毒蛇咬伤致牙龈出血误诊一例报告

患者罗某某,男性,30岁,农民。就诊时主诉:牙龈出血一天,感冒数日。检查:精神好,全身情况尚佳。全口龈上结石十～(?)龈轻度充血,(?)区龈有渗血,血液检查:白细胞10.6×109/L(10600/mm~3),白细胞分类计数,中性粒细胞0.66(66%),淋巴细胞     

人工种植牙修复后咬合平衡与修复体-对颌牙咬合接触紧密程度的关系

目的 探讨人工种植牙修复后咬合平衡与修复体-对颌牙咬合接触紧密程度的关系.方法 选取2020年1月至2021年10月于我院接受后牙种植修复并完成随访的78例患者,按照其咬合紧密程度的不同将其分为观察组(12μm咬合纸进行咬合)和对照组(20μm咬合纸进行咬合),每组各39例,比较两组相关指标(种植体周骨吸收程度、牙周袋...     

银屑病患者治疗前后血清中Npt和VEGF水平的测定

目的探讨Npt和VEGF在银屑病发病中的意义。方法检测37例寻常性银屑病患者在不同病期及治疗前后血清Npt和VEGF水平。结果银屑病患者在治疗前血清Npt,VEGF水平较健康对照组显著升高,治疗后,两者均明显下降。银屑病患者治疗前、后血清Npt,VEGF水平分别与PASI评分有显著正相关,而且治疗前后Npt和VEGF呈正相关。结论血清Npt和VEGF在银屑病的发病机制中起重要作用,并与疾病的活动和严重程度密切相关。     

瑞马唑仑联合地佐辛用于老年患者无痛胃镜检查的半数有效量和95%有效量

目的观察瑞马唑仑复合地佐辛用于老年患者无痛胃镜检查的半数有效量(median effective dose,ED_(50))和95%有效量(95%effective dose,ED_(95))。方法选取2020年12月在扬州大学附属医院日间手术中心行无痛胃镜检查的老年患者31例,年龄65~86岁,体重45~87 kg,ASA分级Ⅰ~Ⅲ级。监测患者生命体征,静脉给予20μg/kg地佐辛,10 min后给予瑞马唑仑,待患者意识消失后立即行胃镜检查,观察受试患者对胃镜检查的反应情况。设定瑞马唑仑0.20 mg/kg为初始剂量,采用改良序贯法确定瑞马唑仑的剂量。采用概率单位Probit回归分析法计算瑞马唑仑ED_(50)、ED_(95)及其95%CI。结果与用药前相比,患者使用瑞马唑仑后出现一过性MAP、心率和SpO2的降低。复合地佐辛时,瑞马唑仑用于老年患者无痛胃镜检查的ED_(50)为0.184(0.062~0.275)mg/kg、ED_(95)为0.354(0.268~1.677)mg/kg。结论瑞马唑仑复合地佐辛用于老年患者无痛胃镜检查的ED_(50)为0.184 mg/kg、ED_(95)为0.354 mg/kg。     

糖尿病患者304例血糖控制指标分析

目的 分析长期在我院门诊就诊的2型糖尿病（type 2 diabetes mellitus,T2DM）患者糖代谢指标的控制现状,为更好地管理患者血糖提供理论依据。方法 于2012年3月1日至4月30日间采用现况调查方式收集304例T2DM患者近3个月的临床及实验室资料,根据降糖治疗方案将患者分为单纯口服降糖药物治疗组（A组）、单纯胰岛素治疗组（B组）和口服药联合胰岛素治疗组（C组）,评估各项代谢指标的控制现状及与并发症和合并症的关系。结果 （1）304例患者平均糖化血红蛋白（hemoglobin A1c,HbA1c）为（8.01±1.14）%,达标率（<7.0%者）为13.16%;74.67%（227/304）的患者至少合并1种并发症或伴随疾病,确诊时的餐后2 h血糖（postprandial glucose,PPG）与合并大血管病变的数目相关（r=0.131,P<0.05）。（2）B组和C组的糖代谢控制情况明显好于A组（P均<0.05）,磺脲类和双胍类药物仍为常用降糖药物,常用的胰岛素治疗方案是预混胰岛素类似物（30/59,50.85%）和每日4次胰岛素强化治疗（16/59,27.12%）。（3）各组患者填表前1周自测血糖者分别占27.56%、57.63%和50.85%,且HbA1c、空腹血糖（fasting blood glucose,FBG）和PPG的控制情况均好于同组未自测血糖者（均P<0.01）。（4）Logistic回归分析显示自测血糖为患者血糖不达标（即HbA1c ≥7%）的影响因素（OR值为0.379,P<0.01）。结论 HbA1c达标率低仍是糖尿病治疗中的棘手问题,血糖控制不佳者,应积极调整治疗方案,包括及时启用胰岛素治疗和积极调整胰岛素用量。     

关节镜下32例踝关节融合术的护理

对32例病人进行踝关节融合术,术前做好检查及心理护理、皮肤护理,术后加强疼痛护理,预防伤口感染,合理指导功能锻炼。结果术后1周踝关节疼痛明显减轻,半年以上随访检查关节全部融合,无感染、不融合等并发症,病人生活质量明显提高。认为关节镜下踝关节融合术具有创伤小、融合率高、并发症少等优点,而正确有效的护理能促进病人早日康复。     

心力衰竭与心肌病（2）

限制型心肌病 限制型心肌病以单侧或双侧心室充盈受限、舒张容量下降和心房扩大为特征,收缩功能和室壁厚度正常、心脏瓣膜正常。以心脏间质纤维化增生为其主要病理变化。主要见于热带和温带地区,我国仅有散发病例。     

骨髓单个核细胞Coombs试验阳性的血细胞减少患者补体水平变化及其意义

Objective To investigate the variation of bone marrow complement level in cytopenia pa-tients with positive BMMNC-Coombs test(CBCPC), and probe the role of complement in destroying hemato-poietic cells of CBCPC patients. Methods One hundred and twenty-four patients with CBCPC and twenty-three healthy donors as controls were enrolled in this study. The levels of CI-150, C3, C4, C5b-9 were tested with ELISA. The auto-antibodies on bone marrow hematupoietic cells (BMHC) were examined with flow cy-tometry. Results The level of C5b-9 in bone marrow(BM) of untreated CBCPC patients [(119.8 ± 54.0)μg,/L] was significantly higher than that of recovered patients [(100.7 ± 33.4) μg/L] or normal controls [(93.9 ± 28.8) μg/I.] (P < 0.05). The levels of CH50 in BM of untreated or recovered CBCPC patients [(33.3 ± 11.5) kU/L, (30.8 ± 10.3) kU/L] were significantly higher than that of normal controls [(24.1 ±6.4) kU/L] (P < 0.05). The level of C3 in BM of untreated or recovered CBCPC patients [(4.9 ± 2.2) mg/ L], (5.0 ± 3.5) mg/L] was significantly lower than that of normal controls [(7.0 ± 5.6) mg/L] (P < 0.05). The level of complement in peripheral blood was consistent with that in BM. CH50 in BM of CBCPC patients was negatively correlated with their C3 (r = - 0. 303, P = 0. 007) and positively correlated with their C5b-9(r = 0. 241, P = 0. 003) levels. The level of C5h-9 in BM of CBCPC patients was higher in the BMHC-IgM positive group [(117.6 ± 55.7) μg/L] than in the BMHC- IgM negative group [(99.2 ± 26.2)μg/L] (P < 0. 05). The positive rate of CD34+ -IgG or CD34 + -IgM of CBCPC patients was positively corre-lated with their C5 b-9 level (r = 0. 593, P = 0.000, r = 0. 326, P = 0. 049). The reticulocyte percentage (r =0. 421, P = 0.000) and serum indirect bilirubin level (r = 0. 230, P = 0. 032) of CBCPC patients were posi-tively correlated with their CHSO level. Conclusions The hematocytopenia of CBCPC patients might be re-lated to the hematopoietic cells destruction caused by auto-antibedy activated complements.     

骨髓单个核细胞Coombs试验(+)血细胞减少症患者有核红细胞膜EPO受体与自身抗体关系的初步研究

骨髓单个核细胞(BMMNC)Coombs试验(+)的免疫相关性血细胞减少症(IRP)是由于B淋巴细胞分泌多种针对骨髓造血细胞自身抗体引起的外周血细胞减少[1-2].目前推测自身抗体的作用机制之一可能是封闭骨髓造血细胞膜功能抗原进而抑制造血.