疏血通联合阿托伐他汀对短暂性脑缺血发作患者血脂及颈动脉内膜厚度的影响

目的:观察疏血通联合阿托伐他汀治疗短暂性脑缺血发作(TIA)的作用及初步探讨其作用机制。方法:回顾分析2009年8月~2010年12月我院收治的46例TIA的患者。采用疏血通+阿托伐他汀进行治疗。收集治疗前后的凝血功能、血脂、空腹血糖、颈动脉彩超等临床资料。出院后继续服用阿托伐他汀至6个月。所有患者均随访6~12个月。结果:疏血通联合阿托伐他汀治疗TIA,总有效率达91.30%(42/46),随访发现治愈或有效42例中复发TIA或发生脑卒中5例,发生率为11.90%。治疗6个月后,患者低密度脂蛋白胆固醇(LDL-C)和甘油三酯(TG)水平较治疗前明显下降,与治疗前比较差异有统计学意义(P<0.05)。治疗6个月后,治疗后患者颈动脉内膜厚度(IMT)明显变薄,斑块面积明显变小,与治疗前比较差异有统计学意义(P<0.05)。结论:疏血通联合阿托伐他汀治疗TIA疗效好,且可降低TIA的复发和脑卒中发生率,可能与降低LDL-C和TG水平、缩小IMT和斑块面积有关。     

不同浓度罗哌卡因术后臂丛神经镇痛的效果观察

Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.     

提高急诊医学留学生实习质量的几点思考

在"一带一路"倡议下,我国医学院校来华留学生招生规模逐步扩大,这为高等院校医学教育国际化提供了新的发展机遇,也提出了新的要求和挑战。此时,如何保证医学留学生教学质量,提高教学水平,是广大医学院校急需解决的问题之一。急诊医学是医学留学生的主要临床课程之一,急诊的轮转培训是医师培养体系的重要组成。文章针对本校留学生急诊医学实习带教状况,从急诊医学实习的特点、急诊带教教师工作和带教的特点和留学生急诊实习的特点三方面分析影响医学留学生急诊医学实习质量的原因,提出了相应解决对策,为不断提高留学生急诊医学实习教学质量提供参考。     

灰质异位症所致癫痫的临床表现与视频脑电图特征分析

目的分析灰质异位症的临床表现与视频脑电图特征。方法MRI确诊灰质异位症患者14例,分析其起病年龄、发作形式等临床资料与清醒期、睡眠期和发作期的视频脑电图特征。结果14例患者精神发育正常,神经系统查体未见定位体征。癫痫起病年龄为5～21岁,平均11．4岁。发作形式以继发全面性强直一阵挛发作（sGTCS）和复杂部分性发作（CPS）常见,其次为全面性强直一阵挛发作（GTCS）。灰质异位症患者视频脑电图监测痫性放电与异位灰质部位相关;10例患者存在颞叶的痫性放电,3例患者脑电图监测到起源于颞叶的发作。结论灰质异位症所致癫痫发病年龄早,发作形式以sGTCS和CPS常见。异位灰质部位和颞叶的异常放电是灰质异位症患者的脑电图特征。     

左乙拉西坦治疗难治性癫痫48例的临床研究

目的：探讨左乙拉西坦（Lev）添加剂量治疗难治性癫痫的疗效和安全性。方法：采用开放性自身对照方法,对48例（儿童23例,成人25例）难治性癫痫患者进行Lev添加治疗,并随访1年以上,收集治疗后患者发作频率变化、无发作情况、不良反应以及退出原因。结果：Lev治疗难治性癫痫总有效率为64．58％,成人有效率高于儿童,对部分性癫痫综合征有效率高;3、6和12个月无发作率分别为6．25％、18．75％和16．67％,保留率为81．25％、56．25％和43．75％。总不良反应发生率为39．58％,无严重不良反应,退出的最主要原因为对疗效欠满意。结论：LEV是一种安全有效的难治性癫痫治疗药物,对部分性和全面性癫痫发作均有效。     

不同浓度罗哌卡因术后臂丛神经镇痛的效果观察

Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.     

不同浓度罗哌卡因术后臂丛神经镇痛的效果观察

Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.     

长期家庭氧疗对慢性阻塞性肺病患者认知功能的影响

目的观察长期家庭氧疗(LTDOT)对老年慢性阻塞性肺病(COPD)患者认知功能的影响。方法20例老年COPD缓解期患者,随机分为氧疗组20例,对照组20例,其中氧疗组患者每日吸氧(15.1±1.6)h,氧流量1～2L/min,疗程为12个月,比较前后两组患者智能简易速检表(MIFE)评分。结果氧疗组治疗后MIFE评分较治疗前及对照组显著提高(P<0.05)。结论LTDOT可显著改善COPD患者的认知功能,延缓向阿尔茨海默病进展,提高生活质量。     

Banach评分对急诊科急性冠脉综合征患者预后的预测价值

目的 探讨Banach评分对急诊科就诊急性冠脉综合征(ACS)患者预后的预测价值.方法 收集年龄≥18岁确诊的ACS患者共229例.记录患者临床资料,完成Banach评分的计算,并对纳入的病例进行7 d、30 d和6个月的随访,对全因死亡率进行相关性分析.结果 收集了229例ACS患者,平均年龄为(69.1±12.9)岁,男163例(71.2%).ACS病例中,ST段抬高型心肌梗死者122例(53.3%),非ST段抬高ACS者107例[46.7%,非ST段抬高型心肌梗死者42例(18.3%),不稳定型心绞痛者65例(28.4%)].年龄、糖尿病史、高脂血症史、就诊时心率、血压、肌钙蛋白T的水平存活组与死亡组比较差异有统计学意义(P<0.05).对病例进行6个月的随访,7 d全因死亡率为7.9%(18例),30 d全因死亡累计10%(23例),6个月全因死亡累计10.5%(24例).应用Banach评分预测ACS患者7 d、30 d和6个月全因死亡率的曲线下面积分别是:0.791(95% CI为0.733~0.842)、0.791(95% CI为0.733~0.842)、0.802(95% CI为0.745~0.852).结论 Banach评分对急诊科ACS患者死亡率的预测效能敏感,能较好地预测ACS患者的短期和中期预后.     

血肌酐水平预测脑干出血预后的价值

目的确定判断脑干出血患者预后的血肌酐临界值,分析血肌酐与格拉斯哥昏迷评分（GCS）相关性,探讨血肌酐对评估脑干出血预后的价值。方法回顾性分析2010年6月至2012年6月期间本院收治的77例自发性脑干出血患者的临床资料,根据预后将患者分为生存组（n=51）和病死组（n=26）。对两组患者行GCS评分和血肌酐检测,根据血肌酐水平绘制血肌酐预测脑干出血患者病死情况的受试者工作曲线（ROC）并评估血肌酐的最优截断点cut-off值。以cut．off值为界将患者分为血肌酐〈96．000μmol／L组（n=39）和i〉96．000μmol／L组（n=38）,对比两组患者的GCS评分和实际病死率。结果病死组GCS评分低于生存组,而血肌酐水平高于生存组（均P〈0．05）。根据ROC曲线,以血肌酐水平来预测患者死亡事件,其cut．off值为96．000μmol／L,其诊断灵敏度为80．77％,特异度为66．67％。血肌酐〈96．000μmol／L组和I〉96．000μm01]L组患者的GCS评分及实际病死率差异均有统计学意义（均P〈0．05）。结论血肌酐水平可应用于脑干出血患者病情严重程度的评估以及预测死亡危险度。