首诊血压和平均血压对急性脑梗死溶栓治疗疗效的影响

目的 观察首诊血压和溶栓后1周平均血压对急性脑梗死溶栓治疗疗效的影响. 方法 78例急性脑梗死患者进行溶栓治疗,测量首诊血压、溶栓后1～7 d平均血压,采用欧洲卒中量表(ESS)评价神经功能恢复状况,记录脑内出血发生例数. 结果 ①首诊血压<180/100 mm Hg患者(A组)第14、90天ESS积分高于首诊血压≥180/100 mm Hg患者(B组)(P0.05). 结论 首诊血压<180/100 mm Hg、溶栓后平均血压<140/100 mm Hg急性脑梗死患者溶栓治疗疗效较好,脑内出血发生率较低.     

早期腰大池引流术与腰椎穿刺脑脊液置换术治疗蛛网膜下腔出血疗效研究

目的 探讨早期腰大池引流术与腰椎穿刺脑脊液置换治疗蛛网膜下腔出血的临床疗效.方法 选取自2016年8月至2018年8月就诊于北部战区总医院的蛛网膜下腔出血患者60例,采用随机数字表法分为腰椎穿刺组(n=30)与腰大池引流组(n=30).腰椎穿刺组患者于出血后1 d内接受腰椎穿刺脑脊液置换术治疗,腰大池引流组患者于出血后1 d内接受腰大池引流术治疗.记录并比较两组患者术后1 d、1周、2周、1个月的大脑中动脉平均流速(MCAVm)、Lingdegaard指数.记录并比较两组患者头痛缓解时间、脑膜刺激征消失时间、脑脊液廓清时间等,术后并发症发生情况.结果 术后1d、1个月,两组患者大脑中动脉平均流速、Lingdegaard指数比较,差异无统计学意义(P>0.05).术后1周,两组患者大脑中动脉平均流速、Lingdegaard指数高于术后1 d,差异有统计学意义(P<0.05).术后1周、2周、1个月,两组患者大脑中动脉平均流速、Lingdegaard指数均逐渐降低,差异有统计学意义(P<0.05).术后1周、2周,腰大池引流组患者大脑中动脉平均流速、Lingdegaard指数均低于腰椎穿刺组,差异有统计学意义(P<0.05).两组患者头痛缓解时间、脑膜刺激征消失时间比较,差异无统计学意义(P>0.05).腰大池引流组患者脑脊液廓清时间显著短于腰椎穿刺组,差异有统计学意义(P<0.05).两组患者术后并发症总发生率比较,差异无统计学意义(P>0.05).结论 与腰椎穿刺脑脊液置换术相比,早期腰大池引流术能更快降低大脑中动脉平均流速、Lingdegaard指数水平,有助于缩短脑脊液廓清时间,有效防治蛛网膜下腔出血患者脑血管痉挛发生.     

重组人血管内皮抑制素联合化疗治疗晚期胃癌的临床观察

目的 观察重组人血管内皮抑制素(恩度)联合sox方案(替吉奥+奥沙利铂)治疗晚期胃癌的疗效和安全性.方法 将50例晚期胃癌患者随机分为两组.观察组应用恩度联合SOX方案化疗,对照组单纯化疗.2个疗程后评价疗效、生活质量及毒性反应.结果 观察组有效率68%,对照组有效率36%,两组差异有统计学意义(P<0.05).观察组疾病进展时间(TTP)及中位生存期(MST)为7.3个月和12.8个月,对照组为6.2个月和10.1个月,两组差异无统计学意义(P>0.05).治疗后观察组KPS评分较对照组明显改善(P<0.05).观察组毒副反应发生率与对照组比较差异无统计学意义(P>0.05).结论 重组人血管内皮抑制素联合sox方案治疗晚期胃癌提高了临床疗效,改善了患者的生活质量,未见毒副反应增加.     

重症脑卒中机械通气患者应用鼻肠管与鼻胃管行早期肠内营养效果评价

目的 探讨重症脑卒中机械通气患者应用鼻肠管与鼻胃管行早期肠内营养支持治疗效果评价.方法 选取自2017年12月至2019年12月河北大学附属医院收治的接受机械通气的72例重症脑卒中患者为研究对象,根据肠内营养方法分为鼻胃管组、鼻肠管组,每组36例.两组患者均在入院48 h内给予早期肠内营养支持治疗,观察两组患者胃肠道并发症发生率、肠内营养达标时间、呼吸机相关性肺炎(VAP)发生率、机械通气时间、病死率及血清白蛋白(ALB)、血清前白蛋白(PA)、白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT).结果 鼻肠管组患者的误吸、呕吐、胃潴留发生率明显低于胃管组,差异有统计学意义(P<0.05).鼻肠管组的VAP发生率及机械通气时间均低于鼻胃管组,差异均有统计学意义(P<0.05).治疗前,两组患者的ALB、PA比较,差异无统计学意义(P>0.05).鼻肠管组治疗前、后ALB比较,差异无统计学意义(P>0.05);治疗后,PA显著升高,差异有统计学意义(P<0.05).鼻胃管组治疗前、后PA比较,差异无统计学意义(P>0.05);治疗后,ALB显著降低,差异有统计学意义(P<0.05).治疗后,两组患者的ALB、PA及肠内营养达标时间比较,差异均有统计学意义(P<0.05).治疗前、后,鼻胃管组患者WBC、CRP、PCT比较,差异无统计学意义(P>0.05).治疗前,鼻肠管组患者WBC、CRP、PCT比较,差异无统计学意义(P>0.05).治疗后,鼻肠管组WBC、CRP、PCT较治疗前下降,差异有统计学意义(P<0.05).治疗后,两组患者的ALB、PA及肠内营养达标时间比较,差异均有统计学意义(P<0.05)治疗后,两组的WBC、CRP、PCT比较,差异有统计学意义(P<0.05).结论 接受机械通气的重症脑卒中患者给予经鼻肠管早期营养支持治疗较鼻胃管更为安全有效,今后可进一步优化鼻肠管置入方法,开展大样本、多中心研究进一步证实上述结论.     

胸痛中心急救护理流程在急性ST段抬高型心肌梗死中的应用

目的 探讨胸痛中心急救护理流程在急性ST段抬高型心肌梗死中的应用效果.方法 按时间分段法将122例STEMI患者分为对照组和观察组,对照组按常规急救护理流程进行急救护理,观察组按照急救护理流程进行急救护理,观察比较两组患者急救流程时间和院内急救死亡率.结果 观察组首诊-完成首次心电图时间、完成首次心电图-导管室完成术前准备时间、肌钙蛋白完成检查时间、急诊停留时间、首诊至直接行经皮冠状动脉介入治疗时间均短于对照组,患者满意度高于对照组,差异有统计学意义(P<0.01);院内急救死亡率观察组与对照组比较差异无统计学意义(P>0.05).结论 胸痛中心急救护理流程缩短了患者急救时间,降低院内急救死亡率,提升患者对急救护理工作满意度.     

腹腔镜下改良阴道旁修补术与前盆底重建术治疗阴道前壁脱垂的临床应用

目的 探讨腹腔镜下改良阴道旁修补术(PR)与前盆底重建术(PFR)治疗阴道前壁脱垂的临床效果.方法 回顾性分析2016年1月至2018年10月在该院妇科行手术治疗的102例阴道前壁脱垂患者的临床资料,按照手术方式不同分为腹腔镜下改良PR组(50例)和PFR组(52例).比较两组患者年龄、体质量指数、孕产次、手术时间、术中出血量、住院费用、盆腔脏器脱垂定量(P O P-Q)等情况.结果 两组患者手术时间、术中出血量、住院费用比较,差异均有统计学意义(P<0.05).术后随访发现,PR组和PFR组患者术后Aa、Ba评分均优于术前,差异均有统计学意义(P<0.05);两组患者术后POP-Q评分比较,差异均无统计学意义(P>0.05).PR组患者术后治愈率高于PFR组,差异有统计学意义(P<0.05).两组患者复发率比较,差异无统计学意义(P>0.05).两组患者术后1个月、3个月、半年及1年PFDI-20、PFIQ-7评分与术前比较均明显降低,差异均有统计学意义(P<0.05);PR组患者术后3个月、半年及1年PFDI-20、PFIQ-7评分均低于PFR组,差异均有统计学意义(P<0.05).结论 腹腔镜下改良PR及PFR均是治疗阴道前壁脱垂的有效术式,掌握多种术式,对选择更适合患者的术式尤为重要.     

中药恒温保留灌肠法在溃疡性结肠炎患者中的应用

目的 探讨恒温灌肠法对溃疡性结肠炎患者行中药保留灌肠的效果.方法 将我院消化科60例溃疡性结肠炎患者随机分为两组,对照组30例为普通灌肠组,实验组30例为恒温灌肠组,观察12 d两组患者药液保留时间、舒适度、24 h大便次数的单项症状的改善情况.结果 患者24h排便次数在6d内排便次数差异有统计学意义(P<0.05),12 d内差异无统计学意义(P>0.05),两组保留时间在6 d内差异具有统计学意义(P<0.05),在12 d内差异无统计学意义(P>0.05),两组舒适度比较具有明显统计学意义(P<0.05).恒温灌肠组总有效率高达96.7％,对照组总有效率为86.6％,差异有统计学意义(P<0.05).结论 恒温灌肠能改善溃疡性结肠炎患者保留灌肠的效果,有效增加药液保留时间,减少24小时排便次数,提高患者的舒适度.     

输尿管软镜碎石取石术前留置双J管治疗肾结石的临床效果

目的 探讨输尿管软镜碎石取石术前留置双J管治疗肾结石的临床效果.方法 选取2018年1月至2020年6月收治的120例肾结石患者作为研究对象,根据双J管留置情况将其分为A组、B1组、B2组,各40例.三组均行输尿管软镜碎石取石术,术前A组不做任何处理,B1组留置双J管7 d,B2组留置双J管1个月.比较三组的治疗效果.结果 B1组、B2组的住院时间、手术时间长于A组,差异具有统计学意义(P<0.05);三组的术后恢复时间比较,差异无统计学意义(P>0.05).三组的通道鞘一次置入成功率比较,差异具有统计学意义(P<0.05);三组的术后7 d及1个月结石清除率比较,差异无统计学意义(P>0.05).B2组的通道鞘一次置入成功率、术后1个月结石清除率高于A组,差异具有统计学意义(P<0.05).三组的尿路感染、输尿管壁损伤发生率比较,差异具有统计学意义(P<0.05);B2组的尿路感染发生率高于A组,差异具有统计学意义(P<0.05);B1组、B2组的输尿管壁损伤发生率低于A组,差异具有统计学意义(P<0.05).结论 输尿管软镜碎石取石术前留置双J管1个月可显著提高肾结石患者的通道鞘一次置入成功率、结石清除率,降低输尿管壁损伤发生率,但增加了尿路感染发生率,因此,对于双J管的具体留置时间应结合患者实际情况定夺.     

钛夹阻断术联合组织胶注射治疗食管胃底静脉曲张临床疗效研究

目的 探究钛夹阻断术联合组织胶注射治疗食管胃底静脉曲张的临床疗效.方法 选取自2019年1月至2020年6月间安徽医科大学附属宿州医院收治的67例食管胃底静脉曲张患者为研究对象,随机分为A组(n=34)、B组(n=33).B组采用钛夹阻断术联合组织胶注射治疗,A组采用单独注射组织胶治疗.治疗结束后分别于1、3、6个月复查胃镜,比较两组患者的疗效、再出血发生率、住院时间、住院费用与并发症发生率.结果 治疗1个月后,两组患者的疗效比较,差异无统计学意义(P>0.05);治疗后3、6个月,B组的治疗总有效率显著高于A组,差异有统计学意义(P<0.05).治疗后,两组患者的近期再出血率比较,差异无统计学意义(P>0.05);B组的止血成功率显著高于A组,远期再出血率、住院时间、并发症发生率显著低于A组,差异均有统计学意义(P<0.05).结论 钛夹阻断术联合组织胶注射治疗食管胃底静脉曲张可提高治疗效果,显著改善静脉曲张,缩短住院时间,降低远期出血率和并发症发生率.     

中西医结合治疗耐药性肺结核的临床免疫学研究

目的 探讨中西医结合治疗耐药性肺结核的临床疗效.方法 选择住院耐药性肺结核病患者80例,随机分成治疗组40例,在给予抗结核药物治疗的基础上肺腑汤加味,1剂/d,2次/d;对照组40例只口服抗结核药物治疗.疗程1个月.流式细胞仪检测外周血T细胞亚群,ELISA检测血清中细胞因子表达.胸部螺旋CT检查病灶吸收情况,痰涂片抗酸染色检测痰菌阴转,ALERT 3D-240培养系统进行痰结核分枝杆菌检测.结果 治疗组与对照组在治疗前,外周血中T细胞亚群差异无统计学意义(P>0.05),与正常组比较差异有统计学意义(P<0.05);治疗组与治疗前比较T细胞亚群差异有统计学意义(P<0.05),而对照组差异无统计学意义(P>0.05).两组患者治疗前IL-5、sIL-2R、IFN-γ、IL4、TNF-α表达水平差异无统计学意义(P>0.05).治疗组在治疗后细胞因子表达与治疗前比较差异有统计学意义(P<0.01),而对照组差异无统计学意义(P>0.05).两组患者治疗后痰涂片和痰培养阴转、病灶吸收情况差异有统计学意义(P<0.05).结论 中西医结合治疗可以改善耐药性肺结核病患者的免疫功能,促进痰菌阴转和病灶吸收.     

Moyamoya syndrome in a pediatric patient with congenital human immunodeficiency virus type 1 infection resulting in intracranial hemorrhage

In the era of Antiretroviral Therapy (ART) in which human immunodeficiency virus type 1 (HIV-1) infection affected children can expect a better prognosis, the importance of careful follow up of pediatric HIV-1 cases for neurological complications has been growing. We present a case of hemorrhagic Moyamoya syndrome in a child with congenital HIV-1 infection. A 10-year-old girl was referred to our hospital for the treatment of Pneumocystis Jirovecii Pneumonia (PCP: Pneumocystis pneumonia). Her HIV-1 control was poor and Moyamoya syndrome was found during the opportunistic infection screening at admission. Despite subsequent successful treatment of PCP and HIV-1 infection, we could not save her life due to the intracranial hemorrhage caused by Moyamoya syndrome. A few reported cases of Moyamoya syndrome associated with HIV-1 infection have shown negative outcomes when the control of HIV-1 infection is unsuccessful. Recently “HIV-associated vasculopathy” has been used to describe the cerebrovascular disorder related to HIV-1 infection that is caused by the endothelial dysfunction induced from chronic inflammation and cytokine imbalances due to HIV-1 infection. We assumed that “HIV-associated vasculopathy” may have contributed to the development of collateral vessels impairment related to the bleeding, although the mechanism of vascular damage with HIV-1 infection is not yet well defined. Therefore proper management of the HIV-1 infection is crucial for Moyamoya syndrome with HIV-1 cases. Furthermore it is better to take into account the risk of intracerebral hemorrhage when considering the indication and timing of the revascularization surgery, although generally hemorrhaging is rare in Moyamoya disease in children.     

Beyond Brief Intervention: Pharmacologic Management of Alcohol Use Disorder

Over 50 years ago, alcohol use disorder (AUD) was recognized as a treatable medical disorder negatively affecting millions of adults, yet pharmacologic management is underused. Most patients seeking AUD treatment are referred to an outpatient program or a peer support group. Relapse is common because frequently medications to treat AUD are recommended yet not prescribed for routine use concurrently with support programs. Therefore, comprehensive treatment of AUD must include pharmacologic management to prevent a relapse to alcohol use. The purpose of this article is to present evidence-based information for nurse practitioners’ pharmacologic management of AUD.     

Proctalgia fugax: a clinical enigma

Proctalgia fugax is a benign condition characterized by paroxysms of anorectal pain in the absence of identifiable anorectal lesions. The cause is unknown but may involve spasm of smooth or striated muscle. Surveys indicate the disorder is common in the general population, with only a minority of victims seeking medical attention. There is no universally accepted treatment for proctalgia fugax. The diagnosis is established by the typical history and the exclusion of other pelvic and anorectal abnormality.     

A contemporary conceptual model of hypochondriasis

Hypochondriasis (HC), which involves preoccupation with the fear of having a serious illness despite appropriate medical examination, is often encountered in medical settings. The most conspicuous feature of this disorder is seeking excessive reassurance from physicians, medical references, or self-inspection; however, many patients also fear they will receive upsetting information if evaluated and thus avoid consultations and remain preoccupied with physiologic events, believing they are physically ill. Thus, HC causes personal suffering for the patient and practical and cost management problems for professionals across fields of clinical practice. The past 2 decades have seen considerable improvement in the understanding and treatment of HC. In this article, we review a contemporary conceptual model of HC and an effective form of treatment called cognitive-behavioral therapy that is derived from this model. Recommendations for presenting this conceptualization to patients and encouraging proper treatment are also discussed.     

成人自发性颅底毛细血管异常增生症临床特点和血管造影表现

目的 分析成人自发性颅底毛细血管异常增生症(Moyamoya病)临床表现,评价全脑血管造影对其的诊断价值.方法 对6例成人Moyamoya病患者的临床表现和血管造影特点进行回顾性分析.结果 均表现为脑缺血症状,经常规治疗无效后行血管造影明确诊断.全脑血管造影均显示不同程度双侧颈内动脉狭窄或闭塞及侧支循环.结论 掌握成人Moyamoya病的临床特点和血管造影表现,有利于早期诊断.全脑血管造影是诊断Moyamoya病的金标准.     

青少年双相障碍病人疾病自我管理经验的质性研究

目的:了解青少年双相障碍病人疾病自我管理经验及其影响因素,为临床制定相关干预措施和完善疾病自我管理评估工具提供依据。方法:使用现象学研究方法,于2020年10月—2021年3月对广州市某三级甲等医院精神心理科诊断为双相障碍的7例病人、5名主要照顾者及8名医护人员进行半结构式访谈,采用Colaizzi 7步分析法进行资料分析。结果:归纳出青少年双相障碍病人疾病自我管理经验及其影响因素2个方面的主题。疾病自我管理经验方面主题包括识别异常情绪和行为、维持规律的生活方式和寻求多重的社会支持;影响因素方面主题包括治疗积极性较低、疾病相关知识水平有限、自知力缺乏、病耻感和社会支持不足。结论:医护人员有必要加强对青少年双相障碍病人疾病自我管理情况的了解与评估,加强病人及主要照顾者对疾病自我管理的认知与培养,提高病人的治疗依从性,进而促进病人良好的预后转归。     

影响输卵管妊娠就诊的相关因素及护理对策

目的：探讨影响输卵管妊娠就诊的相关因素及护理对策。方法：对167例输卵管妊娠病例相关因素进行回顾性分析。结果：小同的就诊方式对治疗方法的选择有明显的区别。结论：早就诊,早治疗可以降低手术率,减少并发症发生。     

Stress and mood of adults with moyamoya disease: A cross‐sectional study

Moyamoya disease in adults is a chronic, progressive disorder characterized by fine collateral vessel networks in the brain. The disorder can lead to negative mood and stress, which, left unresolved, may increase adverse health outcomes. We conducted a cross‐sectional survey to examine stress and mood of adults with moyamoya disease. Participants were recruited at a university hospital in Seoul, Korea. Data were collected through questionnaires and review of participants' electronic medical records. A total of 109 adults participated. Significant correlations were found between perceived stress, anxiety, and depression. Adults with moyamoya disease experience anxiety, depression, and stress related to the risk of cerebral hemorrhage or ischemia, similar to those with other cerebrovascular disease. If negative mood and stress were uncontrolled, those can cuase adverse health outcomes. Health professionals caring for people with moyamoya disease should carefully observe their stress and mood and develop interventions tailored to stages of disease to help them manage. The study results provide baseline information for understanding the level of, and the factors associated with, stress and mood.     

Munchausen syndrome presenting acutely in the emergency department

Munchausen syndrome is a rare psychiatric disorder in which patients purposely harm themselves to gain medical attention. These patients may present to unsuspecting emergency department (ED) staff members with life-threatening signs and symptoms. We report a case of Munchausen syndrome in which a young man with ties to the medical community and a history of substance abuse presented to our ED with refractory hypoglycemia and a dilated right pupil. The patient required large amounts of dextrose, endotracheal intubation, mechanical ventilation, and admission to the intensive care unit. Further investigation revealed that he had purposely injected himself with a large dose of insulin and instilled atropine drops in his right eye for the purpose of seeking hospitalization. The history, details, diagnosis, treatment, and prognosis are discussed in the context of this case.