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幻城读后感范文1
一次很偶然的机会在网上看到了这本书,觉得很开心,自己能读到这样的小说。作者他构造出了一个魔幻绮丽的世界,塑造了很多有着鲜明个性的人物,也描绘出了他们心中永恒的追求。
幻城中人们总是追逐着自己想要守护、想要爱的东西,却总是发现颠倒了,弄错了,错过了,没有时间可以等待了。巧妙的将每个人的关系紧紧地联系在一起,但总会有人死,觉得很凄凉不过,我欣赏这样的人生,因为他们曾快乐过、痛苦过、失望过、期待过的灿烂人生。 卡索和释,有着三世的不解之缘:第一世,卡索是一个被囚禁的巫师,释是用头撞开捆绑卡索的锁链的霰雪鸟,可最后他们被卷入波涛汹涌的大海,卡索得到了自由却失去了生命;第二世,他们成了皇子兄弟,用各自的方式热爱彼此,释为了卡索的自由杀了很多人,连卡索最喜欢的人,却最终死在卡索的手上,但却还依然地希望他能得到自由,真正的自由。卡索则继续被身份所禁锢;第三世,释成为了自己最渴望成为的人——灵力强大得足以使卡索获得自由的人——火族的王子,可惜他已经忘记了自己前世的身份,当他带领大军攻到冰城宫殿中,见到自杀的卡索躺在一片白色的血泊中,才晃过神来想起自己就是那个为了哥哥可以舍弃一切的释。最可怜的是渊祭,没有人和他沟通,没有人了解他,他是孤独的同时也是寂寞的。地位越高,权位越大人心就会越高傲冰冷。
看起来故事很凄美,凄凉中夹着一丝幽美,幽美中带着一丝痛楚,很喜欢这篇虚幻的美丽小说,喜欢那里面的伟大亲情。突然觉得自己应该珍惜现在的亲人,和朋友,因为他们是可贵的,可爱的。我不想像卡索一样,失去自己珍惜的人。一本好书可以给人前所未有的感受,也可以改变一个人。
幻城读后感范文2
【摘要】目的 分析86例新型甲型H1N1流感病毒性肺炎患者的临床资料,探讨在病程早期各临床指标与预后的关系。方法 回顾性分析2009年10月至2010年2月中国医科大学附属第一医院急诊监护室(EICU)救治的86例新型甲型H1N1流感病毒性肺炎患者的临床资料,分析病程早期各临床指标对患者预后的预测价值。结果 86例患者平均发病3.2 d来诊,死亡15例(占17.4%),机械通气治疗12例。来诊后首次外周血白细胞总数(WBC)(6358±483)/mm3,其中WBC减少(
【关键词】新型甲型H1N1流感;肺炎;临床特征;病死率;预后
Clinical analysis of early predictors of patients with 2009 H1N1 pneumonia. LIU Xiao—wei*, LIU Sheng—ye, LIU Zhi. *Department of Emergency Medicine, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
Corresponding author: LIU Zhi ,Email:.cn
【Abstract】Objective To explore the early predictors of patients with 2009 H1N1 pneumonia by analyzing the clinical features. Methods The 2009 H1N1 pneumonia patients, admitted to our emergency intensive care unit(EICU)from October 2009 to January 2010,were retrospectively analyzed.The 86 patients were divided into died and survival groups.The chi—square test and T test were used to examine the difference between groups. Results Of the 86 patients we studied,15(17.4%)cases died and 12 cases received mechanical ventilation.All patients underwent chest radiography on admission and the findings were consistent with pneumonia in all cases. The median duration of symptoms before admission was 3.2 days. The first laboratory test results indicated the average total number of white blood cell(WBC) was (6358±483)/mm3. Of the 86 patients, 47(54.7%) showed a reduction in WBC. Of the 71 patients who survived, 35(49.3%) had leucopenia and 12(80%)in died group(χ2=4.71,P﹤0.05). In survival group,39(54.9%) had lymphopenia and 13(86.7%)in died group (χ2=5.22,P﹤0.05). Of 72 patients had T—lymphocyte subsets results, CD4+ T cell counts on average was (424.8±231.6 )/mm3 in 57 survival cases and (242.5±99.1) /mm3 in 15 died cases(t=2.14,P﹤0.05). On admission,serum creatine kinase (CK) in died group was (794.5±85.1) U/L ,higher than (632.3±47.9) U/L in survival group(t=2.25,P﹤0.05).Elevated CK was found in 14(93.3%)of 15 died cases and 50(70.4%) in survival group(χ2=5.87,P﹤0.05).Serum lactate dehydrogenase (LDH) in died group was(1028.6±97.3) U/L,higher than(832.3±56.1 )U/L in survival group(t=2.31,P﹤0.05).According to the criterion of body mass index (BMI)≥25 kg/m2, 33(38.4%) cases were obesity, in which 13(86.7%)in died group and 20(28.2%) in survival group (χ2 =17.92,P﹤0.01), The mortality was increasing along with the BMI was increasing (r=0.37,P=0.048).Conclusions SOFA,MEDS,CURB—65 score used in emergency room as the risk stratification methods can not effectively predict the 2009 H1N1 pneumonia patients. Peripheral blood lymphocyte counts, serum creatine kinase and lactate dehydrogenase, body mass index in the early course may be factors associated with outcomes of 2009 H1N1 pneumonia patients.
幻城读后感范文3
[关键词] 脑脊液;腺苷脱氨酶;结核性脑膜炎
[中图分类号] R529.3 [文献标识码] A [文章编号] 1673-7210(2014)08(c)-0081-03
Predictive value of cerebrospinal fluid adenosine deaminase for degree of illness and disease prognosis of patients with tuberculous meningitis
WU Sufang PENG Suzhen ZHENG Shufang HUANG Zhenfeng
Department of Tuberculosis, the Third People's Hospital of Shantou City, Guangdong Province, Shantou 515073, China
[Abstract] Objective To investigate the predictive effect of cerebrospinal fluid (CSF) adenosine deaminase (ADA) for tubercular meningitis patients severity and prognosis of the disease. Methods 135 cases of meningitis were selected, and included 50 cases of tubercular meningitis (the tuberculosis group), 45 cases of viral meningitis (the virus group), 40 cases of bacterial meningitis (the bacterial group). 50 healthy subjects were selected as the control group in the same period. The ADA levels of all research objects were detected by enzyme color detection and were compared. TB patients grouped according to systemic inflammatory reaction degree, who were divided into the unincorporated sepsis groups, the mild sepsis group and the combining severe sepsis group, the ADA levels of the three groups were compared, the predictive effect of CSF ADA for tubercular meningitis patients severity and prognosis of the disease were analyzed. Results CSF ADA of the tuberculosis group was significantly higher than the viruses group, the bacteria group and the control group (P < 0.05); ADA levels of patients in severe sepsis group was significantly higher than the none sepsis group and the mild sepsis group (P < 0.05); after treatment for 3, 6, 9 weeks, ADA were significantly lower than patients admission (P < 0.05); and ADA level of the poor prognosis group was obviously higher than the good prognosis group (P < 0.05). Conclusion CSF ADA has important significance in the diagnosis of tubercular meningitis, and predictive value of severity and disease prognosis is reliable.
[Key words] Cerebrospinal fluid; Adenosine deaminase; Tubercular meningitis
结核性脑膜炎(tubercular meningitis,TBM)是指结核分枝杆菌感染性中枢神经系统疾病,占结核感染性疾病的6%[1],但近年来结核性脑膜炎发生率和病死率明显增高。早期诊断、鉴别诊断和及时治疗在提高结核性脑膜炎治疗效果和改善预后中具有重要的作用。文献报道表明结核分枝杆菌感染患者脑脊液腺苷脱氨酶(adenosine deaminase,ADA)异常增高[2]。但关于脑脊液ADA对结核性脑膜炎患者病情程度和疾病预后的预测价值研究甚少,现报道如下:
1 资料与方法
1.1 一般资料
选取广东省汕头市第三人民医院(以下简称“我院”)2012年1月~2014年1月期间住院部收治的135例脑膜炎患者。入选标准:所有患者均年龄大于18岁,符合非结核分枝杆菌细菌性脑膜炎、病毒性脑膜炎、结核性脑膜炎的诊断标准。排除标准:①有肿瘤、继发于神经系统手术的颅内感染等疾病的患者;②有精神系统疾病病史的患者;③患者在入院之前接受过抗生素治疗;④患有非感染性疾病能自发引起无菌性脑膜炎的患者。根据患者脑脊液检测情况分组:结核组50例,脑脊液检查结核分枝杆菌阳性,其他细菌、真菌、肿瘤细胞学检查阴性,其中,男27例,女23例,年龄22~73岁,平均(48.65±10.65)岁;病毒组45例,近期病毒感染病史、脑脊液和血液检查见病毒性抗体阳性或聚合酶链式反应检测病毒DNA阳性,脑脊液结核分枝杆菌阴性、脑脊液真菌阴性和脑脊液肿瘤细胞学阴性,其中,男28例,女17例,年龄21~74岁,平均(49.01±11.72)岁;细菌组40例,脑脊液检查细菌培养阳性,结核分枝杆菌阴性、脑脊液真菌阴性和脑脊液肿瘤细胞学阴性,其中,男21例,女19例,年龄22~75岁,平均(49.33±11.82)岁。同期选取50名健康体检者作为对照组,其中,男28例,女22例,年龄23~75岁,平均(49.41±11.85)岁。各组间年龄、性别分布等一般资料比较差异无统计学意义(P > 0.05),具有可比性。
1.2 检测方法
全部患者入院时、抗结核治疗后3、6、9周行腰椎穿刺术采集脑脊液,3000 r/min离心操作15 min,取脑脊液上清液,采用酶显色检测法(Aeroset生化仪,美国雅培)检测脑脊液常规、脑脊液生化、脑脊液细菌培养、脑脊液涂片(真菌、病毒检测)和脑脊液肿瘤细胞学检查,根据检测结果比较各组ADA水平。
结核组患者根据全身性炎症反应程度进行分组,分为未合并败血症组、合并轻度败血症组和合并重症败血症组。①未合并败血症组:体温、心率、呼吸和外周血白细胞计数正常;②合并轻度败血症组:体温异常(36℃28次/min和外周血白细胞计数异常(12×109/L
1.3 治疗方法
全部患者在抗结核治疗的基础上,根据脑脊液压力采取降颅压治疗,脑脊液压力>19.6 kPa,采用120%甘露醇125 mL降颅压,必要时与速尿、醋氮酰胺类药物联用;对于颅压持续不降者采用缓慢脑脊液抽取治疗;对于合并脑室扩张采用脑室内外分流术;对于合并结核性瘤症、结核性脑脓肿者及时采取外科手术治疗。
1.4 预后判断
治疗后患者临床预后采用Glasgow评分标准[3],分为死亡、植物状态、功能障碍、好转和治愈,其中,死亡、植物状态、功能障碍作为预后不良组,而好转和治愈作为预后良好组。
1.5 统计学方法
采用SPSS 18.0统计学软件进行数据分析,计量资料数据用均数±标准差(x±s)表示,两组间比较采用t检验;多组间比较采用单因素方差分析,组间两两比较采用LSD-t检验,以P < 0.05为差异有统计学意义。
2 结果
2.1 各组脑脊液腺苷脱氨酶水平比较
结核组脑脊液腺苷脱氨酶水平明显高于病毒组、细菌组和对照组,组间比较差异有统计学意义(P < 0.05),见表1。
表1 各组脑脊液腺苷脱氨酶水平比较(U/L,x±s)
注:与结核组比较,*P < 0.05;ADA:腺苷脱氨酶
2.2 腺苷脱氨酶水平与结核性脑膜炎患者病情程度的关系
50例结核性脑膜炎患者中,未合并败血症组20例,合并轻度败血症组23例,合并重症败血症组7例,其中,合并重症败血症组ADA水平明显高于未合并败血症组和合并轻度败血症组,差异有统计学意义(P < 0.05),见表2;随着治疗时间的不断延长,ADA水平不断降低,不同时间段比较差异有统计学意义(P < 0.05),见表3。
表2 不同病情程度患者腺苷脱氨酶水平比较(U/L,x±s)
注:与未合并败血症组比较,*P < 0.05;与合并轻度败血症组比较,#P < 0.05;ADA:腺苷脱氨酶
表3 不同时间段腺苷脱氨酶水平比较(U/L,x±s)
注:与入院时比较,*P < 0.05;与治疗后3周比较,#P < 0.05;与治疗后6周比较,P < 0.05;ADA:腺苷脱氨酶
2.3 腺苷脱氨酶水平与结核性脑膜炎患者疾病预后的关系
50例结核性脑膜炎患者中,死亡5例,植物状态1例,功能障碍2例,治愈或好转 42例。预后不良组ADA水平明显高于预后良好组,差异有统计学意义(P < 0.05),见表4。
表4 不同预后程度患者腺苷脱氨酶水平比较(U/L,x±s)
注:ADA:腺苷脱氨酶
3 讨论
结核性脑膜炎是严重的感染性中枢神经系统性疾病,临床症状复杂,且其症状特异性较低,现缺乏有效的诊断方法和治疗效果评估方法,CT、MRI对早期结核性中枢神经系统感染的诊断缺乏可靠性和特异性[5]。脑脊液检查是中枢神经系统病理性改变的重要反映,脑脊液细菌培养、细菌涂片检查发现结核分枝杆菌是结核性脑膜炎的明确诊断依据,但培养时间较长,延误了结核性脑膜炎的早期诊断和及时治疗,严重影响患者的预后状况[6-7]。ADA是参与嘌呤核苷酸物质代谢的重要蛋白酶,在人体细胞增殖分化中具有重要的作用,其检测结果对部分疾病诊治的作用明显[8]。有文献报道,首次结核分枝杆菌导致的中枢神经系统感染性疾病的ADA阳性(ADA>8 U/L)检出率高达100%,而CT扫描疾病检出率仅为45%,比较差异具有显著性[9]。提示ADA阳性检出率在早期发现结核性脑膜炎中具有重要的作用。但关于ADA在结核性脑膜炎病情、预后状况的预测价值研究较少。
本研究显示:结核性脑膜炎脑脊液ADA水平明显高于病毒性脑膜炎、非结核分枝杆菌细菌性脑膜炎和健康体检者,组间比较差异具有显著性,但后三者ADA水平比较差异无显著性,提示脑脊液ADA在结核性脑膜炎的诊断中具有重要的作用,与文献报道结果相一致[10]。在不同病情方面的比较发现:合并重症败血症的结核性脑膜炎患者ADA水平明显高于未合并败血症的结核性脑膜炎患者和合并轻度败血症的结核性脑膜炎患者;动态监测入院期间脑脊液ADA的变化还发现:治疗后3、6、9周ADA水平显著低于入院时,提示不同病情程度脑脊液ADA水平差异显著,且随着患者病情的好转,脑脊液ADA水平明显降低;在不同预后程度患者的研究中发现:预后不良患者ADA水平亦明显高于预后良好患者。因此,病情越严重,预后越差的结核性脑膜炎患者脑脊液ADA水平越高。
综上所述,脑脊液ADA在结核性脑膜炎的诊断中具有重要的意义,在病情和疾病预后的预测具有可靠的价值。
[参考文献]
[1] Prabhat S,Vimal K,Paliwal,et al. Clinical and magnetic resonance imaging characteristics oftubercular ventriculitis:An under-recognized complication of tubercular meningitis[J]. Journal of the Neurological Sciences,2014,342(2):137-140.
[2] 陈捷.脑脊液腺苷脱氨酶检测对结核性脑膜炎诊断的价值[J].中国实用神经疾病杂志,2010,13(5):61-62.
[3] 金雪华.结核性脑膜炎脑脊液腺苷脱氨酶检测的临床意义及应用价值[J].中华医院感染学杂志,2013,23(10):2513-2515.
[4] 谈鹰,王庄,王亚仙.结核性脑膜炎患者脑脊液中腺苷脱氨酶的诊断意义及动态变化观察实用医学杂志[J].2009,25(3):408-409.
[5] 方乐,李俊明,万腊根,等.腺苷脱氨酶对结核性脑膜炎诊断价值的Meta分析[J].中国全科医学,2011,30(11):1225-1228.
[6] 牛俊梅,张冬杰.脑脊液腺苷脱氨酶检测在结核性脑膜炎诊断中的应用研究[J].现代预防医学,2012,39(14):3766-3769.
[7] Prabhakar S,Garg AK,Modi M,et al. Radiological profile of patients of?tubercular meningitis(Tbm)and its correlation with severity:A prospective study [J]. Journal of the Neurological Sciences,2013,333(15):e638-e639.
[8] 傅京力,李远,谭英征,等.干扰素-γ、腺苷脱氨酶水平对结核性胸膜炎的诊断价值[J].中国医药导报,2014,11(12):25-27.
[9] Lely S,Alonso S,Juan CA,et al. The validity of cerebrospinal fluid parameters for the diagnosis of tuberculous meningitis International [J]. Journal of Infectious Diseases,2013,17(12):1111-1115.