<正>患者,男性,60岁。主诉:发现血压升高16年,加重伴头晕1月。现病史:16年前体检时发现血压升高,当时150/90mmHg(1mmHg=0.133kPa),间断服用降压药。以后血压逐渐升高,最高达210/105mmHg,

Objective:To observe the clinical characteristics of recurrent urinary tract infection of female patients in different ages stages and to evaluate curative effect on using antibiotics only and on combination of antibiotics and Chinese herbal drugs. Methods:A total of 156 female patients with recurrent urinary tract infection were observed,including 90 cases in reproductive age and 66 cases during climacteric and gerontism period.All patients accepted antibiotics therapy and part of them combined with Chinese herbal drugs therapy which had the effects on clearing away heat evil and promoting diuresis.Clinical symptoms,sighs,and laboratory examination results were recorded pre-therapy and post-therapy.A half year following up was done after pharmacotherapy conclusion. Results:Female patients with recurrent urinary tract infection during climacteric and gerontism period had less typical symptoms and higher recurrence rate than the patients in reproductive age.Antibiotics combined with Chinese herbal drugs therapy could decrease recurrence rate and ameliorate clinical symptom. Conclusion:The clinician should think about clinical characteristics of different ages and select reasonable projects when treating female patients with recurrent urinary tract infection.

<正>1临床资料患者男性,68岁。因间断胸闷、心悸半年于2008年6月7日入院。半年余前开始出现活动后胸闷、憋气,伴心悸,无胸痛,休息或服用速效救心丸后可缓解。甲状腺功能亢进病史20年。2型糖尿病病史15年,近期发现眼底病变。问歇性跛行2年余,跛行距离200m。吸烟史50年,10支/d。有糖尿病家族史。体格检查:血压150/80mm Hg。双侧颈动

<正>1临床资料患者男性,60岁。因发现血压升高15年,加重1月余于2010年10月27日入院。患者15年前体检时发现血压升高,测血压150/90 mm Hg,诊断为"高血压",间断口服降压药物治疗,未监测血压。近10年来先后服用多种降压药物,自测血压维持在155～165/80～90 mm Hg,无不适。1个月前因"双下肢丹毒"入当地医院,调整降压药物(具体不详)后出现血压波动,在145～210/80～105 mm Hg之间,伴头晕、站立不稳,无头痛、视物旋转、黑矇。入我院前口服降压药物为吲达帕胺2.5 mg/d,马来酸依那普利10 mg/d,复方

Course integration is one of the curriculum reform focus of the long schooling for higher medical education.Standardized patient (SP) and objective structured clinical examination (OSCE) could offer an exam atmosphere with impersonality and justice for the medical students in clinical skill assessment,which have been widely applied by medical colleges and schools for medical educational evaluation.Internal medicine department began to use SP/OSCE on urinary system course integrated assessment test in 2008.They had achieved some experiences on training SP of urinary system diseases, and on organizing OSCE assessment station, and on writing OSCE examination bank, and on constructing assessment system.Thus to intensify education reform on long schooling clinical students from the angle of course assessment system.

Firstly the author reviewed the background of carrying out problem-based learning (PBL) teaching methods during the period of “early clinical contact” of the 8-year medical program students. Then they introduced the methods of carrying out PBL to those students in the division of nephrology of Huazhong University of Science and Technology. They pointed out that the advantage of carrying out the PBL methods was not only good for medical students to learn basic theory as well as to cultivate the clinical capacity, but also good for clinical intern to review the theoretical knowledge and to improve the teaching capacity of the clinical tutors. These established the helpful basis for studying clinical courses , doing clinical practicing jobs, and undertaking medical work alone of those 8-year medical program students in the later period.

Objective To assess the relationship between pulse wave velocity (PWV) and cardiac function in patients with coronary artery disease.Methods The 366 patients with coronary artery disease were enrolled in the study. The informations of clinical and ultrasonic cardiography were collected.The brachial-ankle PWV (baPWV) was measured noninvasively.Results The baPWV was significantly positively correlated with interventricular septal thickness (TVST,r = 0.306,P<0.001),posterior wall thickness (PWT,r = 0.365,P<0.001),left ventricular mass index (LVMI,r = 0.293,P<0.001),E/Ea (r=0.458,P<0.01) and was negatively correlated with ejection fraction (EF,r= -0.210, P < 0.001 ) ,Ea ( r = - 0.428 ,P < 0.01 ) ,Ea/Aa ( r = - 0.331 ,P < 0.05 ).Except for the effect of hypertension,etc, the partial correlation analysis showed that baPWV was significantly correlated with IVST (r = 0.231 ,P < 0.001 ) ,PWT (r =0.320,P<0.001),LVMI (r =0.233,P<0.001),EF (r= -0.182,P<0.01),Ea (r= -0.429,P<0.01), Ea/Aa ( r = - 0.339 ,P < 0.05 ) and E/Ea (r = 0.437 ,P < 0.01 ).The baPWV values were significantly different among NYHA Ⅰ ,NYHA Ⅱ ,NYHA Ⅲ and NYHA Ⅳ groups ( P < 0.05 ).Conclusions The baPWV is correlated with left ventricular hypertrophy,left ventricular systolic and diastolic function,clinical cardiac function,BaPWV could be used as an indicator in patients with coronary artery disease.

Objective: To investigate the use of antibiotics in 1333 inpatients in our hospital for reference of clinical rational use of antibiotics. Methods:Survey 2009 April 15 to May 15 in our hospital within one month of 1333 cases of clinical inpatients of departments of information,using the pharmacy software system.Resuits:Inpatient utilization rate of antibiotics was 76.52%,DDDs of the the top 10 antibacterial drugs were β-lactam antibiotics accounted for six varieties of the highest rates; The top three DDDs of antimicrobial agents were etimicin,ornidazole and Cefmenoxime respectively; There are seven kinds drugs of DUI≤1,accounting for 70%,there are three kinds drugs of DUI>1,accounting for 30%; the use of antibiotics in our hospital mainly in monotherapy and the percentages of antibiotics used in single kind was 83.43%,combination therapy mainly concentrated in two joint medication,utilization rate was 63.24%.Conclusions: The overall use of antibiotics in our hospital was on the high side, most of the varieties of drug utilization index (DUI) is basically rational,the joint use of antibiotics was basically rational,there was still irrational phenomenon in our hospital,We should strengthen the supervision and management in the use of antibiotics.

目的:了解我院护肝药的应用情况。方法:利用药房软件系统对我院2009年3～4月的住院患者护肝类药物的科室分布,用药频度,销售金额排序等进行统计分析。结果:结核病研究所患者使用率最高,为88.61%;注射用还原型谷胱甘肽用药频度占37.18%;在调查的20种护肝药品中药物利用指数大于1的有5种,占所有品种的25%。结论:我院护肝类药物中注射用还原型谷胱甘肽用药频度列首位,多数护肝药使用合理,但少数存在不合理现象。

Objective:To investigate the use of the Drugs of immunoenhancer in 1527 Inpatients in our hospital for reference of clinical rational use of Immunoenhancer.Method:The use of Immunoenhancer in 1527 Inpatients in our hospital from March to April 2009 was analyzed using pharmacy software system.Result:The percentage of patients received the Immunoenhancer in our institute of Tuberculosis was 90.25%,in other department was 21.23%.The percentages of single kind used or in two or three or four kind used concomitantly were 85.94%、37.35%、6.63%and 1.21%respectively.Leading the list in respect of department were Tuberculosis ICU,TuberculosisⅢdepartment,TuberculosisⅡdepartment,TuberculosisⅠdepartment,and TuberculosisⅣdepartment;Ranking the DDDs of Immunoenhancer were Mycobacterium Phlei F.U.36 Injection,Thymopolypeptides for Injection,Bozhi Glycopeptide Injection, Thymopentin Injection,Recombinant Human Interleukin-2(125Ala) Injection and Ubenimex Capsules;There were 7 drugs of DUI beyond 1,the percentage was 21.21%.Conclusion:The utilization of Immunoenhancer in our hospital were basically ration,but also had the irrational use of Immunoenhancer.

<正> 头孢替安为半合成的第二代头孢菌素,是杀菌性头孢菌素类广谱抗菌药物,头孢替安不但对革兰阳性菌有效,而且对革兰阴性菌如流感嗜血杆菌、大肠杆菌、克雷白菌、奇异变形菌等的作用更强,对肠杆菌、枸橼酸杆菌、吲哚

Objective:To observe the curative effect and security of nicardipine combined with metoprolol succinate sustained-release tablet on renal hypertension.Method:65 renal hypertension patients were randomly divided into two groups.The patients in the nicardipine group were treated with nicardipine 80 mg q8h,while the patients in the therapy group were treated with nicardipine 40mg qd and metoprolol succinate sustained-release tablet 47.5-95mg qd for 8 weeks.Their blood pressure,heart rate,hepatic function,renal function,blood glucose and lipid were observed and recorded before and after the treatment.Result:The total efficiency was 74.4%in the controlled group and 88.5%in the therapy group,respectively. There were no obvious changes or obvious adverse reactions in their heart rate,hepatic function,renal function,blood glucose and lipid after the treatment.Conclusion:Nicardipine combined with metoprolol succinate sustained-release tablet is efficient and safe but more efficient than nicardipine alone in the treatment of renal hypertension.

Objective:To observe the therapeutic effect and safety of nicardipine on chronic renal failure patients with renal hyper- tension.Method:One hundred and thirteen chronic renal failure patients with renal hypertension were treated with nicardipine for 8 weeks,the initial dose was 40 mg q12h,the maximal dose was 80 mg q8h.Blood pressure,heart rate,renal function were detected be- fore and after treatment.Result:Total efficacy of nicardipine on renal hypertension was 91.2%.There were no obvious changes of heart rate and renal function after treatment and no obvious adverse event was showed.Conclusion:Nicardipine is efficiacy and safe on the treatment of chronic renal failure patients with renal hypertension.

Objective:To analyze clinical manifestation and pathogenic bacterium distribution of female urinary tract infection patients during climacterium and senectitude.Methods:The data of 117 female urinary tract infection patients during climacterium and senectitude were collected.Their clinical manifestation,foundational diseases,therapeutic efficacy and urinary pathogenic bacterium detection were analyzed.Results:The clinical manifestation of most female urinary tract infection patients during climacterium and senectitude were atypical.Part of them had foundational diseases.Detection rate of urine culture was low,the pathogenic bacteria mainly consisted of Gram-negative bacteria.Symptomatic relief rate was low after treatment.Conclusion:Clinical manifestation of female urinary tract infection patients during climacterium and senectitude are different from other crowds.Analyzing their clinical characteristic and pathogenic bacterium distribution will be useful for chosing therapeutic strategy for those patients.

<正>患者,男,83岁,因“咳嗽、咳痰、喘2d,发热1d”于2003年12月30日入院。入院前两天患者曾在家自服盐酸莫西沙星(拜复乐,拜耳医药保健有限公司,批号102916)400 mg,qd,共2 d,因效果不好住院治疗。既往有慢性喘息性支气管炎、冠心病、心功能不全、高血压病、糖尿病及脑血管病后遗症史,长期服用扩冠、降压和降糖药物治疗。磺胺类药物过敏史。入院体检:T 36．9℃,P 89次·min-1,R 27次·min-1,BP166／89 mmHg。双上肢和躯干皮肤可见突出于皮肤表面的红色斑丘疹。双肺可闻及多量痰鸣音和少量湿啰音,HR 89次·min-1,律齐,各辦膜区未闻及杂音,腹软,略膨隆、无压痛及反跳痛,肝脾未触及,双下肢轻度水肿。血液检查:血糖213 mg·dl-1,肝肾功能正常。WBC 18．0×109·

Objectives:To observe the clinical effects and safety of early treatment with different doses of simvastatin in aged patients with acute coronary syndrome(ACS).Method:One hundred and seventeen patients with ACS,aged from 62 to 79 years, accompanied by the total cholesterol (TC) no less than 4.68 mmol·L -1 and/or low-density lipoprotein ( LDL)no less than 2.6 mmol·L -1 , were randomly divided into 2 groups: group A (n=58, administrated simvastatin 20 mg·d -1 in the evening), group B (n=59, administrated simvastatin 40 mg·d -1 in the evening).The levels of blood triglycerides (TC), LDL, high-density lipoprotein ( HDL), TG, and high sensitivity C-reactive protein (hsCRP) were all detected before and after 1 month, 3 months of the treatment. All adverse reaction in 3 months were followed up. The primary ending point is the incidence of cardiovascular disease. Result:After 1 month or 3 months of the treatment, the levels of blood TC, LDL, HDL, TG,and hsCRP in both of the 2 groups were decreased significantly than those before the treatment, especially in group B, P0.05. During the follow-up the incidence of cardiac events in group B was less than that in group A markedly, P0.05. No severe adverce effects were found in these 2 groups in the experiment. Conclusion:Early treatment with simvastatin 40 mg·d -1 had a good effect in lowing blood lipid, inhibiting the product of inflammatory factors and reducing the incidence of cardiac events, thus it was safe in the patients with ACS.

目的观察老年急性冠脉综合征(ACS)早期应用不同剂量的辛伐他汀的临床疗效及安全性。方法选择临床确诊为ACS的老年患者共117例,随机分为20mg组和40mg组,每晚服药一次,观察1个月、3个月的血脂和高敏C-反应蛋白(hsCRP),随访3个月内的不良反应及心脏事件的发生率。结果(1)两组服药后第1个月、3个月的总胆固醇、低密度脂蛋白、hsCRp水平40mg组比20mg组降低更明显且心脏事件发生率也明显减少。(2)两组均无严重不良反应。结论辛伐他汀40mg/d,能更有效地降脂及减少心脏血管事件的发生率。

单纯收缩期高血压(isolated systolic hypertension,ISH)是指收缩压≥140 mm Hg,舒张压＜90 mm Hg,是高血压的一种特殊类型,常见于65岁以上的老年人.曾认为老年人收缩压升高是随年龄增长的一种生理现象,舒张压是比收缩压更重要的心脑血管疾病的预测因子,而忽略了收缩压升高的风险.近年来越来越多的研究证明,老年ISH患者具有较高的发生心血管事件的危险性,预后差于单纯舒张期高血压.最近公布的美国预防、检测、评估与治疗高血压全国联合委员会第七次报告(JNC 7)强调,50岁以上的高血压患者,收缩压≥140 mm Hg是比舒张压更重要的心血管疾病危险因素,对于大多数患者而言收缩压比舒张压更难以控制.