门冬氨酸钾镁治疗充血性心力衰竭40例临床疗效观察

目的：探讨慢性充血性心力衰竭时应用门冬氨酸钾镁改善心功能的临床疗效．方法：81例心衰病人分两组，治疗组40例在常规抗心衰的基础上酌情加滴门冬氨酸钾镁7～10天，41例对照组予常规抗心衰治疗。结果：治疗组总有效率97．50％，对照组总有效率78．05％。两组总有效率之间差异显著（P＜0．05）。结论：门冬氨酸钾镁能改善心肌代谢，缩短纠正心衰的时间。     

老年充血性心衰患者血浆内皮素及肾素系统活性变化及其临床意义

目的：研究老年充血性心力衰竭患者血浆内皮素及肾素系统活性的变化及其临床意义。方法：采用放射免疫分析法分别测定了受试者（心衰组、对照组及健康组）血浆内皮素（ET）、血管紧张素Ⅱ（AⅡ）和醛固酮（ALD）含量,同时用心脏多普勒超声检查心脏左室射血分数（LVEF％）,研究血浆内皮素及肾素系统活性的变化及两者相关性。结果：心衰组AⅡ、ET水平较对照组明显增高（P〈0．01）;心功能Ⅲ、Ⅳ级组AⅡ、ET水平明显高于对照组（P〈0．05）;与健康组比较,心衰组和对照组AⅡ、ET、ALD水平均明显增高（P〈0．05）。心衰组ET水平与AⅡ水平呈正相关（r=0．754,P〈0．01）,ET水平与ALD水平亦呈正相关（r=0．352,P〈0．05）。结论：老年充血性心力衰竭ET及肾素系统活性增加与心衰的严重程度有关,提示内皮素及肾素系统活性在老年充血性心力衰竭的发病中可能起到重要作用。     

依那普利与螺内酯联合治疗慢性充血性心力衰竭的临床效果观察

目的分析依那普利与螺内酯联用方案在慢性充血性心力衰竭的应用价值,探讨慢性充血性心力衰竭的有效治疗方案。方法选取2009年5月～2012年11月收治163例慢性充血性心力衰竭患者为实验对象,随机分为实验组82例（依那普利与螺内酯联用方案治疗）和对照组81例（基础治疗）,比较两组治疗效果的不同。结果两组患者均未发生严重不良反应。观察组总有效率95．1％;对照组总有效率71．6％,经统计比较,P〈0．05,差异存在显著性。结论依那普利与螺内酯联用方案是慢性充血性心力衰竭的有效方法。     

小剂量螺内酯治疗收缩性心力衰竭60例疗效观察

目的：探讨并比较小剂量螺内酯在依那普利联合倍他乐克基础上治疗收缩性心力衰竭的临床疗效。方法：在采用依那普利及倍他乐克治疗的基础上将60例心功能Ⅲ级或Ⅳ级患者采用双盲法随机分组，给予小剂量螺内酯治疗．16周后对比观察左心室收缩末期容积、左心室射血分数、胰岛素抵抗指数、血钾平均值的变化，并记录高钾血症的发生率。结果：治疗组患者左心室收缩末期容积、左心室射血分数及胰岛素抵抗指数与治疗前比较有显著改善（P〈0．05．0．01），与对照组治疗后比较存在明显差异（P〈0．05—0．01），心功能改善的有效率治疗组亦明显高于对照组，血钾平均值及高钾血症发生率两组之间比较无明显差异。结论：小剂量螺内酯联合依那普利、倍他乐克治疗收缩性心力衰竭能明显改善收缩性心力衰竭患者的左心室功能及胰岛素抵抗程度，能从生物学调整的角度来改善收缩性心力衰竭。     

小剂量甲状腺素治疗重症心力衰竭疗效观察

目的：观察小剂量甲状腺素在重症充血性心力衰竭中的疗效。方法：将心功能Ⅲ级和Ⅳ级34例随机分成对照组和观察组，测定两组的甲状腺激素水平，观察组给予小剂量甲状腺素治疗，观察其疗效。结果：两组均有不同程度的T3（三碘甲腺原胺酸）、FT3（游离甲状腺胺酸）降低，rT3（反三碘甲腺原胺酸）升高，TSH（促甲状腺素）正常，Ⅳ级心功能者还伴有T4（甲状腺素）、FT4（游离甲状腺素）明显下降（P〈0．01）；观察组经治疗后显效率及总有效率均明显高于对照组（P〈0．01）；观察组治疗后各心功能指标均优于对照组（P〈0．05）。结论：重症心力衰竭多伴有甲状腺激素变化，小剂量补充甲状腺素能提高血中游离甲状腺素含量，对纠正重症心衰有效，且无明显不良反应。     

小剂量甲状腺素治疗慢性充血性心力衰竭伴低T3综合征的疗效观察

目的观察小剂量左旋甲状腺素治疗慢性充血性心力衰竭心功能Ⅲ～Ⅳ级伴低T3综合征的临床治疗效果和安全性。方法选择慢性充血性心力衰竭心功能Ⅲ～Ⅳ级伴低B综合征患者40例，随机分为治疗组和对照组，治疗组在常规心衰治疗基础上加口服左旋甲状腺素（L-T4）25～50μg／d治疗，疗程为12周。比较两组治疗前后血清甲状腺激素水平、左室射血分数（LVEF）、左窒舒张术期（LVDD）、E峰从峰比（E／A），心输出量（CO）、心率变化（HR）以及新发心律失常、急性冠脉综合征发生情况。，结果治疗组治疗后甲状腺激素水平较治疗前明显上升（P〈0．05）。两组心功能LVEF、LVDD、CO、E／A治疗后较治疗前有明显改善．差异最著有统计学意义（P〈0．05）；治疗后治疗组心功能LVEF、LVDD、CO、E／A较对照组有明显改善，差异显著有统计学意义（P〈0．05）．．结论存慢性充血性心力衰竭心功能Ⅲ～Ⅳ级伴低T3综合征患者积极补充小剂量左旋甲状腺素可明显改善患者心功能和提高患者生存质量，本研究认为中短期应用小剂量左旋甲状腺素治疗CHF伴低T3综合征是一种安全有效可行的辅助治疗疗法．     

门冬氨酸钾镁治疗血性心力衰竭40例临床疗效观察

目的：探讨慢充血性心力衰竭时应用门冬氨酸钾镁改善心功能的临床疗效。方法：８１例心衰病人分两组：治疗组４０例在常规抗心衰的基础上酌情加滴六冬氨酸钾镁７￣１０天，４１例对照组予常规抗心衰治疗。结果：治疗组总有效率９７．５０％，对照组总有效率７８．５０％。两组总有效率之间差异显著（Ｐ〈０．０５）。结论：门冬氨酸钾镁能改善心向代谢，缩短纠正心衰的时间。     

常规疗法加螺内酯治疗慢性充血性心力衰竭的疗效观察

目的：观察常规疗法加螺内酯治疗心力衰竭的效果，改善心衰病人的生活质量。方法：选择门诊及住院的心衰病人62例，随机分为观察组和对照组，对照组用心衰的常规治疗方法，观察组是在常规治疗方法的基础上加用螺内酯40mg/日口服。结果：两组病人血清钾稳定，观察组较对照组住院频率明显减低、结论：在常规治疗的基础上加用螺内酯可降低心衰病人的住院频度，明显减少心衰病人室性心律失常的发生，无高钾血症发生。     

苯那普利联合氯沙坦治疗慢性充血性心衰的疗效分析

目的探讨苯那普利联合氯沙坦治疗慢性充血性心衰（CHF）的临床疗效。方法选择26例CHF病人，心功能NYHAⅡ～Ⅳ级，随机分为两组：苯那普利组和苯那普利联合氯沙坦组。观察治疗前后临床症状、体征、心胸比率、左室舒张末内径（LVDd）和左室射血分数（LVEF）。结果两组改善心功能的效果无显著性差异，苯那普利联合氯沙坦组总有效率88．9％；苯那普利组总有效率为87．5％，P〉0．05。但对心脏结构和功能改善的效果，苯那普利联合氯沙坦组优于苯那普利组，有显著性差异，P〈0．05。而且血清钾、肌酐无明显变化，未出现严重副反应。结论苯那普利联合氯沙坦治疗CHF的效果比单用苯那普利的临床疗效好。     

氨基末端脑钠肽对老年血液透析合并充血性心力衰竭的心功能诊断分级的判断价值

目的探讨氨基末端脑钠肽（N terminal—pro brain nalriuretic peptide,NT-pwBNP）水平变化对老年血液透析合并充血性心力衰竭诊断和心功能分级的判断价值。方法选择尿毒症维持性血液透析（maintenance hemodialysis,MHD）合并心力衰竭患者36例作为血透心衰组,选择非血液透析、CKD3期以上[eGFR〉60ml／（min·1．73m2）]的心力衰竭患者38例作为对照组,测定两组心力衰竭及治疗好转后心功能不同等级时的NT-proBNP,采用受试者工作特征（receiveoperatingcharacteris．tic,ROC）曲线评价NT—pmBNP的诊断效能。结果血透心衰组和对照组治疗后随心功能好转,血清NT—pmBNP水平下降,不同心功能分级间NT—pwBNP水平有统计学差异（P〈0．05或P〈0．01）。血透心衰组各心功能分级NT．proBNP水平明显高于对照组,差异有统计学意义（P〈0．05）。血透心衰组心功能Ⅳ级AUC值为0．847,NT．proBNP〉11100ns／L作为界值（cutoff值）的敏感度为83％,特异度为79％;心功能Ⅲ级AUC值为0．794,NT-proBNP〉6465ng／L作为界值的敏感度为100％,特异度为56．4％,心功能Ⅰ级和Ⅱ级时无统计学差异。结论老年MHD合并心力衰竭时NT—proBNP可作为判断心力衰竭及心功能Ⅲ级、Ⅳ级的分级指标。     

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.