慢性肾脏病患者游离脂肪酸与细胞因子及颈动脉病变的关系

Objective To investigate the serum level of free fatty acid (FFA) and explore its relationship with cytokines and atherosclerosis (AS) in chronic kidney disease (CKD).Methods The serum level of FFA was determined with enzymatic colorimetry.IL-1 β, IL-6 and TNFα were determined with ELISA.High-sensitivity C-reactive protein (hsCRP) was measured with immunoturbidimetry.Prevalence of atherosclerosis was detected with carotid ultrasonography.We evaluated the relationship between serum levels of FFA and IL-1β,IL-6, TNFα, hsCRP as well as the renal function in 130 adult patients with CKD, stratified according to the GFR ( based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives) and in 58 hemodialytic (HD) patients.The relationship between FFA level and cardiac geometry incidence in CKD patients was analyzed with logistic regression model.Results The serum level of FFA was significantly higher in CKD patients as compared with that in the healthy controls [(492.63 ± 143.59)vs (302.65 ± 142.18) μ mol/L, P ＜ 0.01], even in the early stage of CKD.The level of FFA increased with the progression of renal dysfunction.In the non-dialytic CKD group, the level of FFA was negatively related to GFR and positively related to the proteinuria (P ＜ 0.05), while in the HD group, it was positively correlated with dialysis duration ( P ＜ 0.05 ).The serum levels of FFA were higher in CKD patients with carotid artery atherosclerosis than those in patients without ( P ＜ 0.05 or ＜ 0.01 ).However, in both groups with impairment of renal function, the levels of FFA were positively correlated with hsCRP, IL-1 β, IL-6,TNFα and TG( all P ＜ 0.05 ).A positive correlation between the level of FFA and the clinical manifestations such as carotid intimal medial thickness (IMT) and AS was also found.A negative correlation was found between the level of FFA and the serum level of albumin and GFR( P ＜ 0.05).Conclusion Serum levels of FFA are significantly higher either in non-dialytic CKD or in HD patients and it is related with hsCRP, IL-1 β, IL-6, TNFα as well as carotid artery atherosclerosis, indicating that FFA is an independent risk factor of AS in CKD.     

甘露聚糖肽在皮肤科的合理应用

目的：通过对皮肤科患者甘露聚糖肽不良反应的分析,为皮肤科合理应用甘露聚糖肽提供参考。方法：对皮肤科患者使用甘露聚糖肽发生不良反应病例进行分析总结,并对皮肤病与免疫功能的关系进行探讨。结果：甘露聚糖肽不良反应主要为速发型、严重的过敏反应,与免疫功能无关的皮肤病不宜使用甘露聚糖肽。结论：皮肤科应用甘露聚糖肽,应严格掌握适应症,加强用药监护,防止不良反应发生,保证患者安全、合理用药。     

高龄患者压疮高危因素分析及对策

目的:探讨高龄患者压疮发生的高危因素,制定积极、有效的预防对策,降低压疮发生率.方法:对Braden评分11分以下的68例80岁以上高龄患者压疮高危因素进行分析,采取相应的预防对策.结果:发生压疮3例,压疮发生率4.41%.结论:通过对高龄患者压疮高危因素的评估分析,及时采取预防护理措施,能有效降低压疮的发生率.     

不同剂型胺碘酮的不良反应分析

目的分析胺碘酮片剂与注射剂的药物不良反应(ADRs)特点,为临床安全用药提供参考。方法收集2006年1月至2012年2月北京市药物不良反应监测中心收到的与胺碘酮肯定有关、很可能有关和可能有关的不良反应报告,比较2种剂型胺碘酮所致ADRs的临床表现、严重ADRs构成比及转归。结果共收集到胺碘酮相关ADRs报告180份,涉及180例患者、195例次ADRs。180例患者中男性119例,女性76例;年龄2个月～97岁,平均年龄64岁。21例患者既往有ADRs史。195例次ADRs中一般ADRs 151例次(77.4%),严重ADRs 44例次(22.6%)。胺碘酮片剂相关ADRs 46例次,其中严重ADRs 13例次(28.3%);胺碘酮注射剂相关ADRs 149例次,其中严重ADRs 31例次(20.8%)。胺碘酮片剂所致严重ADRs的比例稍高于注射剂,但差异无统计学意义(χ2=1.12,P=0.29)。胺碘酮片剂所致ADRs的主要临床表现为肝功能损伤(34.7%)、甲状腺功能亢进或减低(17.3%)、咳嗽、咳痰、呼吸困难(10.9%)、皮疹等(8.7%)、头痛头晕(4.3%)、横纹肌溶解(4.3%)、过敏(2.2%)等。胺碘酮注射剂所致ADRs的主要临床表现为肝功能损伤(25.5%)、静脉炎(27.5%)、皮疹(14.1%)、过敏(8.1%)、心律失常(6.0%)、头痛头晕(5.4%)、血压下降(4.7)等。2种剂型所致ADRs的转归差异无统计学意义(χ2=8.18,P=0.09)。结论胺碘酮片剂与注射剂所致ADRs有所不同,因此其ADR的监测应有所侧重。对使用胺碘酮片剂的患者尤应加强用药指导和相关指标监测。     

无陪护病房老年患者主观幸福感相关因素研究

目的 探讨无陪护病房老年患者主观幸福感及相关因素.方法 采用老年人幸福度量表、社会支持量表、抑郁自评量表、临床记忆量表分别对100例无陪护病房住院老年患者(观察组)及95例普通病房住院老年患者(对照组)进行主观幸福感调查,了解其相关影响因素.结果 观察组主观幸福感的总分、正性因子评分均明显高于对照组(t=2.79、4.93,均P＜0.05),负性因子评分则明显低于对照组(t=0.75,P＜0.05).社会支持高分组的主观幸福感评分(7.86±6.59)分,明显高于社会支持低分组的(5.65±5.31)分(t =1.86,P＜0.05).总社会支持与主观幸福感呈正相关.情绪状态与主观幸福感负相关,认知功能、躯体功能状况与主观幸福感正相关.结论 医养结合的无陪护病房,在药物治疗的同时,对老年住院患者提供全程优质专业的照护服务,可提高和改善其生活质量、增强其主观幸福感、促进患者身心康复.     

闭合性腹部创伤后早期隐匿性小肠破裂的CT排查

目的探讨闭合性腹部创伤中小肠破裂早期隐匿性临床特点的成因及其诊治要点,以提高早期检出率和治愈率,进一步提高腹部创伤的救治水平。方法回顾性分析我院2004年1月～2011年12月经手术证实的外伤性小肠破裂116例资料,分析患者术前CT检查的临床表现特点并分析漏诊原因。结果腹腔内或腹膜后游离气体、肠道壁连续性中断为小肠破裂的特异性直接征象,肠壁增厚、肠壁血肿、腹腔和肠间隙积液以及肠系膜渗出、血肿为小肠破裂的重要提示性间接征象。扫描技术、窗技术运用不当等原因可导致漏诊。结论加强对外伤性小肠破裂CT征象的认识,正确运用扫描技术及窗技术,及时做出明确的诊断,避免漏诊,为临床制定治疗方案提供重要依据。     

微粉化萘丁美酮的工业制粒工艺研究

目的通过优化制粒溶液量百分比和制粒时间,将微粉化的萘丁美酮制成适合片剂生产的颗粒。方法以微粉化的萘丁美酮作为主要活性成分,以萘丁美酮超过80%（W/W）处方配比的条件下,以纯水、羟丙基甲基纤维素E-3和十二烷基硫酸钠为制粒溶液,将萘丁美酮,羟基乙酸淀粉钠和微晶纤维素PH101进行制粒,流化床干燥,并对制得的颗粒进行物理性状检测,包括颗粒外观、颗粒粒径分布、颗粒堆实密度及可压性指标。然后将颗粒压片,检测片剂的硬度、崩解度及和溶出度,获得制粒溶液量百分比和制粒时间的最优值。结果制粒溶液量30%（W/W）和制粒时间60 s时,为最佳制粒工艺参数。结论以此工艺进行制粒,可达到适合工业生产的片剂指标。     

腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小面积软组织缺损

目的 总结不依赖低位穿支的单一腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小软组织缺损的手术方法 及临床效果. 方法 2004年7月-2007年2月,收治14例足踝部中小面积软组织缺损忠者.男9例,女5例:年龄19～53岁.跟腱断裂术后皮肤坏死4例,交通伤后软组织缺损3例,重物压砸伤、慢性感染溃疡及跟骨骨折术后皮肤坏死各2例,黑色素瘤切除术后1例.软组织缺损范围4 cm×2 cm～9 cm×5 cm;位于踝周12例,跟底负重区2例.均合并深部肌腱或骨组织外露.急诊入院3例,其余患者于伤后12 d～13个月入院.术中切取以腓动脉主穿支为单一蒂的腓肠神经营养血管皮瓣修复创面,范围为13 cm × 5 cm～36 cm × 6 cm.供区均直接缝合. 结果 术后皮瓣全部成活,创面及供区Ⅰ期愈合.患者均获随访,随访时间7～23个月.皮瓣质地优良,外形、色泽良好,两点辨别觉7～12 mm.踝关节功能恢复满意,可正常穿鞋行走. 结论 不依赖低位穿支的单一腓动脉主穿支蒂腓肠神经营养血管皮瓣血供可靠,操作简便,创面修复平整美观,肢体功能恢复满意,适合未涉及前足的踝周、跟底中小面积软组织缺损修复,尤其适合低位缺乏满意穿支者.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

49例颞叶癫痫临床分析

目的探讨颞叶癫痫的临床特点及与海马病变的关系。方法对49例颞叶癫痫住院患者的病史、临床表现、脑电图、神经影像学及病理,进行回顾性分析。结果颞叶癫痫以儿童期为首发,男性多于女性。有明确既往史46.92%。脑电图异常率为100%,MRI诊断阳性率为76.60%。41例行病理检查,内侧颞叶硬化29.27%(12/41)。结论颞叶癫痫患者男性多于女性,首发年龄儿童期最高。绝大多数为原发性癫痫。脑电图和影像学阳性率高,病理改变多为海马硬化。