单用体外震波碎石治疗尿路结石的体会

本文报道1988年6月～11月,单独应用上海交通大学电力工程系研制的JT—ESWL—Ⅱ型体外震波碎石机,治疗尿路结石506例,其中肾结石304例(双侧12例)输尿管结石199例(双侧5例),膀胱结石3例。冲击能量15～40焦耳,每次治疗冲击波次数为400～2800次。本组无开放手术、无肾脏丧失、无死亡。效果满意者96.44％。其并发症主要有血尿、结石串。作者认为单用ESWL治疗小于3Cm的尿路结石安全可靠、无严重并发症。文中对单用体外震波碎石(ESWL)治疗尿路结石病例选择,如何减少并发症,提高治疗效果进行了讨论。     

热休克反应对大鼠感染性脑水肿脑组织诱生型一氧化氮合酶mRNA表达的影响

:探讨热休克反应 (HSR)对百日咳杆菌所致的大鼠感染性脑水肿诱生型一氧化氮合酶 (iNOS)mRNA表达的影响。方法 :从大鼠左侧颈内动脉注入百日咳菌液制备感染性脑水肿 (感脑 )模型 ,采用组织细胞原位杂交技术检测脑组织iNOSmRNA的表达。结果 :生理盐水组、4h感脑组及 4h热休克处理组均未见iNOSmRNA表达 ,8h ,2 4h时感染性脑水肿组均有明显的杂交信号 ,以 2 4h更为明显 ;而 8h ,2 4h热休克处理组仅有少数细胞有阳性信号。结论 :热休克反应对感染性脑水肿的保护作用可能与抑制iNOSmRNA的表达有关     

高渗盐液和抗休克裤合并应用对大鼠早期休克的影响

采用高渗盐液，抗休克裤及两者联用纠正大鼠早期失血性休克。结果显示，单独使用ＡＳＴ，仅见动脉血压短时间回升，而单用ＨＴＳ，血压则明显回升。若先用ＡＳＴ，再注入ＨＴＳ，也能取得明显效果。失血休克大鼠血浆纤维连接蛋白水平显著降低，各组之间均无差异血浆脂质过氧化物－丙二醛的含量明显增加，且在ＨＴＳ组，ＨＴＳ＋ＡＳＴ组与ＮＳ对照组之间有显著差异。     

Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure

Measurements of toe temperature and transcutaneous PO₂ (P_tcO₂) have been both suggested for non-invasive assessment of peripheral blood flow in acute circulatory failure. The underlying principle of the two methods is that cutaneous vasoconstriction occurs early when tissue perfusion is altered. In 15 patients, we compared the two measurements during cardiogenic shock (27 measurements) or septic shock (29 measurements). Toe-ambiant temperature gradient and P_tcO₂ correlated well together (r=0.66, p(0.001) especially in hyperkinetic septic shock (r=0.79, p(0.001). In cardiogenic shock, toe-ambiant temperature correlated well with cardiac index (r=0.63), stroke index (r=0.64) and oxygen transport (r=0.65), and these correlations were stronger than for P_tcO₂. In septic shock, both techniques were poor indicators of blood flow indexes but P_tcO₂ rather correlated with arterial pressure (r=0.66) and left ventricular work (r=0.66). Trend evaluation of data revealed in cardiogenic shock that the increase in toe temperature usually preceded the increase in P_tcO₂. Since measurement of P_tcO₂ is technically more complicated, correlates less well with standard hemodynamic parameters and later reflects cardiovascular improvement, it has no advantage over measurement of toe temperature in circulatory shock. In cardiogenic shock, measurements of toe temperature can reliably track cardiac output changes. In septic states, however, non-invasive assessment of skin perfusion is of limited interest.     

Anesthesia for trauma

Trauma is the leading cause of death for persons aged 1 to 38 years. Successful management is facilitated by prehospital endotracheal intubation, transport to regional trauma centers, rapid resuscitation by an on-site team of trained physicians, timely operative intervention, and provision of care by well-prepared anesthesiologists familiar with the potential complications typical of traumatized patients. No particular anesthetic agent or technique is ideal. Causes for intraoperative hypotension include hypovolemia, hemopneumothorax, pericardial tamponade, an intracranial mass, acidosis, and hypothermia. The anesthesiologist should play an active role in all phases of trauma management, including provision of postoperative intensive care and pain relief.     

经皮肾穿气压弹道碎石联合体外冲击波碎石治疗上尿路结石

目的 探讨提高上尿路结石碎石成功率的微创治疗方法。方法 采用经皮肾穿微造瘘输尿管镜气压弹道碎石，术中放置双J管，术后配合体外冲击波碎石术(ESWL)治疗上尿路结石48例。结果 结石总排净率为89．1％，结石最小排净率79．2％，无严重并发症发生。结论 该方法结石排净率高，创伤较小，手术并发症少，是上尿路结石较为理想的微创治疗方法。     

膜表达热休克蛋白70真核表达载体的构建及其对肿瘤细胞的转染

目的构建普遍适合性的膜表达热休克蛋白70(HSP70)的真核表达载体,修饰并建立HSP 70表达并结合在细胞膜表面的肿瘤细胞.方法RT-PCR法从人胚肾中获取HSP 70的cDNA,扩增成带酶切位点的目的基因.选择载体pDisplay,将目的基因插入载体多克隆酶位点中.DNA测序证实后,以脂质体转染的方法,将载体转染到黑色素瘤细胞.用G418抗性筛选获得阳性克隆.结果酶切电泳和DNA测序证实载体构建正确;目的基因的上游带信号肽序列,下游带跨膜序列.RT-PCR产物电泳、Westem Blotting、激光共聚焦显微镜和流式细胞术证实大量HSP 70表达并结合在转染的黑色素瘤细胞膜表面.结论成功地构建了膜表达HSP 70的真核表达载体;转染到黑色素瘤细胞后,细胞膜表面表达丰富的HSP70.转染细胞可以进一步制备新型瘤苗.     

海水浸泡对失血性休克并腹部开放伤实验大鼠肿瘤坏死因子α及肠道热休克蛋白HSP-70的影响

目的探讨海水浸泡失血性休克并腹部开放伤对实验大鼠血浆肿瘤坏死因子α(TNFα-)和肠道热休克蛋白HSP-70水平变化的影响。方法建立失血并腹腔海水浸泡伤动物模型。实验大鼠随机分为对照组(n=6)、失血创伤组(n=14)、失血创伤海水浸泡组(n=14),失血创伤组为单纯失血性休克并腹部开放伤,失血创伤海水浸泡组将动物致伤后置入人工配置的海水中,于伤前和浸泡后30m in及1,1.5,3 h取血测定TNFα的变化,取肠道组织测定HSP-70的表达。结果失血创伤海水浸泡组血中TNFα较失血创伤组伤后明显升高并且高峰出现时间明显提前,肠道损伤病理变化明显重于失血创伤组,肠道组织中HSP-70含量在创伤早期显著升高,后又明显降低。结论TNFα-的过度表达在失血性休克并腹部开放伤后海水浸泡的病理生理变化中起重要作用,肠道组织细胞中HSP-70的异常表达在肠道组织细胞的应激反应机制中,可能有重要的意义。     

浅析中专护生文化休克的护理策略

文化休克(culture shock),又译为文化震撼或文化震惊,是指生活在某一种文化环境中的人初次进入到另一种文化环境,如到了不同的民族、社会群体中或地区甚至国家时所产生的思想混乱与心理上精神紧张综合征。新入校中专护生,由于文化环境的改变,往往会出现孤独、焦虑、无助等文化休克的种种表现,这些现象若不能及时得到解决,将不利于他们的全面健康状态的成长与发展。众所周知,WHO明确规定,健康不但是没有疾病和身体缺陷,还要有完整的生理、心理状态和良好的社会适应能力。因此,新入校中专护生这一特殊群体所产生的文化休克现象应引起学校有…