经不同途径应用万古霉素治疗兔细菌性脑室炎的效果

目的 探讨经不同途径应用万古霉素治疗兔细菌性脑室炎的效果。方法 将新鲜配制的标准表皮葡萄球菌混悬液0.5 ml以0.1 ml/min的速度缓慢注入侧脑室将制作兔细菌性脑室炎模型。将50只细菌性脑室炎成年新西兰大白兔随机分为单纯静脉组（Ⅰ组，静脉注射万古霉素）、单纯动脉组（Ⅱ组，颈内动脉注射万古霉素）、联合静脉组（Ⅲ组，先静脉注射甘露醇，继而注射万古霉素）、联合动脉组（Ⅳ组，先颈内动脉注射甘露醇，继而注射万古霉素），对照组（Ⅴ组，静脉注射生理盐水），每组10只。所有动物均12 h给药一次，直至动物死亡，最多给药6次。结果 Ⅰ组、Ⅱ组给药后96 h内无动物死亡，Ⅲ组给药后72~96 h死亡5只，Ⅳ组给药后72~96 h死亡1只，Ⅴ组给药后24 h内全部死亡。首次给药后1 h，Ⅰ、Ⅱ、Ⅲ、Ⅳ组脑脊液万古霉素浓度分别为（40.02±0.07）μg/L、（89.11±0.19）μg/L、（69.02±0.17）μg/L、（118.13±0.31）μg/L；两两比较，均有统计学差异（P<0.05）。给药72 、96 h，Ⅳ组肛温、外周血白细胞数、脑脊液白细胞数均明显低于Ⅲ组（P<0.05）。结论 经颈内动脉联合应用甘露醇和万古霉素治疗细菌性脑室炎的效果优于单纯静脉或动脉注射万古霉素以及经静脉联合应用甘露醇和万古霉素的效果。     

甘露醇在腰椎间盘突出症术后“反跳痛”治疗中的应用

目的：探讨甘露醇注射液在腰椎间盘突出症术后"反跳痛"治疗中的临床疗效。方法：收集2014年3月到2017年3月在我院行椎间盘镜下髓核摘除术的患者共82例，将所有患者随机分为3组，其中对照组27例，甘露醇组30例，地塞米松组25例。术前记录患者下肢痛的视觉模拟评分（VAS评分），腰椎日本骨科协会评估治疗分数（JOA评分）。术后甘露醇组使用20%甘露醇注射液125 mL静脉滴注，每8小时一次，连用一周。地塞米松组使用20 mg地塞米松磷酸钠注射液加入葡萄糖注射液，3 d后地塞米松减量为10 mg，连用一周。记录术后下肢痛的VAS评分和腰椎JOA评分，以及是否有下肢"反跳痛"及其VAS评分和持续时间。结果：3组患者手术前后VAS评分和JOA评分没有显著性差异（P>0.05）。3组患者术后下肢"反跳痛"的发生率没有显著性差异（P>0.05）。地塞米松可减少术后下肢痛的VAS评分，甘露醇无此效果，差异有显著性差异（P<0.05）。结论：甘露醇不能减少术后下肢"反跳痛"的发生率，疼痛程度和持续时间。     

Nitric oxide donors offer protection to RBC from storage lesion

BackgroundRed blood cell (RBC), which is the most commonly transfused blood component, due to its ability to save a life in absence of any other blood components, can be stored up to maximum 6 weeks by following standard preservation procedure. During storage, RBC undergoes various biophysical and biochemical changes (commonly known as storage lesion) for which blood transfusion with “old RBC” shows a lot of clinical problems especially relevant to critically ill patients. Recent research on S-nitrosylation of haemoglobin to improve oxygen delivery of banked blood revealed the important role of nitric oxide (NO) in protecting storage lesion.Materials and methodsIn the present study, we used various “NO donating” chemicals with different NO release dynamics and chemistries in RBC storage cocktails to test the effects of NO on storage lesion. Changes in different storage markers were evaluated after 7 days storage of pre-treated RBC.ResultsAll the NO donors have shown protection against hemolysis. However, S-nitroso glutathione (GSNO) ranks first in shielding RBCs from storage lesion and additionally, it helps in elevating the value of 2, 3-di phosphoglycerate (2, 3-DPG), improving the RBC membrane fluidity and decreasing the adhesion towards endothelial monolayer.DiscussionPresent study reveals that NO released from NO donors confers protection against storage lesions of the RBC. Further, the study confirms that pre-treatment with GSNO, a NO donor and a nitrosylating agent, ensures the best protection to RBC during low temperature storage, when compared to other NO donor treatments.     

高渗盐水和甘露醇在动脉瘤性蛛网膜下腔出血患者降低颅内压中的应用

目的比较3%高渗盐水和20%甘露醇治疗重症动脉瘤性蛛网膜下腔出血所致颅内压增高的疗效.方法25例动脉瘤性蛛网膜下腔出血患者出现颅内压增高事件时, 随机交替接受等渗透剂量的160 mL 3%高渗盐水与150 mL 20%甘露醇进行降低颅内压治疗, 连续监测患者颅内压、平均动脉压、脑灌注压及中心静脉压.记录有效降低颅内压持续时间、颅内压最大降幅及其时间, 用药前及用药后1 h、3 h血钠水平及血浆渗透压.结果3%高渗盐水和20%甘露醇均可降低颅内压(均 P < 0.01), 两者的降低颅内压作用持续时间及颅内压降幅差异均无统计学意义(均 P >0.05).患者脑灌注压较用药前均上升(均 P < 0.01), 平均动脉压先上升后下降, 但差异无统计学意义( P >0.05).患者中心静脉压稍有波动, 但差异均无统计学意义(均 P >0.05).20%甘露醇治疗后患者血钠下降, 3%高渗盐水治疗后患者血钠值上升, 变化均有统计学意义(均 P < 0.05).20%甘露醇及3%高渗盐水治疗后患者血浆渗透压均先上升后下降, 变化均有统计学意义(均 P < 0.01). 结论3%高渗盐水可作为治疗动脉瘤性蛛网膜下腔出血所致颅内压增高患者的一线治疗药物.     

复方大黄膏预防甘露醇所致静脉炎的效果观察

目的探讨静脉输入甘露醇致静脉血管损伤的预防措施。方法将102例静脉输入甘露醇液体的病人随机分成观察组和对照组。观察组采用复方大黄膏局部外敷预防静脉炎．对照组不进行护理干预．观察输液静脉走向处皮肤有无红肿、压痛及静脉管壁弹性。结果观察组发生静脉炎的程度均低于对照组（P〈0．01）。结论采用复方大黄膏外敷能有效预防甘露醇所致静脉炎的发生。     

连续使用甘露醇治疗重型颅脑损伤患者颅内高压的临床研究

目的观察甘露醇反复长期使用后颅内压（ICP）的变化规律，以探讨甘露醇的有效使用方法。方法选择25例重型颅脑损伤患者术后ICP〈30mmHg的患者作为研究对象，予甘露醇静脉滴注，1．0g／（kg·次）／次，每4—6h1次，连续使用7d以上。同时应用颅内压监测仪持续监测ICP，并进行分析比较。结果用药后ICP均明显下降，至第7d仍能保持有效降颅压；但第2d开始治疗后ICP最低值高于第1d、ICP最大降幅百分比小于第1d，差异有显著性（P〈0．05）。结论连续使用甘露醇后降颅内高压的效力于第2d开始减弱，但至第7d仍能保持有效的降颅压。     

3%氯化钠溶液对老年神经外科手术患者胸腔液体含量和血钠的影响

目的观察不同剂量3%氯化钠溶液对老年神经外科手术患者胸腔液体含量(TFC)和血钠的影响。方法 120例拟行择期神经外科开颅手术的老年患者,随机均分为3%氯化钠溶液2ml/kg组(H1组)、3%氯化钠溶液4ml/kg组(H2组)、3%氯化钠溶液6ml/kg组(H3组)和甘露醇组(M组)。H组所有患者在麻醉诱导后30min内分别给予3%氯化钠溶液2、4、6ml/kg;M组给予20%甘露醇250ml;其后输入复方乳酸钠5 ml·kg-1·h-1。用无创阻抗仪监测入室时(基础值,T0)、麻醉诱导后(T1)、切开硬脑膜(T2)和术毕(T3)时的MAP、HR、CO、TFC,同时记录PaO2、PaCO2、pH、Na+、K+血气分析,观察脑膜张力、出血量、尿量、手术时间和拔管时间。结果与T0时比较,T1~T3四组患者MAP明显降低(P0.05),T1四组CO明显降低(P0.05),而T2时H3组、M组和T3时H3组CO明显升高(P0.05),T2时H3组、M组和T3时H3组TFC明显升高(P0.05)。与M组比较,T3时H3组CO明显升高(P0.05),T2时H1组、H2组TFC明显降低、而H3组TFC明显升高(P0.05)。与T0时比较,T1~T3四组PaO2明显升高(P0.05),T2四组PaCO2明显降低(P0.05),T3时H2组和H3组Na+明显升高(P0.05)。与M组比较,T2时H3组、T3时H2组和H3组Na+浓度明显升高(P0.05)。与H3组比较,H1组、H2组和M组脑张力为良的例数明显增加(P0.05)。与M组比较,H1组、H2组、H3组尿量明显减少(P0.05)。结论甘露醇和高渗盐具有很好的稳定血流动力学和降低颅内压的作用,但是高渗盐可显著增加CO、TFC和Na+浓度,对老年患者具有增加心肺功能负担的风险,应该谨慎使用。     

Effect of some free radical scavengers on reperfusion induced arrhythmias in the isolated rat heart

The possible role of oxygen free radicals in the development of reperfusion arrhythmias was investigated using a 10-min period of coronary ligation followed by reperfusion in the isolated rat heart. Superoxide dismutase (5 to 20 u/ml) glutathione (10(-5) to 10(3)M) and ascorbic acid (10(-4) to 5 X 10(-4) M) when given before coronary ligation attenuated the development of reperfusion arrhythmias. Mannitol (2 X 10(-2)M) and catalase (100 and 300 u/ml) did not have any significant effect on reperfusion arrhythmias when given alone but they did potentiate the antiarrhythmic effect of superoxide dismutase. Glutathione, and a combination of superoxide dismutase, catalase and mannitol also reduced the incidence of reperfusion induced ventricular fibrillation when given just before reperfusion. By perfusing hearts with ferricytochrome C it was possible to show an increased reduction of ferricytochrome C during the first minute of reperfusion which could be prevented by the addition of superoxide dismutase. These results provide evidence that oxygen free radicals are produced and may be important in the genesis of reperfusion induced arrhythmias in the isolated rat heart.     

Forearm Compartment Syndrome After Intravenous Mannitol Extravasation in a Carbosulfan Poisoning Patient

We report a case of forearm compartment syndrome caused by extravasation of mannitol in an intoxicated patient. The pathophysiology and management of a forearm compartment syndrome from extravasation of mannitol are discussed in this case.     

两种肠道清洁剂对便秘患者肠道准备效果影响因素分析

目的：分析复方聚乙二醇(Polyethylene glycol,PEG)电解质散和20%甘露醇对便秘患者肠道准备的效果和影响因素。方法：选取2015年9月-2016年12月结肠镜诊疗前口服PEG或20%甘露醇的便秘患者,对其肠道准备情况进行分级,并记录患者年龄、性别、便秘病程、平时是否服用促动力药或缓泻剂、肠道准备期间饮食情况、活动情况、耐受情况等。结果：本研究共纳入544例便秘患者,PEG组239例,20%甘露醇组305例。肠道准备总无效率为22.79%,其中PEG组无效率为24.27%,20%甘露醇组无效率为21.64%。便秘病程、平时是否服用促动力药或缓泻剂、肠道准备期间活动情况是PEG在肠道准备无效的影响因素；便秘病程是20%甘露醇在肠道准备无效的影响因素。结论：便秘患者在进行肠道准备时,可对其进行个体化处理,有助于提高肠道准备质量。