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外周静脉置入中心静脉导管术在高原地区肿瘤患者中的应用观察

目的　探讨外周静脉置入中心静脉导管（PICC）术在高原地区肿瘤患者中的临床应用，为西藏地区更好开展PICC技术提供依据。 方法　回顾性分析2010年8月－2012年4月113例肿瘤患者临床资料。 结果　穿刺成功111例，失败2例，成功率为98.2%。发生相关并发症14例，发生率12.4%，其中导管异位6例（5.3%），导管相关性感染3例（2.7%），栓塞2例（1.8%），机械性静脉炎2例（1.8%），导管部分脱出1例（0.8%）。 结论　PICC置管是一种置管成功率高，保留时间长，并发症较少、可靠有效的静脉治疗新途径，可在高原地区广泛推广应用。

高原地区诱发胆囊结石的危险因素

胆囊结石是危害人体健康的常见病和多发病。在高原地区除了特殊的地理环境外，不良的饮食习惯、特殊的饮食结构和缺乏运动是发生胆囊结石的高危因素，分析胆囊结石发病率的危险因素，针对性地普及健康饮食及生活的指导，降低胆囊结石的发病率，提高藏民族的生活质量是关键。

Therapeutic Effect on Radial Nerve Injuries in Plateau Area

【摘要】　目的　探讨高原地区桡神经损伤的治疗效果，并总结影响疗效的因素。　方法　回顾性分析2005年6月-2010年6月收治的桡神经损伤并有完整随访资料的54例患者，其中男40例，女14例；年龄8～69岁，平均32.6岁。开放性损伤5例，闭合性损伤49例；左侧26例，右侧28例。受伤原因:刀伤5例，医源性损伤（手术牵拉伤、被钢板挤压伤）10例，肱骨干骨折合并桡神经损伤39例。神经损伤类型:桡神经完全断裂12例；大部分断裂15例；挫伤27例，挫伤长度1.5~4.5 cm。所有患者均有典型的感觉及运动功能障。采用神经吻合修复27 例，神经松解减压27例。骨折均用钢板内固定。　结果　所有患者手术均顺利，术后切口均I期愈合，无手术相关并发症发生。54例均获随访16~24个月，平均18个月。骨折于术后8～14个月达临床愈合。末次随访时根据中华医学会手外科上肢周围神经功能评定标准，神经吻合的27例中，获优14例，良8例，差5例；神经松解减压术治疗的27例均获优。总优良率为91%。　结论　上臂桡神经损伤宜早期手术修复，神经吻合的疗效较神经松解减压术差。【Abstract】　Objective　To explore the therapeutic effect on radial nerve injuries in plateau area, and to analyze the influencing factors.　Methods　The clinical data of 54 patients with radial nerve injuries who were treated between June 2005 and June 2010 were retrospectively analyzed. The patients included 40 males and 14 females and aged 8-69 years (averaged 32.6 years old). Of these 54 patients, 5 were open injuries, 49 were closed injuries; 26 were on the left side, and 28 were on the right sides. Causes of injuries included: 5 direct cut injuries, 10 iatrogenic injuries (including traction injuries and crush injuries by steel plates), and 39 humeral shaft fracture and radial nerve injuries. Types of nerve injuries included: 12 complete radial neurotmesis, 15 partial radial neurotmesis, and 27 radial contusions (with contusion length ranged 1.5-4.5 cm). All patients had radial nerve injuries experienced significant motor dysfunctions. Among these patients, 27 underwent nerve anastomosis, the remaining 27 were treated by nerve decompression; all fractures were treated with internal fixation with steel plates.　Results　During the average follow-up of 18 months (16-24 months), all 54 patients completely recovered from radial nerve injuries without any complications. The time for fracture healing ranged 8-14 months. According to the evaluation standards for radial nerve functional recovery, developed by the Chinese Medical Association, among the 27 cases treated by nerve anastomosis, 14 were “optimal”, 8 were “fair”, and 5 were “bad”; and all 27 cases treated by nerve decompression were “optimal”.　Conclusion　It is suggested to have early surgical treatment for the upper arm radical nerve injuries. The nerve decompression had better curative effects than the nerve anastomosis does.

高原腕关节结核的诊断与治疗

目的 总结高原地区腕关节结核的诊断及治疗方法。 方法 回顾分析2007 年10 月－ 2009 年10月25 例腕关节结核患者临床资料。男12 例，女13 例；年龄25 ～ 65 岁，平均34.6 岁。左腕15 例，右腕 10 例。其中15例有肺结核或既往有肺结核病史。腕关节结核发病至入院时间为2 ～ 8 个月，平均6 个月。单纯腕关节滑膜结核10 例行保守治疗；全腕关节结核12 例、腕部屈肌腱腱鞘结核3 例采用化疗联合手术病灶清除治疗。 结果 治疗后除2 例全腕关节结核及1 例腕部屈肌腱腱鞘结核患者切口Ⅱ期愈合外，其余患者切口均Ⅰ期愈合。患者均获1 年6 个月随访。随访期间无结核复发，切口周围均无再次窦道形成。10 例单纯腕关节滑膜结核者及3 例腕部屈肌腱腱鞘结核者腕关节、掌指关节及指间关节活动自如，均于治疗后2 个月完全恢复劳动。12 例全腕关节结核者前臂旋前平均70°、旋后70°，较术前明显改善，术后4 个月完全恢复劳动。 结论 早期诊断、手术前后联合化疗、及时手术清除病灶、术后腕关节石膏固定、同时加强各掌指及指间关节活动，是治疗腕关节结核的有效方法。

高原地区交锁髓内钉治疗胫腓骨骨折骨不愈合

Comparison of Laparoscopic Cholecystectomy between the Highland and Non-highland Area

【摘要】　目的　探讨高原地区腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）患者的特点，以便更好地进行围手术期处理。　方法　对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者（高原组）367例和非高原地区患者（非高原地区组）167例的一般资料、术前诊断、合并症情况进行回顾性分析，两组患者性别、年龄及病程比较，差异无统计学意义（Pgt;0.05），有可比性。两组患者诊断均以胆囊结石为主，其次为胆囊息肉，诊断构成比较，差异无统计学意义（Pgt;0.05）；两组患者合并症比较，高原组患者高血压、冠心病、血红蛋白增多症及窦性心动过缓的发生率高于非高原地区组（Plt;0.05）；肺部疾病、肝硬化、糖尿病及脑梗死的发生率两组患者比较差异无统计学意义（Pgt;0.05）。两组患者均采用常规LC进行治疗，对两组患者术后临床结果、并发症等进行统计学分析。　结果　高原组患者手术中转开腹率（7.1%）高于非高原地区组（2.4%）患者（Plt;0.05）；高原组患者较非高原地区组患者住院时间长、手术时间长、术中出血量多（Plt;0.05）；术后并发症比较差异无统计学意义（Pgt;0.05）。　结论　高原地区LC患者宜及时中转开腹，其围手术期处理得当将有助于减少术后并发症的发生。【Abstract】　Objective　To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management.　Methods　We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (Pgt;0.05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (Pgt;0.05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (Plt;0.05). There was no significant difference in the incidence of lung disease, liver cirrhosis, diabetes mellitus and cerebral infarction between the two groups (Pgt;0.05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done.　Results　The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7.1%) was higher than that in patients in non-highland area (2.4%) (Plt;0.05). Hospitalization time, operation time and blood loss in Tibetan patients were significantly higher than those in patients in non-highland area (Plt;0.05), but there was no significant difference in postoperative complications between the two groups of patients (Pgt;0.05).　Conclusions　Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.

Related Factors for Acute Altitude Sickness in Tourists and the Nursing Intervention

ObjectiveTo discuss the treatment and nursing care for Daocheng tourists with acute altitude sickness, and analyze its related factors. MethodsFrom April to September 2012, 236 Daocheng tourists with acute altitude sickness were given drugs in time, and underwent oxygen inspiration. On the basis of observing the disease, nurses also provided care and health education to the patients. ResultsBy guiding patients' psychology, diet, oxygen uptake, medication and health related education, we cured 234 patients, and the rest 2 with high altitude cerebral edema were cured after being transferred to low-lying areas. ConclusionTourists from low-lying areas are vulnerable to altitude sickness when touring high lands. Preventive medicine before entering highland areas, more rest and less exercise are important factors to prevent the occurrence of altitude sickness. Health education from nursing care providers can effectively guarantee the safety of tourists entering plateau.

高原地区25例结核性肠梗阻的外科治疗

目的探讨高原地区结核性肠梗阻外科治疗的时机以及术式的选择。 方法对2010年6月至2012年6月期间笔者所在医院科室收治的25例结核性肠梗阻患者的临床资料进行回顾性分析。 结果25例患者中术前确诊7例，疑似诊断14例，误诊为消化道穿孔2例、阑尾炎2例。均经保守治疗48～72 h无效后行剖腹探查术，其中行肿大淋巴结切除术1例，脓肿引流术3例，单纯粘连松解术13例，行粘连松解+肠切除吻合术6例，仅行腹腔引流术1例，行一期坏死肠段切除二期肠吻合手术1例。25例患者术后病理学检查结果：肠系膜淋巴结结核4例，腹膜结核合并小肠结核21例。术后10 d和13 d分别死亡1例，术后给予抗结核治疗，23例治愈，随访2年无复发。 结论短期保守治疗无效的结核性完全性肠梗阻患者应尽早手术，术式宜简单、直接，不宜过度追求手术的彻底性；应重视围手术期抗结核治疗和综合性支持治疗。

Clinical analysis of the pulse oxygen saturation and hemoglobin content of the native high-altitude Tibetans

Objective To observe the changes and influencing factors on pulse oxygen saturation and hemoglobin in Tibetan residents of 4 200 meters above sea level. Methods The health examination data of the Tibetan village residents were collected in Rerong Country, Shannan Prefecture of Tibet autonomous region from January 4 to February 4, 2012. And the information of pulse oxygen saturation was recorded at the same time. The residents were categorized by sex, age and smoking history to observe the difference in each group. Results The clinical data of 234 healthy Tibetan residents were collected with average age of (37.9±13.9) years old, and 97 were male (41.5%). There were no difference in pulse oxygen saturation [(86.1±3.4)% and (86.0±4.7)%, P=0.784) between male and female residents, and heart rate of the male was less than that of the female [(77.9±9.8) bpm and (81.1±12.1) bpm, P=0.036], while the hemoglobin content was higher in male residents [(164.5±15.4) g/L and (139.1±19.2) g/L, P=0.000). With the increase of age, especially in the group older than 60 years, the pulse oxygen saturation significantly decreased (P=0.003), while hemoglobin content showed a gradual increase trend (P=0.000). And in the group which smoking history more than 20 pack-years, the pulse oxygen saturation was lesser than the other groups, and the hemoglobin content increased (P=0.000). Conclusions The pulse oxygen saturation level of Tibetan residents of 4 200 meters above sea level is negatively correlated with age and smoking history, and the level of hemoglobin is positively correlated with age and smoking history. In resting state, there is no significant difference in heart rate between the groups divided by ages.

Current situation and demand analysis of emergency and critical care training for medical staff in different levels of hospitals in plateau areas

Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.