健康教育对ARN并视网膜脱离术后疗效的影响

目的 :研究健康教育对急性视网膜坏死综合征 (acuteretinalnecrosissyndromo ,ARN)并视网膜脱离术后疗效的影响。方法 :随机将 32例 (4 2眼 )ARN并视网膜脱离病人分为A ,B两组。A组 ,2 2例 (2 9眼 )作为观察组 ,术后按制订的健康教育方案进行护理。B组 ,10例 (13眼 )作为对照组 ,常规护理 ,不进行健康教育。对比观察两组术后疗效及并发症。结果 :AB两组对照比较 ,A组手术成功率明显增加 ,术后并发症如视网膜脱离复发、角膜水肿、继发性青光眼等发生率明显降低 (P <0 .0 5 )。结论 :健康教育有助于提高ARN并视网膜脱离病人手术疗效 ,减少术后并发症。     

愈咳方治疗感冒后咳嗽的临床研究

目的评价愈咳方治疗感冒后咳嗽的临床疗效及安全性。方法 160例符合入组标准的患者随机分为治疗组(110例)与对照组(50例),治疗组应用中药愈咳方治疗,对照组常规西药治疗,两组疗程均为10 d。观察两组患者的总有效率及起效时间。结果治疗组中西医症状疗效总有效率为90.0%与92.7%,对照组为70.0%与66.0%,两组比较差异有统计学意义(P0.01)。治疗组平均起效时间为(2.95±1.24)d,对照组为(3.86±1.87)d,两组比较差异有统计学意义(P0.05)。结论愈咳方治疗感冒后咳嗽安全、有效,值得推广。     

汕头地区传染性非典型肺炎研究

目的 :探讨传染性非典型肺炎 (IAP)的流行病学、临床特点、病原学检查及预后。方法 :根据中国卫生部IAP临床诊断标准。采用间接免疫荧光法检测抗冠状病毒IgG。分析本组 (8例 )病例特点 ,患者均有密切接触史 ,潜伏期 1～10天 ;均发热 ,且热型多不规则。胸片特点 :本组肺部均出现片状或斑片状炎症阴影。常规予广谱抗生素、利巴韦林抗病毒以及免疫球蛋白、生物反应调节剂胸腺肽等治疗无效 ,予甲基强的松龙治疗有效。结果 :本组均符合IAP临床诊断标准。 7例存活者于半个月～ 2个月内肺部炎症阴影均完全吸收。 1例死于呼吸衰竭。住院时间 14～ 4 4天 ,平均 (2 8 9± 13 7)天。 3例抗冠状病毒IgG阳性 ,且恢复期的抗体滴度比急性期增高 4倍以上。结论 :IAP是一种传染性极强的疾病。本组以近距离传播为主 ,具有家族局部爆发流行的特点。以发热为主要表现 ,热程多在 14天左右 ,重症者可长达 30多天。该疾病侵犯多个肺叶 ,及肺部以外的其他器官。激素可以促使肺部炎症的吸收。病原体是冠状病毒     

加味四逆散对慢性疲劳综合征模型大鼠额叶和海马区端粒酶及端粒的影响

目的:观察加味四逆散对慢性疲劳综合征模型大鼠额叶、海马区神经元端粒长度及端粒酶活性的影响,探讨中医疏理气机法防治慢性疲劳综合征的神经端粒机制。方法:SD雌性1月龄大鼠100只,随机分为对照组、模型组、加味四逆散组、小柴胡汤组、柴胡加龙骨牡蛎汤组、怀牛膝组、四物汤组、黄芪建中汤组、人参组、帕罗西汀组,每组10只。采用慢性不可预见的中等强度应激刺激,造成动物的慢性疲劳状态。用酶联免疫吸附法研究端粒酶活性变化,用Southern Blotting法研究端粒长度变化。结果:1海马端粒酶活性变化:与对照组比较,除加味四逆散组外,其余各组均降低,且有统计学差异(P0.01);与模型组比较,除怀牛膝组和柴胡加龙骨牡蛎汤组外,其余各组均升高,且有统计学差异(P0.01)。2额叶端粒酶活性变化:与对照组比较,除加味四逆散组和小柴胡汤组外,其余各组均降低,且有统计学差异(P0.01);与模型组比较,除怀牛膝组和柴胡加龙骨牡蛎汤组外,其余各组均升高,且有统计学差异(P0.01)。3海马端粒长度变化:与对照组比较,除加味四逆散组外,其余各组端粒长度均缩短,且有统计学差异(P0.01);与模型组比较,除怀牛膝组和柴胡加龙骨牡蛎汤组外,其余各组端粒长度均延长,且有统计学差异(P0.01)。4额叶端粒长度:与对照组比较,除加味四逆散组外,其余各组端粒长度均缩短,且有统计学差异(P0.01);与模型组比较,除怀牛膝组和柴胡加龙骨牡蛎汤组外,其余各组端粒长度均延长,且有统计学差异(P0.01)。结论:慢性应激能诱发大鼠慢性疲劳状态,降低额叶区、海马区的端粒酶活性,缩短端粒长度。加味四逆散、小柴胡汤、四物汤、黄芪建中汤和人参可不同程度改善慢性应激大鼠的疲劳症状,其中以加味四逆散和小柴胡汤较优,其机制可能与调节额叶和海马区的端粒酶活性及保护端粒损伤有关。     

Relationship of adrenocortical function and TCM Syndrome typing in elderly patients with severe sepsis

Objective: To explore the relationship between TCM Syndrome typing and adrenocortical function in elderly patients with severe sepsis, and to see whether TCM Syndrome Differentiation can provide clinical clues in identifying relative adrenal insufficiency (RAI) in patients with severe sepsis. Methods: Six ty-one old patients with severe sepsis were classified into four types according to TCM Syndrome Differentiation: The severe invasion of toxic-heat type (Type SITH, n = 21 ); the Qi stagnation and blood stasis type ( Type QSBS, n = 11); the sudden depletion of Yang-Qi type ( Type SDYQ, n = 16); and the exhaustion of Qi-Yin type (Type EOQY, n = 13). The base-line level of plasma cortisol in patients of different types and their response to corticotropin stimulation were compared, which were also compared with those of 12 healthy elderly persons synchronously. Results: The base-line level of plasma cortisol was not significantly different between patients of different Syndrome types (P＞0.05), but they were all sgnificantly higher than that in the healthy persons ( P＜0.05). Compared with Type QSBS and Type EOQY, Type SITH and Type SDYQ showed less cortisol concentration increment after corticotropin stimulation ( P＜0.05). RAI was more prevalent in patients of Type SITH and Type SDYQ than in patients of Type QSBS and Type EOQY (57% vs 25 %, P＜0.01). Conclusion: In old patients with severe sepsis, different TCM Syndrome types are associated with different adrenocortical function status. TCM Syndrome differentiation can provide clinical clues in identifying old patients with severe sepsis who have also RAI.     

围急性呼吸窘迫综合征血清CC16蛋白水平的预警意义

目的：探讨围急性呼吸窘迫综合征患者血清Clara细胞分泌的特异性蛋白-CC16蛋白水平的预警意义。方法回顾性分析我院从2013年3月到2014年3月入院治疗的60例急性呼吸窘迫综合症患者(将其定义为观察组)的临床资料。另选取我院同期参加健康体检的健康成年人58例的临床资料为对照组。将观察组患者病情进展过程中不同时期血清中Clara细胞分泌的特异性蛋白-CC16蛋白水平与对照组健康人群指标进行比较,评估其临床预警意义。结果观察组患者各时期血清CC16蛋白水平均高于对照组,随着病情的进展,血清CC16蛋白水平持续增高,前三个阶段血清CC16蛋白水平呈逐级递增趋势,差异具统计学意义(P＜0.05),临终期与ARDS期血清CC16蛋白水平接近,差异无统计学意义(P＞0.05)。结论急性呼吸窘迫综合征患者血清Clara细胞分泌蛋白CC16水平在患者炎症反应初期即开始升高,且变化早于血气分析指标的变化,故可将CC16指标变化情况用于早期急性呼吸窘迫综合征的诊治及预后评估,值得临床广泛推广应用。     

早发ST段抬高型急性心梗患者临床特点分析

目的分析早发ST段抬高型急性心梗（STEMI）患者的传统危险因素分布以及血生化指标及冠状动脉造影结果特点。方法收集自2009年1月-2010年3月STEMI临床资料,比较早发STEMI患者（男性〈55岁,女性〈65岁）和非早发的STEMI患者（男性〉55岁,女性〉65岁）的传统危险因素、血生化代谢指标及冠脉造影结果的差异,并进行统计学分析。结果早发STEMI组与非早发组比较具有以下临床特点：吸烟（56.8%∶38.0%,P〈0.05）和代谢综合征（55.6%∶33.0%,P〈0.05）的比率较高。早发STEMI组的体重指数（BMI）显著高于非早发组[（25.94±3.15）∶（24.75±3.66）P〈0.05]。早发组以冠脉单支病变为主（58.0%∶31.0%,P〈0.05）,以前降支受累为主,而非早发组以三支病变为主（21.0%∶44.0%,P〈0.05）。针对早发STEMI危险因素的Logistic多元回归分析发现代谢综合征和吸烟是早发STEMI的独立危险因素,代谢综合征和吸烟的OR值分别是2.54和2.82。结论吸烟和代谢综合征在早发STEMI的发生、发展过程中起重要作用,对于存在代谢异常的青中年患者进行减肥和戒烟具有尤其重要的预防心血管事件的意义。     

Distribution of prenatal and postnatal risk factors for sudden infant death in Budapest

Mortality from coronary heart disease has decreased by 60% in Finland during the past 25 years. The prevalence of coronary heart disease decreased during the 1990s among the elderly. Silent myocardial infarction was common, especially in elderly women. The number of coronary angioplasty or bypass operations has increased considerably, especially in men. Objective &;#114 - &;#114 To characterise the prevalence of, and changes in, coronary heart disease (CHD) among men and women aged between 64 and 71 years in the 1990s. Design &;#114 - &;#114 A study of clinical epidemiology involving two cohorts of elderly persons in 1990 - 1991 and 1998 - 1999. Setting &;#114 - &;#114 Primary health care in the municipality of Lieto in southwestern Finland. Subjects &;#114 - &;#114 Persons between 64 and 71 years of age in the southwest of Finland in 1990-1991 and 1998-1999. Main outcome measures &;#114 - &;#114 The occurrences of CHD were estimated using the history of a previous myocardial infarction or coronary revascularisation procedure evident in the medical records and with ischaemia or infarction as established on ECG according to the Whitehall criteria. Results &;#114 - &;#114 The prevalence of 'probable' CHD decreased among men and women aged between 64 and 71 years, whereas the prevalence of 'possible' CHD decreased among women alone. Silent myocardial infarctions were common among women of both cohorts. Many more men of the second cohort, compared to the first one, had undergone a coronary angioplasty or bypass operation. Conclusion &;#114 - &;#114 The prevalence of CHD decreased among elderly women more clearly than among young elderly men. The favourable development illustrating a decrease in the prevalence of CHD among women should be sustained, while health promotion activities will need to be directed more actively towards men.