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1.
乌司他丁对成人先天性心脏病手术炎性反应的影响   总被引:9,自引:3,他引:6  
目的 探讨乌司他丁应用于成人先天性心脏病手术中对患者部分炎性介质的影响.方法 成人先天性心脏病患者40例(其中室间隔缺损27例、房间隔缺损13例),随机分为乌司他丁组(U组)和对照组(C组),每组20例.乌司他丁组在麻醉诱导前和体外循环(extracorporeal circulation,ECC)开始时各给予乌司他丁10000U/kg,对照组行常规ECC.分别在麻醉诱导前(T1)、ECC结束时(T2)、术毕6 h(T3)、24 h(T4)采集血标本,检测血清中肿瘤坏死因子(TNF-α)、白细胞介素2(IL-2)和白细胞介素10(IL-10)浓度.结果 ECC结束后两组TNF-α、IL-2、IL-10均有明显增高;U组TNF-α、IL-2在T2、T3、T4时点增值较C组为低(P<0.05,<0.01),而IL-10在T2、T3、T4时点增值则较C组为高(P<0.05,<0.01).结论 乌司他丁应用于成人先天性心脏病手术中可减少TNF-α、IL-2、等促炎细胞因子的释放,同时可促进抑炎细胞因子IL-10的分泌,从而减轻ECC炎性反应.  相似文献
2.
目的 探讨乌司他丁对体外循环冠状动脉旁路移植术患者凝血系统、血小板功能和术后出血的影响.方法 择期行体外循环(CPB)冠状动脉旁路移植术患者36例,随机分为对照组(C组,n=18)和乌司他丁组(U组,n=18).U组将乌司他丁40万单位溶于100 ml生理盐水中,自切皮开始静脉输注,30 min内输注完毕,另将40万单位加入CPB预充液中,另外20万单位以4~6万单位/h速率输注至术毕,总量100万单位,C组不用乌司他丁及任何抗纤溶药物.分别于切皮前1 min(基础值,T0),肝素化前1 min(此时U组已用乌司他丁40万单位,T1),术毕(T2),术后6 h(T3)和术后24 h(T4)经颈内静脉导管采血5 ml,用流式细胞仪测定血小板膜糖蛋白GPⅡb/Ⅲa和血小板α颗粒膜蛋白-140(CD62p),用比浊法测定激活部分凝血致活酶时间(APTT)、凝血酶原时间(PT)和纤维蛋白原,用硅藻土激活剂测定激活全血凝固时间(ACT).记录患者术后24 h出血量和输血量.结果 组间GPⅡb/Ⅲa、CD62p和PT,以及术后24 h出血量和同种输血量比较差异均无统计学意义(P>0.05).与基础值比较,U组APTT在T1、T3和T4均缩短(均P<0.05).与C组比较,U组:APTT在T1~4均缩短(均P<0.05),体外循环中ACT缩短,补充肝素量增加(P<0.01).结论 乌司他丁对血小板聚集和活性无影响,它能缩短APTT及肝素化后的ACT,增加CPB中补充肝素量,对内源性凝血系统有促进作用,该实验所用剂量未见减少CPB术后出血.  相似文献
3.
Background Urinary trypsin inhibitor inhibits the enhanced production of pro-inflammatory molecules. Hemeoxygenase-1 induction protects against ischemia/repeffusion injury, oxidative stress, inflammation, transplant rejection, apoptosis, and other conditions. However, it is unknown if a combined hemin and ulinastatin pretreatment could result in protective effects for septic shock. In this study, we investigated the role of hemin pretreatment combined with ulinastatin on septic shock in rats. Methods Eighty healthy, male Sprague-Dawley rats were randomly divided into four groups: group S, group H, group U and group HU. Groups S and U received 1 ml normal saline intraperitoneally, while groups H and HU both received 1 ml (100 mg/kg) hemin. Twenty-four hours later, 0.5 ml (10 mg/kg) E. coil lipopolysaccharide was injected intravenously to replicate the experimental model of septic shock. After an initial 25% decrease in the mean arterial pressure, corresponding to time point 0, groups HU and U received 0.5 ml 10 000 U/kg ulinastatin intravenously, and the others received 0.5 ml normal saline. Results The number of deaths in groups H and U was lower than that in the group S (P〈0.05), and was higher than that in group HU (all P〈0.05) respectively. The mean arterial pressure (MAP) in the group S was significantly greater than that in group H (P〈0.05), and was lower than that in group HU and group U (P〈0.05). The plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr) and blood urea nitrogen (BUN), the malondial- dehyde (MDA) of liver, kidney and lung, and the lung Evans blue (EB) contents in groups H and U, were greater than that in group HU (all P〈0.05), and were lower than that in group S (all P〈0.05). In contrast, the plasma levels of CO in groups H and HU were higher than that in groups S and U (all P〈0.05), and SOD of liver, kidney and lung in groups H and U were higher than that in group S,  相似文献
4.
乌司他丁治疗急性呼吸窘迫综合征临床研究   总被引:5,自引:2,他引:3  
欧书钦  马渝  文玉明  陶杨 《重庆医学》2008,37(12):1336-1337
目的评价乌司他丁在急性呼吸窘迫综合征(ARDS)患者中的治疗作用。方法36例ARDS患者随机分为实验组(n=18)和对照组(n=18),观察比较两组患者治疗前后血气指标改变、急性生理和慢性健康评分(APACHEⅡ评分)变化及病死率差异。结果实验组患者的动脉血气指标、APACHEⅡ评分的改善率均明显优于对照组,病死率亦明显低于对照组。结论乌司他丁能显著改善ARDS患者的血气指标及APACHEⅡ评分,预防多器官窘迫综合征(MODS)发生,并明显降低ARDS患者的病死率。  相似文献
5.
乌司他丁在体外循环中肺保护机制的研究   总被引:4,自引:0,他引:4  
目的探讨体外循环(cardiopulmonary bypass,CPB)所引起的肺组织炎性损伤,研究术中应用乌司他丁(UTI)对肺的保护作用及可能的机制。方法25例患者随机分为两组,实验组于转流后将UTI加入体外循环机中。动态检测两组患者左、右房中性粒细胞数(polymorphonuclear neutrophils,PMN)、血小板数(Plt);血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平;肺顺应性;CPB后肺组织电镜检查变化结果。结果①对照组心脏复跳后左房PMN、Pt明显低于右房(P〈0.05);②CPB开始后,两组桡动脉血IL-6、TNF-α进行性升高,心脏复跳后逐渐下降,对照组增高更显著(P〈0.05)。③CPB开始后,两组桡动脉血IL-10进行性增高,心脏复跳后逐渐下降,实验组增高更显著(P〈0.05)。④肺顺应性在停CPB后均降低,对照组降低更显著,与实验组比较有显著差异(P〈0.05)。⑤电镜观测:实验组Ⅰ型、Ⅱ型肺泡细胞内细胞器、细胞形态学的改变较轻。结论UTI能减轻CPB后肺损伤,保护术后肺功能。  相似文献
6.
乌司他丁治疗急性胰腺炎65例疗效观察   总被引:4,自引:0,他引:4  
目的:观察乌司他丁治疗急性胰腺炎(AP)的临床疗效及安全性。方法:将131例AP患者随机分为治疗组65例和对照组66例,两组均给予常规治疗,治疗组在此基础上加用乌司他丁治疗。结果:①治疗组轻症的总有效率为100%,与对照组(总有效率为97.2%)比较无显著性差异(P〉0.05),但治疗组轻症的痊愈率(73.5%)则显著优于对照组的47.2%(P〈0.05)。②治疗组重症的总有效率为87.1%,对照组重症的总有效率为63.3%,两者比较差异有显著性(P〈0.05),治疗组重症的痊愈率(61.3%)也显著优于对照组(33.3%)(P〈0.05)。治疗组发生并发症的比率(6.5%)显著低于对照组(26.7%)(P〈0.05),且未见明显副作用。结论:早期使用乌司他丁对AP有明显的抑制作用,且无明显不良反应。  相似文献
7.
Background  The composition of the lung preservation solution used in lung graft procurement has been considered the key to minimize lung injury during the period of ischemia. Low-potassium dextran glucose (LPDG), an extracellular-type solution, has been adopted by most lung transplantation centers, due to the experimental and clinical evidences that LPDG is superior to intracellular-type solutions. Ulinastatin has been shown to attenuate ischemia-reperfusion (I/R) injury in various organs in animals. We supposed that the addition of ulinastatin to LPDG as a flushing solution, would further ameliorate I/R lung injury than LPDG solution alone.
Methods  Twelve male New Zealand white rabbits were randomly divided into 2 groups. Using an alternative in situ lung I/R model, the left lung in the control group was supplied and preserved with LPDG solution for 120 minutes. In the study group 50 000 U/kg of ulinastatin was added to the LPDG solution for lung preservation. Then re-ventilation and reperfusion of the left lung were performed for 90 minutes. Blood gas analysis (PaO2, PaCO2), mean pulmonary artery pressure (MPAP) and serum TNF-α level were measured intermittently. The pulmonary water index (D/W), tissue myeloperoxidase (MPO) activity, tissue malondialdehyde (MDA) content and morphologic changes were analyzed.
Results  The study group showed significantly higher PaO2 and lower MPAP at the end of reperfusion. Serum TNF-α level, left lung tissue MPO and MDA in the study group were significantly lower than those in the control group. D/W and pathologic evaluation were also remarkably different between the two groups.
Conclusions  This study indicated that better lung preservation could be achieved with the use of an ulinastatin modified LPDG solution. Ulinastatin further attenuated lung I/R injury, at least partly by reducing oxidative reactions, inhibiting the release of inflammatory factors and neutrophils immigration.
  相似文献
8.
乌司他丁对脓毒症脏器的保护作用   总被引:3,自引:0,他引:3  
脓毒症是危重症医学研究的热点与难点,是危重症患者死亡的常见原因。其发病机制复杂,与机体多系统、多器官病理生理改变密切相关,而有效的药物应用以维持机体内环境稳态,为抢救治疗措施的实施赢得更多时间。乌司他丁是从人体尿液中分离纯化的一种胰蛋白酶抑制剂,无免疫原性,主要通过调控炎性介质释放以维持肠道黏膜完整性、改善凝血功能、降低血管通透性,进而阻断全身炎性反应综合征/多脏器功能障碍综合征的进程,具有明显的脏器功能保护作用。  相似文献
9.
围术期应用乌司他丁对高血压脑出血患者的脑保护作用   总被引:3,自引:0,他引:3  
目的:研究高血压脑出血围术期应用乌司他丁对神经元特异性烯醇化酶的影响和脑保护作用?方法:高血压脑出血发病7 h内的手术患者40例,随机分为乌司他丁组(A组)和对照组(B组)?测定两组术前和术后12?36 h血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)的浓度及术前和术后第8天的格拉斯哥(glasgow coma scale,GCS)的评分?结果:术后12 h和36 h,A组NSE浓度明显低于B组,术后第8天A组GCS评分明显高于B 组?结论:高血压脑出血术中早期应用乌司他丁有利于神经保护?  相似文献
10.
乌司他丁对体外循环术中肺脏的保护作用   总被引:3,自引:0,他引:3  
目的研究乌司他丁对体外循环术中肺脏的保护作用。方法选择心脏直视手术患者60例,分别设乌司他丁治疗组和对照组各30例,在5个时间点分别检测中性粒细胞弹性酶(NE)、白介素(IL)-8、超氧化物歧化酶(SOD)含量的变化。结果在主动脉开放后的3个时间点两组数据具有显著性差异。结论乌司他丁在体外循环中具有抗蛋白酶分解、调节细胞因子和减少氧自由基的肺保护作用。  相似文献
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