以心血管病为首发症状的老年甲状腺功能亢进症23例临床分析

目的探讨老年甲状腺功能亢进症的首发症状与误诊原因。方法根据23例老年甲状腺功能亢进症患者的临床首发症状特点进行误诊分析。结果23例患者中误诊为心律失常患者15例（65．2％），心力衰竭3例（13．0％），心绞痛5例（21．8％）。结论老年甲状腺功能亢进症起病隐匿，以心血管病为首发症状者多见，容易被误诊。     

冠状动脉介入术患者的意识镇静及其对血流动力学的影响

Objective To observe the safety of midazolam and fentanyl in coronary intervention and its effect on haemodynamics. Methods 150 cases undergoing coronary intervention were randomly divided into three groups(n=50 for each):the control group were given injection of 5 ml saline,midazolam group were given 0.04 mg/kg midazolam and combined fentanyl group were given injection of 0.02 mg/kg midazolam with 1.2μg/kg fent-anyl intravenously. Heart rate(HR),mean blood pressure(MAP),SpO<,2>,OAA/S and BIS were observed during the intervention and the patients' satisfaction and the incidence of complications were investigated. Results There was no significant difference among the three groups in MAP and HR (F=3.34,2.98,P>0.05). MAP increased from (95.7±14.5) mm Hg to (85.4±15.3) mm Hg after treatment (t=4.34,P<0.01) and HR increased from (83.3±23.4) times/min to (78.4±22.7) times/min in control group (t=3.37,P<0.01). BIS score was (90.5±7.2),(75.5±12.8) and (72.3±14.1) during intervention and 24 hVAS score was (53.5±25.4),(58.8±18.2) and (71.9±16.8) in control group,midazolam group and combined fentanyl group,with significant difference between groups (F=10.89,8.56,P<0.01). Conclusion Low dose of midazolam and fentanyl can make the patients calm,which relieves the tensity and anxiety and enhance the tolerance and safety of intervention but has no remarkable effect on bemodynamics.     

Sp1调控DOT1L表达并介导髓核细胞基质代谢的机制研究

目的探讨髓核细胞中Sp1调控DOT1L表达并影响髓核细胞机制代谢的具体机制。方法分离培养人椎间盘髓核细胞,通过PCR、免疫蛋白印迹法对比腰椎间盘突出症患者与脊柱侧弯患者髓核组织的DOT1L表达差异;通过慢病毒转染敲除髓核细胞中DOT1L表达,利用PCR、免疫蛋白印迹法检测基质代谢相关分子表达和Wnt/β-catenin通路激活水平;检测炎性因子刺激前后髓核细胞相关转录因子表达变化,明确髓核细胞退变相关的关键转录因子;慢病毒敲除、过表达Sp1后检测DOT1L的表达变化情况,明确Sp1与DOT1L的调控关系。结果腰椎间盘突出症患者髓核组织DOT1L表达显著降低(P<0.05);在髓核细胞中敲除DOT1L表达后,炎性因子刺激下(TNF-α)髓核细胞的基质代谢相关分子MMP3、MMP13明显升高(P<0.05)而CollagenⅡ、Aggrecan显著降低(P<0.05),且Wnt/β-catenin通路激活水平明显升高(P<0.05);炎性因子刺激后转录因子Sp1表达明显升高(P<0.05),而AP-1无明显改变(P>0.05);慢病毒敲除Sp1后DOT1...     

老年髋关节置换术后下肢深静脉血栓的预防

目的总结髋关节置换术后下肢深静脉血栓的预防措施。方法51例人工髋患者术前彩色多普勒超声筛检,双下肢无深静脉血栓,术后采用以低分子肝素抗凝为主的综合预防措施,术后48h,第4、7天复查彩超,阳性者行下肢深静脉造影,分析术后深静脉血栓的发病情况。结果51例人工髋术后4例发生下肢深静脉血栓,发生率为7.8%,未见症状性肺栓塞。结论对人工髋术后采取以低分子肝素抗凝为主的综合预防措施能显著降低术后深静脉血栓的发生率。     

腰椎间盘突出症的手法治疗体会

腰椎间盘突出症的手法治疗体会颜祖侠陆锐华关伟山主题词腰椎间盘移位／中医疗法穴位按压推拿腰椎间盘突出症以腰痛伴见下肢放射痛为主症。其治疗方法甚多，笔者从１９９３年１０月至１９９５年９月，采用以手法推拿为主的综合疗法治疗本病４９例，取得较好的疗效，...     

跟骨练功治疗器治疗跟骨骨折临床观察

对５１例跟骨骨折在手法整复,石膏托跖屈外固定的基础上,早期应用跟骨练功器治疗,观察近期与远期疗效。结果良好４５个,较好１１个,较差２个,不良１个。认为跟骨练功器对纠正跟距角及骨折复位有特殊效应,减少并发症和后遗症疗效满意。     

清利湿热治疗乳糜血尿100例

一、临床资料患者系1983-89年门诊病人,肉眼血尿者59例,镜检血尿者41例。其中男47人,女53人;年龄最小者16岁,最大者70岁。16—25岁者7人,26—35岁者24人,36—45岁者20人,46—55岁者29人,56—65岁者14人,66岁以上者6人。     

早期复极改变106例心电图特征分析

目的　探讨早期复极改变(ERV)患者的临床心电图特征.方法　根据临床及心电图表现入选ERV患者106例,并入选健康体检者100名作为对照组,分析比较两组心电图特征及ERV好发部位.结果　早期复极改变组与健康对照组平均心率分别为(68.6±8.4)、(74.8±12.6)次/min,QRS时限分别为(95±10)、(96±11)ms,Q-T离散度分别为(388±12)、(379±14)ms,Tp -Te分别为(80.4±7.6)、(78.5±8.3)ms,组间比较差异均无统计学意义(t值分别为0.72、0.58、0.65、0.59,P均＞0.05).J波在下壁导联的发生率为67.9％ (72/106),侧壁为15.1％ (16/106),中胸为17.0％ (18/106),下壁导联的发生率明显高于其他导联(x2值分别为为57.1、68.5,P均＜0.01).结论 ERV在下壁导联多见.     

冠状动脉介入术患者的意识镇静及其对血流动力学的影响

Objective To observe the safety of midazolam and fentanyl in coronary intervention and its effect on haemodynamics. Methods 150 cases undergoing coronary intervention were randomly divided into three groups(n=50 for each):the control group were given injection of 5 ml saline,midazolam group were given 0.04 mg/kg midazolam and combined fentanyl group were given injection of 0.02 mg/kg midazolam with 1.2μg/kg fent-anyl intravenously. Heart rate(HR),mean blood pressure(MAP),SpO<,2>,OAA/S and BIS were observed during the intervention and the patients' satisfaction and the incidence of complications were investigated. Results There was no significant difference among the three groups in MAP and HR (F=3.34,2.98,P>0.05). MAP increased from (95.7±14.5) mm Hg to (85.4±15.3) mm Hg after treatment (t=4.34,P<0.01) and HR increased from (83.3±23.4) times/min to (78.4±22.7) times/min in control group (t=3.37,P<0.01). BIS score was (90.5±7.2),(75.5±12.8) and (72.3±14.1) during intervention and 24 hVAS score was (53.5±25.4),(58.8±18.2) and (71.9±16.8) in control group,midazolam group and combined fentanyl group,with significant difference between groups (F=10.89,8.56,P<0.01). Conclusion Low dose of midazolam and fentanyl can make the patients calm,which relieves the tensity and anxiety and enhance the tolerance and safety of intervention but has no remarkable effect on bemodynamics.     

膝关节骨性关节炎非手术治疗的体会

目的：探讨运用关节腔冲洗，注射透明质酸钠及小针刀和康复训练等综合疗法对膝关节骨性关节炎合并内侧副韧带和髌下脂肪垫损伤的疗效。方法：36例运用关节腔冲洗，注射透明质酸钠及行小针刀治疗和康复训练等作为综合治疗，对病例的疗效做出总结。结果：经1～3次治疗后，治疗总有效率达94．83％。结论：该综合疗法对于膝关节骨性关节炎合并内侧副韧带和髌下脂肪垫损伤者疗效满意。