【摘要】 目的 总结急性肾功能衰竭（acute renal failure， ARF）的病因特点、治疗情况与预后的关系。 方法 回顾性分析2007年8月-2008年4月77例ARF的临床资料，总结各种因素与患者预后的关系。 结果 肾性因素是最主要的致病病因，占77.92%，其中以药物和中毒居多。老年患者、少尿型患者或合并多脏器功能衰竭患者病死率较高，分别为25.93%，29.55%，83.33%。 结论 ARF应早期诊断，积极给予综合治疗，包括肾脏替代治疗，老年ARF患者易出现多脏器功能衰竭、合并感染等，应放宽透析指征，并注意去除高危因素以提高存活率。【Abstract】 Objective To explore the clinical features, treatment, and prognosis of acute renal failure (ARF). Methods The clinical data of 77 patients with ARF from Auguest 2007 to April 2008 were retrospectively analyzed. Results Renal factor was the most important cause of ARF, accounting for 77.92%. The mortalities of elderly patients, oliguric patients and with multiple organ failure were 25.93%, 29.55%, and 83.33%, respectively. Conclusion Patients with ARF should be diagnosed as early as possible and given comprehensive treatments, including renal replacement therapy; the elderly patients with multiple organ failure and infection should be relaxed dialysis indications. We should pay attention to the removal of risk factors to improve the survival rate.
Objective To improve the knowledge of epidemiology, diagnosis and treatment of aspirin induced asthma ( AIA) in China. Methods Thirty-six cases with AIA who were reported in 30 papers in recent 10 years were analyzed retrospectively. Results The drugs which induced AIA in China mainly included acetylsalicylic acid ( aspirin) , ibuprofen ( Fenbid, ibuprofen) , while acetaminophen ( paracetamol,Bufferin, Tylenol ) , phenylpropanoid thiazide ( Piroxicam) , methoxy-naphthalene C acid ( naproxen) ,diclofenac in rare cases. 28. 6% ( 8 /28) of AIA patients were complicated with nasal disease . AIA could occur at all ages, especially for those over 40 years ( 72. 2% , 26 /36) . No significant difference of prevalencein male and female. The onset time of AIA was less than 60min in 71. 4% and gt;120min in 38. 6% . Most patients took the medications by oral ( 83. 3% ,30/36) , but the AIA onset time was not different by different administration route. Conclusions The incidence of AIA increases in recent years because of widely use of NSAIDs. However, no awareness of NSAIDs induced asthma is common in patients and physicians. For asthma patients it must be caution to take antipyretic analgesic anti-inflammatory drugs. If necessary,methoxy-naphthalene C acid ( naproxen) and diclofenac could be better choice.
Objective To explore the number variation trend of inpatients with traumatic brain injury (TBI) in high altitude and plain areas. Methods The first page information in medical records of TBI patients, who were admitted to military hospitals from 2001 to 2007, was searched and extracted from the Chinese Trauma Database. Two military hospitals in high altitude area and another two in the same hospital level in plain area were selected. Then, the number variation trend of TBI inpatients in those two areas was compared. Results In high altitude area, the proportion of male patients and their median inpatient days were higher, while the age, proportion of Han patients and surgery rate were lower than those in plain area (all Plt;0.001). During 2001-2007, there were 9 141 TBI patients discharged from the four hospitals, and the average annual growth rate was 13.15%. In high altitude area, the average annual growth rate of discharged inpatients was 24.00%, while in plain area, it was just 7.09%. The 4 common categories of TBI were intracranial injury, open wound of the head, neck and trunk, skull fracture, and other injuries. Conclusion Compared with the plain area, there are significant differences in the demographics, hospital stay and surgery of inpatients in high altitude area. The average annual growth rate of TBI inpatients discharged from hospitals in high altitude area is faster than that in plain area, to which should be paid attention by relevant departments.
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.
Objective To explore the effects of various kinds of internal fixations on unstable intertrochanteric femoral fractures. Methods From January 2000 to December 2004,88 cases of unstable intertrochanteric femoral fractures were treated. There were 52 males and 36 females (aged 19-86 years). Twenty-two cases were caused by fall from height, 36 by motor vehicle accident and 20 by fall and 10 by tumble. They were divided into 4 groups according to 4 kinds of internal fixations: dynamic hip screw(DHS,group A, n=42), anatomical proximal femur bone plate (group B, n=23), proximal femoral nail（PFN，group C, n=8）and dynamic condylar screw (DCS, group D, n=15). According to the modified Evan’s classification, fractures were all unstable type and were classified as follow types: group A (15 type Ⅲ, 8 type Ⅳ and 19 type Ⅴ); group B (12 type Ⅲ, 5 type Ⅳ and 6 type Ⅴ); group C (3 type Ⅲ,2 type Ⅳ and 3 type Ⅴ); and group D (10 type Ⅲ,3 type Ⅳ and 2 type Ⅴ). The data of operative time, intra-operative blood loss, intraoperative complications, fluoroscopy exposures, clinical healing time of fracture, post-operative restored function and postoperative complications were recorded and analyzed statistically using the SPSS 12.0 software package.Results All patients were followed up for 12-48 month (18 months on average). All patients achieved clinical healing. Coxa varus occurred in 3 cases of group A, in 1 case ofgroup C and in 3 cases of group D . The differences were of no statistical significance in operative time and postoperative complications between 4 groups (P＞0.05). The difference was of statistical significance in the blood loss between groups A,B and groups C,D (P＜0.05) but no statistical significance between group C and group D (P＞0.05). The difference was of statistical significance in the fluoroscopy exposures, clinical healing time of fracture and postoperative complications between group B and the other groups (P＜0.05). The difference was of statistical significance in the postoperative restored functions between group D and theother groups (P＜0.05). Conclusion The anatomical proximal femur bone plate is a useful device in the treatment of unstable intertrochanteric femoral fracture. The operative manipulation is simple and the hip functions recover well.
ObjectiveTo study and analyze the clinical characteristics, treatment and prognosis of chronic kidney disease (CKD) patients with tuberculosis.MethodsThe cases of CKD with tuberculosis treated in respiratory department, nephrology department and infection department of the Affiliated Hospital of Southwest Medical University during January 2014 to December 2018 and followed up for at least half a year were collected as the study subjects. The clinical characteristics of CKD patients with tuberculosis and to observe the treatment, prognosis and adverse reactions were analyzed.ResultsA total of 74 patients were enrolled in the analysis, including 51 males (68.91%) and 23 females (31.08%), and with a mean age of (52.1±15.5) years. The use rate of immunosuppress drug in CKD G1\G2\G3 stage was very high (100%, 100%, 70%, respectively), and patients in G5 stage had the highest TB infection by 49 cases. There were 58 cases of pulmonary tuberculosis, which was the main form of tuberculosis. Extrapulmonary tuberculosis was very common too, and there were 40 cases including 29 cases of lymph node tuberculosis. Among 53 cases of acid fast bacilli smear, 8 cases were positive; lung biopsy positive in 1; lymph node biopsy was positive in 5 cases; 53 cases were initially treated and 21 cases were retreated. The main symptoms of 74 patients were emaciation (33 cases), fever (30 cases), and fatigue (25 cases); the common symptoms of 58 patients with pulmonary tuberculosis were cough and expectoration (41 cases). Pulmonary tuberculosis mainly infected the upper field of lung (39 cases). The most common imaging features was patchy shadow in 17 cases, followed by single or multiple nodules in 15 cases. The number of cases with lymph node enlargement in drainage area, pleural effusion, and pleural thickening were 36, 34 and 24, respectively. The sensitivity of tuberculosis interferon-gamma release assays (TB-IGRA), tuberculosis polymerase chain reaction (TB-PCR) and Mycobacterium tuberculosis protein chip was 79.6%, 18.8% and 61.7%, respectively. After tuberculosis treatments, 51 cases were successful, 14 cases failed, 5 cases died, and 4 cases could not be evaluated. Sixteen cases had serious and typical adverse reactions, including 12 cases of drug-induced liver injury, and 11 cases of treatment failure due to these serious adverse reactions.ConclusionsThe incidence rate of tuberculosis is high in CKD patients and the clinical manifestations are atypical. Pulmonary tuberculosis is the main form of tuberculosis, extrapulmonary tuberculosis is very common and mainly lymph node tuberculosis. The sensitivity of TB-IGRA, TB-PCR and Mycobacterium tuberculosis protein chip detection are lower than that of common patients. The success rate of tuberculosis treatment in CKD patients is low, the adverse reaction rate is high, and the adverse reactions are the main causes of treatment failure.
目的总结自身免疫性胰腺炎（AIP）的影像学特点。 方法回顾性分析13例经手术病理学检查或糖皮质激素治疗证实的AIP患者的临床资料。 结果13例均行CT检查，7例同时行MRI检查、DWI扫描及磁共振胰胆管造影（MRCP）检查，2例同时行超声检查。8例表现为胰腺弥漫性肿大，4例表现为胰腺局限性肿大，1例表现为胰腺混合型肿大。CT动态增强扫描结果提示，胰腺病变呈“雪花状”渐进性强化，T1WI信号减低，T2WI信号略高，DWI信号增高；MRCP检查可见胆总管胰内段呈“鸟嘴样”狭窄；超声检查显示胰腺病变部位肿大，回声减低。 结论AIP具有典型的影像学特征，影像学检查是发现和诊断AIP的重要手段。
Objective To investigate the role of low-dose heparin added to total nutrient admixture (TNA) solutions in the prevention of catheter related infections (CRIs). Methods One-hundred three newborn infants with periph-erally inserted central catheter (PICC) were divided into heparin group (n=63) and control group (n=40). The patients in the heparin group received TNA with 0.5 U/ ml heparin. The patients in the control group received TNA without heparin. We retrospectively analyzed the incidence of CRTs in the two groups. Results We found that the incidence of CRIs was 0 in the heparin group and 12.5% (5/40) in the control group. The incidence of catheter obstruction was 6.3% (4/63) in the heparin group and 20% (8/40) in the control group. The incidence of catheter-tip colonization was 1.58% (1/40) in the heparin group and 17.5% (7/40) in the control group. The incidences of CRIs, catheter obstruction, and catheter-tip colonization were signiicantly lower in the heparin group than those in the control group (Plt;0.05). Conclusion TNA solutions with 0.5U/ml heparin have decreased catheter obstruction and CRIs.