舒芬太尼用于蛛网膜下隙阻滞分娩镇痛量效关系的临床研究

目的 观察不同剂量舒芬太尼用于蛛网膜下隙阻滞分娩镇痛的效果及安全性.方法 100例健康单胎初产妇(ASA分级Ⅰ～Ⅱ级)按随机数字表法分为A、B、C、D、E五组,每组20例.五组行蛛网膜下隙阻滞时舒芬太尼剂量分别为3、4、5、6、7μg,同时均复合罗哌卡因3 mg.记录五组产妇蛛网膜下隙阻滞起效时间及维持时间;注药前及注药后5、15、30、60 rmin的视觉模拟评分(VAS)及生命体征;产程、分娩方式及不良反应;胎儿胎心率和新生儿1、5 min Apgar评分.结果 A组蛛网膜下隙阻滞起效时间长于B、C、D、E组;A、B组维持时间短于C、D、E组.五组注药后5、15、30、60minVAS均较注药前明显降低(P＜0.01);B、C、D、E组注药后5minVAS低于A组(P＜0.05),C、D、E组注药后60minVAS低于A、B组(P＜0.05).五组产妇生命体征、产程、分娩方式,胎儿胎心率和新生儿Apgar评分比较差异均无统计学意义(P＞0.05).D、E组皮肤瘙痒、恶心发生率[D组为25%(5/20)和15%(3/20),E组为40%(8/20)和20%(4/20)]明显高于A、B、C组[A组为5%(1/20)和0,B组为10%(2/20)和0,C组为10%(2/20)和0](P＜0.05).结论 4～6μg舒芬太尼复合3 mg罗哌卡因用于蛛网膜下隙阻滞分娩镇痛安全可靠,尤以5μg舒芬太尼复合3 mg罗哌卡因最理想.

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Objective To observe the effect and safety of different doses of sufentanil plus subarachnoid block during labor. Methods One hundred parturients (single birth) were divided into 5groups by random digits table with 20 cases in each, which sufentanil 3,4,5,6,7 μ g in group A, B, C, D, E plus ropivacaine 3 mg were injected respectively into subarachnoid space. The onset and duration of subarachnoid analgesia were observed; visual analogue scale (VAS) were recorded respectively before injection and 5,15,30,60 min after injection; the vital sign,labor stage,labor type,adverse reactions of parturients,fetal heart rate (FHR) and the Apgar score at 1,5 min of neonate were recorded respectively.Results The onset of subarachnoid analgesia in group A was higher than that in group B,C, D,E;the duration of subarachnoid analgesia in group A,B was shorter than that in group C,D,E.VAS declined gradually 5,15,30,60 min after injection compared with before injection in 5 groups (P ＜ 0.01 );VAS in group B, C, D, E was lower than that in group A at 5 min after injection (P ＜ 0.05 ), and VAS in group C, D, E was lower than that in group A,B at 60 min after injection (P＜ 0.05). There was no significant difference in vital sign,labor stage,labor type,FHR and the Apgar score of neonate among 5 groups (P ＞0.05). The occurrence of itch of skin and nausea in group D,E [25%(5/20), 15%(3/20) in group D,and 40%(8/20),20%(4/20) in group E] was higher than that in group A, B, C [5%(1/20), 0 in group A, 10%(2/20), 0 in group B, 10% (2/20), 0 in group C] (P ＜ 0.05 ). Conclusion Subarachnoid block (sufentanil 4-6 μ g +ropivacaine 3 mg) can offer safety and efficacy of labor analgesia; sufentanil 5 μg is the best dose with subarachnoid block during labor at present.     

硝酸甘油对大鼠重症急性胰腺炎ET/NO、TXA2/PGI2的影响

Objective To explore the effect of nitroglycerin on ET/NO, TXA2/PGI2 and pancreas pathomorphology changes in severe acute pancreatitis (SAP) rats. Methods Sixty SD rats were random divided into five groups, including control group (A group, n = 12) and experimental group(B,C,D and E group, n = 12). The SAP was induced by injection of 5% sodium taurocholate through retrograde common biliopancreatic ducts via duodenal papilla with epidural catheter. Group C, D and E were intravenously injected with nitroglycerin 0.5μg/kg/min,1μg/kg/min and 2μg/min in 30 min respectively, and group A and B was injected with Sodium Chloride 0.5ml. The indexes of changed pathomorphology and ET/NO, TXB2/6-keto-PGF1a, were determined at the 6th and 12th hour after operations, respectively. Results The specimen data of the 6th and 12th hour displayed that the indexes of changed pathomorphology, ET, ET/NO, TXB2, and TXB2/6-keto-PGF1a of the group C,D and E degraded respectively, compared to group B(P < 0.05). Conclusion The nitroglycerin could degrade ET, ET/NO,TXA2 and TXA2/PGI2, improve the microcirculation of pancreas, and delay the pathological inflammation change in SAP rats.     

高频喷射通气对单肺通气患者氧化应激反应的影响

目的 研究高频喷射通气(HFJV)对单肺通气患者氧化应激反应的影响.方法 择期行食管癌根治术患者45例,按随机数字表法分为双肺通气组(A组)、单肺通气组(B组)、单肺通气时非通气侧给予HFJV(驱动压力1 kg/cm2,频率100次/min)组(C组),每组15例.分别于开胸前(T0),单肺通气后(A组于开胸后)30 min(T1)、90 min(T2)、150 min(T3),手术结束时(T4)测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、一氧化氮(NO)浓度.结果 T2～T4时B、C组SOD活性[B组:(47±10)、(37±9)、(41±7)kU/L;C组:(58±12)、(51±11)、(49±9)kU/L]低于A组[(78±8)、(75±7)、(79±6)kU/L](P＜0.05),T1～T4时B、C组MDA、NO浓度高于A组(P＜0.05);T3时C组SOD活性明显高于B组(P＜0.05),T1～T4时C组MDA浓度及T2～T4时NO浓度低于B组(P＜0.05).结论 HFJV能在一定程度上抑制单肺通气患者的氧化应激反应.

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Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

核因子E2相关因子2基因启动子多态性对酒精性肝病小鼠感染创伤弧菌的影响

目的 探讨核因子E2相关因子2(nrf2)基因启动子336位点多态性对酒精性肝病小鼠感染创伤弧菌的影响.方法 取C57B6雄性小鼠,简单随机抽样法分为正常喂养组(A组,10只)、酒精性肝病组(B组,10只)、正常喂养且腹腔注射感染创伤弧菌组(C组,8只)、酒精性肝病感染创伤弧菌组(D组,110只),以基因测序法检测D组小鼠nrf2基因启动子336位点多态性,分为非突变组(336T)(D1组,7只)及突变组(336C)(D2组,10只).应用RT-PCR、Western-blotting、ELISA检测各组小鼠肝组织nrf2、肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)及高迁移率族蛋白B1(HMGB1)的基因及蛋白水平,观察小鼠肝组织病理变化.结果 A、B、C、D1、D2组小鼠在感染创伤弧菌48 h后肝组织nrf2基因的mRNA表达量中位数分别为0.115、0.173、0.211、0.764、0.352 (χ2=40.64,P<0.05);IL-10基因的mRNA表达量中位数分别为0.338、0.637、1.002、1.825、1.403(χ2=41.05,P<0.05);TNF-α基因的mRNA表达量中位数分别为0.140、0.254、0.372、0.399、0.699(χ2=38.16,P<0.05);HMGB1基因的mRNA表达量中位数分别为0.230、0.410、0.668、0.508、1.021(χ2=31.45,P<0.05).A、B、C、D1、D2组小鼠在感染创伤弧菌48 h后肝组织nrf2基因的蛋白表达量中位数分别为0.908、1.461、2.061、3.982、2.243(χ2=33.72,P<0.05);IL-10基因的蛋白表达量中位数分别为13.97、22.54、30.14、57.98、41.53(χ2=37.31,P<0.05);TNF-α基因的蛋白表达量中位数分别为114.07、142.94、175.44、174.60、266.11(χ2=32.29,P<0.05);HMGB1基因的蛋白表达量中位数分别为2.01、6.05、9.62、6.24、12.89(χ2=36.94,P<0.05).与A组比较,B组可见大量散在脂肪滴,呈空泡样改变,C组可见炎症细胞浸润,肝细胞条索紊乱,D组可见肝细胞充血水肿,肝小叶完整性破坏,汇管区可见扩张的肝管和静脉.结论 nrf2基因启动子336位点T→C突变使酒精性肝病C57B6小鼠体内nrf2表达明显降低,并加剧酒精性肝病C57B6小鼠在感染创伤弧菌时的炎症反应及脏器损害.

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Objective To investigate the influence of genetic polymorphism in NF-E2-related factor-2(nrf2) gene promoter locus at 336 in alcoholic liver disease(ALD) with Vibrio vulnificus(VV) sepsis.Methods Through the simple random sampling method,C57B6 male mice were divided into normal feeding group(group A,10 mice),alcoholic liver disease group(group B,10 mice),normal feeding group infected with VV through intraperitoneal injection(group C,8 mice),alcoholic liver disease group infected with VV(group D,110 mice).Through gene sequencing method,nrf2 gene promoter 336 polymorphism in D group was analyzed and grouped into: non-mutation group(336T)( group D1,7 mice) and mutation group(336C)( group D2,10 mice ).Through RT-PCR,Western-blotting and ELISA method,expressions of nrf2,tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),high mobility group protein 1(HMGB1)gene and protein of liver were measured.The pathological changes in liver were recorded with light microscope.Results After infected with VV for 48 hours for A,B,C,D1,D2 group,the expression medians of nrf2 mRNA in liver were 0.115,0.173,0.211,0.764,0.352,respectively(χ2=40.64,P<0.05),the expression medians of IL-10 mRNA in liver were 0.338,0.637,1.002,1.825,1.403,respectively(χ2=41.05,P<0.05),the expression medians of TNF-α mRNA in liver were 0.140,0.254,0.372,0.399,0.699,respectively(χ2=38.16,P<0.05),the expression medians of HMGB1 mRNA in liver were 0.230,0.410,0.668,0.508,1.021,respectively(χ2=31.45,P<0.05).After infected with VV 48 hours for mice in A,B,C,D1,D2 group,the expression medians of nrf2 protein in liver were 0.908,1.461,2.061,3.982,2.243,respectively(χ2=33.72,P<0.05),the expression medians of IL-10 protein in liver were 13.97,22.54,30.14,57.98,41.53,respectively(χ2=37.31,P<0.05),the expression medians of TNF-α protein in liver were 114.07,142.94,175.44,174.60,266.11,respectively(χ2=32.29,P<0.05),the expression medians of HMGB1 protein in liver were 2.01,6.05,9.62,6.24,12.89,respectively(χ2=36.94,P<0.05).Compared with group A,there were large amount of fat drops,fatty changes in group B,inflammatory cell infiltration,disorder of hepatic cell in group C,and extension of hepatic duct and vein,edema of liver cells and disorder of hepatic cells in group D.Conclusion The nrf2 gene promoter of T336C mutation in C57B6 mouse of ALD can significantly decrease the expression of nrf2,and intensify organ inflammation and damage when they were infected by VV.     

哺乳期瘢痕子宫早孕流产方式的临床研究

Objective To estimate abortion ways and announcements of early-staged gestation termination in lactation scarred uterus. Methods A retrospective analysis was made on clinical date of 312 early-staged gestation termination cases in lactation scarred uterus. These cases were divided into three groups based on abortion ways: induced abortion group (group A,92 cases), drugs abortion group (group B,98 cases), misoprostol combined uterine aspiration group (group C,122 cases). The abortive efficiency,operation time, operative bleeding, colporrhagia time, postoperative infection and drug adverse reaction were observed and compared. Results Complete abortion rates in group A (97.8%,90/92) and group C(99.2%,121/122) were significantly higher than that in group B (77.6% ,76/98),colporrhagia times in group A [(5.9 ± 1.1) d] and group C [(5.6 ± 1.2) d] were significantly lower than that in group B [(12.4 ± 1.8) d],postoperative infection and drug adverse reaction rate were lower in group A and group C, with significant difference compared to group B (P ＜ 0.05). The operation time was shorter, bleeding was less,third-grade pain rate was lower in group C, there was significant difference between group A and group C (P ＜ 0.05).Conclusions Misoprostol combined uterine aspiration terminated early-staged gestation in lactation scarred uterus is effective and safe, makes the operation easy and simple, decreases the blood loss. The influence to mother and infant is smaller, it is the best abortion style.     

高频喷射通气对单肺通气患者氧化应激反应的影响

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

吗啡联合间苯三酚治疗急性肾绞痛的疗效观察

目的 探讨吗啡联合间苯三酚在急性肾绞痛治疗中的疗效.方法 将120例急性肾绞痛患者按随机数字表法分为A、B、C三组,每组40例.A组给予0.9%氯化钠100 ml+间苯三酚80 mg静脉滴注及吗啡9 mg分3次静脉推注,B组给予0.9%氯化钠100 ml+间苯三酚80 mg静脉滴注,C组给予0.9%氯化钠100 ml静脉滴注及吗啡9 mg分3次静脉推注.分别于给药后10、20、40min观察镇痛效果及其不良反应.结果 给药后20 min和40 min时,A组总有效率[82.5%(33/40)、95.0%(38/40)]明显高于B组[62.5%(25/40)、80.0%(32/40)]和C组[60.0%(24/40)、77.5%(31/40)](P＜0.05),疼痛缓解率也明显高于B组和C组(P＜0.05).A组在给药后20 min和加min时的总有效率和疼痛缓解率比较差异无统计学意义(P＞0.05).A组除1例患者出现恶心呕吐外,无疼痛加重及严重呼吸抑制等不良反应.结论 吗啡分次注射联用间苯三酚静脉滴注治疗急性肾绞痛具有起效快、效果显著、安全等优点.

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Objective To evaluate the efficacy of multiple injection of morphine combined with phloroglucinol in the treatment of renal colic. Methods One hundred and twenty patients with severe renal colic were equally divided into three groups by random digits table,with 40 cases each group. The group A was administrated with physiological saline 100 ml and phloroglucinol 80 mg intervenous drop infusion combined with morphine 9 mg intravenous injection fractionated into three times, and the group B was administrated with physiological saline 100 ml and phloroglucinol 80 mg intervenous drop infusion,and the group C was administrated with physiological saline 100 ml intervenous drop infusion and morphine 9 mg intravenous injection fractionated into three times. At 10,20 and 40 min after administration, the antalgic efficacy of three groups were analyzed as well as the side effect. Results At 20 min and 40 min both of the total efficacy rates in group A[82.5%(33/40),95.0%(38/40)] were higher than those in group B [62.5%(25/40),80.0%(32/40)] and group C [60.0%(24/40),77.5%(31/40)] (P＜ 0.05),and the colic-exclusion rate in group A was also higher than that in group B and group C (P ＜ 0.05). The difference of the efficacy rates in group A in these two time-points had no statistical significance (P ＞0.05). No increased pain occurred in group A except 1 case of vomiting. Conclusion Multiple injection of morphine combined with phloroglucinol is quick, effective and safe in the early treatment of renal colic.     

舒芬太尼联合罗哌卡因在高龄患者下肢手术术后镇痛的研究

目的 探讨舒芬太尼联合罗哌卡因在高龄患者下肢手术术后患者自控硬膜外镇痛(PCEA)使用的安全性和合适浓度.方法 择期行下肢手术的高龄患者80例,按随机数字表法分为A、B、C、D四组,每组20例,术后PCEA泵内舒芬太尼浓度分别为0.1、0.2、0.3、0.4 μg/ml,并联合0.125%罗哌卡因.记录术后4、10、24、48 h静息状态时视觉模拟评分(R-VAS)、活动状态时视觉模拟评分(C-VAS)、改良Bromage运动神经阻滞评分、Ramsay镇静评分.观察PCEA泵使用情况及其不良反应.结果 术后各时间点A、B组C-VAS、镇痛药用量、有效按压次数明显高于C、D组(P＜0.01或＜0.05);按压有效率明显低于C、D组(P＜0.05);而C、D组间比较差异均无统计学意义(P＞0.05).D组术后10、24 hRamsay镇静评分[(4.5±0.5)、(4.6±0.6)分]明显高于A组[(2.7±0.8)、(2.7±0.8)分]、B组[(2.9±0.9)、(2.7±0.9)分]、C组[(3.0±0.7)、(2.9±0.5)分](P＜0.05).四组患者均未发生低血压和呼吸抑制.结论 四种舒芬太尼剂量联合罗哌卡因用于高龄患者下肢手术术后PCEA均安全有效,其中以0.3μg/ml舒芬太尼浓度联合罗哌卡因镇痛效果更好,且不良反应少.

Abstract：

Objective To investigate the safty and proper concentration of using the sufentanil combined with ropivacaine in patient-controlled epidural analgesia (PCEA) under lower limb surgery in elderly. Methods Eighty patients scheduled for lower limb surgery were divided into 4 groups by random digits table with 20 cases in each. The concentration of the sufentanil were 0.1,0.2,0.3 and 0.4 μ g/ml in group A, B, C, D respectively. The concentration of the ropivacaine were 0.125% in each group for the PCEA.R-VAS, C-VAS , Bromage score, Ramsay score, press times ,dosage and side effects were monitored and recorded at 4,10,24 and 48 h after operation. Results Compared with those in group C, D, C-VAS,dosage of the analgesia,press times of PCEA were higher in group A,B (P＜0.01 or ＜ 0.05),the efficacy of press was lower in group A, B(P＜0.05), but there was no significant difference between group C and group D(P＞0.05 ).The Ramsay score 10,24 h after operation in group D[(4.5 ± 0.5 ), (4.6 ± 0.6) scores] was higher than that in group A,B,C [(2.7 ±0.8), (2.7 ±0.8) scores vs.(2.9 ± 0.9), (2.7 ± 0.9) scores vs. (3.0 ±0.7), (2.9 ±0.5) scores] (P ＜0.05). There were no case with hypotension and respiratory depression.Conclusion PCEA of four methods are safe and effective in elderly which 0.3 μ g/ml sufentanil combined with 0.125% ropivacaine have good analgesic effect and less side effect.     

The curative effect of recombinant human interferon α-2b gel on flooding prevention in loop electrosurgical excision procedure

Objective To evaluate the efficacy of recombinant human interferon α-2b gel on flooding prevention in loop electrosurgical excision procedure (LEEP) during and after the operation. Method The 152 patients with cervical disease were randomly divided into three groups: group A (recombinant human interferon α-2b gel treatment group), group B (hypophysin treatment group)and group C(control group). Results The amount of intraoperative bleeding and the amount of post-operative bleeding of the group A was (2.57±1.19) ml and (2.24±1.75) ml, the group B was (3.00±1.49) ml and (45.86± 26.14) hal, the group C was (45.62±39.57) ml and (56.90±41.90) ml, respectively. There was no difference between group A and group B in the amount of intraoperative bleeding (P>0.05), but significantly less than group C (P<0.01). There was no difference between group B and group C in the amount of post-operative bleeding (P>0.05), but significantly much more than group A (P<0.01). Conclusion Recombinant human interferon α-2b gel is effective on reducing intraoperative and post-operative bleeding in LEEP.     

度洛西汀联合硫辛酸治疗糖尿病痛性神经病变的临床研究

目的 探讨度洛西汀联合硫辛酸治疗糖尿病痛性神经病变的临床效果.方法 将62例糖尿病痛性神经病变患者按照随机数字表法分为三组:A组22例用度洛西汀联合硫辛酸治疗,B、C组各20例分别用度洛西汀和硫辛酸治疗;其他治疗方案相同.疗程均为6周.比较三组患者治疗前后疼痛缓解程度及神经传导速度的变化.结果 A、B、C组患者治疗后疼痛均有明显改善(P＜0.01);总有效率分别为86.4%(19/22)、70.0%(14/20)、50.0%(10/20),差异有统计学意义(P＜0.05);从治疗后2周开始A组视觉模拟评分(VAS)明显低于B组和C组(P＜0.05);A、C组神经传导速度均有改善,与治疗前比较差异有统计学意义(P＜0.01);但治疗后A、C组神经传导速度比较差异无统计学意义(P＞0.05);B组治疗前后神经传导速度比较差异无统计学意义(P＞0.05).结论 度洛西汀联合硫辛酸可提高治疗糖尿病痛性神经病变的临床效果.

Abstract：

Objective To investigate the clinical curative effects of duloxetine combined with thioctic acid on diabetic painful peripheral neuropathy. Methods Sixty-two patients with diabetic painful peripheral neuropathy were divided into three groups by random digits table: group A(22 patients, duloxetine combined with thioctic acid group), group B (20 patients,duloxetine group) and group C (20 patients,thioctic acid group). The other treatments were same. All patients were treated for six weeks. The pain remission level and nerve conductive velocity were compared among three groups. Results The pain level in three groups was significantly alleviated after treatment (P ＜ 0.01 ). The general effective rate was 86.4%(19/22),70.0% (14/20) and 50.0% (10/20) in group A,group B and group C,respectively (P ＜ 0.05). Visual analogue scales (VAS) in group A was significantly lower than that in group B and group C from the second week after treatment (P ＜ 0.05 ). Nerve conductive velocity was improved in both group A and group C after treatment (P＜0.01),but there was no significant difference between two groups (P＞0.05). In group B,compared with that before treatment,nerve conductive velocity had no significantly improved after treatment (P＞ 0.05). Conclusion Duloxetine combined with thioctic acid can enhance the clinical curative effects on diabetic painful peripheral neuropathy.     

激光泪道成形联合药膏灌注术后冲洗时间对疗效的影响

Objective To investigate the curative effect of different time of irrigating after endolacrimal recanalisation surgery by Nd:YAG laser combining eye ointment stuffing. Methods Seventy-five cases (75 eyes) of lacrimal duct obstruction, which received endo-lacrimal recanalisation surgery by Nd:YAG laser combining eye ointment stuffing were divided into three groups by random digits table with 25 cases in each group. Group A received irrigating: the first day postoperative, consecutive 3 days,followed by once a week till a month. Group B received irrigating:the third day postoperative, consecutive 3 days,followed by once a week till a month. Group C received irrigating:the sixth day postoperative, consecutive 3 days, followed by once a week till a month. Followed-up survey for 12 months at the ophthalmologic outpatient clinic,the curative effect in each group was compared. Results In 6 months after surgery, the comparison of the curative effect was no statistical difference between group B and group C (P＞ 0.05), while the curative effects in group B and group C was superior to that in group A (P ＜ 0.05). In 12 months after surgery, the curative effect in group C was better than that in group A and B, the difference were statistically significant (P＜0.05). But there was no statistical significance compared with group A and group B (P＞0.05). Conclusions Properly delayed irrigating may improve the curative effect after endo-lacrimal recanalisation surgery by Nd:YAG laser combining eye ointment stuffing, while easier irrigating can increase the incidence of re-blockage of lacrimal duct and reduce the efficacy.     

三种不同经外周置入中心静脉导管固定方法临床效果的比较

目的 比较3种不同的经外周静脉置人中心静脉导管(PICC)固定方法对导管固定的临床效果.方法 将120例留置PICC导管患者采用便利抽样的方法分为3组,每组各40例,分别采用缝合固定(A组)、免缝胶带交叉固定(B组)和思乐扣免缝导管固定装置固定(C组).观察并比较3组患者置管后留置期间导管固定的牢固性、并发症发生率、固定部位皮肤损伤情况及患者的满意度.结果 B组导管移位的发生率(57.5%)明显高于A组(12.5%,P=0.000)和C组(7.5%,P=0.000),导管脱出的发生率(15.0%)亦明显高于A组(0,P=0.034)和C组(0,P=0.034).导管留置期间静脉炎的发生率在B组(25.0%)明显高于A组(7.5%,P=0.034)和C组(5.0%,P=0.012);在A组中并发穿刺部位蜂窝织炎的发生率明显高于C组(20.0%比2.5%,P=0.034).A组患者出现固定翼下的皮肤压痕的发生率(37.5%)明显高于B组(5.0%,P=0.000)和C组(5.O%,P=0.000),且A组患者皮肤破损的发生率(22.5%)也高于B组(5.0%,P=0.023)和C组(0,P=0.005);各种原因所致的皮肤刺激痛在A组(52.5%)中明显增加,高于B组(0,P=0.000)和C组(2.5%,P=0.000).患者对3组不同导管固定法的满意度在A组(12.0%)显著低于B组(62.5%,P=0.000)和C组(90.0%,P=0.000),且C组满意度最高,明显高于B组(P=0.004).结论 思乐扣免缝导管固定装置固定法可以作为胶带和缝合固定的替代,具有等同于缝合法对导管的固定作用,预防了导管移位、脱出等导管相关并发症,同时也避免了缝合固定造成的皮肤损伤.

Abstract：

Objecfive To compare the clinical effectiveness of three different fixation methods for peripherally inserted central catheter(PICC).Methods Totally 120 patients requiting PICCs were randomized into suture securement group(group A),tape securement group(group B),and sutureless adhesive-hacked device (StatIock)securement group(group C),with 40 patients in each group.Patients were followed up throughout their entire catheter course,and the securement effectiveness,catheter-related complications,risk of skin injury,and patients'satisfaction were observed.Results The rate of catheter migration without function loss in group B (57.5%)was significantly higherthan in group A(12.5%,P=0.000)and in group C(7.5%,P=0.000).Catheter dislodgment rate in group B(15.0%)was also significantly higher than group A(0,P=0.034)and group C(0,JP=0.034).Phlebitis documented during their catheter course in group B(25.0%)were more than in group A(7.5%,P=0.034)and in group C(5.0%,P=0.012).In addition,the rate of cellulitis in group A was significantly higher than group C(20.0%vs.2.5%,P=0.034).The rate of skin injury in group A 0.005).Nearly half of patients in group A (52.5%)complained irritation and/or pain at the sucure site,which was significantly higher than in other two groups ( both P = 0.000 ).The patients' satisfaction rate was significantly lower in group A (12.0% ) than in the other two groups ( both P = 0.000), documented highest in group C (90.0%) (group C vs.group B, P = 0.004).Conclusions The availability of sutureless adhesive-backed de vice StatLock provides an alternative for securement of PICCs.It performs as well as suture securement in catheterfixing.Meanwhile, it can prevent catheter-related complications such as migration and dislodgment Furthermore, it avoids skin injuries during catheter fixation or securement.     

三种术式治疗精索静脉曲张的临床疗效比较

目的 探讨腹腔镜下精索静脉高位结扎术、改良Palomo术和传统开放手术(经腹股沟管精索静脉结扎术)治疗精索静脉曲张的临床疗效及差别.方法 将135例精索静脉曲张手术患者按照随机数字表法分为三组,腹腔镜下精索静脉高位结扎术组(A组,50例)、改良Palomo术组(B组,70例)和传统开放手术组(C组,15例),对三组患者的手术时间、住院时间、手术费用,术前、术后1、6、12个月的精液质量进行比较,并追踪18个月内患者精索静脉曲张复发、配偶临床妊娠结果 及睾丸萎缩的发生情况.结果 三组患者在单侧手术时间、住院时间方面比较差异无统计学意义(P>0.05);住院费用方面A组明显高于B、C组(P<0.05),而B、C组间比较差异无统计学意义(P>0.05);三组术后精液质量均较术前有显著提高(P<0.05),但组内术后1、6、12个月精液质量各参数比较差异无统计学意义(P>0.05).术后随访18个月,C组复发率13.3%(2/15),显著高于A组的0和B组的1.4%(1/70)(P<0.05),三组配偶临床妊娠率比较差异无统计学意义(P>0.05)[A组68.0%(34/50),B组68.6%(48/70),C组66.7%(10/15)].随访期间三组均无睾丸萎缩.结论 腹腔镜下精索静脉高位结扎术和改良Palomo术是治疗精索静脉曲张的安全、简单、有效的手术方式.对于单侧精索静脉曲张,改良Palomo术值得首先推荐;对于双侧和复发的精索静脉曲张,则可以优先考虑腹腔镜手术.

Abstract：

Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.     

拉米夫定联合还原型谷胱甘肽预防乙型肝炎病毒携带者抗结核的肝损害研究

Objective To explore the preventive effect of liver damage treated by lamivadine joint reduced glutathione for the tuberculosis patients with HBV infection. Methods 90 cases of tuberculosis patients with HBV infection were randomly divided into three groups (A, B, C), each group contained 30 cases. Patients in group A were treated by lamivudine combined with reduced glutathione to protect the liver before anti-tuberculosis treatment. Group B were treated with reduced glutathione. Group C were treated with Yiganling tablets. Both the liver function and serum HBV DNA levels before anti-tuberculosis treatment and 1 month and 2 months after treatment were observed and recorded. Results The cases of liver damage in group A, B, C were 1, 12, 18 respectively, there were statistical differences between group A and group B, group C (χ2 = 11.882, 22.259, P < 0.01). The cases of discontinued treatment due to different causes in group A,B,C were 0,4,11 respectively, there were statistical differences between group A and group B,group C(χ2 = 4.286, P < 0.05; χ2 = 13.469, P < 0.01). The cases of discontinue treatment in the no antivirus group were much more than the antivirus group. There were also statistical differences in both liver damage and discontinued treatment between group B and group C(χ2 = 5.455,4.356, P < 0.05). There was no statistical difference of baseline HBV DNA level between group A and group B (P > 0.05), and also no statistical difference between group A and group C ( P > 0.05), but there were statistical differences in HBV DNA level between group A and group B, as well as group A and group C after 1-month and 2-month therapy( t = - 6.542, - 6.746 and t = - 9.358, - 10.085, P < 0.01). Conclusions Tuberculosis patients coinfected with HBV can use reduced glutathione to prevent liver damage while antitubercular therapy, and simultaneous application of lamivudine therapy can restrain HBV replication and improve the prognosis obviously.     

异丙酚对大鼠肺缺血/再灌注损伤的保护作用

Objective To study the protective effects of propofol against ischemia/reperfusion injury in rat lung. Methods Rat model of pulmonary ischemia/reperfusion injury was used in this study. Rats were randomly divided into three groups, including sham opera-tion group (group A), iachemia/reperfusion group (group B) and propofol group (group C), 15 rats in each group. The concentration of tumor necrosis factor -α and interleukin-6 in bronchoalveolar lavage fluid (BALF) were measured by enzyme linked immunosorbent assay (ELISA). Then blood gas analysis, lung wet/dry (W/D) weight ratio were detected in each group. Results Propofol could significantly improve PaO2, reduce the W/D value and the contents of TNF-α and IL-6 in BALF. Conclusion Propofol effectively suppressed the pro-duction and release of inflammatory cytokine, therefore it can protect the lung from isehemia/reperfusion injury.     

基质金属蛋白酶9及微血管密度在前列腺癌组织中的表达及意义

目的 研究前列腺癌(PCa)组织中基质金属蛋白酶9(MMP-9)的表达和微血管密度(MVD),探讨二者与PCa侵袭转移的关系.方法 对42例PCa标本和28例良性前列腺增生症(BPH)标本行MMP-9、CD34(标记MVD)免疫组化染色,检测它们在前列腺组织中的表达情况,对照临床分期及病理结果,采用统计学方法 进行分析.结果 MMP-9在BPH和PCa组织中的阳性表达率分别为10.7%(3/28)、54.8%(23/42),MMP-9在PCa组织中的阳性表达率明显高于BPH(P<0.05).MMP-9在PCa转移者(C+D期)和局限者(A+B期)中阳性表达率分别为76.9%(20/26)、18.8%(3/16),两者比较差异有统计学意义(P<0.01).PCa转移者MVD值为(69.47±11.86)个/视野,局限者MVD值为(51.09±11.98)个/视野,两者比较差异有统计学意义(P<0.01),而且PCa标本的MVD值均明显高于BPH标本的(27.92±8.41)个/视野(P<0.01).在PCa中MVD值与MMP-9阳性表达呈显著正相关(r=0.325,P<0.05).结论 MVD值、MMP-9阳性表达可作为判断PCa浸润转移的指标.

Abstract：

Objective To study the expression of matrix metalloproteinase 9 (MMP-9) and microvessel density (MVD) in prostatic cancer (PCa) and correlation with their metastasis. Methods The expression of MMP-9 and CD34(marked MVD) was detected by immunohistochemistry in 70 cases of prostatic diseases,including PCa (42 cases) and benign prostatic hyperplasia (BPH)(28 cases), compared clinical-stage and pathology and studied their results by statistical methods. Results The positive rate of MMP-9 in BPH and PCa was 10.7% (3/28) and 54.8% (23/42), the positive rate of MMP-9 was significantly higher in PCa than that in BPH (P< 0.05). The positive rate of MMP-9 in PCa metastasis group (C+D phase) and situ group (A+B phase) was 76.9% (20/26) and 18.8% (3/16),there was statistically significant difference between PCa metastasis group and situ group (P < 0.01). The concentration of MVD in PCa metastasis group and situ group was (69.47 ± 11.86), (51.09 ± 11.98) points each view, there was statistically significant difference between PCa metastasis group and situ group(P< 0.01) ,and all of MVD in PCa was significantly higher than that in BPH (27.92 ± 8.41) points each view (P < 0.01). The higher MMP-9 expression was positively correlated with increased MVD in PCa (r = 0.325,P< 0.05). Conclusion MMP-9 and MVD can be as indicator to pridict the metastasis of PCa.     

饮食、C反应蛋白与2型糖尿病颈动脉内膜厚度的关系

Objective To compare the characteristics of food and nutrition intake in type 2 diabetes mellitus (T2DM) patients with or without carotid atherosclerosis and analyze the relationship between diets/C-reactive protein (CRP) and carotid intima-media thickness (C-IMT). Methods Sixty patients with T2DM were enrolled and divided into two groups based on C-IMT: group A (C-IMT ＜ 1 mm, n=30) and group B (C-IMT≥1 mm, n=30). All subjects were investigated with questionnaires including 3-day food recall They all took somatometric measurement. Blood and urine samples were collected in all subjects to examine the levels of high sensitive-CRP,C-peptide, blood glucose, glycosylated hemoglobin, blood lipid, renal function, urine microalbumin, and other indicators. Results The intakes of vegetables, fruits, and aquatic products were significantly higher in group A than in group B ( P ＜ 0. 05 ). The intake of vitamin C in group A was significantly higher than that in group B ( P ＜0. 05 ). The levels of CRP in group B was significant higher than that in group A (P = 0. 000). Positive correlation was found between CRP level and C-IMT in T2DM patients ( r = 0. 36, P = 0. 004). Furthermore, CRP was negatively correlated with the intakes of vegetables and fruits ( r = - 0. 334, P = 0. 01 ), aquatic products ( r = -0. 315, P = 0. 016), and vitamin C ( r = - 0. 2786, P = 0. 038 ), respectively. The intake of fruits was negatively correlated with C-IMT (r, = -0. 33, P = 0. 01 ). Conclusions T2DM patients without carotid atherosclerosis intake more vegetables, fruits, aquatic products and vitamin C than those with atherosclerosis. Vegetables, fruits,sea foods and vitamin C may be the protective factors against atherosclerosis in T2DM patients. CRP is associated with the development of atherosclerosis in T2DM patients.     

慢性乙型肝炎患者血清XCL1与免疫损伤的相关性分析

Objective To explore the relevance between serum XCL1 levels and liver damage in hepatitis B patients.Methods The serum concentration of XCL1 was detected by enzyme linked immu-nosorbent assay (ELISA).Peripheral blood T-cell subsets were detected by flow cytometry (FCM).Liver function was assayed by automatic biochemistry analyzer, hepatitis B antigen/antibody semi-quantitative index was detected by time-resolved fluorescence analyzer, and HBV-DNA load was detected by automatic fluorescence quantitative PCR.Results Serum concentration of XCL1 in control group ( n = 20), mild chronic hepatitis B (CHB) group ( n =29), moderate CHB group ( n =20) and severe CHB group ( n =26)were (8.24±1.94) pg/ml, (10.99±1.94) pg/ml, (12.83 ±2.59) pg/ml, (13.72 ±3.13) pg/ml,respectively.The concentration of XCL1 in all CHB groups was significantly higher than control group ( P＜ 0.05 ).The concentration of XCL1 in severe CHB group was significantly higher than mild CHB group (P ＜ 0.05).XCL1 was positively correlated with ALT, AST, TBIL and DBIL, and the coefficients were (r =0.463、 0.472、 0.413、 0.440, P ＜0.01 ), respectively.The serum XCL1 levels in hepatitis B virus with low load group was lower than hepatitis B virus with high load group.The percentage of CD4 + T in hepatitis B virus with low load group and high load group were (41.26 ± 11.33)%, (33.01 ± 5.96)%,and the difference was statistically significant.Conclusion Serum concentrations of XCL1 were closely related to the degree of liver inflammation in hepatitis B patients.XCL1 may be involved in the process of chronic hepatitis B.     

慢性乙型肝炎患者血清XCL1与免疫损伤的相关性分析

Objective To explore the relevance between serum XCL1 levels and liver damage in hepatitis B patients.Methods The serum concentration of XCL1 was detected by enzyme linked immu-nosorbent assay (ELISA).Peripheral blood T-cell subsets were detected by flow cytometry (FCM).Liver function was assayed by automatic biochemistry analyzer, hepatitis B antigen/antibody semi-quantitative index was detected by time-resolved fluorescence analyzer, and HBV-DNA load was detected by automatic fluorescence quantitative PCR.Results Serum concentration of XCL1 in control group ( n = 20), mild chronic hepatitis B (CHB) group ( n =29), moderate CHB group ( n =20) and severe CHB group ( n =26)were (8.24±1.94) pg/ml, (10.99±1.94) pg/ml, (12.83 ±2.59) pg/ml, (13.72 ±3.13) pg/ml,respectively.The concentration of XCL1 in all CHB groups was significantly higher than control group ( P＜ 0.05 ).The concentration of XCL1 in severe CHB group was significantly higher than mild CHB group (P ＜ 0.05).XCL1 was positively correlated with ALT, AST, TBIL and DBIL, and the coefficients were (r =0.463、 0.472、 0.413、 0.440, P ＜0.01 ), respectively.The serum XCL1 levels in hepatitis B virus with low load group was lower than hepatitis B virus with high load group.The percentage of CD4 + T in hepatitis B virus with low load group and high load group were (41.26 ± 11.33)%, (33.01 ± 5.96)%,and the difference was statistically significant.Conclusion Serum concentrations of XCL1 were closely related to the degree of liver inflammation in hepatitis B patients.XCL1 may be involved in the process of chronic hepatitis B.