老年糖尿病低血糖症的临床分析

目的探讨老年糖尿病低血糖症的原因、危害、治疗及预防。方法进食或口服20—30g葡萄糖,轻者症状迅速缓解,重者予以50％葡萄糖液40—60mL静脉推注;若已出现低血糖症昏迷,则再予以10％葡萄糖液静脉点滴。治疗过程中,血糖监测应间隔1～2小时一次。并根据监测的血糖值随时调整用量,若患者症状逐渐缓解,神志转清,病情趋于稳定,应使其血糖测量值维持在7．8。13．8mmol／L。结果本组65例患者中,62例经上述措施治疗后临床症状显著缓解,血糖逐渐恢复至正常;1例昏迷4．5小时,于治疗48小时后神志转清;2例死于低血糖昏迷合并肾脏、心脏功能衰竭。结论医疗工作者应做好对老年糖尿病患者的宣教工作,以引起患者及家属的高度重视：糖尿病患者合理用药及饮食是减少低血糖症发生的重要举措：一旦发现患者出现低血糖症应快速进行血糖检测并及时抢救处理。     

568例基层医院急性肾衰竭患者病因及其危险因素分析

目的：分析基层医院急性肾衰竭（ARF）的病因,寻找影响其预后的危险因素,为降低ARF发病率,提高临床疗效,判断预后提供参考。方法：以2007年6月～2009年6月就诊于温岭市第一人民医院等4个基层医院的ARF患者为研究对象,归纳引起ARF的病因;将其分为治愈组、好转组、无效组和死亡组,首先采用单因素分析方法初步筛查出危险因素,然后将初筛的危险因素进一步使用二分类Logistic回归法做多因素分析,判别各因素对死亡危险度的影响。结果：（1）301224例住院患者中,ARF患者568例（占0.19%）;其中男366例（占64.45%）,女202例（占35.56%）,男女之比1.8∶1。（2）568例ARF患者中,按照肾性、肾前性和肾后性分类方法,以肾性ARF最常见,共282例（占49.65%）,肾前性ARF140例（占24.65%）,肾后性ARF146例（占25.70%）。按照引起ARF的原因分类,肾实质损害和梗阻所占比例最大,分别为22.89%和21.65%,其次是感染和药物因素,分别占11.97%和9.15%。（3）多脏器功能衰竭（MODS）、高血钾及贫血是导致ARF预后差的危险因素。结论：ARF发病率为0.19%,男性多于女性,除肾原性原因外,肾后梗阻、感染和药物性肾损害是最常见原因。MODS、贫血、高血钾是影响预后的危险因素。     

1例CRRT枸橼酸抗凝管道连接错误事件的根本原因分析及对策

应用根本原因分析法,对1例持续肾脏替代治疗（CRRT）枸橼酸抗凝管道连接错误的护理不良事件进行分析。根据根本原因分析的步骤,应用事件序列表、鱼骨图、五问法等管理工具,分析CRRT枸橼酸抗凝管道连接错误的根本原因并制定对策。转变管理者的管理理念,从系统层面剖析护理不良事件的根本原因,并提出改善对策与防范措施,并与大家分享,以达到更好地改进工作质量的目的。     

Colorectal cancer in Egypt

PURPOSE: The aim of this study was to review the age distribution and pathology features of colorectal cancer in Egypt. METHODS: A seven-year review (retrospective in first six years, prospective in the seventh) of all colorectal adenocarcinoma patients (N = 177; 104 males; mean age, 46; range, 19–74 years) presented to the Department of Surgery, Ain Shams University, was performed. Data from three other major hospitals throughout the country were retrieved and compared with Ain Shams data. Retrospective data were retrieved from patients files and surgery and pathology records. Family history of colorectal cancer and other characteristic hereditary nonpolyposis colorectal cancer tumors was obtained prospectively in all patients. RESULTS: According to Ain Shams data, the disease had no predilection to a specific age group. Thirty-eight percent of the tumors occurred in patients aged less than 40 years, and only 15 percent of patients were aged above 60 years. None of the young patients fulfilled the Amsterdam criteria for hereditary nonpolyposis colorectal cancer. Seventy-five percent of tumors occurred in the left side, 3 percent were Dukes A, and 58 percent were Dukes C. Synchronous and metachronous tumors occurred in 2.8 and 4.5 percent of patients, respectively. Adenomas were present in 5.6 percent of patients and bilharziasis in 3.4 percent of resection specimens. Data from different centers were remarkably similar to Ain Shams results. CONCLUSION: Colorectal cancer in Egypt has no age predilection and more than one-third of tumors affects a young population. The high prevalence in young people can neither be explained on a hereditary basis nor can it be attributed to bilharziasis. The disease usually presents at an advanced stage, and predisposing adenomas are rare. Similarity of the data from different centers suggests that this is the picture of colorectal cancer typical of Egypt.     

Cause-specific mortality adjudication in the UPLIFT® COPD trial: findings and recommendations

Mortality is an important endpoint in chronic obstructive pulmonary disease (COPD) trials, although accurately determining cause of death is difficult. In the Understanding the Potential Long-term Impacts on Function with Tiotropium (UPLIFT?) trial, a mortality adjudication committee (MAC) provided systematic, independent and blinded assessment of cause-specific mortality of all 981 reported deaths. Here we describe this process of mortality adjudication and methodological revisions introduced to help standardise the adjudication of two areas recognised to pose particular difficulty; firstly, the classification of fatal COPD exacerbations that occur in the setting of pneumonia and secondly, the categorisation of sudden death. In addition MAC determined cause of death was compared with that reported by site investigators (SIs). MAC-assigned causes of death were: respiratory, 35%; cancer, 25%; cardiovascular, 11%; sudden cardiac death, 4.4%; sudden death, 3.4%; other, 8.8%; unknown, 12.4%. Cancer/cardiac deaths were more common in Global Initiative for Chronic Obstructive Lung Disease stage II, respiratory deaths in stages III and IV. Agreement between MAC and SI regarding cause of death was complete (50.2%), incomplete (18.5%) or none (31.3%). The SI classified deaths as cardiac three-fold more frequently than MAC (incidence rate [IR]/100 patient-years 0.797 vs. 0.257), although IR ratios for cardiac deaths for tiotropium vs. control were similar between SI and MAC. Discrepancies between MAC- and SI-adjudicated causes of death are common, especially increased reporting of cardiac deaths by the SI. Future multicentre COPD trials should plan appropriate infrastructure before study initiation to ensure collection and interpretation of fatal events data.     

克山病发生的原因、条件和相关因素

目的 探索克山病发生的原因、条件与相关因素.方法 采用病例观察、流行病学调查、真菌学与真菌毒素学、分析化学等方法进行现场调查及实验室检测.结果 1973-1975,在克山病严重流行地区凋查了15家病户和1个病情爆发的村庄,发现每个病人在发病前半年至1年都食用过严重发霉的小米、玉米.取病区小米做微生物学检查,发现主要污染真菌是黄绿青霉菌,占20％,毒素是黄绿青霉素(CIT).克山病致病因子进入人体的途径是病区产的粮食而不是饮水,不同种类粮食的传病作用不同,小米、玉米传病,小麦不传.依据全国地方病监测数据,1990年后全国范围已无克山病病例报告,同时克山病病因物质也在减少,但不如病情变化那样快.1983年后实现的农村、农业改革,显著地提高了粮食的卫生学质量,对消除克山病威胁起到了决定性作用.克山病病区分布在寒冷、干燥的西北高原和温暖、潮湿的东南平原交界带,病区在浅山丘陵区而不在平原,平均温度低、湿度适中,适合真菌的生长和产毒.用CIT毒素污染粮食,按体质量4 mg/kg剂量喂养大鼠,4周即可出现心肌坏死,线粒体肿胀、增生和破坏等与克山病相似的改变.结论 克山病的病因物质是CIT;发生条件是西北干旱高原与东南温湿平原交接地带的特殊地理、气候状况和农业生产中粮食保管不良、霉焐;影响因素繁多,主要是促进接触病因物质以及易感的生理因素,包括年龄、性别、职业及接触的机会.     

儿童先天性矫正大动脉转位解剖矫治术早期疗效初探

目的:探讨儿童先天性矫正大动脉转位(cTGA)解剖矫治术早期疗效。方法:2002年4月至2007年10月我科行双调转手术治疗cTGA合并心内畸形患儿14例,其中男性10例,女性4例;年龄6个月至16岁,平均9.14岁。全组均在全麻深低温低流量体外循环下行心内直视解剖矫治手术。手术方式包括改良Senning+Rastelli13例,Mustard+Rastelli+双向Glenn术。结果:术后早期死亡2例,死亡原因为低心排出综合征(低心排)和左心功能衰竭。早期主要并发症有低心排、房室分离各1例,胸腔积液和低蛋白血症2例。随访2～24个月,恢复良好,复查多普勒超声心动图、心电图和X线胸片显示,窦性心律11例,结性心律1例,心功能均为Ⅰ级。结论:SLL型病例采用改良Senning心房内调转手术效果优于Senning和Mustard手术。双调转手术可以达到解剖矫治cTGA合并心内畸形,早期手术病死率低,中、远期心功能效果良好。     

系统性硬化病患者死亡危险因素分析

目的 了解预测系统性硬化病(SSc)患者死亡的相关因素,以指导临床治疗.方法 回顾性收集门诊和病房的资料完整诊断明确的146例SSc患者的临床资料,包括起病年龄、性别、病程、雷诺现象、皮肤受累程度、胃食管反流、肾损害、硬皮病肾危象、心脏损害等情况,检测其血清中抗Scl-70、抗着丝点抗体、抗RNP抗体,应用超声心动图方法 检测其肺动脉压,应用影像学方法 检测其是否具有间质性肺炎,使用Cox回归方法 分析患者死亡相关的危险因素.结果死亡组患者和存活组患者雷诺现象、胃食管反流、抗核抗体、抗scl-70抗体、抗着丝点抗体、间质性肺炎、弥散功能下降、冠心病、外周动脉硬化发生率差异均无统计学意义(P>0.05);死亡组患者中起病年龄>60岁者更多(P=0.002)、男性更多(P=0.023);死亡组患者弥漫型皮肤受累(P=0.000)、抗RNP抗体阳性(P=0.014)、肺动脉高压(P=0.000)、心脏损害(P=0.000)、脑梗死(P=0.035)、肾损害(P=0.000)、硬皮病肾危象较存活组更常见(P=0.000).Cox回归分析表明,发病年龄>60岁[OR=5.441,95%可信区间(CI)(2.126～13.926,P=0.000]、男性(OR=5.531,95%CI 2.014～15.190,P=0.001)、抗RNP抗体阳性(OR=2.664,95%CI 1.016～6.592,P=0.034)、弥漫型皮肤受累(OR=3.432.95%CI 1.400～8.411,P=0.007)、肺动脉高压(OR=25.718,95%CI 5.954～111.085,P=0.000)、心脏受累(OR=4.141,95%CI 1.685～10.159,P=0.002)、肾脏受累(OR=4.214,95%CI 1.654～10.737,P=0.003)、硬皮病肾危象(OR=20.677,95%CI 4.161～102.764,P=0.000)是预测SSc死亡的危险因素,尤其是严重肺动脉高压(OR=55.809,95%CI 12.879～241.832,P=0.000)是SSc患者死亡的最强预测因素.结论 对于发病年龄>60岁、男性、弥漫型皮肤受累、抗RNP抗体阳性、心脏受累、肾受累、硬皮病肾危象及肺动脉高压患者,尤其是重度肺动脉高压患者,应积极治疗以改善其预后.     

1996例老年护理医院住院患者疾病谱及死因分析

目的了解老年护理医院住院患者主要疾病谱及死因构成。方法收集2006年～2008年住院1996例老年病例计算患病率及死因的构成比并进行排序。结果前十位疾病构成比依次为高血压病（52．6％）、冠心病（49．8％）、脑梗死后遗症（38．3％）、老年性痴呆（21．3％）、肺部感染（19．3％）、2型糖尿病（18．9％）、前列腺增生症（31．14％）、尿路感染（15．4％）、恶性肿瘤（6．9％）、慢性肾功能不全（4．2％）。死亡率前五位疾病排列依次为冠心病（58．1％）、肺部感染（17．5％）、慢性阻塞性肺疾病（7．4％）、恶性肿瘤（5．5％）、尿毒症（1．8％）。结论老年护理医院住院患者的疾病谱及主要死因的结果,为老年专科护理医院如何提高医疗护理质量,制订有效治疗护理对策,提供参考依据。     

慢性咳嗽病因分布的初步调查

目的了解上海地区慢性咳嗽病因分布的特点。方法以中华医学会制定的《咳嗽的诊断与治疗指南》（2009版）中慢性咳嗽诊断流程为指导,对98例咳嗽时间≥8周的患者进行病因分析、咳嗽症状积分、视觉模拟评分及Leicester咳嗽问卷调查。结果 98例患者中明确咳嗽病因诊断94例（95.92%）,病因未明者4例（4.08%）。94例患者中,单一病因82例（87.23%）,双重病因12例（12.77%）。咳嗽病因包括咳嗽变异性哮喘（CVA）44例（40.00%）,上气道咳嗽综合征（UACS）28例（25.45%）,嗜酸粒细胞性支气管炎（EB）21例（19.08%）,变应性咳嗽5例（4.55%）,胃食管反流性咳嗽4例（3.64%）,感染后咳嗽3例（2.73%）。治疗前后咳嗽积分、视觉模拟评分及Leicester咳嗽积分比较差异有统计学意义（P〈0.05）。结论 CVA、UACS和EB是上海地区慢性咳嗽的常见原因。