降钙素原PCT、C-反应蛋白CRP定量检测在重症医学科患者感染诊断及预后判断中的临床应用

目的:探讨血清降钙素原(降钙素原PCT)、C-反应蛋白(CRP)水平在重症医学科重症监护病房(ICU)患者感染的诊治及其预后判断中的临床价值。方法:将重症医学科ICU患者分为重症感染组、一般感染组、对照组,检测其血清降钙素原PCT、CRP水平。结果:重症感染组、一般感染组分别与对照组比较,降钙素原PCT、CRP值均有显著增高(P0.01);重症感染组与一般感染组比较,其降钙素原PCT阳性率有显著增高(P0.05),但CRP阳性率无显著增高(P0.05);重症感染组、一般感染组中,降钙素原PCT阳性率均较hs-CRP阳性率高,差别有统计学意义(P0.05);降钙素原PCT浓度与患者的预后密切相关,一般感染组较重症感染组预后效果良好。结论:血清降钙素原PCT值对重症医学科危重患者感染诊断及判断患者预后具有重要的临床意义。     

血清降钙素原监测在新生儿严重感染的临床意义

目的探讨血清降钙素原(procalcitonin,PCT)在早期诊断新生儿严重细菌感染性疾病中的临床意义。方法将本院新生儿科的67例新生儿分为重症感染、局部感染和非感染组,进行PCT测定,并与C-反应蛋白(C-reactive protein,CRP)和白细胞记数(WBC)进行比较。结果以PCT≥0.5ng/mL为阳性,重症感染组PCT阳性率(88.46%)与局部感染(38.10%)和非感染组(15.00%)比较差异均有统计学意义(P<0.01),重症感染组CRP阳性率与另两组比较差异均有统计学意义(P<0.01),而WBC在3组间比较差异无统计学意义,PCT与CRP及WBC相比,PCT诊断重症感染的敏感性、阳性预测值、阴性预测值、约登指数最高。结论PCT可作为新生儿重症细菌感染早期诊断的标志物。     

降钙素原在感染性疾病早期诊断中的意义

目的 探讨降钙素原(PCT)检测在早期诊断患者感染性疾病中的临床意义.方法 将132例患者分为重症感染(38例)、一般感染(48例)、非感染(46例)三组进行分析,并与C反应蛋白(CRP)、血常规、血培养进行比较,比较它们对细菌感染诊断的敏感性、特异性.结果 PCT阳性率:重症感染组阳性率92.11%,一般感染组54.17%,非感染组8.70%.重症感染组明显高于其他两组.PCT与CRP、血培养比较,阳性率更高.结论 PCT在患者感染性疾病中明显升高,可作为患者全身感染早期诊断的重要指标,动态检测PCT可判定疗效及预后,利于指导临床早期用药.     

降钙素原与C反应蛋白对新生儿感染的应用价值对比

目的评价血降钙素原（PCT）与C反应蛋白（CRP）在新生儿感染时的应用价值。方法将114例新生儿分为感染组和非感染组各57例。所有患儿入院后即取静脉血做PCT、CRP检测，结果进行比较。结果感染组与非感染组PCT阳性率比较有显著性差异（P〈0．01），感染组PCT阳性率高于CRP阳性率。全身感染与局部感染PCT阳性率比较有非常显著性差异（P〈0．01），全身感染PCT阳性率高于CRP阳性率。PCT诊断新生儿感染的敏感度高于CRP，而特异度与CRP相差不大。结论PCT与CRP的检测对诊断新生儿感染均有应用价值，但PCT的应用价值更高。     

降钙素原检测在新生儿感染中的临床运用

目的:分析降钙素原(PCT)的检测对于诊断新生儿感染的临床价值。方法:选择150例新生儿,其中重度感染患儿55例,轻度感染患儿56例,非感染新生儿39例。检测并比较三组新生儿未接受治疗前的降钙素原、超敏C-反应蛋白(CRP)。结果:重度感染组的降钙素原阳性率显著高于其他两组(P<0.01),且三组间比较差异有统计学意义(P<0.05)。且PCT的敏感性和特异度高于CRP。结论:PCT检测对新生儿感染的早期诊断具有重要参考价值,且可作为感染病情程度的指标。     

降钙素原检测在新生儿感染早期的临床应用

目的:探讨降钙素原(PCT)检测在新生儿细菌感染早期的临床应用价值。方法:选取136例新生儿细菌感染早期病例,分为重症感染和一般感染2个观察组,选取52例同期住院非感染性病例作为对照组,统计分析PCT检测值、超敏C反应蛋白、白细胞计数在各组间的差异。结果 :PCT值在2个观察组显著高于对照组,且重症感染组高于一般感染组,3组间比较差异显著(P<0.05),说明PCT值与新生儿细菌感染严重程度相关。在新生儿重症感染组,PCT阳性率与hs-CRP阳性率无显著性差异(P>0.05),但均高于WBC计数阳性率(均P<0.05);在一般感染组,PCT阳性率显著高于hs-CRP及WBC计数(均P<0.05);在对照组,PCT阴性率显著高于hs-CRP及WBC计数(均P<0.05)。结论 :PCT可以作为诊断新生儿细菌感染早期的参考指标和判断感染严重程度的敏感指标。     

降钙素原在重症感染中的意义

目的:探讨降钙素原(PCT)在ICU重症患者感染早期诊断及感染程度判断的意义。方法:将90例ICU重症感染患者随机分为两组,每组45例,对照组采用常规血清CRP(C反应蛋白)及WBC(白细胞)外周计数检测,观察组在对照组的基础上采用PCT检测,就检测结果评价降钙素原在重症感染中的临床意义。结果:经检测结果分析统计,所有重症患者的PCT阳性率、WBC阳性率及CRP阳性率在感染后均有升高,但是PCT阳性率明显高于常规血清CRP及WBC外周计数检测,差异显著(<0.05)。结论:与常规炎症感染检测相比,PCT在ICU重症感染患者早期诊断中具有一定临床价值,且动态的降钙素原检测有助于患者治疗效果的评估,可作为评估感染严重程度的较好参数。     

降钙素原在新生儿感染疾病中的应用

目的评价降钙素原(PCT)在诊断新生儿感染性疾病中的临床应用。方法收集2012年1—12月被我院NICU收治的新生儿感染性疾病138例,并根据感染严重度评分(SSS)将其分为重症感染组55例、一般感染组83例,同时选同期非感染新生儿病例50例,应用半定量免疫色谱法分别测定三组的血清PCT水平,并与血清C-反应蛋白(CRP)的诊断结果相比较。结果重症感染组的PCT均明显高于另两组(P<0.05或P<0.01),一般感染组的PCT阳性率较非感染组间高(P均<0.05);PCT对新生儿重症感染诊断的敏感性为87.3%明显高于CRP的56.4%(P<0.05),二者特异度差异并无显著性。结论 PCT可作为新生儿感染疾病的一项灵敏检测指标,尤其适用于的重症感染新生儿的诊断和治疗,较CRP更具临床应用价值。     

新生儿感染性疾病中血清降钙素原和C反应蛋白检测的临床意义

目的 :探讨新生儿感染性疾病中血清降钙素原 (PCT)和C反应蛋白 (CRP)的变化及其临床意义。方法 :检测 75例感染性疾病新生儿和 3 0例非感染性疾病新生儿血清中PCT、CRP的含量。结果 :(1)细菌感染组与病毒感染组、非感染性组比较PCT、CRP明显升高 ,差异有显著性 (P <0 0 1)。 (2 )病毒感染组与非感染组比较PCT、CRP轻度升高 ,无显著性差异 (P >0 0 5)。 (3 )细菌感染组治疗前后PCT、CRP比较有显著性差异。 (P <0 0 1)。结论 :新生儿感染时 ,PCT、CRP的检测有助于疾病早期的鉴别诊断 ,动态检测其变化对疗效判断有一定的价值     

降钙素原与C反应蛋白在新生儿感染的临床应用研究

目的:探讨降钙素原(PCT)、C反应蛋白(CRP)在新生儿感染性疾病的临床诊断价值。方法:219例确证感染性疾病的新生儿按病情分为重症感染组(86例)、局部感染组(133例),以47例非感染性疾病新生儿患者为对照组,比较三组别PCT、CRP检测情况,另219例感染性疾病新生儿按病原体分为细菌组(139例)、病毒组(80例),比较两组别PCT、CRP检测情况。结果:PCT、CRP血清浓度重症感染组高于局部感染组、对照组,三组比较均存在统计学差异,CRP、PCT随感染性疾病病情的加重,血清浓度呈升高态势。PCT重症感染组主要以>10μg/L为主,占68.6%,局部感染组主要以0.5~10μg/L为主占82%,CRP阳性率两组阳性率无统计学差异;PCT、CRP以细菌感染升高幅度大。结论:CRP、PCT在新生儿感染性疾病的诊断、病情监测上是良好的临床观察指标。     

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.