 and October 2013, the causes, clinical manifestations, treatment and prognosis of 12 cases of HPS were retrospectively analyzed, and related literatures were reviewed. ResultsThere were 4 males and 8 females aged from 23 to 79 years old. Clinical features included fever (100.0%), lung infection (83.3%), enlarged lymph nodes (50.0%), bleeding (25.0%), splenomegaly (16.7%), and hepatomegaly (8.3%). Laboratory test results showed hemophagocytosis in bone marrow (100.0%), elevated ferritin (91.7%), thrombocytopenia (100.0%), decreased count in white blood cells (83.3%), decreased fibrinogen (66.7%), and hypertriglyceridemia (58.3%). Ten cases were related with infection, and 2 were related with diffused large B cell lymphoma. Nine patients died, 2 were cured, and one discharged himself from the hospital. ConclusionHPS is an uncommon disease, in which infection-associated HPS is the most common. The clinical presentation is complex, usually associated with multi-organ dysfunction, aggressive course, and high mortality rate.
ObjectiveTo analyze the related risk factors for catheter-associated urinary tract infection in the Intensive Care Unit (ICU), and make corresponding nursing countermeasures. MethodsBy target monitoring of catheter-associated urinary tract infection in 184 patients in the ICU from 2011 to 2012, infection risk factors were analyzed. The measures of nursing interventions had been taken since January 2012, and the effects before and after the intervention were contrasted and evaluated. ResultsBefore the intervention, 951 out of 1 229 patients in 2011 had indwelling catheter, and catheter-associated urinary tract infection occurred in 127 patients with an infection rate of 13.35%. After the intervention, 841 out of 1 437 in 2012 had indwelling catheter, and catheter-associated urinary tract infection occurred in 57 patients with an infection rate of 6.78%. ConclusionTaking effective intervention measures can effectively reduce the ICU catheter-associated urinary tract infection and it also ensures the safety of medical care.
目的 了解医院感染情况，对医院感染控制工作进行评价，为医院感染控制措施提供依据，提高医务人员的感染控制意识。 方法 采用横断面调查的方法，于2012年8月21日进行医院感染现患率调查，将调查结果进行分类、统计、分析。 结果 应查住院患者1 383例，实查1 378例，实查率99.64%，现患率3.41%。医院感染下呼吸道感染占53.19%，泌尿道感染占25.53%，手术部位感染占4.26%，调查当日抗菌药物使用率20.90%。 结论 通过医院感染现患率调查，可快捷地获得全院医院感染的情况，为医院感染防控工作提供依据。
【摘要】 目的 观察慢性粒细胞性白血病（chronic myelogenous leukemia， CML）急变（blast crisis，BC）患者罕见染色体异常的临床及实验室特点。 方法 2010年2月1例患者因咳嗽和高热来我院就诊，采用常规方法检查患者骨髓细胞，应用R显带技术和荧光原位杂交技术分析骨髓细胞核型。 结果 患者具有CML-BC的典型临床及实验室特点，同时核型出现不典型t（1；9；22）合并亚二倍体罕见核型异常，临床表现病情进展快，对伊马替尼疗效差，生存期短。 结论 慢性粒细胞性白血病患者在急变期出现伴不典型Ph染色体的亚二倍体复杂核型为高危核型，此类患者可能存在对伊马替尼的耐药，如能取得血液学缓解应尽早接受异基因骨髓造血干细胞移植，争取获得长期疗效。【Abstract】 Objective To report a case of chronic myelogenous leukemia (CML) blastic transformation into acute myelogenous leukemia with rare atypical hypodiploid t(1;9;22) complex chromosome abnormalities, and to analyze its clinical and laboratory characteristics. Methods A 47-year-old man was referred to our hospital due to cough and high fever in February 2010. We collected and analyzed the patient’s clinical materials, and performed chromosomal karyotype analysis with R-banding and fluorescence in situ hybridization (FISH). Results The patient demonstrated typical clinical and laboratory characteristics of blastic crisis of chronic myelogenous leukemia (CML-BC) and displayed rare atypical hypodiploid t(1;9;22) complex chromosome abnormalities. Meanwhile, the disease was rapidly progressive, with poor response to imatinib and had short overall survival. Conclusions CML-BC patients with hypodiploidy complex chromosome abnormalities are in high risk. They may show drug-resistance to imatinib. Thus, for this type of patients, once the hematological remission is achieved, allogeneic stem cell transplant should be performed as soon as possible to get better opportunity for long-term survival.
ObjectiveTo explore the risk factors for and preventive measures of orthopedic perioperative surgical site infection. MethodsWe retrospectively analyzed the clinical data of 2 752 cases of orthopedic surgery performed from January 2010 to December 2012. The risk factors for such infection were analyzed and certain preventive measures were put forward. ResultsA total of 97 patients were infected with a surgical site infection rate of 3.52%. The surgical site infection was closely related to ages, basic diseases, surgical site, types of incision, preoperative hospital stay, operative time, urgent elective surgery, the use of antibiotics, medical staff hand hygiene and other factors, of which the rate of infection after amputation was the highest, reaching 23.81% (20/84). ConclusionMaking full preparations before operation, strengthening medical staff's hand disinfection, prophylactic antibiotics, good precautions and regulations in operation, and nursing meticulously after operation can be taken to prevent and reduce surgical site infection in orthopedic operation patients effectively.
【摘要】 目的 探讨阿托伐他汀强化降脂治疗和左旋氨氯地平联用对高血压患者血压的影响。 方法 选择2009年1月-2010年11月住院及门诊原发性高血压合并高脂血症患者196例，均给予左旋氨氯地平和阿托伐他汀治疗8周后，复查血脂，从其中选择血脂正常者120例，随机分为对照组（单用左旋氨氯地平组）和治疗组（继续左旋氨氯地平联用阿托伐他汀），继续治疗20周后的血压情况。 结果 两组治疗20周后，治疗组收缩压和舒张压均较对照组下降明显，组间差异有统计学意义（Plt;0.01），治疗组优于对照组。 结论 高血压合并高脂血症患者，使用左旋氨氯地平降压和阿托伐他汀降脂治疗时，在血脂降至正常后，继续同时左旋氨氯地平降压和阿托伐他汀强化降脂治疗，降压效果优于单用左旋氨氯地平。【Abstract】 Objective To investigate the effects of levamlodipine combined with atorvastatin on blood pressure in patients with primary hypertension. Methods Between January 2009 and November 2010, 196 patients with hypertension and hyperlipidemia in the outpatient and inpatient departments of our hospital were given levamlodipine and atorvastatin for 8 weeks, after which 120 patients with normal blood lipid were chosen and randomly divided into the control group (treated only by levamlodipine) and the treatment group (treated by levamlodipine combined with atorvastatin). After 20 weeks of the treatment, we observed their blood pressure. Results After twenty weeks of treatment, the diastolic and systolic pressure was significantly lower in the treatment group than that in the control group (Plt;0.01). Conclusion For patients with hypertension and hyperlipidemia who have undergone the treatment by levamlodipine and atorvastatin, after their blood lipid level decreases to normal, the continuous enhanced treatment by the two drugs has a better efficacy compared with the therapy of single levamlodipine in decreasing the blood lipid.
Objective To investigate the effects of mechanical ventilation on lung pathology and concentration of proinflammatory cytokines in rats.Methods Forty-five healthy Sprague-Dawley rats were randomly divided into three groups with 15 rats each group，ie.a control group(No mechanical ventilation)，a high tidal volume group(VT 34 mL/kg，RR 30 bpm) and low tidal volume group(VT 8 mL/kg，RR 60 bpm).Results There were enlarged alveolar spaces，interalveolar septum collapse，swollen and spotty hemorrhages，inflammatory cell infiltration in the ventilation groups，which was more serious in the high tidal volume group.Lung wet-to-dry weight ratio of high tidal volume group was significantly higher than that of other groups（both Plt;0.05）.The concentrations in both macrophage-inflammatory protein-2（MIP-2）and tumor necrosis factor-α(TNF-α) of bronchoalveolar lavage fluid(BALF) and blood samples was significantly higher in two ventilation groups than the control group（Plt;0.05），which were higer in the high tidal volume group than in the low tidal volume group（Plt;0.05）.Conclusions These results indicate that mechanical ventilation can cause lung injury，which is more serious in high tidal volume ventilation.And mechanical ventilation-induced lung injury can cause proinflammatory cytokines release，with different levels in bronchoalveolar lavage fluid and blood samples.