重型脑创伤患者脑细胞间液甘油浓度研究

目的研究重型脑创伤后影响脑细胞间液甘油(Gly)浓度变化的因素。方法连续监测53例重型颅脑创伤患者近损伤区脑细胞间液Gly浓度和局部脑血流(CBF),同时监测颅内压(ICP)及脑灌注压(CPP)。选择每小时CPP和CBF的最小值及ICP的最大值与该小时的Gly浓度匹配。根据局部CBF、ICP、CPP及预后将所有Gly样品分组。结果(1)Gly、CCP及CBF与预后的关系:与中残或重残组比较,植物生存或死亡组患者Gly显著增高而CCP及CBF显著降低(P<0.05);与恢复良好组比较,中残或重残组Gly显著增高而CCP及CBF显著降低(P<0.05)。(2)ICP,CCP,CBF对Gly的影响:ICP>15mmHg组、CCP<70mmHg组及CBF<50AU分别比ICP<15mmHg组、CCP>70mmHg及CBF50￣150AU组Gly浓度显著增高(P<0.01)。(3)病理类型和Gly浓度的关系:弥漫性轴索损伤Gly浓度最高,比硬膜外血肿及硬膜下血肿显著增高(P<0.05),但与脑挫裂伤患者无显著差异。结论Gly浓度可以反映原发和继发性脑损伤的严重程度,是细胞膜降解和脑缺血的可靠指标。     

Extracellular glycerol in patients with severe traumatic brain injury

Objective： To study the factors affecting extracellular glycerol （Gly） in patients with severe traumatic brain injury （STBI）.
Methods： Perilesional extracellular Gly and cerebral blood flow （CBF） in 53 patients with STBI were consecutively monitored. Simultaneously, the intracranial pressure （ICP） and cerebral perfusion pressure （CCP） were monitored. The hourly minimum of CCP and CBF and the hourly maximum of ICP levels were matched with the hourly Gly. Gly values were divided into several groups according to regional ICP （〈 15 nun Hg or 〉 15 nun Hg）, CCP （〈70 nun Hg or 〉70 nun Hg）, CBF （〈50 AU or 50-150 AU） and the outcomes （death or persistent vegetative state group, severe or moderate disability group, and good recovery group）.
Results： In comparison with the severe or moderate disability group, the Gly concentration of the death or persistent vegetative state group increased significantly, but CBF and CCP decreased significantly. In comparison with the good recovery group, the Gly concentration of the severe or moderate disability group increased significantly, but CBF and CCP decreased significantly. The Gly concen- trations in patients with ICP〉15 mm Hg, CCP〈70 mm Hg and CBF〈50 AU were respectively higher than those of patients with ICP 〈15 mm Hg, CCP〉70 mm Hg and 50AU 〈CBF〈150AU. In patients with diffuse axial injury, the mean Gly concentration was （201.17±55.00） μmol/L, which was significantly higher than that of the patients with epidural hematoma （n=7, 73.26±8.37, P〈O.05） or subdural hematoma （n=9, 114.67 ±62.88, P〈O.05）, but it did not increase signifi- cantly when compared with those in patients with contusion （n=24, 167.48±52.63）.
Conclusion： Gly can be taken as a marker for degrada- tion of membrane phospholipids and ischemia, which reflects the severity of primary or secondary insult.     

轻型及特重型颅脑创伤患者脑细胞间液生化指标对比研究

应用微透析技术检测10例颅脑创伤患者的脑细胞间液(ECF)中乳酸／丙酮酸(L／P)、乳酸／葡萄糖(L／G)及甘泔(Gly)的浓度并探讨其意义。现将结果报告如下。     

脑细胞间液甘油监测与亚低温治疗

脑细胞间液甘油浓度变化可反映细胞膜的损伤程度,测定脑细胞间液甘油浓度的正常值,并对其在各种病理条件下的意义进行研究有重要意义。联合与甘油有显著相关性的指标如兴奋性氨基酸及乳酸/丙酮酸,可用于评价亚低温的脑保护作用。     

189例不孕妇女宫颈沙眼衣原体与解脲支原体感染的临床观察

沙眼衣原体 (ChlamydiatrachomatisCT)及解脲支原体 (UreaplasmaurealyticumUU)感染是一种常见的性病 ,欧美国家CT感染已超过淋病 ,为性传播疾病的首位。我国人群CT及UU感染也有迅速上升的趋势。CT及UU感染是盆腔炎及非淋菌尿道炎的重要病原体 ,是导致不孕和不育的因素之一[1] 。为了探讨宫颈CT及UU感染与生育的关系 ,我们应用聚合酶链反应 (Poly merasechainreactionPCR)方法 ,对 189例不孕妇女宫颈分泌物进行CT -DNA及UU -DNA检测及治疗 ,现将结果报告如下。1　资料与方法1·1　研究对象　为 2 0 0 0年 1月至 2 0 0 0年 12…     

富血小板血浆治疗慢性难愈性创面的临床研究

目的探讨富血小板血浆(platelet-rich plasma,PRP)对慢性难愈性创面的修复作用。方法 49例慢性难愈性创面患者,随机分为PRP治疗组和常规换药对照组。PRP组23例,给予清创加自体PRP伤口内注射和凝胶覆盖,治疗1周即更换PRP凝胶,3次治疗为1个疗程;对照组26例,采用传统换药为主的治疗方法,治疗过程中根据情况采用植皮术、皮瓣转移等手术方法加速创面愈合。3周后观察治疗效果。结果所有患者均于首次治疗后获随访,随访时间1~4个月。PRP组患者在2~3次PRP治疗后,可发现创面明显缩小,坏死组织及脓苔清除,组织色泽健康,血供良好,特别是外露骨或肌腱组织被新生肉芽组织覆盖。对照组患者在3周治疗后,创面愈合较PRP组面积小,特别是伴有骨或肌腱外露创面,新生肉芽覆盖较差。结论 PRP凝胶由于具有可塑性强、能持续释放多种生长因子的特征,可以作为生长因子缓释系统,能有效促进难愈性创面软组织缺损修复,增加局部血运,加速慢性难愈合伤口愈合。并且与传统负压引流系统相比,在伴有骨或肌腱外露的慢性难愈性创面治疗上,PRP能取得更好的治疗效果。     

重型脑损伤患者脑组织细胞外液成分的变化

目的　研究重型脑损伤患者的治疗结果与伤后早期脑组织细胞外液生化成分间的关系。　方法　对 4 5例格拉斯哥昏迷评分 (GCS) 3～ 8分的患者行脑组织微透析取样监测 10～ 96h ,测定葡萄糖、乳酸、丙酮酸浓度并计算乳酸 /葡萄糖和乳酸 /丙酮酸比值。全部患者在伤后 6个月行格拉斯哥预后评分 (GOS)。　结果　各项指标在GOS良好组、不良生存组和死亡组间差异有非常显著性意义 (P <0 .0 1) ,GOS与乳酸 /葡萄糖 (r=- 0 .75 6 ,P <0 .0 0 1)和乳酸 /丙酮酸 (r =- 0 .115 ,P =0 .0 4 2 )呈负相关 ,GOS与丙酮酸 (r=0 .5 71,P <0 .0 0 1)、葡萄糖 (r =0 .4 74 ,P <0 .0 0 1)和乳酸 (r =0 .4 80 ,P <0 .0 0 1)呈正相关。　结论　通过微透析监测脑细胞外液成分的变化 ,可以揭示创伤后脑组织的能量代谢特点并有助于判断患者的预后。     

Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury

Objective： To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury （STBI） using clinical microdialysis. Methods：Thirty-one patients with STBI （ GCS ≤ 8 ） were randomly divided into hypothermic group （Group A ） and control group（ Group B）. Microdialysis catheters were inserted into the cerebral cortex of perilesional and normal brain tissue. All samples were analyzed using CMA mlcrodialysis analyzer. Results. In comparison with the control group, lactate/glucose ratio （ L/G ）, lactate/pyruvate ratio （ L/P ） and glycerol（Gly） in perilensional tissue were significantly decreased; L/P in normal brain tissue was significantly decreased. In control group, L/G, L/P and Gly in perilensional tissue were higher than that in normal brain tissue. In the hypothermic group, L/P in perileusional tissue was higher than that in relative normal brain. Conclusions： Mild hypothermia protects brain tissues by decreasing L/G, L/P and Gly in perilensional tissue and L/P in ＂ normal brain＂ tissues. The energy crisis and membrane phospholipid degradation in perilensional tissue are easier to happen after traumatic brain injury, and mild hypothermia protects brain better in perilensional tissue than in normal brain tissue.     

9例结肠战伤一期手术的治疗报告

我医疗所于1984年12月～1985年3月,收治15例腹腔脏器伤伤员,其中9例为结肠战伤。现报道于下。一、一般资料损伤部位:盲肠伤2例;升结肠伤1例;横结肠伤3例;降结肠伤1例;乙状结肠伤2例。损伤类型:结肠断裂2例;裂伤穿孔7例。合并伤:合并头部伤2例,胸部伤3例、四肢伤2例、肝脏伤1例、脾脏伤2例、肾脏伤1例、胃部伤2例、小肠伤2例、直肠伤2例、大血管伤1例、休克2例。救治:6例穿破的结肠壁行一期缝合并将修补肠袢     

微囊化Leyding细胞异种移植的实验研究

为探索一种新的补充睾酮的方法，将新生大鼠睾丸Ｌｅｙｉｎｇ细胞分离，培养后制成微囊化Ｌｅｙｄｉｎｇ细胞，移植于小鼠腹腔。结果显示，微囊对睾酮有良好的通透性；微囊内Ｌｅｙｄｉｎｇ细胞对人绒毛膜促性腺激素有良好的反应性．