烧伤后能量消耗基本规律的研究与改善烧伤高代谢方法的探讨

92例住院烧伤病员代谢营养指标的调查结果如下: 1、烧伤后能量消耗规律 (1)烧伤后能量代谢分为缓升期和高代谢期;(2)高代谢期随烧伤面积的增大而延长,REE峰值约为正常的1.5～2.0倍;(3)创面愈合后REE在短期内仍高于正常;(4)烧伤总面积相同,三度烧伤面积大者,REE升高明显;(5)REE持续不升或升高后又突然降低提示预后不良;(6)烧伤后蛋白质分解增强,糖利用相对减低及脂肪分解和利用增加,烧伤面积越大和越近伤行早期,这种情况越明显。     

烧伤后静息能量消耗与烧伤面积的关系

75例烧伤病员静息能量消耗(REE)与烧伤面积及创面深度关系调查的结果显示:REE随烧伤面积的增加而升高;烧伤总面积相同,Ⅲ度面积大者,REE升高明显;创面愈合后短期内REE仍然明显高于正常。     

烧伤早期能量消耗变化的临床研究

目的:调查烧伤后1~7 d能量消耗(REE)的基本改变,以指导烧伤早期患者的营养治疗。方法:实测75例烧伤患者的REE,测点为烧伤后1、2、3和7 d,13名正常人测定值作为对照。结果:患者伤后1 d的REE与烧伤面积呈负相关(r=-0.658,P<0.05);伤后2、3 d则相关性不显著(r分别为-0.207和-0.264,P>0.05);而伤后7 d则为正相关(r=0.890,P<0.05)。REE的变化可分为缓升期和高代谢期,伤后REE不升或升高后又迅速降低者提示预后不良。结论:大面积烧伤患者伤后早期REE有明显的缓升阶段,营养补充应有计划进行,切忌过量补给。     

严重烧伤患者血清肌钙蛋白I的变化及意义

目的 :了解烧伤患者的血清肌钙蛋白I(TnI)水平 ,以明确TnI测定对烧伤后心肌损伤诊断价值。方法 :采用双抗体夹心ELISA方法测定92例烧伤患者的血清TnI水平并与患者伤后血清心肌酶水平比较,同期与22例心肌梗死患者进行对照。结果 :TnI在特重度烧伤组为 (8.12±1.44)ng/ml,阳性率为50.0 % (10/20) ;重度烧伤组为 (3.62±0.99)ng/ml,阳性率为20.0 % (5/25) ;电击伤组为 (8.90±1.70)ng/ml,阳性率为48.0 % (12/25) ;心梗组为 (74.45±22.5 )ng/ml,阳性率为100.0% (22/22)。表明烧伤后血清TnI升高水平及阳性率与烧伤面积有关 ,且多数病人血清TnI水平在伤后48h内升高。结论 :烧伤患者早期即存在心肌损伤 ,测定血清TnI对于烧伤后心肌损伤诊断的特异性明显优于心肌酶。     

三度烧伤面积≥90％极重度伤员救治经验

三度(全层皮肤)烧伤面积≥90%，的极重伤员病情危重，烧伤休克和感染的发生率高，修复三度创面需要的自体皮肤供皮区缺乏，病程长，并发症多，是烧伤救治的难题。1966年救治成功1例三度烧伤面积90％，的成年工人，1973年救治成功1例烧伤总面积98%，三度94％的2．5岁幼儿，到2000年共收治48例三度烧伤面积≥90％的伤员，16例救治成功。现将主要救治经验报告如下。     

电损伤中损伤面积与血清sIL-2R水平的关系

目的探讨电损伤患者血清sIL-2R水平的变化及其与损伤面积的关系。方法电损伤病人26例,按电损伤后Ⅲ度面积的不同分为三组,A组(11例):面积≤5%;B组(8例):5%<面积≤10%;C组(7例):面积>10%健康组和普通重度烧伤组各10例为对照组。采用ELISA法,检测患者伤后不同时相点血清sIL-2R水平,加以比较。结果各实验组与健康组比较血清sIL-2R水平均明显升高。组间比较示:伤后1周、2周和3周;烧伤组、B及C组较A组明显上升;伤后3周烧伤组较A组明显上升而较C组下降明显;伤后四周烧伤组与A、B组间无差异外,其余各组间比较均有统计学意义。组内比较:烧伤组在伤后4周巳降至2周水平;A组在伤后2、3、4周无明显变化;B组在伤后3、4周较1周明显上升;C组仅在3、4周间组伤后各周间比较无统计学意义。结论各损伤面积均能使sIL-2R水平升高,损伤面积与sIL-2R水平升高有正相关关系,Ⅲ°面积>10%电损伤造成的sIL-2R升高较其它原因引起的重义度烧伤更明显也更持久。     

重度烧伤的治疗体会

烧伤总面积50％以上或三度烧伤面积超过20％的重度烧伤61例,经综合治疗,治愈40例(66％),死亡21例(34％)。     

严重烧伤后肠道损伤与肠源性高代谢的关系

目的　探讨烧伤后肠道损害与“肠源性高代谢”的关系。方法　在建立严重烧伤加清洁肠道动物模型的基础上 ,将 96只Wistar大鼠随机分为烧伤对照 (B)组和烧伤加清洁肠道 (SDD)组。观察了伤后 0～ 10d大鼠静息能量代谢率(REE)的变化 ,同时检测了伤后 0、1、3、5、7、10d血中内毒素 (LPS)、肿瘤坏死因子 (TNF)和二胺氧化酶 (DAO)的含量 ,并进行相关分析。结果　烧伤后两组大鼠的REE、TNF、LPS和DAO均明显高于伤前 ,两组相比 ,SDD组的REE、TNF和LPS较B组均有不同程度的降低 ,而DAO则明显高于B组。相关分析显示 ,REE同LPS和TNF呈显著正相关 (r1 =0 .77,P <0 .0 5 ,r2 =0 .81,P <0 .0 5 ) ,与DAO相关不显著 (r >0 .0 5 )。结论　烧伤后肠源性高代谢与血中炎症介质含量呈正比 ,但肠道损伤程度加重并不引起代谢率相应增加 ,二者不存在线性关系     

烧伤患者能量消耗的基本变化

目的：调查烧伤患者静息能量消耗（REE）的基本情况,为烧伤患者营养治疗提供依据。方法：采用间接测热法,测量75例烧伤总体表面积（TBSA）为5%-98%患者的能量消耗情况,测量时间点为烧伤后1、2、3、7、14、21和28 d;13例正常者测定值作为正常对照。结果：①烧伤后能量代谢过程分为缓升期和高代谢期。②高代谢期因烧伤面积的增加而延长,能量消耗峰值约为正常人的1.5-2.0倍。③创面愈合后,短期内能量消耗仍高于正常人,大面积烧伤更为明显。④能量消耗持续不升或升高后又突然降低者,提示预后不良。⑤烧伤后蛋白质分解增强,糖利用相对减低,脂肪分解和利用增加。结论：烧伤后能量消耗呈规律性变化,对严重烧伤患者采取积极的营养治疗是十分必要的。     

生物电阻抗法评估严重烧伤后营养代谢

目的 通过应用生物电阻抗法测定人体组成,探讨其对严重烧伤病人的营养评价的临床意义.方法 选择38例烧伤患者(男性32例,女性6例),烧伤面积10%~80%,平均面积33.1%±17.6%,本组病例分成两组;A组2例(烧伤面积>30%),B组18例(烧伤面积<30%),在烧伤后l、3、5、7、14、21、28～70d用生物电阻抗法测定人体组成.通过间接测能计算出静息能量消耗在治疗中提供了充足的热卡.结果 本组病例死亡2例(早期死于MODS),治愈36例,平均住院时间33.1%±17.6%,两组病人瘦体组织,体脂,随烧伤病程发展逐渐减低,尤其是A组中尽管给病人补充了充足的热卡瘦体组织的值仍降低,统计学分析A,B两组有统计学差异(P<0.05).结论 严重烧伤后分解代谢普遍存在整个烧伤治疗过程中,瘦体组织下降不随提供充足的热卡而改变,生物电阻抗法测定人体组成简便、准确,有助于临床客观地评价严重烧伤机体营养状况.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.