广东省急性脑梗死中医证型与血常规检验指标的关系探讨

[目的]探讨广东省急性脑梗死(ACI)患者中医证型分布情况及其与血常规检验指标之间的关系,从而为ACI的中医辨证分型提供更加客观的辨证依据.[方法]选取符合纳入标准的385例ACI患者为研究对象,观察不同证型患者的红细胞分布宽度(RDW)、中性粒细胞总数(NEU)、淋巴细胞总数(LYM)、中性粒细胞与淋巴细胞比值(NL...     

腰椎穿刺致反常性脑疝一例

对于急性颅高压患者,去骨瓣减压手术是一种可以挽救生命的治疗手段.反常性脑疝是去骨瓣减压术后脑脊液过度引流后出现的罕见并发症,往往被医师漏诊、误诊,危及患者的生命.作者通过典型病例的分析,提高对于反常性脑疝的认识,有助于临床诊断及治疗,进而挽救患者生命.     

标准外伤大骨瓣开颅联合外侧裂池打开引流治疗额颞顶部重型颅脑损伤的疗效分析

目的探讨采用标准外伤大骨瓣开颅去骨瓣减压联合外侧裂池打开引流术治疗额颞顶部重型颅脑损伤患者的效果。方法回顾性分析该科采用标准外伤大骨瓣开颅去骨瓣减压联合外侧裂池打开引流术治疗109例额颞顶部重型颅脑损伤患者的临床资料,并进行GOS疗效评定。结果随访6个月,存活93例（85．3％）,良好41例（37．6％）,中残32例（29．4％）,重残14例（12．8％）,植物生存6例（5．5％）。死亡16例（14．7％）。结论标准外伤大骨瓣开颅去骨瓣减压联合外侧裂池打开引流术治疗额颞顶部重型颅脑损伤患者疗效确切,可降低病死率与减少术后并发症,提高患者生存质量。     

用Excel电子表格制作血常规室内质控图

目的 探讨用Excel电子表格制作血常规室内质控图的方法,提高质控图的质量。方法利用Microsoft Excel电子表格的函数计算功能,在活动单元格中输入各种质控参数及计算公式,自动计算平均值（x^-）、标准差（s）和变异系数（CV％）,利用制作图表功能,设计制作质控图。结果每天在数据表中输入质控制,结果,计算机自动计算作图。可以对非随机因素引起的失控现象予以纠正。作好的质控图和数据表可以打印保存。结论用Excel电子表格制作室内质控图省时省力、美观准确。     

加味葛根芩连汤联合常规治疗对重度湿热型溃疡性结肠炎患者的临床疗效

目的考察加味葛根芩连汤联合常规治疗对重度湿热型溃疡性结肠炎患者的临床疗效。方法82例患者随机分为对照组和观察组,每组41例,对照组给予常规治疗(美沙拉嗪、氢化可的松琥珀酸钠),观察组在对照组基础上加用加味葛根芩连汤,疗程4周。检测症状评分、中医证候疗效、肠镜Baron评分、膜屏障功能指标(HIF⁃1α、DAO、D⁃LA)、血清促炎因子(IL⁃2、IL⁃6、TNF⁃α、IFN⁃γ、CRP)、血清抗炎因子(IL⁃4、IL⁃10、IL⁃13)、免疫功能指标(CD3+、CD4+、CD8+、CD4+/CD8+、NK细胞)、凝血功能指标(FIB、APTT、PLT)、不良反应发生率变化。结果观察组总有效率较对照组升高(P<0.05)。治疗后,观察组症状评分、肠镜Baron评分、膜屏障功能指标、血清促炎因子、CD8+、FIB、PLT、不良反应发生率较对照组降低(P<0.05),血清抗炎因子、CD3+、CD4+、CD4+/CD8+、NK细胞、APTT升高(P<0.05)。结论加味葛根芩连汤联合常规治疗能有效缓解重度湿热型溃疡性结肠炎患者临床症状,保护肠黏膜,降低不良反应,其机制可能与抑制促炎因子分泌、促进抗炎因子分泌、激活免疫功能、改善凝血功能有关。     

血常规在感染判定的价值

感染性疾病是儿科最常见的疾病之一,是由病原体侵入机体引起的局部组织损伤或全身炎性反应。儿童免疫力低下,病情进展快,需早期诊断及时治疗。各种感染性疾病的临床症状无显著特异性,尤其在早期阶段,而作为诊断金标准的病原学检测,因对检验环境要求高、耗时长、阳性率低及易污染等缺点,不利于早期诊断。血常规是临床上最基本及廉价易行的检验项目,具有操作简单、用时短等优点,主要检测白细胞、红细胞、血小板等血液有形成分的质和量及形态变化,特别是白细胞检测对感染性疾病的早期诊断、鉴别诊断,评估严重程度及治疗效果均具有重要价值,是目前儿科临床诊断感染性疾病的首选辅助检查方法。     

Liver is widely eaten by preschool children in the Northern Cape province of South Africa: Implications for routine vitamin A supplementation

Previous research has demonstrated a virtual absence of vitamin A deficiency and adequacy of vitamin A intake through consumption of liver in preschool children of a community in the Northern Cape province of South Africa where sheep farming is common, and liver, an exceptionally rich source of vitamin A, is frequently eaten. Only 60–75 g of liver per month is needed to meet the vitamin A requirement of preschool children. Because this may have implications for routine vitamin A supplementation, and because liver consumption for the rest of the province is unknown, the study aim was to establish the prevalence and frequency of liver intake in a provincial‐wide survey. An unquantified liver‐specific food frequency questionnaire, covering a period of 1 month, complemented by a 1‐year recall, was administered to mothers of 2‐ to 5‐year‐old children (n = 2,864) attending primary health care facilities in all five districts and 26 subdistricts. A total of 86% of children were reported to eat liver, which was eaten in all districts by at least 80% of children. The overall median frequency of liver intake was 1.0 [25th, 75th percentiles: 0.5, 3.0] times per month and ranged from 1.0 [0.3, 2.0] to 2.0 [1.0, 4.0] for the various districts. Based on a previously reported portion size of 66 g, these results suggest vitamin A dietary adequacy in all districts and possibly also vitamin A intake exceeding the Tolerable Upper Intake Level in some children. Routine vitamin A supplementation in this province may not be necessary and should be reconsidered.     

Pedicled,vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis

Atlantoaxial pseudoarthrosis is a challenging postoperative complication. The use of a local, vascularized bone graft, without free tissue transfer, to support a revision atlantoaxial fusion has not been previously described. We report the first surgical patient who received a semispinalis capitis muscle pedicled, occipital bone graft for supplementation of a revision atlantoaxial arthrodesis. A 72-year-old female had a failed atlantoaxial fusion and developed neck pain from continued instability and fractured hardware. The fixation and fusion were revised and supplemented with a novel, pedicled occipital bone graft. A craniectomy was performed in the occipital bone while still attached to the semispinalis capitis muscle to provide graft vascularity. This graft was rotated inferiorly from the skull base to the C1 arch and C2 spinous process in order to supplement a revision atlantoaxial arthrodesis. The patient had excellent clinical recovery over 18-month clinical follow up. The bone graft harvesting and rotation were performed safely and without complication. The 6-month postoperative CT scan showed partial fusion into the graft. This novel surgical technique leverages the advantages of vascularized structural autograft without adding extensive time or morbidity to the procedure as observed in free-tissue transfers. It is a safe and useful salvage technique to supplement revision atlantoaxial fusion surgeries.     

血栓弹力图在急性一氧化碳中毒患者中的应用

目的探讨血栓弹力图(TEG)在急性一氧化碳中毒(ACOP)患者抗凝治疗中的应用价值。方法选取44例确诊为ACOP的患者作为ACOP组,以及45例健康体检者作为对照组,于治疗前后抽取静脉血,做TEG检测及常规凝血试验,并对检测结果进行统计学分析。结果 ACOP患者的TEG主要检测参数,包括反应时间(R)、血栓形成的速度(由α角度反映)、血栓最大幅度(MA),均高于对照组,差异有统计学意义(P0.01);常规凝血检测的指标,包括凝血酶原时间、活化部分凝血酶原时间、凝血酶时间、纤维蛋白原,两组差异无统计学意义(P0.01)。结论 TEG指标能更敏感地反映ACOP患者的血小板功能活性,为临床治疗提供一定的参考。     

儿童末梢血不同放置时间对血常规各参数的影响

目的探讨儿童末梢血不同放置时间对血常规各参数的影响,以此提高临床血常规检测的工作效率。方法收集2015年1月至2016年1月于该院就诊的50名健康儿童的右手无名指末梢血各300μL,室温下(20~25℃)使用全血细胞分析仪于采集即刻(0min),5、10、15、30min进行血常规检验。结果以15min的测定结果为对照,与其他时点的血常规检测结果比较差异无统计学意义(P0.05);与5min的血常规检测结果比较,白细胞计数(WBC)、血小板体积分布宽度(PDW)、淋巴细胞绝对值(LYM)、中性粒细胞绝对值(NEU)、血小板计数(PLT)、红细胞体积分布宽度(RDW)、红细胞压积(HCT)、血小板压积(PCT)差异均具有统计学意义(P0.05)。结论合理安排时间,消除分析前误差,减少末梢血放置时间对血常规各参数的影响,对临床数据的准确判定具有重要意义;建议血常规检测时间控制在10~30min内,以此提高临床检测的工作效率。