胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

神经源性肺水肿

神经源性肺水肿(neurogenic pulmonary ede-ma,简称NPE)临床上不多见,起病急,治疗困难,死亡率高,是神经外科中呼吸障碍的一种类型。1992-05～1997-01我院共收治此类患者9例,现报告如下:     

重庆城乡育龄妇女中介生育率变量研究

影响妇女生育率的直接因素,如妇女已婚比、避孕及人工流产等的定量分析是卫生人口统计分析中的重要内容。本文应用美国人口学者Bongaarts提出的中介生育率变量模型就重庆城乡妇女生育率直接影响因素作一定量研究     

增生性玻璃体视网膜病变基质金属蛋白酶的定量研究

目的:研究增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)玻璃体中基质金属蛋白酶(matrix metalloproteinases,MMPs)的表达,探讨MMPs在PVR病理过程中的作用。方法:PVR患者采用标准三切口巩膜扁平部玻璃体切割术(pars plana vitrectomy,PPV),取未稀释的玻璃体21只眼,PPV术后复发的玻璃体腔液20只眼,意外死亡的正常人玻璃体10只眼,采用明胶酶谱分析法定量分析MMP-2和MMP-9活性水平。结果:PVR玻璃体有MMP-2活性水平增高,与正常玻璃体比较差异有显著性意义(P<0.05)。21眼PVR玻璃体中13只眼有MMP-9活性水平增高,平均(171.52±13.17)扫描单位。20眼PPV术后PVR复发的玻璃体腔液19只眼有MMP-9活性水平增高,平均(156.01±37.21)扫描单位。正常人玻璃体无MMP-9的表达。结论:PVR玻璃体有MMP-2和MMP-9活性水平增高,MMP-9活性水平增高可能与术后PVR复发有关。眼科学报2003;19:130-132。     

DSA单帧双期成像法在肝癌栓塞治疗中的应用

探讨肝癌栓塞治疗中 DSA成像的新方法。 1肝动脉加门静脉像 ,将 mask分别设在肝动脉早、中、晚期和实质期 ,对应的减影像设在门静脉期。 2肝动脉双期像 ,将 m ask设在肝动脉早期 ,对应的减影像设在肝动脉中、晚期和实质期。结果发现 :腹腔动脉 DSA单帧双期成像 37例次 ,肝动脉 DSA单帧双期重建 33例次。提示 :DSA单帧双期成像法有利于指导肝癌栓塞治疗的操作 ,提高超选择性肝内动脉插管成功率 ,缩短手术时间。     

青光眼术后白内障超声乳化手术探讨

青光眼术后白内障患者常因眼部条件较差,青光眼所至视功能损害情况难以测定,往往给决定是否手术带来一定困难。为了探讨超声乳化手术对此类患者的治疗价值,我院自１９９８年１月至１９９８年８月应用超声乳化术治疗青光眼术后白内障３８例,获得较满意疗效,现报告如下...     

异丙酚对老年病人机械通气的镇静效果分析

目的观察异丙酚对老年病人机械通气的镇静效果。方法将48例需机械通气的病人按年龄平均分两组,A组为老年病人(年龄≥60岁),B组为非老年病人(年龄<60岁),气管插管前按1.5mg/kg给异丙酚,然后改用微量注射泵持续静注异丙酚1~4mg/(kg.h)。镇静持续时间为(25.3±6.4)h。结果镇静和停药后神志恢复时间两组无显著性差异(P>0.05);两组病人用药前后R,SaO2,PaO2和PaCO2均有明显改善(P<0.05),组间差异无显著意义;用药后两组病人血压和心率无明显变化(P>0.05)。结论异丙酚用于老年病人机械通气的镇静是安全有效的。     

硫喷妥钠对CpG DNA诱导人外周血单个核细胞NF-κB表达和TNF-α、IL-6释放的影响

目的 探讨硫喷妥钠对CpG DNA诱导人外周血单个核细胞(hPBMC)核因子-κB(NF-κB)表达及肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)释放的影响.方法 采集健康志愿者外周血,使用淋巴细胞分离液(Ficoll-Hypaque)密度梯度离心分离hPBMC.分别加入不同浓度的硫喷妥钠后(0.2～1.0 mg/ml),ELISA测定hPBMC培养上清中TNF-α和IL-6浓度,确定硫喷妥钠对CpG DNA刺激细胞分泌TNF-α及IL-6的抑制作用及其剂量-效应关系和时间-效应关系;免疫蛋白印迹法(Western blotting)分析hPBMC胞核NF-κB表达.结果 不同浓度的硫喷妥钠(0.2～1.0mg/ml)显著抑制CpG DNA诱导hPBMC NF-κB P65表达和TNF-α、IL-6释放(P<0.05或P<0.01).提前1～4 h给予硫喷妥钠或同时给予硫喷妥钠和CpG DNA(0 h),其拮抗CpG DNA诱导细胞因子释放的作用非常显著(P<0.01),且硫喷妥钠在刺激物CpG DNA给予后1 h再加入,也能观察到显著拮抗作用(P<0.05).结论 硫喷妥钠可通过下调CpG DNA诱导hPBMC NF-κB P65表达,从而降低促炎细胞因子TNF-α和IL-6的释放.     

纤维支气管镜肺泡灌洗治疗肺部严重感染合并呼吸衰竭

采用BAL治疗严重肺部感染合并Ⅱ型呼吸衰竭43例，结果显示：患者咳嗽、咳痰、气促均明显好转，细菌清除率达92％，真菌全部清除。43例患者BAL术前胸片及CT片均可见大片状阴影及肺不张．术后32例肺部炎症基本吸收，肺不张复张．7例好转，4例无效。35例血气分析正常。肺脑嗜睡状态12例，8例经一次BAL后特醒。BAL治疗急有效率达90．7％。BAL还可缩短病程，减轻患者经济负担。改善病灶局部通气功能，为选择用药提供细菌学依据。BAL治疗安全可靠．无1例发生严重并发症。     

胎儿淋巴器官发育的形态学与免疫关系

与免疫系统疾病有关的免疫器官的正常和病理结构的探讨,日益引起人们的注意,可是有关胎儿免疫系统的解剖组织学及其免疫功能状态,国内尚缺乏有系统的报导。我们收集不同胎龄的胎儿428例,对其免疫器官包括胸腺、脾脏、淋巴结(包括颈部、腹膜后及肠系膜淋巴结),以及阑尾,分别进行了测量和组织学观察,目的是进一步弄清胎儿免疫器官发育的形态学,并对其是知具有免疫功能作了初步的探讨。