152例肝移植术后肝功能异常的肝活检

目的评价肝活检在明确肝移植术后肝损害病因中的作用，分析组织学诊断存在误差的常见原因，进一步提高肝活检的准确性，以利临床治疗。方法260例肝活检来自于152例肝移植受者，术后出现临床无法解释的肝功能异常，肝功能检测结果高于正常值的2倍以上。回顾组织学改变及最终的临床诊断，评价相符程度。结果大部分的组织学诊断与最终的临床诊断相符，有7例组织学改变为胆管炎后经进一步临床检查证实4例为血管并发症、2例为败血症、1例为保存性损伤。2例组织学诊断为保存性损伤的病例后证实为药物性肝损害。结论移植后肝活检可明确许多肝功能异常的原因；评判病变的严重程度，指导临床治疗；对一些复杂病例应将以往的活检和整个临床病程、其他实验室检查及影像学检查进行综合考虑，可提高诊断的准确性。     

骨膜间质干细胞移植时机的实验和临床研究

目的 研究骨膜间质干细胞异体移植时机。方法 根据骨缺损内纤维组织生长时间的不同，将从大鼠骨膜分离培养的细胞分别分批植入，在植入的第2、3、4和8周时动态观察其成骨量，即骨小梁体积比；另将幼儿骨膜间质干细胞悬液，移植于26例长管状骨干骨折2周后的缺损内，观察骨折临床愈合的时间。结果 大鼠骨缺损后2周以内移植干细胞其骨小梁体积比大，愈合快，2周以后与对照组比无显著差异；临床应用9个月内病人骨折缺损愈合15例(57．7％)，骨不愈合者11例(42．3％)。结论 大鼠骨缺损2周以内移植干细胞其疗效好，大鼠实验和临床上骨缺损2周以后移植骨膜间质干细胞不能明显促进骨缺损愈合。     

雷米芬太尼复合异丙酚靶控输注对心功能影响的观察

目的:比较雷米芬太尼复合异丙酚靶控输注(TCI)与吸入麻醉对心功能的影响。方法:选择ASAⅠ～Ⅱ级、年龄18～65岁、择期行鼻内窥镜手术的病人40例,随机分为两组,每组20例。靶控输注组(TCI组):以异丙酚(血浆靶浓度4μg/kg)和雷米芬太尼(血浆靶浓度4ng/kg)同时TCI诱导和维持,吸入麻醉组(IN组)予单次推注异丙酚、芬太尼和阿曲库铵诱导,术中复合吸入地氟醚和氧化亚氮。两组术中均维持BIS值40～60。以Bioz.com无创心功能监测仪监测并记录入室时、诱导后、插管时、插管后5min、术中刺激较大操作时和拔管时的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心指数(CI)、外周血管阻力(SVR)和心室加速指数(ACI),记录血管活性药物的使用例数。结果:诱导以后的心率IN组明显高于TCI组(P<0.05),插管时和拔管时IN组HR、MAP和SVR的波动比TCI组明显,术中IN组SVR下降程度大于TCI组(P<0.05)。整个麻醉过程TCI组CI和CO有轻度下降,ACI也有所下降。结论:雷米芬太尼复合异丙酚TCI较传统吸入麻醉在诱导、插管、术中和拔管过程血流动力学都较为平稳,对ACI有所抑制...     

硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响

目的探讨硬膜外腔注射生理盐水对剖宫产术患者腰麻效果的影响。方法择期行子宫下段剖宫产术患者60例,年龄24～30岁,体重59～73 kg,随机分为2组,每组30例,A组蛛网膜下腔注射规定剂量的0.75%布比卡因后硬膜外腔注射生理盐水5 ml;B组蛛网膜下腔注射0.75%布比卡因。按序贯法进行试验,设定布比卡因的起始剂量为9 mg,剂量梯度为1.5 mg,若上一例有效,则下一例递减一个剂量梯度,若无效则下一例递增一个剂量梯度,蛛网膜下腔阻滞有效的标准为注射布比卡因后20 min内阻滞上平面达T5。采用概率单位法计算ED50。结果A组布比卡因的ED50（5.8 mg）低于B组（8.1 mg）,两组比值为0.72,95%置信区间为0.27～0.98,区间范围不包括1,差异有统计学意义（P〈0.05）。结论硬膜外腔注射生理盐水可增强剖宫产术患者腰麻的效果。     

Role of angiotensin Ⅱ and JAK2 signal pathway in transdifferentation of renal tubular cells in mice after acute ischemic followed by reperfusion

Objective To investigate the effect of angiotensin (Ang) Ⅱ and its Janns-activated kinase-2 (JAK2) signal pathway in transdifferentiation of renal tubular cells under the challenge of acute ischemic reperfusion injury.Methods Models of acute ischemic reperfusion injury were established and the level of local Ang Ⅱ ,a key element of renin-angiotensin system (RAS),in kidney was measured using radioimmunity technique.The expression of α-smooth muscle actin (α-SMA),a phenotype of mesenchymal cells,was detected by RT-PCR and inununohistochemistry methods.Renal tubule cells ( NRK-52E) were cultured with various concentration of Ang Ⅱ ,followed by blocking of PD123319,Ang U receptor 2 antagonist,and AG490,an inhibitor of JAK2 signal pathway.Results Ang 0 of kidney tissue increased immediately after acute ischemic-reperfusion injury,in time dependent fashion.Expression of α-SMA in renal tubule cells was found at 48 hours after ischemic-reperfusion injury and in NRK-52E cells treated by high concentration of Ang Ⅱ and was dose and time dependent.The peak of α-SMA expression was seen after 30 minute treatment at the dose of 10-9'mol/L,which was interrupted by both of PD123319 and AG490.Conclusions Transdifferentiarion of renal tubular epithelial cells occurs under acute ischemic- reperfusion injury.Local renin-angiotensin system may play a role in the transdifferentiation of TEC through AT2 receptor and its JAK2 signal pathway.     

Role of angiotensin Ⅱ and JAK2 signal pathway in transdifferentation of renal tubular cells in mice after acute ischemic followed by reperfusion

Objective To investigate the effect of angiotensin (Ang) Ⅱ and its Janns-activated kinase-2 (JAK2) signal pathway in transdifferentiation of renal tubular cells under the challenge of acute ischemic reperfusion injury.Methods Models of acute ischemic reperfusion injury were established and the level of local Ang Ⅱ ,a key element of renin-angiotensin system (RAS),in kidney was measured using radioimmunity technique.The expression of α-smooth muscle actin (α-SMA),a phenotype of mesenchymal cells,was detected by RT-PCR and inununohistochemistry methods.Renal tubule cells ( NRK-52E) were cultured with various concentration of Ang Ⅱ ,followed by blocking of PD123319,Ang U receptor 2 antagonist,and AG490,an inhibitor of JAK2 signal pathway.Results Ang 0 of kidney tissue increased immediately after acute ischemic-reperfusion injury,in time dependent fashion.Expression of α-SMA in renal tubule cells was found at 48 hours after ischemic-reperfusion injury and in NRK-52E cells treated by high concentration of Ang Ⅱ and was dose and time dependent.The peak of α-SMA expression was seen after 30 minute treatment at the dose of 10-9'mol/L,which was interrupted by both of PD123319 and AG490.Conclusions Transdifferentiarion of renal tubular epithelial cells occurs under acute ischemic- reperfusion injury.Local renin-angiotensin system may play a role in the transdifferentiation of TEC through AT2 receptor and its JAK2 signal pathway.     

术前术后介入治疗30例子宫颈浸润癌

目的：应用介入、手术、再介入的方法治疗子宫颈浸润癌30例，观察其消长变化，与以往的常规治疗方法相比较，评价该治疗方案在临床上的应用价值。方法：收集子宫颈浸润癌Ⅰb-Ⅲ期患者30例，术前常规行盆腔介入治疗。介入后14天，行子宫颈癌根治术，术后根据临床分期分别再介入3-6次。结果：30例患者经过介入、手术、再介入治疗后，分别追踪随访1-6年，未见复发。结论：子宫颈癌介入、手术、再介入治疗，效果肯定，并可延长患者的生存时间，值得临床借鉴。     

2000年～2002年广东省40余家医院抗心律失常药用药分析

目的 :了解广东省40余家医院抗心律失常药应用情况。方法 :对所选医院3年中使用的抗心律失常药购药金额、用药频度及日均费用数据进行统计分析。结果 :3年中 ,抗心律失常药物购药金额呈逐年上升趋势 ,但增长速度逐年减慢 ;国产药市场份额逐年上升 ,进口药市场份额逐年下降 ,合资药市场份额保持平稳 ;用药频度最高的药是美托洛尔和门冬氨酸钾镁。用药金额排第1位的是美托洛尔。结论 :我国抗心律失常药市场将继续扩大 ,国内制药企业应加大对抗心律失常药物的开发、研制力度。     

术中液体治疗量对100例妇科腔镜患者术后恶心呕吐的观察

目的　比较术中补充30 ml/kg乳酸林格液与10 ml/kg乳酸林格液的妇科腔镜患者术后恶心呕吐的发生率。方法　选择100名ASAⅠ~Ⅱ级择期行妇科腔镜不孕查因的患者, 随机分为两组, Ⅰ组患者入手术室至手术结束出麻醉恢复室前共接受30 ml/kg 乳酸林格液, Ⅱ组患者入手术室至手术结束出麻醉恢复室前接受10 ml/kg乳酸林格液, 观察术后发生恶心呕吐的患者例数及需要补救止吐药例数。结果　两组患者年龄、体重、禁食时间、手术操作时间差异无显著性; 术后48h恶心呕吐发生率, 30 ml/kg组较10 ml/kg组明显降低(P<0 05),需要补救止吐药人数30 ml/kg组较10 ml/kg组明显降低(P<0 05)。结论　与输注10 ml/kg乳酸林格液相比,术中输注30 ml/kg乳酸林格液可以降低妇科腔镜患者术后恶心呕吐的发生率。     

葡萄球菌医院感染及其耐药性

目的通过院内患者葡萄球菌感染及耐药状况调查分析,为临床治疗提供依据。方法按《全国临床检验操作规程》培养分离菌种,用法国生物梅里埃公司VITEK-60 System全自动细菌分析仪鉴定菌种及K-B单片琼脂扩散法做药敏试验。结果门诊患者626例分离出葡萄球菌159株,其中耐甲氧西林葡萄球菌(MRS)占46.1%,以生殖道感染为主;住院患者3 236例分离葡萄球菌390株,其中MRS占81.7%,以呼吸道感染为主;甲氧西林敏感葡萄球菌(MSS)对青霉素的耐药率较高,而万古霉素和替卡拉宁则对MRS显示较强的抗菌活性。结论从感染部位显示,门诊患者以生殖道为主,住院患者以呼吸道为主,预防和控制MRS传播应成为医院感染的重要课题;从药敏试验结果显示,万古霉素是MRS感染的最佳抗菌药物,其次是替考拉宁,对MRS感染联合用药是必要的。