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胸外科禁食患者经外周行静脉高营养的效果观察

目的观察胸外科禁食患者行外周静脉高营养的临床效果，分析其输液相关并发症的发生率、留置针保留时间以及护理干预和健康指导的作用。 方法观察2014年4月-6月40例短期内需行全肠外营养支持的患者。建立外周静脉通道，输注脂肪乳氨基酸（17）葡萄糖（11%）注射液（1 440 mL/d）行静脉高营养治疗和贯穿整个疗程的护理干预及健康指导，观察其输液相关并发症的发生率和留置时间。 结果纳入患者中仅1例发生输液通路的阻塞，并予更换留置针；另有4例静脉炎（Ⅰ级）。其他患者全肠外营养输注疗程中均无红斑、疼痛、水肿或静脉条纹等静脉炎发生或其他输液相关并发症的发生，平均留置时间为（3.07±1.73）d。 结论胸外科术前或术后禁饮禁食患者，短期内通过外周静脉给予高营养支持并辅以护理干预和健康指导，其输液相关并发症发生率低且静脉留置针的使用时间合理，在改善患者预后的同时减轻了患者的经济负担，并提高了患者满意度。

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

目的　探讨经阴道B型超声（B超）在诊断早期宫外孕中的临床应用价值。 方法　回顾分析2011年5月－2012年3月应用阴道B超与腹部B超对78例宫外孕患者进行对比检查的临床资料并回顾性分析，评价两种检查方法的临床效果。 结果　78例宫外孕患者，应用经阴道B超检查诊断准确率为97.44%，应用腹部B超准确率为61.54%，差异具有统计学意义（χ2=6.472，P＜0.05）；经阴道B超检查诊断附件包块、宫内假孕囊、心血管搏动、胚芽、盆腔积液的检出率明显高于经腹部B 超检查的检出率（P＜0.05）。 结论　阴道B超具有操作简单、快速、无副作用、无需充盈膀胱等优点，在宫外孕的早期诊断中具有绝对的优越性，为临床提供了更方便、更快捷的诊断手段，减轻了患者痛苦，提高了诊断的准确率，值得临床广泛推广和应用。

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

【摘要】　目的　探讨乳腺浸润性导管癌中表皮钙黏蛋白（E-cadherin，E-cad）的表达及其意义。　方法　选取2005年1月－2009年12月的组织病理切块，用免疫组织化学EnVision二步法检测63例乳腺浸润性导管癌（invasive ductal carcinoma，IDC）组织中E-cad的表达情况，设为IDC组；另检测15例乳腺纤维腺瘤及15例乳腺小叶增生症乳腺组织中E-cad的表达情况，设为对照组；比较两组的E-cad表达。　结果　E-cad在IDC组及对照组中表达阳性率分别为58.7%、80.0%；两组间差异有统计学意义（Plt;0.05）。在乳腺IDC患者中，年龄lt;38岁和≥38岁组的E-cad阳性表达率分别是54.2%、61.5%，两组间差异无统计学意义（Pgt;0.05）；肿块直径lt;3 cm和≥3 cm组的E-cad阳性表达率分别是54.8%、66.7%，两组间差异无统计学意义（Pgt;0.05）；组织学分级为Ⅰ+Ⅱ级和Ⅲ级组的E-cad阳性表达率分别是76.3%、32.0%，两组间差异有统计学意义（Plt;0.05）；无、有腋窝淋巴结转移组的E-cad阳性表达率分别是78.3%、47.5%，两组间差异有统计学意义（Plt;0.05）。　结论　E-cad的表达与患者年龄及肿块大小无关，而与组织学分级、淋巴结转移相关。在乳腺浸润性导管癌中，无淋巴结转移者E-cad表达高于有淋巴结转移者，提示E-cad是乳腺浸润性导管癌发生淋巴结转移的重要指标。【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.

弹力绷带在经外周静脉置入中心静脉导管置管中的固定作用及效果

目的　讨论弹力绷带在经外周静脉置入中心静脉导管（PICC）置管中的固定作用及对减少局部渗血、渗液和预防机械性静脉炎的效果。 方法　选择2011年6月－2012年3月在某三甲医院重症医学科（ICU）行PICC置管的100例患者，按穿刺时间先后顺序单号纳入对照组，双号归于试验组,每组各50例。对照组置管后在穿刺局部放置8层无菌方纱，外用 10 cm×12 cm的透明敷料外固定；试验组在对照组的基础上增加弹力绷带固定,分别观察两组患者置管后24、72 h局部渗血、渗液、机械性静脉炎的发生情况。 结果　在24、72 h两个时间点，试验组渗血、渗液发生率少于对照组（χ2=4.57，P＜0.05）；静脉炎发生率在24 h时低于对照组（χ2=4.00，P＜0.05），但在72 h差异无统计学意义。 结论　PICC置管患者使用弹力绷带固定不仅可防止穿刺点渗血渗液，减少机械性静脉炎的发生，而且可减轻护士工作量，值得临床推广使用。

全胸腔镜下二尖瓣置换术麻醉体会

目的探讨全胸腔镜下二尖瓣置换术的麻醉心得。 方法回顾性分析2011年10月至2012年7月四川大学华西医院拟在全胸腔镜下行二尖瓣置换术7例患者的临床资料。男4例、女3例，年龄19～53（34.17±5.58）岁，体重42～69（56.00±3.69）kg。心功能根据纽约心脏协会（NYHA）分级为Ⅱ～Ⅲ级，术前心电图显示均为窦性心律，超声心动图检查提示，以二尖瓣狭窄病变为主3例，以二尖瓣反流病变为主4例。采用双腔气管内插管，静脉吸入复合全身麻醉，麻醉维持以异丙酚4～10 mg（/kg·h）静脉输注，间断给予舒芬太尼和维库溴铵维持镇痛肌松。在食管超声引导下采用右侧股动静脉插管建立体外循环，主动脉阻断后行主动脉根部顺行性灌注心肌保护液。 结果7例患者中有6例在全胸腔镜辅助下顺利完成二尖瓣置换术，1例中转开胸完成二尖瓣置换术。6例行全胸腔镜下二尖瓣置换术患者主动脉阻断时间71～144（112.33±9.90）min，体外循环（CPB）时间97～180（150.33±11.60）min，手术时间200～300（251.67±13.52）min，术后拔管时间8.0～20.5（14.37±2.06）h，住ICU时间42.5～53.2（47.65±1.42）h，住院时间11～16（14.17±0.79）d。术后均无二尖瓣机械瓣瓣周漏，无血肿、感染、肺不张等严重并发症，无死亡。 结论对于电视胸腔镜下二尖瓣手术的麻醉，充分的术前评估和麻醉前准备是基础，术中充足的大脑灌注和静脉引流是重点，经食管超声心动图的指导作用是关键。

气管切开术后专用一次性护理包的设计

空巢老人健康状况及护理需求调查

目的 了解空巢老人健康状况及其对社区护理的需求，为社区老年护理的开展和完善提供科学依据。 方法 2012年1月－2013年12月采用自制调查表对成都市主城区（武侯区、锦江区、成华区、青羊区）的600名空巢老人进行问卷调查，了解其健康状况及护理需求。 结果 空巢老人随着年龄的增加，日常生活不能自理者占被调查对象的6.3%；空巢老人慢性病排在前3位的分别为高血压、糖尿病及冠状动脉粥样硬化性心脏病；心理卫生自评方面心理状态很好占20.2%，好占42.9%；对护理需求排在前3位的分别为生病时提供上门护理（94.4%）、老年慢性病预防与护理知识（89.0%）、紧急救护知识与护理（79.3%）。 结论 成都市空巢老人生活自理能力下降，对护理需求增加，为空巢老人提供多种途径、多种形式的社区护理，有利于提高其生活质量。

呼吸系统疾病治疗中干粉吸入疗法的研究进展

急性重症肺栓塞救治失败一例

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.