目的:研究对支气管哮喘老年患者应用孟鲁司特钠片联合硫酸镁注射液的治疗效果.方法:于我院收治的支气管哮喘老年患者中随机抽取90例,使用随机抽签法分为对照组(45例,常规治疗)和观察组(45例,常规治疗+孟鲁司特钠片+硫酸镁注射液),对比两组疗效.结果:观察组患者FVC(3.58±0.28)L,FEV1(65.49±9.37)％,PEF(7.39±1.15)L/s,显著高于对照组.观察组IL-6(116.52±17.30)μg/L,IL-8(48.25±15.10)μg/L,TNF-α(34.21±8.62)μg/L,均较对照组降低.观察组咳嗽持续(4.10±0.95)d,胸闷持续(3.52±0.86)d,喘息持续(2.24±0.28)d,较对照组显著缩短.观察组治疗有效率43例(95.56％),高于对照组治疗有效率34例(75.56％).两组各指标对比差异有统计学意义(P<0.05).对照组未出现不良反应,观察组出现1例(2.22％)出汗乏力,1例(2.22％)头晕恶心,无其他不良反应,2组对比无统计学意义(P>0.05).结论:对支气管哮喘老年患者给予孟鲁司特钠以及硫酸镁联合治疗更有利于缓解症状,改善肺功能,并减轻炎症反应,提高治疗效率,且联合用药安全性高,可在临床推广应用.

目的 探讨冬季野营拉练特点和误诊原因,以提高野营拉练卫勤保障能力,减少误诊,降低致伤、致残率,避免非战斗性减员.方法 回顾性分析我院卫勤分队2015年1月至2020年1月诊治的41例病例冬季野营拉练官兵临床资料.结果 41例均有不同程度、不同时长的误诊,涉及6个临床专业,最长误诊时间12天,平均误诊2.5天,经治疗37例(90.2％)痊愈归队,3例(7.32％)原发疾病得到有效控制,1例(2.44％)继发甲状腺功能低下,长期口服药物治疗;33例(80.5％)为基层卫生队首诊,8例(19.5％)为总队医院卫勤分队首诊,干部5例(12.2％),战士36例(87.8％),其中新兵27例(65.9％).结论 冬季野营拉练天气、路况、场地等自然条件差,卫勤保障人员业务水平参差不齐,人员短缺,前期准备不充分,沟通协调不够,设备携带、使用受限等诸多因素是造成误诊主要原因,因此专业化、实战化的训练和准备,科学的统筹安排,注重信息化、智能化、发展建设,加大联勤力度,拓展保障渠道都是减少误诊的关键,能打仗、打胜仗的强军目标才能实现.

Rh( D)阴性(无D抗原阳性者)血型属于稀有血型[1] ,汉族人群中Rh ( D)阴性比例占0.2％ ～0.5％,Rh(D)阴性血型患者本身存在输血来源困难的情况.而输血是烧伤治疗的一项重要措施,重度烧伤患者在治疗的过程中需要的输血量巨大[2].因此面对重度烧伤合并稀有血型的患者,如何在治疗过程中使用最少的血液制品达到最好的疗效,是一个重大挑战.2020 年6 月武警河北总队医院救治了1例Rh( D)阴性血型的大面积深度烧伤患者.

目的 探究维持性血液透患者治疗中高通量透析血液净化对患者生活质量存在的影响.方法 将60例研究对象分为对照组(低通量透析)与观察组(高通量透析),对两组生活质量相关指标进行观察与比较.结果 治疗后观察组皮肤瘙痒改善率、MQSGA评分、SF-36各维度评分均好于对照组(P<0.05).结论 维持性血液透患者治疗中高通量透析血液净化对患者生活质量提升存在积极影响.

目的 观察重症急性左心心力衰竭治疗中无创呼吸机应用效果.方法 从2016.08～2020.08医院收治重症急性左心心力衰竭患者中选取80例分成两组,对照组行常规治疗,观察组在对照组基础上行无创呼吸机治疗.对两组临床治疗效果进行观察比较.结果 与对照组比较,观察组心率、呼吸频率、血氧分压、动脉二氧化碳分压等生命体征水平更好(P<0.05);临床治疗有效率更高(P<0.05).结论 在治疗急性左心心力衰竭时,给予患者无创呼吸机治疗利于其临床指标改善与临床治疗效果提升.

目的 探究急性颅脑损伤患者心肺复苏后凝血功能变化及其与脑损伤相关性.方法 选取2012年3月～2018年3月武警河北省总队医院收治的因急性颅脑损伤引起心脏骤停行心肺复苏治疗的患者60例,根据入组患者入院治疗后1个月时格拉斯哥预后(GOS)评分分为预后良好组(4～5分)23例和预后不良组(1～3分)37例,另选取同期在本院体检的健康志愿者20例为健康对照组.采用酶联免疫吸附(ELISA)法检测受试者血清脑损伤标志物水平,采用血常规分析仪、凝血功能分析仪及免疫比浊法进行凝血功能相关指标检测,分析凝血功能指标变化与脑损伤相关性.结果 预后良好组、预后不良组患者平均动脉压明显低于健康对照组,差异有统计学意义(P<0.05).预后不良组患者停搏至复苏开始时间、开始通气时间及自主循环恢复(ROSC)时间均明显高于预后良好组患者,差异有统计学意义(P<0.05).健康对照组、预后良好组、预后不良组急性生理学及慢性健康状况(APACHEⅡ)评分及血清S-100β蛋白、神经元特异性烯醇化酶(NSE)、胶原纤维酸性蛋白(GFAP)、β淀粉样蛋白(Aβ42)、髓鞘质碱性蛋白(MBP)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)、D-二聚体(D-D)水平依次显著升高,格拉斯哥昏迷(GCS)评分依次显著降低,差异均有统计学意义(P<0.05).患者GCS评分与纤维蛋白原(Fg)水平呈正相关,与PT、TT、APTT、D-D水平呈负相关(P<0.05).APACHEⅡ评分与PLT、Fg水平呈负相关,与PT、TT、APTT、D-D水平呈正相关(P<0.05).GCS评分、APACHEⅡ评分、Fg、APTT、D-D水平是影响急性颅脑损伤心肺复苏患者不良预后的危险因素(P<0.05).结论 急性脑损伤心肺复苏患者PT、TT、APTT、D-D水平显著升高,Fg水平显著降低,可能与患者脑损伤加重等不良预后发生有关.

目的 探讨腹部闭合伤的临床特点和漏诊原因,以提高创伤救治水平.方法 回顾性分析我院急诊科2013年1月-2017年7月收治的43例腹部闭合伤患者的临床资料.结果 43例均为多发伤,均在急诊科漏诊腹腔脏器损伤.28例(65.1％)在对已明确损伤脏器进行急诊手术中发现合并其他腹腔脏器损伤;7例(16.3％)复查影像学发现腹腔脏器损伤;6例(14.0％)保守治疗无效患者手术探查发现腹腔脏器损伤;1例(2.3％)二次手术探查时发现新的腹腔脏器损伤;1例(2.3％)在尸检中发现合并其他腹腔脏器损伤.除1例死亡病例,余患者发现新的腹部脏器损伤后,40例(93.0％)予相应外科手术治疗,2例(4.7％)予保守治疗,均痊愈出院.结论 腹部闭合伤在多发伤中常见,病理生理因素导致其容易漏误诊.故对多发伤患者应行腹腔脏器常规检查,严密观察病情变化,充分利用合理的检查手段,最大限度避免漏误诊.

目的：探讨关节镜手术治疗化脓性关节炎的临床意义。方法对我院2011年6月—2014年4月采用关节镜手术治疗的30例化脓性关节炎的临床资料进行回顾性分析。结果本组手术时间40 min~1 h,术中出血<10 ml。术后体温恢复正常时间2~3 d,关节疼痛明显缓解或消失时间3~4 d。术后3周复查血常规及红细胞沉降率、C-反应蛋白、D-二聚体均恢复正常。术后6~8周关节功能恢复：优25例,良4例,可1例。术后随访6个月~1年,均无复发。结论关节镜手术治疗化脓性关节炎效果可靠,切口小,对关节结构破坏少,术后恢复快,且不易发生因手术造成的关节活动障碍。

Objective To investigate the feasibility and safety of noninvasive positive pressure ventilation(NPPV) in treatment of acute lung injury(ALI).Methods The 29 patients with ALI during January 2009 and October 2012 in our department were treated by NPPV with S/T model,and the parameters of breathing apparatus were adjusted according to pathogenetic conditions.The change of respiratory rates,pappenheimer O2(PaO2) and oxygenation indexes before NPPV,1 h,12 h and 24 h after NPPV and after off-line were recorded.Results After NPPV treatment,the 25 patients' symptoms improved with stable vital signs.The respiratory rates,PaO2 and oxygenation indexes at each time point after NPPV and after off-line were significantly improved,except 1 h after NPPV of respiratory rate(P0.05).The average time of using breathing apparatus was 8.9 days without ventilator-associated pneumonia.All the patients were cured and discharged.The other 4 patients were given invasive positive pressure ventilation treatment after NPPV treatment failed,3 patients recovered,and one with severe pneumonia died of acute respiratory distress syndrome caused by incontrollable pathogenetic condition.Conclusion The method of NPPV in treatment of ALI is safe and effective with better prognosis.

<正>腓骨肌腱滑脱症由Monteggia于1803年首先报道,临床并不多见[1-3],近20年文献报道有增多趋势。该病多发生于军训战士及运动员,手术治疗方法较多,有些术式采用的单纯重建腓骨上支持带远期复发可能性大。我科1985年4月～2008年7月采用重叠缝合腓骨

Objective To investigate the protective effect of lysine against methamphetamine -induced neurotoxicity in C_6 cells.Methods C_6 cells were randomly divided into control group,methamphetamine(2 mM,3 mM,4mM) group,lysine group, methamphetamine + lysine group.To determine the oxidative damage induced by methamphetamine,catalase(CAT) and glutathione peroxidase(GPx) were detected in C_6 cells.To estimate apoptosis,flow cytometry analysis using annexin V - FITC and propidium iodide staining as well as detection for caspase - 3 and Bcl - 2 proteins were performed after methamphetamine exposure for 48 hours. Results Lysine reversed the change of the form of C6 cells caused by methamphetamine and greatly improved CAT and GPx activities. It also reversed the expression of Bcl -2 apoptosis protein induced by methamphetamine.Conclusions Lysine can ameliorate methamphetamine - induced oxidative insult and apoptosis in C6 cells,probably due to its antioxidant activity rather than the activation of GABA receptors.

Objective:To analyze the risk factors for acute cerebral infarct progression in posterior circulation(ACIPPC)and predicting function of plasma MMP-9.Methods:In this study we focused on ACIPPC and compared factors between ACIPPC and N-ACIPPC by single factor analysis,and sieved the independent risk factors for ACIPPC by logistic(Forward:Wald)analysis and demonstrated the predicting role of plasma MMP-9 to the infarction volume of ACIPPC by linear correlation and regression analysis.Results:Single factor analysis showed that hypertension history,diabetes mellitus history,dysphagia,neurological severity,blood glucose and plasma MMP-9 were significantlt different between ACIPPC and N-ACIPPC(P0.05).Logistic regression analysis indicated that blood glucose,neurological severity and plasma MMP-9 were independent risk factors for ACIPPC.Linear correlation and regression analysis manifested that plasma MMP-9 was a predicting factor for the DWI volume of ACIPPC patients.Conclusion:ACIPPC results from multi-factors,while blood glucose,neurological severity and plasma MMP-9 are independent risk factors for ACIPPC,and plasma MMP-9 may be a predicting factor for the brain stroke volume of DWI in ACIPPC patients.

目的:探讨急诊科对于输尿管结石的诊断与治疗方法,并提出本病的预防措施。方法:回顾性分析我科2001年6月~2006年8月接诊的125例输尿管结石临床资料。结果:本组均行急诊B超检查,113例(90%)发现阳性结石,5例加摄X线平片发现结石。105例(84%)行体外冲击波碎石(EWSL)治疗,2例行输尿管镜检查治疗均取得良好效果,18例(14%)经保守治疗痊愈。结论:B超检查是输尿管结石首选诊断手段,EWSL治疗最方便、快捷、有效,保守治疗、输尿管镜检查治疗、手术治疗可酌情选择。

Objective:To study clinical features and emergency treatment of injuries from accidents on the expressways.Methods:Full data of 327 cases of expressway injuries during January 2003 to April 2006 were retrospectively analyzed.Results:Of the 327 cases from 128 accidents,who were sent to hospital within an average time of 2.16 hours,there were 253 cases of multiple compound injuries(77.4%),including 192 cases(58.7%) of serious multiple injuries,33 cases of serious complications(10%),294 survivals(89.9%),including 45 cases(13.8%) being disabled.The people rescued stayed in hospital for an average time of 17.3 days.33 cases died,including 12 who failed the rescue and treatment and 21(10.1%) being killed on the spot.Conclusion:The features of expressway injuries are of special clinical features,which are complicated,urgent and difficult to diagnose.The key to successful rescue of expressway injuries is quick and efficient on-the-spot rescue and comprehensive,detailed,early and accurate emergency treatment.

目的 探讨盐酸乌拉地尔在高血压脑出血术后的应用价值.方法 对96例高血压脑出血患者手术后应用盐酸乌拉地尔250 mg加入5%葡萄糖液250 mL中缓慢泵入,观察不同时问段的血压心率变化.结果 血压在用药后5 min即明显下降,20-30 min迭到高峰并保持稳定;心率无明显改变.结论 乌拉地尔治疗高血压急症起效快,降压效果显著、平稳,不良反应小,可作为首选降压药物之一.

泰必利为临床常用的苯酰胺类抗精神病药物,由于不良反应小,临床较常使用,笔者在工作中遇到2例典型泰必利引起锥体外系反应,报道如下.