抗结核药物对HBsAg阳性者肝功能影响30例分析

目前使用的有乙胺丁醇 (Ｅ)、异烟肼 (Ｈ)、利福平 (Ｒ)及吡嗪酰胺 (Ｚ) ,联合应用ＨＲＺ易引起肝功能损害 ,以ＨＢｓＡｇ阳性患者尤为明显。现就我院近年来收治的 30例ＨＢｓＡｇ阳性患者用抗结核药物引起肝功能损害的情况加以分析。1　临床资料本组 30例ＨＢＳＡｇ阳性结核病患者用抗结核药物前肝功能正常 ,用药过程中出现不同程度的肝功能损害。男 2 1例 ,女 9例 ,年龄 2 0～ 62岁 ,平均 36 5岁。初治结核 2 4例 ,复治结核 6例。患者的肝功能损害症状多发生在用药初 3个月 ,均在用药过程中出现 ,但也有无明显症状而出现肝功能异常者。主…     

主诉:腹胀、纳差、乏力、上腹痛、黄疸1月余

1 病历摘要患者男,47岁。因腹胀、纳差、乏力、上腹痛1个半月,于1977年9月12日来院诊治。患者自1977年7月下旬以来,自觉上腹部不适和隐痛,伴纳差、乏力。查体发现肝在右肋缘下1.5厘米,血清谷丙转氨酶(SGPT)190单位,诊断为“肝炎”,给予护肝治疗。一周后,上腹部疼痛加重,转为持续性隐痛,阵发性加剧,并向腰背部放射,平卧位加重,端坐前倾位时减轻。但无畏寒、发热。住院两天后,皮     

乏力、纳差伴紫癜

病历摘要 患者男,19岁,油漆工人.2007年5月主因"乏力、纳差半个月"入住北京大学第一医院.患者入院前半个月乏力、纳差,不伴发热、头晕、咳嗽、咳痰、腹痛、腹泻.10 d前发现胸背部出血点,紫红色,不高出皮肤,无痛痒感,未经特殊治疗.     

纳差、乏力、咳嗽、发热

病案摘要: 患者,女,57岁,于1991年2月17日第八次入院。主诉:纳差、乏力十年,加重三年。咳嗽发热三天。现病史:十年前无诱因出现纳差、乏力、口干,并出现牙齿脱落。曾在某医院诊为“慢性肝炎”。近三年乏力、纳差加重,并伴有心悸;反复因肺部感染及胸膜炎住院治疗。持续存在较严重贫血,血色素最低为30克/升,最高时未超过80克/升,三天前因咳嗽、低热再次入院。病后口千、吞咽困难、视物模糊。体     

乏力、纳差、腹胀、腹痛、消瘦、发热、腰背酸痛、右肾包块

病历摘要患者,女性,61岁,因反复乏力、纳差、消瘦6年余,腹胀、少尿2年余于1990年3月26日入院。患者自1984年初起无明显诱因出现乏力、纳差、轻度恶心及中上腹不适,拟诊为“慢性乙型肝炎”予以中草药及其他一般保肝治疗,病情尚稳定,但血清ALT(丙氨酸转氨酶)时高时低。同年年底患者自觉烦渴,容易饥饿,体重明显减轻,检查发现尿糖强阳性,空腹血糖高达22.2mmol/L,确诊为糖尿病,先后给予控制饮食、口服D860、优降糖、达美康等药     

水肿、腹胀、乏力

低蛋白血症可见于临床多种疾病,如营养不良、肾病综合征、肝硬化、恶性肿瘤等.严重低蛋白血症(指血浆总蛋白<50 g/L、白蛋白<25 g/L)往往是疾病预后不良的表现.我们收治了1例患者,白蛋白最低为10.4 g/L,经过一系列检查,明确诊断后针对病因治疗,效果非常满意.现复习该患者的诊治过程,旨在整理治疗低蛋白血症的临床思路.     

腹胀、纳差、呕血、皮肤黄染

1病历摘要患者男，66岁。因腹胀、乏力、纳差4月余，皮肤黄染1月余于1995年8月6日人院．患者于1995年3月底出现上腹胀．餐后加重，伴乏力、纳差。无发热、腹痛、胸痛、咳嗽、呕血等症状。入院前1个月曾在某医院住院给予一般的护肝治疗后,病憎加重，皮肤出现黄染，尿呈茶红色，伴有皮肤出血点、少尿等症状百转本院治疗。既往无肺结核、肝炎、骨髓炎等病史。查体：T36℃，P80次／分，R20次／分，BP11．5／7kPa。慢性肝病面容，营养差，精神美自，定向力差，无扑翼样震颤，皮肤、巩膝深度黄染，面部、颈部以及购部皮肤可见蜘蛛病和散在的出…     

纳差、乏力、腹胀、尿少、黄疸、神志不清——查房选录之八

病历摘要患者男性,55岁,因乏力、纳差、腹胀、尿少、黄疸10余天,神志不清1天急诊入院。病人原有乙型病毒性肝炎10余年,时而出现消化道症状及肝功能异常,乙型肝炎表面抗原(HBsAs)持续阳性。于入院前3个月,病人曾因腹胀、尿少、肝功能异常住某院内科。经保肝、利尿等治疗,症状减轻而出院,当时     

异甘草酸镁注射液治疗药物性肝损害的疗效及其对患者肝功能指标的影响

目的 探讨异甘草酸镁注射液治疗药物性肝损害的临床疗效以及对患者肝功能指标的影响.方法 选取2018年6月至2019年10月在许昌市中心医院治疗的300例药物性肝损害患者的临床资料,分为对照组和观察组,每组150例.对照组采取常规治疗,观察组患者在此基础上采取异甘草酸镁注射液治疗.比较两组患者临床疗效、不良反应及相关肝功...     

Abdominal Distention and Emesis in a Term Neonate

BackgroundNecrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis of the bowel wall. Although there are numerous studies on clinical presentations of preterm NEC, approximately 10–15% of cases occur in full-term neonates. Nearly 10% of all infants with NEC will develop a rapidly progressive and fatal form of the disease called NEC totalis.Case ReportA 24-day-old term male infant presented to the Emergency Department (ED) with emesis. The infant was ill-appearing with a tense abdomen and had significant tachycardia and hypotension. The patient was immediately volume resuscitated and started on empiric antibiotics. Initial radiographs revealed no evidence of bowel obstruction or pneumatosis. Pediatric Surgery was consulted, and upper gastrointestinal and abdominal computed tomography scans were obtained, which were nondiagnostic. The patient was taken to the operating room for an exploratory laparotomy after continued clinical deterioration and was diagnosed with NEC totalis and passed away within 6 days.Why Should an Emergency Physician Be Aware of This?This case demonstrates an uncommon presentation of NEC in an otherwise healthy term neonate without any known risk factors. The diagnosis of NEC is challenging because imaging studies may be inconclusive, particularly early in the clinical course. Regardless of the etiology, all infants who present to the ED with signs and symptoms of severe gastrointestinal distress should be treated with basic emergency care, including rapid fluid resuscitation, empiric antibiotics, bowel decompression, and early surgical consultation.     

An Unusual Case of an Icteric Infant with Abdominal Distention

Background

Jaundiced infants are uncommon in most emergency departments (EDs). Biliary rupture remains one of the more rare and less described causes of this condition.

Case Report

A 5-month-old male presented to our ED with scleral icterus, increasing abdominal distention, and increased irritability. A bedside ultrasound revealed a moderate amount of ascites and further imaging suggested he had a rupture of his common bile duct. Surgical exploration confirmed this and revealed the presence of choledocholithiasis, which was the likely cause of the rupture.

Why Should an Emergency Physician Be Aware of This?

Biliary rupture remains a rare but serious condition in very young patients. Emergency physicians should consider bedside ultrasound as an adjunct in undifferentiated abdominal distention or jaundice in this patient population.     

脓毒症发生早期肝功能障碍的临床研究

目的:研究脓毒症病人早期肝功能障碍的发生率和预后的相关性.方法:回顾性调查2001～2005年间ICU住院确诊脓毒症病人268例的资料,记录早期肝功能障碍发生率、APACHE Ⅱ评分、住院时间、器官衰竭数目和病死率等.结果:原有肝硬化和急性肝衰竭或慢性肝衰竭急性发作的病例除外,共有33例出现早期肝功能障碍(12.3%),与不存在早期肝衰竭病例相比,这些病人的基本情况有差异,平均ICU住院天数延长(7∶3 d),病死率(30.4%:16.4%;P＜0.001)增高.Logistic回归分析显示肝功能障碍是病死率的独立危险因素(OR,1.87;95% CI,1.72～2.03;P＜0.001),其特异性超过其他脏器功能障碍的影响.结论:脓毒症病人早期肝功能障碍的发生率较高,对预后病死率的预警作用具有特异性,可以作为独立的危险因素.     

生姜敷脐法治疗损伤性腹胀60例

损伤性腹胀多见于脊柱、骨盆及腹部损伤的病人。为解决这类病人的腹胀难题，自１９９１年以来，根据中医理论采用生姜敷脐法治疗本病６０例，取得较好效果，现介绍如下：１临床资料本组６０例均为骨折后卧床病人，其中腰椎压缩性骨折４２例，骨盆骨折１８例。男性４８例，...     

耳穴压豆护理预防60例腹部手术后腹胀的疗效观察

目的:观察耳穴压豆预防腹部手术后腹胀的护理效果。方法:将120例行腹部手术的患者按随机法分为观察组和对照组,每组60例。对照组术后给予常规护理;观察组在常规护理的基础上加用耳穴压豆,压豆期间按压患者特定耳穴,每次5 min,3次/d。观察两组病人肠鸣音恢复时间、肛门首次排气时间及腹胀发生情况。结果:观察组肠鸣音恢复时间为(15.04±7.15)h,肛门首次排气时间为(25.26±11.13)h,腹胀发生率为15.00%;对照组肠鸣音恢复时间为(22.16±8.59)h,肛门首次排气时间为(34.37±13.21)h,腹胀发生率为36.67%。两组肠鸣音恢复时间、肛门首次排气时间及腹胀发生率相比具有显著差异(P0.05)。结论:耳穴压豆能有效缩短腹部手术后患者的肛门排气时间,促进其胃肠功能恢复,预防腹胀的发生。     

Graves病合并肝功能异常临床研究

目的：了解Graves病合并肝功能异常的发生率、临床表现及相关因素。方法：1990～2001年复旦大学附属华山医院收治Graves病住院患者312例，分析其临床表现，肝功能指标，血清甲状腺激素水平以及甲状腺自身抗体水平。结果：312例患者中，Graves病合并肝功能异常的发生率为50．3％。这些患者的甲状腺激素水平、TsAb水平显著高于无肝功能异常患者；同时，他们合并甲亢性心脏病的比例更高。抗甲状腺药物治疗后，肝功能的恢复与甲状腺激素水平的回落一致。结论：Graves病合并肝功能异常的发生率较高，与患者的甲状腺激素水平、TsAb水平关系密切。     

The Spectrum of Hepatic Dysfunction in Inflammatory Bowel Disease

The spectrum and incidence of liver disease is described amonga large series of patients with inflammatory bowel disease.The incidence of significant liver disease identified by thepresence of serial biochemical abnormalities of liver functionwas 8·2 per cent. Transient peri-operative changes inliver function tests are common and usually relate to underlyingintra-abdominal sepsis. Percholangitis, sometimes termed portaltriaditis, is one of the commoner lesions, and is usually associatedwith extensive colitis and improves with resection of the underlyingbowel disease. Cirrhosis of the liver is an important but uncommoncomplication and is usually associated with extensive long-standingdisease. Stenosing cholangitis and biliary tract carcinoma areboth important though rare associations. They are both associatedwith extensive disease of long-standing, but resection of theunderlying inflammatory bowel disease does not necessarily protectthe individual from these complications. Although stenosingcholangitis is a diffuse lesion of the biliary tree it is importantto exclude strictures of the extra-hepatic biliary tree whichmay be amenable to surgical correction. Hepatic dysfunctionis rarely the sole indication for advising surgery for the underlyingbowel disease but the identification of the nature of the hepaticdysfunction provides a rational basis for such a decision andopportunities for the surgical correction of the hepatic lesionitself.     

住院患者肝功异常病因分析

目的 探讨住院患者肝功异常病因及影像学诊断意义。方法 对2008年1月—12月住院的223例18～83岁肝功异常患者进行相关实验室检查,以及B超、CT和MRI检查。结果 肝脏本身疾病引起135例,占6054%,肝外疾病引起83例,占37.22%,原因不明5例,占2.24%。B超作为无创性检查,价格低亷,准确率高,可作为常规检查。结论 住院患者肝功损害病因复杂,以药物性肝炎、胆道系统疾病及脂肪肝较多见。