左半结肠癌性肠梗阻处理方式的再探讨

结肠癌是我国常见的恶性肿瘤之一，其发病率和病死率在我国呈上升趋势。据文献报道其中8％～23％的患者可表现为不全或完全性肠梗阻，且梗阻性结肠癌患者的5年生存率〈20％。20世纪未“损伤性控制性外科”（DCS）作为一种严重创伤救治的技术被提出，近年来DCS在应用于严重创伤救治的同时，还作为一种外科理念在非创伤重症患者的救治中逐渐被普遍应用，取得了很好的效果。     

损伤控制外科技术在开放性腹部外伤救治中的应用

目的探讨损伤控制外科技术在严重开放性暇部外伤救治中临床应用价值。方法182例严重开放性腹部外伤患者,依据救治方式分为常规治疗组（108例）和损伤控制组（74例）,常规治疗组采用常规治疗,损伤控制组运用损伤控制外科技术对严重开放性腹部外伤患者采用控制手术、重症监护、确定性手术等三个阶段的综合治疗,观察丽组患者手术持续时间、术后休克的纠正情况、术后并发症发生情况及预后。结果损伤控制组手术持续时间（72．1±18．8）min、休克纠正时间（6．7±3．1）h、多脏器功能不全发生率24．3％、病死率2．7％与常规治疗组的（153．8±44．7）min、（20．4±11．2）h、48．1％、5．6％相比较,差异均有统计学意义（均P〈0．01）;损伤控制组并发症发生率明显低于常规治疗组（均P〈0．05）。结论在严重开放性腹部外伤救治中运用损伤控制外科技术能显著缩短手术时问,早期纠正休克,减少术后并发症的发生,降低病死率。     

严重胸部创伤的急救护理

目的总结严重胸部创伤急救护理经验。方法回顾性分析48例严重胸部创伤临床资料。开放性损伤11例,闭合性损伤37例。诊断符合创伤评分AIS-85标准：重度（3分）26例,危重（4分）15例,极危重（5分）6例。结果治愈43例（89．6％）,死亡5例（10．4％）。死亡原因：心脏挫伤和心脏破裂2例,急性呼吸窘迫综合征（AROS）2例,多发伤顽固性休克1例。结论抓紧伤后“黄金1h”内的紧急救治,强调快速早期诊断、抢救治疗、急救护理作为抢救严重胸伤患者的主要手段。     

损伤控制外科技术在严重腹部创伤急救中的应用及护理

目的总结损伤控制外科技术(DCS)在严重腹部创伤急救中的应用效果及护理重点。方法对2006年1月-2009年10月应用DCS救治的109例严重腹部创伤患者的临床资料进行回顾性分析。结果 93例患者复苏后情况良好痊愈出院,APACHEⅡ评分明显低于复苏前(P<0.05),复苏后pH、PT、T、SpO2水平与复苏前比较差异有统计学意义(P<0.05)。16例患者死于多器官功能衰竭或严重脑外伤。结论护士应理解DCS的内涵,明确每阶段的护理重点,掌握各项监测指标的动态变化及意义,为成功救治危重患者发挥积极的作用。     

重症创伤病人的抢救及护理体会

重症创伤病人常因创伤严重,大出血,全身情况危重而引起生命垂危。求治成功的关键是在短时间内控制出血、抗休克,尽快矫正严重的生理紊乱,以挽救患者的生命。自2000年以来救治124例重症创伤病人,现就抢救与护理体会     

损伤控制外科技术在严重腹部创伤急救中的应用及护理

目的 总结损伤控制外科技术(DCS)在严重腹部创伤急救中的应用效果及护理重点.方法 对2006年1月-2009年10月应用DCS救治的109例严重腹部创伤患者的临床资料进行回顾性分析.结果 93例患者复苏后情况良好痊愈出院,APACHEⅡ评分明显低于复苏前(P＜0.05),复苏后pH、PT、T、SpO2水平与复苏前比较差异有统计学意义(P＜0.05).16例患者死于多器官功能衰竭或严重脑外伤.结论 护士应理解DCS的内涵,明确每阶段的护理重点,掌握各项监测指标的动态变化及意义,为成功救治危重患者发挥积极的作用.     

损伤控制外科技术在急诊科多发伤救治中的应用

目的：探讨损伤控制外科（DCS）技术在急诊科多发伤救治中的应用,为今后的临床工作提供借鉴。方法我院2011年5月至2013年2月收治的急诊科多发伤患者,分为观察组和对照组,每组38例,分别以DCS方法和传统治疗方式进行抢救,比较两组患者的各个指标。结果观察组患者的体温恢复时间、血浆凝血酶原时间（PT）测定及活化部分凝血活酶时间（APTT）测定恢复时间、碱剩余（BE）恢复时间、乳酸恢复时间均明显短于对照组,出血量明显少于对照组,并发症发生率和死亡率均明显低于对照组,差异均有统计学意义;而两组手术时间接近,差异无统计学意义。结论在多发伤救治中运用DCS技术能有效提高多发创伤患者的生存率,减少其他并发症的发生,结论值得进一步研究。     

颅脑损伤合并多发伤的临床分析

目的探讨颅脑损伤合并多发伤的临床救治原则和处理。方法采集本科2006年4月至2009年2月人院的169例重症颅脑损伤合并多发伤患者进行临床资料研究,并对其救治过程进行回顾性分析。结果患者术后依照格拉斯哥结局量表GOS评分恢复良好65例（38．5％）,轻残48例（28．4％）,重残21例（12．4％）,植物生存5例（3．0％）,死亡30例（17．8％）。结论合理救治程序至关重要,重视院前急救和术后综合治疗,强调先重后轻,先开放后闭合的救治原则。早诊断早治疗能提高重型颅脑损伤合并多发伤的治疗效果,同时是减少致残率及降低死亡率的最佳选择。重型颅脑损伤合并多发伤应早期诊断,及时抢救,避免漏诊和误诊,首先处理危及生命的损伤以及专科治疗配合ICU监护是重型颅脑损伤合并多发伤救治成功的关键。     

损伤控制理论对野战卫勤保障的影响

目的 探讨在战创伤早期即采用损伤控制性外科（damage control surgery,DCS）理念并形成临床路径,为改善我军战伤救治进行尝试.方法 2007-2012年收治的按DCS纳入的严重多发伤患者,86例采用整体DCS,56例仍按传统DCS进行救治,对两组的病死率及并发症发生率进行对比.结果 传统DCS组的病死率及并发症发生率均显著高于整体DCS组（P＜0.01）.结论 严重多发伤的患者,应尽早积极实施整体DCS,有利于伤员的高效、批量的救治,最大限度地提高战伤救治能力和野战卫勤保障能力.     

珠海西区急重症创伤患者事故特征及对策

目的:分析探讨某院急重症创伤患者事故的特征和护理对策,为事故的预防和患者的救治提供参考。方法:采用回顾性调查方法,对某院172例急重症创伤患者事故进行分析。结果:急重症创伤患者以23~43岁年龄段最多,占86.46%,不同的年龄组男女性别构成差异有显著性,男性明显高于女性;在前两位事故类型中,交通事故伤害部位多为头部和四肢,斗殴致伤部位多为胸、腹部和四肢;受伤者以外来工为主;就诊时间以20时~次日3时为高峰期。结论:提高公民安全意识,加强交通管理、维护良好的社会治安,减少事故的发生。加强护士急救技能和意识,实施专业化的急重症创伤护理小组;做好急诊、手术室和重症医学科等科室的沟通,实行急重症创伤患者的一体化救治模式,规范急重症创伤患者救治流程,提高工作效率,争取时间挽救生命,减少死亡。     

肺结核诊治中有关问题的探讨附483例藏族肺结核病例的分析

分析 483例肺结核的诊治、诊断中 ,为了提高痰涂阳性率 ,反复查痰 ,延误治疗时间有长达 90天者 ,治疗应用“标准疗法”的 483例中 ,症状好转98 84% ,痰涂阴转率 1 0 0 %。胸片吸收好转率97 45 %。应用“间歇疗法”者 5 1例 ,症状好转率3 7 2 5 % ,痰涂阴转率 2 2 2 2 % ,胸片吸收好转率2 1 5 6%。综上 ,肺结核的诊断应进行综合诊断法 ,治疗方案的选定最好是“标准疗法”及WHO推荐的9个月与 1 2个月方案比较适合我地区实际情况。     

限制性液体复苏在创伤失血性休克中的临床应用研究

目的探讨限制性液体复苏在创伤失血性休克中的临床应用。方法回顾性分析我院ICU2011年1月至2012年1月的64例创伤失血性休克患者并分为治疗组和对照组加以比较,限制性液体复苏者为治疗组,快速大量液体复苏者为对照组,分析患者复苏后外周血乳酸水平的变化以及单器官功能障碍或多脏器功能障碍综合征的发病率、患者死亡率。结果治疗组和对照组在复苏后24 h、48 h血乳酸达正常标准的例数,前者明显多于后者（P〈0.05）;治疗组出现器官功能障碍9例（22%）,对照组出现器官功能障碍11例（47.8%）,治疗组的器官功能障碍的发病率显著低于对照组组（P〈0.05）;治疗组出现死亡5例（12.2%）,对照组出现死亡6例（26%）,治疗组的死亡率显著低于对照组组（P〈0.05）。结论限制性液体复苏可减少创伤后并发症的发生率,降低死亡率。     

A randomized, placebo-controlled laboratory study of the effects of d-cycloserine on craving in cocaine-dependent individuals

Rationale

d-Cycloserine (DCS), a partial glutamate N-methyl-d-aspartate (NMDA) receptor agonist, enhances extinction of conditioned fear responding; preliminary data suggest that it may facilitate extinction of drug cue reactivity.

Objective

This study investigates DCS effects on cocaine cue craving and drug use in cocaine-dependent subjects.

Methods

Thirty-two subjects were randomly assigned to receive (1) DCS only, (2) DCS before sessions 1 and 3, placebo (PBO) before session 2, or (3) PBO only 15-min before each of 3 1-h cocaine cue exposure sessions conducted 1 day apart. Craving ratings were obtained before, during, and after sessions. Drug use and cue-induced craving were assessed 1 week after the last cue session.

Results

Repeated presentation of cocaine cues resulted in decreased craving both within and between sessions. DCS did not facilitate extinction learning and may have enhanced craving. The group that received three doses of DCS had significantly higher craving than the PBO group at the baseline ratings taken before sessions 2 and 3, as well as significantly higher cue-induced craving at follow-up. The group that received two doses of DCS did not differ from the PBO group. There were no group differences in postextinction cocaine use.

Conclusions

The reduction of cocaine cue reactivity in the PBO group suggests that the study procedures were sufficient to produce extinction. Under these conditions, DCS did not facilitate extinction and may have enhanced craving. Further studies of glutamatergic agents and extinction in cocaine dependence should include consideration of procedural variables that could have a major impact on study outcomes.     

Albumin/hetastarch drug utilization review in an operating room pharmacy

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12,346.00 could be realized by the Department of Pharmacy.     

双氯芬酸钠巴布剂的制备及体外透皮研究

目的：制备双氯芬酸钠（DCS）的巴布剂,并对其体外释药特性进行考察。方法：制备1％的DCS巴布剂及凝胶剂,考察两者对小鼠离体皮肤的渗透性。结果：与同剂量DCS凝胶相比,DCS巴布剂的离体皮肤累积渗透量及渗透速率均有显著提高（P〈0．05）。结论：DCS巴布剂体外渗透性能优于其凝胶剂,值得进一步研制,以期为DCS新型外用制剂的研制奠定基础。     

The facilitative effects of d-cycloserine on extinction of a cocaine-induced conditioned place preference can be long lasting and resistant to reinstatement

Rationale and objective

The N-methyl-d-aspartate receptor agonist, d-cycloserine (DCS), accelerates extinction of a cocaine-induced conditioned place preference (CPP) when given after daily extinction tests. Here, we studied the effects of DCS in rats given spaced-extinction sessions at 3- or 7-day intervals using two different extinction procedures.

Materials and methods

Rats were trained on a CPP (four cocaine, 10 mg/kg, i.p., and four saline pairings with one of two compartments). Immediately following the CPP test and all extinction tests (days 4, 7, 10, and 24, experiment 1), DCS (15 mg/kg, i.p.) or saline was administered. In experiment 2, extinction was conducted by exposing rats to the drug-paired cues for 2 or 20 min, three times, at 7-day intervals followed immediately by DCS or saline. After extinction, tests for retention and cocaine-induced reinstatement were given.

Results

In experiment 1, rats given DCS lost the cocaine CPP after one extinction trial, an effect that persisted for 2 weeks after the last DCS injection and that was resistant to cocaine-induced reinstatement. In experiment 2, extinction was facilitated by DCS compared to saline when rats received 2-min exposures to the conditioned stimulus. Longer 20-min exposures minus/plus repeated testing led to retention of extinction in both groups regardless of DCS treatment.

Conclusions

Extinction of appetitive conditioning is facilitated by DCS after 1–3 post-spaced trial injections, and retention is lasting and resistant to reinstatement. The facilitative effects appear early in extinction, but when extinction procedures are intensive, DCS appears to have no additional benefit.     

A controlled trial of the adjunct use of D-cycloserine to facilitate cognitive behavioral therapy outcomes in a cocaine-dependent population

Cocaine dependence is a chronically relapsing disorder for which its predominant behavioral therapies are associated with only partial efficacy. The goal of this study was to determine if the N-methyl-d-aspartate (NMDA) glutamate receptor partial agonist and cognitive enhancer, d-cycloserine (DCS), could boost the cocaine abstinence and treatment retention goals of cognitive behavioral therapy (CBT). This study employed a placebo-controlled, randomized double-blind trial design of 44 cocaine-dependent men enrolled in a 4-week outpatient Substance Abuse Treatment Program (SATP) at the Atlanta Veteran's Administration Medical Center. Subjects received 50mg of DCS or placebo prior to four weekly sessions of a condensed version of a manual-based CBT for cocaine dependence. Cocaine abstinence and treatment retention measures represented primary outcome variables. Relative to a 12-step based treatment-as-usual, an under-dosed CBT was associated with significant improvements in drug abstinence and treatment retention at 4-weeks and for maintenance of drug abstinence after four more weeks of follow-up. The robust response to the under-dosed CBT was not enhanced by the adjunct administration of DCS at either the 4- or 8-week endpoints. This controlled clinical trial failed to demonstrate an ability of DCS to boost the relapse prevention or treatment retention goals of CBT.     

Facilitation of extinction of operant behaviour in mice by d-cycloserine

Rationale and objective

The N-methyl-d-aspartate receptor agonist d-cycloserine (DCS) facilitates extinction following Pavlovian fear conditioning or conditioned place preference in rats, but its effects on extinction following operant conditioning are not previously established. We studied the effects of DCS on operant extinction with mice, previously shown to be facilitated by GABAergic potentiators including chlordiazepoxide.

Materials and methods

Following training of lever pressing by C57Bl/6 male mice on a discrete-trial fixed-ratio food reinforcement schedule with six reinforcers per session, 48-trial extinction sessions were conducted at 3- (Experiment 1) or 4-day intervals (Experiment 2). Effects of DCS (15 or 30 mg/kg, i.p.) administered immediately after 48-trial extinction sessions were compared with those of saline injections.

Results

With 3-day intervals between extinction sessions, post-session administration of DCS facilitated extinction, and this effect was stronger with 4-day intervals between extinction sessions. Facilitation of extinction by post-session drug administration persisted over a number of extinction sessions.

Conclusions

Operant extinction in mice can be facilitated by DCS, a glutamatergic agonist, as well as by GABAergic potentiators. The relationship between glutamatergic and GABAergic processes in operant extinction is yet to be established. These findings strengthen the basis for clinical uses of DCS.     

Relevance of trauma team organization in the management of severe injuries: the Niguarda model in Milan

A major trauma is not merely an accident but a disease needing a continuity of care for patients involved. The extension of injuries is often unpredictable and hence patients need a trauma service composed of many specialists constantly available 24 h round. This study was undertaken to analyze comprehensive strategy and outcomes of Niguarda Trauma Team System in the management of severe trauma over a 6-year experience (October 2002–December 2008). The data of 2,256 consecutive patients’ classified red or yellow code were derived from the database of Niguarda Trauma Registry and analyzed according to severity scores: Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS) and Probability of Survival (Ps). Missing the diagnosis of major trauma (ISS ≥ 16) was regarded as an undertriage, while treating patients with minor trauma (ISS < 16) within the Trauma Team System was considered an overtriage. Blunt injuries accounted for 93.6%, the main cause of blunt trauma was represented by road accidents (75%) and the majority of patients showed multiple injuries. The undertriage rate was 1.12%, while the overtriage rate increased over the last years, resulting in a decreased proportion of patients with true major trauma (ISS ≥ 16) managed by the trauma team. Cyclists and pedestrians showed lethality rates two to threefold higher than motor riders and car occupants. Emergency surgical procedures were required in 16.6% of patients. Overall, 64% of patients required emergency or delayed surgery. Interventional angiography with embolization was carried out in 9% of patients, more commonly to control acute bleeding from pelvic fractures or hepatic lesions. In 58% of cases, patients were initially admitted to intensive care unit. The quality assessment revealed a significant decrease in preventable deaths (Ps > 0.25) in patients with AIS ≤ 5. Patients who died showed a progressively increased ISS outlining a more severe patterns of injuries in deceased patients. The adoption of a comprehensive strategy in the management of severe trauma proved a beneficial impact on outcomes and mortality rates.