不同营养支持方式对重症急性胰腺炎患者肠道菌群失调的影响分析

目的 探讨不同营养支持方式对重症急性胰腺炎(SAP)患者肠道菌群失调的影响.方法 将2003年1月至2010年6月收治的66例SAP患者按随机数字表法分为研究组和对照组,每组33例,分别接受肠内营养和全胃肠外营养支持治疗,观察并比较两组患者肠道菌群失调的发生情况.结果 经营养支持治疗后,研究组大肠埃希菌和肠球菌的数量明显低于对照组,差异有统计学意义(P＜0.05);双歧杆菌和乳酸杆菌的数量则显著高于对照组,差异有统计学意义(P＜0.05).研究组肠道菌群失调的发生率为24.2%(8/33),显著低于对照组的51.5%(17/33),差异有统计学意义(P＜0.05).结论 肠内营养支持较单独全胃肠外营养支持能减少SAP患者肠道菌群失调的发生.

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Objective To investigate the influence of different nutritional support ways on intestinal dysbacteriosis in patients with severe acute pancreatitis (SAP).Methods Sixty-six patients with SAP from January 2003 to June 2010 were divided into study group and control group according to random digits table,33 cases in each group,they were treated with enteral nutrition and total parenteral alimentation support treatment respectively and the incidence of intestinal dysbacteriosis was observed and compared.Results In 7 - 10 d after the onset of SAP,the number of escherichia coli and enterococci in study group were significantly lower than those in control group,the difference was statistically significant (P ＜ 0.05 );the number of bifidobacterium and lactobacillus were significantly higher than those in control group (P ＜ 0.05 ).A total of 25 patients in both groups occurred intestinal dysbacteriosis,the total incidence was 37.9%,the incidence in study group was 24.2% (8/33) and which was significantly lower than that in control group [51.5%( 17/33 )](P ＜ 0.05 ).Conclusion Enteral nutrition support treatment can reduce the incidence of intestinal dysbacteriosis in patients with SAP,its efficacy is better than parenteral nutrition.     

持续静脉泵入呋塞米与多巴胺联合参麦注射液治疗难治性心力衰竭患者利尿剂抵抗

目的 观察持续静脉泵入呋塞米与多巴胺联合参麦注射液治疗难治性心力衰竭患者利尿剂抵抗的疗效、可行性及安全性.方法 将56例产生利尿剂抵抗的难治性心力衰竭患者按随机数字表法分为对照组及治疗组,每组28例.对照组给予常规利尿剂及常规抗心力衰竭治疗;治疗组在常规抗心力衰竭治疗的基础上持续静脉泵入呋塞米与多巴胺联合参麦注射液,连用5～7 d.比较两组的临床疗效以及心功能指标等方面的变化.结果 治疗后治疗组显效10例,有效14例,无效4例,总有效率为85.7%(24/28);对照组显效3例,有效10例,无效15例,总有效率为46.4%(13/28),两组总有效率比较差异有统计学意义(P＜0.05).对照组治疗后左室舒张末期内径(LVEDD)、短轴缩短率(FS)、左室射血分数(LVEF)及心脏指数(CI)与治疗前比较无显著改善(P＞0.05),而治疗组治疗后上述指标均有显著改善(P＜0.05),并且两组治疗后上述指标比较差异也有统计学意义(P＜0.05).治疗组出现低钾、低钠血症2例,经积极补钾、补钠治疗后纠正,未见其他不良反应.结论 在常规抗心力衰竭治疗基础上,持续静脉泵入呋塞米与多巴胺联合参麦注射液治疗,对难治性心力衰竭利尿剂抵抗疗效显著,临床安全可行.

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Objective To observe the efficacy,feasibility and safety of continous intravenous infusion of furosemide,dopamine combined with Shenmai on treatment of refractory heart failure. Methods Fifty-six patients with diuretic resistance and refractory heart failure were divided into control group(28 patients)and treatment group(28 patients)by random digits table. Conventional diuretics and other anti-heart failure treatment were used in two groups, meanwhile, continuous intravenous infusion of furosemide,dopamine and Shenmai were used in treatment group for 5-7 days. The clinical symptoms and signs, pulmonary edema in chest X-ray and the improvements of pulmonary congestion were observed before and after treatment. Results In treatment group, 10 patients were markedly effective, 14 patients were effective, and 4 patients were unfruitful. The total effective rate was 85.7%(24/28). In control group, 3 patients were markedly effective, 10 patients were effective, and 15 patients were unfruitful. The total effective rate was 46.4%(13/28). There was significant difference in total effective rate between two groups (P ＜ 0.05). The indexes of left ventricular end-diastolic dimension, fractional shortening, left ventricular ejection fraction and cardiac index were significantly improved in treatment group(P ＜ 0.05), but was not significantly improved in control group(P ＞ 0.05). After treatment,2 patients emerged hypokalemia and hyponatremia, after symptomatic treatment,they all recovered. Conclusion Conventional treatment combined with continuous intravenous infusion of furosemide,dopamine and Shenmai in patients with refractory heart failure is markedly effective, feasible and safe.     

特发性血小板减少性紫癜患者血清白细胞介素11水平、淋巴细胞亚群及NK细胞变化的临床意义

目的 检测特发性血小板减少性紫癜(ITP)患者血清白细胞介素11(IL-11)水平、淋巴细胞亚群及NK细胞的变化,探讨相关因素在ITP发病中的作用.方法 应用酶联免疫吸附法(ELISA)、流式细胞术分别检测50例ITP(ITP组)和30例健康体检者(对照组)血清IL-11水平、淋巴细胞亚群及NK细胞的变化.结果 ITP组的血小板计数[(30.21±19.40)×109/L]明显低于对照组[(207.21±31.55)×109/L](P＜0.05),ITP组患者血清IL-11水平[(255.72±163.43)ng/L]明显高于对照组[(40.60±5.57)ng/L](P＜0.05),相关分析表明ITP患者血清IL-11水平与血小板计数呈负相关(r=-0.557,P＜0.05);ITP组患者CD3+、CD4+T淋巴细胞百分比及CD4+/CD8+明显低于对照组(P＜0.05),CD8+T淋巴细胞百分比明显高于对照组(P＜0.05);CD3-CD(16+56)+NK细胞百分比明显低于对照组(P＜0.05).结论 IL-11水平、淋巴细胞亚群及NK细胞变化与ITP的发病密切相关,且IL-11水平与血小板计数可能存在负反馈调节作用.

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Objective To detect the serum level of interleukin (IL)-1 1, lymphocyte subsets and NK cells in patients with idiopathic thrombocytopenic purpura (ITP), and explore the related factors in the pathogenesis of ITP. Methods The serum level of IL-11, lymphocyte subsets and NK cells were detected by double antibody sandwich enzyme linked immunosorbent assay (ELISA) and flow cytometry in 50 ITP patients (ITP group) and 30 controls (control group). Results The platelet in ITP group [ (30.21 ± 19.40) ×109/L] was lower than that in control group [ (207.21 ± 31.55 ) × 109/L] obviously (P ＜ 0.05 ); the serum level of IL-11 in ITP group [(255.72 ± 163.43) ng/L] was significantly higher than that in control group [ (40.60 ± 5.57 ) ng/L ] (P ＜ 0.05 ). The correlation analysis indicated that the blood serum levels of IL- 11 had negative relationship with the platelet (r = -0.557 ,P ＜ 0.05). The percentage of CD3+ and CD4+ T lymphocyte percentage, CD4+/CD8+ in ITP group were lower and the percentage of CD8+ T lymphocyte was higher than those in control group obviously (P ＜ 0.05 ). The percentage of CD3- CD(16+56) +NK cell in ITP group was lower than that in control group (P ＜ 0.05). Conclusion IL-11, lymphocyte subgroup and NK cell change correlate with ITP morbidity closely, and the IL-11 level and the platelet possibly have the negative feedback control action.     

支气管镜下高频电灼联合球囊扩张治疗结核炎性气道狭窄

目的 探讨支气管镜下高频电灼联合球囊扩张治疗结核炎性气道狭窄的疗效和安全性.方法 根据内镜治疗方法的不同,将55例结核炎性气道狭窄患者分成球囊扩张组(球囊组,26例)和高频电灼联合球囊扩张组(联合组,29例).两组患者每周接受内镜治疗1次,观察气道狭窄治疗有效率、需要治疗的次数,结核菌转阴时间以及术中和术后并发症;并于治疗结束后3个月复查纤维支气管镜,观察两组气道再狭窄率.结果 球囊组、联合组再通有效率分别为69.2%(18/26)、89.7%(26/29),两组比较差异无统计学意义(P＞0.05),达到再通有效的治疗次数分别为(3.5±1.3)、(1.5±1.1)次,两组比较差异有统计学意义(P＜0.01),术后结核菌转阴时间分别为(23.3±3.6)、(13.2±2.3)d,两组比较差异有统计学意义(P＜0.01).两组术中出血、严重缺氧、心律失常及气胸等发生率比较差异无统计学意义(P＞0.05),术后3个月气管再狭窄率分别是33.3%(6/18)、7.7%(2/26),两组比较差异有统计学意义(P＜0.05).结论 支气管镜下高频电灼联合球囊扩张治疗结核炎性气道狭窄安全有效,并可减少介入治疗次数,缩短结核菌阴转时间,还有可能减少再狭窄率.

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Objective To explore the efficacy and safety of the bronchoscopic high frequency electrocoagulation combined with balloon dilatation in treating tuberculosis inflammatory airway constriction. Methods According to the different methods of treatment, 55 patients with tuberculosis airway constriction were randomly divided into two groups, the balloon dilatation group (26 cases) and combination group (29 cases). The patients in balloon dilatation group underwent bronchoscopic balloon dilatation and the patients in combination group underwent bronchoscopic balloon dilatation combined with high frequency electrocoagulation. The patients of the two groups accepted endoscopic therapy once a week. Effective rate of recanalization for the narrow airway, frequency of effective treatment and the time of tuberculosis bacterium vanishing was recorded. Intraoperative and postoperative complications were also observed. Three months after the treatment, all patients accepted bronchoscopic to observe and assess the airway restenosis rate. Results After treatment, the effective rate in balloon dilatation group and combination group had no significant difference[69.2%(18/26) vs. 89.7% (26/29 )](P＞ 0.05 ),but frequency of effective treatment and time of tuberculosis bacterium vanishing had significant difference[(3.5 ±1.3) times vs. (1.5 ± 1.1) times, (23.3 ±3.6) d vs.(13.2 ±2.3) d](P<0.01). There was no significant difference on the intraoperative and postoperative complications between two groups (P＞0.05). The airway restenosis rate was 33.3%(6/18) in balloon dilatation group and 7.7%(2/26) in combination group after treatment for 3 months (P ＜0.05). Conclusions Combination of bronchoscopic balloon dilatation and high frequency electrocoagulation is an efficacy and safety way for the tuberculosis inflammatory airway stenosis. It can reduce the frequency of interventional therapy, shorten the time of tuberculosis bacterium vanishing, and may also decrease the airway restenosis rate.     

预注帕瑞昔布用于腹腔镜疝修补术后镇痛的效果

Objective To investigate the effect of pretreatment with parecoxib for postoperative analgesia in patients undergoing laparoscopic hernia repair. Methods Sixty patients undergoing laparoscopic hernia repair were assigned in two groups by random digits table with 30 cases each. The patients in pretreating group received parecoxib 40 mg intravenously before anesthesia, and in control group with the same capacity of normal saline. All patients were anesthetized with combined spinal epidural blockage and tranquilized with pethidine, droperidol and diazepam. Postoperative pain of the abdomen incision was assessed by visual analogue scale (VAS) and the pain of shoulder or back was judged by a 4 grade scale. Side-effects, supplement analgesic, passage of gas by anus 24 h after surgery were observed as well. Results The abdomen incision VAS at 4,8,12,24 h after surgery in pretreating group were lower than those in control group (P ＜ 0.05). And the incidence of pain of shoulder or back was lower in pretreating group (13.3% ,4/30) than that in control group (33.3% ,10/30)(P ＜0.05). While the cases needing supplement analgesic also decreased in pretreating group (13.3% ,4/30) compared with control group (40.0%, 12/30)(P ＜ 0.05). And the side effects and passage of gas by anus 24 h after surgery had no significant difference in two groups. Conclusion Pretreatment with parecoxib in patients undergoing laparoscopic hernia repair may relieve the postoperative incision pain and the pain of shoulder or back while reducing the analgesic supplement without side effects.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

拉米夫定联合还原型谷胱甘肽预防乙型肝炎病毒携带者抗结核的肝损害研究

Objective To explore the preventive effect of liver damage treated by lamivadine joint reduced glutathione for the tuberculosis patients with HBV infection. Methods 90 cases of tuberculosis patients with HBV infection were randomly divided into three groups (A, B, C), each group contained 30 cases. Patients in group A were treated by lamivudine combined with reduced glutathione to protect the liver before anti-tuberculosis treatment. Group B were treated with reduced glutathione. Group C were treated with Yiganling tablets. Both the liver function and serum HBV DNA levels before anti-tuberculosis treatment and 1 month and 2 months after treatment were observed and recorded. Results The cases of liver damage in group A, B, C were 1, 12, 18 respectively, there were statistical differences between group A and group B, group C (χ2 = 11.882, 22.259, P < 0.01). The cases of discontinued treatment due to different causes in group A,B,C were 0,4,11 respectively, there were statistical differences between group A and group B,group C(χ2 = 4.286, P < 0.05; χ2 = 13.469, P < 0.01). The cases of discontinue treatment in the no antivirus group were much more than the antivirus group. There were also statistical differences in both liver damage and discontinued treatment between group B and group C(χ2 = 5.455,4.356, P < 0.05). There was no statistical difference of baseline HBV DNA level between group A and group B (P > 0.05), and also no statistical difference between group A and group C ( P > 0.05), but there were statistical differences in HBV DNA level between group A and group B, as well as group A and group C after 1-month and 2-month therapy( t = - 6.542, - 6.746 and t = - 9.358, - 10.085, P < 0.01). Conclusions Tuberculosis patients coinfected with HBV can use reduced glutathione to prevent liver damage while antitubercular therapy, and simultaneous application of lamivudine therapy can restrain HBV replication and improve the prognosis obviously.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

肺结核患者血清骨桥蛋白检测及临床意义

目的 了解骨桥蛋白(OPN)在肺结核中的临床意义.方法 对80例抗结核治疗前肺结核患者[病例组,其中单纯肺结核60例(单纯肺结核组),肺结核合并结核性胸膜炎20例(肺结核合并胸膜炎组)]血清OPN水平进行检测,并与30例健康体检者(健康对照组)、20例有效抗结核治疗随访6个月后的患者(随访组)进行对比,同时依据临床常用结核检测指标研究OPN的临床意义.结果 病例组血清OPN水平[(843.49±569.23) ng/L]较健康对照组[(352.50±185.02) ng/L]明显升高,差异有统计学意义(P＜0.05).随访组治疗后血清OPN水平[(494.11±352.40) ng/L]较治疗前[(1106.60±628.39) ng/L]明显降低,差异有统计学意义(P＜0.05).随访组治疗后血清OPN水平与健康对照组比较差异无统计学意义(P＞0.05).肺结核合并胸膜炎组血清OPN水平[(1179.80±606.33) ng/L]高于单纯肺结核组[(727.53±511.66) ng/L],差异有统计学意义(P＜0.05);而且两组OPN水平均高于健康对照组,差异有统计学意义(P＜0.05).单纯肺结核组患者有空洞者血清OPN水平[ (836.51±549.80) ng/L]高于无空洞者[(535.52±375.95)ng/L],差异有统计学意义(P＜0.05);病变范围累及＜3叶与≥3叶患者、痰结核菌阳性与阴性患者、结明试验阳性与阴性患者、红细胞沉降率升高与正常患者、PPD强阳性与非强阳性患者血清OPN水平比较差异均无统计学意义(P＞0.05).结论 OPN与肺结核活动性密切相关,血清OPN水平可以作为判断肺结核活动、病情转归的临床指标,血清OPN水平与肺结核病情严重程度有一定相关性.     

67例老年肺结核的临床特点分析

目的探讨老年肺结核患者的临床特点。方法回顾67例老年肺结核患者病例资料(设为老年组),以30例中青年肺结核患者为对照,比较两组的临床表现、实验室检查、胸部X线结果。结果老年组中23.8%(16/67)有肺结核病史,而对照组仅6.7%(2/30)有结核感染史(P<0.05);老年组以咳嗽、盗汗、纳差及体重减轻为多见,对照组则以咳嗽、咯血、发热多见;老年组外周血WBC均值为(6.64±1.2)×109,显著低于对照组(P<0.05),两组中性粒细胞均升高,ESR均明显升高,而CRP仅轻中度升高,两组比较均无显著性差异(P>0.05);胸片提示老年肺结核患者的病灶呈非常规分布(双侧和/或中下肺野),而对照组多呈常规分布(单侧和/或上肺),其差异有统计学意义(P<0.05),两组肺部X线病灶性质无明显差别(P>0.05)。结论老年肺结核患者常有结核病感染史,以消耗性表现为主,ESR可更好地评估活动状态,肺X线表现常不典型。     

更昔洛韦联合卡介菌多糖核酸治疗带状疱疹疗效观察

目的 探讨更昔洛韦联合卡介菌多糖核酸治疗带状疱疹的临床疗效.方法 将86例带状疱疹患者按随机数字表法分为观察组和对照组,每组43例.对照组单纯应用更昔洛韦治疗;观察组在此基础上联合应用卡介菌多糖核酸治疗,观察并比较两组疗效、修复皮肤损害(止疱、结痂)时间和疼痛缓解时间、后遗神经痛发生率和不良反应情况.结果 两组患者均顺利完成治疗,没有因为无法耐受药物而退出者.观察组止疱、结痂和疼痛缓解时间均较对照组明显缩短,差异有统计学意义(P＜0.05);后遗神经痛发生率明显低于对照组,差异有统计学意义(P＜0.05);治疗14 d后观察组有效率为90.7%(39/43),与对照组的74.4%(32/43)比较差异有统计学意义(P＜0.05);两组均无严重不良反应发生.结论 更昔洛韦联合卡介菌多糖核酸治疗带状疱疹疗效确切,安全可行.     

化疗加用卡介苗免疫治疗预防耐多药结核病的研究

目的 探讨卡介苗(BCG)免疫治疗对结核病化疗效果的影响及预防耐多药结核病形成的可能性能.方法 初治菌阳肺结核病志愿者360例,按年龄、性别、病灶范围、空洞和初始耐药等情况相近的原则,配对数字表法随机分成加用BCG的4个月短程化疗组、6个月单纯化疗组.比较两组的细菌学、影像学等临床疗效,以及对继发耐药病例形成的影响.结果 (1)两组结束疗程时痰菌阴转率分别是98.3%(177/t80)和97.2%(175/180),χ2=0.1278,P＞0.05.(2)5年随访痰菌复阳率BCG免疫治疗组2.3%(4/177),对照组6.9%(12/175),χ2=4.2864,P＜0.05.5年细菌学总成功率BCG免疫治疗组高出对照组5.5%,差异有统计学意义(96.1%,173/180;90.6%,163/180,χ2=4.4643,P＜0.05).(3)5年随访期内,两组病例影像学改变与细菌学结果相一致.(4)BCG免疫组继发性耐多药发生率2.3%(4/177),6个月单纯短化组病人中继发性耐多药发生率7.3%(13/178),两组差异有统计学意义,χ2=4.9513,P＜0.05.结论 化疗1个月后加用BCG免疫治疗可提高化疗效果和减少耐多药病例发生率.     

肺结核空洞切除术在空洞性肺结核治疗中的临床应用研究

目的 照机械抽样法随机分为两组,Ⅰ组15例,用标准化疗方案治疗,Ⅱ组28例,用标准化疗方案治疗的同时行肺结核空洞切除术.结果 Ⅱ组患者治疗后咯血停止者占85.7％(24/28),痰菌阴性者占96.4％ (27/28),退热者占92.9％(26/28),均显著高于Ⅰ组患者的13.3％(2/15)、33.3％(5/15)、26.7％(4/15),两组比较差异有统计学意义(P＜0.01).Ⅰ组患者治疗后咯血停止时间、痰菌转阴时间及退热时间分别为( 10.2±1.1)、(8.3±1.2)、(9.1±1.1)个月,均显著长于Ⅱ组患者的(6.3±1.2)、(4.5±1.3)、(5.3±1.2)个月,两组比较差异有统计学意义(P＜0.05).结论 肺结核空洞切除术应用于空洞性肺结核的治疗,可显著提高疗效,缩短治疗时间,成为空洞性肺结核的治疗手段之一.     

斯奇康治疗小儿慢性腹泻疗效与T淋巴细胞亚群变化的关系

目的:研究斯奇康治疗慢性腹泻患儿的疗效及与T淋巴细胞亚群变化的关系。方法:对30例慢性腹泻患儿,用斯奇康注射液治疗6周,观察病情变化。同时治疗前后分别测定患儿血清CD3、CD4、CD8及CD4/CD8。来自门诊保健的同龄正常婴幼儿25例为对照组。结果:总有效率达93.34%。慢性腹泻组治疗前CD3、CD4、CD4/CD8降低,CD8升高,与斯奇康治疗后、对照组相比,差异无有统计学意义(P<0.05)。慢性腹泻组治疗后与正常对照组相比CD3、CD4、CD8、CD4/CD8差异无统计学意义(P>0.05)。结论:慢性腹泻患儿存在有细胞免疫缺陷;斯奇康可有效改善慢性腹泻患儿T细胞亚群状况,对提高患儿整体免疫功能水平具有重要意义。     

膦甲酸钠联合阿昔洛韦对复发性生殖器疱疹患者免疫功能的影响

目的:探讨膦甲酸钠联合阿昔洛韦对复发性生殖器疱疹患者免疫功能的影响。方法:将94例复发性生殖器疱疹患者分为观察组和对照组各47例。对照组采用阿昔洛韦治疗,观察组采用膦甲酸钠联合阿昔洛韦治疗。治疗前后,检测两组患者血清辅助T淋巴细胞(CD4)、细胞毒性T淋巴细胞(CD8)、CD4/CD8、自然杀伤细胞(NK细胞)、白介素4(IL-4)、干扰素γ(IFN-γ)、IFN-γ/IL-4的水平。随访6个月,记录患者复发频率、皮损愈合时间的变化。结果:观察组疗效优于对照组(P0.05);两组治疗后CD4、CD4/CD8、NK细胞的水平均较治疗前升高,且观察组高于对照组(P0.05);两组治疗后IL-4水平较治疗前降低,IFN-γ、IFN-γ/IL-4升高(P0.05),且观察组IL-4低于对照组,IFN-γ、IFN-γ/IL-4高于对照组(P0.05);治疗后6个月随访,两组复发频率、皮损愈合时间较治疗前均明显降低,且观察组低于对照组(P0.05)。结论:膦甲酸钠联合阿昔洛韦能提高复发性生殖器疱疹患者的疗效,并显著改善免疫功能。     

帕瑞昔布钠对腹腔镜胆囊切除术后的镇痛作用及安全性研究

目的 探讨帕瑞昔布钠对腹腔镜胆囊切除术后的镇痛效果和安全性.方法 将90例行腹腔镜胆囊切除术患者按随机数字表法分为帕瑞昔布钠组、氟比洛芬酯组和对照组,每组30例,均于术前30min给予不同药物.观察并比较三组视觉模拟评分(VAS)、镇痛满意度、凝血功能和血小板聚集试验的最大聚集率(MAR)及术后不良反应等.结果 帕瑞昔布钠组、氟比洛芬酯组术后不同时间点VAS和精神症状发生率均明显低于对照组(P＜0.05),术后24 h镇痛满意率分别为93.3%(28/30)和90.0%(27/30),均明显高于对照组[20.0%(6/30)](P＜0.05);三组给药前后凝血功能和MAR比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠对腹腔镜胆囊切除术后的镇痛效果好,不良反应发生率低,值得临床推广应用.     

左氧氟沙星治疗复治肺结核62例的疗效观察

目的探讨左氧氟沙星治疗复治肺结核的临床效果。方法 62例复治肺结核患者被随机分为实验组(n=32)和对照组(n=30),两组均给予常规治疗,实验组在对照组基础上给予左氧氟沙星治疗。结果两组在总有效率,显效率方面有显著性差异(P<0.05),实验组疗效显著优于对照组,在用药副反应方面无显著性差异(P>0.05)。结论左氧氟沙星结合常规治疗应用于复治肺结核患者的治疗,对于提高治疗效果,减轻患者痛苦是很有意义的。