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57例成人破伤风的急救护理

【摘要】　目的　总结成人破伤风的急救护理经验，以降低破伤风并发症及其病死率。　方法　对2009年9月-2010年8月期间收治的57例破伤风患者，采用破伤风抗毒素治疗、伤口清创、气道护理、控制痉挛和镇静、维持水电解质平衡等急救护理过程及治疗效果进行回顾性分析，总结急救护理经验，探讨护理技术重点。　结果　56例破伤风患者经过急诊监护室、观察室或住院治疗治愈/好转出院，1例死亡，总病死率为1.8%。　结论　重视伤口处理、毒素中和、气道护理，控制痉挛，营养支持等为主的急救护理措施，对于减少成人破伤风患者并发症、降低病死率有十分重要的作用。

Correlation analysis of visual sensitivity, best corrected visual acuity and central retinal thickness in diabetic macular edema

ObjectiveTo investigate the correlation of visual sensitivity, best corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME).MethodsA retrospectives study. Forty-five eyes of 30 patients in DME were included. There were 20 eyes of 16 males, 25 eyes of 14 females, with an average age of 54.49±7.45 years. All the patients had type 2 diabetes; the average duration of diabetes was over 10 years. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithmic logarithm (logMAR) visual acuity. The following parameters provided by the MAIA microperimetric device were evaluated, including average threshold (AT), macular integrity index (MI), fixation indexes (P1 and P2), bivariate contour ellipse area (BCEA) for 63% and 95% of points, and horizontal and vertical axes of the ellipse of fixation (H63, H95, V63, V95). The CRT was measured and the integrity of the ellipsoidal band was observed by optical coherence tomography (OCT). The integrity of the ellipsoid band was divided into continuous smooth (group A): fully visible; part of the light band was interrupted (B group): not completely visible; missing light band (C group): completely invisible. Pearson correlation analysis was used to analyze the correlation between the factors; non-parametric tests were used to compare the logMAR BCVA, AT, and CRT between the different ellipsoid zone integrity groups; multiple linear regression analysis was used to analyze factors related to AT.ResultsPearson correlation analysis showed that the logMAR BCVA was positively correlated with MI (r=0.303, P=0.04) and CRT (r=0.342, P=0.02), negatively correlated with AT (r=−0.59, P=0.00) and P1 (r=−0.38, P=0.01). There was negative correlation between AT and MI (r=−0.55, P=0.00). The result of multivariate linear regression analysis showed that the logMAR BCVA is inversely correlated with AT (t=−3.53, P=0.001). Group A, B and C were 23, 17 and 5 eyes in the 45 eyes, respectively. There were significant differences in logMAR BCVA, AT, and CRT between the three groups of eyes (P=0.045, 0.049, 0.018).ConclusionsIn DME patients, the logMAR BCVA was positively correlated with CRT, negatively correlated with AT and P1. The logMAR BCVA is inversely correlated with AT. Microperimetry combined with OCT and visual acuity can be used to assess the visual function of patients with DME.

内镜在胆道围手术期处理中的应用（附253例报告）

OPTIMIZING CULTURE SYSTEM OF MOUSE MARROW MESENCHYMAL STEM CELLS IN VITRO AND INVESTIGATING EFFECT OF ALCOHOL AND ACETALDEHYDE ON THE CELLS

Objective To optimize the in vitro culture system of C57/BL6 marrow mesenchymal stem cells (MSCs) and to investigate the effect of alcohol and acetaldehyde on MSCs. Methods The MSCs were isolated from the femur marrow of C57/BL6 mice and were cultured in the optimized system, so that highlypurified MSCs were harvested and identified by immunohistochemistry. Then, MSCs were cultured in the medium containing alcohol or its metabolic product acetaldehyde, with the following concentration groups: alcohol 5.7，17.0，50.0，100.0 and 150.0 mmol/L; acetaldehyde 4.5, 0.9, 0.18, 0.036, 0.007 2, 0.001 44 , 0.000 28 mmol/L. MSCs were cultured with α-MEM as the control group. After 3 days, their proliferation activity was measured by the MTT method. Results MSCs within 6 passages had a good stability and a high proliferation activity. They were identified to express CD90 but no CD34. The MTT assay showed that alcohol at the concentration greater than 100.0 mmol/L and acetaldehyde at the concentration greater than 4.5 mmol/L could inhibit proliferation of MSCs(P＜0.05) . But the proliferation activity might rise with an increase in the acetaldehyde concentration smaller than 0.18 mmol/L(P＜0.05) . Conclusion Theoptimized culture system can effectively isolate and culture MSCs. Both alcoholand acetaldehyde can inhibit proliferation of MSCs but toxicity of acetaldehydeis more serious. 

Human leukocyte antigen alleles polymorphism in Han nationality suffered from Eales disease or tuberculosis in Zunyi city

　　Objective　To analyze the relationship of human leukocyte antigen alleles (HLA-A/B, HLA-DRB/DQB) polymorphism and Eales disease, tuberculosis infection in a Han population in Zunyi city of China. Methods　The subjects were analyzed by case control study, which consisted of three groups including Eales disease group (47 patients), pulmonary tuberculosis group (36 patients) and normal control group (100 healthy people). Thirty-nine patients in Eales disease group who had complete history were divided into 4 subgroups according to the history and tuberculin PPD test. Twelve patients with past or present pulmonary tuberculosis were in group A, 27 patients without pulmonary tuberculosis were in group B, 27 patients with positive PPD test were in group C, and 12 patients with negative PPD test were in group D. Fifty-nine alleles of HLA-A/B and HLA-DRB/DQB were analyzed by polymerase chain reaction with sequencespecific primers (PCR-SSP) in all subjects. Odds ratios between each group (OR) and 95% confidence interval (CI) were calculated; Frequency distribution of HLA-A02 gene were analyzed for the group A and the TB group. Results　The frequency distribution of HLA-A02 （OR=9.719, OR95% CI:4.377-21.580,P=0.000）and HLA-B07 （OR=11.605, OR95% CI:2.397-56.191,P=0.001）alleles in Eales disease group were obviously higher than that in normal control group, but frequency distribution of HLA-A11（OR=0.495, OR95% CI:0.245-1.000,P=0.048）in Eales disease group was obviously lower than that in normal control group. There was no significant difference in frequency distribution of HLA-A02, HLA-A11 and HLA-B07 alleles between groups A and B, and between groups C and D (P＞0.05). The distribution frequency of HLA-A02, HLA-A24, HLA-B07 and HLA-DRB16 alleles among Eales disease group, pulmonary tuberculosis group and control group was statistically different (P＜0.05). The frequency distribution of HLA-A24 alleles in pulmonary tuberculosis group was lower than that in Eales disease group （chi;2=7.289,P=0.007）, but the frequency distribution of HLA-A02 alleles had no significant difference (OR=0.515,P=0.202) between two groups. Conclusions　The alleles of HLA-A02 and HLA-B07 may be genetic predisposing genes of Eales disease, but HLA-A11 alleles may be protective gene in population of Han nationality from Zunyi city. The alleles of HLA-DRB16 and HLA-A02 may be genetic predisposing genes of pulmonay tuberculosis. The alleles of HLA-A02 may be a common susceptible gene for Eales disease and pulmonary tuberculosis. HLA-A11 and HLA-A24 alleles were protective genes of Eales disease and pulmonary tuberculosis respectively.

三氯氢硅中毒群体急救护理

目的　总结群体患者三氯氢硅中毒的急救护理方法与经验，为类似群体事件的发生与救治提供借鉴与参考。 方法　对2010年9月30例三氯氢硅群体中毒患者的救护措施及效果进行回顾性分析，交流救治及护理技术重点。 结果　30例患者经及时救治和细致护理均痊愈出院，住院时间1～5 d，平均2.7 d。所有患者均未发现、发生肺部感染、气胸、纵隔气肿、多器官功能衰竭等严重并发症。门诊随访或电话了解，未发现异常。 结论　及时的现场救护和正确的救治策略，以及各部门的密切配合，是降低中毒群体整体死亡率的关键。

乌头碱中毒的急救护理

The Application of Quality Control Circles in Reducing the Emergency Application Times of Maintenance Hemodialysis

ObjectiveTo investigate the efficacy of Quality Control Circles (QCC) in reducing the emergency application times of maintenance hemodialysis. MethodsIn December, 2012, the quality circle was formed by eight nurses and a physician, through brainstorming. The group finally selected "Reducing emergency maintenance dialysis times" as the theme. With the help of questionnaire, interview, and comparative study, we analyzed the emergency situation of maintenance hemodialysis patients, and regulate and implement related policies. ResultsBy QCC practices, the times of hemodialysis declined from 11.7 to 5.3 cases per month, which exceeded our expectations largely. As to the circle members, their problem-solving skills, responsibility, communication skills, self-confidence, motivation and QCC techniques were also improved. ConclusionQCC can not only reduce the times of maintenance dialysis, but also improve the team cohesion, harmony and quality management capabilities.

Application of PDCA Cycle in Examination of Medical Quality in Tibetan Area Hospitals

ObjectiveTo explore the application of PDCA cycle in the examination of medical quality of Tibetan area hospitals. MethodsIn the October 2014, PDCA cycle theory was introduced into the examination of Tibetan hospital medical quality. We collected quality problems existing in the medical activities actively, analyzed the reason and influencing factors and made corresponding plans. Then we implemented the plans and measures strictly, surveyed the results, found out and analyzed the problems, summarized the results of the examination, and turned the unsolved problems to the next PDCA circulation. Continuous follow-up was performed until the results were satisfactory. Based on Sichuan Province Secondary Comprehensive Hospital Evaluation Standard, we analyzed the medical quality of the hospital before PDCA application (July to September 2014) and after PDCA application (October to December 2014). ResultsThe incidence of medical nursing documents writing defects decreased from 12.4% to 5.9%. Hospital infection management defect rate declined from 13.5% to 5.3% and drug safety management defect rate declined from 11.8% to 2.5%, and all the differences were statistically significant (P<0.05). ConclusionPDCA cycle in the Tibetan hospital for medical quality examination has greatly improved the medical quality of Tibetan hospitals.

急诊科护士分诊时初筛胸痛患者心电图在诊断急性冠状动脉综合征的作用

目的 探讨护士在急诊科分诊时，针对胸痛患者进行心电图筛查在诊断急性冠状动脉综合征（ACS）的作用。 方法 回顾性分析实施分诊心电图筛查前（2013年1月－6月）和实施分诊心电图筛查后（2014年1月－6月）分诊至普通诊断室的胸痛患者中确诊为ACS的例数。对两组ACS患者检出率进行比较分析。 结果 护士在分诊时对胸痛患者进行心电图初筛后，分诊至普通诊断室的患者中ACS检出率低于未使用心电图初筛前，分别为1.74%和3.51%，差异有统计学意义（χ2=3.849，P＜0.05）。 结论 在急诊科分诊对胸痛患者进行心电图初筛能降低分诊至普通诊断室的患者ACS检出率，降低了ACS患者在急诊滞留的风险，减少了医疗纠纷的发生，值得在临床推广使用。