143例玉树地震藏族伤员临床特点和救治分析

目的总结玉树地震藏族伤员的临床特点和救治经验,为健全地震灾害应急预案机制提供决策参考。方法回顾性分析绵阳地震救援队2010年4月16～22日收治的143例玉树地震藏族伤员情况,根据伤员登记表,调查伤员性别、年龄、致伤方式、救援地点、救援时间、主诉、初步诊断、现场处置、转运以及心理危机干预等。结果收治的143例玉树地震藏族伤员中,男74例,女69例,软组织损伤74例,骨折伤员67例(开放性骨折4例,闭合性骨折63例),关节脱位5例,神经损伤3例;采用藏汉疗法结合外固定治疗62例,急诊手术5例,拒绝外科清创缝合6例,无死亡病例。对所有伤员均进行了3～11次心理干预治疗。在伤员转运方面,建议转出54例,实际转出48例,6例失访或拒绝,继续在原地治疗。结论玉树地震藏族伤员的临床特点明显。民族地区灾害医疗救治要适合灾区特点,个体化救治,及早心理干预,是提高非汉语言地震医疗救援整体水平的重要措施。     

老年慢性阻塞性肺气肿患者49例疗效观察

目的观察抗生素联合糖皮质激素用于老年慢性阻塞性肺气肿的临床疗效。方法对笔者所在医院收治的49例老年慢性阻塞性肺气肿患者随机分成两组,对照组25例与观察组24例,对照组采用常规治疗,观察组采用糖皮质激素配合常规治疗的治疗方法,分析比较对照组与观察组的疗效与不良反应。结果经过常规治疗,对照组总有效率为64.0%;观察组总有效率为91.7%,两组比较差异有统计学意义(P<0.05);治疗过程中对照组2例出现不良反应,观察组3例出现不良反应;两组不良反应的发生情况比较差异无统计学意义(P>0.05)。结论抗生素联合糖皮质激素用于老年慢性阻塞性肺气肿治疗,与常规治疗相比疗效显著,值得在临床治疗中予以推广。     

小儿气管插管时七氟醚合适临床浓度的研究

目的探讨小儿气管插管时七氟醚的合适浓度。方法择期小儿腹股沟斜疝或鞘膜积液手术30例。术前常规禁食禁饮。根择Dixon序贯法来确定气管插管的七氟醚浓度。在咽喉反射消失、下颌松弛、睫毛反射消失时由同一熟练的麻醉医生行气管插管。结果气管插管时呼末七氟醚浓度的ED50为5%。结论在不用其他药物辅助时,小儿气管插管时适宜的七氟醚浓度为5%。     

髓芯减压与钽棒植入治疗早期股骨头坏死的比较

目的：对比多孔髓芯减压与钽金属棒治疗早期股骨头坏死的临床疗效。方法：将早期股骨头坏死患者29例36髋随机分为2组,髓芯减压组17例22髋采用多孔髓芯减压治疗患髋,钽棒组12例14髋采用多孔钽金属棒治疗。术后3月、6月、12月随访比较2组病例髋关节功能Harris评分和视觉模拟疼痛评分(VAS)。并于末次随访时,根据ARCO分期和坏死面积大小进行VAS评分及Harris评分。结果：所有患者均获得随访,随访时间6～12个月,平均10.5个月。术后3月、6月、12月2组患者VAS评分均较术前明显降低（P＜0.05）,髋关节功能Harris评分均较术前明显提高（P＜0.05）。但相同随访时间点2组VAS评分和Harris评分均无显著差异（P＞0.05）。末次随访时ARCOⅡb期、Ⅲ期患者VAS评分明显高于Ⅰ期、Ⅱa期患者,髋关节功能Harris评分明显低于Ⅰ期、Ⅱa期患者（P＜0.05）。股骨头坏死面积＜25%患者VAS评分明显低于坏死面积＞25%患者,髋关节功能Harris评分明显高于坏死面积＞25%患者（P＜0.05）。结论：多孔髓芯减压和钽金属棒治疗早期股骨头坏死均有效,但ARCOⅡb期、Ⅲ期及股骨头坏死面积＞25%患者预后欠佳。     

Inhibition of 5-HT3 receptors-activated currents by cannabinoids in rat trigeminal ganglion neurons

This study investigated the modulatory effect of synthetic cannabinoids WIN55,212-2 on 5-HT3 receptor-activated currents (I5-HT3) in cultured rat trigeminal ganglion (TG) neurons using whole-cell patch clamp technique. The results showed that: (1) The majority of examined neurons (78.70%) were sensitive to 5-HT (3-300 μmol/L). 5-HT induced inward currents in a concentration-dependent manner and the currents were blocked by ICS 205-930 (1 μmol/L), a selective antagonist of the 5-HT3 receptor; (2) Pre-application of WIN55,212-2 (0.01-1 μmol/L) significantly inhibited I5-HT3 reversibly in concentration-dependent and voltage-independent manners. The concentra-tion-response curve of 5-HT3 receptor was shifted downward by WIN55,212-2 without any change of the threshold value. The EC50 values of two curves were very close (17.5±4.5) mmol/L vs. (15.2±4.5) mmol/L and WIN55,212-2 decreased the maximal amplitude of I5-HT3 by (48.65±4.15)%; (3) Neither AM281, a selective CB1 receptor antagonist, nor AM630, a selective CB2 receptor antagonist re-versed the inhibition of I5-HT3 by WIN55,212-2; (4) When WIN55,212-2 was given from 15 to 120 s before 5-HT application, inhibitory effect was gradually increased and the maximal inhibition took place at 90 s, and the inhibition remained at the same level after 90 s. We are led to concluded that-WIN55,212-2 inhibited I5-HT3 significantly and neither CB1 receptor antagonist nor CB2 receptor an-tagonist could reverse the inhibition of I5-HT3 by WIN55,212-2. Moreover, WIN55,212-2 is not an open channel blocker (OCB) of 5-HT3 receptor. WIN55,212-2 significantly inhibited 5-HT-activated currents in a non-competitive manner. The inhibition of I5-HT3 by WIN55,212-2 is probably new one of peripheral analgesic mechanisms of WIN55,212-2, but the mechanism by which WIN55,212-2 in-hibits I5-HT3 warrants further investigation.     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.     

内膜下血管成形术治疗股腘动脉TASC Ⅱ C、D型病变

目的观察内膜下血管成形术治疗股胭动脉TASCⅡC、D型病变的近期疗效。方法回顾性分析采用内膜下血管成形术治疗的48例以股胭动脉病变为主的动脉硬化闭塞症患者的临床资料。结果48例患者中，技术成功38例，临床症状改善40例。患者术后平均随访12个月（1—21个月），临床症状消失和缓解的患者中有6例术后2—6个月症状复发，行第2次介入治疗，其余患者症状均无加重或复发。结论内膜下成形术治疗粥样硬化导致的股胭动脉段TASCⅡC、D型病变完全可行，近期疗效确切，其长期疗效还需进一步随访观察。     

浙江省肺结核病人发现模式和效果分析评价

目的充分发挥综合医院作用，提高肺结核病人发现率。方法通过全面推行结核病控制策略(DOTS)，实行以综合医院为中心的归口转诊模式，明确结核病诊治机构和综合医院职责和分工，建立综合医院转诊制度。结果全省传染源发现率平均已达55．7％；新发涂阳肺结核病新登记率从2001年16．37／10万上升到2003年25．60／10万，增长了55．5％；转诊率从2000年77．8％上升到2003年95．9％，增长了44．2％。结论全省以综合医院为中心的归口转诊制度的推行，有效提高了综合医院肺结核病人的转诊率和涂阳病人的发现工作，因此如何利用现有医疗资源，发挥综合性医院的作用，对结核病控制工作是至关重要的。     

动力髋螺钉内固定与人工股骨头置换治疗高龄股骨转子间骨折短期疗效比较

目的 探讨动力髋螺钉(DHS)与人工股骨头置换(HA)治疗高龄转子间骨折的效果.方法 对行DHS内固定(90例)与HA(66例)的高龄顺转子间骨折患者临床资料进行回顾性研究,对比分析两组患者术后功能恢复及并发症情况.结合Tronzo-Evans骨折分型及Singh指数分级,探讨高龄转子间骨折治疗方式的选择.结果 对患者随访12～108个月.HA组较DHS组术后下地早,并发症发生率低,髋关节功能优良率高.在内固定失败率和假体松动率方面,HA组不仅在Ⅲ、Ⅳ型不稳定骨折和Singh指数在1～3级患者中明显低于DHS组,在Ⅰ、Ⅱ型稳定骨折和Singh指数在4～6级患者中亦明显低于DHS组(P<0.05).结论 HA治疗高龄顺转子间骨折短期疗效良好.结合Tronzo-Evans分型和Singh指数分级对高龄转子间骨折治疗具有指导意义,高龄转子间Ⅲ、Ⅳ型骨折首选HA治疗;对于严重骨质疏松Singh指数在1～3级的高龄患者,即使Ⅰ、Ⅱ型稳定骨折,也可首选HA治疗.