虎仗4号结晶可改善重症不可逆性失血性休克微循环的紊乱

本文观察了虎仗4号结晶对大鼠不可逆性失血性休克时血压的影响,用彩色显微电视装置观察了提睾肌微循环的变化.结果表明,静脉注入不同剂量的虎仗4号结晶和回输放出的血液后,可使动物血压稳定上升,使休克时缩窄的细动脉口径恢复,毛细血管开放,动物存活率明显提高;虎仗4号结晶的作用效果与剂量增加有一致的趋势.讨论了虎仗4号结晶的作用机理.     

Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage

Purpose  The goal of this study was to compare results of open arthrotomy versus arthroscopic drainage in treating septic arthritis of the hip in children. Methods  This prospective controlled study was conducted on twenty patients (20 hips) with acute septic arthritis of the hip. Diagnosis was suspected if there was: a history of fever, non-weight-bearing on the affected limb, erythrocyte sedimentation rate (ESR) of at least 40 mm/h, and white blood cell count of more than 12,000 cells per cubic millimeter. Diagnosis was established by ultrasonographic examination of the affected hip followed by ultrasound-guided aspiration of the joint. Patients were allocated to have either open arthrotomy or arthroscopic drainage of the joint. There were ten patients (ten hips) in each treatment group. The mean age of the patients was 7.3 years in the arthrotomy group, and 8 years in the arthroscopy group. The mean temperatures for the arthrotomy and arthroscopy groups were 38.8 and 38.7°C, respectively. All the children were unable to bear weight on the affected limb. Results   Staphylococcus aureus was the most common causative microorganism in both groups. The mean duration of the children’s hospital stay was 6.4 days in the arthrotomy group and 3.8 days in the arthroscopy group. The difference was highly significant. Infection could be eradicated in all patients of both groups. At the latest follow-up, seven children in the arthrotomy group (70%) had excellent results and three children (30%) had good results. In the arthroscopy group, nine children (90%) had excellent results and one child (10%) had good results. The difference was not statistically significant. Conclusions  Arthroscopic drainage is an effective method in treating septic arthritis of the hip. It is a minimal invasive procedure which is associated with less hospital stay. Arthroscopic drainage of septic arthritis of the hip in children is a valid alternative procedure in early uncomplicated cases and for orthopedic surgeons skilled in pediatric arthroscopy.     

社会支持对体外震波碎石术后排石效果的影响

目的探讨社会支持对体外震波碎石（ESWL）术后排石效果的影响。方法应用社会支持评定量表（SSRS）、自制调查表及健康指导执行卡，对123例上尿路结石病人分为A组、B组、C组分别于术前、术后社会支持及术后排石效果进行调查，术前根据结石部位对3组病人及家属均进行相应的健康指导，观察3组病人对术后体位、运动、饮水治疗的依从性及排石效果，所有资料采用SPSS11．0统计软件包进行统计及χ^2检验分析。结果术后3组病人社会支持总分、运动及饮水依从性比较，差别有统计学意义（P〈0．01）；3组病人术后体位的依从性、术后3天及6天排石效果比较，差别均有统计学意义（P〈0．05）；结论充分的社会支持可增强病人ESWL术后体位、运动、饮水治疗的依从性及排石效果，护士是病人住院期间最重要的社会支持来源之一。     

经皮肾微造瘘气压弹道碎石取石术治疗复杂性肾结石

目的总结经皮肾微造瘘取石术（MPCNL）配合气压弹道碎石治疗复杂性肾结石的经验。方法本组复杂性肾结石患者53例，男29例，女24例；其中单侧复杂性肾结石45例，双侧8例。先采用经皮肾微造瘘气压弹道碎石取石术治疗，较大残留结行再行体外冲击波碎石术（ESWL）。结果一次取石45例，二次取石3例，5例残留结石，配合ESWL，结石取净率93．4％。平均手术时间为95min，出血100-800ml，无大出血、尿瘘、气胸、假性尿液囊肿、腹腔脏器损伤等严重的并发症。结论MPCNL配合气压弹道碎石治疗复杂性肾结石安全、有效。具有损伤小、出血少、恢复快等的优点。     

Combined use of impella device and intra‐aortic balloon pump to improve survival in a patient in profound cardiogenic shock post cardiac arrest

Patients who suffer cardiogenic shock after cardiac arrest have a very poor prognosis. Left ventricular assist devices have proven to be useful in these patients to improve survival. Recently introduced percutaneous assist devices are easier to use and can be inserted quickly in the catheterization laboratory. We describe a case where intra‐aortic balloon pump by itself was not enough to provide hemodynamic support in a patient with cardiogenic shock after cardiac arrest. The Impella Recover^® LP 2.5 system (ABIOMED, Inc., Danvers, MA) was successfully used along with the balloon pump for hemodynamic support and resulted in dramatic improvement of the patient's condition. © 2009 Wiley‐Liss, Inc.     

Protective effect of pentoxifylline plus thalidomide against septic shock in mice

Mortality caused by septic shock in experimental animals is reduced by thalidomide, an inhibitor of tumour necrosis factor alpha. Another drug that could act on the pathophysiological mechanisms of septic shock is pentoxifylline, an inhibitor of platelet aggregation that increases the flexibility of the erythrocyte membrane and has fibrinolytic activity. We studied the effect of pentoxifylline alone and combined with thalidomide in septic shock; 97 NIH mice were injected with lipopolysaccharides of Salmonella abortus equi and D galactosamine. Animals were separated in 4 groups; group A (n = 20) was used as control, group B (n = 15) received thalidomide 50 mg/kg, group C (n = 20) received pentoxifylline 40 mg/kg, and group D (n = 15) received thalidomide plus pentoxifylline. Mortality was recorded every hour. Additionally, 5 animals from each group were sacrificed 8 h after the induction of septic shock for histological analysis of heart, lung, brain, kidney, small intestine, adrenal glands and liver. Microscopic findings were rated as absent, mild, moderate and severe damage. In control animals histological analysis showed intense haemorrhage and necrosis in all organs studied. When compared with controls, treatment with pentoxifylline plus thalidomide reduced mortality (P < 0.03). The tissue damage was less severe in animals from the groups that received pentoxifylline or pentoxifylline plus thalidomide (P < 0.05). Pentoxifylline seems to potentiate the beneficial effects of thalidomide, reducing mortality and attenuating the pathological changes produced by septic shock.     

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1990年12月至2006年12月，我院共收冶759例急性肠梗阻，其中21例（占2．77％）死亡。本文对其死亡原因及其防治措施加以探讨。     

体外冲击波疗法联合钻孔减压术治疗战士训练后股骨头缺血性坏死的效果观察

目的探讨战士训练后股骨头缺血性坏死(ANFH)的发病机制及体外冲击波疗法(ESWT)的疗效。方法ARCO分期Ⅰ-Ⅲ期的股骨头坏死战士(排除股骨颈骨折后股骨头坏死者)108例,男86例,女22例,年龄18~25岁,由患者自愿选择治疗方法。其中50例采用ESWT联合钻孔减压术治疗,于钻孔减压术后第2天将9~12kV(0.16~0.22mJ/mm2)的体外冲击波作用于患处,治疗后6、12个月复查双髋X线、MRI及髋关节Harris评分(HHS)。58例患者采用单纯钻孔减压术治疗。对两组治疗结果进行统计学分析。结果随访两组中均无ANFH恶化。ESWT治疗后ARCOⅠ、Ⅱ、Ⅲ期病例股骨头坏死区分别减小了22.9%、32.8%、34.3%,其中ARCOⅡ、Ⅲ期改善程度明显优于单纯钻孔减压治疗组(P<0.01)。治疗后6、12个月复查显示,ESWT联合钻孔减压治疗组HHS升高较早、较快,由54.2分分别升至90.2、83.2分,疗效优于单纯钻孔减压治疗,其中ARCOⅡ、Ⅲ期改善程度明显优于单纯钻孔减压治疗组(P<0.01)。结论ESWT对早中期ANFH疗效显著,有望在临床治疗骨肌系统慢性损伤性训练伤中发挥更为积极的作用。     

Sensitization of norepinephrine release in medial prefrontal cortex: effect of different chronic stress protocols

Previously, we demonstrated that continuous exposure of rats to cold (5°C) for 2–3 weeks potentiates the increase in extracellular norepinephrine in the medial prefrontal cortex produced by acute tail shock. In the present study, we used in vivo microdialysis to examine whether this sensitization of evoked norepinephrine release also occurs in the medial prefrontal cortex following exposure to other chronic stress protocols. Rats exposed to 30 min of intermittent foot shock (0.6 mA) each day for 14 days, did not exhibit a greater increase in extracellular norepinephrine in response to acute tail shock. To determine whether this discrepancy between cold exposure and foot shock might be related to differences in the nature or the pattern of exposure to the chronic stressor, we also examined the effect of intermittent exposure to cold or continuous exposure to a foot shock protocol on tail shock-evoked norepinephrine release. Sensitized norepinephrine release did not develop following either intermittent exposure to cold (5°C; 4 h/day for 14 days) or continuous exposure to a foot shock protocol (0.6 mA trains at random intervals 24 h/day for 14 days), suggesting that both the nature of the stressor as well as the pattern of exposure to the chronic stressor play a role in the development of sensitized norepinephrine release.     

失血性休克狗微循环和血液流变学的变化

在9只失血性休克狗(平均血压维持在40mmHg)观察其球结膜微循环,并定期从股动脉采血检查血液和血浆比粘度、红细胞比容、血小板聚集和红细胞变形能力。结果:一、微循环反应非常敏感,放血后数分钟球结膜微动收缩,血流速度变慢,红细胞出现聚集;休克期镜下可见毛细血管数目减少,血流停滞,红细胞重度聚集。二、血液流变学检查:放血停止后,血液和血浆比粘度,红细胞比容均明显下降;血小板聚集加强;红细胞变形能力的变化发生较晚,休克后一小时开始降低。三、回输失去的血液和生理盐水后,微循环和血液流变学诸指标都趋向恢复。作者分析了失血性休克狗微循环和血液流变学的关系。