严重植物日光性皮炎1例

患者,女,42岁,于2012-06-20中餐及晚餐进食芹菜、野葱。于2012-06-21在日光暴晒下劳动,劳动过程中出现双手剧烈疼痛,进而肿胀、皮肤僵硬、手背皮下淤血、青紫发绀,伴有麻木,用手擦拭颜面部及吸吮刺痛拇指后,颜面部同时出现肿胀、淤血、青紫发绀,并气喘、呼吸困难、视物不清。经当地医院对症治疗后气喘、呼吸困难、视物不清症状缓解,但颜面部肿胀、淤血、青紫发绀进一步加重。于2012-06-23入我院。体格检查:生命体征平稳,神智清楚。颜面部及双手手背弥漫性肿胀,皮     

氨基胍与左旋硝基精氨酸甲酯在兔心脏骤停复苏中的比较

Objective To observe the changes of nitric oxide (NO) levels in plasma during cardiopul-monary resuscitation (CPR) and to compare the effects of aminoguanidine (AG) and NG-nitro-L-arginine methyl ester (L-NAME) on CPR. Method This was a prospective, randomized animal study performed at the Function Laboratory of Lanzhou University. Cardiac arrest was electrically induced and was left untreated for 5 min. After performing chest compression for 1 min, 40 domestic rabbits were divided into four groups (n = 10) to receive ei-ther 20 mg/kg AG, 25 mg/kg L-NAME, 0.02 mg/kg epinephrine or 2 ml saline placebo before defibrillation. Successfully resuscitated rabbits were observed for a further 4 h. Hernodynamics variables and cardiac functions were monitored with appropriate instrumentation. Arterial blood NO levels were examined at baseline, at the end of 1 min chest compression and at 15, 30, 60 and 120 min after survival. Repeated measures analysis of variance was used to determine statistical significance between groups. Results During chest compression, the mean + stan-dard deviation coronary perfusion pressure was higher in the AG group (40±10 mmHg) than in the L-NAME group (34±8 mmHg; P =0.001) and was higher in both groups with the control group (20±5 mmHg; both P =0.000). Left ventricular + dp/dtmax and- dp/dtmax were higher in the AG group than in the L-NAME group. In the surviving rabbits, the left ventricular + dp/dtmax and - dp/dtmax were higher in the AG and L-NAME groups than in the epinephrine and control groups and were higher in the AG group (4783±912, 4409±827 mmHg/s)than in the b-NAME group (3554±847, 3398±764 mmHg/s; P = 0.001 and 0.023, respectively). Conclu-sions Both AG and L-NAME increased the coronary perfusion pressure, and improved left ventricular systolic and diastolic function during CPR and prevented post-resuscitation myocardial dysfunction. However, AG was signifi-canfly superior to L-NAME.     

乌司他丁对心肺复苏后兔心脏保护作用的实验研究

目的了解心肺复苏后心功能不全的发生情况,探讨乌司他丁心脏保护作用的机制。方法建立心肺复苏家兔模型,30只新西兰大白兔随机分为手术对照组(S组)、常规复苏组(C组)和乌司他丁组(U组),每组10只,S组只行手术操作,不致颤;C组造成心搏骤停并行常规复苏;U组在心搏骤停并复苏成功后静脉注射乌司他丁(Ulilastatin,UTI)2.5万U/kg。动态观察左室舒张末压(LVEDP)、左室内压上升和下降速率(±dp/dt)、血清心肌酶(CK、CK-MB)的变化,取左心室肌行光、电镜检查。结果与S组比较,C组和U组复苏成功后LVEDP和CK、CK-MB有不同程度升高(P<0.01),±dp/dt不同程度下降(P<0.01),光、电镜下可见不同程度的心肌损害。U组与同时相C组比较,LVEDP和CK、CK-MB升高幅度减小(P<0.05,P<0.01),±dp/dt下降程度减轻(P<0.05),光、电镜下心肌损害减轻。结论乌司他丁可以改善心肺复苏后心功能不全,减轻心肌损伤,对复苏后心脏有保护作用。     

急性百草枯中毒患者肺部感染病原菌分布与药敏情况及治疗的研究

目的分析急性百草枯中毒患者肺部感染病原菌分布及药敏情况。方法选取2011年1月-2016年1月收治的114例急性百草枯中毒合并肺部感染患者,采用全自动微生物分析仪对痰液样本进行菌种鉴定,分析病原菌种类并进行药敏试验。结果 114例百草枯中毒合并肺部感染患者共分离病原菌169株,其中肺炎链球菌及肺炎克雷伯菌占比最高,分别为16.57%及14.79%;革兰阴性菌中肺炎克雷伯菌、大肠埃希菌及鲍氏不动杆菌占比最高,对亚胺培南敏感;革兰阳性菌中肺炎链球菌、金黄色葡萄球菌占比最高,对万古霉素敏感;真菌中白假丝酵母、光滑假丝酵母占比最高,对两性霉素B敏感。结论百草枯中毒合并肺部感染患者感染病原菌以肺炎链球菌及肺炎克雷伯菌为主,应通过药物敏感试验合理选择抗菌药物,针对性的个体化给药,提供有效药物治疗。     

姜黄素对百草枯中毒致肺纤维化大鼠肺功能及TGF-β1、NF-κB表达的影响北大核心CSCD

目的观察姜黄素对百草枯中毒致肺纤维化大鼠肺功能及TGF-β1、NF-κB的影响,为其临床应用提供理论依据。方法SPF级Wistar大鼠72只随机（随机数字法）分为百草枯染毒组（百草枯50mg／kg一次性灌胃染毒）、姜黄素治疗组（百草枯染毒后30min给予姜黄素200mg／kg一次性腹腔内注射）,空白对照组（相同时间点注射等体积生理盐水）。常规饲养14d后观察大鼠肺功能,免疫组化法检测转化生长因子-β1（TGF-β1）、核因子-κB（NF-κB）蛋白的表达。结果姜黄素干预组动物生存率41．67％,百草枯中毒组生存率70．83％,两组比较差异具有统计学意义（P〈0．05）。与空白对照组相比,百草枯染毒组TE（呼气时间）、PIF（吸气峰流量）、PEF（呼气峰流量）、EF50（呼出50％气量时的流速）、TV（潮气量）、F（呼吸频率）等肺功能指标均下降,差异具有统计学意义（P〈0．05或P〈0．01）,与百草枯染毒组比较,姜黄素治疗组Te、PEF、TV、F均升高,差异具有统计学意义（P〈0．05或P〈0．01）;大鼠肺组织中TGF-β1、NF-κB在空白对照组有少量表达,与空白对照组比,百草枯染毒组表达明显增强（P〈0．01或P〈0．05）;姜黄素治疗组与百草枯染毒组比较,TGF-β1、NF-κB表达显著减弱（P〈0．01或P〈0．05）;结论抑制肺组织中TGF-β1、NF-κB的过度表达,是姜黄素减轻百草枯中毒肺纤维化程度的作用机制之一。     

氨基胍与左旋硝基精氨酸甲酯在兔心脏骤停复苏中的比较

Objective To observe the changes of nitric oxide (NO) levels in plasma during cardiopul-monary resuscitation (CPR) and to compare the effects of aminoguanidine (AG) and NG-nitro-L-arginine methyl ester (L-NAME) on CPR. Method This was a prospective, randomized animal study performed at the Function Laboratory of Lanzhou University. Cardiac arrest was electrically induced and was left untreated for 5 min. After performing chest compression for 1 min, 40 domestic rabbits were divided into four groups (n = 10) to receive ei-ther 20 mg/kg AG, 25 mg/kg L-NAME, 0.02 mg/kg epinephrine or 2 ml saline placebo before defibrillation. Successfully resuscitated rabbits were observed for a further 4 h. Hernodynamics variables and cardiac functions were monitored with appropriate instrumentation. Arterial blood NO levels were examined at baseline, at the end of 1 min chest compression and at 15, 30, 60 and 120 min after survival. Repeated measures analysis of variance was used to determine statistical significance between groups. Results During chest compression, the mean + stan-dard deviation coronary perfusion pressure was higher in the AG group (40±10 mmHg) than in the L-NAME group (34±8 mmHg; P =0.001) and was higher in both groups with the control group (20±5 mmHg; both P =0.000). Left ventricular + dp/dtmax and- dp/dtmax were higher in the AG group than in the L-NAME group. In the surviving rabbits, the left ventricular + dp/dtmax and - dp/dtmax were higher in the AG and L-NAME groups than in the epinephrine and control groups and were higher in the AG group (4783±912, 4409±827 mmHg/s)than in the b-NAME group (3554±847, 3398±764 mmHg/s; P = 0.001 and 0.023, respectively). Conclu-sions Both AG and L-NAME increased the coronary perfusion pressure, and improved left ventricular systolic and diastolic function during CPR and prevented post-resuscitation myocardial dysfunction. However, AG was signifi-canfly superior to L-NAME.     

氨基胍与左旋硝基精氨酸甲酯在兔心脏骤停复苏中的比较

Objective To observe the changes of nitric oxide (NO) levels in plasma during cardiopul-monary resuscitation (CPR) and to compare the effects of aminoguanidine (AG) and NG-nitro-L-arginine methyl ester (L-NAME) on CPR. Method This was a prospective, randomized animal study performed at the Function Laboratory of Lanzhou University. Cardiac arrest was electrically induced and was left untreated for 5 min. After performing chest compression for 1 min, 40 domestic rabbits were divided into four groups (n = 10) to receive ei-ther 20 mg/kg AG, 25 mg/kg L-NAME, 0.02 mg/kg epinephrine or 2 ml saline placebo before defibrillation. Successfully resuscitated rabbits were observed for a further 4 h. Hernodynamics variables and cardiac functions were monitored with appropriate instrumentation. Arterial blood NO levels were examined at baseline, at the end of 1 min chest compression and at 15, 30, 60 and 120 min after survival. Repeated measures analysis of variance was used to determine statistical significance between groups. Results During chest compression, the mean + stan-dard deviation coronary perfusion pressure was higher in the AG group (40±10 mmHg) than in the L-NAME group (34±8 mmHg; P =0.001) and was higher in both groups with the control group (20±5 mmHg; both P =0.000). Left ventricular + dp/dtmax and- dp/dtmax were higher in the AG group than in the L-NAME group. In the surviving rabbits, the left ventricular + dp/dtmax and - dp/dtmax were higher in the AG and L-NAME groups than in the epinephrine and control groups and were higher in the AG group (4783±912, 4409±827 mmHg/s)than in the b-NAME group (3554±847, 3398±764 mmHg/s; P = 0.001 and 0.023, respectively). Conclu-sions Both AG and L-NAME increased the coronary perfusion pressure, and improved left ventricular systolic and diastolic function during CPR and prevented post-resuscitation myocardial dysfunction. However, AG was signifi-canfly superior to L-NAME.     

甘肃省岷县地震后转入兰州市地震伤员伤情分析

2013-07-22 07∶45甘肃省定西市岷县、漳县交界（北纬34.5°,东经104.2°）发生6.6级地震,震源深度20km,造成极大数量的人员伤亡,远远超过了当地的医疗救治能力。灾难发生后危重伤员陆续被转往兰州市各三甲医院进行救治。由于地震伤突发性强、伤员数量多、伤情复杂,医疗机构需积极行动,挽救尽可能多的生命。组织救援者应该熟悉该类灾害特点,有针对性地进行抢救。本文对地震发生后转入兰州市伤员的特点进行总结,以期对以后类似的抢救提供借鉴。     

以口腔和食管溃疡为主要临床表现的急性百草枯中毒1例

患者,男,30岁,于2012年6月17日口服百草枯约30ml后出现口腔、胸骨后灼烧样疼痛,在当地医院治疗3d,症状未见明显缓解并出现吞咽障碍,于2012年6月20日入院。入院体检：生命体征平稳,神志清楚。口腔、咽部及舌黏膜严重溃烂,表面附着脓苔,口腔内可闻及恶臭味。双肺呼吸音粗,未闻及干湿性啰音,心率：100次/min,律齐,各瓣膜听诊区未闻及病理性杂音,余无异常。