老年高血压患者血压波动与靶器官损害的相关性研究

目的探讨老年高血压患者血压波动与靶器官损害的关系。方法对该院收治的老年高血压患者98例行24h动态血压监测,将夜间平均收缩压下降率10%～20%的患者作为勺型组(n=45),夜间平均收缩压下降率小于10%或大于20%的患者作为非勺型组。应用超声心动图检测患者室间隔厚度(IVS)、左心室舒张末期内径(LVDd)、左心室舒张末期后壁厚度(LVPWd),左心室质量指数(LVMI);应用颈动脉超声检测患者颈动脉中膜厚度(IMT);并进行24h尿蛋白定量。结果非勺型组IVS、LVDd、LVPWd、LVMI明显高于勺型组,勺型组差异有统计学意义(P<0.05)。非勺型组尿蛋白阳性率、斑块检出率明显高于勺型组,IMT厚度明显高于非勺型组,差异有统计学意义(P<0.05)。结论老年高血压患者大多存在血压波动紊乱,患者血压波动紊乱与靶器官损害有关。     

Acceptability and Use of Evidence-Based Practices for Firearm Storage in Pediatric Primary Care

ObjectivePromoting safe firearm storage in pediatric primary care is one way to address youth suicide by firearm. The study objective was to determine the perspectives of primary care physicians (PCPs) and leaders of primary care practices regarding the acceptability and use of screening, counseling, and firearm locks—all components of an adapted evidence-based intervention known as the Firearm Safety Check.MethodsIn 2016, an online survey was conducted in two large US health systems. PCPs (n = 204) and leaders (n = 57) from 83 clinics were invited to participate. Respondents included 71 clinics (86%), 103 PCPs (50%), and 40 leaders (70%). Main outcomes included acceptability (6-point Likert scale, with higher scores indicating better acceptability) and use of the 3 intervention components (4-point Likert scale, with higher scores indicating greater use), as measured by an adapted validated instrument.ResultsAnalyses were conducted in 2017. PCP acceptability of screening (mean = 4.28; standard deviation [SD] = 1.12) and counseling (mean = 4.56; SD = 0.89) were high, but acceptability for firearm lock provision was more neutral (mean = 3.78; SD = 1.16). Most PCPs endorsed sometimes screening (85%) and counseling (80%). Few PCPs offered firearm locks to caregivers (15%). Leaders reported consistent information.ConclusionThe acceptability of screening for firearms and safe storage counseling was high; both components were used commonly but not routinely. The acceptability of providing firearm locks was neutral, and use was rarely endorsed. This study provides important insights about areas of focus for future implementation efforts from policy and research perspectives.     

Analysis of Surgical Treatment of Patients with Carotid Artery Stenosis Endarterectomy Versus Stenting

The aim of this paper is to characterize a group of patients with internal carotid artery stenosis and to analyze the outcome of internal carotid artery stenosis treatment. The outcome of treatment of 230 patients with internal carotid artery stenosis hospitalized from 1^st January 2004 to 31^st August 2006 was analyzed. Twenty nine percent of the patients were selected for medical treatment, 70.4% received surgical or endovascular treatment (83.3% of all invasive procedures were endarterectomies, versus 16.7% stenting). The peri-procedural stroke-death rate was 4.9% of patients [3.7% after CEA and 11.1% after CAS (N.S.)]. Statistical analysis disclosed that endarterectomy was associated with a longer in-hospital stay (p < 0.001). In conclusion: Both surgical methods, endarterectomy and stenting are equivalent in safety and present comparable clinical outcomes in selected subgroups of patients (classified to the specific procedure on the basis of the type of atherosclerotic plaque).     

肌注长托宁救治急性有机磷中毒患者副反应的观察研究

目的：通过观察肌注长托宁救治急性有机磷中毒患者副反应,提出相关对策以防治其发生。方法：观察我院165例使用长托宁救治急性有机磷中毒患者过程中出现的长托宁及注射相关的副反应．结果：肌注长托宁救治急性有机磷中毒患者副反应发生率高达903％．与注射相关反应364％,延迟反应发生率85％。结论：肌注长托宁救治急性有机磷中毒患者副反应发生率高．有部分与注射相关可以防治。     

肺泡灌洗液宏基因测序诊断儿童肺放线菌感染一例

儿童肺放线菌感染很罕见,且临床症状不典型,仅凭影像学表现易误诊为真菌、结核、肿瘤等。该文报道了1例儿童肺放线菌感染病例的诊治经过：7岁男性患儿,临床表现为发热、咳嗽,血常规提示白细胞及CRP明显升高,肺部CT提示肺部感染、待排除真菌等特殊菌群感染,常规抗感染治疗1周后肺部影像学无明显变化,行纤维支气管镜冲洗并取肺泡灌洗液进行宏基因测序后提示为放线菌感染,确诊后予静脉大剂量青霉素治疗,出院后予阿莫西林克拉维酸钾口服近2个月后复查CT明显好转。该例诊治过程提示,肺泡灌洗液宏基因测序有助于儿童肺放线菌感染的早期诊断,大剂量足疗程的青霉素可获得较好的疗效。     

布地奈德与可必特联合雾化吸入治疗重症哮喘的疗效分析

目的观察布地奈德与可必特联合雾化吸入治疗重症哮喘患者的效果。方法选择2012年7月～2013年7月期间我院重症哮喘患者88例,随机分为观察组和对照组。对照组患者给予可必特进行治疗,观察组患者在对照组基础上,加用布地奈德。结果治疗14 d后,观察组有效率、FEV1与FVC均大于对照组,同时两组PaO2、PaCO2、pH指标比较,观察组改善更为明显,差异具有统计学意义(P<0.05)。结论布地奈德和可必特联合雾化吸入促进了患者肺通气功能的改善,提高了PaO2和pH值,且降低了PaCO2含量。