参附注射液对缺血再灌注家兔多脏器损伤的治疗作用

目的：观察参附注射液（ＳＦ）对缺血再灌注家兔多脏器细胞损伤的保护作用。方法：家兔１８只，采用失血性休克模型，随机分为三组，检测多脏器组织中ＳＯＤ、ＭＤＡ、ＴＮＦ含量及血浆酸性磷酸酶（ＡＣＰ）、镁浓度，小肠组织作透射电镜观察。结果：再灌９０分钟后ＳＦ治疗组肝、肾、肺、肠组织中的ＭＤＡ和ＴＮＦ水平低于对照组，ＳＯＤ水平则高于对照组，血ＡＣＰ、Ｍｇ２＋浓度治疗组低于对照组。电镜观察，肠粘膜上皮细胞损伤ＳＦ组不明显。结论：ＳＦ对兔缺血再灌注多脏器细胞的损伤有保护作用。     

肝硬变门脉高压休克再灌注胃粘膜损伤的实验研究

本实验应用电子自旋共振（ＥＳＲ）技术及自旋捕捉剂ＰＢＮ直接测定肝硬变门脉高压（ＰＨＴ）大鼠胃粘膜在休克再灌注前后及应用超氧化物歧化酶（ＳＯＤ）、丹参（ＲＳＭ）治疗后氧自由基（ＯＦＲ）的动态变化，同时检测胃粘膜中ＳＯＤ活性，并观察同期胃粘膜的光镜、电镜病理改变。结果：ＰＨＴ胃粘膜在休克再灌注过程中有大量ＯＦＲ产生，粘膜损伤的严重程度与ＯＦＲ含量及ＳＯＤ活性密切相关；ＰＨＴ胃粘膜更易受休克再灌注时ＯＦＲ的损伤，早期应用抗氧化剂ＳＯＤ及ＲＳＭ，可通过不同机理减轻胃粘膜再灌注损伤。     

不同灌注途径在鼠肝隔离灌注5－FU时肝组织与周围血中药物液度测定的比较

我们按Ｗｉｇｇｅｒ法建立失血性休克晚期家兔模型。结果发现失血性休克晚期家兔红细胞超氧化物歧化酶（ＳＯＤ）活性明显下降，血浆丙二醛（ＭＤＡ）、血液乳酸盐（ＢＬ）及血浆镁离子（Ｍｇ２＋）浓度显著上升，提示失血性休克晚期存在由氧自由基所致的细胞膜脂质过氧化损伤。我们将丹参＋川芎嗪或三七十川芎联合用药治疗失血性休克晚期家兔，可明显提高ＳＯＤ活性，降低ＭＤＡ、ＢＬ及Ｍｇ２＋浓度。与单一药物组相比，证实前者可减半用药剂量，达到减轻其降压、法慢心率等负性变力变频作用，但却可取得超过各单一药物应用全量时的清除氧自由基效果。丹参正交实验结果显示：再灌注前若经动脉途径先轮入丹参，再同时使用携平衡盐液治疗，则可使组织细胞的损伤减轻到最低程度。     

失血性休克中丹参和超氧化物歧化酶抑制脂质过氧化反应的研究

观察了复方丹参液及ＳＯＤ对失血性休克家免再灌注血液及组织（肝、肠）脂质过氧化反应的影响。结果表明，丹参及ＳＯＤ均能有效降低休克再灌注动物血液脂质过氧化反应程度，丹参降低组织（肠）脂质过氧反应作用优于ＳＯＤ。本实验将１８只失血性休克家兔随机分为三组。休克９０分后，回输放血总量的１／３血液，同时各组动物分别输注平衡盐液（Ａ组）、含ＳＯＤ平衡盐液（Ｂ组）及含复方丹参液平衡盐液（Ｃ组）。Ａ组再灌注后血清ＭＤＡ显著增加，ＭＡＰ逐渐下降，组织（肠、肝）ＭＤＡ含量较高。而Ｂ组及Ｃ组再灌注后血清ＭＤＡ迅速下降，于再灌注３小时恢复至休克前水平，并显著低于Ａ组，且ＭＡＰ进行性升高，于再灌注第３小时显著高于Ａ组。再灌注３小时时Ｃ组肠组织ＭＤＡ含量显著低于Ａ组（Ｐ＜０．０１）及Ｂ组（Ｐ＜０．０５），而肝组织ＭＤＡ含量各组无显著差别。丹参降低组织（肠）脂质过氧化反应作用优于ＳＯＤ，可能与丹参分子量小、容易透过细胞膜以及丹参的组织分布较快等有关。     

1,25（OH）2D3口服冲击治疗透析患者继发性甲状旁腺功能亢进

１，２５（ＯＨ）＿２Ｄ＿３口服冲击治疗透析患者继发性甲状旁腺功能亢进陶立坚，池田，孙明ＯＢＳＥＲＶＡＴＩＯＮＯＮＳＨＯＲＴ－ＴＩＭＥＥＦＦＥＣＴＯＦＯＲＡＩ．１，２５（ＯＨ）＿２，Ｄ＿３ＰＵＬＳＥＴＨＥＲＡＰＹＩＮＨＥＭＯＤＩＡＬＹＳＩＳＰＡＴＩＥＮ...     

丹参及血栓通注射液对缺血再灌注大鼠肾脏的影响

丹参及血栓通注射液对缺血再灌注大鼠肾脏的影响徐幼筠，杜学海，邹万忠ＴＨＥＥＦＦＥＣＴＯＦＳＡＬＶＩＡＥＭＩＬＴＩＯＲＲＨＩＺＡＥ（ＳＭ）ＡＮＤＡＲＡＳＡＰＯＮＩＮ（ＡＲ）ＯＮＩＳＣＨＥＭＩＡ－ＲＥＰＥＲＦＵＳＩＯＮＲＡＴＫＩＤＮＥＹＸｕＹｏｕｊｕｎ；...     

血透前后甲状腺素、胰岛素、钙调蛋白对红细胞膜钙泵的影响

血透前后甲状腺素、胰岛素、钙调蛋白对红细胞膜钙泵的影响林新伟，刘钟明ＴＨＥＥＦＦＥＣＴＳＯＦＴＨＹＲＯＸＩＮＥ，ＣＡＭ－ＯＤＵＬＩＮ．ＡＮＤＩＮＳＵＬＩＮＯＮＣａ（２＋）ＡＴＰａｓｅＡＣＴＩＶＩＴＹＯＦＲＥＤＢＬＯＯＤＣＥＬＬＭＥＭ－ＢＲＡＮＥＤＵＲ...     

大鼠局部创伤一周内组织中TNF、MDA和SOD变化

我们测定了大鼠局部皮肤切除后创面自然愈合过程中，肉芽组织内肿瘤坏死因子（ＴＮＦ）、超氧化物歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）含量的动态变化，以探讨它们在创伤修复中的变化或相互关系。结果表明：伤后３、５、７天，ＴＮＦ、ＳＯＤ呈Ｖ型改变，ＴＮＦ含量第７天与第５天、ＳＯＤ含量第７天与第３天有显著差异（Ｐ＜０．０５），ＭＤＡ含量逐渐升高，第７天与第３无比较有显著差异（Ｐ＜０．０５）。相关性检验表明：ＴＮＦ与ＭＤＡ各时间点均呈显著正相关。ＴＮＦ与ＳＯＤ在伤后３、７天呈显著正相关。ＴＮＦ含量＜９０ｎｇ／ｇ蛋白时创面愈合最佳，ＳＯＤ低浓度时创面愈合延缓。提示：在局部创伤修复过程中存在ＴＮＦ、ＭＤＡ、ＳＯＤ的变化；内源性低浓度ＴＮＦ及抗氧化能力的提高，对创面修复是有益的。     

1,6—二磷酸果糖对内毒素休克犬TNF,MDA,SOD的影响

目的：观察１，６－二磷酸果糖对内毒素休克犬血浆ＴＮＦ，ＭＤＡ水平和ＲＢＣ－ＳＯＤ活性的影响，为ＦＤＰ治疗ＥＴ休克提供实验依据。方法：１２只犬随机分成两组，内毒素休克组和内毒素休克１，６－二磷酸果糖治疗组，每组６例，外周静脉注射灭活大肠杆菌３０分钟、９０分钟后、ＦＤＰ组输入７．５％ＦＤＰ３７５ｍｇ／ｋｇ，ＥＴ组输入等容量平衡盐液。注ＥＴ前及注后２、４、６、８小时测ＣＯ及血浆ＴＮＦ、ＭＤＡ水平和ＲＢＣ     

抗肾小球基底膜抗体在各类肾小球疾病中的检测及其致病性研究

抗肾小球基底膜抗体在各类肾小球疾病中的检测及其致病性研究吕红，郭怡清，吴长龙，江世益，钟慈声，杨俊华ＴＨＥＤＥＴＥＲＭＩＮＡＴＩＯＮＡＮＤＲＥＳＥＡＲＣＨＯＦＡＮＴＩＢＯＢＹＯＦＡＮＴＩＧＢＭＯＮＤＩＦＦＥＲＥＮＴＧＬＯＭＥＲＵＬＡＲＤＩＳＥＡＳＥＬ...     

The unchanged mortality of flail chest injuries.

Six hundred eighty-five patients with major blunt thoracic injuries from 1968 through 1977 were retrospectively studied. This series was compared to a similar series from 1959 through 1964. Between 1964 and 1968 a vastly improved hospital was built, laboratory support improved, pressure-controlled ventilators replaced by volume-controlled ventilators and the trauma service was reorganized. The treatment regimen for flail chest injuries during the last decade evolved from the previous early tracheostomy and prolonged ventilator support to an avoidance of tracheostomy and brief ventilator support. The overall mortality in the present series was 20% compared to 35% for the 1959--1964 series; however, improved mortality occurred only among patients with hemothorax who had one or more major concomitant extrathoracic injuries. The mortality for flail chest injuries did not improve (29.5 vs 35.0%). Mortality was unchanged for isolated flail chest injuries, isolated pneumothorax, isolated hemothorax, and for flail chest injuries, and pneumothorax in patients with concomitant major extrathoracic injuries. In both series deaths from isolated thoracic injuries were rare. It is evident that the continued high mortality for blunt thoracic trauma principally relates to concomitant extrathoracic injuries and that recent treatment innovations have not reduced the mortality of flail chest injuries.     

Blunt chest trauma

Summary Blunt chest trauma is the leading cause of thoracic injuries in Germany, penetrating chest injuries are rare. Hereby, single or multiple rib fractures, hemato-pneumothorax and pulmonary contusion represent the most common injuries. The early managment of thoracic injuries consists of detection and sufficient therapy of acute life threatening situations like tension pneumothorax, acute respiratory insufficiency or severe intrathoracic bleeding. Most of the isolated thoracic injuries are adequately treated by conservative means, sufficient analgesia, drainage of intrapleural air or blood, physiotherapy and clearance of bronchial secretions provided; operative intervention is rarely indicated. In multiple injured patients however, severe blunt chest trauma and especially pulmonary contusion negatively affects outcome with a significant increase of morbidity and mortality. Hence, patients with this combination of pulmonary injuries, such as lung contusion and associated severe injuries, carry a particular high risk of respiratory failure, ARDS and MOF with a considerable mortality. Therefore, early exact diagnosis of all thoracic injuries is essential and can be achieved by thoracic computed tomography, which becomes more and more popular in this setting. Early intubation and PEEP-ventilation, alternate prone and supine positioning of multiple injured patients with lung contusion and differentiated concepts of volume- and catecholamine therapy represent the basic therapeutic principles. Additionally, the entire early trauma management of multiple injured patients must focus on the presence of pulmonary contusion. Every additional burden on their pulmonary microvascular system like microembolisation during femoral nailing, the trauma burden of extended surgery or mediator release in septic states may cause rapid decompensation and organ failure and therefore, has to be avoided.      

Blunt Abdominal Trauma Requiring Laparotomy: an Analysis of 342 Polytraumatized Patients

Abstract Introduction: Hemorrhage due to abdominal trauma is one of the most frequent causes of early mortality in polytraumatized patients. Therefore, the initial management of abdominal trauma is an important factor in determining the outcome. The aim of this study was to evaluate the clinical course in multiple trauma patients who sustained abdominal trauma requiring operative intervention. Patients and Methods: In this retrospective analysis, a database containing prospectively collected data on polytraumatized patients from a European level I trauma center was used. The following inclusion criteria were applied: (1) operative intervention for blunt abdominal injuries with positive intraoperative findings, (2) injury severity score (ISS) > 18, and (3) age 16–65 years. Results: The inclusion criteria were met by 342 patients (229 male and 113 female patients, mean ISS 39.9±8.9). The most frequently observed intra-abdominal injuries were to the spleen (62.1%) and the liver (47.7%). The most common extra-abdominal injury observed in combination with abdominal trauma was trauma to the chest (71.9%). One hundred forty-three patients (41%) died during their hospital stay. The most frequent reasons for death were hemorrhagic shock (26.7%), ARDS (27.6%) and head trauma (23.2%). The severity of liver injury correlated positively with mortality. In contrast, no correlation between splenic injuries and mortality was observed. Significantly more deaths were attributed to primarily extra-abdominal injuries (111 patients, 77.6%) and then to intra-abdominal injuries (12 patients, 8.4%). In 20 patients (14%), a combination of intra- and extra-abdominal injuries caused posttraumatic death. Conclusion: Mortality was significantly higher for extra-abdominal injuries and their associated complications compared to intra-abdominal injuries. These findings should be considered in the development of treatment algorithms for blunt trauma.     

ARDS complicated severe chest trauma: a review of 12 cases

A total of 140 patients of thoracic trauma were admitted and treated in our hospital from 1970 to 1988. Thirty cases conformed the diagnosis of severe chest injury. Among them 12 patients (40%) were complicated by the adult respiratory distress syndrome (ARDS) with two deaths (16.7%). The diagnosis and treatment of ARDS following severe chest trauma was often-times delayed by the overlapping clinical manifestations of severe chest injury. Patient's condition usually deteriorates rapidly. Authors suggest early tracheotomy and appropriate mechanical ventilation as one of the major measures to decrease mortality.     

Traumatic diaphragmatic hernia. Occult marker of serious injury.

OBJECTIVE: Recent experience with traumatic diaphragmatic hernias at the Massachusetts General Hospital was reviewed to identify pitfalls in the diagnosis and treatment of this injury. SUMMARY BACKGROUND DATA: Traumatic diaphragmatic disruption is a common injury and a marker of severe trauma. It occurs in 5% of hospitalized automobile accident victims and 10% of victims of penetrating chest trauma. Numerous reports describe splenic rupture in 25% of patients with blunt diaphragmatic rupture, liver lacerations in 25%, pelvic fracture in 40%, and thoracic aortic tears in 5%. Diaphragmatic rupture is a predictor of serious associated injuries which, unfortunately, is itself often occult. METHODS: A chart review of all patients admitted to the Trauma Service with traumatic diaphragmatic hernias was undertaken for the period of January 1982 to June 1992. RESULTS: Data on 68 patients sustaining blunt (n = 25) and penetrating (n = 43) diaphragmatic rupture or laceration were presented. The diagnosis was made preoperatively in only 21 (31%). Associated injuries were frequent in those injured by either blunt or penetrating trauma. Sixty-six patients underwent repair, 54 (82%) through a laparotomy alone and 12 (18%) with the addition of a thoracotomy. There were five (7.4%) deaths that were caused by coagulopathy, hemorrhagic shock, multisystem organ failure, and pulmonary embolism. Complications were twice as frequent in the blunt-trauma group and included abscess, pneumonia, and the sequelae of closed head injuries. CONCLUSIONS: The recognition of diaphragmatic rupture is important because of the frequency and severity of associated injuries. The difficulties in reaching the diagnosis require an aggressive search in patients at risk.     

Chest trauma in a Canadian urban setting--implications for trauma research in Canada

The trauma registry at the Montreal General Hospital was reviewed to provide basic epidemiologic data on chest trauma in Canada and to compare these data with the minimal data available in the literature. Chest trauma in multiply injured patients resulted in higher Injury Severity Scores (ISSs) than the average. This was reflected in higher mortality for patients with chest trauma. The majority of injuries were caused by blunt trauma. Less than 9% of patients admitted to the hospital required thoracotomy for thoracic vascular and cardiac trauma. Outcome (measured by mortality) was better than that predicted from the literature based on admission ISS. The etiology of trauma in this Canadian setting and the resulting injury profiles were substantially different from those obtained from the predominantly American epidemiologic data available in the literature. This suggests the need for gathering more Canadian population-based trauma data for the planning of trauma prevention and care in this country.     

Factors affecting postoperative mortality in abdominal trauma.

Records of 345 patients in whom laparatomies were performed because of blunt and penetrating abdominal trauma were reviewed retrospectively with respect to factors affecting mortality. One hundred and twenty-eight patients had blunt abdominal trauma (Group I), 114 patients had gunshot wounds of the abdomen (Group II), and 103 patients had stab wounds of the abdomen (Group III). Mortality rates were 14.8%, 12.3% and 1.9% in groups I, II and III respectively. The presence of head trauma especially if accompanied by hypotension in group I, and the presence of chest trauma (hemothorax and/or pneumothorax) and hypotension (less than 90 mmHg) in group II were associated with a high mortality rate (p less than 0.05). Of the two patients who died in group III, one had septic shock due to massive intestinal necrosis and the other had hemorrhagic shock due to multiple organ injury and bleeding from an injured internal thoracic artery as the cause of death.     

Thoracic and abdominal injuries in skiers: the role of air evacuation

The increasing popularity of skiing as a recreational sport has resulted in a greater number of major thoracic and abdominal injuries. These injuries, unlike the more common orthopedic injuries, are often life threatening. This 8-year study reviews 44 thoracic and abdominal ski injuries managed at an urban trauma center since the inception of a helicopter air evacuation program with in-flight resuscitation capabilities. Twenty-five per cent of the injured had signs of hemorrhagic shock, and nearly 60% required a major operation. The injuries were caused by high-speed collisions with stationary objects or other skiers and by falls. Three were penetrating injuries. Organs injured were: heart, lung, kidney, spleen, liver, rectum and abdominal wall, and more than half were multiple injuries. Almost half had associated orthopedic trauma. Resuscitation was initiated on helicopter arrival in these seriously injured patients (78% of helicopter-transported patients came to operation), and apparently contributed to the low mortality of 4.5%.     

Trauma fatalities: time and location of hospital deaths

BACKGROUND: Analysis of the epidemiology, temporal distribution, and place of traumatic hospital deaths can be a useful tool in identifying areas for research, education, and allocation of resources. STUDY DESIGN: Trauma registry-based study of all traumatic hospital deaths at a Level I urban trauma center during the period 1993 to 2002. The time and hospital location where deaths occurred were analyzed according to mechanism of injury, age, Glasgow Coma Score, and body areas with severe injury (Abbreviated Injury Scale [AIS] >/= 4). Logistic regression analysis was used to identify risk factors associated with death at various times after admission. RESULTS: During the study period there were 2,648 hospital trauma deaths. The most common body area with critical injuries (AIS >/= 4) was the head (43%), followed by the chest (28%) and the abdomen (19%). Overall, 37% of victims had no vital signs present on admission. Chest AIS >/= 4, penetrating trauma, and age greater than 60 years were significant risk factors associated with no vital signs on admission. Patients with severe chest trauma (AIS >/= 4) reaching the hospital alive were significantly more likely to die within the first 60 minutes than were patients with severe abdominal or head injuries (17% versus 11% versus 7%). In patients reaching the hospital alive, the time and place of death varied according to mechanism of injury and injured body area. Deaths caused by severe head trauma peaked at 6 to 24 hours, and deaths caused by severe chest or abdominal trauma peaked at 1 to 6 hours after admission. CONCLUSIONS: The temporal distribution and location of trauma deaths are influenced by the mechanism of injury, age, and the injured body area. These findings may help in focusing research, education, and resource allocation in a more targeted manner to reduce trauma deaths.