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中国临床保健杂志

中国临床保健杂志

CSTPCD

Chinese Journal of Clinical Healthcare
中国科技论文统计源期刊（中国科技核心期刊） 《中国临床保健杂志》征稿征订启事 由国家卫生部主管，卫生部北京医院、安徽省保健委员会主办，国内外公开发行的《中国临床保健杂志》，是以临床医学与保健为主题的综合性学术期刊。国家卫生部副部长、卫生部保健局局长黄洁夫同志兼任本刊编委会主任。自2005年第1期起，本刊已被收录为“中国科技论文统计源期刊”（中国科技核心期刊），并于2008年3月、5月相继被美国《化学文摘》(CA)、波兰《哥白尼索引》（IC）收录。 中国临床保健杂志社热诚欢迎医疗卫生工作者为本刊提供稿件。欢迎各有关单位和广大读者订购，每期9元，全年54元，全国各地邮局均可订购，邮发代号26-184，也可直接向中国临床保健杂志社邮购。 通讯地址：安徽省合肥市红星路1号省委大院715信箱中国临床保健杂志社收 邮编：230001 电话：0551-62608457 传真：0551-62606415 E-mail:J.C.Healthcare＠163.com 网址：http://bjzz.ahbj.cn
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  • 发文量：5200
  • 被引量：2259
  • H指数：1
  • 开始收录时间：1998(1)
  • CNKI综合因子：0.869
  • 维普期刊影响因子： 2.39
  • 万方期刊影响因子：1.97
  • 创刊时间：1998
  • 国内刊号/CN：34-1273/R
    国际刊号/ISSN：1672-6790
  • 发行周期：双月刊
    邮发代号：26-184
  • 主管单位：中华人民共和国卫生部
    主办单位：卫生部北京医院 安徽省保健委员会
中国临床保健杂志-联系信息
  • 主编：
  • 电话：0551-62608457
  • 邮箱：J.C.Healthcare@163.com
  • 地址：安徽省合肥市红星路1号
  • 邮编：230001
中国临床保健杂志-获奖情况
  • • 2009年，荣获“安徽省优秀期刊二等奖”
  • • 荣获“第四届华东地区优秀期刊二等奖”
  • • 2015年，荣获国家卫生计生委颁发的委管出版物主题宣传“优秀期刊奖”
  • • 2016年，在第四届《中国学术期刊评价研究报告（武大版）（2015-2016）》中被评为“RCCSE中国核心学术期刊（A）”
  • • 2017年，荣获“安徽优秀期刊奖”
  • • “保健论坛”栏目被评为安徽期刊“特色栏目”
  • • 荣获“第六届华东地区优秀期刊奖”
  • • 2018年，荣获“十佳皖版期刊”（自科类）称号
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  • 摘要：精神分裂症是以精神活动与环境的不协调为主要特征的一类最常见的精神病，好发于青壮年，为一种功能性精神病，本病患者一般无意识和智能方面的障碍，但发作时不仅影响本人的劳动能力，且对家庭和社会也有影响，应引起各界人士的关注。精神分裂症到目前为止病因未明，有环境因素、遗传因素、精神刺激、生理原因、体质因素等，临床上单纯的药物治疗过，疗效并不是很理想。我院对48例精神分裂症患者在精神科疾病常规治疗的基础上给予为期8周的护理干预，并随访1年，取得了较好的临床疗效，现报告如下。
  • 摘要：目的：探讨多层螺旋CT（MSCT）对良、恶性胃间质瘤（GST）的诊断价值。方法回顾性分析GST25例，所有病例均行螺旋CT平扫及三期增强扫描，对肿瘤部位、大小、形态、强化方式、与周围器官关系及有无淋巴结转移进行回顾性分析。所有病例均经病理及免疫组织化学诊断。统计采用SPSS 18．0统计软件分析。结果25例GST中，良性10例（其中交界性2例），恶性15例。 GST的大小、形态、生长方式同良、恶性相关（P＜0．05），肿瘤发生部位、年龄、性别和均匀与不均匀的强化方式与良恶性无相关性。结论良、恶性胃间质瘤具有其影像学特征，MSCT可较好的作出诊断。
  • 摘要：目的：探讨动力髋螺钉（ DHS）结合防旋钉治疗股骨粗隆间骨折疗效。方法应用DHS联合防旋钉治疗股骨粗隆间骨折54例。结果随访8～16个月，平均11．6个月，骨折均愈合良好，关节功能活动较好，颈干角正常或接近正常，无主钉及防旋钉切割穿出。 Harris关节功能评分：优：20例；良：25例；可：9例；优良率：83．3％。结论 DHS联合防旋钉治疗股骨粗隆间骨折简便、实用、可靠，相对安全。
  • 摘要：全身麻醉后留置导尿，虽然减轻了术前导尿给患者造成的疼痛和不适，减轻了患者因术前导尿引起的血压升高和心跳加快。但全身麻醉后留置导尿的患者在术后复苏期对尿管的刺激征比在术前清醒情况下留置导尿的患者更严重，表现为躁动、烦躁甚至自主拔管等，严重影响了患者在麻醉恢复期的平稳过渡Hj。为了消除或减轻患者复苏期因留置尿管而引起的躁动，安全平稳地度过复苏期，我们在护理过程中应用利多卡因乳膏代替石蜡油润滑尿管，对男性患者麻醉后进行导尿并随机抽取80例患者对其临床效果及安全性进行对比研究，现报告如下。
  • 摘要：肺气虚常出现卫外功能减退，呼吸功能失常，从而出现治节功能障碍。根据中医理论且结合临床实际，将肺气虚证可分为轻、中、重三度。当前关于肺气虚证本质研究成为热点，为运用现代医学手段来研究肺气虚证本质提供了思路。肺气虚证本质研究采用的方法包括心功能、肺功能检查、肺部影像学检查、血液流变学、细胞能量代谢、植物神经功能状态、生化学、免疫学、代谢组、蛋白组及基因芯片等，涉及慢性阻塞性肺疾病、肺心病、慢性支气管炎等疾病。笔者根据近年来关于肺气虚证的研究概括如下，以进一步揭示肺气虚证的本质特征。
  • 摘要：Objective To explore the feasibility and the value of Bayes analysis in clinical decision of ovari -an neoplasms .Methods A total of 152 ovarian neoplasms were divided into 3 groups:benign group ( n=51 ) ,border-line group(n=10)and malignant group(n=91).We took age,serum CA125 level,ultrasonographic parameters and Doppler blood flow signals as differential diagnosis variable .Results The parameters of age ,serum CA125 level,ul-trasonographic parameters in benign groups had statistical difference with those in malignant groups ( P<0 .05 ) .The accuracy of Bayes analysis rate was 76.92%,70.00%,and 74.51%respectively.Conclusion Combination of sono-graphic and clinical feature might be helpful for making differential diagnosis .It is feasible to use Bayes analysis for the management of ovarian neoplasms .%目的：探讨Bayes分析指导卵巢肿瘤诊断的可行性及其意义。方法将卵巢肿瘤患者分为良性肿瘤组、交界性肿瘤组和恶性肿瘤组三组，选取每组患者的年龄、CA125、肿块最大径及肿瘤内动脉的阻力指数（ RI）作为代表因素；比较三组间代表因素间的差异，最后行Bayes判别分析。结果三组卵巢肿瘤患者的年龄、CA-125、肿块最大径及肿瘤内动脉RI差异有统计学意义（P＜0．05）。 Bayes分析法判断良性肿瘤组、交界性肿瘤组和恶性肿瘤组正确率分别为76．92％、70．00％及74．51％。结论年龄、CA125、肿块大小及肿瘤内动脉RI的Bayes 逐步判别分析用于指导卵巢肿瘤的诊断具有一定的可行性。
  • 摘要：Objective To evaluate the value of N-terminal-pro-brain (Nt-proBNP) in predicting death or hospital readmission after hospital discharge in the aged ( elder than 65 years old ) patients with chronic heart failure (CHF).Method A total of 115 CHF patients were included in the study , 65 cases of cardiovascular group and 50 cases of non-cardiovascular group .And the cardiovascular group was divided into death group and survive group .We compared the Nt-proBNP, left ventricular end-diastolic dimension and left ventricular ejection fraction .Result (1) The concentration of Nt-proBNP increased with the decreasing of the cardiac function , the difference of each group was statistically significant (P<0.05);(2) The Nt-proBNP concentration of cardiovascular group was higher than that of non-cardiovascular group (P<0.05);(3) The Nt-proBNP concentration in death group was higher than that in survive group (P<0.01), Nt-proBNP was significantly related to the events-occurring.Conclusion Nt-proBNP level at admission is a strong predictor of rehospitalization and death within 12 months after hospital discharge in the aged patients with CHF .%目的：探讨N末端脑利钠肽原（ Nt-proBNP）水平对老年慢性心力衰竭（ CHF）患者预后的影响。方法老年CHF患者115例为研究对象。心血管事件组65例，非心血管事件组50例，将心血管事件组进一步分为死亡组（21例）与非死亡组（44例），比较不同组间Nt-proBNP、左室舒张末期内径、左室射血分数。结果随着心功能下降，Nt-proBNP水平增高，各组间比较，差异有统计学意义（均P＜0．05）；心血管事件组的Nt-proBNP基线水平高于非心血管事件组（P＜0．05）；Nt-proBNP水平在死亡组高于非死亡组（P＜0．01）， Nt-proBNP与是否发生事件明显相关。结论老年CHF患者Nt-proBNP水平增高，且随着心功能下降递增；血浆Nt-proBNP是预测老年CHF患者1年内发生心血管事件或死亡的良好指标。
  • 摘要：Objectives To investigate the changes of serum growth hormone levels with increasing age in middle-aged men.To explore the association between GHD and body composition .To assess GHD impact on QOL. Methods A total of 120 patients who were hospitalized or physical examination in our hospital ward cadres were se -lected from February 2012 to April 2013,divided into three groups by age:the middle-aged group(40-59yrs),the old age group(60-79yrs),the elderly group(≥80yrs),to compare the serum GH levels among three groups .The 120 pa-tients were divided into two groups according to the presence or absence of GHD ,GHD group and GH normal group , to compare two group differences on body mass index (BMI),total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),fasting blood glucose (FBG),glyco-sylated hemoglobin (HbA1c),and SF-36 scale score.Results The comparison among the three groups GH:The ser-um GH average changed with increasing age ,the GH levels in the middle-aged group was statistically significant than that in the elderly group (P<0.01).The age and serum GH levels were negatively correlated .GHD group compared with normal GH group:BMI,TC,TG,LDL-C were higher,HDL-C was reduced,the difference was statistically signifi-cant (P<0.05).FBG and HbA1c differences were not statistically significant (P >0.05).Comparing the two groups:The GHD group various dimensions of quality of life scores were lower ,differences were statistically significant (P<0.05).GH and detect indicators of relevance analysis:GH with age,BMI,TC,TG,LDL-C was negatively correla-ted (r<0,P<0.05),and HDL-C,various dimensions of quality of life was positively correlated (r>0,P<0.05),and FBG,HbA1 c no significant correlation .Conclusions The serum GH levels in older men were gradually reduced with increasing age,GHD maybe related to the BMI,TC,TG,LDL-C increased,HDL-C reduction,reduced quality of life.%目的：探讨中老年男性血清生长激素（ GH）水平与年龄的变化关系；中老年男性血清生长激素缺乏（ GHD）与机体组分的关系；GHD对生活质量有何影响。方法选取干部病房住院或体检的中老年男性患者120例，按年龄段分成三组，40～59岁：中年组，60～79岁：老年组，80岁以上：高龄组，比较三组之间血清GH水平的关系；将该120例患者按照有无GHD分成两组，GHD组和GH正常组，比较两组之间体质量指数（ BMI）、总胆固醇（ TC）、三酰甘油（ TG）、低密度脂蛋白胆固醇（ LDL-C）、高密度脂蛋白胆固醇（ HDL-C）、空腹血糖（ FBG）、糖化血红蛋白（ HbA1 c）、SF-36量表评分有无差异；比较所有检测指标与GH有何相关性。结果随着年龄的改变血清GH平均值发生改变，中年组与高龄组比较，差异有统计学意义（P＜0．01），且年龄与血清GH水平呈负相关；GHD组与GH正常组比较：BMI、TC、TG、LDL-C均升高，HDL-C降低（P＜0．05）；FBG、HbA1c差异无统计学意义（P＞0．05）；两组比较：GHD组生活质量各维度评分均降低，差异均有统计学意义（P＜0．05）。 GH与检测指标的相关性分析中，GH与年龄、BMI、TC、TG、LDL-C呈负相关（r＜0，P＜0．05），与HDL-C及生活质量各维度呈正相关（r＞0，P＜0．05），与FBG、HbA1c无明显相关性。结论随着年龄的变化中老年男性血清GH水平逐渐降低，GHD可参与BMI、TC、TG、LDL-C增高，HDL-C减低，生活质量下降。
  • 摘要：Objective To assess the immune function in MG patients ,and to investigate the immunomodula-tory of immunosuppressants (IS) such as GC and Ig.Methods 6-color flow cytometry was used for analysis .57 pa-tients with MG were divided into three groups classified as control group ,GC group and IVIg group according to the treatment strategy.Results (1)The percentage of CD4 +CD25 +FOXP3 +T cells in the peripheral circulation was sig-nificantly reduced in control group .while increased in GC group ,with no statistical difference .There were significant differencebetween treated group and control group ,(P<0.05).The percentage of CD4 +CD25 +FOXP3 +T cells sig-nificantly increased in IVIg group compared to the control group (P<0.05),and the other groups(P<0.001).(2) The treatment of GC and Ig was associated with increased percentage of CD 4 +CD25 +FOXP3 +T cells in peripheral blood in patients with MG ,and the latter were increased more significantly than those of the former .Conclusion The significant reduction in the percentage of CD 4 +CD25 +FOXP3 +T cells in the peripheral blood of patients with MG may be involved in the pathogenesis of MG .The therapeutic effect of GC and Ig is correlated to the increasing percent-age of CD4 +CD25 +FOXP3 +T cells in peripheral blood in patients with MG .%目的：评估重症肌无力（ MG）患者体内的免疫紊乱，并探讨免疫抑制剂治疗MG患者的机制。方法将57例患者分为未治疗组、糖皮质激素（GC）治疗组和静脉注射免疫球蛋白（IVIg）治疗组，采用流式细胞仪的六色荧光分析技术。分析GC、免疫球蛋白（Ig）等免疫抑制剂对调节性T细胞（Tregs）的影响。结果（1）外周血CD4＋CD25＋FOXP3＋T细胞百分比在未治疗组患者外周循环中显著减少，GC治疗组有所升高，但差异无统计学意义，两者与健康对照组比较差异显著，P＜0．05；IVIg治疗组Treg比例显著升高，与健康对照组比较，P＜0．05，与其他各组比较，P＜0．01。（2）GC和Ig不同程度提升了患者外周血Tregs比例，后者更加显著。结论（1）CD4＋CD25＋FOXP3＋T细胞百分比在MG患者外周循环中显著减少，可能是MG发病的原因。（2）GC和Ig的治疗作用与其提升Tregs比例有关。
  • 摘要：Objective To observe atopic dermatitis ( AD) pathological changes and their influence on aller-gic airway inflammation in order to investigate the mechanism .Methods 20 BALB/c mice were randomly divided in-to the AD group and the control group , and there were 10 in each group .AD group used 7% dinitrochlorobenzene (DNCB) to sensitive mice abdominal skin,with 0.5%dinitrochlorobenzene and 40 μg OVA irritating to mouse back skin,where was coated with acetone in the control group at the same time .All the mice in the two groups were inhaled 1%OVA aerosol inhalation to induce airway inflammation;The mice skin and lung pathological changes were ob-served,and the bronchoalveolar lavage fluid (BALF) was collected and counted .The level of BALF and IL-4,IL-5, IFN-γand OVA-IgE in serum were tested by ELISA kit .Results Pathological changes in AD mice skin were charac-terized by thickening of epidermis and dermis layer and inflammatory cell infiltration , with no changes in control group.The number of lung inflammatory cells in AD group increased significantly compared with that in the control group.The number of blood WBC ,neutrophils ,lymphocytes and eosinophils inAD group were significantly increased , and the levels of IL-4,IL-5,IFN-γand OVA-IgE in both BALF and serumwere increased significantly compared with that in the control group .Conclusions The allergen stimulation to the skin in AD mice could induce systemic aller-gic reactions.The inhale of soluble antigen inhalation could aggravate airway inflammation ,which may be involved in the imbalance of Th1/Th2,and infiltration of eosinophils ,particular IgE and Th2.%目的：观察特应性皮炎（ AD）的病理变化及其对呼吸道过敏性炎症产生的影响，探讨其形成机制。方法 BALB/c小鼠20只，随机分为AD组和丙酮对照组各10只；AD组以7％二硝基氯苯（ DNCB）致敏小鼠腹部皮肤，0．5％二硝基氯苯及40μg鸡卵清蛋白（OVA）激发小鼠背部皮肤；对照组相同时间相同部位涂以丙酮；两组均以1％OVA雾化吸入诱导小鼠气道炎症。观察两组小鼠皮肤及肺部病理改变，收集小鼠支气管肺泡灌洗液（BALF），对BALF进行细胞计数，并用ELISA方法测试BALF及血清中白细胞介素-4（IL-4）、白细胞介素-5（IL-5）、干扰素-γ（IFN-γ）和卵清蛋白IgE（OVA-IgE）含量变化。结果 AD组小鼠皮肤病理表现为表皮真皮层增厚，炎症细胞浸润；而对照组皮肤正常。 AD组肺部组织炎性细胞较对照组明显增多。 BALF中细胞数AD组白细胞总数、中性粒细胞、淋巴细胞及嗜酸性粒细胞增多明显，IL-4、IL-5、IFN-γ和OVA-IgE含量均较对照组增高；血清中IL-4、IL-5与OVA-IgE含量较对照组增高。结论特应性皮炎因皮肤受到过敏原刺激能导致全身过敏反应，当吸入同种可溶性抗原时，能使气道炎症加重；其机制可能与Th1/Th2比例失衡，嗜酸性粒细胞、特定性IgE和Th2细胞浸润相关。
  • 摘要：Objective To compare the ultrasonic and pathological characteristics of Radiofrequency Ablation and acetic acid injection in normal rat liver tissue .Methods 20 SD rats were divided into RFA group ( n=10 ) and acetic acid injection group(n=10).RFA was performed after laparotomy in RAF group,and precutaneous acetic acid injection was operated under the ultrasound real -time monitoring in acetic acid injection group .Two-dimensional ul-trasound and color doppler ultrasound were used to assess local liver damage .The Pathologic changes were observed after the rats were killed .Results The post-RFA ultrasound image showed a strong echo on the border with no signif-icant observable signal of blood flow ,and the pathological changes were characterized by the evolution of coagulation necrosis,cellular degeneration and granulation tissue formation at the position of lesion and surrounding .The ultra-sound images after acetic acid injection showed multiple focal strong echoes ,and the pathological changes were char-acterized by multifocal coagulation necrosis and a surrounding degeneration .Conclusion Radiofrequency ablation and acetic acid injection could induce coagulation necrosis in rat liver tissue .The former was associated with focal scope damage while the latter was diffuse .%目的：比较射频消融与醋酸经皮注射对大鼠肝脏的超声影像及病理学改变产生的影响。方法20只健康SD大鼠均分为射频组（10只）和醋酸注射组（10只），射频组大鼠开腹后对其肝组织给予射频消融；醋酸注射组大鼠在超声实时监视下经皮醋酸肝脏注射治疗，其后即刻应用二维B型超声及彩色多普勒超声观察肝脏局部损伤的特点；并在即刻处死后取大鼠肝脏进行病理学观察。结果大鼠肝脏射频消融灶超声影像表现为边界较为清晰的强回声团，其内未见明显血流信号；病理检查显示从射频消融灶中心到周边呈凝固性坏死-细胞变性-肉芽组织形成的演变特点。经皮醋酸肝脏注射后，注射部位超声影像表现为局限性多发点片状强回声，病理组织学检查呈现出多灶性凝固性坏死，周边肝细胞变性。结论射频消融与经皮醋酸肝脏注射均可对大鼠肝脏造成凝固性坏死，前者损伤范围较为局限；后者造成的损伤范围较为弥散。
  • 摘要：目的：探讨并分析卵巢恶性肿瘤开腹再分期手术的范围、安全性等相关情况的临床意义。方法31例患者均为安徽省立医院2001年1月至2011年12月收治的开腹再分期手术卵巢恶性肿瘤。其中，1a期19例，Ib期6例，Ic期5例，IIa期1例；卵巢上皮性癌21例（67．7％），恶性生殖细胞肿瘤5例（16．1％），颗粒细胞肿瘤5例（16．1％）。结果31例患者中15例（48．3％）患者经再分期手术后证实期别提高，其中6例（19．4％）实际应为Ⅲa期，4例（12．9％）III b期，5例（16．5％）IIIc期。15例开腹再分期手术期别提高患者中，腹膜后淋巴结5例（腹主动脉旁3例，盆腔淋巴结2例），结肠旁沟转移4例；侧腹膜2例，大网膜转移2例，盆腔腹膜2例。16例再分期手术期别无改变患者，术中出血量平均为300 ml，手术时间平均为3 h。余15例再分期手术患者，术中出血量平均为400 ml，手术时间平均为3．5 h。无围手术期死亡病例。结论对卵巢恶性肿瘤开腹再分期手术是安全可行的，有利于准确确定分期及指导术后辅助化疗，判断预后。
  • 摘要：坐骨神经主要负责支配下肢活动，长期存在坐骨神经痛有可能导致患者患侧下肢出现肌肉萎缩，严重可导致患者出现跛行¨J。为研究汉防己甲素片应用于治疗坐骨神经痛的临床疗效，我院选取近两年来收治的患有坐骨神经痛患者资料进行分析，现将具体结果报告如下。
  • 摘要：消化道息肉以往尤其是20世纪80年代前常采用开腹手术摘除，近年来由于内窥镜治疗技术的不断提高，镜下治疗消化道息肉已取得显著疗效…，现将内镜下高频电凝切除消化道广基型息肉治疗体会报告如下。
  • 摘要：目的：回顾性分析感染性心内膜炎（ IE）围手术期的护理治疗经验。方法92例IE患者按IE的常规处理措施，完成手术前相关检查和准备；严密观察术后病情变化，针对性的做好预防并发症的监护，加强呼吸道的管理、高热的处理和营养支持、应用呼吸器期间及拔管后呼吸道的管理；严密监测心率、心律、动脉压、中心静脉压、循环和尿量的变化、维持心功能稳定，减少或避免发生各种并发症，平稳度过术后危险期。结果术后早期死亡6例（6．52％），随访71例（77．17％），随访时间3～12个月，无心内膜炎复发，心功能恢复至Ⅰ级53例，Ⅱ级18例。结论 IE患者做到早期诊断，加强围手术期处理，可取得良好的治疗效果。
  • 摘要：异基因外周造血干细胞移植（allo．PBSCT）是目前治疗恶性血液病的最佳方法，但其主要并发症移植物抗宿主病（GVHD）是造血干细胞移植后致死的一个重要原因。脐带血间充质干细胞（UC—MSC）具有免疫抑制作用，降低GVHD的发生率；具有造血支持和促进造血干细胞植入；
  • 摘要：心力衰竭可能的病因有很多，高血压被认为是导致心力衰竭重要的原因之一，目前在临床上备受重视。我科共收治高血压性心力衰竭老年患者80例，并在其中一部分患者中创新性的在传统护理策略的基础上结合强化心理护理治疗的护理策略，取得了一定的效果，现总结汇报如下。
  • 摘要：目的：探讨采用低剂量扫描条件和低剂量对比剂进行128层螺旋CT头颈部动脉造影的可行性。方法将100例接受头颈部CT血管造影（CTA）检查的患者随机分为研究组和对照组，管电压、管电流和对比剂用量分别为100 kV、300 mA、50 ml和120 kV、450 mA、70 ml，对比分析图像质量、血管强化情况、静脉硬化伪影及辐射剂量、对比剂剂量。结果①除右侧锁骨下动脉外，各主要动脉节段影像评分两组间差异无统计学意义（P＞0．05）；②研究组CT值高于对照组（P＜0．05）；③对照组静脉伪影较研究组明显（P＜0．05）。④对照组辐射剂量及对比剂用量明显高于研究组（P＜0．05）。结论采用低剂量扫描条件和低剂量对比剂进行头颈部128层螺旋CTA可获得较好的图像质量。%Objective To evaluate the feasibility of low-dose radiation and low volume contrast medium pro-tocol for cerebral and carotid CTA with 128-slice spiral CT scanner.Methods Totally 100 patients who underwent cere-bral and carotid CTA were included and divided randomly into experimental group and control group,with the tube voltage of 100kVand 120kV,tube current of 300mA and 450mA,and contrast medium of 50mland 70ml,respectively. Image quality,vascular enhancement,venous artifacts as well as the radiation dose were independently compared be-tween the two groups.Results ①There was no significant difference of image quality of the cerebral and carotid ar-teries except for the right subclavian artery between the two groups(P>0.05).②The CT number in experimental group was higher than that in control group (P<0.05).③The grading score of venous artifacts in control group was significantly higher than that in experimental group (P<0.05).④The radiation dose and the contrast medium vol-ume in experimental group was significantly lower than that in control group(P<0.05).Conclusion The applica-tion of 128-slice CT scanner withlow-dose radiation and low volume contrast medium protocol for cerebral and carotid CTA can result in high quality images.
  • 摘要：Objective To investigate the clinical characteristics and pathogens distribution in patients with Hospital-acquired pneumonia.Methods A retrospective observational study involving 50 patients with HAP who were hospitalized in emergency ward was conducted from January 2010 to December 2011.50 patients with CAP were in-cluded as control.The clinical characteristics,laboratory data and prognosis were collected and analyzed.Results Compared with CAP group,the patients in HAP group were characterized by higher average age,longer hospitaliza-tion,much more complications,higher ratio of smokers,higher level of white blood cell counts,lower level of serum al-bumin and oxygenation Index,and higher level of mortality.Re-admissions in HAP group were higher than that in CAP group (40% ).Gram-negative bacilli were the major organism in HAP group(54.3%),of which 62.9% was multi-drug-resistant bacilli.While Gram-positive bacilli were the major organism in CAP group (63.6%),with no multi-drug-resistant bacilli..There were significant difference between the two groups (P <0.05).Conclusions The age, chronic disease and unhealthy lifestyle were the risk factors for patients with HAP.Gram-negative bacilli were the dominant pathogen of HAP with high porporation of MDR.%目的：探讨老年患者医院获得性肺炎的临床症状表现、实验室指标、病原学分布及预后等各方面特点，为采取有效的预防及治疗措施提供必要的依据。方法急诊病房（含 ICU）内50例新发老年医院获得性肺炎（HAP）病例为研究对象，同时选取同时期入院的50例老年社区获得性肺炎（CAP）病例作为对照，对临床特征、实验室指标及预后情况等特点进行统计学分析。结果HAP 患者较 CAP 患者平均年龄更大，住院周期长，合并基础疾病多，吸烟者比例高，实验室指标中血白细胞计数高，血清白蛋白低，氧合指数低，预后中病死率高；HAP 患者构成中反复多次入住医院病房中的发生比例最高，占40％；两组比较均差异有统计学意义。在病原菌分布方面，HAP 以革兰阴性菌为主，占54．3％，MDR 菌株占62．9％；CAP 以革兰阳性菌为主，占63．6％，未见 MDR 菌株，两组比较均差异有统计学意义。结论高龄、慢性基础疾病、不良生活习惯等均为 HAP 高危因素，病原菌分布以革兰阴性杆菌为主，MDR 菌株比例高。
  • 摘要：Objective To evaluate the effects of amlodipine combined with flupentixol/melitracen on hyper-tensive patients with Mixed Anxiety-Depressive Disorder (MADD).Methods A total of 85 hypertensive patients with MADD were randomly divided into two groups.Patients in control group (n =43)were treated with amlodipine, and those in treatment group (n =42)were given medication (amlodipine plus flupentixol/melitracen)and psycho-therapy.The Hamilton anxiety (HAMA)scale,Hamilton depression (HAMD)scale and blood pressure were applied to access the clinical response.Results The blood pressure (BP)of all patients was significantly decreased after treatment.Statistical analysis showed a significant reduction of BP of patients in treatment group compared with those in control group.Furthermore,scores of HAMA and HAMD in treatment group were markedly reduced,whereas scores remain unchanged in control group.Conclusion Our data indicate that hypertensive patients with MADD may benefit from the combination of amlodipine plus flupentixol/melitracen and psychotherapy.%目的：探讨氨氯地平与氟哌噻吨美利曲辛联合应用，结合心理干预对原发高血压合并混合性焦虑忧郁症患者的治疗效果。方法选择原发高血压病伴焦虑抑郁患者85例，随机分为对照组（氨氯地平）和研究组（氨氯地平＋氟哌噻吨美利曲辛＋心理干预）进行治疗，疗程8周，观察2组治疗前后汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评分及血压变化情况。结果经过治疗，两组患者血压都有明显下降，且研究组较对照组降低更加明显（P ＜0．05）。研究组患者经过治疗 HAMD、HAMA 评分明显降低（P ＜0．05），而对照组无明显变化。结论在应用氨氯地平降压基础上联合氟哌噻吨美利曲辛与心理干预，可显著提高对原发高血压合并焦虑症患者的治疗效果。
  • 摘要：Objective To explore the application of dexmedetomidine administered in the aged patients with total hip replacement surgery in aged patients.Methods A total of 60 ASA II patients,aged 65 ~80 years,scheduled for total hip replacement surgery Under the general anesthesia were allocated randomly to either dexmedetomidine group (group D)or normal saline group (group C),withn =30 cases in each group.Anesthesia was induced with dexamethasone 10 mg,etomidate 0.2 mg/kg,sufentanil 0.3 μg/kg,rocuronium 0.6 mg/kg.After induction anesthesia was injected continuous intravenous propofol 1 ~1.5 mg/L and sufentanil 0.5 ~0.8μg·kg -1 ·h -1 ,discontinuous suction sevoflurane maintain appropriate anesthesia depth.A gastric tube was inserted througu the drain tube of LMA. Group D patients before the induction of anesthesia,intravenous dextromethorphan prop microphone pyridine (Jiangsu Hengrui Pharmaceutical Company,Lot No.1,112,111)0.6μg/kg (15 min),and then changed to 0.2μg·kg -1 · h -1 until the end of surgery,group C injected with normal saline.SBP,DBP,HR,Ramsay and the incidence of agita-tion were recorded immediately before anesthesia(T0),5 min after the drug(T1),15 min after the drug (T2),30 min after the drug (T3),60 min after the drug(T4),at the end of the surgery (T5)and 30 min after pulling out LMA. Results The sedation of dexmedetomidine was effective at a 0.6 μg/kg dose of continuous dexmedetomidine infu-sioncould lead to elevated blood pressure and bradycardia.The incidence of EA was lower,and the Ramsay score was higher in group D than that in group C(P <0.05)after operation.Conclusions Dexmedetomidine administered in the aged patients during total hip replacement surgery could maintain hemodynamic stability and performed sedative effect.%目的：探讨盐酸右美托咪定在老年患者全髋关节置换手术中的临床应用。方法全身麻醉下全髋关节置换手术老年患者60例（年龄65～80岁），ASA Ⅱ级，随机均分为盐酸右美托咪定组（D 组）和0．9％氯化钠注射溶液组（C 组）。试验组患者术前（15 min 内）给予盐酸右美托咪定0．6μg/kg 及术中0．2μg ·kg -1·h -1静脉持续泵注直至手术结束，对照组给予同等剂量的0．9％氯化钠注射溶液，并在不同时间点观察患者平均动脉血压（MAP ）、心率（HR）、呼吸频率（RR ）、脉搏血氧饱和度（SpO2）等血流动力学指标、Ramsay 评分及苏醒期躁动的发生率。结果盐酸右美托咪定镇静效果良好，0．6μg/kg 盐酸右美托咪定持续泵入时可引起患者一过性血压上升及窦性心动过缓。术后 D 组患者苏醒期躁动发生率明显低于 C 组，而Ramsay 评分明显高于 C 组（P ＜0．05）。结论盐酸右美托咪定应用于老年患者全髋关节置换手术全身麻醉时显现出维持血流动力学稳定及良好的镇静效果。
  • 摘要：Objective To construct the recombinant eukaryotic expression vector pcDNA3.1(+/-)-miR-214 and investigate its transfection and expression in COS-7 cell.Methods The PCR product of miR-214 was ac-quired from genomic DNA from mice.The miR-214 PCR product was digested with restriction enzyme EcoRI and No-tI,then the digested miR-214 was cloned into vector pcDNA3.1(+/-).The recombinant plasmid pcDNA3.1(+/-)-miR-214 was identified with restriction enzyme digestion and sequence analysis.It was then transfected into COS-7 cells by lipofectamin reagent and the expression of miR-214 was determined by real time PCR.Results Restriction enzyme digestion analysis and DNA sequencing indicated the correct construction of the recombinant plasmid pcD-NA3.1(+/-)-miR-214.The expression of miR-214 in COS-7 cells increased after transfection with pcDNA3.1 (+/-)-miR-214.Conclusion The construction of the eukaryotic plasmid pcDNA3.1(+/-)-miR-214 has been achieved successfully.%目的：构建小鼠 miR-214的 pcDNA3．1（＋/-）真核表达载体并在 COS -7细胞中转染检测其表达。方法小鼠基因组 DNA 扩增得到 miR -214序列，将酶切后的 miR -214克隆到真核表达载体pcDNA3．1（＋/-），重组 pcDNA3．1（＋/-）-miR-214经过酶切和测序鉴定后转染 COS-7细胞并应用萤光定量 PCR 法检测 miR-214表达水平。结果小鼠 miR-214真核表达载体序列分析完全正确；转染 COS-7细胞后miR-214的表达水平可增加1．41倍。结论成功构建了 pcDNA3．1（＋/-）-miR-214真核表达载体并能在真核细胞中进行表达，为进一步进行 miR-214的功能研究提供了实验基础。
  • 摘要：目的：研究血浆氨基末端脑钠肽前体（NT-ProBNP）水平与慢性心功能不全患者的肺动脉高压的相关性。方法110例慢性心功能不全患者均进行超声心动图检查和血浆 NT-proBNP 测定，根据超声左室射血分数分为收缩性心功能不全和舒张性心功能不全，再根据右房室瓣反流速率估测肺动脉压力（PASP），分为对照组（PASP ＜36mmHg），肺动脉高压 A 组（PASP 37～50 mm Hg），肺动脉高压 B 组（PASP ＞50 mm Hg）。用罗氏 cobasR h 232 Cardiac System 心脏标志物检测仪检测 NT-proBNP 的表达水平。结果（1）NT-pro BNP在收缩性心功能不全组表达高于舒张性心功能不全组，差异有统计学差异（P ＜0．05）；（2）EF ＞55％组中，肺动脉高压 B 组与肺动脉高压 A 组及对照组血浆 NT-proBNP 水平差异有统计学意义（P ＜0．05），肺动脉高压 A组与对照组血浆 NT-proBNP 水平差异无统计学意义（P ＞0．05），EF ＜55％组中，三组之间的血浆 NT-proBNP水平差异无统计学（P ＞0．05）。（3）无论 LVEF 正常与否，PSAP 均与血浆 NT-proBNP 具有正相关性（r ＝0．366，0．325；P ＜0．01，P ＜0．05）。结论慢性心功能不全人群中，PSAP 与 NT-proBNP 呈正相关，这种相关性在舒张性心功能不全人群中更明显。
  • 摘要：男性，91岁，因反复发热、咳嗽、咳脓痰50年，加重4年余于2007年10月入院。患者1957年诊断两下肺支气管扩张，此后多次因支扩合并感染住院治疗。1996年因患急性会厌炎而后遗严重误吸。此后经常因误吸而发生吸入性肺炎。平素每日咳痰量至少100 ml。2001年患者出现气短，活动后加重。胸片出现左肺渐进性、多形性病灶、肺不张（痰栓堵塞）等改变，左侧胸腔明显变小，塌陷。自2007年10月起，患者反复发热，咳嗽、咳脓痰，血象增高。经抗生素治疗，病情曾一度好转。2008年3月后两肺感染加重，无力咳痰，出现Ⅱ型呼吸衰竭。遂行经鼻气管插管，呼吸机辅助呼吸。2008年4月行气管切开术。此后多次床旁像提示两肺多发炎性病变。痰培养革兰阴性杆菌主要是铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌，革兰阳性菌主要为肺炎链球菌、金黄色葡萄球菌，真菌主要为白假丝酵母菌。住院期间应用抗生素、机械通气、纠正水、电解质紊乱、营养支持治疗等，2011年3月因多脏器功能衰竭死亡。
  • 摘要：目的：探讨优质护理服务对于改善腹壁巨大切口疝患者术后抑郁及焦虑状态的效果。方法腹壁巨大切口疝患者50例，按随机分组的方法分为观察组与对照组。对照组采用常规护理，观察组采用优质护理模式进行护理。观察两组手术前后患者焦虑抑郁状态变化，利用 Zung 焦虑自评量表（SAS）和抑郁自评量表（SDS）进行评价，比较两组术后 SAS 评分及 SDS 评分的变化及护理服务满意度情况。结果患者应用优质护理干预后，SAS 评分及 SDS 评分均有明显的下降，观察组满意度显著高于对照组。结论优质护理服务模式能有效改善巨大腹壁切口疝患者术后抑郁及焦虑状态，明显提高患者对护理服务的满意度。
  • 摘要：目的：探讨血糖波动对2型糖尿病患者肾病发生的影响。方法采用美敦力动态血糖监测系统（CGMS）对136例2型糖尿病患者进行连续72 h 动态血糖监测，通过尿白蛋白/肌酐测定值将所有糖尿病患者分为无糖尿病肾病组（NDN 组）和早期 DN 患者（DN 组），观察其72 h 平均血糖水平、血糖波动水平以及HbA1 c、血压和血脂谱等一般情况，并进行相关分析。结果（1）两组间血压、FBG 、24hMBG、MAGE、HbA1 c 等差异有统计学意义（P ＜0．05）。（2）回归分析显示24hMBG、MAGE 是早期糖尿病肾病发生的独立危险因素，OR 值分别为0．563、1．220（P 值分别为0．005和0．011）。结论血糖波动是糖尿病肾病发生发展的危险因素之一。%Objective To investigate the influence of the blood glucose fluctuation on the incidence of dia-betic nephropathy in patients with type 2 diabetes.Methods Continuous glucose monitoring system (CGMS)for 72 h was applied for 136 patients with type 2 diabetes mellitus.All diabetes mellitus were divided into non diabetic ne-phropathy group (NDN group)and patients with early DN (DN group)according to the ratio of urinary albumin to creatinine.The levels of 72 h average blood glucose,blood glucose fluctuation and HbA1 c,blood pressure,blood lipid were recorded and analysed.Results (1)There was significant difference of blood pressure,fasting blood glucose, the 24 h average blood glucose level(24hMBG),average blood glucose excursion amplitude(MAGE)and HbA1 c be-tween the two groups (P <0.05).(2)The results of Logistic analysis showed that 24hMBG and MAGE were inde-pendent risk factors to the incidence of early diabetic nephropathy,with the OR of 0.563 and 1.220(P =0.005and 0.011),respectively.Conclusion Glucose fluctuation is a important risk for the development of diabetic nephropathy.
  • 摘要：Objective To explore the effect and safety of clopidogrel and aspirin combination in the treat-ment of ST-segment elevation acute myocardial infarction in the aged patients.Methods A total 180 aged patients with ST-segment elevation acute myocardial who underwent thrombolytic therapy were randomly divided into control group and treatment group,with 90 patients in each group.Patients in control group were treated with aspirin and treat-ment group received the combination of clopidogrel and aspirin treatment for 4 weeks.The combined endpoint events of death,recurrent myocardial infarction and postinfarction angina,the change of ST-T and bleeding complications were re-corded and analyzed.Results The combined endpoint events in treatment group was 5.6%,which was much lower than that in control group (23.3%,P <0.05);The effective rates in the treatment of ST-T judged by ECG were 95.6% and 75.5% in treatment group and control group with significant difference (P <0.05);There were no significant differ-ence in bleeding complications between the two groups (10.0% vs 6.7%,P <0.05).Conclusions The combination of Clopidogrel and aspirin in the treatment of ST-segment elevation acute myocardial infarction in the aged patients could greatly decrease the incidence of cardiovascular events with no increase in the risk of bleeding complication.%目的：探讨氯吡格雷联合阿司匹林治疗老年 ST 段抬高型急性心肌梗死的疗效及安全性。方法将180例行溶栓治疗的老年 ST 段抬高型急性心肌梗死患者随机分入对照组与观察组，每组各90例。给予对照组患者口服阿司匹林治疗，观察组患者接受氯吡格雷联合阿司匹林治疗，连用4周。比较两组死亡、再发心肌梗死、梗死后心绞痛的联合终点事件发生率、患者 ST-T 的改变以及出血并发症发生率。结果观察组联合终点事件发生率为5．6％，显著低于对照组23．3％（P ＜0．05）；观察组与对照组心电图判定 ST-T 治疗有效率分别为95．6％和75．5％，差异有统计学意义（P ＜0．05）；观察组与对照组出血并发症发生率差异无统计学意义（10．0％比6．7％，P ＜0．05）。结论氯吡格雷联合阿司匹林治疗老年 ST 段抬高型急性心肌梗死可显著降低心血管事件发生率，且不增加出血并发症。
  • 摘要：Objective To investigate the diagnostic value of color Doppler ultrasound in the carotid artery le-sion of type 2diabetes (T2DM)patients.Methods The morphologic and hemodynamic parameters of carotid artery in 127 patients with T2DMand 146 healthy participants recruited as control group were assessed by color Doppler ul-trasound,Results There was significant difference between the T2DMgroup and the control group in intima -media thickness (IMT)(P <0.05).Among 127 patients with T2DM,the thickening of IMT were observed in 79 cases(62. 2%),the formation of atherosclerotic plaques and carotid stenosis were in 64 (50.4%)and 35 (27.6%)cases,re-spectively,and there was significant difference between the two groups(P <0.05).Conclusion The incidence of ca-rotid atherosclerosis in the patients with T2DMincreased significantly.The color Doppler ultrasound is an effective and convenient means to detect the formation of carotid atherosclerosis of patients with T2DM.%目的：研究彩色多普勒超声对2型糖尿病颈动脉病变的诊断价值。方法彩色多普勒超声检查127例2型糖尿病患者颈动脉结构形态及血流动力学指标，与146例对照组颈动脉检查结果做比较。结果2型糖尿病组内膜中层厚度（IMT）与对照组 IMT 比较差异有统计学意义（P ＜0．05）；2型糖尿病组中有79例 IMT 增厚，占62．2％；64例斑块形成，占50．4％；35例管腔发生不同程度狭窄，占27．6％；与对照组比较，差异均有统计学意义（P ＜0．05）。结论2型糖尿病患者颈动脉硬化的发生率明显增高，彩色多普勒超声是发现2型糖尿病患者颈动脉硬化的一种简便有效的手段。
  • 摘要：目的：探讨叶酸改善老年期轻度认知功能障碍（MCI）大鼠学习和记忆能力的机制。方法老年SD大鼠40只，随机等分为假手术对照组（SC）、模型对照组（MC）、低剂量给药组（LD）和高剂量给药组（HD）。造模后30 d起对LD组4 mg·kg-1·d-1、HD组12 mg·kg-1·d-1连续叶酸灌胃，SC组及MC组给予相同剂量生理盐水灌胃，30 d后分别检测其学习记忆能力、血清叶酸和同型半胱氨酸（Hcy）浓度、海马组织G蛋白偶联受体激酶2（GRK2）mRNA及蛋白表达。结果HD、LD组学习记忆能力、血清叶酸浓度均高于MC组（P＜0．05）；HD、LD组血清Hcy浓度、GRK2mRNA及蛋白表达均低于MC组（P＜0．05）。结论补充叶酸可以改善老年期MCI大鼠学习记忆能力，其机制可能与提高血清叶酸水平、降低血浆Hcy水平、减轻海马组织GRK2基因及蛋白表达有关。%To investigate the mechanism of folic acid on the improvement of learning and memory abilities in the elderly rat model of mild cognitive impairment.Methods Forty elderly SD rats were randomly divided into four groups including a sham-operated contorl(SC)group,a model control(MC)group,a low dose(LD)group and a high dose(HD)group(n=10 in each group).30 days after operation,LD group(low-dose folic acid 4 mg·kg-1 ·d-1 ) and HD group(high-dose folic acid 12 mg·kg-1 ·d-1 )were given intragastric administration with folic acid tablets dissovled in saline daily for 30 days.The rats in SC group and MC group were given intragastric administration with the same dose of saline daily also for 30 days.On the 30th day of intragastric administration,we measured the learning and memory abilities,serum folic acid and plasma homocysteine concentration,GRK2 mRNA and protein expression in hippocampal tissues.Results The learning and memory abilities and serum folic acid concentration in HD and LD groups were all significantly higher than those of MC group(P<0.05).The plasma homocysteine concentration and GRK2 mRNA and protein expression in HD and LD groups were all significantly lower than those of MC group(P<0.05).Conclusion Supplementation of folic acid can improve the learning and memory abilities of elderly MCI rats. The mechanism may be related with increasing serum folic acid concentration,reducing plasma homocysteine concen-tration and decreasing GRK2 gene and protein expression in hippocampal tissues.

    中国临床保健杂志的期刊信息

    • 曾用名：临床中老年保健医学;临床中老年保健
    • 创刊时间：1998
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    中国临床保健杂志的获奖情况

    • • 2009年，荣获“安徽省优秀期刊二等奖”
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    • • 2015年，荣获国家卫生计生委颁发的委管出版物主题宣传“优秀期刊奖”
    • • 2016年，在第四届《中国学术期刊评价研究报告（武大版）（2015-2016）》中被评为“RCCSE中国核心学术期刊（A）”
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