抗抑郁剂对慢性应激抑郁大鼠脑内5-HT1A受体和5-HT2A受体的影响

目的 以慢性不可预见性应激抑郁模型为基础,探讨三环类抗抑郁剂 (TCAs)和 5 羟色胺再摄取抑制剂(SSRI)在 5 羟色胺受体水平的药理学机理。方法 将 24只SD雄性大鼠随机分对照组、抑郁模型组、阿米替林治疗组、氟西汀治疗组。应用 [3H]8 OH DPAT、[3H]Ketanserin作为标记配基,采用放射性配体受体结合法,分别测定大鼠海马 5 HT1A受体、大脑皮层 5 HT2A受体的特异性结合。结果 与正常对照组比较,抑郁大鼠海马 [3H] 8 OH DPAT特异性结合明显下降 ( 18. 78±5. 62vs26. 12±5. 52, P<0. 05),抑郁大鼠大脑皮层[3H]Ketanserin特异性结合显著增加(86. 28±4. 24vs112. 58±4. 21,P<0. 05)。阿米替林治疗 3周后,抑郁大鼠海马 [3H] 8 OH DPAT特异性结合回升到正常水平,大脑皮层 [3H]Ketan serin特异性结合下降至正常水平(P<0. 05)。氟西汀治疗 3周后,抑郁大鼠海马 [3H]8 OH DPAT特异性结合(26. 63±5. 50)、大脑皮层[3H]Ketanserin特异性结合 (83. 16±2. 54)与抑郁组比较差异无显著性 (P>0. 05)。结论 1.阿米替林通过增强海马 5 HT1A受体功能、抑制大脑皮层 5 HT2A受体功能发挥抗抑郁作用。2.氟西汀可能不通过影响海马 5 HT1A受体和大脑皮层 5 HT2A受体功能发挥抗抑郁作用。     

心理支持疗法对机械通气患者应激反应的影响

目的 观察心理支持疗法(PST)对ICU患者机械通气应激反应的影响。方法 将34例连续机械通气时间在20h的清醒患者，随机分为采用标准的PST方法进行治疗的观察组和对照组，观察焦虑抑郁程度和应激反应改变情况。结果 对照组患者的焦虑抑郁程度明显高于观察组，部分应激反应激素水平升高幅度也明显大于观察组。结论 PST可通过缓解机械通气患者的焦虑抑郁等不良情绪状态减轻机械通气带来的各种心身应激反应，有利于提高机械通气治疗的有效性和安全性。     

Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure <20 cm H₂O and a Valsalva leak point pressure <60 cm H₂O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3–36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.     

机械应力对幼鼠髋臼发育影响的实验研究

目的阐明异常机械应力对髋臼发育和髋臼软骨生长板内软骨细胞增殖的影响,探讨髋臼发育不良的修复方法。方法将60只3周龄的雌性Wistar大鼠分成3组,每组20只,左侧髋关节为实验侧,右侧为对照侧。A组:在2周内反复将髋关节手法脱位后再复位;B组:膝关节伸直位钢针固定,制作髋臼发育不良的动物模型,2周后拔出钢针;C组:持续伸直位固定膝关节。三组动物分别于第5、7、9、12周时进行钼靶软X线、组织形态学及透射电镜观察。结果A组第5周时唇缘变钝,髋臼角比对侧增大约5°,软骨生长板内增殖层软骨细胞极向紊乱,SO染色无差异,圆韧带有淋巴细胞浸润,第7、9、12周时变化小,两侧无差异;B组第5周时髋臼角比对侧明显增大,第7周时唇缘变钝、内翻,纤维增生,柱状细胞极性紊乱,肥大细胞层增多,第9、12周时接近正常,12周时髋臼角为23.4°,髋臼入口最短径为5.0mm;C组髋臼角比对侧持续增大,没有任何改善倾向,第12周时唇缘内翻、扁平,无明显柱状细胞排列,细胞核变小,细胞器减少,空泡形成,髋臼角为71.3°,髋臼入口最短径为2.9mm。结论在髋臼发育旺盛期解除异常机械应力、恢复头臼同心,髋臼发育不良有治愈倾向。造成髋臼发育不良的直接原因是软骨生长板内增殖层软骨细胞代谢功能发生改变,骨化延迟。     

Diabetic and nondiabetic hyperglycemia in the ICU

Hyperglycemia is a common feature in critically ill patients, whether they are diabetic or not, and it is associated with unfavorable outcome. The more severe the underlying disease, the more important the hyperglycemia appears to be although, we still cannot define whether hyperglycemia is just a marker of the severity of the acute illness or rather an active contributor to poor outcome. The review of the literature on this subject published from 2001 up today conveys a massive amount of information the interpretation of which is equivocal, due to the heterogeneity of patients (nondiabetic vs. diabetic, medical intensive care unit (ICU) pts vs. surgical ICU pts) and of interventions (dose and modality of insulin infusion).The association between high glucose level and mortality is strong in critically ill patients without a previous history of diabetes. Admission hyperglycemia seems to be an independent risk factor of in-hospital mortality in patients both with and without diabetes in cardiac, cardiothoracic and neurosurgical ICUs. No data are still available on general surgical ICU patients.Tight control of blood glucose levels has been demonstrated to improve outcome in both diabetic and nondiabetic critically ill patients. In surgical ICUs, tight glucose control improves mortality and reduces morbidity only among patients admitted in ICU for more than 5 days, while outcome is not improved in patients who stay in ICU for less than 3 days.However, it is not yet understood if such favorable effect is secondary to glucose control itself or if insulin plays a part, by means of its nonglucose, anabolic effects. More randomized controlled trials are needed, addressing specific issues—such as the optimal target glucose concentration and the most effective insulin regimen—especially in the general surgical patient.     

Wounding,shock and stress lesions of the upper gastrointestinal tract

This retrospective study included 2532 wounded, of whom 354 (14 per cent) were treated in surgical intensive care units. In 32 patients, 1.3 per cent of all admissions, upper gastrointestinal bleeding was detected. It occurred on average 8.9 days (3–21 days) after the wounding or surgical procedure in severely injured patients and those treated in intensive care units, respectively (32 of 354 patients, 9.0 per cent). All patients received different analgesic drugs and 17 of a group that presented with bleeding were given psychotropic agents as well. The majority of patients (96.3 per cent) were administered H₂-receptor antagonists as prophylaxis against stress ulcer disease. There was a statistically significant difference between these patients treated with H₂-receptor antagonists and those on no prophylactic therapy. No statistically significant difference was found between cimetidine and ranitidine in terms of their efficacy. Endoscopic examination revealed multiple bleeding gastric and duodenal erosions. The lesions were most commonly located in the corpus of the stomach. In the majority of patients (56.25 per cent), the haemorrhage stopped spontaneously and rebleeding presented in four of 32 (12.5 per cent) patients. Of 354 patients treated in intensive care units, five (1.4 per cent) had to be operated on because of bleeding arrest. Despite all therapeutic and surgical procedures undertaken, five of 32 (15.6 per cent) patients died.     

NF-κB信号传导通路在大鼠急性结肠炎应激反应中的作用

目的探讨NF-κB通路在大鼠急性结肠炎应激反应中的作用.方法建立大鼠急性结肠炎应激模型,固定化蛋白印迹法（Western blot）检测脊髓内I-κB蛋白水平,逆转录-聚合酶链式反应法（RT-PCR）检测脊髓内COX-2 mRNA水平,免疫组化法检测L5-S1和C2-4脊髓内COX-2蛋白水平.结果结肠内灌注6%醋酸可产生明显局部炎症反应;急性结肠炎0.5 h后L5-S1脊髓内I-κB蛋白表达明显上调（P＜0.05）;急性结肠炎3 h后L5-S1脊髓内COX-2 mRNA表达开始增加,24 h后达到高峰;免疫组化结果显示结肠炎24 h后胞浆内COX-2蛋白表达增加.结论大鼠急性结肠炎时,NF-κB通路可能通过调控COX-2的表达而介导炎症反应,I-κB有可能成为急性结肠炎治疗的靶点.     

孕妇配偶的心理压力研究

目的描述孕妇配偶的压力水平 ,找出引起孕妇配偶压力的主要压力源。方法对 167例孕妇配偶用妊娠压力量表测量其压力水平及压力源。结果孕妇配偶的妊娠压力水平总分为 1.5 3 ,引起孕妇配偶压力的最主要的压力源是“为确保母子健康和安全而引发的压力 ( 1.88)”。结论护士的服务对象不应局限于孕妇 ,还应包括其配偶 ,根据孕妇配偶具体的压力源给予有针对性的护理 ,以利于有效地降低其压力水平。使孕妇配偶能顺利地度过角色转变期 ,在妊娠和分娩的应激下保持心身健康 ,更好地完成照顾孕妇和婴儿的任务。     

负性生活事件对抑郁症患者血清细胞因子水平的影响

目的　探讨负性生活事件对抑郁症患者血清细胞因子水平的影响。方法　采用酶联免疫吸附法 (EL SIA)对有负性生活事件诱因的抑郁症患者 2 3例、无诱因的抑郁症患者 2 9例和 2 9名正常人的血清白介素 2 (IL 2 )、可溶性白介素 2受体 (sIL 2R)、白介素 10 (IL 10 )和白介素 12 (IL 12 )水平进行检测。结果　 3组间IL 2、sIL 2R及IL 12水平存在显著性差异 ,而IL 10则 3组间无显著性差异 ,有负性生活事件诱因组IL 2及sIL 2R水平明显低于无诱因组和对照组 (P <0 0 1) ;有诱因组其负性生活事件对患者心理活动影响的严重程度与IL 2和sIL 2R水平呈负相关(P <0 0 5 )。结论　负性生活事件对抑郁症患者的细胞免疫激活系统有抑制作用 ,IL 2可能是起主要的中介作用。