小婴儿黄疸50例临床分析

目的 探讨小婴儿黄疸的病因,为诊断及治疗提供帮助.方法 收集年龄32天～2.5月小婴儿黄疸50例患者进行临床分析.结果 常见的致病原因为感染,其中CMV感染占居首位,经丽科伟抗病毒,抗生素抗感染及其它对症治疗,大部分病例治愈.结论 CMV感染是小婴儿黄疸最常见的病因.CMV几乎可以侵犯机体的所有器官,其中肝脏是CMV的重要靶器官,明确病因对指导治疗有重要意义.     

婴儿手足搐搦症60例临床分析

低钙是婴儿惊厥中常见原因之一 ,若不及时诊治可导致一系列并发症 ,如喉痉挛 ,严重者可并发窒息、呼吸、循环衰竭致死。本文将我科1999年 1月～ 2 0 0 2年 3月资料完整的 6 0例作一临床分析。资料与结果　男 37例 ,女 2 3例。母乳喂养2 8例 ,人工喂养 32例。年龄 1月至 1岁不等。婴儿中口服活性钙冲剂 11例 ,金钙颗粒 4例 ,鱼肝油 5例 ,均为间断性少量补充。生长发育过快 2 7例。发病季节 :1～ 4月 36例 ,～ 10月 11例 ,～12月 13例。临床表现以呼吸道感染起病 2 3例 ,以腹泻起病 14例。表现全身性抽搐 2 9例 ,手足搐搦 16例 ,局限性小抽搐 …     

人工监测睡眠呼吸紊乱140例分析

目的 :探讨简便实用的睡眠呼吸紊乱诊断手段。方法 :人工监测 14 0例患者睡眠中脉搏血氧饱和度 (Sp O2 )、鼾声、口鼻气流、胸腹运动等情况 ,记录于表格中 ,结合症状、体征综合分析作出诊断。结果 :诊断阻塞性睡眠呼吸暂停低通气综合征 10 2例 (72 .86 % ) ;单纯鼾症 2 3例 (16 .4 3% ) ;混合性睡眠呼吸暂停综合征 15例 (10 .71% ) ;中枢性睡眠呼吸暂停综合征未见。结论 :人工监测方法能够诊断常见的睡眠呼吸紊乱 ,是简便实用的诊断手段。     

睡眠性呼吸紊乱

人生约 1/ 3时间处于睡眠状态 ,研究表明 ,睡眠期间可发生各种呼吸紊乱 ,某些呼吸紊乱将诱发心脑血管疾病 ,重则导致猝死 ,故已引起广泛关注。现就睡眠性呼吸紊乱的基本概念、患病情况、病因和影响因素 ,以及防治原则进行综述。1　睡眠性呼吸紊乱的基本概念睡眠性呼吸紊乱是睡眠期各种呼吸异常的统称。表现为打鼾、呼吸费力、呼吸气流减弱或持续中断 10秒以上、去氧饱和状态、通气不足。通气不足是指睡眠期呼吸气流持续中断或呼吸用力减少超过 10秒 ,并伴有 3%以上时间的去氧饱和状态和 (或 )有觉醒脑电图表现的状况。不过 ,目前有些概念的…     

38例小婴儿化脓性脑膜炎的临床分析

目的分析38例小婴儿化脓性脑膜炎的临床特点,以提高对小婴儿化脓性脑膜炎的诊治水平,减少并发症及后遗症。方法对我院2011年1月至2012年5月收治的38例6月以下的化脓性脑膜炎进行回顾性分析。结果发热35例、抽搐26例、呕吐6例、前囟膨隆14例、颈抗(+)15例,四肢肌张力增高9例、膝反射亢进7例,并发症:硬膜下积液20例。结论小婴儿化脓性脑膜炎临床表现不典型,容易误诊,青霉素+头孢曲松、青霉素+美罗培南疗效好,但有一部分需将青霉素换为万古霉素。硬膜下积液为常见并发症。     

小婴儿麻疹28例临床分析

自1965年我国推广接种麻疹减毒活疫苗以来,麻疹的周期性流行已得到控制,麻疹的发病率,死亡率明显下降。随着免疫抗体的缺乏,8个月内婴儿成为易感人群,我院在2001年1月至2004年6月共诊治麻疹180例,其中8个月以内婴儿28例,占总数的15．6％。     

小儿唇裂麻醉手术期间的呼吸紊乱

小儿唇裂麻醉手术期间的呼吸紊乱０６３００Ｑ唐山工人医院蔡翠英我院自１９７９年以来，共行小儿唇裂修复手术２０１例，在麻醉手术期间发生呼吸紊乱１７例，发生率８．４６％。本文仅就发生原因及预防做一讨论。１１６床资料“本组１７例，年龄７个月～８岁。男１２例，...     

普鲁卡因抢救小婴儿百日咳窒息16例分析

目的:观察普鲁卡因对小婴儿百日咳窒息的抢救效果。方法:对32例发生频繁窒息的小婴儿百日咳进行分组及治疗。结果:除2例并发百日咳脑病死亡外,治疗对72h,治疗组窒息全部控制,对照组9/15(60%)控制,二组效果差异显著(P＜0.05)。结论:静脉注射普普卡因治疗本病有效,值得临床推广,同时提出早期行DPT预防接种可降低其发生率。     

0～3个月小婴儿心律失常26例临床分析

目的 探讨0-3个月小婴儿引起心律失常的病因及预后。方法 本组26例患儿均为新生儿科及儿内科的住院患儿．在治疗原发病基础上应用心肌营养药物,补液、补钾及纠正水电紊乱、酸碱失衡,室上性心动过速者使用洋地黄知己或普罗帕酮进行治疗：心动过缓者给予阿托品。结果 治疗4-14d后,治愈18例,好转6例,自动出院2例。16例出院后6个月随诊无心律失常发作。结论 小婴儿心律时常无症状者占多数,常在生后常规体检或在其它疾病就诊时发现,且多数为功能性。新生儿引起心律失常的病因以感染、缺氧为主要因素。而1～3个月的小婴儿常因先天性心脏病和电解质紊所致。未合并器质性心脏病的小婴儿在0～3个月时出现心律失常时预后均良好。     

针灸对睡眠呼吸紊乱的影响

目的探讨针灸对睡眠呼吸紊乱的影响。方法 50例睡眠呼吸紊乱患者随机分为研究组和对照组,研究组25例针灸联合阿普唑仑进行治疗,对照组采用阿普唑仑进行治疗。结果。结论针灸可以有效的改善患者睡眠呼吸紊乱症状,安全性高,值得在临床广泛推广。     

^14C呼气试验在诊断幽门螺杆菌感染中的价值

目的 :研究14C呼气试验在诊断幽门螺杆菌 (HP)感染中的价值。方法 :选择80例经胃镜活检组织病理证实的HP阳性病例作为研究对象 ,并在抗HP治疗前同步进行血清抗HP及14C呼气试验检查。结果 :在80例组织病理证实的HP阳性病例中 ,14C呼气试验阳性率为92 5 % ,血清抗HP试验阳性率为60%。14C呼气试验阳性率与组织学诊断阳性率之间差异无显著性 ,14C呼气试验阳性率与血清抗HP阳性率之间比较差异有显著性 (P<0 05)。结论 :14C呼气试验是一较理想的非侵入性诊断HP的方法     

不同停药方法对抑郁症复发影响的研究

目的研究不同停药方法对抑郁症复发的影响,间歇递减药量直至停药方法可减少抑郁症复发。方法95例经相同药物治疗缓解的抑郁症患者按随机数字表法分2组,以递减和突然两种方法停药。其中递减停药组（46例）：噻奈普汀联合氟哌噻吨美利曲辛治疗抑郁症缓解后,再以递减给药方法维持6周后停药。突然停药组（49例）：噻奈普汀联合氟哌噻吨美利曲辛治疗抑郁症缓解后,再以同样方法同样量给药,维持6周后停药。观察2组停药第1周和第2周抑郁症状复发情况。2组分别于停药第1,2周末,采用汉密尔顿抑郁量表（HAMD）评分和患者主诉相结合评定抑郁症复发程度。结果递减停药组第1周和第2周复发率分别为32．6％和39．1％,差异没有统计学意义（χ^2=0．43,P〉0．05）。突然停药组第1周和第2周复发率分别为53．1％和73．5％,复发增加情况差异有统计学意义（χ^2=4．39,P〈0．05）,提示随时间延长复发率可能再增加。停药第1周和第2周复发率递减停药组均低于突然停药组（χ^2=4．06、11．40,P〈0．01）。结论抑郁症缓解后以递减给药再逐渐停药的方法比足量给药直接停药的方法可减少复发率。     

Agomelatine for the treatment of generalized anxiety disorder

Introduction: Agomelatine is a melatonergic antidepressant, approved for the treatment of Major Depressive Disorder (MDD) in Europe and Australia, but not in the United States. This compound seems to be promising in the short-term and maintenance treatment of Generalized Anxiety Disorder (GAD).

Areas covered: This paper presents an evaluation of the available data about the clinical efficacy and tolerability of agomelatine in the treatment of GAD.

Expert opinion: First-line GAD treatments are limited by high rates of lack of clinical response. Preliminary data would indicate agomelatine as a safe compound, and with a higher rate of clinical response in the short-term and an earlier improvement of symptoms with respect to Selective Serotonine Reuptake Inhibitors (SSRIs) and Selective Serotonin Noradrenaline Reuptake Inhibitors (SNRIs). In addition, agomelatine has not been associated with potential risk of abuse as in case of pregabalin and with long-term metabolic side effects similar to quetiapine. The major limitation of the results presented is that little data has come from long-term or comparative trials. Furthermore, some caution should be reserved in case of liver impairment (e.g. in subjects with alcohol abuse).     

Assaying all of the nitrogen oxides in breath modifies the interpretation of exhaled nitric oxide

Exhaled nitric oxide (NO) assays measure the quantity of NO that emanates from the airway, not the amount of NO that is formed. Consumptive processes-including oxidation reactions-decrease the amount of gas phase NO available for exhalation. Higher oxides of nitrogen (HiNO(x)) are resulting reaction products, and are easily measured in exhaled breath condensate (EBC). We performed concurrent sampling of exhaled breath for gas phase NO and EBC HiNO(x) in controls and stable asthmatics. We identified that, mole for mole, asthma patients hourly exhale more HiNO(x) than they do NO, with a HiNO(x)/NO ratio of 1.21 (0.54-3.4). This is the reverse of the ratio found in controls, in whom the HiNO(x)/NO ratio was 0.75 (0.44-0.93), p=0.04. The sum of the hourly molar exhalation of NO and HiNO(x) was significantly higher in asthmatics (333 nmol/h (221-543) than controls (179 (138-231), p<0.001). We conclude that exhaled oxides of nitrogen are more informative when measured together as opposed to in isolation. We suggest that inflammation can be better evaluated with HiNO(x) and NO measured concurrently, and that the level of oxidation in the lung can be evaluated by comparing the easily measured ratios of HiNO(x) to NO in the exhaled breath.     

呼唤式护理干预对脑卒中昏迷患者促醒的临床作用

目的探讨呼唤式护理干预对脑卒中昏迷患者的促醒作用。方法将86例脑卒中昏迷患者按护理方法不同分为对照组与治疗组。对照组按神经内科护理常规进行护理,治疗组在常规护理基础上加用呼唤式护理干预,并在病程不同时间段评定两组患者昏迷量表评分及清醒例数。结果两组患者治疗后的格拉斯哥昏迷量表（GCS）评分比较,差异有统计学意义（P〈0．05）,且呼唤组清醒率显著优于对照组（P〈0．01）。结论应用呼唤式护理模式护理脑卒中昏迷患者,能加速患者清醒,提高其生活质量。     

Assessment of the percutaneous absorption of trichloroethylene in rats and humans using MS/MS real-time breath analysis and physiologically based pharmacokinetic modeling.

The development and validation of noninvasive techniques for estimating the dermal bioavailability of solvents in contaminated soil and water can facilitate the overall understanding of human health risk. To assess the dermal bioavailability of trichloroethylene (TCE), exhaled breath was monitored in real time using an ion trap mass spectrometer (MS/MS) to track the uptake and elimination of TCE from dermal exposures in rats and humans. A physiologically based pharmacokinetic (PBPK) model was used to estimate total bioavailability. Male F344 rats were exposed to TCE in water or soil under occluded or nonoccluded conditions by applying a patch to a clipper-shaved area of the back. Rats were placed in off-gassing chambers and chamber air TCE concentration was quantified for 3-5 h postdosing using the MS/MS. Human volunteers were exposed either by whole-hand immersion or by attaching patches containing TCE in soil or water on each forearm. Volunteers were provided breathing air via a face mask to eliminate inhalation exposure, and exhaled breath was analyzed using the MS/MS. The total TCE absorbed and the dermal permeability coefficient (K(P)) were estimated for each individual by optimization of the PBPK model to the exhaled breath data and the changing media and/or dermal patch concentrations. Rat skin was significantly more permeable than human skin. Estimates for K(P) in a water matrix were 0.31 +/- 0.01 cm/h and 0.015 +/- 0.003 cm/h in rats and humans, respectively. K(P) estimates were more than three times higher from water than soil matrices in both species. K(P) values calculated using the standard Fick's Law equation were strongly affected by exposure length and volatilization of TCE. In comparison, K(P) values estimated using noninvasive real-time breath analysis coupled with the PBPK model were consistent, regardless of volatilization, exposure concentration, or duration.     

^14C呼气试验与快速尿素酶试验检测幽门螺杆菌感染的对比研究

目的：探讨^14C呼气试验和快速尿素酶试验两种方法对幽门螺杆菌（H.pylori）感染的诊断价值。方法：107例有消化道症状的患者,分别用^14C呼气试验和快速尿素酶试验两种方法进行检测,比较两种方法对H.pylori检测符合率及灵敏度、特异度、阳性预测值和阴性预测值。结果：两种方法对H.pylori感染的检出率分别为92.0%和89.8%,但差异无统计学意义。^14C呼气试验的灵敏度、特异度、阳性预测值和阴性预测值分别为92.7%、88.0%、93.8%和84.6%。快速尿素酶试验灵敏度、特异度、阳性预测值和阴性预测值分别为87.8%、80.0%、91.1%和71.4%。结论：^14C呼气试验和快速尿素酶试验对H.pylori感染的诊断均有很高的敏感性和特异性,是临床上用于H.pylori感染诊断的可靠方法。     

布洛芬-安定混合液直肠给药治疗小儿高热惊厥的疗效

目的探讨布洛芬-安定混合液直肠给药治疗小儿高热惊厥的临床效果。方法 82例高热惊厥患儿作为研究对象,随机分为实验组和对照组,两组均给予布洛芬-安定混合液治疗,对照组采用静脉注射,实验组采用直肠给药。结果实验组体温下降时间和惊厥改善时间显著短于对照组(均P<0.01),药物副反应低于对照组,1h有效率高于对照组,但无显著性差异(均P>0.05)。结论布洛芬-安定混合液直肠给药治疗小儿高热惊厥,安全性和有效性高,值得临床考虑。     

Current and emerging pharmacotherapy for the treatment of adult attention deficit hyperactivity disorder (ADHD)

ABSTRACT

Introduction: ADHD is characterized by a developmentally inappropriate level of inattentiveness, impulsivity and/or hyperactivity. In adults, the disorder is frequently accompanied by Emotional Dysregulation (ED), associated to a variety of related psychiatric comorbidities, complicating its recognition and treatment management.

Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of pharmacotherapy in adults with ADHD and ED, other neurodevelopmental disorders, Bipolar Disorder (BD) and Anxiety Disorders (ADs). When controlled data are unavailable, the authors have included open-label and observational studies.

Expert opinion: ED in adult patients with ADHD is a very common and impairing problem that can be treated with stimulants or atomoxetine. ADHD studies in adults with other neurodevelopment disorders are scarce; stimulants seem to be the most effective and safe drugs in treating ADHD symptoms, without worsening the core features of other neurodevelopmental disorders. In patients with ADHD and comorbid BD, the treatment of BD alone may result in residual symptoms of ADHD. Patients should be treated hierarchically: BD should be treated first, while ADHD should be treated combining ADHD medications and mood stabilizers after mood stabilization. The available evidence for treating patients with ADHD and comorbid ADs in adults supports the idea of an anti-anxiety/ADHD-specific treatment association.     

内固定手术治疗不稳定性胫骨平台骨折临床分析

目的 观察和分析内固定手术治疗不稳定性胫骨平台骨折的临床疗效。方法 选取35例不稳定性胫骨平台骨折的患者,均切开复位、钢板内固定,骨缺损者植骨,术后早期进行功能恢复训练。结果 术后随访12～48个月,平均22个月。膝关节功能参照Rasmussen膝关节功能评分标准,结果 优11例,良10例,可10例,差4例。优良率平...