多器官功能障碍与应激性溃疡

1932年Cushing发现颅脑损伤可并发急性胃溃疡出血及穿孔。1936年Selye首先采用应激性溃疡的命名,并提出应激三联证（肾上腺肿大,淋巴腺、胸腺、脾脏萎缩,胃肠道急性溃疡或糜烂）。40年代后又出现不少其它名称,如出血性胃炎、急性胃粘膜损害、急性胃粘膜糜烂等。 应激性溃疡（SU）泛指休克、严重创伤、大手术、重度全身性感染等危重病人发生急性胃粘膜损害,是一种严重的应激反应,故以应激性溃疡的命名较为合适,如称之为应激性胃粘膜损害也无不可。     

内皮素-1与梗阻性黄疸大鼠应激性溃疡关系的研究

目的　研究梗阻性黄疸 (梗黄 )大鼠应激状态下胃黏膜中内皮素 -1(ET 1)变化及其与胃黏膜血流和胃黏膜损伤程度的关系。方法　动物随机分为 :( 1)实验组 ,梗黄大鼠 ;( 2 )对照组 ,假手术组。两组再分成 5个亚组 ,即不予冷束缚和冷束缚 10 ,3 0 ,60 ,12 0min的应激组 ;( 3 )抗ET 1血清预处理组 ,于成模后行 3 0 ,60 ,12 0min冷束缚前注射抗ET 1血清。放免法检测胃黏膜中ET 1,激光多普勒法测定胃黏膜血流 ,光镜下观察胃黏膜损伤程度。结果　实验组与对照组相比 :胃黏膜中ET 1明显增高 (P <0 .0 1) ,胃黏膜血流明显减少 (P <0 .0 1) ,溃疡指数增加 (P <0 .0 1)。静脉注射抗ET 1血清后 ,胃黏膜血流增加 ( P <0 .0 1) ,溃疡指数下降 ( P <0 .0 1)。结论　内源性ET 1在梗黄大鼠应激性溃疡的发病机制中有一定作用 ;抗ET 1血清对梗黄大鼠应激性溃疡有预防作用。     

直肠孤立性溃疡综合征

直肠孤立性溃疡综合征北京航天中心医院肛肠科（１０００３９）杨新庆，王立勇所谓直肠孤立性溃疡综合征（ＳＲＵＳ），即在临床上以直肠出血、排便困难、里急后重、粘液便为常见症状的一种慢性、非特异性直肠良性疾病。活检病理检查有其典型的病理改变。其溃疡多为单发亦...     

椎间盘源性腰痛的再认识

腰痛是脊柱疾患中复杂的临床综合征中最为常见的症状。临床上除一部分腰痛的患者能作出明确的诊断，如腰椎间盘突出症、椎管狭窄症等；其余部分的诊断概念较为模糊。近年来，由于对腰痛的不断认识，椎间盘源性腰痛也逐渐被作为一种独立的疾病用于临床诊断。本文就椎间盘源性腰痛的发病机制、临床表现、诊断及治疗方面进行探讨，以更好地认识椎间盘源性腰痛。     

对胆肠吻合术的再认识

胆肠吻合术是治疗胆道外科疾病、重建胆汁引流的重要方法,是胆道外科最常应用的手术方法之一.在多年的临床实践中,胆肠吻合的术式不断改进,在不同的历史时期均有其代表性术式.     

应激性溃疡的研究进展

应激性溃疡是LCU病人常见的并发病之一。本文现将其发病机制中的重要环节、诊断、预防和治疗等方面的研究进展及作者自己的体会做一综述。     

应激性溃疡的研究进展

应激性溃疡是ＩＣＵ病人常见的并发病之一。本文现将其发病机制中的重要环节，诊断，预防和治疗等方面的研究进展及作者自己的体会做一综述。     

对骨筋膜室综合征的再认识

骨筋膜室综合征是创伤骨科领域中最严重的并发症之一，对患者和医生都构成严重的威胁，一旦发生并延误诊治将造成灾难性后果，这在某种意义上说骨筋膜室综合征比骨折本身的医疗风险更大。因此，作为一名创伤骨科医生要对其有足够的重视。     

对“卡-梅现象”的认识

卡梅现象(Kasabach-Merritt Phenomenon,KMP)的概念是在卡梅综合征Kasabach-Merritt Syndrome,KMS)的基础上提出来的,在近两年逐渐被广大学者所接受,成为主流     

儿童原发性肾病综合征肾活检致应激性溃疡1例

<正>病例资料患儿,女,10岁,因“咳嗽6 d,全身浮肿伴少尿3 d”入院。病前6 d有受凉史,因受凉后出现咳嗽,无发热、鼻塞、流涕等,期间未予重视。3 d前出现浮肿,初为颜面部、眼睑,伴少尿（尿量描述不清）,尿色为淡红色,后浮肿逐渐出现在双上肢、双下肢,为凹陷对称性水肿;咳嗽同前,无尿频、尿急、尿痛,无声嘶、喉鸣,无发热、寒颤,无呕吐、腹泻等不适。入院体格检查：体温36.5℃,脉搏88次/min,呼吸20次/min,血压123/79 mm Hg(1 mm Hg=0.133 k Pa),     

Surgical treatment of stress ulcers

Fifty-six patients underwent surgery because of massive gastrointestinal hemorrhage apparently caused by stress ulcers. Twenty-five of these patients had subtotal gastrectomy as the initial procedure. The over-all mortality was 36 per cent. Twenty-eight patients had pyloroplasty and vagectomy as the initial surgical procedure. The associated over-all mortality was 35 per cent. Three patients had hemigastrectomy and vagectomy with a mortality of 33 per cent.A closer review of these figures indicates that if pyloroplasty and vagectomy were the first operation and the patient continued to bleed, operation should be performed immediately. This gave us our lowest mortality in the series (23 per cent). Second best results were obtained when subtotal gastrectomy was the initial operation but no operation was performed in patients who continued to bleed (31 per cent mortality). These data, however, have no statistical significance and only indicate a trend in a certain direction. There is no clear-cut evidence that one type of operation is preferred to the other.     

Pressure ulcers: Current understanding and newer modalities of treatment

This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient''s quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.KEY WORDS: Bedsore, decubitus ulcer, pressure sore, pressure ulcer