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胸外科禁食患者經外周行靜脈高營養的效果觀察

目的觀察胸外科禁食患者行外周靜脈高營養的臨床效果，分析其輸液相關并發癥的發生率、留置針保留時間以及護理干預和健康指導的作用。 方法觀察2014年4月-6月40例短期內需行全腸外營養支持的患者。建立外周靜脈通道，輸注脂肪乳氨基酸（17）葡萄糖（11%）注射液（1 440 mL/d）行靜脈高營養治療和貫穿整個療程的護理干預及健康指導，觀察其輸液相關并發癥的發生率和留置時間。 結果納入患者中僅1例發生輸液通路的阻塞，并予更換留置針；另有4例靜脈炎（Ⅰ級）。其他患者全腸外營養輸注療程中均無紅斑、疼痛、水腫或靜脈條紋等靜脈炎發生或其他輸液相關并發癥的發生，平均留置時間為（3.07±1.73）d。 結論胸外科術前或術后禁飲禁食患者，短期內通過外周靜脈給予高營養支持并輔以護理干預和健康指導，其輸液相關并發癥發生率低且靜脈留置針的使用時間合理，在改善患者預后的同時減輕了患者的經濟負擔，并提高了患者滿意度。

Evaluation of Transvaginal B-ultrasound in the Early Diagnosis of Ectopic Pregnancy

目的　探討經陰道B型超聲（B超）在診斷早期宮外孕中的臨床應用價值。 方法　回顧分析2011年5月－2012年3月應用陰道B超與腹部B超對78例宮外孕患者進行對比檢查的臨床資料并回顧性分析，評價兩種檢查方法的臨床效果。 結果　78例宮外孕患者，應用經陰道B超檢查診斷準確率為97.44%，應用腹部B超準確率為61.54%，差異具有統計學意義（χ2=6.472，P＜0.05）；經陰道B超檢查診斷附件包塊、宮內假孕囊、心血管搏動、胚芽、盆腔積液的檢出率明顯高于經腹部B 超檢查的檢出率（P＜0.05）。 結論　陰道B超具有操作簡單、快速、無副作用、無需充盈膀胱等優點，在宮外孕的早期診斷中具有絕對的優越性，為臨床提供了更方便、更快捷的診斷手段，減輕了患者痛苦，提高了診斷的準確率，值得臨床廣泛推廣和應用。

Expression of E-cadherin in Invasive Ductal Carcinoma of the Breast and Its Significance

【摘要】　目的　探討乳腺浸潤性導管癌中表皮鈣黏蛋白（E-cadherin，E-cad）的表達及其意義。　方法　選取2005年1月－2009年12月的組織病理切塊，用免疫組織化學EnVision二步法檢測63例乳腺浸潤性導管癌（invasive ductal carcinoma，IDC）組織中E-cad的表達情況，設為IDC組；另檢測15例乳腺纖維腺瘤及15例乳腺小葉增生癥乳腺組織中E-cad的表達情況，設為對照組；比較兩組的E-cad表達。　結果　E-cad在IDC組及對照組中表達陽性率分別為58.7%、80.0%；兩組間差異有統計學意義（Plt;0.05）。在乳腺IDC患者中，年齡lt;38歲和≥38歲組的E-cad陽性表達率分別是54.2%、61.5%，兩組間差異無統計學意義（Pgt;0.05）；腫塊直徑lt;3 cm和≥3 cm組的E-cad陽性表達率分別是54.8%、66.7%，兩組間差異無統計學意義（Pgt;0.05）；組織學分級為Ⅰ+Ⅱ級和Ⅲ級組的E-cad陽性表達率分別是76.3%、32.0%，兩組間差異有統計學意義（Plt;0.05）；無、有腋窩淋巴結轉移組的E-cad陽性表達率分別是78.3%、47.5%，兩組間差異有統計學意義（Plt;0.05）。　結論　E-cad的表達與患者年齡及腫塊大小無關，而與組織學分級、淋巴結轉移相關。在乳腺浸潤性導管癌中，無淋巴結轉移者E-cad表達高于有淋巴結轉移者，提示E-cad是乳腺浸潤性導管癌發生淋巴結轉移的重要指標。【Abstract】　Objective　To explore the expression of the protein E-cadherin (E-cad) in invasive ductal carcinoma (IDC) of the breast and its significance.　Methods　We chose 63 cases of pathological wax with IDC between 2005 and 2009, and immunohistochemical EnVision method was used to detect the expression of E-cad protein in these cases which were designated to be the IDC group. At the same time, the E-cad expression in 15 cases of breast adenoma and another 15 cases of breast lobular hyperplasia were also detected, and these cases were designed to the the control group. The expression of E-cad in these two groups were compared.　Results　The positive rates of E-cad protein expression in the IDC group and the control group were respectively 58.7% and 80.0% with a significant difference between the two groups (Plt;0.05). In the IDC group, the positive rates of E-cad protein expression in patients agedlt;38 and ≥38 years old were respectively 54.2% and 61.5% without a significant difference (Pgt;0.05). The positive rates of E-cad protein expression for tumors with a diameter lt;3 cm and ≥3 cm were respectively 54.8% and 66.7% without a significant difference (Pgt;0.05). The positive rates of E-cad protein expression for class Ⅰ+Ⅱ tumors and class Ⅲ tumors were respectively 76.3% and 32.0% with a significant difference (Plt;0.05). The positive rates of E-cad protein expression for patients without and with axillary lymph node metastasis were respectively 78.3% and 47.5% with a significant difference (Plt;0.05).　Conclusions　The expression of E-cad is correlated with histological classification and lymph node metastasis and was not related to tumor size and age of the patients. The expression of E-cad is higher in IDC patients without lymph node metastasis than that in IDC patients with lymph node metastasis, which indicates that E-cad is an important index for lymph node metastasis of IDC.

氣管切開術后專用一次性護理包的設計

空巢老人健康狀況及護理需求調查

目的 了解空巢老人健康狀況及其對社區護理的需求，為社區老年護理的開展和完善提供科學依據。 方法 2012年1月－2013年12月采用自制調查表對成都市主城區（武侯區、錦江區、成華區、青羊區）的600名空巢老人進行問卷調查，了解其健康狀況及護理需求。 結果 空巢老人隨著年齡的增加，日常生活不能自理者占被調查對象的6.3%；空巢老人慢性病排在前3位的分別為高血壓、糖尿病及冠狀動脈粥樣硬化性心臟病；心理衛生自評方面心理狀態很好占20.2%，好占42.9%；對護理需求排在前3位的分別為生病時提供上門護理（94.4%）、老年慢性病預防與護理知識（89.0%）、緊急救護知識與護理（79.3%）。 結論 成都市空巢老人生活自理能力下降，對護理需求增加，為空巢老人提供多種途徑、多種形式的社區護理，有利于提高其生活質量。

Analysis of Ambulatory Blood Pressure in Elderly Patients with Fracture and Hypertension

目的　探討不同年齡段老年骨折合并高血壓的動態血壓變化，評估心腦血管事件發生風險。 方法　將2009年4月－2012年2月入住的184例60歲以上老年骨折合并高血壓患者分為低齡老年骨折組（97例，60～79歲）與高齡老年骨折組（87例，≥80歲），對每位患者行動態血壓分析。 結果　兩組患者平均收縮壓均升高，差異無統計學意義（P＞0.05）；但高齡老年骨折組平均舒張壓和平均脈壓差在全天、日間及夜間均低于低齡老年骨折組，差異有統計學意義（P＜0.05）；高齡老年骨折組血壓節律紊亂更明顯，心腦血管事件發生率明顯高于低齡老年骨折組，差異有統計學意義（P＜ 0.05）。 結論　高齡老年骨折患者血壓節律紊亂明顯，應及時調整并制定有效的個體化降壓方案，積極防止以及血管事情的發生。

負壓封閉引流技術在胸外科手術后胸壁切口感染治療中的臨床應用

目的總結使用負壓封閉引流技術治療胸壁傷口感染的初步經驗及體會。 方法回顧性分析2011年7月至2013年10月四川大學華西醫院16例開胸手術后發生胸壁切口感染患者的臨床資料，其中男13例，女3例；年齡（50.8±6.7）歲。手術種類包括膿胸廓清術、肺葉切除術、縱隔腫瘤切除術和食管癌根治術。通過應用負壓封閉引流技術，進行傷口的持續負壓吸引治療，觀察治療效果，積累初步經驗。 結果經過持續負壓引流，16例患者中有3例未達到二期縫合的標準（負壓封閉引流愈合標準），其中2例由于患者耐受差，不愿繼續使用，轉為每日更換敷料；1例由于傷口感染控制不佳，感染范圍增加，更換為每日換藥治療。總的負壓封閉引流治療愈合率為81.2%（13/16）。6例（37.5%）患者為多次安置負壓封閉引流。累計保留負壓封閉引流時間為4～24 d，中位時間9 d。治療過程中無負壓封閉引流相關不良事件發生。隨訪11例，隨訪時間2～8個月，失訪5例。11例患者中，1例出現輕微的傷口異物反應（皮下縫線），經拆除皮下縫線后治愈；其余患者傷口均愈合良好，未見感染復發。 結論負壓封閉引流技術治療胸外科手術后胸壁切口感染安全、可行、有效，患者耐受好，具有較高的臨床應用價值。而通過初期的使用經驗總結，有利于我們拓展負壓封閉引流技術的應用領域，整體提高胸外科手術后傷口感染的治療效果。

Effect of Precise Management on Life-saving Equipment Management in Surgical Intensive Care Unit

ObjectiveTo explore the effect of precise management on life-saving equipment management in Surgical Intensive Care Unit (SICU). MethodsWe actualized precise management in the life-saving equipment management process in March 2014, including precise management control system, precise personnel training, and precise process management. ResultsAfter precise management, the knowledgement of life-saving equipment of the nurses increased from 90.2% (May, 2014) to 98.5%. The number of equipments repaired before (March-May, 2014) and after the management (June-August, 2014) was 65 and 47, respectively; the number of nonstandard management times in nurses after the equipments were used was 98 and 10, respectively. ConclusionPrecise management can drastically improve management efficiency, serviceability rate and service efficiency of life-saving equipment, obviously enhancing the degree of familiarity and using skills of clinical nurses, and ensuring quick and smooth emergency work. It plays an active role in securing severe patients' life.

Tissue Doppler Strain Rate Imaging to Evaluate the Impact of Dopamine and Milrinone on Left Ventricular Function　of Patients Undergoing Heart Valve Replacement

Abstract：　Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods　 Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group： milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup， left ventricular ejection fraction （LVEF） was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view， which was compared with Doppler parameters. Results LVEF， ratio of early-diastolic to end-diastolic velocity （E/A） of transmitral flow， ratio of mitral　 inflow velocity to early diastolic velocity in the annulus （E/Et） of both 2 groups were significantly different between before and after dopamine and milrinone administration （P＜0. 05）. In the milrinone group， 4 segments systolic peak velocity （Vs）， 1 segment early diastolic peak velocity （Ve）， 4 segments late diastolic peak velocity （Va）， 3 segments Ve/Va ratio， 2 segments systolic peak strain rate （SRs）， 2 segments late diastolic peak strain rate （SRa）， and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine　 and milrinone administration （P＜0. 05）. In the dopamine group， 4 segments systolic peak velocity （Vs）， 1 segment Ve， 4 segments Va， 1 segment Ve/Va ratio， 2 segments SRs， 1 segment SRe， 1 segment SRa， and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0.05）. To compare the milrione group and dopamine group after medication administration， 2 segments Vs， 4 segments Va， 1 segment SRe， 1 segment SRa， 2 segments Ve/Va ratio， and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group （P＜0.05）， and 1 segment Vs， two segments SRs of the milrione group were significantly lower than those of the dopamine group （P＜0.05）. Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement assessed by tissue Doppler strain rate imaging， while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.

鹽酸萬古霉素與頭孢哌酮鈉舒巴坦鈉使用存在配伍禁忌

目的探討在臨床輸液過程中，鹽酸萬古霉素與頭孢哌酮鈉舒巴坦鈉使用存在配伍禁忌。 方法將頭孢哌酮鈉舒巴坦鈉3 g加入生理鹽水50 mL內，將鹽酸萬古霉素100萬U加入生理鹽水100 mL內，各抽取2 mL混勻，觀察兩組藥物之間的反應。 結果將混合的液體在常溫下放置10 min、1 h、2 h，觀察混合液是否變澄清，但發現液體仍為渾濁液體。 結論鹽酸萬古霉素與頭孢哌酮納舒巴坦納使用存在配伍禁忌。