目的 系統評價藥物干預高血壓合并不同疾病指南。方法 計算機檢索MEDLINE、EMbase、CBM、WanFang Data、NGC（national guideline clearinghouse）、GIN（guideline international netword）、NICE（national institute for health and clinical excellence）及中國臨床指南協作網（CPGN）等中、英文數據庫和指南網站，納入藥物干預高血壓合并其他疾病的臨床指南，采用指南評價工具（appraisal of guidelines for research and evaluation， AGREE）評價指南的方法學質量，通過同類比較，分析不同地區和質量疾病的指南對藥物推薦的異同及特點。結果 共納入21篇藥物干預高血壓合并其他疾病的指南。其中高血壓合并冠心病、卒中、糖尿病及腎病的指南分別有5、5、7及4篇，發布于2000～2011年。其中A級指南0篇，B級19篇，C級2篇和循證指南9篇。4類指南均在“制定指南的參與人員”及“適用性”2個領域的平均得分欠佳。循證指南中的證據級別和推薦強度級數的分類方法各有4和3種，表達形式各有10和6種。對高血壓伴心絞痛患者，指南一致推薦β受體阻滯劑（β-blocker， BB）和CCB；對高血壓伴心梗患者，指南一致推薦ACEI和BB；對高血壓伴心衰患者，ACEI、血管緊張素受體拮抗劑（angiotensin-receptor blocker，ARB）及BB是指南一致推薦藥物。對高血壓卒中后期患者，76.47%的指南推薦D和ACEI。對急性腦卒中的血壓控制，指南推薦內容主要基于美國相關專業委員會制定的指南。對高血壓合并糖尿病或腎病患者，收縮壓/舒張壓控制范圍一致推薦應分別小于130/80 mmHg。對高血壓合并糖尿病患者，一致推薦ACEI，其次為D和CCB；對高血壓合并腎病患者，一致推薦ACEI/ARB。5篇推薦使用CCB的指南中有3篇來自亞洲。結論 高血壓合并不同疾病的指南中循證指南占比較高，但方法學質量存在差異。循證指南中對證據級別和推薦強度的劃分標準不一，有待進一步完善。對高血壓合并冠心病、糖尿病、腎病及卒中后期患者，臨床證據充分且結果具有一致性，指南推薦內容基本一致，且無地區和質量級別差異。對目前臨床研究尚未達成共識的疾病，臨床推薦藥物存在差異。目前對高血壓合并急性卒中患者的血壓管理暫無定論。
摘要:目的：探討纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應用價值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機分為纖支鏡經口引導氣管插管組(纖支鏡組)125例和喉鏡經口引導氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導下按常規進行氣管插管術。結果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現咽喉部少量出血,并發癥發生率為40%;喉鏡組共有12例發生并發癥,并發癥發生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側肺通氣1例,插入食管2例,心跳呼吸驟停1例。結論：纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡便快速、成功率高和并發癥少的有效方法,值得臨床推廣應用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
【摘要】 目的 探討超聲動態觀察流行性腮腺炎合并睪丸炎的診斷和預后價值。 方法 回顧性分析2008年10月-2010年12月53例流行性腮腺炎合并睪丸炎治療前后的聲像圖特征和臨床治療效果。 結果 全部患者均有腮腺、頜下腺、睪丸、附睪不同程度長大，而腮腺、頜下腺以單側長大為主，睪丸及附睪長大多以單側為主；53例腮腺炎合并睪丸炎經臨床治療15~20 d后，腮腺、睪丸腫痛及自覺癥狀消失，聲像圖恢復正常40例，聲像圖基本恢復正常13例。治療出院后全部患者均獲得遠期超聲觀察隨訪，分別于出院后3~4個月及4~6個月觀察聲像圖均為正常。 結論 超聲動態觀察流行性腮腺炎合并睪丸炎在治療前后聲像圖的改變對其診斷和預后有重要的價值。【Abstract】 Objective To investigate the diagnostic and prognostic value of ultrasonic inspection on epidemic parotitis accompanied by orchitis through observing ultrasonic image changes of the disease before and after treatment. Methods We retrospectively analyzed the ultrasonographic features before and after treatment, and the clinical treatment results of 53 patients with epidemic parotitis accompanied by orchitis between October 2008 and December 2010. Results All patients had different level of increment in their parotid gland, submaxillay gland, testicle or epididymis. Most cases of the increment occurred to unilateral parotid gland and submaxillay gland on the same side, as well as unilateral testicle and unilateral epididymis. After clinical treatment for 15 to 20 days, parotid and testicular swelling and pain, and self-conscious symptoms disappeared. Forty patients returned to normal ultrasonic image, and the ultrasonic images of 13 other patients resumed normal basically. After being discharged, all patients were followed up and ultrasound observation was carried out which showed that 3 to 4 months or 4 to 6 months later, all ultrasonic images were normal. Conclusion Ultrasound dynamic observations before and after treatment have important values to the diagnosis and prognosis of epidemic parotitis accompanied by orchitis.
