相关指标在评价急性胰腺炎严重程度及预后方面的研究进展

全球范围内急性胰腺炎的发病率不断上升,其中重症急性胰腺炎的预后差、并发症多、死亡率高。如何早期识别急性胰腺炎的严重程度及预后受到医护人员的普遍关注。本文就目前临床常用相关指标在评价急性胰腺炎严重程度及预后方面的作用做一综述。     

产科护理经验与体会(二)

自然分娩坐、卧式助产优、缺点效果观察坐式分娩在全国许多医院已经开展或试用,这是产科工作中一项重大改革,有一定的科学性。坐式分娩可使产妇感到舒适,助产士感到省时省力,对缩短第二产程、减少产后出血和新生儿窒息的发生都有积     

急性肾功能衰竭的非透析疗法

近年来 ,我科经过不断研究探索 ,摸索出一组对急性肾衰 (ＡＲＦ)行之有效的综合治疗药物 ,并成功地治愈了部分ＡＲＦ病人。一、对象与方法1.研究对象　肌酐 >45 0 μｍｏｌ/Ｌ ,尿量≤ 40 0ｍｌ/ｄ ,Ｂ超检查示双侧肾脏弥漫性增大的 5 9例ＡＲＦ病人 ,根据病因按随机号分为两组 ,心血通组 (河北医科大学生物医学工程生产 ,内含心房肽(ＡＮＰ) >16 0 0ｐｇ/ｍｌ,降钙素基因相关肽 (ＣＧＲＰ) 4 86ｐｇ/ｍｌ,以及三磷酸腺苷、腺苷和多种氨基酸及其代谢中间产物 )和常规治疗组。2　治疗方法及观察指标　常规治疗经补足血容量、应用多巴胺、速尿…     

脑栓康对D-半乳糖诱导小鼠脑功能衰退的保护作用

目的：探讨脑栓康(NSK)对D-半乳糖诱导小鼠脑功能衰退的保护作用。方法：ICR小鼠随机分为空白对照组、模型对照组、银杏叶提取物(天保宁片)40mg／kg组、NSK25mg／kg组、NSK50mg／kg组、NSK100mg／kg组。小鼠每日颈背部皮下注射D-半乳糖120mg／kg，采用水迷宫试验，测试小鼠的学习记忆能力，并通过测定模型小鼠的学习记忆能力和脑组织超氧化物歧化酶(SOD)，谷胱甘肽过氧化物酶(GSH-Px)活力、丙二醛(MDA)和脂褐素含量，观察NSK对模型小鼠脑功能衰退的保护作用。结果：NSK25，50，100mg／kg可不同程度地改善模型小鼠的学习能力[3组小鼠平均到达B点时间为(43&;#177;18)，(54&;#177;29)，(59&;#177;61)s；而模型对照组到达B点时间为(63&;#177;26)s,t=2．525～2．731，P&;lt;0．05]和记忆能力[NSK25mg／kg组和模型对照组小鼠平均到达B点时间为(25&;#177;26)，(50&;#177;35)8，t=2．254，P&;lt;0．05]。3个剂量均可以增强模型小鼠脑组织SOD，GSH-Px活力，降低MDA和脂褐紊含量(t=-2．675～2．712，P&;lt;0．05，t=-8．806～15．989，P&;lt;0．01)。结论：抑制脑组织脂质过氧化反应，提高脑组织的抗氧化能力，可能是NSK改善行为学异常，防治老年期痴呆的作用机制之一。     

抑郁症患者自杀意念主题统觉测验分析

抑郁症患者是自杀的高危人群,长期追踪发现约15%的抑郁症患者最终死于自杀〔1〕。自杀意念是自杀未遂和自杀死亡者早期的心理活动,尽管自杀意念与自杀行为之间无必然的联系,但反映了个体某个时期的消极思想动态。中国对存在自杀意念的人群研究通常采用自陈量表〔2-4〕,主要集中在流行病学、评估与诊断及其防御机制等方面研究,对其潜在     

心电图在急性肺栓塞诊治中的应用

目的探讨心电图在诊治急性肺栓塞中的作用。方法回顾性分析38例确诊的急性肺栓塞患者入院时及溶栓后1周的心电图变化。结果入院时S1〉0．1mV者32例次（84．21％），S1QⅢTⅢ型23例次（60．53％）。QⅢTⅢ型21例次（55．26％），TⅢ倒置29例次（76．32％），Tv1-v3倒置26例次（68．42％），Tv1-v3倒置19例次（50．0％），Tv1-v4倒置15例次（39．47％），Tv1-v5R倒置4例次（10．53％）。T波倒置均呈对称性，不完全性右束支传导阻滞7例次。Sv1-vm粗钝、挫折17例次（44．74％）。溶栓后1周S1〉0．1mV、S1QⅢTⅢ型、QⅢTⅢ型、顺钟向转位、电轴右偏、窦性心动过速、房性心律失常及aVR终末R波等指标阳性率均有减少。差异均有显著性意义（P〈0．05）。溶栓后胸导联T波倒置较溶栓前大多加深。结论急性肺栓塞心电图改变是非特异性的．但如能紧密结合临床、动态观察心电图改变，则有助于诊断急性肺栓塞。有效溶栓治疗后胸导联T波倒置加深可能是右心室负荷减轻的一种表现。     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

精神分裂症病人一般自我效能感与应对方式相关性研究

目的探讨精神分裂症病人一般自我效能感与应对方式的关系，为精神分裂症病人心理健康教育提供依据。方法采用一般自我效能感量表（GSES）和简易应对方式问卷（SCSQ）对81例精神分裂症病人进行测评。结果本组对象中，不同性别、年龄、病程的精神分裂症病人的一般自我效能感、积极应对、消极应对的差异无统计学意义；本组精神分裂症病人一般自我效能感显著低于常模（P〈0．001）；其消极应对显著低于常模（P〈0．05），比常模较少采用消极应对方式；积极应对与常模比较，差异无统计学意义（P〉0．05）；一般自我效能感与积极应对、消极应对存在一定的正相关关系（P〈0．05）。结论精神分裂症病人的一般自我效能感与积极应对、消极应对存在一定的正相关关系，提高病人自我效能，将有助于其采取积极有效的应对方式。     

房颤

房颤是危害人群健康的高发疾病，据统计，房颤大约占成年人群的4％，40岁以后房颤发生开始增加，65岁以后开始显著增加。老年人房颤发生率约7％～14％。一项包括23250例意大利老年患者药物应用研究（GIFA）公布的资料显示，在住院的患者中，房颤患者占10．1％，其中大于80岁的患者高达14．8％。     

脑心通胶囊对大鼠局灶性脑缺血再灌注后脑组织IL-1β、IL-6和TNF-α含量的影响

目的观察脑心通胶囊对大鼠局灶性脑缺血再灌注后脑损伤的保护作用.方法以大鼠局灶性脑缺血再灌注模型为研究对象,应用神经功能行为学评分、TTC染色技术和ELISA观察脑心通胶囊对大鼠局灶性脑缺血再灌注后脑损伤的保护作用及对脑组织内白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)含量的影响.结果脑心通胶囊0.24 、0.48 g/kg能降低模型大鼠神经功能行为学评分(P<0.05),减少模型大鼠脑组织脑梗死范围(P<0.01),降低脑组织中IL-1β、IL-6和TNF-α的含量(P<0.05,P<0.01).结论脑心通胶囊对大鼠局灶性脑缺血再灌注后脑损伤有保护作用,其作用机制与降低模型大鼠脑组织中IL-1β、IL-6及TNF-α的含量有关.