A组β型溶血性链球菌性咽炎的研究进展

从流行病学史、症状和体征中寻找A组β型溶血性链球菌性咽炎的诊断线索,以及该病的治疗现状等均是医者感兴趣的问题.该文谨就上述方面的研究进展作一综述,供同道参考.     

特异性抗菌抗体喷剂与牛黄上清胶囊治疗急性咽炎的疗效比较

目的：比较抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG喷剂与牛黄上清胶囊治疗急性咽炎的临床疗效。方法：100例急性咽炎患者随机分为两组：治疗组50例和对照组50例。治疗组采用0．2％抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG喷剂口腔喷雾治疗，对照组采用牛黄上清胶囊治疗。两组均5d为l疗程。结果：治疗组治愈率26．0％、显效率34．0％、有效率28．0%、无效率12．0％、总有效率88．0％；对照组治愈率5．0％、显效率26．0％、有效率32．0％、无效率32．0％、总有效率68．0％，两组总有效率比较，差异有显著性（x^2=9．00，P〈0．05）。结论：0．2％的抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG抗体喷剂治疗急性咽炎疗效显著，安全、无毒副作用。     

美国心脏病协会发表冠心病合并抑郁的科学建议

抑郁与心血管疾病之间存在密切联系。急性心肌梗死患者中抑郁症的发生率是普通人群的3倍,心肌梗死住院患者中约20％符合重症抑郁诊断标准。年轻女性发生急性心肌梗死后患抑郁的风险更高。有研究显示,严重抑郁患者发生主要不良心血管事件的危险性显著增高。为进一步加强并规范心血管疾病患者抑郁症的筛查与干预,美国心脏病协会（AHA）新近发表一项科学建议,其主要内容如下：     

新疆喀什地区医护人员《2015年美国心脏病协会心肺复苏术》培训现状及调查分析

目的 了解喀什地区十二县市综合及专科二级甲等医院医护人员对《2015年美国心脏病协会心肺复苏术》知识的认知、培训现状及培训需求,探讨培训的方法 .方法 采用目的 抽样的方法 对喀什地区十二县市综合及专科二级甲等医院693名医护人员进行《2015年美国心脏病协会心肺复苏术》知识现状及培训需求的问卷调查.结果 693名医护人员参加过培训的占17.9%、未参加过培训的占到82.1%,82.1%的被调查对象希望通过观看视频结合示范来培训此项技能,培训内容方面心肺复苏的流程不正确人数占58.5%,按压的深度占48.5%,按压频率占51.9%,按压的部位占40.7%,按压的手法73.6%的医护人员掌握不正确.结论 通过采取视频结合示范的培训方式有利于医护人员对心肺复苏术的掌握.心肺复苏术作为一项基本的抢救技能,在新疆喀什地区各县市医院需要大力加强培训,以规范心肺复苏术操作技能,且对提高医护人员急救技能水平及抢救成功率将起到不可忽略的作用.     

欧洲心脏病协会更新急性肺栓塞诊疗指南

2008年10月30日,欧洲心脏病协会（ESC）公布了最新急性肺栓塞（PE）的诊断和治疗指南,该指南已发表于EuropeanHeartJ,2008,29（18）：2276—2315。与原指南相比,新指南更新的要点如下。     

浅谈急性链球菌感染后肾小球肾炎的诊治

急性肾小球肾炎简称急性肾炎（AGN），是以急性肾炎综合征为主要临床表现的一组疾病。其特点为急性起病，患者出现血尿、蛋白尿、水肿和高血压等症状，并可伴有一过性氮质血症。各种细菌、病毒及寄生虫感染均可引起，但多见于链球菌感染。     

小儿心脏病的诊治/肥厚型心肌病的诊治

肥厚型心肌病（hypertrophic cardiomyopathy,HCM）是一种遗传性疾病，1958年Teare首次报本病。其特点为心肌肥厚，心腔无扩大。临床表多样化，是较大儿童和青少年猝死的原因之一。肌以不对称性肥厚多见，可累及室间隔，偶见向性肥厚。由于心室肌肥厚使左心室腔缩小，多有肌收缩舒张功能障碍。     

急性亚硝酸盐中毒的诊治与预防

根据国家最近统计的重大食物中毒事件中,亚硝酸盐中毒已经取代农药中毒成为我国食物中毒事件的首位。急性亚硝酸盐中毒是内科急症之一,中毒原因多为误食亚硝酸盐或进食含有亚硝酸盐的食物所致,病情危急,严重者可致命［1］。所以亚硝酸盐中毒应引起临床医生,特别是急诊科医生的高度重视。现对本院急诊科2010年1月至2013年12月接诊的集体亚硝酸盐中毒事件8起共53例患者资料进行回顾性分析。     

小儿先天性心脏病诊治的进展

先天性心脏病的发病率约占全部活产婴儿的0.7%～0.9%。据此估计我国每年出生先心病患儿9万～14万。由于人口众多,医疗技术相对落后,大量的先心病患儿不能得到及时有效地诊治,先心病已成为影响我国儿童身心健康及人口生存质量的重大公共卫生问题。外科手术是先心病传统治疗方法,已经积累了丰富的经验,并且仍在不断发展。近年来,随着介入技术的日趋成熟和介入材料的迅速发展,先心病的治疗模式也发生了重大转变,由单一的外科手术治疗发展为手术、介入和镶嵌治疗等多种治疗相结合的模式,本文     

2012年美国心脏病学院基金会关于肌钙蛋白升高对缺血性心脏病的专家共识

由美国心脏病学院带领的7个专业团体发布了一项共识性声明,帮助医生们了解何时进行肌钙蛋白（Tn）检测及怎样解释检测结果。这一共识文件引用了最近完成的心肌梗死（MI）第三次通用定义,确定了确诊MI所要达到的心肌Tn （cTn）水平。这份由52位专家组成的国际组织所完成的文件,确定了Tn是检测急性MI最佳生物标志物,并确定了在不同临床情况下, Tn达到何种阈值水平即可判定为阳性。     

The basic life support guidance of American Heart Association (AHA)

The American Heart Association (AHA) and other member councils of International Liaison Committee on Resuscitation (ILCOR) complete review of resuscitation science every 5 years. And ILCOR publishes Consensus on Science with Treatment Recommendations(CoSTR). The AHA published "American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation(CPR) and Emergency Cardiovascular Care (ECC)" (G2010), that basis on CoSTR 2010 on Oct. 18th, 2010. The switchover to new curriculum based on G2010 on and after Mar. 1st, 2011 is the policy of AHA in their all training courses. The AHA maintains the quality of their training courses by some systems. AHA instructors are trained by some steps of instructor courses and monitoring systems and update their scientific knowledge on resuscitation by e-learning. The authors introduce an outline of basic life support for healthcare providers, the instructor training systems of AHA and summary of basic life support basis on G2010.     

The development of AHA (American Heart Association) guidelines for emergency cardiac care

In summary, the value of the ECC training programs is improving the outcome for patients in cardiac arrest. It is believed that, by giving clinicians overall guidelines to use for this emergency situation, better decisions will be made. The Guidelines are in a dynamic state of re-evaluation, and the development process for guidelines is imperfect. However, every effort has been made to look at all sides of any controversy and make decisions based on scientific evidence. In addition, recommendations are now based on the relative strength of the scientific data. The process will continue even in the absence of National Consensus meetings. Finally, the importance of transmitting the Guidelines to participants in an educationally sound program has received a great deal of emphasis. The ACLS course is now interactive and based on clinical scenarios. The emphasis is on improving the knowledge and skills of the participants who take the course rather than on certification or evaluation. The effect of these changes will be evaluated over the next several years.     

Studies of streptococcal membrane antigen--binding cells in acute rheumatic fever

Blood specimens from patients with rheumatic heart disease in both India and New Mexico were typed for the presence of B cell alloantigen 883 by use of a mouse monoclonal antibody with identical specificity to the original 883 human alloantiserum. Strong relative segregation was recorded for 883 positive B cell typing in patients with rheumatic heart disease in both geographic locations as compared with that in normal unaffected controls. In patients with acute rheumatic fever, studies of actual B-lymphocyte membrane binding by anti-883 monoclonal antibody and sonicated group A streptococcal membrane antigens showed separate but contiguous localization on isolated cell surfaces. Although physically distinct, 883 B cell alloantigen and sonicated group A streptococcal membrane antigens moved together in cell capping studies after incubation at 37 degrees C. These findings reaffirm the apparent close association between 883 B cell alloantigen and rheumatic heart disease. They also demonstrate that the B cell alloantigen 883 itself is physically distinct from but very close to sites on antigen-reactive B cells actually binding to group A streptococcal membrane antigens.     

Multicenter comparison of cyclacillin and amoxicillin in the treatment of acute streptococcal pharyngitis

A double-blind study of 134 pediatric outpatients with acute streptococcal pharyngitis demonstrated that cyclacillin, administered three times a day for ten days, is as effective as a similar regimen of amoxicillin. Clinical success was achieved in 95% of the children treated with either drug. A bacteriological cure was seen in 82% of the children evaluated in the cyclacillin group and 90% of those evaluated in the amoxicillin group. The mean time required for remission of signs and symptoms in the respective treatment groups was 3.1 and 3.0 days. Only two patients (3%) in each treatment group experienced an adverse effect of the prescribed drug.     

Controversies in the treatment of streptococcal pharyngitis

An increasing number of cases of sore throat caused by group A beta-hemolytic streptococci occur with concomitant colonization by organisms that may "protect" the streptococci through beta-lactamase inactivation of penicillin at the site of infection. The failure of penicillin to eradicate many of these bacteria, which include Staphylococcus aureus, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and a multitude of pharyngeal anaerobes, may help to explain why penicillin is sometimes ineffective for acute and recurrent group A streptococcal infections. Therapeutic alternatives currently include cephalosporins, erythromycin, rifampin combined with penicillin, amoxicillin/clavulanate potassium and others.     

Prevention of rheumatic fever and heart disease

This brief overview of current information on rheumatic fever and rheumatic heart disease focuses on the problems of diagnosis, prevention, and treatment in relatively undeveloped countries.