目的 探讨伴异常染色体核型的初诊急性髓系白血病(acute myeloid leukemia,AML)患者的临床、实验室特征.方法 收集我院收治的伴异常染色体核型的初诊AML患者资料,分析其临床及实验室资料.结果 除M2b外14例患者骨髓合并病态造血,FAB分型中M2a13例、M51例,染色体核型中复杂核型10例、单体核型2例、染色体易位2例.71例异常染色体核型表现为染色体易位42例(其中M2b6例,M321例,M4EO4例)、单体核型14例、复杂核型15例.结论 伴异常染色体核型的初诊AML以染色体易位为主,但除M2b、M3、M4EO外,3种染色体核型异常(染色体易位、单体核型、复杂核型)无明显差异.合并病态造血的AML多见于复杂核型且以M2a为主.

目的 优选莲房黄酮苷最佳回流提取工艺条件. 方法 选取乙醇浓度(30％、50％、70％)、提取时间(60、90、120 min)、提取次数(1、2、3次)、料液比(1:12、1:14、1:16)作为考察因素,以杨梅素-3-O-β-D-葡萄糖醛酸苷、金丝桃苷、异槲皮苷、槲皮素-3-O-β-D-葡萄糖醛酸苷、山奈酚-3-O-β-D-半乳糖苷、异鼠李素-3-O-β-D-半乳糖苷、山奈酚-3-O-β-D-葡萄糖醛酸苷、丁香亭-3-O-β-D-葡萄糖苷8个黄酮苷总含量为考察指标,以HPLC法进行含量测定. 结果 最佳提取条件为16倍量70％乙醇回流提取3次,每次1h. 结论 正交试验优选出的莲房8个黄酮苷类成分总合量的提取工艺合理可行,为莲房黄酮类化合物的进一步研究提供参考.

Objective To evaluate the effect of low-flow sevoflurane anesthesia on the early postoperative renal function in patients.Methods Sixty patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,scheduled for elective non-urological surgery with general anesthesia,with an expected surgical duration＞4 h,were divided into 2 groups (n =30 each) using a random number table method:middle-flow anesthesia group (group Ⅰ) and low-flow anesthesia group (group Ⅱ).Anesthesia was induced with Ⅳ midazolam,sufentanil,propofol and cisatracurium besylate.Mechanical ventilation was performed after tracheal intubation.Pure oxygen served as carrier,the fresh gas flow of oxygen was set at 4-5 L/min,sevoflurane was inhaled for 10-15 min,and then fresh gas flow was decreased to 2 L/min (group Ⅰ) and 0.5 L/min (group Ⅱ).End-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.The end-tidal concentration of sevoflurane was set at 2.0％-2.4％,remifentanil and cisatracurium besylate were infused intravenously,and sufentanill or propofol was injected intermittently to maintain anesthesia.Bispectral index value was maintained at 40-60 during operation.Before anesthesia induction (T0),at 1,2,3 and 4 h after anesthesia induction (T1-4),immediately after operation (T5) and at 24 h after operation (T6),peripheral venous blood samples were collected for determination of serum fluoride ion concentrations.Peripheral venous blood samples and urine specimens were collected at T0,T5,T6,48 h after operation (T7) and 72 h after operation (T8) for determination of creatinine (Cr),blood urea nitrogen (BUN) and cystatin C (Cys C) and serum and urine β2-microglobulin (β2-MG) concentrations.Results Compared with the baseline at T0,serum fluoride ion concentrations were significantly increased at T1-6 in two groups,the serum Cys C concentration was increased at T5,and serum and urine β2-MG concentrations were increased at T5 and T6 in group Ⅰ,serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5 and T6,and the serum Cys C concentration was increased at T5-T7 in group Ⅱ (P＜0.05).Compared with group Ⅰ,serum fluoride concentrations were significantly increased at T1-6,serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5,and serum Cys C concentrations at T5-T7 and urine β2-MG concentrations at T5 and T6 were increased in group Ⅱ (P＜0.05).Conclusion Low-flow sevoflurane anesthesia produces no marked effect on early postoperative renal function in patients.

目的 探讨性别、年龄对同型半胱氨酸及骨代谢指标的影响.方法 收集80例健康体检者,其中年龄23～35岁女性20例为A组,年龄25～35岁男性20例为B组,年龄36～45岁女性20例为C组,年龄36～45岁男性20例为D组,E组为A组和C组,F组为B组和D组.比较A组和B组、C组和D组、E组和F组、A组和C组、B组和D组之间血清中的同型半胱氨酸(HCY)、钙(Ca)、磷(P)、碱性磷酸酶(ALP)、维生素D(Vit-D)、总Ⅰ型胶原氨基端延长肽(PINP)、β-胶原特殊序列(β-CTX).结果 男性各组(包括B组、D组、F组)中HCY、ALP、Vit-D、β-CTX分别相应高于女性各组(包括A组、C组、E组),男性各组(包括B组、F组)中PINP分别相应高于女性各组(包括A组、E组),女性C组HCY、Vit-D高于A组,男性D组Vit-D高于B组,D组PINP、p-CTX低于B组,每两组之间的比较差异均有统计学意义(P＜0.05).结论 健康男性血清中的HCY、ALP、Vit-D、p-CTX均高于女性.女性随着年龄的增长,HCY、Vit-D会有升高;男性随着年龄的增长,PINP、β-CTX有所下降.

目的 探讨预出院模式在患者出院过程中的应用效果.方法 将2012年1月～ 2014年6月泌尿外科出院的患者随机分为实验组和对照组,实验组1669例,按照预出院模式办理出院手续,对照组2835例,未开预出院按照当天开出院医嘱当天办出院.比较2组患者满意度.结果 实验组满意度明显高于对照组,差异有统计学意义(P＜0.05).结论 预出院模式能缩短患者办理出院手续的时间,精简出院流程,提高患者满意度,值得临床推广.

Objective To analyze the distribution and the drug resistance of the pathogens from blood culture,and to provide basici for the clinicians to rationaly use antibiotic.Methods The retrospective analysis was conducted on distribution and drug-resistance profile of the pathogens from blood culture colected from both inpatients and outpatients in our hospital from 2013 to 2015. The identification of strains and the drug susceptibility testing wereperformed by the VITEK-2 Compacts system.ResultsThe positive incidence of these 8736 samples is 9.89%. There were 407 strains of gram-negative bacili (47.11%),386 strains of gram-positive bacili(44.67%)and 59 strains of fungi(6.83%). The top three species of the gram-negative bacili were escherichia coli,klebsiela pneumonia and pseudomonas aeruginosa. The top three species of the gram-positive bacili were the coagulase-negative staphylococcui, staphylococcus aureusande,faecalis,the pathogens were mainly from ICU,department of hematology and immunology,respiratory medicine and pediatrics, the detection rates of ESBLs and E.coli were 45.3% and 24.1%,pneumonia and enterobacteriaceae were 100.00% sensitive to carbapenems,resistance rates of pseudomonas aeruginosa to amikacin,piperacilin/tazobactam and tobramycin were 9.09%、9.09% and 11.36%,MRSA were16.0%. No strains of ancomycin-resistantdetection or linezolid-resistantdetection strains were found in gram-positive bacili.ConclusionTo promote and standardize the rational use of antibiotics,and to strengthen the control of hospital infection is an important strategy to reduce the drug resistance of the bacteria.

目的 探讨血清同型半胱氨酸(Hcy)和血清维生素D检测在老年高血压合并糖尿病诊断中的临床应用价值.方法 选取单纯高血压患者40例,高血压合并糖尿病患者40例,以健康体检者40例为对照组,分别用免疫比浊法测定Hcy,用电化学发光法测维生素D含量,并进行组间比较.结果 对照组Hcy为(14.36±3.04) μmol/L,维生素D为(30.86±4.04) ng/mL;高血压合并糖尿病组Hcy为(21.85±7.02)μmol/L,维生素D为(25.10±7.44) ng/mL;单纯高血压组Hcy为(18.89±6.01) μmol/L,维生素D为(28.38±4.80)ng/mL.3组差异有统计学意义(P＜0.05).高血压合并糖尿病组高Hcy比例为70.0％,低维生素D为65.0％,同时存在高Hcy和低维生素D为50.0％;单纯高血压组高Hcy比例为45.0％,低维生素D为45.0％,同时存在高Hcy和低维生素D为25.0％,两组间比较,差异有统计学意义.结论 高Hcy、低维生素D对老年高血压合并糖尿病的诊断与监测有一定意义,值得临床推广.

OBJECTIVE:To study the purification technology of total flavonoids from Nelumbinis receptaculum by macroporous resin. METHODS:Using adsorption rate and desorption rate of total flavonoids from Nelumbinis receptaculum as index,the type of macroporous resin was selected by static adsorption-desorption tests;With adsorption rate of total flavonoids as index,single factor test was used to investigate the effects of the concentration of total flavonoids,adsorption time,adsorption speed,drug-loading amount,water amount,volume fraction and amount of eluant and other factors on the purification technology. The optimal technology was validated. RESULTS:Among 10 kinds of resin,HPD-400 macroporous resin was found to have the best adsorption and desorption effects. The optimal purification conditions was as follows as the concentration of total flavonoids 7.00 mg/ml,adsorption time of 3 h,flow rate for sampling of 3 column volume(BV)/h,drug-loading amount of 8 BV,water amount of 6BV,50% ethanol elution amount of 4 BV. In validation test,mass fraction of total flavonoids from purified Nelumbinis receptaculum were 63.88%,62.50% and 63.44%(RSD=1.11%,n=3). CONCLUSIONS:HPD-400 macroporous resin could purify total flavonoids from purified Nelumbinis receptaculum,and established purification technology is stable and practical.

OBJECTIVETo study the amount change of peripheral blood NK cells in patients with hematologic malignancies and its significance.METHODSA total of 200 patients with hematologic malignancies in our hospital from June 2013 to March 2015 were chosen as study objects, out of them 105 patients were in aute stage and 95 patients were in remisson stage. At same time 100 people from healthy medical examination in our hospital were chosen as control group. The mumber change and subgroups of their peripheral blood NK cells were analyzed and compared.RESULTSIn control group the absolute number of NK cells was (412.91 ± 167.35)/µl, the relative number of NK cells was (13.31 ± 2.56) %; in group at acute stage of leukemia the absolute number of NK cells was (97.84 ± 23.18)/µl, the relative number of NK cells was (6.79 ± 0.78) %; in group at acute stage of lymphoma, the absolute number of NK cells was (101.79 ± 25.63)/µl, and the relative number of NK cells was (7.12 ± 1.03) %; in group at remission stage of leukemia, the absolute number was (297.17 ± 87.56)/µl, and the relative number was (10.15 ± 1.64) %; In group at remission of lymphoma, the absolute number of NK cells was (288.52 ± 118.52)/µl, and the relative number of NK cells was (10.82 ± 1.97) %. The number of NK cells between different groups showed statistical difference (P < 0.05). In remission group, the number of NK cells before and after treatment had statistical difference (P < 0.05). In control group, the number of CD56(bright) subgroup was (25.28 ± 4.72) %, the number of CD56(bright) subgroup at the acute stage of leukemia was (65.46 ± 11.21) %, and the number of CD56(bright) subgroup at the acute stage of lymphoma was (70.71 ± 12.14) %, the number of CD56(bright) subgroup at remission stage of leukemia was (23.35 ± 4.67) %, the number of CD56(bright) subgroup at remission stage of lymphoma was (24.89 ± 4.58) %. The number of CD56(bright) subgroup between different groups showed statistical significance (P < 0.05).CONCLUSIONThe number and function of peripheral blood NK cells in patients with hematologic malignancies have been confirmed to be obvious decrement, but after treatment the number of NK cells in those patients showed increment.

目的:探究分析白血病初诊患者血常规综合指标的临床价值.方法:随机选取笔者进修的某三甲医院在2012年1月到2015年1月期间接收的80例白血病初诊患者,对所有患者的白细胞、血小板以及血红蛋白等指标进行综合分析.结果:在白细胞、血小板以及血红蛋白等指标方面,白血病初诊患者均与正常人存在差异,其中急性白血病患者45例,慢性白血病患者35例,急性白血病和慢性白血病,在白细胞血小板以及血红蛋白指标方面,急性白血病显著低于慢性白血病(P<0.05),在血红蛋白方面,两者之间差异不明显.结论:白血病初诊患者血常规与健康人群相比,存在着明显差异,急性白血病和慢性白血病患者相比较,在血小板以及血红蛋白方面存在着明显差异,通过血常规综合指标分析,可以进一步明确白血病的诊断.

目的 优化莲房总黄酮的回流提取工艺. 方法 用正交试验进行回流提取莲房总黄酮,以紫外分光光度法测定莲房总黄酮的吸光度,标准曲线法计算莲房总黄酮的提取率. 结果 回流提取莲房总黄酮的影响因素为:提取次数＞乙醇浓度＞料液比＞提取时间;最优提取工艺条件是:提取次数3次,乙醇浓度70％,料液比1∶16,提取时间1.5 h.在此条件下莲房总黄酮的平均提取率为14.33％,RSD为4.03％. 结论 优化后的回流提取工艺提取莲房总黄酮,具有简便、高效、稳定可行的特点.

目的 优选墨旱莲总黄酮的超声提取工艺条件. 方法 采用正交试验优化超声波辅助提取墨旱莲总黄酮的最佳工艺,以紫外分光光度法测定墨旱莲中总黄酮的含量. 结果 影响超声提取墨旱莲总黄酮的因素为:提取次数＞料液比＞乙醇浓度＞提取时间;最佳提取条件为:乙醇浓度40％,料夜比1:30,提取次数3次,提取时间50 min.在此条件下墨旱莲总黄酮的平均提取率为0.95％,RSD为0.61％. 结论 优选的超声提取工艺稳定、可行.

为了比较鳢肠不同部位提取物的抗骨质疏松活性及总皂苷、总黄酮含量,采用MTT法和对硝基苯酚磷酸二钠法测定鳢肠不同部位乙醇提取物对UMR106细胞的增殖和碱性磷酸酶(ALP)活性;采用紫外分光光度法测定鳢肠不同部位总皂苷和总黄酮含量.结果表明,鳢肠根和叶提取物对UMR106细胞的增殖具有促进作用,浓度为50 μg/mL时促增殖作用最强,增值率分别为7.7％和16.9％,茎提取物没有明显的作用;鳢肠根、茎、叶提取物对ALP活性均有促进作用,浓度为100 μg/mL时促增殖作用最强,分别促进18.9％、20.1％和17.0％;鳢肠根、茎、叶中总皂苷含量分别为3.6％、4.0％和2.2％,总黄酮含量分别为1.4％、1.4％和3.4％.这些结果表明;鳢肠不同部位提取物均有抗骨质疏松活性,其不同部位总皂苷和总黄酮的含量差异较大.

目的 优化墨旱莲总皂苷超声提取工艺. 方法 以墨旱莲总皂苷提取率为指标,考察乙醇浓度、料液比、提取时间、提取次数对超声提取墨旱莲总皂苷的影响,进行单因素试验和正交试验. 结果 影响超声提取墨旱莲总皂苷的因素为:提取次数＞料液比＞提取时间＞乙醇浓度;最佳工艺条件为:乙醇浓度80％,提取时间40 min,料液比1∶30,提取次数3次.在此条件下墨旱莲总皂苷的平均提取率为1.97％,RSD为3.03％. 结论 用超声提取法提取墨旱莲总皂苷,具有简便、快速、高效、节能的特点.

目的探讨血清降钙素原(PCT)与C反应蛋白(CRP)在感染性疾病中的诊断价值。方法将103例感染性疾病患者分为细菌性感染组(71例)与非细菌性感染组(32例),采用酶联荧光分析和免疫比浊方法分别检测患者血清PCT与CRP水平。结果细菌性感染组血清PCT与CRP水平均明显高于非细菌性感染组,差异均有统计学意义(P<0.01)。PCT检测对于诊断细菌性感染的特异性、阳性预测值及阴性预测值均高于CRP检测,差异均有统计学意义(P<0.05)。结论血清PCT与CRP的检测对细菌感染性疾病的早期诊断具有重要的应用价值,血清PCT检测更具有特异性。

Objective To investigate the clinical value of combined detection of SCys C and UMA in the diabetic patients with early renal injury.Methods The levels of UMA and SCys C were detected with the enzymic method in 91 diabetic type 2 patients and 40 healthy persons(as control).Results The levels of UMA and SCys C in the diabetic patients were significantly higher than those of the normal control(t values were 14.46 and 24.96 respectively,both P<0.01);The level of SCys C had a positive correlation with the level of UMA(r=0.459,P<0.01).The positive rate of combined detection of SCys C and UMA was significantly higher than that of single detection of SCys C or UMA(χ2=8.19,P<0.05).Conclusions UMA and SCys C are sensitive indexes of early renal injury in diabetic patients.The combined detection of UMA and SCys C is useful and accurate in the diagnosis of early renal injury caused by diabetes.

胸部外伤患者的护理重点在于早期的病情观察和护理。在接诊后能得到及时准确有效的治疗和护理,是抢救重症胸部外伤的关键,对于潜在的病情变化予及早的发现和正确的处理,能最大限度地挽救患者的生命。

对17例食管癌并发颈部吻合口晚期瘘的护理进行回顾性总结,从营养支持、充分的术前消化道准备、保持有效引流、瘘口护理、饮食指导及心理护理等方面给予预防和护理,结果16例病人治愈出院,1例病人因并发肺部感染自动出院。

自发性乳糜胸病例临床较为少见,其病因复杂,且治疗效果并不乐观,住院时间长、昂贵的医疗费用、疾病的痛苦、担心疾病的愈后,使患者及家属易产生悲观、失望、焦虑、恐惧等各种心理问题,因此,做好心理护理、基础护理、对症护理,显得尤为重要。使用胸膜粘连剂治疗成功与否,与胸液的彻底引流和注药后翻转体位能否达到理想的胸膜状态密切相关。

<正>随着我国社会人口的老龄化,高龄手术治疗人数呈上升趋势。老年人各器官功能均有不同程度的减退,对手术耐受力低,组织修复能力差;贲门癌手术时间长,创伤大,对心肺功能影响大,因此,做好术前充分准备、术后严密观察和护理是提高手术成功率,降低术后并发症的关键。2008年4月至2010年4月,我科对46例高龄贲门癌患者进行手术治疗。现将护理情况报告如下。1临床资料本组46例,男37例,女9例;年龄70～86岁,平均