通下法治新生儿破伤风感染性休克1例

梁某某，男，６ｄ。１９８５年８月５日入院。代述：患儿频繁抽搐，伴张口困难１ｄ，当天上午不吸乳，初则哭声嘶哑，继则无声，伴频繁抽搐。发作时颜面及口唇青紫，面呈苦笑，牙关紧闭，并有呼吸暂停。追问其病史，曾使用不洁剪刀断脐。体温正常。诊断为新生儿破伤风。经...     

高龄患者的心理护理体会

随着社会老龄化的进程，住院患者中高龄患者的比例呈逐年上升趋势，如果临床实践中忽视了心理护理与整体护理这一重要环节，将会给患者带来不应有的损失和痛苦，下面对高龄患者的特点作如下分析。１　高龄患者的心理特点希望自己健康长寿，自己不服老，也不愿意听到别人自己衰老，对病情估计多悲观，尤其是离退休患者及易产生孤独和无价值感，特别易形成退休综合症，并有强烈地被重视被尊敬的心理。一般多希望亲人，朋友来探望，高龄患者都有有不同程度的脑动脉硬化、健忘、耳聋、眼花，有对自身情感、行为控制力减弱的倾向，容易出现积极的…     

中频脉冲治疗急性缺血性脑卒中偏瘫94例临床观察

目的观察中频脉冲在治疗脑卒中偏瘫中的临床效果。方法选取2013年3月至2014年9月来我院治疗的急性缺血性脑卒中偏瘫患者94例,随机分对照组46例,观察组48例,对照组行常规治疗及康复训练,观察组在常规治疗及康复训练的基础上配合中频脉冲治疗,观察治疗后的临床效果,并将其疗效进行对比分析。结果患者治疗后偏瘫肢体的运动功能恢复均较治疗前有明显的改善(P<0.01)。结论在常规治疗的基础上配合中频脉冲治疗能有效提高脑卒中偏瘫患者的运动能力及日常生活能力。     

基层医院3600张中成药处方分析

目的：调查浙江省江山市人民医院近3年的中成药处方,分析存在的问题,以指导医生正确开方,合理用药,避免不良反应的发生。方法：随机抽取每月含中成药的处方100张,共3600张,并从中检出不合格处方进行归类分析。结果：合格处方3300张,合格率为91.67%。不合格处方300张,不合格率为8.33%。不合格主要表现为处方书写不完整、诊断与治疗不符合、超说明书用药等。结论：医师对中成药的了解不够,存在不合理用药的现象,应引起重视。     

精神分裂症患者出院后庇护式职业康复的效果

目的探讨精神分裂症患者出院后庇护式职业康复的方法与效果。方法将出院后符合入选标准的90例患者,随机分为研究组45例(其中脱落2例)和对照组45例(无脱落)。在药物治疗的基础上,对照组进行1年的家庭康复,研究组进行1年的庇护式职业康复,在康复干预前后,采用日常生活能力量表(ADL)、阳性和阴性症状量表(PANSS)和康复状态量表(MRSS)分别对两组患者进行评估;同时监测患者的病情复发率。结果研究组ADL、PANSS和MRSS评分分别为22.25±3.12,50.38±8.10和51.48±18.15,明显优于对照组24.69±3.79,56.35±9.08和59.47±19.41,差异有统计学意义(P0.05)。研究组复发率6.98%低于对照组22.22%。结论精神分裂症患者出院后经庇护式职业康复能提高其日常生活自理能力、改善精神症状、社会功能和减少疾病复发。     

针灸医案四则

1 踝关节扭伤 杨某某，女，45岁，本院职工，1999年6月8日来诊。患者右踝关节扭伤疼痛1月余，伴局部活动受限，之后每因用力不当或负重而复发。查受伤部位轻微肿胀，肤色正常，有压痛，舌红苔白，脉细涩。证属气滞血瘀，经气受阻。治当行气活血、疏通经脉。取局部穴位昆仑、阿是穴、阳陵泉，毫针刺，平补平泻手法，留针20分钟，隔日一次，治疗两次后踝关节肿胀疼痛消失，活动正常，痊愈。随访至今未复发。     

农村社区精神分裂症患者职业康复训练的效果观察

目的：探讨职业康复训练对农村社区精神分裂症患者的作用。方法将江山市精神疾病康复试点的2个农村社区登记在册的精神分裂症患者中符合入选标准的100例患者随机分成研究组50例和对照组50例,对照组接受常规的社区精神卫生学康复服务,研究组在此基础上,接受为期24周的职业康复训练,随访观察1年。在训练前后1年,分别用阳性和阴性症状量表（PANSS）、康复状态量表（MRSS）和找寻工作与职业保持相关社交能力的自我评估量表（WSSS）对两组患者进行评估;同时监测患者的病情复发率和就业率。结果研究组PANSS、MRSS和WSSS评分分别为（54.34±6.12）、（51.56±16.8）和（32.19±11.7）分,明显优于对照组（59.78±7.85）、（62.58±24.28）和（21.53±8.46）分,差异均有统计学意义（P＜0.05）。研究组复发率（8.33％）低于对照组（18.00％）,研究组的就业率（25.00％）高于对照组（6.00％）。结论职业康复训练能改善农村社区精神分裂症患者的精神症状和社会功能,减少复发率,提高就业率。     

雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.     

雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

目的 首次将雾化吸入灭活草分枝杆菌用于防治中度支气管哮喘,并观察临床效果.方法 本研究为前瞻性、对照性研究.收集2009年3月至2010年12月于广西医科大学第一附属医院门诊确诊的哮喘患者,满足以下条件纳入研究:年龄≥14岁,符合2008年全球哮喘防治创议(GINA)支气管哮喘慢性持续中度标准,在1个月内无全身使用糖皮质激素、酮替芬或孟鲁斯特等抗炎抗过敏药物并无明显呼吸道感染及已知有其他任何严重的疾病或异常.选取100名哮喘患者,其中男/女比例为37/63,年龄(32.11±12.95)岁.将其随机(随机数字法)分为两组,A组为治疗组,男/女比例为16/34,年龄(33.56±14.23)岁;B组为对照组,男/女比例为21/29,年龄(30.66±11.50)岁;各50名.两组患者的年龄、性别构成差异均无统计学意义,具有可比性.A组雾化吸入灭活草分枝杆菌F.U.36注射液1.72μg/mL×2支加入3 mL生理盐水,1次/d,连续5 d.B组吸入沙美特罗替卡松粉吸入剂(50/100μg),每天两次,持续使用.观察1个月,期间两组患者均可按需吸入硫酸沙丁胺醇气雾剂缓解症状并记录使用喷数.于第0天、第6天、第31天查患者肺功能及哮喘激发试验,治疗前后测ACT评分.结果 于治疗后第6天、第31天,A组哮喘激发试验转阴率分别为82%,78%,B组分别为84%,90%,两组治疗后患者激发试验均明显转阴,经x2检验两组间相比差异无统计学意义(P＞0.05).经完全随机设计资料的方差分析:治疗后A,B组乙酰甲胆碱累积用量明显增加(P＜0.05),而两组之间无差别;A组治疗后第一秒用力呼气容积(FEV1)有改善趋势,但差异无统计学意义,B组显著增高(P＜0.05),在第31天较A组明显增高(P＜0.05);两组最大呼气流量(PEF)在治疗后第6天、第31天均显著增高(P＜0.05),在第31天B组较A组增高明显(P＜0.05);治疗后两组患者哮喘控制测试(ACT)评分均显著提高、硫酸沙丁胺醇气雾剂的使用量均明显减少(P＜0.01),B组较A组明显(P＜0.05).治疗期间仅有2例患者在治疗期间出现一过性低热的不良反应,以第3天明显.结论 雾化吸入灭活草分枝杆菌能在短期内抑制中度哮喘患者的气道高反应性并改善症状、减少发作,减少缓解药物的使用量,在一定时间内对中度哮喘发作有防治作用.

Abstract：

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.