系统性红斑狼疮合并可逆性后部脑病综合征1例

This case report concerns a 22-year-old woman who had been diagnosed with systemic lupus erythematosus (SLE). She had intermittent fever, butterfly erythema, photosensitivity, oral ulcers, and multiple arthralgia in the past seven years, but she did not adhere to regular treatments. The edema of the lower extremities and face aggravated in the recent two weeks, so she was admitted to our Department of Rheumatology and Clinical Immunology. Meanwhile, we found she had severe hypertension, the maximal blood pressure was 170/120 mmHg. The patient had high SLE disease activity (the disease activity index score was as high as 23) with blood involvement, acute renal insufficiency, multiple serous effusion and rash. After one week treatments of intravenous methylprednisolone 80 mg daily and other drugs, her conditions made some extent improvement. However, she suffered sudden epileptic attacks. No positive neuro-pathological signs were found, and the blood pressure was up to 190/130 mmHg before the onset of the seizures. Her cerebrospinal fluid (CSF) pressure was 330 mmH₂O, the CSF protein level was normal value, and the white blood cell count was 0 cell/mm ³, with no signs of infection. Cranial MRI showed vasogenic edema at bilateral parietal, occipito-parietal regions, and centrum ovale. We prescribed drugs of decreasing intracranial pressure, intravenous drugs of decreasing blood pressure and midazolam for sedation, without corticosteroid impulse therapy. She recovered consciousness in the next day, without epilepsy recurrence. We eventually diagnosed it as posterior reversible encephalopathy syndrome (PRES), according to the history, laboratory results, imaging featuresand clinical outcome. PRES is a disorder of reversible subcortical vasogenic brain edema in patients with acute neurological symptoms (eg, seizures, encephalopathy, headache, and visual disturbances).PRES is mainly caused by blood pressure changes or endothelial injury, which lead to breakdown of the blood-brain barrier and subsequent brain edema. Most patients have a favourable prognosis.SLE complicated with PRES is not rare, especially in patients with disease activity, hypertension, lupus nephritis and/or renal insufficiency, and use of cytotoxic drugs, early recognition and appropriate treatment remain important. Brainstem involvement, intracranial hemorrhage, renal insufficiency and high disease activity of lupus are risk factors for poor prognosis.     

Twenty-four hour ambulatory blood pressure and heart rate in a patient with a predominantly adrenaline secreting phaeochromocytoma.

In this report, we present the symptoms, biochemical investigations, 24 hour ambulatory blood pressure and heart rate recordings in a patient before and following removal of a predominantly adrenaline-secreting phaeochromocytoma. The symptoms were of episodic shaking, faintness, nausea, palpitations, sweating and panic, chest and neck pain with headache, and are consistent with previous reports. Ambulatory blood pressure recording demonstrated that mean daily blood pressure was normal, with normal diurnal variation, and two episodes of severe hypertension and bradycardia coincident with symptoms (MAP 150 mmHg and HR 49 beats/minute, MAP 178 mmHg and HR 29 beats/minute, respectively), not reported in predominantly adrenaline-secreting phaeochromocytoma.     

Which is the best peri-operative anti-coagulative therapy of transverse sinus stenting for refractory idiopathic intracranial hypertension?

Treatment of refractory idiopathic intracranial hypertension (IIH) is a challenging problem. We reported a refractory IIH patient who manifested with typical intracranial hypertensive symptoms successfully treated with endovascular stent implantation. Pre-operative cerebrospinal fluid (CSF) opening pressure is 36 cmH₂O. Cerebral angiography demonstrated a stenotic lesion located at the right transverse sinus (TS). The stenotic TS returned to its normal caliber and the pressure gradient deceased from 36 mmHg to 4 mmHg after the stent placement. The intracranial hypertensive symptoms resolved and one month later, the CSF opening pressure decreased to 14 cmH₂O.

     

异丙酚在胃肠镜检查术中的麻醉效果观察

目的 观察异丙酚在胃肠镜检查术中的麻醉效果.方法 选择2007年12月至2010年12月在我院拟行胃肠镜检查的患者600例,检查前由麻醉师按1.5 mg/kg缓慢静脉注射异丙酚,待患者睫毛反射消失,开始进行检查.记录患者检查前后血压、心率、血氧饱和度的变化及不良反应.检查结束后调查患者的满意度.结果 异丙酚麻醉后行胃肠...     

有麻醉科参与的卒中单元有效救治围手术期脑卒中1例

围手术期脑梗塞指围手术期发生的缺血性脑卒中,在非心脏、非脑科手术中,其发生率大约为 0.7%,但其一旦发生,病死率却高达26%~40%［1-2］,严重影响手术患者的生活质量和预后。2015年5月,北京大学第三医院一位患者在全身麻醉下行腰椎后路减压内固定手术,术毕全身麻醉清醒后2 h之内发生了脑梗塞,经麻醉医师早期发现、多科室协作的围手术期卒中单元迅速启动,患者预后良好,现报道如下。     

A case of acromegaly

A fifty years old woman hailing from Purbadhala of Netrokona district complaining of gradual enlargement of hands, feet, nose and other acral parts of the body for about last eight years. She noticed coarsening of the skin and gradual protrusion of her lower jaw. She complained of headache, vertigo, frequent passage of urine, increased thirst, weight loss and fatiguability. She was found hypertensive having blood pressure 200/110 mm of Hg. Her appearance was coarse with rough skin. There were enlargement of hands, feet, nose, lower jaw with prognathism and enlargement of other acral parts. Investigations revealed high plasma glucose level, both fasting and 2 hrs. after glucose, high level of growth hormone, failure of suppression of growth hormone during OGTT. Thyroid function tests of the patient were found normal with increased heel pad size and enlarged sella turcica in all diameters. She was diagnosed as a case of acromegaly due to growth hormone hypersecretion.     

3例肾移植受者妊娠的围产期随访及护理

目的 探讨肾移植受者妊娠的护理经验.方法 收集2005年～2011年间3例肾移植术后女性受者4次妊娠临床资料.妊娠前后均采用环孢素A或普乐可复、骁悉、泼尼松三联抗排斥治疗.结果 例1孕12周,胎儿宫内发育不良,终止妊娠.例2孕23周,血压183/120mmHg,水肿,尿蛋白(+++),保守治疗不理想,终止妊娠.例3先后二次妊娠,均因泌尿系感染,自然流产.结论 肾移植女性受者一般在术后2年妊娠,但仍被认为具有高风险性,必须在医护人员的孕前指导和围产期密切监护下进行.     

拉氧头孢静滴后飞行员少量饮酒出现戒酒硫样反应1例报告

摘要：目的总结戒酒硫样反应的诊治经验。方法回顾我院2010年4月1例使用头孢类抗生素期间的飞行员少量饮用啤酒引起戒酒硫样反应的诊治过程。患者直升机飞行员,男,31岁。输尿管镜下钬激光碎石取石术后给予拉氧头孢1．0g2／d静滴。术后第5日,患者晚饭时饮用一瓶啤酒后1h,自觉头晕、胸闷、嗜睡、醉酒感明显。血压80／30mmHgf1mmHg=0．133kPa）,心率110／min。结果根据患者使用药物史、少量饮酒史、症状、体征及检查结果,诊断为戒酒硫样反应。给予输液、吸氧、糖皮质激素等治疗后症状消失。结论使用头孢类抗生素期间少量饮酒即可引起戒酒硫样反应。     

卡维地洛治疗慢性肾病患者高血压的临床观察

目的卡维地洛治疗慢性肾病患者高血压的临床研究。方法采用随机人选其他药物治疗无效或疗效欠佳的高血压患者共34例,其中男性20例,女性14例,平均年龄（57.2±9.4）岁（24～69岁）。患者在不停用其他药物的基础上加用β受体阻滞剂-卡维地洛（落得,巨能药业生产）,从小剂量开始（2.5mg,2次/d）观察疗效,以后每周递增2.5mg,逐步加至靶剂量直至血压控制160/90mmHg以下。结果服药卡维地洛4周后,总有效率79.2%,心率从治疗前（77.5±14.8）次/min降至＂（66.7±7.2）次/min;收缩压和舒张压分别由治疗前（168.8±21.1）mmHg,（109.3±14.0）mmHg降至治疗后137.9±11.2）mmHg,（89.8±8.7）mmHg,服药8周后卡维地洛总有效率91.7%,收缩压和舒张压分别降至治疗后（134.1±10.5）mmHg,（85.3±7.6）mmHg,心率平均为（65.4±6.9）次/min。结论卡维地洛能有效治疗慢性肾病患者高血压。     

子痫前期并脑血管意外致死亡6例临床分析

目的研究子痫前期并脑血管意外致死亡的病例临床特点,探讨其早期诊断及治疗,以降低孕产妇死亡率。方法对2007年3月至2008年3月广州医学院第三附属医院6例重度子痫前期并脑血管意外致死亡孕产妇的临床资料进行回顾性分析。结果 6例患者中并发脑出血3例,脑梗塞2例,脑卒中（动脉出血）1例;孕周均超过32周,发生在产前4例,产后2例。多以昏迷或抽搐起病,首次检查血压舒张压〉110mmHg,呼吸系统及血液系统受损是脑损伤后最常见受累器官。从发病到死亡时间为5h至9d。新生儿存活5例,死胎1例。结论重度子痫前期并脑血管意外,发病突然,进展迅速,病死率高。治疗的关键在于预防和早期诊断。     

A case of idiopathic intracranial hypertension related with vesicoureteral reflux

Pseudotumor cerebri is idiopathic intracranial hypertension. The etiology of this syndrome has not been fully clarified. Excess cerebrospinal fluid production, scarcity of cerebrospinal fluid absorption, intracranial venous pressure elevation, increased intracranial blood volume are all thought to be responsible. The symptoms of the disease may be ordered according to prevalence as follows: headache due to increased intracranial pressure, blurred vision and diplopia. A thirteen-year-old female patient was brought in with complaints of headache, double and blurred vision. Systemic arterial hypertension (140/70 mmHg) was determined. Vesicoureteral reflux was detected as the hypertension etiology. In this article a rare pseudotumor cerebri case is presented secondary to vesicoureteral reflux which caused hypertension.     

经尿道精囊囊肿去顶减压术的应用

目的 探讨经尿道囊肿去顶减压术在精囊囊肿治疗中的效果.方法 对7例经B超、CT、MRI及膀胱镜诊断为精囊囊肿的患者行经尿道囊肿去顶术并随访.结果 手术顺利,平均手术时间20 min,平均手术出血量5 ml,平均住院时间3 d,术后平均随访28.3个月,患者临床症状均消失,未见复发,1例逆行射精.3例术前未育患者中2例术后1年生育;1例术后因逆行射精,将尿液中精子行卵胞质内单精子注射术治疗,术后半年生育.结论 经尿道囊肿去顶术具有创伤小,手术时间和术后住院时间短、术后恢复快的特点,是精囊外科手术治疗中的有效治疗方法.     

A case of pulmonary embolism after abdominal angiography

The patient was a 72-year-old woman who had been diagnosed with cholecystolithiasis and had undergone laparoscopic cholecystectomy. Since the postoperative pathologic diagnosis was a gallbladder cancer with a depth of wall penetration of subserosa, she was admitted to Kurume University Hospital for a second-look operation. After admission, abdominal angiography was performed with a right femoral arterial puncture. After the release of inguinal compression with a belt, chest pain and difficulty in breathing appeared. Despite her normal blood pressure, arterial blood gas analysis showed a PO2 of 74.7 mmHg and a PCO2 of 41.5 mmHg, representing a slight decrease in PO2. Chest X-rays showed an increased cardiothoracic ratio and decreased lucency in the left upper lung field. The electrocardiogram revealed atrial premature contraction. Cardiac ultrasound did not show expansion of the right heart and blood vessels or abnormal structures in the main pulmonary artery. Since lung perfusion scintigraphy revealed perfusion defects in the left upper to middle and right upper lung fields, acute pulmonary embolism was diagnosed, and oxygen inhalation, thrombolytic, and anticoagulant therapy were instituted immediately. The symptoms improved the following day, but 240,000 u/day of urokinase was administered for 5 days, and 1,500 u/day of heparin for 10 days. On lung perfusion scintigrams 6 days later, the defects had disappeared. Moreover, no definite abnormal shadows were noted on chest X-rays. Radical surgery for gallbladder cancer was performed 3 weeks later. Considering the possible development of pulmonary embolism, we felt the need for careful management if the patient is released from bed rest after abdominal angiography.     

全天血压动态监测在冠心病合并高血压患者中的应用

目的：探究全天血压动态监测在冠心病合并高血压患者中的应用效果。方法：选取我院2014年1月至2014年12月收治的180例冠心病合并高血压患者,采用简单随机分组方法将患者分为研究组与对照组。研究组患者采用血压动态监测仪对血压进行每日动态监测,对照组患者采用随机偶测血压的方法进行每日血压监测。所有患者依据每日血压监测结果调整用药方案,治疗三个月。结果：治疗前研究组与对照组患者的血压和心率无差异（P＞0．05）。3个月后,研究组患者的收缩压差值均值为（16．6±1．0）mmHg、舒张压均值为（10．7±0．8）mmHg,心率为（11．5±0．7）次／min,优于对照组差值（5．0±0．9）mmHg、（2．7±0．7）mmHg、（1．6±0．6）次／min,且差异具有统计学意义（P＜0．01）。研究组患者用药期间有9例发生不良反应,分别为严重头晕头痛2例、恶心呕吐4例、心前区疼痛3例,不良反应发生率为10％,对照组患者用药期间有17例发生不良反应,分别为严重头晕头痛6例、恶心呕吐5例、心前区疼痛6例,不良反应发生率为18．89％,两组对比研究组的治疗效果更优,差异具有统计学意义（P＜0．05）。结论：对冠心病合并高血压患者进行全天血压动态监测能够更好的控制患者的血压水平,并减少治疗过程中的一些不良反应的发生。     

Blood pressure in schoolchildren measured under standardized conditions

The blood pressures of 6346 children who were between the ages of seven and 17 years were measured under standardized conditions. Blood pressures were similar in prepubertal boys and girls. After puberty, the systolic blood pressures of the girls remained unchanged whereas those of the boys continued to rise. The difference between the fourth and fifth Korotkoff sounds was 2 mm at both the 50th and 95th percentiles. The systolic blood pressure was observed to fall over a 10-min period by 4-9 mmHg at the 50th percentile and 9-15 mmHg at the 95th percentile. Over the same period of time, the diastolic blood pressure was seen to fall by 2-3 mmHg and 3-6 mmHg at the 50th and 95th percentiles, respectively. There was no further fall in blood pressure after 10 min. The conditions and timing of measurement are important in blood-pressure evaluation and may explain the differences in blood pressure that have been reported for different populations.     

Renal sympathetic denervation for the treatment of resistant hypertension with chronic renal failure: first-in-man experience

A 39-year-old man with resistant hypertension,presented with headache and dizziness at the emergency department on January 6,2012.The patient had a history of hypertension for 3 years,his highest blood pressure was 250/110 mmHg,and he was taking antihypertensive medication regimens for at least 6 months.A mitral replacement by bioprosthetic valve had been implanted 6 months before.The patient was in chronic renal failure (CRF) uremia,maintenance of which he underwent the standard hemodialysis treatment three times a week for 6 months.Hemodialysis was done using anti-seepage,bicarbonate dialysate,the German Fresenius 4008S dialysis machine,with a blood flow of an average of 240 ml/min,dialysis flow 500 ml/min,4 hours/time.Coronary artery disease,secondary hypertension,and type 2 diabetes mellitus were excluded.After admission,this patient was subjected to ambulatory blood pressure monitoring and adrenal computed tomography.Estimated glomerular filtration rate (eGFR) was calculated by simple modification of diet in renal disease (MDRD) equation for Chinese.1 All blood samples were taken a day before dialysis in order to exclude interference.     

应用多频生物电阻抗法调节血液透析患者干体重对血压的影响

目的 观察在多频生物电阻抗法指导下调节干体重(DBW)对血液透析患者血压及透析相关并发症的影响.方法 应用多频生物电阻抗分析仪测量细胞外液(ECW).根据同性别正常对照组的ECW值确定正常参考范围.对ECW增高(提示容量过负荷)者,逐步降低DBW,观察ECW和血压的变化.对ECW降低(提示容量不足)者,逐步升高DBW,...     

围产期新生儿血压正常值

本文应用DINAMAPTM847XT型新生儿生命体征监护仪测定了351例足月新生儿出生7日内血压正常值。此期新生儿血压95%正常值范围为:收缩压57.0～91.2mmHg,舒张压为29.3～55.1mmHg,平均动脉压为43.7～71.5mmHg。根据本文资料,我们提出:出生7日内新生儿收缩压>90mmHg或舒张压>55mmHg,或平均动脉压>70mmHg,可诊断为高血压,而收缩压<50mmHg,或舒张压<30mmHg,或平均动脉压<40mmHg,可诊断为低血压。     

复发性多软骨炎（附3例报告及文献复习）

目的：研究复发性多软骨炎的临床表现、诊断与鉴别诊断以及治疗与预后。方法：总结３例诊断为复发性多软骨炎患者的临床表现及治疗方法。例１先出现鼻染塌陷，后出现声嘶、呼吸困难。气管切开后带管出院，未确诊。４个月后又因双耳胀痛，胸骨帝隐痛、发热，再次住院，诊断为复发性多软骨炎。例２首发症状亦是鼻梁塌陷，２年后出现右眼突，诊断为此病。例３首发症状为耳郭红、肿、热、痛，诊断不耳郭软骨膜炎。３个月后出现声嘶，按喉     

针对性护理模式对冠心病心绞痛患者心率血压及心理状态的影响分析

目的 探讨针对性护理模式在冠心病心绞痛患者临床治疗中的应用效果,结合患者的心率血压及心理状态变化情况进行评价。方法 选取解放军东部战区总医院心血管内科2019年2月至2020年2月期间收治的74例冠心病心绞痛患者作为研究对象,应用随机数字表法,分为观察组37例,进行针对性护理模式,对照组37例,进行常规护理,对比两组患者的护理效果。结果 与对照组相比,观察组患者在护理后的心率(HR)水平[(76.17±4.82)次/min vs.(80.62±3.94)次/min]、收缩压(SBP)水平[(134.42±10.25)mmHg vs.(143.57±11.94)mmHg]、舒张压(DBP)水平[(88.92±7.63)mmHg vs.(44.73±5.05)mmHg]、心绞痛发作频次[(0.52±0.13)次/周vs.(1.47±0.31)次/周]以及焦虑自评量表(SAS)评分[(38.14±4.37)分vs.(93.71±5.09)分]相对更低(P0.05),与对照比,观察组患者的护理满意度相对更高(P0.05)。结论 冠心病心绞痛患者的治疗恢复期间,针对性护理模式的应用,可以有效纠正患者的心率、血压异常,同时改善其心理状态,减少症状的发作,改善患者的预后。