目的 研究神经元特异性烯醇化酶(NSE)及D-二聚体(D-D)动态监测在老年高血压脑出血(HICH)患者术后预后评估的临床应用价值.方法 选择老年HICH患者为研究对象,根据格拉斯哥预后评分(GOS评分)进行分组:4～5分为预后良好组(41例)、3分为重度残疾组(24例);1～2分为预后恶劣组(15例),比较各组术前、术后1 d、5 d NSE及D-D的变化特点.结果 HICH组NSE、D-D浓度均显著高于对照组;预后良好组、重度残疾组NSE、D-D术前、术后1 d及术后5 d依次降低,任意组间均有统计学差异(P<0.05),预后恶劣组NSE、D-D术前、术后1 d及术后5 d无显著变化,任意组间均无统计学差异(P>0.05);不同转归HICH患者NSE、D-D监测情况比较,预后良好组、重度残疾组及预后恶劣组三组术前NSE、D-D比较均无统计学差异(P>0.05),术后1 d及术后5 d预后良好组、重度残疾组及预后恶劣组三组NSE、D-D比较均有统计学差异(P<0.05),同一时间段NSE、D-D在预后良好组、重度残疾组及预后恶劣组依次升高,任意组间均有统计学差异(P<0.05).结论 HICH患者NSE及D-D的动态监测对患者的预后评估有重要的临床应用价值.

目的 探讨相关血清标志物对主动脉夹层疾病的早期诊断及预后价值的评价,并探索各血清标志物间最佳联合方案.方法 纳入突发急性胸痛为主诉的患者128例,其中90例明确诊断为急性主动脉夹层(AAD)的患者为病例组,剩余为对照组38例.90例主动脉夹层患者根据治疗后好转出院以及治疗后无效死亡分为生存组64例与死亡组26例.测定主动脉夹层13种相关血清标志物浓度,利用ROC曲线早期诊断AAD及评估AAD患者在院预后,并分别计算不同方式联合诊断时的灵敏度(Sen)、特异度(Spe)、阳性预测值(PPV)、阴性预测值(NPV)、阳性似然比(LR+)、阴性似然比(LR-)、诊断准确度(AC)等相关参数.结果 与对照组相比,病例组各项指标均有不同程度升高,差异具有统计学意义(P＜0.01),而Hcy于两组间比较未见统计学差异(P＞0.05).最佳早期诊断组合为TGF-β+CRP+NT-proBNP+D-Dimer,该四项平行联合检测的灵敏度(Sen)为95.45％,特异度(Spe)为58.33％;序列联合检测的Sen与Spe分别为68.18％、95.74％.生存组与死亡组相比较,除LP-α、UA、Hcy外,死亡组各项指标均高于生存组,差异均有统计学意义(P＜0.01).最佳在院预后评估组合为D-Dimer+CRP+ET-1,该三项指标平行联合检测的Sen为92.36％,Spe为62.12％;序列联合检测的Sen为71.25％,Spe为88.23％.结论 单项血清标志物的检测对主动脉疾病的诊断及预后存在一定的局限性,而联合各项血清标志物可相互协调互补,能有效提高敏感度及准确度.

目的 探讨地佐辛持续静脉泵注对ICU高龄患者髋部手术后早期镇痛效果和谵妄发生的影响.方法 83例高龄髋部骨折手术后进入ICU的患者,年龄70~89岁,随机分为两组,对照组41例于术后4 h静脉注射氟比洛芬酯(1.0 mg/kg)镇痛,观察组42例患者术后4 h静脉注射氟比洛芬酯(1.0 mg/kg)+地佐辛持续静脉泵注[1.0 mg/(kg· h)],对比两组患者术后疼痛、睡眠时间减少情况及出现谵妄的例数.结果观察组患者出现谵妄的例数明显1例(2.4%),对照组6例(14.6%),两组相比差异有统计学意义(P <0.05);观察组患者有19例(45.2%)术日睡眠时间无减少,明显多于对照组9例(22.0%),差异有统计学意义(P<0.05);观察组术后24 h 的 VAS分值为1.98 ±1.26、1.74 ±1.20,低于同时间对照组分值(2.68 ± 1.39、2.44 ±1.40),差异有统计学意义(P<0.05).结论 与单纯使用氟比洛芬镇痛相比术后应用氟比洛芬酯(1.0 mg/kg)+地佐辛持续静脉泵注[1.0 mg/(kg· h)]对ICU高龄患者髋部手术早期患者镇痛效果更好,可改善患者术后睡眠,并可减少术后谵妄的发生.

"Theory of Childlike Innocence"is an important statement in the development of theory of literature and art of ancient China. It is not only a reflection of Li Zhi on neo-Confucianism, but a consequence of the emphasis on e-motion and innocence in the late Ming Dynasty. Philosophically speaking, Li Zhi criticized the hypocrisy of pseudo-Confu-cianism and advocated the "absolute and pure"childlike innocence. Literately speaking, when encountered with the simi-larity and sameness in writing styles, Li Zhi objected to the restoration of ancient ways, discarded the tendency of valuing the ancient and despising the present, and stressed that writing based on childlike innocence would be the best in the world. Tracking down the origin of Li Zhi's "Theory of Childlike Innocence", we can easily find the trails of the merge of Confucianism, Buddhism and Taoism, and his emphasis on purity, truth and emotion has also been stressed in the his-tory of ancient literature in China.

目的:探讨序贯性通气治疗重症急性左心衰竭伴呼吸衰竭的效果.方法:收治重症急性左心衰竭伴呼吸衰竭患者88例,随机分为对照组和观察组,各44例.对照组采用常规治疗,观察组采用序贯性通气治疗.结果:治疗后,观察组患者氧分压、二氧化碳分压、氧合指数均优于对照组(P<0.05).观察组患者机械通气时间、有创通气时间均少于对照组(P<0.05).结论:序贯性通气治疗重症急性左心衰竭伴呼吸衰竭患者,能够改善各项血气指标,减少机械通气及有创通气时间.

Objective To investigate the effects of combined use of Xuebijing and CVVH on PLT,TBil and Cr in elderly patients with multiple organ dysfunction syndrome.Methods Ninety-four cases of elderly patients with multiple organ dysfunction syndrome were selected,which were treated in hospital ICU hospitalization from March 2013 to March 2017,and they were divided into the observation group (47 cases) and control group (47 cases).The patients of two groups were all treated with conventional comprehensive treatment.The patients of control group were treated with CVVH (blood flow rate 200 ml/min,ultrafiltration volume 150-300 ml/min,replacement fluid flow 3 000 ml/h,continuous treatment for 1-4d).Based on control group,the patients of observation group were treated with Xuebijing injection (intravenous infusion of 100 ml times,3 times / d,treatment for 7d).Compare the clinical efficacy,ventilator support time and ICU hospital stay and changes of the levels of SCr,BUN,IL-1β,IL-10,TNF-α,TBil,PLT,PaO2,PaO2/FiO2,APACHE Ⅱ scores of two groups.Results After the appropriate treatment,the total effective rate of the observation group was 91.5％,which was significantly higher than 74.5％ of the control group (x2 =4.821,P =0.028);In terms of ventilator support time,ICU hospitalization time,PLT and APACHEⅡscore,the performance of the observation group was significantly better than the control group (P ＜ 0.05);The TBil,PaO2,PaO2/FiO2 of the two groups were significantly improved than before,and the patients in the observation group improved more significantly (P ＜ 0.05);The SCr,BUN of the two groups were significantly decreased than before,and the patients in the observation group decreased more significantly (P ＜ 0.05);The IL-1β,IL-10,TNF-α of the two groups were significantly decreased than before,and the patients in the observation group decreased more significantly (P ＜ 0.05).Conclusion Combined use of Xuebijing and CVVH in the treatment of elderly patients with multiple organ dysfunction syndrome can get the exact effect,significantly improve the organ function and prognosis,which makes it worthy of clinical application.

南通范氏为北宋名臣范文正公之苗裔,范公后世皆能克绍箕裘,以诗礼书香传家,形成了赓续薪传的诗文世家.有德者必有言,丰厚的"家风"积淀是涵养、维系范氏家族爝火不息、代有闻人的源泉.范仲淹的道义担当在荦荦大端为范氏家风的构建导夫先路,其《家训百字铭》则在细谨之处为范氏子孙的行为准则设为悬鹄、奠定基调.儒家传统思想的濡染,文正遗风的承袭与践行,以及注重庭训、面命耳提的家庭教育模式是其家风形成的主要原因.南通范氏的家风不仅体现在修身齐家之层面,更重要的是其家风体现出治国平天下的淑世之志,民胞物与的济世情怀始终贯彻其中.习总书记指出家风是一个家庭的精神内核,也是一个社会的价值缩影,只有千千万万家庭的好家风才能支撑起全社会的好风气.南通范氏家族恪守文正家风,修其心齐其家,也为今天崇尚好家风、践行家庭美德提供了可资借鉴的模板.

唐代是我国封建社会繁盛的典范,它不仅缔造了我国诗歌史上的黄金时代,而且促成了音乐、舞蹈、绘画、马球、剑术诸多文体形式的空前繁荣.在蔚为壮观的唐诗殿堂里徜徉,不仅可以观赏到音乐、舞蹈、绘画、马球、剑术等诸多展示精湛技艺的历史画卷,而且可以揣摩出唐代诗人不囿于一艺而全面丰厚的文化素养.文能治国、武能安邦的现实需求使得唐代诗人大都娴熟于形态各异的诸多技能.通过对唐诗人全面素质教育的解读,或许能为今天如何解决素质教育、应试教育这一两难命题提供一个更好的途径.

作为清末朴学大师,俞樾在揅经释子之余兼弄词章之学.俞樾虽以学人为诗,但其诗歌创作如水流花放,自然清切,审美趋向迥异于当时学人之诗所标榜的旨趣.俞樾“随笔而书随意造,不雕不琢全吾天”的诗学主张不仅可视为性灵文学在晚清时段的嗣响独存,也可视为五四新文学运动发生的肇基先导.其诗学理论如散金片玉,言简意赅,散落于各种序论随笔之中.作为一位学无常师、左右采获的经学集大成者,俞樾的诗学理论呈现出古典文学总结期包容性的特点,对诗坛上断断相角的宗派纷争,他主张应摒弃宗唐宗宋的门户偏见,择善而从.如俞樾不仅强调诗歌应具有“大裘万丈”的民本关怀与忧时感事的时代责任感,同时也不菲薄纯任自然、陶写性灵的琐屑之作、缪悠之词;俞樾一方面强调“此事须知本性情,不徒词藻斗纵横”;另一方面又主张只有恪守“直而不野,丽而有则”的审美准则才能锤炼出“不求纤密之巧,自有宏肃之美”的真醇诗境.

作为清代中兴功臣,曾国藩对奏疏之学极为重视.他不仅提出奏疏典、显、浅三字诀,而且还主张奏疏的喷薄之势.他一方面肯定了"远近易于传播"、"君上亦易感动"的浅显风格,另一方面对声韵铿锵、气势喷薄的骈文奏疏亦大加揄扬.其对奏疏的甄选、评价乃至草拟,都体现出既强调致用性又注重气势、强调骈散合一的古文义法.其奏疏风格由戆直激切到恬淡老确的转变也和其前后期古文审美取向的演进轨迹一一印证,相互合拍.

In the field of poetry in the late Qing Dynasty,Fan Bozi,who cared a lot about the livelihood of civilians,built his reputation for his marvelous achievements in poems despite his humble family.Besides his unique composition of po-ems,he spared no efforts in the composition of couplets with his excellent cultural qualities and deliberation.Fan put ancient grammar of Chinese into couplets,and his composition broke away from conventions and showed peculiarities. The couplet lines are wide and unchained,and combine momentum with majesty,which reveal his personal aesthetic taste.His elegiac couplets for historic heroes also differ from his peers in following traditions.The study of couplets com-posed by Fan Bozi can reveal his artistic features and aesthetic pursuit,and can show us the profound cultural connotations between the lines of his couplets.

在晚清文坛,范伯子以古诗文而名动天下.相较于其诗歌得到诸多类似"接迹李杜,平视坡谷"的激赏与赞誉,对其古文的论述与品评却相对冷清.范伯子初闻《 艺概》于刘熙载,受古文法于张裕钊,又从吴汝纶上下切劘,后与桐城姚氏联姻,文酒唱和甚为相得,古文益进.范伯子不仅能缵桐城、湘乡之遗绪,并在有所法而后大的基础上,自领一军.故其桐城姻亲皆绝推隆其诗,而不甚论列其文.范伯子古文创意造言皆奇绝,也得到张裕钊、吴汝纶"今世所罕觏"、"当今文学无出肯堂右者"的认可与揄扬.

俞樾在研求经训之余兼为词章之学，不仅留下众多洋洋洒洒的骈散之作，而且在各种序论随笔中屡屡发摅自己的古文心得。俞樾的古文理念呈现出一种宏大的文学视野，以杂文统揽碑、传、序、表等诸多文体，主张古文、时文非文体之谓，乃古今之别，并反对以桐城一家之言而牢笼天下之文。俞樾一方面主张骈文为文章正宗，认为宋人以八代为衰，自此有语言而无文字；另一方面俞樾又强调文章家贵深入显出，反对艰深之辞，提倡文从字顺的为文准则。在俞樾的古文理念中，原本经史、抒写性真是其根柢，强调随所遇而异的多样化审美风格。俞樾的古文抒写其驰骋自得之乐，游戏而有节制，或许不符合传统文章家清真雅正的审美口味，但“我自写我文”的古文理念却无意中开启了传统文学向新文学的转变契机。

金泽荣是韩国李朝后期的文坛翘楚之一,也是沟通中、韩文坛的桥梁与纽带.作为韩国著名的遗民诗人,金泽荣的诗学体系不可避免会受到本土文学理念的影响,留下韩国文学的发展印记;同时,在与晚清士人的诗文唱和中,中国传统诗学的诸多特点也无疑会渗透到金氏诗学体系的建构之中.后世学者的研究目光大都聚焦在金泽荣与张謇等中国文人的诗文交游上,往往忽视了金氏家族及李建昌在其诗学取法轨辙上留下的深刻印迹.

目的：探讨早期高压氧治疗急性脑梗死对患者脑能量代谢及疗效的影响。方法回顾性分析我院2012‐01—2014‐01收治的100例急性脑梗死患者的临床资料。结果治疗组治疗效果明显优于常规组，脑能量代谢恢复情况明显优于常规组，差异有统计学意义（ P＜0.05）。结论早期高压氧治疗急性脑梗死疗效显著，且在脑能量代谢恢复中有重要意义，值得临床应用。

After his failure in the imperial examination in the year 1885, Fan Dangshi went back to Jizhou from the River-south of China and wrote the poem Passing by Mountain Tai when he passed by the mountain. The elaborate and imposing poem which broke the ordinary format was praised and regarded as the representative of Fan Dang-shi’s works by previous researchers. This paper is aimed to see Fan Dangshi’s exceptional talent and great feel-ings by illustrating the poem from three parts: the characteristics of composition, the insights of the poetic theory and the bosom of containing the whole world.

目的观察文拉法辛在治疗心衰伴焦虑抑郁患者中的作用。方法将128例心衰伴焦虑抑郁患者随机均分为治疗组及对照组,治疗组在心衰常规治疗基础上加用文拉法辛治疗8周,对比分析两组治疗前后纽约慢性心功能分级(NYHY分级)、血清脑利钠肽(BNP)水平、超声心动图等指标的变化。结果治疗组较对照组心功能改善显著,焦虑抑郁症状改善显著;血清BNP水平降低显著,左室舒张末期内径(LVDD)下降显著,左室射血分数(LVEF)升高显著。结论文拉法辛结合常规抗心衰治疗能有效抑制慢性心力衰竭患者神经内分泌的过度激活,逆转心室重构,改善心功能,疗效优于单纯常规药物治疗。

目的探讨伴抑郁及焦虑等负面情绪的老年心律失常患者睡眠质量状况及其对心律失常的影响。方法抽选175例因心律失常而入院治疗的患者为研究对象,均予以抑郁、焦虑自评量表检测,其中仅伴有焦虑情绪障碍的心律失常者43例(焦虑组),仅伴抑郁情绪障碍55例(抑郁组),二者同时伴有的心律失常患者36例(共病组),无抑郁、焦虑等情绪障碍的41例(病例组),同时抽选46例正常健康体检者为对比研究,均排除抑郁、焦虑等情绪障碍(对照组),对四组患者的匹茨堡睡眠质量以及HRV时域指标等进行分析比较。结果焦虑组、抑郁组以及病例组睡眠质量、总分、入睡及睡眠时间、睡眠障碍、睡眠效率等6个因子指数与对照组比较差异均具有统计学意义(P<0.05)。共病组在上述6个因子指数均明显高于对照组(P<0.05),尤其以睡眠质量及总分比较差异明显。焦虑组、抑郁组以及共病组HRV时域等各项指标均低于病例组(P<0.05),与对照组相比较差异更为显著(P<0.05)。结论伴有抑郁或(和)焦虑的心律失常病人的HRV时域指标明显下降,自主神经调节心脏功能障碍;伴抑郁、焦虑负性情绪的睡眠障碍患者,更易发生恶性室性心律失常。

脊髓损伤(SCI)通常是在劳动、交通或运动事故中导致的严重神经功能障碍或残疾,是致残的主要原因之一,对个人和家庭及社会造成严重的负担.因此,如何减轻脊髓损伤、促进脊髓功能恢复,是当今临床研究迫切需要解决的课题. 1 脊髓损伤的机制 脊髓损伤后的结构损害一般可分为原发性损伤和继发性损伤两类.原发性损伤发生在损伤即时及损伤后的短时间内,它由直接作用于脊髓的机械暴力,对脊髓剪切、压迫、撕裂以及挫伤,以及损伤后移位的骨折块、脱位的椎骨、脱出的椎间盘或皱褶的韧带等压迫脊髓,造成神经元、胶质细胞、血管等组织结构的即刻细胞死亡,一般是不可逆损伤.

目的 观察脓毒症患者血浆内血管生成素-2(Ang-2)水平变化,并探讨其与病情严重程度之间的关联,达到判断脓毒症患者病情进展及预后的目的.方法 调查2011年12月-2012年12月ICU收治的67例脓毒症患者,根据感染病原菌不同将67例脓毒症患者分为深部真菌感染组(SFI)、革兰阴性菌组以及革兰阴性菌合并真菌感染(双重感染组),并选择20名健康体检者作为对照组,分别对各组患者的体温、白细胞、血浆降钙素原(PCT)、氧合指数、健康状况(APACHEⅡ)、序贯器官衰竭(SOFA)评分以及血浆Ang-2水平进行检测.结果 脓毒症患者体温、白细胞(WBC)、氧合指数、APACHEⅡ、SOFA评分以及血浆Ang-2水平均明显高于对照组(P＜0.05),而脓毒症各组Ang-2水平差异均无统计学意义;SIF组、双重感染组、革兰阴性菌组脓毒症患者血浆Ang-2水平分别为13.7、12.9、13.8 ng/ml,与APACHEⅡ、SOFA评分呈正相关性(P＜0.05),APACHEⅡ、SOFA评分均有明显的独立相关性(β=0.468,P＜0.05;β=0.626,P＜0.001).结论 在脓毒症患者血浆Ang-2的水平可表现出显著的上升,而且Ang-2上升的程度与APACHEⅡ以及SOFA评分均存在明显的正相关性,APACHEⅡ以及SOFA评分均能够作为本病病情进展及预后判断的独立危险因素.