护肾合剂治疗中晚期糖尿病肾病临床疗效观察

糖尿病肾病 (DiabeticNephropathy ,DN)是糖尿病 (Dia betesmellitus ,DM )的严重并发症之一 ,我国目前DM的发生率约为 3.2 1%。DM约有 4 0 %发展为DN。在我国DN致终末期肾病患者约占透析患者的 5 %且呈增长趋势 ,而在其他地区和国家则为 2 6 %～ 38% [1] 。因此DN应早期诊断和治疗 ,但由于 2型DM大多起病隐匿 ,患者发病后未能得到及时和正规治疗 ,故当就诊时往往已进入DN中晚期。我们以中西医对糖尿病肾病的理论认识为依据 ,结合自己的临床经验 ,研制成中药护肾合剂治疗中晚期DN ,取得了较好的疗效 ,现报告如下。资料与方法1　一…     

舒适护理在58例重型肝炎治疗中的应用

目的探讨舒适护理在重型肝炎患者治疗中的应用效果。方法将118例重型肝炎患者随机分为观察组58例和对照组60例,观察组采用舒适护理,对照组给予常规护理,比较2组患者护理后的舒适度改善及对护理工作的满意度情况。结果观察组舒适度较对照组明显改善;观察组满意度为95.5%,对照组满意度为73.6%,2组比较有显著性差异（P〈0.05）。结论对重型肝炎患者实施舒适护理,可改善其精神状况及身体舒适度,显著提高患者对护理工作的满意率。     

护理干预对支气管哮喘患者使用舒利迭的效果观察

目的观察专科护士对支气管哮喘患者使用舒利迭的护理干预效果。方法选取呼吸内科2016年度共125例应用舒利迭的支气管哮喘患者为对象,按照住院时间,将上半年住院61例患者作为对照组,下半年住院64例患者作为观察组,对照组由主管医生加药师指导患者用药,观察组在对照组基础上由专科护士指导患者用药,方法上包括健康教育、舒利迭药物使用图示指引、护士示范、患者操作示范、电话跟踪随访等护理干预,比较两组患者药物吸入方法的掌握情况、用药依从性、哮喘缓解时间、复发率。结果经治疗护理,观察组患者吸入方法掌握情况及用药依从性均优于对照组,两组差异具有统计学意义(P<0.05);另外,实验组患者的哮喘缓解时间、复发率均优于对照组,两组差异有统计学意义(P<0.05)。结论专科护士对支气管哮喘患者使用舒利迭进行积极护理干预,能提高患者药物使用的正确率,提高患者药物使用依从性,可以显著缓解患者的咳嗽症状,有利于患者的生命健康安全。     

理气法治疗胆石症的体会

理气法是调理气机的一种治法,适用于气机失调的病症。临床观察胆囊结石合并胆总管结石的患者应用此法疗效显着。现将理气法在胆石症治疗中的具体应用分述如下。     

C末端缺失NR2B亚单位表达载体的构建及其在NMDA受体装配研究中的应用

目的：研究NMDA受体NR2B亚单位细胞内C末端，在NR1—1a／NR2B亚型NMDA受体装配和表面表达中的作用。方法：构建C末端不同缺失和GFP标记的NR2B亚单位表达载体，单独转染或与NR1亚单位共转染到HEK293细胞，用抗GFP多克隆抗体和Cy3荧光素交联的二抗作活细胞表面受体染色。结果：成功构建了8个C末端不同缺失的GFP—NR2B表达质粒(GFP—NR2B△1～△8)。将GFP—NR1—1a，GFP—NR2B及GFP—NR2B△1～△8分别单独转染HEK293细胞，不能获得迭细胞膜表面的表达。而将这些质粒分别与NR1—1a共转染293细胞，发现GFP—NR2B及C末端部分缺失的GFP—NR2B△1～△6，均能与NR1—1a一起表达于细胞膜表面，而仅留有PDZ结合基序的GFP—NR2B△7和C末端全长缺失的GFP—NR2B△8，则不能与NR1—1a一起表达于细胞膜表面。结论：NR1—1a与NR2B的共表达和装配，是形成NR1—1a／NR2B亚型NMDA受体并表达于细胞表面的必要条件。NR2B与NR1—1a装配时，NR2B对NR1—1a C1盒中内质网滞留基序的遮蔽和阻滞作用，并不依赖于NR2BC末端某一特定的区域，相反可能仅要求有一定长度的NR2BC末端。     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

急性肾损伤对远隔脏器的影响

急性肾损伤(acute kidney injury,AKI)是一种常见、具有较高病死率的危重症,其发患者群占总人口的1％、住院人数的8％ ～ 15％[1].这些患者通常住院时间较长,费用较高,出院后往往需要继续透析治疗.多国ICU内流行病学调查显示,ICU内AKI的总发病率达到57.3％,透析依赖性AKI的发病率亦达13.5％,此外,急性肾损伤2期和3期患者病死率明显升高[2].     

先天性巨结肠患儿的围术期护理

先天性巨结肠是小儿常见的先天性肠道畸形。由于结肠远端及直肠神经节细胞阙如,引起肠管持续性痉挛,造成不完全性肠梗阻,粪便淤积在近端的结肠内,使近端结肠代偿性扩张、肥厚、肠壁水肿,失去正常排便功能。该病可影响生长发育,应尽早实施手术治疗。2007年8月-2009年6月,我院采用经肛门行巨结肠根治术22例,此术式对患儿损伤小,痛苦少,术后恢复快,且体表无瘢痕。     

颅脑外伤患者血液中微粒促凝活性的变化

目的 观察颅脑外伤患者血液中微粒促凝活性的时程变化规律,探讨其在脑损伤中的作用及对预后的预测价值.方法 收集中重型颅脑外伤患者139例作为颅脑外伤组;收集同期健康体检人群40例作为对照组.对照组静脉血体检时获得.颅脑外伤组静脉血在入院时及入院后第1、2、3、5和7天获得.利用发色底物法测定血液中微粒促凝活性.结果颅脑外伤患者入院后1个月内死亡50例(36.0%),血液中微粒促凝活性6 h内开始升高,24 h内到达高峰,后逐渐下降,6个时间点血液中微粒促凝活性分别为(10.5±4.3)、(14.7±6.9)、(12.4±5.4)、(10.0±4.6)、(7.8±3.8)、(6.0±3.0)U/ml,经协方差分析,均显著高于对照组(1.7±0.6)U/ml(P<0.001).经多因素分析,血液中微粒促凝活性(OR 1.432,95%CI 1.194～1.719,P<0.01)是颅脑外伤1个月内死亡的危险因素.经重复测量方差分析,死亡组血液中微粒促凝活性显著高于生存组(P=0.01),重型颅脑外伤组血液中微粒促凝活性显著高于中型颅脑外伤组(P=0.002).经Spearman相关分析,血液中微粒促凝活性与入院时GCS评分显著负相关(P<0.05).经多无线性同归分析,血液中微粒促凝活性与入院时血浆C-反应蛋白浓度(P=0.019)和D-二聚体浓度(P=0.012)显著正相关.ROC曲线辨别了血液中微粒促凝活性的预测界值(12.2 U/ml),对预测颅脑外伤1个月内死亡有较高的灵敏度(72.0%)和特异度(85.4%).血液中微粒促凝活性的曲线下面积(0.847±0.037)小于GCS评分(0.917±0.023)的曲线下面积,但差异无统计学意义(P=0.104).结论 颅腩外伤后血液中微粒促凝活性升高,可能参与脑损伤的炎症反应和凝血级联反应,检测这个指标有助于早期判断颅脑外伤患者的预后.