Objective To discuss the effect of early rehabilitation on intensive care unit（ICU） acquired weakness in patients with mechanical ventilation. Methods A total of 100 cases of mechanically ventilated patients patients with ICU acquired weakness were studied and randomly divided into treatment group and control group, with 50 cases in each group. The control group was treated with conventional ICU care, and the treatment group was treated with early rehabilitation on the basis of the control group. The duration of ICU stay, duration of mechanical ventilation, death at 28 d of hospitalization and changes in muscle parameters before and after intervention were compared between the two groups. Results The treatment group had duration of ICU stay of（6.41±0.45） d and mechanical ventilation of（5.01±1.03） d, which were shorter than those of（8.77±0.71） and（6.51±1.99） d in the control group; the mortality rate at 28 d of hospitalization was 4.00% in the treatment group,which was lower than that of 22.00% in the control group; the differences were statistically significant（P＜0.05）.After the intervention, the transverse area of the rectus femoris, thickness of the rectus femoris, thickness of the vastus intermedius, rate of diaphragm thickening and activity of diaphragm in both groups were better than those before the intervention in this group, and the treatment group was better than the control group. The differences were statistically significant（P＜0.05）. After the intervention, the rate of diaphragm thickening in the two groups were better than that before the intervention in this group, and the difference was statistically significant（P＜0.05）,but there was no statistically significant between the two groups（P＞0.05）. Conclusion Application of early rehabilitation has ideal effect in improving ICU acquired weakness in patients with mechanical ventilation, and is worthy of popularization and application.

目的:探讨硫代硫酸钠联合中医外治法对血透患者钙化防御的临床疗效.方法:将2020年1月—2021年1月于我院就诊钙化防御的80例血透患者纳入研究,运用随机数据表法进行分组,对照组40例予以常规治疗,观察组40例在此基础上予以硫代硫酸钠联合中医外治法.比较两组患者的钙化防御评分、视觉模拟量表评分(VAS)、生活质量评分、治疗总有效率.结果:治疗后两组患者的钙化防御评分、VAS评分均降低,且观察组两项评分均低于对照组,差异有统计学意义(P<0.05);治疗后两组患者生理职能、心理健康、情绪职能评分均升高,且观察组各生活质量评分优于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05).结论:硫代硫酸钠联合中医外治法对血透患者钙化防御的疗效突出,能缓解钙化部位疼痛,改善皮肤溃疡,提高睡眠及生活质量,值得临床推广.

目的:分析血液透析相关性低血压的中医证型分布特点及发生相关因素.方法:选取2018年6月至2020年1月在江西省中西医结合医院住院部及门诊确诊为血液透析相关性低血压的患者60例为病例组,选择同期无血液透析相关性低血压的61例患者为对照组.分析血液透析相关性低血压患者中医证型,同时对患者临床资料进行回归性分析,探讨透析相关性低血压发生的相关因素.结果:两组尿素氮、血肌酐水平比较,差异无统计学意义(P>0.05).病例组血红蛋白、血清白蛋白、左室射血分数低于对照组,体质量增长、超滤量、进食人数大于对照组,差异有统计学意义(P<0.05).影响因素分析显示,血红蛋白、血清白蛋白、左室射血分数、体质量增长、超滤量、进食情况为血液透析相关性低血压发生的影响因素.病例组本虚证以脾肾阳虚证所占比例最高,其次是脾肾气虚证和气阴两虚证;对照组以脾肾气虚证所占比例最高,其次是脾肾阳虚证和气阴两虚证.病例组中脾肾阳虚证明显高于对照组,差异有统计学意义(P<0.05).两组标实证以湿浊证所占比例最高,其次为血瘀证和湿热证.两组中医标实证分布比较,差异无统计学意义(P>0.05).结论:血液透析相关性低血压与血红蛋白、血清白蛋白、左室射血分数水平低相关,与透析间体质量增长、透析超滤量过大及进食有关,证型多表现为脾肾阳虚证.

目的:探讨益气温阳法配合中药保留灌肠辅助治疗IV型心肾综合征的临床效果.方法:2017年3月至2019年3月本院收治的41例IV型心肾综合征患者,按随机数字表法分为对照组21例与观察组20例,对照组采用基础治疗,观察组在此基础上采用益气温阳法配合中药保留灌肠辅助治疗,对比两组患者中医积分,左心功能及肾功能.结果:治疗2 w后,观察组中医症状积分低于对照组,心功能及肾功能改善优于对照组(P<0.05).结论:益气温阳法配合中药保留灌肠辅助治疗可缓解IV型心肾综合征患者的临床症状,改善左心功能,保护肾功能,值得临床推广.

目的:探讨血压晨峰及残余肾功能水平对尿毒症患者桡动脉钙化的影响.方法:收集2016年4月～2018年3月行动静脉内瘘术患者的桡动脉标本42例,根据是否存在桡动脉钙化分为钙化组18例和无钙化组24例,再根据血管钙化程度将钙化组分为轻度钙化组11例和重度钙化组7例.记录血磷、甲状旁腺激素、晨峰血压,通过估算内生肌酐清除率来代替残余肾功能.对比钙化组与无钙化组及轻度钙化组与重度钙化组的残余肾功能水平、血磷水平、甲状旁腺激素水平、血压晨峰.结果:钙化组的血磷、甲状旁腺激素、血压晨峰水平均高于无钙化组,残余肾功能低于无钙化组(P＜0.05);重度钙化组的血磷、甲状旁腺激素水平、血压晨峰均明显高于轻度钙化组,残余肾功能低于轻度钙化组(P＜0.05).结论:随着血压晨峰值增加,残余肾功能越少,尿毒症患者桡动脉钙化程度越严重.

目的 观察通心络胶囊联合盐酸贝尼地平片治疗冠状动脉痉挛性心绞痛(CSA)的临床疗效,并对患者的生活质量进行评价.方法 将收治的327例CSA患者按随机数字表法分为对照组(n=163)和治疗组(n=164),两组患者均给予一般基础治疗,对照组患者给予盐酸贝尼地平片,口服,治疗组患者在对照组患者治疗基础上加服通心络胶囊,比较两组患者治疗前后的临床症状分级量化积分、心绞痛改善情况、血脂指标[血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平、血液流变学指标[全血高切黏度(WBV-HS)、全血低切黏度(WBV-LS)、血浆黏度(PV)、血浆纤维蛋白原(FIB)及红细胞压积(PCV)]水平、血清相关指标[肿瘤坏死因子-α(TNF-α)、血清肌钙蛋白I(cTnI)、血管内皮生长因子(VEGF)、内皮素-1(ET-1)、超敏C反应蛋白(hs-CRP)]水平等,并比较两者患者的临床疗效、不良反应发生情况及生活质量评价情况.结果 治疗后,治疗组患者的各临床症状分级量化积分、心绞痛改善情况、血脂指标水平、血液流变学指标水平及血清相关指标均明显优于对照组患者(P<0.05);治疗组的临床总有效率显著高于对照组(93.29％比84.05％,χ2=6.961,P=0.008);两组患者治疗期间均无明显不良反应发生;治疗组治疗后的生活质量评分均显著高于对照组(P<0.05).结论 通心络胶囊联合盐酸贝尼地平片治疗CSA能显著提高临床疗效,明显改善临床症状及血脂、血液流变学和血清相关指标水平,且安全性好,能有效提升患者的生活质量,值得临床推广.

目的:探析重症超声联合被动抬腿试验指导感染性休克液体复苏的价值.方法:选取惠州市中心人民医院收治的120例感染性休克患者为研究对象,随机分为两组,每组60例.对照组给予漂浮导管指导液体复苏,观察组采用重症超声联合被动抬腿试验指导,对两组的指导效果进行比较.结果:复苏6h,两组患者的平均动脉压、中心静脉压、心率、乳酸、碱剩余值均明显优于复苏前,差异具有统计学意义(P＜0.05);观察组的ICU住院时间、机械通气时间、6h复苏达标率均优于对照组,差异具有统计学意义(P＜0.05).结论:重症超声联合被动抬腿试验指导感染性休克液体复苏的效果理想.

目的:分析比较重症超声与脉波指示剂连续心排血量(PiCCO)监测指导感染性休克液体复苏的效果.方法:选取2015年1月至2017年12月于惠州市中心人民医院接受液体复苏治疗的56例感染性休克患者为研究对象,采用数字随机表达法分组,每组28例.对照组采用PiCCO监测指导,观察组采用重症超声监测指导,对两组的复苏效果及各项指标进行对比.结果:两组患者复苏6h后的收缩压、舒张压、中心静脉压、平均动脉压均明显优于复苏前,差异具有统计学意义(P＜ 0.05),复苏6h、12h,观察组患者的尿量多于对照组,液体正平衡量低于对照组,差异具有统计学意义(P＜0.05).两组28 d死亡率、血管活性药物用量对比无显著差异,差异无统计学意义(P＞0.05),观察组需连续性肾脏替代治疗(CRRT)治疗的例数明显少于对照组,差异具有统计学意义(P＜0.05).结论:相对于PiCCO,用重症超声对感染性休克患者液体复苏治疗进行监测指导可获得更为理想的效果,同时可降低不良事件的发生风险,提高液体复苏治疗的安全性.

目的 探讨PiCCO指导脓毒症心肌抑制患者液体复苏的效果.方法 选取2016年12月～2017年12月入住惠州市中心医院重症医学科的脓毒症患者100例,根据PICCO监测的GEF分为心肌抑制组(56例)和正常组(44例),3h内给予30mL/kg的积极液体复苏,比较两组患者液体复苏后血流动力学参数的变化.结果 (1)治疗前,两组患者MAP、HR、CVP、CI、EVLWI及GEDVI差异无统计学意义(P＞0.05);心肌抑制患者SVI、GEF、LVSWI及dPmx均较正常组患者降低,差异有统计学意义(P＜0.05).(2)经液体复苏后,两组患者的液体输注量差异无统计学意义(P＞0.05);两组患者MAP、HR、CVP及CI均较治疗前有所改善,两组患者治疗后差异无统计学意义(P＞0.05);治疗后心肌抑制组患者EVLWI和GEDVI均显著高于正常值患者,差异有统计学意义(P＜0.05);治疗后心肌抑制患者SVI、GEF、LVSWI及dPmx仍然较正常组患者降低,差异有统计学意义(P＜0.05).结论 脓毒症心肌抑制患者需要更少的液体输注量,可以根据GEDVI的变化值来指导脓毒症患者如何实施液体复苏治疗,保证足够的液体参与血液循环,并且血管外肺水合适,从而明显改善患者的临床状况及预后.

Objective To observe the clinical effect of combined internal and external traditional Chinese medicine on treatment of acute gouty arthritis and high uric acid hematic disease. Methods The patients with acute gouty arthritis were randomly divided into the observation group and control group by using digital table method, which were given life adjust-ment, diet control and alkalize urine therapy. The obsevation group was treated with oral modified Siwei powder and exter-nal modified Sihuang powder. The control group was administrated with oral colchicine and allopurinol tablets. The changes of blood uric acid (UA), serum creatinine (Scr), urea nitrogen (BUN), serum c-reactive protein (CRP) and blood sedimentation (ESR), joint swelling pain improvement were observed in the two groups before and after treatment, treatment for 2 weeks. Results The total effective rate of the observation group was for 90.3%, total effective rate of control group was for 74.2%, the difference was statistically significant (P<0.05). The UA in the two groups before and after treatment was compared, which was significantly lower after treatment than before treatment (P<0.05). Comparison between the two groups after treatment, the observation group was lower than the control group (P<0.05). The Scr and BUN in the two groups before and after treat-ment had no obvious difference (P>0.05). The CRP and ESR in the two groups after treatment were significantly lower than that before treatment (P<0.05). Comparison between groups after treatment, the observation group was reduced significantly than the control group (P<0.05). Conclusion The combined internal and external application traditional Chinese medicine is safe and effective in treatment of acute gouty arthritis and high uric acid hematic disease, and shows certain advantages in reduc-ing the UA, ESR and CRP.

目的 探讨益肾排毒汤内服配合灌肠治疗慢性肾衰竭疗效.方法 选取于2014年1月-2015年5月收治的慢性肾衰竭患者75例,随机分为对照组37例和观察组38例,对照组患者予以常规西药治疗,观察组患者实施益肾排毒汤内服配合灌肠治疗,观察比较2组患者的治疗效果.结果 治疗后观察组中医证候积分及主观综合营养评估评分、生存质量各项指标评分、总有效率、肾功能指标均明显优于对照组(P＜0.05).结论 益肾排毒汤内服配合灌肠治疗慢性肾衰竭疗效好,值得在临床实践中推广应用

目的 分析被动抬腿试验(PLRT)联合PiCCO预测老年脓毒性休克患者容量反应性的价值.方法 采用前瞻性、观察性队列设计方法,收集2014年9月～2015年9月惠州市中心人民医院急诊ICU的老年脓毒性休克患者21例,所有患者进行序贯器官衰竭估计评分(SOFA)及APACHE-Ⅱ评分,采用PLRT和补液试验(10 min内输注250 mL生理盐水),结合PiCCO技术,测定PLRT前后和补液前后心率(HR)、中心静脉压(CVP)、动脉收缩压(SAP)、平均动脉压(MAP)、脉压(PP)、脉搏指示心指数(PCCI)、每搏量(SV)等参数变化,将患者分为有反应组和无反应组,通过受试者工作曲线评价PLRT预测容量反应性价值.结果 21例患者共进行67次PLRT和补液测试,其中26例次患者补液试验有反应.经PLRT,容量有反应组患者PLRT后PCCI[(4.6±1.1) L/(min· m2)]、SV[(80±7)mL]较PLRT前[(4.1±0.6)L/(min·m2)、(66±7)mL]明显增加,差异均有统计学意义(P＜ 0.05);PLRT试验前后患者HR、CVP、SAP、MAP比较,差异无统计学意义(P＞0.05).PLRT-△SV (PLRT诱导的每搏量变化率)与补液试验后△SV(补液试验诱导的每搏量变化率)呈正相关(r=0.91,P＜0.05);PLRT-△PP与△SV呈正相关(r=0.84,P＜0.05).PLRT-△SV预测容量反应性最佳临界值、灵敏度和特异度分别为14.5％、92.3％、87.8％,PLRT-△PP预测容量反应性最佳临界值、灵敏度和特异度分别为12.0％、84.6％、85.4％.结论 PLRT联合PiCCO可用来评估老年脓毒性休克患者容量反应性.PLRT-△SV可作为指导容量复苏的可靠指标.PLRT-△PP可作为PLRT-△SV的替代指标.

Objective To investigate the effects of dobutamine on the improvement of perfusion levels and ox-ygen metabolism in the elderly patients with septic shock. Methods A total of 40 cases of the elderly patients with sep-tic shock, who admitted to ICU of our hospital and underwent fluid resuscitation treatment with dobutamine from March 2014 to December 2015, were selected as research objects. The heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), cardiac output index (CI), oxygen delivery (DO2), central venous oxygen saturation (ScvO2), lactic acid (Lac) and Lac clearance of before treatment, and 6 h and 24 h after treatment were recorded. Results The HR of pa-tients of preoperative [(112 ± 17) times/min] was significantly higher than postoperative 6 h [(101 ± 16) times/min] and 24 h [(94±10) times/min] (P<0.05). The MAP, CO, CI levels of postoperative 24 h [(68±11) mmHg, (4.3±0.2) L/min, (2.4 ± 0.4) L/(min·m2), respectively] were significantly higher than preoperative [(86 ± 10) mmHg, (6.0 ± 0.3) L/min, (4.1±0.3) L/(min·m2), respectively] (P<0.05). The DO2 of postoperative 6 h [(0.96±0.11) L/min and 24 h [(1.21±0.58) L/min] were significantly higher than preoperative [(0.80 ± 0.06) L/min] (P<0.05). The ScvO2 of postoperative 24 h [(77 ± 6)%] was significantly higher than preoperative [(49 ± 5)%] (P<0.05). The Lac of postoperative 24 h [(2.67 ± 0.57) mmol/L] was significantly lower than preoperative [(5.81 ± 1.98) mmol/L] (P<0.05). The Lac clearance rate of postoperative 24 h [(56.43 ± 2.65)%] was significantly higher than postoperative 6 h [(36.31 ± 2.21)%] (P<0.05). Conclusion The dobuta-mine treatment for the elderly patients with septic shock can significantly improve the patient's perfusion levels and oxy-gen metabolism, which is worthy of clinical application.

目的 对应用中西医结合方案对患有慢性肾功能衰竭疾病的患者实施治疗的临床效果进行研究.方法 选择在我院就诊的患有慢性肾功能衰竭疾病的患者88例,随机分为对照组和治疗组,平均每组44例.采用单纯西医疗法对对照组患者实施治疗;采用中西医结合方案对治疗组患者实施治疗.对比两组患者慢性肾功能衰竭疾病药物治疗效果、肾功能各项指标水平在治疗前后的改善幅度、肾功能恢复正常时间和用药治疗总时间、药物不良反应情况等.结果 治疗组患者慢性肾功能衰竭疾病药物治疗效果明显优于对照组;肾功能各项指标水平在治疗前后的改善幅度明显大于对照组;肾功能恢复正常时间和用药治疗总时间明显短于对照组;药物不良反应明显少于对照组.结论 应用中西医结合方案对患有慢性肾功能衰竭疾病的患者实施治疗的临床效果非常明显.

Objective To investigate the clinical efficacy of levocarnitine for elderly diabetic patients with heart failure. Methods Forty- eight elderly diabetic patients with heart failure were randomly divided into two groups. The control group was treated with conventional therapy for 14 days,the treatment group was treated with conventional therapy plus intravenous infusion of 3. 0 g of levocarnitine per day for 14 days. The 6min walk test,echocardiography and plasma natriuretic peptide,glucose,lipids,and insulin levels were examined in two groups of patients be-fore and after treatment. Results The 6min walk test,left ventricular end - diastolic diameter(LVEDD),left ventricular end - systolic diameter (LVESD),left ventricular ejection fraction(LVEF),fractional shortening(FS)and E / A ratio significantly improved( P ﹤ 0. 05)after treat-ment in both groups,and the improvements of 6min walk test,LVEF and E / A ratio of treatment group were more significant than control group( P ﹤ 0. 05). The BNP,FBG and HOMA - IR improved over the treatment in the both groups,they were more significant( P ﹤ 0. 05)in the treat-ment group;the improvements of BNP,FBG,TC and HOMA - IR were significant compared with the control group( P ﹤ 0. 05). The clinical effi-cacy of the treatment group was significantly higher than control group( P ﹤ 0. 05). Conclusion Levocarnitine can significantly correct myocardi-al energy metabolism in elderly diabetic patients with heart failure,regulate myocardial diastolic and systolic function,improve insulin resistance, thereby improve the clinical symptoms and the prognosis of patients,slow the progression of heart failure.

Objective To observe the clinical efficacy and safety of liraglutide on obese type 2 diabetes pa-tients with resistant to combinations of oral hypoglycemic drugs and insulin. Methods Twenty one obese type 2 dia-betic patients with resistant to combinations of oral hypoglycemic drugs and insulin were investigated. Liraglutide were added to the original treatment strategy for 12 weeks and its effects were observed on fasting blood glucose (FBG), 2h postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbA1c), body mass index (BMI), blood lip-ids, blood pressure, fasting insulin (FIns), homeostasis model assessment of insulin resistance index (HOMA-IR), ho-meostasis model assessment index of pancreatic β cell secretion (HOMA-β), insulin dosage and adverse reactions. Results The patient's FBG, 2hPBG, HbA1c, TG, BMI, FIns, HOMA-IR, and insulin dosage decreased significant-ly after 12 weeks of treatment with Liraglutide (P<0.05). HOMA-β increased remarkably after Liraglutide treat-ment (P<0.05). The main adverse reactions were gastrointestinal reactions and low blood sugar, both of which were mild and transient. Conclusion For obese type 2 diabetic patients with poorly controlled blood glucose even underwent combination therapy of multiple oral hypoglycemic drugs and insulin, liraglutide can effectively control blood sugar, improve insulin resistance and insulin sensitivity, and enhance isletβcells function.

目的:探讨益肾化湿颗粒联合厄贝沙坦治疗糖尿病肾病的临床效果.方法:选取我院自2011年2月-2013年2月间门诊及住院的糖尿病肾病(Ⅲ期-Ⅳ期)患者60例分为治疗组和对照组各30例,2组均常规控制血糖、降血脂等相同的基础治疗.对照组口服厄贝沙坦150mg,1次/d;治疗组口服厄贝沙坦150mg,1次/d,并口服益肾化湿颗粒10g,3次/d.2个月为一个疗程,共2个疗程.2组均检测治疗前后的血肌酐、血浆白蛋白、甘油三酯、总胆固醇、24h尿蛋白定量.结果:2组在治疗2个疗程前后比较检测血肌酐、甘油三酯、总胆固醇、血浆白蛋白、24h尿蛋白定量,结果均有统计学意义(P＜0.05),但治疗组改善情况好于对照组(P＜0.05).结论:益肾化湿颗粒联合厄贝沙坦治疗糖尿病肾病比单用厄贝沙坦疗效显著,可明显改善病情.

Objective:To Observe the clinical efficacy of Sang Ting Xiefei decoction in uremic patients with Lung infection.Methods: 40 patients met the inclusion criteria of uremic Lung infection,Were randomly divided into a control group and a treatment group;The control group(n = 20) were given routine western medicine;Treatment group(20 patients) were given Sang Ting Xiefei de coction on the basis of routine western medicine,treatment last two weeks,the clinical efficacy,C-reactive protein(CRP) and markedly time were observed between the two groups.Results : the Total effective rate in treatment group was 95%,The total effective rate in the control group was 65%,The difference was statistically significant(P 0.05);The average time in treatment was 5.9 ± 2.3 days,Which was Significantly shorter than the control group(P 0.01);Compared with the observation group CRP in treatment group decreased significantly(P 0.05).Conclusion : Sang Ting Xiefei decoction is effective in the treatment of uremic Lung infec tion,it shorten the healing time.

目的:观察复方氨基酸注射液（9AA）（肾安）联合左卡尼汀对维持性血液透析（MHD）高龄患者营养状况的影响。方法:将40例MHD高龄患者随机分为3组:肾安联合左卡尼汀组（13例）、左卡尼汀组（16例）、常规营养治疗组（11例）;观察各组治疗前后血清白蛋白（Alb）、前白蛋白（PA）、转铁蛋白（TRF）、胆固醇（TC）、甘油三酯（TG）、肱三头肌处皮褶厚度（TSF）、上臂肌围（MAMC）和体重指数（BMI）等指标,计算标准化的氮表现率蛋白相当量（nPNA）、透析充分性,并检查水钠潴留情况;疗程为3个月。结果:治疗后肾安联合左卡尼汀组患者Alb、PA、TRF、BMI、TSF、MAMC、TC、TG水平均显著高于左卡尼汀组和常规营养治疗组（P＜0.01）;左卡尼汀组上述指标均较常规营养治疗组显著增高（P＜0.01）;而3组间的nPNA、透析充分性及水钠潴留发生率的差异均无统计学意义（P＞0.05）。结论:肾安联合左卡尼汀可进一步改善MHD高龄患者的营养不良状况。

To discuss the effect of small dose diuretics and Irbesartan on the blood glucose of hypertension patients.120 patients were randomly assigned to Group A(60 cases)treated with Irbesartan,Group B(60 cases)treated with Irbesartan combined with Hydrochlorothiazide,and the control group with 30 normal people.Blood pressure,fasting plasma glucose(FPG)and fasting insulin(Fins)were observed before and after treatment,and the insulin sensitivity index(IAI)calculated.Before treatment,there were significant differences between treatment groups and the control group in Fins,IAI and blood pressure(P < 0.05).Differences in Fins,IAI and blood pressure in treatment groups were significant before and after treatment(P < 0.05).After treatment,there were no significant differences between Group A and Group B in Fins,IAI and blood pressure(P > 0.05).Insulin resistance more obviously exists in hypertension patients than in normal people.Irbesartan can effectively improve the insulin resistance.Irbesartan combined with small dose diuretics doesn't influence the blood glucose of hypertension patients.