舒血管药和缩血管药选择性动脉三管介入治疗食管静脉曲线出血…

采用舒血药酚受拉明，硝酸甘油和缩血药垂体后叶素三管介入治疗食管静脉曲张出 血３２例，并与ＶＰ肠系膜上动脉输注３１例和ＰＬ、ＶＰ静脉滴注２４例进行疗效对比。结果：三组总有效率分别为９６．９％、５８．１％、７０．８％。Ⅰ组疗效明显优于Ⅱ组和Ⅲ组。并对其治疗机理作了探讨。     

抗结核组合药对HBVM阳性肺结核病人肝功能影响的观察

目的 观察抗结核组合药对ＨＢＶＭ阳性肺结核病人肝功能的影响。方法 比较ＨＢＶＭ阳性和阴性肺结核病人组合药治疗前后肝功能损害情况。结果 ＨＢＶＭ阳性病人肝损率比阴性者明显增高（Ｐ〈０．０１）;其中“模式Ⅰ”与“模式Ⅱ”病人肝损率差异不显著（Ｐ〉０．０５）,而“模式Ⅰ＋Ⅱ”病人肝损率比“模式Ⅲ”高（Ｐ〈０．０５）。结论 组合药致肝功能损害,ＨＢＶＭ阳性病人比阴性多见,尤以“模式Ⅰ、Ⅱ”病人更易发生,可能与用药前肝脏病理损害严重程度有关。应慎用组合药并积极采取综合措施防范。     

血浆置换治疗弥漫性硬皮病的前瞻性研究

报告血浆置换（ＰＥ）合用青霉时治疗１３例弥漫性硬皮病患者（Ⅰ组）的疗效，并与青霉胺治疗的１６例患者（Ⅱ组）进行比较。Ⅰ组于ＰＥ结束时皮肤积分、齿距、指距、关节压痛指数、握力、血沉、ＩｇＧ、血浆肾素、血管紧张素Ⅱ与治疗前相比有显著改善（Ｐ＜０．０５～ｐ＜０．０１），医生和患者评价有效率分别为６１．１％和６９．２％。观察至治疗后１８个月，病情继续改善，疗效与Ⅱ组相比差异有显著性（Ｐ＜０．０５）。７８次ＰＥ中发生低血压４次，经处理后恢复正常。     

高血压患者血浆和淋巴细胞中血管紧张素Ⅱ、内皮素和一氧化氮的变化及关系

分析一组高血压病患者血浆和淋巴细胞中血管紧张素Ⅱ（ＡｎｇⅡ）、内皮素（ＥＴ）和一氧化氮（ＮＯ）含量的变化及它们间的相互关系。方法高血压（ＥＨ）组３９例，正常对照（ＮＣ）组４１例，放射免疫分析法测定ＡｎｇⅡ、ＥＴ，高效液相色谱分析法测定ＮＯ。结果ＥＨ患者血浆和淋巴细胞中ＥＴ均高于ＮＣ组（Ｐ分别＜０．０５和＜０．０１），ＮＯ低于ＮＣ组（Ｐ分别＜０．０５和＜０．０１）。除血浆ＥＴ和ＮＯ外，各指标改变ＥＨⅡ期较Ⅰ期明显（Ｐ分别＜０．０５和＜０．０１）。逐步回归分析表明，ＥＨ组平均动脉压（ＭＡＰ）与血浆及淋巴细胞中ＡｎｇⅡ、ＥＴ呈正相关，与ＮＯ负相关（ｒ分别＝０．６７，０．８１，Ｐ均＜０．０１）；ＥＨ组血浆和淋巴细胞中ＮＯ与ＡｎｇⅡ、ＥＴ均呈负相关（ｒ分别＝－０．６５１，－０．７２５，Ｐ均＜０．０１）。结论淋巴细胞反映血管内皮细胞内分泌功能比血浆更为敏感，与ＭＡＰ相关性更好，ＡｎｇⅡ、ＥＴ和ＮＯ三者分泌失平衡，是ＥＨ发病的重要原因之一。     

脑干听觉诱发电位对椎基底动脉供血不足的评定价值

目的：研制脑干听觉诱发电位对椎基底动脉供血不足（ＶＢＩ）的评定价值。方法：采用脑干听觉诱发电位（ＢＡＥＰ）对８０例ＶＢＩ患和３８名健康进行检查,测量Ⅰ、Ⅱ、Ⅲ、Ⅴ波峰潜伏期（ＰＬ）和Ⅰ～Ⅲ、Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期（ＩＰＬ）。结果：疾病组的ＶＰＬ、Ⅲ～ⅤＩＰＬ较对照组延长（Ｐ〈０．０５）。疾病组的Ⅲ～Ⅴ／Ⅰ～Ⅲ与对照组比较,具非常显性差异（Ｐ〈０．００１）。８０例ＶＢＩ虱ＢＡＥＰ的异常率为８     

肾功能衰竭患者脑干听觉诱发电位的监测

对３１例老年肾功能患者肾功能和脑干听觉诱发电位（ＢＡＥＰ）监测，并动态检测１１例血液透析（血透）患者治疗前后ＢＡＥＰ变化。结果表明：老年肾功衰竭患者ＢＡＥＰ中Ｉ、Ⅲ、Ｖ主波潜伏期（ＰＬ）、Ｉ～Ⅲ、Ｉ～Ｖ峰间潜伏期较对照组均明显延长（Ｐ＜０．０５～０．０１），且其诱发电位异常与血尿素氮、肌酐呈正相关。１１例血透患者平均透析６．２个月，透析前后同体比较，血透后Ⅲ、Ｖ主波潜伏期和Ｉ～Ⅲ、Ｉ～Ｖ峰间潜伏期均较透析前明显缩短（Ｐ＜０．０５～０．０１）。提示脑干听觉诱发电位监测可作为病情及疗效判断指标，有助于该病神经系统异常的早期诊断。     

心肌缺血预适应对心肌梗死的影响

目的观察缺血预适应对心肌梗死的影响。方法９８例老年患者按梗死前心绞痛病史不同分为远期组（Ⅰ组，２３例）、近期组（Ⅱ组，２５例）、远及近期组（Ⅲ组，２８例）和无预适应组（Ⅳ组，２２例）。分别观察心肌缺血和心肌梗死范围、心律失常发生率及病死率。结果心肌梗死／心肌缺血范围，Ⅰ组（５９．４％±１４．９％）、Ⅱ组（６０．４％±１４．１％）及Ⅲ组（３４．６％±７．８％）均小于Ⅳ组（７２．８％±１７．３％，Ｐ值均＜０．０５），Ⅲ组也小于Ⅰ组和Ⅱ组（Ｐ值＜０．０５）。心律失常发生率，Ⅱ组（１６．０％）和Ⅲ组（１０．７％）低于Ⅰ组（５２．２％）和Ⅳ组（６８．２％，均为Ｐ值＜０．０５）。病死率各组差异无显著性（ｘ２＝７．３８８，Ｐ值＞０．０５）。结论远期和近期缺血预适应都能减少心肌梗死范围，但只有近期缺血预适应能缩小心律失常的发生。     

溴化异丙托品与沙丁胺醇雾化吸入对COPD病人的支气管扩张作用

以随机公开对照试验比起对ＣＯＰＤ病人的支气管扩张作用及副作用．雾化吸入沙丁胺醇（５００μｇ）为Ａ组１６例；雾化吸入溴优异丙托品（５０μｇ）为Ｂ组１５例，雾化吸入沙丁胺醇（５０μｇ）合并异丙托品（５００μｇ）为Ｃ组１５例。结果：Ａ组１５分钟起效；Ｂ组６０分钟起效，其ＦＥＶ１（第一秒用力肺活量）及ＦＶＣ（用力肺活量）的最大改善率（２２．０％、２２．７％）与Ａ给（２１．５％、２３．２％）相比无差异（Ｐ＞０．０５），Ｃ组５、１５分钟ＦＥＶ１的改善率（８．７％、１３．０％）高于Ｂ组（０％、２％）；１８０、３６０分钟ＦＥＶ１的改善率为（２３．９％、１７．３％）高于Ａ组（１３．７％、５．８％）（Ｐ＜０．０５），ＦＶＣ与ＦＥＶ１的改变相近，三组均无严重的副反应。提示：ＣＯＰＤ患者雾化吸入异丙托品具有与沙丁胺醇相近的气道扩张作用．但起效慢．两者合用时，起效快，持续时间长，作用优于单药应用．     

老年人不同体质对心脏结构、血流、功能及血压的影响

目的观察体重对老年人心血管系统的影响。方法６２３例老年人根据体质指数（ＢＭＩ）分为肥胖、超重、正常及消瘦４组，检测血压、空腹血糖（ＢＳ）、胆固醇（ＴＣ）、甘油三酯（ＴＧ）及超声心动图。结果肥胖及超重组较正常体重及消瘦组收缩压（ＳＢＰ）及舒张压（ＤＢＰ）均增高（均为Ｐ＜０．０５），主动脉径（ＡｏＤ）、左房径（ＬＡＤ）、左室舒张及收缩末径（ＥＤＤ及ＥＳＤ）及心肌质量（ＬＶＭ）增加（均为Ｐ＜０．０５）。ＳＢＰ、ＤＢＰ均与体重、ＢＭＩ、ＴＣ、ＬＶＭ及心房收缩期与舒张早期充盈峰值流速（ＡＰＦＶ与ＥＰＦＶ）之比值（Ａ／Ｅ）呈明显正相关（Ｐ＜０．０５、０．０１或０．００１），ＤＢＰ与年龄呈明显负相关（Ｐ＜０．００１）。多元逐步回归分析证实ＬＶＭ、ＡＰＦＶ及ＬＡＤ均与ＢＭＩ呈正相关（均为Ｐ＜０．０１），ＥＰＦＶ与ＢＭＩ呈负相关（Ｐ＜０．０５）；射血分数（ＥＦ）、年龄、ＢＳ与ＳＢＰ呈正相关（Ｐ＜０．０５、０．００１及０．０１），与ＤＢＰ呈负相关（Ｐ＜０．０５或０．００１）。结论体重是影响心脏结构、血流、功能及血压的重要因素；ＥＦ、年龄、ＢＳ是分别影响ＳＢＰ及ＤＢＰ的独立因素。     

消炎痛雾化吸入对慢性支气管炎的疗效观察

采用随机、单盲、安慰剂及正常对照的方法，观察了４８例慢性支气管炎（慢支）急性发作期患者痰及血中６－酮－前列腺素Ｆ１ａ（６－ｋｅｔｏ－ＰＧＦ１ａ）、血栓素Ｂ２（ＴＸＢ２）含量的变化以及它们与疾量，痰干／湿比，肺活量实测值占预计值百分比（ＶＣ％），１秒用力肺活量占用力肺活量百分比（ＦＥＶ１％）的相关性。并观察了消炎痛对它们的影响。结果表明：慢支患者痰及血中６－ｋｅｔｏ－ＰＧＦ１ｕ及ＴＸＢ２均高于正常对照组（Ｐ＜０．０１）。痰及血中６—ｋｅｔｏ－ＰＧＦ１ａ和ＴＸＢ２与痰量和疾干／湿比里正相关（Ｐ＜０．０１）；与ＶＣ％和ＦＥＶ１％呈负相关（Ｐ＜０．０５，Ｐ＜０．０１）。与安慰剂组相比消炎痛雾化吸入可明显降低慢支患者的痰量，痰粘度和血沉（Ｐ＜０．０１）；明显提高ＶＣ％和ＦＥＶ１％（Ｐ值分别小于０．０５，Ｐ＜０．０１）；明显缩短病程（Ｐ＜０．０５）。     

新型净水剂WS-F和MR实验室降氟试验研究

目的 探讨WS-F和MR高分子絮凝剂降氟改水的前景。方法 用自配高氟水和高氟区压把井中取来的高氟水进行室内混凝沉淀模拟试验。结果 用WS-F和MR对自配水(含氟置2．0-7．5mg／L)和高氟区取来的天然井水(含氟量1．15-10．07mg／L)进行降氟试验，都可使被处理的水氟含量控制在饮用水标准以内。结论 本方法降氟能控制处理水的氟含量，有应用前景。     

Advantages of CT nano-contrast agent in tumor diagnosis: A retrospective study

The purpose of this retrospective study was to explore the advantages of computed tomography (CT) nano-contrast agent in tumor diagnosis.A total of 100 patients with malignant tumor who were diagnosed in Shaanxi Province Public Hospital between January 2018 and January 2019 were included in this retrospective study. They were randomly divided into observation and control groups with 50 patients in each group. The patients in the observation group used new type of nano-contrast agent for examination, and the patients in the control group used traditional iohexol contrast agent for examination. The detection rate, misdiagnosis rate, and incidence of adverse reactions were observed. In addition, single photon emission computed tomography or CT scan was performed on patients to observe the radioactive concentration.The detection rate was 100% in the observation group and 84% in the control group, and the difference between the 2 groups was statistically significant (χ² = 8.763, P = .001). The incidence of adverse reactions was 2% in the observation group and 30% in the control group, and the difference between the 2 groups was significantly different (χ² = 12.683, P = .000). The radioactive concentration in the observation group was markedly higher than that in the control group (t = 19.692, P = .001).The use of CT nano-contrast agent in tumor diagnosis had higher detection rate of tumor and radioactive concentration, and it had lower misdiagnosis rate and adverse reaction rate than traditional iohexol contrast agent.     

左西孟旦治疗心衰的临床研究进展

左西孟旦（levosimendan,LS）是一种新型钙增敏剂,其正性肌力作用主要通过增加心肌肌钙蛋白对Ca2＋的敏感性和开放细胞膜上ATP敏感的K＋通道,增加心肌收缩力,同时扩张外周血管和冠状动脉,减轻心脏前后负荷。LS目前主要用于治疗急性和顽固性心力衰竭（HF）。国内外指南已将其列为IIa类（B级证据）,为HF的药物治疗增加了选择。     

抗结核药物引起的副作用综合报告

目的了解各种抗结核药物引起的副作用并掌握一般处理原则。方法直接或间接证明６２例中由抗结核药物引起的副作用，观察并分析各种副作用分布情况、出现时间及表现形式。结果过敏反应频度占副作用的首位，共３７例，占６０％；严重副反应绝大多数由利福霉素类引起；副作用出现时间多为服药后２个月以内；药物服用过量易导致副反应发生；多种药物可同时或相继产生严重副作用。结论一旦发生严重药物副作用，必须立即停药，及时治疗，否则后果严重；利福霉素类药停药后再服，有可能加重过敏反应程度，故要详细询问既往用药情况，对有肝炎史、酗酒史、药物过敏史和年老体弱者用药过程中要严密观察；对多种药物过敏者，无论反应轻重，以快停药、早脱敏为原则；必须确定过敏原时，要使用常量的１／１０以下，并制定应急处理措施，严重过敏者不应进行重复验证     

Optimal strategy of systemic treatment for unresectable pancreatic neuroendocrine tumors based upon opinion of Japanese experts

Background/objectivesA number of therapeutic agents have been reported to be clinically useful for the management of the patients with unresectable pancreatic neuroendocrine tumors (PanNETs) including somatostatin analogues, molecular-targeted agents and cytotoxic agents. However, the optimal strategy for selection among those treatment modalities above in these patients has remained unexplored.MethodsJapanese experts for PanNET discussed and determined the optimal treatment strategies according to the results of previously reported studies.ResultsThe tumor volume of liver metastases and the Ki-67 labeling index were unanimously accepted as indicators of the tumor burden and tumor aggressiveness, respectively, which are two most clinically pivotal factors for determining the strategy of systemic treatment for unresectable PanNETs. In addition, for those with a relatively small tumor burden and slow disease progression, somatostatin analogues were selected as the first-line treatment agents. For those with a relatively large tumor burden and rapid tumor progression, cytotoxic agents were selected, possibly aiming at tumor shrinkage. For those of intermediate tumor volume and/or growth rate, molecular-targeted agents were selected as the first choice. Based on this strategy discussed among the experts, we tentatively prepared a MAP for proposing optimal treatment strategy and examined its validity in some patients with unresectable PanNETs. Results validated the usefulness of this MAP proposed for patients harbouring unresectable PanNETs.ConclusionWe herein propose a tentative MAP for optimal treatment selection for the patients harbouring unresectable PanNETs. Further large scale studies are, however, warranted to validate the usefulness of this MAP proposed in this study.     

A meta-analysis of the risk of total cardiovascular events of isosmolar iodixanol compared with low-osmolar contrast media

BackgroundThe iso-osmolar contrast agent iodixanol may be associated with a lower incidence of cardiac events than low-osmolar contrast media (LOCM), but previous trials have yielded mixed results.ObjectiveTo compare the risk of total cardiovascular events of the iso-osmolar contrast medium, iodixanol, to LOCM.MethodsMedical literature databases were searched to identify comparisons between iodixanol and LOCM with cardiovascular events as a primary endpoint. A random-effects model was used to obtain pooled odds ratio (OR) for within-hospital and 30-day events.ResultsA total of 2 prospective cross-sectional studies and 11 randomized controlled trials (RCTs) (covering 6859 subjects) met our criteria. There was no significant difference in the incidence of within-hospital and 30-day cardiovascular events when iodixanol was compared with LOCM, with pooled OR of 0.72 (95%CI 0.49–1.06, p = 0.09) and 1.19 (95%CI 0.70–2.02, p = 0.53), respectively. Subgroup analysis showed no relative difference when iodixanol was compared with ioxaglate (OR = 0.92, 95%CI 0.50–1.70, p = 0.80) and iohexol (OR = 0.75, 95%CI 0.48–1.17, p = 0.21). However, a reduction in the within-hospital cardiovascular events was observed when iodixanol was compared with LOCM in the RCT subgroup (OR = 0.65, 95%CI 0.44–0.96, p = 0.03). Sensitivity analyses revealed that three studies had a strong impact on the association of within-hospital cardiovascular events between iodixanol and LOCM. Meta-regression analysis failed to account for heterogeneity. No publication bias was detected.ConclusionsThis meta-analysis demonstrates that there is no conclusive evidence that iodixanol is superior to LOCM overall with regard to fewer cardiovascular events.     

12例嗜麦芽窄食单胞菌感染及其药敏研究

目的：研究嗜麦芽窄食单胞菌引起的感染危险因素及有效抗生素,方法分析１２例嗜麦芽窄食单胞菌感染的临床资料,应用Ｓｃｅｐｔｏｒ系统测定了１８株嗜麦芽窄食单胞菌对２０种抗性素的敏感度。结果嗜麦芽窄食单胞菌多见于呼吸道染,其次为菌血症及局部感当了菌株对大多数抗生素耐药,结论严重基础疾病,应用广谱抗生素及免疫抑制剂是嗜麦芽窄食单胞菌感染的危险因子,替卡西林、环丙沙星和阿米卡星为抗嗜麦芽窄食单胞菌有相对活性的     

溶栓药物的研究现状及发展趋势

血栓性疾病是西方富裕国家人类死亡的主要原因,严重危害着人类健康。动脉血栓性疾病可导致急性心肌梗死（AMI）、中风;静脉血栓性疾病可导致深静脉栓塞（DVT）和肺栓塞（PE）。这类疾病主要危害心、脑、肺的血管系统,使成年人死亡或残疾。在美国,每年大约有20万人死于PE;在我国,每年超过200万人死于心脑血管疾病,每年需要进行溶栓治疗的患者超过300万。全世界有血栓患者1500万,所需溶栓剂的潜在市场约20亿美元。