纤维支气管镜对不明原因咯血的诊治价值及安全性评价

目的评价纤维支气管镜对不明原因咯血的诊治价值及安全性。方法对335例影像学检查阴性且原因不明的咯血患者行纤维支气管镜检查,并予镜下局部止血治疗。结果发现炎症为主要的咯血病因,占55.8%,其次为结核15.8%肺癌14.3%。诊断阳性率为86%。镜下发现有活动性出血164例,镜下局部综合止血治疗后显效者141例,有效者18例,无效者为大咯血5例,有效率为97%。并发喉痉挛或支气管痉挛者2例;严重低氧血症(SaO2<80%)1例。结论纤维支气管镜检查是原因不明的少中量咯血患者必要且安全的有创检查之一。     

纤维支气管镜检查在青壮年不明原因咯血患者中的诊断价值及治疗

目的探讨纤维支气管镜检查在青壮年不明原因咯血患者中的诊断价值及纤维支气管镜治疗的安全评价。方法 29例不明原因咯血患者,在咯血期间或在咯血停止48～72 h内进行检查,经肉眼观察、活组织检查、刷片和实验室的各项检查以及CT选择性检查,镜下发现出血病灶的同时给予止血治疗。结果发现咯血的原因为：支气管肺癌1例,普通炎症23例,支气管扩张2例,支气管结核1例,无异常发现2例,总阳性率为93%。发现10例活动性出血,并给予镜下止血治疗,有效率为100%,无并发症发生。结论纤维支气管镜检查对青壮年不明原因咯血是可选的一种检查手段,对咯血的诊断和治疗安全有效。     

立止血在支气管镜检查治疗中的应用

目的 观察经支气管镜注入立止血治疗镜下检查出血及大咯血的疗效。方法 所有病例均采用Pemax EB—1530T2型电子支气管镜进行检查，操作步骤按常规进行。发现病灶或出血部位先用1：10000肾上腺2ml注入，取标准活钳行支气管黏膜或肺组织活检、刷检。遇到出血立即予负压吸引，再次冰冻盐水加肾上腺素注入，保留数秒，尽量吸除积血，如仍然有血液涌出随即用立止血1，2ku经吸引口用长硅胶管直接注洒出血部位，支气管镜保留该位置片刻，观察止血情况，确定出血停止后退出支气管镜。结果 该院进行的4970例纤维支气管镜检查治疗中，活检出血量在5～20ml左右不需要注入立止血，超过50ml需要注入立止血有128例，超过300ml及咯血3d以上共26例，经注入立止血后，得以迅速止血。结论 支气管注入立止血治疗镜下出血及咯血能起到良好的止血作用。     

2361例不明原因咯血患者支气管镜下特点与临床

目的 了解不明原因咯血患者支气管镜下特点,探讨支气管镜检查对咯血病因诊断的价值.方法 结合临床资料对2 361例不明原因咯血患者支气管镜镜下表现和病因进行分析.结果 2 361倒不明原因略血患者镜下表现为管腔内菜花样、乳头状、球形或结节样新生物时93.5%为支气管肺癌,炎症也占有一定比率(4.2%);镜下表现为支气管黏膜肥厚、凹凸不平者支气管肺癌仍然是主要病因,占95.6%,4.20%为支气管结核所致;镜下见黏膜充血水肿、伴或不伴脓性或黏性分泌物是支气管炎性病变的突出表现,支气管炎88.7%、支气管扩张5.1%;而瘢痕狭窄仅见于结核患者.结论 不明原因咯血患者支气管镜下表现主要为支气管黏膜充血水肿,其次是管腔内新生物形成,黏膜肥厚、凹凸不平,主要病因分别是支气管肺癌、支气管炎性病变和结核.     

纤维支气管镜对大咯血患者手术止血定位的价值

目的 评价纤维支气管镜对大咯血患者手术止血定位的价值.方法 11例因大咯血而内科治疗无效的患者,6例患者利用纤维支气管镜经气管插管或开胸后气管侧切口入支气管,判断出血部位后行肺段或肺叶切除术止血;5例患者通过肺部多层螺旋CT和临床体征判断出血部位,再行肺段或肺叶切除术止血.结果 经纤维支气管镜定位后的6例大咯血患者,术后未出现大咯血;经肺部多层螺旋CT和临床体征定位的5例大咯血患者,有2例因再次大咯血二次手术,1例因再次大咯血死亡.结论 纤维支气管镜可以准确判定大咯血所在肺段或肺叶的位置,对确定手术治疗方案有很大辅助作用.     

经纤维支气管镜局部联合应用去甲肾上腺素与立止血治疗大咯血

该文报告４８例咯血量在６００ｍｌ／２４ｈ以上的大咯血病人经纤维支气管镜局部联合应用去甲肾上腺素与立止血治疗，其中肺结核２６例，肺癌８例，支气管扩张７例，支气管结石１例，原因不明者６例。镜下均即刻止血，取得满意效果，无严重心血管副作用出现。     

静脉注射立止血在支气管镜检查活检术中的应用

目的 评价静脉注射立止血对支气管镜检查活检术后出血的止血效果.方法 选择需要接受支气管镜检查并进行镜下活检术的患者132例,随机分为两组.局部用药组(对照组):即活检术时局部应用1:10000肾上腺素盐水镜下止血治疗;联合用药组(立止血组):即在活检术前静脉注射立止血1 ku,活检时局部应用1:10000肾上腺素盐水镜下止血治疗.每次活检术后观察患者伤口出血量,判定出血程度.结果 立止血组患者活检术后出血程度较对照组明显降低(P<0.05).结论 静脉注射立止血在支气管镜检查活检术中具有良好的止血作用,值得推广应用.     

经纤维支气管镜针吸活检诊断纵隔病变

目的探讨纤维支气管镜针吸活检术对肺门、纵隔不明原因肿块的诊断价值。方法选择肺部CT检查发现有纵隔、肺门软组织块状阴影,临床诊断性质待查,常规纤维支气管镜检查无支气管腔内肿块病变的患者,经过CT定位后,予以纤维支气管镜下穿刺针吸活检检查。结果44例患者,穿刺成功获得病理诊断者32例(72.7%)。其中诊断肺癌者30例,结核2例,此外,核异质细胞4例,另外8例患者为正常淋巴结和正常气道黏膜上皮细胞。部分患者施行针吸活检术后穿刺点局部微量出血,不需要止血处理;无其他并发症。结论经纤维支气管镜针吸活检是鉴别诊断纵隔、肺门不明原因肿块和肿大淋巴结的有效手段,不良反应少而轻微,有较高的临床诊断价值,值得推广应用。     

纤维支气管镜对胸片正常咯血患者的诊断价值

目的 探讨纤维支气管镜检查（纤支镜）在胸片正常咯血患者病因诊断中的价值及应用。方法 对X线胸片正常的68例咯血患者进行纤支镜检查，一般在活动性出血时或出血停止后24-48h内完成，并对其中12例活动性出血患者用凝血酶溶液5mL或1：5000肾上腺素3-5mL行局部注入止血治疗。结果 68例中明确诊断者47例，纤支镜诊断率69％，其中诊断肺癌7例，炎症31例，支气管扩张6例，内膜结核2例，乳头状瘤1例，未获诊断的21例中有12例明确了出血部位，并获得满意止血效果。结论 纤支镜用于胸片正常咯血患者的诊断最大价值是发现早期肺癌或气管肿瘤，对非恶性病变，纤支镜也有一定作用，不仅提高了诊断率，而且对进一步明确出血部位及治疗有很大帮助。     

经纤维支气管镜凝血酶滴入治疗大咯血

对于原因不明的大咯血患者在经保守治疗短期内不能达到有效的止血时是否行纤维支气管镜检查治疗，是呼吸内科难题之一。我科近７年期间共收治大咯血３１例，咯血量５００～８００ｍｌ／ｄ以上，经采用纤支镜下凝血酶局部滴入止血，取得了满意的疗效，报告如下。１临床资料...     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Activity of amikacin and ampicillin in succession and in combination

One strain each of Escherichia coli and Streptococcus faecalis were exposed to amikacin and ampicillin in combination as well as in succession. Exposure to ampicillin for 1 hr followed by amikacin for 3 or 4 hr had the greatest antibacterial activity when the antibiotics were applied in succession. The least effective exposures for both organisms were 1 hr to amikacin followed by 3 or 4 hr to ampicillin. Exposure to the antibiotics in combination each at 1 MIC had the overall greatest antibacterial activity. Simultaneous exposure to the antibiotic combination does not necessarily mean simultaneous activity of both ampicillin and amikacin on the E. coli. The cell wall autolytic activities produced by ampicillin are triggered within 10 min after physical contact with the bacteria. In contrast, amikacin requires at least 30 min after physical contact to manifest its activity on the ribosome. Although physical exposure to both antibiotics in the combination is simultaneous, the specific activity of each is in fact sequential, with ampicillin acting first. This explains the synergistic effect of the combination. It appears, therefore, that the synergistic or antagonistic affect of a drug combination is determined by the sequence and timing of the antibacterial manifestations of its components.     

Sites of in vivo extraction and interconversion of testosterone and androstenedione in dogs

The interconversion and extraction of testosterone and androstenedione across and within different tissues or areas have been studied by the constant infusion technique. The results were calculated using the (3)H/(14)C ratios and radioactive concentrations of testosterone and androstenedione obtained from afferent and efferent blood and tissues at equilibrium. In each tissue studied, the interconversion between testosterone and androstenedione inside the tissue was significantly higher than the corresponding interconversion across the tissue. The pulmonary contribution to the total interconversion between testosterone and androstenedione was far more important than that of any of the other tissues studied. The hepatic metabolic clearance rates of testosterone and androstenedione were not different from their metabolic clearance rates in the mesenteric area. The extraction of each of these compounds, although not negligible, was lower in the kidney and the femoral bed compared with the extraction in the liver and the mesenteric area. Finally, with the possible exception of the liver, testosterone and androstenedione were more completely metabolized when they originated from the cells than from afferent blood.The evaluation of these different tissue transfer constants provides more precise information concerning the relative importance of different sites in the metabolism of these interconverting hormones.     

Role of oxidants and antioxidants in atherosclerosis: results of in vitro and in vivo investigations

Both in vitro and in vivo studies have shown that oxidants are central in the development of atherosclerosis. Consequently, additional studies evaluated the protective effects of various natural and synthetic antioxidants, alone and in combination, with most studies focusing on alpha-tocopherol (vitamin E). Here, we summarize the role of oxidants in the pathomechanism of atherosclerosis. We also discuss epidemiological studies and others focused on the protective effect of vitamin E against atherosclerosis. Other antioxidants are also considered if they were included in studies involving vitamin E. The protective effect of antioxidants on atherosclerotic pathomechanisms has been confirmed in vitro, but only in some animal studies. Various epidemiological and observational studies have produced conflicting results on the protective effect of antioxidants. Most studies of primary or secondary prevention failed to show a protective effect. These conflicting results are biased by a number of factors, including differences between the study groups. Therefore, we describe these studies in detail.     

Pharmacokinetics and tolerance of flunitrazepam in neonates and in infants.

OBJECTIVE: To study the pharmacokinetics of flunitrazepam (used for sedation in neonates and infants), to determine the influence of both gestational and postnatal age on the pharmacokinetic parameters, and to analyze the relationship between the hemodynamic parameters and flunitrazepam plasma concentration. METHODS: Flunitrazepam was infused for 20 minutes as a single dose (0.2 mg x kg(-1)) and as multiple doses (0.1 mg x kg(-1)). Six to eight 1-mL blood samples were collected per patient. Flunitrazepam plasma concentration was measured by gas chromatography-mass spectrometry. RESULTS: Thirty-one patients (25 neonates and six infants) were included in the study. Only three of them received multiple doses. After the single dose (n = 28), half-life was 22.6 +/- 7.3 hours, clearance was 0.15 +/- 0.14 L x kg x h(-1), and volume of distribution was 4.6 +/- 4.1 L x kg(-1) (mean +/- SD). Plasma clearance and volume of distribution significantly increased with postnatal age (P < .05), but no pharmacokinetic parameter varied significantly with gestational age. Diastolic blood pressure significantly decreased with increasing flunitrazepam plasma concentrations (P < .05). CONCLUSION: Postnatal age but not gestational age influenced flunitrazepam pharmacokinetic parameters in neonates and infants. Diastolic blood pressure was inversely correlated to flunitrazepam plasma concentration.     

基层医院手术室器械清洗存在的问题和对策

目的：分析目前基层医院手术室医疗器械清洗的现状,寻求科学的清洗方法,保证消毒灭菌效果。方法：分析基层医院手术室器械清洗现状,找出存在的问题。结果：改进清洗器械的方法,保证清洗质量,是灭菌有效的保证。结论：有效、彻底、规范地清洗器械,是灭菌成功和预防交叉感染的有效方法。