目的 探讨血常规和CRP联合检测对急性上呼吸道感染的诊断价值.方法 对本院急诊科就诊的254例患者采血,检测血常规和CRP；并同时用咽拭子或痰样做细菌培养.依据细菌培养的结果将患者分为细菌感染组(A组)和非细菌感染组(B组),同时以55例健康体检者的资料作为正常对照组(C组).应用受试者工作特征曲线(ROC曲线)对单项指标及联合指标的诊断价值进行评估.结果 254例中共检出50例细菌感染(A组),其WBC、中性粒细胞百分比(NEU)和CRP显著升高,与B组和C组比较差异均有统计学意义(P＜0.01).各种指标ROC曲线下面积分别为0.920( WBC)、0.975(NEU)、0.995 (CRP)、0.985( WBC+ NEU)和0.999( WBC+ NEU+ CRP).通过ROC曲线分析,各项指标最佳诊断界值分别为11.9×109/L(WBC)、75.4％(NEU)和27.8 mg/L(CRP).结论 联合检测血常规和CRP可帮助明确急性上呼吸道感染细菌感染情况,进一步提高诊断效率。

Objective To compare the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism (APTE),and to explore a optimum screening method for APTE in the emergency department of China.Methods The study was carried out by using random,crossed,prospective methods to compare the screening effects between Wells and revised Geneva scores for 167 suspected APTE patients in the emergency department of the First Affiliated Hospital of Xiamen University.Results The areas under the receiver operating characteristic curve of Wells and revised Geneva scores for screening APTE in the emergency department were (0.917 ± 0.022 ) and (0.927 ± 0.020),respectively ( P ＜ 0.05 ).The diagnostic concordance between the two score systems for predicting APTE was poor (Kappa value =0.276 ). In addition, the difference between their hierarchical discrimination for the possibility of APTE was statistically significant ( P ＜ 0.05 ).Compared with revised Geneva score,fewer patients were diagnosed with low clinical probability of APTE and more patients were diagnosed with intermediate or high clinical probability of APTE through Wells score.The patients with low chnical probability of APTE were excluded from pulmonary embolism in Wells or revised Geneva score.At intermediate clinical probability,the accuracy rate of Wells score for predicting APTE (9.64％) was lower than that (32.84％ ) of revised Geneva ( P ＜ 0.05 ).At high clinical probability,there was no significant difference between their accuracy rate [ (67.24％ vs.86.21％),P＞0.05]. Conclusions Revised Geneva score is more suitable than Wells score in screening suspected APTE patients in the emergency department in our country.

OBJECTIVE:To investigate the clinical significance of D-dimer contents in peripheral blood for monitoring the efficacy of thrombolytic therapy in patients with return of spontaneous circulation (ROSC) of cardiopulmonary resuscitation (CPR) cardiopulmonary resuscitation after cardiac arrest.METHODS:Forty-seven patients with sudden cardiac arrest received CPR according to 2005 American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care (ECC). At the early stage of ROSC, those patients underwent head and breast CT scan if they were in a state of unconsciousness and had unstable vital signs. If intracranial hemorrhage, dissection of aorta and pneumothorax were rule out, and those patients who maintained blood circulation for over 24 hours were included. The expression of D-dimer contents in peripheral blood was determined at 0, 1, 2, 4, 8, 12 h after CPR in all patients. And the patients were randomly divided into control and experiment groups. Prior to thrombolysis, the patients whose D-dimer more than 512 µg/L were classified as Group A (n = 17); those whose D-dimer below 512 µg/L Group B (n = 14); and the remaining control group whose family members refused thrombolytic therapy Group C (n = 16). The general data, Glasgow coma scale, survival rate and the change of D-dimer in peripheral blood were analyzed.RESULTS:In Group A, D-dimer level began to increase significantly at CPR 1 hour. It peaked at CPR 2 hours then decreased gradually. The final survival rate was 67%. The survival rate and GCS were higher than those of Groups B and C. In Group B, the D-dimer concentrations began to increase gradually at CPR1 hour, peaked at CPR 12 hours and then decreased. The survival rate and GCS was lower than those of Group A and similar to those of Group C. Group C was control group with no thrombolysis.CONCLUSION:For those ROSC patients with D-dimer concentrations significantly higher than usual, the pathogenesis of cardiac arrest may be concerned with thromboembolism, thrombosis in circulatory system and hyperviscosity. After an initiation of thrombolytic therapy, blocked blood vessels are recanalized, blood circulation improves and the cause of cardiac arrest is removed. Thus their survival rate becomes better. For those with D-dimer concentrations no higher than usual, the cause of cardiac arrest is not concerned with thromboembolism, thrombolytic therapy can not improve the patient outcome. And the final survival rate remains unchanged. The significance of thrombolytic therapy is none.

Objective To observe the effects of Propafenone and Amiodarone in treating paroxysmal supraventricular tachycardia (PSVT). Methods 36 patients of PSVT were treated with Propafenone and the other 28 patients were treated with Amiodarone. Results The termination rate of PSVT was 100% in Propafenone and 89. 3% (25 /28) in Amiodarone respectively. Cardioversion time: Propafenone (12. 6 ± 6. 7) min was significantly shorter than Amiodarone (29. 5 ± 11. 3) min(P < 0. 01). Conclusion Propafenone and Amiodarone both have good effects in treating PSVT,Propafenone takes effect faster,but better for patients with normal cardiac function and without serious organic heart diseases. Amiodarone takes effect slower,but with wide indications. For patients with organic heart diseases,myocardial ischemia or heart failure,Amiodarone can be preferred.

急性肺栓塞(Acute pulmonary embolism,APE)是常见的急诊危重症,是最常见的肺血管疾病,发病率在心血管疾病中继高血压病和冠心病位居第三位,病死率高居所有疾病第三,仅次于肿瘤和心肌梗死~([1]).目前治疗方案成熟有效,一旦确诊疗效良好,可使死亡率由未治的25%～30%降至2%～8%~([2]).

1 病例介绍 患者,男,52岁.因全身乏力、步态不稳、恶心、呕吐0.5 h,于2009-02-10 21:02来我院急诊科.患者否认心悸、胸闷、胸痛,否认高血压病、心脏病及糖尿病病史.既往有痛风史,近半个月每天服中药治疗.

Objective To investigate the relationship between serum levels of macrophage migration inhibitory factor (MIF) and CT findings in the patients with acute pancreatitis (AP),and to analyze its clinical significance. Methods 58 cases with AP were divided into A,B,C,D and E five grades based on Balthazar CT grades,and the CT grades were compared with the serum MIF. Results Compared with the control group(214.1±6.3) g/mL,the serum MIF increased markedly in grade A (596.6±7.9) pg/mL and grade B(658.4±12.6) pg/mL (P0.05),and it was also higher significantly in grade C (3663.5±14.3) pg/mL,grade D (4630.6±14.6) pg/mL and E (5013.8±8.5) pg/mL with acute necrosis pancreatitis (ANP) than in normal subjects(NS) and acute edematous pancreatitis(AEP),and there were statistical differences (P0.05). Meanwhile,positive correlation was found between CT grades and serum levels of MIF (r=0.637,P0.05). Conclusion MIF plays an important role in the patients with acute pancreatitis. To detect dynamically serum levels of MIF in the patients with AP can be useful to predict the patient′s condition and guide clinical diagnosis and treatment.