高原肺水肿不同治疗方案的疗效比较及其规范化治疗初步探讨

目的通过高原肺水肿（HAPE）不同治疗方案的疗效比较,对其规范化治疗进行初步探讨。方法将400例HAPE患者或随机分为A、B、C、D4组,A组给予吸氧、地塞米松、氨茶碱治疗,B组在A组基础上给予速尿治疗,C组在A组基础上给予硝苯地平治疗,D组在A组基础上给予左旋精氨酸治疗,并对4组的治疗效果及安全性（包括副作用及肝肾功能）进行综合评价,对其中安全、疗效显著的一组治疗方案进行规范化。结果 4种治疗方案对HAPE均具有明显的治疗作用,通过对其临床症状消失时间、体征消失时间、肺部X线阴影消失时间及住院时间比较,B组均显著低于A组、C组及D组（P〈0.01或P〈0.05）,A组、C组及D组之间相互比较无显著差异;4种治疗方案安全性比较,C组副作用发生率显著高于A组、B组及D组（P〈0.01）,A组、B组及D组之间副作用及4组肝肾功能之间比较均无显著差异。结论以吸氧、地塞米松、氨茶碱、速尿组成的HAPE治疗方案具有使用方便、高效、安全的特点,可作为HAPE规范化治疗方案加以推广。     

腹腔镜下经后腹膜切除结核性无功能肾的应用价值

 目的 探讨后腹腔镜手术切除结核性无功能肾的应用价值。方法 收集西藏军区总医院37例后腹腔镜切除结核性无功能肾的临床资料。统计手术时间、术中出血量、术后住院时间、术后并发症、病人随访情况等指标,综合评价该手术方法的有效性及安全性。结果 37例均成功实现腹膜后腹腔镜下切除,手术时间120~200 min,平均(150±23)min;术中出血80~300 ml,平均(l50±36)ml。所有切口均一期愈合,术后住院时间5~7 d,平均(6±1)d。随访6～24个月,平均(12±3)个月,无远期并发症。结论 腹腔镜下经后腹膜切除结核性无功能肾安全、有效、可靠。     

HLA-A^＊0201／WTl五聚体联合胞内IFNγ染色在检测白血病患者外周血WT1特异性T细胞中的应用

本研究探讨五聚体及胞内因子染色在定性定量检测抗原特异性T细胞中的应用价值。用RT—PCR方法检测受试者WT1表达水平;用HLA—A＊0201／wTl五聚体及胞内IFNγ染色检测14例表达HLA—A＊020l的白血病患者全相合移植前后及其供者外周血中的WT1特异性T细胞。结果表明：14例供者中2例有低水平WT1表达,白血病患者均有不同水平的WT1表达。14例供者均未检测到WT1＋CD8^＋CTL和WT1^＋IFNγ^＋细胞;移植前14例患者中2例可检出WT1^＋CD8^＋CTL,3例检出WTl^＋IFNγ^＋细胞,二者间无明显差异（P=0．357）,而移植后均可检出WT1^＋CD8^＋CTL和WT1^＋IFNγ^＋细胞,明显高于移植前（P值均〈0．01）。移植后大部分患者均在30天内检出WT1^＋CD8^＋CTL和WT1^＋IFNγ＋细胞,但后者检出率高于前者（P=0．014）。14例患者中WT1^＋CD8^＋CTL峰值中位数为0．18％,而WT1^＋IFNγ^＋细胞峰值中位数为0．83％,明显高于前者（P=0．005）;WT1^＋CD8^＋CTL峰值中位时间为移植后75天,WT1^＋IFNγ^＋细胞峰值中位时间为移植后105天,但二者间无明显差异（P=0．455）。结论：五聚体及胞内IFNγ染色能有效检测白血病患者外周血中白血病抗原特异性T细胞;两种方法联合检测有助于抗原特异性T细胞的准确定性定量检测。     

高海拔地区战士血管迷走性晕厥导致面部外伤临床分析

目的通过回顾分析高原地区晕厥导致颌面部外伤患者病例资料,了解这类面部外伤伤情和治疗特点。方法选择1997～2007年收治的以晕厥而导致的面部外伤病例36例,患者均为部队战士,由于长时间站立发生晕厥,导致面部外伤。回顾分析这类伤情的临床特征和治疗特点。结果所有患者均有颏部线形软组织挫裂伤,清创缝合后伤口I期愈合;32例（88．9％）共116颗牙齿有不同程度牙折,其中12．9％的牙齿需要拔除,其余牙齿进行相应的牙体牙髓治疗,并义齿修复牙体牙列缺损;9例（25％）发生颞下颌关节挫伤,对症处理;其中5例由岗台跌落者中4例发生下颌骨骨折,通过牙弓夹板和坚固内固定治疗恢复原有的咬合关系。结论高海拔地区战士长时间站立发生晕厥导致面部外伤的原因和伤情特殊,在处理软组织伤的同时要避免漏诊牙齿、颞下颌关节和下颌骨损伤;牙齿和下颌骨损伤是治疗的重点,恢复患者咀嚼功能是治愈的标准。     

片仔癀逆转人结肠癌细胞HCT-8/5-Fu耐药性的实验研究

目的为提高高原部队医疗服务效能、充分利用卫生资源提供依据。方法总结2011年西藏那曲175名军官的健康查体资料,进行统计分析。结果前八位主要疾病谱为：高原红细胞增多症,高尿酸血症,高脂血症,脂肪肝,心电图及心脏彩超异常,脾脏增大,肺气肿,高血压,部分疾病与年龄及入藏时间有相关性。体检正常者仅12例,检出阳性率为93．1％;检出2种及以上疾病者116例,占66．3％。结论西藏那曲驻军军官的健康状况不容乐观,而加强对高原疾病的预防和高原疾病的诊治研究,是该地区卫生勤务工作的重点。     

Calcific uremic arteriolopathy ameliorated by hyperbaric oxygen therapy in high-altitude area

Background: Calcific uremic arteriolopathy (CUA), previously called calciphylaxis, is a devastating complication of end-stage kidney disease (ESKD) with an annual incidence of 1–4% in dialysis patients and the mortality is as high as 80%. The rarity of the disease and the multifactorial nature of its causes have compromised good evidences that could determine the best therapy for the condition. For inhabitants in high-altitude area, the content of oxygen in the air is significantly lower than that in sea level area, which leads to the differences in the clinical manifestations and treatments to CUA. Case presentation: We presented a patient with CUA on Tibetan Plateau successfully treated by hyperbaric oxygen (HBO). This 46-year-old uremic Tibetan peasant received hemodialysis for 10 years, and over the last six months, skin necrosis occurred progressively on the distal joint of the middle finger of his right hand and the distal knuckles became paled, hardened, and severely painful. Extensive calcification of the arteries of both hands was revealed and his serum phosphorus elevated and serum calcium decreased. After diagnosis of CUA, patient was treated with HBO therapy for successive three weeks with a session per day, on the basis of secondary infection prevention. Pain of the affected finger was quickly alleviated in one week and the lesions of the affected finger healed in two months. Conclusion: As the dialysis population in high-altitude area increasing rapidly in recent years, this management strategy of improving focal oxygen supply by HBO might act as a reference for the treatment of CUA patients in similar conditions.     

西藏地区再发性上消化道出血临床特征与防治探讨

本组上消化道出血患者再出血率较高(汉族43.1%、藏族22.2%).两次出血时诱因、病因大多各异(分别为93.9%、89.4%),第二次出血量较第一次增大(P相似文献   

高原缺氧高度相关性疾病及对高原病新分型探讨

在平原存在的疾病,于高原低氧环境下大部分会表现出与平原不同的特征。有的高原特征不明显;而有的疾病高原特征非常明显,与缺氧高度相关。笔者将那些平原已有的、在高原环境下受高原缺氧影响特别大、与高原缺氧相关性特别强、     

西藏地区588例颌面部创伤的临床分析

目的:回顾性分析西藏地区颌面部损伤的临床流行病学特点.方法:对西藏军区总医院口腔科2001-06-2010-06间收治的588名颌面部创伤患者的病历资料进行回顾性研究.结果:颌面部损伤患者人数占本科住院总人数的26.4％,男女比例为4.8∶1,21～50岁为发病高峰年龄段,5～10月份为高发期.交通事故在致伤原因中居首...     

Effects of recombinant human granulocyte colony-stimulating factor on central and peripheral T lymphocyte reconstitution after sublethal irradiation in mice

Granulocyte colony-stimulating factor (G-CSF) is one of the most critical cytokines used for the treatment of acute radiation syndrome (ARS). In addition to the hematopoietic effects of G-CSF on the differentiation and proliferation of myeloid progenitor cells, G-CSF is also known to have immunomodulatory effects. The aim of the present study was to investigate whether G-CSF could accelerate central and peripheral T lymphocyte recovery after a sublethal dose of irradiation. Female BALB/c mice were subjected to 6 Gy of total body irradiation and then were treated with either 100 μg/kg G-CSF or an equal volume of PBS once daily for 14 days. Percentages of thymocyte subpopulations including CD4 − CD8 − , CD4 + CD8 + , CD4 + CD8− and CD4 − CD8+ T cells, peripheral CD3 + , CD4+ and CD8+ cells were analyzed by flow cytometry. Recent thymic emigrants (RTEs) were assessed by real-time polymerase chain reaction (PCR) using primers specific to the 257-bp T cell receptor rearrangement excision circles (sjTRECs). The proliferative capacity of splenic mononuclear cells upon exposure to ConA was measured by using the Cell Count Kit-8 (CCK-8). G-CSF treatment promoted thymocyte regeneration, accelerated the recovery of CD4 + CD8+ cells and increased the frequency of thymocyte sjTRECs. These effects were more prominent at early time points (Day 28) after irradiation. G-CSF also increased the rate of recovery of peripheral CD3 + , CD4+ and CD8+ cells and shortened the period of severe lymphopenia following irradiation. G-CSF also increased the splenic mononuclear cell mitotic responsiveness to ConA more than control-treated cells. Our results show that G-CSF accelerates T cell recovery through both thymic-dependent and thymic-independent pathways, which could be used to increase the rate of immune reconstitution after sublethal irradiation.