Objective:To investigate the effect of Salvia miltiorrhiza Ligustrazine Injection in the treat-ment of Refractory hypertension in elder in serum CRP and homocysteine. Methods:90 cases with refractory hypertension in our hospital were selected and divided into 2 groups, 44 cased in the control group received irbesartan and hydrochlorothiazide treatment,44 cases in the treatment group received more with Salvia milti-orrhiza Ligustrazine Injection treatment,a total of 14 days treatment. Changes of laboratory indexes were com-pared to explore the clinical effect and mechanism of the Salvia miltiorrhiza Ligustrazine Injection in the treat-ment of Refractory hypertension. Results: After 14 days of treatment, diastolic blood pressure and systolic blood pressure in 2 groups were significantly decreased than before(P<0.05),and the average blood pressure in the treatment group was lower than the control group(P<0.05). After 14 days of treatment,the total effec-tive rate of the treatment group was significantly higher than the control group(P<0.05).Before treatment,two groups of CRP,Hcy,whole blood viscosity,whole blood low shear viscosity was no significant difference after treatment,CRP,Hcy,whole blood viscosity,whole blood low shear viscosity of treatment group improvement were better than the control group,there was significant difference between two groups. (P<0.05). Conclu-sion:Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection adjuvant therapy can significantly improve serum CRP and homocysteine levels in patients with refractory hypertension,and it has good clinical therapeu-tic effect.

Objective To investigate the clinical effect of eplerenone and ivabradine hydrochloride in the treatment of chronic heart failure (CHF).Methods A total of 76 patients with chronic heart failure were selected from March 2014 to January 2016.The patients were divided into two groups according to the random number table method.The two groups of patients were given conventional anti heart failure treatment,patients of control group treated with eplerenone on the basis of routine therapy in 38 patients,patients of observation group treated with iviradepine hydrochloride treatment of 38 patients,two groups of patients were treated for 12 months.The levels of interleukin 6 (IL-6) and tumor necrosis factor (TNF-α) were measured before and after treatment,and the clinical efficacy of the two groups was compared.Results The total effective rate of the observation group was 71.5％,which was higher than the control group of 39.5％ (χ2=7.664,P=0.005).After 12 months of treatment,the 6 min walking distance and LVEF were significantly increased in the observation group than those in control group (t=6.237,P=0.000;t=4.712,P=0.000),serum TNF-α level,IL-6 level,BNP,systolic blood pressure,diastolic blood pressure,LVPWT,IVST and LVEDD were significantly improved than those in control group(t=2.153,P=0.035;t=2.704,P=0.009;t=2.215,P=0.029;t=2.020,P=0.047;t=2.251,P=0.027;t=4.875,P=0.000;t=3.188,P=0.002;t=3.742,P=0.000).Conclusion In the treatment of conventional anti-heart failure treatment,the combination of ivabradine hydrochloride can significantly reduce the serum TNF-α level and IL-6 level,and improve the cardiac function of patients.

目的 探讨白介素-6(IL-6)及超敏C反应蛋白(hs-CRP)、前白蛋白(PA)在高原地区老年慢性阻塞性肺疾病(COPD)中的表达及意义.方法 采用对照研究法.对高原地区32例COPD急性加重期患者治疗前、后血清中IL-6及hs-CRP、PA进行检测,并分别与平原地区老年COPD急性加重期患者进行比较.结果 高原地区COPD组治疗前、后血清IL-6及Hs-CRP水平高于平原对照组(P＜0.05),PA低于平原对照组(P＜0.05);AECOPD患者血清IL-6与肺功能FEV1呈负相关(r=-0.75,P＜0.05).结论 高原地区血清IL-6、Hs-CRP在老年AECOPD发病中的表达水平要高于平原地区,PA的表达水平低于平原地区.提示高原地区以血清IL-6、Hs-CRP、PA水平判断老年AECOPD发病进程时,要考虑高原低氧因素在其中的作用.

随着世界人口老龄化的到来，越来越多的老年人患有不同程度的高血压，高血压是老年人群最重要的心脑血管病危险因素，是全球范围内的重大公共卫生问题。大量流行病学及临床证据表明，高血压显著增加老年人发生缺血性心脏病、卒中、肾衰竭、主动脉与外周动脉疾病等靶器官损害的危险，是老年人群致死和致残的主要原因之一。而单纯收缩期高血压（ISH）又是老年高血压的最主要表现形式，严重危害老年人健康，是一种独立类型的疾病，这种特殊的血压类型通常伴随着更高的心血管事件和死亡风险。因此全面了解老年 ISH（0ISH）对减少靶器官损害，降低死亡率，以及对今后探索老年 ISH 治疗的新途径有着重要意义。

目的:探讨腹腔镜手术治疗异位妊娠的优越性.方法:回顾性分析手术治疗输卵管妊娠的临床资料共227例,其中腹腔镜手术64例,与开腹手术63例.比较两组的手术时间、术中出血量、术后下床活动时间、肛门排气时间、术后发热时间、术后镇痛时间、平均住院时间及术后妊娠率等临床资料.结果:腹腔镜组和开腹手术组在术中出血量、手术时间、下床活动时间、肛门排气时间、术后发热时间、术后镇痛时间、平均住院天数及术后妊娠率方面有明显差异(P＜0.05).结论:腹腔镜手术治疗输卵管妊娠优于传统开腹手术.

目的:探讨腹腔镜下保守性手术治疗输卵管妊娠的临床价值.方法:将116例输卵管妊娠患者分为两组,观察组58例行腹腔镜下保留输卵管手术,术中患侧输卵管注射甲氨蝶呤25mg.对照组58例行腹腔镜下输卵管切除术,比较术后持续性异位妊娠发生率、再次异位妊娠发生率和宫内妊娠率.结果:术后2年内观察组宫内妊娠率23例(60.53％),对照组宫内妊娠率13例(34.5％),两组比较差异有统计学意义.再次异位妊娠发生率观察组9例(23.68％),对照组7例(18.92％),两组比较差异无统计学意义.结论:腹腔镜下保守性治疗输卵管妊娠安全、有效、宫内妊娠率高,不增加持续性宫外孕及再次异位妊娠发生的风险.

目的:探讨米非司酮联合米索前列醇用于中期妊娠引产的临床效果.方法:选择2007年～2010年间孕14～26周引产的孕妇120例.随机分成2组,观察组60例,用米非司酮150mg+米索前列醇600ug引产；对照组60例,采用利凡诺尔100mg羊膜腔内注射引产.结果:2组用药至宫缩发动时间、宫缩发动至胎儿胎盘娩出时间,2小时产后出血量、胎盘胎膜残留量、软产道损伤等方面比较差异有统计学意义(P＜0.05)；在引产成功率、药物副反应等方面比较差异无统计学意义.结论:药物引产效果优于利凡诺尔羊膜腔穿刺引产,米非司酮联合米索引产是一种安全有效的引产方法.

患者男,26岁.因精神抑郁自服100片卡马西平(每片100 mg)30 min被家人于2008-03-01送入我院急诊科.患者烦躁不安,头晕、恶心,无呕吐,无大、小便失禁及抽搐.既往有抑郁症史.体格检查:体温36.8℃,脉搏104次/分,呼吸26次/分,血压170/120 mmHg(10 mmHg=1.33 kPa).神志恍惚,呼吸急促,皮肤、黏膜无皮疹及出血点,双侧睑结膜充血,无水肿,双侧瞳孔等大、等圆,对光反射灵敏,耳、鼻无异常分泌物,口唇轻度紫绀,颈部无抵抗,双肺呼吸音粗,可闻及广泛哮鸣音,未闻及湿啰音.心率104次/分,心律整齐,各瓣膜听诊区未闻及病理性杂音.腹部柔软,肝、脾肋下未触及,双下肢无水肿,四肢肌张力增高,肌力4级,生理反射存在,病理反射未引出.

目的:探讨老年妇科患者合并糖尿病的围手术处理.方法:回顾分析46例老年妇科患者合并糖尿病的手术治疗经过,分析手术前、中、后的治疗方法.结果:46例患者中妇科良性肿瘤合并糖尿病18例,恶性肿瘤合并糖尿病22例,子宫脱垂6例.入院前糖尿病诊断已成立者25例,21例为住院检查发现糖尿病.术前、术中、术后、均用普通胰岛素控制糖尿病,46例患者均安全度过围手术期.结论:准确估计病情,充分术前准备,确保血糖、尿糖在允许的范围内是手术成功的重要措施,并可减少并发症的发生.

目的:探讨西宁地区慢性阻塞性肺病机械通气人机对抗的原因及处理对策.方法:统计西宁地区(海拔高度为2 260m)COPD急性期合并呼吸吸衰竭行机械通气患者39例,均至少发生一次人机对抗.结果:39例患者中发生人机对抗的总例次为62次,其中插管上机立即发生人机对抗19例(30.65%),正常机械通气过程中,后发生人机对抗43例(69.34%),其中肺部感染加重痰液引流不畅8例(12.9%)气道痰痂阻塞110例(16.13 %)其他11种因素25例(40.32%).结论:西宁地区慢性阻塞性肺病机械通气人机对抗的主要原因是不能耐受气管插管,其次是气道痰痂阻塞,痰液引流不畅,加强气道管理有助于改善人机对抗.

目的:探讨腺苷蛋氨酸对妊娠期肝内胆汁淤积症(ICP)患者皮肤瘙痒的治疗价值及对妊娠结局的影响。方法:ICP患者68例,随机分为治疗组和对照组各34例;对照组应用常规治疗,包括:卧床休息、吸氧、熊去氧胆酸、地塞米松的应用等。治疗组在常规治疗的基础上,应用腺苷蛋氨酸1g/d静脉点滴治疗。结果:治疗组瘙痒评分由3.7±0.3降至1.2±0.6分,对照组瘙痒评分由3.6±0.8降至2.4±0.6分,两组比较差异有非常显著性(P<0.01)。治疗组平均孕周37.2±0.9周,对照组平均孕周34.1±1.1周,两组比较差异有显著性(P<0.05);治疗组剖宫产23例(占63.89%),对照组剖宫产26例(占72.22%),两组比较差异无显著性(P>0.05)。治疗组胎儿宫内窘迫、新生儿窒息、新生儿颅内出血、生产后出血的发生率均低于对照组。结论:腺苷蛋氨酸可改善ICP患者的皮肤瘙痒症状及围产儿结局,是治疗ICP的有效药物。

患者女,35岁.因误服含川乌的藏药后出现口唇及全身麻木、恶心、呕吐10小时于2006-04-26急诊入院.患者于12小时前因胃部不适,误服含川乌藏药(每粒含乌头碱0.5 mg)35粒.服药2小时后出现口唇及全身麻木无力,自服50%葡萄糖注射液5支(100 mL)无效,随后出现眼花、恶心、呕吐,家属急送入我院就诊.体格检查:体温35℃,脉搏60次/分,呼吸18次/分,血压80/50 mmHg(10 mmHg=1.33 kPa).精神萎靡,双侧瞳孔等大,直径3 mm,对光反射存在.双肺呼吸音清,未闻及啰音.

绝经后妇女因卵巢功能低下,体内雌激素水平下降,盆底组织萎缩退化,加之分娩损伤,长期腹压增加或先天性盆底组织发育不良等因素,易引起子宫脱垂和(或)阴道前后壁膨出,目前仍以手术治疗为主.但由于阴道粘膜萎缩变薄,常使得术中出血增多,手术时间延长等[1].本文观察绝经后妇女阴式术前应用己烯雌酚并与对照组用凡士林作比较,了解应用己烯雌酚的疗效及安全性.

Objective To discuss the clinical significance of abdominovaginal intrafassial hysterectomy. Methods Because of the finance and disease. This operation can't use Laparoscopy. So AVIH is better for the 56 case. In fact, AVIH was composed of normal subtotal hysterectomy and laparoscopy assisted-intrafassial vaginal Hysterectomy.(CASH) the way of trmove cervic when made normal intrafassial hysterectomy replace with the semm's Cervical cutter. Results The AVIH diminish difficuit hysterectomy It don’t ndde to Left bladdet, to cut cardinal and Saral ligament Avoid to injury bladder and ureters especily for having opration history and difficuit adhesion of pelvic. This operation keep normal vaginal anatomy. The opst-operation recovery more quickly Sesual intercourse leek usually The patients receive easily Because neuron of bladder and ureters were injuride mile. So none patient had urinary complication. AVIH could prevent the cervical carcinoma and prolapse. Conclusions Nowday This operatoion is better Hysterectomy. To name Abdoninovaginal intrafassiai hysterectomy(AVIH)

目的探讨小剂量比索洛尔在慢性阻塞性肺病中心力衰竭的疗效及对肺功能的影响。方法肺心病患者40例,随机分为治疗组和对照组各20例。治疗组在常规治疗的基础上加用小剂量比索洛尔口服,疗程4￣6周,对比分析疗效及治疗前后血气变化。结果应用比索洛尔组治疗慢性肺源性心脏病心力衰竭,心功能改善明显;两组治疗前后心率变化差异有非常显著性(P<0.001);观察组治疗前后血PO2、PCO2、SaO2均无明显改变(P>0.05)。结论小剂量比索洛尔治疗肺源性心脏病心力衰竭疗效显著,且无气道阻力增高副作用,是心力衰竭的治疗方法之一特别是经常规治疗效果不佳者。

探讨急性亚硝酸盐中毒的发病诱因 ,分析了 38例亚硝酸盐中毒患者的临床资料。结果提示 ,亚硝酸盐中毒病情的轻重与食用亚硝酸盐的量成正比 ,疗效与就诊时间和能否及时确诊有关

患者,女,40岁.因咽痛、咳嗽1周,胸闷、心慌、气短、周身乏力3 d,心电图示:窦性心律过速,心率:124次/min,ST-T改变,诊断为"急性气管炎".给予静脉滴注丹参注射液,利巴韦林注射液、能量合剂及力派注射液0.9g(山东新华制药股份有限公司,批号0303013)加入到0.9%氯化钠注射液250 mL内静脉滴注,静滴结束约5 h后患者开始出现全身肌肉、骨骼剧烈疼痛,难以入睡.

患者,女,24岁,因反复头晕、乏力伴抽搐、晕厥10天,于2001年10月以"抽搐原因待查"收住我院.入院时查体:T 36.4℃,P 84次/分,R 21次/分,BP 120mmHg/80mmHg,神志清楚,听力正常,颈部无抵抗,双肺呼吸音清,HR 84次/分,心律规则,心音有力,各瓣区未闻及病理性杂音,肝脾无肿大,四肢活动如常,神经系统无阳性体征.

患者男,40岁.因头晕、头痛、视物旋转、恶心欲吐一天,以"头晕待查,高血压病,美尼尔氏综合征?"收住院.查体:T 36.5℃,P 68次/min、R 15次/min,BP 120mmHg/90mmHg,神志清楚、精神欠佳,双瞳孔等大等圆,对光反射存在,双眼球震颤(±),双肺呼吸音清,未闻及干、湿性罗音,心率68次/min,心律规则,心音有力,各瓣区未闻及病理性杂音,腹部无异常.