卡托普利与美托洛尔治疗慢型克山病的临床效果评价

Objective To observe the curative effect of captopril and metoprolol in the treatment of chronic Keshan disease (CKD). Methods One hundred and ninty-five patients with CKD chosen from Juxian, Wulian, Yishui, Pingyi, Sishui and Zoucheng in Shandong Province were randomly assigned to control group, captopril group and metoprolol group according to NYHA cardiac functional grading. All cases were given diuretics, digitalis and vasodilating agents as routine treatment. On this basis, captopril and metoprolol was administered in captopril group and metoprolol group respectively. After 12 months of follow-up visit, the causes of cardiac death, hospitalization status and the changes of heart size, electrocardiogram, blood pressure and heart rate were all observed. Results It was found that the mortality of captopril group and metoprolo] group was 4.76% (3/63), 5.00% (3/60) respectively, both lower than the control group 10.61%(7/66). But this difference had no statistically significance(P=0.39). Besides, the hospitalization days of each year in captopril group and metoprolol group was respectively (19.12± 20.35) and(18.86±21.52)days, much more reduced than in the control group[(21.45±21.74)days, q=3.17, 3.38, P<0.05]. The detection rate of cardiothoracic ratio decreased in captopril group and metoprolol group [45% (27/60) and 40.4% (23/57)] After treatment showed more pronounced amelioration than the control group [18.6% (11/59), χ2=9.51,6.59, all P<0.0125], still the detection rate of cardiomegaly and invariability had no significant difference among three groups (χ2=2.50,4.75, all P>0.05). The elimination coefficient of ectopic rhythm in metoprolol group [56.5% (13/23)] was pronounced higher than the control group and captopril group [23.8% (5/21), 22.7% (5/22)], but differences had no statistically significance(P=0.0358,0.0331, all P>0.0125). Significant differences were found in systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) in three groups prior and post-treatment(F=47.51,44.23,80.66, all P<0.01). The interaction of therapy and treatment time had influence on SBP and HR (F=3.19,37.44, all P<0.05), but had no influence on DBP(F=2.21, P> 0.05). There was no difference in SBP, DBP or HR among three groups before treatment(F=0.28,0.57,1.80, all P>0.05). After treatment, SBP and DBP in captopril group, metoprolol group and the control group[(109.0±10.9), (112.2±12.8), (114.7±13.2)mm Hg, (69.3±7.2), (72.1±9.5), (73.3±9.3)mm Hg] were all lowered compared with pre-treatment[ (117.1±13.4), (119.0±14.4), (117.6±14.1)mm Hg and (74.2±10.2), (76.3±10.8), (75.4±11.1)mm Hg, t=4.79,4.47,2.08,5.12, 4.32,2.15, all P<0.05]. HR was reduced in metoprolol group, being [(66.2±7.7), (75.9±11.5)times/min] before and after treatment(t=10.81, P<0.01), while it remained unchanged in captopril group and control group[(70.6±8.0), (72.6±10.5) times/min and (71.9±10.4), (73.8± 12.2)times/min, t=1.77,1.74, all P>0.05]. After treatment, both SBP and DBP of captopril group were significantly lower than that in the control group (q=3.52,3.56, all P<0.05); HR was reduced in metoprolol group, lower than that in captopril group and control group(q=5.44,3.73, all P<0.01). Conclusions Having a tendency of depressing mortality, captopril and metoprolol can reverse or delay myocardial remodeling and reduce admission rate in a safe,reliable and economic way, and are worth to be widely used in the treatment of chronic Keshan disease.     

产后出血42例护理体会

胎儿娩出后2h内失血量超过400ml或24h内失血量超过500ml称为产后出血。产后出血是产科常见的严重并发症,其发病突然来势迅猛直接危及产妇生命,抢救不及时可造成孕产妇死亡,是导致孕产妇死亡的四大原因之一。产后短时间内大量出血可迅速发生失血性休克,严重者危及生命。休克时间过长可引起脑垂体缺血坏死继发严重的腺垂体功能减退,     

异位妊娠早期诊断方法探讨

异位妊娠（EP）是指受精卵着床于子宫体腔以外部位的妊娠。最常见的发生部位为输卵管,占97％,一旦发生破裂,严重危及患者生命,据报道因EP死亡的妇女占所有孕产妇死亡的1／5。因此,早期诊断EP,防止其破裂导致孕妇死亡以及其他严重并发症变得尤为重要。     

中医情志护理在手术室护理中应用研究简况

中医情志护理是一种重要心理疗法。总结和汲取医学和心理学相关理论,通过护理人员语言、表情、姿势、态度、行为、气质等来改善患者情绪,根据患者病情进行恰到好处的心理调护,使患者能在最佳心理状态下接受治疗,早日康复。从中医情志护理特点和重要性分析入手,结合手术室护理过程中情志护理技术要点,探讨术前、术中、术后临床实践的启示,完善当前手术室情志护理模式。     

“三防”医学救援体系建设的思考

目的 分析面临的现实威胁,查找“三防”医学救援体系建设存在的突出问题,研究解决应对措施.方法 结合“三防”医学救援能力建设的特点规律,总结近年来好的经验做法.结果 提出5点建议:(1)加强组织体系建设,理顺领导指挥关系;(2)加强防护体系建设,积极构筑防护屏障;(3)加强救治力量体系建设,合理配置救治力量;(4)加强技...     

辽宁省东部山区长角血蜱中SFGR DNA的检测和序列分析北大核心CSCD

目的调查辽宁省东部地区蜱类携带斑点热群立克次体(SFGR)情况及种型分布。方法采集辽宁省本溪、宽甸长角血蜱,提取DNA,采用PCR扩增SFGR ompA基因,并进行测序和聚类分析。结果 65份(368只)长角血蜱标本有7份扩增出SFGR OmpA基因片段,阳性率为10.77%。对其中3份标本的扩增片段(BH36、BH30、KD9)测序后进行聚类分析,ompA基因序列与SFGR河北株暂定种Candidatus R.hebeiii(HQ651815、HQ651817)同处于一个分支,同源性为99.83%~100%;与R.heilongjiangensis和R.japonica遗传距离较近,与其他SFGR遗传距离较远。结论辽宁省东部地区长角血蜱携带SFGR Candidatus R.hebeiii,且感染较普遍。     

暂定新埃立克体属研究进展

暂定新埃立克体属(candidatus neoehrlichia)是新发现的一类蜱媒病原体,隶属立克次体目无形体科,目前主要包括新埃立克体(candidatus neoehrlichia mikurensis,CNM),浣熊新埃立克体(candidatus neoehrlichia lotoris,CNL)等。近年来研究发现,该类病原体分布广泛,潜在威胁性大。随着CNM相关报道,新埃立克体属的研究也越来越被重视。本研究主要从CNM,CNL的发现历程、病原特征、传播媒介、动物宿主、临床病例等方面对近年来的研究进行简要综述,同时对下一步的研究方向提出展望。     

研究母子保健手册在儿童早期发展中的应用价值

目的研究并探讨应用母子保健手册对儿童早期发展的智能、体格、营养状况的影响。方法于2017年7月-2018年7月,选取该阶段内我院应用母子保健手册的200例婴儿作为研究对象,将其设置为观察组,另在我院儿保门诊随机选取年龄与性别相匹配的同期未应用母子保健手册的200例婴儿作为参照对象,将其设置为对照组。比较2组的体格发育情况、智能发育情况、营养状况。结果观察组的体格发育情况、智能发育情况均优于对照组(P 0.05),且观察组的营养不良发生率、贫血发生率均较对照组明显更低(P 0.05)。结论对婴儿应用母子保健手册,可促进婴儿的体格发育、智能发育、改善营养状况,有益于儿童的早期发展。     

声脉冲辐射力弹性成像联合常规超声诊断乳腺肿物的应用价值

目的 探讨声脉冲辐射力(acoustic radiation force impulse,ARFI)弹性成像联合常规超声鉴别乳腺良恶性肿物的价值.方法 选取2014年1月至2020年6月就诊于中日友好医院并经病理证实的乳腺肿物患者360例,共360个肿物,术前行常规超声及ARFI成像,获得剪切波速度(shear wave velocity,SWV)值.所有肿物行乳腺影像报告与数据系统(breast imaging reporting and data system,BI-RADS)分类,并绘制 SWV值的 ROC 曲线.VTQ界值取约登指数最大时ROC曲线的值4.05 m/s,BI-RADS及联合法界值均为3～4A类,计算3种方法的AUC、敏感性、特异性、准确性、阳性预测值及阴性预测值,比较三者对乳腺肿物的诊断效能.结果 乳腺恶性肿物227个,良性133个,恶性肿物SWV值高于良性,差异有统计学意义[(6.08±2.95)m/s 比(3.16±2.14)m/s,P=0.000].常规超声、ARFI及联合法 AUC 分别为0.742、0.748、0.833,敏感性为98.7％、66.1％、90.7％,特异性为49.6％、83.5％、75.9％,准确性为80.6％、72.5％、85.3％,阳性预测值为77.0％、87.2％、86.6％,阴性预测值为95.7％、59.0％及82.8％.联合法将86.3％的病理良性4A类肿物降为3类.结论 ARFI辅助常规超声能够提高乳腺肿物诊断效能,诊断特异性提高26.3％,能够避免86.3％的病理良性4A类肿物穿刺活检.     

弹性应变率比值联合乳腺超声影像报告和数据系统诊断乳腺结节的应用价值

目的 探讨弹性应变率比值(SR)与乳腺超声影像报告和数据系统(BI-RADS-US)联合诊断乳腺结节的应用价值。方法 回顾性分析经病理确诊的471例乳腺结节,术前行常规超声及应变弹性成像检查,应用SR联合BI-RADS-US对乳腺结节分类进行分级调整,以病理结果为金标准,通过受试者工作特征(ROC)曲线下面积评估联合法与BI-RADS-US单独诊断乳腺结节的效能,比较两者敏感度、特异度及准确性。结果 471例乳腺结节中,良性180例,恶性291例,联合法诊断乳腺癌的ROC曲线下面积明显高于BI-RADS-US(0.798比0.730;Z=2.583,P=0.010)。SR法、BI-RADS-US及联合法诊断乳腺癌的敏感度分别为86.6%、99.0%、96.6%,特异度分别为67.2%、47.2%、63.3%,准确性分别为79.2%、79.2%、83.9%。联合法较BI-RADS-US单独诊断乳腺癌特异度从47.2%提高到63.3%(χ ²=14.25,P<0.001),将57.5%(42/73)BI-RADS 4A类中的良性结节降为3类。结论 SR联合BI-RADS-US可明显提高乳腺癌的诊断效能,提高诊断特异度,避免不必要的穿刺活检。