糖尿病首发酮症酸中毒的临床特征研究

目的：研究糖尿病首发酮症酸中毒的临床特征及分型。方法将2组首发酮症酸中毒的糖尿病患者按照其体质指数分为α组和β组,检测和归纳2组年龄、性别、发病特征、胰岛功能、血糖及血脂,并进行临床比照。结果α组年龄（42.2±3.3）岁,体质指数（28.1±1.7）kg/m 2,血糖（23.6±5.8）mmol/L,糖化血红蛋白（10.6±3.1）%,总胆固醇（6.12±2.81）mmol/L,甘油三酯（3.66±2.65）mmol/L;β组与其相对应的值分别为（42.9±2.9）岁,（19.8±3.0）kg/m 2,（23.8±6.1）mmol/L,（11.5±3.5）%,（4.39±1.55）mmol/L,（1.71±0.78）mmol/L。2组常规资料相比,年龄、血糖及糖化血红蛋白差异无统计学意义,体质指数及血脂水平差异有统计学意义（P＜0.05）。而α组空腹胰岛素及餐后2 h胰岛素分别为（6.22±2.84）及（21.18±6.57）UIu/mL;β组相对应的值分别为（2.79±1.91）及（6.04±3.47）UIu/mL,可见α组酮症发病时其胰岛素缺乏程度显著低于β组（P＜0.05）,差异有统计学意义。结论糖尿病首发酮症酸中毒患者其临床表现与传统1型糖尿病及2型糖尿病患者有很大差异,其相关血生化指标规律特点不同于常规糖尿病,应予进一步研究以明确其独立分型。     

急诊糖尿病酮症酸中毒124例临床分析

目的 分析急诊科治疗的第一诊断为糖尿病酮症酸中毒患者的原因、临床表现等。方法 急诊科就诊后明确诊断糖尿病酮症酸中毒124例患者，对其临床治疗过程进行回顾性研究分析。入选患者按年龄分为成年组95例，未成年组29例。分析患者性别、年龄、糖尿病病程、疾病分型、起病诱因、临床表现、实验室检查结果(指尖血糖、尿糖、尿酮体、动脉血气分析)等指标。结果 糖尿病酮症酸中毒124例患者中，1型糖尿病患者占67.00%;未成年组中62.50%为首次发病就诊患者。起病诱因显示，感染比例最高，为35.00%,其中成年组感染比例为36.70%;未成年组中无明显诱因占58.30%,其次为感染占29.20%。临床表现为恶心、呕吐38.00%,口干、多饮、多尿25.0%,意识不清12.10%。结论 糖尿病酮症酸中毒患者常见于1型糖尿病，约60%未成年患者为首次发病就诊；感染为最主要发病诱因，约50%的未成年患者起病时无明确诱因；主要的临床表现为恶心、呕吐，其次为口干、多饮、多尿。     

以腹痛为首发症状的糖尿病酮症酸中毒8例分析

目的：探讨糖尿病酮症酸中毒以腹痛为首发症状起病的机制及特点。方法：对我院近4年以腹痛为首发症状的糖尿病酮症酸中毒8例患者的临床资料进行总结分析。结果：除1例死亡外均好转出院。结论：以腹痛为首发症状的糖尿病酮症酸中毒易与外科急腹症相混淆,临床医师应对腹痛性糖尿病酮症酸中毒患者提高认识,提高诊疗水平。     

糖尿病酮症酸中毒56例心电图分析

目的探讨糖尿病酮症酸中毒患者的心电图异常情况,通过临床分析加深对糖尿病酮症酸中毒的病理研究。方法选取2003年7月至2009年7月在我院住院治疗的糖尿病酮症酸中毒患者56例,分为1型糖尿病和2型糖尿病进行分析。其中1型糖尿病患者共23例,2型糖尿病患者33例。结果 1型糖尿病组与2型糖尿病组在心电图表现异常比例方面,差异无统计学意义χ2=0.115,P〉0.05）;心动过速的差异也无统计学意义（χ2=0.254,P〉0.05）,两组ST-T改变有非常显著统计学意义（χ2=9.98,P〈0.01）。结论本次研究证明,糖尿病酮症酸中毒患者在入院时应常规通过心电图检查身体状况,通过对心电图的监测确保患者的安全。     

糖尿病酮症酸中毒合并上消化道出血的危险因素分析

目的探讨糖尿病酮症酸中毒（DKA）并发上消化道出血的可能危险因素。方法对DKA合并上消化道出血患者进行临床分析及病例对照研究。结果上消化道出血发生率为20.83%（10/48）,经t及χ2检验发现：年龄、血糖、血尿素氮或肌酐升高、酸中毒程度、血酮体水平、HBA1C等因素与对照组比较有显著性差异（P〈005）;逐步回归显示上消化道出血与年龄、随机血糖、糖化血红蛋白、血酮体呈正相关,与CO2CP呈负相关;结论老年、高血糖、酮症、酸中毒可能是DKA合并上消化道出血的危险因素。     

糖尿病酮症酸中毒40例临床分析

目的通过对比分析近1年我院40例老年糖尿病酮症酸中毒患者与糖尿病患者和健康人群胰岛素抵抗(HOMA指数)、糖代谢异常和脂代谢异常状况及相互关系,以探索糖尿病酮症酸中毒的相关危险因素,为今后针对糖尿病酮症酸中毒的诊断和治疗提供参考。方法记录患者的年龄、性别、病程、诊断糖尿病酮症酸中毒的年龄、糖尿病酮症酸中毒家族史、身高、体重、计算BMI、吸烟史、饮酒史、伴发疾病(冠心病、中风病史),收缩压、舒张压。测定患者生化指标(血钠、血糖、血脂)。该研究数据采用SPSS 18.0统计软件进行统计分析,计数资料采用四格表精确概率法和χ2检验,以P0.05为差异有统计学意义。结果 40例糖尿病酮症酸中毒患者中,首先表现为头晕、头痛的临床症状分别为66.67%和62.22%;糖尿病酮症酸中毒组和糖尿病组患者的FPG、Hb A1c、TC、TG和HOMA-IR明显高于健康对照组,差异有统计学意义(P0.05);而URIC含量四组之间的差异不显著(P0.05)。结论糖尿病酮症酸中毒多见于中年人,35~45岁年龄段的患者最多,主要症状是头晕和头痛;糖尿病酮症酸中毒发病与患者的血糖、血脂水平以及胰岛素抵抗具有密切的相关性。     

糖尿病酮症酸中毒并发脑水肿临床分析

目的:探讨糖尿病酮症中毒并发脑水肿的临床特征以及危险性。方法:随机选取50例患有糖尿病酮症酸中毒患者进行临床观察与分析,将并发脑水肿的患者分为研究组,未并发脑水肿的患者分为参考组,并对两组患者的临床资料进行比较。结果:50例患者当中,研究组患者即并发脑水肿患者例数为9例(18%),经过临床诊断后判定为重度的酮症酸中毒,与其他未并发脑水肿却同等酮症酸中毒情况的患者相比,研究组患者在接受临床治疗期间血钠提升的速度较为缓慢,个别患者还会出现降低的情况,尿素氮的水平较非研究组患者较高。在研究组9例患者当中,有5例患者进行了碳酸氢盐的应用,剂量大于参考组。结论:糖尿病在并发重度的酮症酸中毒时较为容易引发脑水肿,在临床当中对血钠变化、血尿素氮变化以及碳酸氢盐剂量的控制不合理,会使得脑水肿的危险性增加,进而造成严重的不良后果。     

以腹痛为首发症状的糖尿病酮症酸中毒36例诊治及误诊分析

目的探讨糖尿病酮症酸中毒以腹痛为首发症状起病的机制及特点。方法对笔者所在医院近4年以腹痛为首发症状的糖尿病酮症酸中毒36例患者的临床资料进行总结分析。结果除2例死亡外均好转出院。结论以腹痛为首发症状的糖尿病酮症酸中毒容易误诊,临床医师应对腹痛性糖尿病酮症酸中毒患者提高认识,提高诊疗水平。     

23例糖尿病酮症酸中毒的诊疗分析

目的:为了更好地了解糖尿病酮症酸中毒的诊治。方法:23例糖尿病酮症酸中毒患者,根据年龄、性别、临床表现、实验室检查、诊治情况等进行回顾分析。结果:23例糖尿病酮症酸中毒患者17例(74%)患者在24h内降至11.1~13.9mmol/L左右,血钾、钠、氯、二氧化碳结合率恢复正常,尿酮体转阴,尿糖(+)或消失。5例合并脑血管意外及心肾功能不全,1例合并急性胰腺炎,于1周后尿酮体转阴。结论:早期诊断,早期进行综合性治疗是糖尿病酮症酸中毒抢救成功的关键。     

以酮症酸中毒为首发病征的糖尿病临床特点分析

目的探讨以酮症酸中毒为首发病征的糖尿病的临床特点。方法选择2010年2月份到2011年9月份于我院治疗的糖尿病酮症酸中毒患者108例,根据发病前患者是否确诊糖尿病分为两组,一组为观察组（以酮症酸中毒为首发）共37例;一组为对照组（发病前已确诊糖尿病）共51例。总结两组患者的糖尿病酸中毒时的发病诱因、2型糖尿病患者所占比例及急诊误诊率,并组间比较。结果观察组发病的主要诱因为酒食,急诊的误诊率为32.4%,2型糖尿病比例为75.7%,均明显高于对照组患者,P均小于0.05。结论以酮症酸中毒为首发病征的老年糖尿病患者酒食是发病的主要诱因,发病后,误诊率较高,此类患者医师在临床诊疗时应该加以重视。     

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.