乌司他丁治疗急性胰腺炎临床疗效观察

目的：观察乌司他丁对急性胰腺炎的治疗作用。方法：回顾性对比分析1996－06－2001－06 72例急性胰腺炎，应用乌司他丁，生长抑素和其他方法的治疗效果。结果：应用乌司他丁治疗组体温，白细胞总数，SpO2，腹部胀痛及压痛恢复与生长抑素组和对照组有显著差异（P＜0．05），血压，心率，呼吸，肠鸣音，血，尿淀粉酶恢复明显优于对照组（P＜0．05），结论：乌司他丁对急性胰腺炎有较好的治疗作用，尽早应用能在较短时间内稳定，控制急性胰腺炎的病情发展，减少并发症的发生。     

蛋白酶抑制剂短期腹腔灌洗治疗重症急性胰腺炎的实验观察

目的：研究蛋白酶抑制剂短期腹腔灌洗治疗重症急性胰腺炎的效果及作用机制。方法：80只Wistar大鼠随机分为5组：假手术对照组、SAP模型组、乌司他丁组、生理盐水腹腔灌洗组、乌司他丁腹腔灌洗组,并于处理后6、24h取血液、腹水、胰腺组织测定IL-1β、TNF-α、淀粉酶、脂肪酶、NF—κB水平,并作胰腺病理检查。结果：上述指标中,乌司他丁腹腔灌洗组明显好于其他各组,其次为乌司他丁组,SAP模型组与生理盐水腹腔灌洗组无明显差异。结论：乌司他丁腹腔灌洗可以抑制淀粉酶、脂肪酶、NF-κB、TNF—α、IL-1β的激活,减轻胰腺组织的损害;蛋白酶抑制剂腹腔灌洗治疗重症急性胰腺炎的方法简单、有效。     

腹腔巨噬细胞对急性出血坏死性胰腺炎大鼠血清细胞因子的影响

目的研究腹腔巨噬细胞对急性出血坏死性胰腺炎大鼠血清肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）和白细胞介素-6（inter leucocyte-6,IL-6）的影响。方法96只大鼠随机分为PMs（＋）组、PMs（-）组和S0组。采用胰胆管逆行注射2％去氧胆酸钠制作大鼠出血坏死性胰腺炎模型。使用氯屈磷酸二钠脂质体腹腔注射特异性清除PMs（-）组大鼠腹腔巨噬细胞。造模后1h、3h、6h、12h取标本,做胰腺病理学检查、血清淀粉酶检测,血浆内毒素测定,腹水和血清细胞因子测定。结果PMs（＋1组和PMs（-）组之间胰腺病理评分、血清淀粉酶水平无显著差异,两组间血浆内毒素水平,腹水和血清细胞因子水平差异显著。结论出血坏死性胰腺炎过程中腹腔巨噬细胞的活化对实验大鼠血清细胞因子水平有显著影响。     

乌司他丁治疗急性胰腺炎的临床疗效观察

目的：探讨乌司他丁治疗急性胰腺炎的临床疗效。方法：回顾性分析我院近年来收治的85例急性胰腺炎患者的临床资料,根据治疗方法不同,将患者随机分为两组,比较两组患者的疗效差异。结果：对照组42例患者,经过奥曲肽治疗,痊愈率为69．1％,总有效率为100．0％;治疗组43例患者,经过乌司他丁治疗,痊愈率为76．7％,总有效率为100．0％;两组患者的临床疗效经统计学分析,无明显差异性,P〉0．05,而且,治疗组的痊愈率比对照组略高,不良反应发生情况之间无明显差异性,P〉0．05。结论：乌司他丁治疗急性胰腺炎疗效确切,不良反应小,值得临床推广使用。     

外周血多形核白细胞凋亡情况及生存率与急性胰腺炎严重程度相关性研究

目的研究急性胰腺炎大鼠模型外周血多形核白细胞即中性粒细胞(PMN)的凋亡情况及生存率与急性胰腺炎严重程度的关系。方法采用在大鼠胰胆管共同通道内逆行注射不同浓度的脱氧胆酸钠,制备不同严重程度的急性胰腺炎模型。18只SD大鼠随机分为对照组、模型1组(0.75%脱氧胆酸钠剂量组)、模型2组(1.5%脱氧胆酸钠剂量组)。分别于造模后6 h处死各组存活大鼠。观察各组大鼠的胰腺组织病理学变化、组织病理学评分,血清、腹水淀粉酶水平,腹水量及外周血清IL-6、IL-8水平。同时用TUNEL法分析外周血多形核白细胞凋亡情况,用流式细胞分析法分析外周血多形核白细胞存活率。并与急性胰腺炎严重程度各项指标进行统计学相关分析。结果模型1组大鼠较模型2组大鼠胰腺组织坏死及出血程度轻,组织病理学评分低,腹水及血清淀粉酶水平低,腹水量相对少,外周血清IL-6,IL-8水平低;病变程度较轻的模型1组大鼠外周血多形核白细胞凋亡指数比病变重的模型2组大鼠高(30±6 vs 20±4P<0.05);病变程度较轻的模型1组大鼠外周血多形核白细胞存活率比病变重的模型2组大鼠低[(56.12±4.21)%vs(67.15±5.11)%,P<0.05]。结论急性胰腺炎时,外周血多形核白细胞凋亡指数与急性胰腺炎严重程度呈负相关,外周血多形核白细胞存活率与急性胰腺炎严重程度呈正相关。     

血清总补体与犬急性胰腺炎

目的:探讨血清总补体活性变化与犬急性胰腺炎胰腺组织病变程度之间的关系。方法:30只实验犬根据病情分为3组:急性水肿性胰腺炎(AEP)组、急性出血坏死性胰腺炎(AHNP)组及对照组,测定发病前后不同时相点血清总补体活性。结果:AHNP组血清总补体活性于发病后12h明显降低,而AEP组无明显改变。结论:血清总补体活性与胰腺组织病变程度有关。     

益生菌对急性坏死性胰腺炎大鼠的保护作用研究

目的观察益生菌对急性坏死性胰腺炎大鼠的保护作用,并对其作用机理进行探讨。方法SD大鼠120只,随机分为假手术组、急性坏死性胰腺炎模型组以及大、小剂量益生菌治疗组。大鼠急性坏死性胰腺炎模型是经胆胰管逆行注射5％牛磺胆酸钠形成,益生菌制剂成分为双歧杆菌、乳杆菌和嗜热链球菌。益生菌经灌胃途径预防给药,于造模前3d起,每天给药1次,连续给药3d。分别于造模后6h、12h取血,测定血清淀粉酶、TNF-α和IL-6水平,观察各组动物48h死亡率。结果益生菌能明显降低急性坏死性胰腺炎大鼠48h死亡率,降低血清淀粉酶、TNF-α和IL-6水平。结论益生菌通过抑制炎症因子的表达。对急性坏死性胰腺炎起到保护作用。     

营养支持、生长抑素联合乌司他丁治疗重症急性胰腺炎疗效分析

目的探讨营养支持、生长抑素联合乌司他丁治疗重症急性胰腺炎患者的疗效。方法选取自2011年3月至2016年3月北京医院收治的重症急性胰腺炎患者92例,采用随机数字表法将患者分为两组,每组各46例患者。两组均给予禁食、肠胃减压、体液复苏、维持水电解质平衡等常规治疗;A组在常规治疗基础上给予营养支持、生长抑素治疗;B组在A组基础上给予乌司他丁治疗。观察并比较两组患者治疗前后的炎症因子水平和凝血功能变化情况,及治疗后的临床症状改善时间和有效率。结果治疗后,两组白细胞介素-6、白细胞介素-8、肿瘤坏死因子-α水平均较治疗前降低,且B组低于A组,两组比较,差异有统计学意义(P<0.05);两组凝血酶原时间、部分活化凝血酶原时间、纤维蛋白原均较治疗前降低,且B组低于A组,两组比较,差异有统计学意义(P<0.05);B组患者腹痛缓解时间、C反应蛋白恢复时间、血淀粉酶恢复时间、平均住院时间均短于A组,差异有统计学意义(P<0.05);B组有效率高于A组,差异有统计学意义(P<0.05)。结论营养支持、生长抑素联合乌司他丁治疗重症急性胰腺炎疗效显著,能够有效改善患者凝血功能,降低患者炎症因子表达。     

急性应激大鼠脑组织NO、SOD含量变化及意义

目的 :观察急性应激大鼠脑组织一氧化氮 (NO)含量和超氧化物歧化酶 (SOD)活力变化 ,探讨其在急性应激障碍发病中的作用。方法 :通过建立急性应激模型 ,分别取脑边缘系统大脑额叶、海马、下丘脑及中脑 ,制成脑组织匀浆测定NO的含量和SOD的活力。结果 :急性应激组大鼠大脑额叶、海马、下丘脑及中脑组织SOD活力明显高于对照组 (P <0 .0 5) ,NO含量在海马、下丘脑升高明显 (P <0 .0 5)。结论 :结果提示 ,在应激反应过程中自由基对脑有损害作用 ,可能参与应激障碍的发病。     

乌司他丁在创伤性急性肺损伤治疗中的作用

目的探讨乌司他丁对创伤性急性肺损伤的治疗作用。方法选择60例创伤性急性肺损伤患者,随机分为乌司他丁治疗组(n=30)和对照组(n=30),对照组接受常规治疗。乌司他丁治疗组在常规治疗基础上静脉滴注乌司他丁50000 U/kg,1次/d,连用3 d,观察两组的临床疗效并检测治疗前及治疗第2天、第3天的血清TNF-α、IL-6和IL-8水平变化。结果乌司他丁治疗组与对照组在治疗前TNF-α、IL-6和IL-8水平无差异。治疗后乌司他丁治疗组的TNF-α、IL-6和IL-8水平下降较对照组明显(P<0.05)。乌司他丁治疗组治疗后呼吸频率(RR)、氧分压(PaO2)、二氧化碳分压(PaCO2),氧合指数(PaO2/F iO2)与对照组差异有统计学意义(P<0.05)。结论乌司他丁可显著抑制机体炎症介质的产生,创伤性急性肺损伤早期应用治疗效果明显。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.