血液透析与血液灌流联合治疗对维持性血液透析患者微炎症状态及iPTH的影响

目的:考察血液透析与血液灌流联合治疗对维持性血液透析患者微炎症状态及iPTH的影响.方法:收治维持性血液透析患者45例,随机分为两组,血液透析联合血液灌流(HD+HP)组23例,血液透析(HD)组22例.观察治疗前后血CRP,iPTH指标的变化.结果:①HD+HP组CRP水平从19 620±12 812mg/L降至10 710±7 043mg/L;治疗前后(P＜0 01),有统计学意义.iPTH从795 4±599 2pg/ml降至507 1±404 4pg/ml,治疗前后比较差异显著(P＜0 01);②HD组CRP水平从2 060±1 008mg/L升至2 990±2 385mg/L,且随着透析时间延长而逐渐升高,但无统计学意义(P＞0 05).iPTH从758 2±540 8)pg/ml下降至696 8±341 5pg/ml,治疗前后(P＞0 05)无统计学意义;结论:HD+HP治疗能有效地降低血液透析患者体内部分CRP及iPTH.     

氟伐他汀降低维持性血液透析患者血CRP水平44例临床研究

目的 探讨氟伐他汀对血液透析(HD)患者血C-反应蛋白(CRP)的影响.方法 44例血胆固醇＞6.0mmol/L的HD患者纳入研究对象,氟伐他汀剂量40mg/d口服,观察12周.观察指标包括:血总胆固醇、甘油三酯、LDL-胆固醇、高密度脂蛋白(HDL)、脂蛋白a[Lp(a)];血CRP反映炎症情况.结果 在治疗组(n=24),使用氟伐他汀12周后血总胆固醇、甘油三酯、LDL-胆固醇均明显下降,而HDL上升.CRP从治疗前(11±2.4)mg/L降至(4.3±1.2)mg/L(P＜0.01),血清清蛋白经氟伐他汀12周治疗后上升,从治疗前(29±10)g/L上升至(34±12)g/L(P＜0.05),血清清蛋白上升与血CRP下降呈负相关(r=-0.75,P＜0.01).结论 氟伐他汀对HD患者除降脂外,还具有抗炎作用,能明显降低血CRP水平.     

血液透析患者血液标志物检验的临床价值

目的:探讨维持性血液透析(MHD)患者标志物对血管疾病预测价值.方法:维持性血液透析患者49例,心血管疾病非维持性血液透析组23例(C组),正常对照30例.血液透析患者分心血管疾病组17例(A组)和非心血管疾病组32例(B组),检测血TG、TC、HDL-C、LDL-C、Fg、D-D、vWF、CRP.结果:心血管疾病组患者的年龄明显高于无心血管疾病组(P＜0.01);A组患者TG、TC、HDL-C、LDL-C、Fg、D-D、vWF、CRP增高,与正常对照组及B组、C组相比差异具有显著统计学意义(P＜0.05).多元Logistic逐步回归分析证实:Fg、D-D、vWF、CRP是心血管疾病的致病危险因素.结论:MHD患者发生心血管并发症与Fg、D-D、vWF、CRP有一定的关系.     

维持性血透患者高抵抗素血症及其意义探讨

目的:观察维持性血透患者血浆抵抗素(Resistin)水平,探讨与微炎症状态的关系.方法:选择我院肾内科病情稳定的维持性血透患者73例,健康志愿者20例,ELISA法测研究对象的空腹IL-6、TNF-α、血抵抗素水平与免疫比浊法测定CRP,并测定血脂、白蛋白、空腹血糖及胰岛素水平,采用空腹血糖×胰岛素/22.5计算胰岛素抵抗(IR)值.结果:维持性血透患者血浆抵抗素水平较正常组明显升高,为(40.15±22.46)ug/L vs(11.78±6.29)ug/L(P＜0.01),同时CRP、IL-6、TNF-α也较正常组明显升高,分别为(4.56±1.46)mg/L vs (2.10±0.67)mg/L (P＜0.01),(90.19±32.04)ng/L vs(49.30±28.12)ng/L(P＜0.01),(115.16±90.35)ng/L vs (48.21±36.54)ng/L(P＜0.01),Spearmen相关分析显示抵抗素与TG、CRP呈正相关(r=0.271,0.246,P＜0.05).结论:维持性血透患者抵抗素水平明显升高且与微炎症状态有关,抵抗素可能在ESRD患者心血管损伤中起作用.     

透析治疗对维持性血液透析患者C反应蛋白水平的影响及其与贫血的关系

目的 探讨维持性血液透析(MHD)患者透析前后C反应蛋白(CRP)水平的变化以及CRP水平与贫血之间的关系.方法以46例维持性血液透析治疗患者为研究对象,分析患者入组时以及持续透析1年后CRP水平变化情况及其与贫血相关指标之间的关系.结果46例患者持续透析1年后,CRP、红细胞压积(Hct)以及血红蛋白(Hb)水平和入组时比较差异均有统计学意义(P＜0.05),但是血浆白蛋白(Alb)水平变化不大(P＞0.05).对透析1年后CPR水平≥8.0 rmg/L(CPR升高组)和＜8.0 mg/L(CRP正常组)的患者贫血相关指标进行比较,Hb、Alb以及Hct水平差异均有统计学意义(P＜0.05);CPR升高组贫血发生率为79.3％,明显高于CRP正常组的41.2％,差异有统计学意义(P＜0.05).结论 持续血液透析患者体内微炎症状态明显,持续透析一定程度上可以改善微炎症状态、纠正贫血,但是C反应蛋白水平持续升高的患者贫血发生率明显较高.     

2型糖尿病患者血糖波动性与CRP的关系

目的 探讨2型糖尿病患者血糖波动性与CRP的关系.方法 用速率比浊法测定慢性持续性高血糖组、慢性波动性高血糖组和正常血糖组CRP水平.结果 慢性持续性高血糖组、慢性波动性高血糖组和正常血糖组CRP水平分别为(6.5±2.1) mg/L、(8.6±2.5) mg/L、(3.2+±1.5) mg/L,三组之间差异有统计学意义(P<0.01).结论 随着血糖波动性的升高,2型糖尿病患者CRP水平升高,检测糖尿病患者CPR水平对临床有指导意义.     

血液透析对老年慢性肾功能衰竭患者炎症标志物的影响研究

目的 探讨血液透析对老年慢性肾功能衰竭患者炎症标志物的影响.方法 方便选取2014年10月—2016年1月于博州人民医院肾内科进行血液透析的老年慢性肾功能衰竭患者82例为观察组,同时选取100名于该院体检的健康老年人为对照组,所选取的两组对象年龄均为60~75岁.分别于入院时、14 d、30 d、60 d后检测透析前后血清脂联素、CRP、IL-6等炎症标志物的水平,将两组炎症标志物水平进行对比.结果 观察组患者血清脂联素、CRP、IL-6分别为(14.88±2.56)mg/L、(7.35±1.88)mg/L、(60.33±6.77)pg/L,对照组患者血清脂联素、CRP、IL-6分别为(7.10±0.89)mg/L、(2.11±0.25)mg/L、(43.25±5.20)pg/L,观察组患者血清脂联素、CRP、IL-6显著高于对照组,差异有统计学意义(P<0.05);观察组患者炎症标志物血清脂联素、CRP、IL-6的水平随着时间的延长不断升高,但各时间点透析前后水平差异无统计学意义(P>0.05);4个时刻点血液透析前炎症标志物水平相比,2个月后比其他3个时刻点显著升高,差异有统计学意义(P<0.05).结论 血液透析不能降低老年慢性肾功能衰竭患者炎症标志物血清脂联素、CRP、IL-6的水平,因此有必要在临床治疗中进行抗炎治疗.     

早期辛伐他汀治疗对急性脑梗死患者血脂和炎症反应标志物C-反应蛋白浓度的影响

目的观察急性脑梗死(ACI)早期辛伐他汀治疗对血脂和炎症反应标志物C-反应蛋白(CRP)的影响及差异,探讨他汀类药物在急性脑梗死早期治疗中的作用.方法选择急性脑梗死住院患者96例,随机分为辛伐他汀治疗组和非辛伐他汀治疗组,比较入院前和出院后甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-ch)、高密度脂蛋白胆固醇(HDL-ch)和CRP水平.同期选取15例健康者作为对照组.结果①出院时辛伐他汀组与非辛伐他汀组的血浆CRP为(9.32±6.40)mg/L和(12.22±7.18)mg/L,显著低于入院时的(28.12±25.62)mg/L和(27.98±27.01)mg/L(P＜0.01);出院时辛伐他汀组血浆CRP亦显著低于非辛伐他汀组(P＜0.01).②据入院时血浆CRP水平,将急性脑梗死患者分为CRP高值组和低值组,出院与入院时比较,高值组和低值组血浆CRP均显著降低(P＜0.01),但只有高值组出院时辛伐他汀治疗者血浆CRP显著低于非辛伐他汀治疗者(P＜0.05).结论急性脑梗死患者早期辛伐他汀治疗使CRP显著降低,有明显抗炎症作用.     

超敏C-反应蛋白水平与慢性肾功能衰竭和透析治疗病人的关系

目的探讨慢性肾功能衰竭、血液透析和腹膜透析患者血浆超敏C-反应蛋白(hs-CRP)的变化规律及其临床意义.方法用胶乳增强散射浊度法测定122例患者(慢性肾衰未透析45例、血液透析32例和腹膜透析45例)的血浆hs-CRP,同时检测了总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、白蛋白和前白蛋白,并与42名健康人比较.结果三组患者hs-CRP平均水平分别为慢性肾衰未透析组4.82(6.86 mg/L、血液透析3.58(4.28 mg/L、腹膜透析6.89(7.54 mg/L,均明显高于对照组1.78(2.26mg/L,统计学分析有显著性差异(P＜0.01、P＜0.05和P＜0.001).各组hs-CRP＞升高的比率分别为:慢性肾衰组44.44%、血液透析组40.63%、腹膜透析组62.22%,对照组14.28%.慢性肾衰未透析组hs-CRP水平的变化与肌酐水平有正相关关系(r=0.35,P＜0.05);与白蛋白和前白蛋白有负相关关系(r=-0.34和r=-0.43,P＜0.05).在血脂测定中,慢性肾衰未透析组和腹膜透析组的水平显著高于正常对照组,而血液透析组与正常对照组无显著性差异.结论慢性肾衰、血液透析和腹膜透析患者血浆hs-CRP平均水平都升高;检测hs-CRP水平对肾脏病患者心血管并发症的预防和治疗有一定临床意义.     

C反应蛋白在急性冠脉综合征中的临床意义

目的 探讨C反应蛋白(CRP)急性冠脉综合征(Acute coronary syndromesACS)的关系.方法 测定经冠脉造影确诊的冠心病患者60例(其中急性冠脉综合征患者30例,非急性冠脉综合征的冠心病患者30例)和冠脉造影排除冠心病患者30例的血CRP浓度.结果 ACS患者组(A组)血CRP浓度为(14.53±16.87)mg/dL;非ACS患者组(B组)血CRP浓度为(4.07±4.56)mg/dL;对照组(C组)血CRP浓度为(3.67±4.43)mg/dL,A组与B组之间CRP浓度有显著性差异(P<0.001);B组与C组之间CRP浓度无显著性差异.结论 急性冠脉综合征患者血CRP浓度明显升高,提示炎症反应与急性冠脉综合征密切相关,CRP浓度潮定可作为急性冠脉综合征的监测指标.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.