四物汤加减应用验案2则

四物汤是补血调经的基本方,长于调理一切血症,被后世医家称为"妇科第一方"。笔者在临床应用四物汤加减治疗低血压眩晕、老年性震颤取得较好的效果,本文举验案两则,以飨同道。     

老年急性心肌梗死患者肾功能损害的临床观察

【摘要】目的：探究老年的急性心肌梗死患者的肾功能不全的发生状况。方法：选择140例从2013年1月至2014年6月在本院住院确诊的急性心肌梗死的老年患者,测定尿素氮（BUN）、肌酐（Scr）等指标,统计肾小球的滤过率（OFR）,并判断慢性的肾脏病（CKD）的患病率。结果：随着年龄的增长,CKD患病率也在逐渐的增加,死亡的患者中CKD的患病率比存活患者明显高（P〈0．05）。通过统计分析入院的Scr、BUN、GFR等指标可以发现,随着年龄的增加,患者的肾功能也在逐渐的下降,死亡患者中的GFR比存活患者明显低（P〈0．05）。结论：老年的急性心肌梗死的患者存在着肾功能的损害,关注肾功能的水平可有助于预后的判定。     

浅睡眠状态下的行为观察测听

目的 分别测试低龄儿双耳的听力状况.方法 对327名婴幼儿进行浅睡眠状态下的行为观察测听,并与click声刺激ABR结果进行比较;其中有58名婴幼儿一段时间后再进行游戏测听和纯音测听.结果 浅睡眠状态下的行为观察测听在2 kHz和4 kHz的平均反应阈与ABR的反应阈相当,但比跟踪测得的同频率纯音听阈值高约5～10 dB HL.结论 浅睡眠状态下的行为观察测听可分别测得低龄儿的双耳听反应阈.     

Prognostic value of postoperative stimulated thyroglobulin levels on 131Ⅰ ablation therapy in papillary thyroid cancer

Objective Stimulated thyroglobulin (Tg) levels postablation was associated with disease recurrence in papillary thyroid cancer (PTC). The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after 131Ⅰ ablation therapy in PTC. Methods One hundred and thirty-eight patients (28 men, 110 women; age range 6-70 years, mean age 39.4 years) with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. 131Ⅰ ablation was performed in 3- 4 weeks after thyroidectomy. Sera levels of thyroid hormones (FT3, FT4), thyrotropin (TSH), anti-Tg anti-body (TgAb), and Tg were measured before and after 131Ⅰ ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg lev-el had a significantly positive association with pestablation stimulated Tg level (r = 0. 960, P < 0.01). Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega-tive pestablation Tg group [(199.8±327.7) μg/L vs (3.5±5.6) μg/L, t =5. 567, P <0.01]. About 76% (78/102) patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% (446/1088) resected lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes resected had a significantly positive relationship with stimulated Tg at pestopera-tion and postablation (r = 0. 697, 0. 633, both P < 0.01). Conclusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after 131Ⅰ ablation therapy. Total or near-total thyroidec-tomy simultaneously conjugated with lymphadenectomy might have a better result in lower postablation stimu-lated Tg pesitivity in patients with PTC.     

血清α－L－岩藻糖苷酶自动分析法

本文报道了血清α－Ｌ－岩藻糖苷酶的自动分析法。酶促反应的最适ｐＨ５．０～５．１，Ｋｍ＝０．１８０ｍｍｏｌ／Ｌ，用柠檬酸－磷酸盐缓冲液可发挥酶的最大催化活性。线性范围为０～５０Ｕ／Ｌ，批内ＣＶ１．５３％～１．７１％，批间ＣＶ３．０％～３．２％。１３７例健康成人血清中酶活力为６．０６±１．３１Ｕ／Ｌ（ｘ±ｓ），男女性别间无显著差异（Ｐ＞０．０５）。本法具有简单、快速、灵敏等特点。     

阿霉素对K562细胞Gfi-1表达的影响及其与相关凋亡基因关系的研究

本研究探讨阿霉素体外作用于K562细胞的细胞效应及癌基因Gfi-1和相关凋亡基因表达变化的机制。用不同浓度的阿霉素作用于K562细胞24小时,然后应用DNA电泳和流式细胞术检测K562细胞凋亡;用RT-PCR、流式细胞术检测Gfi-1、Bcl-2、bax基因和蛋白表达的变化。结果表明：当阿霉素浓度在0、0.5、2.0mg/L作用K562细胞24小时,细胞凋亡增加,可见典型的DNA断裂电泳条带;同时,当ADM浓度自0.5增为2.0mg/L时,Gfi-1表达减少,bax表达增加;Bcl-2表达在ADM0.5-2.0mg/L之间变化不明显,mRNA及蛋白水平均无统计学差异;当阿霉素浓度大于2.0mg/L时,细胞凋亡率并不增加,而是下降,且出现细胞坏死。结论：一定浓度阿霉素能诱导K562细胞凋亡,细胞凋亡率表达的变化与阿霉素浓度呈一定的量效依赖关系,阿霉素诱导K562细胞凋亡可能与抑制Gfi-1基因的表达和激活bax基因的表达有一定的关系。     

老年COPD患者伴发低钾血症的护理体会

钾缺乏在临床上比较常见，且其后果较严重，甚至危及生命，因此近年来这一病症已在临床上引起广泛注意。我科多为老年COPD病人，由于饮食、疾病以及药物等原因常有低钾血症的发生，在治疗低钾血症的过程中细致周到的护理是至关重要的。COPD病人多数消化能力较弱，食欲差，可导致钾摄入不足，大部分病人还会用到利尿剂，可导致钾从尿中丢失，一些平喘类药物如舒喘灵和茶碱类可导致钾转入细胞内，以及酸碱平衡失调对血钾的影响，等等。     

En-bloc淋巴结清扫在腹腔镜胆囊癌根治术中的应用

目的探讨en-bloc淋巴结清扫在腹腔镜胆囊癌根治术中的安全性和可行性。方法回顾性分析2014年1月至2022年2月于浙江省人民医院接受腹腔镜胆囊癌根治术的87例胆囊癌患者的临床资料, 其中男性26例, 女性61例, 年龄67.0(59.0, 72.0)岁。依据淋巴结清扫手术方式分为en-bloc清扫组(n=29)与非en-bloc清扫组(n=58)。比较两组患者一般资料、肿瘤特征、手术情况及复发生存等指标的差异。利用电话随访患者的术后生存状态。结果 En-bloc清扫组的淋巴结清扫数目9.0(8.0, 12.0)个多于非en-bloc清扫组的8.0(4.8, 11.0)个, 差异有统计学意义(Z=-2.39, P=0.017)。两组患者在年龄、性别、术前血生化指标、肿瘤糖类抗原19-9、肿瘤分期、神经和脉管侵犯、手术时间、术中出血量、术后引流管留置时间、术后住院时间、术后并发症(胆瘘、腹腔出血及腹腔感染)发生率方面差异均无统计学意义(均P>0.05)。En-bloc清扫组患者的中位生存时间长于非en-bloc清扫组患者(21比15个月), En-bloc清扫组患者的中位无复发生...     

Prognostic value of postoperative stimulated thyroglobulin levels on 131Ⅰ ablation therapy in papillary thyroid cancer

Objective Stimulated thyroglobulin (Tg) levels postablation was associated with disease recurrence in papillary thyroid cancer (PTC). The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after 131Ⅰ ablation therapy in PTC. Methods One hundred and thirty-eight patients (28 men, 110 women; age range 6-70 years, mean age 39.4 years) with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. 131Ⅰ ablation was performed in 3- 4 weeks after thyroidectomy. Sera levels of thyroid hormones (FT3, FT4), thyrotropin (TSH), anti-Tg anti-body (TgAb), and Tg were measured before and after 131Ⅰ ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg lev-el had a significantly positive association with pestablation stimulated Tg level (r = 0. 960, P < 0.01). Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega-tive pestablation Tg group [(199.8±327.7) μg/L vs (3.5±5.6) μg/L, t =5. 567, P <0.01]. About 76% (78/102) patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% (446/1088) resected lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes resected had a significantly positive relationship with stimulated Tg at pestopera-tion and postablation (r = 0. 697, 0. 633, both P < 0.01). Conclusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after 131Ⅰ ablation therapy. Total or near-total thyroidec-tomy simultaneously conjugated with lymphadenectomy might have a better result in lower postablation stimu-lated Tg pesitivity in patients with PTC.     

Prognostic value of postoperative stimulated thyroglobulin levels on 131Ⅰ ablation therapy in papillary thyroid cancer

Objective Stimulated thyroglobulin (Tg) levels postablation was associated with disease recurrence in papillary thyroid cancer (PTC). The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after 131Ⅰ ablation therapy in PTC. Methods One hundred and thirty-eight patients (28 men, 110 women; age range 6-70 years, mean age 39.4 years) with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. 131Ⅰ ablation was performed in 3- 4 weeks after thyroidectomy. Sera levels of thyroid hormones (FT3, FT4), thyrotropin (TSH), anti-Tg anti-body (TgAb), and Tg were measured before and after 131Ⅰ ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg lev-el had a significantly positive association with pestablation stimulated Tg level (r = 0. 960, P < 0.01). Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega-tive pestablation Tg group [(199.8±327.7) μg/L vs (3.5±5.6) μg/L, t =5. 567, P <0.01]. About 76% (78/102) patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% (446/1088) resected lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes resected had a significantly positive relationship with stimulated Tg at pestopera-tion and postablation (r = 0. 697, 0. 633, both P < 0.01). Conclusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after 131Ⅰ ablation therapy. Total or near-total thyroidec-tomy simultaneously conjugated with lymphadenectomy might have a better result in lower postablation stimu-lated Tg pesitivity in patients with PTC.