新疆阿克苏地区重点人群碘营养和智力水平调查

Objective To investigate the iodine nutritional status of school children, lactating women and infants in iodine deficient areas of Baicheng and Wushi Counties in Xinjiang Autonomous Region. Methods According to the geographic location of east, south, west and north of county, 10 primary schools of 8 townships were selected. In each school, 10 children among each gender and age group from 8 to 10 years old were selected. A total of 300 school children were chosen. One hundred and four infants aged 0-2 years old and their mother were selected in 8 townships. Iodine content in edible salt at household level, the urinary iodine in school children and lactating women, total goiter rate(TGR) and the status of the intelligence quotient (1Q) of school children, the status of psychological development of infants were observed. Direct titration assay for testing the salt iodine, colorimetric ceric-arsenic assay and vitriolic ammonium assimilation were used for testing urinary iodine. The size of thyroid gland was measured by palpation. The Combined Raven Test for Chinese Rural was used to test the IQ. The psychological development of infants was tested by Danver Development Screening Test (DDST). Results The coverage rate of iodized salt at household level was 73.1% (123/182), however, the proportion of households using adequately iodized salt was 64.1% (118/182). The medium of urinary iodine in school children was 103.7 μ/L, with 47.8%(75/157) less than 100 μg/L and 28.0% (44/157) less than 50 μg/L; it was 123.0 μg/L in Baieheng County, with 44.4%(28/63) less than 100 μg/L and 33.3%(21/63) less than 50 μg/L; it was 100.3 μg/L in Wushi County, 50.0%(47/94) less than 100 μg/L and 24.5%(23/94) less than 50 μg/L. The medium of urinary iodine in locating women was 143.3 μg/L, it was 119.7 μg/L and 184.6 μg/L in Baicheng and Wushi Counties, respectively. The total rate of goiter in school children was 14.3%(43/300), it was 10.8%(13/120) and 16.6%(30/180) in Baicheng and Wushi Counties, respectively. The average IQ in school children was 80.6±11.6, it was 83.0±11.6 and 79.0±11.7 in Baicheng and Wushi Counties, respectively. The proportion of mental retardation in school children (IQ≤69) was 13.0% (39/300), it was 6.7% (8/120) and 17.2%(31/180) in Baicheng and Wushi Counties, respectively. In addition, the proportion of psychological development in infants being normal, suspicious and abnormal was 78.8%(82/104), 12.5% (13/104) and 8.7%(9/104), respectively. Conclusion This study confirms the fact that there is also existence of mental retardation in children and infants, caused by iodine deficiency.     

哺乳期妇女口服不同剂量碘油丸效果及时效观察

目的观察哺乳期妇女口服400 mg及200 mg碘油丸后妇女及其婴儿的碘营养状况。方法在新疆阿克苏地区两个村选择81名近半年未服用过碘油丸的哺乳期妇女,分别一次性口服400 mg或200 mg碘油丸,服药前采集妇女及其婴儿一次性随意尿样,在服药后第1至9个月每月采集妇女一次性随意尿样,第1、3、6个月每月采集婴儿一次性随意尿样,采用砷铈催化分光光度法测定尿碘。结果在干预后的9个月中,两组妇女尿碘中位数均高于干预前,差异有统计学意义(P0.05)。除第3个月外,其他时间两组妇女尿碘中位数均为400 mg组高于200 mg组,两组之间在第7、9月差异有统计学意义(P0.05)。干预后两组婴儿尿碘中位数均高于干预前,差异有统计学意义(P0.05)。400 mg组婴儿尿碘中位数始终高于200 mg组,两组间仅第1个月差异有统计学意义(P0.05)。结论两种剂量碘油丸均可提高哺乳期妇女及婴幼儿碘营养水平;400 mg碘油丸效果持续时间更长;在妇女日常食用碘盐的情况下,200 mg碘油丸对母子更加安全。     

心血管内科住院患者临床感染因素分析

目的：探讨心血管内科住院患者临床常见感染的原因以及如何预防。方法420例心血管疾病患者,其中出现感染的患者42例,分析其临床原因。结果42例患者中,皮肤软组织感染12例,肺部感染21例,泌尿系统以及胃肠道感染9例。结论对于年老体弱以及免疫力低下的患者给予重点观察,对于已经合并感染的患者给予积极治疗是患者康复的关键。     

早期心肌缺血缺氧性坏死中周细胞数量的变化

目的 探讨周细胞在心肌纤维化发生发展中的作用。方法 采用免疫荧光双重标记技术，将周细胞染色后，在激光扫描共聚焦显微镜下观察周细胞在早期心肌缺血缺氧性坏死中该细胞的数量变化情况。结果 激光共聚焦显微镜观察发现，内皮细胞定位明确的周细胞的数量在注射盐酸异丙肾上腺素（Isp） 4 h后明显增多，12 h后开始下降，48 h后显著低于正常水平（P<0.05）。结论 周细胞作为心肌中的间质细胞可能是心肌纤维化发生发展中的主要效应细胞。     

心血管疾病的临床综合治疗措施

目的：探讨心血管疾病临床综合治疗方法。方法各类心血管疾病患者128例,搜集其临床综合治疗方法及其措施,分析临床效果,治疗周期40 d,并与40 d前进行比较。结果经过1个疗程40 d的综合治疗,患者的临床症状明显好转,部分患者痊愈,与治疗前比较差异有统计学意义（P〈0.05）。结论综合治疗心血管疾病在临床上意义重大,效果明显,值得在基层卫生院应用推广。     

早期肠内营养在重症胰腺炎中的治疗意义

目的：研究早期肠内营养在重症胰腺炎中的治疗效果。方法：选取2013年1～12月期间来我院接受治疗的30例患有重症急性胰腺炎的病患，将病患随机分为实验组和对照组，对对照组实行常规治疗，主要包括对病患的肠胃减除压力，禁止病患口服食物，通过注射生长抑制素对胰腺的分泌进行相关的抑制等治疗；对实验组在此治疗基础上，还需要对病患进行治疗3～5d，放置营养管治疗。结果：两组病患的尿淀粉酶、WBC等均得到了有效控制，实验组的恢复时间要少于对照组；血清蛋白有上升的趋势，实验组要明显高于对照组；在住院时间方面，实验组明显要低于对照组，比较差异具有统计学意义（P〈0.05）。在病死率、感染率以及并发症等方面，实验组要低于对照组，比较差异不具有统计学意义（P〉0.05）。结论：早期肠内营养在对重症胰腺炎病患进行治疗中具有良好的治疗效果，可以改善病患的营养状况，同时也可以使病患得到较早恢复，值得在实际临床中进行推广。     

新疆阿克苏地区重点人群碘营养和智力水平调查

Objective To investigate the iodine nutritional status of school children, lactating women and infants in iodine deficient areas of Baicheng and Wushi Counties in Xinjiang Autonomous Region. Methods According to the geographic location of east, south, west and north of county, 10 primary schools of 8 townships were selected. In each school, 10 children among each gender and age group from 8 to 10 years old were selected. A total of 300 school children were chosen. One hundred and four infants aged 0-2 years old and their mother were selected in 8 townships. Iodine content in edible salt at household level, the urinary iodine in school children and lactating women, total goiter rate(TGR) and the status of the intelligence quotient (1Q) of school children, the status of psychological development of infants were observed. Direct titration assay for testing the salt iodine, colorimetric ceric-arsenic assay and vitriolic ammonium assimilation were used for testing urinary iodine. The size of thyroid gland was measured by palpation. The Combined Raven Test for Chinese Rural was used to test the IQ. The psychological development of infants was tested by Danver Development Screening Test (DDST). Results The coverage rate of iodized salt at household level was 73.1% (123/182), however, the proportion of households using adequately iodized salt was 64.1% (118/182). The medium of urinary iodine in school children was 103.7 μ/L, with 47.8%(75/157) less than 100 μg/L and 28.0% (44/157) less than 50 μg/L; it was 123.0 μg/L in Baieheng County, with 44.4%(28/63) less than 100 μg/L and 33.3%(21/63) less than 50 μg/L; it was 100.3 μg/L in Wushi County, 50.0%(47/94) less than 100 μg/L and 24.5%(23/94) less than 50 μg/L. The medium of urinary iodine in locating women was 143.3 μg/L, it was 119.7 μg/L and 184.6 μg/L in Baicheng and Wushi Counties, respectively. The total rate of goiter in school children was 14.3%(43/300), it was 10.8%(13/120) and 16.6%(30/180) in Baicheng and Wushi Counties, respectively. The average IQ in school children was 80.6±11.6, it was 83.0±11.6 and 79.0±11.7 in Baicheng and Wushi Counties, respectively. The proportion of mental retardation in school children (IQ≤69) was 13.0% (39/300), it was 6.7% (8/120) and 17.2%(31/180) in Baicheng and Wushi Counties, respectively. In addition, the proportion of psychological development in infants being normal, suspicious and abnormal was 78.8%(82/104), 12.5% (13/104) and 8.7%(9/104), respectively. Conclusion This study confirms the fact that there is also existence of mental retardation in children and infants, caused by iodine deficiency.     

小儿肺炎支原体肺炎合并全身炎症反应综合征炎性因素分析的临床意义

目的探讨血清C反应蛋白(CRP)、中性粒细胞(NE)、红细胞沉降率(ESR)、血常规白细胞(WBC)、免疫球蛋白(Ig G、Ig A和Ig M)和降钙素原(PCT)的变化与肺炎支原体肺炎(MPP)合并全身炎症反应综合征(SIRS)的关系,及对临床病情评估、病情恶化、判定疗效的影响及临床意义。方法选择住院急性期MPP患儿182例,分为SIRS组和非SIRS组,SIRS组又分为S1组和S2组,同时选择正常健康80例儿童作为对照组,所有研究对象入院初及治疗后分别检测血清CRP、PCT、ESR及血常规。结果 1SIRS组CRP和PCT及阳性率明显高于非SIRS组(P0.01或P0.05),S2组显著高于S1组(P0.01)。2治疗7 d后CRP和PCT较治疗前均明显下降(P0.01),S2组仍高于S1组和非SIRS组(P0.01)。CRP值S1组明显高于非SIRS组(P0.01)。3治疗前与非SIRS组比较,S2组所有值均明显增加(P0.01或P0.05),S1组WBC、NE、Ig G及Ig M值增加明显(P0.01或P0.05);S2组ESR、WBC、NE、Ig A及Ig M仍显著高于S1组(P0.01或P0.05)。4治疗7 d后,S1组ESR、WBC、NE及Ig G均明显下降(P0.01或P0.05);S2组所有值均明显下降(P0.01或P0.05);SIRS组均高于非SIRS组(P0.01或P0.05)。结论CRP是炎症反应的敏感检测指标,可动态监测病情轻重、判断疗效,临床需结合PCT、WBC、NE、免疫球蛋白多项感染炎症指标检测,更准确把握MPP病情、并发症及混合细菌感染情况。     

酒石酸美托洛尔治疗慢性心力衰竭疗效观察

目的：研究酒石酸美托洛尔治疗慢性心力衰竭的疗效。方法：回顾分析本院2007年1月～2009年12月门诊和住院收治的64例慢性心力衰竭患者的临床资料,将其随机分为治疗组和对照组各32例,两组患者均采用常规治疗,如休息、低盐饮食、给予钙离子阻滞剂、强心剂、利尿剂、抗心律失常药等,治疗组在常规治疗的基础上加用酒石酸美托洛尔。结果：对照组总有效率为75.00%,治疗组总有效率为93.75%,两组比较,差异有统计学意义（χ2=4.27,P〈0.05）。治疗组与对照组治疗前心率比较,差异无统计学意义（P〉0.05）;治疗后比较,差异有高度统计学意义（P〈0.01）。两组均无不良反应发生。结论：酒石酸美托洛尔治疗慢性心力衰竭,可明显改善心功能和临床症状,提高生活质量,疗效显著,值得推广。     

我国四地区正常孕妇的尿碘水平分析

Objective To analyze the median urinary iodine(MUI)level in normal pregnant women based on World HeMth Organization(WHO) recommended criterion,and to provide the MUI reference values for monitoring and evaluating iodine nutrition during pregnancy and related studies.Methods Total 604 normal pregnant and 192 non-pregnant women(as a comparison)were selected from a cross-sectional survey.These women were all healthy,iodine sufficient,with normal thyroid function,and negative anti-thyroid antibodies.The iodine content in drinking water,edible salt,and urine was determined by standard methods,and serum TSH,FT4,FT3,thyroid peroxidaseantibody(TPOAb),and thyroglobulin antibody(TgAb)were measured using chemiluminescent immunoassay.Resuits (1)The iodine in drinking water was 3.0μg/L indicating such small amount of iodine could be neglected for daily iodine intake.(2)All women consumed iodized salt with the median iodine in salt of 31.7 mg/kg.The daily iodine intake of at least 240 μg could be roughly estimated if an average of 10 g salt was taken per person per day and further subtracted by 20%iodine lost during cooking,which could meet the iodine needs during pregnancy.(3)The MUI of 173.1μg/L was calculated from 604 pregnant women having 174.5,167.0,and 180.7 μg/L during the first,second,and third trimesters,respectively,reaching the optimal level of 150-249 μg/L recommended by WHO for pregnant women.However,our data showed relatively lower levels,not reaching 200μg/L.The MUI of 240.2μg/L was calculated from 192 non-pregnant women,reaching the level of"above requirement"(200-299μg/L) recommended by WHO for adults.(4)All women were euthyroid and antibody-negative,but the TSH level in pregnant women was lower than that in non-pregnant women,in particular during the first trimester,while FT4 and FT3 were considerably decreased compared with the non-pregnant(with an exception of FT4 in the first trimester),and both gradually declined with the gestational age.Conclusions The optimal MUI level of 150-249 μg/,L recommended by WHO can be applied to pregnant Chinese women,but our data provided a relatively low range of 150-200μ/L throughout pregnancy.The higher MUI of 240.2μg/L in non-pregnant women indicated that iodized salt with different contents should be supplied on market to meet the requirement of different groups of population.