探讨情景模拟教学在急诊住院医师规范化培训中的应用价值,以期活跃学习氛围,提高住院医师考核成绩,提高其参与积极性,实现能力、素养、职业认同等全方位提升.

目的 探讨血小板分布宽度(PDW)在青年冠心病人群中的分布特征及其与冠脉病变严重程度的关系,评价PDW对青年冠心病的预测价值.方法 收集扬州大学附属医院2018年10月至2019年10月连续住院的青年患者(年龄14～44岁)为研究对象,经冠脉造影(CAG)确诊冠心病组240例,除外冠心病88例为对照组.比较2组及青年冠心病各亚组间的PDW水平,分析PDW与冠脉病变严重程度(Gensini评分)的相关性及青年冠心病的独立危险因素.结果 青年冠心病组PDW水平明显高于对照组(P＜0.05),PDW在急性心肌梗死(AMI)、不稳定性心绞痛(UAP)和稳定性心绞痛(SAP)组均高于对照组(P＜0.05);青年冠心病组PDW与Gensini评分之间存在正相关(r= 0.371,P＜0.01);多因素 logistic 回归分析显示 PDW(OR= 2.757,95％CI:2.117～3.590,P＜0.01)是青年冠心病的独立危险因子,绘制ROC曲线分析,PDW预测青年冠心病的截断点为15.65％,ROC曲线下的面积为0.87(95％CI:0.826～0.914,P＜0.01),敏感度84％,特异度82％.结论 PDW与青年冠心病的冠脉病变严重程度密切相关,是青年冠心病的独立危险因素,为青年冠心病的诊断提供一定预测价值.

Objective To investigate the effect of allopurinol treatment on renal function in chronic kidney disease (CKD) patients with asymptomatic hyperuricemia.Methods Select the patients whom diagnosed CKD 2～3a phase with asymptomatic hyperuricemia from February 2014 to February 2015 in nephrology department of yangzhou NO.1 people's hospital.All patients were randomly divided into allopurinol treatment group and control group.Both groups treated with low salt,low fat,low protein and low purine diet.ccnt rol blood pressure and blood glucose.Allopurinol treatment group received allopurinol 200 mg per day,the control group was not given uric acid lowering treatment.One year after the treatment,observing two groups of eGFR,albuminuria and blood pressure in patients.Results In allopurinol treatment group,3 patients withdrawal due to rash,the incidence rate is 7.14％.Allopurinol treatment significantly lower blood uric acid levels after 1 year later(515.28 ± 114.13 vs 280.21 ± 72.58,P＜0.01),the eGFR has no obvious change before and after the treatment (73.46 ± 18.38 vs 70.37 ± 20.11,P＞0.05),while control group's blood uric acid higher(487.02 ± 78.57 vs 545.43 ± 89.56,P＜0.05) and eGFR decline dramatically in a year later(70.43 ± 20.65 vs 64.21 ± 17.42,P＜0.05).In allopurinol treatment group,the level of proteinuria decreased slightly (0.62 ± 0.43 vs 0.48 ± 0.12,P＞0.05),but there was no statistical significance(P＞0.05),in the control group,albuminuria have no difference before and after treatment(0.60 ± 0.47 vs 0.64 ± 0.37,P＞0.05).Systolic blood pressure(155.44± 12.12 vs 125.21 ± 10.08,P＜0.05;157.42 ± 14.12 vs 128.45 ± 9.64,P＜0.05) and diastolic blood pressure(88.56 ± 10.21 vs 80.45 ± 9.23,P＜0.05;86.45 ± 11.56 vs 82.27 ± 6.25,P＜0.05) were significantly lower than before after treatment in both groups,but there was no statistical difference between the two groups(P＞0.05).Conclusions Allopurinol slowed the decline of eGFR in CKD 2～3a phase with asymptomatic hyperuricemia.