强化健康教育模式在维持性血液透析患者控制超滤量中的应用

目的:探讨强化健康教育在维持性血液透析患者控制超滤量中的应用效果。方法:对42例维持性血液透析患者进行为期2个月的强化健康教育,并与强化健康教育前进行比较。结果:强化健康教育后患者超滤量占干体重<5%的例数较强化健康教育前增多(P<0.05),强化健康教育后患者超滤量、透析后体重、透析前收缩压及舒张压均较健康教育前降低(P<0.05)。结论:强化健康教育可降低维持性血液透析患者的超滤量。     

脓毒性休克早期液体复苏的临床研究

目的:探讨早期液体复苏容量对脓毒性休克的治疗意义。方法:定义正平衡即液体入量大于液体出量,负平衡即液体入量小于液体出量。回顾性分析80例脓毒性休克患者入院后24h和入院后72h液体复苏正平衡组及负平衡组的资料,分析两组间患者的预后。结果:入院后24h内负平衡组,负平衡液体量-218±21.4ml,死亡率显著低于正平衡组,正平衡液体量3206±57.9ml(P<0.01)。入院后72h内负平衡组,负平衡液体量-278±25.9ml,死亡率显著低于正平衡组,正平衡液体量5265±98.7ml(P<0.01)。结论:脓毒性休克患者早期液体复苏容量负平衡可以降低病死率。     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

严重脓毒症患者血清血管内皮生长因子的临床研究

目的 检测严重脓毒症患者血清血管内皮生长因子(VEGF)水平的动态变化,探讨VEGF与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及相关临床参数的关系.方法 采用前瞻性随机对照研究,选择2006年7月-2007年10月本院重症监护病房(ICU)收治的29例严重脓毒症患者,检测发病后1、3、7 d血小板计数(PLT)、白蛋白(Alb)水平,并计算APACHEⅡ评分;采用酶联免疫吸附法(ELISA)检测血清VEGF水平,并按患者生存与死亡分为两组,比较两组的异同.以同期31例健康体检者作为健康对照组.结果 健康对照组VEGF水平为(78.77±8.15)ng/L;生存组16例患者随时间延长VEGF水平逐渐下降(F=40.32,P<0.01),7 d时接近健康对照组(P>0.05);死亡组13例患者VEGF水平3 d下降,7 d又上升(F=29.61,P<0.01).VEGF水平与APACHEⅡ评分呈显著正相关(r=0.510,P=0.000),与PLT呈显著负相关(r=-0.221,P=0.046),与Alb未显示相关性(r=-0.029,P=0.789).结论 严重脓毒症患者VEGF水平在发病早期明显升高,随病程进展生存组VEGF水平逐渐下降,死亡组下降不明显,VEGF在一定程度上反映脓毒症病情严重程度.     

102例癫痫患者服药依从性差的原因分析和策略

采用自行设计的问卷对102例癫痫患者进行调查,以分析癫痫患者服药依从性差的原因,探讨提高服药依从性的策略。结果显示,需采取多种方式大力宣传癫痫的药疗知识,以提高癫痫患者服药依从性及其治愈率。     

9例ANCN相关性血管炎误诊原因分析

目的了解抗中性粒细胞胞浆抗体(ANCN)相关性小血管炎的临床表现及其常见的误诊原因.方法对我院自2008年6月至2010年6月期间9例确诊为ANCN相关性小血管炎患者的临床资料进行回顾性分析.结果此9例ANCN相关性小血管炎患者入院时首诊均误诊.误诊为的疾病有:慢性肾炎导致尿毒症、肺结核、肺炎、脑梗塞、类风湿性关节炎、过敏性紫癜性肾炎、肠梗阻.此9例病人均有尿检异常.ANCN(+),其中8例P-ANCN(+),1例C-ANCN(+).肾脏和肺脏是最常见受累的器官,其中2个脏器同时受累者7例.9例患者均采用糖皮质激素或糖皮质激素联合环磷酰胺治疗或(和)透析治疗,随访半年,3例患者治疗后血尿、蛋白尿完全消失;2例肾功能部分恢复.2例患者症状好转;死亡2例,病死率22.2%.结论 ANCN相关性小血管炎常出现多个系统损害,早期实验室重点筛查ANCA均能较早诊断,从而减少误诊、漏诊.     

氦氖激光穴位照射治疗三叉神经痛

本组原发性三叉神经痛30例,均由神经科门诊确诊。男19例、女11例;年龄20～46岁14例,50～70岁16例。均为单侧发病,右侧第Ⅰ支4例,右侧Ⅱ、Ⅲ支混合发病6例,左第Ⅰ支6例,左Ⅱ支8例,左Ⅱ、Ⅲ支混合发病4例,左Ⅲ支2例。疗程2天4例,7天16例,14天10例,3例拔牙后发病。既往以穴位封闭2例,内服药物治疗19例,未曾治疗9例。     

半夏泻心汤加减治疗肝胃不和不寐证的探讨

肝胃不和与不寐证通常为两种不同的症状,肝胃不和主要表现为上腹部饱胀感、恶心、胀气、并伴有干呕等现象,该类患者有较为明显的消化道症状。而不寐证主要是以入睡困难,睡眠质量差等为主要症状。中医学认为肝胃不和与人自身情志因素有着非常重要的联系。半夏泻心汤在中医治疗中主要用于消化道疾病的治疗,本文主要对半夏泻心汤加减治疗临床中肝胃不和之不寐证进行探讨。     

树脂直接粘结与嵌体间接粘结修复对根管治疗后牙抗折能力的影响

目的分析接受根管治疗的患者应用树脂直接粘结与嵌体间接粘结修复对其牙扛折能力产生的影响。方法将2017年10月至2018年7月在我院接受根管治疗的62例患者纳入研究范围,应用随机抽签法将研究对象分为比对组(n=31)和探讨组(n=31),全部患者均接受根管治疗,比对组患者应用树脂直接粘连修复法,探讨组患者应用树脂嵌体间接粘结修复法,对比分析2组患者修复效果。结果探讨组患者病情总缓解率为96.77%,明显高于比对组患者总缓解率80.65%,2组患者治疗效果差异有统计学意义(P 0.05)。结论接受根管治疗的患者应用嵌体间接粘结修复法能够显著增强其牙抗折能力,修复效果以及牙齿美观度更加理想。     

补气脉通片治疗脑卒中后疲劳的疗效观察

目的探讨补气脉通片治疗卒中后疲劳的疗效。方法对60例卒中后疲劳患者给予补气脉通片连续治疗4周,参照《中药新药临床指导原则》制定疗效评定标准,根据症状改善情况对其进行疗效评价。结果 60例患者中,显效45例(75.0%),有效11例(18.3%),无效4例(6.76%),总有效率为93.3%,全身乏力、纳差、肌肉酸痛等症状均有明显的改善,以全身乏力症状改变最为显著。结论补气脉通片治疗卒中后疲劳疗效显著,有利于康复治疗的顺利进行。