雌马酚对芥子气所致家兔皮肤损伤的治疗作用及其机制的初步研究

目的 探讨具有雌激素样活性的雌马酚( equol,Eq)对芥子气染毒皮肤创面愈合的影响及可能的机制.方法 以芥子气(0.5 mg/cm2)染毒家兔臀部皮肤为实验模型,染毒创面连续1周外用不同浓度(10、50、100 μmol/L)的Eq 后,观察创面外观变化;取创面活检标本观察组织病理学变化;用流式细胞术分析细胞凋亡、DNA周期变化;用试剂盒检测染毒创面中IL-6、TNF-α的浓度.结果 染毒120 h后,所有治疗组染毒创面红斑、水肿、糜烂、坏死等皮损评分低于染毒对照组(P＜0.05);染毒168 h后,50 μmol/L治疗组染毒创面组织病理学炎症、坏死等改变评分低于染毒对照组(P＜0.05),各治疗组细胞凋亡百分比低于染毒对照组(P＜0.05),各治疗组细胞DNA(S+G2-M)周期百分比高于染毒对照组(P＜0.05),治疗组细胞中的IL-6、TNF-α含量低于染毒对照组(P＜0.05).结论 Eq可能通过抑制皮损局部炎症反应减少细胞凋亡,增强细胞增殖能力,从而促进芥子气所致皮肤损伤的愈合.     

碱性成纤维细胞生长因子治疗猪皮肤芥子气损伤

目的 :研究基因重组碱性成纤维细胞生长因子 (rb FGF)作为外源性生长因子对皮肤芥子气染毒创面愈合的影响。方法 :以芥子气 (0 .5 m g/ cm2 )染毒断乳小猪背部皮肤为实验模型 ,染毒创面经连续 1周外用 rb FGF后观察创面外观和组织病理学变化 ,并取创面活检标本用流式细胞术分析细胞 DNA周期变化以评价细胞增殖活力。 结果 :用药后芥子气染毒创面红斑糜烂期出现时间、程度和范围无明显改变 ,但创面结痂出现时间较早 [治疗组为 (8.2 5± 0 .96 ) d,对照组为 (9.75± 1.71) d,P <0 .0 5 ],愈合时间也明显缩短 [治疗组为 (14± 0 .82 ) d,对照组为 (2 0± 0 .82 ) d,P<0 .0 1];组织病理学变化显示治疗组细胞及纤维增生活跃 ;流式细胞术分析结果显示 S+G2 +M期百分比显著增高 [治疗组染毒后 3 d和 5 d分别为 (12 .49±0 .76 ) %和 (14.46± 1.6 1) % ,对照组则分别为 (9.92± 1.14) %和 (10 .43± 0 .70 ) % ,P<0 .0 1]。结论 :rb FGF对猪皮肤芥子气染毒创面的愈合有明显的促进作用。     

奥伐尼对芥子气所致皮肤损伤的保护作用

目的 研究奥伐尼对芥子气所致皮肤损伤的保护作用.方法 采用32和128 g/L芥子气5μl于KM小鼠右耳内侧染毒,建立两种损伤程度的小鼠耳郭染毒皮肤损伤模型.在32 g/L芥子气染毒模型中,染毒前20 min于小鼠右耳内侧涂抹奥伐尼0.125、0.25和0.5 mg/耳,或染毒前30 min灌胃给予吲哚美辛10 mg/kg,染毒24 h后,观察各组耳郭肿胀程度,制备耳郭皮肤切片观察皮肤组织病理变化.在128 g/L芥子气染毒模型中,小鼠右耳给予奥伐尼0.25 mg/耳或灌胃给予吲哚美辛10 mg/kg,染毒24 h后观察各组耳郭肿胀程度.结果 奥伐尼可显著降低32 g/L芥子气所致耳郭肿胀,并显著改善皮肤炎症、坏死等病理变化,但对128 g/L芥子气所致耳郭肿胀无明显影响.结论 奥伐尼对低剂量芥子气染毒所致皮肤损伤具有显著的保护作用.     

实验研究

目的：筛选治疗芥子气皮肤损伤的有效药物。方法：以刚断奶小猪为动物模型,染毒创面经连续1周分别外用速愈平,医用几丁糖,肤康霜,喜疗妥4种药物后,观察创面形态学和组织病理学变化,并取创面活检标本用流式细胞术分析细胞DNA周期变化来评价细胞增殖活力。结果：大体形态学发现,治疗组与对照组相比,红斑糜烂期出现时间,程度和范围无明显差别,但其中速愈平,几丁糖,肤康霜3组创面结痂时间早,愈合时间短,组织病理学观察也表明这3组创面细胞和纤维增生活跃,而喜疗妥组和对照组相比无明显差别,流式细胞术分析结果显示速愈平,几丁糖,肤康霜3组的创面S＋G2＋M期细胞比例显著高于喜疗妥组和对照组。结论：速愈平,几丁糖,肤康霜对猪皮肤芥子气损伤创面愈合有一定的促进作用。     

不同复方软膏制剂对家兔芥子气皮肤染毒的预防作用

目的:筛选预防芥子气皮肤中毒的有效药物.方法:以家兔为动物模型,以空白对照组和软膏基质组为对照,从创面形态学和组织病理学变化来观察分别含有半胱氨酸、甲壳胺、烟酸、EDTA这4种药物成分的软膏制剂对芥子气皮肤染毒的预防作用.结果:从创面形态学看,甲壳胺组、半胱氨酸组比对照组损伤面积小、恢复时间快、毛发再生早;从病理组织学变化看,这两组创面的表皮基底层基本完好,真皮充血、水肿、炎细胞渗出程度相对较轻.结论:甲壳胺和半胱氨酸对芥子气皮肤中毒有一定的保护作用,而烟酸和EDTA的效果不明显.     

表皮生长因子联合银离子敷料对III期、IV期压力性损伤患者血清炎性细胞因子和临床疗效的影响

目的 探讨分析表皮生长因子联合银离子敷料对III期、IV期压力性损伤患者血清炎性细胞因子和临床疗效的影响。方法 选取于2019年6月~2021年4月来我院接受治疗的压力性损伤患者120例,随机分为观察组和对照组,各60例。对照组患者外用药物为表皮生长因子凝胶,观察组患者外用药物为表皮生长因子凝胶联合银离子敷料。对比分析两组患者治疗前后的血清炎性细胞因子变化情况,观察对比各组患者不同时间点创面炎性反应情况和临床疗效情况。 结果 治疗后1周和治疗后2周,观察组患者的各项血清炎性细胞因子水平均明显低于对照组,差异有统计学意义（P＜0.05）。治疗后,两组患者创面中重度炎症发生率均逐渐降低。治疗1周后、治疗2周后和治疗4周后,观察组患者的中重度炎症发生率均明显低于对照组,差异有统计学意义（X2=5.673、13.807、4.227,P＜0.05）。治疗8周后,观察组患者总有效率为93.33%明显高于对照组总有效率73.33%,差异有统计学意义（X2=8.641,P＜0.05）。结论 联合使用重组人表皮细胞生长因子和银离子敷料能够有效降低中重度炎症的发生,降低炎性细胞因子水平,提高临床治疗有效率。     

VAC对猪爆炸伤感染创面细菌数和G+/G-比例的影响

目的:观察封闭负压引流技术(VAC)对猪皮肤软组织爆炸伤感染创面细菌数和G /G-比例的影响,为将该技术应用于爆炸伤的临床治疗提供实验依据.方法:用电雷管在4只15～20 kg的小白家猪双侧肩胛及双侧臀部造成16个爆炸伤创面,随机分为对照组和治疗组. 两组创面伤后前2 d不做任何治疗,以造成创面感染. 伤后3 d,对照组常规换药,治疗组采用-15 kPa负压的VAC治疗. 于治疗前和治疗后1,3,6,9,14和19 d取创面活组织,匀浆后将匀浆液倍比稀释,在血琼脂糖平板上37℃孵育24 h,进行细菌计数,并对每份标本的200个菌落进行革兰氏染色,计算革兰氏阳性菌的比例.结果:治疗前创面中的细菌数高达107,VAC治疗后3 d,治疗组细菌数迅速下降到(1.91±0.245)×105 cfu/g,治疗后6 d降至(0.51±0.120)×105 cfu/g. 对照组创面内的细菌数下降缓慢,在治疗后9 d降至(19.54±3.67)×10 5 cfu/g;治疗后19 d仍高达(3.26±0.83 )×105 cfu/g,治疗后1～19 d,治疗组创面内的细菌数比对照组明显减少(P＜0.01). 治疗前两组创面革兰氏阳性(G )细菌比例在31%～36%之间; 治疗后治疗组创面革兰氏阳性细菌比例逐渐增高,6 d增至(55.58±2.98)%,其后维持在较高水平;对照组中G 细菌的比例在治疗后1～19 d始终维持在30%～40%,明显较治疗组低(P＜0.01).结论:与对照组相比,VAC能有效地减少猪皮肤软组织爆炸伤感染创面的细菌数,且能降低创面内革兰氏阴性细菌的比例.     

银锌抑菌霜联合重组人表皮生长因子凝胶在皮肤碾挫伤创面中的应用

目的探讨银锌抑菌霜联合重组人表皮生长因子凝胶在皮肤碾挫伤创面中的疗效。方法选取2017年4月至2018年12月在我院门诊换药室换药的皮肤碾挫伤患者50例,随机分为对照组和观察组,每组25例。对照组运用碘伏油纱常规换药,观察组运用银锌抑菌霜联合重组人表皮生长因子凝胶换药,比较两组伤口换药次数、伤口愈合时间、治疗有效率。结果观察组的换药次数为(8.16±1.21)次,显著少于对照组的(17.92±1.93)次,创面愈合时间为(17.56±2.62)d,显著短于对照组的(30.16±3.09)d,差异有统计学意义(P0.05)。观察组的治疗有效率为96.0%(24/25),高于对照组的60.0%(15/25),差异有统计学意义(P0.05)。结论皮肤碾挫伤创面使用银锌抑菌霜联合重组人表皮生长因子凝胶可减少创面换药次数,缩短创面愈合时间,安全有效,值得临床推广应用。     

rHuEPO、rHuGM-CSF对大鼠芥子气全身中毒疗效的初步评价

目的：评价重组人红细胞生成素（rHuEPO），重组人粒细胞－巨噬细胞集落刺激因子（rHuGM－CSF）,对SD大鼠芥子气全身中毒的治疗作用。方法：本实验以SD大鼠为动物模型，4mg/kg体重芥子气皮下注射为中毒剂量。治疗组动物在中毒后0.5h即皮下注射治疗药物，其中rHuEPO的剂量为300IU/kg体重，第1天和第3天各1次；rHuGM－CSF的剂量为15μg/kg体重，连续应用5d。通过观察1周内动物腹泻率，死亡率，体重变化，血常规指标变化，骨髓细胞增生程度和细胞学分类等来评价药物疗效。结果：和中毒对照组相比，药物治疗组的腹泻率，死亡率，动物体重，血常规指标以及骨髓细胞学分类等均无显著差异。但治疗组在中毒后第8天的血常规中红细胞（RBC）和血红蛋白（HGB）已上升到和正常对照组无明显差异，而中毒对照组却仍然显著低于正常对照组。另外，虽然统计学上无显著差异，但骨髓细胞分类显示治疗中单核细胞系比例和红细胞系比例也较中毒对照组有升高趋势。结论：SD大鼠芥子气中毒后，只应用rHuEPO和rHuGM－CSF进行药物治疗，虽然能一定程度上刺激骨髓红细胞系和单核细胞系的生长，但对其他细胞系的刺激作用不明显，而且反而可能由于其副作用使动物的腹泻率和死亡率升高。因此在芥子气全身中毒的综合治疗方案中，rHuEPO和rHuGM－CSF只能起辅助治疗作用。     

矾冰液联合康复新液湿敷治疗Ⅲ～Ⅳ度放射性皮肤损伤的护理观察

目的 观察矾冰液联合康复新液湿敷治疗Ⅲ～Ⅳ度放射性皮肤损伤的临床疗效.方法 将68例Ⅲ～Ⅳ度放射性皮肤损伤患者随机分为2组,清洗创面后,观察组34例分别矾冰液、康复新液湿敷创面,对照组34例用硫酸庆大霉素、康复新液湿敷创面.结果 观察组换药次数比对照组少,愈合时间观察组比对照组短,观察组总有效率97.06%,对照组为91.18%,两组比较有统计学意义.结论 矾冰液联合康复新液湿敷治疗Ⅲ～Ⅳ度放射性皮肤损伤,在缩短伤口愈合时间、促进损伤皮肤愈合等方面有较好效果.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.