非生物人工肝支持系统治疗肝功能衰竭的血清氨基酸谱变化

Objective To analyze the patterns of amino acid changes in liver failure patients treated with non-bioartificial liver support system (ALSS), and to explore the efficacy of ALSS in liver failure treatment. Methods A total of 146 liver failure patients treated with ALSS from June 2009 to August 2010 were recruited in this study. Paired blood samples were collected from every patient and serum amino acids and ammonia were tested by automatic amino acid analyzer. The changes of amino acids in patients with different prognoses, different types/phases of liver failure were evaluated.Measurement data were compared by paired t test. Results After ALSS treatment, liver failure patients experienced a significant decrease in serum glutamic acid and lysine [(395.62±200.24)μmol/Lvs (260. 05±169.56) μmol/L and (436. 73±326. 18)μmol/L vs (407. 12±292.01) μmol/L,respectively; t= 8. 611 and 2. 659, respectively; both P＜0.01)], while experienced greatly increases in threonine and branched-chain amino acids/aromatic amino acid ratio [( 1302. 90 ±1288.70) μmol/L vs (1406.70 ±1272. 34) μmol/L and 1. 23 ± 0. 53 vs 1. 36 ± 0.57, respectively; t = 2. 895 and 1. 061,respectively; both P＜0. 01)]. The changes of glutamic acid, tyrosine, arginine and methionine before and after ALSS treatment in patients with different prognoses, different types/phases of liver failure were all significantly different. Conclusions ALSS treatment could improve the serum amino acid disorder in liver failure patients. The amino acids in patients with different types/phases or different prognoses of liver failure change significantly after ALSS treatment.     

大剂量利多卡因救治乌头碱中毒致心律失常1例

大剂量利多卡因救治乌头碱中毒致心律失常１例马五一杜景柏谭利张国君李建州我们应用大剂量利多卡因抢救乌头碱中毒致室性心律失常１例，报告如下。１病历简介患者女，５７岁，误食生川乌（后经药检证实）炖鸡汤及熟川乌１５ｇ后１０分钟出现反复呕吐，全身麻木、胸闷、心...     

非生物人工肝支持系统治疗肝功能衰竭的血清氨基酸谱变化

目的 分析肝功能衰竭患者接受非生物人工肝支持系统(ALSS)治疗引起的血清氨基酸谱变化,阐述非生物ALSS治疗肝功能衰竭的有效性.方法 对2009年6月至2010年8月间146例肝功能衰竭患者行非生物ALSS治疗,观察治疗前后患者血清氨基酸谱的变化情况,并对不同预后、不同肝功能衰竭类型以及处于不同肝功能衰竭时期患者的血清氨基酸水平的变化进行研究.计量资料采用配对样本的t检验.结果 非生物ALSS治疗后,血清谷氨酸和赖氨酸下降明显[(395.62±200.24)μumol/L比(260.05±169.56)μmol/L,(436.73±326.18)μmol/L比(407.12±292.01)μmol/L;t＝8.611,t＝2.659;均P＜0.01],苏氨酸、支链氨基酸/芳香族氨基酸显著上升[(1302.90±1288.70)μmol/L比(1406.70±1272.34)μmol/L,1.23±0.53比1.36±0.57;t＝2.895,t＝1.061;均P＜0.01].在预后不同的患者间、不同肝功能衰竭类型以及处于不同时期的肝功能衰竭患者间,谷氨酸、酪氨酸、精氨酸以及蛋氨酸等治疗前后差异有统计学意义.结论 非生物ALSS治疗可以改善肝功能衰竭患者血清氨基酸紊乱状况.不同肝功能衰竭分类、分期以及不同预后患者的血清氨基酸谱在非生物ALSS治疗后有显著不同的变化.

Abstract：

Objective To analyze the patterns of amino acid changes in liver failure patients treated with non-bioartificial liver support system (ALSS), and to explore the efficacy of ALSS in liver failure treatment. Methods A total of 146 liver failure patients treated with ALSS from June 2009 to August 2010 were recruited in this study. Paired blood samples were collected from every patient and serum amino acids and ammonia were tested by automatic amino acid analyzer. The changes of amino acids in patients with different prognoses, different types/phases of liver failure were evaluated.Measurement data were compared by paired t test. Results After ALSS treatment, liver failure patients experienced a significant decrease in serum glutamic acid and lysine [(395.62±200.24)μmol/Lvs (260. 05±169.56) μmol/L and (436. 73±326. 18)μmol/L vs (407. 12±292.01) μmol/L,respectively; t= 8. 611 and 2. 659, respectively; both P＜0.01)], while experienced greatly increases in threonine and branched-chain amino acids/aromatic amino acid ratio [( 1302. 90 ±1288.70) μmol/L vs (1406.70 ±1272. 34) μmol/L and 1. 23 ± 0. 53 vs 1. 36 ± 0.57, respectively; t = 2. 895 and 1. 061,respectively; both P＜0. 01)]. The changes of glutamic acid, tyrosine, arginine and methionine before and after ALSS treatment in patients with different prognoses, different types/phases of liver failure were all significantly different. Conclusions ALSS treatment could improve the serum amino acid disorder in liver failure patients. The amino acids in patients with different types/phases or different prognoses of liver failure change significantly after ALSS treatment.     

益气清脑通颗粒治疗急性脑梗死的临床疗效观察

目的观察益气清脑通颗粒治疗急性脑梗死的临床疗效。方法选择400例急性脑梗死患者,随机分为两组。对照组按常规卒中单元治疗模式进行,包括常规西药治疗、肢体康复、语言训练、心理康复和健康教育等方法;治疗组在对照组治疗的基础上,口服益气清脑通颗粒10g,3次/d,连续28d。比较两组治疗的临床疗效。结果治疗组、对照组实际分别完成192例、189例。两组治疗后较治疗前神经功能缺损评分及中医证候积分各方面均有显著性差异(均P0.01),治疗后治疗组在语言及上下肢肌力、半身不遂、言语蹇涩不利及舌苔改善方面效果较对照组差异有统计学意义(均P0.05)。结论常规卒中单元治疗模式基础上加用益气清脑通颗粒治疗急性脑梗死,其神经功能缺损及中医证候改善效果方面较常规卒中单元治疗模式高,值得进一步研究。     

杭州市三甲医院服务质量患者评价量表的研究

目的研究基于患者视角的杭州市三级甲等(三甲)医院服务质量评价量表。方法采用现场调查的方法,抽取杭州市7所三甲医院的364名患者进行问卷调查,运用统计分析方法对调查的问卷进行信度、效度检验分析。结果经过统计分析,本研究量表的Cronbach’sα信度系数为0.90,5个因子累计贡献率为69.89%。结论本研究所构建的量表具有较高的信度和效度,能够对杭州市三甲医院医疗服务质量进行有效的评价。     

阿利吉仑对大鼠急性肝衰竭的保护作用及机制研究

目的 探讨阿利吉仑对急性肝衰竭的保护作用及其分子机制。方法 将30只健康SD大鼠按随机数字表法分为正常对照组、肝衰竭组和阿利吉仑组。通过D-氨基半乳糖(D-galactosamine,D-GalN)/脂多糖(lipopolysaccharide,LPS)联合腹腔注射诱导急性肝衰竭模型。阿利吉仑组造模前30min腹腔注射阿利吉仑(25mg/kg)。所有实验大鼠造模后10h统一处死采样,检测大鼠血清的ALT、AST、LDH、ALP及TNF-α、IL-6、TGF-β1、AngⅡ、Ang(1-7)水平,观察肝脏组织中炎症坏死及细胞凋亡水平,分析大鼠肝脏组织GRP78、CHOP分子的表达水平。结果 阿利吉仑干预可以明显降低ACE-AngⅡ-AT1R轴激活水平。与肝衰竭组比较,阿利吉仑组大鼠血清的ALT、AST、LDH、ALP水平及TNF-α、IL-6、TGF-β1水平均明显下降,阿利吉仑组大鼠肝脏组织炎症损伤明显减轻,肝细胞凋亡指数明显下降。阿利吉仑组大鼠的肝脏组织中ERS相关因子GRP78 和CHOP的表达水平较肝衰竭组明显下调。结论 阿利吉仑通过阻断RAS,能够明显减轻急性肝衰竭进程中的肝脏炎症,减少肝细胞的凋亡,其保护作用可能与抑制内质网应激有关。     

非生物人工肝支持系统治疗肝功能衰竭的血清氨基酸谱变化

Objective To analyze the patterns of amino acid changes in liver failure patients treated with non-bioartificial liver support system (ALSS), and to explore the efficacy of ALSS in liver failure treatment. Methods A total of 146 liver failure patients treated with ALSS from June 2009 to August 2010 were recruited in this study. Paired blood samples were collected from every patient and serum amino acids and ammonia were tested by automatic amino acid analyzer. The changes of amino acids in patients with different prognoses, different types/phases of liver failure were evaluated.Measurement data were compared by paired t test. Results After ALSS treatment, liver failure patients experienced a significant decrease in serum glutamic acid and lysine [(395.62±200.24)μmol/Lvs (260. 05±169.56) μmol/L and (436. 73±326. 18)μmol/L vs (407. 12±292.01) μmol/L,respectively; t= 8. 611 and 2. 659, respectively; both P＜0.01)], while experienced greatly increases in threonine and branched-chain amino acids/aromatic amino acid ratio [( 1302. 90 ±1288.70) μmol/L vs (1406.70 ±1272. 34) μmol/L and 1. 23 ± 0. 53 vs 1. 36 ± 0.57, respectively; t = 2. 895 and 1. 061,respectively; both P＜0. 01)]. The changes of glutamic acid, tyrosine, arginine and methionine before and after ALSS treatment in patients with different prognoses, different types/phases of liver failure were all significantly different. Conclusions ALSS treatment could improve the serum amino acid disorder in liver failure patients. The amino acids in patients with different types/phases or different prognoses of liver failure change significantly after ALSS treatment.     

适用于生物人工肝的3种不同肝细胞的增殖能力及代谢功能的比较研究

目的 比较Huh7细胞、HepLi3细胞与C3A细胞的增殖能力及合成、代谢功能,评估其作为生物人工肝细胞源的潜力。方法 在同样的培养条件下,观察3种肝细胞的形态和增殖能力,检测肝细胞功能相关基因的表达水平,比较3种肝细胞白蛋白、尿素合成功能及代谢功能,评估肝衰竭血浆对肝细胞活性的影响。结果 3种肝细胞均具有良好的增殖能力,其中HepLi3的增殖能力最强。荧光定量PCR结果显示,ALB、GST、CYP1A2、CYP2E1、CYP3A4等功能相关基因在3种肝细胞中均有不同程度的表达,Huh7细胞GST、CYP1A2、CYP3A4的表达水平最高。免疫荧光结果显示3种肝细胞中均能够表达CYP1A2、CYP2E1、CYP3A4等功能蛋白。3种肝细胞均具有良好的白蛋白、尿素合成功能及CYP1A2、CYP3A4代谢活性,Huh7细胞的CYP1A2代谢活性最高,HepLi3细胞的CYP3A4代谢活性最高。肝衰竭血浆对3种肝细胞的活性均没有明显影响。结论 Huh7、HepLi3细胞具备成为生物人工肝细胞源的潜力。     

公立医院非技术性服务质量评价综述

回顾医疗服务质量概念,提出患者视角医疗服务质量评价的重要意义;总结、分析了医疗服务质量的评价指标及评价方法,认为将服务管理领域的SERVQUAL量表应用到医疗服务行业具有重要的研究价值;SERVQUAL量表对评价医院服务的功能性质量(非技术性服务质量)有重要价值,但建议进行维度和条目的 相应调整.