连续发生输液发热反应的原因分析及其对策

连续发生输液发热反应的原因分析及其对策栾湘宁，陈琦，王洪波，王国卿１９９５年８月２４日至９月１３日，我院４个科室连续发生了１０起输液发热反应（下称输液反应）。有４起残液中分离出细菌，１例病人发生了休克。所用液体均为医院制剂室配制的５％葡萄糖溶液和１０...     

外周α1受体作用参与应激对颈动脉窦反射的抑制

目的探讨外周α1受体是否影响应激对颈动脉窦反射(carotid sinus reflex,CSR)的重调定.方法应激1周的SD大鼠,麻醉后孤离双侧颈动脉窦区,将不同窦内压(intracarotid sinus pressure,ISP)与其对应的平均动脉压(me8n arterial pressure,MAP)值进行Logistic五参数曲线方程拟合,求得ISP-MAP关系曲线及其特征参数,观察外周静脉注射选择性α1受体拮抗剂酚苄明(phenoxybenzamine,PBZ)对CSR的影响.结果静脉注射PBZ(3 μ,moL/L,0.15 μL/ g)导致应激大鼠ISP(MAP关系曲线的后半程显著下移(P＜0.05),反射参数中阈压、饱和压和最大增益时的窦内压值分别从(128.37±10.05)mm Hg(1 mm Hg=0.133 kPa)、(205.15±12.18)和(166.72±11.35)mmHg减少至(116.41±8.51),(188.15±11.77)和(152.28±9.30)mm Hg(F=6.60、8.05和7.75,P＜0.05);静脉注射相同剂量的PBZ对非应激大鼠的CSR无明显影响(P＞0.05);静脉注射PBZ不能使应激的CSR水平恢复到非应激给药后水平.结论外周α1受体参与应激对CSR的抑制性重调定;除此之外,应激作用中尚有其他因素的参与.     

低氧高碳酸血症对心脏功能的影响的模型研究

目的建立动脉血氧分压作用于外周化学感受器的计算机仿真模型。方法利用包含多种心血管反射的血流动力学模型,整合外周化学感受器反射,应用动态仿真工具Simulink实现仿真。结果低氧高碳酸血症条件下,心交感神经传出冲动发放频率明显增加,心肌耗氧量增加,心肌收缩能力增强。结论仿真模型构造清晰,可以作为动物实验设计的辅助工具。     

微创置管胸腔内注射顺铂及香菇多糖治疗恶性胸腔积液

目的：总结微创置管引流、胸腔内注射顺铂及香菇多糖治疗恶性胸腔积液的疗效。方法：70例患者按顺序分为治疗组（35例）和对照组（35例）,均采取留置中心静脉导管穿刺引流,治疗组胸腔内注射顺铂及香菇多糖,对照组注射顺铂。结果：治疗组、对照组有效率分别为88．6％、54．3％（P〈0．05）,治疗组胸水中CEA、CYFRA21—1、NSE浓度较治疗前明显下降,较对照组明显降低（P〈0．05）,外周血NK细胞活性,T淋巴细胞中的CD3^＋、CD4^＋及CD4^＋／CD8^＋比值明显增高（P〈0．05）。结论：微创置管引流、胸腔内注射顺铂及香菇多糖治疗恶性胸腔积液安全有效,具有创伤小、操作简便、痛苦少、对年老体弱患者也适用等特点.     

胸腔镜下胸腔内热化疗对肺癌合并胸腔积液的治疗作用

目的 探讨胸腔镜下胸腔内热灌注化疗对肺癌合并胸腔积液患者的治疗效果.方法 40例肺癌合并胸腔积液患者于全身麻醉下用胸腔镜探察胸腔,并行胸膜活检,用人工心肺机将预充液(生理盐水3 000 mL+顺铂300 mg)加热至42～44℃后,通过2根导管连接至胸腔内,循环灌注胸腔约60min.结果 胸水控制有效率为97.5%,KPS评分升高率为67.5%;未见明显的毒副作用.结论 胸腔镜下胸腔内热灌注化疗具有快速诊断、创伤小、控制胸水效果好、副作用小的优点.     

胃癌患者血微量元素测定

本文对34例胃癌患者和等数量的非肿瘤病人进行了血微量元素钙、镁、铁、锰、锌和铜含量测定,结果表明:胃癌患者血钙和铁明显高于非肿瘤病人,而血锰显著低于非肿瘤患者。提示胃癌和高血钙、铁,低血锰有密切联系。     

慢性硬膜下血肿137例治疗体会

目的探讨慢性硬膜下血肿的治疗。方法回顾性分析137例慢性硬膜下血肿患者的临床资料。结果 133例治愈出院,4例复发,再次手术治疗好转出院。结论单孔钻孔冲洗引流术是治疗慢性硬膜下血肿(CSH)的有效方法;对于血肿未完全液化者,宜采用骨瓣开颅手术治疗;CSH有自行吸收的可能性。     

伴NPM1基因突变的成年人急性髓系白血病临床研究

Objective To evaluate the clinical feature of adult acute myeloid leukemia with nucleophosmin (NPM1) cytoplastic positive (NPMc+AML), and to investigate the significance of the NPM1 gene mutations regularly in detecting the early relapse. Methods The NPM1 gene mutations was screened by the PCR-capillary electrophoresis in 95 newly diagnosed adult AML patients. 5 complete remission AML patients were selected to detecte the NPM1 gene mutations regularly. Results In 95 cases of adult AML patients, the incidence of the NPM1 mutations was 9.5 % (28/95). The incidence of the NPM1 mutations in patients (≥40-year-old) was higher clearly than it' s in pazients (40-year-old) (λ 2= 6.963, P = 0.012). That in the AML patients with normal karyotype (51.1%) was higher than that in the patients with abnormal karyotype (8.3 %) (λ2= 20.860, P= 0.0000). NPM1 mutations occured with a considerate percentage in AML patients with M5/M2 subtype. In AML with recurrent genetic abnormalities the NPM1 mutations wasn' t found.The white blood cell count, platelet count, lactate dehydrogenase in the NPMc+AML patients were clearly higher than that in the NPMc-AML patients (t were individually 4.132, 4.603, 4.069, P ＜0.05). The rate of complete remission, relapse-free survival and overall survival in the NPMc+AML patients were also higher than that in the N PMc-AML patients (λ 2 were individually 10.448, 4.146, 4.384, P ＜0.05). In cases detected regularly NPM1 mutations preceded the hematological relapse about 1.5-2 months. Conclusion NPM1 gene mutations has a higher incidence in adult AML, particularly in normal karyotype AML. The clinical manifestations are older, and higher in white blood cell count, platelet count, and lactate dehydrogenase. The NPM1 mutations in adult AML is a good factor for prognosis. The regular detection of NPM1 mutation could find relapse early.     

某市副局级以上干部健康体检分析

目的了解某市在职副局级以上干部的健康情况,为制定预防措施提供依据。方法对2007年在本院进行体检的936例副局级以上干部(男性812例,女性124例)的高血压、高脂血、高血糖和脂肪肝的检测数据进行统计分析。结果体检正常或基本正常的共计154例;四项指标一项或一项以上异常782例,异常率为83.55%,高脂血检出率排序第一,占39.42%,男性四项指标异常率均较女性高,其中高血压、高血糖、脂肪肝有统计学意义。结论机关干部尤其是机关领导干部的健康状况不容乐观,应重视对他们的健康教育。     

伴NPM1基因突变的成年人急性髓系白血病临床研究

Objective To evaluate the clinical feature of adult acute myeloid leukemia with nucleophosmin (NPM1) cytoplastic positive (NPMc+AML), and to investigate the significance of the NPM1 gene mutations regularly in detecting the early relapse. Methods The NPM1 gene mutations was screened by the PCR-capillary electrophoresis in 95 newly diagnosed adult AML patients. 5 complete remission AML patients were selected to detecte the NPM1 gene mutations regularly. Results In 95 cases of adult AML patients, the incidence of the NPM1 mutations was 9.5 % (28/95). The incidence of the NPM1 mutations in patients (≥40-year-old) was higher clearly than it' s in pazients (40-year-old) (λ 2= 6.963, P = 0.012). That in the AML patients with normal karyotype (51.1%) was higher than that in the patients with abnormal karyotype (8.3 %) (λ2= 20.860, P= 0.0000). NPM1 mutations occured with a considerate percentage in AML patients with M5/M2 subtype. In AML with recurrent genetic abnormalities the NPM1 mutations wasn' t found.The white blood cell count, platelet count, lactate dehydrogenase in the NPMc+AML patients were clearly higher than that in the NPMc-AML patients (t were individually 4.132, 4.603, 4.069, P ＜0.05). The rate of complete remission, relapse-free survival and overall survival in the NPMc+AML patients were also higher than that in the N PMc-AML patients (λ 2 were individually 10.448, 4.146, 4.384, P ＜0.05). In cases detected regularly NPM1 mutations preceded the hematological relapse about 1.5-2 months. Conclusion NPM1 gene mutations has a higher incidence in adult AML, particularly in normal karyotype AML. The clinical manifestations are older, and higher in white blood cell count, platelet count, and lactate dehydrogenase. The NPM1 mutations in adult AML is a good factor for prognosis. The regular detection of NPM1 mutation could find relapse early.