卡维地洛对慢性充血性心力衰竭患者左室功能及运动耐量的影响

目的观察卡维地洛对慢性充血性心力衰竭（CHF）患者左室功能及运动耐量的影响。方法选择100例病因不同的CHF患者,随机分为两组,对照组48例应用洋地黄、利尿剂、血管紧张素转换酶抑制剂等常规治疗,卡维地洛组52例在对照组常规治疗的基础上口服卡维地洛。疗程均为6个月。观察两组治疗前后临床疗效、左室舒张末内径（LVEDd）、左室射血分数（LVEF）、血清B型尿钠肽（BNP）、6min步行距离等。结果治疗6个月后,卡维地洛组的总有效率显著高于对照组（P〈0．05）。治疗后卡维地洛组的LVEDd及BNP比治疗前显著减少（P〈0．01）,比对照组显著减少（P〈0．05）。治疗后卡维地洛组的LVEF、6min步行距离比治疗前显著增加（P〈0．01）,比对照组显著增加（P〈0．05）。结论卡维地洛可明显改善CHF患者左室功能,提高运动耐量,降低BNP的浓度。     

甲状腺素对慢性心力衰竭患者心功能及血管内皮功能的影响

目的：探讨甲状腺素对慢性心力衰竭（chronic heart failure,CHF）患者心功能及血管内皮功能的影响及安全性。方法：选择CHF心功能Ⅳ级患者134例,随机分为对照组68例和进行甲状腺素治疗的治疗组66例,比较两组治疗前后和两组治疗后甲状腺功能（主要评价指标：3,5,3,-triiodothyronine．T3;3,5,3,5,-tetraiodothyronine,T1;thyroid stimulating hormone,TSH）、心脏彩超（主要评价指标：left ventricular ejection fractions,LVEF;cardiac output,Co;left ventricular end—diameter systolic,LVDS;left ventricular end—diameter diastolic,LVDD）、明尼苏达心力衰竭生活质量评分（简称：生活质量评分）、6min步行距离以及评价血管内皮功能（主要评价指标：endothelin,ET;nitric oxide,NO）。结果：甲状腺功能指标：治疗组T3改善显著（P〈0．05）,和对照组比较亦改善显著（P〈0.01）,T3、TSH变化不显著;心脏泵血功能参数（LVEF、Co）和结构参数（LVDD,LVDS）显著改善（P〈0．01）,治疗组改善更显著（P〈0．01）;两组生活质量评分治疗前后均显著改善（P〈0．05）,治疗组改善更显著（P〈0．05）。两组治疗前后6min步行距离均显著改善（P〈0．01）,治疗组改善更显著（P〈0．01）。两组患者治疗前后ET、NO均显著改善（P〈0．05）,治疗组改善更显著（P〈0.05）。治疗组未出现甲状腺素的明显副作用。结论：甲状腺素能改善CHF患者心功能及血管内皮功能且安全。     

卡维地洛治疗慢性充血性心力衰竭的疗效和安全性评价

目的 评价卡维地洛治疗慢性充血性心力衰竭（CHF）的临床疗效、最佳有效剂量和安全性。方法 76例CHF患者常规治疗后随机分为两组，对照组（常规治疗2个月），卡维地洛组（常规治疗＋口服卡维地洛2个月，6．25～50．00mg／d）。观察两组治疗前后心功能、左室大小、左室射血分数（LVFE）、6min步行试验改善情况。治疗中严密监测心率、血压等各项指标并观察不良反应。治疗结束后测定肝、肾功能等各项生化指标。结果 卡维地洛组（6．25～50．00mg／d）治疗后心功能、LVFE、6min步行试验较对照组明显改善，差异均具有统计学意义（P〈0．05）；治疗后肝、肾功能等各项生化指标改变差异无统计学意义（P〉0．05）；两组均未见明显不良反应。结论 卡维地洛治疗CHF安全、有效；最佳有效剂量为12．50～25．00mg/d。     

蝶骨电极脑电图在颞叶癫痫中的诊断价值

目的 观察曲美他嗪（trirnetazldine，TMZ）治疗缺血性心力衰竭（IHD）患者的临床疗效。方法 选择缺血性心力衰竭患者74例，随机分为两组：对照组和试验组各37例。用6min步行试验（6MWT）、超声心动图（UOG）和Holter评价曲美他嗪辅助治疗缺血性心力衰竭的疗效。结果 治疗前后自身比较示6min步行距离（6MWD）、左室射血分数（LVEF）、左室舒张末期容积指数（LVEDVI），左室收缩末期容积指数（LVESVI）和24h内心肌缺血次数差异均有统计学意义（P〈0．01或P〈0．05）；治疗后的组间比较示曲美他嗪进一步提高缺血性心力衰竭患者的6MWD（P〈0．01）和LVEF（P〈0．05），降低LVESVI（P〈0．05）及LVEDVI（P〈0．05），且无不良反应出现。结论 曲美他嗪与其他治疗缺血性心力衰竭的常规药物联用可进一步改善IHD患者的心功能，增加其运动耐量。     

卡维地洛对老年充血性心力衰竭患者心功能及血浆脑钠肽的影响

目的观察卡维地洛对老年人充血性心力衰竭（CHF）患者心功能及血浆脑钠肽（BNP）的影响。方法选择70例CHF患者,随机分成对照组30例和治疗组40例。监测治疗前及治疗6个月后6min步行距离,每搏输出量fSV）及每分钟心输出量（CO）。超声心动图监测左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）及左心室收缩末期内径f（LVESD）;同时监测心功能、收缩压、舒张压及心率的变化;测定两组治疗前后的血浆BNP含量。结果治疗6个月后,两组心功能均见明显改善,治疗组血浆BNP明显降低。治疗组6min步行距离较对照组明显改善;LVEF、SV及CO较对照组明显增加（P〈0．05）;LVEDD及LVESD较对照组明显降低;收缩压、舒张压及心率较对照组明显降低。结论卡维地洛显著改善老年人CHF。改善左心室重构。     

双心室再同步治疗对慢性心力衰竭患者的近期疗效观察

目的观察心脏再同步治疗（cardiac resynchronization therapy,CRT）对慢性心力衰竭（congestive heart failure,CHF）患者的近期疗效。方法入选心功能Ⅲ级。Ⅳ级CHF患者30例,分为CRT组15例,对照组15例。两组于治疗前、治疗后1个月及3个月分别评估心功能．测定6min步行距离。Minnesota生活质量问卷评估（QOF）,超声心动图测量左室射血分数（LVEF）、左心室舒张末期内径（LVEDD）,观察两组的死亡率和再住院率。结果治疗后1个月、3个月,CRT组NYHA心功能分级、6min步行距离、QOF、LVEF及LVEDD均较治疗前改善（治疗前分别为3．38±0．53、218．61±79．02m、42．68±18．82、0．30±0．05、71．52±6．10mm,治疗3个月分别为1．91±0．72、427．62±25．46m、20．33±15．57、0．38±0．08、66．85±5．59mm）,差异有统计学意义（P〈0．05．P〈0．01）;与对照组（治疗3个月时分别为3．30±0．63、242．71±62．52m、42．75±27．32、0．32±0．07、71．88±6．49mm）比较．差异有统计学意义（P〈0．05,P〈0．01）,CRT组再住院率低。结论CRT有助于纠正CHF患者的血流动力学紊乱,使扩大的心腔缩小．改善患者的心功能．提高其生活质量。     

阿托伐他汀治疗慢性充血性心力衰竭的临床研究

目的：观察阿托伐他汀治疗慢性充血性心力衰竭患者对心功能及C反应蛋白的影响。方法：将慢性充血性心力衰竭患者62例随机分为阿托伐他汀（20mg／d）组（n=31）与对照组（n=31）,2组均按慢性充血性心力衰竭常规治疗,治疗组另外服用阿托伐他汀,2组治疗前后检查6分钟步行距离、TC、LDC—C、CRP、LVEDD、LVESD、LVEF。结果：6个月后,阿托伐他汀组与对照组治疗前后差值相比,TC（P〈0．05、TDL（P〈0．05）、CRP（P〈0．05）、LVEDD（P〈0．05）、LVESD（P〈0．05）均有不同程度降低,6分钟步行距离（P〈0．05）、LVEF（P〈0．05）则有明显提高。结论：慢性充血性心力衰竭患者在常规扩心衰基础上加用阿托伐他汀20mg／d,治疗6个月可显著改善左室功能,降低C反应蛋白水平。     

运动护理干预对老年慢性心力衰竭患者心功能的影响

目的 观察运动护理干预对老年慢性心力衰竭(CHF)患者心功能的影响.方法 60例病情稳定的老年CHF患者随机分成常规治疗组和运动干预组,每组各30例,两组均给予相同的基础治疗,运动干预组患者予以运动护理干预,观察干预过程的安全性和干预后心功能分级、LVEF及6分钟步行试验(6 MWT)距离的变化.结果 干预8周后,运动干预组①在研究期间未发现严重心血管事件;②心功能分级和6 MWT距离均有改善(分别P＜0.05,P＜0.01),高于对照组(均有P＜0.05);③LVEF没有明显改善.结论 对老年CHF患者实施合理的运动护理干预是控制其心衰、改善运动能力的安全干预方法之一.     

卡维地洛治疗慢性心力衰竭临床疗效观察

目的观察卡维地洛对慢性心力衰竭（CHF）的临床疗效。方法76例慢性心力衰竭患者随机分为治疗组和对照组,2组均给予常规抗心力衰竭治疗,治疗组加用卡维地洛。疗程为24周。观察并比较治疗后2组在纽约心脏协会（NY—HA）心功能分级、左室射血分数（LVEF）、6min步行距离、心率、血压及病死率。结果治疗组较对照组NYHA心功能分级、LVEF、6min步行距离均明显改善,血压、心率明显降低,病死率下降。结论在常规治疗基础上加用卡维地洛治疗慢性心力衰竭,可明显增加LVEF、改善心脏功能,增加6min步行距离,改善运动耐量,提高患者生存率,且不良反应小。     

老年慢性心力衰竭的院外康复锻炼

目的 了解院外康复锻炼配合药物治疗对老年慢性心力衰竭患者心功能的影响。方法 41例老年慢性心力衰竭患者分为两组，康复组21例，对照组20例，两组均按《慢性收缩性心力衰竭治疗指南》给予药物治疗。康复组另外配合康复锻炼，治疗第6个月末评价心功能等级及6min步行距离。结果 康复组心功能平均提高0．29级，而对照组平均降低了0．15级。6min步行距离康复组也较对照组提高明显。康复组疗效优于对照组（P〈0．05）。结论 老年慢性心力衰竭患者在院外药物治疗的同时配合康复锻炼，可以改善患者心功能，提高生活质量。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。