监测膝关节感染患者6种感染指标水平的临床意义

［摘要］目的　探讨膝关节感染患者中WBC、CRP、ESR、SAA、PCT、GR%的临床价值．方法　选取2012年3月至2015年1月间185例患者进行分析,根据细菌学结果将185例患者分为术前膝关节感染组（实验组）和术前术后均无膝关节感染组（对照组）,其中实验组37例,对照组148例．收集临床数据,比较2组间术前及术后第1、3、7 天 WBC、CRP、ESR、SAA、PCT、GR%的差异．结果　术前实验组WBC、CRP、ESR、SAA、PCT、GR%均高于对照组,差异有统计学意义（P＜0.05）;在术后第1天实验组WBC、CRP、ESR、SAA均高于对照组,差异有统计学意义（P＜0.05）,而PCT、GR%在2组之间无明显差异（P>0.05）;在术后第3天及第7天WBC、CRP、ESR、SAA、PCT、GR%在2组之间无明显差异（P＞0.05）．结论 WBC、CRP、ESR、SAA、PCT、GR%对于早期诊断、早期预防感染有良好的参考价值,可作为膝关节感染初筛检测指标．     

三种炎症指标对颅脑术后发热原因诊断价值的比较

选择2013年1-12月间91例颅脑术后发热患者,根据是否并发感染分为未感染组（42例）和感染组（49例）,随机选取51例无感染未手术病例为对照组.检验3组的降钙素原（PCT）、CRP和白细胞水平.未感染组与对照组PCT水平差异无统计学意义（P＞0.05）,感染组与未感染组的PCT水平差异有统计学意义（P＜0.01）.未感染组与对照组,感染组与未感染组之间的CRP水平差异有统计学意义（P＜0.01）.白细胞水平在未感染组与对照组间、感染组与未感染组间差异有统计学意义（分别为P＜0.05和＜0.01）.ROC曲线示PCT的灵敏度、特异度均最高.     

永久起搏器围手术期阿莫西林舒巴坦与头孢呋辛预防感染效果比较

目的：探讨不同的抗生素在永久起搏器围手术期预防感染中的效果及安全性,为临床选择合理的抗生素提供依据。方法：将2015年8月至2017年8月温州市中心医院就诊的植入永久起搏器的患者共120例,按照随机数表法分为观察组和对照组,每组均为60例;观察组术前0.5 h采用阿莫西林舒巴坦（1.5 g静脉滴注）,术后24 h内停用,对照组使用头孢呋辛（1.5 g静脉滴注）预防感染,使用方法与观察组相同;在术前、术后48、72 h均比较2组临床特征,比较2组患者手术后7 d感染发生情况,检测2组病原菌种类,比较2组住院情况和不良反应发生率。结果：2组患者术前体温、白细胞（WBC）、C-反应蛋白（CRP）、降钙素原（PCT）差异均无统计学意义（P＞0.05）;而术后48、72 h观察组体温、WBC、CRP、PCT显著低于对照组（P＜0.05）;7 d内发热发生率观察组低于对照组（P＜0.05）;观察组起搏器囊袋感染的发生率低于对照组（P＜0.05）;2组囊袋血肿、肺部感染及感染性心内膜炎发生率差异均无统计学意义（P＞0.05）;而且对照组出现严重感染需拔除起搏器及电极1例,观察组未出现;2组起搏器感染的病原菌最常见的为金黄色葡萄球菌,对照组培养出表皮葡萄球菌、大肠埃希菌、肺炎克雷伯杆菌,而观察组未见;2组的不良反应发生率差异无统计学意义（P＞0.05）;观察组抗生素成本少于对照组（P＜0.05）。结论：阿莫西林舒巴坦在永久起搏器植入术围手术期预防感染效果优于头孢呋辛,感染发生率较低,而不良反应与头孢呋辛相当,且费用低廉。     

降钙素原在感染性结石术后早期诊断脓毒血症中的临床意义

目的探讨降钙素原（PCT）在感染性结石术后早期诊断脓毒血症中的临床意义。方法选取179例行输尿管软镜碎石术的上尿路感染性结石患者为研究对象,其中术后发生尿源性脓毒血症53例（观察组）,未发生尿源性脓毒血症126例（对照组）。监测并比较两组患者术后6、24、48h血清PCT、C反应蛋白（CRP）、WBC等指标变化。结果观察组术后6、24、48h血清PCT均明显高于对照组,差异均有统计学意义（均P＜0.05）;而血清CRP、WBC在术后6h变化不明显（均P＞0.05）,24、48h观察组均明显高于对照组,差异均有统计学意义（均P＜0.05）。以临界值为标准计算术后6h各项指标的阳性率,观察组血清PCT、CRP的阳性率均高于对照组（均P＜0.05）,WBC阳性率低于对照组（P＜0.05）。结论与传统感染监测指标CRP、WBC比较,血清PCT水平能更早提示全身感染情况,在感染性结石术后早期诊断脓毒血症中具有一定的临床意义。     

PCT在重型肝炎继发感染临床诊治中的应用研究

摘要 目的:探讨重型肝炎继发感染患者的降钙素原（PCT）水平变化意义。方法：回顾性分析2019年7月至2021年5月本院收治的99例重型肝炎患者（研究组）及99例健康志愿者（健康组）的临床资料。比较所有纳入研究对象白细胞（WBC）、降钙素原（PCT）、C-反应蛋白（CRP）及体温水平。根据研究组患者有无合并感染情况,将患者分为感染组及非感染组,比较两组患者PCT、CRP、WBC及体温的阳性率。感染组患者给予半个月的抗感染治疗,根据感染控制情况将患者分为控制组及非控制组,比较两组患者治疗前后PCT、CRP、WBC及体温水平。结果：与健康组比较,研究组患者WBC、CRP、PCT及体温水平更高（P＜0.05）。99例重型肝炎患者感染发生率为68.69%（68/99）。与非感染组患者比较,感染组WBC、CRP、PCT阳性率更高（P＜0.05）;与其他三种指标比较,PCT诊断重型肝炎继发感染的敏感性、阳性预测值、特异性、准确率及阴性预测值更高（P＜0.05）;11例患者感染未得到控制,未控制率为16.18%（11/68）;与治疗前未控制组患者比较,治疗后WBC、CRP、PCT水平更高,与控制组治疗后比较,未控制组患者WBC、CRP、PCT水平更高（P＜0.05）;与治疗前控制组比较,治疗后治WBC、CRP、PCT水平更低（P＜0.05）。结论：血清PCT对重症肝炎继发性感染的临床诊断具有一定的参考价值,有助于临床治疗的管理。     

经肛门内镜显微手术前预防性应用抗生素的临床价值

目的  探讨术前预防性使用抗生素在经肛门内镜显微手术（TEM）中的临床价值。方法 选取30例于该院行TEM手术治疗直肠肿瘤的患者作为研究对象,随机分为抗生素组和对照组,抗生素组为术前和术后均应用抗生素,对照组为仅术后应用抗生素。评估患者术前和术后血沉（ESR）、C-反应蛋白（CRP）、降钙素原（PCT）、白细胞计数（WBC）、中性粒细胞（NE%）和体温（T）等指标的变化。结果  抗生素组患者术后第1天和第3天ESR、CRP、WBC、NE%和T均明显低于对照组（P <0.05）,并且WBC、NE%和T在术后第3天较术后第1天有明显的下降趋势。对于PCT,在术后第1天两组比较差异有统计学意义,抗生素组低于对照组（P <0.05）,但在术后第3天,两者之间差异无统计学意义（P >0.05）。结论  术前预防性应用抗生素对TEM微创手术引起的炎症减轻和感染预防可能有一定的临床价值,但最终结论仍需要扩大病例数进一步研究。

     

PCT、CRP 及 WBC 测定在儿童感染性疾病诊疗中的应用

目的：研究血清降钙素原（ procalcitonin,PCT）、C 反应蛋白（ C-reactive protein,CRP）水平及白细胞（white blood cell,WBC）计数在儿童感染性疾病诊疗中的应用价值。方法：选择2012∽2013年间在阳泉市第三人民医院儿科就诊的157例感染性疾病患儿,按临床诊断分为细菌感染组和非细菌感染组,同时选取79例健康儿童作为对照组,分别进行血清 PCT、CRP 水平测定和全血 WBC 计数。结果：细菌感染组的 PCT、CRP 和 WBC 水平高于对照组,差异具有统计学意义（P 〈0.05）;非细菌感染组的 WBC、CRP 水平高于对照组,差异具有统计学意义（P 〈0.05）,而 PCT 差异无统计学意义（P〉0.05）;细菌感染组和非细菌感染组 PCT 差异有统计学意义（P 〈0.05）,而 CRP、WBC 差异无统计学意义（P〉0.05）。结论：PCT 可以快速客观地判别儿童感染的类型以及感染严重程度,对临床合理使用抗生素以及疗效观察具有重要的指导意义。     

降钙素原对亚急性甲状腺炎合并细菌感染的诊断价值

【摘要】 目的 探讨降钙素原（PCT）对亚急性甲状腺炎（SAT）合并细菌感染的诊断价值。 方法 选取2017年6月～2019年6月我院收治的195例SAT患者,根据是否合并细菌感染将其分为感染组（n=72）和非感染组（n=123）,另选取同期健康志愿者100例作为对照组。对三组患者的白细胞计数（WBC）、中性粒细胞百分比（NE%）、红细胞沉降率（ESR）及血清游离三碘甲状原氨酸（FT3）、游离甲状腺素（FT4）、C反应蛋白（CRP）、PCT水平进行检测和比较。采用受试者工作特征（ROC）曲线分析各项指标在SAT合并细菌感染诊断中的价值。 结果 感染组与非感染组患者的血清FT3、FT4、CRP水平及ESR水平的差异无统计学意义（P＞0.05）,但均高于对照组,差异均有统计学意义（P＜0.05）;感染组患者的WBC、NE%水平均高于非感染组或对照组,非感染组患者的WBC、NE%水平均高于对照组,差异均有统计学意义（P＜0.05）;感染组患者的血清PCT水平高于非感染组或对照组,差异均有统计学意义（P＜0.05）,而非感染组患者与对照组血清PCT水平的差异无统计学意义（P＞0.05）。ROC曲线所示：PCT的AUC最大,在Cutoff值下,灵敏度和特异度分别达到0.861和1.000。 结论 SAT合并细菌感染患者的血清PCT水平会出现显著升高,其对于病原学鉴别诊断的价值高于WBC等常规感染指标,可用于辅助指导针对SAT患者的抗菌药物应用。     

血清降钙素原在儿童感染性疾病中的诊断价值

目的：探讨血清降钙素原（PCT）、C反应蛋白（CRP）及WBC的测定在儿童不同病原感染性疾病中的诊断价值。方法回顾分析132例确诊感染性疾病的患儿,分为细菌感染组（56例）、肺炎支原体感染组（40例）和病毒感染组（36例）,比较每组患儿血清PCT、CRP及WBC的差异。结果细菌感染组血清PCT、CRP及WBC水平较病毒感染组明显升高（P＜0．05）,肺炎支原体感染组CRP水平较病毒感染组明显升高（P＜0．05）,细菌感染组与肺炎支原体感染组比较,血清PCT及WBC水平明显升高（P＜0．05）,血清CRP水平的差异无统计学意义（P＞0．05）。血清PCT、CRP及WBC诊断细菌性感染疾病的曲线下面积分别为0．74、0．69和0．69。结论血清PCT、CRP及WBC联合检测对鉴别儿童感染性疾病有一定的指导价值。     

WBC、NEU%、hs-CRP、PCT水平变化在辅助血流感染早期诊断中的应用价值

目的探讨WBC、中性粒细胞百分比（NEU%）、超敏C反应蛋白（hs-CRP）和降钙素原（PCT）在辅助血流感染早期诊断中的应用价值。方法选取2018年1至9月在中国人民武装警察部队浙江省总队医院病原菌血培养阳性且为单一菌株感染的患者130例为血培养阳性组,并按血培养结果分为革兰阴性菌组96例、革兰阳性菌组26例和真菌组8例。另选取同期怀疑血流感染但血培养阴性的患者79例为血培养阴性组。比较各组患者WBC、NEU%、hs-CRP和PCT的差异。结果血培养阳性组患者NEU%、hs-CRP、PCT均高于血培养阴性组,差异均有统计学意义（均P＜0.01）;而两组患者WBC比较差异无统计学意义（P＞0.05）。革兰阴性菌组、革兰阳性菌组和真菌组患者WBC、NEU%和hs-CRP比较差异均无统计学意义（均P＞0.05）,但3组患者PCT比较差异有统计学意义（P＜0.05）。结论NEU%、hs-CRP、PCT可作为辅助血流感染早期诊断的理想检测指标,其中PCT更加敏感,有一定的临床应用价值。     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.