114

January 11th, 2009

湖北中医杂志 size="2" face="Times New Roman">.2000 size="2" face="Times New Roman">22 size="2" face="Times New Roman">8): size="2" face="Times New Roman">13-14 

中西医结合治疗原发性肾综合征临床观察 

全毅红

武汉市第二医院( size="2" face="Times New Roman">430014) 

摘要:  目的:探讨复方丹参滴丸与西药联合运用治疗原发性肾综合征的疗效。方法:对比观察了中西药联合运用(治疗组)与单纯西药(对照组)治疗原发性肾综合征的临床疗效。结果:治疗组完全缓解率和总有效率为55%和90%,显著高于对照组的27.5%和65%(P<0.05) size="2" face="Times New Roman">;治疗组复发率为7.5%,低于对照组的20%(P<0.05)。结论:在常规西药治疗原发性肾综合征基础上,加用复方舟参滴丸口服,确为治疗的有效方法之一。

关键词:原发性肾综合征;中西医结合治疗法;复方舟参滴丸 
 

   我院1998年 size="2" face="Times New Roman">1999年收治了原发性肾综合征患者80例。随机分为两组:治疗组40例用复方丹参滴丸与西药联合运用治疗.对照组40例用单纯西药治疗。现将结果报告如下。

  1. 临床资料

1.1  诊断标准  

   所选病例在病史、体征、辅助检查、病程方面,均符合1992年第三届全国肾脏学术会议讨论修订的肾综合征诊断标准,并排除各种原因所致的继发性肾综合征。

1..2  一般资料   

   治疗组40例中,男性24例,女性16例;年龄在13岁~54岁,平均年龄27岁;病程15天~6年,平均1年2个月。治疗组中单纯蛋白尿者28例,蛋白尿兼有血尿者12例(其中间歇性肉眼血尿2例,持续性镜下血尿10例),血胆固醇增高者32例,血甘油三酯升高者40例,尿素氮增高者14例,血肌酐升高者6例,肾功能衰竭者4例,浮肿者32例,高血压者4例,对照组中男性22例.女性18例;年龄在14岁~52岁,平均年龄26岁;病程18天~8年,平均1年5个月。两组在性别、年龄及治疗前病情和病程方面进行比较.均无显著性差异( size="2" face="Times New Roman">P>0.05),有可比性。

  1. 治疗方法   

   对照组:用常规疗程的强的松治疗及西药对症治疗

   治疗组;在用常规疗程的强的松治疗基础上,不用其他降脂、抗凝、抗拴、溶栓和扩血管药物.只用复方丹参滴丸.每次10粒~15粒,3次/ size="2" face="Times New Roman">d,连续胶用8周。治疗前后记录病人的症状、体征、血压.做血尿常规、血生化、血免疫学、血液流变学、24小时尿蛋白定量、尿渗透压、尿溶菌酶与尿 size="2" face="Times New Roman">C3测定及彩超等项检查。

  1. 治疗结果

3、l  疗效标准  

   按第二次全国中医肾会议制定的疗效标准分为:(1)完全缓解:症状、体征消失,尿蛋白定量<0.2g/24h,肾功能、血脂恢复正常.尿红细胞不超过0~3个/HP;(2)基本缓解:症状、体征消失,尿蛋白定量<1 size="2" face="Times New Roman">g/24 size="2" face="Times New Roman">h,尿红细胞少许~(+);[3]部分组解:症状、体征好转.实验室检查有好转,但未达到基本缓解的标准;[4]无效:用本法治疗两个月以上,症状、体征和实验室检查均无好转或恶化。

    1. 两组疗效比较 size="2" face="宋体">  见表1。

    表 size="2" face="Times New Roman">1治疗组完全缓解率和总有效率分别为55 size="2" face="Times New Roman">%和90 size="2" face="Times New Roman">%,显著高于对照组中的27.5%和65%(P<0.05),说明配合复方丹参滴丸治疗可提高疗效,减少复发率。

3.3  两组治疗前后部分生化指标以及血液流变学的比较 size="2" face="宋体">  见表2,表3

size="2" face="黑体">两组临床疗效比较

  n 完全缓解 基本缓解 部分缓解 无效 复发 总有效率
治疗 40 22 10 4 4 3 90%
对照组 40 11 9 6 14 8 65%

 
 

表2 两组部分生化指标的比较( size="2" face="Symbol">±
s
 
 

          
尿蛋白   血尿白蛋白  甘油三酯  
胆固醇   血肌酐   血尿素氮  
血免疫球蛋白  尿渗透压  尿溶菌酶  尿C3

           size="1" face="Times New Roman"> (g/24h)     
(g/l)      (mmol/L)  (mmol/L)  ( size="1" face="宋体">μmol/L) 
(mmol/L)    (g/L)   (mOsm/kg.H2O) 
(
μg/ml) 
(ml/l)
 
 

治疗组治前 size="1" face="Times New Roman">7.10± size="1" face="Times New Roman">3.67 23.30± size="1" face="Times New Roman">5.70  3.79± size="1" face="Times New Roman">1.58 10.83± size="1" face="Times New Roman">1.23 123.72± size="1" face="Times New Roman">87.35 9.95± size="1" face="Times New Roman">3.71 5.39± size="1" face="Times New Roman">1.70 690± size="1" face="Times New Roman">205 5.42± size="1" face="Times New Roman">4.23 1.98± size="1" face="Times New Roman">2.13

(40例)治后0.78± size="1" face="Times New Roman">0.33 35.42± size="1" face="Times New Roman">0.76 1.77± size="1" face="Times New Roman">0.74 4.99± size="1" face="Times New Roman">0.92 80.35± size="1" face="Times New Roman">24.67 5.41± size="1" face="Times New Roman">2.13 9.00± size="1" face="Times New Roman">2.37  721± size="1" face="Times New Roman">315 5.98± size="1" face="Times New Roman">4.77 1.87± size="1" face="Times New Roman">2.27

对照组 治前 size="1" face="Times New Roman">6.24± size="1" face="Times New Roman">2.35 24.10± size="1" face="Times New Roman">5.30 3.32± size="1" face="Times New Roman">1.94 11.23± size="1" face="Times New Roman">1.35 127.82± size="1" face="Times New Roman">67.37 10.73± size="1" face="Times New Roman">4.35 5.91± size="1" face="Times New Roman">2.48 603± size="1" face="Times New Roman">298 6.12± size="1" face="Times New Roman">4.15 2.16± size="1" face="Times New Roman">2.62

(40例)治后 size="1" face="Times New Roman">1.76± size="1" face="Times New Roman">0.54 31.47± size="1" face="Times New Roman">2.64  1.99± size="1" face="Times New Roman">0.92 6.82± size="1" face="Times New Roman">2.05 89.74± size="1" face="Times New Roman">51.73  6.90± size="1" face="Times New Roman">2.21 7.87± size="1" face="Times New Roman">2.19 674± size="1" face="Times New Roman">213 5.98± size="1" face="Times New Roman">4.63 2.24± size="1" face="Times New Roman">3.87 
 

表3  两组血液流变学比较 size="2" face="宋体"> ( size="2" face="Symbol">±
s
)

                 
 
  全血比粘度(高切) 全血比粘度(低切) 血浆比粘度 红细胞压积 红细胞聚集指数
治疗 治前 7.83± size="1" face="Times New Roman">1.31 11.78± size="1" face="Times New Roman">1.96 1.96± size="1" face="Times New Roman">0.37 46.81± size="1" face="Times New Roman">3.05 2.09± size="1" face="Times New Roman">0.01
(40例) 治后 4.96± size="1" face="Times New Roman">1.24 7.91± size="1" face="Times New Roman">1.52 1.48± size="1" face="Times New Roman">0.17 42.74± size="1" face="Times New Roman">3.23 1.41± size="1" face="Times New Roman">0.21
对照组 治前 7.46± size="1" face="Times New Roman">1.19 11.31± size="1" face="Times New Roman">2.04 1.89± size="1" face="Times New Roman">0.41 47.01± size="1" face="Times New Roman">2.99 2.11± size="1" face="Times New Roman">0.19
(40例) 治后 5.47± size="1" face="Times New Roman">1.35 8.27± size="1" face="Times New Roman">1.18 1.61± size="1" face="Times New Roman">0.26 44.35± size="1" face="Times New Roman">2.72 1.62± size="1" face="Times New Roman">0.24

 

   表2中仅见尿渗透压、尿溶菌酶、尿C3测定,同组治疗前后比P>0.05;治疗组与对照组治疗后比P>O.05,提示肾小球、肾小管的损害在短期内较难恢复。表2中其余各项指标同组治疗前与治疗后比均P<0.01,治疗组与对照组治疗后比P<0.05,有显著差异。表3中,除红细胞压积无显著意义外.余各项指标治疗前与治疗后比均P<0.0l,治疗组与对照组治疗后比P<0.05,有显著差异。

  1. 讨论   

   祖国医学认为,原发性肾综合征属中医“水肿”、“虚劳”、“淋证”、“尿血”等范畴,是一种正虚邪实之证。内脏虚损、阳阳失调是发病的根据和交的重点,而水湿、瘀血内阻之机尤为突出。脏腑功能失调可生湿产瘀,湿邪阻滞亦可生瘀,而瘀血的停滞又影响气机升降,阻碍三焦通路.损伤脏腑阴阳,化湿生水,互为因果.形成恶性循环,从而使病情胶结难愈。即张仲景所说的“血不利则为水”和唐容川之谓“失血家往往水肿,瘀血化水.亦发水肿也”。现代医学研究发现,血液凝固机制紊乱对原发性肾小球疾病的发生发展有着极为重要的影响。肾小球疾病的血凝引起的肾脏损害为纤维沉积及血小板凝集,可导致肾脏组织损伤及肾功能减退。此外血小板功能亢进、授血酶原时间(PT)及凝血酶时间(KPTT)的缩短,在肾综合征中表现尤为明显,所有这些均表明.在肾综合征中确实存在着“瘀血”[1]

   复方丹参滴丸是复方丹参片的改良剂型,主要成分是丹参、三七、冰片等。属活血化瘀、辛凉芳香开窍之品,它能迅速被口腔及胃肠道粘膜吸收。有关研究表明,复方丹参滴丸中的丹参素所含有效成分是良好的慢钙道阻滞剂,具有膜稳定作用,可防止缺血、映氧条件下膜结构及功能的障碍.并具有抗缺氧,扩张心、脑、肾血管,抗血小板凝集,抗感染等作用[2]。复方丹参滴丸中所含三七总皂甙能清除过量的自由基,促进脂质的转运和排泄,减少内源性脂质合成。并保护内源性抗氧化酶的活性,提高红细胞膜的流动性,延长红细胞寿命等作用[3]。可见复方丹参滴丸具有流通血脉、改善局部病灶瘀滞情况,改善肾血流.并促进肾脏病变的修复和纤维蛋白吸收等作用[4] 

参考文献:

  1. 刘伟,原发性肾小球疾病患者血液流变学的变化与中医证型相关性探讨,中国血液流变学杂志, size="2" face="Times New Roman">1998 size="2" face="Times New Roman">(2) size="2" face="Times New Roman">80
  2. 汪宗江,丹参实验研究进展,中国中匪药信息杂志, size="2" face="Times New Roman">1998 size="2" face="Times New Roman">(7) size="2" face="Times New Roman">14
  3. 王宇辉,周超凡,中药降脂研究进展,中国中药杂志,1999,24(3):184
  4. 李幼姬,叶任高,原发性肾综合治疗的探讨。中华肾杂志,1995(11):133

 

收稿日期:2000-01-06

12

January 10th, 2009
Page 1

第10卷第4期
2008年8月
                    


中国当代儿科杂志


ChinJContempPediatr


Vol.10No.4
Aug.2008
[收稿日期]20080121;[修回日期]20080313
[作者简介]肖丹夏,女,大学本科,住院医师。主攻方向:新生儿疾病。


·病例报告·


新生儿先天梅毒伴先天性综合征1例


肖丹夏,傅万海,游楚明,李小娥,赵雪婷


(广东省第二人民医院儿科,广东 广州 510317)
    [中图分类号] R722  [文献标识码] E  [文章编号] 1008-8830(2008)04-0555-02


1 临床资料


患儿,男,1d,因早产(胎龄31


+2


周)于2007年
3月31日入住新生儿科。为第1胎第1产,在我院
产科顺产出生,胎龄31


+2


周,出生时羊水清,阿氏评
分1min7分,5min8分,10min9分,出生体重
1445g,生后即发现全身水肿明显,皮肤可见大片
脱皮,眼睑水肿,口周及肢端发绀明显,呼吸急促,双
肺呼吸音弱,闻及大量湿性音,心率140次/min,
律齐,未闻及杂音。腹部明显膨隆,肝脏于右肋缘下
3cm触及,质软,脾脏于左肋缘下2cm触及,肠鸣
音存在。双下肢凹陷性水肿。实验室检查:WBC
21.1×10



/L,Hb126g/L,PLT94×10



/L。血生化:
总蛋白 60.4g/L,白蛋白 26.8g/L,C反应蛋白
75.3mg/L,总胆固醇 6.0mmol/L(参考值 3.0~
6.0),甘油三脂2.3mmol/L(参考值0.4~1.8),C3
补体0.6g/L(参考值0.8~1.6),尿素氮2.4mmol/
L(参考值2.5~7.5),肌酐63.9μmol/L(参考值
40~140)。不加热血清反应素试验(USR)阳性,滴
度1∶8阳性,梅毒螺旋体血凝试验(TPHA)阳性。
风疹病毒抗体、弓形虫抗体、巨细胞病毒抗体、单纯
疱疹病毒抗体均阴性。尿常规:蛋白(++++),
潜血(+++),24h尿蛋白定量0.3g/110mL。追
问病史,其父有不洁性生活史,其父母查血不加热血
清反应素试验(USR)、TPHA均阳性。入院诊断:先
天性梅毒伴先天性综合征。入院后予以青霉素
每日10万U/kg,静脉分两次注射,连续14d,但尿
蛋白持续(+++),潜血(+++),低蛋白血
能纠正,仍水肿明显,遂予激素治疗,剂量为泼尼松
每日2mg/kg,分2次口服,10d后复查尿常规蛋白
(++),潜血(++),激素减量至每日1mg/kg,4d
后停用,疗程共两周。停药1周后复查尿常规蛋白
(-),潜血(++),血生化:总蛋白 53.5g/L白蛋
白33.8g/L。出院前复查尿常规正常,低蛋白血
纠正,住院56d,病情好转出院。随访半年,尿常规
正常,USR阴性。患儿体格发育稍落后于同龄儿
童,智力及运动发育基本正常。


2 讨论


先天性综合征(CNS)是指出生时或生后半
年内出现水肿、蛋白尿、低蛋白血和高脂血的一
组疾病


[1~3]


。分为两大类:①原发性可分为芬兰型
CNS和法国型CNS(弥漫性系膜硬化);②继发性可
继发于感染(先天性梅毒、先天性弓形虫、巨细胞
病毒感染等)、溶血尿毒综合征、婴儿系统性红斑狼
疮等。在婴儿期起的 NS除先天性外,尚可有早
发性综合征(微小病变、局灶节段硬化和增生
硬化)。该病例未行穿刺活检,不能完全排除原
发性先天性,但据报道,原发性类型预后差,无
有效治疗方案,存活时间短,而该病例预后佳,且伴
随于先天性梅毒感染,风疹病毒抗体、弓形虫抗体、
巨细胞病毒抗体、单纯疱疹病毒抗体等均阴性,因此
考虑为继发性先天性综合征。
近年来,由于性传播疾病的蔓延,先天性梅毒发
率明显上升。先天性梅毒又称胎传梅毒,是梅毒
螺旋体由母体经胎盘进入胎儿血循环中所致的感
染。胎传梅毒因系血行感染,无I期梅毒阶段,出生
后即已进入II期感染阶段,常合并系统性损害,如
眼、耳、鼻等感官系统及骨骼系统、肝、等内脏常受


[4]


。生后即出现表现有全身水肿、低蛋白血
、高脂血,伴大量蛋白尿,可有血尿,少数有
功能损害。本典型病理改变为膜性,可伴有
·
·


Page 2

第10卷第4期
2008年8月
                    


中国当代儿科杂志


ChinJContempPediatr


Vol.10No.4
Aug.2008


轻重不等的系膜组织增生,免疫荧光显示IgG和C3
沿毛细血管壁呈颗粒状沉积,电镜下可见上皮下电
子致密物沉积,组织可存在螺旋体抗原


[5]


。诊断
先天性梅毒伴综合征的实验室依据主要依靠梅
毒血清学试验,其中包括非梅毒螺旋体抗原试验和
梅毒螺旋体特异性抗体检测,而新生儿血清学反应
易与来源于母、经胎盘的抗体混淆,因此应该对比
分娩时母亲和新生儿的梅毒血清学试验结果,如新
生儿抗体滴度高于母亲的抗体滴度提示新生儿受到
梅毒感染,若明显低于母亲抗体滴度,则不能肯定新
生儿受到感染


[6]


疾病诊断明确后,按照常规治疗,青霉素治疗有
效,不宜用肾上腺皮质激素治疗


[7]


。但是对于该
例,我们在应用充足剂量、规范疗程的青霉素治疗
后,症状改善不明显,考虑到该被认为是由免疫复
合物介导和补体激活的免疫性疾病,遂予以激素治
疗,效果明显,这可以说明一点,先天性梅毒伴有
时除了青霉素治疗之外,在疗效不佳的情况下可
考虑加用肾上腺皮质激素,激素起到抑制免疫损伤
的作用。胎儿感染的危险性与母亲的期、是否经
过治疗有关,母亲有原发或继发梅毒和螺旋体血
且未经过治疗者,较潜伏感染者更易将本传给胎
儿。研究发现,母孕期如经适当治疗则新生儿感染
率明显下降,为避免先天性梅毒的发生,可能患梅毒
的孕妇应在孕前及产前3个月做梅毒血清学检查,
并及时予以青霉素正规根治治疗,则可防止胎儿受
累,保证儿童健康。


[参 考 文 献]


[1] 莫樱.先天性综合征[M].//黄绍良,陈述枚,何政贤.小
儿内科学.北京:人民卫生出版社,2004,613.
[2] 楚和平.先天性综合征1家2例报告[J].中国当代儿科
杂志,2001,3(2):206.
[3] 汤飞鸽,岳少杰,刘丽旭.先天性综合征伴右位心,左位肝
1例[J].中国当代儿科杂志,2003,5(6):578.
[4] 薄幕琴,尹娜,张翠丽,张燕.先天梅毒致先天性综合征一
例[J].中华儿科杂志,2000,38(9):565.
[5] 林瑞霞,杨青,杨宇真,庄捷秋.先天性梅毒致先天性综合
征临床分析[J].中国妇幼保健,2005,20(2):202203.
[6] 夏斌,熊英,母得志.早期先天性梅毒临床分析[J].中国当代
儿科杂志,2007,9(3):257258.
[7] 周秦玉.先天性综合征[M].//金汉珍,黄德珉,官希吉.
实用新生儿学.第 3版.北京:人民卫生出版社,2003,719
720.
(本文编辑:吉耕中)


·消息·


我刊被新闻出版总署评定为首批出版规范A类期刊


国家新闻出版总署在2007年对全国期刊进行了一次全面的出版规范检查评定,对7300余种期刊进行
了初检、复检,并经各省新闻出版局核实,首批合格期刊名录已在媒体和中国记者网上公布。《中国当代儿
科杂志》顺利通过此次检查,成为国家新闻出版总署首批出版规范检查评定合格(A类)期刊。同时国家新
闻出版总署对A类期刊进行了表扬,认为这些期刊是全国期刊的学习榜样。
《中国当代儿科杂志》多年来秉承严谨的科学态度,严格的执行各项规章制度,保证了期刊的科学性、先
进性、规范性。本刊将以此次评定为契机,更加努力工作,为中国期刊的发展作出积极的贡献。
中国当代儿科杂志编辑部
·
·

11

January 10th, 2009

<font size=2 face=”Times”><span style=”font-size:9px;font-family:Times”>
<div style=”position:absolute;top:193;left:15″><nobr>第10卷第4期</nobr></div>
<div style=”position:absolute;top:206;left:14″><nobr>2008年8月</nobr></div>
<div style=”position:absolute;top:199;left:92″><nobr>                    </nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:11px;font-family:Times”>
<div style=”position:absolute;top:192;left:331″><nobr>中国当代儿科杂志</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:8px;font-family:Times”>
<div style=”position:absolute;top:205;left:335″><nobr>ChinJContempPediatr</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:9px;font-family:Times”>
<div style=”position:absolute;top:193;left:675″><nobr>Vol.10No.4</nobr></div>
<div style=”position:absolute;top:206;left:682″><nobr>Aug.2008</nobr></div>
<div style=”position:absolute;top:1264;left:39″><nobr>[收稿日期]20080121;[修回日期]20080313</nobr></div>
<div style=”position:absolute;top:1278;left:39″><nobr>[作者简介]肖丹夏,女,大学本科,住院医师。主攻方向:新生儿疾病。</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:15px;font-family:Times”>
<div style=”position:absolute;top:265;left:581″><nobr>·病例报告·</nobr></div>
</span></font>
<font size=4 face=”Times”><span style=”font-size:23px;font-family:Times”>
<div style=”position:absolute;top:316;left:134″><nobr>新生儿先天梅毒伴先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征1例</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:367;left:243″><nobr>肖丹夏,傅万海,游楚明,李小娥,赵雪婷</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:11px;font-family:Times”>
<div style=”position:absolute;top:401;left:235″><nobr>(广东省第二人民医院儿科,广东 广州 510317)</nobr></div>
<div style=”position:absolute;top:444;left:15″><nobr>    [中图分类号] R722  [文献标识码] E  [文章编号] 1008-8830(2008)04-0555-02</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:15px;font-family:Times”>
<div style=”position:absolute;top:510;left:14″><nobr>1 临床资料</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:559;left:46″><nobr>患儿,男,1d,因早产(胎龄31</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:556;left:251″><nobr>+2</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:559;left:264″><nobr>周)于2007年</nobr></div>
<div style=”position:absolute;top:583;left:14″><nobr>3月31日入住新生儿科。为第1胎第1产,在我院</nobr></div>
<div style=”position:absolute;top:608;left:15″><nobr>产科顺产出生,胎龄31</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:605;left:171″><nobr>+2</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:608;left:184″><nobr>周,出生时羊水清,阿氏评</nobr></div>
<div style=”position:absolute;top:632;left:15″><nobr>分1min7分,5min8分,10min9分,出生体重</nobr></div>
<div style=”position:absolute;top:656;left:14″><nobr>1445g,生后即发现全身水肿明显,皮肤可见大片</nobr></div>
<div style=”position:absolute;top:680;left:15″><nobr>脱皮,眼睑水肿,口周及肢端发绀明显,呼吸急促,双</nobr></div>
<div style=”position:absolute;top:704;left:15″><nobr>肺呼吸音弱,闻及大量湿性音,心率140次/min,</nobr></div>
<div style=”position:absolute;top:728;left:15″><nobr>律齐,未闻及杂音。腹部明显膨隆,肝脏于右肋缘下</nobr></div>
<div style=”position:absolute;top:752;left:14″><nobr>3cm触及,质软,脾脏于左肋缘下2cm触及,肠鸣</nobr></div>
<div style=”position:absolute;top:776;left:15″><nobr>音存在。双下肢凹陷性水肿。实验室检查:WBC</nobr></div>
<div style=”position:absolute;top:800;left:14″><nobr>21.1×10</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:797;left:77″><nobr>9</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:800;left:85″><nobr>/L,Hb126g/L,PLT94×10</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:797;left:267″><nobr>9</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:800;left:275″><nobr>/L。血生化:</nobr></div>
<div style=”position:absolute;top:824;left:15″><nobr>总蛋白 60.4g/L,白蛋白 26.8g/L,C反应蛋白</nobr></div>
<div style=”position:absolute;top:848;left:14″><nobr>75.3mg/L,总胆固醇 6.0mmol/L(参考值 3.0~</nobr></div>
<div style=”position:absolute;top:872;left:14″><nobr>6.0),甘油三脂2.3mmol/L(参考值0.4~1.8),C3</nobr></div>
<div style=”position:absolute;top:896;left:15″><nobr>补体0.6g/L(参考值0.8~1.6),尿素氮2.4mmol/</nobr></div>
<div style=”position:absolute;top:920;left:15″><nobr>L(参考值2.5~7.5),肌酐63.9μmol/L(参考值</nobr></div>
<div style=”position:absolute;top:944;left:14″><nobr>40~140)。不加热血清反应素试验(USR)阳性,滴</nobr></div>
<div style=”position:absolute;top:968;left:15″><nobr>度1∶8阳性,梅毒螺旋体血凝试验(TPHA)阳性。</nobr></div>
<div style=”position:absolute;top:992;left:15″><nobr>风疹病毒抗体、弓形虫抗体、巨细胞病毒抗体、单纯</nobr></div>
<div style=”position:absolute;top:1016;left:15″><nobr>疱疹病毒抗体均阴性。尿常规:蛋白(++++),</nobr></div>
<div style=”position:absolute;top:1040;left:15″><nobr>潜血(+++),24h尿蛋白定量0.3g/110mL。追</nobr></div>
<div style=”position:absolute;top:1064;left:15″><nobr>问病史,其父有不洁性生活史,其父母查血不加热血</nobr></div>
<div style=”position:absolute;top:1088;left:15″><nobr>清反应素试验(USR)、TPHA均阳性。入院诊断:先</nobr></div>
<div style=”position:absolute;top:1112;left:15″><nobr>天性梅毒伴先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征。入院后予以青霉素</nobr></div>
<div style=”position:absolute;top:1136;left:15″><nobr>每日10万U/kg,静脉分两次注射,连续14d,但尿</nobr></div>
<div style=”position:absolute;top:1159;left:15″><nobr>蛋白持续(+++),潜血(+++),低蛋白血<b style=”color:black;background-color:#ff9999″>症</b>未</nobr></div>
<div style=”position:absolute;top:1183;left:15″><nobr>能纠正,仍水肿明显,遂予激素治疗,剂量为泼尼松</nobr></div>
<div style=”position:absolute;top:1207;left:15″><nobr>每日2mg/kg,分2次口服,10d后复查尿常规蛋白</nobr></div>
<div style=”position:absolute;top:1231;left:15″><nobr>(++),潜血(++),激素减量至每日1mg/kg,4d</nobr></div>
<div style=”position:absolute;top:487;left:392″><nobr>后停用,疗程共两周。停药1周后复查尿常规蛋白</nobr></div>
<div style=”position:absolute;top:511;left:392″><nobr>(-),潜血(++),血生化:总蛋白 53.5g/L白蛋</nobr></div>
<div style=”position:absolute;top:535;left:392″><nobr>白33.8g/L。出院前复查尿常规正常,低蛋白血<b style=”color:black;background-color:#ff9999″>症</b></nobr></div>
<div style=”position:absolute;top:559;left:392″><nobr>纠正,住院56d,病情好转出院。随访半年,尿常规</nobr></div>
<div style=”position:absolute;top:583;left:392″><nobr>正常,USR阴性。患儿体格发育稍落后于同龄儿</nobr></div>
<div style=”position:absolute;top:607;left:392″><nobr>童,智力及运动发育基本正常。</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:15px;font-family:Times”>
<div style=”position:absolute;top:654;left:391″><nobr>2 讨论</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:702;left:424″><nobr>先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征(CNS)是指出生时或生后半</nobr></div>
<div style=”position:absolute;top:726;left:392″><nobr>年内出现水肿、蛋白尿、低蛋白血<b style=”color:black;background-color:#ff9999″>症</b>和高脂血<b style=”color:black;background-color:#ff9999″>症</b>的一</nobr></div>
<div style=”position:absolute;top:751;left:392″><nobr>组疾病</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:748;left:440″><nobr>[1~3]</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:751;left:469″><nobr>。分为两大类:①原发性可分为芬兰型</nobr></div>
<div style=”position:absolute;top:775;left:392″><nobr>CNS和法国型CNS(弥漫性系膜硬化);②继发性可</nobr></div>
<div style=”position:absolute;top:799;left:392″><nobr>继发于感染(先天性梅毒、先天性弓形虫<b style=”color:black;background-color:#a0ffff”>病</b>、巨细胞</nobr></div>
<div style=”position:absolute;top:823;left:392″><nobr>病毒感染等)、溶血尿毒<b style=”color:black;background-color:#99ff99″>综合</b>征、婴儿系统性红斑狼</nobr></div>
<div style=”position:absolute;top:847;left:392″><nobr>疮等。在婴儿期起<b style=”color:black;background-color:#a0ffff”>病</b>的 NS除先天性外,尚可有早</nobr></div>
<div style=”position:absolute;top:871;left:392″><nobr>发性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征(微小病变、局灶节段硬化和增生</nobr></div>
<div style=”position:absolute;top:895;left:392″><nobr>硬化)。该病例未行<b style=”color:black;background-color:#ffff66″>肾</b>穿刺活检,不能完全排除原</nobr></div>
<div style=”position:absolute;top:919;left:392″><nobr>发性先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b>,但据报道,原发性类型预后差,无</nobr></div>
<div style=”position:absolute;top:943;left:392″><nobr>有效治疗方案,存活时间短,而该病例预后佳,且伴</nobr></div>
<div style=”position:absolute;top:967;left:392″><nobr>随于先天性梅毒感染,风疹病毒抗体、弓形虫抗体、</nobr></div>
<div style=”position:absolute;top:991;left:392″><nobr>巨细胞病毒抗体、单纯疱疹病毒抗体等均阴性,因此</nobr></div>
<div style=”position:absolute;top:1015;left:392″><nobr>考虑为继发性先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征。</nobr></div>
<div style=”position:absolute;top:1039;left:424″><nobr>近年来,由于性传播疾病的蔓延,先天性梅毒发</nobr></div>
<div style=”position:absolute;top:1063;left:392″><nobr><b style=”color:black;background-color:#a0ffff”>病</b>率明显上升。先天性梅毒又称胎传梅毒,是梅毒</nobr></div>
<div style=”position:absolute;top:1087;left:392″><nobr>螺旋体由母体经胎盘进入胎儿血循环中所致的感</nobr></div>
<div style=”position:absolute;top:1111;left:392″><nobr>染。胎传梅毒因系血行感染,无I期梅毒阶段,出生</nobr></div>
<div style=”position:absolute;top:1135;left:392″><nobr>后即已进入II期感染阶段,常合并系统性损害,如</nobr></div>
<div style=”position:absolute;top:1159;left:392″><nobr>眼、耳、鼻等感官系统及骨骼系统、肝、<b style=”color:black;background-color:#ffff66″>肾</b>等内脏常受</nobr></div>
<div style=”position:absolute;top:1183;left:392″><nobr>损</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:1180;left:408″><nobr>[4]</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:1183;left:425″><nobr>。生后即出现<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b>表现有全身水肿、低蛋白血</nobr></div>
<div style=”position:absolute;top:1207;left:392″><nobr><b style=”color:black;background-color:#ff9999″>症</b>、高脂血<b style=”color:black;background-color:#ff9999″>症</b>,伴大量蛋白尿,可有血尿,少数有<b style=”color:black;background-color:#ffff66″>肾</b></nobr></div>
<div style=”position:absolute;top:1231;left:392″><nobr>功能损害。本<b style=”color:black;background-color:#a0ffff”>病</b>典型病理改变为膜性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b>,可伴有</nobr></div>
<div style=”position:absolute;top:1303;left:388″><nobr>·</nobr></div>
<div style=”position:absolute;top:1303;left:380″><nobr>5</nobr></div>
<div style=”position:absolute;top:1303;left:372″><nobr>5</nobr></div>
<div style=”position:absolute;top:1303;left:365″><nobr>5</nobr></div>
<div style=”position:absolute;top:1303;left:349″><nobr>·</nobr></div>
</span></font>

<div style=”position:absolute;top:1331;left:0″><hr><table border=0 width=100%><tr><td bgcolor=eeeeee align=right><font face=arial,sans-serif><a name=2><b>Page 2</b></a></font></td></tr></table></div><font size=2 face=”Times”><span style=”font-size:9px;font-family:Times”>
<div style=”position:absolute;top:1349;left:15″><nobr>第10卷第4期</nobr></div>
<div style=”position:absolute;top:1362;left:14″><nobr>2008年8月</nobr></div>
<div style=”position:absolute;top:1355;left:92″><nobr>                    </nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:11px;font-family:Times”>
<div style=”position:absolute;top:1348;left:331″><nobr>中国当代儿科杂志</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:8px;font-family:Times”>
<div style=”position:absolute;top:1361;left:335″><nobr>ChinJContempPediatr</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:9px;font-family:Times”>
<div style=”position:absolute;top:1349;left:675″><nobr>Vol.10No.4</nobr></div>
<div style=”position:absolute;top:1362;left:682″><nobr>Aug.2008</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:1397;left:15″><nobr>轻重不等的系膜组织增生,免疫荧光显示IgG和C3</nobr></div>
<div style=”position:absolute;top:1421;left:15″><nobr>沿毛细血管壁呈颗粒状沉积,电镜下可见上皮下电</nobr></div>
<div style=”position:absolute;top:1444;left:15″><nobr>子致密物沉积,<b style=”color:black;background-color:#ffff66″>肾</b>组织可存在螺旋体抗原</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:1442;left:297″><nobr>[5]</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:1444;left:313″><nobr>。诊断</nobr></div>
<div style=”position:absolute;top:1468;left:15″><nobr>先天性梅毒伴<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征的实验室依据主要依靠梅</nobr></div>
<div style=”position:absolute;top:1491;left:15″><nobr>毒血清学试验,其中包括非梅毒螺旋体抗原试验和</nobr></div>
<div style=”position:absolute;top:1515;left:15″><nobr>梅毒螺旋体特异性抗体检测,而新生儿血清学反应</nobr></div>
<div style=”position:absolute;top:1539;left:15″><nobr>易与来源于母、经胎盘的抗体混淆,因此应该对比</nobr></div>
<div style=”position:absolute;top:1562;left:15″><nobr>分娩时母亲和新生儿的梅毒血清学试验结果,如新</nobr></div>
<div style=”position:absolute;top:1586;left:15″><nobr>生儿抗体滴度高于母亲的抗体滴度提示新生儿受到</nobr></div>
<div style=”position:absolute;top:1609;left:15″><nobr>梅毒感染,若明显低于母亲抗体滴度,则不能肯定新</nobr></div>
<div style=”position:absolute;top:1633;left:15″><nobr>生儿受到感染</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:1630;left:110″><nobr>[6]</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:1633;left:126″><nobr>。</nobr></div>
<div style=”position:absolute;top:1656;left:46″><nobr>疾病诊断明确后,按照常规治疗,青霉素治疗有</nobr></div>
<div style=”position:absolute;top:1680;left:15″><nobr>效,不宜用肾上腺皮质激素治疗</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:6px;font-family:Times”>
<div style=”position:absolute;top:1678;left:231″><nobr>[7]</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:1680;left:247″><nobr>。但是对于该<b style=”color:black;background-color:#a0ffff”>病</b></nobr></div>
<div style=”position:absolute;top:1704;left:15″><nobr>例,我们在应用充足剂量、规范疗程的青霉素治疗</nobr></div>
<div style=”position:absolute;top:1727;left:15″><nobr>后,症状改善不明显,考虑到该<b style=”color:black;background-color:#a0ffff”>病</b>被认为是由免疫复</nobr></div>
<div style=”position:absolute;top:1751;left:15″><nobr>合物介导和补体激活的免疫性疾病,遂予以激素治</nobr></div>
<div style=”position:absolute;top:1774;left:15″><nobr>疗,效果明显,这可以说明一点,先天性梅毒伴有<b style=”color:black;background-color:#ffff66″>肾</b></nobr></div>
<div style=”position:absolute;top:1798;left:15″><nobr><b style=”color:black;background-color:#a0ffff”>病</b>时除了青霉素治疗之外,在疗效不佳的情况下可</nobr></div>
<div style=”position:absolute;top:1822;left:15″><nobr>考虑加用肾上腺皮质激素,激素起到抑制免疫损伤</nobr></div>
<div style=”position:absolute;top:1845;left:15″><nobr>的作用。胎儿感染的危险性与母亲的<b style=”color:black;background-color:#a0ffff”>病</b>期、是否经</nobr></div>
<div style=”position:absolute;top:1869;left:15″><nobr>过治疗有关,母亲有原发或继发梅毒和螺旋体血<b style=”color:black;background-color:#ff9999″>症</b>、</nobr></div>
<div style=”position:absolute;top:1892;left:15″><nobr>且未经过治疗者,较潜伏感染者更易将本<b style=”color:black;background-color:#a0ffff”>病</b>传给胎</nobr></div>
<div style=”position:absolute;top:1397;left:392″><nobr>儿。研究发现,母孕期如经适当治疗则新生儿感染</nobr></div>
<div style=”position:absolute;top:1421;left:392″><nobr>率明显下降,为避免先天性梅毒的发生,可能患梅毒</nobr></div>
<div style=”position:absolute;top:1444;left:392″><nobr>的孕妇应在孕前及产前3个月做梅毒血清学检查,</nobr></div>
<div style=”position:absolute;top:1468;left:392″><nobr>并及时予以青霉素正规根治治疗,则可防止胎儿受</nobr></div>
<div style=”position:absolute;top:1491;left:392″><nobr>累,保证儿童健康。</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:11px;font-family:Times”>
<div style=”position:absolute;top:1539;left:510″><nobr>[参 考 文 献]</nobr></div>
</span></font>
<font size=2 face=”Times”><span style=”font-size:9px;font-family:Times”>
<div style=”position:absolute;top:1582;left:392″><nobr>[1] 莫樱.先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征[M].//黄绍良,陈述枚,何政贤.小</nobr></div>
<div style=”position:absolute;top:1599;left:424″><nobr>儿内科学.北京:人民卫生出版社,2004,613.</nobr></div>
<div style=”position:absolute;top:1617;left:392″><nobr>[2] 楚和平.先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征1家2例报告[J].中国当代儿科</nobr></div>
<div style=”position:absolute;top:1634;left:424″><nobr>杂志,2001,3(2):206.</nobr></div>
<div style=”position:absolute;top:1651;left:392″><nobr>[3] 汤飞鸽,岳少杰,刘丽旭.先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征伴右位心,左位肝</nobr></div>
<div style=”position:absolute;top:1668;left:423″><nobr>1例[J].中国当代儿科杂志,2003,5(6):578.</nobr></div>
<div style=”position:absolute;top:1685;left:392″><nobr>[4] 薄幕琴,尹娜,张翠丽,张燕.先天梅毒致先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征一</nobr></div>
<div style=”position:absolute;top:1702;left:424″><nobr>例[J].中华儿科杂志,2000,38(9):565.</nobr></div>
<div style=”position:absolute;top:1719;left:392″><nobr>[5] 林瑞霞,杨青,杨宇真,庄捷秋.先天性梅毒致先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b></nobr></div>
<div style=”position:absolute;top:1736;left:424″><nobr>征临床分析[J].中国妇幼保健,2005,20(2):202203.</nobr></div>
<div style=”position:absolute;top:1753;left:392″><nobr>[6] 夏斌,熊英,母得志.早期先天性梅毒临床分析[J].中国当代</nobr></div>
<div style=”position:absolute;top:1770;left:424″><nobr>儿科杂志,2007,9(3):257258.</nobr></div>
<div style=”position:absolute;top:1787;left:392″><nobr>[7] 周秦玉.先天性<b style=”color:black;background-color:#ffff66″>肾</b><b style=”color:black;background-color:#a0ffff”>病</b><b style=”color:black;background-color:#99ff99″>综合</b>征[M].//金汉珍,黄德珉,官希吉.</nobr></div>
<div style=”position:absolute;top:1804;left:424″><nobr>实用新生儿学.第 3版.北京:人民卫生出版社,2003,719</nobr></div>
<div style=”position:absolute;top:1821;left:423″><nobr>720.</nobr></div>
<div style=”position:absolute;top:1855;left:634″><nobr>(本文编辑:吉耕中)</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:15px;font-family:Times”>
<div style=”position:absolute;top:1987;left:623″><nobr>·消息·</nobr></div>
</span></font>
<font size=4 face=”Times”><span style=”font-size:20px;font-family:Times”>
<div style=”position:absolute;top:2038;left:116″><nobr>我刊被新闻出版总署评定为首批出版规范A类期刊</nobr></div>
</span></font>
<font size=3 face=”Times”><span style=”font-size:13px;font-family:Times”>
<div style=”position:absolute;top:2092;left:46″><nobr>国家新闻出版总署在2007年对全国期刊进行了一次全面的出版规范检查评定,对7300余种期刊进行</nobr></div>
<div style=”position:absolute;top:2116;left:15″><nobr>了初检、复检,并经各省新闻出版局核实,首批合格期刊名录已在媒体和中国记者网上公布。《中国当代儿</nobr></div>
<div style=”position:absolute;top:2141;left:15″><nobr>科杂志》顺利通过此次检查,成为国家新闻出版总署首批出版规范检查评定合格(A类)期刊。同时国家新</nobr></div>
<div style=”position:absolute;top:2165;left:15″><nobr>闻出版总署对A类期刊进行了表扬,认为这些期刊是全国期刊的学习榜样。</nobr></div>
<div style=”position:absolute;top:2189;left:46″><nobr>《中国当代儿科杂志》多年来秉承严谨的科学态度,严格的执行各项规章制度,保证了期刊的科学性、先</nobr></div>
<div style=”position:absolute;top:2213;left:15″><nobr>进性、规范性。本刊将以此次评定为契机,更加努力工作,为中国期刊的发展作出积极的贡献。</nobr></div>
<div style=”position:absolute;top:2237;left:534″><nobr>中国当代儿科杂志编辑部</nobr></div>
<div style=”position:absolute;top:2459;left:388″><nobr>·</nobr></div>
<div style=”position:absolute;top:2459;left:380″><nobr>6</nobr></div>
<div style=”position:absolute;top:2459;left:372″><nobr>5</nobr></div>
<div style=”position:absolute;top:2459;left:365″><nobr>5</nobr></div>
<div style=”position:absolute;top:2459;left:349″><nobr>·</nobr></div>
</span></font>

Nursing Career Opportunities - Training Available job in San Jose, CA

October 15th, 2008

nursing, nursing careers, nursing jobs, RN, nurse


Nursing Career Opportunities - Training Available

Join the Community of Caring in the high-demand field of Nursing

Nurses constitute the largest segment of the healthcare industry, with over 2 million jobs. They are indispensable in the healthcare setting and with an expected growth rate of nearly 25% for the next decade, they will continue to be in high-demand. Hospitals, physician offices, and other health care facilities are constantly looking for dedicated and caring individuals to join their professional health care teams. And with an average salary of $48,000 to $70,000, those you care for won't be the only ones who benefit.

So find a new passion in life and reap the benefits! Let us help you find a nursing career today.

Nursing Job Requirements

  • Must be reliable, have mechanical aptitude, and be able to follow detailed instructions.
  • Associates degree or equivalent training required.
  • A pleasant, relaxed manner for putting patients at ease.
  • Must have excellent listening skills and hearing.
  • Must be articulate so they can communicate technically with physicians and also explain procedures simply to patients.

CareerSpeed is dedicated to providing you with the quality information that you need to find the career and job that you have always wanted. Let us put our expertise to work for you in finding your passion. CareerSpeed helps find jobs for qualified applicants and training at select schools and colleges for those who need certification.

Job ID 63E019DC230005 Company Name CareerSpeed Job Category Healthcare Location San Jose, CA

Medical Documentation Auditor job in Livermore, CA:

October 15th, 2008

This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is proud to be an equal opportunity/affirmative action employer.

DEPARTMENT: ENCOUNTER INFORMATION OPERATIONS

The physical work location is at 300 Pullman, Building C, Livermore , 94551 CA

NOTE: Occassional travel to other KP Northern California Facilities may be required based upon operational needs.

SCHEDULE: Full-time regular; 40 hours per week; Day Shift; Monday through Friday; 07:00AM – 03:30PM.

POSITION SUMMARY: Under minimal supervision, ensures accurate and appropriate documentation through local coaching and monitoring. Provides documentation coaching to clinicians in the Outpatient Clinic and Emergency Department. Monitors success of coaching and training efforts through encounter audits which ensure documentation meets requirements for diagnosis and E&M assignment, based on Official ICD-9-CM Documentation Guidelines.

EDUCATION/LICENSE/CERTIFICATION:

BS (Business Administration, Health Care, Public Health, Finance, Business Medical Records Technology) or equivalent experience. Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).

QUALIFICATIONS: Significant experience coding (3 or more years) based on Coding Clinical Guidelines for inpatient and outpatient. Demonstrated experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements. Demonstrated project management experience including design and implementation of audit plans. Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas. Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data. Strong interpersonal and excellent written, verbal and presentation skills. Demonstrated ability to work independently with minimal supervision. Demonstrated ability to work within a team environment. Willingness to be flexible depending upon department and/or physician schedule needs. Demonstrated ability to review analytical data and audit findings to identify documentation trends and other risk areas. Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data. Must be able to work in a Labor / Management Partnership environment.

PREFERRED QUALIFICATIONS: Experience using PC applications such as MS Word, Excel, Access, PowerPoint. Medical center operations or clinical experience. Three or more years CPT, ICD9 and E&M Coding Experience. Proficient in the use of CPT, ICD9 and HCPCS coding principles. Comprehensive knowledge of medical diagnostic and procedural terminology is required. Ability to prioritize workload and meet deadlines. Ability to read and interpret medical data. Demonstrated ability to work within a team environment, willingness to be flexible depending upon department and/or physician schedule needs. Experience using PC applications such as MS Word, Excel, Access, PowerPoint. Experience using Epic electronic health records systems preferred. Experience using Web based applications preferred. Medical center operations or clinical experience.

SKILLS TESTING: ICD9, CPT and E&M Coding skills assessment will be given to all applicants.

DUTIES: Using independent judgment and sensitivity, coaches individual physicians, reviewing their audit findings, making suggestions for documentation improvements and updating on changes to Federal and State government billing and coding guidelines. Partners with Trainer in the development of future training that will address documentation risk areas identified through local and regional audits. Plans, schedules and performs encounter audits to monitor performance and ensure lasting improvement. Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements. Monitors corrective actions for audit review findings.

Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)). Actively participates with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.

Works with medical center leadership to provide confidential audits and feedback on an “as needed” basis. Assists in the identification of operational processes that hinder encounter data capture. Enters encounter audit results into regional audit database to support quality assurance process, regional analysis and regional training activities.

Prepares and/or performs medical center auditing analysis and/or special projects as assigned. Partners with Data Quality Trainer and other local analytical workgroups to identify audit trends and risk areas based on audit findings and data analysis. Assists in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements.

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures.

Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.

- Kaiser Permanente is an AA/EEO employer.


Job ID RE.0802207 Company Name Kaiser Permanente Job Category Healthcare Location Livermore, CA Position Type Full-Time, Employee Experience 5-10 Years Experience Date Posted October 15, 2008

DIR, PHYS ONBOARDING - 0805019317 job in Boca Raton, FL: Healthcare and

October 15th, 2008

Description
Seasoned healthcare professional with extensive years of experience in the healthcare industry managing the onboarding of new Physicians. Heavy involvement on starting up new practices to include staffing, training and development, internal processes, billing and management of electronic medical records. Responsible for the relationship between Physicians and Tenet Florida Physicians Services. Demonstrate an excellent customer service delivery with strong communication skills and dynamic administrative experience and comprehensive knowledge of Federal-State health care and regulations.

Qualifications

Minimum of a Bachelor's Degree in Healthcare Management, Master's Degree Preferred
Job ID 0805019317 Company Name Tenet Florida Physicians Services Job Category Healthcare; Healthcare Location Boca Raton, FL Position Type Full-Time, Employee Experience Unspecified Date Posted October 15, 2008

Nursing - Training Available job in San Diego, CA

October 15th, 2008

nursing, nursing careers, nursing jobs, RN, nurse


Nursing Career Opportunities - Training Available

Join the Community of Caring in the high-demand field of Nursing

Nurses constitute the largest segment of the healthcare industry, with over 2 million jobs. They are indispensable in the healthcare setting and with an expected growth rate of nearly 25% for the next decade, they will continue to be in high-demand. Hospitals, physician offices, and other health care facilities are constantly looking for dedicated and caring individuals to join their professional health care teams. And with an average salary of $48,000 to $70,000, those you care for won't be the only ones who benefit.

So find a new passion in life and reap the benefits! Let us help you find a nursing career today.

Nursing Job Requirements

  • Must be reliable, have mechanical aptitude, and be able to follow detailed instructions.
  • Associates degree or equivalent training required.
  • A pleasant, relaxed manner for putting patients at ease.
  • Must have excellent listening skills and hearing.
  • Must be articulate so they can communicate technically with physicians and also explain procedures simply to patients.

MedicalCareersOnline is dedicated to providing you with the quality information that you need to find the career and job that you have always wanted. Let us put our expertise to work for you in finding your passion. MedicalCareersOnline helps find jobs for qualified applicants and training at select schools and colleges for those who need certification.

Job ID D96C25BEF40004 Company Name Medical Careers Online Job Category Healthcare Location San Diego, CA

CCT/CNA FT Nights job in Torrance, CA: Healthcare and

October 15th, 2008

CCT/CNA FT Nights


External Description:

. POSITION SUMMARY: The Clinical Care Technician (CCT) role is a non-licensed
health care employee who performs delegated routine and predictable patient care
tasks/duties and works under the direct supervision of a Registered Nurse (RN).
These duties may include, but are not limited to EKGs, vital signs, monitoring,
basic patient care and transportation. Responds appropriately to patients and
families with knowledge of age-specific needs based on scope of service of
unit/department where assigned. II. SUPERVISION 1. Supervises: None 2.
Supervisory Authority: None 3. Supervised by: Unit Manager, Clinical Supervisors
and RN/patient Care Leader III. MINIMUM SKILLS/EXPERIENCE/EDUCATION REQUIRED 1.
Required: · Requires certification of Nursing Assistant from a state approved
program or graduate of the SCROC CCT Program or demonstrated equivalency (such
as experience as a Corpsman, EMT, foreign licensed RN or MD), completion 2nd
semester of accredited Nursing Program, HHA with 1-2 years experience. Requires
high school graduation or GED. · Requires fluent ability to understand oral and
written English directives, including English text. · Requires the ability to
perform basic arithmetic computations (add, subtract, multiply, divide). ·
Requires the ability to perform all physical requirements pertaining to
delegated tasks. · Requires satisfactory completion of The American Heart
Association's Heart Saver course. · Requires ability to accurately and
efficiently complete assigned tasks. · Requires ability to organize and
prioritize work to complete assignments in a timely manner. · Must demonstrate
an understanding of basic medical terminology and abbreviations. · Ability to
establish and maintain a courteous and cooperative (service-oriented) working
relationship with patients, families and co-workers. 2. Preferred: Prefer
recent, hospital direct patient care experience on an acute, sub-acute or
skilled nursing facility.

Job ID 42893 Company Name Providence Health and Services Job Category Healthcare; Healthcare Location Torrance, CA Position Type Full-Time, Employee Experience 1-2 Years Experience Date Posted October 15, 2008

Medical Billing Clerk - Training Available job in Dallas, TX

October 15th, 2008

Begin your career in the medical field with a job you can be proud of.

The Doctor is in, and you should be too — as their new Medical Billing and Coding Specialist!

Medical Billing and Coding experts play an integral part in the medical industry, and are a key member of any health care facility. Medical Billing clerks calculate charges, develop bills, and prepare them to be mailed to customers, they ensure that even the most complicated bills are accurate.

Skilled Medical Billing and Coding Professionals are in demand RIGHT NOW, and Hospitals, Private and Public Clinics, Medical Offices, Chiropractors, Optometrists, Podiatrists, Family Doctors, Nursing Homes, Children's Clinics and other Health Practitioners are looking for career minded people like you to fill these jobs immediately. They want trained and licensed professionals they can trust with their patient's billing and that can keep things running smoothly. Best of all they pay between $22,000 to $41,000 a year!

We want to help you get the training to become a licensed Medical Billing and Coding professional. Why work at Wall-Mart in a thankless job when you could be apart of a medical office team. They're looking for someone just like you, so why not give them you?

Don't delay, now is the best time to begin your Medical Billing training. Be the one to send the bills instead of receiving the bills for a change.

Medical Billing and Coding Training Requirements:

  • High School diploma or equivalent.
  • Possess excellent organizational skills and detail oriented.
  • Basic math and analytical skills.
  • A Desire For A Better Life For Yourself and Your Family

Begin your career in the medical field with a job you can be proud of. Medical Office pay well and offer great benefits. Apply Today!!
Job ID D253AC8E800036 Company Name Medical Careers Online Job Category Healthcare Location Dallas, TX

Medical Coding Specialist - Training Available job in Virginia Beach, VA

October 15th, 2008

Begin your career in the medical field with a job you can be proud of.

The Doctor is in, and you should be too — as their new Medical Billing and Coding Specialist!

Medical Billing and Coding experts play an integral part in the medical industry, and are a key member of any health care facility. Medical Billing clerks calculate charges, develop bills, and prepare them to be mailed to customers, they ensure that even the most complicated bills are accurate.

Skilled Medical Billing and Coding Professionals are in demand RIGHT NOW, and Hospitals, Private and Public Clinics, Medical Offices, Chiropractors, Optometrists, Podiatrists, Family Doctors, Nursing Homes, Children's Clinics and other Health Practitioners are looking for career minded people like you to fill these jobs immediately. They want trained and licensed professionals they can trust with their patient's billing and that can keep things running smoothly. Best of all they pay between $22,000 to $41,000 a year!

We want to help you get the training to become a licensed Medical Billing and Coding professional. Why work at Wall-Mart in a thankless job when you could be apart of a medical office team. They're looking for someone just like you, so why not give them you?

Don't delay, now is the best time to begin your Medical Billing training. Be the one to send the bills instead of receiving the bills for a change.

Medical Billing and Coding Training Requirements:

  • High School diploma or equivalent.
  • Possess excellent organizational skills and detail oriented.
  • Basic math and analytical skills.
  • A Desire For A Better Life For Yourself and Your Family

Begin your career in the medical field with a job you can be proud of. Medical Office pay well and offer great benefits. Apply Today!!
Job ID 6314237E400040 Company Name Medical Careers Online Job Category Healthcare Location Virginia Beach, VA