肾外氮质血症

氮质血症可由肾内或肾外因素引起,由肾脏疾病所引起的氛质血症已比较熟识,而由肾脏以外病变所致的氮质血症了解比较少,目前国内外未见专门描述,观介绍如下。l定又由肾脏或泌尿系以外的病变所致的血尿素氮（BUN）增高,称为肾外氛质血症。2病因分类2．l急性心肌梗死有研究表明,急性心肌梗死（AMI）时部分患者可出现BUN和血肌研（Scr）水平增高,其发生率约33．8％～50．O％。AMI时BUN增高的机理尚未完全阐明,可能与下列因素有关：①肾小球游过BUN减少。大面积心肌梗死时,』0脏泵功能减退,血压下降,使肾小球游过率降低。此外…     

肾前性氮质血症和急性肾小管坏死的鉴别诊断

肾前性氮质血症和急性肾小管坏死的鉴别诊断中国医科大学附属第一医院（１１０００１）周希静急性肾功能衰竭的发病原因分为肾前性、肾性和肾后性。急性肾小管坏死是急性肾功能衰竭的常见类型，据报道约占急性肾功能衰竭（ＡＲＦ）的４０％～８０％。急性肾小管坏死（ＡＴ...     

肾病氮质血症中医及康复治疗24例临床观察

自1996年3月至1998年12月我们应用中药配合康复疗法治疗肾病氮质血症24例．疗效满意,现报告如下。     

中药保留灌肠液治疗小儿氮质血症操作方法的临床研究

我们自１９９５年￣１９９８年５月期间利用中药保留灌肠治疗小儿急性氮质血症,采用多因素对照比较的方法,进行小儿中药保留灌肠操作的临床研究。结果：灌肠有温度为３８℃￣４０℃,插管的浓度为１４．１ｃｍ￣１８ｃｍ,灌肠时的速度为２０￣２５滴／分,保留时间〉２ｈ,患儿取右侧卧位时,灌肠药物疗效果佳,患儿痛苦最小,从而总结出小儿中药保留灌肠的最佳操作方法。     

进行性少尿,浮肿,氮质血症

1 病历摘要 患者,男,17岁。以进行性少尿、浮肿20天,恶心、呕吐一周于1989年儿月10日入院。患者1989年9月中旬受凉后咽痛,自服“三黄片”好转。10月15日再次受凉后发热、鼻塞。未治疗。4天后双下肢浮肿。查尿常规:蛋白++,白细胞++,红细胞+++。血常规:血红蛋白99克/L。红细胞3.45×10~(12)/L。给予青零素、利尿剂治疗。9天后浮肿加重,24     

中药脐敷和灌肠不同护理方法在肝硬化诱发氮质血症中的应用

目的探讨不同护理方法在中药脐敷和中药灌肠治疗肝硬化难治性腹水诱发氮质血症中的作用,为本治疗方案的最佳护理措施提供依据。方法将42例病人随机分为观察组和对照组各21例,观察组采用改良方法护理,对照组采用传统方法护理。结果治疗中,观察组用药脐部皮肤不良反应发生率明显低于对照组(P<0·001),中药灌肠后中药保留时间明显长于对照组(P<0·01),治疗第1周24h尿量多于对照组(P<0·05),肌酐、尿素氮改善明显(P<0·01)。结论改良护理方法可显著提高疗效。     

难治性肝硬化腹水并发氮质血症患者结肠透析联合中药贴敷的疗效

目的探讨结肠透析联合改良中药贴敷对肝硬化腹水并发氮质血症患者治疗效果的影响。方法将50例肝硬化腹水并发氮质血症患者随机分成两组，每组25例。两组患者除基础治疗外，观察组给予结肠透析治疗机肠道灌洗和改良中药贴敷（以蜜糖和丁香油为基质调制）；而对照组采用普通肠道灌洗及传统的中药贴敷（温开水调制）。结果观察组患者结肠灌洗后中药保留时间长于对照组，局部皮肤过敏反应的发生率低于对照组；治疗后腹水消退的效果及肌酐、尿素氮的清除率均优于对照组（P〈0．05或0．01）。结论在肝硬化腹水并发氮质血症患者的治疗、护理中采用结肠透析联合改良的中药贴敷方法，具有良好的效果。     

改良脐敷合灌肠治疗肝硬化难治性腹水诱发氮质血症的疗效观察

目的 探索改良后的脐敷合灌肠治疗肝硬化难治性腹水诱发氮质血症的临床疗效。方法 将100例住院患者随机分为改良组和对照组,改良组采用改良后的护理方法,对照组采用常规护理。结果 两组治疗效果差异有显著性意义（P＜0．01）。结论 改良后的脐敷合灌肠治疗肝硬化难治性腹水诱发氮质血症疗效确切。     

难治性肝硬化腹水并发氮质血症患者结肠透析联合中药贴敷的疗效

目的探讨结肠透析联合改良中药贴敷对肝硬化腹水并发氮质血症患者治疗效果的影响。方法将50例肝硬化腹水并发氮质血症患者随机分成两组,每组25例。两组患者除基础治疗外,观察组给予结肠透析治疗机肠道灌洗和改良中药贴敷(以蜜糖和丁香油为基质调制);而对照组采用普通肠道灌洗及传统的中药贴敷(温开水调制)。结果观察组患者结肠灌洗后中药保留时间长于对照组,局部皮肤过敏反应的发生率低于对照组;治疗后腹水消退的效果及肌酐、尿素氮的清除率均优于对照组(P<0.05或0.01)。结论在肝硬化腹水并发氮质血症患者的治疗、护理中采用结肠透析联合改良的中药贴敷方法,具有良好的效果。     

肌骨超声评分系统在类风湿关节炎中的应用

类风湿关节炎(RA)是一类以关节滑膜病变为主要特征的慢性自身免疫性疾病。肌骨超声在RA的早期诊断、病情监测和预后评估中具有重要的作用,超声定性、定量和半定量评分系统可评估RA患者关节病变的范围和程度,超声整体评分系统可从患者整体水平对RA的疾病活动性和病变程度进行评价。本文对肌骨超声评分系统及其在RA中的应用进行综述。     

超声综合评分法在不同大小甲状腺结节良恶性鉴别诊断中的价值

目的探讨超声综合评分法在诊断不同直径甲状腺结节良恶性中的价值。方法对301个甲状腺结节进行常规超声检查,根据结节大小分为A组(90个,直径≤1.0 cm)、B组(130个,直径1.1~1.9 cm),C组(81个,直径≥2.0 cm)。选取具有诊断价值的5个超声征象:低回声或极低回声、纵横比1、边界不清晰、微小钙化及Rago血管分型Ⅲ型,根据其征象赋值,符合者记为1,不符合者记为0,计算结节综合评分。所有结节均经术后病理证实,以病理结果作为金标准构建ROC曲线,比较超声综合评分法对不同直径甲状腺结节的诊断价值。结果三组中恶性结节的评分均明显高于同组良性结节(P0.05)。三组间良性结节比较差异均有统计学意义(P=0.000),C组评分低于A组(P=0.000)和B组(P=0.01),A、B组比较差异无统计学意义;三组间恶性结节评分比较差异无统计学意义。三组ROC曲线下面积分别为0.65、0.79及0.88,超声评分法对C组的诊断价值明显高于A组(Z=3.07,P0.01)和B组(Z=1.98,P0.05),A、B组诊断价值比较差异无统计学意义(Z=1.40)。结论超声综合评分法在诊断不同直径甲状腺结节良恶性中有一定价值,肿块直径越大诊断价值越高。     

超声评分评估瘢痕妊娠终止术预后的临床价值

目的探讨超声评分评估剖宫产瘢痕妊娠终止手术预后的临床价值。方法对2010年1月~2017年1月我院诊断53例剖宫产瘢痕妊娠资料进行回顾性分析,52例纳入本研究。根据超声图像指标特征进行赋分并分组:孕囊或包块位于子宫峡部,宫腔内无孕囊,评为1分;在此基础上合并孕囊或包块与肌层分界不清,加1分;孕囊或包块与肌层间显示丰富滋养细胞血流信号(与其周边正常子宫肌层血流信号对比,血流信号增多),加1分;孕囊或包块最大直径大于4cm,加1分。全部病例得分为1~4分,分为4组。比较各组患者术中出血量、住院时间、术中并发症、术后并发症。结果1分组20例,2分组14例,3分组11例,4分组7例。超声评分1分组的术中出血量、住院时间、术中并发症、术后并发症率分别为60.35±14.3 ml、3.05±0.51 d、0%、5%,超声评分2分组的术中出血量、住院时间、术中并发症、术后并发症率分别为104.71±56.87 ml、5.21±0.70 d、14.2%、14.2%,超声评分3分组的术中出血量、住院时间、术中并发症、术后并发症率分别为172.36±98.12 ml、5.91±0.70 d、27.3%、18.2%,超声评分4分组的术中出血量、住院时间、术中并发症、术后并发症率分别为248.14±194.8 ml、8.29±1.80 d、42.9%、28.6%。超声评分与CSP的术中出血量、住院时间、术中并发症发生率呈正相关,评分越高,术中出血量、住院时间越长,术中并发症发生率越高,各组间差异有显著性(P均0.05)。结论超声诊断评分法能有效预测剖宫产瘢痕妊娠终止术治疗的相关指标,为剖宫产瘢痕妊娠的诊治提供参考。     

超声评分法在良恶性甲状腺结节鉴别中的临床研究

目的 通过甲状腺结节超声评分法,探讨一种准确率高,容易为超声医师掌握和量化的评估方法.方法 对我院超声检出并经病理确诊的90例甲状腺结节进行回顾性评分,利用甲状腺结节超声评分法,计算超声评分法判断甲状腺结节良恶性的敏感性、特异性、阳性预测值及阴性预测值,拟定甲状腺良恶性结节评分临界值.结果 甲状腺结节超声评分法诊断甲状腺癌的敏感性为94.1%,特异性为96.6%,假阳性预测值为94.1%及假阴性预测值为96.6%:而良恶性结节评估的最佳临界值为7分.结论 甲状腺结节超声评分法提高了良恶性甲状腺结节定性评估的准确率,特别是对微小癌的诊断更具有较高的临床价值,弥补了传统超声评估法存在尺度把握较难,认知差异较大等不足.     

A scoring system to predict the evolution of respiratory distress syndrome into chronic lung disease in preterm infants

Objective: The purpose of this study was to develop and validate an empirical scoring system to predict the evolution of neonatal respiratory distress syndrome (RDS) into chronic lung disease (CLD) in preterm infants, by comparing it with a more complicated logistic regression model. Design: Clinical study. Setting: Neonatal intensive care unit. Patients: The retrospective analysis of a 3-year experience showed that a gestational age (GA) of less than 30 weeks, a birth weight (BW) of less than 1000 g, the diagnosis of hyaline membrane disease (HMD) and pulmonary interstitial emphysema (PIE) during the first 72 h of life, the peak inspiratory pressure (PIP) and the fraction of inspired oxygen (FIO₂) were the highest relative risk factors correlated with the evolution of CLD. On this basis an empirical and a statistical scoring system were defined and prospectively applied at 3 and 5 days of life to 228 neonates with BW less than 1250 g. The results obtained with both scoring systems were then compared. Results: Of the 149 infants surviving at 28 days of life, 67 (GA: 29.9 ± 2.3 weeks; BW: 1058 ± 143 g) were normal and 82 (GA: 27.5 ± 3.9 weeks; BW: 838 ± 200 g) had CLD. Using a cut-off value of 4.0, the empirical scoring system showed a specificity of 97.0 % and a sensitivity of 92.7 % on the 3rd day of life; on the 5th day of life the specificity was still 95.5 %, while sensitivity remained 92.7 %. The areas under the ROC curves plotted with both scoring systems tested were similar. Conclusions: The proposed empirical scoring system is easy to use and is highly reliable. The application of this scoring system provides the opportunity to direct aggressive treatment for CLD toward only very high risk patients between the 3rd and 5th days of life. Received: 21 August 1997 Accepted: 10 March 1998     

Performance of clinical scoring systems in acute organophosphate poisoning

Abstract

Introduction. Clinical scoring systems are used to predict mortality rate in hospitalized patients. Their utility in organophosphate (OP) poisoning has not been well studied. Methods. In this retrospective study of 396 patients, we evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Simplified Acute Physiology Score (SAPS) II, Mortality Prediction Model (MPM) II, and the Poisoning Severity Score (PSS). Demographic, laboratory, and survival data were recorded. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to study the relationship between individual scores and mortality rate. Results. The mean (standard deviation) age of the patients was 31.4 (12.7) years, and at admission, their pseudocholinesterase (median, interquartile) level was 317 (222–635) U/L. Mechanical ventilation was required in 65.7% of the patients and the overall mortality rate was 13.1%. The mean (95% confidence interval) scores were as follows: APACHE-II score, 16.4 (15.5–17.3); SAPS-II, 34.4 (32.5–36.2); MPM-II score, 28.6 (25.7–31.5); and PSS, 2.4 (2.3–2.5). Overall, the AUC for mortality was significantly higher for APACHE-II (0.77) and SAPS-II (0.77) than the PSS (0.67). When patients were categorized, the AUCs were better for WHO Class II (0.71–0.82) than that for Class I compounds (0.60–0.66). For individual compounds, the AUC for APACHE-II was highest in quinalphos (0.93, n = 46) and chlorpyrifos (0.86, n = 38) and lowest in monocrotophos (0.60, n = 63). AUCs for SAPS-II and MPM-II were marginally but not significantly lower than those for APACHE-II. The PSS was generally a poorer discriminator compared to the other scoring systems across all categories. Conclusions. In acute OP poisoning, the generic scoring systems APACHE-II and SAPS-II outperform the PSS. These tools may be used to predict the mortality rate in OP poisoning.     

Ultrasonographic scoring system: An auxiliary to differential diagnosis of gastric pathologies

In a prospective clinical study, 64 patients with gastric pathologies (27 malignant and 37 benign) were examined ultrasonographically. Gastric wall layer changes, gastric wall thickness, lesion length, and protrusion into the lumen were evaluated. A scoring system was defined based on the distribution of these parameters and the score of each patient was calculated retrospectively. Six of the malignant cases had scores in the benign range and 3 of the benign cases had scores in the malignant range. Sensitivity of this scoring system in terms of detecting malignancy was 78% and specificity 92%. The positive predictive value was 88%, the negative predictive value was 85%, and overall diagnostic accuracy was 86%. This scoring system was considered to be a useful aid in the differential diagnosis of gastric pathologies. © 1993 John Wiley & Sons, Inc.     

Internal validation of a scoring system to evaluate the probability of ureteral stones: The CHOKAI score

Objective

The CHOKAI and STONE scores are prediction models for ureteral stones. The aims of the present study were to evaluate the diagnostic performance, to examine the optimal cut-off value, and to compare the diagnostic performance of each model.

Validation of the simplified therapeutic intervention scoring system on an independent database

Objective: To evaluate the performance of the Simplified Therapeutic Intervention Scoring System on an independent database and determine its relation with the Therapeutic Intervention Scoring System in the quantification of nursing workload in intensive care. Design: Analysis of the database of a multicenter prospective Portuguese study. Setting: 19 intensive care units (ICUs) in Portugal. Patients: Data on 1094 patients consecutively admitted to the ICUs were collected during a period of 3 months. Methods: Collection of the data necessary for the calculation of the Therapeutic Intervention Scoring System (TISS-76) and the Simplified Therapeutic Intervention Scoring System (TISS-28) during the first 24 h in the ICU. Basic demographic statistics and all the variables necessary for the computation of the Simplified Acute Physiology Score II were also collected. Vital status at discharge from the hospital was registered. Regression techniques, Pearson's correlation and paired sample t-test were used. Results are presented as mean ± standard deviation except when stated otherwise. Reliability was evaluated by the use of intraclass correlation coefficients in a 5 % random sample. Measurements and results: After exclusion of all the patients with missing data, 1080 patients were analysed. The overall mean TISS-28 (29.82 ± 10.64) was significantly lower than the mean TISS-76 (31.14 ± 11.95). Both systems showed very significant differences between ICUs (p < 0.001). The correlation between the two was good, with TISS-28 explaining 72 % of the variation of TISS-76 (r = 0.85, r ² = 0.72). The relation between the two systems was TISS-28 = 6.22 + 0.85 TISS-76. In this cohort, reliability of data collection was very high, with intraclass correlation coefficients greater than 0.90 for both systems. Conclusions: TISS-28 was validated on this independent population. The results indicate that TISS-28 can replace TISS-76 for the measurement of the nursing workload in Portuguese ICUs Received: 29 October 1996 Accepted: 27 February 1997