肺部低剂量螺旋CT检查技术可行性探讨

目的:探讨肺部低剂量螺旋CT扫描技术的可行性。方法:对50例受检者在行常规剂量肺部螺旋CT扫描后再进行低剂量螺旋CT扫描,而后对两组图像进行对比分析。结果:在显示正常肺部结构方面两组图像无明显差别;在不同肺部疾病中两组图像均可提供相近的诊断与鉴别诊断信息。结论:肺部低剂量螺旋CT是切实可行的,特别适用于大批量体格检查。     

胸段和腰段硬膜外腔给药开胸术后镇痛的比较研究

目的：比较开胸术后胸段和腰段硬膜外给药的镇痛作用。方法：60例择期开胸手术病人随机分配到胸段（TEA）或腰段（LEA）硬膜外镇痛组，每组30例。麻醉前行T5～6间隙（TEA组）或L1～2间隙（LEA组）硬膜外置管。术毕首先经硬膜外导管推注（8ml），随后持续输注（5ml／h）20μg／ml吗啡溶液。观察TEA和LEA的镇痛效果、额外镇痛药用量、对呼吸功能的影响和不良反应。结果：①LEA组术后咳嗽时疼痛评分与TEA组相比差异无显著性（P＞0．05）。②两组病例术后无需额外使用镇痛药。③术后24h和48h FEV1和FVC组间比较无显著性差异（P＞0．05），与术前组内比较差异非常显著（P＜0．01）。④术后各时点Ramsay镇静评分和恶心评分组间比较无显著性差异（P＞0．05）。结论：吗啡LEA可以作为吗啡TEA的一种替代方法用于开胸术后镇痛。     

Case Report of Rapid-eye-movement(REM) sleep behavior disorder

Summary

A 23-year-old female student presented with a five-year history of abnormal sleep in which she would sit up or stand up for brief periods in the early morning, talk loudly for a couple of minutes and then lie back down. When woken by family members she would remember vivid dreams and nightmares. In one episode she had a fall that resulted in a subdural hematoma. On presentation at the psychiatric hospital she had a normal mental status exam except for being mildly depressed and anxious about the chronic fatigue from poor sleep. Overnight polysomnography (PSG) showed multiple waking periods each night, poor sleep efficiency and a lack of normal muscle paralysis during REM sleep. The patient was diagnosed with REM Sleep Behavior Disorder and treated with 1 mg clonazepam nightly. Her sleep improved dramatically and remained better at a six-month follow-up, but repeat PSG exam found that the lack of muscle paralysis during REM sleep remained.     

经阴道无张力尿道中段吊带悬吊术治疗女性压力性尿失禁30例报告

[目的]探讨经阴道无张力尿道中段吊带悬吊术(TVT)治疗女性压力性尿失禁(SUI)的临床效果.[方法]2004年1月至2007年12月采用TVT治疗SUI患者30例.术前尿动力学检查排除神经原性膀胱和急迫性尿失禁.术前常规检查排除泌尿系感染和阴道感染.患者均未接受其他针对女性SUI的手术治疗.[结果]手术均成功.手术时间在25～35 min,平均30 min.术中出血10～100 mL,平均40 mL.术后住院5～9 d,平均7 d.1例术中发生膀胱穿孔,经留置导尿2周后治愈.1例去除尿管后出现急性尿潴留、排尿困难,再次留置尿管2周后排尿通畅.其余患者排尿通畅.无切口感染、继发出血等.随访3～12个月,尿失禁无复发.[结论]TVT治疗SUI操作简便、手术时间短、手术创伤小、吊带悬吊程度可随意调整,近期效果理想,远期效果尚有待于长期随访观察.     

测定血小板表面CD62p评估心房颤动的高血凝状态

目的通过测定心房颤动(房颤)患者血小板表面CD62p了解血小板活化百分率,评估原发病、左房内径(LAD)、年龄和心室率对房颤的血凝状态的影响,以期对临床治疗产生一定的指导作用.方法采用流式细胞仪(FCM)测定房颤组和对照组血小板表面CD62p了解血小板活化百分率.结果除孤立性房颤组外,其它各房颤组血小板活化率均高于对照组(P<0.05).血小板活化率与LAD、年龄有良好的相关性(r分别为0.655和0.508,P值均<0.01),与心室率无相关性.结论血小板活化率和LAD可以作为评估房颤患者高血凝状态的两个重要指标,对指导抗凝治疗有重要意义.     

UF-1000i全自动尿有形成分分析仪对尿路感染的诊断价值

Objective To evaluate the application value of UF-1000i automated urine formed elements analyzer in the diagnosis of urinary tract infection. Methods 150 urine specimens were analyzed using the UF-1000i in parallel with detection of leukocyte, yeast-like fungus, and bacteria. These detection results were collected for evaluation of urinary tract infection and scatter grams were recorded. At the same time, these samples were cultured for bacterial identification, which results were compared with that of the UF-1000i. The clinical diagnose criteria of the UTI was performed as golden standard. As compare with results obtained with UF-1000i, the sensitivity and specificity of UF-1000i for diagnosis of urinary tract infection were evaluated, and the consistency were analyzed among scatter grams, bacterial culture and final diagnosis. Results The statistical results from 146 specimens showed that the positive rate of UF-1000i was 32. 9% (48/146), the positive rate of urine culture is 28. 8% (42/146). There was no significant statistical difference found (χ2 = 1.79 ,P = 0. 18 )and Kappa test showed a considerable consistency (K = 0. 775 6). The UF-1000i detection results showed the sensitivity 76. 0% ( 38/50 ), specificity 89. 6% ( 86/96 ), positive predictive value 79. 2% ( 38/48 ) and negative predictive value 87. 8% ( 86/98 ), respectively. The distribution of coccus and bacilli obtained from the UF-1000i testing was basically in accordance with the results of bacterial culture. Conclusion The "UTI-information" of UF-1000i is very important for the diagnosis of urinary tract infections.     

联合测定血清转铁蛋白受体和C-反应蛋白指导肾性贫血治疗的意义

目的:探讨血清转铁蛋白受体(STfR)和C-反应蛋白(C-RP)的联合测定在人重组红细胞生成素(r-HuEpo)治疗肾性贫血方面的作用。方法:47例慢性肾功能不全伴肾性贫血的患者在用r-HuEpo治疗前测定血红蛋白(Hb)、网织红细胞计数(Ret)、红细胞压积(Hct)、STfR、血清促红细胞生成素(SEpo)、C-RP,按STfR在正常值范围内或以上及正常值以下分为A、B两组,给予皮下注射r-HuEpo,50U·kg-1.次-1,1周2次,2周、4周后复测以上数据,并对结果进行分析。结果:A组27例,B组20例。两组治疗前Hb、Hct、Ret、SEpo均无明显差异(P>0.05),STfR、C-RP有明显差异(P<0.01)。A组治疗前Hb、Ret、HCT与治疗后2周、4周后的值比较均有明显差异(P1<0.05、P2<0.01)。B组治疗前Hb、Ret、HCT和治疗后2周、4周后的值比较均无明显差异(均P>0.05)。A组Hb与STfR呈正相关(r=0.7,P<0.01),B组Hb与C-RP呈负相关(r=-0.8,P<0.01)。结论:联合检测STfR和C-RP对r-HuEpo的疗效有预测作用。     

中国汉族人群血管内皮细胞生长因子基因的单核苷酸多态性研究

目的探讨中国汉族人群血管内皮细胞生长因子 (VEGF)基因的单核苷酸多态性 (SNPs)分布规律。方法应用等位基因特异性扩增技术 ,对 2 5 2名中国汉族正常人的VEGF基因SNPs进行检测 ,并与文献报道的欧洲白人数据进行比较。结果VEGF基因启动子区的多态位点C2 5 78A的基因型频率分布中 ,CC为 48 8%、CA为 46 0 %、AA为 5 2 % ;C等位基因频率为71 8% ,A等位基因频率为 2 8 2 %。与欧洲白人相比较 ,各基因型和等位基因分布存在非常显著性差异 (P <0 0 1)。结论中国汉族人群VEGF基因SNPs与欧洲白人显著不同 ,中国人低VEGF表达的 2 5 78A/A纯合子明显少于欧洲白人。     

老年特发性血小板减少性紫癜患者的临床观察

目的 总结老年特发性血小板减少性紫癜(ITP)患者的发病特点、治疗及临床转归.方法 回顾分析1992-2007年我院住院治疗的老年ITP患者的临床资料,并与同期住院的非老年患者的临床资料进行对照.结果 老年患者(老年组)43例,男性16例,女性27例;随访时间1个月～15年,存活35例.43例患者中,7例血小板持续(30～50)×109/L,出血不显著,未予以治疗;36例首选泼尼松治疗,敏感型25例(69.4%),以完全反应或部分反应健康存活;脾切除或栓塞4例,3例血小板恢复正常;对于泼尼松治疗不敏感者分别使用免疫抑制剂,其中硫唑嘌呤21例,环孢A23例,长春新碱3例及环磷酰胺9例,硫唑嘌呤、环孢A疗效优于长春新碱及环磷酰胺.进展为难治性ITP5例,难治率为13.9%;进展为未定性单克隆免疫球蛋白增多症(MGUS)和淋巴瘤各1例.死亡8例,死于外伤感染引发的心肺功能衰竭4例,肿瘤3例,脑出血1例.结论 老年ITP患者临床表现不典型,致命性出血的风险低,对免疫抑制剂的反应与非老年组近似,治疗宜个体化.     

许济群治疗肺系疾病撷菁

许济群教授为孟河贺氏学派再传弟子,尤擅肺系疾病的治疗。其临证中通过问汗、问大便、察喉,并配合西医诊疗手段,准确辨证,师古方而不泥古方,于药量、用法上有着独到的经验,临床上颇有疗效。