Child abuse in the 24 hours after psychotherapy sessions.

Six cases in which, unknown to the therapist, psychotherapy apparently initiated or exacerbated child abuse are reviewed. Once the connection between therapy and child abuse was recognized and pointed out to the patients, further therapy led to a significant clinical improvement. The necessity for additional support, such as is offered by Prevention, is emphasized.     

溶栓后即刻经皮冠状动脉介入治疗对发病3 h内急性ST段抬高型心肌梗死预后的影响

目的探讨溶栓后即刻经皮冠状动脉介入治疗(PCI)对发病3h内急性ST段抬高型心肌梗死(STEMI)的安全性和疗效,并与直接PCI策略进行比较。方法连续135例接受PCI的发病3h内STEMI患者,随机分为尿激酶150万U溶栓后即刻PCI和直接PCI两组,记录术前梗死相关动脉(IRA)狭窄程度和术后心肌梗死溶栓试验(TIMI)血流分级、出血并发症及90d随访期间终点事件(死亡、再梗死、再次血运重建、休克及急性左侧心力衰竭)发生率。结果即刻PCI组与直接PCI组相比,出血发生率的差异无统计学意义(7.5%比7.4%,P>0.05),但术前IRA开通率显著升高(50.7%比19.1%,P<0.01),术中慢血流发生率显著降低(13.4%比27.9%,P<0.05),90d复合终点事件发生率呈减低趋势(6.0%比13.2%,P=0.06)。结论发病3h内溶栓后即刻PCI不增加出血并发症,90d预后可能优于直接PCI。     

肾穿术6小时后下床排尿对患者术后并发症的影响

目的探讨经皮肾脏穿刺组织活检术(肾穿术)6小时后患者下床排尿对术后并发症影响。方法将86例行肾穿术的患者分为实验组和对照组各43例,两组在术后6小时采取不同的排尿方法:下床排尿(实验组)和卧床排尿(对照组),观察两种排尿方法对术后并发症及尿潴留的影响。结果术后并发症在两组之间无统计学差异(P>0.05);而尿潴留情况,实验组低于对照组(P<0.05)。结论肾穿术6小时后患者下床排尿不会增加术后并发症,且明显降低术后尿潴留。     

正常产后38小时发生急性肺栓塞1例

1病历简介患者25岁、孕1产0,孕38^＋1W,住院号58902,因“孕足月,阴道流水9h,阵发腹痛4h”为主诉,于2009年11月3日8Am以“G1P0孕338^＋1w临产、胎膜早破”急诊收住院。患者系G1P0,平素月经规律,孕期过程顺利,     

严重烧伤病人伤后8小时的心肌酶谱变化

目的探讨烧伤后是否发生心肌损害，心肌损害程度与烧伤面积的关系，以及与骨折、脑外伤等创伤病人的区别。方法检测烧伤、骨折、脑外伤病人伤后8小时血清心肌酶谱活性，与正常对照组进行比较；烧伤后8小时CK-MB活性与烧伤面积的关系采用线性相关分析。结果烧伤病人CK、CK-MB、AST显著增高（P＜0．01），LDH无显著性差异（P＞0.05）；骨折及脑外伤病人CK显著增高（P＜0．01），CK-MB、AST、LDH无显著性差异（P＞0.05）。烧伤后8小时CK-MB活性与烧伤面积呈正相关（r=0．73．P＜0．01）。结论与骨折、脑外伤等创伤病人不同，烧伤后病人在早期即可发生心肌损害，并随烧伤面积的增加而加重。骨折及脑外伤病人CK显著增高是骨骼肌损伤所致。     

急性心肌梗死溶栓后24小时内T波倒置的临床观察

目的 :探讨急性心肌梗死溶栓后 2 4h内T波倒置与冠脉再通的关系及临床意义。方法 :根据溶栓后2 4h内T波倒置与否 ,将 5 6例接受溶栓治疗的患者分为A组 (倒置组 )和B组 (未倒置组 ) ,根据临床间接血管再通标准观察两组冠脉再通情况及临床意义。结果 :两组冠脉再通率分别为 72 4%和 3 3 3 % (P <0 .0 1) ;住院期间室射血分数分别为 ( 5 7 5± 11 6) %和 ( 4 6 2± 13 2 ) % (P <0 .0 1) ;住院期间冠脉事件发生率分别为 13 7%和 3 7 0 % (P <0 .0 5 )。结论 :急性心肌梗死溶栓后 2 4h内T波倒置可作为冠脉再通的临床间接指标 ,同时提示更好的临床预后。     

窒息新生儿生后24小时血糖的检测结果分析

目的 :探讨窒息新生儿生后 2 4小时血糖的变化及意义。方法 :93例新生儿于生后 2 4小时内、治疗前抽血送检 ,2 0例正常新生儿于生后次日清晨抽血送检。血糖由全自动生化分析仪进行分析。结果 :(1)重度窒息组血糖明显高于轻度窒息组及对照组。(2 )死亡儿血糖明显高于存活儿 (P <0 .0 0 1) ,且高血糖发生率亦高 (P <0 .0 0 1)。(3)重度窒息儿高血糖发生率明显高于轻度窒息儿 (P <0 .0 0 1)。结论 :窒息早期由于应激 ,儿茶酚胺及皮质醇分泌增加 ,促使血糖升高 ,与病情和预后有一定联系。病情越重 ,血糖越高 ,预后越差     

Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction

Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients. The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 +/- 0.10 vs 6.18 +/- 0.09 mmol/l) and women (6.75 +/- 0.30 vs 6.44 +/- 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P less than 0.0005). Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there with a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance. These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients' basal lipid state.     

体外受精后不同时期观察受精对胚胎质量的影响

目的探讨体外受精后不同时期观察受精对胚胎质量的影响。方法随机对进行体外受精-胎移植（in vitro fertilization- embryo transfer, IVF- ET）治疗的264个周期分两组进行观察,均于取卵后2—6小时授精。A组为实验组（176周期）：于受精后5小时左右去除卵丘细胞提早进行受精观察;B组为对照组（88周期）：受精后20小时左右去除卵丘细胞观察原核形成的情况。分别统计两组的年龄、不孕年限、获卵数、正常受精率、异常受精率、优质胚胎率。结果两组的女方年龄、不孕年限、获卵数、正常受精率、异常受精率、优质胚胎率等差异无统计学意义（P〉0．05）。结论IVF—ET中提早观察受精对胚胎质量无明显影响。