血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

目的 探讨血液灌流(hemoperfusion,HP)结合连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)对于急性百草枯中毒患者的疗效.方法 急性百草枯中毒患者91例随机分成HP组(49例)和HP后给予CVVH治疗组(HP-CVVH组,42例),比较两组患者的病死率、存活时间和死亡原因.结果 HP组病死率为59.2%(29/49),HP-CVVH组为61.9%(26/42),两组比较,差异无统计学意义(χ2=0.070,P=0.791).HP-CVVH组患者中毒至死亡时间为(4.9±3.1)d,明显长于HP组[(3.5±2.0)d],差异有统计学意义(t=2.026,P=0.049).HP组和HP-CVVH组中毒后4 d内死亡构成比分别为62.1%(18/29)和30.8%(8/26),HP组和HP-CVVH组中毒至死亡＞4 d的构成比分别为37.9%(11/29)和69.2%(18/26),差异有统计学意义(χ2=5.388,P=0.020).HP-CVVH组患者出现中毒至低氧血症时间为(4.3±2.5)d,明显长于HP组[(3.2±1.9)d],差异有统计学意义(t=2.033,P=0.047).HP组呼吸衰竭导致死亡的发生率为20.4%(10/49),明显低于HP-CVVH组(40.5%,17/42),差异有统计学意义(χ2=4.365,P=0.037);HP组患者急性肾衰竭的发生率为63.3%(31/49),明显高于HP-CVVH组(40.5%,17/42),差异有统计学意义(χ2=4.712,P=0.030).结论 HP结合CVVH可减少急性百草枯中毒的早期死亡,延长病死患者的存活时间,降低急性肾衰竭的发生率,但无法降低总体病死率.

Abstract：

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

血清高迁移率族蛋白1水平与急性有机磷农药中毒的相关性探讨

目的 探讨急性有机磷农药中毒(AOPP)与血清高迁移率族蛋白1(HMGBl)的相关性.方法 采用蛋白质免疫印迹检测116例AOPP患者及40例健康体检者(健康对照组)HMGB1水平,按病情严重程度将AOPP患者分为轻度组(40例)、中度组(39例)、重度组(37例),再将重度组分为多器官功能不全综合征(MODS)组(20例)和非MODS组(17例),比较各组血清胆碱酯酶(CHE)、HMGB1水平.结果 AOPP患者中重度组血清HMGB1吸光度值为(2.91±0.12),显著高于中度组(2.15±0.17)、轻度组(1.16±0.29)和健康对照组(0.84±0.30),差异有统计学意义(P＜0.01),中度组显著高于轻度组和健康对照组(P＜0.01),轻度组显著高于健康对照组(P＜0.05).重度组中,MODS组血清HMGB1吸光度值显著高于非MODS组(P＜0.01),而CHE两组比较差异无统计学意义(P＞0.05).结论 AOPP患者病情严重程度与血清HMGB1水平明显相关,血清HMGB1水平可作为评价AOPP患者病情严重程度的指标之一.

Abstract：

Objective To study the correlation between the serum high mobility group protein B1 (HMGB1)and the acute organophosphorus pesticide poisoning(AOPP). Methods The serum HMGB1 levels of the 116 patients with AOPP(AOPP group)and 40 healthy adults(control group)were detected by immunoblotting method. According to illness severity, AOPP group was divided into mild group(40 cases),moderate group(39 cases)and severe group(37 cases), and severe group was divided into multiorgan dysfunction syndrome(MODS)group(20 cases)and no MODS group(17 cases). The serum levels of CHE,HMGB1 were compared. Results The absorbance of HMGB1 in severe group(2.91±0.12)was significantly higher than that in moderate group(2.15±0.17), mild group(1.16 ± 0.29)and control group (0.84±0.30)(P＜0.01).The absorbance of HMGB1 in moderate group was significantly higher than that in mild group and control group(P＜0.01). The absorbance of HMGB1 in mild group was significantly higher than that in control group(P＜0.05). The absorbance of HMGB1 in MODS group was significantly higher than that in no MODS group(P＜0.01),but the absorbance of CHE had no significant difference between two groups(P＞0.05). Conclusions The degree of AOPP has notable correlation with the level of serum HMGB1. The level of serum HMGB1 is an useful index for evaluating the degree of AOPP.     

苯中毒患者骨髓象56例临床分析

目的 通过对56例苯中毒患者骨髓象进行分析,探讨苯对造血系统损害的骨髓象的特点.方法 按GBZ 68-2008<职业性苯中毒诊断标准>将苯中毒患者分为轻度中毒组、中度中毒组、再生障碍性贫血及全血细胞减少症组(再障组)、白血病组,均进行骨穿、涂片、以瑞氏-姬姆萨染色的骨髓片计数100个有核细胞,进行分类并观察细胞形态.结果 骨髓增生程度和巨核细胞增殖按轻度中毒、中度中毒、再障依次递减.轻度、中度中毒患者的原始和幼稚细胞增殖有受抑制的趋势,出现中毒相关的细胞形态异常.与其余各组及正常参考值比较,再障组的骨髓细胞占有核细胞百分率(早幼粒0.17%、中幼粒3.11%,早幼红0.06%、中幼红3.16%)降低,差异有统计学意义(P＜0.01,P＜0.05).白血病表现为粒系、红系幼稚细胞单克隆性增殖伴成熟障碍,巨核细胞增殖分化受明显抑制,与其余各组及正常参考值比较,白血病组的骨髓细胞占有核细胞百分率(原幼粒21.25%、早幼粒4.88%)升高、差异有统计学意义(P＜0.01).再障组、白血病组的粒细胞、红细胞出现细胞形态异常和核畸形比例增高,以白血病组尤为明显.结论 慢性苯中毒轻度、中度病例的骨髓象可见骨髓原始和幼稚细胞增殖已出现受抑制的趋势,且出现部分细胞形态异常.重度中毒骨髓象表现出与临床分型相对应的异常改变.

Abstract：

Objective To explore the bone marrow feature of hemopoietic system injured by benzene through analyzing 56 benzolism cases. Methods The 56 benzolism cases were divided into mild poisoning group, midrange poisoning group, aplastic anemia group, pancytopenia group and leukemia group. All cases progressed bone marrow aspiration and smear, and counted hundred karyocytes by Wright-Giemsa tinct bone marrow smear to classification and observe the cells' feature. Results The megakaryocytes and the extent of bone marrow hyperplasia were decreased by turns of mild poisoning group, midrange poisoning group and aplastic anemia group. The archaeocytes and juvenile cells proliferation in mild poisoning group and midrange poisoning group were inhibited and occured cell paramorphia which related to intoxication. Comparing with the other groups and mormal reference value, the pancytopenia group' s percentage of bone marrow cells in karyotes was significantly decreased (P＜0.01. P＜0.05) and the leukemia group's pecentage of bone marrow cells in karyotes was significantly increased (P＜0.01). The proportion of cell paramorphia and nucleus malformation of granulocytes and red blood cells in pancytopenia group and leukemia group were increased, expecially in leukemia group. Conclusion We saw the inhibition of archaeocytes and juvenile cells proliferation and somecell paramorphia appearances in mild poisoning and midrange poisoning cases of chronic benzolism. The abnormality changes which can be seen in bone marrow of severe benzolism cases were corresponding with the clinical classification.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

依托咪酯与普鲁泊福在困难气管纤维支气管镜引导插管时安全性比较

Objective To investigate the risk factors and anticoagulation parameters in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with deep venous thrombosis (DVT). Methods All of 110 AECOPD patients were divided into two groups according to Doppler examination of lower extremities: DVT group and non-DVT group. The risk factors and anticoagulation parameters were compared. Results Twelve cases (10.9%) were in DVT group,of whom 2 cases (1.8%)had pulmonary embolism. The rate of lying in bed > 3 d, smoke, mechanical ventilation, hospital stays and the levels of PaCO2 were significantly higher in DVT group than those in non-DVT group (P < 0.01 or <0.05 ). In DVT group, the activity of antithrombin Ⅲ and the level of protein S decreased (P < 0.05 ), and the level of D-Dimer increased (P < 0.05). Conclusions Long-term bed, smoke and mechanical ventilation requirement are the main risk factors of DVT in patients with AECOPD. Respiratory failure (type Ⅱ ) is easier to combine with DVT. Abnormality of coagulation and fibrinolytic system exists in AECOPD with DVT.     

急性二氧化碳中毒大鼠不同氧疗效果评价

目的 研究急性二氧化碳中毒大鼠应用不同氧疗的效果,以筛选急性二氧化碳中毒现场最佳氧疗技术.方法 健康雄性SD大鼠60只,随机分为正常对照组、二氧化碳染毒组、高压氧治疗组(压力为2 ATA、氧浓度100%)、高浓度常压吸氧治疗组(氧浓度50%)、低浓度常压吸氧治疗组(氧浓度33%).以二氧化碳吸入制作急性二氧化碳中毒大鼠模型,给予不同方式氧疗后,检测各组大鼠动脉血pH、氧分压(PO2)和二氧化碳分压(PCO2),取肺组织和脑组织,观察病理变化.结果 二氧化碳染毒组动脉血pH(7.31±0.06)和PO2[(68.50±15.02)mm Hg]比正常对照组[pH(7.42±0.02)和PO2(92.83±8.27)mm Hg]低,PCO2[(71.66±12.10)mm Hg]比正常对照组[(48.25±2.59)mm Hg]高,差异均有统计学意义(P＜0.05);高压氧治疗组、高浓度常压吸氧治疗组、低浓度常压吸氧治疗组动脉血pH(分别为7.37±0.02、7.39±0.03、7.38±0.02)和PO2[分别为(82.25±12.98)、(84.75±11.24)、(83.75±16.77)mm Hg]比二氧化碳染毒组高,PCO2[分别为(52.25±4.95)、(51.75± 4.82)、(52.66±5.61)mm Hg]比二氧化碳染毒组低,差异均有统计学意义(P＜0.05);各氧疗组动脉血pH、PO2和PCO2与正常对照组的差异无统计学意义(P＞0.05);各氧疗组之间动脉血pH、PO2和PCO2的差异无统计学意义(P＞0.05).病理大体解剖可见,二氧化碳染毒组大鼠肺脏可见大面积点、片状淤血,高浓度和低浓度常压吸氧治疗组的大鼠肺脏淤血情况较染毒组有所减轻,高压氧治疗组大鼠肺脏外观未见明显异常.光学显微镜下可见,二氧化碳染毒组大鼠肺组织出现弥漫性出血和渗出,高浓度和低浓度常压吸氧治疗组大鼠的肺组织出血和渗出情况较染毒组有所减轻,高压氧治疗组大鼠肺组织仅有轻微的出血和渗出.各组动物脑组织大体解剖和光学显微镜下所见没有区别,均未见明显出血、水肿、细胞变性和坏死.结论 急性二氧化碳中毒大鼠给予高压氧治疗后肺脏病理改变明显好于高浓度和低浓度常压吸氧治疗组,高浓度和低浓度常压吸氧治疗组治疗效果无明显差异,但血气分析结果和肺脏病理较染毒组有所好转,建议有条件的医疗单位可以尽早给予高压氧治疗,在无高压氧治疗设施的情况下,早期吸氧也是应急救治的良好措施.

Abstract：

Objective To study therapeutic effects by using different oxygen therapies in rats with acute carbon dioxide poisoning, to select the best oxygen therapy technology for patients with acute carbon dioxide poisoning on the spot. Methods Sixty healthy male Sprague-Dawley rats were randomized into normal control group, carbon dioxide exposure group, hyperbaric oxygen treatment group (pressure 2 ATA,FiO2100% ),high concentration of atmospheric oxygen treatment group (FiO250%),low concentration of atmospheric oxygen treatment group(FiO233%). After treated with different oxygen in rats with acute carbon dioxide poisoning, arterial pH, PO2 and PCO2 of rats were detected, in addition observe pathological changes of lung tissue and brain tissue. Results The arterial pH (7.31±0.06) and PO2 [(68.50±15.02)mm Hg] of carbon dioxide exposure group were lower than those of control group [pH (7.42±0.02) and PO2(92.83±8.27)mm Hg],PCO2[(71.66±12.10)mm Hg] was higher than that of control group[(48.25±2.59)mm Hg](P＜0.05);the arterial pH (hyperbaric oxygen treatment group 7.37 ±0.02, high concentration of atmospheric oxygen treatment group 7.39±0.03, low concentration of atmospheric oxygen treatment group 7.38±0.02) and PO2 of oxygen treatment groups [hyperbaric oxygen treatment group, high concentration of atmospheric oxygen treatment group, low concentration of atmospheric oxygen treatment group were (82.25±12.98), (84.75±11.24),(83.75 ±16.77)mm Hg, respectively] were higher than that of carbon dioxide exposure group,PCO2 [hyperbaric oxygen treatment group, high concentration of atmospheric oxygen treatment group, low concentration of atmospheric oxygen treatment group were ( 52.25±4.95 ), ( 51.75 ±4.82 ), ( 52.66±5.61 ) mm Hg,respectively] was lower than that of carbon dioxide exposure group (P＜0.05);there was no significant difference of the arterial pH, PO2 and PCO2 between oxygen treatment groups and control group (P＞0.05);there was no significant difference of the arterial pH, PO2 and PCO2 among oxygen treatment groups (P＞0.05). There was large area of bleeding of lungs in rats with carbon dioxide poisoning,the bleeding of lungs in rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment was better than the rats with carbon dioxide poisoning,there was no abnormal appearance of lungs in rats with hyperbaric oxygen treatment. The light microscope observation showed that there were diffuse bleeding and exudation of lungs in rats with carbon dioxide poisoning, the bleeding and exudation of lungs in rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment were better than the rats with carbon dioxide poisoning, there were only minor bleeding and exudation of lungs in rats with hyperbaric oxygen treatment. There was no difference of brain in anatomy and microscopy among all groups, there were no significant bleeding, edema, cell degeneration and necrosis.Conclusions Lung pathology in acute carbon dioxide poisoning rats with hyperbaric oxygen treatment is better than the rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment, there is no significant difference of effect between high concentration of atmospheric oxygen treatment group and low concentration of atmospheric oxygen treatment group,however,the results of blood gas analysis and lung pathology than the exposure group improved, so qualified medical unit for hyperbaric oxygen therapy as soon as possible, hyperbaric oxygen treatment facilities in the absence of circumstances,the emergency treatment of early oxygen is also a good measure.     

磷脂酰肌醇3-激酶/蛋白激酶B信号转导通路在苯醌致HL-60细胞增殖过程中的作用

目的 探讨磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/Akt)信号转导通路在苯醌(BQ)致HL-60细胞增殖中的作用.方法 取对数生长期的HL-60细胞,分为对照组(PBS处理细胞)、BQ染毒组(3 μmol/L BQ染毒)、LY294002+BQ染毒组(3μmol/L BQ染毒前加20 μmol/L LY294002),用alamar blue 法检测细胞增殖率,免疫印迹(Western blot)法检测细胞内p-Akt、Akt蛋白的表达,流式细胞仪检测细胞周期情况.结果 BQ染毒组细胞增殖率(185.00%±30.00%)和S、G2期细胞比例(分别为48.23%±1.37%、15.40%±1.21%)均高于对照组(分别为100.00%±0.00%、42.47%±0.45%、5.40%±0.40%),G1期细胞比例(36.37%±0.40%)低于对照组(52.13%±0.75%),差异均有统计学意义(P＜0.05);BQ染毒组细胞内p-Akt蛋白表达量明显高于对照组,差异有统计学意义(P<0.05),Akt表达量与对照组的差异无统计学意义(P＞0.05).LY294002+BQ染毒组细胞增殖率(82.59%±15.00%)和S、G2期细胞比例(分别为42.03%±0.50%、3.87%±0.47%)比BQ染毒组低,G1期细胞比例(54.43%±0.40%)比BQ染毒组高,差异均有统计学意义(P<0.05),细胞内p-Akt蛋白表达量明显低于BQ染毒组,差异有统计学意义(P<0.05);Akt蛋白表达量与BQ染毒组的差异无统计学意义(P>0.05).结论 PI3K/Akt信号转导通路在BQ致HL-60细胞增殖过程中可能起着重要作用.

Abstract：

Objective To explore the effects of phosphatidylinositol 3-kinase/ Serine-threonine kinase (PI3K/Akt) signal pathway on the proliferation of HL-60 cells exposed to benzoquinone (BQ). Methods HL-60 cells were divided into 3 groups: control group (treated with PBS), BQ group (treated with 3 μmol/L BQ) and LY294002 plus BQ group (treated with 20 μmol/L LY294002 plus 3 μmol/L BQ). The cell proliferation was measured with alamar blue dye assay. Western blot assay was used to detect the expression of p-Akt and Akt proteins and flow cytometer was used to observe the cell cycle. Results The cell proliferation rate and the cell proportion in the S, G2 phase of BQ group were 185.00%±30.00%, 48.23%±1.37% and 15.40%±1.21%, respectively, which were significantly higher than those ( 100.00%±0.00%, 42.47%±0.45% and 5.40%±0.40%) of control group (P<0.05 ). But the cell proportion rate (36.37%±0.40% ) in the G1 phase in BQ group was significantly lower than that (52.13%±0.75% ) in control group (P<0.05). The expression level of p-Akt protein in BQ group was significantly higher than that in control group (P<0.05). The cell proliferation rate and the cell proportion in the S, G2 phase of LY294002 plus BQ group were 82.59%±15.00%, 42.03%±0.50% and 3.87%± 0.47%, respectively, which were significantly lower than those of BQ group (P<0.05). But the cell proportion rate (54.43%±0.40%) in the G1 phase in LY294002 plus BQ group was significantly higher than that in BQ group (P<0.05 ). Conclusion The PI3K/Akt signal pathway may play an important role in the proliferation of HL-60 cells exposed to BQ.     

餐后血糖水平与冠心病发生的相关性

目的 探讨餐后血糖水平与冠心病发生的相关性.方法 选择血糖水平异常并已行冠状动脉造影的患者85例,按血糖水平将患者分为三组:空腹血糖调节受损(IFG)组28例、糖耐量减低(IGT)组29例及糖尿病(DM)组28例,观察各组冠心病发生率及冠状动脉病变程度,分析三组患者C反应蛋白(CRP)、颈动脉内膜中层厚度(CIMT)、血脂、血压、体重指数(BMI)的变化及与冠心病危险因素的相关性.结果 IGT组和DM组冠心病发生率[分别为79.3%(23/29)、85.7%(24/28)]明显高于IFG组[53.6%(15/28)](P＜0.01),DM组冠心病发生率高于IGT组,但差异无统计学意义(P＞0.05).IGT组和DM组2支病变、3支病变发生率均高于IFG组(P＜0.01),DM组2支病变、3支病变发生率高于IGT组,但差异无统计学意义(P＞0.05).IGT组、DM组CRP、CIMT、BMI、三酰甘油(TG)、收缩压(SBP)较IFG组明显升高(P＜0.01或＜0.05),高密度脂蛋白胆固醇(HDL-C)较IFG组明显降低(P＜0.01);DM组CRP、TG、SBP较IGT组升高(P＜0.05),其他指标比较差异无统计学意义(P＞0.05);相关性分析表明,IGT组和DM组餐后2 h血糖与CRP、CIMT、BMI、TG呈显著正相关(P＜0.05或＜0.01),与HDL-C呈显著负相关(P＜0.05或＜0.01).结论 餐后高血糖与冠心病的发生、发展有密切关系,对于IGT患者应尽早予以干预治疗,可有效预防心血管事件的发生.

Abstract：

Objective To investigate the correlation between the level of postprandial blood glucose (PBG)and the incidence of coronary artery disease(CAD). Methods Eighty-five patients performed coronary angiography with abnormal blood glucose levels were divided into 3 groups according the blood glucose levels: impaired fasting glucose(IFG)group(28 cases), impaired glucose tolerance(IGT)group(29cases)and diabetes mellitus(DM)group(28 cases). The detection rate and the extent of CAD were observed. The risk factors of CAD in 3 groups such as C-reactive protein(CRP),carotid artery intima-media thickness(CIMT), blood lipids, blood pressure, body mass index(BMI)and the correlation with CAD were analyzed. Results Sixty-two cases were confirmed CAD by coronary angiography. The incidence rate of CAD in IGT group[79.3%(23/29)]and DM group[85.7%(24/28)]was significantly higher than that in IFG group[53.6%(15/28)](P ＜ 0.01). The incidence rate of CAD in DM group was higher than that in IGT group, but there was no significant difference(P ＞ 0.05). The incidence rate of two-lesion and three-lesion in IGT group and DM group were significantly higher than those in IFG group(P＜ 0.01). The incidence rate of two-lesion and three-lesion in DM group were higher than those in IGT group, but there was no significant difference(P＞0.05). The levels of CRP, CIMT, BMI, triacylglycerol(TG)and systolic blood pressure(SBP)were higher and HDL-C was lower in IGT group and DM group than those in IFG group(P ＜ 0.01 or ＜ 0.05).The levels of CRP,TG and SBP were higher in DM group than those in IGT group(P＜0.05). Correlation analysis showed, in IGT group and DM group,2 h PG had significantly positive correlation with CRP, CIMT,B MI, TG(P＜0.05 or＜0.01), and had significantly negative correlation with HDL-C(P＜0.05 or ＜0.01).Conclusions PBG is closely related with the development of CAD.IGT patients should be intervened as early as possible, which can be effective in preventing cardiovascular events.     

高压氧联合化疗对卵巢上皮性癌疗效研究

Objective To discuss the therapentic efficacy of hyperbaric oxygen combined with PC program in newly diagnosed epithelial ovarian cancer patients. Methods Fifty-eight patients with epithelial ovarian cancer were divided into two groups by random digits table: HBO group(30 cases) and PC group(28cases). HBO group were exposed to hyperbaric oxygen of 2 standard atmospheric pressure 60 min, then given chemotherapy 25-30 min after extravehicular: cyclophosphamide 1000 mg/m2 + cisplatin 75 mg/m2.PC group with the same regimen without hyperbaric oxygen therapy were analyzed. The two groups were compared in the efficacy and 3-year survival rate, progression-free survival and adverse reactions. Results The total effective rate, not controlled rate, recurrence rate,recurrence time, 3-year survival rate in HBO group [83.3%(25/30),6.7%(2/30),33.3%(10/30), (21.0 ± 0.8) months,43.3%(13/30)] were better than those in PC group [67.9% (19/28), 17.9% (5/28), 46.4% (13/28), (18.0 ± 0.6) months, 17.9% (5/28)] (P ＜0.05), progression-free survival and overall survival time in HBO group were longer than those in PC group (P ＜0.05) and adverse reactions rate in HBO group was lower than that in PC group (P ＜0.05).Conclusions The hyperbaric oxygen combined with PC programs are better than PC programs in advanced epithelial ovarian cancer chemotherapy response rate, progression-free survival time and 3-year survival rates in ovarian cancer adjuvant chemotherapy. HBO can significantly reduce the PC's hematological toxicity and toxicity of the digestive system.     

颅内微创血肿穿刺术与小骨窗血肿清除术治疗高血压性脑出血的疗效比较

目的 对比观察颅内微创血肿穿刺术与小骨窗血肿清除术治疗高血压性脑出血的临床疗效.方法 选取2008年6月至2010年6月收治的116例高血压性脑出血患者.按照随机数字表法分为两组,每组58例.A组采用颅内微创血肿穿刺术治疗,B组采用小骨窗血肿清除术治疗,比较两组的临床疗效及神经功能恢复情况.结果 A组治疗的总有效率为87.9%(51/58),明显高于B组的72.4%(42/58),两组比较差异有统计学意义(P

Abstract：

Objective To compare and observe the clinical effects of microscopic evacuation of intraeranial hematoma and small bone flap approach mierosurgical operation in treatment of hypertensive cerebral hemorrhage.Methods From June 2008 to June 2010,116 cases of patients with hypertensive cerebral hemorrhage were classified into two groups with 58 cases in each by random digits table.Group A was treated with microscopic evacuation of intracranial hematoma and group B was treated with small bone flap approach microsurgical operation.The clinical efficacy and neurological impairment Scores were observed and compared between the two groups.Results The total effective rate in group A[87.9%(51/58)]was significantly higher than that in group B[72.4%(42,58)](P<0.05).After treatment 14 d and 28 d,the neurological impairment scores in group A were (22.1±6.2).(12.6±3.3)scores and in group B were (23.5±6.7),(18.6±5.1)scores.Compared with pre-treatment[group A:(41.9±8.1)scores;group B (41.7±7.9)scores],after treatment l4 d and 28 d,the neurological impairment scores in two groups were significantly decreased(P<0.05).Moreover,After treatment28 d,the neurological impairment scores in group A were significantly lower than those in group B(P<0.05).Conclusion Both microscopic evacuation of intracranial hematoma and small bone flap approach microsurgical operation are effective methods in hypertensive cerebral hemorrhage,but microscopic evacuation of intracranial hematoma can enhance the effect and improve the neurological function.     

氯解磷定治疗急性敌敌畏中毒的疗效

目的 探讨肟类药物氯解磷定(PAM-C1)治疗急性敌敌畏(DDV)中毒的疗效和作用机制。方法 比较急性DDV灌胃染毒大、小鼠用PAM-Cl治疗与未治疗的中毒表现、存活率及大鼠全血胆碱酯酶(12hE)活力的变化；观察PAM-Cl治疗急性DDV中毒患者的疗效和对其被抑制的全血ChE的重活化作用。结果 (1)急性DDV染毒大、小鼠PAM-Cl治疗组与未治疗组相比，中毒表现减轻、出现时间延迟，存活率明显提高；(2)急性DDV染毒大鼠PAM-Cl治疗组不同时点全血ChE活力普遍高于未治疗组，差异有统计学意义(P＜O．05)；(3)急性DDV中毒患者PAM-CL治疗后肌束震颤明显减轻并消失，受抑制的ChE活力逐渐恢复。结论PAM-CL对急性DDV中毒有治疗作用，该作用是通过ChE重活化效应来实现的。     

早期血液灌流在急性有机磷农药中毒患者治疗中的经济学评价

目的 从经济学方面对急性有机磷农药中毒治疗中的早期血液灌流技术进行评价.方法 40例急性有机磷农药中毒患者根据是否行早期血液灌流分为早期灌流组（20例）和对照组（20例）.观察两组患者在基础情况、治疗和预后情况以及治疗费用方面的差别.结果 两组在性别构成、年龄、初始胆碱酯酶（ChE）水平、中毒程度方面比较差异无统计学意义（P＞0.05）.两组患者在病程中均接受了至少1次血液灌流治疗.早期灌流组和对照组开始血液灌流时间分别为（1.6±0.9）h和（6.4±3.6）h,两组比较差异有统计学意义（P＜0.05）.早期灌流组ChE恢复正常时间和住院时间短于对照组[（8.5±2.1）d比（10.0±1.8）d、（10.5±4.2）比（12.3±5.4）d],差异有统计学意义（P＜0.05）.早期灌流组再次血液灌流5例,机械通气4例,对照组分别为8、5例,早期灌流组无院内死亡及28 d死亡,对照组院内死亡1例,28 d死亡1例.早期灌流组总住院费用、每天治疗费用、监护费用及药品费用均低于对照组[（17 231.75±5 411.45）元比（21 394.52±6 049.81）元、（1 412.25±169.33）元比（1 579.41±307.19）元、（4 309.22±1 490.12）元比（5 581.71±1 681.00）元、（8 223.41±1 426.10）元比（9 790.02±1 909.24）元],差异有统计学意义（P＜0.05）.结论 对于急性有机磷农药中毒患者,在病程早期实施血液灌流对其预后有益,缩短了血ChE恢复正常时间和住院时间,且降低了总住院费用.     

梗阻型胆源性胰腺炎内镜治疗时机及疗效的临床分析

目的 探讨梗阻型胆源性胰腺炎内镜治疗的时机与疗效.方法 回顾性分析160例梗阻型胆源性胰腺炎患者内镜治疗的临床资料.根据发病后内镜治疗时间分为两组:急诊组78例在发病<48 h行急诊内镜治疗;延期组82例在早期非手术治疗基础上于发病≥48 h行延期内镜治疗.结果 两组内镜治疗总成功率为96.2%(154/160).急诊组腹痛缓解时间[(4.98±1.75)d]、实验室指标恢复正常时间[(10.08±5.22)d]以及住院时间[(12.24±7.20)d]均显著低于延期组[分别为(5.54±2.53)、(12.93±6.60)、(16.38±6.94)d](P<0.05或<0.01).重症梗阻型胆源性胰腺炎急诊组术后总并发症发生率(9.6%,5/52)显著低于延期组(23.6%,13/55)(P<0.05),两组病死率比较差异无统计学意义(P>0.05).结论 重症梗阻型胆源性胰腺炎应在发病48 h内行急诊内镜治疗;轻症患者如早期非手术治疗无效或出现急性胆道感染症状,亦应争取及时行急诊内镜治疗.     

氯解磷定对不同有机磷杀虫剂中毒后乙酰胆碱酯酶活力恢复的影响

目的比较氯解磷定（PAM-Cl）对急性甲胺磷、敌敌畏和氧乐果中毒后乙酰胆碱酯酶（AChE）活力恢复的影响，为临床上合理治疗提供科学依据。方法收集4省1市7家县、市级医院收治的101例急性有机磷杀虫剂中毒患者资料，按接触杀虫剂品种不同分为急性甲胺磷中毒组59例、急性敌敌畏（或敌百虫）中毒组32例、急性氧乐果中毒组10例，比较3组患者红细胞AChE活力抑制程度和PAM-Cl对AChE的复能作用。结果入院时甲胺磷组、敌敌畏组、氧乐果组红细胞AChE活力分别为（9．12±7．99）、（7．32±4．62）和（12．01±9．53）U／gHb，均受抑制，但差异无统计学意义（P〉O．05）。经PAM-Cl治疗后3组患者中毒症状减轻或消失。甲胺磷组红细胞AChE活力在治疗后12、24、48、72h及出院时分别为（11．37±8．67）、（12．51±6．98）、（15．90±7-31）、（18．33±4．78）及（18．91±7．00）U／gHb，均较入院时明显升高并且呈不断回升趋势，差异有统计学意义（P〈O．01或P〈0．05）。敌敌畏组患者AChE活力在治疗后3、12、24、48、72h及出院时均较入院时明显增高，差异有统计学意义（P〈0．05）；12h后各时间点AChE活力则无进一步上升。氧乐果组患者AChE活力只有出院时较入院时明显增高，差异有统计学意义（P〈0．05）；其余各时间点AChE活力较入院时始终无明显恢复，差异均无统计学意义（P〉0.05）。结论PAM-Cl对甲胺磷、敌敌畏、氧乐果中毒均有治疗作用，对甲胺磷抑制的AChE活力有明显的重活化作用，对敌敌畏（敌百虫）抑制的AChE活力有一定重活化作用，而对氧乐果（乐果）抑制的AChE活力无重活化作用。     

丙溴磷对家兔SOD、CAT、GSH-Px影响的实验研究

为探讨丙溴磷对SOD、CAT、GSH Px的影响及其意义 ,将家兔随机分为A组 (高剂量组 )、B组 (低剂量组 )、C组 (对照组 ) ,分别于染毒不同时间测定血浆超氧化物歧化酶 (SOD)、过氧化物酶 (CAT)、谷胱甘肽过氧化物酶 (GSH Px)等指标 ,同时测定全血胆碱酯酶 (ChE)活力。结果显示 ,A组、B组SOD、CAT、GSH Px与同组染毒前及对照组相比显著升高 (P <0 0 5和P <0 0 1) ,ChE与同组染毒前及对照组相比降低或显著降低(P <0 0 1) ,且ChE的显著降低发生于抗氧化酶指标显著升高之后。结果提示 ,丙溴磷可致SOD、CAT、GSH Px等抗氧化酶活性增高 ,可能造成脂质过氧化的增强 ,并可能是丙溴磷早期中毒的表现之一。     

不同途径汞中毒对机体影响的分析研究

目的 研究不同接触途径所致汞中毒的临床特点。 方法 将33例患者按汞进入体内途径的不同分为3组,即呼吸道吸入中毒组、消化道摄入中毒组和皮肤吸收中毒组,分析其临床特点。 结果 3种不同接触途径所致汞中毒的临床表现各有特点,呼吸道吸入中毒组呼吸系统症状较突出,试排尿汞升高明显。皮肤吸收中毒组以亚急性中毒为主,无明显症状,多为肾病等,发病后检查发现尿汞升高;消化道摄入中毒者为急性起病,可伴有胃肠道症状,治疗后尿汞值最低。治疗前呼吸道吸入中毒组的平均尿汞值分别为消化道摄入中毒组、皮肤吸收中毒组的18.5倍和9.2倍;呼吸道吸入中毒组的试排平均尿汞水平高达5 838.2 μg/gCr。呼吸道吸入中毒组患者平均治疗3.91个疗程,其中58.3%患者超过5个疗程;消化道摄入中毒组患者平均治疗仅1.56个疗程,其中55.56%病例仅需治疗一个疗程;皮肤吸收中毒组患者平均治疗2.25个疗程,其中50%的患者超过5个疗程。3组患者治疗所用疗程比较,差异有统计学意义(F=8.98,P<0.05)。 结论 3种不同接触途径所致汞中毒临床表现不一,应强化汞中毒诊疗规范,以达到早期有效治疗,减少后遗症,降低死亡率。     

骨化三醇冲击联合树脂吸附治疗严重继发性甲状旁腺功能亢进症

目的 探讨骨化三醇冲击联合树脂吸附治疗严重继发性甲状旁腺功能亢进症的疗效.方法 将32例血液透析患者采用随机数字表法分为骨化三醇冲击组(CP组)12例、骨化三醇冲击联合树脂吸附组(CP+RA组)10例和树脂吸附组(RA组)10例.治疗前及治疗后1、2、3个月测定血清免疫反应性甲状旁腺素(iPTH)、白蛋白、尿素、肌酐和血红蛋白.每半个月测定血钙、磷.结果 每次树脂吸附后较吸附前iPTH明显下降(P<0.05).CP+RA组治疗后2个月iPTH水平较治疗前明显下降,治疗后3个月,CP+RA组iPTH水平为(598.50±317.45)ne/L,明显低于CP组的(1008.67±436.85)ng/L和RA组的(1464.60±411.27)ng/L (P<0.05).结论 骨化三醇冲击联合树脂吸附能有效降低严重继发性甲状旁腺功能亢进症患者的iPTH水平.     

更年期潮热妇女睡眠状况分析

目的：探讨更年期潮热的妇女睡眠状况,以及潮热程度与睡眠的关系。方法回顾分析2006年10月至2008年5月间于西安交通大学医学院第一附属医院体检中心进行健康体检的1206名40～60岁妇女分为潮热组、无潮热组,分别完成调查问卷。问卷具体内容包括一般情况、潮热状况和匹兹堡睡眠质量指数（ PSQI）,并对结果进行分析。结果潮热组妇女PSQI总分平均值高于无潮热组妇女（8．03±4．28 vs 5．58±3．56,t＝－2．359,P＜0．05）;潮热妇女发生睡眠质量差的风险是无潮热妇女的4．172倍（OR＝4．172,95％CI：1．26～13．80,P＜0．05）。 PSQI表中睡眠质量、睡眠障碍及日间功能项,潮热组妇女均高于无潮热组妇女（t值分别为－1．936、－2．556、－2．217,均P＜0．05）。重度潮热妇女的PSQI得分显著高于轻度潮热的妇女（9．85±3．72 vs 7．96±3．92,F＝12．316,P＜0．05）,亦显著高于中度潮热的妇女（9．85±3．72 vs 8．31±4．08,F＝4．261,P＜0．05）。结论更年期潮热影响妇女的睡眠,其中以重度潮热最为显著,导致妇女出现睡眠障碍、睡眠质量和日间功能下降。     

百草枯中毒大鼠肺组织ACE和ACE2基因表达及二巯丙磺钠的保护作用

目的 探讨急性百草枯(PQ)中毒大鼠肺组织中血管紧张素转化酶(ACE)、血管紧张素转化酶2(ACE2)的基因表达及二巯丙磺钠(Na-DMPS)的保护作用.方法 100只SD雄性大鼠分为正常对照组(10只)、Na-DMPS对照组(10只)、PQ染毒组和Na-DMPS保护组(各40只).PQ染毒组和Na-DMPS保护组大鼠一次性腹腔注射PQ 20 mg/ks,其中保护组大鼠于染毒前15 min以Na-DMPS 200mg/kg腹腔注射进行保护.观察各组大鼠在中毒后6、24 h及3、7d各时间点的临床表现和光学显微镜下肺脏的组织学改变,并使用反转录一聚合酶链反应(RT-PCR)方法测定各组大鼠各时间点肺组织ACE和ACE2 mRNA的表达.结果 PQ染毒组大鼠染毒后出现呼吸急促、抽搐,呈进行性加重,Na-DMPS保护组大鼠中毒症状出现延后且明显减轻.光学显微镜下可见,染毒组大鼠肺组织损伤的表现以肺部毛细血管和肺泡结构破坏、肺泡内渗出物增多、炎症细胞聚集为主,而Na-DMPS保护组大鼠肺组织受损则相对较轻.各时点PQ染毒组肺组织ACE及ACE2 mRNA的表达均下降,在24 h时ACE mRNA表达为0.457±0.262,3 d时为0.385±0.179;3 d时ACE2 mRNA表达为0.415±0.247,7 d时为0.365±0.215,与正常对照组(ACE mRNA为0.781±0.354,ACE2 mRNA为0.761±0.420)和Na-DMPS对照组(ACEmRNA为0.765±0.364,ACE2mRNA为0.725±0.424)比较,差异均有统计学意义(P<0.05).Na-DMPS保护组肺组织ACEmRNA表达在24 h时为0.739±0.558,3d时为0.749±0.414,ACE2 mRNA表达在3d时为0.584±0.345,7d时为0.493±0.292,明显高于相同时间点的PQ染毒组,差异均有统计学意义(P<0.05).结论 PQ中毒大鼠肺组织ACE和ACE2mRNA表达下降,Na-DMPS可上调肺组织ACE和ACE2 mRNA表达,减轻肺组织病理改变,对PQ中毒所致急性肺损伤有一定的保护作用.     

布地奈德气雾剂联合氨溴索注射液雾化治疗新生儿肺炎的疗效研究

目的 观察研究布地奈德气雾剂联合氨溴索注射液雾化治疗新生儿肺炎的临床疗效。方法 选取2018年1月—2019年4月在我院治疗的94例新生儿肺炎进行研究,通过随机分组的方式将其分为对照组(45例)和研究组(49例),对照组患儿采取氨溴索注射液雾化治疗,研究组患儿采取布地奈德气雾剂联合氨溴索注射液雾化治疗,研究比较两组患儿的治疗效果、临床症状改善时间以及呼吸指数改善情况等。结果 研究组患儿治疗总有效率为91.84%,高于对照组的68.89%,P<0.05;研究组患儿气喘改善时间(8.15±2.26)d,咳嗽改善时间(8.02±2.10)d,湿啰音改善时间(8.16±1.25)d,呼吸增快改善时间(49.69±6.11)h,紫绀改善时间(35.29±6.52)h,短于对照组的气喘改善时间(3.96±1.88)d,咳嗽改善时间(4.11±1.29)d,湿啰音改善时间(5.13±0.86)d,呼吸增快改善时间(28.92±5.99)h,紫绀改善时间(18.85±4.12)h,差异具有统计学意义 P<0.05;两组患儿PCO2与OI值在治疗之前进行对比P>0.05,PCO2值治疗后与对照组比较明显较低 P<0.05,OI值与对照组比较明显较高P<0.05。结论 对新生儿肺炎患儿采取布地奈德气雾剂联合氨溴索注射液雾化治疗具有显著的疗效,能明显缩短患儿临床症状的改善时间,改善呼吸指数,值得临床应用及推广。