阿托品治疗有机磷中毒3种给药方式疗效比较

目的:寻找阿托品治疗有机磷中毒患者最佳给药方式。方法:对120例有机磷中毒患者,随机分为3组,采取不同给药方式,A组40例给予微量泵持续静脉给药,B组40例静脉滴注给药,C组40例间隔静脉推注给予。对给药后患者达到阿托品化时间、维持时间及中毒情况等进行分析比较。结果:微量泵持续静脉推注和静脉滴注与间隔静脉推注给药方式比较差异具有显著性(P0.01)。结论:微量泵持续静脉推注给药具有阿托品化时间短、容易维持和不易发生中毒等优点,临床疗效可靠。     

多途径介入治疗37例急性坏死性胰腺炎的临床分析

目的 :探讨经多途径介入治疗急性坏死性胰腺炎的效果。方法 :回顾性总结 6 7例用不同方法治疗的急性坏死性胰腺炎患者资料 ,其中介入组 (采用胰腺动脉插管灌注奥曲肽、抗生素、地塞米松、普鲁卡因四联药物 ) 37例 ,对照组 (四联药物静脉给药 ) 30例。结果 :介入组腹痛缓解、胰淀粉酶恢复正常及住院时间均短于对照组 (P<0 .0 5或 P<0 .0 1) ,两组严重并发症的发生率 (分别为 19.4 4 %和 4 1.93% )及病死率 (分别 2 .70 %和16 .6 7% )均有显著性差异 (P均 <0 .0 5 )。结论 :经多途径介入治疗急性坏死性胰腺炎较传统方法有效。     

血清酶及心电图变化在有机磷中毒中的临床意义

目的　研究急性有机磷中毒患者血清酶及心电图变化的临床意义。方法　所有患者入院后均予清除毒物、应用解毒剂和阿托品及其他治疗 ,入院第二天抽取静脉血测定血清天冬氨酸转氨酶 (AST)、乳酸脱氢酶 (LDH)、肌酸磷酸激酶 (CK)、羟丁酸脱氢酶 (HBDH) ,监测心电图 ;并于同期测定当地 30名健康人血清酶及心电图作为对照组。结果　血清酶学指标 ,轻度中毒组与对照组均无显著性差异 (P >0 .0 5 ) ,中度中毒组与轻度中毒组差异有显著性意义 (P <0 .0 5 ) ,重度中毒死亡组与中度中毒组差异有显著性意义 (P <0 .0 5 ) ,重度中毒治愈组与中度中毒组AST、LDH、CK差异有显著性意义 (P <0 .0 5 ) ,重度中毒死亡组与中度中毒组AST、CK、HBDH差异有显著性意义 (P <0 .0 5 ) ,重度中毒死亡组与重度中毒治愈组HBDH有显著性差异 (P <0 .0 5 ) ;重度中毒组严重室性心律失常 (室速、室颤 )较其他组高 (P <0 .0 1)。结论　血清酶及心电图变化可用于判断病情的发展趋势和预后 ,在治疗上具有指导意义     

两种给药方法对急性有机磷中毒的效果观察

目的：探讨微量泵持续静脉输注阿托品治疗急性有机磷中毒（AOPP）的可行性．方法：观察组23例AOPP患者采用微量泵持续静脉输注阿托品。对照组23例AOPP患者采用间断静注阿托品,观察并记录患者生命体征变化。达阿托品化时间及住院时间。结果：统计分析表明。观察组患者入院后24h～72h体温、脉搏较对照组平稳,差异极显著（P〈0．01）；两组的阿托品化时间、治疗时间及死亡例数差异显著（P〈0．05）,观察组疗效明显优于对照组。结论；微量泵持续静脉输注阿托品治疗急性有机磷中毒（AOPP）的效果优于常规分次间断静注药物,是一种安全可靠,简便有效的给药方法。     

血脂康治疗混合型高脂血症的临床观察

目的 :评价国产调脂药血脂康与烟酸肌醇酯的调脂效果及不良反应。方法 :将 118例混合型高脂血症患者随机分 2组 :A组 (6 0例 )早、晚餐后各服血脂康 0 6 ;B组 (5 8例 )早、晚餐后各服烟酸肌醇酯 0 4。2 4周后评价调脂效果及不良反应。结果 :两组均显著降低甘油三酯 (TG)及低密度脂蛋白胆固醇 (LDL C) ;组间比较A组降低总胆固醇 (TC) ,LDL C和升高高密度脂蛋白胆固醇 (HDL C)较B组显著 (P <0 0 5 )。A组不良反应发生率 12 % ,B组发生率 2 8% ,差异有统计学意义 (P <0 0 5 )。结论 :血脂康对混合型高脂血症降低TC、TG及LDL C和升高HDL C效果显著 ,不良反应轻微 ,耐受性好 ,可完全代替烟酸肌醇脂。     

参附注射液配合常规抢救治疗中重度有机磷中毒29例

目的 :观察参附注射液配合常规抢救治疗中重度有机磷中毒的临床效果。方法 :将 5 6例中重度有机磷中毒患者随机分为治疗组 2 9例 ,对照组 2 7例 ,2组均采用常规抢救治疗 ,清除残留药物 ,补液纠酸、降低肺水肿、抗胆碱治疗等 ;治疗组并给予参附注射静脉推注 ,2组治疗 5d观察疗效。结果 :2组治愈率分别为 89 7%、6 3 0 % ,有效率分别为 96 6 %、77 8% ,经统计学处理均为显著性差异 (P <0 0 5 ) ,治疗组明显为优。结论 :参附注射液静脉推注配合常规抢救方法治疗中重度有机磷中毒 ,在缩短病程、提高治愈率及有效率方面具有突出的临床效果。     

盐酸戊乙奎醚注射液联合阿托品对急性有机磷中毒患者康复进程及不良反应发生率的影响

目的:探究盐酸戊乙奎醚注射液联合阿托品对急性有机磷中毒患者康复进程及不良反应发生率的影响。方法:选取我院2016年7月～2017年9月急性有机磷中毒患者82例,随机数字表法分组,各41例。对照组给予阿托品治疗,观察组给予阿托品+盐酸戊乙奎醚注射液治疗。比较两组康复进程[中毒症状消失时间、胆碱酯酶活性恢复时间及平均住院时间]及不良反应发生情况。结果:观察组中毒症状消失时间、胆碱酯酶活性恢复时间及平均住院时间短于对照组,差异有统计学意义(P 0. 05);观察组视力模糊、尿潴留、药物中毒昏迷、心跳过速、反跳现象发生率低于对照组,差异有统计学意义(P 0. 05)。结论:盐酸戊乙奎醚注射液联合阿托品治疗急性有机磷中毒患者能缩短康复进程,降低不良反应发生率。     

地塞米松不同给药途径对吗啡硬膜外镇痛术后恶心呕吐的影响

目的 :研究地塞米松静脉给药与硬膜外给药对降低术后吗啡硬膜外镇痛恶心呕吐 (PONV)的作用是否存在不同。方法 :选择 15 0例硬膜外麻醉的妇科手术病例 ,随机分为 3组 ,手术结束前A组硬膜外腔注射 10mg地塞米松 ,B组静脉给予 10mg地塞米松 ,而C组不用地塞米松 (对照组 )。术毕所有病例均行吗啡联合小剂量氟哌利多硬膜外镇痛。观察 4 8h内恶心呕吐的发生率和严重程度 ,随访伤口感染或延迟愈合等情况。结果 :PONV发生率A组为 16 % ,B组为 8% ,两组无显著差异 (P >0 .0 5 ) ,均明显低于C组 (4 8% ) ,两组与C组相比均有显著差异 (P <0 .0 1)。未发生伤口感染或延迟愈合的病例。结论 :地塞米松10mg无论静脉给药还是硬膜外给药均能显著降低妇科手术后吗啡镇痛患者PONV的发生率 ,且单次给药无明显的不良反应     

长托宁治疗有机磷中毒80例临床分析

目的：观察新型抗胆碱能药长托宁治疗急性有机磷农药中毒的效果。方法：160例患者急性有机磷中毒患者随机分为长托宁组与阿托品组各80例,并对其治疗效果进行比较。结果：两组治愈率、死亡率在轻、中度患者中差异无显著性（P〉0.05）,但在重度中毒者中差异有显著性（P〈0.05）,两组的中毒症状消失时间、住院日、不良反应发生率有显著性差异（P〈0.05）。结论：长托宁是治疗有机磷中毒理想的抗胆碱能药物。     

磷酸肌酸钠静脉给药致新生儿低血钙的原因与治疗分析

目的分析磷酸肌酸钠静脉给药引起新生儿低血钙的原因及临床治疗效果。方法选取2016年8月至2018年8月行磷酸肌酸钠静脉给药治疗的60例患儿为研究对象,依据治疗方案分为对照组与观察组,每组30例。对照组给予常规剂量磷酸肌酸钠治疗,观察组给予低剂量磷酸肌酸钠治疗,比较两组治疗前后生化指标[血清游离钙、血清磷及肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(c TnⅠ)]及不良反应发生情况。结果对照组治疗后血清钙低于治疗前,血清磷高于治疗前,差异有统计学意义(P 0. 05);观察组治疗后血清钙、磷与治疗前比较,差异未见统计学意义(P 0. 05);两组治疗后CK-MB、c TnⅠ均低于治疗前,差异有统计学意义(P 0. 05);治疗后,两组CK-MB、c TnⅠ比较,差异未见统计学意义(P 0. 05);观察组低钙血症发生率及其他不良反应发生率均低于对照组,差异有统计学有意义(P 0. 05)。结论磷酸盐过量摄入可导致钙磷代谢失衡,增加低钙血症发生率,故在磷酸肌酸钠静脉给药时应严密监测血清钙、血清磷水平,适当调整给药剂量,以保障患儿用药安全。     

Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients

Background: In vitro studies have shown that nonionic radiographic contrast material may induce the generation of thrombin in blood, whereas ionic contrast agents, such as iohexol, do not. However, knowledge of the effects of contrast material on coagulation and fibrinolytic systems in vivo is limited.Objective: This study was designed to assess the effects of the nonionic radiographic contrast material iopamidol on hemostasis in patients undergoing coronary angiography or cardiac catheterization.Methods: Patients aged ≥18 years with chest pain and/or dyspnea who underwent coronary angiography or cardiac catheterization with intra-arterial contrast material were assessed for hemostasis. Blood samples were drawn before and 3 minutes after injection of iopamidol. Complete blood count and coagulation profile (bleeding time, clotting time, clot retraction time, euglobulin lysis time [ELT], prothrombin and partial thromboplastin times, coagulation factor I [CFI] level, and platelet factor 3 [PF-3] availability) were assessed. The natural coagulation inhibitors protein C, protein S, and antithrombin III (AT-III) also were measured.Results: Thirty patients (7 males, 23 females; mean [SD] age, 51.3 [20.2] years; range, 17-79 years) were included in this single-center study. All hematologic variables (hemoglobin, white blood cell count, and platelet count) decreased significantly (P<0.001, P<0.001, and P<0.05, respectively) after administration of iopamidol but remained within normal limits. Mean levels of protein C, protein S, and AT-III did not change significantly after administration of iopamidol. Bleeding time was not changed significantly, and PF-3 availability was prolonged in both groups, but the changes were not statistically significant.Conclusions: In this study population, although hemostasis remained grossly intact after injection of nonionic contrast material, the coagulation system may have been affected by the accelerated consumption of CFI and platelets. The affected variables were platelets, clot retraction time, ELT, and natural coagulation inhibitors (protein C, protein S, and AT-III). Although the natural coagulation inhibitors remained within the normal range, the correlations were found significant. These changes in hemostasis affected the vascular phase. If the vascular compartment, especially the endothelium, remained intact, the infusion of nonionic agents in low concentrations might be safe for angiography and other procedures; however, more studies are needed.     

化妆美容护理干预在妇科恶性肿瘤化疗患者中的应用

目的：探讨化妆美容护理干预在妇科恶性肿瘤化疗患者中的应用效果。方法：采用便利抽样法,选取接受化疗的妇科恶性肿瘤患者114例,按住院时间先后分为对照组和观察组各57例。对照组接受常规护理及知识宣教,观察组在对照组基础上,给予化妆美容干预。比较两组患者的焦虑得分、自尊水平及身体意象得分。结果：首次化疗时两组焦虑得分差异无统计学意义（P>0.05）;第3次化疗及全部化疗结束后观察组焦虑得分低于对照组,差异有统计学意义（P<0.05）,且两组的焦虑得分随干预时间变化而变化（P<0.05）。首次化疗、第3次化疗后两组自尊水平得分差异无统计学意义（P>0.05）,全部化疗结束后观察组自尊水平得分低于对照组,差异有统计学意义（P<0.05）,且两组的自尊水平得分随干预时间变化而变化（P<0.05）,干预方法与干预时间之间存在交互效应（P<0.05）。首次化疗时两组身体意向得分比较差异无统计学意义（P>0.05）;第3次化疗后及全部化疗结束后观察组身体意象得分低于对照组,差异有统计学意义（P<0.05）,且两组的身体意象得分干预方法与干预时间之间存在交互效应（P<0.05）。结论：化妆美容干预可有效改善妇科肿瘤化疗患者的焦虑情绪,提高患者的自尊和身体意象水平。     

肝硬化患者血清一氧化氮和食管动力关系的研究

目的: 探讨肝硬化患者血清一氧化氮(NO)与食管动力的关系。方法: 35 例肝硬化患者(HC)和30 例健康人(HS)采用硝酸还原酶法测定血清NO含量;核素法测定食管液体通过时间和胃食管反流。结果: HC组血浆NO含量显著高于HS组(P<0.01);HC组胃食管反流发生率显著高于HS组;HC组中胃食管反流患者的NO含量显著高于无胃食管反流的患者(P<0.01),HC组的食管液体通过时间较HS组显著延长(P<0.01),但NO含量与食管通过时间无相关性(P>0.05)。结论: 肝硬化患者血浆NO含量的升高可能使食管下括约肌(LES)松弛而产生胃食管反流,但不影响食管蠕动功能。     

Intramuscular injection of granisetron into the masseter muscle increases the pressure pain threshold in healthy participants and patients with localized myalgia

OBJECTIVES: The aims of this study were to experimentally investigate whether an intramuscular injection of the 5-HT(3) antagonist granisetron into the masseter muscle increases the mechanical pain threshold in healthy participants and reduces masseter muscle pain or allodynia in patients with craniofacial myalgia. METHODS: Eighteen patients with bilateral localized myalgia of the masseter muscle and 24 healthy participants participated in this randomized, double-blind study, in which granisetron was injected on one side and isotonic saline on the other side. Pain (Visual Analog Scale) and pressure pain threshold (PPT) were recorded before and during 30 minutes after injections and the changes from baseline were analyzed with analysis of variance. RESULTS: In both groups, the PPT increased after injection of granisetron whereas it decreased after saline. The difference between substances was significant (patients: P=0.016; healthy participants: P=0.029). In the healthy participants there was also a significant time effect (P<0.001) and an interaction between time and substance (P=0.022). The post-hoc test showed that the difference between substances was significant 0 to 15 minutes after injections (Bonferroni t test; P<0.05). The pain intensity from the masseter muscle did not differ between substances, but there was a significant time effect (P<0.001) and an interaction between time and substance (P<0.001). The post-hoc test showed significantly lower pain intensity on the granisetron side 0 to 2 minutes after injections (Bonferroni t test; P<0.05). CONCLUSIONS: This study indicates that intramuscular injection of granisetron into the masseter muscle increases the PPT in healthy participants and in patients with craniofacial myalgia.     

影响长期机械通气患者预后的危险因素分析

目的 探讨影响重症加强治疗病房（ICU）中长期机械通气（LTMV）患者预后的危险因素。方法 回顾性分析42例在ICU机械通气≥7d的患者人ICU时的一般情况、原发病分布、通气前生命体征、辅助检查、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和气管切开时间。根据撤机后的生存情况分为生存组和死亡组，依照设定的临床资料对两组患者进行对比分析，并进行Logistic多元回归分析。结果 生存组22例，死亡组20例。死亡组APACHEⅡ评分、校正心率（PAR）及血尿素氮（BUN）水平均明显高于生存组（P均〈0．01），气管切开时间明显晚于生存组（P〈0．05），血浆白蛋白（ALB）、血细胞比容（HCT）和血小板计数（PLT）均明显低于生存组（P〈0．05或P〈0．01）；而两组间的机械通气时间、白细胞计数（WBC）和呼吸机相关性肺炎的发生率差异均无显著性（P均〉0．05）。Logistic多元回归分析显示，气管切开时间、HCT和PLT与LTMV患者的预后呈显著相关性（P〈0．05或P〈0．01）。结论 气管切开时间、HCT和PLT是影响LTMV患者预后的主要危险因素。     

优质护理在小儿胃肠炎中的效果

目的：分析优质护理在小儿胃肠炎患者中的应用价值。方法：随机选取我院儿科诊室于2021年1月~2021年12月期间收治的胃肠炎患儿66例作为研究对象,使用随机数字表法分组,对照组与观察组各33例,分别使用常规护理方案与优质护理措施,比较两组护理有效率、止泻时间、住院时间,家属满意度与患儿生活质量评分。结果：观察组患儿护理有效率高于对照组,数据差异明显(P＜0.05)；观察组止泻时间(1.23±0.45)d、住院时间(4.46±1.15)d,对照组止泻时间(1.67±0.78)d 、住院时间(5.65±1.26)d,指标差异明显,有统计学意义(P＜0.05)；观察组满意度评分、生活质量评分均高于对照组,组间经过比较后,差异显著,有统计学意义(P＜0.05)。结论：将优质护理措施应用在小儿胃肠炎护理中,产生的价值显著,能够提高护理有效率,缩短患儿止泻时间、住院时间,并且提高了家属满意度和患儿生活质量,优质护理方案具有推广意义。     

血清一氧化氮对肝硬化患者食管动力及食管静脉曲张破裂出血的影响

目的 :探讨肝硬化患者血清一氧化氮 (NO)对食管动力及食管静脉曲张破裂出血 (EVB)的影响。方法 :本文采用核素扫描法测定 4 2例肝硬化食管静脉曲张患者 (EV)和 30例健康人 (HS)食管液体通过时间和胃食管反流 ,硝酸还原酶法测定血清NO含量 ;并随访 1年。结果 :EV组血浆NO含量显著高于HS组 (P <0 .0 5 ) ;EV组胃食管反流发生率显著高于HS组 (P<0 .0 5 ) ;EV组中胃食管反流患者的NO含量显著高于无胃食管反流的患者 (P <0 .0 5 ) ,EV食管动力异常组血清NO含量显著高于EV食管动力正常组 (P <0 .0 5 ) ;EV食管动力异常组出血率显著高于EV食管动力正常组 (P <0 .0 5 )。结论 :肝硬化患者血清NO含量的升高可能使食管下段括约肌 (LES)松弛而产生胃食管反流 ,进而导致EVB机会增加。     

Contrast material injection protocol with the flow rate adjusted to the heart rate for dual source CT coronary angiography

To investigate the effect on coronary arterial attenuations of contrast material flow rate adjusted to a patient’s heart rate during dual source CT coronary angiography (DSCT-CCTA). A total of 296 consecutive patients (mean age: 58.7 years) undergoing DSCT-CCTA without previous coronary stent placement, bypass surgery, congenital or valvular heart disease were included. The image acquisition protocol was standardized (120 kV, 380 mAs) and retrospective electrocardiograph (ECG) gating was used. Patients were randomly assigned to one of three groups [flow rate: G1: dosage/16, G2: dosage/(scan time +8), G3: fixed flow rate]. The groups were compared with respect to the attenuations of the ascending aorta (AA) above coronary ostia, the left main coronary artery (LM), the proximal right coronary artery (RCA), the left anterior descending artery (LAD), the left circumflex artery (LCX), and the contrast to noise ratio of the LM (LM_CNR) and the proximal RCA (RCA_CNR). Correlations between heart rate and attenuation of the coronary arteries were evaluated in three groups with linear regression. There was no significant difference in the three groups among the mean attenuations of AA (P = 0.141), LM (P = 0.068), RCA (P = 0.284), LM_CNR (P = 0.598) and RCA_CNR (P = 0.546). The attenuations of the LAD and the LCX in group 1 were slightly higher than those in group 2 and 3 (P < 0.05). In group 1, the attenuations of the AA (P < 0.01), LM (P < 0.01), RCA (P < 0.01), LAD (P = 0.02) and LCX (P < 0.01) decreased, respectively, with an increasing heart rate. A similar finding was detected in group 3 (AA: P < 0.01, LM: P < 0.01, RCA: P < 0.01, LAD: P < 0.01and LCX: P < 0.01). In contrast, the attenuations of the AA (P = 0.55), LM (P = 0.27), RCA (P = 0.77), LAD (P = 0.22) and LCX (P = 0.74) had no significant correlation with heart rate in group 2. In all three groups, LM_CNR (P = 0.77, 0.69 and 0.73 respectively) and RCA_CNR (P = 0.75, 0.39 and 0.61 respectively) had no significant correlation with heart rate. Contrast material flow rate adjusted to heart rate can diminish the influence of heart rate on attenuations of the coronary arteries in DSCT-CCTA.     

星状神经节阻滞与点式直线偏光近红外线照射对眼压及皮肤温度影响的临床研究

目的：研究星状神经节阻滞和星状神经节点式直线偏光近红外线照射对眼压及皮肤温度的影响，进而阐明作用效果的异同。方法：将临床疼痛诊疗病例50例随机分为两组，SGB25例，SGL25例，分别用YZ7A压陷式眼压计和UY200M型温度记录器测定每一患者操作侧眼压和皮肤温度。结果：SGB和SGL两组的眼压，在治疗后10min时有显著性差异（P〈0．05），其余时段内两组间无显著性差异（P〉0．05）；SGB和SGL两组皮肤温度，在治疗后5min时有显著性差异（P〈0．05），10min、15min时有非常显著性差异（P〈0．01），其余测定时段内两组间对皮肤温度的影响无显著性差异（P〉0．05）。结论：SGB和SGL对眼压均起一过性上升随后下降、皮肤温度上升的作用。SGB和SGL两种方法对眼压及皮肤温度的影响程度相仿，且其临床作用效果基本相同。     

不同取穴电针对腰椎间盘突出症腰椎功能的康复作用

目的：探讨电针治疗腰椎间盘突出症的有效方法.方法：将全部入组98例患者随机分成治疗组（n=53）与对照组（n=45）,采用改良Oswestry失能量表（ODI）对两组患者腰椎功能进行连续动态观测,治疗组采用局部单穴电针治疗,对照组采用常规取穴电针治疗,各组的电针参数与针刺频度一致.结果：首次治疗后两组ODI每次后续评分均较治疗前差异有显著性意义（P＜0.001）,且每个时间点两指标组间差异也分别具有显著性意义（P＜0.001）.结论：局部单穴电针疗法对腰椎间盘突出症较常规取穴电针有更好的临床疗效.