目的 觀察茵陳柴平湯治療重度慢性乙型肝炎的療效及不良反應。 方法 2009年3月－2010年3月，選擇采用茵陳柴平湯聯合常規保肝藥物治療50例重度慢性乙型肝炎患者（治療組），并與50例僅用常規保肝藥物治療的重度慢性乙型肝炎患者（對照組）進行比較，觀察治療2、4周時的臨床癥狀、肝功能及凝血酶原活動度等指標的變化。 結果 治療2、4周時，治療組在肝功能及凝血酶原活動度等指標均有顯著改善，無嚴重不良反應；4周時，治療組的癥狀緩解率（84%）明顯高于對照組（66%）；其總有效率（96%）亦高于對照組（80%）。 結論 茵陳柴平湯治療重度慢性乙型肝炎具有較好的臨床療效，且無嚴重不良反應。
Objective To review the latest progress in the major biological properties of adipose-derived stem cells (ADSCs) and ADSCs assisted autologous lipotransfer in breast repair and reconstruction. Methods Recent literature about ADSCs assisted autologous lipotransfer in breast repair and reconstruction was reviewed. Results ADSCs have multipotential differentiation capacity, and they could promote angiogenesis and regulate immune reactions. ADSCs assisted autologous lipotransfer can obtain satisfactory effectiveness in breast repair and reconstruction with few complications, but more studies are needed to confirm the long-term safety. Conclusion ADSCs assisted autologous lipotransfer has good effectiveness in breast repaired and reconstruction. But further clinical trials are needed to confirm the long-term safety.
【摘要】 目的 探討并分析導致肺曲霉病患者誤診的原因，為早期診斷并及時正確治療提供科學的依據。 方法 回顧性分析2010年1-4月間確診為肺曲霉病的3例患者在診治過程中被誤診的原因。 結果 3例患者均缺乏明顯的特異性臨床表現和影像學表現，最后確診均依據病理學活檢證實。 結論 肺部的曲霉菌感染缺乏特異性的臨床和影像學表現，及早行纖維支氣管鏡檢查或肺組織活檢可提高早期診斷率。【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.
【摘要】 目的 比較靶控誘導后Shikani喉鏡、Macintosh直接喉鏡和GlideScope?視頻喉鏡插管時的應激反應。 方法 選取2008年12月-2009年2月期間ASA Ⅰ~Ⅱ級、擬于全身麻醉下行擇期顱內占位病變切除術的患者30例，隨機分為Shikani喉鏡組（S組）、Macintosh直接喉鏡組（M組）與GlideScope?視頻喉鏡組（G組）。靶控異丙酚和瑞芬太尼誘導，分別采用上述3種喉鏡行經口氣管插管。記錄患者的心率、血壓，計算心率收縮壓乘積（RPP）。 結果 3組插管時間、心率、血壓和RPP比較差異無統計學意義（Pgt;0.05）。S組和M組插管后心率、血壓及RPP均較插管前顯著升高（Plt;0.05），而G組插管后的心率、60~300 s時的收縮壓、平均動脈壓和RPP與插管前比較，差異無統計學意義（Pgt;0.05）。 結論 3種喉鏡進行經口氣管插管時具有相似的血流動力學反應，GlideScope?視頻喉鏡更有利于循環穩定。【Abstract】 Objective To compare the hemodynamic responses of orotracheal intubations with GlideScope? videolaryngoscope, Macintosh direct laryngoscope, and Shikani optical stylet after target-controlled-infusion (TCI). Methods Thirty patients with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, scheduled for elective intracranial mass lesion surgery under general anesthesia were randomly allocated equally to Shikani optical stylet group (group S) Macintosh laryngoscope group (group M), and GlideScope? videolaryngoscope group (group G). After the patients became unconscious by TCI induction of propofpol and remifentanil, the endotracheal intubation were carried out through above three laryngoscope. The heart rate (HR), blood pressure and rate pressure product (RPP) were recorded. Results The differences of intubation time, HR, blood pressure and RPP in three groups were not statistically significant (Pgt;0.05). After intubation, the HR, blood pressure and RPP of group S and M were obviously higher than those before intubation (Plt;0.05); while there was no obvious change on the HR, systolic pressure at 60-300 s, mean arterial pressure and RPP of group G compared before intubation (Pgt;0.05). Conclusions There are similar hemodynamic responses in the three laryngoscope. GlideScope? is more advantageous to cycle stability.
目的 探討陽性激發點推拿治療對足底筋膜炎的臨床療效。 方法 對2011年3月－8月門診確診為足底筋膜炎的52例患者，采用隨機方式分為治療組和對照組各26例，治療組采用陽性激發點推拿，對照組采用電針治療。并對兩組患者治療5次后的即時療效率、日本骨科學會（JOA）足底治療療效評分、每次治療后的疼痛面譜量化評分、3個月隨訪疼痛復發率等療效進行對照分析。 結果 治療組和對照組經連續治療5次后，其JOA足底治療療效評分分別為（91.32 ± 10.61）、（82.92 ± 13.61）分，總有效率分別為96.15%、80.77%，差異均有統計學意義（P＜0.05）。疼痛面譜量化評分，治療組在第一次治療后較對照組改善明顯，差異有統計學意義（P＜0.05）。3個月后隨訪疼痛復發情況，治療組復發人數較對照組少，差異有統計學意義（P＜0.05）。結論 陽性激發點推拿治療法對改善足底筋膜炎引發的足底疼痛、步行不適等癥狀優于電針治療法，值得臨床推廣運用。
【摘要】 目的 對季也蒙念珠菌感染患者的臨床及微生物學特征進行分析，為臨床診治提供參考。 方法 收集2006年1月-2008年12月病原菌培養為季也蒙念珠菌的10例住院患者資料進行回顧性分析。 結果 季也蒙念珠菌感染患者存在多種基礎疾病，大多數患者（8/10）有易感因素，其中7例使用廣譜抗菌藥物。10例中有8例為深部真菌感染。其臨床表現與感染部位有關，主要累及泌尿道、呼吸道和皮膚軟組織。多數深部感染患者（6/8）在感染前存在同部位細菌感染，部分患者（3/8）在相同部位還可分離出其他真菌。全部季也蒙念珠菌菌株對兩性霉素B敏感，大多數菌株（9/10）對氟康唑敏感。僅1例患者因肺部感染、呼吸衰竭死亡，其余患者經氟康唑、伊曲康唑或特比萘芬等抗真菌藥物治愈。 結論 季也蒙念珠菌感染多發生于有基礎疾病、存在真菌易感因素者，感染部位多為原細菌感染部位，常合并其他細菌或真菌感染。部分菌株對氟康唑和伊曲康唑中敏或耐藥，治療應根據藥敏進行選擇。【Abstract】 Objective To analyze the clinical and microbiologic characters of candida guilliermondii to improve the clinical diagnosis and treatment. Methods The clinical data of 10 patients with candida guilliermondii infection diagnosed in our hospital from January 2006 to December 2008 were retrospectively analyzed. Results All the patients had several underlying conditions; eight patients had predisposing factors and seven patients were prescribed with broad-spectrum antibacterials. Eight patients had deep mycoses, whose clinical manifestation was associated with the infectious sites, mainly involved in urinary tract, respiratory tract and skin-soft tissues. Most deep mycoses (6/8) had prior bacterial infection at the candida guilliermondii infection site; some patients (3/8) had other fungous infection at the same time. All the strains were sensitive to amphotericin B; most fungous strains (9/10) were sensitive to fluconazole. One patient died of pulmonary infection and respiratory failure, and the others were cured by fluconazole, itraconazole or terbinafine. Conclusion Candida guilliermondii infection mainly occurs in patients with underlying conditions and predisposing factors. The infectious sites have prior bacterial infection and bacterial infection or fungous infection at the same time. Since some candida guilliermondii strains were not sensitive to fluconazole and itraconzole, drug sensitive test should be consulted.
Objective To investigate the effect of preoperative rehabilitation on early function of joints after total hip arthroplasty by comparing with non-preoperative rehabilitation. Methods Between March 2010 and November 2011, 98 patients with hip disease were recruited in study. Of 98 patients, 49 received preoperative rehabilitation for 2 weeks in trial group, and 49 did not receive preoperative rehabilitation in control group. There was no significant difference in gender, age, disease duration, disease cause, preoperative visual analogue scale (VAS) score, and preoperative Harris score between 2 groups (P gt; 0.05). Results There was no significant difference in VAS score at each time point after operation between 2 groups (P gt; 0.05), but significant differences were found in Harris score (P lt; 0.05). At 3 days after operation, compliance evaluation results showed that 36 cases were of full compliance, and 13 cases were of partial compliance in trial group; 27 cases were of full compliance, 14 cases were of partial compliance, and 8 cases were of non-compliance in control group; there was significant difference between 2 groups (Z=2.286, P=0.002). The ambulation time was within 7 days in trial group, and was within 7 days in 47 cases and more than 7 days in 2 cases in control group; there was significant difference between 2 groups (Z=3.840, P=0.000). Conclusion Preoperative rehabilitation plays an important role in compliance, decreased bed rest time, and hip function improvement in patients after total hip arthroplasty.
目的 探討和分析葡萄球菌性燙傷樣皮膚綜合征(SSSS)的誘發因素、臨床表現、診治特點及其治療方法，為臨床提供依據。 方法 對1995年1月－2010年12月收治46例確診為SSSS患兒臨床資料進行回顧性分析，數據應用SPSS 13.0統計軟件包處理。 結果 該病發病人群以1～6歲健康嬰幼兒居多（71.1%），感染為主要發病誘因，早期出現眼周紅斑、口周紅斑伴放射狀裂紋，具有特殊的診斷意義。治療上應早期足量應用抗生素，早期使用丙種球蛋白療效顯著。 結論 SSSS是一種少見的皮膚病，目前診斷主要依據其典型的臨床表現、感染病灶細菌培養等。治療以早期選用足量敏感抗生素，一般5～7 d好轉，10 d左右痊愈，長期并發癥少見，聯用丙種球蛋白能有效緩解癥狀，縮短病程，系統使用糖皮質激素并不能有效縮短病程。
Objective To explore the effect of rolling compression loading bioreactor on chondrogenesis of rabbit bone marrow mesenchymal stem cells (BMSCs) with different loading parameters. Methods BMSCs were isolated from New Zealand rabbits, aged 2.5 months. BMSCs at passage 3 were used to prepare BMSCs-agarose gels (4 mm in diameter and height, respectively). Samples were divided into 8 groups: 10% (group A1), 20% (group A2), and 30% (group A3) compression groups (0.4 Hz, 3 h/ d) and 20 minutes (group B1), 3 hours (group B2), and 12 hours (group B3) rolling time groups and static culture (control groups). The living cell rate, the collagen type II and Aggrecan gene expressions, and glycosaminoglycan (GAG) content were determined, and histological staining was done at 24 hours, 7 days, 14 days, and 21 days after culture. Results At 14 and 21 days, the living cell rates of groups A1 and A2 were significantly higher than that of group A3 (P lt; 0.05), groups B1 and B2 were significantly higher than group B3 (P lt; 0.05). Collagen type II and Aggrecan gene expressions of the experimental groups at each time point were significantly higher than those of the control groups (P lt; 0.05); at 14 and 21 days, collagen type II and Aggrecan gene expressions of groups A1 and A2 were significantly higher than those of group A3, and groups B1 and B2 were also significantly higher than group B3 (P lt; 0.05). At 14 and 21 days, the GAG contents of groups A1 and A2 were significantly higher than those of group A3 (P lt; 0.05); groups B1 and B2 were also significantly higher than group B3 (P lt; 0.05). At 21 days, toluidine blue staining showed that obvious blue-staining and even cartilage lacunae were seen in groups A2 and B2, but light and quite rare blue-staining in groups A1, A3, B1, and B3. Conclusion The rolling compression loading bioreactor has great promotion effect on chondrogenesis of rabbit BMSCs with rolling parameters of 0.4 Hz, 3 hours, and 20% compression.
目的 探討臨床實施醫護一體化傷口治療模式的效果和前景。 方法 利用調查問卷方式，對2010年12月－2011年12月19個科室臨床實施醫護一體化傷口治療模式的效果進行滿意度調查。 結果 醫生、患者、護士的總體滿意度分別達到94.51%、94.56%、91.43%。 結論 醫護一體化傷口治療模式能夠明顯提高醫護患三方滿意度，值得在臨床推廣。