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1.
阿曲库铵和罗库溴铵量-效关系和恢复时相的比较   总被引:1,自引:0,他引:1  
目的:对比观察阿曲库铵和罗库溴铵的量-效关系和恢复时相特征。方法:选择60例ASAⅠ级,年龄18~50岁,施择期整形外科手术的患者,随机平均分成阿曲库铵组和罗库溴铵组。用60%NO2-O2-硫喷妥钠-芬太尼维持麻醉;通过加速度仪监测神经肌肉功能,采用TOF刺激方式,以T1抑制的百分比为研究指标。采用累计给药方法建立阿曲库铵和罗库溴铵的量撤关系曲线。结果:根据量-效关系曲线,阿曲库铵和罗库溴铵的作用强度比率为1:1.2,两药的ED90、ED90和ED90均有显著性差别。应用等效剂量(1.5×ED95)后,两药的高峰时间、临床作用时间和体内作用时间具有显著性差别,但恢复时间无显著性差别。结论:阿曲库铵和罗库溴铵均是弱效能的中效非去极化肌肉松弛药。与阿曲库铵相比,罗库溴铵的作用强度大约弱20%。而且作用时间较短。  相似文献   

2.
性别对顺式阿曲库铵量效关系的影响   总被引:1,自引:0,他引:1  
摘要:目的研究性别对顺式阿曲库铵量效关系的影响。方法选取择期腹部手术患者80例,ASA Ⅰ~Ⅱ级,分为男、女性
别组,每组各40例,术前无酸碱平衡及水电解质紊乱,心肺、肝肾功能正常,酸碱4个剂量组,每组10例。记录拇内收肌四
个成串刺激第1次反应最大抑制的百分率并进行概率单位转换,将顺式阿曲库铵的首次剂量进行对数转换,用线性回归
方法分别建立男、女患者顺式阿曲库铵剂量-反应曲线,并记录起效时间。结果男性顺式阿曲库铵ED95值为67.4±4.4 μg/
kg,女性ED95值为48.7±1.0 μg/kg,两者差异有统计学意义(P<0.05),各剂量组起效时间在性别组之间差异无统计学意义
(P>0.05)。结论性别对顺式阿曲库铵量效关系有显著影响,女性对顺式阿曲库铵较男性敏感。  相似文献   

3.
目的:观察阿曲库铵和罗库溴铵的量效关系和恢复时相特征。方法:选择60例ASAⅠ级,择期腹部手术的患者,随机平均分成阿曲库铵组和罗库溴铵组。用60%NO2-O2-硫喷妥钠-芬太尼维持麻醉。用加速度仪监测神经肌肉功能,采用TOF刺激方式,以T1抑制的百分比为指标。用累计给药方法建立阿曲库铵和罗库溴铵的量效关系曲线。结果:阿曲库铵和罗库溴铵的作用强度比率为1∶1.2,两药的ED50、ED90和ED95均有明显差别。应用等效剂量(1.5×ED95)后,两药的高峰时间、临床肌松时间和体内作用时间具有明显差别,但恢复时间则无差别。结论:阿曲库铵和罗库溴铵均是弱效能的中效非去极化肌松药。阿曲库铵比罗库溴铵的作用强度高20%,且作用时间较短。  相似文献   

4.
性别对顺式阿曲库铵预注法肌松起效时间的影响   总被引:1,自引:0,他引:1  
目的:观察性别对顺式阿曲库铵肌松起效时间影响。方法:选择80例ASAⅠ-Ⅱ级择期手术患者,男性40例(M1,M2组,各20例),女性40例(F1,F2组,各20例),共四组。F1,M1直接给予顺式阿曲库铵0.2mg/kg诱导,使用多功能肌松监测仪监测肌松效果。F2,M2在全麻诱导时给予顺式阿曲库铵预注量0.05mg/kg,诱导时给予顺式阿曲库铵0.2mg/kg。将T4/T1=0所需时间作为插管时间。结果:F2组起效时间明显快于M2组(P〈0.05)。结论:女性患者预注顺式阿曲库铵肌松起效时间快于男性患者。  相似文献   

5.
目的 观察并比较单次静脉注射2倍95%的有效药物剂量(ED95)顺式阿曲库铵对不同年龄患者的肌松效应。方法 将60例按美国麻醉协会(ASA)标准定为Ⅰ~Ⅱ级的患者分为幼儿组(3~7岁)、青壮年组(18~65岁)和老年组(≥65岁),每组20例。麻醉诱导期间单次注入2倍ED95顺式阿曲库铵,用TOF Watch加速度仪进行肌肉松弛监测,观察起效时间、阻滞维持时间、临床作用时间、体内作用时间和恢复指数。结果 3组间气管插管评级差异无统计学意义(P>0.05)。幼儿组肌松起效时间、阻滞维持时间、临床作用时间及体内作用时间均明显短于青壮年组和老年组,差异有统计学意义(P<0.05)。3组的肌松恢复指数比较差异无统计学意义(P>0.05)。结论 幼儿对顺式阿曲库铵更为敏感,起效快,肌松阻滞维持时间和作用时间短,与成人的肌松效应相似;肌松恢复时间与年龄无关,2倍ED95诱导剂量对不同年龄的患者均安全有效。  相似文献   

6.
目的观察全麻过程中琥珀胆碱对后续罗库溴铵剂量效应关系的影响.方法 48例ASA I ~ II级择期全麻手术病人,年龄16 ~ 65岁,分为对照组和处理组各24例.对照组麻醉诱导后静注罗库溴铵,处理组采用琥珀胆碱1.5 mg/kg插管,待肌松作用消失5 min后静注罗库溴铵.各组再分为4个亚组(n=6)分别静注罗库溴铵150、200、250、300 μg/kg,观察4个成串刺激(TOF)的第1次反应(Th)的抑制程度.罗库溴铵剂量对数转换,Th抑制百分比概率单位转换后进行直线回归分析,求得罗库溴铵量效关系曲线.结果对照组罗库溴铵有效剂量ED50和ED95为(193±69)、(367±73 )μg/kg,处理组分别为(158±35)、(317±80) μg/kg.处理组罗库溴铵量效关系曲线向左移动,有效剂量降低约15%(P<0.05).结论琥珀胆碱肌松作用消失5 min后,仍使后续使用的罗库溴铵肌松效力增强约15%,可适当减少罗库溴铵的剂量.  相似文献   

7.
七氟醚和异氟醚对顺式阿曲库铵肌松效应的影响   总被引:7,自引:0,他引:7  
林赛娟  黑子清  池信锦  田国刚 《广东医学》2008,29(10):1682-1684
[摘要] 目的 观察七氟醚和异氟醚对顺式阿曲库铵肌松效应的影响。方法 30例择期行妇科腹腔镜手术的患者,ASAⅠ级,随机均分为七氟醚组(SEV组)和异氟醚组(ISO组)。麻醉诱导用咪唑安定、异丙酚、芬太尼,2%利多卡因3ml舌根部及咽喉部表面麻醉,3min后行气管插管。所有患者插管后均靶控输注3ng/ml瑞芬太尼(血浆靶控浓度),SEV组和ISO组分别吸入七氟醚和异氟醚维持麻醉,当呼气末浓度稳定为1.3MAC后继续维持40min,静脉注射总量为45ug/kg的顺式阿曲库铵,用TOF GUARD(丹麦)加速度仪进行肌松监测。顺式阿曲库铵45ug/kg分为3等份分次静注,记录每次注药(15ug/kg)后的起效时间及最大阻滞效应。用累积剂量法建立两组患者的剂量反应曲线。在最后一次注药后记录:T1恢复到25%、50%、75%的时间(T125%、T150% 、T175%);TOF比值(T4/T1)恢复到70%的时间(TOFR 0.7)以及恢复指数(RI)。结果 1.3MAC七氟醚和异氟醚麻醉下顺式阿曲库铵的ED50、ED95分别为21(17~25)ug/kg、39(31~62)ug/kg和24(19~28)ug/kg、44(36~68)ug/kg,两组无显著性差异(P >0.05);两组之间顺式阿曲库铵的起效时间、恢复至T175%、TOFR 0.7及RI无显著性差异(P >0.05)。SEV组顺式阿曲库铵的T125%、T150%较ISO组明显延长(P <0.05)。结论 1.3MAC七氟醚和异氟醚对顺式阿曲库铵量效关系的影响相似;但七氟醚对顺式阿曲库铵恢复至T125%、T150%的影响大于异氟醚。 [关键词] 顺式阿曲库铵 七氟醚 异氟醚 剂量-效应关系 ED50 ED95  相似文献   

8.
目的 本研究以3ED95顺式阿曲库铵分别联合不同低剂量阿曲库铵用于麻醉诱导,与单独使用3ED95和4ED95顺式阿曲库铵比较,旨在探索联合用药加快起效时间的临床效应.方法 选择ASA分级Ⅰ~Ⅱ级,需全麻下手术的患者80例,随机分为4组.A组,顺式阿曲库铵0.15 mg/kg;B组,顺式阿曲库铵0.20mg/kg;C组,顺式阿曲库铵0.15mg/kg联合阿曲库铵0.10mg/kg;D组,顺式阿曲库铵0.15mg/kg联合阿曲库铵0.20 mg/kg.使用肌松监测仪进行拇内收肌肌松监测,诱导均采用咪唑安定0.05mg/kg,芬太尼4ug/kg,依托咪酯0.3 mg/kg,T1/Tc<10%时气管插管.记录各组肌松效应起效时间、插管条件评级及MAP、HR、SpO2变化.结果 各组患者插管条件及相应时间点血液动力学参数无统计学差异.B、C、D组起效时间加快,其中C、D组与A组比较有统计学差异(P<0.05),B组虽起效时间短于A组,但无统计学差异(P>0.05).结论 3ED95顺式阿曲库铵联合少量的阿曲库铵可以显著缩短起效时间,效果优于4ED95顺式阿曲库铵,不影响血液动力学参数,更有利于全麻气管插管的应用.  相似文献   

9.
牛洁  李军  冉茂荣  巩固 《四川医学》2011,32(11):1705-1707
目的观察单次静脉注射不同诱导剂量顺式阿曲库铵的起效时间、阻滞持续时间及对术中追加顺式阿曲库铵的阻滞持续时间的影响。方法将60例ASAⅡ~Ⅲ级择期腹部手术男性患者随机分为A、B、C组,各20例;分别单次静脉注射顺式阿曲库铵0.1mg/kg(A组,2×ED95)、0.15mg/kg(B组,3×ED95)、0.2mg/kg(C组,4×ED95)进行诱导,使用多功能肌松监测仪观察并记录阻滞开始起效时间、阻滞完全起效时间及T1恢复后再单次追加0.05 mg/kg顺式阿曲库铵的阻滞时间。结果 B组和C组的阻滞开始起效时间和完全起效时间均显著短于A组(P〈0.01),而首剂阻滞时间和第1次追加1×ED95顺式阿曲库铵的阻滞持续时间显著长于A组(P〈0.01),且C组较B组差异更显著(P〈0.01),B组和C组第2次和第3次追加1×ED95顺式阿曲库铵的阻滞持续时间与A组相比,差异无统计学意义。结论顺式阿曲库铵用于成年男性麻醉诱导插管时起效时间随剂量增加而缩短,对于长时间手术通过加大诱导剂量来缩短诱导时间是安全可行的。  相似文献   

10.
目的探讨顺式阿曲库铵采用闭环靶控输注时不同年龄组肌松效应的差异。方法将45例接受择期妇科开腹手术的患者按年龄分为青年组(20~39岁)﹑中年组(40~59岁)及老年组(60~79岁),各15例。均采用闭环靶控输注系统输注顺式阿曲库铵,比较各组顺式阿曲库铵的起效时间﹑阻滞维持时间﹑恢复指数﹑停止输注顺式阿曲库铵至TORr恢复至0.7的时间﹑停止输注顺式阿曲库铵至TORr恢复至0.9的时间﹑麻醉维持期单位时间维持用药量。结果老年组顺式阿曲库铵的起效时间和阻滞维持时间均较青年组延长(均<0.05),老年组肌松恢复时间延长(均<0.05)。老年组麻醉维持期顺式阿曲库铵的单位时间用药量少于其他两组(均<0.05)。结论顺式阿曲库铵采用闭环靶控输注时其肌松效应存在年龄差异,老年患者肌松恢复过程明显延长。  相似文献   

11.
Objective To compare the characteristics of the dose-response relationship and the time course of action between atracurium and rocuronium in adult patients anestheti zed with N(2)O-0(2)-fentanyl-thiopene. Methods Sixty patients, ASA grade Ⅰ, aged 18-50 years, scheduled for elective plastic s urgery were studied.All patients were randomly divided into either the atra c urium or rocuronium group.General anesthesia was maintained with 60% nitrous o xide and 40% oxygen, thiopentone, and fentanyl. Neuromuscular function was ass essed using an accelograph with train-of-four (TOF) stimulation at the wrist e very 12 seconds.The percentage depression of the first twitch (T(1)) was used as th e study parameter.The dose-response relationship of atracurium and rocuronium was determined by the cumulative dose-response technique.Results According to the dose-response curves established by a least squares linear reg ression, the potency ratio of atracurium to rocuronium was 1∶1.2. There were si gnificant differences in the ED(50), ED(90), and ED(95) between the two drugs. After the intravenous administration of equipotent doses of both dr ugs (1.5×ED(95)), the duration of peak effect, clinical duration, and total duration were significantly different between the two drugs, but their rec overy indexes were similar.Conclusions Atracurium and rocuronium are low-potency nondepolarizing relaxants with in termediate duration. As compared to atracurium, the neuromuscular blocking eff ect of rocuronium was about 20% less potent and its duration of action was shorter.  相似文献   

12.
CONTEXT: Three major coronary risk factors-serum cholesterol level, blood pressure, and smoking-increase incidence of coronary heart disease (CHD) and related end points. In previous investigations, risks for low-risk reference groups were estimated statistically because samples contained too few such people to measure risk. OBJECTIVE: To measure long-term mortality rates for individuals with favorable levels for all 3 major risk factors, compared with others. DESIGN: Two prospective studies, involving 5 cohorts based on age and sex, that enrolled persons with a range of risk factors. Low risk was defined as serum cholesterol level less than 5.17 mmol/L (<200 mg/dL), blood pressure less than orequal to 120/80 mm Hg, and no current cigarette smoking. All persons with a history of diabetes, myocardial infarction (MI), or, in 3 of 5 cohorts, electrocardiogram (ECG) abnormalities, were excluded. SETTING AND PARTICIPANTS: In 18 US cities, a total of 72144 men aged 35 through 39 years and 270671 men aged 40 through 57 years screened (1973-1975) for the Multiple Risk Factor Intervention Trial (MRFIT); in Chicago, a total of 10025 men aged 18 through 39 years, 7490 men aged 40 through 59 years, and 6229 women aged 40 through 59 years screened (1967-1973) for the Chicago Heart Association Detection Project in Industry (CHA) (N = 366559). MAIN OUTCOME MEASURES: Cause-specific mortality during 16 (MRFIT) and 22 (CHA) years, relative risks (RRs) of death, and estimated greater life expectancy, comparing low-risk subcohorts vs others by age strata. RESULTS: Low-risk persons comprised only 4.8% to 9.9% of the cohorts. All 5 low-risk groups experienced significantly and markedly lower CHD and cardiovascular disease death rates than those who had elevated cholesterol level, or blood pressure, or smoked. For example, age-adjusted RRs of CHD mortality ranged from 0.08 for CHA men aged 18 to 39 years to 0.23 for CHA men aged 40 through 59 years. The age-adjusted relative risks (RRs) for all cardiovascular disease mortality ranged from 0.15 for MRFIT men aged 35 through 39 years to 0.28 for CHA men aged 40 through 59 years. The age-adjusted RR for all-cause mortality rate ranged from 0.42 for CHA men aged 40 through 59 years to 0.60 for CHA women aged 40 through 59 years. Estimated greater life expectancy for low-risk groups ranged from 5.8 years for CHA women aged 40 through 59 years to 9.5 years for CHA men aged 18 through 39 years. CONCLUSIONS: Based on these very large cohort studies, for individuals with favorable levels of cholesterol and blood pressure who do not smoke and do not have diabetes, MI, or ECG abnormalities, long-term mortality is much lower and longevity is much greater. A substantial increase in the proportion of the population at lifetime low risk could contribute decisively to ending the CHD epidemic.  相似文献   

13.
目的通过观察不同剂量顺阿曲库铵的起效时间、临床有效时间的变化,并与罗库溴铵比较,为临床手术患者个体化选择肌松药物及剂量提供理论依据。方法ASAI~Ⅱ级择期妇科手术女性患者120例,随机分为4组,每组30例,分别予顺阿曲库铵0.1mg/kg(A组)、0.15mg/kg(B组)、O.2mg/kg(c组)和罗库溴铵0.9mg/kg(D组),咪达唑仑、芬太尼、异丙酚诱导麻醉,观察心率、血压和全身皮肤情况以及TOF的变化,并进行气管插管条件评级。结果各组肌松药起效时间分别是(226±57)s、(184±56)s、(135±45)s、(80-.I-25)S,C组分别与A、B、D相比较均有统计学意义(P〈0.05);各组临床有效时间分别是(334±5)min、(41±8)min、(534±8)min、(42±11)min,C组分别与A、B、D相比较差异均有统计学意义(P〈0.05)。c组临床有效时间的离差与D组相比较差异有统计学意义(P〈0.05)。结论增大剂量法明显缩短顺阿曲库铵的插管起效时间,但与罗库溴铵相比,临床作用时间延长,便不适于短小外科手术的麻醉,而罗库溴铵临床作用时间的变异性较大,顺阿曲库铵的可控性优于罗库溴铵。  相似文献   

14.
中国人冠状动脉钙化检出率初步报告   总被引:5,自引:1,他引:4  
目的 :冠状动脉钙化是冠状动脉粥样硬化的标志 ,电子束 CT是非创伤检测冠状动脉钙化的首选方法。本研究旨在研究中国人冠状动脉钙化的检出率。 方法 :用 EBCT检测 95 9例患者 ,按年龄分为 6组 :1<2 9岁 ;2 30~39岁 ;34 0~ 49岁 ;45 0~ 5 9岁 ;5 6 0~ 6 9岁 ;6 >70岁 ;根据有无症状分为三个亚组 :1症状组 :有典型冠心病症状 ;2可疑症状组 :患者有非典型胸痛 ,但无足够证据证明其为心绞痛 ;3无症状组 :患者无冠心病症状。 结果 :1无症状男女性随年龄增加 ,其冠状动脉钙化检出率及总积分增加 ;2无症状女性 40~ 49岁组和 5 0~ 5 9岁组冠状动脉钙化检出率增加 ;3无症状男性随着年龄的增加 ,其冠状动脉钙化积分增加。 结论 :1中国人男女性别随着年龄增加其冠状动脉钙化检出率增加 ;2男女性别间钙化检出率明显不同 ;3EBCT可无创性检测冠状动脉钙化 ,对冠状动脉疾病有预测价值。  相似文献   

15.
BACKGROUND: The aim of this study was to compare quantitative ultrasound parameters between women and men of various ages in a population from central Croatia and also to estimate the prevalence of osteoporosis in women. MATERIAL/METHODS: A total of 1006 participants were recruited for this study (550 men, 456 women), aged 20 to 89 years. Calcaneal quantitative ultrasound measurements were performed using a Sahara device (Hologic). Data were analyzed using the t-test and analysis of variance (ANOVA) with Tukey's post hoc test. RESULTS: Comparison of the ultrasound measures of the men exhibited significant differences across the age groups with the exception of broadband ultrasound attenuation (BUA). In the women, significant differences were found for BUA, speed of sound (SOS), and the quantitative ultrasound index (QUI). Gender comparison revealed significant differences between ultrasound parameters in the last three decade groups. Using a T-score threshold of -1.8, the prevalence of osteoporosis in women aged over 50 was 30.7% based on the quantitative ultrasound index. CONCLUSIONS: This study is the first report of quantitative ultrasound parameters in Croatian women. The results revealed lower QUI, BUA, and SOS in postmenopausal women than in men of the same age. The prevalence of osteoporosis in women over 50 years of age based on the quantitative ultrasound index was considerably higher than the previously reported prevalence of osteoporosis in men.  相似文献   

16.
目的:了解吉林省女性自然绝经年龄的状况,阐明影响吉林省女性自然绝经年龄的相关因素。方法:采用多阶段分层随机整群抽样方法,在吉林省9个市(州)共32个区/市/县选取18~79岁的23 050名居民进行面对面的问卷调查及体格检查,实际完成有效样本21 435名,共筛选出女性样本11 098名,其中已自然绝经女性4 875名作为本次研究样本。采用复杂加权方法估计平均自然绝经年龄和自然绝经年龄中位数,采用方差分析比较不同出生年份女性自然绝经年龄差异,并应用多元线性回归分析自然绝经年龄的影响因素。结果:吉林省女性平均自然绝经年龄为(49.11
±4.19)岁,自然绝经年龄中位数为50.00岁,自然绝经者4 881名,<40岁绝经者111名(2.27%),40~45岁绝经者643名(13.17%),46~53岁绝经者3 513名(71.97%),54岁以上绝经者573名(11.74%),另有41名(0.85%)绝经年龄缺失。不同出生年份(70~79岁为1933-1942年、60~69岁为1943-1952年、57~59岁为1953-1955年)女性自然绝经年龄比较显示,城市和农村不同年份出生女性自然绝经年龄比较差异均有统计学意义(F=16.633,P<0.001;F=7.400,P<0.001),未分地区女性自然绝经年龄比较差异有统计学意义(F=21.178,P<0.001),经SNK法
比较,3组女性自然绝经年龄两两之间比较差异均有统计学意义(P<0.01),自然绝经年龄分别为1953-1955年出生组50.38岁、1943-1952年出生组49.51岁、1933-1942年出生组48.81岁;城市不同年份出生女性自然绝经年龄差异有统计学意义(F=16.633,P<0.001),经SNK-q检验比较,3组女性自然绝经年龄任意2组之间比较差异均有统计学意义(P<0.05),自然绝经年龄分别为 1953-1955年出生组50.77岁、1943-1952年出生组49.73岁和1933-1942年出生组48.85岁;农村不同年份出生女性自然绝经年龄比较差异有统计学意义(F=7.400,P=0.001),经SNK-q检验比较,1953-1955年出生组与另外2组自然绝经年龄比较差异有统计学意义(P<0.05),自然绝经年龄分别为 1953-1955年出生组50.09岁、1943-1952年出生组49.33岁和1933-1942年出生组48.74岁。多元线性回归分析显示,体质量指数(BMI)、体育锻炼与女性自然绝经年龄呈正相关关系(r=0.089,P<0.001;r=0.150,P=0.025),吸烟、心理健康状况得分与女性自然绝经年龄呈负相关关系(r=-0.257,P=0.002;r=-0.061,P=0.016)。饮食因素,例如蔬菜、水果、牛奶、豆制品和肉类食用频率与自然绝经年龄无相关性。结论:吉林省不同出生年份的女性平均自然绝经年龄有差异;BMI、吸烟、心理健康状况和体育锻炼可能是女性自然绝经年龄的影响因素。  相似文献   

17.
Fasting plasma cholesterol and triglyceride concentrations were determined for 6407 working Canadian adults aged 20 to 69 years in Toronto and Hamilton. Means, medians and 5th and 95th percentiles were ascertained from the data for men, women taking oral contraceptives or estrogen preparations, and women not taking such medication. Mean plasma cholesterol values (mg/dL) ranged in men from 168.3 at ages 20 to 24 years to 211.5 at ages 45 to 49 years, and in women using hormone preparations from 180.3 at ages 20 to 24 years to 224.2 at ages 50 to 54 years; corresponding values in women not using these preparations were 164.9 and 220.6. Plasma triglyceride means (mg/dL) ranged in men from 108.7 at ages 20 to 24 years to 166.7 at ages 40 to 44 years, in women using hormone preparations from 115.4 at ages 20 to 24 years to 145.3 at ages 45 to 59 years, and in women not using these preparations from 77.5 at ages 20 to 24 years to 112.4 at ages 50 to 54 years.  相似文献   

18.
老年甲状腺功能亢进症临床特点分析   总被引:3,自引:0,他引:3  
林榕  唐彬 《河北医学》2008,14(8):932-935
目的:总结老年甲状腺功能亢进症患者的临床特点。方法:收集我院2003年至2007年244例内分泌科门诊甲状腺功能亢进症(甲亢)患者:分为两组,非老年组173例,年龄14~59岁,男性67例,女性106例;老年组71例,男性29例,女性42例,年龄60~81岁。对其临床特点进行回顾性研究,分析老年甲亢患者临床特点、误诊原因。结果:老年甲状腺功能亢进症起病以心血管系统症状和消化道系统症状为主。甲状腺肿大多伴结节,占47.9%,突眼占8.5%。结论:老年甲亢患者临床表现不典型,极易被误诊、漏诊,须加以注意。  相似文献   

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