胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

尿αl微球蛋白与微量白蛋白联合检测在高血压病肾损伤早期诊断中的临床价值

在原发性高血压中，因肾功能受损导致蛋白尿甚至血清尿素氮、肌酐增高并依赖透析的患者在临床非常多见，然而一旦出现BUN、Cr增高及肾功能不全时，往往已经对临床治疗造成困难，于是，早发现、早治疗，对控制高血压肾病的发生与发展是十分必要的。     

人工肱骨头置换术治疗高龄复杂肱骨近端骨折

目的探讨和分析采用人工肱骨头置换术治疗复杂肱骨近端骨折的适应证、手术技术要点和早期疗效。方法对12例肱骨近端四部分骨折伴肱骨头脱位的高龄患者,早期手术行人工肱骨头置换。手术采用三角肌胸肌间入路,先复位大小结节,确定假体高度,骨水泥固定假体保持30°左右的后倾,大小结节再复位固定,必要时取骨折的肱骨头自体骨植骨,术后早期功能锻炼。结果术后平均随访16．6个月,术后未发生感染、神经损伤、关节脱位和假体周围骨折。采用Neer评分系统评定人工关节功能,平均为84．4分,90分以上(优)3例,80～89分(满意)7例,70～79分(不满意)2例,满意率为83．3%。12例患者疼痛方面平均得分为33．5分,功能方面为25．6分,运动方面为16．5分,解剖重建方面为8．8分。结论在正确选择手术适应证、掌握手术技术以及合理的术后康复等前提下,人工肱骨头置换术是治疗高龄患者复杂肱骨近端骨折的有效方法,尤其在减轻创伤后肩关节疼痛方面效果最为显著。但在恢复肩关节活动度方面仍欠满意,需加强对患者术后关节康复训练的指导工作。     

结直肠癌患者血清上皮型钙粘附蛋白水平变化与临床意义

上皮型钙粘附蛋白（E-cd）是维持上皮细胞及上皮组织形态结构完整性和极性的重要基因.以免疫组化法检测结直肠癌患者结肠组织E-cd表达的研究报道较多,但以ELISA法检测其血清E-cd水平变化及临床意义的报道甚少,我们现研究报道如下.     

《汉英对照医学真菌学》书讯

本研究应用大疱性类天疱疮（BP）和寻常型天疱疮（PV）患者口腔中的唾液进行自身抗体检测，并与其在血清中的滴度相比较，以确定这些患者唾液与血清抗体的相关性及在疾病诊断中的意义。     

婴幼儿腹泻的护理

婴幼儿腹泻是儿科的常见病，护理人员应熟识其腹泻的临床症状及其表现，给予恰当的治疗和有效的护理措施，做好卫生预防宣教，指导家长科学育儿，合理喂养，减少腹泻的发病率，保证婴幼儿健康成长。     

胃大部切除术后反复腹泻、消瘦

病历摘要患者男 ,5 3岁 ,海员。因胃大部切除术后反复腹泻 ,伴消瘦 14年于 2 0 0 1年 11月 2 8日入院。患者 14年前因胃溃疡穿孔在外院行胃大部切除术 (毕氏Ⅱ式 )。术后 1个月开始腹泻 ,每天 4～ 5次 ,多则 10余次。均为不消化食物残渣 ,未见黏液及脓血 ,常在进粗糙或油腻类食物后加剧 ,进半流质饮食时则明显减轻 ,有时大便成形。腹泻时无里急后重 ,无恶心、呕吐及畏寒发热。服用多酶片、双歧杆菌 (培菲康 )治疗稍有好转。近半年来出现下腹胀闷不适 ,曾在外院行胃镜检查提示吻合口溃疡、胃肠钡剂造影为残胃毕氏Ⅱ式吻合口通畅 ,结肠镜检查…     

5／6肾切除大鼠细胞增殖和凋亡的动态变化及意义

目的 了解细胞增殖与凋亡在肾小球硬化和肾间质纤维化中的意义。方法 动态观察5／6肾切除大鼠模型第1～40周中不同时段肾脏增殖细胞核抗原（PCNA）的表达和细胞凋亡（TUNEL）情况并计算增殖和凋亡指数、检测肾组织Bax、Bcl-2蛋白的表达水平。结果 5／6肾切除大鼠残肾组织增殖和凋亡指数均升高；肾小球、肾小管的增殖和凋亡指数先升高后下降；肾间质的增殖和凋亡指数一直高居不下。Pax蛋白（促凋亡基因）在病变过程中呈波浪式变化，高峰分别在第4周和第40周。而Bcl-2（抑制凋亡因子）表达轻度增加。结论 增殖和凋亡的平衡紊乱在5／6肾切除大鼠的发病中起着重要的作用肾小球、肾小管实质细胞的凋亡持续增加，肾间质的过度增殖最终导致肾小球硬化、肾小管萎缩和间质纤维化。