系统性红斑狼疮合并伤寒败血症及皮肤多发脓肿1例

系统性红斑狼疮（SLE）是一种全身性自身免疫病,由于存在免疫功能紊乱易继发感染,严重时常危及生命。伤寒是由伤寒杆菌引起的急性消化道传染病,临床特征为持续发热、相对缓脉、神经系统中毒症状与消化道症状、玫瑰疹、肝脾肿大与白细胞减少等。伤寒感染所致皮肤多发脓肿临床较为少见。我们报告1例老年女性SLE患者合并伤寒败血症及皮肤多发脓肿。     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.     

不同肾脏替代治疗模式对脓毒症休克合并多脏器功能损害患者的疗效观察

目的：比较不同连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）模式对脓毒症休克合并多脏器功能损害患者的临床疗效,为脓毒症休克合并多脏器功能损害的CRRT治疗模式选择提供参考依据。方法：选取我院2015年7月至2017年3月收治的92例脓毒症休克合并多脏器功能损害患者作为研究对象,按照随机数字表法分为连续性静-静脉血液滤过（CVVH）组和连续性静-静脉血液透析滤过（CVVHDF）组,每组各46例,分别给予CVVH及CVVHDF治疗。比较两组患者CRRT参数、治疗转归及治疗前后生化指标变化,分析两种治疗模式对患者预后的影响。 结果：两组患者比较,CVVH组矫正剂量（Kpc）、交付剂量（Kd）、实际溶质清除剂量（K）均低于CVVHDF组,差异均有统计学意义（P＜0.05）。两组患者治疗转归比较,差异均无统计学意义（P＞0.05）。两组患者治疗后尿素氮（BUN）、肌酐（Cr）、β2-微球蛋白（β2-MG）、急性生理与慢性健康（APACHEⅡ）评分均较治疗前下降;白细胞介素-6（IL-6）、排尿量均较治疗前升高;CVVH组患者β2-MG下降更为明显,差异均有统计学意义（P＜0.05）。两组患者治疗期间均未见不良反应发生。 结论：CVVH与CVVHDF模式治疗脓毒症休克合并多脏器功能损害的效果相仿,CVVHDF清除小分子溶质的能力较强,而CVVH清除中大分子的效果更为理想。     

试管凝集试验与虎红平板凝集试验对布鲁氏杆菌病的诊断价值

目的 研究试管凝集试验与虎红平板凝集试验对布鲁氏杆菌病的诊断价值.方法 于2017年1月至2019年12月将清丰县疾病预防控制中心接受布鲁氏杆菌病筛查的120例疑似布鲁氏杆菌病患者纳入研究,对血液标本进行试管凝集试验、虎红平板凝集试验,比较试管凝集试验与虎红平板凝集试验的诊断结果.结果 在布鲁氏杆菌病诊断中,参照布鲁氏...     

加味防己茯苓汤联合CRRT疗法对脓毒症急性肾损伤患者肾功能及血清APN、PCT、Lac水平变化的影响

目的：探讨加味防己茯苓汤联合持续肾脏替代治疗（CRRT）对脓毒症急性肾损伤患者肾功能及血清脂联素（APN）、降钙素原（PCT）、乳酸（Lac）水平变化的影响。方法：选取2014年6月至2017年2月我院78例脓毒症急性肾损伤患者,随机数字表法分为对照组（n=39）与研究组（n=39）。对照组采取CRRT治疗,研究组采取CRRT疗法+加味防己茯苓汤,持续服用28 d。入院时及治疗结束后统计对比两组中医证候积分、肾功能指标[尿酸（UA）、尿素氮（BUN）、肌酐（Scr）]、血清PCT、APN、Lac水平、7 d及28 d病死率。结果：治疗后两组中医证候积分较治疗前降低,且研究组较对照组低（P＜0.05）;治疗后两组UA、BUN、Scr水平较治疗前均降低,且研究组肾功能指标水平较对照组均低（P＜0.05）;治疗后两组血清PCT、Lac水平较治疗前降低,血清APN水平较治疗前增高,且研究组血清PCT、Lac水平较对照组低,血清APN水平较对照组高（P＜0.05）;研究组7 d及28 d病死率（5.13%、7.69%）较对照组（12.82%、28.21%）低,且两组28 d病死率比较,差异有统计学意义（P＜0.05）。结论：联合采用CRRT疗法及加味防己茯苓汤治疗脓毒症急性肾损伤患者效果显著,可有效缓解其临床症状,改善血清APN、PCT、Lac水平,促使肾功能恢复,降低病死率。     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.     

63例颅脑损伤后精神障碍患者的治疗及护理体会

笔者所在医院2005年1月至2008年12月收治的63例颅脑损伤并发精神障碍患者,通过有效的临床治疗及护理,疗效满意。现将治疗及护理体会报告如下。     

促进自然分娩,转变产时服务模式

目的支持自然分娩,保障母婴安全,降低剖宫产率。方法抽取5年来我院自然足月妊娠孕妇与剖宫产调查及对比。结果我院产妇自然分娩率高于剖宫产率。结论转变产时服务模式可以有效促进自然分娩。     

瑞芬太尼应用于高血压脑出血术后镇痛镇静治疗的临床研究

目的分析瑞芬太尼应用于脑出血术后镇痛镇静治疗的临床价值。方法将140例行开颅手术的高血压脑出血患者随机分为观察组、对照组各70例,对照组在术后予以芬太尼0.6～0.9μg/(kg·h)静脉泵入,观察组术后给予瑞芬太尼5～7.5μg/(kg·h)持续静脉泵入,效果不佳者均可联合丙泊酚静脉泵入,记录2组血压[收缩压(SBP)、舒张压(DBP)]变化及机械通气时间、入住ICU时间、再出血率,比较其重症监护疼痛观察量表(CPOT)、躁动-镇静评分(RASS)变化及不良反应发生率,采用美国国立卫生研究院量表(NIHSS)评估2组术后28 d及2个月、6个月神经功能。结果观察组术后4 h、8 h、16 h、24 h、48 h SBP、DBP均低于对照组(P均0.05);观察组机械通气时间、入住ICU时间短于对照组,而再出血率低于对照组(P0.05);观察组术后1 h、4 h、8 h、16 h、24 h CPOT评分、RASS评分均低于对照组(P均0.05);2组不良反应发生率比较差异无统计学意义(P0.05);观察组术后28 d及2个月、6个月NIHSS评分均低于对照组(P均0.05)。结论瑞芬太尼应用于高血压脑出血,可较好控制血压,并起到镇痛镇静、降低再出血率、缩短机械通气时间与入住ICU时间的作用,且安全可靠,有助于改善预后。     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.