股动脉置管持续微量动脉泵给药治疗糖尿病足病的疗效观察

目的 观察微量动脉泵持续股动脉输注前列地尔治疗糖尿病足病（DF）的疗效.方法 DF患者56例随机分为微量泵治疗组和对照组,治疗组给予微量泵持续股动脉输注前列地尔,对照组予静脉输注前列地尔,均持续3～7 d.观察两组冷感或红肿减轻例数及侧支循环建立例数.结果 治疗组病变肢体皮温升高多于对照组,比较差异有统计学意义[（2.52±0.70） vs （0.07±0.26）℃,t=17.61,P=0.002].治疗组患肢溃疡愈合情况好于对照组（P=0.001）.结论 微量动脉泵持续股动脉输注前列地尔治疗Foutain 3级及3级以上DF,可使患肢血管建立侧支循环,改善足部血供.     

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。     

ICU病房应用微量泵持续胰岛素输注控制糖尿病患者血糖的护理体会

目的分析ICU病房应用微量泵持续胰岛素输注控制糖尿病患者血糖的护理措施与实施效果。方法采用随机数字表法将该院2016年10月—2017年10月期间接收的90例ICU糖尿病患者分为对照组与观察组,各45例。两组患者均接受微量泵持续胰岛素输注治疗,对照组、观察组分别开展常规护理、联合全面护理。将两组结果对比分析。结果观察组患者的空腹血糖与餐后2 h血糖均明显低于对照组,其血糖恢复时间、ICU留住时间以及住院天数均短于对照组,胰岛素注射量和低血糖发生率均明显较对照组低,差异有统计学意义(P0.05)。结论为ICU病房应用微量泵持续胰岛素输注控制糖尿病患者实施全面护理的效果显著,其可促进患者血糖水平控制效果,且对低血糖的发生有预防作用。     

高血糖危象患者在停止静脉输注胰岛素向皮下注射胰岛素时转换方式的探讨

目的探讨高血糖危象患者静脉输注胰岛素向皮下注射速效胰岛素类似物的转换时机。方法将符合纳入和排除标准的使用微量泵持续静脉输注胰岛素降糖的糖尿病高血糖危象患者98例,采用随机数字表法分为实验组46例,在停止微量泵持续静脉输注胰岛素同时皮下注射速效胰岛素类似物;对照(Con)组52例,在停止微量泵持续静脉输注胰岛素前1h皮下注射速效胰岛素类似物,观察两组停泵前60、30min,停泵时,停泵后30、60、120min 6个时间点平均血糖值、血糖波动幅度。结果两组不同时间段血糖波动幅度比较,差异无统计学意义(P0.05)。结论停止微量泵持续静脉输注胰岛素,同时皮下注射速效胰岛素类似物可实现静脉胰岛素向皮下注射转换的连续性和血清胰岛素相对恒定,值得临床推广应用。     

留置胃管反复洗胃配合微量泵持续静注阿托品抢救急性重度有机磷农药中毒的临床观察与护理

目的观察留置胃管反复洗胃配合微量泵持续静注阿托品治疗急性重症有机磷农药中毒（ASOPP）的临床效果。方法观察组36例ASOPP病人,在常规治疗基础上,留置胃管反复洗胃并在首次静脉冲击后采用微量泵持续输注阿托品治疗;对照组34例常规治疗并以肌注加静脉持续滴注阿托品治疗。比较两组病人的疗效、阿托品和氯磷定用量的差异,病人昏迷持续时间、治愈率及死亡数、中间综合征发生率及住院时间的差异。结果观察组病人入院后24～72 h生命体征相对稳定;阿托品和氯磷定治疗用量、病人昏迷持续时间及住院天数明显少于对照组（P〈0.01）;中间综合征（IMS）发生率少于对照组,其差异均有统计学意义（P〈0.05）。结论留置胃管反复洗胃可及时、彻底、有效清除ASOPP病人胃肠道内的毒物;微量泵持续输注阿托品具有恒量、恒速、用药量稳定的优点,相互配合能显著提高疗效,减少并发症的发生并减轻护理工作量。     

动态血糖监测与胰岛素泵皮下持续输注联用于2型糖尿病患者胃转流术后血糖控制临床研究

目的 探讨动态血糖监测与胰岛素泵皮下持续输注联用于2型糖尿病患者胃转流术后血糖控制临床效果.方法 选取该院2012年8月-2014年4月收治的2型糖尿病行胃转流术患者60例,采用随机抽样法分为对照组(30例)和观察组(30例);其中对照组患者采用微量泵+皮下注射胰岛素进行术后血糖控制;而观察组患者则采用胰岛素泵皮下持续输注进行术后血糖控制;两组患者均以动态血糖监测系统评估术后血糖变化情况;比较两组患者术后血糖控制指标、住院时间及护理满意率等.结果 观察组患者平均血糖、血糖漂移最大幅度及胰岛素用量等术后血糖控制指标均显著优于对照组(P＜0.05);对照组和观察组患者住院时间分别为(8.37±1.50)d,(6.72±1.23)d;观察组患者住院时间显著少于对照组(P＜0.05).观察组患者护理满意率显著高于对照组(P＜0.05).结论 动态血糖监测与胰岛素泵皮下持续输注联用于2型糖尿病患者胃转流术后可有效控制血糖水平,加快康复进程,并提高护理满意程度.     

胰岛素不同给药方式治疗糖尿病酮症酸中毒的临床疗效分析

目的对比4种不同胰岛素给药方式治疗糖尿病酮症酸中毒的临床疗效。方法将该院2013年7月—2015年7月收入的168例糖尿病酮症酸中毒患者平均分为4组,分别在对症治疗的基础上采取不同胰岛素给药方式治疗:小剂量胰岛素持续静脉滴注、小剂量胰岛素微量泵持续泵入静脉、胰岛素一次性静脉冲击+小剂量持续静注和胰岛素泵持续皮下输注胰岛素。分别对患者的空腹血糖值、低血糖情况、血糖达标时间、PH值恢复时间、尿酮体转阴时间和胰岛素总用量进行统计和分析,评价胰岛素不同给药方式治疗糖尿病酮症酸中毒的临床疗效。结果在四种不同的胰岛素给药方式中,糖尿病酮症酸中毒治疗前后空腹血糖差异无统计学意义(P0.05),胰岛素泵持续皮下输注胰岛素方法治疗后血糖达标时间(3.98±1.71)h、PH恢复时间(8.93±2.22)h、尿酮体转阴时间(20.12±4.21)h均最短,且胰岛素总用量(59.34±8.90)U也最少,差异有统计学意义(P0.05)。此外,胰岛素泵持续皮下输注胰岛素方法治疗糖尿病酮症酸中毒后低血糖发生率(0例,0%)最低(P0.05)。结论采用胰岛素泵持续皮下输注胰岛素方法治疗糖尿病酮症酸中毒能够有效降低患者低血糖发生率,减少胰岛素的使用量,实现更好的血糖控制效果,可进行临床广泛推广应用。     

糖尿病足溃疡大鼠模型的建立

目的建立一种稳定简单的糖尿病足溃疡大鼠模型。方法50只雄性Wistar大鼠随机分为对照组（10只）和造模组（40只）。造模组高脂喂养后腹腔注射链脲佐菌素（STZ）,对照组注射等量缓冲液。监测两组空腹血糖、体质量、饮水量、尿量及股动脉血流变化。将两组大鼠足背部-矩形全层皮肤组织切除,建立糖尿病足溃疡模型,记录二组溃疡愈合时间。结果造模组比对照组大鼠血糖升高,体质量减轻,饮水量、尿量增加;造模3周后造模组双股动脉呈粥样化性改变,即血流频谱呈锯齿形,对照组血流正常;造模组溃疡愈合时间较对照组延迟（P〈0．01）。结论该方法建立的糖尿病足溃疡大鼠模型操作简单,成功率高,溃疡面积可控,是稳定的糖尿病足溃疡模型。     

胰岛素泵治疗糖尿病酮症酸中毒32例的护理

目的观察胰岛素泵持续输注小剂量胰岛素治疗糖尿病酮症酸中毒（DKA）的临床疗效及安全性。方法选择64例住院DKA患者,随机分成观察组和对照组各32例,观察组采用胰岛素泵持续输注微量胰岛素,对照组采用常规胰岛素小剂量静脉滴注。比较观察两组的临床疗效及不良反应。结果观察组血糖达标时间、尿酮转阴时间、二氧化碳结合力值恢复时间均较对照组明显缩短（P〈0．001）,低血糖发生率则比对照组明显减少（P〈0．001）。结论胰岛素泵微量持续输注胰岛素治疗DKA患者,给药更均衡与准确,安全性好,能更快、更有效地控制血糖。     

微量泵支气管动脉灌注化疗治疗中晚期肺癌35例疗效评价

目的研究微量泵支气管动脉灌注化疗治疗中晚期肺癌的疗效和安全性。方法采用Seldinger法,经皮穿刺股动脉插管,选择病灶靶血管支气管动脉并连接微量泵持续靶动脉内泵入紫衫醇＋奈达铂灌注化疗。结果经治疗患者临床症状均明显改善,未见并发症。鳞癌缓解率88%,腺癌缓解率67%,腺鳞癌缓解率40%。结论中晚期肺癌患者采用微量泵持续支气管动脉灌注化疗是一项疗效好、安全可靠的治疗手段。     

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.     

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。     

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。     

A comparison of methods of pathogen inactivation of FFP

Introduction Current methods for pathogen inactivation of plasma involve four major processes using solvent–detergent (SD), methylene blue (MB), amotosalen and riboflavin as additives. Three of these methods involve the use of visible or ultraviolet light. Methods A comparison of the four methods was made using publications in Medline, Pubmed, Embase and Biosis to obtain data on the logistics of use, the quality of the plasma proteins and the effectiveness of pathogen inactivation. Results Three of the methods, MB, amotosalen and riboflavin, are designed for use in a blood bank; the SD method is generally applied at a centralized manufacturing centre and involves large plasma pools. All methods result in a reduction in protein values with the per cent retention of FVIII activity in the range of 67–78% and fibrinogen of 65–84%. Protein S and alpha₂‐antiplasmin are lower following solvent–detergent treatment. Alterations in fibrinogen structure have been reported with methylene blue. Discussion Three of the methods are designed for small volume use in a blood bank. All four methods have some effect on the coagulant proteins; however, the final concentrations are within regulated limits. While there is variability in the effectiveness against pathogens, direct comparison is difficult because of the methodologies used. Nonetheless, all are effective in inactivating HIV and other lipid‐enveloped pathogens. Clinical studies on the effectiveness of these products are surprisingly sparse, and no randomized clinical trials have yet been performed with amotosalen or riboflavin plasmas.     

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。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.