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中国临床保健杂志

中国临床保健杂志

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Chinese Journal of Clinical Healthcare
中国科技论文统计源期刊（中国科技核心期刊） 《中国临床保健杂志》征稿征订启事 由国家卫生部主管，卫生部北京医院、安徽省保健委员会主办，国内外公开发行的《中国临床保健杂志》，是以临床医学与保健为主题的综合性学术期刊。国家卫生部副部长、卫生部保健局局长黄洁夫同志兼任本刊编委会主任。自2005年第1期起，本刊已被收录为“中国科技论文统计源期刊”（中国科技核心期刊），并于2008年3月、5月相继被美国《化学文摘》(CA)、波兰《哥白尼索引》（IC）收录。 中国临床保健杂志社热诚欢迎医疗卫生工作者为本刊提供稿件。欢迎各有关单位和广大读者订购，每期9元，全年54元，全国各地邮局均可订购，邮发代号26-184，也可直接向中国临床保健杂志社邮购。 通讯地址：安徽省合肥市红星路1号省委大院715信箱中国临床保健杂志社收 邮编：230001 电话：0551-62608457 传真：0551-62606415 E-mail:J.C.Healthcare＠163.com 网址：http://bjzz.ahbj.cn
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  • 发文量：5200
  • 被引量：2259
  • H指数：1
  • 开始收录时间：1998(1)
  • CNKI综合因子：0.869
  • 维普期刊影响因子： 2.39
  • 万方期刊影响因子：1.97
  • 创刊时间：1998
  • 国内刊号/CN：34-1273/R
    国际刊号/ISSN：1672-6790
  • 发行周期：双月刊
    邮发代号：26-184
  • 主管单位：中华人民共和国卫生部
    主办单位：卫生部北京医院 安徽省保健委员会
中国临床保健杂志-联系信息
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  • 电话：0551-62608457
  • 邮箱：J.C.Healthcare@163.com
  • 地址：安徽省合肥市红星路1号
  • 邮编：230001
中国临床保健杂志-获奖情况
  • • 2009年，荣获“安徽省优秀期刊二等奖”
  • • 荣获“第四届华东地区优秀期刊二等奖”
  • • 2015年，荣获国家卫生计生委颁发的委管出版物主题宣传“优秀期刊奖”
  • • 2016年，在第四届《中国学术期刊评价研究报告（武大版）（2015-2016）》中被评为“RCCSE中国核心学术期刊（A）”
  • • 2017年，荣获“安徽优秀期刊奖”
  • • “保健论坛”栏目被评为安徽期刊“特色栏目”
  • • 荣获“第六届华东地区优秀期刊奖”
  • • 2018年，荣获“十佳皖版期刊”（自科类）称号
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  • 摘要：目的：总结阿尔茨海默病治疗过程中意外事件的发生、类型、临床表现，提高对不良事件的认识，从而减少和避免以上事件。方法对203例阿尔茨海默病患者出现意外事件的类型、数量进行回顾性分析。结果203例患者中有154例并发一种以上其他慢性疾病；意外事件方面跌倒为21例，排尿困难12例，噎食10例，深静脉血栓形成7例，癫痫发作15例，褥疮13例、其他10例。结论阿尔茨海默病患者可以并发排尿困难、骨折等不良事件；在诊治过程中应警惕不良事件的出现，提高患者生活质量，减少纠纷的发生。
  • 摘要：2013中国老年医学大会暨老年健康产业博览会于9月13-15日在苏州国际博览中心开幕。为期三天的时间内，来自全国的2000名专家就老年医学和老年健康进行专题论坛、开展相关活动。　开幕式上，全国政协副主席、大会名誉主席韩启德进行视频致辞，原国务院副总理吴仪给大会发来贺信，原全国人大副委员长顾秀莲致开幕词，江苏省委常委、苏州市委书记蒋宏坤，中国工程院院士王陇德、钟南山等出席开幕式。
  • 摘要：近年来，经桡动脉径路行心血管病介入诊疗已经逐渐成熟，由于其术后无体位限制、住院时间短、穿刺部位并发症少、创伤小、能避免患者产生便秘痛苦等优点［1-3］，受到医护人员及患者的欢迎。但是如何快而好的止血成为随之而来的问题。以往我们常规采用普通纱布绷带“8”字包扎［4］，但该方法包扎松紧度不易控制、操作时间长，影响静脉回流的缺点，从而引起肢端麻木、瘀血肿胀等不适，后我们改进为桡动脉止血器，大大提高了患者的舒适度，降低了肢端麻木、青紫的发生。目前我们又有了新的武器--桡动脉止血贴，本文通过其与桡动脉止血器比较，进而探讨其临床使用效果及安全性。
  • 摘要：目的：探讨武汉市老年住院患者对护理服务的需求情况及满意度，为医院改善医疗服务质量提供理论依据。方法根据马斯洛需要理论自行设计调查问卷，采取分层抽样方法，选取武汉市住院老年患者148例进行问卷调查。结果老年住院患者对健康指导需求及自我实现需求较高，对自尊需求最低；对护理服务的需求与对护理工作的满意度的排序基本一致。结论医院应该以患者需求为导向，主动提供针对性的护理措施，有助于提高患者满意度。
  • 摘要：Objective To summarize the characteristics and principles of acupoints seletion in the treatment of cervical spondylosis of vertebroarterial type(CSA).Method The RCTs for acupuncture treatment for CSA were searched from CNKI journal database(1915 to July,2013)and Wanfang database(1990 to July,2013),and the acu-points were recorded and analyzed using Excellfor statistic analysis.Results A total 207 articles involving 84 acu-points were included.The total frequency of usage was 1154 times including Fengchi(GB20)171 times,Cervical Jiaji 149 times and Baihui(DU20)110 times et cetera.There were 63 main acupoints for CSA with using frequency 848 times,and Fengchi(GB20)was most frequently used one(164 times).While Zusanli (ST36)was most frequently used (23 times)among the 60 match acupoints with using frequency 306 times.The fourteen meridians were all cov-ered,of which the most acupoints selected from was the bladder meridian of foot Taiyang (14 acupoints)and the most frequently used one was gallbladder meridian of foot Shaoyang (233 times).The main acupoints were selected at the local of lesion,and the match acupoints in the distal.Different specific points were widely used.Conclusion The lo-cal acupoints selection of meridian is an important method of acupuncture in the treatment of CSA,and the distal acu-points selection is an beneficial supplement for acupuncture treatment in patients with different TCM syndrome types of CSA.%目的：总结与分析针灸治疗椎动脉型颈椎病的临床用穴特点和规律。方法检索1915年至2013年7月 CNKI 期刊数据库及1990年至2013年7月万方数据库针灸治疗椎动脉型颈椎病（CSA）的临床随机对照（RCT）文献，对所用腧穴进行统计归纳分析。结果纳入文献207篇，涉及84个腧穴，使用总频次1154次，其中风池171次、颈夹脊149次、百会110次；涉及主穴63个，使用频次848次，以风池164次频次最高；配穴60个，使用频次306次，以足三里23次频次最高。十四经脉腧穴均有涉及，其中以足太阳膀胱经腧穴选用最多，为14个；而腧穴使用频次最高的为足少阳胆经，总使用频次233次。主穴重视局部腧穴，配穴以远端腧穴为主，五输穴、原穴、络穴、交会穴、下合穴等特定穴运用广泛。结论循经局部取穴是针灸治疗 CSA的重要方法，配穴远端取穴是针灸治疗不同中医证型 CSA 患者的有益补充。
  • 摘要：急性心肌梗死（AMI）是院前急救常见的急危重症，大多发生在院外，一般有50％左右的死亡是在发病后1 h 以内［1-2］，院前急救护理干预对于患者的预后和挽救患者生命具有重要的意义［3］。早而有效的急救和护理干预是减少死亡率、赢得下一步治疗的关键。现将我科抢救院前 AMI 患者的护理体会总结介绍如下。
  • 摘要：Objective To explore the differential diagnosis value of combination detection of serum alpha-fe-toprotein (AFP),Carbohydrate antigens 125 (CA125)and Carbohydrate antigens 19-9(CA19-9)between hepatocel-lular carcinoma (HCC)and liver metastases.Methods The level of serum AFP,CA125 and CA19-9 were detected in 95 patients,including 45 cases of HCC,38 cases of liver metastases,and 10 cases of benign liver disease.Results ① Three markers in patients with benign liver disease were all negative.The positive rate of serum AFP was in-creased significantly (P <0.05)in patients with HCC compared with liver metastases,and the positive rate of joint detection of AFP,CA125 and CA19-9 was 88.9%,which were significantly (P <0.05)higher than AFP detection,② The positive rate of serum CA19-9 and CA125 were 57.8% and 77.8%,respectively,and the positive rate of de-tection of CA19-9 and CA125 significantly (P <0.05)higher in patients with HCC than those of patients with liver metastases.Conclusion AFP is still one of the most important tumor markers in the diagnosis of HCC.Combined de-tection of serum AFP,CA125 and CA19-9 can significantly improve the sensitivity of HCC.%目的：探讨联合检测甲胎球蛋白（AFP）、糖抗原125（CA125）、糖抗原19-9（CA19-9）在肝细胞癌（HCC）与肝脏转移瘤鉴别诊断中的价值。方法检测93例患者的血清 AFP，CA125和 CA19-9浓度，其中HCC 组45例，肝脏转移瘤组38例，良性肝病组10例。结果①良性肝病组三种标志物均阴性，HCC 组 AFP阳性率明显高于肝脏转移瘤组，且联合检测 AFP、CA125、CA19-9阳性率高达88．9％，明显高于 AFP 单项检测（P ＜0．05）；② HCC 组血清 CA19-9和 CA125阳性率分别为57．8％和77．8％，联合检测 CA19-9、CA125阳性率明显高于肝脏转移瘤组（P ＜0．05）。结论AFP 仍是诊断肝细胞癌的主要血清学肿瘤标志物，联合检测AFP、CA125、CA19-9可明显提高 HCC 的敏感性。
  • 摘要：目的：探讨血清脂联素水平与2型糖尿病大血管并发症的相关性。方法将所选的2型糖尿病患者106例分为单纯2型糖尿病组和2型糖尿病合并大血管病变组。对所有受试者测量身高、体质量、血压，同时分别测定三酰甘油，总胆固醇，低密度脂蛋白胆固醇，高密度脂蛋白胆固醇，糖化血红蛋白、空腹血糖、高敏 C-反应蛋白、血清脂联素水平、空腹胰岛素、颈动脉内膜中层厚度等。结果两组间血清脂联素水平差异有统计学意义（P ＜0．05），Logistic 回归进行多因素分析显示调整年龄、性别、BMI 及高敏 C 反应蛋白等因素后血清脂联素与高密度脂蛋白显著正相关（P ＜0．05），与收缩压及颈动脉内膜中层厚度呈负相关（P ＜0．05）。结论血清脂联素水平与2型糖尿病大血管并发症的发生发展有关，其在糖尿病动脉粥样硬化过程中可能起重要作用。
  • 摘要：目的：调查老年心血管病患者睡眠呼吸暂停低通气综合征（SAHS）的患病情况。方法采用微动敏感床垫睡眠监测系统对60岁以上住院老年心血管病患者进行睡眠呼吸监测并数据分析。结果127例患者（男性101例，女性26例），平均（76．4±6．8）岁，分别或合并患有冠心病、高血压、各种心律失常以及糖尿病及空腹血糖受损和（或）糖耐量异常、高尿酸血症、慢性肾脏病等。检出 SAHS 107例，患病率84．3％。SAHS 组冠心病患病多于对照组，P ＜0．05；SAHS 患者平均呼吸紊乱指数（AHI）22．6±14．7，其中 AHI≥15者64例，呼吸事件主要为阻塞性，但随着增龄，阻塞性呼吸事件时长减少，低通气事件时长增加。监测血氧饱和度118例均存在夜间低氧血症，重度患者50例占41．7％，最低血氧饱和度（LO2）（79．0±7．2）％，平均血氧饱和度（AO2）（92．8±2．7）％。患者年龄与低通气指数正相关，与 LO2负相关，均 P ＜0．01，在调整呼吸紊乱参数后，年龄与 LO2的负相关依然存在，r ＝-0．223，P ＜0．05。结论老年心血管病患者有很高的 SAHS 和夜间低氧血症患病率，SAHS 的低通气事件加重老年患者随增龄增加的夜间低氧血症。%Objective To investigate the prevalence of obstructive sleep apnea hypopnea syndrome (OS-AHS)in the aged patients with cardiovascular disease.Methods The sleep and breath monitoring was performed by using micro -movement sensitive mattress sleep monitoring system (MSMSMS)in 127 hospitalized patients with car-diovascular disease aged more than 60 years old or over at least two nighs for detecting SAHS.Results A total of 127 patients (101 males and 26 females)were included in the study.The average age of patients was (76.4 ±6.8) years.The patients were alone or complicated with coronary heart disease,hypertension,arrhythmias,heart failure,or/and diabetes and impaired fasting glucose and (or)glucose tolerance abnormalities,hyperuricemia and chronic kidney disease.There were totally 107 cases with OSAHS (84.3%).The number of cases with coronary heart disease in SAHS group was more than that in the control group.The mean apnea hypopnea index (AHI)was (22.6 ±14.7), of which 64 cases were AHI≥15.The majority were obstructiverespiratory events.However,with the increase in the age,the decreased length of obstructive respiratory events and increased length of hypopnea events were observed. Nocturnal hypoxemia was detected in all of 118 cases who received monitoring of oxygen saturation,of which 50 cases (41.7%)were severe.The average level of lowest oxygen saturation(LO2 )was (79.0 ±7.2)% and mean oxygen saturation(AO2 )was (92.8 ±2.7)%.The age of patients was significantly positively correlated with HI and nega-tively correlated with LO2 (P <0.01).The negative correlation between age and LO2 was still present after the adjust-ment of the parameters of breathing disorder(r =-0.223,P <0.05).Conclusions The prevalence of OSAHS and nocturnal hypoxemia disease is high in the aged patients with cardiovascular diseases.The hypopnea events of OSAHS aggravate the nocturnal hypoxemia,which is increased with age in the aged patients.
  • 摘要：在我国，脑卒中的发病率为2‰，近年来，急性脑血管病发病率有明显上升趋势，发病年龄呈下降趋势，随着现代化科学技术的应用，脑卒中的救治水平不断提高，死亡率下降，残疾率和残疾人数不断上升。
  • 摘要：目的：探讨新疆维、汉两民族阿尔茨海默病（AD）患者的血清血脂水平特点、ApoE 基因多态性对血脂代谢的影响，及两者在 AD 发病中的作用。方法对新疆地区维、汉两民族≥50岁常住居民（共8284例）进行 AD 流行病学调查，选取其中诊断为 AD 的患者157例（汉族65例、维族92例）作为 AD 组、非痴呆对照组155例（汉族68例、维族87例），应用聚合酶链反应-限制性片断长度多态性分析方法（PCR-RFLP）测定两组载脂蛋白 E（ApoE）各基因型和等位基因频率，并测定其血浆胆固醇（TC）、三酰甘油（TG）的水平。结果（1）AD 组血清 TC、TG 水平高于对照组（P ＜0．05）；AD 组中维、汉两民族间 TC、TG 水平比较差异无统计学意义（P ＞0．05）。（2）ApoEε4组中 AD 患者血清 TC 水平高于对照组（P ＜0．05）；AD 患者中 ApoEε4组、ApoEε3组与 ApoEε2组三组之间 TC 水平差异有统计学意义（F ＝3．65，P ＜0．05）；在 AD 组中不同基因型维、汉族血脂水平差异均无统计学意义（P ＞0．05）。结论AD 患者存在血脂代谢紊乱，ApoE 基因多态性可能对血脂代谢进行着调控；ApoEε4等位基因、TC 水平升高可能是散发性 AD 的危险因素。%Objective To investigate the characteristics of serum lipid levels in patients with Alzheimer's disease (AD)of the Xinjiang Uygur and Han nationalities,and the impact of ApoE gene polymorphism on lipid me-tabolism and its role in AD pathogenesis.Methods An AD epidemiological investigation was carried out among the permanent residents(8.284 cases,age≥50 years old),including both Uygur and Han nationalities in Xinjiang.ApoE genotypes and allele frequency was detected by Polymerase chain reaction -restriction fragment length polymorphism analysis (PCR-RFLP)in potential 157 cases (65 cases Han,92cases Uygus)of AD and 155 cases(68cases Han, 87cases Uygus)of control.The concentration of serum cholesterol (TC),and triglyceride (TG)were also measured. Results (1)The levels of serum TC and TG in AD group were higher than that of control group (P <0.05),with no no statistical differences between Uygur and Han AD patients meaning(P >0.05).(2)The level of serum TC in ApoEε4 group of AD patients was higher than control group (P <0.05).There were siginificant difference among the three ApoE groups of AD patients (F =3.65,P <0.05).In the three ApoE groups,there were no differences in the levels of TC,TG among the different ethnic of Uygur and Han nationality in AD group.Conclusion AD patients are characteristized by Lipid metabolism disorder.The level of serum TC and TG in AD group is increased signficantly. ApoE gene polymorphism plays a role in the regulation of lipid metabolism,and ApoEε4 allele and higher TC level might be a risk factor in Sporadic AD.
  • 摘要：目的：探讨老年高血压患者血压昼夜节律紊乱对心率的影响。方法选择降压治疗期间诊室血压正常的200例老年单纯收缩期高血压患者，根据动态血压检查结果，分为杓型组56例，非杓型组80例，反杓型组64例，选择健康者32例做为对照组。全部患者进行24 h 动态心电图检查，比较各组与对照组24 h、白昼和夜间的心率水平、心率变异性，分析血压与心率的相关性。结果心率在非杓型组和反杓型组快于杓型组或对照组（P ＜0．01、P ＜0．05）；SDANN、SDNN、rMSSD、PNN50在反杓型组显著降低（P ＜0．01、P ＜0．05）；白昼心率增快与白昼平均收缩压和舒张压增高呈正相关（P ＜0．05），夜间心率增快与夜间平均收缩压增高呈正相关（P ＜0．05）。结论血压增高与心率增快具有相关性，血压昼夜节律紊乱可使心率增快，心率变异性下降。%Objective To investigate the influence of circadian rhythm disorders of blood pressure on heart rate in elderly hypertensive patients.Methods 200 elderly patients with isolated systolic hypertension were selected and divided into three groups [dipper type (n =56),non-dipper type (n =80)and reverse-dipper type (n =64)] according to the ambulatory blood pressure,32 healthy individuals were recruited as control group.All the patients and healthy subjects were submitted to 24-h ambulatory blood pressure monitoring.The 24 h daytime and nighttime heart rate and heart rate variability were recorded.Results The heart rate of hypertensive patients with non-dippers and re-verse-dipper was significantly higher than that of patients with dipper and healthy subjects (P <0.01,P <0.05);The values of SDANN、SDNN、rMSSD、PNN50D were significantly lower in the reverse-dippers type group(P <0.01, P <0.05)compared with those of dippertype and non-dipper type group,the heart rate was positively correlated to the average systolic and diastolic blood pressure during the daytime and nighttime (P <0.05).Conclusion The circadi-an rhythm disorders of blood pressure is associated with higher heart rate and lower heart rate variability.
  • 摘要：Objective To evaluate the effect of gonadotropin-releasing hormone agonist (Gonadotrophin re-leasing hormone agonist,GnRHa)combined with add back therapy for moderate /severe endometriosis after conserva-tive surgery in China.Methods In addition to manually searching,Cochrane CentralRegister of Controlled Trials (CENTRAL),the Cochrane Library,PubMed,Medline,EMBASE,SCI,Chinese journal full-text database,Chinese bi-omedical literature database,Chinese sci-tech periodical full-text database,VIP Chinese Periodical Database and Wan-fang Chinese Periodical Database were electronically searched from the establsihment of the database till March 2013, and state was limit as China.A total of seven RCTs meet the criteria.The data was extracted and analyzed by two re-viewers independently using the RevMan5.1 software.Results ①The increase in serum estrogen (E2 )levels,P <0.01,decrease in levels of serum follicle-stimulating hormone (FSH)was observed in the add-back therapy group,P=0.006,there was no statistic difference in the levels of serum CA125 and LH between the add-back therapy group and the GnRHa group,P >0.05.②There was no significant difference in the VAS score between the add-back thera-py group and the GnRHa group,P =0.12.③The menopause symptom(Kupperman score)caused by GnRHa was re-lieved in the add-back therapy group,P =0.001,There was no statistic difference in the levels of serum BMD and BPG levels,P >0.05.Conclusions GnRHa combined with add-back therapy post operation for moderate /severe en-dometriosis can effectively reduce the the menopause symptoms caused by GnRHa,with no evidence of changes in bone density,pain symptoms and CA125 levels.%目的：评价促性腺激素释放激素激动剂（GnRHa）联合反向添加疗法用于我国中重度子宫内膜异位症患者术后疗效。方法检索 cochrane central Register of Controlled Trials（CENTRAL）、the cochrane Li-brary、PubMed、Medline、EMBASE、SCI、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、维普数据库、万方数据资源，检索时间截止2013年3月，国家限制为中国，并辅以手工检索，根据入选标准选出 RCT 文献7篇，对其进行文献质量评价。采用 RevMan5．1软件进行 meta 分析。结果①反加疗法组较 GnRHa 组增加雌激素（E2）水平，P ＜0．01，降低卵泡刺激素（FSH）水平，P ＝0．006，两组差异均有统计学意义。反加组与 GnRHa 组间 CA125水平、黄体生成素（LH）水平差异无统计学意义。②在缓解疼痛 VAS 评分上反加疗法组与 GnRHa 组差异无统计学意义。③在药物不良反应中绝经症状严重程度（Kupperman 评分）上反加疗法组缓解了使用 GnRHa 造成的绝经症状，两组差异有统计学意义，P ＝0．001，在骨密度、骨钙素水平上，两组差异无统计学意义。结论保守手术后中重度子宫内膜异位症患者应用反加疗法，可以减少由GnRHa引起的低雌激素水平，但是未能对于骨密度水平和疼痛症状有显著地改善。
  • 摘要：目的：分析多重耐药鲍曼不动杆菌与多重耐药铜绿假单胞菌的耐药性，为临床治疗提供依据。方法用 VITEK-32微生物自动鉴定与药敏系统，对临床分离出的非重复铜绿假单胞菌56株、鲍曼不动杆菌72株进行鉴定、药敏试验，并对比分析两种菌的耐药性。结果鲍曼不动杆菌对阿米卡星、左氧氟沙星的耐药率最低，分别为2．8％和68．1％。铜绿假单胞菌对哌拉西林/他唑巴坦的耐药率最低，为19．6％，其次为阿米卡星与亚胺培南，均为37．5％。鲍曼不动杆菌对哌拉西林/他唑巴坦、庆大霉素、妥布霉素、氨曲南、环丙沙星、左氧氟沙星、头孢吡肟、头孢他啶和亚胺培南的耐药率明显高于铜绿假单胞菌，差异有统计学意义（P ＜0．01或 P ＜0．05），只有对阿米卡星的耐药率低于铜绿假单胞菌（P ＜0．01）。71．7％的鲍曼不动杆菌只对阿米卡星敏感，鲍曼不动杆菌的多重耐药率（97．2％）显著高于铜绿假单胞菌（67．9％），P ＜0．01。结论铜绿假单胞菌、鲍曼不动杆菌的多重耐药现象严重，尤其是鲍曼不动杆菌，应加强耐药性监测。%Objective To analysis multidrug-resistant of Pseudomonas aeruginosa and Acinetobacter bau-mannii isolated from hospitalized patients and provide reliable reference for rational clinical use of antibiotics.Meth-ods The identification and antibiotics resistance test of 56 strains of Pseudomonas aeruginosa and 72 stranis of Acin-etobacter baumannii isolated from patients in emergency department from May 2009 to Oct 2011 were performed by VITEK-32 system.Results The resistance rate of Acinetobacter baumannii to Amikacin was the lowest (2.8%),fol-lowed by Levofloxacin(68.1%).The antibiotics resistance rate of Pseudomonas aeruginosa to Piperacillin/tazobactam was lowest(19.6%),followed by Amikacin and Imipenem(37.5%).The antibiotics resistance rate of Acinetobacter baumannii to Piperacillin/tazobactam,Gentamycin,Tobramycins,Aztreonam,Levofloxacin,Ciprofloxacin,Ceftazidime, Cefepime and Imipenem were significantly higher than that of Pseudomonas aeruginosa (P <0.01 or P <0.05),ex-cept for Amikacin,the resistance rate of Acinetobacter baumannii was lower than that of Pseudomonas aeruginosa (P<0.01).The multidrug-resistant rate of Acinetobacter baumannii (97.2%)was significantly higher than that of Pseudomonas aeruginosa(67.9%)(P <0.01),with 71.7% of Acinetobacter baumannii was only sensitive to Ami-kacin.Conclusion The multidrug-resistant rates of Pseudomonas aeruginosa and Acinetobacter baumannii are high, especialy for Acinetobacter baumannii.The antibiotics resistance monitoring and rational use should be paid more at-tention according to the results of drug susceptibility test.
  • 摘要：Objective To analyze the correlation of serum procalcitonin(PCT),C reactive protein(CRP) and severity and prognosis of acute pancreatitis(AP).Methods The serum levels of PCT,CRP of 106 cases of acute pancreatitis were collected and analyzed retrospectively,including 45 severe acute pancreatitis(SAP)and 61 mild a-cute pancreatitis(MAP).Then their relationship with other biochemical parameters,the severity and prognosis of AP was analyzed.Results The serum PCT and CRP levels were(7.86 ±2.38)μg/L and(148.26 ±16.46)mg/L in SAP group,and both were significantly higher than those in MAP(5.22 ±2.13)μg/L and(47.62 ±9.89)mg/L(P <0.01).The serum levels of PCT was positively correlated with serum levels of CRP(r =0.316,P <0.01),and both were positively correlated with 24 h APACHE IIscore,Ranson score,Balthazar CT score(P <0.05 or <0.01).Con-clusion Our results indicate PCT and CRP levels may evaluate progression of AP and predict prognosis at an early date.%目的：探讨降钙素原（PCT）、C 反应蛋白（CRP）与急性胰腺炎（AP）严重程度和预后的相关性。方法回顾性分析106例急性胰腺炎（AP）的降钙素原、C 反应蛋白水平，其中重症急性胰腺炎（SAP）45例，轻症急性胰腺炎（MAP）61例。分析它们与其他生化指标、AP 病情程度及患者预后的相关性。结果SAP 组患者血清 PCT 及 CRP 水平分别为（7．86±2．38）μg/L 和（148．26±16．46）mg/L，明显高于 MAP 组的（5．22±2．13）μg/L 和（47．62±9．89）mg/L（P ＜0．01）。AP 患者血清 PCT 水平与 CRP 水平呈正相关（r ＝0．316，P ＜0．01），且两者与24 h APACHE II 评分、Ranson 评分、Balthazar CT 评分均呈正相关（P ＜0．05或＜0．01）。结论检测 PCT 与 CRP 水平有助于判断 AP 病情发展和预测预后。
  • 摘要：目的：探讨采用声触诊组织量化（VTQ）技术评估肝实质纤维化的应用价值。方法应用VTQ技术对36例慢性乙型肝炎患者和55例健康志愿者的肝实质进行检测，用9L4线阵超声探头测定肝实质的剪切波速度（SWV）。结果健康对照组和慢性乙型肝炎组缺失值出现率分别为26．55％和51．11％，差异有统计学意义（P＜0．01）；健康对照组和慢性乙型肝炎组SWV测值分别为（1．35±0．39）m/s和（2．27±0．76）m/s，健康对照组小于慢性乙型肝炎组（P ＜0．05）。通过ROC曲线确定变量的临界值为1．79 m/s，曲线下面积为0．94（P ＜0．05），对应的敏感度、特异度、阳性似然比、阴性似然比和Youden指数分别为86．89％、91．11％、9．77、0．14和0．78。结论VTQ可快速无创测量肝实质剪切波速度，可客观反映肝组织的弹性模量。%Objective To explore the values of virtual touch tissue quantification (VTQ)in the assessment of liver fibrosis.Methods 36 patients with chronic hepatitis B (CHB group)and 55 healthy volunteers (control group)were recruited.The shear wave velocity (SWV)of the right hepatic lobe was measured by linear (9L4)array transducer.Results There were significant difference in the occurrence rate of missing data using the 9L4 transducer between control group and CHB groups,which was 26.55%and 51.11%,respectively (P<0.01).The SWV of con-trol group and CHBs were(1.35 ±0.39)m/s and (2.27 ±0.76)m/s (P<0.05).The cut-off level was 1.79 m/s and area under the receiver-operating characteristic curve (AUROC)was 0.95 according to the ROC curves,and the corresponding sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and Youden's index were 86. 89%,91.11%,9.77,0.14,and 0.78,respectively.Conclusion VTQ is a reliable,noninvasive and rapid method for estimating the value of SWV,which may reflect the elastic modulus of liver tissues objectively.
  • 摘要：Objective To assess the relationship between the methylation of RASSF1A gene and gender, age,TNMstage,differentiation,lymph node metastasis,Lauren's type of patients with gastric cancer,and to discuss the significance of RASSF1A gene methylation in gastric cancer.Methods We searched PUBMED(1998.01 ~2012. 07),CNKI(1998.01 ~2012.07),WANFANG data base(1998.01 ~2012.07).Randomized controlled trials(RCTs) in which methylation of RASSF1A gene was detected in the patients with gastric cancer were collected.Then we screened the retrieved studies according to inclusion and exclusion criteria,evaluated the quality of the included stud-ies,and performed meta-analyses by RevMan 5.1 software.Results A total of 36 articles were searched and 9 arti-cles involving 506 patients were finally included.We choosed the fixed-effect model to conduct meta-analysis because heterogeneities were not found among these articles.The different analysis between Ⅰ-Ⅱ stages and Ⅲ-Ⅳ stages showed that the combined OR was 0.36[95%CI(0.22,0.60),P <0.01].The different analysis between well and moderate differentiations and poor differentiation showed that the combined OR was 0.73[95%CI(0.39,1.34),P >0.05].The different analysis between with and without lymph node metastasis showed that the combined OR was 2.07,[95%CI(1.19,3.60),P =0.01].The different analysis between male and female showed that the combined OR was 1.09[95%CI(0.68,1.73),P >0.05].The different analysis between <60 years old and ≥ 60 years old showed that the combined OR was 0.77[95%CI(0.47,1.25),P >0.05].The different analysis between Intestinal type and Diffuse type showed that the combined OR was 0.95,[95%CI(0.37,2.46),P >0.05].Conclusion The TNM stages,differentiation,lymph node metastasis of patients with gastric cancer are closely related with the methyla-tion of RASSF1A.Methylation rate of RASSF1A is higher in Ⅲ-Ⅳstages and in lymph node metastasis,and there is not significant correlation between methylation of RASSF1A and gender,age,differentiation,Lauren's type.%目的：探讨 RASSF1A 甲基化与胃癌临床病理资料的关系。方法通过计算机检索 PUBMED （1998．01～2012．07）、中国知网（1998．01～2012．07）、万方数据库（1998．01～2012．07）等数据库，收集RASSF1A 甲基化与胃癌关系的相关文献，按纳入与排除标准筛选病例对照试验。评价质量及提取资料后，采用 RevMan 5．1软件对数据进行 Meta 分析。结果共检索到36篇，经筛选最终纳入9篇，共506例胃癌组织。Meta 分析结果显示，早期（Ⅰ期-Ⅱ期）与中晚期胃癌（Ⅲ期-Ⅳ期）患者胃癌组织中 RASSF1A 甲基化阳性率合并的 OR 值为0．36[95％CI（0．22，0．60），P ＜0．01]，中高分化与低分化胃癌组织中 RASSF1A 甲基化率合并的 OR 值为0．73[95％CI（0．39，1．34），P ＞0．05]，淋巴结转移与无转移患者胃癌组织中 RASSF1A 甲基化阳性率合并的 OR 值为2．07[95％CI（1．19，3．60），P ＝0．01]，男性与女性患者 OR 值为1．09[95％CI（0．68，1．73），P ＞0．05]，＜60岁与≥60岁患者胃癌组织中 RASSF1A 甲基化阳性率合并的 OR 值为0．77[95％CI （0．47，1．25），P ＞0．05]，肠型与弥漫型患者胃癌组织中 RASSF1A 甲基化阳性率合并的 OR 值为0．95[95％CI（0．37，2．46），P ＞0．05]。结论胃癌患者病理分期、有无淋巴结转移与胃癌组织 RASSF1A 甲基化密切相关，中晚期胃癌患者 RASSF1A 甲基化阳性率高于早期胃癌患者，有淋巴结转移的胃癌患者 RASSF1A 甲基化阳性率较高。而胃癌患者的性别、年龄、分化程度、Lauren 分型与胃癌组织中的 RASSF1A 甲基化阳性率无显著相关性。
  • 摘要：目的：比较宫颈环形电切术、冷刀宫颈锥切术在宫颈上皮内瘤样病变（CIN）治疗中的临床价值。方法156例 CIN 患者按随机数字表法分为两组，A 组（采用宫颈环形电切术）85例采用宫颈环形电切术治疗，B 组（采用冷刀宫颈锥切术）71例采用冷刀宫颈锥切术治疗，比较两组的手术情况、治疗效果及术后感染情况。结果A 组手术时间、愈合时间、出血量及花费分别为（11．24±4．17）min、（33．49±4．51）d、（12．18±3．92）ml 和（1256．24±268．91）元，明显少于 B 组的（28．62±7．54）min、（39．25±6．23）d、（25．36±8．23）ml和（3216．93±375．28）元（P ＜0．05）。两组治愈、持续存在、手术残留及复发发生率比较，以及下腹疼痛、宫颈充血肥大、宫颈赘生物及创面感染发生率比较，均差异无统计学意义（P ＞0．05）。结论冷刀锥切术和宫颈环形电切除术在 CIN 治疗效果以及术后感染方面相似，但宫颈环形电切除术可缩短手术操作时间，加速愈合，降低术中出血量，减少患者的花费，在 CIN 治疗中更具优势。%Objective To compare the effect of loop electrosurgical excision procedure and cold knife conization in treatment with cervical intraepithelial neoplasia (CIN).Method From March 2010 to March 2012,156 cases of CIN patients were classified into two groups,which A of 85 cases were treated with loop electrosurgical exci-sion procedure and B group of 71 cases were treated with cold knife conization.The operation,clinical effect and post-operative infection between the two groups were compared.Results The operative time,healing time,bleeding volume and cost in A group were (11.24 ±4.17)min,(33.49 ±4.51)d,(12.18 ±3.92)ml and(1256.24 ±268.91)yuan, which significantly lower than those in B group with (28.62 ±7.54)min,(39.25 ±6.23)d,(25.36 ±8.23)ml and (3216.93 ±375.28)yuan(P <0.05).There were no significant differences the incidence of cured,persistence,surgi-cal residual and recurrence between two groups(P >0.05).There were no significant differences in the incidence of abdominal pain,cervical hyperemia hypertrophy,cervical neoplasm and wound infection between two groups(P >0. 05).Conclusion There are similar effects of clinical effect and postoperative infection between loop electrosurgical excision procedure and cold knife conization in treatment with CIN.But loop electrosurgical excision procedure can shorten operation time,accelerate healing,low operation bleeding and reduce cost.
  • 摘要：目的：分析心内科病房医院感染的临床特征，为临床提供参考。方法回顾性分析2010年12月到2012年11月心内科2339例住院患者的临床资料。结果2339例住院患者，感染182例，感染发生率7．8％；感染部位以呼吸道为主，占61．54％；医院感染危险因素按大小依次为：年龄≥65岁（OR ＝3．98， P ＜0．05），住院天数≥20 d（OR ＝3．05，P ＜0．05），心功能Ⅲ-Ⅳ（OR ＝2．97，P ＜0．05），留置尿管（OR ＝2．72， P ＜0．05），餐后血糖≥7．8mmol/L（OR ＝2．01，P ＜0．05），应用抑酸剂（OR ＝1．79，P ＜0．05）。结论心内科住院患者易于并发医院内感染，感染因素多，临床应予针对性预防，合理利用抗菌药物、加强基础疾病治疗、减少侵入性操作、缩短住院时间等，以降低医院感染的发生。
  • 摘要：男性，70岁，右肺腺癌术后3年，脑转移1年余。该患者2009年4月查体发现右肺中叶占位，血CEA 升高，2009年4月27日行右肺中叶切除及纵隔淋巴结清扫术，术后病理为中分化腺癌，肿物大小5．5 cm，肺门淋巴结转移1／4，纵隔淋巴结转移5／13，EGFR19及21未见基因突变，分期为T2N2M0，术后血 CEA 降至正常，行四周期健择和顺铂方案辅助化疗，未放疗。2010年6月患者出现左侧肢体肌力减退，行头颅 CT 发现左侧顶叶及桥脑多发转移瘤，血 CEA 升高至10μg／L，外周未发现转移复发，随行全脑放疗，并行四周期培美曲塞化疗四周期，血 CEA 下降至正常，2011年8月患者再次出现右下肢无力，肌力三级，行走不稳，无头晕恶心呕吐，无意识障碍，脑 CT 示转移瘤较前增大，血 CEA再次升高至13μg／L，给予甘露醇及激素后症状稍有缓解，2011年10月10日开始口服替莫唑胺（江苏天士力帝益药业有限公司，批号：110704，每粒50 mg），第1周期100 mg／m2，连服5 d，患者有轻度恶心，无余不良反应，28 d 为1周期，第1周期后血CEA 逐渐下降，第2周期替莫唑胺加量至150 mg／m2，复查 CEA 下降至正常，肌力改善，头颅 CT 颅内病灶稳定，共服用替莫唑胺6周期，除Ⅰ度恶心外，无其他不良反应，血 CEA 一直正常，疾病稳定8个月。
  • 摘要：目的：观察系统电话护理教育对维吾尔族绝经后妇女骨质疏松症生活质量的改善、腰背痛的缓解及知识掌握率、生活方式影响、遵医嘱服药行为改善的效果。方法收集80例新疆边远地区维吾尔族绝经后妇女骨质疏松症患者作为受试者。随即分组为系统电话护理教育干预组及未干预组，比较干预后（时限12个月、24个月）生活质量、知识掌握率、生活方式影响、遵医嘱服药行为方面比较；干预12个月、干预24个月进行腰背痛评分的比较。结果干预后患者生活质量、知识掌握率、生活方式影响、遵医嘱服药行为方面较未干预组有明显改善（P ＜0．05）；干预12个月、干预24个月，患者腰背痛评分均较前有明显的缓解（P ＜0．05）。结论系统电话护理教育能显著提高新疆边远地区维吾尔族绝经后妇女骨质疏松症用药依从性及病理性骨折发生率。
  • 摘要：目的：探讨如何做好 PET-CT 检查过程中给予口服造影剂的护理配合。方法对200例胃肠道肿瘤患者行静脉注射18F-FDG 后，分次给予1％泛影葡胺溶液口服。结果197例患者口服泛影葡胺溶液后胃肠道充盈较好，图像清晰，无伪影，符合诊断要求。结论胃肠道肿瘤患者行 PET-CT 检查程中口服泛影葡胺时，给予积极有效的护理指导是患者口服对比剂取得满意效果的重要保证。
  • 摘要：近年来，胰腺癌的发病率呈逐年上升趋势，其早期症状不典型，至出现明显症状时，多已进入晚期，且侵袭性强，恶性程度高，手术切除率低，预后极差，5年生存率仅5％，死亡率接近100％，在美国已成为癌症死亡的第四大病因［1］。治疗主要以外科手术切除为主，但切除率低，只有10％～15％。吉西他滨（GEM）、顺铂等化学药物虽能减缓肿瘤的进展，提高患者的生活质量，但对于胰腺癌的预后几乎没有影响［2］。胰腺癌治疗效果不理想、预后差，因此需要寻找早期诊断和更有效、安全的治疗手段。纳米颗粒因具有独特的声、光、电、磁、力学性能［3］，使其在肿瘤的光热治疗，生物传感、分子影像及基因转移方面独特的特性已成为医学基础和临床研究的热点。
  • 摘要：Objective To observe the changes of serum Bone Gla Protein(BGP)and Tartrate-Resistant Acid Phosphatase(TRACP)according to different clinical factors in patients with Ankylosing Spondylitis(AS).Method Enzyme-linked immunosorbent assay(ELISA)was used to detect the level of serum BGP and TRACP,and the differ-ence in sex,age,course of disease,disease activity were compared in patients with AS.Results (1)Compared with health control group,the level of TRACP in the treatment group was increased,while the level of BGP was decreased (P <0.05 or P <0.01).(2)The changes of serum bone metabolism index according to clinical factors in sixty AS patients:① the level of TRACP in male group was higher than that in female group(P <0.05),while there was no statistical difference in the level of BGP between the two groups.②The level of BGP in the age >30year-old patients group was lower than that of younger patients group,while the level of TRACP was higher than that of the latter(P <0.01 or P <0.05).③ the level of TRACP in duration >5 years group was higher than that in duration ≤ 5 years group,while the level of BGP was on the contrary(P <0.01).④ the level of TRACP in patients with active period of AS was significantly higher compared with patients with non-active period of AS,while the level of BGP was on the contrary(P <0.01).Conclusion In patients with AS,the levels of BGP is significantly decreased,and the levels of TRACP is significantly increased,both of which have a close correlation with sex,age,course of disease,disease activity.%目的：按不同临床因素分组观察强直性脊柱炎（AS）患者骨钙素（BGP）、抗酒石酸酸性磷酸酶（TRACP）的变化。方法采用 ELISA 试剂盒检测60例 AS 患者和健康对照组 BGP、TRACP 的变化，然后比较该两项指标在不同性别、年龄、病程、疾病活动性 AS 患者中的差异。结果（1）与健康对照组比较，AS 患者组 TRACP 水平明显增高（P ＜0．01），而 BGP 水平明显降低（P ＜0．05）。（2）60例 AS 患者中按不同临床因素分组后比较骨代谢指标变化：①男性组的 TRACP 比女性组的 TRACP 明显增高（P ＜0．05），而两组 BGP 比较差异无统计学意义（P ＞0．05）；②＞30岁组 BGP 显著低于≤30岁组，而 TRACP 显著高于≤30岁组（P ＜0．01或 P ＜0．05）；③病程＞5年组的 TRACP 比病程≤5年组的 TRACP 明显增高（P ＜0．01），而病程＞5年组 AS患者的 BGP 较病程≤5年组 AS 患者的 BGP 明显降低（P ＜0．01）；④疾病活动组的 TRACP 比缓解组的TRACP 明显增高（P ＜0．01），而疾病活动组的 BGP 较缓解组的 BGP 明显降低（P ＜0．01）。结论AS 患者骨代谢特点表现为血清 BGP 水平的降低，TRACP 水平的升高，并在不同性别、年龄、病程中存在着明显的差异，同时受到疾病活动的影响。
  • 摘要：目的：探讨声触诊组织定量（VTQ）技术评估乳腺纤维腺瘤的弹性。方法应用 VTQ 技术对24例女性患者共34个病灶进行测量，同时测量病灶周围的乳腺腺体组织及脂肪组织，获取病灶内部、乳腺腺体组织及脂肪组织的剪切波速度（SWV）。结果纤维腺瘤、乳腺腺体组织及脂肪组织 SWV 测值缺失值出现率分别为20．59％、6．87％及2．94％，纤维腺瘤 SWV 测值缺失值出现率高于乳腺腺体组织及脂肪组织（P ＜0．01）；乳腺腺体组织和脂肪组织 SWV 测值缺失值出现率比较差异无统计学意义（P ＞0．05）。纤维腺瘤、乳腺腺体组织及脂肪组织 SWV 测值分别为（2．82±0．60）m/s、（1．69±0．41）m/s 及（1．27±0．36）m/s， SWV 值纤维腺瘤＞乳腺腺体组织＞脂肪组织（均 P ＜0．05）。结论VTQ 可快速无创测量纤维腺瘤的剪切波速度，从而客观反映纤维腺瘤的弹性模量。%Objective To explore the value of virtual touch tissue quantification (VTQ)in the assessment of breast fibroadenoma.Methods A total of 24 cases with 34 breast lesions were examined by ultrasonography.VTQ measurements were performed in mammary gland tissues and adipose tissues around the leisions.Results The occur-rence rate of missing data of fibroadenoma,mammary gland tissues and adipose tissues was 20.59%,6.87%,and 2.94%,respectively,with significantly difference between fibroadenoma and mammary gland tissues (P <0.01)and no significant difference between mammary gland tissues and adipose tissues(P >0.05).The SWV of fibroadenoma, mammary gland tissues,and adipose tissues were (2.82 ±0.60)m/s,(1.69 ±0.41)m/s,and (1.27 ±0.36)m/s. Significant differences regarding SWV were observed among fibroadenoma,mammary gland tissues,and adipose tissues (all P <0.05).Conclusion VTQ is a reliable and rapid elastographic methods,which is helpful for noninvasive e-valuation of fibroadenoma.
  • 摘要：目的：探讨平板运动试验诱发室内阻滞类型特征及其对冠心病诊断的意义。方法分析50例在平板运动试验（TET）中发生室内阻滞的冠状动脉造影结果。结果室内阻滞发生率为3．34％，其中14例患者发生冠状动脉狭窄（占28％），36例发生室内阻滞但冠状动脉正常（占72％）。结论平板运动试验诱发室内阻滞对冠心病诊断具有一定价值，且不同类型的室内阻滞对冠心病诊断的意义不同。%Objective To describe the characteristics of intraventricular block induced by treadmill exercise test (TET)and investigate the diagnositic values for coronary heart disease.Methods The results of the coronary angiography in 50 patients with intraventricular block induced by TET were analyzed.Result The incidence of intra-ventricular block was 3.34%.4 The coronary artery stenosis was detected in 14 patients (28%);and the intraventric-ular block with normal coronary arteries was observed in 36 (72%)patients.Conclusion The diagnostic value of intraventricular block induced by TET for coronary heart disease is confirmed and varied with types of intraventricular block.
  • 摘要：Objective To explore the impact of the different diluents on the serum β-hCG by Electrochem-iluminescence immunoassay.Methods A total of 27 serum samples from 3 ~8 weeks of pregnancy were collected and divided them into 3 groups by hCG concentration:low concentration group(hCG < 1 000mIU /ml),medium concentration group (hCG 1001 ~10 000 mIU /ml),and high concentration group(hCG >10 000mIU /ml).Di-luted with Elecsys universal dilution,0.9% sodium chloride injection solution,distilled water in 1:10 dilution,respec-tively.The hCG level was detected by Roche Cobas E601 chemiluminescence analyzer.Results In the low concentra-tion group,the results diluted by saline solution were different from those by Elecsys universal dilution (P =0.042), while there were no differences in the other two groups (P =0.201,P =0.076);There were significant difference be-tween Elecsys universal dilution and distilled water among three groups (P =0.000).Conclusion The influence of diluents on the β-hCG concentration detected by electrochemiluminescence immunoassay is obvious.Saline solution and distilled water are not available for low concentration group,while saline solution could be substitute for diluents in medium and high concentration group.%目的：探讨不同的稀释液对电化学发光法检测血清中人绒毛膜促性腺激素（hCG）水平结果的影响。方法27例孕周为3～8周的妊娠妇女血清，按β-hCG 的浓度分为以下3组：低浓度组β-hCG ＜1000 mIU /ml；中浓度组β-hCG 1001～10000 mIU /ml；高浓度组β-hCG ＞10000 mIU /ml。分别用通用稀释液、0．9％氯化钠注射溶液、蒸馏水以1∶10稀释，然后用 Roche cobas E601电化学发光分析仪测定其β-hCG 值。结果低浓度组用0．9％氯化钠注射溶液稀释所测得的β-hCG 值与通用稀释液稀释后测得的值相比差异有统计学意义（P ＝0．042），而在中、高浓度组两者的检测结果差异无统计学意义（P ＝0．201，P ＝0．076）；在低、中、高三个浓度组用蒸馏水稀释所测得的β-hCG 值与通用稀释液测得的值相比，差异均有统计学意义（P ＝0．000）。结论稀释液对电化学发光分析仪测定β-hCG 结果影响较大，0．9％氯化钠注射溶液和蒸馏水均不适宜作为低浓度β-hCG 的替代稀释液，而对于中高浓度的标本可以选0．9％氯化钠注射溶液作为替代稀释液。
  • 摘要：Objective To discuss the choose of operation timing in patient with non-infected pancreatic nec-rosis of acute pancreatitis.Method The indiction for operation was decided according to results of Computer-tomo-graphy evaluation in 62 patients with non-infected necrotic pancreatitis,and operation timing was analyzed according to findings of operation.Results There were 9 and 49 patients with preoperative non-infected pancreatic necrosis re-ceived surgical treatment in 2 weeks and 3 or 4 weeks after onset of illness,respectively.Of the 49 cases,adhesive or oppressive obstruction of the digestive tract was observed in 3 patients,and 5 cases were dead post-operatively,fatality rate was 10.2 percent.The 4 cases were operated after 4 weeks,the rate of infection was 75 percent(3 /4),2 cases were dead post-operatively,fatality rate was 50 percent.Conclusions In patients with non-infected pancreatic necro-sis of acute pancreatitis,whether or not the necrotic pancreas tissue resection should depend on regular CT evaluation;surgical intervention should be considered for patients whose erosions are larger than 6 cm,early infection,and oppres-sive or obstructive symptoms of the digestive tract.The reasonable operation timing is 3 or 4 weeks after the onset of illness.%目的：探讨急性重症胰腺炎非感染性胰腺坏死手术时机。方法对62例非感染性坏死性胰腺炎进行临床和 CT 评估以决定手术指征，根据手术发现对手术治疗的时机进行评估分析。结果9例患者发病2周内手术治疗。49例发病3～4周后手术治疗，其中3例有粘连性或压迫性消化道梗阻；10例发生感染，发生率为20．4％；5例术后死亡，病死率为10．2％。4周后手术患者感染率发生率75％（3/4），2例死亡，病死率50％。结论应对急性胰腺炎非感染性胰腺坏死患者进行动态 CT 评估，对于坏死大于6 cm、有早期感染表现、有消化道压迫梗阻症状的患者，应行手术治疗，手术时机宜在发病后3～4周。
  • 摘要：目的：探讨自我效能理论在2型糖尿病患者系统性教育中应用的效果。方法将100例收治的2型糖尿病患者随机分为观察组50例，对照组50例。对照组采用常规健康教育，观察组采用糖尿病系统性教育（在常规健康教育基础上加疾病预见性教育）。比较两组患者出院后6个月自我管理执行情况（遵医率）及各项指标检测值。结果观察组出院后6个月遵医率明显高于对照组（P ＜0．05）。观察组出院后6个月各项指标值优于入院时及对照组出院后6个月各项指标值（P ＜0．05）。结论糖尿病系统性教育中应用自我效能理论增强了患者自我效能感，改善了患者自我管理，提高了患者遵医率，提高治疗效果。
  • 摘要：共刺激信号是1970年由Bretscher和Cohn在T细胞活化双信号模型的基础上提出并证实的［1］，属于免疫球蛋白超家族（IgSF）的B7家族中的共刺激分子有些是激发或增强免疫应答，有些是下调或终止免疫应答。B7-H1是新发现的 B7家族成员之一，它在诱导初始T 细胞的增殖，抑制活化T细胞的增殖分化和分泌细胞因子，促进活化T细胞的凋亡中发挥重要作用。研究发现，B7-H1分子可在人类多种肿瘤组织中表达，促进效应性CTL（细胞毒T淋巴细胞）的凋亡，参与肿瘤的免疫逃逸过程［2］。本研究应用免疫组织化学法检测 B7-H1在结直肠癌组织和正常结直肠组织中的表达，并探讨该分子与肿瘤发生、发展及预后等方面的关系。

    中国临床保健杂志的期刊信息

    • 曾用名：临床中老年保健医学;临床中老年保健
    • 创刊时间：1998
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    中国临床保健杂志的获奖情况

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    • • 2015年，荣获国家卫生计生委颁发的委管出版物主题宣传“优秀期刊奖”
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