海水淹溺肺水肿药物治疗方案的临床观察

目的观察不同方案对海水淹溺肺水肿的治疗效果，探讨更为优化的药物治疗方案。方法用两种不同的药物组合方案（常规治疗方案与优化方案）对107例海水淹溺性肺水肿患者进行救治，通过观察两组患者肺部湿性哕音、胸部X线阴影消失时间、生命体征和血氧饱和度改善情况评价治疗方案。结果优化方案组肺部湿性哕音和胸部X线阴影消失早，病程短（P〈0．05）；心率、呼吸频率、平均动脉压和血氧饱和度等的改善优于常规治疗组（P〈0．01）。结论优化方案治疗海水淹溺肺水肿更为科学、安全和有效。     

左旋精氨酸治疗高原肺水肿疗效观察

在海拔 370 0m高度采用静脉滴注左旋精氨酸 (L Arg)治疗高原肺水肿患者 10例 ,并与吸入一氧化氮 (NO)混合气体治疗的 11例和常规治疗的 2 4例作对照。NO组肺部湿音和X线阴影消失时间较精氨酸组缩短 (P <0 .0 1) ,但病程日差异无显著性意义 (P >0 .0 5 ) ;常规组肺部湿音和X线阴影消失时间及病程日较NO组延长 (P <0 .0 5或P <0 .0 1) ;精氨酸组肺部X线阴影消失时间和病程日较常规组缩短 (P <0 .0 1)。作者认为 ,静脉滴注L Arg治疗高原肺水肿经济简便、无毒性 ,便于基层推广应用。     

左旋精氨酸治疗高原肺水肿的临床研究

目的 :观察左旋精氨酸 (L -Arg)治疗高原肺水肿的临床效果。方法 :在海拔 370 0m ,静脉滴注L -Arg治疗高原肺水肿10例 ,雾化吸入L -Arg治疗 16例 ,并与吸入一氧化氮 (NO)混合气体治疗的 11例作对照。结果 :三组患者的肺部湿罗音消失时间和病程日数均无显著性差异 (P >0 .0 5 ) ,NO吸入组肺部x线阴影消失时间较L -Arg静脉注射组和L -Arg雾化吸入组缩短 ,差异非常显著 (P <0 .0 1)。结论 :静脉滴注和雾化吸入L -Arg治疗高原肺水肿疗效较好且经济、简便、无毒性 ,便于基层推广应用     

静滴精氨酸治疗高原肺水肿对比观察

目的：研究静脉滴注左旋精氨酸（L－arg)对高原肺水肿的治疗价值;方法：75例高原肺水肿患者随机分为3组,硝苯吡啶组（24例）,口服硝苯吡啶、吸氧、静脉注射速尿、氨茶碱和地塞米松治疗;一氧化氮（NO）组（25例）,在硝苯吡啶治疗的基础上一次性吸入10ppmNO30分钟;精氨酸组（26例）,在硝苯吡啶治疗的基础上,以L－arg 20g加入5％葡萄糖溶液500ml,一次性4h静脉滴注,比较各组病例肺部罗音、X线胸片阴影消失时间及病程长短;结果：精氨酸组肺部湿性罗音消失时间较NO组长,较硝苯吡啶组短,差异显著（P＜0．05）;精氨酸组肺部X线阴影消失时间及病程时间较NO组长,较硝苯吡啶组短,差异非常显著（P＜0．01或P＜0．001）;结论：静脉滴注L－arg是治疗高原肺水肿比较有效的方法。     

雾化吸入L-精氨酸对高原肺水肿患者NOS的影响

目的：探讨左旋精氨酸（L－Arg) 对高原肺水肿治疗前后一氧化氮合酶（NOS）的影响;方法：在海拔3700m处采用氧气驱动雾化吸入L－Arg(L-Arg组）治疗高原肺水肿患者9例,并与吸入低浓度一氧化氮（NO）混合气治疗8例高原肺水肿（NO组）作对照,分别检测血中NO及NOS含量;结果：吸入NO组和L－Arg组治愈后较治疗前NO、NOS均增高显著（P＜0．05或P＜0．01）;NO组与L－Arg组比较治疗后NO吸NOS均无统计学差异（P＞0．05）;结论：L－Arg可提高高原肺水肿患者NOS活性,是一种很有前途的治疗高原肺水肿的药物,且经济简便,易于推广应用。     

两种机械通气方式在兔海水型肺水肿中的应用比较

目的　观察不同通气方式对海水淹溺型肺水肿的救治作用。方法　应用常规机械通气和高频喷射通气对 4 2只海水淹溺型肺水肿兔进行分组救治。不同时间点观察血气分析、呼吸动力学、血流动力学、肺损伤指标 ,并进行病理学检查和观察存活时间。结果　两种通气方式治疗后血氧分压、血氧饱和度、二氧化碳分压均较未治疗组有明显改善 (P <0 .0 1) ,呼吸动力学、血流动力学异常得到一定程度纠正 ,肿瘤坏死因子 α、肺泡灌洗液中性粒细胞计数等肺损伤指标也显示通气治疗后肺损伤情况减轻。两种通气方式之间比较显示常规机械通气较高频喷射通气治疗能更好地改善海水淹溺型肺水肿时的低氧情况。结论　常规机械通气和高频喷射通气治疗海水淹溺型肺水肿时低氧血症均取得满意效果 ,并减轻了肺损伤的程度。     

海水淹溺肺水肿大鼠肺血管通透性变化的观察

目的研究海水淹溺肺水肿大鼠的肺血管通透性变化与超氧化物歧化酶(SOD)、丙二醛 (MDA),髓过氧化物酶(MPO)的关系。方法 16只雄性SD大鼠按随机表法随机分为对照组和淹溺组,均以伊文思蓝(EB)20 mg／kg静脉注射,淹溺组气管内注射海水4 ml／kg,建立海水淹溺性肺水肿大鼠模型,于注射4 h后处死大鼠,计算肺组织湿重／干重比(W／D),取肺组织做病理切片HE染色,高倍镜下中性粒细胞(PMN)计数,测定肺组织中的EB浸出量(每100 mg湿肺用1 ml甲酰胺浸泡),测定肺组织匀浆中的SOD、MDA、MPO含量,以及血浆的SOD、MDA含量。结果对照组和淹溺组结果分别为: W／D 4．45 ±0．18、8．61±0．42,P<0．05;PMN(13．6±3．4)、(120．2±21．2)个／高倍视野,P<0．05;肺组织EB浸出量(18．4 ±1．8)、(30．9±4．1)μg/ml,P<0．05;肺匀浆MPO(0．64±0．08)、(1．14 ±0．16)活力单位／g湿片,P<0．05;SOD(75．6±11．7)、(67．6±10．3)U／mg protein,P>0．05;MDA(1．32±0．21)、 2．21±0．33 nmol／mg protein,P<0．05;血浆中的SOD(96．6±29．3)、(92．3±33．9)U／mg protein,P> 0．05;MDA(8．24±1．79)、(15．21±2．93)nmol／ml,P<0．05。结论海水淹溺后4 h肺血管通透性明显增加,组织湿重／干重比、中性粒细胞计数、MPO含量、血浆和肺组织匀浆中的MDA含量均增加。血浆和肺组织匀浆中的SOD未见明显变化。     

重型颅脑伤伴海水淹溺性肺水肿疗效观察

单纯海水淹溺性肺水肿 (ＰＥ ＳＷＤ)不伴血压下降者的伤死率为 5 2 % ,伴有血压下降者为 19 4 % ,伴有呼吸停止或呼吸、心跳停止者 ,高达 4 4 %～93% [1] ,因海水浸泡的严重创伤伤死率是陆地的 5～ 10倍[2 ] 。为探讨海水浸泡重型颅脑伤伴肺水肿伤员的治疗措施 ,减少伤死率 ,1991～ 2 0 0 1年 ,我们将收治的此类伤分别采用常规治疗方法与常规加高频喷射通气 (ＨＦＪＶ)及钙离子拮抗剂尼莫通等综合治疗进行疗效对比 ,后者效果较好。1　对象和方法1 1　对象　常规治疗组 4 5例 ;年龄 36 5 6± 12 0 4岁。受伤至救治 2 2 6± 1 4 5ｈ。ＧＣ…     

吸一氧化氮或氧对高原健康人和高原肺水肿患者血氧饱和度及心率的影响

目的　研究吸一氧化氮(NO)或氧(O2)对高原健康人和高原肺水肿患者血氧饱和度(SaO2)及心率(HR)的影响。方法　高原健康士兵20名及高原肺水肿患者24名,随机各分为两组,每组10人和12人。一组分别吸入0.001％(10PPm)NO,另一组分别吸O2,吸入气O2含量均为80％,结果　高原健康人吸NO或O2后及高原肺水肿患者吸NO后SaO2明显增高(P<0.01);高原健康人吸NO10-30min及吸后3-5min和高原肺水肿患者吸NO20-30min及吸后3-5min HR明显降低(P<0.01),吸氧后改变不明显(P>0.05)。结论　吸入低浓度NO可明显提高高原健康人和高原肺水肿患者的SaO2及降低HR,改善其心肺功能。     

L-精氨酸治疗高原肺水肿病人肌红蛋白、乳酸及血氨的变化

目的　探讨左旋精氨酸 (L Arg)对高原肺水肿病人肌红蛋白 (MB)、血乳酸 (BLA)、血氨 (Ammo)的影响。方法　在海拔 3 70 0m采用氧气驱动雾化吸入L Arg治疗高原肺水肿 9例 (L Arg组 ) ,并与吸入低浓度一氧化氮 (NO)混合气治疗 8例高原肺水肿 (NO组 )作对照 ,分别检测血中Mb ,BLA及Ammo含量。结果　NO组和L Arg组治疗前较治愈后Mb ,BLA ,Ammo均增高非常显著 (P <0 .0 1)。吸入NO组和L Arg组比较 ,Mb ,BLA ,Ammo无统计学差异 (P >0 .0 5 )。结论　L Arg治疗高原肺水肿有效 ,使乳酸性和非乳酸性氧债均降低 ,且经济简便 ,易于推广应用     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.