西宁地区急诊室内重组组织型纤溶酶原激活剂与尿激酶治疗急性心肌梗死的疗效分析

目的：观察重组组织型纤溶酶原激活剂（rt-PA）与尿激酶（UK）治疗西宁地区急性心肌梗死（AMI）的疗效.方法：按溶栓药物不同将60例AMI病人随机分为两组.rt-PA组（30例）,先给rt-PA 15mg,余量35mg用微量泵于30min内泵入,继以50mg于60min内泵入,特殊情况可适当加量;UK组（30例）,将UK150万单位于30min内泵入.结果：rt-PA组血管再通率为80.0％,UK组为53.3％,两组比较差异有显著性（x2=4.800,P＜0.05）;出血并发症的发生,rt-PA组为10.0％,UK组为13.3％,两组比较无显著性差异（x2=0.16,P＞0.05）.住院四周的病死率rt-PA组为6.7％,UK组为10.0％,两组比较无显著性差异（x2=0.22,P＞0.05）.结论：西宁地区rt-PA溶栓疗效优于UK,尤其是在患者发病后3h内进行溶栓治疗效果更佳,不增加出血风险,四周住院病死率无增加.     

联合应用尿激酶和前列腺素E1治疗脑梗死的临床研究

 目的研究探索联合溶栓剂尿激酶(Urokinase,UK)和前列腺素E1(Protaglandin E1,PGE1)对急性脑梗死患者进行静脉溶栓的临床疗效观察.方法将急性脑梗死患者,随机分为联合用药组(46例)和单一用药组(37例)进行溶栓治疗,联合用药组应用UK和PGE1进行治疗,单一用药组应用UK进行治疗.结果联合用药组临床有效率为93.4%,明显高于常规单一用药组(87%).PGE1能增强UK的溶栓效果,两组结果相比,总有效率有显著差异(P＜0.05).两组均未发生大量脑出血及严重其他部位出血.结论静脉内联合应用UK和PGE1,对急性脑梗死患者能降低病死率、致残率,可减少并发症的发生率,是一种疗效好、不良反应少且安全可靠的溶栓方法.     

不同溶栓方法治疗急性大脑中动脉闭塞性脑梗死疗效探讨

目的 探讨不同溶栓治疗方法对急性大脑中动脉闭塞所致急性脑梗死的疗效及安全性.方法 132例大脑中动脉闭塞急性脑梗死患者按就诊顺序采用抽签的方法随机分成3组,分别为静脉溶栓组(48例)、颈内动脉溶栓组(43例)及局部血栓内接触性溶栓组(41例),3组患者均给予阿替普酶治疗.对3组患者治疗前后神经功能缺失情况、疗效、并发症及病死率进行记录并进行统计学分析,符合正态分布的计量资料组间比较采用方差分析,计数资料比较采用x2检验,以P＜0.05为差异具有统计学意义.结果 静脉溶栓组治疗后2、24h及2周有效率分别为18.8％ (9/48)、39.6％(19/48)、45.8％( 22/48),颈内动脉溶栓组治疗后2、24h及2周有效率分别为39.5％( 17/43)、53.5％ (23/43)、58.1％ (25/43),血栓内接触性溶栓组治疗后2、24h及2周有效率分别为78.0％(32/41)、85.4％ (35/41)、87.8％(36/41),血栓内接触性溶栓组2、24h及2周有效率明显高于颈内动脉溶栓组(x2值分别为12.809、9.979、9.289,P值均＜0.01)与静脉溶栓组(x2值分别为31.295、19.425、17.161,P值均＜0.01),差异具有统计学意义.颈内动脉溶栓组治疗后2h有效率高于静脉溶栓组,差异具有统计学意义(x2 =4.801,P＜0.05),24h、2周有效率与静脉溶栓组差异无统计学意义(x2值分别为1.765、1.375,P值均＞0.05).静脉溶栓组、颈内动脉溶栓组、血栓内接触性溶栓组术后2周出血率分别为14.6％( 7/48)、14.0％( 6/43)、7.3％ (3/41),病死率分别为6.2％( 3/48)、4.6％( 2/43)、2.4％( 1/41),各组间差异均无统计学意义(x2值分别为1.328、0.786,P值均＞0.05).结论 血栓内接触性溶栓治疗急性大脑中动脉闭塞性脑梗死起效快,效果好,值得推广.     

急性下肢深静脉血栓溶栓15例疗效分析

目的探讨尿激酶治疗急性下肢深静脉血栓（ADVT）的疗效。方法对15例急性下肢深静脉血栓（ADVT）患者采用尿激酶溶栓治疗。结果溶栓后14天进行疗效判断。本组病例显效10例,有效4例,无效1例,总有效率93．33％。结论应用尿激酶治疗急性下肢深静脉血栓（ADVT）的疗效确切。     

注射用奥美拉唑治疗胃溃疡出血的疗效分析

目的：探讨注射用奥美拉唑治疗胃溃疡出血的疗效。方法110例胃溃疡出血患者随机分为2组,观察组给予注射用奥美拉唑40 mg＋生理盐水100 mL静滴,每天2次,共治疗3天。对照组给予西咪替丁800-1200 mg静滴,每天1次,3天为一疗程。疗程结束后评价疗效及复查胃镜。结果奥美拉唑组的治疗有效率为90.9％,西咪替丁组的治疗有效率为76.4％,比较有统计学差异（ P＜0.05）。奥美拉唑组的溃疡愈合总有效率为85.5％,而西咪替丁组的总有效率为65.5％,两组溃疡愈合总有效率比较有统计学差异（ P＜0.05）。结论注射用奥美拉唑治疗胃溃疡出血疗效显著,明显改善溃疡愈合,是治疗胃溃疡出血的有效药物,值得临床推广。     

重组组织型纤溶酶原激活药静脉溶栓治疗发病4.5 h内急性脑梗死的疗效和安全性

 目的 观察重组组织型纤溶酶原激活药(rt-PA)静脉溶栓治疗发病4.5 h内急性脑梗死的疗效和安全性。方法 选择2012-07至2016-09武警北京总队医院收治的发病在4.5 h内急性脑梗死患者81例,根据患者及家属意愿分为溶栓组和对照组,溶栓组 58 例给予rt-PA 0.9 mg/kg静脉溶栓;对照组23 例采用抗血小板聚集药物等治疗;比较溶栓和常规治疗前和治疗后24 h、7 d及14 d 美国国立卫生研究院卒中量表 (NIHSS) 评分并记录不良反应。结果 溶栓组治疗后 24 h、7 d 及 14 d 时,NIHSS 评分较溶栓前及对照组均明显减少,差异有统计学意义(P<0.05)。溶栓组临床总有效率为86.21％,对照组为52.17％。溶栓组脑出血发生率为10.34％,其中症状性脑出血发生率3.45％;对照组脑出血发生率8.69％,其中症状性脑出血发生率4.35％。溶栓组和对照组病死率分别为5.17%和8.69％,差别无统计学意义(P=0.587)。结论 急性脑梗死患者4.5 h 内给予rt-PA 静脉溶栓治疗较常规治疗有效。     

派通欣治疗急性心肌梗死38例

目的：对比观察派通欣（reteplaserPA）联合低分子肝素与联合普通肝素用于急性心肌梗死（AMI）溶栓治疗的疗效。方法：自2007-10～2009-04,共38例AMI患者随机接受rPA＋普通肝素和rPA＋低分子肝素溶栓治疗,观察溶栓再通率、急性期死亡率及并发症。结果：溶栓后2hrPA＋低分子肝素组再通17例,再通率为89.47%;rPA＋普通肝素再通16例,再通率为84.21%（P〉0.05）。rPA＋低分子肝素组死亡1例,死亡率为5.26%;rPA＋普通肝素死亡1例,死亡率为5.26%（P〉0.05）。rPA＋低分子肝素组出血并发症1例,发生率为5.26%;rPA＋普通肝素出血并发症2例,发生率为10.52%（P〉0.05）。两组共再通33例,再通率为86.84%;共死亡2例,死亡率为5.26%;出血并发症3例,发生率为7.89%。结论：PA联合低分子肝素或联合普通肝素溶栓治疗AMI安全、有效,两组在再通率、死亡率、出血发生率的差异无统计学意义。     

血必净联合舒普深治疗急性胆囊炎34例疗效观察

目的 观察血必净联合舒普深治疗急性胆囊炎的治疗效果.方法 选择消化科收治的急性胆囊炎患者共34例为观察研究对象.随机分为治疗组和对照组,每组17例,除给予常规综合治疗外,观察组与治疗组均给予舒普深3.0+0.9％氯化钠注射液100 mL每12 h一次静点;治疗组给予血必净50 mg加入生理盐水100 mL每日一次静点.所有患者疗程均为7天.结果 治疗组的显效率、有效率及总有效率均大于对照组,且差异有统计学意义(P＜0.05);治疗组的症状缓解好转时间短于观察组;治疗组的化验指标较对照组的化验指标好转明显,并具有统计学意义(P＜0.05).结论 血必净联合舒普深治疗急性胆囊炎疗效确切,能迅速改善症状,缩短住院时间.     

重组人前尿激酶溶栓治疗的血浆纤溶参数监测

目的观察重组人前尿激酶（rhPro—UK）对心肌梗死患者纤溶系统的影响,建立纤溶指标的临床参考标准。方法将127例符合溶栓标准的急性心肌梗死患者随机给予不同剂量的rhPro—UK进行溶栓。观察溶栓前和溶栓后2h血浆纤溶酶原（PLG）、抗纤溶酶（α2-AP）和纤溶酶原激活物抑制物（PAI）的变化以及出血并发症。结果各用药组溶栓开始后2h的PLG及α2-AP活性较溶栓前显著降低（P〈0．001）,rhPro-Uk组与UK组相比溶栓前后未见显著性差异。结论动态监测心机梗死患者rhPro—UK溶栓后血浆中PLG、AP和PAI有助于疗效判定和调节药物剂量。     

重组型纤溶酶原激活剂与尿激酶在急性心肌梗死溶栓治疗中的比较

目的比较小剂量重组型纤溶酶原激活剂（rt-PA）与尿激酶（UK）溶栓治疗急性心肌梗死（AMI）的疗效和安全性。方法回顾42例接受rt-PA和49例接受UK溶栓治疗的AMI患者病例资料,对结果进行比较分析。结果冠脉总再通率rt-PA组和UK组分别为85．71％和61．22％（P〈0．05）;患者在发病3h和3—12h内溶栓,冠脉再通率在rt-PA组为94．11％和80．00％（P〉0．05）,在UK组为70．00％和58．97％（P〉0．05）;出血并发症rt．PA组和UK组分别为9．52％和10．20％（P〉0．05）。结论rt-PA的溶栓冠脉再通率显著高于UK,并且两组在发病后3h内较3h后溶栓均能取得更高的冠脉再通率,但无统计学差异。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.