筋膜间室综合征治疗的实验研究

应用袖带压迫法建立新的筋膜间室综合征动物模型,观察用药前后血CPK、MDA、组织压以及病理学变化,研究甘露醇和山莨菪碱对筋膜间室综合征的治疗作用.结果发现,治疗组血清酶含量及组织压较对照组下降(P＜0.01);神经、肌肉组织变性程度减轻、范围缩小.说明本法建立的模型是成功的;甘露醇对筋膜间室综合征有明确的治疗作用,并可防治缺血再灌注损伤;山莨菪碱对改善微循环、减轻肢体肿胀有确切疗效;血CPK可做为判断筋膜间室综合征疗效的指标.     

令人闻之色变的骨筋膜室综合征

在日常生产活动中,各类创伤的发生使患者遭受不同程度病痛,挤压伤的发生较常见,如道路交通伤、高处坠落伤、建筑物倒塌、矿井坍塌等,其中一类严重的并发症是骨筋膜室综合征,又称筋膜室综合征,是指由骨、骨间膜、肌间隔、深筋膜等组成的所有密闭的解剖空间,即筋膜室内任何原因造成的组织间隙压力超过灌注压, 导致筋膜室内组织(如肌肉神经...     

胸腔灌洗对犬海水浸泡胸部开放伤低氧血症的影响观察

目的：观察胸腔灌洗对犬海水浸泡胸部开放伤低氧血症的影响。方法：选择健康成年杂交犬20只,随机分为胸腔灌洗组（观察组）和常规救治组（对照组）各10只。均预先制成海水浸泡胸部开放伤动物模型,对照组采用常规方法救治,观察组在常规救治基础上给予胸腔灌洗。观察两组氧分压及肺组织病理改变情况。结果：（1）两组动脉血氧分压在救治后0.5 h及1 h变化大致相同（P〉0.05）;对照组2 h、4 h、8 h动脉血氧分压分别为（142.8±13.2）mmHg、（114.0±13.2）mmHg、（77.5±13.5）mmHg,观察组分别为（202.6±11.8）mmHg、（184.4±11.8）mmHg（、158.8±12.1）mmHg,两组对应时间点比较,观察组动脉血氧分压显著高于对照组（P〈0.05）。（2）两组各时间点二氧化碳分压波动类似,经统计学处理差异不显著（P〉0.05）。观察组肺组织病理损伤较轻。结论：胸腔灌洗能够有效纠正犬海水浸泡胸部开放伤所致的低氧血症。     

犬急性大块肺动脉栓塞动物模型的建立

目的制作一种适合器械祛栓试验使用的犬急性大块肺栓塞动物模型。方法7只杂种犬,体外制作动物自体血栓,采用经皮股静脉穿刺置入导管,选择性插入一侧肺动脉中央分支动脉后注入制作好的自体血凝块,栓塞一侧肺动脉中央分支动脉,栓塞前后检测血气、肺动脉压及肺动脉造影。实验存活动物于12h后处死,取两侧肺组织进行病理检查。结果1只注射血栓时造成两侧肺栓塞死亡,1只在栓塞12h后肺动脉有部分再通;其余各只均成功栓塞至靶肺动脉的中央分支动脉。结论该方法制作急性大块肺栓塞的动物模型是可行和可重复的,可以为相关试验提供急性大块肺动脉栓塞动物模型。     

犬重型脑损伤后神经源性肺水肿的血流动力学发生机制

目的：探讨犬重型脑损伤后神经源性肺水肿（NPE）的血流动力学发生机制。方法：采用自由落体致犬重型脑损伤模型，24h动态监测血肾上腺素（E）、去甲肾上腺素（NE），血流动力学参数及血气变化;测定肺含水量及伊文思蓝透入量；观察肺脏病理改变。结果：犬脑损伤后30min血NE、E显著增高，此后3，8，12，24h血NE、E始终维持于高水平，体循环血管阻力指数（SVRI）、肺循环血管阻力指数（PVRI）、中心静脉压（CVP）持续上升，心脏指数（CI）、左室每搏做功指数（LVSWI）、右室每搏做功指数（RVSWI）进行性下降， 肺动脉楔压（PAWP）上升，动脉血氧分压（PaO2)下降，至24hCI、PaO2降至最低，PAWP达最高值；脑损伤组肺含水量和伊文思蓝透入量显著高于对照组；脑损伤组24hCI与PaO2 呈显著正相关、与肺含水量呈显著负相关。结论：重型脑损伤后血NE、E升高引起心脏前、后负荷持续增加，最终导致心功能失代偿引发急性心功能受损；急性左心功能受损可直接导致或加重神经源性肺水肿。     

丹参对大鼠烫伤早期肝脏酶谱的影响

目的：观察大鼠严重烫伤早期血清肝脏酶谱[丙氨酸氨基转移酶（ALT）,天冬氨酸氨基转移酶（AST）,乳酸脱氢酶（LDH）]的动态变化及丹参的影响作用。方法：建立30%Ⅲ度烫伤模型,88只Wistar大鼠随机分为正常对照组（A组,8只）、平衡液复苏组（B组,40只）和丹参治疗组（C组,40只）。B、C两组烫伤后立即按Parkland公式腹腔注射平衡液120ml/kg体重,C组在同样治疗的基础上腹腔注射丹参注射液3ml/kg,B、C两组分别于伤后3,6,12,24,48h检测血清ALT、AST、LDH的含量。结果：与对照组相比较,复苏组血清ALT、AST、LDH的含量在伤后3h明显高于对照组,12h达高峰,伤后48h仍保持在较高水平;丹参治疗组在各相应时相点与对应的复苏组比较,两者的变化趋势基本一致,但血清ALT、AST、LDH水平均低于复苏组,伤后3h起显著低于复苏组。结论：大鼠严重烫伤早期存在肝功能损伤。丹参对烧伤早期肝损伤有保护作用。     

胸部开放伤后海水浸泡致多器官功能障碍综合征

目的：通过动物模型,探讨胸部开放伤后海水浸泡致多器官功能障碍综合征（MODS）的发生率和发生特点。方法：成年杂犬致伤后随机分为对照组（单纯胸伤组,n=10)和实验组（n=10)。实验组动物于伤后置入人工配制的海水中。实验过程中动态监测血清丙氨酸转氨酶（ALT）、门冬氨酸转氨酶（AST）、肌酸激酶（CK）、乳酸脱氢酶（LDH）、尿素氮（BUN）和肌酐（Cr)以及肿瘤坏死因子α（TNF-α）和白细胞介素1β（IL－1β）的变化。结果：实验组MODS发生率明显高于对照组,而且出现时间早于对照组。实验组死亡率也明显高于对照组,并且生存时间明显短于对照组。结论：胸部开放伤后海水浸泡可能是引起MODS和早期死亡的最主要原因。     

结肠途径治疗对中暑犬炎症因子及内毒素血症的影响

目的研究结肠途径治疗(肠疗)对中暑犬血清酶、炎症因子及内毒素血症的影响。方法建立高温中暑犬的动物模型,将犬随机分为两组(肠疗组、常规治疗组),比较两组的降温时间,测定中暑前、中暑后6、24、48 h的血丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)和肌酸磷酸激酶(CK),测定上述时点血白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及内毒素(ET)水平,进行统计学分析。结果与常规治疗组相比,肠疗组降温时间明显缩短(P<0.01),ALT、AST、CK明显降低(P<0.05),IL-1β、IL-6、TNF-α和ET水平显著下降(P>0.05)。结论肠疗可加快高温中暑犬降温速度,促进血清酶恢复,清除血清炎症因子,减轻内毒素血症。     

第一掌骨闭合性完全脱位1例

1临床资料 患者，男性，34岁，3h前因左手被冲压机齿轮绞轧后剧痛、肿胀入院。诊断“前臂绞压伤：第一掌骨脱位、手部筋膜间室综合征”。手外科检查：左前臂掌背侧广泛皮肤挫伤，左手重度肿胀，皮肤张力极高，色紫并有花斑；左拇指内收畸形，左掌大鱼肌桡侧缘压之空虚，前臂掌侧远端皮下可触及逆行脱位掌骨头；各指皮温低、感觉减退、血运差；各指被动牵拉痛阳性。左手x线片提示第一掌骨逆行性完全脱位。     

肘关节畸形致肘管综合征肌电图特征分析

目的 对肘关节畸形致肘管综合征（CTS）患者肌电图特征进行分析,并与颈椎病、胸出口综合征等疾病相鉴别.方法 对82例肘关节一侧或双侧畸形患者,分别采用运动神经传导速度（MCV）、感觉神经传导速度（SCV）、针电极肌电图方法,对双侧尺神经、正中神经、桡神经进行检测.对仅有尺神经的MCV、SCV异常,并有肘管传导速度减慢,且有明显神经传导阻滞点,而正中神经、桡神经不受累患者,确诊为CTS.结果 在测定的82例164条尺神经中,腕-肘下3 cm处MCV减慢的共56条（34.3%）,腕部测定SCV减慢45条（27.4%）、未引出41条（25%）;36例双侧、46例单侧共118条尺神经肘管传导速度均不同程度减慢,并伴有波幅降低,卡压部位均位于肘正中或上、下1 cm左右处.82例正中神经MCV与SCV均正常;针电极肌电图检测第一背侧骨间肌、小指展肌及尺侧屈腕肌异常48例（58%）,拇短展肌及桡侧屈腕肌均未见异常.82例中,最后明确诊断为CTS单侧46例、双侧36例,均可见确定的肘管内卡压点.结论 对有肘关节畸形的患者均应作神经肌电图检测,尽早明确CTS诊断,以便及时治疗.     

Effect of tourniquet ischaemia on muscle energy metabolism in meniscectomy patients.

The enzyme levels of muscle energy metabolism were studied in eight male meniscectomy patients before and 10 minutes after release of the tourniquet and on the third post-operative day. The average tourniquet time was 65.1 min. The muscle samples were taken from the vastus lateralis muscles; the healthy side served as the control. The greatest enzyme changes 10 min after release of the tourniquet were the falls in succinate dehydrogenase (SDH) and creatine phosphokinase (CPK) activities, (p less than 0.01 and p less than 0.025 respectively). On the 3rd day phosphofructokinase (FFK) and malate dehydrokinase (MDH) activities were also lowered in the tourniquet limb, but the lactate dehydrogenase (LDH) was not changed significantly. In the control extremity only SDH showed a lowered value on the 3rd post-operative day (p less than 0.05), perhaps due to hypokinesia in hospital. The results indicate that even one-hour tourniquet ischaemia causes an enzyme release from muscle and for at least three days after the tourniquet enzyme activities in muscle are lowered, perhaps because of the combined effect of the tourniquet ischaemia and hypokinesia after the operation.     

Haptoglobin and serum enzymatic response to maximal exercise in relation to physical fitness

This study investigated the potential value of specific cellular responses to acute and chronic exercise as indices of physical fitness. Muscle enzymatic and hemolytic responses following a progressive cycle-ergometer test to maximal aerobic capacity were studied in 12 women and 12 men, aged 27 to 55 yr, who had been previously assigned to "high" and "low" fitness groups. Venous blood samples were obtained at rest prior to the cycle test, immediately following maximal effort, and 1, 2, 4, 6 and 24 h post exercise. The samples were analyzed for hematocrit (Hct), hemoglobin (Hb), lactate dehydrogenase (LDH), serum glutamic oxalacetic transaminase (SGOT), creatine phosphokinase (CK), CK isoenzymes, and haptoglobin (Hapt). Hemoglobin and Hct were the only variables to rise significantly (P less than 0.05) following exercise, and at all sampling times were significantly lower in the women compared with the men; CK was constituted in the MM isoenzyme band at all times; and Hapt levels were significantly lower in high-fitness men and women as compared with low-fitness men and women. These results indicate that one progressive test to maximal aerobic capacity is not sufficient to induce significant muscle enzymatic or hemolytic stress responses. They do suggest, however, that a chronic hemolytic condition exists as a result of aerobic conditioning activity.     

Enzyme changes after coronary angiography

The enzymatic response to contrast media after coronary angiography was observed in 24 patients. The enzymes studied were glutamic oxaloacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), lactic dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), γ-glutamyl transferase (γ-GT), creatine phosphokinase (CPK), and the myocardial-specific isoenzyme of CPK (CK-MB). Angiography produced no significant elevations in SGOT, SGPT, α-HBDH, LDH, or CK-MB activities; γ-GT increased up to the twelfth hour. High levels of CPK and CK-MB observed in one patient were found to be products of a thymus carcinoma. In vitro examinations also showed that concentrations of contrast media used in coronary angiography do not inhibit γ-GT, LDH, and CPK activities.     

Uptake of67Ga in the heart of rats treated with isoproterenol

Gallium-67 citrate (⁶⁷Ga) accumulation and various enzyme activities during the repair of rat heart with infarct-like lesions induced by isoproterenol (ISP) treatment were measured for 10 days after treatment. Serum creatine phosphokinase (CPK) and glutamic oxalacetic transaminase (GOT) activities were increased immediately after ISP treatment, reaching maximum levels of activity of 545±64 U/ml and 542±94 KU/ml, respectively, within 12 h. Uptake of⁶⁷Ga in the rat heart was elevated 12 h after ISP treatment, reaching a maximum on day 1 (0.473±0.015% dose/g heart). This pattern was essentially similar to the pattern of uronic acid content in the 1.2 M NaCl fraction, which contained mainly heparan sulfate (HS). The activity of glucose-6-phosphate dehydrogenase (G-6-PDH), a marker enzyme for fibrogenesis of damaged tissues, was also elevated 12 h after the ISP treatment, reaching a maximum of approximately 2.47 times that of the control heart on day 1. On the other hand, there were no significant changes in the⁶⁷Ga uptake and uronic acid content in any of the fractions of the liver and kidneys. These findings suggested that HS might be an acceptor for⁶⁷Ga accumulation during the repair of rat heart with infarct-like lesions, in accord with our previous results on CCl₄-damaged rat liver.     

地震伤骨筋膜室综合征伤员酶学指标监测分析

目的 初步探讨外周血酶学指标在骨折合并骨筋膜室综合征(CS)早期诊断及治疗中的临床意义.方法 从地震受伤后入院开始,连续7天测肌钙蛋白(TPI)、肌红蛋白(Mb)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH),单纯胫腓骨折与骨折合并CS进行上述测量指标分组比较分析.结果 骨折合并CS患者入院后T...     

高寒环境犬肢体爆炸伤后代谢变化特点研究

目的：观察高寒环境下杂种犬肢体爆炸伤早期机体代谢变化特点和规律,为战伤早期救治提供依据。方法：建立高寒环境杂种犬肢体爆炸伤模型,12只杂种犬雷管炸伤肢体后,于12、24、36h采血标本测定血清乳酸、血糖、CK、LDH和ALP浓度,并与伤前比较。结果：高寒环境杂种犬肢体爆炸伤后,乳酸、血糖,血清CK、LDH、ALP均升高;其中乳酸、血糖在创伤后12h内达到高峰,并维持在较高水平。结论：高寒环境杂种犬肢体爆炸伤后早期代谢明显改变,血糖、乳酸代谢障碍尤为显著。其代谢改变的特点为早期救治和预后判断提供理论依据。     

止血带缺血预处理对大鼠肢体缺血再灌注损伤的保护作用——电生理学研究

目的 :研究止血带缺血预处理对大鼠肢体骨骼肌、外周神经缺血再灌注损伤的保护作用。方法 :选择健康SD大鼠 5 0只 ,随机分成实验组和对照组。用特制气囊止血带制成大鼠后肢缺血再灌注损伤模型 ,连续观察骨骼肌、周围神经的电生理和组织病理变化。结果 :持续缺血 3小时后 ,再灌注损伤的病理变化在第 3天时最明显 ,预处理的保护作用此时最突出 ;而在电生理方面此时却表现为损伤后的逐渐恢复状态。结论 :止血带缺血预处理对骨骼肌和周围神经的缺血再灌注损伤有明显保护作用 ,电生理变化是监测肢体缺血再灌注损伤与恢复的敏感和确切指标。     

The effects of cycling and marathon training on eighteen blood parameters.

Abnormal blood chemistry values may be normal for competitive cycling and marathon training, with significant differences (p less than 0.05) between the two groups. The purpose of this study was to examine the effects of bicycle training and marathon training on fasting blood chemistry values. Ten significant differences (p less than 0.05) were observed between cyclists and marathoners on the eighteen blood parameters studied, with four of the blood parameters being outside the established laboratory norms of +/- 2 standard deviations. This was shown by the elevations in creatine phosphokinase levels in the competitive cyclists with the marathoners having higher than the normal ranges for lactate dehydrogenase and lower than normal ranges for hematocrit and red blood cells. Significant differences for albumin, cholesterol, creatine phosphokinase, globulin, hematocrit, lactate dehydrogenase, low density lipoprotein, total protein, red blood cells and triglycerides were observed between the groups.     

Drop foot after high tibial osteotomy: a prospective study of aetiological factors

Drop foot is not uncommon after high tibial osteotomy for genu varum. The authors report their results of a prospective study of 16 patients operated on between May 1990 and May 1991. All patients had medial femoro-tibial osteoarthritis with a constitutional genu varum. They all had a subtraction valgus high tibial osteotomy fixed by a blade plate. The experimental protocol included clinical review, antero-lateral compartment pressure measurements, intra- and post-operative electromyography, assessment of the post-operative drainage, serum estimation of muscle ensymes and post-operative arteriography. From their own results and a literature review, the authors consider successively the different aetiological factors for post-operative drop foot. Certain deficits occur due to direct trauma on the nerve during high osteotomy of the fibula, by local high pressure due to poor haemostasis or ineffective drainage. In addition, there are several related phenomena. The pneumatic tourniquet ssensitises the nerve to trauma, and stretching of the nerve during correction of the deformation depends on the local anatomical factors and their marked variation. In order to diminish the frequency of these post-operative complications, the authors suggest limiting the surgical approach, and limiting as far as possible the traumatic manoeuvres on the nerve by using a tibial resection jig, which allows correction without forced manoeuvres. Finally, the authors discuss the benefits of using a pneumatic tourniquet.     

Changes in serum enzyme values as possible indicators of the severity of blast injuries]

In order to detect biochemical parameters in the peripheral blood which would serve as an indicator of severity of blast injuries, the enzyme dynamics (creatine kinase, aspartat transaminase, alanin transaminase, lactic dehydrogenase, alkaline phosphatase, angiotensin convertase) has been followed up in the serum of sheep. The significant increase was found in the values of creatine kinase, aspartat transaminase and alanine transaminase in the serum of the experimental animals an hour after effects of the blast wave. The authors have concluded that changes of the mentioned enzymes can serve as one of signs of damages of the lungs and gastrointestinal tract caused by blast wave in the early posttraumatic period.