心脏穿透伤快速诊断与救治15例

目的探讨心脏穿透伤的快速诊断和救治方法,提高抢救成功率。方法深圳市第六人民医院1993年5月至2010年5月救治15例心脏穿透伤患者,男13例,女2例;年龄17~40岁,平均年龄25岁。均为锐器伤,伤后至就诊时间20~120 min。典型的临床表现为胸闷,不能平卧,低血压,脉压差小,心音遥远,颈静脉怒张,上腔静脉引流区域广泛瘀血。床旁B超示：心包积液5例;CT检查示：心包积液1例;其余患者均未做辅助检查。临床分型为亚临床型4例,心脏压塞型4例,失血性休克型5例,濒死型2例。除2例濒死型患者在急诊科开胸探查外,其余患者均送手术室。全身麻醉后经第4或第5肋间进胸探查,进胸后如发现心脏有破口或心包张力大呈紫蓝色,即可确定有心脏损伤,剪开心包,迅速找到破口,予以修补;如胸腔出血〉1 000 ml予以回输;术后给予抗生素预防感染,注意保护肾、脑功能。结果全组生存13例,1例为多发伤合并呼吸窘迫综合征（ARDS）;死亡2例,1例为濒死型,另1例为失血性休克型。平均住院时间17 d（9~88 d）。随访11例,随访3个月~8年。13例生存患者心功能良好,无后遗症。结论根据伤口的部位,临床表现,快速作出诊断并及时手术,是提高心脏穿透伤抢救成功率的关键。     

青藏铁路沿线人间鼠疫流行规律分析

青藏铁路西藏段北起开心岭,南至西藏自治区首府拉萨,由北至南依次穿越那曲、拉萨两地（市）所辖的安多、那曲、当雄、堆龙德庆县、城关区4县1区。该区域平均海拔4500m,总面积107251km2,人15约39万。自然景观以高山草甸草原、高山荒漠灌丛草甸草原和高山峡谷草甸草原为主,属亚寒带气候区和高寒温带半干旱季风气候区,年平均气温-2．1℃,年平均降水380mm,     

Effects of chronotherapy of benazepril on the diurnal profile of RAAS and clock genes in the kidney of 5/6 nephrectomy rats

This study investigated the effects of benazepril administered in the morning or evening on the diurnal variation of renin-angiotensin-aldosterone system (RAAS) and clock genes in the kidney. The male Wistar rat models of 5/6 subtotal nephrectomy (STNx) were established. Animals were randomly divided into 4 groups: sham STNx group (control), STNx group, morning benazepril group (MB) and evening benazepril group (EB). Benazepril was intragastrically administered at a dose of 10 mg/kg/day at 07:00 and 19:00 in the MB group and EB group respectively for 12 weeks. All the animals were synchronized to the light:dark cycle of 12:12 for 12 weeks. Systolic blood pressure (SBP), 24-h urinary protein excretion and renal function were measured at 11 weeks. Blood samples and kidneys were collected every 4 h throughout a day to detect the expression pattern of renin activity (RA), angiotensin Ⅱ (AngⅡ) and aldosterone (Ald) by radioimmunoassay (RIA) and the mRNA expression profile of clock genes (bmal1, dbp and per2) by real-time PCR at 12 weeks. Our results showed that no significant differences were noted in the SBP, 24-h urine protein excretion and renal function between the MB and EB groups. There were no significant differences in average Ald and RA content of a day between the MB group and EB group. The expression peak of bmal1 mRNA was phase-delayed by 4 to 8 h, and the diurnal variation of per2 and dbp mRNA diminished in the MB and EB groups compared with the control and STNx groups. It was concluded when the similar SBP reduction, RAAS inhibition and clock gene profile were achieved with optimal dose of benazepril, morning versus evening dosing of benazepril has the same renoprotection effects.     

中药贴敷理疗辅助治疗小儿支气管肺炎的临床观察

目的：研究中药贴膏穴位贴敷对治疗小儿支气管肺炎的疗效.方法：将支气管肺炎患儿随机分为：治疗组108例,在西医治疗的基础上加用中药膏贴穴位贴敷;对照组100例给予西医常规治疗.1疗程后观察两组患儿咳嗽症状及肺部体征变化.结果：治疗组患儿咳嗽症状及肺部症状在治疗3天后明显好转101例,对照组有81例.结论：中药贴敷理疗对治疗小儿支气管肺炎有显著的疗效.     

低负荷作业水平颈肩肌肉骨骼疾患的肌电信号特征研究

探讨低负荷作业水平下颈肩肌肉骨骼疾患的特征性肌电信号。使用北欧肌肉骨骼疾患问卷将24名缝纫女工分为症状组和无症状组。采用表面肌电图技术(sEMG)连续记录两组女工在缝纫操作时双侧颈竖脊肌(LCES和RCES)、双侧上斜方肌(LUT和RUT)200 min的肌电信号。肌电的时域指标以电活性(EA)表示,频域指标为中位频率(MF),并计算每分钟EA随时间变化的斜率(EA slope)和每分钟MF随时间变化的斜率(MF slope)。通过频谱振幅联合分析(JASA),统计测试肌肉EA slope与MF slope交点在JASA图中的频数和时间赋值,结果表明无症状组测试肌肉EA slope与MF slope交点在JASA图各象限分布均匀,差异无显著性;症状组在JASA图各象限分布频数的差异有显著性(χ2=46.08,P<0.01)。两组工人不同肌肉在各象限中分布:LCES和RCES在第2象限(χ2LCES=5.35,P<0.05;χ2RCES=9.36,P<0.01)和第4象限(χ2LCES=5.63,P<0.05;χ2RCES=5.93,P<0.01)中频数分布差异有显著性。LUT和RUT在这两个象限中频数分布差异无显著性。EA slope与MF slope的交点在JASA图中时间赋值分析表明,无症状组肌电在JASA图4个象限点的分布差异经方差分析显示无显著性;症状组则差异有显著性(FLCES=2.29,P<0.05;FRCES=4.02,P<0.01;FLUT=3.39,P<0.05;FRUT=4.98,P<0.01)。两组EA slope与MF slope交点在JASA图4个象限中时间赋值分布有显著性差异(F=5.43,P<0.01)。振幅指标和频谱指标的斜率交点在JASA图第4象限分布不均,是颈肩部肌肉骨骼疾患肌电信号的特征性变化。     

老公是没有类型的

不少人问我：“如果遇到同事老公那样的男人,你会嫁给他吗？”那个男人什么样呢？长相好、气质佳、脾气温厚、收入中上,是个典型的理科男人。唯一的缺点是,有点儿闷。     

防病健身揉耳朵

上班族身心压力大,头痛脑热、腰酸背疼成了常事。专家建议大家,不妨学学清代的长寿皇帝乾隆的保健方法——"耳常弹"。在工作间隙,或上下班途中,将耳朵揉一揉、拉一拉,每天只需花几分钟,不仅可使身体的不适症状减轻或消失,还能使人神清气爽、精神振奋、疲劳消除。