L-精氨酸对严重腹腔感染大鼠肠屏障功能的影响

目的　探讨L 精氨酸对严重腹腔感染大鼠肠屏障功能的影响。方法　SD大鼠 90只 ,随机分成对照组、感染组和精氨酸组 ,每组 30只。对照组仅行单纯剖腹手术 ;感染组采用盲肠结扎加穿孔 (CLP)手术制作严重腹腔感染模型 ;精氨酸组行CLP后每天添加L 精氨酸饮食 [0 2 6 4g/ (kg·d) ]。各组术后 1、2、 4d分别取肠黏膜行病理学观察、增殖细胞核抗原 (PCNA)指数测定、血细菌培养和血浆内毒素水平测定。结果　精氨酸组较感染组小肠黏膜病理性损害明显减轻。感染组术后 2、 4d血浆内毒素水平明显高于精氨酸组 ,分别是 (1 4 2± 0 10 )EU/mlvs (1 14± 0 11)EU/ml,(1 94± 0 0 7)EU mlvs (1 5 8± 0 14 )EU/ml,P <0 0 1。精氨酸组术后 2d血细菌阳性率明显低于感染组 (10 %vs 30 % ,P <0 0 1)。感染组PCNA指数先升高 ,后下降 ,而精氨酸组 4d内下降不明显。结论　当严重腹腔感染导致肠屏障功能障碍时 ,L 精氨酸有促进肠黏膜损伤修复、维护肠屏障功能的作用     

比较麻醉和清醒状态对高频超声心动图评价小鼠心功能影响的研究

目的 比较小鼠在麻醉和清醒状态下，高频超声心动图检测心功能的重复性和可行性。方法 随机将40只小鼠平均分为两组，在清醒的基础状态下予超声心动图检查一次，随后麻醉组腹腔注射氯胺酮和甲苯噻嗪，清醒组注射同等剂量生理盐水，每隔10min检测超声心动图一次，至30min后变为隔15min一次，至第60min停止。观察心率、左室短轴缩短率（FS）、每分钟心输出量（CO）随时间的变化情况。结果 与基础状态比较，麻醉剂使小鼠心率、FS、CO显著降低（P〈0．05），在10～20min降为最低，随后逐渐恢复，至第60min不能完全恢复至基础状态；左室收缩末期内径（LVESD）和舒张末期内径（LVEDD）均扩大，第20min最大，随后降低，LVEDD能在第60min恢复至基础值，而LVESD不能恢复正常；小鼠的心率与FS呈正相关（r=0．884，P〈0．001）。清醒组小鼠各个时间点测量值变异系数比麻醉组小。结论 麻醉小鼠心功能显著降低，重复测量不稳定；清醒状态下小鼠心功能重复测量稳定。高频超声检查小鼠心脏功能应当采取清醒状态下的评价参数。     

栀子甘草豉汤加味对反流性食管炎患者胃肠功能的影响

目的探讨栀子甘草豉汤加味治疗反流性食管炎(RE)的效果及对患者胃肠功能的影响。方法选取2017年1月—2018年1月就诊的110例RE患者为研究对象,随机分为观察组(55例)与对照组(55例)。对照组给予常规治疗,观察组在对照组的基础上联合栀子甘草豉汤加味治疗,2组连续治疗8周。统计2组患者治疗前后中医证候积分及内镜检查积分;检测并比较2组患者治疗前后胃肠道激素水平。结果治疗后2组患者反酸、烧心、胸骨后灼痛等各项中医证候积分、内镜检查积分、立位反流时间、卧位反流时间、立位酸清除时间所占总监测时间百分比显著低于治疗前,且观察组显著低于对照组(P<0.05或P<0.01)。治疗后2组患者MTL、GAS、LES长度、LES松弛率均显著高于治疗前,且观察组显著高于对照组(P<0.01)。结论栀子甘草豉汤加味治疗RE可更加有效缓解患者临床症状,改善其胃肠功能,胃食管受到的酸损伤减少更为显著,因此值得推广。     

Opioid medication and driving ability

In many European countries the use of opioids for long‐term treatment of nonmalignant pain has dramatically increased during the last decade in order to improve the patient's quality of life, to allow an active social life and the return to work. In modern society, driving is regarded as an essential activity of daily living. Since opioids are centrally acting drugs that may interfere with the ability of safely driving a motor vehicle, the question arises of whether or not and on which conditions patients under continuous opioid medication may be considered fit to drive. In this article the evidence from recent studies of opioid effects on driving ability of patients is reviewed. Based on these data, the prerequisites and restrictions for driving under chronic opioid medication are outlined and practical guidelines are proposed.     

子宫肌瘤二种术式对卵巢功能的影响

目的探讨子宫肌瘤病人用子宫次全切除或肌瘤剜出二种术式对卵巢功能的影响. 方法对78例子宫肌瘤患者分别于术前,术后3个月、2年,用化学免疫发光法测定生殖内分泌5项指标(FSH、LH、E2、PRL、T),观察二种术式对卵巢功能的影响. 结果子宫次全切除术组术后3个月、2年FSH、LH较术前显著增高(P＜0.01),E2较术前明显降低(P＜0.01);子宫肌瘤剜出术组5项指标术前、术后3个月、2年无明显变化(P＞0.05). 结论子宫肌瘤行子宫次全切除术对卵巢功能影响明显,而行肌瘤剜出术则卵巢功能无明显影响.     

Effects of Postmyocardial Infarction Scar Size, Cardiac Function, and Severity of Coronary Artery Disease on QT Interval Dispersion as a Risk Factor for Complex Ventricular Arrhythmia

The aim of the study was to determine the relation between QT dispersion and ventricular arrhythmia after myocardial infarction, as well as the effects of postinfarction scar size, cardiac function, and severity of coronary artery disease on QT dispersion. Three hundred three patients, 3 months after myocardial infarction, and a group of 21 healthy subjects were evaluated. QT dispersion was the difference between maximal and minimal QT interval in 12-ECG leads. Postinfarction scar size was determined by Selvester's QRS scoring system. Cardiac function was evaluated by echocardiography and exercise stress test, and the severity of coronary artery disease by the number and degree of coronary artery stenoses. QT dispersion increased significantly in relation to the severity of arrhythmia (< 50 premature ventricular complexes vs ventricular tachycardia; 61.6 [± 12.3] vs 84.8 [± 16.4] ms, P < 0. 001). QT dispersion > 80 ms was associated with ventricular tachycardia with the sensitivity of 68% and specificity of 88%. QT dispersion also increased significantly, dependent on the postinfarction scar size (0% vs ± 33% of left ventricular myocardium; 61.8 [± 16.4] vs 74.7 [± 16] ms, P < 0. 001), as well as in the case of significantly impaired cardiac function. Although QT dispersion increased with the number of diseased vessels and the degree of stenoses, the differences were not significant (P > 0. 05). In conclusion, QT dispersion is a risk marker of complex ventricular arrhythmia in the chronic stage of myocardial infarction. Multiple regression analysis indicates that only the postinfarction scar size has an independent effect on QT dispersion (R²= 0. 39, P < 0. 05).     

肺炎患儿潮气呼吸肺功能检测及其临床意义

目的观察婴儿肺炎的潮气呼吸肺功能动态变化并探讨其临床意义。方法采用德国耶格公司婴幼儿肺功能仪,对23例肺炎婴儿急性期、恢复期及15例正常婴儿进行肺功能检查,统计方法采用单因素方差分析,两两比较采用q检验。结果肺炎急性期组与恢复期组及正常组比较,呼吸频率（RR）、潮气峰值流速与潮气量的比率（PTEF/Vt）明显增高,每千克体重潮气量（Vt/kg）明显下降,差异有显著性;潮气峰值流速（PTEF）、达峰时间比（tPTEF/tE）及达峰容积比（vPTEF/vE）等指标差异均无显著性（P〉0.05）。结论肺炎婴儿急性期肺功能并不等同于毛细支气管炎肺功能表现,它主要表现为Vt/kg、RR、PEF/VT的改变,而非tPTEF/tE、vPTEF/vE的改变,Vt/kg、RR、PEF/VT可作为观察本病病情变化的敏感指标。     

保留后瓣及瓣下结构二尖瓣置换术分析

目的比较传统二尖瓣置换术与保留后瓣及瓣下结构的二尖瓣置换术对心功能的改善情况。方法回顾过去二尖瓣置换术58例,其中传统二尖瓣置换术33例为A组,保留后瓣及瓣下结构的二尖瓣置换术25例为B组,观察围术期多巴胺使用时间、ICU停留时间、术后3个月时超声心动图测定的左心室直径、左心室舒张末期直径、左心室收缩末期直径、左射血分数、左室短轴缩短率等指标与术前对比改善情况。结果B组各项指标均优于A组。结论二尖瓣置换保留后瓣及瓣下结构有助于术后心功能改善和长期改善心功能。     

20名医务人员重症急性呼吸综合征临床及随访分析

目的 :探讨医务人员重症急性呼吸综合征 (SARS)患者的临床特点和预后。方法 :选择 2 0名患SARS的医务人员为研究对象 ,收集病例资料并进行 3个月随访。结果 :2 0名患者均有SARS患者接触史 ,90 %为未防护时受感染 ,其家人均未患病。潜伏期 3～ 8(4.2± 1.5 )d ,临床症状主要有发热、咳嗽、呼吸困难及腹泻、心悸、胸痛 ,3例出现ARDS ,无一例死亡。实验室检查示部分患者血白细胞及淋巴细胞计数降低 ,ALT、AST、CPK升高。影像学改变主要为双肺中下野多发斑片状阴影。病愈后 3个月随访发现患者常有易疲乏、多汗、气短、心悸、脱发及易患感染等症状 ,5例CT示肺纤维化 ,肺功能检查示约半数患者有弥散功能下降。结论 :SARS患者潜伏期可能无传染性 ,临床特点为以呼吸系统为主的多系统损害 ,病愈后部分患者可能有肺功能下降。