甲泼尼龙治疗支气管哮喘的临床疗效观察

目的了解甲泼尼龙 [1] 治疗支气管哮喘急性发作的临床效果,方法将60例支气管哮喘患者随机分为两组,对照组常规止喘治疗,实验组在相同治疗基础上,加用甲泼尼龙静点治疗前和治疗第2d、第4d分别观察症状、体征及动脉血PaO2变化.结果治疗前两组患者动脉血PaO2平均值比较无统计学意义;治疗第2d、第4d,治疗组和对照组缓解率及动脉血PaO2值比较有统计学意义.结论甲泼尼龙治疗支气管哮喘急性发作快速有效,缩短住院日.     

甲泼尼龙与地塞米松治疗过敏性休克50例临床疗效观察

目的 探讨甲泼尼龙与地塞米松对过敏性休克症状的临床治疗效果分析.方法 选择我院2012年5月～2014年6月收治的50例过敏性休克患者为研究对象,随机分为对照组与观察组,各组25例,两组患者均实施常规治疗,观察组加用甲泼尼龙琥珀酸钠治疗,对照组加地塞米松治疗,对两组患者治疗后效果进行分析.结果 观察组治疗总有效率为92.00％,对照组为72.00％,观察组显著高于对照组(P＜0.05);对照组神志恢复、血压恢复、皮疹消退、呼吸频率恢复时间均较观察组长,差异有统计学意义(P＜0.05).结论 甲泼尼龙应用于过敏性休克治疗中,安全性高,效果显著,可快速使症状改善,利于患者预后,值得临床推广.     

甲泼尼龙冲击递减疗法在重症过敏性紫癜治疗中的应用分析

目的：探讨采用甲泼尼龙冲击递减疗法治疗重症过敏性紫癜患者的临床应用和疗效。方法选取我院在2012年1月~2014年1月收治的重症过敏性紫癜患儿60例,采用双盲法按1：1比例分为观察组和对照组,观察组采用甲泼尼龙冲击递减疗法治疗,对照组采用甲泼尼龙常规治疗,并观察两组患儿临床症状改善情况、炎症因子变化情况、疗效以及不良反应。结果观察组患儿治疗后皮疹、腹痛、消化道反应以及关节痛的消退时间、肾损害恢复时间和住院时间均明显短于对照组(<0.05),IL-6、IL-8和TNF-α指标明显小于对照组(<0.05),总有效人数共29例(96.7%),明显大于对照组(<0.05);两组不良反应率比较无明显差异(>0.05)。结论甲泼尼龙冲击递减疗法在重症过敏性紫癜治疗中的应用效果显著,可快速改善患儿临床症状,降低炎症反应,且不明显不良反应,值得临床推广应用。     

甲泼尼龙针在广泛脑挫裂伤急性期的应用

目的对广泛脑挫裂伤急性期患者使用甲泼尼龙针进行治疗的方法进行分析和探讨。方法回顾和分析本院收治的38例广泛脑挫裂伤急性期患者的临床资料。结果恢复良好有24例,占63.2%;中残有6例,占15.8%;重残有4例,占10.5%;植物生长有2例,占5.25%;死亡有2例,占5.25%。结论要重视对广泛脑挫裂伤急性期患者的治疗,在对患者进行非手术治疗的过程中,要对患者的意识和生命体征以及瞳孔情况进行严密的观察。脱水剂的停用不能太早和太快,对患者进头颅CT动态观察,对手术适应征要能够把握好,及时地对患者进行开颅,将坏死的脑组织清除等,有效地提高治疗效果。同时对患者采用甲泼尼龙针进行治疗,能够提高治疗效果,缓解患者的症状。     

甲泼尼龙治疗SCAP的效果及其对降钙素原水平的影响

目的 探讨糖皮质激素对重症社区获得性肺炎（SCAP）治疗效果及血清降钙素原（PCT）水平的影响。方法 选取我院2017年1月~2019年1月收治的SCAP患者120例,按照随机数字表法分为对照组与研究组,每组60例。对照组予以常规对症治疗,研究组在对照组基础上加用甲泼尼龙治疗。比较两组临床疗效、二重感染率、病死率、住院时间及PCT水平变化。结果 研究组总有效率为88.33%,高于对照组的71.67%,差异具有统计学意义（P＜0.05）。治疗后,研究组PCT为（0.40±0.27）μg/L,低于对照组的（1.05±0.587）μg/L,差异具有统计学意义（P＜0.05）。两组病死率比较,差异无统计学意义（P＞0.05）;研究组再感染率为18.33%、住院时间为（12.17±3.45）d,分别低于对照组的36.67%、（17.26±5.19）d,差异有统计学意义（P＜0.05）。结论 甲泼尼龙有助于提高SCAP的临床疗效,降低PCT水平,有效缩短住院治疗时间,改善预后。     

鼓室注射甲泼尼龙琥珀酸钠联合糖皮质激素治疗 突发性耳聋的疗效

目的 探讨鼓室注射甲泼尼龙琥珀酸钠联合糖皮质激素治疗突发性耳聋的临床疗效。方法 选择2015年11月~2018年9月我院收治的突发性耳聋患者86例,随机分成联合组和对照组,每组43例。对照组给予糖皮质激素治疗,联合组在对照组基础上给予鼓室注射甲泼尼龙琥珀酸钠联合治疗,比较两组临床疗效,治疗前后不同频率听力及不良反应发生率。结果 联合组总有效率为97.62%,高于对照组的76.74%,差异有统计学意义（P＜0.05）。治疗后,联合组500 Hz、1000 Hz、2000 Hz、4000 Hz听力优于对照组,差异有统计学意义（P＜0.05）。联合组不良反应总发生率为2.33%,低于对照组的9.30%,差异有统计学意义（P＜0.05）。结论 鼓室注射甲泼尼龙琥珀酸钠联合糖皮质激素可有效治疗突发性耳聋,改善患者听力,且不良反应较少。     

甲泼尼龙联合羟基脲治疗原发性膜性肾病的疗效

目的 探讨甲泼尼龙联合羟基脲治疗原发性膜性肾病的临床效果。方法 选取2016年1月~2018年12月我院经肾穿刺活检病理确诊为原发性膜性肾病患者42例,按照随机数字表法分成观察组（20例）和对照组（22例）。观察组给予甲泼尼龙联合羟基脲治疗,对照组接受甲泼尼龙联合环磷酰胺治疗,比较两组24h尿总蛋白、血浆白蛋白、临床疗效及并发症发生率。结果 两组治疗前后24h尿总蛋白、血浆白蛋白比较,差异无统计学意义（P＞0.05）;观察组总有效率为80.00%,低于对照组的86.36%,但差异无统计学意义（P＞0.05）。观察组并发症总发生率为35.00%,低于对照组的40.91%,但差异无统计学意义（P＞0.05）。结论 甲泼尼龙联合环磷酰胺治疗原发性膜性肾病较甲泼尼龙联合羟基脲降尿蛋白效果具有非劣效性,且无严重并发症发生,可作为治疗的备选方案。     

甲泼尼龙联合阿奇霉素治疗难治性支原体肺炎患儿的 临床效果分析

目的 分析难治性支原体肺炎患儿应用甲泼尼龙联合阿奇霉素方案的效果。方法 择取2016年7月~2017年9月我院收治的86例RMPP者为研究对象,随机分为对照组和观察组,每组43例。对照组应用阿奇霉素方案,观察组在对照组基础上使用甲泼尼龙,观察两组患者体温恢复时间、治疗时间、治疗前后C反应蛋白水平,治疗效果以及治疗过程中不良反应发生情况。结果 观察组治疗时间、体温恢复时间短于对照组,差异具有统计学意义（P＜0.05）。治疗前,两组患儿C反应蛋白差异无统计学意义（P＞0.05）;治疗后,两组患儿C反应蛋白均有一定改善,观察组优于对照组,差异具有统计学意义（P＜0.05）。观察组治疗有效率为95.35%,高于对照组的72.09%,差异具有统计学意义（P＜0.05）。两组不良反应发生率相比,差异无统计学意义（P＞0.05）。结论 对于小儿RMPP患者使用应用甲泼尼龙联合阿奇霉素方案治疗,临床效果确切,不良反应少,有效率高,有助于疾病转归,值得进一步推广。     

甲泼尼龙琥珀酸钠减轻下肢高压喷射伤模型大鼠的肢体损害

目的 研究甲泼尼龙琥珀酸钠(MP)对大鼠下肢高压喷射伤(HPII)的干预作用。方法 将大鼠随机分为对照组、模型组(高压喷射伤模型)、治疗组(尾静脉注射MP 30 mg/kg)。6 h后观察喷射面积、肢体循环情况、HE染色检查血管、神经、肌肉病理变化,计算肝指数,ELISA检验血清TNF-α、IL-1β、IL-6含量。多组间比较采用单因素方差分析。结果 与对照组相比,模型组肢体循环障碍,血管、神经和肌肉病理明显断裂损伤,肝指数下降,而血清TNF-α、IL-1β和IL-6含量明显增加(P<0.05),与模型组相比,治疗组上述指标改善明显(P<0.05),差异有统计学意义。结论 高压喷射伤后注射MP可以减轻大鼠肢体损害,降低肝脏负荷,改善血清炎性指标变化。     

甲泼尼龙琥珀酸钠辅助治疗难治性小儿支原体肺炎的临床疗效观察

目的:探讨甲泼尼龙琥珀酸钠辅助治疗难治性小儿支原体肺炎(Refractory mycoplasma pneumoniae pneumonia,RMPP)的临床疗效.方法:2019年1月至2020年1月在本院治疗的86例RMPP儿童,根据治疗方法差异,将86例患儿分为对照组44例(阿奇霉素治疗)、观察组42例(在对照组的...     

Methylprednisolone pulse therapy in acute severe asthma

Methylprednisolone pulse therapy (MPPT) has been shown to possess a long-lasting effect in other immune-inflammatory diseases without the well-known side effects caused by long-term treatment with glucocorticosteroids. In an attempt to reduce the long-term use of oral steroids in asthmatics, we conducted this double-blind, double-dummy study to compare the use of MPPT (1 g of methylprednisolone intravenously) (8 patients) with a short course of oral prednisolone (10 patients) in asthmatics presenting with acute severe asthma. Both treatments were effective in relieving the acute attack of asthma. The MPPT-treated patients did not show a faster resolution than did the orally treated group. No patients needed assisted ventilation, and no deaths occurred. One week after the treatment FEV1 tended to decrease in the methylprednisolone group compared with the oral prednisolone group (P = 0.06). The patients initially receiving MPPT needed supplementary prednisolone earlier and in higher doses than did the patients receiving oral prednisolone as initial treatment. At the end of the 12 weeks' study period, the groups reached identical FEV1. In conclusion, we did not find intravenous methylprednisolone superior to oral prednisolone in the treatment of acute attacks of severe asthma, but methylprednisolone pulse therapy had a shorter duration as regards protection against future asthma attacks.     

Effects of Methylprednisolone Pulse Therapy on Refractory Mycoplasma pneumoniae Pneumonia in Children

Purpose

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. The clinical course is typically self-limited and benign; however, rare cases of severe pneumonia can develop despite appropriate antibiotic therapy. We studied the effects of methylprednisolone pulse therapy on severe refractory M. pneumoniae pneumonia in children.

Methods

The clinical effects of methylprednisolone therapy were evaluated retrospectively in 12 children with severe refractory M. pneumoniae pneumonia, which was diagnosed serologically. All patients developed respiratory distress, high fever, and initial lobar pneumonic consolidation based on radiological findings. All clinical symptoms deteriorated despite appropriate antibiotic therapy. Thus, children were treated with intravenous methylprednisolone pulse therapy in addition to antibiotics.

Results

The average febrile period before admission was 4.9±1.7 days, and fever persisted in all children until steroid administration. Methylprednisolone pulse therapy (30 mg/kg) was given 5.4±2.5 days after admission. After methylprednisolone pulse therapy, clinical symptoms improved in all patients without adverse events. The fever subsided 0-2 h after initiation of corticosteroid therapy. The abnormal radiological findings resolved within 2.6±1.3 days, and the high C-reactive protein levels (6.7±5.9 mg/dL) on admission decreased to 1.3±1.7 mg/dL within 3.0±1.1 days after starting corticosteroid therapy.

Conclusions

Three-day methylprednisolone pulse therapy could be applied to treatment of refractory M. pneumoniae pneumonia despite appropriate antibiotic therapy and appeared to be efficacious and well-tolerated.     

Distinguishing Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion from Prolonged Febrile Seizures by Acute Phase EEG Spectrum Analysis

Background

To differentiate the features of electroencephalography (EEG) after status epileptics in febrile children with final diagnosis of either febrile seizure (FS) or acute encephalopathy for an early diagnosis.

Methods

We retrospectively collected data from 68 children who had status epilepticus and for whom EEGs were recorded within 120 h. These included subjects with a final diagnosis of FS (n = 20), epileptic status (ES; n = 11), acute encephalopathy with biphasic seizures and late reduced diffusion (AESD; n = 18), mild encephalopathy with a reversible splenial lesion (MERS; n = 7), other febrile encephalopathies (n = 10), hypoxic-ischemic encephalopathy (n = 1), and intracranial bleeding (n = 1). Initially, all EEGs were visually assessed and graded, and correlation with outcome was explored. Representative EEG epochs were then selected for quantitative analyses. Furthermore, data from AESD (n = 7) and FS (n = 16) patients for whom EEG was recorded within 24 h were also compared.

Results

Although milder and most severe grades of EEG correlated with neurological outcome, the outcome of moderate EEG severity group was variable and was not predictable from usual inspection. Frequency band analysis revealed that solid delta power was not significantly different among the five groups (AESD, MERS, FS, ES and control), and that MERS group showed the highest theta band power. The ratios of delta/alpha and (delta + theta)/(alpha + beta) band powers were significantly higher in the AESD group than in other groups. The alpha and beta band powers in EEGs within 24 h from onset were significantly lower in the AESD group. The band powers and their ratios showed earlier improvement towards 24 h in FS than in AESD.

Conclusion

Sequential EEG recording up to 24 h from onset appeared to be helpful for distinction of AESD from FS before emergence of the second phase of AESD.     

癌症治疗新进展:不可逆性电击穿脉冲疗法

特定电场参数的电脉冲被广泛应用于生物医学领域中。传统的电穿孔常用于细胞融合、转染、电化学疗法等。近年来出现了细胞内电处理的应用,即电场强度为MV/cm、脉宽达到10 ns级的电脉冲能绕过细胞膜影响细胞内信号转导与胞内结构。研究表明,在以上两者的电参数范围之间存在致使癌细胞发生不可逆性凋亡的电场参数,这种介于电穿孔和细胞内电处理的过程即为不可逆性电击穿。不可逆性电击穿通过诱导细胞凋亡而选择性地杀死肿瘤细胞,可能为癌症治疗提供了一种新的方法。     

A Case of Life-Threatening Acute Kidney Injury with Toxic Encephalopathy Caused by Dioscorea quinqueloba

Some herbal medications induce acute kidney injury. The acute kidney injuries caused by herbal medications are mild and commonly treated by palliative care. A 51-years-old man who drank the juice squeezed from the raw tubers of Dioscorea quinqueloba (D. quinqueloba) was admitted with nausea, vomiting and chilling. He developed a seizure with decreased level of consciousness. He was diagnosed with acute kidney injury, which was cured by continuous venovenous hemodialfiltration. Non-detoxified D. quinqueloba can cause severe acute kidney injury with toxic encephalopathy. It is critical to inform possible adverse effects of the medicinal herbs and to implement more strict regulation of these products.     

Therapeutic Effect of Curcumin and Methylprednisolone in the Rat Spinal Cord Injury

In addition to imperiling an individual's daily life, spinal cord injury (SCI), a catastrophic medical damage, can permanently impair an individual's body function. Methylprednisolone (MP), a medically accepted therapeutic drug for SCI, is highly controversial for the lack of consensus on its true therapeutic effect. In recent years, curcumin has served as a potential and novel therapeutic drug in SCI. Our study was intended to investigate the precise effect of MP and curcumin in SCI. We examined the function of MP and curcumin in a SCI model rat, both in vivo and in vitro, and found that there was a momentous improvement in Basso‐Beattie‐Bresnahan scores in the MP‐treated group when compared with Cur‐treated group within 14 days. Results obtained from the histological, immunohistochemistry and ultrastructural examinations evidenced the curative effect of MP was better than curcumin before Day 14. Nonetheless, there was a significant variation in the treatment effect between the MP‐treated and Cur‐treated groups after 14 days. The curcumin's effectiveness was more obvious than MP after 14 days following SCI. As such, we surmise that curcumin has a better therapeutic potential than MP with a prolong treatment time in the wake of SCI. Anat Rec, 301:686–696, 2018. © 2017 Wiley Periodicals, Inc.     

左旋肉碱治疗肝硬化并显性肝性脑病的效果观察

目的 探讨左旋肉碱治疗肝硬化并显性肝性脑病患者的临床疗效。方法 选择2011年3月~2018年6月天津市宝坻区人民医院收治的84例肝硬化并发肝性脑病显性症状,且住院治疗＞1周的患者作为研究对象,随机分为左旋肉碱组和对照组,每组42例。对照组接受常规治疗,左旋肉碱组在常规治疗基础上联合应用左旋肉碱。比较治疗7 天时两组患者肝性脑病West-Haven分级、NCT-A时间、血氨情况,以及两组住院天数、随访6周时肝性脑病复发情况。结果 治疗7天时左旋肉碱组NCT-A时间为（52.31±17.92）s ,低于对照组的（61.32±18.24）s（P＜0.05）;空腹静脉血氨水平为（45.23±27.42）μmol/L,低于对照组的 （60.44±25.43）μmol/L（P＜0.05）;左旋肉碱组HE分级为（1.47±0.51）,与对照组的（1.43±0.54）比较,差异无统计学意义（P＞0.05）。两组患者平均住院日［（8.32±3.60）d vs（9.12±5.81）d］及随访6周肝性脑病早期复发率（35.71% vs 28.57%）分别比较,差异均无统计学意义（P＞0.05）。结论 左旋肉碱虽能降低肝硬化并显性肝性脑病患者血氨水平、改善NCT-A时间,但不能改善肝性脑病严重程度分级、降低住院日及肝性脑病复发率,其在肝硬化并显性肝性脑病中的应用价值有待进一步证实。     

The Effect of Specialized Continuous Renal Replacement Therapy Team in Acute Kidney Injury Patients Treatment

Purpose

Continuous renal replacement therapy (CRRT) has been established for critically ill acute kidney injury (AKI) patients. In addition, some centers consist of a specialized CRRT team (SCT) with physicians and nurses. To our best knowledge, however, ona a few studies have yet been carried out on the superiority of SCT management.

Materials and Methods

A total of 551 patients, who received CRRT between January 2008 and March 2009, were divided into two groups based on the controller of CRRT. The impact of the CRRT management on 28-day mortality was compared between two groups by Kaplan-Meier curve and Cox analysis.

Results

During the study period, the number of filters used, down-time per day, and intensive care unit length of day were significantly higher in non-SCT group than in SCT group (6.2 hrs vs. 5.0 hrs, p=0.042; 5.0 hrs vs. 3.8 hrs, p<0.001; 27.5 days vs. 21.1 days, p=0.027, respectively), while net ultrafiltration rate was significantly lower in non-SCT group than SCT group (28.0 mL/kg/hr vs. 29.5 mL/kg/hr, p=0.043, respectively). In addition, 28-day mortality rate was significantly lower in SCT group than with non-SCT group (p=0.031). Moreover, Cox regression analysis showed that 28-day mortality rate was significantly lower in SCT control group, even after adjusting for age, gender, severity scores, biomarkers, risk, injury, failure, loss, and end-stage renal disease, and contributing factors (hazard ratio 0.91, p=0.046).

Conclusion

A well-trained CRRT team could be beneficial for mortality improvement of AKI patients requiring CRRT.     

36例急性一氧化碳中毒后迟发性脑病的P300电位分析

目的　了解急性一氧化碳中毒后迟发性脑病与 P30 0电位之间的联系 ,为诊疗本病提供更多的依据。方法　对 36例急性一氧化碳中毒后迟发性脑病患者与 4 0例健康者分别进行了 P30 0测定和智商测定 ,并将两组结果进行了比较。结果　患病组与对照组比较 ,P30 0电位成份中 N2、P3潜伏期延长 ,P3波幅降低与对照组存在显著性差异 ( P<0 .0 1 )。智商测定中 1 1分量表得分低于对照组 ,存在显著性差异 ( P<0 .0 1或 P<0 .0 5 )。结论　P30 0电位对急性一氧化碳中毒后迟发性脑病的认知功能及疗效判定有一定的价值。     

瑞替普酶静脉溶栓治疗急性心肌梗死的疗效观察

目的观察瑞替普酶静脉溶栓治疗急性心肌梗死的疗效和安全性。方法30例患者均符合入选和不入选标准,予以瑞替普酶静脉溶栓治疗,观察血管再通的临床指标及不良反应。结果根据冠脉再通标准判断,30例患者血管再通构成比为76.7%,出血发生率为0.67%。结论急性心肌梗死患者选用瑞替普酶静脉溶栓是一种安全、有效的治疗方法。