在人工气道内持续泵入硝酸甘油降低肺动脉高压和静滴酚妥拉明的临床疗效

目的探索在人工气道内持续采用微量注射泵泵入硝酸甘油(NTG)注射液,降低肺动脉高压的疗效.方法把肺动脉压增高的患者,随机分为两组治疗组采用微量注射泵在人工气道泵入NTG 20 mg,加入生理盐水50 mL,5～10 mL/h,持续1周.对照组用酚妥拉明10～20 mg加入生理盐水50 mL,用微量泵静脉泵入2～5 μg/(min·kg),持续1周.对两组进行血压、中心静脉压、心率、动脉血氧分压、心脏超声、平均肺动脉压(MPAP)监测.结果治疗组较对照组更能明显地降低肺动脉压,两组比较具有显著的差异(P<0.05).结论通过人工气道泵入NTG,经肺泡吸收作用血管内皮细胞NTG受体,和氧气结合,合成一氧化氮(NO)使血管扩张来降低肺动脉压,疗效显著,不影响血压、心率等,副作用少,应用安全.     

丙泊酚在高血压急症中的应用

目的观察丙泊酚在高血压急症中与其他静脉应用降压药协同降压作用。方法高血压急症患者60例,随机分为观察组(丙泊酚联合乌拉地尔组)和对照组(乌拉地尔组)。对照组给予乌拉地尔50~100mg加0.9%氯化钠注射液至50ml,根据血压水平以5~10mg/h微量泵持续泵入降压。观察组静脉注射丙泊酚1.0~1.5mg/kg,然后用静脉微量泵恒速输注维持剂量0.5~4.0mg·kg-1·h-1,控制患者镇静水平于RamsayⅡ~Ⅳ级。同时给予乌拉地尔50~100mg加0.9%氯化钠注射液至50ml,根据血压水平以5~10mg/h微量泵持续泵入,其余处理同对照组。观察治疗前后两组血压、心率、血氧饱和度变化,及药物用量。结果两组均显效或有效降压,但观察组乌拉地尔24小时用量(149.82±15.63)mg,明显小于对照组(216.61±19.64)mg,两者差异有统计学意义(P<0.01)。结论丙泊酚应在高血压急症患者中作为常规药物较早使用,以发挥其降压协同作用。     

经微量泵静脉注射硝普钠治疗高血压急症的疗效观察

目的:观察经微量泵静脉注射硝普钠治疗高血压急症的疗效。方法:高血压急症84例随机分为硝普钠治疗组(n=43)和硝酸甘油对照组(n=41),两组经微量注射泵持续给药,硝普钠组50mg加入5%葡萄糖50ml,0.25μg/kg.min开始,5min监测血压1次,据血压调整给药剂量;硝酸甘油组:硝酸甘油10mg加入5%葡萄糖48ml,10μg/min开始,据血压调整速度,观察头痛、胸闷、气促等不良反应,记录血压、心率、心电图等资料。结果:硝普钠组42例(97.7%)显效,1h内收缩压从治疗前的(203.3±15.5)mmHg降至(167.2±16.4)mm-Hg(P<0.05),舒张压也显著下降[(124.6±13.9)mmHg∶(103.0±15.8)mmHg,P<0.05];两组显效率有显著差异(97.7%∶82.9%,P<0.05)。结论:硝普钠治疗高血压急症更有效,经微量注射泵持续给药更安全。     

米力农与硝普钠合用治疗顽固性心力衰竭

47例顽固性心力衰竭患者随机分为A、B、C三组。A组,15例,米力农+硝普钠组,将米力农5mg用生理盐水稀释后,先按40μg/kg速度从静脉注射(微量泵入)10min,继续以0.5μg/(kg·min)静脉点滴(微量泵入)持续约120min,每日1次,7d为一疗程;另予硝普钠10mg加入5％葡萄糖溶液50ml稀释后,以10μg/min的起始速度,从另一静脉通道(微量泵)     

微量泵持续输注美罗培南干预脑肿瘤术后颅内感染的效果分析

目的探讨微量泵持续输注美罗培南治疗脑肿瘤术后颅内感染的效果。方法选取2013年4月—2016年4月四川省攀枝花市中心医院治疗的脑肿瘤术后颅内感染病人102例,将病人随机分为微量泵静脉持续输注组和间断输注组,每组51例。微量泵静脉持续输注组:2.0g美罗培南置于50mL生理盐水中,首先以50mL/h的速度泵入体内,持续0.5h,之后以10mL/h的速度泵入,持续2.5h,每次8h。间断输注组:2.0g美罗培南置于100mL生理盐水中,0.5h内匀速滴完,每次8h。观察两组治疗疗效,头痛缓解、体温好转以及住院天数等。结果持续输注组治疗疗效优于间断输注组(P0.05);持续输注组病人治疗后3d体温下降、头痛缓解和脑脊液糖定量正常的比例分别为70.59%、68.63%和58.82%,均明显高于间断输注组,差异有统计学意义(P0.05);持续输注组治疗疗程和住院天数分别为(9.81±2.41)d和(16.20±3.17)d,明显短于间断输注组,差异有统计学意义(P0.05)。结论微量泵持续输注美罗培南治疗脑肿瘤术后颅内感染的效果较好,能缩短药物治疗的疗程以及住院时间。     

微量注射泵输入硝酸甘油治疗慢性肺心病的临床应用和护理体会

目的探讨微量注射泵输入硝酸甘油治疗慢性肺心病的作用以及护理体会。方法将85例慢性肺心病患者随机分成治疗组(45)和对照组(40),两组患者除给予常规的吸氧、支气管扩张剂、强心药、小剂量利尿剂等外,治疗组给予微量注射泵输入硝酸甘油10 mg加0.9%生理盐水100 ml,对照组仅静滴0.9%生理盐水100 ml,每天一次,连用1周。观察两组动脉氧分压(PaO2)上升和二氧化碳分压(PaCO2)下降的变化。结果治疗1周后,治疗组PaO2上升(14.5±1.4)mmHg和PaCO2下降(6.5±1.2)mmHg与对照组PaO2上升(11.2±1.6)mmHg和PaCO2下降(5.2±1.5)mmHg相比有显著性差异(P0.01)。结论微量注射泵输入硝酸甘油治疗慢性肺心病安全有效,不良反应少,症状改善明显。     

系统化抗凝治疗频发短暂性脑缺血发作的对照研究1)

目的探讨普通肝素微量持续静脉泵入治疗频繁发作的颈内动脉系统短暂性脑缺血发作(TIA)的疗效。方法 90例患者随机分为治疗组和对照组,每组45例。治疗组给普通肝素12 500 U加入到生理盐水500 mL中,以40 mL/h[约合18U/(kg.h)]速度用微电脑输液泵持续泵入。对照组采用奥扎格雷钠80mg加入到生理盐水250mL中静脉输注,1次/日;合用阿司匹林100mg口服,每日1次,连用14d。观察治疗后TIA发作停止的时间、例数,复查头颅CT有无脑梗死或脑出血发生。监测治疗前后活化部分凝血活酶时间(APTT)、血小板计数、肝肾功能及牙龈出血、镜下血尿、皮下出血等不良反应。结果两组患者治疗前后活化部分凝血活酶时间、肝肾功能均无明显变化(P>0.05)。治疗组3d内TIA得到完全控制44例,占97.78%,而对照组为34例,占75.56%(χ2=9.615,P=0.002),提示治疗组较对照组控制TIA发作有优势。治疗组发生出血不良事件共6例(13.33%),对照组发生出血不良事件2例(4.44%),经卡方检验无统计学意义(χ2=2.195,P=0.138)。结论普通肝素微量持续抗凝治疗频繁发作的颈内动脉系统TIA可以尽快控制发作,降低进展为脑梗死的风险,与对照组相比出血不良风险没有增加。     

血压调节对脑缺血再灌注大鼠的神经保护作用

目的探讨不同的血压干预方式对急性缺血性脑梗死的神经保护作用。方法 48只SD大鼠均采用腔内线栓法制作大鼠脑缺血再灌注损伤模型,然后随机分为四组各12只:Ⅰ组为对照组:使用微量输入泵以2 mL/h的速度泵入生理盐水,不对血压进行干预。Ⅱ组再灌注后诱导血压升高,Ⅲ组再灌注后诱导血压降低;Ⅳ组再灌注后通过使用微量泵泵入降压药物使MAP降低并维持在90～100 mmHg,再逐渐升高血压到140～150 mmHg。各组血压干涉前后进行神经功能评分。实验结束时大鼠均断头处死,取脑组织以冠状切片,在2%氯化三苯基四氮唑(TTC)中染色,测定各组脑组织梗死体积。结果Ⅳ组与Ⅰ组比较,大鼠脑缺血后梗塞体积减少,Bederson评分明显改善(P均<0.05);Ⅱ组与Ⅰ组比较梗死体积增大(P<0.05)。结论适应性的血压调节灌注方式,能减少再灌注损伤,降低梗塞体积,改善神经功能。     

乌拉地尔治疗肺心病心衰14例观察

自 1999年始 ,我们应用乌拉地尔治疗肺心病心衰、肺动脉高压患者 14例 ,疗效满意。现报告如下。临床资料 :本组 14例均为慢性阻塞性肺心病患者 ,男 12例 ,女 2例 ,年龄 62 .64± 9.6岁 ,病史 3.0 7±1.54年。治疗方法 :治疗前通过锁骨下静脉插管将Ganz- Swan导管插至肺动脉测量平均肺动脉压( m PAP) ,肺动脉楔压 ( PCWP) ,同时测量心率 ( HR)、收缩压 ( SBP)。然后给予乌拉地尔 12 .5mg静注 ( 5min内 ) ,并且按 5μg/ ( kg· min)用微量泵持续泵入 1～ 3天 ,以保持稳定准确的血药浓度。分别于用药后10 min、30 min、60 min、12 0 min…     

静脉输注单硝酸异山梨酯及硝酸甘油治疗慢性充血性心力衰竭的临床观察

目的 比较单硝酸异山梨酯（ISMN）注射液及硝酸甘油（NTG）治疗慢性充血性心力衰竭（CHF）的有效性及其安全性。方法 65例慢性充血性心力衰竭病人随机分为两组，ISMN组（32例）用单硝酸异山梨酯注射液（20～40）mg加入5％葡萄糖液250mL中静脉输注，每天1次；NTG组（33例）以（10-20）ug／min持续静脉泵入，治疗5d后，比较两组疗效及不良反应发生的情况。结果 ISMN组治疗5d后CHF病人心功能改善的总有效率明显高于NTG组（P〈0．05）；ISMN组心悸、气短、水肿、肝缩小、肺部啰音改善时间明显短于NTG组（P〈0．05），且和NTG组相比ISMN不良反应少（P〈0．05）。结论 静脉输注ISMN治疗CHF病人疗效优于NTG持续静脉泵入。副反应小，可作为治疗CHF病人的有效措施之一。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。