危重患儿血糖与胰岛素水平的临床分析

Objective To analyse the changes of blood glucose and insulin levels in children with critical illness,and to investigate the mechanism of hyperglycemia in critical illness.Methods Blood glucose and insulin levels were detected among 51 critically ill children hospitalized in our PICU from January to December,2007,which were compared with those of 15 healthy children.Results (1) All the patients had hyperglycemia after admission within 2Ah,septic shock patients showed the highest level with the maximum value of 27.30 mmol/L The dally mean blood glucose levels of the first 5 days after admission peaked on the admission day.(2) Within 24 h after admission,the blood insulin levels of patients with pulmonary infection,intracranial infection,septic shock and congenital heart disease were(17.65±16.85) mU/L,(13.45±7.33) mU/L,(16.24±12.41) mU/L,(6.75±3.22) mU/L respectively.The blood insulin levels of all the patients within the first 5 days after admission wrere higher than that of healthy children[(8.70±6.57) mU/L].According to blood glucose level on admission day,the patients were divided into normoglycemia and hyperglycemia group,and the blood insulin levels of the former and the letter were(5.44 ± 3.38) mU/L and (14.22±12.29) mU/L respectively.(3) The mean of PIM Ⅱscore of the patients averaged 12.96±16.82,and the mortality rate was 15.6%.The blood glucose level and the insulin level within 24 h after admission were(10.97±5.76) mmol/L and(49.46±90.35) mU/L in dead cases and(8.73±2.58) mmol/L and(11.91±11.24) mU/L for the survivals,and both the blood glucose level and insulin level had significant difference between the dead cases and survivals(P ＜0.05).(4) The scatter graphic analysis did not show significant linear relation between blood glucose and insulin,nor did it show significant linear relation between PIM Ⅱ and insulin levei,or blood glucose.Condusion Hyperglycemia and hyperinsulinemia are common in critical illness,which reflects indirectly the severity and prognosis of the disease.Hyperglycemia may be related to relative insulin insufficiency or insulin resistance;however,the definite relationship can not be confirmed until more reliable clinical data were available in the future.     

危重病人血清甲状腺激素的变化及其与APACHEⅡ评分和预后的关系

目的 探讨危重病人血清甲状腺激素水平的变化及其与APACHE Ⅱ评分和危重病预后的关系。方法 应用放射免疫分析法及免疫放射分析法测定危重病人的血清甲状腺激素含量。危重病程度按APCHE Ⅱ评分系统进行评分。结果 危重病人的血清TT3、TT4、FT3、FT4含量明显低于正常对照组(P＜0．001)，而TSH的变化无显著性(P＞0．05)；危重病存活组与死亡组血清甲状腺激素之间的差异无显著性(P＞0．05)；不同APACHE Ⅱ评分分段下危重病人的血清甲状腺激素水平比较差异无显著性(P＞0．05)；而危重病人死亡组的APACHE Ⅱ评分明显高于存活组的APACHE Ⅱ评分(P＜0．001)。结论 非甲状腺疾病的危重病人常出现甲状腺功能指标异常。血清甲状腺激素的变化不能作为判断病情的严重程度及评估预后的指标。而APACHEⅡ评分系统适用于危重病人严重程度及评估预后的评估。     

Receptor-mediated toxicity of pahutoxin, a marine trunkfish surfactant.

Pahutoxin (PHN, choline chloride ester of 3-acetoxypalmitic acid) is a natural fish-killing (ichthyotoxic) agent derived from the defensive secretions of trunkfish. In spite of its obvious structural resemblance to synthetic cationic long-chain quaternary ammonium detergents, we show that PHN's action does not rely on its surfactant properties and is in fact, receptor-mediated. The above conclusion is supported by the following data: 1. Ichthyotoxicity is not related to its detergency or surfactivity, as indicated by the fact that the lethal concentration is about 1.5 orders of magnitude below its critical micelle concentration value (69 microM) and its liposomal/seawater partition coefficient is low (62-85); 2. The trunkfish is tolerant to its own pahutoxin; 3. Ichthyotoxicity occurs only upon application to the surrounding water, suggesting the existence of externally located receptors; 4. The receptor hypothesis was supported by the aid of equilibrium saturation binding assays revealing the presence of specific binding sites to PHN on the fish gill membranes; 5. The PHN tolerant trunkfish was shown to be devoid of PHN-binding sites. Some chemo-ecological, and environmental implications are discussed.     

重症监护病房急性危重病患者的临床营养支持

目的 探讨综合性重症监护病房（ICU）急性危重病患者临床营养支持的时机与模式、营养液输注途径与方法以及营养支持并发症的防治等问题.方法 回顾性分析1 141例原发病因混杂、伴单一或多器官功能障碍的急性危重病患者在综合性ICU内积极治疗原发病的同时接受肠外营养（PN）与肠内营养（EN）支持临床资料.结果 1 141例患者接受PN 3～45 d（平均4.9 d）,其中687例患者在PN过程中联合EN 3～32 d（平均5.1 d）,营养支持效果满意.结论 急性危重病患者完整的治疗方案中必须包括合理的临床营养支持;合理的营养支持就是要模式合理、营养物质供给比例和量合理,同时还要提供辅助疗法.     

Postnatal development of NR1, NR2A and NR2B immunoreactivity in the visual cortex of the rat

N-Methyl-D-aspartate receptors (NMDARs) are critically involved in some types of synaptic plasticity. The NMDAR subunits NR1, NR2A and NR2B are developmentally regulated, and it has been proposed that developmental changes in their expression may underlie developmental changes in cortical plasticity. Age-dependent change in cortical plasticity is most commonly measured by the monocular deprivation effect, which occurs during a critical period between P22 and P50 in the rat. Although the development of NMDAR subunits has been studied from birth through the fourth postnatal week, there is only meager information from older ages when visual plasticity ends. We hypothesized that there will be significant age-dependent change in expression of NR1, NR2A or NR2B between P22, when the cortex is plastic, and P90, when it is not. We applied specific antibodies recognizing NR1, NR2A and NR2B to the primary visual cortex at P14, P22, P30, P45 and P90. We found age-dependent changes in NR1-IR that were negatively correlated with changes in NR2A-IR; these subunits are not regulated in unison. In contrast, NR2A-IR and NR2B-IR were positively correlated. NR2A-IR and NR2B-IR both passed through a developmental minimum around P45, then recovered to approximately their P22 level. NR1-IR passed through a maximum at P45. There were no significant differences between P22 and P90. These results do not support the simple hypothesis that the loss of plasticity corresponds to a simple transition from juvenile levels of NMDAR subunit proteins to new adult levels. On the other hand, the results do confirm the hypothesis that there are significant changes in processing of NMDAR proteins during the time that plasticity is lost. How these changes of IR relate to synaptic transmission and plasticity needs to be clarified.     

现代复苏技术在危重新生儿转运中的应用体会

目的：探讨现代复苏技术在危重新生儿转运中的应用及其临床价值。方法:对我院2000年3月-2004年2月危重新生儿转运中接受心肺脑复苏(CPCR)的26例息儿进行回顾性分析，总结出危重新生儿转运中CPCR程序及其要点。结果：在26例息儿中，转运前给予CPCR 18例，占69.2％；转运途中给予CPCR 8例，占30.8％；除2例息儿复苏失败于转运途中死亡外，其余24例均复苏成功，成功率为92.3％。结论：危重新生儿转运中的CPCR程序具有临床实用价值。     

神经刺激器定位腰骶丛阻滞在高危病人下肢手术中的应用

目的 观察外周神经刺激器定位下的腰骶丛阻滞应用于高危病人下肢手术的效果。方法 38例临床合并各种高危疾病拟行单侧下肢手术的病人，施行单侧腰骶丛神经阻滞。腰丛阻滞分腰肌间隙入路和腹股沟入路；坐骨神经阻滞为臀区入路。采用神经刺激器定位技术，刺激器电流频率1Hz，起始强度1mA，麻醉总量为1％利多卡因20ml，0．5％罗哌卡因30ml。结果 38例病人均阻滞完善，麻醉效果满意，术中生命体征平稳，血流动力学稳定。结论 神经刺激器定位技术下腰骶丛阻滞定位准确，客观指征明显，效果可靠，对患者各系统干扰小，对有严重合并症病人更为适用。     

论英语写作教学中批判性阅读模式的培养

无论采取哪种英语写作教学法，前提是使学生具备英语语言意识，而语言意识的获得依赖于大量阅读，批判性阅读作为一种高效的阅读模式能大大促进写作活动。本文分析了批判性阅读模式的三个发展阶段和英语写作活动的密切关系。     

当归妇康胶囊剂成型工艺的研究

目的:确定当归妇康胶囊剂成型工艺条件.方法:考察不同辅料对浸膏粉吸湿性的影响;以颗粒的流动性与吸湿性为指标,用单因素法优选制粒工艺条件.结果:最佳制粒工艺条件为:浸膏粉(药材提取物:淀粉=5:2)与微晶纤维素按7:1的比例混匀,以95%乙醇为润湿剂制软材,醇用量为浸膏粉的5%.结论:成品颗粒的流动性好,临界相对湿度约为65%.