急性CO中毒后迟发性脑病患者脑脊液和血清可溶性白细胞介素-2受体水平

目的　探讨急性一氧化碳中毒后迟发性脑病 (DEACMP)患者血清和脑脊液可溶性白细胞介素 2受体 (sIL 2R)的变化。方法　采用双抗体夹心ELISA法测定 31例DEACMP患者入院时、出院前的sIL 2R含量 ,并与 32例其他脑病组和 31例对照组作比较。结果　DEACMP组血清sIL 2R水平[(32 9.2 1± 16 0 .99)U/ml]明显高于对照组 [(115 .6 7± 89.5 8)U/ml],差异有显著性 (P <0 .0 5 ) ;与其他脑病组 [(36 7.5 0± 12 3.14 )U/ml]比较 ,差异无显著性 (P >0 .0 5 ) ;DEACMP组脑脊液sIL 2R水平[(5 4 .4 8± 4 3.0 4 )U/ml]略高于对照组 [(34.96± 2 2 .70 )U/ml],但明显低于其他脑病组 [(110 .2 4±76 .5 6 )U/ml],差异有显著性 (P <0 .0 5 )。DEACMP组血清sIL 2R水平入院时 [(338.34± 16 1.5 3)U/ml]与出院前 [(35 1.31± 175 .93)U/ml]比较 ,差异无显著性 (P >0 .0 5 ) ,而脑脊液sIL 2R水平出院前[(10 0 .2 6± 93.6 5 )U/ml]较入院时 [(5 2 .2 8± 4 3.31)U/ml]明显增高 ,差异有显著性 (P <0 .0 5 )。结论　本病的发生与免疫病理损伤有关 ,血清和脑脊液sIL 2R水平可以反映DEACMP患者机体的免疫状态 ,对判断病情程度及预后有一定的价值。     

铅暴露对生长发育期大鼠不同脑区一氧化氮合酶活力的影响

目的　观察低水平铅暴露对生长发育期大鼠不同脑区一氧化氮合酶 (NOS)活力的影响。方法　SD大鼠经饮含 0 .0 2 5 %、0 .0 5 0 %、0 .0 75 %醋酸铅水方法染毒 ,建立生长发育期低水平铅中毒的大鼠模型 ,应用荧光测定法测定大鼠海马、小脑、大脑皮层、脑干的NOS活力。结果　出生 2 1d ,3组铅暴露组海马、小脑NOS活力 [海马 :(1.5 3± 0 .2 0 )、(1.6 6± 0 .2 3)、(1.88± 0 .32 )U mgpro ,小脑 :(0 .87± 0 .2 4 )、(0 .85± 0 .0 9)、(0 .91± 0 .18)U mgpro]明显低于对照组 [海马 :(2 .36± 0 .18)、小脑 (1.4 1± 0 .18)U mgpro](海马F =14 .4 15 ;小脑F =7.933,均P <0 .0 1) ;出生 7、14、2 1d ,0 .0 75 %醋酸铅组大鼠大脑皮层NOS活力 [7d :(1.2 9± 0 .14 )、14d :(1.0 3± 0 .15 )、2 1d :(0 .6 9± 0 .10 )U mgpro]明显低于对照组 [7d :(2 .5 4± 0 .31)、14d :(1.6 4± 0 .2 2 )、2 1d :(1.2 4± 0 .14 )U mgpro],0 .0 2 5 %组 [7d :(2 .4 2±0 .19)、14d :(1.5 9± 0 .17)、2 1d :(1.2 7± 0 .12 )U mgpro],0 .0 5 0 %组 [7d :(2 .5 6± 0 .5 3)、14d :(1.77±0 .19)、2 1d :(1.2 4± 0 .10 )U mgpro](F =4 2 .6 30 ,P <0 .0 5 ) ,对照组、0 .0 2 5 %组、0 .0 5 0 %组之间两两比较 ,差异无显著性     

26例糖尿病并发脑梗死分析

脑梗死是糖尿病重要并发症之一。本文就我院近 2年来住院确诊的糖尿病病人 10 4例 ,其中经计算机Ｘ线断层扫描 (ＣＴ)证实为脑梗死 2 6例的临床资料分析如下。临床资料1　一般资料　本组糖尿病人 10 4例。并发脑梗死 2 6例 (脑梗死组 )占 2 5 % ,均为 2型糖尿病 :男 9例 ,女 17例 ;平均年龄 6 7 6± 1 7岁 ;糖尿病病程平均 5 2± 1 9年。无并发脑梗死 78例 (无脑梗死组 )占 75 % ,其中 1型糖尿病 2例 ,2例糖尿病 76例 ,男 40例 ,女 38例 ,平均年龄 5 4 8±1 5岁 ;糖尿病病程平均 4 2± 0 8年 ;有高血压病者 36例 ,平均病程 6 0± 0 9年…     

二甲双胍对多囊卵巢综合征患者生殖内分泌功能的影响

目的　评价二甲双胍对多囊卵巢综合征 (PCOS)患者的生殖内分泌功能的影响。　方法　 32例 PCOS患者 ,采用二甲双胍 75 0 mg/d口服 ,连续 12周 ,治疗前后检测患者血 L H、FSH、T水平及卵巢体积 ,用药期间患者自己记录基础体温 (BBT) ,每 4周随访 1次 ,直至停药后 3个月 ,了解患者月经及妊娠情况。　结果　治疗后月经恢复正常者占 6 2 .5 0 % (2 0 /32 ) ,BBT双相者占37.5 0 % (12 /32 ) ,妊娠者占 2 5 .0 % (8/32 )。卵巢体积治疗前右侧为 (7.2 0± 1.2 3) cm3,左侧为(7.5 0± 1.17) cm3,治疗后 2 4例行卵巢体积测量右侧为 (6 .5 0± 0 .85 ) cm3,左侧为 (6 .6 0± 1.0 8) cm3,差异均有显著性 (P<0 .0 1,P<0 .0 5 )。血 T、 L H、 L H/FSH比值分别由治疗前的 (2 .36±1.4 6 ) nm ol/L,(10 .16± 3.78) U/L 和 (2 .72± 1.0 0 ) ,下降为治疗后的 (1.5 7± 1.2 1) nm ol/L 和(6 .97± 3.99) U/L,(1.86± 1.2 8) ,差异有显著性 (P<0 .0 1,P<0 .0 5 )。　结论　二甲双胍可以改善 PCOS患者的生殖内分泌异常及一些临床症状 ,是治疗 PCOS的一条安全、有效的新途径。     

睡眠剥夺对大鼠脑组织SOD的影响

目的 :观察睡眠剥夺后大鼠脑组织SOD含量的影响 ,探讨睡眠剥夺引起的脑损害机制及干预药物的作用。方法 :采用小平台水环境法 (FlowerPot)制作大鼠睡眠剥夺模型 ,以黄嘌呤氧化酶法测定睡眠剥夺后大鼠额叶、海马、脑干和下丘脑SOD含量变化 ,并观察黄芪干预对SOD活性的影响。结果 :睡眠剥夺 3d后大鼠脑额叶、海马、中脑和下丘脑的SOD活性分别为 (44 .3±5 .9)、(47.5± 7.8)、(5 7.8± 6 .0 )、(6 4.5± 6 .8)、NU·mgpro 1高于正常对照组的 (16 .7± 5 .8)、(11.3± 2 .8)、(2 0 .3± 3.8)和 (17.0± 5 .7)NU·mgpro 1(P <0 .0 1)。经黄芪干预后额叶、海马、中脑及下丘脑SOD活性分别降为 (31.3± 5 .7)、(2 7.3± 5 .8)、(32 .8± 6 .9)、(31.7± 7.8)NU·mgpro 1,低于生理盐水对照的 (46 .9± 5 .8)、(5 1.3± 10 .4 )、(5 9.4± 7.6 )和 (5 9.6± 8.3)NU·mgpro 1(P <0 .0 1)。结论 :睡眠剥夺过程可能存在自由基损害影响 ,黄芪有一定的抗氧化应激作用     

慢性铅接触对大鼠学习和记忆的影响

目的　观察长期低铅暴露对大鼠学习及记忆功能的影响并探讨其可能的机理。方法　选择刚断乳的Wistar大鼠 2 0只 ,随机分为实验组 (n =13)和对照组 (n =7) ,分别饮用 0 0 5%醋酸铅水溶液和蒸馏水。饲养10 0～ 110d后用Y迷宫检测分辨学习及记忆能力 ,然后取血和脑行铅、钙含量的测定。结果　慢性低铅接触后大鼠的学习能力 (2 0 2 3± 5 52 )和记忆保持百分数 (6 4 17± 9 92 )均显著低于正常对照组 (分别为 13 86± 1 95,86 6 7± 5 16 ) ,(P <0 0 1,t =2 95,2 98)。染铅大鼠血铅 (0 399± 0 82 ) μg/ml、脑铅 (2 189± 0 818) μg/g湿重 ,浓度均显著高于对照组 (0 0 4 93± 0 0 12 μg/ml,0 6 9± 0 0 8μg/g湿重 ) ,(P <0 0 1,t =10 94和 4 4 1) ;而两组间血钙和脑钙差异无显著性。学习记忆能力与血铅、脑铅含量有关。结论　慢性铅接触可损害大鼠的学习记忆功能 ,铅通过血脑屏障沉积于大脑并与钙离子拮抗 ,干扰了细胞内的钙稳态 ,是造成脑损害的机制之一。     

高压氧治疗儿童脑损伤疗效观察

【目的】　探讨高压氧综合治疗小儿脑损伤的疗效。　【方法】　 79例采用高压氧综合治疗 ,79例作为对照组 ,比较两组疗效。　【结果】　高压氧组治疗后惊厥时间 ( 3 .3 6± 1.16)d ,显著少于对照组 ( 8.74± 1.92 )d(P <0 .0 0 1) ;昏迷时间 ( 4 .91± 1.72 )d ,明显少于对照组 ( 10 .90± 2 .5 0 )d(P <0 .0 0 1) ;高压氧组有效率为 91.14 %,明显优于对照组 63 .2 9%(P <0 .0 0 5 )。　【结论】　高压氧综合治疗小儿脑损伤有缩短病程、促进康复、减少后遗症的作用     

极低频电磁场对小鼠脑和肝细胞凋亡及细胞周期的影响

目的　研究极低频电磁场暴露对小鼠脑和肝细胞凋亡及细胞周期的影响。方法　小鼠经 5 0Hz、0 .2mT或 5 0Hz、6 .0mT电磁场暴露 2周 ,采用TUNEL法观察凋亡细胞 ,采用流式细胞术检测细胞凋亡率和细胞周期。结果　 0 .2mT和 6 .0mT电磁场暴露后 ,脑细胞凋亡率分别为 ( 5 .6 0±1.4 7) %和 ( 4 .73± 0 .4 8) % ,与对照组 [( 2 .90± 0 .75 ) % ]比较 ,差异有显著性 (P <0 .0 5 ) ;肝细胞凋亡率分别为 ( 4 .19± 2 .0 8) %和 ( 3.38± 0 .6 5 ) % ,与对照组 [( 1.84± 0 .76 ) % ]比较 ,差异亦有显著性 (P <0 .0 5 )。脑细胞G0 G1期细胞百分率分别为 ( 80 .2 1± 1.6 8) %和 ( 79.5 4± 0 .5 6 ) % ,肝细胞G0 G1期细胞百分率分别为 ( 79.4 2± 1.80 ) %和 ( 80 .4 7± 1.79) % ,与对照组 [分别为 ( 76 .85± 0 .83) %、( 73.36±3.10 ) % ]比较 ,差异均有显著性 (P <0 .0 5 )。与此同时 ,S期和G2 +M期的细胞百分率明显下降。结论　极低频电磁场暴露可能诱发小鼠脑和肝细胞周期改变 ,并可能进一步导致细胞凋亡。     

41例医务人员严重急性呼吸综合征的临床特点分析

目的　探讨严重急性呼吸综合征 (SARS)的临床特点。方法　对我院 2 0 0 3年 3月中旬至 4月中旬收治的 4 1例医务人员SARS患者的临床资料进行回顾性分析。结果　患者年龄 2 3～ 5 5岁 ,平均 32岁。男 8例 ,女 33例 ;医生 13例 ,护理人员 2 8例。传播途径为近距离接触传播 ,过度劳累是发病诱因。以发热为首发症状者 30例 (73% ) ,乏力伴周身酸痛 10例 (2 4 % ) ,1例在体检时发现双下肺部炎症而整个病程无临床症状。 4 1例中危重型病例 2例 (5 % ) ,重型病例 4例 (10 % ) ,普通型35例 (85 % )。外周血白细胞计数 (× 10 9/L)在病程第 1周最低 ,为 4 4± 1 5 ,与第 2～ 4周的白细胞计数 (7 1± 5 2 ,11 0± 5 2 ,10 5± 4 5 )比较差异有显著性。血小板计数 (× 10 9/L)第 1周最低 ,为14 3± 37,与第 2～ 4周的血小板计数 (16 8± 85 ,2 5 4± 90 ,2 6 2± 10 9)比较差异有显著性。肝功能异常者 2 7例 (6 6 % ) ,以丙氨酸转氨酶升高为主 ,发生于病程第 3～ 4周者 19例 (70 % )。病程第 1天CT发现肺部病变者 30例 (73% ) ,累及双肺 15例 (37% )。应用糖皮质激素者 36例 ,31例 (86 % )用量为 80～ 2 4 0mg/d。使用人工通气者 2 7例 ,有创机械通气者 1例。死亡 2例 ,病死率为 5 %。结论　 1/ 3的医务人员SA     

兴奋性氨基酸与1,2-二氯乙烷急性中毒性脑病关系的探讨

目的　探讨兴奋性氨基酸 (EAAs)与 1 ,2 二氯乙烷 (1 ,2 DCE)急性中毒性脑病的关系。方法　将SD大鼠随机分为 7组 :对照组、3个染毒组 (5 .0、1 0 .0、2 0 .0g/m31 ,2 DCE)和 3个时间组(1 0 .0g/m31 ,2 DCE染毒后 2、4、6h) ;连续静式吸入染毒 1 2h ;干湿重法测定大鼠脑皮质和髓质含水量 ;高效液相色谱法 (HPLC)检测脑组织中谷氨酸 (Glu)、天冬氨酸 (Asp)、甘氨酸 (Gly)及γ 氨基丁酸(GABA)含量的变化。结果　 (1 )大鼠脑皮质和髓质含水量 :不同剂量染毒组大鼠脑皮质含水量分别为 76 .1 0 %± 1 .41 %、76 .45 %± 0 .75 %、79.95 %± 1 .45 % ,均高于对照组 (74.2 2 %± 1 .77% ) ,差异有显著性 (P <0 .0 5 ,P <0 .0 1 ) ;髓质含水量仅 2 0 .0g/m3组 (71 .77%± 3 .0 7% )有明显升高 ,差异有显著性(P <0 .0 5)。染毒后 2、4、6h脑皮质含水量分别为 79.36 %± 2 .1 0 %、79.48%± 1 .2 1 %、80 .64 %±1 .93 % ,均高于 1 0 .0g/m3即刻组 ,差异有显著性 (P <0 .0 5)。 (2 ) 4种氨基酸递质含量 :不同剂量染毒组Asp含量分别为 (4.83± 0 .35)、(7.1 7± 0 .40 )、(1 0 .52± 0 .39) μmol/g ;Glu含量分别为 (2 3 .86± 0 .62 )、(31 .2 1± 2 .50 )、(2 8.2 3± 1 .58) μmol/g;Gly含量分别为 (5 .59±     

急性一氧化碳中毒后迟发性脑病的临床表现和CT及MRI研究

目的研究急性一氧化碳中毒后迟发性脑病（DEACMP）的临床与CT、MRI表现及其与预后的关系。方法对46例DEACMP患者临床表现、预后、颅脑CT及MRI进行分析。结果DEACMP患者临床表现以精神意识障碍和锥体外系神经损害最为突出。CT的典型表现为双侧大脑白质、两侧或单侧基底节或苍白球低密度改变；MRI异常表现为苍白球变性坏死，双侧大脑白质脱髓鞘，以脑室周围为主，T2加权呈高信号，T1加权呈等信号或低信号，海马区及脑干的病变，后期出现脑萎缩征象。MRI阳性检出率为82．1％，CT阳性检出率为43．2％，MRI敏感性高于CT。结论患者预后与年龄、中毒后昏迷时间的长短和治疗效果有关系，CT、MRI对DEACMP脑损伤的诊断和评价预后均有意义，MRI对DEACMP脑损伤的诊断优于CT。     

Nutritional and clinical efficacy of ornithine alpha-ketoglutarate in severe burn patients

Ornithine alpha-Ketoglutarate (OKG) displays anabolic and anticatabolic properties in situations of stress. However, studies including both biological and clinical end points are scarce. In this prospective, randomized and double-blind study, 60 patients who had undergone severe burns (20-60% of body surface area) received either ornithine alpha-ketoglutarate (20 g/day) or an isocaloric placebo, for 21 days, starting mean 4 days after injury. In the OKG group, nitrogen balance reached positive values at d5 and stabilized at higher levels vs controls (P< 0.05 or less from day 3 to day 21), resulting in a strongly positive cumulated nitrogen balance at day 21 (mean +/- SEM, OKG group: +127 +/- 13; Control group: -63 +/- 18g nitrogen). As measured at day 21, transthyretin and RBP levels were higher in the OKG group (respectively 259 +/- 9 vs 161 +/- 10, and 45 +/- 1 vs 33 +/- 1 mg/l, P< 0.001). Body weight loss was counteracted at d21 in the OKG group (-2.6% vs -6.3%, P< 0.001). Assessment of the quality of wound healing using objective scoring showed better performances in the OKG group (P< 0.05). The results suggest that improvement in nutritional parameters observed during the treatment of burn-injured patients with ornithine a-ketoglutarate allows better clinical recovery.     

多发性硬化增强磁共振成像与甲基强的松龙治疗的相关性研究

目的探讨多发性硬化（MS）中增强磁共振成像（MRI）与甲基强的松龙治疗的相关性。方法选择确诊MS60例,检查增强MRI及平扫,并常规给予大剂量甲基强的松龙冲击治疗,每4-8w复查1次增强MRI及平扫,观察病灶的形态变化及临床表现情况。结果60例MRI增强病灶中,约69.15％在治疗后的4w内消失,93.3％）：8w内消失,其余增强病灶明显弱化,病灶强化程度的变化与临床呈正相关。而病灶未强化者治疗前后相差不大。结论Ms增强MR灶阳性者绝大多数对激素治疗敏感,而增强MR灶阴性者对激素治疗不敏感,可考虑使用免疫抑制剂或干扰素。     

急性一氧化碳中毒患者血清酶活力的动态变化

目的探讨血清酶变化在急性一氧化碳(CO)中毒中的临床意义.方法检测62例急性CO中毒患者血清酶活力及心电图(ECG),并进行动态观察.结果急性CO中毒者5种血清心肌酶活力在中毒后24h开始增高,天冬氨酸转氨酶(AST)、肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶同工酶(CK-MB)活力分别为(20.2±12.3)、(151.6±91.8)、(146.8±50.4)、(154.8±47.7)、(13.8±8.1)U/L,对照组分别为(12.1±6.7)、(90.6±17.3)、(118.7±13.5)、(89.9±27.9)、(5.9±3.3)U/L,两组的差异均有显著性(P＜0.01);3 d后分别为(21.3±12.3)、(105.8±51.4)、(144.8±51.4)、(159.8±35.4)、(16.2±9.1)U/L;7、12 d后α-HBDH和CK-MB活力仍较对照组增高,差异均有显著性(P＜0.01).乳酸脱氢酶同工酶1(LDH1)、乳酸脱氢酶同工酶2(LDH2)活力中毒后24h内增高,并达峰值,分别为(35.3±5.8)、(43.8±5.7)U/L,3 d时LDH1、LDH2和7 d时LDH1与对照组的差异均有显著性(P＜0.01).轻、中度中毒组同期比较,7 d时LDH1与12 d时的差异有显著性(P＜0.01).LDH1血清酶检查异常率最高达78.7%,LDH2为58.3%,LDH为45.2%,CK-MB为37.1%,α-HBDH为33.6%.ECG检查异常率＜10%.结论CO中毒可引起心肌损害,血清酶活力检测可提示心肌损害,有助于此种损害的的早期诊治、疗效观察及预后判断.     

Carbohydrate-protein drinks do not enhance recovery from exercise-induced muscle injury

This study examined the effects of carbohydrate (CHO), carbohydrate-protein (CHO+PRO), or placebo (PLA) beverages on recovery from novel eccentric exercise. Female participants performed 30 min of downhill treadmill running (-12% grade, 8.0 mph), followed by consumption of a CHO, CHO+PRO, or PLA beverage immediately, 30, and 60 min after exercise. CHO and CHO+PRO groups (n=6 per group) consumed 1.2 g x kg body weight(-1) x hr(-1) CHO, with the CHO+PRO group consuming an additional 0.3 g x kg body weight(-1) x hr(-1) PRO. The PLA group (n=6) received an isovolumetric noncaloric beverage. Maximal isometric quadriceps strength (QUAD), lower extremity muscle soreness (SOR), and serum creatine kinase (CK) were assessed preinjury (PRE) and immediately and 1, 2, and 3 d postinjury to assess exercise-induced muscle injury and rate of recovery. There was no effect of treatment on recovery of QUAD (p= .21), SOR (p= .56), or CK (p= .59). In all groups, QUAD was reduced compared with PRE by 20.6%+/-1.5%, 17.2%+/-2.3%, and 11.3%+/-2.3% immediately, 1, and 2 d postinjury, respectively (p< .05). SOR peaked at 2 d postinjury (PRE vs. 2 d, 3.1+/-1.0 vs. 54.0+/-4.8 mm, p< .01), and serum CK peaked 1 d postinjury (PRE vs. 1 d, 138+/-47 vs. 757+/-144 U/L, p< .01). In conclusion, consuming a CHO+PRO or CHO beverage immediately after novel eccentric exercise failed to enhance recovery of exercise-induced muscle injury differently than what was observed with a PLA drink.     

Substrate efficacy in early nutrition support of critically ill multiple trauma victims.

The metabolic consequences of excessive nutrition support in patients have been increasingly recognized in recent years. Time-dependent optimal nutrition support is desired for an early and uncomplicated recovery after severe injury or illness. Metabolic effects of adding balanced amino acids to glucose infusion during total parenteral nutrition were investigated in 18 patients after major trauma (injury severity score 32 +/- 2). Two studies were conducted on each subject, one in the early "flow" phase of injury (40-60 hours postinjury) in the basal state without any dietary intake and then after 4 to 6 days of intravenous nutrition provided solely as glucose (24 +/- 2 kcal/kg per day, 80% resting energy expenditure, n = 8) or isocaloric glucose (28 +/- 3 kcal/kg per day) with amino acids (275 +/- 28 mg of nitrogen per kilogram per day, n = 10). Whole-body fuel substrate kinetics were studied for energy metabolism (indirect calorimetry), protein kinetics (primed-constant infusion of 15N glycine), and lipid mobilization (two-stage infusion of 10% glycerol). Injury-induced hypoaminoacidemia was equally modulated whether the glucose-based nutrition had amino acids or not. The negative nitrogen balance is reduced similarly in both groups. Protein breakdown rate is significantly (p = .025) decreased in both groups and it is more so (30% vs 18%) in patients receiving total parenteral nutrition. Intravenous nutrition could not stimulate protein synthesis. Whole-body lipolysis rate as well as net fat oxidation rate are suppressed more when glucose alone is given, and this also results in less reesterification. Provision of intravenous glucose alone, not to exceed the resting energy expenditure, seems to be superior to isocaloric glucose with amino acids during this early catabolic flow phase of injury because the injured body could not assimilate this exogenous amino acid.     

弥漫性轴索损伤的诊断与治疗

目的探讨脑弥漫性轴索损伤(DAI)的临床诊断及治疗方法。方法回顾分析32例脑弥漫性轴索损伤的临床资料。结果87.5%的DAI为交通事故伤，伤后立即昏迷并呈持续状态，CT扫描有异常者占75%，而MR对DAI的诊断敏感性优于CT，能清楚显示脑干损伤。DAI的治疗以非手术治疗为主，亚低温治疗是处理DAI的关键。结论临床与影像学的结合有助于DAI的早期诊断，加强监护和治疗是防止DAI引起继发性脑损害的重要环节。     

脑弥漫性轴索损伤60例临床分析

[目的]了解脑弥漫性轴索损伤（DAI）临床特点及诊断方法，为进一步治疗提供依据。[方法]对60例DAI病人的临床和影像学资料，将原发性脑损伤的特征及治疗进行描述性分析。[结果]DAI是常见的弥漫性脑损伤，脑震荡和原发脑干伤被包含其中，且常常与脑皮质挫裂伤伴发。主要依靠临床经验和CT、MRI诊断。60例DAI伤者中，手术治疗28例（46．66％），恢复良好6例（21．42％），死亡15例（53．57％）；保守治疗32例（53.33％），恢复良好6例（18.75％），死亡14例（43．75％）。[结论]对DAI伤者采取支持及手术治疗等综合措施，可获提较好的疗效。     

Similar metabolic responses to standardized total parenteral nutrition of septic and nonseptic critically ill patients

BACKGROUND: Nutritional support is an important link between the response to injury and recovery in critical illness. OBJECTIVE: Our goal was to evaluate energy and substrate metabolism in septic and nonseptic critically ill patients in the resting state and during the administration of standardized total parenteral nutrition. DESIGN: This was a prospective, clinical cohort study of 25 consecutively admitted critically ill patients either with (n = 14) or without (n = 11) sepsis who received total parenteral nutrition. Resting energy expenditure was measured on days 0, 2, and 7 by indirect calorimetry. Energy and substrate balances were calculated on days 2 and 7. RESULTS: Resting energy expenditure was not significantly different between septic and nonseptic patients on day 0 (2.65 +/- 0.49 and 2.36 +/- 0.56 kJ x min(-1) x m(-2), respectively). Energy balances were positive for both groups on days 2 (0.68 +/- 0.4 and 0.74 +/- 0.6 kJ x min(-1) x m(-2), respectively; NS) and 7 (0.65 +/- 0.3 and 0.78 +/- 0.5 kJ x min(-1) x m(-2), respectively; NS). Substrate balances were not significantly different between groups on days 0, 2, and 7. Resting energy expenditure on day 0 was negatively correlated with the severity of illness in septic patients only (r = -0.58, P < 0.05). CONCLUSIONS: Metabolic changes were not significantly different between septic and nonseptic critically ill patients during the administration of standardized total parenteral nutrition. A disease-specific macronutrient composition of total parenteral nutrition formulas does not seem to be necessary in either septic or nonseptic critically ill patients.