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熊磊教授以理脾为本,将治痰贯穿始终。根据小儿脾常不足、肾常虚、肝常有余的生理特点,癫痫发作期治疗主以涤痰开窍,辅以理气健脾,同时配合活血化瘀通窍与平肝息风潜阳。主要选方为柴芍温胆汤、天麻钩藤饮、桃红四物汤加减;缓解期则以补肾养肝为主,兼以健脾化痰,主要选方为杞菊地黄丸合定痫丸加减,取得较好临床疗效。  相似文献   
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目的 探讨心脏骤停患者心肺复苏抢救中的影响因素。方法 回顾性收集2015年9月-2018年9月急救中心收治的304例成年心脏骤停患者的临床数据,包括患者基本人口学信息、现场心肺复苏(cardio-pulmonary resuscitaion,CPR)情况[包括是否有目击者、目击者是否实施CPR、胸部按压分数(chest compression fraction,CCF)、到达急救中心时间等],患者24 h的存活率,采用单因素分析和Logistic回归分析研究心脏骤停患者CPR后24 h存活率的影响因素。结果 单因素分析发现,目击者是否进行CPR及接受不同CCF的患者,其24 h存活率比较,差异有统计学意义(P<0.05);Logistic回归分析显示,CCF≤80%为24 h存活率的危险因素(P<0.05),目击者进行CPR为24 h存活率的保护因素(P<0.05)。结论 对心脏骤停患者,目击者尽早实施CPR及增加有效持续胸部按压时间,能够提高心脏骤停患者心肺复苏后的24 h存活率。  相似文献   
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BackgroundIn the POST SCD study, the authors autopsied all World Health Organization (WHO)–defined sudden cardiac deaths (SCDs) and found that only 56% had an arrhythmic cause; resuscitated sudden cardiac arrests (SCAs) were excluded because they did not die suddenly. They hypothesized that causes underlying resuscitated SCAs would be similarly heterogeneous.ObjectivesThe aim of this study was to determine the causes and outcomes of resuscitated SCAs.MethodsThe authors identified all out-of-hospital cardiac arrests (OHCAs) from February 1, 2011, to January 1, 2015, of patients aged 18 to 90 years in San Francisco County. Resuscitated SCAs were OHCAs surviving to hospitalization and meeting WHO criteria for suddenness. Underlying cause was determined by comprehensive record review.ResultsThe authors identified 734 OHCAs over 48 months; 239 met SCA criteria, 133 (55.6%) were resuscitated to hospitalization, and 47 (19.7%) survived to discharge. Arrhythmic causes accounted for significantly more resuscitated SCAs overall (92 of 133, 69.1%), particularly among survivors (43 of 47, 91.5%), than WHO-defined SCDs in POST SCD (293 of 525, 55.8%; p < 0.004 for both). Among resuscitated SCAs, arrhythmic cause, ventricular tachycardia/fibrillation initial rhythm, and white race were independent predictors of survival. None of the resuscitated SCAs due to neurologic causes survived.ConclusionsIn this 4-year countywide study of OHCAs, only one-third were sudden, of which one-half were resuscitated to hospitalization and 1 in 5 survived to discharge. Arrhythmic cause predicted survival and nearly one-half of nonsurvivors had nonarrhythmic causes, suggesting that SCA survivors are not equivalent to SCDs. Early identification of nonarrhythmic SCAs, such as neurologic emergencies, may be a target to improve OHCA survival.  相似文献   
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BACKGROUND Nonalcoholic fatty liver disease(NAFLD)and type-2 diabetes mellitus(T2DM)have an intricate bidirectional relationship.Individuals with T2DM,not only have a higher prevalence of non-alcoholic steatosis,but also carry a higher risk of progression to nonalcoholic steatohepatitis.Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.AIM To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM.METHODS During the study period(November 2018 to January 2020),59 adult patients with T2DM and 26 non-diabetic control group individuals were recruited prospectively.Patients with known significant liver disease and alcohol use were excluded.Demographic data and lab parameters were recorded.Liver elastography was performed in all patients.RESULTS In the study group comprised of patients with T2DM and normal alanine aminotransferase levels(mean 17.8±7 U/L),81%had hepatic steatosis as diagnosed by elastography.Advanced hepatic fibrosis(stage F3 or F4)was present in 12%of patients with T2DM as compared to none in the control group.Patients with T2DM also had higher number of individuals with grade 3 steatosis[45.8%vs 11.5%,(P<0.00001)and metabolic syndrome(84.7%vs 11.5%,P<0.00001)].CONCLUSION A significant number of patients with T2DM,despite having normal transaminase levels,have NAFLD,grade 3 steatosis and advanced hepatic fibrosis as measured by liver elastography.  相似文献   
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BackgroundThe current understanding of ventilator efficiency variables during ramp exercise testing in the normal Japanese population is insufficient, and the responses of tidal volume (VT) and minute ventilation (V?E) to the ramp exercise test in the normal Japanese population are not known.MethodsA total of 529 healthy Japanese subjects aged 20–78 years underwent cardiopulmonary exercise testing using a cycle ergometer with ramp protocols. VT and V?E at rest, at anaerobic threshold, and at peak exercise were determined. The slope of V?E versus carbon dioxide (V?CO2) (V?E vs. V?CO2 slope), minimum V?E/V?CO2, and oxygen uptake efficiency slope (OUES) were determined.ResultsFor males and females in their 20 s, peak VT (VTpeak) was 2192 ± 376 and 1509 ± 260 mL (p < 0.001), peak V?E (V?Epeak) was 80.6 ± 18.7 and 57.7 ± 13.9 L/min (sex differences p < 0.001), the V?E vs. V?CO2 slope was 24.4 ± 3.2 and 25.7 ± 3.2 (p = 0.035), the minimum V?E/V?CO2 was 24.2 ± 2.3 and 27.0 ± 2.8 (p < 0.001), and the OUES was 2452 ± 519 and 1991 ± 315 (p < 0.001), respectively. VTpeak and V?Epeak decreased with age and increased with weight and height. The V?E vs. V?CO2 slope and minimum V?E/V?CO2 increased with age, while conversely, the OUES decreased with age.ConclusionsWe have established the normal range of VT and V?E responses, the V?E vs. V?CO2 slope, the minimum V?E/V?CO2, and the OUES for a healthy Japanese population. Some of these parameters were influenced by weight, height, sex, and age. These results provide useful reference values for interpreting the results of cardiopulmonary exercise testing in cardiac patients.  相似文献   
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ObjectiveTo compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR.DesignRandomized experimental pilot study by groups.SettingOut-hospital care basic life support units on the Island of Mallorca.ParticipantsAdults attended after cardiorespiratory arrest of non-traumatic origin.InterventionsAdvanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring.Main measurementsCapnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions.ResultsTwenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3 mmHg in the control group and 27.4% in the intervention group. 34.8% (n = 8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n = 6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P = .066).ConclusionsThe use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.  相似文献   
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