目的:探讨主动脉夹层患者误诊的原因,提高主动脉夹层患者的早期诊断率,为及时、正确救治患者生命提供有力的科学依据。方法:回顾性分析3例主动脉夹层患者实际诊断与误诊的情况,查明误诊原因。结果:3例主动脉夹层患者经检查后证实,1例误诊为急性食道撕裂伤或消化性溃疡,占33.33%;1例误诊为急腹症,占33.33%;1例误诊为急性颅内病变,占33.33%。结论积极评估其病情的危险程度,监测生命体征,快速建立静脉通道,同时仔细询问相关病史,认真查体,积极采取相应辅助检查,可降低误诊率。
目的:减少雷公藤多苷片引起的严重不良反应发生,保证用药安全。方法:通过检索雷公藤多苷片不良反应相关文献,筛选个案或典型病例报告,分析该类不良反应的临床特征。结果:64例个案病例中,不良反应累及器官或系统以血液系统为主、其次为生殖系统、泌尿系统和肝胆系统,大多较轻微,为一过性,停药后对症治疗可以恢复,但长期或大剂量服用可能导致严重的不良反应。结论:雷公藤多苷片所致不良反应与服药时间相关,可累积多个系统,建议根据病情严格控制服药剂量,并且在服药前和服药期间检查血、尿常规和肝肾功能。
摘要:目的：评价围手术期预防性应用抗菌药物现状及合理性。方法：采用回顾性调查的方法，随机抽查2009年度Ⅰ类切口手术围手术期病案500份，设计外科围手术期预防性应用抗生素调查表，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。结果：未使用抗生素5例，预防性使用抗生素495例，其中不合理80例（16.00％）。预防性使用抗生素总品规数为540，其中头孢菌素类453例（83.89%），青霉素类（包括加酶抑制剂）26例（4.81%），喹诺酮类44例（8.15%）。选用头孢唑啉钠178例（32.96%）居第一位，头孢替唑钠第二，151例（2796%）。结论：Ⅰ类切口手术患者围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、抗菌药物使用时间较长等问题，有待进一步规范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.
摘要:目的: 通过分析地市级急救中心院前急救资料,探讨ICD10疾病分类方法在院前急救中的实用性。 方法 :回顾性分析2007年1~12月份自贡市急救中心出诊的全部有效急救患者的急诊诊断以及随访诊断,使用ICD10编码进行归类,比较疾病性别构成比。 结果 :全年院前急救4109例,排5位的疾病分别为损伤、中毒和外因的某些其他后果(484%)、循环系统疾病(170%)、消化系统疾病(81%)、呼吸系统疾病(64%)、精神和行为障碍(52%),损伤、中毒和外因的某些其他后果、循环系统疾病以及消化系统疾病出诊量男性多于女性(P＜005),耳和乳突疾病以及妊娠、分娩和产褥期疾病出诊量女性多于男性(P＜005)。 结论 :采用ICD10标准对院前急救病谱分类有进一步探讨的价值。Abstract: Objective: To investigate the value of ICD10 in prehospital care by the analysis of cases in Zigong Urgent Rescue Center. Methods : All cases of prehospital care during the year of 2007 were studied, whose emergency Diagnoses and followup diagnoses were recorded, and they were classified by international classification of diseases 10th revision (ICD10). The gender composition ratio of diseases was analyzed. Results : Four thousand one hundred and nine cases of prehospital care in 2007 were included. Topfive diseases were injury, poisoning and certain other consequences of external causes (484%), diseases of the circulatory system (170%), diseases of the digestive system (81%), diseases of the respiratory system (64%), and mental and behavioral disorders (52%) respectively. The amout of the male prehospital cases was more that of than the female’s in the diseases of injury, poisoning and certain other consequences of external causes, diseases of the circulatory system, diseases of the digestive system (P＜005); the amount of the female prehospital cases was more than that of the male’s in the diseases of the ear and mastoid process, pregnancy, childbirth and the puerperium (P＜005). Conclusion : Further research on the spectrum of diseases classified by ICD10 is valuable.
目的:在移动平均趋势剔除法、最小二乘法两种趋势剔除法中找出一种能较好反映某医院门诊量季节变化规律的方法。方法:根据该医院2005~2008年各月门诊数据,运用移动平均趋势剔除法、最小二乘法分别计算该医院门诊患者的季节指数(seasonal index)和各月预测值,并对预测结果进行平均绝对偏差(MAD)、平均平方误差(MSE)、平均预测误差(AFE)、平均绝对百分误差(MAPE)分析。同时,判断实际值与预测值的容许区间的关系。结果:移动平均趋势剔除法和最小二乘法预测值的MAD、MSE、AFE、MAPE分别为766.94,888236.8542,-0.23,5.478249.8%和739.0196,802281.2,0.125,5.259-453%。移动平均趋势剔除法有4个实际值落在容许区间之外,最小二乘法有2个。结论:最小二乘法能够更好反映出该院门诊量季节变化的规律,是预测的最佳选择方案。
目的:了解我院药品不良反应(ADR)发生的特点。方法:对我院2006年1月至2009年8月收集到的67例ADR报告进行回顾性统计分析。结果:我院报告ADR例数最多的部门为新生儿,有51例(7612%);0~28 d年龄段患儿ADR发生率较高(5223%),且男性高于女性;静脉给药方式是导致ADR的主要因素(9701%);ADR发生率最高的为抗感染药(8056%),其中绝大多数是由头孢菌素类和青霉素类引发;临床表现以皮肤及其附件损害最为常见(8841%)。结论:儿童用药更应该加强ADR的监测,提高ADR报告的质量,合理、规范使用药物,尤其是抗菌药物,以减少或避免ADR的发生。
摘要:目的: 研究尿微量白蛋白与冠心病的相关性。 方法 : 按冠状动脉造影诊断标准将116例患者分为冠心病组(82人) 与非冠心病组(34人),测定晨尿白蛋白/ 肌酐浓度值(ACR),比较两组患者尿ACR 并分析ACR与冠脉病变程度的相关性。 结果 : 冠心病组ACR显著高于非冠心病组的; ACR与冠脉计分呈显著的直线正相关。 结论 :冠心病患者ACR水平升高,微量白蛋白尿与冠状动脉病变范围和程度密切相关, 且对冠状动脉狭窄程度具有独立预测价值。Abstract: Objective: To investigate the relationship between microalbuminuria and coronary artery disease(CAD). Methods : According to the diagnostic standard of coronary artery angiography,116 patients were divided into CAD group (82 patients) and nonCAD group (34 patients). The albumin and creatinine concentrationratio ratio(ACR) in morning urine samples from patients of both groups was estimated and compared. The correlation of ACR to the extent of coronary lesions was analyzed. Results : ACR in the CAD group was significantly higher than that in nonCAD group. A distinctly linear positive correlation existed between ACR and the score of the coronary lesions. Conclusion : ACR increase in patients with CHD.Micoalbuminuria was associated with the severity of coronary lesions in patients with CHD and is an independent predictor of CAD.
目的：探讨脑梗死出血转化(HT)的病因，发生率，临床表现和影像学特点及预后。方法：对我院2002年1月至2008年7月96例脑梗死出血转化患者进行回顾性分析。结果：糖尿病、高血压、心房纤颤、血脂异常、大面积脑梗死是HT的主要病因，其发生率为20.3%，第一周为62.5%，第二周为31.2%，两周后为6.3%，其临床表现为头痛、呕吐、肢体无力加重、意识障碍加深，CT或MRI表现为非血肿型与血肿型，死亡率为16.7%。结论：对神经症状及体征加重的患者，尤其是大面积脑死患者，应及早查复查CT或MRI，有利于HT的早期诊治。
摘要:目的: 分析特非那定所致不良反应的临床特征、相关因素,为临床药物治疗中药品不良反应的防治提供参考依据。 方法 :检索1986～2008年国内文献源特非那定的不良反应资料,并加以分析研究。 结果 :34例不良反应报告中女性明显多于男性;不良反应以心血管系统损害最多(23例,占6766%),其次为皮肤及附件损害(5例,1470%);不良反应预后较好。 结论 :患者的性别、体质、合并用药等因素能影响不良反应的发生,对于引起心律失常不良反应临床应提高警惕,减少不良反应的发生。Abstract: Objective: To analyze the clinical features、correlation factors of ADRs caused by Terfenadine drugs and provide beneficial references for preventing and curing the ADRs. Methods :To collect and analyze the cases of ADRs caused by Terfenadine from medical journals of 19862008 Results :Women were more than men in 34 ADRs;cardiovascular system lesions accounted for 6766%,skin and its appendix lesions accounted for 1470%;ADRs prognosis well. Conclusion :The occurrence of ADRs caused by Terfenadine due to many factors such as sex、age and combination drug,ect. The ADRs caused by second generation antihistamine drugs must be reconstred.