住院糖尿病患者60例死因分析

目的分析我院近8年间住院死亡的60例糖尿病患者的死因及特点。方法对2000～2007年我院住院死亡糖尿病患者的资料进行纵向分析，分析死因构成特点和代谢控制情况。结果（1）心脑血管疾病、恶性肿瘤、感染占所有死亡病例的71．7％，与糖尿病直接相关的死亡占5．0％；（2）入院时患者血糖、血脂、血压等多种代谢指标控制未能达标；（3）其中代谢综合征（MS）患者占近40％，并随着病程的延长其MS发生率随之升高。结论心脑血管疾病、恶性肿瘤和感染是糖尿病患者的主要死亡原因，与糖尿病直接相关的死亡原因所占比例较低，糖尿病患者应早期、定时筛查防治心脑血管疾病及肿瘤和代谢综合征。     

大屯矿区20年住院病例流行病学调查

1材料与方法本组调查内容根据大屯煤电公司中心医院1972～1992年外科、内科、儿科、传染科、骨科和五官科全部住院病历，填写有关数据用“SAS”软件进行分析处理。2结果与分析2．1疾病分布6个科室20年共收治住院患者37297人次，其中本矿患者25828人次，占69．3％，其疾病百分构成排在前五位的依次是呼吸系统疾病（25．l％），消化系统疾病（18．9％），传染病门巳卫％），创伤（9．6％），循环系统疾病（8．5％）。心脑血管疾病的发病率也较高。2．2年龄分布传染病以10岁以下及20～40岁年龄组发病率较高，分别为21．9％和30．5％；肿瘤病…     

糖尿病68例死亡原因分析

目的分析住院糖尿病患者的死亡原因，为防治提供依据。方法对8年住院糖尿病患者死亡原因进行回顾性分析。结果（1）糖尿病病死率2．29％；（2）糖尿病患者的主要死冈依次是心血管疾病（36．76％）、多器官功能衰竭（14．71％）、脑血管疾病（13．24％）、急性并发症（11．76％）、终末期肾衰（7．35％）、感染性疾病（7．35％）、急性重症胰腺炎（4．41％）；（3）糖尿病病死率与患者年龄、并发症有关。结论糖尿病已成为目前住院患者的常见死因。心脑血管疾病、多器官功能衰竭、急性并发症、终末期肾衰、感染性疾病是糖尿病死亡的主要原因。严格控制血糖、血压、血脂、尿酸等代谢指标达标，重视糖尿病并发痱和合并疖的防治可能隆低糖尿病病矸蜜，     

2型糖尿病患者慢性并发症临床分析（附47l例报告）

目的 分析2型糖尿病住院患者各种糖尿病慢性并发症及相关大血管疾病的患病状况及相关危险因素。方法 以471例2型糖尿病住院患者为研究对象，依据患者的病历，针对各种糖尿病慢性并发症及相关大血管疾病进行统计分析。结果 人选患者中，糖尿病视网膜并发症者为57．3％；糖尿病肾脏并发症者为31．0％；糖尿病神经病变者为56．5％；高血压为50．6％；冠状动脉粥样硬化性心脏病为26．9％；脑血管疾病为13．6％；下肢血管疾病为5．3％。经多因素Logistic回归分析发现，患者的年龄、糖尿病病程、空腹血糖水平、收缩压水平、舒张压水平、甘油三酯水平分别为各种糖尿病慢性并发症及相关大血管疾病的独立危险因素。结论 为改善患者的预后，应重视对糖尿病高危人群的早期防治；对已出现2型糖尿病的患者应采取降糖、降压、调脂等多种措施并重的综合治疗。     

老年糖尿病住院病人死亡原因分析

目的分析住院老年2型糖尿病患者的死亡原因及相关影响因素。方法对2001年1月至2008年12月在我院住院并死亡的老年糖尿病患者138例的临床资料进行回顾性分析,并与同期非糖尿病住院并死亡的老年患者412例相对照。结果前3位的死亡原因依次是心血管疾病（31．88％）,肺部感染（21．01％）．脑血管疾病（19．57％）。心血管疾病和肺部感染是糖尿病病人的主要死亡原因。结论糖尿病是增加老年人死亡率的一个重要因素之一。有效的控制高血糖,高血压、高血脂,保护脏器功能,防治感染,对降低老年糖尿病患者的死亡,提高生活质量,十分重要。     

老年患者医院内下呼吸道真菌感染相关因素分析

目的分析老年患者医院内呼吸道真菌感染主要相关因素及菌种分布，为其早期诊断和有效治疗提供依据。方法对医院呼吸科2002年1月-2004年11月60岁以上的住院患者发生呼吸道真菌感染57例进行回顾性分析。结果发生医院内呼吸道真菌感染的67例患者中〉60岁的患者占85．1％，所有病例均伴有明显的基础疾病，3种以上疾病并存的患者56例，占98.25％。全部患者在真菌感染前均反复使用过多种抗生素，39例患者使用过糖皮质激素，占68．42％。5例患者接受化疗或放疗，占8．77％。20例患者接受过侵入性操作，占35．09％。57例患者中40例检出白色念珠菌（70．18％），8例热带念珠菌（14．04％），6例其它念珠菌（10．53％），2例平滑念珠菌（3．5％），1例克柔念珠菌（1．75％）。结论老年患者医院内呼吸道真菌感染与年龄、基础疾病、抗生素和糖皮质激素及免疫抑制剂的应用、留置导管等有关。白色念珠菌仍是医院内真菌感染的主要病原，占70．18％。临床上应警惕真菌感染，及早诊断和有效治疗，从而降低该病的病死率。     

9年住院糖尿病患者死亡原因分析

目的 探讨住院糖尿病患者的死亡原因。方法 对9年糖尿病住院死亡患者205例死亡原因进行分析。结果 （1）9年糖尿病住院死亡人数占住院死亡总人数的7．1％;（2）糖尿病死亡原因以心、脑血管疾病和感染为主。结论 心、脑血管疾病已经成为糖尿病患者的主要死亡原因。     

5年住院糖尿病病人死亡原因分析

目的：探讨糖尿病病人死亡原因，方法：对5年住院糖尿病病人死因进行分析，结果：（1）5年住院糖尿病病人死亡人数占住院死亡总人数的8．38％。（2）糖尿病病人死亡人数的构成比有下降趋势；（3）近年来以心、脑血管疾病，尿毒症为糖尿病病人死亡的前三位死因。结论：心脑血管疾病已经成为糖尿病病人死亡的主要原因。     

上海市长风社区2型糖尿病高危人群糖代谢异常和危险因素分析

目的了解社区糖尿病高危人群中糖代谢异常情况及相关危险因素。方法对40～80岁符合糖尿病高危人群招募条件的1197位上海市长风社区居民，进行问卷调查、体检和生化检测，确定是否有糖尿病高危因素。同时予75g口服葡萄糖耐量试验。结果根据检测结果，982人符合糖尿病高危人群定义（高危组），215人不符合糖尿病高危人群定义（非高危组）。高危组中糖代谢异常占47．9％（470／982），新诊断糖尿病占11．5％（113／982），糖调节受损占36．4％（357／982），其中单纯空腹血糖受损（IFG）占14．8％（145／982），单纯糖耐量异常（IGT）占10．7％（105／982），IFG合并IGT占10．9％（107／982），明显高于非高危组[分别为17．2％（37／215），0．9％（2／215），16．3％（35／215），9．3％（20／215），5．1％（11／215），1．9％（4／215）]（P均〈0．05）。Logistic回归分析显示，年龄、糖尿病家族史、体重指数、收缩压、甘油三酯与糖代谢异常呈正相关，高密度脂蛋白胆固醇与糖代谢异常呈负相关。结论采用糖尿病高危人群筛查模式能提高糖代谢异常的筛查效率。增龄、糖尿病家族史、超重或肥胖、高血压、脂代谢紊乱是糖代谢异常的主要危险因素。     

糖尿病足的护理

糖尿病足部病变是周围神经病变[包括自主神经病变]，微血管病变，大血管病和不良的卫生等诸多因素之间复杂的相互作用所导致的。一旦发病，由于其治疗复杂，会面临截肢等后果。据不完全统计，欧美国家糖尿病患者发生足病的比例约3％-10．2％。在我国糖尿病足病的发病率占糖尿病患者的2．6％-5．2％。截肢（趾）率约为14％。其治疗费用也比因其他原因住院的同期糖尿病患者高得多。[第一段]     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.