糖尿病对老年创伤病人的影响分析(附11例报告)

糖尿病是老年人中较常见的一种代谢性疾病，病人的围手术期并发病较非糖尿病患者高5倍［1］，而糖尿病对老年创伤病人危害则更大，因此恰当地处理这类糖尿病人值得重视。我们1994年起治疗糖尿病并存老年创伤病人11例，现分析如下。1临床资料本组11例，男6例，女5例，年龄在巩～so岁，平均67岁，有糖尿病病史7例，无糖尿病病史4例。入院时血糖为9．01mmol／L～32．4mmol／L之间，其中9．ofmmol／L～豆6．12mmol／L6例，16．6mmol／L～32．4tnmol／LS例。本组患者依据1980年WHO制定的糖尿病诊断标准，均为！型糖尿病。且互例人中，四肢骨…     

业医者需博览医书

为医者,不但要深研《内》《难》《伤寒》等典籍,更要博览古今名家著述和医案,以开扩视野,启迪思路,从而提高临床辨证治疗水平。笔者于此颇有体会。1984年冬,我曾治一刘姓男青年,身劳汗出,感冒风寒,翌日即颜面红肿发硬,瘙痒尤甚,颜面及颈部呈弥漫性红肿,眼睑尤甚,难于睁开。经某医院诊为“顽固性丘疹型荨麻疹”,迭经肌注氢化考的松,静脉滴注地塞米松,口服扑尔敏等药,虽稍见小效,然消而复肿如初,痒状不减。余接诊时,查舌质淡、苔     

“魄门亦为五脏使”刍议

<正> 《素问·五脏别论》云:“魄门亦为五脏使”。魄门亦即肛门,为人体九窍之一。魄门之启闭与人体精微物质的吸收及糟粕的排泄关系极为密切。魄门开合有节,启则糟粕得以及时排出,闭则水谷精微得以进一步再吸收。如魄门启闭失度,启而不闭则清浊不分,俱出体外,机体失养,耗伤正气;闭而不启,则糟粕积蓄不得排出,这不仅是脏腑功能失常的表现,反之,也可以影响脏腑功能。魄门启闭功能的正常发挥,有赖于心神主宰、肝气条达、脾气升提、肺气宣肃和肾气固摄。只有魄门启闭功能不失常度,方能协调脏腑之气机。魄门为心使:《素问·灵兰秘典论》曰:“心者,     

无创通气治疗慢性阻塞性肺疾病急性呼吸衰竭的临床研究

目的探讨早期应用无创通气治疗慢性阻塞性肺疾病(COPD)急性呼吸衰竭的价值.方法 56例COPD急性加重合并Ⅱ型呼吸衰竭患者随机分为对照组和实验组,每组28例.对照组用常规药物治疗,实验组用常规药物治疗加无创正压通气.结果两组患者治疗前的基础情况和血气指标差异无显著性(P＞0.05).治疗后呼吸频率(RR)、心率(HR)、动脉血pH、氧分压(PaO2)、二氧化碳分压(PaCO2)均明显改善(P＜0.01).总有效率实验组和对照组分别为89.3%和82.1%,差异无统计学意义(P＞0.05),但实验组与对照组比较,治疗后PaO2上升更明显(P＜0.01),PaCO2下降更明显(P＜0.01).实验组和对照组平均住院日分别为(13±5) d和(17±6) d(P＜0.01);治疗4 h后实验组和对照组呼吸困难明显缓解的人数分别为19例和9例(P＜0.01),48 h后分别为24例和16例(P＜0.05).需气管插管有创通气者分别为3例(10.7%)和5例(17.9%)(P＞0.05).结论早期应用无创通气治疗COPD急性呼吸衰竭较仅用常规药物治疗能更快地缓解临床症状,提高PaO2和降低PaCO2.     

脉冲振荡法在慢性咳嗽临床应用中的探讨

目的 观察本院门诊就诊的慢性咳嗽患者的肺通气功能及气道阻力变化情况.方法 设立实验组和健康对照组,采用普通肺功能及脉冲振荡法检查,比较两组75%最大呼气流量(MEF75)、50%最大呼气流量(MEF50)、25%最大呼气流量(MEF25)以及脉冲振荡法之呼吸总阻抗(Z5)、总气道阻力(R5)、中心气道阻力(R20)及周边弹性阻力(X5)各项指标的数值变化.实验组行支气管扩张剂治疗14 d,再观察上述指标.结果 治疗前实验组同健康组比较,各项指标差异有统计学意义.实验组治疗前后比较,各项指标差异有统计学意义.治疗后实验组与对照组比较,各项指标差异无统计学意义.结论 总气道阻力、小气道阻力及周边弹性阻力增加,大气道阻力未增加.支气管扩张剂治疗慢性咳嗽有效.     

细胞蜡块在诊断棘球蚴病中的应用北大核心CSCD

棘球蚴病又名包虫病,是细粒棘球绦虫幼虫（棘球蚴）寄生于家畜等多种食草动物和人的组织器官内的人兽共患寄生虫病,多发于世界各地牧区。以往该病的诊断是基于普通细胞学,如今,随着细胞蜡块技术的不断发展,大大拓展了细胞病理学诊断的实用范围和能力。     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

小剂量茶碱联合氟替卡松治疗激素低敏感型支气管哮喘患者的机制探讨

激素低敏感型支气管哮喘(简称哮喘)是哮喘中的难点,因其对糖皮质激素治疗的反应性很低,或只对较大剂量的糖皮质激素起反应,但大剂量的糖皮质激素常常导致严重副作用。许多研究表明,茶碱有助于控制吸入大剂量糖皮质     

速尿吸入治疗夜间发作性哮喘13例临床观察

速尿吸入治疗夜间发作性哮喘１３例临床观察四川泸州医学院附属医院呼吸内科（６４６０００）熊瑛，彭启灿，范运斌，李国平，王宋平自Ｂｉａｎｃｏ［１］等首先报道速尿可以预防运动性支气管收缩以来，速尿在治疗哮喘方面的作用已不断受到关注。我们于１９９３年底～１９...     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.