血清降钙素原与C-反应蛋白对单纯急性左心衰竭患者肺部感染的诊断效果研究

目的探究血清降钙素原与C-反应蛋白对单纯急性左心衰竭患者肺部感染的诊断效果,为临床对此类患者的诊断及治疗提供参考。方法选取2016年2月-2018年5月河北北方学院附属第一医院收治的急性左心衰竭患者200例为研究对象,根据肺部感染情况分为对照组97例与研究组103例,对照组为单纯急性左心衰竭患者,研究组为急性左心衰竭并发肺部感染患者。比较两组患者入院第1天、第3天、第5天及第7天的血清降钙素原与C-反应蛋白水平,并分别分析两组血清降钙素原、C-反应蛋白与脑钠肽的相关性,通过ROC曲线图寻求最佳诊断界值。结果入院后第1天、3天、5天及7天,研究组患者的血清降钙素原、C-反应蛋白及脑钠肽水平均高于对照组患者(P<0.001);两组患者的血清降钙素原、C-反应蛋白及脑钠肽水平变化趋势均一致,但并不存在相关性;血清降钙素原最佳诊断界值为0.574μg/L,且当血清降钙素原水平>0.574μg/L时,诊断单纯急性左心衰竭患者肺部感染的特异性及敏感度较好;C-反应蛋白最佳诊断界值为110 mg/L,且当C-反应蛋白水平高于此值时,诊断单纯急性左心衰竭患者肺部感染的敏感性为0.705,特异性为0.762。结论血清降钙素原在诊断单纯急性左心衰竭肺部感染患者时存在最佳诊断界值,且特异性及敏感度均较高,而C-反应蛋白则不适于作为诊断单纯左心衰竭肺部感染患者的标志物。     

调节肠道微生态疗法对肝硬化自发性细菌性腹膜炎的治疗意义

目的 研究调节肠道微生态疗法在肝硬化自发性细菌性腹膜炎(SBP)中的作用.方法 将38例肝硬化SBP患者(SBP组)按机械抽样法随机分为两组,常规治疗组18例,采用抗感染、保肝、利尿等常规综合治疗,微生态治疗组20例,在常规综合治疗基础上加用微生态制剂(枯草杆菌、肠球菌二联活菌肠溶胶囊和乳果糖口服液),观察两组患者治疗前后血浆内毒素(LPS)、降钙素原(PCT)和C反应蛋白(CRP)水平变化,并与15例肝硬化无菌性腹水(SA组)和15例健康体检者(健康对照组)比较.结果 SBP组血浆LPS、PCT、CRP水平明显高于SA组以及健康对照组,差异有统计学意义(P<0.05).微生态治疗组治疗前血浆LPS、PCT、CRP水平与常规治疗组比较差异无统计学意义(P>0.05),但微生态治疗组治疗后血浆LPS、PCT、CRP水平较常规治疗组治疗后明显下降[(0.032±0.016)kU/L比(0.068±0.027)kU/L、(0.98±0.72)μg/L 比(3.24±1.12)μg/L、(5.74±2.89)mg/L比(12.35±7.65)mg/L](P<0.05).结论 加用微生态调节治疗能明显改善肝硬化SBP患者体内LPS水平,降低炎性反应,从而控制SBP发生发展,值得临床推广.     

血清C-反应蛋白及降钙素原对评估儿童社区获得性肺炎的作用

目的探讨血清C-反应蛋白及降钙素原在儿童社区获得性肺炎(CAP)病情评估中的作用。方法选取我院2014年6月至2017年6月期间收治的100例CAP患儿,按病情严重程度分为轻度CAP组(54例)和重度CAP组(46例),另选取同期于我院体检的50例健康儿童作为对照组。对比三组的血清C-反应蛋白和降钙素原水平。结果轻度CAP组和重度CAP组的血清C-反应蛋白和降钙素原水平均明显高于对照组(P<0.05)。重度CAP组的血清C-反应蛋白和降钙素原水平均明显高于轻度CAP组(P<0.05)。结论 CAP患儿的血清C-反应蛋白和降钙素原水平均明显升高,血清C-反应蛋白及降钙素原可有效评估儿童CAP的病情严重程度。     

血清降钙素原水平变化在脑梗死患者肺部感染检测中的临床价值

目的研究血清降钙素原水平变化在脑梗死肺部感染的检测及临床价值,为诊治脑梗死患者肺部感染提供参考。方法将2011年8月-2013年9月收治的100例脑梗死肺部感染患者纳入观察组,将同期在医院体检的100名健康者纳入对照组,检测两组受试者的血清降钙素原、C-反应蛋白含量及血常规指标,观察肺部感染患者的临床症状、体征缓解情况,采用SPSS18.0软件对数据进行统计分析。结果观察组患者的血清降钙素原(13.8±2.5)μg/L、C-反应蛋白(14.27±2.68)mg/L、白细胞计数(14.8±1.9)×109/L、中性粒细胞(71.4±10.4)%均高于对照组;血清降钙素原联合检测的灵敏度和特异性分别为94.0%和96.0%,高于血常规和C-反应蛋白单独检测;血清降钙素原水平与咳嗽、咳痰、气喘、肺部罗音缓解时间呈正相关关系。结论血清降钙素含量联合检测能够提高脑梗死患者肺部感染诊断的敏感性和特异性,且与临床症状和体征的缓解具有相关性,是理想的辅助检查指标。     

不同检验方法应用于肺炎支原体感染患儿中的临床诊断价值

目的探讨检测血清降钙素原及C-反应蛋白对肺炎支原体感染的诊断价值。方法选取我院2016年1—12月500例下呼吸道感染患者为研究对象,其中112例确诊为肺炎支原体肺炎患者纳入此次研究对象,其中66例为急性期,46例为恢复期;另选取医院同期健康体检者36例作为本次研究对照组,分别于患者入院时抽取其空腹下肘静脉血液5 ml,待离心处理后进行检测,采用免疫增强散射比浊法检测其血清降钙素原(PCT)水平,采用Quik Read CRP分析仪分析检测其血清C-反应蛋白(CRP)水平。结果急性期患者PCT及CRP水平分别为(0.29±0.10)ng/ml、(17.1±3.3)mg/L,明显高于恢复期(0.20±0.07)ng/ml、(8.5±3.3)mg/L,差异有显著统计学意义(P0.05);急性期患者PCT及CRP水平分别为(0.29±0.10)ng/ml、(17.1±3.3)mg/L,明显高于对照组(0.10±0.01)ng/ml、(5.5±1.9)mg/L;恢复期患者PCT及CRP水平明显高于对照组,差异有显著统计学意义(P0.05)。结论小儿肺炎支原体感染患者血清降钙素原及C-反应蛋白均较正常健康人群高,因此,检测患者血清降钙素原及C-反应蛋白可有助于临床肺炎支原体感染的诊断,从而为临床治疗提供参考。     

胸腔感染与血清降钙素原水平变化的相关性分析

目的分析胸腔感染与血清降钙素原水平变化的相关性,以探讨血清降钙素原的检测在胸腔感染诊治中的临床应用价值。方法选取医院收治的胸腔感染患者480例,根据患者感染的严重程度,将其分为重症感染组189例及非重症感染组291例,同时选取同期在医院体检的健康受试者100名为对照组,所有受试者均接受血清降钙素原水平的检测,对比3组受试者的血清降钙素原水平和APACHEⅡ评分结果,并对比胸腔感染患者治疗前后血清降钙素原水平的变化。结果重症感染组的血清降钙素原水平为(67.51±12.7)μg/L,显著高于非重症感染组和对照组(P<0.05),非重症感染组的血清降钙素原水平为(17.21±5.38)μg/L,显著高于对照组(P<0.05);重症感染组的APACHEⅡ评分为(23.22±5.32)分,显著高于非重症感染组和对照组(P<0.05),非重症感染组的APACHEⅡ评分为(3.21±1.90)分,与对照组对比,差异无统计学意义;Pearson相关分析结果显示,重症胸腔感染和非重症胸腔感染的血清降钙素原水平和APACHEⅡ评分结果呈正相关(P<0.05);胸腔感染治疗前的血清降钙素原水平为(40.23±8.91)μg/L,显著高于胸腔感染治疗后和对照组(P<0.05),胸腔感染治疗后的血清降钙素原水平为(6.31±1.93)μg/L,与对照组对比差异无统计学意义。结论血清降钙素原的检测有助于早期诊断胸腔感染,同时对胸腔感染严重程度的判断以及治疗策略的制定均有重要的指导意义。     

C-反应蛋白与降钙素原在儿童感染性疾病中的诊断价值

目的分析C-反应蛋白与降钙素原在小儿脓毒症血流感染及其他部位感染性疾病中的含量,从而探讨其临床诊断价值。方法选取2013年3月-2014年3月小儿全身炎症反应综合征患儿90例,分为脓毒症组和非脓毒症组,患儿各45例;测定患儿C-反应蛋白与降钙素原含量,数据采用SPSS 19.0软件进行统计分析。结果脓毒症组C-反应蛋白为(119.34±17.34)mg/L、降钙素原为(11.92±1.59)μg/L;非脓毒症组C-反应蛋白为(46.12±16.60)mg/L、降钙素原为(1.41±0.42)μg/L,脓毒症组明显高于非脓毒症组,差异有统计学意义(P<0.05)。结论 C-反应蛋白与降钙素原在小儿脓毒症血流感染及其他部位感染性疾病中的早期诊断有一定鉴别作用,其中,降钙素原意义更大,临床值得推广。     

血清降钙素原在患者腹膜透析感染性腹膜炎中的诊断价值

目的探讨腹膜透析并发感染性腹膜炎患者血清降钙素原(PCT)检测的临床意义,为腹膜透析并发感染性腹膜炎的早期发现提供参考依据。方法选取2011年3月-2013年3月医院腹膜透析中心行腹膜透析患者126例,采用电化学发光免疫分析方法检测腹膜透析相关性腹膜炎组62例、非腹膜炎组64例,同期选取健康体检人员60名为对照组,对3组受试者血清PCT水平检测,比较其C-反应蛋白(CRP)和白细胞计数(WBC)。结果腹膜炎组、非腹膜炎组和健康对照组PCT水平和阳性率分别为(5.25±1.72)(0.68±0.16)(0.51±0.13)μg/L和88.71%、4.69%、3.33%;腹膜炎组PCT水平和阳性率均明显高于非腹膜炎组和健康对照组(P<0.05);腹膜透析并发感染性腹膜炎患者治疗后血清PCT表达水平和阳性率明显下降,与治疗前比较差异有统计学意义(P<0.05)。结论血清PCT水平在腹膜透析并发感染性腹膜炎患者中明显升高,是一项良好的对腹膜透析并发感染性腹膜炎鉴别诊断和疗效监测指标。     

天枢穴贴敷对呼吸机相关性肺炎患者的呼吸力学与血清炎症因子的影响

目的探讨天枢穴贴敷对呼吸机相关性肺炎的呼吸力学及血清炎症因子的影响。方法选择2017年3月-2018年3月淳安县中医院收治的呼吸机相关性肺炎患者98例为研究对象,随机分为试验组与对照组,各49例。两组均采用常规抗感染治疗,常规细菌培养后依据细菌学检查和药敏试验结果,按照结果采用有效抗菌药物进行抗感染治疗。试验组加用天枢穴贴敷,贴敷膏采用医院自配的通里膏(药物成分为生大黄、芒硝、枳实、冰片)于天枢穴贴敷。比较两组患者治疗前后氧和指数(PaO_2/FiO_2)、呼吸力学及血清超敏C-反应蛋白(hs-CRP)和降钙素原(PCT)水平。结果两组患者治疗后PaO_2/FiO_2较治疗前均升高(P<0.001);试验组治疗后PaO_2/FiO_2为(243.68±20.19)mmHg高于对照组(P<0.001)。两组患者治疗后肺顺应性较治疗前升高,而气道峰压和气道阻力较治疗前降低(P<0.001);试验组治疗后肺顺应性为(34.68±3.10)ml/mmH_2O高于对照组,而气道峰压和气道阻力分别为(18.49±1.80)cmH_2O、(8.78±1.01)cmH_2O/(L/s)低于对照组(P<0.001)。两组患者治疗后血清hs-CRP和PCT较治疗前降低(P<0.001);试验组治疗后血清hs-CRP和PCT分别为(16.89±1.92)mg/L、(2.41±0.67)ng/L低于对照组(P<0.001)。结论天枢穴贴敷可改善呼吸机相关性肺炎患者的呼吸力学指标,及减轻患者炎症反应,具有一定的临床价值。     

血清降钙素原与C-反应蛋白水平评价美罗培南与头孢他啶对中枢神经系统感染疗效研究

目的探讨应用血清降钙素原(PCT)和C-反应蛋白(CRP)水平评价美罗培南和头孢他啶对中枢神经系统感染疗效,为合理应用抗菌药物提供依据。方法对医院2011年3月-2013年1月收治的90例中枢神经系统革兰阴性杆菌感染患者,采取两种不同的抗菌药物治疗,A组48例患者采用美罗培南治疗,B组42例患者采用头孢他啶治疗,对两组疗效进行分析,同时比较患者血清降钙素原和C-反应蛋白水平的变化,并与30名健康者为对照组进行比较。结果两种抗菌药物对中枢神经系统革兰阴性杆菌感染治疗,A组总有效率为95.84%、B组为80.95%,差异有统计学意义(P<0.05);同时两组患者发病后血清降钙素原和C-反应蛋白水平要显著高于对照组,而经过相同时间治疗后,A组两种指标要显著优于B组,差异有统计学意义(P<0.05);血清降钙素原和C-反应蛋白水平对中枢系统感染诊断具有较高的灵敏度、特异度和准确度。结论中枢神经系统感染患者降钙素原和C-反应蛋白水平可以作为中枢系统感染程度的指标,同时不同抗菌药物对中枢神经系统感染疗效不同而影响降钙素原和C-反应蛋白水平。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.