在过去二十年间，麻醉技术和手术技术的改进使肺部恶性肿瘤患者的手术死亡率大大降低，但术后并发症仍是主要问题。肺切除术后的常见并发症是肺部并发症[1]，主要表现是低氧血症，尤其在肺功能减退的肺切除患者中发病率更高[2]。目前国内对低氧血症的诊断缺乏统一的诊断标准，一些作者采用Russell等[3]提出的标准，吸空气氧的情况下，患者动脉血氧饱和度（SpO2）≤92%，大于30 s就可诊断为术后低氧血症。也有作者建议[4]将一次或以上血气检查PaO2lt;8 kPa或PaO2/FiO2lt;300 mm Hg（1 mm Hg=0.133 kPa）作为诊断低氧血症的标准。30%~50%的术后患者可发生低氧血症，一般认为这样的低氧血症是一过性的，对大多数患者是无害的[5]。但如果合并心脑或其他器官动脉硬化或其他原因的血管阻塞，这种低氧血症就是很危险的[6]。常见低氧血症的原因是肺萎陷不张和误吸、心源性肺水肿、静脉输入液体过量、通气血流比例失调和急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）[7]，其中ALI/ARDS是肺切除术后患者死亡的主要原因[8-10]。
目的 了解医院内血源性职业暴露高风险人群，有针对性采取防护措施，降低血源性职业暴露的发生率。 方法 对2008年1月－2011年12月四川省妇幼保健院52例血源性职业暴露医务人员，按照暴露人群、暴露方式、暴露病种、暴露地点的不同进行调查分析。 结果 52例职业暴露人群中护士27例（占51.9%）；产房和手术室为高发职业暴露场所，共32例，分别为17例（占32.7%）和15例（占28.8%）；职业暴露病种主要为乙型肝炎，共27例（占51.9%）；暴露方式主要为针刺伤，共37例（占71.2%）。 结论 提高医务人员职业防护意识，规范操作流程，加强自身防护是减少职业暴露的根本所在。
【摘要】 目的 探讨并分析导致肺曲霉病患者误诊的原因，为早期诊断并及时正确治疗提供科学的依据。 方法 回顾性分析2010年1-4月间确诊为肺曲霉病的3例患者在诊治过程中被误诊的原因。 结果 3例患者均缺乏明显的特异性临床表现和影像学表现，最后确诊均依据病理学活检证实。 结论 肺部的曲霉菌感染缺乏特异性的临床和影像学表现，及早行纤维支气管镜检查或肺组织活检可提高早期诊断率。【Abstract】 Objective To analyze the misdiagnostic causes of pulmonary aspergillosis. Methods The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed. Result No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy. Conclusion Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.
Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.
Objective To explore the application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians, and compare it with traditional rotational training. Methods Continuing physicians who received training in the Department of Neurology of Xuanwu Hospital, Capital Medical University between March 2021 and February 2023 were selected. The continuing physicians who received traditional rotational training between March 2021 and February 2022 would serve as the control group, and the continuing physicians who received four-dimensional teaching library model training between March 2022 and February 2023 would serve as the experimental group. The Mini-CEX scale was used to evaluate the clinical comprehensive abilities of two groups of continuing physicians. At the same time, self-made questionnaires were used to evaluate the evaluation of two groups of continuing physicians on different teaching modes. Results A total of 55 continuing physicians were included. Among them, there were 27 people in the control group and 28 people in the experimental group. There was no statistically significant difference in the comparison of general information between the two groups (P＞0.05). At the time of graduation, all items on the Mini-CEX scale in the experimental group were higher than those in the control group (P<0.05). The survey questionnaire results showed that the experimental group scored higher than the control group in terms of improving learning interest, improving self-learning ability, improving clinical thinking, improving analysis and problem-solving ability, improving doctor-patient communication ability, and increasing teamwork (P<0.05). Conclusion The application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians is better than that of traditional rotational training, which can significantly improve the clinical comprehensive ability of continuing physicians and is worth promoting.
Researches in evidence-based medicine have provided important evidence for family planning doctors to guide their clinical practice. With examples of clinical researches, the practical methods of evidence-based medicine in family planning service are discussed in this paper.
目的 评价盐酸氨基葡萄糖治疗膝骨关节炎的疗效。 方法 将2012年1月－5月收治的150例膝骨关节炎患者随机分为A、B、C组。A组给予盐酸氨基葡萄糖治疗，B组给予碳酸钙D3片治疗，C组给予盐酸氨基葡萄糖联合碳酸钙D3片治疗，疗程8周。3组患者膝关节疼痛发作时服用塞来昔布并记录用量。比较试验前后3组患者骨关节炎指数评分（WOMAC）以及第1、8周塞来昔布用量变化情况。 结果 3组患者WOMAC总分、疼痛程度评分、关节僵硬程度评分、日常活动困难程度评分改善值比较，差异均无统计学意义。经过8周治疗，塞来昔布每周用量减少值A、B、C组分别为（0.41 ± 0.17）、（0.16 ± 0.22）、（0.46 ± 0.19）g，A、C组高于B组（P＜0.01），A、C组每周用量减少值差异无统计学意义（P＞0.05）。 结论 短期使用盐酸氨基葡萄糖治疗膝骨关节炎，在关节疼痛、僵硬及功能改善方面并不优于碳酸钙D3片，但可通过减少非甾体抗炎药物用量，使患者获益。
Objective To investigate the genetic polymorphism of methicillin resistant Staphylococcus aureus ( MRSA) isolated from hospital acquired pneumonia. Methods Seventy-four hospitalized patients were diagnosed as noscomial MRSA pneumonia from January 2007 to January 2008 in Xinhua Hospital, Shanghai Jiaotong Univesity. The genes of MRSA were amplified by random amplified polymorphic DNA typing ( RAPD) assay in 82 clinical isolates from these patients. Results Two to 15 amplified DNA fragments were observed in agarose gel and they were classified into 11 genotypes. Genotypes Ⅲ, Ⅵ and Ⅶ ( 32. 56% , 30. 23% and 13. 95% , respectively) were mainly isolated from the ICU. Both independent genotypes and overlapping genotpyes with those from ICU were identified in isolates from the departments of geriatrics, emergency and respiratory medicine. Outbreak or cluster cases ( 48. 65% ) were found in 36 of the 74 patients while all outbreak cases occurred in the ICU. Conclusions Noscomial MRSA pneumonia is easy to disseminate and small-scale outbreak may occur especially in ICU. RAPD is valuable for identification and prevention of the spread of MRSA in hospital.
Abstract： Objective To compare minimally invasive technique with multiple short incisions and traditional open technique for great saphenous vein (GSV) harvesting in coronary artery bypass grafting (CABG). Methods Fortyseven patients underwent first time CABG between November 2007 to January 2009. These patients included 37 males and 10 females with their age ranged from 43 to 78 years and their average age was 61.3±84 years old. The patients were prospectively randomized into the minimally invasive harvesting group (group A,n=21) and the traditional open harvesting group (group B, n=26). For group A, we adopted the method of minimally invasive technique with multiple short incisions, while for group B, the traditional long incisions were adopted. The incision length, GSV harvesting time, lower limbs suture time and incision complications were compared between the two groups. Results During harvesting, no injury to the saphenous vein trunk or complications related to the quality of venous grafts occurred in both groups. There were no significantly differences in the number of venous grafts and the GSV length between the two groups. Group A had significantly longer GSV harvesting time than group B (51.9±11.5 min vs. 40.3±7.6 min,P=0.000). However, incision length (16.1±4.1 cm vs. 49.2±7.2 cm, P=0.000), incision suture time (11.0±3.0 min vs. 33.6±4.8 min,P=0.000) and lower limbs total operation time (62.6±14.9 min vs.73.8±11.6 min,P=0.006) in group A were much shorter than those in group B. Fortyseven patients were followed up (100%) and the followup time ranged from 3 to 26 months. The rate of leg wound complications such as serous exudates, hematomas and wound infection was 4.8% (1/21) in Group A and 34.6% (9/26) in Group B. These complications were all cured with additional treatments. Group A had lower leg wound complication rate than Group B (Plt;0.05). Conclusion Our study demonstrates that minimally invasive technique for GSV harvesting can be performed at a satisfactory speed and helpful in decreasing the lower limb incision complication rate.
Objective To investigate the clinical characteristics of primary malignant tumors of the left atrium and the late results of surgical treatment. Methods The clinical experience with surgical treatment of 13 primary malignant tumors of left atrium was analyzed retrospectively. Complete resection of malignant tumor was achieved in 7 cases(53.8％ )，and subtotal resection was achieved in 3 cases(23.0％), only biopsy was performed in 2 patients(15.4％ )because of extensive metastasis of tumor. Heart transplantation was performed in 1 case(7.7％). Results There was no hospital death. The pathological diagnosis was undifferentiated sarcoma in 5 cases, leiomyosarcoma in 2 cases, malignant transformation of myxoma in 2 cases, angiosarcoma in 1 case, fibrosarcoma in 1 case, malignant fibrous histocytoma in 1 case and malignant hemangiopericytoma in 1 case. There were 11 patients followedup for 3 months to 65 months and showed 9 late death due to recurrence or metastasis. There was 2 patients lost of follow-up. Conclusion Primary malignant tumors of the left atrium should be resected to relieve symptoms caused by local tumor growth. Surgery provides control of primary tumor and allows the potential for cure or longterm survival with effective adjuvant therapy. The prognosis of these patients is still poor.