134例慢性咳嗽病因及诊治分析

目的探讨慢性咳嗽的常见原因,寻找有效的治疗方法。方法通过询问病史、体格检查、胸部X线检查、肺功能、食道24hpH值监测等检查,回顾分析笔者所在科室收治的134例慢性咳嗽患者的临床资料。结果主要病因为咳嗽变异性哮喘55例（41.04%）,其次是鼻后滴流综合征24例（17.91%）,胃食管反流性咳嗽23例（17.16%）,嗜酸性粒细胞性支气管炎11例（8.21%）,变应性咳嗽4例（2.99%）,ACEI诱发的咳嗽4例（2.99%）,心理性咳嗽3例（2.24%）,支气管内膜结核3例（2.24%）,不明原因咳嗽7例（5.22%）。均予对症治疗,取得满意疗效。结论慢性咳嗽要查明原因,拓宽思路,采用分步诊断程序,针对病因进行治疗,避免盲目使用抗生素。     

45例老年非病毒性肝炎患者肝功能异常临床分析

目的探讨老年非病毒性肝炎患者肝功能异常病因及临床特点。方法检测甲～戊型肝炎病毒血清学标志物、EB病毒等非嗜肝病毒抗体及自身抗体,并行腹部B超或CT等影像学检查,对病因及临床表现进行分析。结果老年人非病毒性肝炎患者肝功能异常的常见原因有胆源性肝损、非肝炎病毒感染、药物性肝损、心源性肝损等,其中胆原性肝损害和非肝炎病毒感染伴肝损共27例,占60%。老年肝功能异常患者常见症状有乏力、纳差、尿黄。肝功能指标中,白蛋白降低、白球比例倒置、γ球蛋白升高等相对明显。结论老年非病毒性肝炎患者肝功能异常病因以胆原性肝损害和非肝炎病毒感染伴肝损为多,其他原因引起的肝功能异常亦不容忽视。     

兖州市2010年居民死因监测现况分析

目的了解2010年兖州市居民死亡报告基本情况,为制定兖州市健康防治策略提供基础资料。方法利用死因登记信息报告系统,建立Excel数据库,采用SPSS软件分析兖州市2010年居民死亡现况。结果 2010年1月1日零时～2010年12月31日24时兖州市共报告已审核死亡病例717例,总死亡率为113.33/10万,75～79岁年龄段报告死亡率最高,死亡率为17.23/10万;农、林、牧、渔、水利业生产人员伤病死亡率最高,占总死亡率的61.23%;前5位死因依次为循环系统疾病、肿瘤、损伤和中毒外部原因疾病、呼吸系统疾病、诊断不明疾病,且男女之间死因顺位差异无统计学意义（x2=0.241,P〉0.05）。结论兖州市2010年老年人口死亡率占较高比例,慢性非传染性疾病是引起兖州市居民死亡的主要原因,应加强对慢性非传染性疾病的控制工作。     

肠梗阻的常见病因分类与治疗策略

肠梗阻的常见病因分类较多,按肠梗阻的病因可分为机械性和非机械性两大类;按肠壁血运有无障碍可分为单纯性肠梗阻和绞窄性肠梗阻;按梗阻程度可分为完全性和不完全性或部分性肠梗阻;按梗阻部位可分为高位小肠梗阻,低位小肠梗阻和结肠梗阻等。在治疗策略上大约60%～70%患者可经非手术治愈。需手术的病例,针对不同病因,采用不同的术式治疗。     

腹腔镜胆囊切除术中转开腹的临床分析

目的探讨腹腔镜胆囊切除术（LC）中转开腹的原因及预防措施。方法对我院672例腹腔镜胆囊切除术的临床资料进行研究,回顾性分析其中21例中转开腹的原因。结果本组中转开腹率为3．1％,21例患者经中转开腹手术后均治愈出院。结论LC中转开腹原因分析为胆囊及Calot三角周围严重粘连、术中出血、胆管损伤及Mirizzi综合征等。做好完善的术前准备,术中仔细谨慎、果断灵活及规范的操作等,可有效降低中转开腹率。另外,及时中转开腹可减少LC并发症,提高手术成功率。     

Trends in the Leading Causes of Death in Korea, 1983-2012

This study aimed to analyze trends in the 10 leading causes of death in Korea from 1983 to 2012. Death rates were derived from the Korean Statistics Information Service database and age-adjusted to the 2010 population. Joinpoint regression analysis was used to identify the points when statistically significant changes occurred in the trends. Between 1983 and 2012, the age-standardized death rate (ASR) from all causes decreased by 61.6% for men and 51.2% for women. ASRs from malignant neoplasms, diabetes mellitus, and transport accidents increased initially before decreasing. ASRs from hypertensive diseases, heart diseases, cerebrovascular diseases and diseases of the liver showed favorable trends (ASR % change: -94.4%, -53.8%, -76.0%, and -78.9% for men, and -77.1%, -36.5%, -67.8%, and -79.9% for women, respectively). ASRs from pneumonia decreased until the mid-1990s and thereafter increased. ASRs from intentional self-harm increased persistently since around 1990 (ASR % change: 122.0% for men and 217.4% for women). In conclusion, death rates from all causes in Korea decreased significantly in the last three decades except in the late 1990s. Despite the great strides made in the overall mortality, temporal trends varied widely by cause. Mortality trends for malignant neoplasms, diabetes mellitus, pneumonia and intentional self-harm were unfavorable.

Graphical Abstract

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肝移植术后患者呼吸衰竭原因及防治措施探讨(附19例分析)

目的 探讨肝移植术后患者呼吸衰竭的原因及相应防治措施.方法 回顾本院19例因各种不同肝脏疾病而行肝移植手术的病例,分析其术后呼吸衰竭发生率、相关监测项目数据及相应处理措施.结果 术后14/19例(73.7%)发生呼吸衰竭,其中8/19例(57.1%)为急性呼吸窘迫综合征(ARDS),4/19例(28.6%)为急性肺损伤(ALI).呼吸衰竭的发生与围手术期血制品输入量、液体出入量、pH值异常、术前并发症、合并感染有密切关系.给予氧疗、抗感染、控制液体出入量及其它对症治疗后,14例呼吸衰竭均得以纠正.结论 围手术期输入过多血制品,液体出入量正平衡,PH值异常、合并其他严重并发症及感染是术后呼吸衰竭的主要原因.控制血制品的输入量及液体出入量、纠正PH值,给予氧疗,治疗感染及并发症可有效地纠正呼吸衰竭.     

Aetiology,timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND‐HF

Aims

Patients hospitalized for heart failure (HF) are at high risk for 30‐day readmission. This study sought to examine the timings and causes of readmission within 30 days of an HF hospitalization.

Methods and results

Timing and cause of readmission in the ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial were assessed. Early and late readmissions were defined as admissions occurring within 0–7 days and 8–30 days post‐discharge, respectively. Patients who died in hospital or remained hospitalized at day 30 post‐randomization were excluded. Patients were compared by timing and cause of readmission. Logistic and Cox proportional hazards regression analyses were used to identify independent risk factors for early vs. late readmission and associations with 180‐day outcomes. Of the 6584 patients (92%) in the ASCEND‐HF population included in this analysis, 751 patients (11%) were readmitted within 30 days for any cause. Overall, 54% of readmissions were for non‐HF causes. The median time to rehospitalization was 11 days (interquartile range: 6–18 days) and 33% of rehospitalizations occurred by day 7. Rehospitalization within 30 days was independently associated with increased risk for 180‐day all‐cause death [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.93–2.94; P < 0.001]. Risk for 180‐day all‐cause death did not differ according to early vs. late readmission (HR 0.99, 95% CI 0.67–1.45; P = 0.94).

Conclusions

In this hospitalized HF trial population, a significant majority of 30‐day readmissions were for non‐HF causes and one‐third of readmissions occurred in the first 7 days. Early and late readmissions within the 30‐day timeframe were associated with similarly increased risk for death. Continued efforts to optimize multidisciplinary transitional care are warranted to improve rates of early readmission.

     

病因为重叠综合征的多发性神经病1例报告

1临床资料 患者,女性,68岁,因四肢末端麻木乏力5个月,于2006年5月入院。入院前无明显诱因出现缓慢进展性四肢末端麻木,伴乏力、肿胀,僵硬（晨起时明显,持续1h以上）,最初为双手指末端麻木,渐进性出现全手、腕部、双足麻木及四肢末端怕凉、双手指及足趾皮肤变黑（以右端为重）,伴有全身大关节疼痛及多个指（趾）关节疼痛肿胀,曾于当地医院诊断为：“类风湿性关节炎”,经治疗（具体药物及剂量不详）后,病情无明显好转。既往史：有“淋巴结结核”史,已行手术切除;有“美尼埃氏病”史;1982年曾因左肩关节外伤于当地医院手术治疗,术中有输血史;平素全身皮肤易出现瘀斑。入院查体：神志清,四肢末端皮肤稍黑、发凉,四肢肌力稍低于5级,双侧肱二头肌反射、双膝反射活跃,双侧桡骨膜反射、双侧踝反射减弱,双侧病理征阴性。     

椎管内麻醉下剖宫产手术中麻醉相关死亡病例分析

目的总结椎管内麻醉下剖宫产手术中麻醉相关死亡的原因。方法对2002—2011年间国内文献公开报道和成都地区孕产妇死亡评审病例中因蛛网膜下腔阻滞或（和）硬膜外腔阻滞麻醉引起剖宫产死亡的6例病例进行回顾分析。结果2例病例缺少年龄报道,其余病例年龄24－35岁。2例为瘢痕子宫。1例蛛网膜下腔阻滞麻醉,4例硬膜外腔阻滞麻醉,1例硬膜外腔与蛛网膜下腔联合阻滞麻醉。麻醉危象出现时间在给予麻醉药后3～55min。2例死亡病例未做尸检,其余4例硬膜外腔阻滞麻醉者均做尸检,其中3例发现硬膜有裂伤,脑脊液外渗;另1例为瘢痕子宫,尸检报告腰段脊髓切面均未见出血,肺泡壁毛细血管有羊水中细胞成分和微血栓,不排除羊水栓塞,未提及检查穿刺点附近硬膜有无破损。结论由于操作为盲式,硬膜外给药可能出现意料之外的硬膜下腔或蛛网膜下腔麻醉,并由此导致孕产妇死亡。因此,在麻醉过程中,务必操作仔细,避免损伤硬膜,必须给予试探剂量,同时密切观察孕产妇生命体征,特别是有瘢痕子宫者更应关注。