垂体后叶素治疗咯血致低钠血症12例分析

目的 研究垂体后叶素对咯血患者血钠的影响.方法 应用垂体后叶素止血的咯血患者40例.垂体后叶素的用量为3～5 U稀释后缓慢静脉推注,之后6～12 U+0.9%氯化钠注射液250 ml缓慢静脉滴注,止血后继续应用12～24 h后停药.同时治疗原发病.结果 40例中12例出现低钠血症,其中有症状7例.有症状患者应用垂体后叶素前血钠值(142±3.26)mmol/L,用后为(123±4.69) mmol/L,两者相比差异有统计学意义(P＜0.05).经治疗后血钠均恢复正常,除一例遗留构音障碍外,余无后遗症.结论 对使用垂体后叶素止血的咯血患者,要监测血钠,及时发现及处理低钠血症.     

停用垂体后叶素引起6例尿崩症的临床分析

咯血是呼吸科常见症状,在临床治疗中常用垂体后叶素,它有“内科止血钳”之称,疗效确切,但在止血的过程中,也有一些如胸闷、腹痛、便意增加、头昏、头痛等较常见不良反应,临床上也偶见如尿崩症这样的不良反应。现收集了我院2005～2011年间在使用垂体后叶素治疗咯血患者共200余例,其中有6例患者在停用垂体后叶素时出现尿崩症,现报告如下。     

垂体后叶素联合酚妥拉明治疗支气管扩张并大咯血的临床疗效观察

目的观察垂体后叶素联合酚妥拉明治疗支气管扩张并大咯血的临床疗效。方法选取2013年6月—2016年3月南通市通州区人民医院呼吸内科收治的支气管扩张并大咯血患者50例,采用硬币投掷法分为对照组和观察组,每组25例。两组患者入院后均给予抗感染、镇静、止咳及吸氧等常规治疗,对照组患者在常规治疗基础上给予垂体后叶素静脉滴注,观察组患者在常规治疗基础上给予垂体后叶素联合酚妥拉明静脉滴注。比较两组患者临床疗效、咯血时间、总咯血量及不良反应发生率。结果观察组患者临床疗效优于对照组(P0.05)。观察组患者咯血时间短于对照组,总咯血量低于对照组(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论垂体后叶素联合酚妥拉明治疗支气管扩张并大咯血的临床疗效优于单用垂体后叶素,可有效缩短咯血时间、降低总咯血量,且不良反应发生率较低。     

垂体后叶素对咯血患者血钠水平的影响及相关不良反应的分析

目的分析垂体后叶素对咯血患者血钠水平的影响及相关不良反应的临床特点。方法收集2014年1月至2019年5月哈尔滨医科大学附属第一医院呼吸内科应用垂体后叶素治疗咯血患者的临床资料,进行回顾性分析。结果 70例咯血患者单独应用垂体后叶素治疗;36例患者联合酚妥拉明治疗。所有患者治疗前血钠正常。单用垂体后叶素治疗组中23例出现低钠血症,用药前血钠浓度为(139.5±2.428)mmol/L,用药后血钠浓度下降为(126.2±4.830)mmol/L,且垂体后叶素的剂量与血钠降幅呈正相关(P0.0001)。在垂体后叶素导致的不良反应中,垂体后叶素用量越大,其不良反应发生率越高(P0.05)。在单用组与联合用药组不良反应发生率的对比中,联合用药组低钠血症发生率更低,不良反应发生率显著降低(P0.05)。结论使用垂体后叶素治疗咯血,应密切关注患者血钠变化及临床表现,可联合应用酚妥拉明治疗咯血,降低副反应的发生。     

垂体后叶素联合普鲁卡因治疗大咯血疗效观察

目的比较垂体后叶素联合普鲁卡因治疗大咯血和单用垂体后叶素治疗大咯血的效果。方法垂体后叶素联合普鲁卡因治疗组40例,单用垂体后叶素治疗组各36例,观察两组治疗后止血的有效率。结果两组止血有效率有显著性差异（P〈0.05）。结论联合治疗咯血组治疗咯血有效率优于垂体后叶素组。     

12小时1次垂体后叶素静脉滴注治疗肺结核大咯血的临床分析

垂体后叶素是治疗肺结核大咯血较常用而有效的药物之一 ,我们采用 1 2ｈ1次垂体后叶素静脉滴注治疗肺结核大咯血 ,取得较好的疗效 ,报告如下。     

联合善宁与垂体后叶素治疗大咯血的疗效及减轻低钠血症的观察

目的善宁联用垂体后叶素治疗大咯血可减少低钠血症的发生。方法58例大咯血病人随机分为观察组与对照组,观察组善宁与垂体后叶素联合使用;对照组仅使用垂体后叶素。结果善宁联合垂体后叶素治疗大咯血疗效更佳且明显减低低钠血症的发生。结论使用善宁联合垂体后叶素可缩短病程,减少垂体后叶素的用量,进而减少低钠血症的发生,使治疗更有效且更容易接受。     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

硝普钠联合垂体后叶素治疗肺结核大咯血的疗效观察

目的观察和比较硝普钠联合垂体后叶素治疗肺结核大咯血的临床疗效。方法52例肺结核大咯血患者随机分为两组,对照组（n=26）仅采用垂体后叶素治疗,观察组（n=26）则采用硝普钠联合垂体后叶素治疗。观察和比较两组患者的临床疗效和不良反应。结果观察组治疗总有效率（92．3％）明显高于对照组（73．1％）（P〈0．05）;观察组止血时间明显较对照组缩短（P〈0．05）;两组不良反应发生率比较无明显差异性（38．5％,46．2％,P〉0．05）。结论硝普钠联合垂体后叶素治疗肺结核大咯血疗效显著,不良反应少,值得临床推广应用。     

垂体后叶素联合酚妥拉明治疗大量肺咯血临床分析

目的探讨肺咯血治疗方法。方法回顾分析63例大量肺咯血患者,在常规治疗基础上,分别采用三种不同治疗方法。A组为垂体后叶素治疗组,B组垂体后叶素联合酚妥拉明治疗组,C组采用凝血酶治疗组。以止血时间为观察指标,对比分析三组疗效。结果垂体后叶素联合酚妥拉明治疗组疗效显著优于其他两组。结论治疗咯血疗效显著,值得临床应用。     

通心络胶囊治疗急性脑梗死的疗效评价简

目的评价通心络胶囊对急性脑梗死的治疗效果。方法将符合条件的139例急性脑梗死患者随机分为常规治疗组和通心络治疗组,常规治疗组给予肠溶阿司匹林、他汀类药物等常规治疗,通心络治疗组在常规治疗的基础上加用通心络胶囊治疗。结果治疗4周后,通心络治疗组患者卒中量表评分（NIHSS）明显低于治疗前（P〈0．05）;治疗后两组患者Barthel指数均明显高于治疗前（P均〈0．05）;通心络组患者NIHSS评分及Barthel指数改善程度优于常规组,差异均有统计学意义（P〈0．05）。通心络治疗组治疗总有效率为88．9％,常规治疗组为56．3％,两组比较差异有统计学意义（P〈0．01）;通心络治疗组临床疗效优于常规治疗组（P〈0．05）。无药物不良反应。结论通心络胶囊治疗急性脑梗死疗效确切,安全可靠。     

原发性肝癌多学科整体治疗方案的设计与实施

恶性肿瘤的治疗模式正在经历从传统的单项专科治疗向联合治疗,再向多学科综合治疗的转变。笔者提出了以整体医学观为基础的肿瘤多学科整体治疗(MDHT)模式以指导肿瘤综合治疗方案的设计与实施。MDHT模式涉及治疗目标、治疗方法和治疗疗程三个方面。以原发性肝癌为例,可以将整体治疗的靶向目标分为肿瘤局部病灶、区域病灶、系统病灶、器官基础病、全身内环境以及康复等六项基本目标。针对MDHT模式中各项治疗目标,可分别采用多种治疗方法的序贯疗法、同步治疗和交替疗法。整体治疗方案的实施是由不同治疗方法的多个治疗疗程来实现的。在肿瘤MDHT模式中,多学科治疗是治疗方式的体现,整体治疗是治疗目标的追求。MDHT的理念有助于指导多学科团队设计和实施肿瘤综合治疗方案。     

Modeling the 5-year cost effectiveness of treatment strategies including tumor necrosis factor-blocking agents and leflunomide for treating rheumatoid arthritis in the Netherlands

OBJECTIVE: To determine the cost effectiveness of treatment strategies for rheumatoid arthritis patients satisfying the indication for tumor necrosis factor (TNF)-blocking treatment. METHODS: A Markov model study was performed. The following treatment strategies were considered: 1) usual treatment; 2) treatment with leflunomide, in the case of nonresponse after 3 months, switch to usual treatment; 3) TNF-blocking treatment, in the case of nonresponse after 3 months, switch to usual treatment; 4) treatment with leflunomide, in the case of nonresponse, switch to TNF-blocking treatment, in the case of nonresponse to TNF-blocking treatment, switch to usual treatment; 5) TNF-blocking treatment, in the case of nonresponse, switch to leflunomide treatment, in the case of nonresponse to leflunomide, switch to usual treatment. Expected patient-years in the different Markov states, costs, and quality-adjusted life years (QALYs) were compared between the treatment strategies; incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS: Over the 5-year period, the expected effect on disease activity and QALYs was better for treatment strategies that included TNF-blocking treatment than for the other treatment strategies. The greater effectiveness of these treatment strategies reduced medical and nonmedical costs compared with usual treatment by about 16% and 33%, respectively, omitting the costs of medication. When the costs of medication were included, the costs of strategies that started with TNF-blocking treatment were higher than those of the other treatment strategies. Treatment strategy 4 had the most favorable ICER of the treatment strategies that included TNF-blocking treatment: 163,556/QALY compared with usual treatment. CONCLUSION: Among strategies that include TNF-blocking agents, one starting with leflunomide and, in the case of nonresponse, switching to TNF-blocking treatment probably results in the most favorable ratio between incremental costs and effects.     

标准短程化疗方案治疗初治复治肺结核失败原因分析

目的探讨标准短程化疗方案治疗初复治肺结核失败的影响因素,特别是与耐药的关系,以便针对有相关性的因素进行控制,为结核病的治疗,尤其是耐药结核病的治疗提供依据。方法采用队列研究方法,追踪观察标准短程间歇化疗方案收治的初复治结核病患者的治疗效果,收集患者的各种信息,采用单因素和多因素方法分析,探讨导致患者治疗失败的因素。结果初治患者中,性别、职业、医疗费支出类型、是否漏服药和耐药情况与治疗失败有关,耐多药患者的失败风险是敏感患者的2.0倍;复治患者中,家庭年收入、耐药类型和最近一次治疗的结果是影响治疗失败的因素,耐药患者的失败风险是敏感患者的4.7倍。结论要降低结核病治疗失败率,控制结核病疫情,应该增加对贫困患者提供的救助,加强患者的督导管理,提高服药依从性,控制耐药的发生,开展对复治患者治疗方案的实施性研究。     

影响肺结核治疗转归的因素分析

目的分析影响肺结核患者治疗转归的有关因素,为结核病防治提供理论依据。方法收集1993—2001年世界银行贷款结核病控制项目期间涟源市卫生防疫站4 747份肺结核病历资料,对影响肺结核患者治疗转归的有关因素进行单因素分析和多因素非条件Logistic回归分析。结果单因素分析表明,年龄、性别、疾病治疗之初有咯血症状(χ²=10.20,P=0.01)及临床症状超过3种、合并其他结核、就诊延误、既往用药、空洞、非全程督导管理方式、治疗2个月末痰菌阳性、初治涂阳病人不含链霉素治疗方案对肺结核患者的治疗转归有影响。多因素分析结果显示:治疗之初痰菌阳性及乏力症状为促进患者治愈的有利因素;治疗初相关临床症状及体征如发热、肺部空洞的存在非全程督导为影响肺结核患者治疗转归的不利因素。结论加强宣传教育以减少患者的就诊延误现象,提高对结核病患者的全程督导率,提高患者正确服药依从性将有利于患者的预后。     

罗格列酮结合BiPAP呼吸机无创治疗AECOPD的临床效果观察

目的：探讨罗格列酮结合 BiPAP 呼吸机无创治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果。方法选择2013年1月至2015年6月本院收治的AECOPD患者80例,按照随机数字法分为2组,各40例,2组患者入组后均实施对症支持治疗,对照组同时使用美国伟康BiPAP Vision型无创呼吸机支持治疗,观察组则在对照组基础上使用罗格列酮,每次4 mg,每日1次,晨起口服,连续治疗2周为1疗程,连续2个疗程为一个治疗周期。比较2组治疗前后炎症性细胞因子(TNF-α、IL-1和 hs-CRP)变化情况,治疗前后抗氧化因子(SOD和 MDA)变化情况,治疗前后血气分析(PO2和PCO2)变化情况,及肺功能结果(FEV1和 FEV1/FVC)变化情况,并统计2组使用无创呼吸机辅助治疗时间。结果治疗后2组 TNF-α、IL-1及 hs-CRP 水平均显著低于治疗前(t=280.000、37.210、57.351、115.772、4.650、26.415,P<0.05),且治疗后观察组TNF-α、IL-1及 hs-CRP水平低于治疗后对照组(t=212.132、30.679、33.527,P<0.05),治疗后观察组SOD水平高于治疗前(t=36.829,P<0.05),MDA水平低于治疗前(t=32.000,P<0.05),且治疗后观察组 SOD水平高于治疗后对照组(t =23.382,P <0.05),MDA 水平低于治疗后对照组(t =16.971,P<0.05),治疗后观察组PO2高于治疗前(t=9.609,P<0.05),PCO2低于治疗前(t=27.548,P <0.05),FEV1高于治疗前(t =41.777,P <0.05),FEV1/FVC 高于治疗前(t =33.621,P<0.05),且治疗后观察组PO2高于治疗后对照组(t=6.276,P<0.05),PCO2低于治疗后对照组(t=9.499,P<0.05),FEV1高于治疗后对照组(t=16.611,P <0.05),FEV1/FVC高于治疗后对照组(t=15.882,P<0.05)。结论罗格列酮结合 BiPAP 呼吸机无创治疗 AECOPD 患者,能有效抑制机体炎症反应,减轻氧化应激反应,提高肺通气与换气功能,缩短使用呼吸机治疗时间,值得临床重视。     

耐多药肺结核患者治疗结果及其影响因素调查

目的了解耐多药肺结核患者的治疗结果及其影响因素。方法对纳入项目治疗的患者进行问卷调查,并将相关结果进行病例对照研究。结果 70例接受耐多药治疗的患者中,32例治愈,1例完成疗程;多因素logistic回归分析,年龄>38岁和耐多药治疗前累计服药>15个月是患者未治愈的主要危险因素。结论规范二线药物使用,前移耐多药检测关口和加强患者的治疗管理,对具有治疗失败高风险患者进行个体化调整。     

Predictors of treatment difficulties and satisfaction with haemophilia therapy in adult patients

Summary. Adherence is a complex and multifaceted behaviour. The study of factors influencing adherence behaviour, including difficulties with treatment and treatment satisfaction (TS), are still needed. This research report describes different questions related to treatment adherence, focusing on perceived barriers and difficulties with treatment, satisfaction with treatment and risk factors that help explain the experience of difficulties and low TS. A cross‐sectional study assessing 121 Spanish adult patients (range 17–70) collected information about the characteristics of treatment, perceived barriers to treatment, difficulties and satisfaction with treatment and negative affect. The results show differences in difficulties and satisfaction with treatment depending on haemophilia severity level and describe an association of negative affect with the greater experience of treatment difficulties and lower TS. In conclusion, perceived barriers, level of skills related to self‐treatment, haemophilia severity level and affective state are important predictors of treatment difficulties and satisfaction with treatment and these should be taken into account in strategies for improving compliance and maintaining quality of life.     

Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort study

Aims This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7‐year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. Design, setting and participants Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross‐linked with national criminal records. The period of observation was divided into four phases; pre‐treatment, in‐treatment, between treatments and post‐treatment. Findings During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting‐list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre‐treatment criminal convictions were associated with significantly (P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment. Conclusions Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment.     

吸入舒利迭治疗稳定期COPD的临床研究

目的观察吸入丙酸氟替卡松/沙美特罗（舒利迭）（Fluticasone prpionate,FP）对稳定期COPD的临床疗效。方法 60例稳定期Ⅱ级COPD患者随机分成4组,分别给予不同剂量的丙酸氟地卡松和安慰剂（对照组）吸入治疗12周,于治疗前及治疗2周后、6周后、12周后测定FEV1、血浆皮质醇、骨密度,并记录临床症状记分和生活质量记分。结果临床症状评分各治疗组吸入丙酸氟地卡松迭2周后较治疗前明显下降（P〈0.05）,但治疗后不同时间段间比较无显著性差异（P〉0.05）;各组FEV1治疗前与治疗12周后比较无显著性差异（P〉0.05）。生活质量评分各组治疗前较治疗12周后无显著性差异（P〉0.05）。血浆皮质醇水平高剂量组治疗2周后即较前降低（P〈0.05）,治疗12周后更降低（P〈0.01）;中剂量组治疗12周后较治疗前降低（P〈0.05）;低剂量组和对照组治疗前较治疗12周后无显著性差异（P〉0.05）。股骨颈的股密度各组治疗前后无显著性差异（P〉0.05）。结论吸入一定剂量的丙酸氟地卡松,可减轻稳定期COPD患者的临床症状,而不引起骨密度降低,但不能改善其FEV1,不能改善生活质量,但有可能引起血浆皮质醇水平下降。