甲状腺功能亢进症合并周期性麻痹12例临床分析

目的:探讨甲状腺功能亢进症(甲亢)合并周期性麻痹临床特点。方法:对12例甲亢合并周期性麻痹患者的临床资料进行回顾性分析。结果:本组无1例死亡。血钾在2 h~3 d恢复正常。肢体瘫痪症状于补钾后3~24 h缓解,肌力于2 h~3 d完全恢复。抗甲亢治疗1年内随访无周期性麻痹再复发。结论:甲亢合并周期性麻痹多见于壮年男性,大部分为重度低血钾,补钾治疗迅速有效,甲亢控制后周期性麻痹无复发。     

甲亢合并低钾性周期麻痹15例的临床分析与护理

目的:探讨甲亢合并低钾性周期麻痹的临床特点及护理要点。方法:分析15例甲亢合并低钾性周期麻痹治疗及护理过程。结果:15例甲亢合并低钾性周期麻痹经积极的补钾和抗甲亢治疗病情明显控制。结论:甲亢合并低钾性周期麻痹经积极的抗甲亢治疗和护理低钾性周期麻痹可显著降低发病率。     

婴幼儿营养不良合并低钾麻痹44例的治疗方法

目的探讨婴幼儿营养不良合并低钾麻痹的治疗方法。方法对44例婴幼儿营养不良合并低钾麻痹的患儿根据血钾浓度给予不同的剂量和浓度静脉补钾联合口服补钾,较高浓度(>0.3%)静脉补钾在心电监护和监测血钾下进行,同时注意补镁。观察神志、呕吐、腹胀及四肢肌力、肌张力恢复情况。结果44例中多数于24h内病情明显好转,呕吐、腹胀缓解,12~48h内四肢肌力、肌张力恢复正常,血钾浓度于入院后48~72h逐渐恢复至3.5 mmol/L以上。4例患儿补钾4d后测血钾仍低于3.5mmol/L,予补镁2d后血钾渐恢复正常,未出现高钾血症及死亡病例。结论营养不良患儿出现低钾血症时易引起四肢骨骼肌,消化道平滑肌、呼吸肌麻痹,并累及心肌,根据血钾调整静脉补钾浓度加口服补钾,注意补镁,加强支持治疗效果良好。     

门冬氨酸钾镁治疗重度低钾血症疗效观察

目的：观察门冬氨酸钾镁治疗重度低钾血症的疗效。方法：将80例重度低钾血症分为对照组40例,采用常规补钾加螺内酯治疗;治疗组40例,在常规补钾加螺内酯治疗基础上加用门冬氨酸钾镁（潘南金）,分别观察、统计患者血钾浓度恢复至3.5mmol/L时间、心电图恢复正常时间、双下肢肌力恢复至5级时间及门冬氨酸钾镁不良反应。结果：治疗组患者血钾浓度恢复至3.5mmol/L时间、心电图恢复正常时间及双下肢肌力恢复至5级时间均显著少于对照组患者（P〈0.05）,且未见明显不良反应。结论：门冬氨酸钾镁治疗重度低钾血症安全、有效,值得临床应用。     

甲状腺毒症合并Gitelman综合征2例临床特征及基因突变分析

目的 分析甲状腺毒症合并Gitelman综合征(GS)2例患者的临床特征及基因突变情况.方法 回顾性分析2例甲状腺毒症合并GS患者的临床资料,并对SLC12A3基因进行测序.结果 2例患者分别诊断为亚急性甲状腺炎合并GS和Graves病合并GS,均有乏力、低血钾、低血镁、低尿钙等临床表现.SLC12A3基因测序发现4处不同的基因突变位点,3处为错义突变,1处为剪切变异.给予氯化钾、螺内酯和门冬氨酸钾镁治疗后,病情较前缓解.结论 甲状腺毒症与GS可合并存在,临床上容易漏诊.对于难以纠正的低钾血症患者要警惕可能合并两种或多种引起低血钾的疾病,及时给予正确的诊断,必要时进行基因筛查.     

老年肝硬化腹腔积液患者肛注补钾41例疗效分析

肝硬化腹腔积液患者由于食欲减退或恶心呕吐、摄入减少、继发醛固酮增多和长期应用利尿剂，常伴有钾代谢紊乱，临床上多表现为低钾血症。采用肛注补钾的方法治疗41例老年肝硬化腹腔积液合并低钾患者，并与静脉补钾的治疗效果作对比。报告如下：     

低钾低镁血症对慢性肺源性心脏病难治性心力衰竭的影响及对策

本文应用钾、镁制剂治疗慢性肺源性心脏病难治性心力衰竭并发低钾低镁血症46例,均取得满意效果。结合文献说明了低钾低镁对慢性肺源性心脏病难治性心力衰竭的影响,洋地黄中毒、哮喘与低钾低镁明显相关。揭示：对慢性肺源性心脏病难治性心力衰竭的患者,不仅要积极纠正低钾低镁血症,而且常规治疗上应用镁剂能增加心肌的舒缩功能,缓解支气管平滑肌痉挛,这种对循环和气道的双重扩张作用,对改善心肌收缩状态,减轻心脏前后负荷,扩张肺小动脉,降低肺动脉压力,调整肺内通气,血流比例失调,增强利尿作用,均具有较显著的治疗作用,体会：慢性肺源性心脏病难治性心力衰竭并发低血钾者,均并发低血镁,在迅速补钾同时必须补镁。补镁可显效,慢性肺源性心脏病难治性心力衰竭出现洋地黄中毒引起的心律失常和顽固性哮喘,顽固性低血钾,镁制剂不失为治疗的首选药物;镁为治疗慢性肺源性心脏病难治性心力衰竭提供了一种新的途径和理论依据,可作为常规治疗的一组措施。     

乏力、低钾、两下肢瘫痪

本病例具有以下特点:1.51岁,既往有胆囊切除史,首发症状以两下肢无力为主,病情进展迅速;2.四肢温痛觉存在,腓肠肌有压痛,无病理反射;3.冬季发病,无发热,无腹泻,无多饮多尿;4.血压正常,无头痛。5.低钾、低钙,虽经积极补钾,血钾仍进行性下降。6.ECG 示u 波>T 波。故该病例考虑以下疾病。一、摄入不足引起的低钾麻痹该病往往因     

甲亢合并周期性麻痹35例临床分析

目的探讨甲亢合并周期性麻痹的临床特点。方法回顾性分析35例甲亢合并周期性麻痹患者的临床资料。结果男性35例，发作时均有不同程度的双下肢瘫软或四肢软瘫，无颅神经、感觉神经受累，伴有血钾降低者35例，而且T3、T4均高于正常。结论甲亢合并周期性麻痹以年轻男性多见，补钾治疗可迅速改善症状，抗甲亢治疗是控制甲亢合并周期性麻痹复发的关键。甲亢周期性麻痹是甲亢病人常见的神经肌肉并发症。国内资料提示4％的甲亢病人合并此症。本症多见男性，周期性麻痹多为首发症状和就诊原因，而容易忽视甲亢的临床症状，导致甲亢误诊、漏诊。此文对1988～2006年间收治的35例甲亢合并周期性麻痹患者的临床资料作回顾性分析，现报告如下。     

低钾型周期性麻痹病人的病情观察和护理

目的总结低钾型周期性麻痹病人的护理体会。方法通过回顾性分析48例低钾型周期性麻痹病人的病情特点,护士进行血钾的监测,观察血钾对心脏的影响,并进行心理护理,观察病人的尿量及做好健康宣教。结果48例低钾血症的病人经过补钾等治疗护理后,有47例病人于2～4天痊愈出院,1例经上呼吸机等抢救治疗9天后治愈出院。结论密切观察病情是防止低钾患者在补钾过程中出现并发症的重要措施之一,作好健康宣教和随访等护理工作能促进患者康复及有效地避免低钾麻痹症的频繁复发。     

Erythrodermia induced by omeprazole

OBJECTIVE: To report a case of erythrodermia that appears to be related to the intake of omeprazole (OMP) for treatment of gastroesophageal reflux disease. CASE SUMMARY: We describe a case of erythrodermia associated with OMP therapy in a 58-year-old white woman with no predisposing factors. In 1995, at the Rheumatology Outpatients' Clinic, she was diagnosed as having scleroderma (CREST subgroup) and Sj?gren's syndrome associated with corticoid osteoporosis and multiple crushed vertebrae, Raynaud's disease and joint pain. In March 1998, treatment with OMP 20 mg/d p.o. was started for treatment of gastroesophageal reflux disease. She came to our hospital emergency room in October 1999 because of a severe cutaneous reaction and poor general health. The dermatology service diagnosed the erythrodermia as a skin reaction to medication. We suspected that the causative agent was OMP. Examination of a skin biopsy specimen demonstrated that it was compatible with a toxicodermic reaction to medication. Administration of OMP was suspended and the skin lesions and the patient's general state of health improved. She was discharged without symptoms. CONCLUSIONS: Our case reports, and others from the literature, suggest the importance of recognizing of the possibility of cutaneous adverse drug reactions even with medications, such as OMP, which has a good safety profile. Caution is recommended with the use of OMP, especially in elderly patients, in patients with renal insufficiency or decompensating liver disease and in patients who receive drugs that affect OMP metabolism.     

Current management of pain associated with multiple sclerosis

While pain is a common problem in patients with multiple sclerosis (MS), it is not frequently mentioned by patients and a more direct approach is required in order to obtain information about pain from patients. Many patients with MS experience more than one pain syndrome; combinations of dysaesthesia, headaches and/or back or muscle and joint pain are frequent. For each pain syndrome a clear diagnosis and therapeutic concept needs to be established. Pain in MS can be classified into four diagnostically and therapeutically relevant categories: (i) neuropathic pain due to MS (pain directly related to MS); (ii) pain indirectly related to MS; (iii) MS treatment-related pain; and (iv) pain unrelated to MS. Painful paroxysmal symptoms such as trigeminal neuralgia (TN), or painful tonic spasms are treated with antiepileptics as first choice, e.g. carbamazepine, oxcarbazepine, lamotrigine, gabapentin, pregabalin, etc. Painful 'burning' dysaesthesias, the most frequent chronic pain syndrome, are treated with TCAs such as amitriptyline, or antiepileptics such as gabapentin, pregabalin, lamotrigine, etc. Combinations of drugs with different modes of action can be particularly useful for reducing adverse effects. While escalation therapy may require opioids, there are encouraging results from studies regarding cannabinoids, but their future role in the treatment of MS-related pain has still to be determined. Pain related to spasticity often improves with adequate physiotherapy. Drug treatment includes antispastic agents such as baclofen or tizanidine and in patients with phasic spasticity, gabapentin or levetiracetam are administered. In patients with severe spasticity, botulinum toxin injections or intrathecal baclofen merit consideration. While physiotherapy may ameliorate malposition-induced joint and muscle pain, additional drug treatment with paracetamol (acetaminophen) or NSAIDs may be useful. Moreover, painful pressure lesions should be avoided by using optimally adjusted aids. Treatment-related pain associated with MS can occur with subcutaneous injections of interferon-beta or glatiramer acetate, and may be reduced by optimizing the injection technique and by local cooling. Systemic (particularly 'flu-like') adverse effects of interferons, e.g. myalgias, can be reduced by administering paracetamol, ibuprofen or naproxen. A potential increase in the frequency of pre-existing headaches after starting treatment with interferons may require optimization of headache attack therapy or even prophylactic treatment. Pain unrelated to MS, such as back pain or headache, is common in patients with MS and may deteriorate as a result of the disease. In summary, a careful analysis of each pain syndrome will allow the design of the appropriate treatment plan using various medical and nonmedical options (multimodal therapy), and will thus help to improve the quality of life (QOL) of the patients.     

椎间关节阻滞治疗椎间关节综合征疗效观察

目的:观察椎间关节阻滞对椎间关节综合征的治疗效果。方法:52例椎间关节综合征患者在C型臂X线机定位下行椎间关节阻滞,采用视觉模拟评分法(VAS)及活动功能评分法评价治疗前、后的疗效,治疗结束后随访6～12个月。结果:治疗前、后运动性疼痛评分、压痛点疼痛评分、活动功能评分比较差异有显著性(P<0.01),治疗有效率达96%,有2例复发。结论:在C型臂X线机定位下椎间关节阻滞治疗椎间关节综合征具有定位准确、疗效显著、复发率低的特点,值得临床推广应用。     

妊娠期高血压患者硫酸镁治疗后钙、镁元素代谢的研究

目的:探讨妊娠期高血压(简称妊高征)患者硫酸镁治疗前、后血浆、红细胞内钙、镁元素代谢情况。方法:采用原子吸收分光光度法测定正常妇女、正常妊娠妇女及妊高征患者的血浆、红细胞内钙、镁离子浓度。结果:妊高征患者存在着血浆低钙、红细胞内高钙以及红细胞内低镁现象,经硫酸镁治疗后有所改善。结论:妊高征患者存在明显的钙、镁代谢异常,硫酸镁治疗可以改善这种异常,但给药剂量应考虑个体化。     

针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征的可行性及安全性

目的：探讨针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征的可行性及安全性。方法选取本院2012年10月~2013年11月收入院的慢性腰腿疼痛综合征患者605例,随机分为观察组305例和对照组300例,观察组采用针灸联合腰腿痛丸治疗,对照组采用腰腿痛丸治疗,比较两组的临床疗效、关节疼痛评分及疼痛综合评分。结果观察组总有效率明显高于对照组,差异有统计学意义（P〈0.05）。观察组治疗后的关节疼痛评分明显低于对照组,疼痛综合评分明显高于对照组,差异有统计学意义（P〈0.05）。两组治疗后的关节疼痛评分低于治疗前,差异有统计学意义（P〈0.05）。结论采用针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征,可明显缓解患者疼痛,疗效显著,安全可靠,值得推广应用。     

Recurrent lead poisoning in a child with immobilization osteoporosis

Lead poisoning associated with progressive osteoporosis in patients who have been previously lead poisoned has been described but poorly documented. We managed a 4-year-old child with a prior history of plumbism who developed recurrent blood lead elevations (as high as 70 mcg/dl), requiring multiple courses of EDTA, after acute paraplegia from transverse myelitis. The patient was hospitalized throughout these periods of chelation. No exogenous sources of lead were found. Calcium, phosphate, magnesium, alkaline phosphatase and parathyroid hormone levels remained normal while vitamin D levels were depressed. Metabolic studies revealed negative calcium balance with an elevated urinary calcium:creatinine ratio. Long-bone radiographs were remarkable for progressive osteoporosis with no evidence of metallic foreign bodies. This case illustrates that bone, the major repository of lead, can become a source of significant lead level elevations in conditions associated with accelerated resorption.     

不同血液净化方式对重症砷中毒患者疗效分析

目的：探讨持续床旁血滤治疗与持续床旁血滤联合血浆置换治疗对存在多器官功能不全的砷中毒患者的疗效。方法回顾性分析2010年1月至2012年2月我科收治的8例重症砷中毒患者治疗,将其随机分两组。其中治疗组4例行持续床旁血滤治疗,对照组4例行床旁血滤联合血浆置换治疗。比较观察患者临床症状改善情况,血红蛋白,肝肾功能,尿量, ICU住院时间等指标。结果两组患者经持续床旁血液净化治疗后恶心、呕吐、腰痛、腹痛等临床症状均能明显缓解。治疗组及对照组经治疗后第7d血肌酐、胆红素、心肌酶较治疗前有明显好转。但两组患者尿量恢复时间、ICU住院时间及总住院时间无明显差异。结论重症砷中毒患者存在多器官功能不全时,早期给予持续床旁血滤治疗或持续床旁血滤联合血浆置换治疗能明显改善患者预后,且两种治疗方式对患者预后无明显差异。     

针灸治疗慢性肩关节运动性软组织损伤的疗效

目的 研究分析针灸治疗慢性肩关节运动性软组织损伤的疗效.方法 100例慢性肩关节运动性软组织损伤患者作为研究对象,根据动态随机分组法分为研究组和参照组,每组50例.参照组患者行频射治疗,研究组患者行针灸治疗.比较两组患者治疗前后疼痛程度.结果 参照组患者治疗前轻微疼痛、中度疼痛、重度疼痛、剧烈疼痛例数分别为7、11、2...     

未分化脊柱关节病1024例随访分析

目的:了解未分化脊柱关节病(uSpA)的临床特征及发展规律。方法:分析1 024例uSpA患者临床表现及随访转归情况。结果:男女比例为1.7∶1;腰背部疼痛(93.7%)和外周关节痛(96.0%)最多见;女性腰背部疼痛的首发率明显高于男性(P<0.05);男性髋关节、臀区或足跟及其他附着点部位疼痛起病的首发率均高于女性(P<0.05);家族史阳性率为40.6%,HLA-B 27阳性率为47.4%,两性间比较差异无统计学意义(P>0.05);CT对诊断uSpA较X线敏感,二者骶髂关节炎阳性率分别为88.6%(287/324)和45.7%(468/1 024),男性骶髂关节破坏的阳性率高于女性(P<0.05);648例经治疗随诊0.5~8年,其中186例症状消失,234例仍为uSpA,余228例转归为其他疾病:进展为强直性脊柱炎190例,转归为炎性肠病关节炎7例,银屑病性关节炎11例,uSpA合并干燥综合征12例,类风湿关节炎4例,系统性红斑狼疮2例,白塞病和混合性结缔组织病各1例。结论:uSpA是一组常见的临床症状多样的脊柱关节病,有遗传倾向。男性骶髂关节受累较女性严重,女性腰背部疼痛及手关节发生率较高。部分患者可进展为强直性脊柱炎、银屑病性关节炎及炎性肠病关节炎等其他脊柱关节病,个别患者演变或合并干燥综合征、类风湿关节炎、系统性红斑狼疮、混合性结缔组织病、白塞病等,密切随访uSpA患者至关重要。     

循证护理在妊娠高血压综合征孕妇护理中的应用

目的探讨循证护理对妊娠高血压综合征孕妇护理的临床效果。方法对我科2011年1月．2012年3月收治的34例重度妊高征患者采用循证护理模式,对比护理前后患者不良情绪、疾病的了解、24h蛋白尿、血压的变化、胎儿存活率。结果患者对疾病了解程度提高,不良情绪患者例数下降。34例患者中32例血压恢复至正常水平,2例转慢性高血压。蛋白尿例数减少,与护理前无明显差异。新生儿4例转入上级医院治疗,胎儿无一例死亡。结论循证护理可以改善患者的不良情绪,提高患者对疾病的了解程度,增加患者的依从性,阻止疾病的进一步发展,增加孕产妇及新生儿的安全系数。