7例子宫内翻病例的回顾性分析

子宫内翻是指子宫底部向宫腔内陷入,甚至自宫颈翻出的病变,多数发生在第3产程,这是一种分娩期罕见而严重的并发症,若不及时处理,可因休克、出血导致产妇在3-4h内死亡。国内报道子宫内翻病死率可达62%左右。子宫内翻按发病时间可分为：（1）急性子宫内翻：子宫翻出后宫颈尚未缩紧占75%左右;（2）亚急性子宫内翻：子宫翻出后宫颈已缩紧,占15%左右;（3）慢性子宫内翻：子宫翻出宫颈回缩已超过4周,子宫在内翻位置已经缩复但仍停留在阴道内,占10%左右。按子宫内翻程度可分为：（1）不完全子宫内翻：子宫底向下内陷,可接近宫颈口或越过但还存在部分子宫腔;（2）完全子宫内翻：子宫底下降于子宫颈外,但还在阴道内;（2）子宫内翻脱垂：整个内翻子宫暴露于阴道口外。及时发现并明确诊断子宫翻是治疗子宫内翻的基础。子宫内翻患者在诊断和治疗的过程中常合并严重的疼痛、出血、感染和休克等临床表现,所以积极地缓解疼痛,控制出血、感染和休克是进行子宫内翻治疗的前提。患者全身情况控制后,针对子宫内翻的治疗措施包括保留子宫的治疗措施和切除子宫的治疗措施,前者包括经阴道徒手复位、经阴道水压复位、经腹手术复位和经阴道手术复位,后者经腹或经阴道部分或全子宫切除术。采用何种措施主要根据患者的全身状况、翻出时间、感染程度、有无生育要求是否合并其他生殖系统肿瘤等。本文对7例子宫内翻病例进行了回顾性分析和总结。虽然在临床上尚属罕见,但应高度引起产科医者的重视。

厄洛替尼上市后不良反应的文献回顾性分析

目的探讨厄洛替尼自2007年在中国上市后所致不良反应的种类及特点,以指导临床合理用药。方法检索2007～2012年中国期刊全文数据库和中华医学会全文数据库内收录的521例厄洛替尼不良反应,进行统计学分析。结果 521例患者中,60岁以上男性有合并用药史者,在服药后14d内易出现不良反应,主要是皮疹、腹泻、肝功能异常。间质性肺病是严重不良反应。结论临床医师、药师应重视厄洛替尼的不良反应,坚持合理用药。

重型颅脑损伤术后颅内感染因素的回顾分折及干预建议

目的分析重型颅脑损伤术后颅内感染因素及干预建议效果。方法将2010年3月~2018年3月我院收治30例重型颅脑损伤患者作为研究对象,开展对重型颅脑损伤术后颅内感染因素的回顾性分析,并提出针对性的干预措施。结果 30例患者共分离出37株病原菌,其中革兰阴性菌共20株(54.05%),革兰阳性菌共14株(37.84%),真菌共2株(5.41%)。年龄≥50岁、术前GCS评分<8分、手术次数≥2次、糖蛋白含量>1000mg/L、手术时间≥4h、引流管拔管时间≥3天、术后白蛋白<35g/L、切口脑脊液漏、发生合并症、脑室外引流、抗菌药物应用时间超过14天是颅内感染的危险因素,P<0.05。发生切口脑脊液漏危险性最高,其次为手术次数≥2次、糖蛋白含量>1000mg/L、低蛋白血症、手术时间≥4h、术前GCS评分<8分、引流管拔管时间≥3天、高龄。结论针对重症颅脑损伤患者在接受手术后可能发生颅内感染,需积极查找感染原因,加强临床预防与干预,降低感染发生。

恶性肿瘤患者医院感染的探讨

目的 :探讨恶性肿瘤患者并发医院感染的特点及危险因素。方法 :回顾性分析 136例恶性肿瘤患者并发医院感染的临床特点。结果 :恶性肿瘤患者医院感染常见于肺癌 ,感染部位依次为肺部、胃肠道、口腔、泌尿道 ,病原菌以革兰阴性杆菌为主 (5 4 % ) ,其中以大肠埃希菌最常见 ,其次为铜绿假单胞菌。肿瘤晚期、住院时间长、长期使用广谱抗生素、白细胞下降、低蛋白血症、各种侵入性操作是医院感染的危险因素。结论 :为减少恶性肿瘤医院感染发生率 ,应采取的主要措施是缩短住院时间、合理使用抗生素、预防化、放疗所致的白细胞下降、增强患者自身的抵抗力。

Ileoscopy in patients with ileocolonic tuberculosis

AIM: To study the role of retrograde terminal ileoscopy in patients suspected to have ileocolonic tuberculosis. METHODS: A retrospective analysis was performed for patients undergoing colonoscopy for suspected ileocolonic tuberculosis between January 2000 and June 2004, in whom retrograde ileoscopy had been performed. Only patients diagnosed with tuberculosis on the basis of histological findings of either a caseating granuloma or those having non-caseating granuloma or a collection of epithelioid cells at a minimum of one endoscopic lesion (either in the colon or the terminal ileum) on histology with good responses to conventional anti-tuberculous drugs were enrolled for the study. RESULTS: Fifty-three patients were included. The terminal ileum was involved in only 11 patients. Eight of these patients had involvement of the cecum too. Two patients had ileal lesions without cecal involvement; however, lesions were noted in the ascending colon. In one patient the whole colon was normal and only the terminal ileum showed nodularity and ulceration. Histological examination of the ileal biopsies obtained from the ileal lesions showed noncaseating granulomas in five, collection of epithelioid cells in four and nonspecific histology in two patients. Mucosal biopsies obtained from the lesion in the terminal ileum, in the patient in whom mucosal abnormality was observed to be confined to the ileum, showed noncaseating granulomas. In two other patients the ileal biopsies alone showed histological evidence of tuberculosis with biopsies from the colonic lesions showing non-specific inflammatory changes only. CONCLUSION: Retrograde ileoscopy should be performed in all patients undergoing colonoscopy for suspected ileocolonic tuberculosis. In some patients only the terminal ileum may be involved and histological examination may reveal evidence of tuberculosis only from the lesions in the terminal ileum. This approach would lead to additional lesions being picked up andincreasing the chances of well-timed diagnosis of tuberculosis.

经尿道气压弹道与钬激光碎石术治疗小儿下尿路结石的比较

目的探讨经尿道气压弹道与钬激光碎石术治疗小儿下尿路结石的安全性和有效性。方法回顾性分析2016年9月至2017年8月在喀什地区第一人民医院和伽师县人民医院就诊的14例气压弹道碎石术与30例钬激光碎石术治疗的下尿路结石患儿的临床资料。结果气压弹道组结石清除率达93%,手术时间7~45min(22±13),术后1例因排尿困难需要尿道外口取石2次、1例因尿潴留需留置尿管。而钬激光组,一次性清石率为97%,手术时间10~50min(26±14),术后1例排尿困难复查有残留结石,行二次经尿道钬激光碎石术后排尿通畅。两组均无其余严重并发症。两组手术时间、术后留置尿管时间、术后住院天数及并发症的比较差异无统计学意义。结论气压弹道和钬激光碎石术治疗小儿下尿路结石均疗效好、结石清除率高、无严重并发症。