PCT联合CRP指导小儿肺炎抗菌治疗的应用效果

目的研究血清降钙素原(PCT)联合C反应蛋白(CRP)指导小儿肺炎抗菌治疗的应用效果。方法选取2016年10月至2019年10月在本院接受治疗的138例确诊肺炎患儿,采用随机数字法分为实验组和对照组,每组69例。对照组采用抗菌药物常规治疗,实验组在治疗过程中每天检测血清PCT及CRP水平,并依据检测结果指导进行抗生素治疗。治疗后,比较两组患儿抗生素使用情况、住院时间、症状体征消失时间等。结果治疗前,两组患儿PCT、CRP水平比较差异无统计学意义;治疗第7天,两组患儿两项指标水平均下降,实验组明显低于对照组(P<0.05),且实验组治疗前,治疗第3、5及7天PCT、CRP水平依次下降(P<0.05)。两组抗生素使用率比较差异无统计学意义;实验组抗生素使用时间、住院时间以及症状体征消失时间均短于对照组(P<0.05)。结论小儿肺炎抗菌治疗过程中监测PCT、CRP水平并以之为依据指导治疗效果显著,有助于促进康复进程,值得临床进一步推广。     

降钙素原检测在抗生素应用中的意义

目的探讨降钙素原(PCT)检测在抗生素应用中的临床意义。方法将2014年3月至2016年3月杞县疾病预防控制中心收治的200例呼吸道感染患者随机分成对照组和观察组,各100例。对照组通过C反应蛋白(CRP)、白细胞计数(WBC)水平以及临床症状指导抗生素应用,观察组则通过检测PCT水平指导抗生素应用,记录两组患者的治疗有效率、抗生素使用疗程及使用率、住院时间、住院费用。结果两组总有效率比较,差异无统计学意义(P>0.05),而观察组抗生素使用率及使用疗程、住院时间、住院费用均优于对照组,差异具有统计学意义(P<0.05)。结论 PCT检测可有效指导抗生素应用,缩短使用疗程,降低使用率,减少住院费用。     

外周血内PCT、CRP水平对小儿急性腹泻采取抗生素治疗的指导效果评价

目的 考察外周血内降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)水平对小儿急性腹泻采用抗生素治疗的指导效果评价。方法 采集2016年8月～2019年12月于我院诊治的急性腹泻患儿60例,PCT与CRP联合评分≥0.52均为阳性,根据时间顺序随机分为观察组和对照组,每组30例,对照组患者不应用抗生素,观察组患者给予抗生素,比较两组患儿外周血PCT、CRP的水平及二者联合评分、明显黏液脓血便率、大便细菌阳性率及临床治疗有效率。结果 观察组和对照组患儿在外周血PCT、CRP及二者联合评分上相比,差异无统计学意义(P0.05);相比于对照组,观察组患儿的明显黏液脓血便率显著降低,差异具有统计学意义(P0.05),大便细菌阳性率相比,差异无统计学意义(P0.05);观察组患儿的临床治疗有效率显著高于对照组,差异具有统计学意义(P0.05)。结论 外周血内PCT、CRP水平对于无典型症状的小儿急性腹泻抗生素的早期应用具有指导意义,治疗效果良好。     

抗生素降阶梯疗法治疗新生儿感染性肺炎患儿的效果及其对血清学感染指标水平的影响价值

目的 探讨新生儿感染性肺炎患儿应用抗生素降阶梯疗法的效果及其对血清学感染指标水平的影响价值。方法 选取2019年8月至2021年3月期间平顶山市妇幼保健院收治的97例新生儿感染性肺炎患儿作为研究对象,以抽签的方法进行分组。对照组48例给予常规抗生素治疗,观察组49例给予抗生素降阶梯疗法,比较两组患儿临床疗效、症状控制情况、血清学感染指标、不良反应。结果 观察组患儿总有效率高于对照组（P<0.05）;观察组患儿体温恢复时间、肺啰音消失时间、呼吸平稳时间、住院时间均低于对照组（P<0.05）;观察组患儿血清降钙素原（PCT）、C反应蛋白（CRP）水平、白细胞（WBC）计数均低于对照组（P<0.05）;两组患儿腹泻、呕吐、鹅口疮发生率比较,差异无统计学意义（P>0.05）。结论 抗生素降阶梯疗法治疗新生儿感染性肺炎患儿效果确切,能够有效控制感染情况,减轻临床症状,缩短住院时间,改善CRP、WBC、PCT水平,具备较高的临床推广应用价值。     

乳铁蛋白胶囊佐治儿童反复下呼吸道感染后发病率的临床分析

目的:探究乳铁蛋白胶囊佐治儿童反复下呼吸道感染的临床效果。方法:选取收治的60例反复下呼吸道感染的患儿作为研究对象,采用乳铁蛋白胶囊治疗,视为观察组;另选取同期接受常规治疗而未实施乳铁蛋白胶囊治疗的60例反复下呼吸道感染患儿,视为对照组,比较两组症状消失或改善的时间、治疗前后各项免疫球蛋白(IgG、IgM、IgA)水平以及反复下呼吸道感染发病率、抗生素使用率、感染后住院率。结果:在发热、咳嗽、咯痰、肺部炎性反应消失等症状的改善或消失时间方面,观察组明显快于对照组,差异有统计学意义(P<0.05)。治疗前,两组IgG、IgM、IgA水平差异无统计学意义(P>0.05);治疗1个月后,两组IgG、IgM、IgA水平均有一定提高,但观察组要高于对照组,差异有统计学意义(P<0.05)。对照组反复下呼吸道感染发病率、抗生素使用率、感染后住院率分别为20.00%、25.00%、16.67%,观察组反复下呼吸道感染发病率、抗生素使用率、感染后住院率分别为6.67%、10.00%、5.00%,两组差异有统计学意义(P<0.05)。结论:乳铁蛋白胶囊佐治儿童反复下呼吸道感染效果明显,可以促进患儿症状的改善,增强患儿免疫功能,降低治疗后发病率,值得推广。     

140例儿童呼吸道感染血清降钙素原检测结果分析

目的监测患儿的血清降钙素原(PCT)以指导抗生素的使用,探讨PCT在治疗儿童呼吸道感染性疾病中的应用价值。方法回顾性分析呼吸道感染患儿140例,分为对照组和PCT组,每组70例。对照组为常规治疗,PCT组为在PCT指导下使用抗生素的治疗。观察记录两组治疗前后的体温、白细胞计数、C反应蛋白、降钙素原、体温恢复正常时间、出院时间、抗生素使用时间及抗生素使用率。比较分析两组的治疗情况。结果两组观察指标中PCT组的抗生素使用时间和抗生素使用率明显少于对照组(P0.01),差异具有统计学意义;两组其余的观察指标差异无统计学意义(P0.05)。结论监测血清降钙素原可有效指导抗生素的使用,在治疗儿童呼吸道感染性疾病中具有重要应用价值,可有效减少不必要的使用抗生素,而不影响疾病预后。     

头孢噻肟与丙种球蛋白联合治疗新生儿败血症疗效观察

目的:探讨分析头孢噻肟联合丙种球蛋白治疗新生儿败血症的临床疗效。方法:选取84例败血症患儿随机分为观察组和对照组,对照组患儿给予头孢噻肟治疗,观察组患儿给予头孢噻肟联合丙种球蛋白治疗,比较两组患儿临床疗效、临床症状缓解时间、住院时间、治疗前后血清CRP和PCT水平。结果:观察组新生儿临床疗效优于对照组,观察组新生儿拒奶缓解时间、神经系统症状缓解时间、体温恢复时间、住院时间短于对照组,治疗后观察组新生儿血清CRP和PCT水平低于对照组,差异均具有统计学意义(P<0.05)。结论:头孢噻肟联合丙种球蛋白治疗新生儿败血症疗效显著,并且较单用头孢噻肟治疗临床疗效更佳,可缩短患儿临床症状缓解时间、住院时间,改善血清CRP和PCT指标,促进患儿的康复,值得推广。     

抗生素降阶梯疗法对新生儿感染性肺炎的治疗效果

目的观察抗生素降阶梯疗法对新生儿感染性肺炎的治疗效果。方法选择2016年9月至2018年9月许昌市建安区妇幼保健院治疗的122例感染性肺炎新生儿,采用随机数表法将患儿分为对照组和观察组,每组61例。入选患儿均接受吸氧、扩张支气管等综合治疗。对照组患儿接受头孢他啶治疗。治疗3 d后可依据痰培养结果选取敏感抗生素治疗。观察组患儿接受亚胺培南治疗。治疗3 d后依据痰培养结果选取敏感抗菌药物治疗。两组均连续治疗7 d。观察两组患儿临床疗效。评估患儿治疗前后血清降钙素原(PCT)、C反应蛋白(CRP)及白细胞计数(WBC)水平变化。比较两组患儿治疗过程中临床症状消失时间。结果观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05);治疗后两组患儿WBC、PCT、CRP水平低于治疗前,观察组患儿WBC、PCT、CRP水平低于对照组,差异有统计学意义(均P<0.05);观察组气促、肺部啰音、发热、喘憋症状消失时间均短于对照组,差异有统计学意义(均P<0.05)。结论采用抗生素降阶梯疗法治疗新生儿感染性肺炎,可快速控制病情,加快患儿症状缓解,降低机体炎症水平。     

降钙素原C反应蛋白白细胞计数联合检测在儿科呼吸道感染中的应用

目的 探讨血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)联合检测在儿科呼吸道感染性疾病中的应用价值.方法 选择2015年1月—12月在我院儿科住院的140例呼吸道感染患儿,其中细菌感染组80例,病毒感染组60例,所有患儿均在入院时抽取静脉血做PCT、CRP、WBC检测,比较三项检测指标在儿科呼吸道感染疾病中的应用价值.结果 细菌感染组患儿PCT、CRP、WBC水平均高于病毒感染组患儿(P<0.05).结论 在儿科呼吸道感染疾病诊断过程中,PCT、CRP、WBC三项联合检测能提高早期感染诊断的准确性,更好地指导抗生素的合理应用,避免不必要的抗生素治疗.     

血清降钙素原指导儿童呼吸道感染抗生素应用的临床意义

目的探讨血清降钙素原(PCT)在治疗儿童呼吸道感染性疾病中的临床应用价值。方法将儿童呼吸道感染患儿200例,随机分为对照组和PCT组,每组100例。对照组为常规治疗,PCT组为在PCT指导下使用抗生素的治疗。观察记录两组治疗前后的体温、降钙素原、体温恢复正常时间、抗生素使用时间及抗生素使用率。比较分析两组的治疗情况。结果两组观察指标中PCT组的抗生素使用时间和抗生素使用率明显少于对照组(P<0.01),差异具有统计学意义;两组其余的观察指标差异无统计学意义(P>0.05)。结论血清降钙素原可有效指导抗生素的使用,在治疗儿童呼吸道感染性疾病中具有重要的应用价值,能有效减少不必要的使用抗生素,且不影响疾病预后。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.