增强CT扫描后对比剂急性肾损伤的风险评估模型

对比剂急性肾损伤（CI-AKI）是增强CT扫描后的严重并发症。由于增强CT扫描后CI-AKI的发生率很低,利用风险评估模型筛选出CI-AKI高风险人群进行针对性防范尤为重要。本文通过检索国内外文献,检索到6个增强CT扫描后CI-AKI风险的预测模型,分别是Herts预测方程、Kim列线图预测模型、Huang评分预测模型...     

纳美芬治疗急性脊髓损伤的临床观察

目的 观察纳美芬对急性脊髓损伤患者治疗的临床特点.方法 将62例急性脊髓损伤患者完全随机分为对照组32例和纳美芬组30例.2组患者入院后,对照组仅给予常规治疗,而纳美芬组在常规治疗的基础上予以静脉注射盐酸纳美芬0.5 mg/d,连用14 d治疗.观察患者2周、3个月和6个月随访时的神经功能改善,比较二者的疗效.结果 纳美芬组和对照组的运动功能评分在治疗后2周分别为11.6±4.6 和8.4±3.6,3个月后分别为19.0±5.7和15.3±4.7,6个月后分别为25.7±5.5和21.9±4.9,2组差异均有统计学意义（P〈0.05或P〈0.01）;2组的痛觉评分在治疗后2周分别为8.1±3.0和6.6±3.2,3个月后分别为14.3±3.9和9.6±3.6,6个月后分别为16.3±3.8和11.7±3.9,2组差异均有统计学意义（均P〈0.05）;2组的触觉评分在治疗后2周分别为6.7±2.8和4.8±2.4,3个月后分别为9.1±2.7和7.8±2.3,6个月后分别为11.2±3.2和9.2±2.6,2组差异均有统计学意义（均P〈0.05）.结论 纳美芬能够促进急性脊髓损伤患者的神经功能恢复,改善患者预后.     

Systemic inflammation after spinal cord injury: A review of biological evidence,related health risks,and potential therapies

Individuals with chronic traumatic spinal cord injury (SCI) develop progressive multi-system health problems that result in clinical illness and disability. Systemic inflammation is associated with many of the common medical complications and acquired diseases that accompany chronic SCI, suggesting that it contributes to a number of comorbid pathological conditions. However, many of the mechanisms that promote persistent systemic inflammation and its consequences remain ill-defined. This review describes the significant biological factors that contribute to systemic inflammation, major organ systems affected, health risks, and the potential treatment strategies. We aim to highlight the need for a better understanding of inflammatory processes, and to establish appropriate strategies to address inflammation in SCI.     

广州工伤脊髓损伤患者慢性期生存质量影响因素研究

目的工伤人群主要是青壮年劳动力,是家庭经济支柱,因工伤原因导致脊髓损伤给这类人群及其家庭带来严重影响。本研究对工伤导致的脊髓损伤患者慢性期生存质量进行调查,并探讨脊髓损伤工伤患者生存质量的社会学、人口学、医学等因素,以寻找改善这类人群生存质量的突破口。方法按照纳入排除标准,采用非随机抽样,通过面谈或电话访谈的形式对79例工伤脊髓损伤患者进行问卷调查,填写一般情况调查表和健康相关生命质量问卷36简表(SF-36)。结果单因素分析结果显示,不同受伤年数、损伤部位、损伤类型和并发症情况下调查对象生理维度及生理内容综合测量得分差异有统计学意义(P<0.05),不同家庭供养比的调查对象心理维度得分差异有统计学意义(P<0.05);婚姻状况、调查时年龄不同的调查对象在生理和心理维度部分指标及综合测量差异有统计学意义(P<0.05)。多因素分析结果显示,对生理内容综合测量有影响的因素主要为性别、并发症、婚姻状况;而对心理内容综合测量有影响的因素主要为教育情况、家庭人均收入、损伤部位、婚姻状况。结论并发症、婚姻状况、教育程度和家庭经济负担等医学、社会、经济因素对慢性期脊髓损伤工伤患者生存质量有影响,提高脊髓损伤工伤患者慢性期生存质量,不仅仅要为他们提供适宜的医疗服务,还需要针对这类特征提供有针对性的支持和干预,同时做好长期健康管理,控制并发症。     

Abating progressive tissue injury and preserving function after CNS trauma: The role of inflammation modulatory therapies

Brain and spinal cord injuries result in cognitive and/or sensorimotor impairments that can significantly diminish the quality of life for the patient and their carers, and result in healthcare system costs totaling in the billions. The current gold-standard of acute care for spinal cord injury is to administer high doses of glucocorticoids within 8 h of injury; administration after 8 h may be without effect or detrimental to the outcome of the patient. Therefore, improved pharmacological approaches for limiting the extent of tissue damage and neurological dysfunction in the acute injury setting are urgently needed. Early intervention in CNS injury by antagonizing or controlling the post-injury inflammatory process with pharmaceutical agents is a major focus of current clinical and preclinical investigations. In this editorial overview, recent clinical trials and preclinical studies of brain and spinal cord injuries are discussed, including studies focusing on the use of broad-spectrum immunosuppressive drugs (eg, minocycline); growth factors (eg, erythropoietin); dual anti-inflammatory and anti-vasospasm drugs, such as Rho and ROCK kinase inhibitors; and broad-spectrum anti-inflammatory drugs, such as PDE4 inhibitors. These new approaches hold great promise to improve outcomes for patients with brain and spinal injuries.     

Implementation and evaluation of guidelines for use of enoxaparin as deep vein thrombosis prophylaxis after major trauma

Although enoxaparin is more efficacious than many other deep vein thrombosis (DVT) prevention strategies after trauma, its routine use in trauma patients at low risk for venous thrombosis is unlikely to be cost-effective and may be deleterious if risk factors for bleeding are present. By way of consensus of opinion of trauma surgeons and pharmacists, enoxaparin DVT prophylaxis guidelines were developed, implemented, and evaluated. Fifty patients with major orthopedic or spinal trauma were followed throughout hospitalization. Enoxaparin use and frequency of DVT, pulmonary embolism (PE), thrombocytopenia, and enoxaparin-related major bleeding (overt bleeding associated with a hemoglobin decrease > or = 2 g/dl, need for > or = 2 units of packed red blood cells, or need for surgery) were recorded. All pharmacist interventions pertaining to enoxaparin prophylaxis were collected. Average patient age was 45.6+/-19.5 years, average Injury Severity Score was 19.0+/-11.2, and average length of hospitalization was 14.3+/-10.0 days. Most injuries were related to motor vehicles (52%) and falls (30%). Sites of injury were femur or tibia (52%), pelvis or acetabulum (32%), hip (20%), and spinal cord (12%). Two-thirds (72%) of patients received enoxaparin during part of their hospital stay (on average, for 53% of the duration of hospitalization). Sequential compression devices and vena caval filters were used in 86% and 10% of patients, respectively. Duplex-proven DVT occurred in two patients, and angiography-proven PE developed in one patient. Enoxaparin-related major bleeding and thrombocytopenia occurred in three and one patient(s), respectively. Pharmacists recommended enoxaparin initiation in nine (18%) patients and discontinuation of the agent in seven (14%) patients (one for bleeding; six for lack of indication). Most recommendations (78%) were accepted. Data from the 50 patients in this study showed fewer thrombotic complications but more bleeding than the frequencies found in controlled studies. It is unclear whether the large number of days that patients did not receive enoxaparin was due to fears of enoxaparin-related bleeding or other factors.     

大鼠脊髓损伤后NEK6表达的实验研究

目的 探讨大鼠急性脊髓损伤后脊髓组织中NEK6的表达变化及意义.方法 采用改良Allen's打击法,构建大鼠脊髓T8-T10撞击伤模型,利用蛋白免疫印迹、免疫荧光双标的方法,研究大鼠脊髓损伤后脊髓组织中NEK6表达的时间和空间分布特征.结果 脊髓损伤后NEK6表达于撞击后2h有轻微抬高趋势,损伤后8h达到高峰,随后逐渐...