甲型H1N1流感重症肺炎与非甲型H1N1流感重症肺炎患者心肌酶学变化的比较研究

目的 通过对甲型H1N1 流感(甲流)重症肺炎患者与非甲流重症肺炎患者心肌酶学变化的研究,探讨二者对心肌酶影响的差异及其临床意义.方法 分析32例甲流重症肺炎患者及30例非甲流重症肺炎患者血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)和乳酸脱氢酶(LDH)活性的变化规律.结果 甲流重症肺炎患者诊断初期血清AST、ALT、CK、LDH均明显升高,随病情进展逐渐下降,至恢复期基本降至正常;非甲流重症肺炎患者诊断初期血清AST、ALT、CK、LDH较缓解期和恢复期略有增高,但幅度明显低于甲流重症肺炎患者,且整个病程均在正常范围.诊断初期两组AST、ALT、CK、LDH值均有统计学差异(P=0.021、0.01、0.016、0.013,<0.05),缓解期两组ALT、LDH值有统计学差异(P=0.041、0.023,<0.05),恢复期仅ALT值有统计学差异(P=0.01,<0.05).两组CK-MB、cTnT值始终无差异(P=0.491、0.438、0.602,>0.05).结论 甲流重症肺炎患者血清AST、ALT、CK、LDH呈一过性升高,非甲流重症肺炎患者心肌酶无明显变化.     

30例甲型H1N1流感患者的护理

目的探讨甲型H1N1流感患者护理经验。方法回顾性分析30例甲型H1N1流感患者住院临床资料和护理。结果30例确诊患者病原学检测连续二次阴性,体温正常、流感样症状消失≥3d,无并发症,临床情况稳定,全部治愈出院。结论做好发热期间病情观察,正确采集标本及用药后的观察,心理干预等对疾病康复起到积极作用,落实消毒隔离和防护流程有效控制院内感染的发生。     

甲型H1N1流感患者的分布特征

目的 了解甲型H1N1流感患者的人群分布特征,以便对易感人群采取积极有效的防控措施.方法 收集陕西省人民医院2009年10月24日～12月8日在发热门诊就诊,具有流感样症状的发热病人,采用RT-PCR法分别检潮呼吸道标本鼻咽拭子中甲型流感病毒的H1及N1核酸,H1及N1均阳性时判断为甲型H1N1流感病毒阳性.结果 2968例标本中甲型H1N1流感病毒阳性 1878例,阳性率63.3%;男性患者1 510例.阳性率60.9%(919/1 510),女性患者1 458例,阳性率65.8%(959/1 458),经统计学分析,男女性别差异无统计学显著性意义(P＞0.05);10岁以下、11～15岁、16～20岁的儿童及青少年是甲型H1N1流感病毒感染的主要人群,分别占总阳性的24.3%(457/1 878),33.7%(633/1 878)和19.8%(371/1 878),随年龄增长感染的比例逐渐下降,整个"甲流"人群明显呈偏态分布,峰值出现在11～15岁的年龄段,而且25岁以下各年龄组闯的差异有统计学意义(P≤0.01或P≤0.05).结论 甲型H1N1流毒病毒阳性的病人中,20岁以下的少年儿童占阳性病人的77.8%.随年龄增长逐渐下降.故青少年和儿童是甲型H1N1流感病毒防控的主要人群.     

216例轻症甲型H1N1流感病例分析

2009年3月,墨西哥暴发“人感染猪流感”疫情,并迅速在全球范围内蔓延。此次流感为一种新型呼吸道传染病,其病原为新甲型H1N1流感病毒,病毒基因中包含有猪流感、禽流感和人流感三种流感病毒的基因片段。世界卫生组织（WHO）初始将此型流感称为“人感染猪流感”,后将其重新命名为“甲型H1N1流感”。本院2009年7月31日至2009年10月21日共收治北京市朝阳区确诊的216例轻症甲型H1N1流感患者。现将患者资料分析如下。     

军队老年甲型H1N1流感轻症患者居家隔离治疗期间焦虑状态调查分析

目的了解军队老年甲型H1N1流感轻症患者居家隔离治疗期间焦虑状态及其原因。方法采用焦虑自评量表对居家隔离治疗的62例军队老年甲型H1N1流感轻症患者进行调查。结果共有42例患者焦虑评分总粗分超过40分的正常上限。患者焦虑评分为(32.33±9.34)分,高于中国常模。引起焦虑的原因包括对疾病预后担心,对居家隔离治疗不理解、不信任,担心家庭成员受影响。结论罹患疾病和隔离增加了患者焦虑,应采取积极有效的应对措施,减轻患者的焦虑。     

重症甲型H1N1流感患者2例的护理

甲型H1N1流感是甲型流感病毒引起的急性、人畜共患的呼吸道传染性疾病^[1]。病毒主要通过空气和接触传播,儿童、老年人、孕妇、肥胖者以及慢性疾病患者是甲型H1N1流感的高危人群,极易演变为病情凶险、病死率高的甲型H1N1流感重症患者。本院近期收治2例重症甲型H1N1流感患者,现将抢救及护理体会报告如下。     

重症甲型H1N1流感的护理

回顾性分析了17例重症甲型H1N1流感并肺炎患者的住院临床资料和所采用的护理措施.发现进行密切的病情观察,严格落实消毒隔离,做好气道护理以及心理干预等对疾病康复起到积极作用.认为细致周到的护理是重症甲型H1N1流感患者恢复健康的重要因素.     

甲型H1N1流感患者的护理

目的探讨收治甲型H1N1流感患者的护理措施及医护人员的自我防护方法。方法加强消毒隔离,个人防护,心理护理和健康教育,确保了甲型H1N1流感患者的成功救治。结果13例患者进行发热医学观察,确诊病例4例,临床诊断病例1例,疑似病例8例,实现了患者零死亡、医院内患者零交叉感染、医护人员零感染的目标。结论采取有效的护理措施和双向防护方法,保证了医务人员的安全,确保了患者的成功救治,减少了院内感染的发生。     

重型甲型H1N1流感患者的护理

总结5例重型甲型H1N1流感患者的护理经验,包括严格消毒隔离、细致的病情观察、用药护理、并发症的护理、营养支持、基础护理、心理护理及健康教育等一系列护理措施.患者均痊愈出院,无交叉感染.认为细致的观察与到位的护理措施,能有效地控制甲型流感的传播和流行.     

甲型H1N1流感C反应蛋白动态变化分析

目的探讨甲型H1N1流感不同临床类型及不同阶段C反应蛋白(CRP)动态变化特征。方法回顾性分析2009年5月10日-2010年1月18日实验室确诊的271例甲型H1N1流感住院患者不同临床类型、疾病不同阶段CRP动态变化情况。结果甲型H1N1流感患者感染初期CRP较正常升高,且升高程度随着病情的加重而更明显;CRP在治疗第3天即明显下降或接近正常,其动态改变在不同疾病严重程度组间无明显差异;有脏器功能损害者CRP较无脏器功能损害者明显升高;多个脏器损害CRP较单一脏器损害组明显升高。结论甲型H1N1流感CRP升高程度可间接反映其疾病严重程度和脏器功能损害多少。     

重型甲型H1N1流感患者T淋巴细胞亚群变化分析

[目的]探讨重型甲型H1N1流感患者T淋巴细胞亚群的动态变化.[方法]采用流式细胞仪对21例重型甲型H1N1流感患者(重症组病例12例,危重组病例9例)病程初期(入院24 h)、病程中期(入院后10 d)、恢复期(入院后30 d)外周血T淋巴细胞亚群CD3+、CD4+、CD8+进行检测和统计分析.[结果]两组患者病程初...     

厄贝沙坦联合螺内脂治疗慢性充血性心力衰竭的疗效观察

目的:观察厄贝沙坦联合螺内脂对慢性充血性心力衰竭的临床疗效。方法:70例中、重度慢性充血性心力衰竭患者随机分为常规治疗组(对照组)和厄贝沙坦联合螺内脂治疗组(治疗组),取不同时间点(治疗前及治疗后第4、8、12周),观察脑钠肽(NBP)、左室射血分数(LVEF)、左室内径(LVDd)等指标。结果:与治疗前相比,2组在治疗后第8、12周时,NBP、LVDd均下降,LVEF上升,相比较具有统计学意义(P<0.05);与对照组比较,治疗组在治疗12周时,NBP、LVDd明显下降,LVEF上升幅度更大,相比较具有统计学意义(P<0.05)。结论:厄贝沙坦联合螺内脂治疗能明显改善慢性充血性心力衰竭患者的心功能。     

金钠多治疗冠心病疗效观察

目的　观察金钠多注射液对冠心病(CHD)的疗效。方法　病人分为金钠多治疗组(44例)和复方丹参对照组(30例) ,治疗前后检测患者心电图、心功能、微循环、血液流变学等指标。结果　两组病人治疗后症状、体征及上述各项指标均有明显改善(P <0 .0 5～0 .0 1) ,但金钠多治疗组明显优于复方丹参对照组(P <0 .0 1)。结论　金钠多注射液对冠心病有明显疗效,比复方丹参疗效佳。     

甲型H1N1流感持续高热患儿四肢温水浴降温效果观察

目的探讨四肢温水浴在甲型H1N1流感（简称甲流）持续高热患儿中应用的降温效果。方法将174例甲流持续高热患儿随机分为试验组和对照组各87例,对照组采用常规方法：遵医嘱实施药物降温,30min后体温持续不退者再实施物理降温,头部、两侧颈部、腋窝、腹股沟等大血管处置冰袋或酒精擦浴;试验组入院即实施四肢温水浴加头部冰敷,将患儿双小腿、足、手和双前臂放入水中浸泡,水面要浸泡到双小腿2／3以上,双前臂1／3以上,双手和双足全部浸泡在水中,每次15～20min。观察两组患儿实施降温后30min、60min、120min的体温情况。结果降温处理30min和60min后体温下降,试验组优于对照组（P〈0．05）,120min后体温下降情况两组比较差异无统计学意义（P〉0．05）。结论甲型H1N1流感持续高热患儿采用四肢温水浴降温效果好,是一种安全、方便、有效的降温方法,值得临床推广应用。     

Influenza A Subtyping: Seasonal H1N1, H3N2, and the Appearance of Novel H1N1

Influenza virus subtyping has emerged as a critical tool in the diagnosis of influenza. Antiviral resistance is present in the majority of seasonal H1N1 influenza A infections, with association of viral strain type and antiviral resistance. Influenza A virus subtypes can be reliably distinguished by examining conserved sequences in the matrix protein gene. We describe our experience with an assay for influenza A subtyping based on matrix gene sequences. Viral RNA was prepared from nasopharyngeal swab samples, and real-time RT-PCR detection of influenza A and B was performed using a laboratory developed analyte-specific reagent-based assay that targets a conserved region of the influenza A matrix protein gene. FluA-positive samples were analyzed using a second RT-PCR assay targeting the matrix protein gene to distinguish seasonal influenza subtypes based on differential melting of fluorescence resonance energy transfer probes. The novel H1N1 influenza strain responsible for the 2009 pandemic showed a melting profile distinct from that of seasonal H1N1 or H3N2 and compatible with the predicted melting temperature based on the published novel H1N1 matrix gene sequence. Validation by comparison with the Centers for Disease Control and Prevention real-time RT-PCR for swine influenza A (novel H1N1) test showed this assay to be both rapid and reliable (>99% sensitive and specific) in the identification of the novel H1N1 influenza A virus strain.The 2009 novel influenza A/H1N1 viral pandemic has presented challenges for hospital laboratories and health care systems seeking to rapidly diagnose, treat, and limit the spread of this virus. As is the case for routine diagnosis of seasonal influenza infections, molecular amplification assays offer the potential for the sensitivity and speed needed to manage an influenza outbreak. However, standardized RT-PCR assays specific for this strain of influenza were not initially available, leaving many laboratories to diagnose this infection through indirect means.Our laboratory has used PCR for rapid detection of influenza A and B for several years, and more recently had implemented a rapid RT-PCR/melt-curve assay designed to differentiate seasonal influenza A subtypes H1N1 and H3N2.¹ This approach was initially developed for viral subtyping to guide clinicians on the appropriate antiviral therapy. Antiviral resistance has risen during recent years, with the majority of seasonal H1N1 strains no longer being sensitive to oseltamivir (Tamiflu), and seasonal H3N2 strains being largely resistant to adamantanes.² Rapid determination of influenza A subtype is essential for determining optimal therapy and for prudent use of antiviral agents. Consequently, this RT-PCR assay has become part of our influenza testing algorithm.The design of the RT-PCR assay exploits minor variations in a relatively conserved sequence within the matrix protein gene. Not surprisingly, the novel H1N1 strain of influenza that appeared in the spring of 2009 had a distinct melting temperature consistent with the published matrix gene sequence and the sequence of the fluorescence resonance energy transfer probes used in this assay designed to differentiate seasonal influenza A subtypes H1N1 and H3N2. As part of our influenza testing algorithm, this assay allowed definitive diagnosis of the 2009 influenza H1N1 from nasopharyngeal swabs within hours after arrival in the clinical laboratory.     

血浆置换对重型肝炎心肌酶及脂质指标的影响

目的　探讨血浆置换 (TPE)对重型肝炎患者心肌酶学指标及脂质指标的影响 ,为重型肝炎合并心肌损害的患者更安全地进行TPE治疗提供帮助。方法　对 5 4名重型肝炎患者TPE前后及 5 0名对照患者的肌酸激酶(CK)、肌酸激酶同工酶 (CK MB)、α 羟丁酸脱氢酶 (α HBD)、总乳酸脱氢酶 (LDH)、乳酸脱氢酶同工酶 1(LDH1)、谷草转氨酶 (AST)、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)、脂蛋白α(Lpα)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、甘油三酯 (TG)、总胆固醇 (CHO)进行检测和比较。结果　重型肝炎患者TPE前CK、CK MB、α HBD、LDH、LDH1、AST均明显高于对照组 ,TPE后CK、CK MB、α HBD、LDH、AST较TPE前明显降低 ,LDH1虽有所降低 ,但不明显。TPE前Apo A1、Apo B、Lpα、HDL C、LDL C、TG、CHO均明显低于对照组 ,TPE后Apo A1、Lpα、HDL C、TG、CHO较TPE前明显升高。结论　重型肝炎患者有不同程度的心肌损害。TPE可改善患者的肝脏功能 ,同时也在一定程度上减轻了重型肝炎患者的心肌损害。TPE时必须严密监测患者的心功能及心电图。     

冠心病患者Omentin-1、MPO水平变化及对患者病情的影响

[目的]探讨冠心病(CHD)患者血浆网膜素-1(Omentin-1)、血清髓过氧化物酶(MPO)水平变化及与患者病情严重程度的关系.[方法]选取本院收治的120例CHD患者(观察组),另选择同期60例健康自愿者作为对照组.检测并比较两组血浆Omentin-1、血清MPO水平.将CHD组依据不同疾病类型、冠脉病变支数进行分层分析.[结果]观察组血清MPO水平显著高于对照组,血浆Omentin-1水平显著低于对照组,差异有统计学意义(P<0.05).急性心肌梗死(AMI)、稳定性心绞痛(SAP)、不稳定性心绞痛(UAP)患者血清MPO水平逐渐降低,血浆Omentin-1水平逐渐升高,组间比较差异均有统计学意义(P<0.05).单支、双支及三支病变患者血清MPO水平逐渐上升,组间比较差异均有统计学意义(P<0.05);单支、双支及三支病变患者血浆Omentin-1水平逐渐下降,组间比较差异均有统计学意义(P<0.05).[结论]冠心病患者血浆Omentin-1水平较健康人群显著降低、血清MPO水平较健康人群显著升高,并且与患者冠脉病变支数、病情严重程度有关.     

Therapeutic Effects of Focused Ultrasound in 4014 Patients with Symptomatic Cervical Ectopy

This study aimed to explore the therapeutic effect of focused ultrasound (FU) therapy in patients with symptomatic cervical ectopy. 4677 patients with symptomatic cervical ectopy were enrolled and treated with FU. Three months after treatment, we analyzed the therapeutic effects and the adverse reactions in 4014 cases with complete records. All influential factors were also analyzed with logistic regression analysis. For the treatment of symptomatic cervical ectopy, the effective rate of FU was 99.8%, and the cure rate was 72.52%. Bleeding that either reached or exceeded normal menstrual volume occurred in 12 cases. Logistic regression analysis showed that the degree of illness, vaginal cleanliness, economic level, occupation, age and artificial abortion frequency were all influential factors. Focused ultrasound is a promising new therapeutic option for the treatment of symptomatic cervical ectopy. Additionally, it can be widely used for a variety of patients.