肿瘤患者化疗期间的护理

2006年1月-2008年1月，收治恶性肿瘤18例，针对患者出现的化疗反应，采取不同的护理措施，效果满意。18例中，男11例，女7例，年龄35～68岁，平均56岁，其中肺癌10例，胃癌3例，乳腺癌3例，食道癌2例。应用阿霉素、顺铂、氟脲嘧啶、环磷酰胺、丝裂霉素、甲氨喋呤等化疗药物，     

瘙痒难耐试试苦参

苦参，又名苦骨、牛人参、野槐根，记载于我国现存最早的药学专著《神农本草经》中，位列中品，是中国使用历史最悠久的中药之一。味苦，性寒，归心、肾、肝、脾、大肠经。功能清热燥湿，祛风杀虫，兼通利小便。主治湿热痢疾、便血、黄疸、小便不利、带下、阴痒、     

“网络就诊”常见四大误区

一个偶然的机会，我在网上发现了一个很好的医患交流平台，便很快地全身心投入进去，乐此不疲。尽管平日门诊、查房，平时的专家电话咨询，每年数次的医院糖尿病健康讲座，每年一次的“联合国糖尿病日”半天专家咨询也都是在和患者交流，但仍感到有很大的局限，会受到时间和空间的限制，受众太少。如今已是信息时代，有了网络的平台，也就有了超越时间、空间的可能，可以把自己生活、工作中所思、所想、所读，在闲暇之余，与更多的患者、同行分享，感到异常的充实、满足。     

补气要药黄芪

中医认为，黄芪为补气要药，性味甘、微温，归脾肺二经，有健脾补中益气、升阳举陷，固表、止汗、利水消肿、托毒生肌的作用。中医临床多用于治疗气虚体弱，行走气急，四肢无力，体虚多汁，脾胃虚弱，气虚脱肛，精神萎靡不振以及心悸等症。     

大动脉僵硬度检查:一种早期检测动脉粥样硬化的方法

随着我国经济的快速发展，人民生活水平的提高，生活方式发生了很大改变。多吃、少动，体内能量过剩，脂肪堆积，体重超重，使患高血压、高血脂、高血糖等疾病风险增高，促进了动脉粥样硬化斑块形成，而斑块破裂、阻塞血管导致心、脑、肾及双下肢不同程度的缺血与坏死，又可引起猝死和致残的急性事件。     

鞍区肿瘤术后内分泌代谢紊乱的防治和管理

随着神经外科经鼻蝶内镜技术的进步，鞍区肿瘤手术全切率和安全性已明显提高。但由于肿瘤类型、大小、生物特性多变，且鞍区位置特殊，术中有时难免损伤下丘脑、垂体，造成垂体内分泌和水、盐代谢紊乱，导致患者术后出现记忆力下降、生长发育停滞、不孕不育、肥胖、多尿、电解质紊乱等，并且医患存在对下丘脑、垂体和靶腺激素替代认识不足，治疗不规范，随访不积极，严重时危及生命。本文从内分泌专科医生角度，详细阐述鞍区肿瘤术后垂体功能减退、下丘脑综合征及水、盐代谢紊乱的防治和管理，希望通过本文规范激素替代治疗，促进患者垂体功能重建，改善患者预后，提高远期生活质量，减少死亡率。     

针灸与中药综合治疗慢性萎缩性胃炎36例

目的观察针刺、艾灸与中药综合治疗慢性萎缩性胃炎的治疗效果．方法针刺中脘、天枢、内关、足三里，得气后留针30min，用艾条温灸中脘、足三里、胃俞、脾俞，每穴15min，1次／d，10次为一疗程，共治疗六个疗程，两疗程间休息3d～5d．同时口服中药党参、丹参、蒲公英、黄芪、茯苓、白芍、当归、木香、甘草等水煎服，1剂／d，分两次服，连服3mo结果36例中显效15例，有效17例，无效4例，总有效率为89％．结论针刺、艾灸与中药综合治疗慢性萎缩性胃炎疗效显著，总有效率大于单一疗法．     

药物治疗下肢慢性缺血性溃疡4例分析

随着人们生活水平的提高，膳食结构的改变，动脉硬化性血管病的发病率越来越高，医学上将动脉硬化所导致的全身动脉阻塞性疾病统称为动脉硬化闭塞症，高血压、高血脂、吸烟、糖尿病等为其好发因素，尤其是糖尿病，1988年，据Laing报道2型糖尿病病人下肢动脉硬化闭塞病的发生率较对照组高20倍，糖尿病病人发生动脉硬化后，病情进展较快，预后也更差，而下肢动脉硬化闭塞为全身动脉硬化中最常见的，表现为肢体发凉、麻木、苍白、疼痛、溃疡及坏疽。下肢远端的缺血性溃疡是肢体缺血的最好证明。没有血管重建，坏疽和截肢就不可避免。而临床上血管重建并不总能实现，对于流出道差，末梢循环障碍，以及其他一些如经济条件、个人意愿等因素，保守治疗是唯一的治疗手段。     

老年感染性心内膜炎合并毛细血管内增生性肾小球肾炎1例

1 病例摘要 患者，男，61岁，北京市昌平区邓庄村农民。主因间断发热伴寒战半月，水肿10d于2008年1月25日入院。患者从2008年1月10日开始，在无明确诱因下出现发热，体温38．5℃，伴有寒战，发热每天出现1次或2次，无固定时间，持续约1～2h，出汗后可自行缓解，无盗汗，无咳嗽、咳痰、咯血、胸痛、胸闷、心悸，无尿频、尿痛、腰痛，尿色无异常，无皮疹、关节和肌肉酸痛，     

中西医结合加食疗治疗重症肝炎

目的临床观察中西医结合加食疗对重症肝炎的治疗效果．方法观察1例患者，中年男性，乙肝表面抗原携带着，有慢性肝损害，因发烧、酗酒等引起急性黄疽型肝炎（乙型）暴发，伴有活动性肝硬变及腹水．采用中西医结合加食疗的方法．西药给予强力宁，能量合剂、补液、休息等支持疗法．中药用自拟正肝汤（主要包括党参、白术、云苓、山药、赤芍、丹皮、郁金、茵陈、栀子、川连、板蓝根、鸡内金、苡仁、车前子、砂仁、枳壳、甘草）口服60余剂，配合其他有关中成药．食疗主要是水果（苹果、葡萄、猕猴桃），随意进食，平均每天约苹果200g，葡萄400g，猕猴桃80g，约服用3＋mo．结果治疗前肝硬变、腹水、黄疸．肝功酶谱：ALT304μ／L，BIL1162μmol／L，AST388μ／L，Y-GT79μ／L，CHE4075μ／L乙肝系统：HBSAg（＋），抗HBCIg100×（＋），RCR（HBV））（＋）．治疗6mo后，ALT38μ／L，BIL134μmol／L，AST30μ／L，PCR（HBV）（－），其余肝功皆正常．上腹部CT扫描，未见明显异常．追踪观察，患者已正常上班，未有复发．结论中西医结合加食疗治疗重症肝炎，在较短时间内，乙肝表面抗原转阴，恢复健康．说明这种疗法，对抵御肝炎病毒，保护肝脏，恢复受损肝细胞的功能，增强人体新陈代谢，提高免疫力都有明显的作     

冠心丹参滴丸治疗冠心病及其危险因素研究

目的观察冠心丹参滴丸治疗冠心病心绞痛的临床疗效及其对血脂、血液流变学、心电图的影响。方法选择150例明确诊断为冠心病心绞痛型的住院患者,通过简单随机分组分为A组(n=50)和B组(n=50),A组为常规西医治疗组(包括应用硝酸酯类药物、β受体阻滞剂、抗血小板聚集药和阿托伐他汀),B组在常规治疗基础上加用冠心丹参滴丸(10粒/次,3次/d),治疗1个月后观察临床疗效以及血脂和血液流变学、心电图的变化。结果两组治疗后临床疗效以及血脂和血液流变学、心电图均较治疗前有明显改善,差异有统计学意义(P<0.01)。B组治疗后临床疗效以及血脂和血液流变学、心电图均较A组有明显改善,差异有统计学意义(P<0.05)。B组治疗期间心血管事件发生率低于A组,差异有统计学意义(P<0.05)。结论常规西医治疗基础上加用冠心丹参滴丸疗效较单纯西医治疗效果好,还可明显降低血脂,改善血液流变学和心电图,并降低心脑血管事件发生率。     

Beta-Adrenergic Blockade Decreases Coronary Collateral Blood Flow in Patients with Coronary Artery Disease

The effect of -adrenergic blockade on coronary collateral blood flow has not been clarified. We examined the acute effects of -adrenergic blockade on coronary collateral blood flow. Fifteen patients (Part A) with stable angina were studied while undergoing coronary angioplasty. According to the protocol, all patients underwent a minimum of three balloon inflations. Collateral flow velocity was determined during balloon inflations using the Doppler flow guidewire positioned distally to the lesion. The two tested balloon inflations, the second and third, were maintained for the same length of time. Between the second and third balloon inflations, 1 mg of propranolol was administered IC into the treated artery. Ten controls were studied following saline infusion. In 10 other patients (Part B), the effect of 1 mg IC propranolol on the coronary artery area distal to the lesion was studied, and five patients served as controls. In the treated group, in Part A blood pressure remained stable during the balloon inflations tested. Heart rate decreased from 79 ± 11 to 73 ± 12 beats/min (P < .05), velocity time integral from 9.6 ± 8.2 to 6.6 ± 4.1 cm (P < .05), and ST elevation from 1.3 ± .9 to .9 ± 1.0 mV (P < .05) between the second and third balloon inflations. In the controls the variables examined did not change during the balloon inflations tested. In Part B, neither propranolol nor normal saline had any significant effect on coronary artery lumen area. Thus, IC administration of -adrenergic blockade decreases coronary collateral blood flow, and this potentially worsens the ischemic zone. However, -adrenergic blockade ameliorates myocardial ischemia during coronary angioplasty.     

Activation of Blood Platelets after Percutaneous Transluminal Coronary Angioplasty and Coronary Artery Bypass Graft Surgery

We have evaluated the activation of platelets in blood samples taken from patients with stable angina undergoing balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) (n=11) or coronary artery bypass grafting (CABG) under hypothermic (n=11) or normothermic conditions (n=11). We have found that surface expression of P-selectin on platelets in whole blood from PTCA patients upon thrombin treatment was significantly reduced, as compared with control platelets from healthy subjects. This effect was partially reversed when platelets washed from the same blood sample were used, but even then P-selectin expression was significantly lower in PTCA patients than it was in control subjects. There was a significant increase in basal expression of P-selectin in blood platelets taken from patients who underwent CABG under normothermic conditions (warm blood cardioplegia) as opposed to hypothermic patients (cold crystalloid cardioplegia). These platelets retain the ability to respond to agonists, although to a much lower extent than do those from healthy control donors. The surface exposure of P-selectin on resting and thrombin-treated platelets isolated from CABG surgery patients was not different from that of the control platelets. The adhesion to fibrinogen of resting and thrombin-treated platelets from patients who underwent balloon angioplasty as well as CABG surgery under normothermic and hypothermic conditions was significantly reduced when compared with the fibrinogen of the control platelets. These results suggest that the function of platelet fibrinogen receptor is impaired in patients with stable angina pectoris and that PTCA and CABG surgery activates platelets.     

Coronary heart disease in treated hypertensive patients and risk-matched normotensive control subjects

The incidence of coronary heart disease (CHD) was recorded prospectively for 543 persons--335 treated hypertensive patients and a group of 208 normotensive control subjects, individually matched to a subgroup of the hypertensive patients on the basis of seven risk factors. If antihypertensive therapy reduces CHD, CHD should have occurred at a rate predicted by initial blood pressure levels in the normotensive control subjects and at a rate predicted by post-treatment blood pressure levels in the hypertensive patients. A treatment effect seemed possible in hypertensive men, since CHD occurred at the rate predicted by post-treatment blood pressure levels. However, because the reduction was not statistically significant and was similar to a reduction observed in the normotensive control subjects, a treatment effect could not be confirmed. There was no evidence of a treatment effect in hypertensive women, since CHD occurred at a rate higher than that predicted by post-treatment blood pressure levels and the normotensive control subjects showed a lower than expected rate.     

冠心病糖尿病患者行血脂检验的临床探析

目的探讨血脂检验在诊断冠心病糖尿病中的效果。方法将2019年3月—2020年8月该院40例冠心病糖尿病患者作为实验组,选择同期健康体检40名作为对照组。两组均给予血脂检验,比较两组高密度脂蛋白胆固醇和总胆固醇、低密度脂蛋白胆固醇、甘油三酯和空腹血糖。结果实验组高密度脂蛋白胆固醇显著低于对照组,总胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹血糖显著高于对照组,差异有统计学意义(P<0.05)。结论血脂检验在诊断冠心病糖尿病中的效果确切,可准确有效反映患者血脂水平和健康人之间的差异,患者的总胆固醇、低密度脂蛋白胆固醇、甘油三酯明显升高,而高密度脂蛋白胆固醇明显降低,对于冠心病糖尿病的早期诊断,疾病预后的评估有重要的作用。     

导管射频消融与冠状动脉的相互影响

导管射频消融可引起冠状动脉损伤,而冠状动脉血流的冷却效应对消融疗效亦有影响,冠状动脉与消融靶点之间的距离长短是有相互影响的关键因素。现对这方面的文献作一综述。     

冠心舒通胶囊治疗冠状动脉慢血流现象的临床疗效研究

目的探讨冠心舒通胶囊治疗冠状动脉慢血流现象(CSFP)的临床疗效。方法选择2011年8月—2013年2月在我院心内科进行治疗的CSFP患者40例,将其随机分成对照组19例和治疗组21例。对照组采用常规辛伐他汀、硝酸酯类、曲美他嗪和阿司匹林治疗,治疗组在对照组基础上加用冠心舒通胶囊。治疗结束后观察患者症状、心电图变化,复查冠状动脉造影观察冠状动脉血流变化,并观察治疗期间不良反应情况。结果临床症状改善:治疗组有效率为76.2%,高于对照组的52.6%(P0.05);心电图疗效:治疗组总有效率为52.4%,与对照组的47.4%比较,差异无统计学意义(P0.05);冠状动脉血流改善:治疗组有效率为61.9%,低于对照组的42.1%(P0.05)。两组均未出现明显不良反应。结论冠心舒通胶囊治疗CSFP虽然对心电图无明显改善,但患者临床症状及冠状动脉血流有改善。     

Pathophysiology of Coronary Collaterals

While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand.However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion.This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation.     

代谢综合征与冠心病

代谢综合征已成为新世纪,继高血压、糖尿病、肥胖和血脂异常等疾病之后的又一慢性流行性疾病。代谢综合征的成分如肥胖、2型糖尿病、致粥样硬化血脂表型与高血压是冠心病重要的独立危险因素,每一个成分都可直接促进动脉粥样硬化发生。由于代谢综合征是这些独立危险因素的聚集,因此代谢综合征伴有更大比例、更大程度和病变更广泛的冠心病发病率及病死率。但代谢综合征所有组分对心血管危险的确切影响还需进行更深入的研究,今后代谢综合征的研究和防治还需多个学科和专业人才的合理整合。     

Coronary blood flow in chronic insulin-dependent diabetic dogs

Summary Diabetic patients appear to be at an increased risk for perioperative morbidity and mortality following coronary artery bypass grafting. Many have suggested that microangiopathy is a primary cause. Using radionuclide labelled microspheres, we measured the perfusion of the subendocardium, midmyocardium, subepicardium, and the subendocardium/subepicardium ratio in alloxan-induced diabetic and normal dogs. We found no statistical difference in the myocardial perfusion of dogs made diabetic for five months when compared to normal dogs. By using repeated measures two-factor analysis of variance-regression model, changing blood glucose levels had no effect on coronary blood flow in either the diabetic or normal dogs. This study was supported in part by Veterans Administration research funds, a Core Grant for Vision Research (P30 EY05722) from the National Eye Institute, Bethesda/MD, a recognition award from the Alcon Research Institute, and a generous gift from Dr. and Mrs. Harris Vernick.