体外培养的成骨细胞与珊瑚复合的实验研究

目的:观察SD大鼠成骨细胞在珊瑚表面的贴附、伸展及生长情况,并探讨珊瑚作为骨组织工程支架材料与细胞复合植入体内的最佳时间。方法:分离的骨髓基质干细胞用含10％胎牛血清的DMEM培养,5d后加矿化液诱导培养,分化为骨髓基质成骨细胞。将成骨细胞与处理过的珊瑚复合,通过细胞计数检测附着后的细胞生长增殖特性,并在扫描电镜下观察细胞在珊瑚表面的贴附情况。结果:细胞接种后,在材料表面贴附良好,继续增殖。结论:珊瑚的生物相容性良好,细胞贴附后继续保持成骨细胞的表型,作为骨组织工程的支架材料有较好应用前景。     

体外培养的成骨细胞与珊瑚复合的实验研究

目的：观察SD大鼠成骨细胞在珊瑚表面的贴附、伸展及生长情况，并探讨珊瑚作为骨组织工程支架材料与细胞复合植入体内的最佳时间。方法：分离的骨髓基质干细胞用含10％胎牛血清的DMEM培养，5d后加矿化液诱地培养，分化为骨髓基质成骨细胞。将成骨细胞与处理过的珊瑚复合，通过细胞计数检测附着后的细胞生长增殖特性，并在扫描电镜下观察细胞在珊瑚表面的贴附情况。结果：细胞接种后，在材料表面贴附良好，继续增殖。结论：珊瑚的生物相容性良好，细胞贴附后继续保持成骨细胞的表型，作为骨组织工程的支架材料有较好应用前景。     

天然珊瑚做为成骨细胞接种支架的可行性观察

目的通过观察培养成骨细胞(Osteoblasts,OBs)在天然珊瑚(NaturalCoral,NC)表面的生长情况来评价其作为骨组织工程支架材料的可行性.方法将NC处理后,用扫描电镜(Scanning Electronic Microscope,SEM)观察其立体结构,并测定孔径和孔隙率.分离、培养兔颅骨OBs,将细胞按5×106个/ml浓度接种于NC中,通过倒置显微镜、SEM观察OBs在NC表面的贴附、伸展情况,并测定细胞在NC表面生长时的碱性磷酸酶(ALP)活性.结果NC中含有三维交通的孔隙,其孔率约为36%,OBs接种后1d,即可在NC表面贴附并伸展,5d后可长满珊瑚表面,并保持其ALP活性.结论珊瑚对OBs具有良好的相容性,并具有多孔性,适于作为OBs接种的支架而用于骨的组织工程.     

可吸收性珊瑚羟基磷灰石与人骨髓间充质干细胞诱导成骨细胞复合培养及碱性成纤维细胞生长因子的作用

目的:观察人骨髓间充质干细胞诱导的成骨细胞与珊瑚羟基磷灰石的相容性及碱性成纤维细胞生长因子的作用。方法:实验于2003-02/2005-10在大连医科大学附属第一医院中心实验室及上海第二医科大学完成。实验材料:①可吸收性珊瑚羟基磷灰石。②人骨髓间充质干细胞:取自单纯性骨囊肿行自体骨髓注射治疗的患者(年龄10～16岁,平均14.5岁),患者均知情同意。实验分组:使用含地塞米松、β甘油磷酸钠和抗坏血酸的条件培养基诱导骨髓间充质干细胞分化为成骨细胞,与珊瑚羟基磷灰石复合培养,分为实验组(RPMI1640完全培养液 成骨细胞 可吸收性珊瑚羟基磷灰石),促增殖组(完全培养液 成骨细胞 可吸收性珊瑚羟基磷灰石 10μg/L碱性成纤维细胞生长因子),正常培养组(完全培养液 同等数量的成骨细胞)。实验评估:①采用扫描电镜观察成骨细胞与可吸收性珊瑚羟基磷灰石复合培养6h,1,3,7d时细胞形态。②成骨细胞附着于材料表面后生长增殖特性:于接种后24h,各组均取6孔细胞用胰蛋白酶消化贴壁细胞,包括材料上贴附的细胞,计数孔内细胞数及平均细胞数,绘制细胞生长曲线。③成骨细胞分泌碱性磷酸酶活性的测定:于接种后1,3,5,7d采用酶联免疫监测仪测410nm波长的吸光度值,计算每1000个细胞的吸光度值。结果:①成骨细胞与可吸收性珊瑚羟基磷灰石复合培养后细胞形态:复合培养6h,细胞多为单层结构,形态多样,有数个突起;复合培养1d,成骨细胞附着于可吸收性珊瑚羟基磷灰石表面并深入到材料的孔隙内,与材料牢固结合,并在材料表面伸展,细胞表面可见大量微绒毛;复合培养7d,细胞数量增多,可见少量胞体表面及细胞间有颗粒状钙盐结晶沉积,细胞形态无明显差异。②成骨细胞附着于材料表面后生长增殖特性:实验组细胞接种后,随时间延长数量逐渐增加,仍可保持正常的分裂增殖速度,与正常培养组相比差异无显著性意义(P>0.05)。复合培养4,5,6,7d后促增殖组细胞附着载体后数量增长明显高于实验组、正常培养组,差异均有显著性意义(P<0.05)。③成骨细胞分泌碱性磷酸酶活性的测定:随着培养时间的增加,3组细胞碱性磷酸酶含量(每1000个细胞的平均吸光度值)均逐渐增高(以实验组为例,复合培养1,3,5,7d分别为0.0121±0.0014,0.0154±0.0013,0.0172±0.0012,0.0183±0.0015),差异无显著性意义(P>0.05)。结论:①人骨髓间充质干细胞诱导的成骨细胞可以在一定的生物载体上正常生长、增殖,并保持生理功能。②10μg/L碱性成纤维细胞生长因子可促进此过程中细胞增殖。     

应用纳米晶胶原基骨体外构建组织工程骨

目的:应用组织工程技术,建立体外诱导人骨髓间充质干细胞,与纳米晶羟基磷灰石/胶原骨共培养的人工骨模型,探求细胞与纳米晶胶原基骨结合的最佳模式。方法:实验于2005-09/2006-09在江苏大学医学技术学院中心实验室完成。①实验材料:纳米晶胶原基骨材料由清华大学材料系崔福斋等人研制。骨髓取自骨科取髂骨患者(男性,30岁,患者知情同意)。②实验干预:全骨髓法体外培养骨髓间充质干细胞并扩增,应用成骨诱导剂诱导向成骨细胞表型转化。取纳米晶胶原基骨材料经60Co照射灭菌,无水乙醇疏水化,三蒸水洗去乙醇等处理制备支架材料。细胞与支架材料复合培养。③实验分组:骨髓间充质干细胞培养至第3代后分为两组:复合材料后加成骨诱导剂组:骨髓间充质干细胞先与纳米晶胶原基骨复合培养3d后再加入成骨诱导剂;成骨细胞复合材料组:骨髓间充质干细胞在诱导成骨细胞后与纳米晶胶原基骨复合培养。④实验评估:记录第3代骨髓间充质干细胞生长曲线。将诱导后细胞分别进行碱性磷酸酶染色、Von Kossa染色。扫描电镜比较两组复合物经体外孵育2周后,细胞在其中生长情况。结果:①细胞生长情况:倒置显微镜下观察原代培养的骨髓细胞增殖迅速,基本都呈形态均一成纤维样细胞,10～12d左右即可长满,并可稳定传代,传代细胞7～9d即可传代。诱导培养后的细胞呈现典型的成骨细胞形态和生物学特征。构建出骨髓间充质干细胞与骨组织共培养的模型。②体外复合后细胞生长及基质分泌情况:细胞可在纳米晶胶原基骨内表面良好贴壁,复合材料后加成骨诱导剂组,细胞贴附,但成骨细胞少见;成骨细胞复合材料组,细胞数量明显较前者多。复合培养8d,分布于支架材料上的细胞大量增殖、分泌细胞外基质。第14天,大量细胞在材料表面和孔隙中生长。细胞之间广泛存在突起连接,局部有胶原分泌,且可见成骨细胞形成。结论:证实纳米晶胶原基骨适合种子细胞的贴附、生长和增殖,经成骨诱导后的细胞较骨髓间充质干细胞更易与材料贴附、增殖。     

珊瑚羟基磷灰石，骨形态发生蛋白复合骨组织工程细胞支架的生物相容性

背景:理想的骨细胞支架材料除具有良好的生物相容性外,还能促进细胞的增殖和分化,诱导骨组织再生,各种细胞支架材料单独使用时的成骨能力是有限的。目的:观察复合有骨形态发生蛋白的珊瑚羟基磷灰石与成骨细胞的生物相容性。设计:对比观察。材料:珊瑚羟基磷灰石/骨形态发生蛋白、珊瑚羟基磷灰石,将其分别切割成4mm×4mm×3mm和10mm×10mm×3mm大小块状物,高压灭菌后,完全培养基浸泡4d后备用。方法:实验于2005-03/08在广州军区广州总医院中心实验室完成。①取新西兰大白兔骨髓成骨细胞培养。②将成骨细胞分别和珊瑚羟基磷灰石/骨形态发生蛋白(复合珊瑚羟基磷灰石组)、珊瑚羟基磷灰石(单纯珊瑚羟基磷灰石组)混合培养,并设空白对照。③混合培养后2,4,6,8d分别检测细胞增殖指数和碱性磷酸酶活性。主要观察指标:①成骨细胞相差显微镜观察结果。②复合珊瑚羟基磷灰石材料扫描电镜观察结果。③各组细胞碱性磷酸酶活性测定。④各组细胞增殖指数测定。结果:①成骨细胞相差显微镜观察结果:细胞呈梭形、扁圆形及多角形外观,有数量不等、长短及粗细不一的突起,细胞通过突起相互间接触。②复合珊瑚羟基磷灰石材料扫描电镜观察结果:材料表面呈颗粒状,具有微孔。成骨细胞在材料表面贴壁生长,初为单层,随着细胞的进一步分化、增殖,细胞开始叠层生长,细胞周围出现高密度颗粒,排列方式绝大多数呈一定取向,随着钙盐结晶的增多,最终形成骨结节。细胞被包埋在基质中。③各组细胞碱性磷酸酶活性测定显示:混合培养后2,4,6,8d复合珊瑚羟基磷灰石组的碱性磷酸酶活性(A值)明显高于单纯珊瑚羟基磷灰石组和对照组(4d:101.6±7.7,93.7±6.8,94.4±5.0;8d:120.1±8.2,108.3±8.8,110.4±7.5;P<0.01或0.05)。单纯珊瑚羟基磷灰石组与对照组比较差异不明显。④各组细胞增殖指数测定显示:随着时间的延长,两组的细胞增殖指数均有所增加,但相互间差异不明显。结论:复合珊瑚羟基磷灰石内部呈珊瑚状,微孔数量多,细胞在其表面附着良好,具有很好的生物相容性,另外由于其复合了骨形态蛋白可以增强细胞碱性磷酸酶活性,故有一定的骨诱导作用。     

纤维连接蛋白表面修饰后聚酯纤维韧带细胞相容性的变化

目的：观察纤维连接蛋白表面预处理增加新型聚酯纤维韧带（ligament advanced reinforcement system,LARS）的细胞相容性的作用. 方法：实验于2005-09/11在上海复旦大学放射医学研究所骨细胞实验室完成.①实验分组：采用纤维连接蛋白表面修饰LARS人工韧带材料,为蛋白处理组.LARS人工韧带材料不做任何处理,为未处理组.蛋白处理组和未处理组在培养后2,4,6,8,10,12 d测定成骨细胞数量、MTT法测定吸光度（A值）、测定碱性磷酸酶值（A值）.②实验评估：成骨细胞和与LARS人工韧带材料体外共培养.培养后3,7 d扫描电镜观察成骨细胞在两组材料上的形态.培养后7 d行碱性磷酸酶染色,观察细胞的形态及细胞和材料的细胞相容性情况. 结果：①成骨细胞的数量：细胞在接种到材料后即开始增殖,在1～3 d内增殖较缓慢,自第4天起细胞增殖迅速,蛋白处理组至第8天达到增殖高峰,未处理组至第10天才达到增殖高峰.蛋白处理组材料和未处理组材料上细胞增殖基本符合正常细胞增殖.蛋白处理组材料细胞对数增长期较未处理组细胞增殖期长,且最高峰值也高（P＜0.05）.②成骨细胞的增殖能力：培养后2,4,6,8,10,12 d细胞增殖能力迅速增加,两组细胞增殖能力到第6天达最高峰,以后逐渐降低,在每个时间段蛋白处理组材料上的细胞的增殖能力均高于未处理组,差异有显著性意义（P＜0.05）.③成骨细胞的功能：培养后2,4,6,8,10,12 d细胞碱性磷酸酶值随时间推移基本稳定,略有下降,两组间差异无显著性意义（P=0.46）.④扫描电镜下成骨细胞形态：培养后3 d,未处理组材料上细胞沿材料表面和纤维孔径之间生长,细胞形态尚不典型.蛋白处理组材料上细胞形态比较典型,具有伪足和触角结构,细胞表面具有大量毛刺样结构.培养后7 d,蛋白处理组材料和未处理组材料上细胞生长情况均较好,可见细胞大量汇合,沿纤维表面和纤维间隙之间生长,可见细胞在蛋白处理组材料上数量更多,汇合面积更大.⑤成骨细胞的碱性磷酸酶染色：成骨细胞与LARS人工韧带支架材料共培养后,培养后2 d起在材料的周边可见梭形和三角形的细胞游离出,进而贴壁汇合,数量逐渐增多,细胞生长情况良好,尤其是在蛋白处理组可发现更明显的细胞黏附生长情况. 结论：LARS人工韧带在体外实验中表现出良好的生物相容性,采用纤维连接蛋白表面预处理的方法简便、有效,能够有效增加材料的细胞相容性.     

自行设计模压增强法制备可塑形材料脱钙骨/聚乳酸重组人工骨的体外相容性

目的：脱钙骨和聚乳酸都是生物相容性良好的骨替代材料,观察脱钙骨/聚乳酸重组人工骨的体外相容性。 方法：实验于2004-05/2006-12在解放军成都军区总医院完成。①材料制备：将人成骨细胞与脱钙骨/聚乳酸重组人工骨薄片复合培养。实验分为两组,脱钙骨/聚乳酸重组人工骨组和盖玻片组。脱钙骨/聚乳酸重组人工骨组每孔中加入脱钙骨/聚乳酸重组人工骨薄片1片,盖玻片组加入盖玻片1片。②实验评估：相差显微镜逐日观察成骨细胞的生长及贴附情况;扫描电子显微镜下观察接种后第2,4,6,8天细胞在材料上的生长及附着情况;四甲基偶氮唑盐法分析脱钙骨/聚乳酸重组人工骨对成骨细胞生长及增殖的影响。 结果：①成骨细胞的生长及贴附：细胞接种24h后,脱钙骨/聚乳酸重组人工骨组和盖玻片组成骨细胞均完全贴壁。培养第2天,两组均开始出现细胞增殖;培养第4天,两组的细胞数量均明显增多,脱钙骨/聚乳酸重组人工骨周围的细胞继续保持数量上的优势;培养第6天,两组的细胞数量均迅速增多,脱钙骨/聚乳酸重组人工骨周围和培养孔周缘的细胞已连接成片;培养第8天,两组整个培养孔内的细胞均汇合成片,细胞形态无明显差别。②细胞在材料上的生长及附着：随着培养时间的延长,附着于材料表面和孔隙的细胞数量逐渐增多,并向孔隙内部长入,细胞形态以多角形为主。③脱钙骨/聚乳酸重组人工骨对人成骨细胞增殖的影响：除接种第2天外,各时间点脱钙骨/聚乳酸重组人工骨组细胞数量均显著高于盖玻片组（P〈0.01）。结论：脱钙骨/聚乳酸重组人工骨在体外能明显促进人成骨细胞的贴附和增殖,具有良好的细胞相容性。     

骨髓来源成骨细胞接种于珊瑚颗粒中异位成骨的观察

目的:为了寻找更好的构建组织工程骨的方法,探讨以天然多孔珊瑚作为支架材料,接种骨髓来源成骨细胞,植入体内后异位再造骨组织的可行性。方法:分离、培养、扩增兔骨髓基质干细胞,细胞长满后用基因重组人骨形成蛋白-2诱导3d;收集细胞,按5×107的浓度接种于珊瑚颗粒中,体外继续培养48h后,植入裸鼠背部皮下组织中,分别于植入术后1,2月取材,通过大体标本、X射线片、组织学检查观察新骨的形成情况。结果:植入术后1,2月,在裸鼠背部皮下组织中均形成了硬组织,1月标本表面粗糙,红白相间,2月标本表面较为光滑,为暗红色;2月标本X线摄片检查可见,在珊瑚颗粒间有明显的X射线阻射影;组织学检查可见,1月标本中,在珊瑚颗粒之间及珊瑚孔隙内,均有大量类骨质形成,并可见较多软骨组织,2月标本中新骨已较为成熟。结论:骨髓来源成骨细胞接种于珊瑚颗粒中,植入体内后可以在异位有效形成骨组织,为其用于组织工程骨提供了有利的实验依据。     

体外构建人工仿生骨膜

背景：小肠黏膜下层既具有良好的生物相容性和降解性,又富含多种生长因子,能明显促进细胞的黏附、增殖及分化,在国外已被广泛应用于骨与软骨、血管、皮肤、膀胱、平滑肌及胰岛等组织的修复,且已表现出良好的组织工程化细胞支架性能。 目的：探讨兔骨髓间充质干细胞经体外诱导成成骨细胞与猪小肠黏膜下层复合构建组织工程骨膜的可行性。方法：采用贴壁筛选法分离2周龄健康新西兰大白兔骨髓间充质干细胞,并进行体外扩增培养、诱导分化及鉴定。将经成骨诱导分化的骨髓间充质干细胞与猪小肠黏膜下层复合构建组织工程骨膜,观察细胞在生物材料上的附着、生长、增殖情况。 结果与结论：接种5 d后,细胞散在附着于小肠黏膜下层材料上,细胞形态呈圆形,细胞之间无连接;10 d后细胞之间形成桥粒连接,成骨细胞伸出突起,与小肠黏膜下层贴附;15 d后细胞增殖,分泌基质,在小肠黏膜下层表面形成多层细胞组成的复层膜样结构。表明将骨髓间充质干细胞诱导成成骨细胞后与猪小肠黏膜下层复合可构建组织工程骨膜,有可能成为理想的组织工程支架材料。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.