泥浆灌注洗胃辅助治疗急性百草枯中毒疗效观察

目的 评估用泥浆洗胃辅助治疗急性百草枯中毒的临床疗效.方法 选择符合入选标准的急性百草枯中毒41例,随机分为泥浆洗胃辅助治疗组(观察组)及常规治疗组(对照组);观察2组多脏器功能衰竭(MODS)的发生时间、住院期间死亡时间及死亡病例存活时间和痊愈率.结果 观察组MODS发生时间为(2.84±0.43)d,住院至死亡时间为(5.98±0.57)d,全部死亡病例存活时间为(10.76±1.38)d,痊愈率42%;对照组MODS发生的时间为(2.09±0.35)d,住院至死亡的时间为(3.17±0.44)d,全部死亡病例存活时间为(8.56±1.02)d,痊愈率18%;2组比较差异均有统计学意义(均P＜0.05).结论 用泥浆灌注洗胃辅助治疗急性百草枯中毒可以延缓病情进展,延长患者生存时间,提高痊愈率.     

全身性炎症反应综合征患者血清C反应蛋白及其基因型检测的临床意义

检测全身性炎症反应综合征(SIRS)220例患者(发热104例,无发热116例)和正常对照组80例血清C反应蛋白(CRP)水平和CRP 1059G/C基因型.结果 与对照组比较,SIRS发热、不发热患者CRP均明显升高(P均<0.01);发热患者CRP升高程度及持续时间与不发热患者比较差异有统计学意义(P均<0.01).SIRS发热、不发热患者、对照组比较CRP基因型及等位基因分布差异无统计学意义,但GG基因型与GC或GC基因型比较CRP水平差别有统计学意义(P均<0.01).认为SIRS发热患者CRP水平明显升高且持续时间长,GG基因型患者CRP水平高于GC、CC基因型者.     

骨髓间充质干细胞移植治疗重症急性胰腺炎肺损伤

BACKGROUND:A large number of studies have confirmed that bone marrow mesenchymal stem cells can couple with the circulation of the blood to other organs, promote pancreatic tissue repair injury and reduce pulmonary fibrosis, which have certain therapeutic effects on pancreas and lung injuries. OBJECTIVE:To study the therapeutic effect on severe acute pancreatitis-associated lung injury in rats after the transplantation of bone marrow mesenchymal stem cells. METHODS:Animal models of severe acute pancreatitis-associated lung injury were prepared in rats via retrograde injection of 4% sodium taurocholate. Sprague-Dawley rats were randomized into three groups and received bone marrow mesencnymal stem cell injection via the tail vein in transplantation group, the same volume of normal saline in control group, or no treatment in normal groups. All the treatments in each group were performed 24 hours after modeling. Twenty-four hours after transplantation, hematoxylin-eosin staining of the pancreatic and lung tissues was performed. mRNA expressions of tumor necrosis factor-α and interleukin-1β in pancreatic and lung tissues were detected. ELISA kit was used to detect levels of serum C-reactive protein and tumor necrosis factor-α. RESULTS AND CONCLUSION:After modeling, under hematoxylin-eosin staining, there were a large number of inflammatory cells infiltrating in the damaged pancreatic tissues, accompanied by incomplete acinar structures, seriously destroyed lobular structures, alveolar fusion in the lung tissues, thickening of the alveolar walls, and a large amount of inflammatory cells infiltrating in the alveoli. These findings indicated successful modeling of severe acute pancreatitis-associated lung injury in rats. After cell transplantation, the number of infiltrated inflammatory cells in the damaged pancreatic tissue was reduced, with clear lobular structures and no bleeding from the acini; the structure of lung tissues was clear, with complete alveolar walls, and the width of alveolar space was reduced. Immunohistochemical results showed that transplanted DAPI-labeled bone marrow mesenchymal stem cells were aggregated in the pancreas and lung tissue, and uneven distributed in the damaged area. No DAPI expression in the pancreas and lung tissue was found in the control group, indicating transplanted bone marrow mesenchymal stem cells migrated into the damaged pancreas and lung tissue through the blood circulation, to further repair the damage area. RT-PCR test results showed that compared with the control group, bone marrow mesenchymal stem cell transplantation significantly reduced the levels of tumor necrosis factor-α and interleukin-1β in the pancreatic and lung tissues (P < 0.05). Higher levels of C-reactive protein and tumor necrosis factor-α were found in the control group compared with the normal group (P < 0.01), while the lower levels were obtained in the control group (P < 0.05). To conclude, our findings suggest that bone marrow mesenchymal stem cell transplantation is an effective therapy for severe acute pancreatitis-associated lung injury, and its mechanism may be associated with the reduction of inflammatory reactions and translation into the pancreas and lung tissue.     

慢快综合征患者植入自动化功能双腔起搏器后参数调整及预后分析

目的探讨慢快综合征患者在植入自动化功能双腔起搏器后参数的调整对预后的影响。方法选取2011年6月-2013年6月在我院植入自动化功能双腔起搏器的慢快综合征患者62例,随机分为对照组和观察组各31例,观察组的起搏心率设置为55次/min,对照组的起搏心率设置为65次/min,观察并比较在术后一年内两组患者频发心房事件的发生率(AHRE)、心室起搏百分率(Vp)、心房起搏百分率(Ap)、左心室内径(LAD)、左心室射血分数(LVEF)、左心室舒张末内径(LVEDD)、血脑钠肽(BNP)。结果观察组Ap和Vp明显降低,而LVEDD和LVEF得到较大改善,BNP明显减少,差异有统计学意义(P0.05),但是两组间的AHRE和LAD组间比较差异无统计学意义(P0.05)。结论适当降低起搏心率,能较好的调整患者的LVEF和LVEDD,同时可降低BNP。     

百草枯中毒肺纤维化患者血清基质金属蛋白酶及其抑制剂水平的变化

目的探讨血清基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制剂-1(TIMP-1)在百草枯(PQ)中毒肺纤维化患者中的动态变化。方法 30例健康对照组于受检时,30例PQ中毒患者于入院时及入院后7 d、14 d、28 d抽取静脉血,采用酶联免疫吸附法(ELISA)检测血清MMP-9和TIMP-1的水平。结果 PQ中毒患者入院时、入院后7 d、14 d血清MMP-9水平较对照组明显升高,差异有统计学意义(P<0.05)。PQ中毒患者入院后7d血清MMP-9水平较入院时及入院后14 d均明显升高,差异有统计学意义(P<0.05),PQ中毒患者血清MMP-9水平于入院后7 d达高峰。PQ中毒患者入院后7 d、14 d、28 d血清TIMP-1水平较对照组明显升高,差异有统计学意义(P<0.05)。PQ中毒患者入院后14 d血清TIMP-1水平较入院后7 d明显升高,差异有统计学意义(P<0.05),PQ中毒患者血清TIMP-1水平于入院后14 d达高峰。结论 MMP-9和TIMP-1在PQ中毒肺纤维化的发病机制中起重要作用。     

急性一氧化碳中毒迟发性脑病的康复治疗

目的：确立一个提高一氧化碳中毒迟发性脑病治愈率的指导原则。方法：以记分法对急性一氧化碳中毒迟发性脑病（1DEACMP）患者治疗前后常见的临床症状、体征进行统计学处理。结果：51例DEACMP患者经高压氧等综合治疗后，痊愈率为58．82％，远远高于未经治疗的一氧化碳中毒迟发性脑病患者。结论：高压氧等综合治疗能大大提高DEACMP的治愈率，改善患者的生活质量，减轻家庭负担。     

刺络联合刮痧治疗紧张型头痛的临床研究

目的观察刺络联合刮痧治疗紧张型头痛的临床疗效并探讨其作用机制。方法 84例患者随机分为两组。对照组采用盐酸阿米替林治疗,治疗组采用刺络联合刮痧治疗,两组均治疗4周。结果两组治疗2周后及治疗4周后头痛程度、头痛持续时间及头痛指数较本组治疗前均有降低(P0.05),两组治疗4周后较本组治疗2周后均有降低(P0.05),治疗组治疗2周后及治疗4周后降低程度均大于对照组(P0.05);两组治疗2周后左椎动脉(VAL)、右椎动脉(VAR)、基底动脉(BA)血流速度较本组治疗前略降低,但差异无统计学意义(P0.05),两组治疗4周后较本组治疗前均降低(P0.05),治疗组治疗4周后降低程度大于对照组(P0.05);治疗组总有效率为92.86%,高于对照组的80.95%(P0.05)。结论刺络联合刮痧治疗紧张型头痛,能够降低头痛程度,缩短头痛持续时间,改善椎-基底动脉血流动力学,提高临床疗效。     

人脐带间充质干细胞移植治疗急性肺损伤

BACKGROUND:Studies have shown that human umbilical cord mesenchymal stem cells can improve pulmonary ventilation function by reducing inflammations. OBJECTIVE:To observe the therapeutic effect of human umbilical cord mesenchymal stem cell transplantation on acute lung injury. METHODS:Thirty Sprague-Dawley rats were randomized into normal group, model group and experimental group. Rats in the latter two groups were used to establish animal models of acute lung injury by intratracheal instillation of lipopolysaccharide. One hour after modeling, rats in the experimental group were intratracheally administered human umbilical cord mesenchymal stem cell suspension (0.1 mL, 1×10⁶ cells), and those in the other two groups were given normal saline in the same dose intratracheally. Twenty-four hours after treatment, the pathological changes of lung tissue were observed using hematoxylin-eosin staining; the wet and dry weight ratio of the lung tissue and the levels of serum interleukin-1 and interleukin-8 were detected. RESULTS AND CONCLUSION:Compared with the normal group, the wet and dry weight ratio of the lung tissue and the levels of serum interleukin-1 and interleukin-8 were significantly increased in the model group (P < 0.05), while compared with the model group, these levels were significantly decreased in the experimental group (P < 0.05). Hematoxylin-eosin staining results showed clear alveolar space structure with complete alveolar septum in the normal group. In the model group, the alveolar septum was markedly thickened, and there was visible pulmonary capillary hyperemia, edema, as well as a large amount of inflammatory cell infiltrations in the pulmonary capillaries and alveolar space. Edema fluid rich in proteins was observed in a part of the pulmonary alveoli, and an extensive transparent membrane formed in the alveolar space. In the experimental group, the alveolar structure was clear, but the alveolar septum became thickened, and red blood cells and a small amount of infiltrated inflammatory cells were leaked from the pulmonary interstitial tissue. In conclusion, human umbilical cord mesenchymal stem cell transplantation for treatment of acute lung injury can reduce inflammatory factor levels and alleviate lung injury.     

补阳还五汤增强小鼠脑缺血耐受的实验研究

目的:本实验建立小鼠脑缺血耐受(brain ischemic tolerance,BIT)模型,观察BYHWT干预脑预缺血(cerebral ischemic preconditioning,CIP)诱导BIT形成的情况,以证实BYHWT具有增强C IP脑保护效果,促进脑缺血耐受形成的作用。方法:将64只健康昆明小鼠随机分为四组:假手术组、缺血损伤组、BIT模型组和中药干预组,每组16只。用微动脉夹夹闭双侧颈总动脉6min作为预处理,夹闭20min作为缺血模型,中药干预组灌服补阳还五汤。结果:术后7d海马CA1区,假手术组组织学组织学分级多为0级和1级,神经元密度ND=214±28n/mm;缺血损伤组组织学分级多为2级和3级,神经元密度ND=76±26 n/mm;BIT模型组海马CA1区组织学分级多为1级和2级,神经元密度ND=153±31n/mm;中药干预组海马CA1区组织学分级多为1级和0级神经元密度ND=196±23n/mm。每组间相比均有显著差异(P<0.05)。Bax和bcl-2蛋白表达变化,假手术组(Bax:12.35±2.23。bcl-2:5.17±1.34);缺血损伤组(Bax:53.96±1.42。bcl-2:5.77±1.22);BIT模型组(Bax:22.59±1.83。bcl-2:21.14±1.21);中药干预组(Bax:15.82±1.40。bcl-2:28.43±1.43)每组间相比均有显著差异(P<0.05)。提示:在小鼠前脑缺血模型中,以6min脑缺血作为预处理,可对间隔2d后20m in脑缺血引起的海马神经元损伤产生一定的保护作用,补阳还五汤能够对其产生良性干预效应,增强其脑保护作用,促进脑缺血耐受形成。     

产超广谱β-内酰胺酶大肠埃希菌与肺炎克雷伯菌2013-2015年耐药谱动态分析北大核心CSCD

目的分析2013-2015年医院产ESBLs大肠埃希菌和肺炎克雷伯菌耐药性变迁情况,旨在合理制定医院感染抗菌治疗方案。方法选取医院2013年1月-2015年12月诊治的感染性疾病患者标本,分析各类标本中产ESBLs大肠埃希菌和肺炎克雷伯菌检出情况,分析病原菌耐药性,同时对所得数据行统计比较。结果 2013年-2015年产ESBLs大肠埃希菌株检出率依次是7.92%、9.30%、8.77%,肺炎克雷伯菌检出率依次是21.31%、20.57%、20.17%,各年份产ESBLs大肠埃希菌株和肺炎克雷伯菌检出率,无显著性差异;产ESBLs大肠埃希菌对头孢菌素、青霉素类耐药性最高,2014年头孢吡肟耐药率为100.00%,对替加环素、美罗培南、亚胺培南耐药性较低,其中替加环素为0%,且2015年产ESBLs大肠埃希菌对米诺环素、头孢噻肟耐药率显著高于2014年水平(P<0.05);2013年-2015年肺炎克雷伯菌对氨苄西林耐药率最高,对哌拉西林、环丙沙星、头孢类药物耐药率不断升高,肺炎克雷伯菌对亚胺培南、美罗培南耐药率低。结论产ESBLs大肠埃希菌及肺炎克雷伯菌均为感染性疾病的主要致病菌,二者对常见抗菌药物均有较高耐药性,且随着年代更替,其耐药谱有一定变迁。