目的:探讨血小板制剂联合去骨瓣减压术治疗高血压基底节区脑出血的效果.方法:选取2019年3月—2021年7月在华中科技大学医院接受治疗的120例高血压基底节区脑出血患者作为研究对象,随机分为对照组和试验组,各60例.所有患者接受开颅血肿清除联合去骨瓣减压术治疗,对照组采用阿司匹林治疗,试验组在对照组基础上于术前、术后1d输注血小板制剂.比较两组再出血量及术后1d血压水平、再出血率及病死率、昏迷程度及生活能力.结果:试验组再出血量少于对照组,术后1 d收缩压、舒张压、平均动脉压均低于对照组,差异有统计学意义

目的 探讨血浆置换疗法治疗重症大疱性类天疱疮的临床疗效和作用机制.方法 选择2015年2月1日至2019年6月1日武汉市第一医院重症医学科(ICU)治疗的64例重症大疱性类天疱疮患者,按随机数字表法分为常规治疗组(给予常规糖皮质激素和免疫抑制剂治疗)与联合血浆置换组(在常规治疗的基础上给予血浆置换治疗),每组32例.于治疗前及治疗10d后,分别采用酶联免疫吸附试验(ELISA)检测两组患者的血清自身抗体〔抗BP180抗体及其抗体亚型(IgG1、IgG4)〕水平,采用鲎试剂法检测血浆内毒素水平,采用ELISA法检测血浆炎性因子〔肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)〕水平.观察两组患者治疗前后的血清自身抗体、内毒素和血浆炎性因子水平,比较两组治疗2周后的多器官功能障碍综合征(MODS)发生率、病死率、机械通气时间、ICU住院时间以及临床疗效.结果 治疗后两组的抗BP180抗体、IgG1、IgG4、血浆内毒素、TNF-α、IL-6、IL-8水平均较治疗前降低,且联合血浆置换组治疗后上述指标水平均明显低于常规治疗组〔抗BP180抗体(U/mL):46.2±13.5比75.4±19.4,IgG1(U/mL):0.29±0.14比0.41±0.22,IgG4(U/mL):0.16±0.08比0.23±0.12,内毒素(EU/mL):1.1±0.2比2.5±0.4,TNF-α(μg/L):69.4±8.5比104.3±19.6,IL-6(μg/L):89.1±13.8比164.8±24.7,IL-8(μg/L):186.4±32.7比286.1±47.6,均P<0.05〕.联合血浆置换组的MODS发生率〔9.4％(3/32)比31.2％(10/32)〕、病死率〔0(0/32)比9.4％(3/32)〕、机械通气时间〔(3.3±0.4)d比(5.7±1.4)d〕、ICU住院时间〔(10.4±1.7)d比(14.5±2.6)d〕均明显低于常规治疗组,总有效率明显高于常规治疗组〔96.9％(31/32)比78.1％(25/32)〕,差异均有统计学意义(均P<0.05).结论 血浆置换联合常规糖皮质激素治疗重症大疱性类天疱疮效果明显优于单纯的糖皮质激素治疗,其机制可能与降低抗BP180抗体及IgG1、IgG4水平、血浆内毒素水平以及炎性因子水平有关.

患者女,33岁,主诉"发现心脏杂音30余年".该患者儿童时期汗多、消瘦、有反复肺炎史,无明显呼吸困难、口唇紫绀,可耐受一般体力活动.10岁后开始出现体力下降,寒冷或劳累后可见口唇轻微紫绀,感染肺炎次数明显减少;随后活动耐量进一步减低,慢跑100 m即出现气促,仅可从事轻微体力劳动,夜间尚可平卧位入睡,无明显憋气、咳嗽、咯血、胸痛等不适.2013年(患者31岁时)曾在武汉亚洲心脏病医院行心脏超声检查,诊断为"巨大室间隔缺损(ventricular septal defect,VSD)并 重 度 肺 动 脉 高 压(pulmonary hypertension,PH)",医生提出已失去手术适应证,建议予肺高压靶向药物保守治疗.

目的 比较在脓毒血症相关的急性肾损伤(AKI)患者中,连续静脉血液透析滤过(CVVHDF)高剂量与常规剂量治疗后患者细胞因子的清除效果.方法 选取2014年5月至2016年9月华中科技大学同济医学院附属武汉市第一医院重症监护病房收治的符合纳入标准和排除标准的脓毒症合并AKI患者41例,其中男24例,女17例;平均年龄(40.2±9.6)岁.根据患者透析治疗剂量将患者分为常规剂量组[25 mL/(kg·h),18例]和高剂量组[40 mL/(kg·h),23例].比较不同透析剂量治疗前后白介素(IL)-6、肿瘤坏死因子-α (TNF-α)、IL-10的变化.结果 常规剂量组中8例患者(44.4％)在28 d内死亡,高剂量组中9例(42.9％)死亡.两组患者在年龄、体重指数、急性生理与慢性健康评分(APACHEⅡ)评分、序贯器官功能评价(SOFA)评分、治疗前IL-6、TNF-α、IL-10等差异均未见明显统计学意义(P＞0.05).CVVHDF干预的平均持续时间为常规剂量CWHDF组5.5 d和高剂量CVVHDF组6.2 d.高透析剂量组的IL-6和TNF-α在24较基线显著降低(P＜0.05).高剂量组CVVHDF治疗滤器出口处IL-6和TNF-α较入口处显著降低(P＜0.05).而常规剂量组中的出口未观察到细胞因子显著下降.IL-10在两组患者治疗前后比较差异均无统计学意义(P＞0.05).结论 在脓毒症诱导的AKI患者中,与需要RRT治疗的的常规CVVHDF剂量相比,高CWHDF剂量增加一些炎性细胞因子的清除,但并不改善患者临床结果.

1 临床资料 患者 男,25岁.因"复杂先天性心脏病(先心病)双向Glenn术后8年,乏力并下肢水肿6年,加重1年"入住华中科技大学同济医学院附属协和医院.患者8年前外院诊断为先心病,右心室双出口(室间隔缺损远离两大动脉),右心室流出道狭窄,行双向Glenn手术治疗,术后患者口唇发绀及体力均有所好转.

目的 探讨布地奈德与复方异丙托溴铵联合雾化吸入治疗慢性阻塞性肺疾病(COPD)的临床疗效.方法 选择2014年9月——2016年2月240例COPD患者为研究对象,根据入院时间分为观察组和对照组各120例,在常规治疗的基础上,对照组加用复方异丙托溴铵雾化吸入,观察组加用布地奈德与复方异丙托溴铵联合雾化吸入.比较两组患者临床症状、炎性因子、肺功能与动脉血气指标、临床疗效等.结果 观察组总有效94.17%明显高于对照组81.67%(x2=8.825,P<0.05);咳嗽缓解时间、气促消失时间、喘息消失时间、肺部体征消失时间均明显短于对照组(t=5.198-16.845,P<0.05);血清白细胞介素IL-6、IL-8明显低于对照组,IL-10含量明显高于对照组(t=11.640-23.007,P<0.05);观察组第一秒末呼吸容积(FEV1)、FEV1/最大呼气流量(FVC)、血氧分压(PaO2)明显高于对照组,动脉血二氧化碳分压(PaCO2)明显低于对照组(t=6.565-9.383,P<0.05).结论 布地奈德与复方异丙托溴铵联合雾化吸入有助于缓解慢性阻塞性肺疾病临床症状,减轻炎病症状态,改善肺功能,提高治疗效果.

目的:本次研究主要探讨沐舒坦联合中药治疗老年慢性支气管炎的临床疗效.方法:选取了2016年2月至2017年2月期间内的80例慢性支气管炎患者作为研究对象,随机分为观察组与对照组各40例,其中对照组采用常规治疗,观察组在常规治疗的基础上采用了沐舒坦联合中药治疗,对比两组患者的临床指标与疗效.结果:观察组的血氧饱和度.排痰量以及平均住院天数均优于对照组,且观察组的总有效率95.0%高于对照组的75.0%,两组之间存统计学意义(P<0.05).结论:针对老年慢性支气管炎患者采用沐舒坦联合中药治疗能够有效提升临床疗效,同时能够改善临床指标并缩短住院时间,值得在临床上进行广泛推广.

Objective To analyze the use of hypoglycemic agents of diabetic adult patients who were managed in the Community Health Service Center of Huazhong University of Science and Technology in Wuhan .Methods By analyzing of fol-low-up record of 647 adults with diabetes of the Community Health Service Center outpatient in 2014 to understand about their drug use .Results The ages of prevalence of adult diabetes were 50 to 79 years old (79 .29% ) ,of which the majority of pa-tients aged 60 or older (73 .11% ) ,men are more than women ;the using of antidiabetic monotherapy accounted for 61 .36% , the two drugs together accounted for 34 .93% ,and three or more drugs accounted for 3 .71% ;α-glucosidase inhibitors ,met-formin ,insulin secretagogues are the highest frequency of use ;outpatient diabetics administered orally based .Conclusion The medication use of diabetes in this community was consisted with the requirement of ChinaGuideline for Type 2 Diabetes (2013 edition) .

Objective:To investigate the clinical characteristics of thyrotoxic heart disease.Methods:The clinical data of 190 cases of patients with thyrotoxic heart disease were analyzed retrospectively.Results:The incidence of heart failure was related to the course of disease.The longer the course of disease,the worse the heart function.Conclusion:Thyrotoxic heart disease was the most common complication of Graves disease.The longer the course of disease,the worse the heart function.

OBJECTIVE To explore the risk factors for pulmonary infections in the patients with uremia so as to meet the purpose of early prevention .METHODS Totally 63 uremia patients with pulmonary infections who were treated from Mar 2012 to Sep 2014 were chosen as the observation group ,meanwhile ,50 uremia patients without pulmonary infections who were treated during the same period were set as the control group .The contents of ser‐um albumin ,globulin ,hemoglobin ,C‐reactive protein ,and serum creatinine were determined ;the length of hos‐pital stay was statistically analyzed .RESULTS The contents of serum albumin and hemoglobin of the observation group were significantly lower than those of the control group .The nutrition status was poorer and the infection was more severer in the observation group ,as compared with the control group ,the difference was significant (P< 0 .05) .The levels of C‐reactive protein and creatinine of the observation group were increasingly elevated , the length of hospital stay of the observation group was significantly longer than that of the control group (P <0 .05) .The infection rate of the observation group was increased with the age ,and the difference was significant (P< 0 .05) .CONCLUSION The high risk factors for the pulmonary infections in the uremia patients include the in‐crease of age ,renal dysfunction ,malnutrition ,and prolonged length of hospital stay .The corresponding preven‐tion measures may facilitate the rehabilitation of the patients .

Objective To evaluate the precision and accuracy of blood glucose meter(BGM ) for community home use testing . Methods According to the In Vitro Diagnostic Test Systems‐Requirements for Blood Glucose Monitoring Systems for Self‐Testing in Managing Diabetes Mellitus in DIN EN ISO15197 :2013 .Capillary blood and venous blood were tested by BGM and the laborato‐ry biochemical analyzer respectively .The measurement results of each BGM were compared with the results of the biochemical ana‐lyzer for conducting the bias analysis .Results In evaluated 20 BGM ,none of them met the requirements of ISO15197 :2013(when blood glucose concentrations < 5 .5 mmol/L ,the bias in 95% of detection results is within the range of ± 0 .83 mmol/L ;when blood glucose concentrations ≥ 5 .5 mmol/L ,the bias in 95% of detection results is within the range of ± 15% .Only 11 imported BGM (55% ) met the state standard .Conclusion The bias of 20 BGM ranged - 28 .7% - 3 .8% ,with the average bias of - 12 .2% . These detection results will bring the large risk of therapy in the diabetic patients .The regular and standardized evaluation of BGM performance may ensure the quality of blood glucose self - monitoring .

<正>假性甲旁减是一种以甲状旁腺功能减退症的症状和体征为临床特征的遗传性疾病,常与特征性骨骼和发育缺陷相关联。1病历摘要患者,女,24岁,因"发作性的四肢麻木伴抽搐17年,再发加重4天伴胸闷、气短"入院。患者于17年前起出现发作性四肢麻木、手足抽搐,伴四肢肌肉强直,无意识丧失、口角歪斜、

Objective With the application of SPSS 19 software to analyze major factors of anxiety disorder with a sample of students form a university in Wuhan,this paper provides constructive suggestions to relieve students′ anxiety in terms of individual developments as well as external environmental controlling factors,contributing to the researches on emotional management and personality development theories for university students.Objective A SAS questionnaire survey was conducted among 200 students who had chosen a health education course in a university.Method It showed that the proportion of anxiety-prone students was 6.5%(13 among 200),4.2% and 12.9% for male and female students respectively.The percentage for science and liberal arts students is 5.6% and 7.9%,which implied no significant difference(χ2=0.285,P=0.593).The result of Logistic regression analysis showed that factors such as the burden of learning,personalities and temperaments all had significant impacts on student anxiety.Conclusion To prevent and get rid of anxieties,the paper suggests that joint efforts,active coordination and cooperation between individual students and university education system are vital.

Objective To observe the clinical efficacy of alprostadil combined with valsartan in treatment of patients with diabetic nephropathy.Methods A total of 74 patients with diabetic nephropathy were randomly divided into two groups.Patients in control group were treated with valsartan on the basis of basic treatment,and patients in observation group were treated with alprostadil and valsartan on the basis of basic treatment.The course of treatment in two groups was 3 months.The changes in 24 h urinary protein excretion(24 h Upr),blood levels of urea nitrogen(BUN) and creatinine(Cr) in two groups were observed before and after treatment.Results The total rate of efficacy in patients of observation group(81.1%) was significantly higher than that of patients in control group(64.9%)(P < 0.05).The indicators of 24 h Upr,Scr and BUN in patients of two groups were all decreased,but the indicator of 24 h Upr in patients of observation group declined more significantly than that of control group(P < 0.05).Conclusion The treatment of alprostadil combined with valsartan for diabetic nephropathy has good efficacy.It is worthy to be recommended for clinical application.

目的探讨老年原发性甲状腺功能减退症(甲减)的临床特点及误诊原因,以提高临床诊断水平.方法回顾性分析40例老年甲减患者误诊的临床资料.结果老年性甲减起病隐袭,临床表现多样复杂.误诊为冠心病l0例,脂肪肝7例,慢性胃炎5例,胸腔积液5例,心包积液4例,慢性心功能不全3例,高血压病2例、贫血2例和老年痴呆症2例.经甲状腺功能检查确诊为甲减,予甲状腺片治疗后病情恢复良好.结论老年人缺乏典型症状,临床表现多样,极易造成误诊、误治,提高对老年甲减的认识,综合分析病情,是明确诊断、减少误诊的关键.

<正>病历简介患者,女,24岁,因"发作性四肢麻木伴抽搐17年,再发加重4天伴胸闷、气短"入院。患者于17年前起出现发作性四肢麻木、手足抽搐,伴四肢肌肉强直,无意识丧失、口角歪斜、大小便失禁。多于感冒、劳累后夜间发作,多次在当地医院诊断"缺钙、

患者男,71岁.1989年因对油烟、冷热空气、花粉过敏,诊断"支气管哮喘"住院.以后反复发作,每年住院治疗2～4次,恢复期未治疗.2000年因"急性心肌梗死"诊断为冠心病、糖尿病、高甘油三酯血症.2001年接受全科医疗服务.