172例老年社区获得性肺炎的临床分析

目的探讨老年人社区获得性肺炎(CAP)的临床特点。方法分析172例老年CAP(老年组)的临床表现、实验室检查、胸部影像学检查资料,并与同期收治的69例非老年CAP(对照组)作比较。结果老年组合并1种以上基础疾病的占93.60%,对照组为33.33%(P<0.01);老年组有胸闷、气促、胸痛症状的分别占75.58%、62.21%、21.51%,对照组分别为26.09%、21.74%、43.48%(P<0.01);老年组有精神状态改变、消化道症状的占29.07%、62.79%,对照组分别为7.25%(P<0.01)和39.13%(P<0.05);老年组有低蛋白血症的占43.02%,对照组为17.39%(P<0.01)。结论老年CAP容易合并有基础疾病,临床表现不典型,须加重视。当出现胸闷、气促、消化道症状或精神状态的改变并伴有不同程度的咳嗽时,应警惕肺炎。     

慢性乙型肝炎病毒感染者外周血单个核细胞表达程序性死亡分子-1及其配体与血清乙型肝炎病毒DNA水平的相关性

Objective To study the relationship between programmed death-1 (PD-1)/programmed death-1 ligand (PD-L1) expressions and serum hepatitis B virus (HBV) DNA levels in chronic hepatitis B (CHB) patients. Methods A total of 137 CHB patients and 10 healthy controls were enrolled in the study. The peripheral blood mononuclear cells (PBMCs) were isolated from fresh blood samples. HBV-specific cytotoxic T lymphocyte (CTL) was expanded in vitro in 64 human leucocyte antigen (HLA)-A2 positive patients. Flow cytometry was used to detect HLA-A2 type,expressions of PD-1/PD-L1 on PBMCs and PD-1 on HBV specific CTL. Interferon gamma (IFN-γ)was measured by commercial enzyme-linked immunosorbent assay (ELISA) kits. PD-1/PD-L1expressions on PBMCs, HBV-specific CTL and IFN-γ level in PBMC culture medium were compared among patients with different baseline HBV DNA levels. Ten hepatitis B e antigen (HBeAg) positive patients were treated with telbivudine for 24 weeks. The above mentioned parameters were determined and compared before and after the antiviral treatment. Independent-samples t test were used to compare means between two groups and one-way A NOVA were used to compare means among multigroups. We used the pearson corretation test to assess corretation significance. Results The PD-1 and PD-L1 expressions on PBMCs in patients with baseline HBV DNA＜3 lg copy/mL, 3-6 lg copy/mL and ＞6 lg copy/mL were all significant higher than those in healthy control group, but no statistical differences were found. PD-1 expressions on HBV-specific CTL in the three CHB patient groups were (69.3±11.2)%, (76.5±9. 1)% and (78.0±11.7)%, respectively. However, PD-1 expression on HBV-specific CTL was higher, while the frequency of HBV-specific CTL cells was lower in HBV DNA ＞6 lg copy/mL group compared to HBV DNA＜3 lg copy/mL group. The above parameters, including expressions of PD-1 and PD-L1, the frequency of HBV-specific CTL and its PD-1 expression were not significantly different between HBeAg-positive group and HBeAg-negative group. Compared with baseline, PD-1 and PD-L1 expression decreased obviously accompanying with increase of HBV-specific CTL cells frequency and IFN-γ level after 12 weeks and 24 weeks of telbivudine treatment. Conclusions PD-1 expression on HBV-specific CTL correlates with serum HBV DNA level, but not HBeAg status in CHB patients. Suppression of HBV replication can reduce PD-1/PD-L1 expressions and partially restore HBV specific CTL function.     

食品铅污染状况及对儿童健康的影响

目前已有研究显示，儿童多动症及儿童行为异常逐年增多，导致这一现象出现的原因之一是铅对儿童的危害。除了环境污染(汽油、文具、家庭装潢污染等)外，食品中铅污染也是重要的因素。铅除了影响儿童的行为外，还可对健康造成多种损害。因此儿童铅中毒需引起全社会的广泛重视。     

嗜麦芽窄食单胞菌老年下呼吸道感染48例临床分析

目的 分析嗜麦芽窄食单胞菌老年下呼吸道感染的临床特点及对抗菌药物的敏感度。方法分析48例嗜麦芽窄食单胞菌老年下呼吸道感染的临床资料。采用美国DADE公司全自动微生物分析系统MicroScan Walkaway 40系统鉴定细菌，PCIZ和NC11复合鉴定板进行体外药物敏感试验。结果48例中47例（97．9％）患有1种以上基础疾病，其中慢性阻塞性肺疾病急性加重期（AECOPD）最常见，占79％，免疫功能低下者68．8％，血浆白蛋白降低者79．2％，先期曾使用广谱抗生素者100％，曾行介入性导管治疗者72．9％。临床表现发热75％，咳嗽咳痰81．3％，肺部闻及哮鸣音或湿哕音89．6％，X线胸片多表现为两下肺片状、斑片状浸润性阴影，部分患者有胸腔积液。白细胞和中性粒细胞明显增高，C反应蛋白（CRP）增高。药敏试验结果表明该菌株耐药率高，除亚胺培南外，对氨基苷类和头孢菌素类亦普遍耐药。细菌对左氧氟沙星、环丙沙星、复方磺胺甲嗯唑的敏感度分别为89．6％、79．2％和68．8％。结论嗜麦芽窄食单胞菌老年下呼吸道感染易发生在患有多种基础疾病、免疫功能低下、血浆白蛋白降低和先期使用广谱抗菌药物及临床有介入性导管治疗患者，细菌耐药现象严重。临床上应尽早进行病原学检查，根据药敏试验结果选用合适的抗菌药物。     

新生儿听力筛查中实施精细化护理的体会分析

目的:分析新生儿听力筛查中实施精细化护理的临床价值.方法:2019年4月开始在新生儿听力筛查护理中实施精细化护理,以实施前的120例新生儿为对照组,以实施精细化护理后的120例新生儿为观察组,比较两组护理效果.结果:精细化护理后,观察组新生儿初筛、复筛通过率,均明显高于对照组(P＜0.05);家属护理满意度明显高于对照...     

中心静脉压监测下行腰穿持续外引流术治疗脑室出血37例分析

目的探讨中心静脉压（CVP）监测下行腰穿持续外引流术治疗脑出血的疗效。方法对符合入选标准的脑室出血的患者随机分成两组。治疗组37例采用中心静脉压监测下行腰穿持续外引流术,对照组37例则采用单侧侧脑室持续外引流术。结果显示治疗组与对照组有差异性。结论在CVP监测下行腰穿持续外引流术对中小量侧脑室积血伴或不伴有Ⅲ、Ⅳ脑室出血疗效可靠。既能有效引流又能保证有效脑灌注,值得临床进一步研究。     

外伤所致血管角皮瘤1例

正1病历摘要患儿,女,12岁。因左膝关节黑色斑块7年来诊。患儿于7年前外伤后左膝关节留有黑色丘疹、斑块,逐渐增多扩大,融合为大片斑块,表面呈疣状改变。无明显自觉症状,未行任何诊治。家族中无同样病史,平素体健。体格检查:系统检查未见异常。专科检查:左膝关节处见2cm×2cm隆起性斑块,边缘不清,表面凹凸不平,呈疣状增生,蓝黑色,质稍硬,无压痛(图1)。组织病理示:表皮角化过度,棘层     

腰椎间盘突出症康复护理中腰背肌功能锻炼的应用效果分析

目的探讨在腰椎间盘突出症患者中采用腰背肌功能锻炼的效果。方法选取我院2017年5月-2019年6月收治的64例腰椎间盘突出症患者,按照随机分组法将其分为观察组和对照组,每组32例患者。对照组实施常规护理,观察组除了使用常规护理外,增加腰背肌功能锻炼。对比两组患者护理前后的腰椎功能评分、腰椎疼痛情况及护理后的并发症发生情况。结果护理前,观察组患者与对照组患者在腰椎功能评分上无显著差异(P>0.05),经护理锻炼后,观察组患者的腰椎功能评分高于对照组(P<0.05);护理前,观察组与对照组疼痛评分比较差异不显著(P>0.05),护理后,观察组疼痛评分明显比对照组低(P<0.05);经过护理,观察组患者的并发症明显少于对照组(P<0.05)。结论在腰椎间盘突出患者的康复护理中,使用腰背肌功能锻炼可以有效改善患者的腰椎功能,减轻疼痛,患者经过护理后并发症发生率降低,临床可推广应用。