干扰素联合胸腺肽治疗慢性乙型肝炎62例

目的：观察干扰素α（ＩＮＦ－α）联合胸腺肽治疗慢性乙型肝炎（Ｃｈｒｏｎｉｃ Ｈｅｐａｔｉｔｉｓ Ｂ，ＣＨＢ）的疗效。方法：１２６例患者随机分为治疗组６２例，给ＩＦＮ－α３００万ＩＵ＋胸腺肽２０ｍｇ，均隔日１次；对照组６４例，单用ＩＮＦ－α３００万ＩＵ，隔日１次，疗程均为６个月。主要观察患者治疗前后症状、体征、病毒复制指标、肝功能指标的变化。结果：①两组患者在主要症状、体征方面改善明显（ｘ＾２＝７．４５，Ｐ〈０．０５）。②疗程结束时及１年后，治疗组患者ＨＢｅＡｇ及ＨＢＶ－ＤＮＡ的阴转率均显著高于对照组（ｘ＾２＝５．４７、ｘ＾２＝８．６１，Ｐ〈０．０５、Ｐ〈０．０１）。结论：两药联用能明显抑制ＨＢＶ复制，降低其反跳和病情复发。     

铁等微量元素和自由基对冠心病发病的影响

本文对３８例冠心病患者（ＣＨＤ组，其中心肌梗塞１８例，心绞痛２０例）和３２例健康人（对照组）的血清铁（Ｆｅ）、铜（Ｃｕ）、锌（Ｚｎ）、硒（Ｓｅ）、脂质过氧化物（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）、血清载脂蛋白Ａ１、３（ａｐｏ－Ａ１、ａｐｏ－Ｂ）和血压的水平进行了对比观察。结果发现：ＣＨＤ组的血清Ｆｅ、ａｐｏ－Ｂ、甘油三酯（ＴＧ）及血压明显高于对照组；而Ｚｎ、Ｓｅ、ａｐｏ－Ａ１／ａｐｏ－Ｂ和ＳＯＤ则明显低于对照组。多元相关分析表明，Ｆｅ和舒张压与ＣＨＤ的发生呈正相关；Ｚｎ和ＳＯＤ与其呈负相关。提示体内Ｆｅ储存增加可能是ＣＨＤ发病的危险因素之一。     

国产基因工程干扰素α1治疗慢性乙型肝炎的临床研究

２２５例慢性乙型肝炎分三组治疗，Ａ和Ｂ组７４例配对随机用干扰素α１及安慰剂双盲对照观察，Ｃ组１５１例为干扰素α１４０微克连用三个月，ＨＢｅＡｇ、ＨＢＶ－ＤＮＡ、ＨＢｅＡｇ和ＨＢＶ－ＤＮＡ双转阴率及抗ＨＢｅ转阳率分别为４０．５％、５７．１％、３９．３％及２９．７％，与对照组差异有非常显著性（Ｐ＜０．０１）。扩大治疗组结果与Ａ组相似，均明显优于对照组。治疗组随访半年和一年ＨＢｅＡｇ及ＨＢＶ－ＤＮＡ转阴率与治疗结束时相似，表明有较持久的效果。     

奥曲肽对犬急性重症胰腺炎Oddi括约肌的影响

目的 观察急性重症胰腺炎Ｏｄｄｉ括约肌（ＳＯ）的压力变化及奥曲肽对之影响,方法 １５只犬分为２组,急性重症胰腺炎非治疗组（５只）,奥曲肽组（１０只）;制备犬急性急症胰腺炎模型,于制备前,后及给药后各时间点分别测定ＳＯ的基础压和时相收缩幅度。结果 急性重症胰腺炎时ＳＯ压力显著升高（Ｐ＝０．０００１）;奥曲肽能显著降低重症胰腺炎时ＳＯ的基础压（Ｐ＝０．０００３）;但对时相收缩幅度无影响（Ｐ＝０．２３０     

FMB联合局注治疗晚期食管癌

ＦＭＢ联合局注治疗晚期食管癌张治民我院自１９８８年至１９９０年对２１例晚期食管癌患者，采用５－氟尿嘧啶（５－Ｆｕ），丝裂霉素（ＭＭＣ），平阳霉素（ＢＨ）联合于癌组织内直接注射治疗，近期效果较好。现报道如下：一、一般资料：２１例患者作完三次治疗为随访对...     

1,6-二磷酸果糖与硝酸甘油合用治疗心力衰竭的疗效

为观察１,６－二磷酸果糖（ＦＤＰ）与硝酸甘油合用治疗心力衰竭的疗效,以及对急性心肌梗死患者死亡率的影响,选择病因不同的心力衰竭患者１０１例,分为２组．Ａ组３４例,单用硝酸甘油静脉滴注;Ｂ组６７例,除静脉滴注硝酸甘油外,还加用ＦＤＰ５ｇ静脉点滴,每日２次,共７ｄ～１０ｄ;对照组２０例．观察结果显示:Ａ组、Ｂ组和对照组中冠心病心力衰竭患者心功能纠正显效率分别为４０％（８／２０）,５７％（１２／２１）和１０％（２／２０）,Ａ组、Ｂ组与对照组比较,差异有显著性（Ｐ＜０．０１）,并以Ｂ组疗效最佳,说明ＦＤＰ与硝酸甘油合用能有效治疗冠心病心力衰竭。ＦＤＰ对病因不同的心力衰竭患者的治疗,则以冠心病心力衰竭患者疗效为佳。ＦＤＰ可作为辅助药物治疗急性心肌梗死,但不能明显减少重症患者的死亡率。     

HDCF/5-Fu加中药扶正护膜汤治疗晚期胃肠癌的临床观察

我们自１９９４年三月至１９９６年８月采用大剂量醛氢叶酸合并５－氟尿嘧啶（ＨＤＣＦ／５－Ｆｕ）配以中药扶正护膜汤治疗晚期胃癌,疗效满意,且副作用小。１临床资料１．１一般资料４２例经病理证实的晚期胃癌患者均为术后复发转移者。全部病例均为我院住院病人,均有可测量的肿瘤病变。选择扶正护膜汤加ＨＤＣＦ／５－Ｆｕ治疗者２３例为观察组,其中男１５例,女８例,年龄３５～７３岁。Ｋｐｓ评分６０分以上。其中肝转移８例,双肺转移３例,胰头转移６例,腹壁刀口种植性转移２例,锁骨上淋巴结转移４例。１３例病人术后曾用含５Ｆ…     

重症急性胰腺炎的并发症及治疗体会

目的：总结重症急性胰腺炎的主要并发症及治疗体会。方法：回顾性分析１９９４年６月至１９９８年１２月收治的重症急性胰腺炎３９例,对主要并发症的原因及治疗方法进行总结。结果：３９例重症急性胰腺炎主要并发症为肺损害、休克、腹腔感染、多器官功能紊乱等,治愈率达７２％。结论：重症急性胰腺炎并发症多,应重点防治ＡＲＤＳ、休克、腹腔感染等。     

高血压病遗传性血小板一氧化氮合酶活性缺陷

为了解高血压病是否存在一氧化氮合酶（ＮＯＳ）遗传缺陷，采用同位素（３Ｈ－Ｌ精氨酸）法测定人血小板ＮＯＳ活性，观察高血压病（ＥＨ）患者（１９例）及有高血压病家族史的正常血压子女（ＦＨ＋，１３例）组的血小板在胶原（５μｇ／ｍｌ）激活下ＮＯＳ活性改变。结果：ＥＨ组和正常对照组（ＮＴ）、ＦＨ＋和无ＥＨ家族史的正常血压子女（ＦＨ－，１２例）组胶原激活的血小板ＮＯＳ活性分别为４．７６±２．０１比８．０９±２．３６ｐｍｏｌ·ｇ－１·ｍｉｎ－１、３．６４±２．０７比５．５１±２．１３ｐｍｏｌ·ｇ－１·ｍｉｎ－１（Ｐ＜０．０５）。表明ＥＨ组和ＦＨ＋组血小板ＮＯＳ活性均明显低于相应的对照组，提示ＥＨ有血小板ＮＯＳ活性缺陷，且与遗传因素有关，这可能是该病一种临床亚型，如进一步证实它是新的“遗传标记”，可为揭示ＥＨ相关基因及为早期预防合理治疗提供依据。     

不同剂量干扰素治疗慢性乙型肝炎时血清2′,5′寡腺苷酸合成…

目的：观察不同剂量干扰素治疗慢性乙型病毒性肝炎时血清２′５′－寡腺苷合成酶（２′，５′－ＯＡＳ）的变化，了解细胞抗病毒状态建立与乙肝病毒复制的关系。方法：３２例慢性乙肝患者随机分为３组，即ＩＭＵ干扰素腹腔注射１１例（治疗Ｉ组）３ＭＵ干扰素皮下注射１１例（治疗Ｉ组）分别连续注射５天，以后每周３次，共１６周，并与不同干扰素治疗的１０例（对照组）作对比，通过２′，５′－ＯＡＳ，ＡＬＴ，ＨＢｅＡｇ，ＨＢＶ     

白蛋白和速尿早期联合使用治疗重症急性胰腺炎

为探讨早期联合使用白蛋白和速尿治疗重症急性胰腺炎（SAP）的临床疗效，我们将66例SAP患者随机分为对照组（32例）和治疗组（34例），对照组按照SAP常规处理原则予监护，禁食，胃肠减压，抑酸，应用生长抑素、抗生素，纠正水、电解质、酸碱平衡及支持治疗；治疗组在此基础上给予白蛋白和速尿早期联合使用。比较两组治疗效果。治疗组的腹痛消失时间，体温、血淀粉酶、白细胞恢复正常的时间，平均住院时间均短于对照组（P〈0．05）；治疗组并发症的发生率低于对照组（P〈0．05）。可见白蛋白和速尿剂可缩短重症急性胰腺炎病程，减少并发症，可以常规早期使用。     

简易腹腔灌洗联合早期血液滤过治疗重症急性胰腺炎

目的 探讨简易腹腔灌洗联合早期血液滤过治疗重症急性胰腺炎(SAP)的临床效果.方法 以腹腔穿刺针穿刺入腹腔,连接三通管,滴入生理盐水1000 ml,然后排出,如此反复3次.之后滴入利多卡因、地塞米松及抗生素,每日一次,直至灌洗液由血性变清亮.同时行床旁血液滤过.结果 按随机数字表法将61例SAP患者分为腹腔灌洗+血液滤过组(治疗组,31例)和对照组(30例).治疗组腹痛缓解、腹胀缓解、恶心呕吐消失及腹膜刺激征消失天数分别为(1.5±0.3)d、(2.7±0.3)d、(1.9±0.3)d、(1.5±0.2)d,住院天数为(11.0±2.0)d,显著短于对照组的(3.9±0.3)d、(4.5±0.6)d、(3.7±0.2)d、(5.3±0.4)d、(18.0±2.5)d(P值均＜0.05).治疗组治疗后1 d起,血ALT及AST浓度较对照组显著下降;3 d起血、尿淀粉酶及TNF-α、IL-6、IL-8含量较对照组显著下降,血HCO3-、IL-10含量显著增高(P＜0.05或＜0.01);5 d起血尿素氮、肌酐含量较对照组显著下降(P＜0.05).结论 腹腔灌洗联合早期血液滤过能及时清除炎性因子,对于SAP的治疗更合理、有效.     

早期应用生大黄对重症急性胰腺炎的疗效

目的探讨早期应用生大黄液对并发肠麻痹的重症急性胰腺炎(SAP)的治疗效果及对其预后的影响。方法将48例并发肠麻痹的SAP患者随机分为对照组和治疗组,对照组按照SAP常规处理原则予监护,禁食,胃肠减压,抑酸,应用生长抑素,抗生素,纠正水、电解质、酸碱平衡等支持治疗;治疗组在此基础上给予生大黄液胃管注入。观察两组患者的腹痛腹胀缓解时间、胃肠道功能恢复时间、全身炎症反应综合征(SIRS)改善时间、并发症发生的例数、病死率、住院时间及住院费用。结果两组患者的腹痛腹胀缓解时间、胃肠道功能恢复时间、SIRS改善时间、住院时间及住院费用有显著性差异(P<0.01);治疗组并发症发生率低于对照组(P<0.05),但两组病死率无显著性差异(P>0.05)。结论生大黄液能缩短SAP的病程,降低住院费用,是治疗SAP肠麻痹的理想药物,可以常规早期使用。     

Combination of allopurinol and hyperbaric oxygen therapy： A new treatment in experimental acute necrotizing pancreatitis？

AIM： To investigate the individual and combined effects of allopurinol and hyperbaric oxygen （HBO） therapy on biochemical and histopathological changes, oxidative stress, and bacterial translocation （BT） in the experimental rat acute pancreatitis （AP）. METHODS： Eighty-five Sprague-Dawley rats were included in the study. Fifteen of the eighty-five rats were used as controls （sham, Group I ）. AP was induced via intraductal taurocholate infusion in the remaining seventy rats. Rats that survived to induction of acute necrotizing pancreatitis were randomized into four groups. Group H received saline, Group m allopurinol, Group IV allopurinol plus HBO and Group v HBO alone. Serum amylase levels, oxidative stress parameters, BT and histopathologic scores were determined. RESULTS： Serum amylase levels were lower in Groups Ⅲ, Ⅳ and v compared to Group H （974 ± 110, 384 ± 40, 851 ＋ 56, and 1664 Ⅳ 234 U/L, respectively, P 〈 0.05, for all）. Combining the two treatment optionsrevealed significantly lower median [25-75 percentiles] histopathological scores when compared to individual administrations （13 [12.5-15] in allopurinol group, 9.5 [7-11.75] in HBO group, and 6 [4.5-7.5] in combined group, P 〈 0.01）. Oxidative stress markers were significantly better in all treatment groups compared to the controls. Bacterial translocation into the pancreas and mesenteric lymph nodes was lower in Groups m, iV and v compared to Group H （54%, 23%, 50% vs 100% for translocation to pancreas, and 62%, 46%, 58% vs 100% for translocation to mesenteric lymph nodes, respectively, P 〈 0.05 for all）. CONCLUSION： The present study confirms the benefit of HBO and allopurinol treatment when administered separately in experimental rat AP. Combination of these treatment options appears to prevent progression of pancreatic injury parameters more effectively.     

The effect of combination therapy of hyperbaric oxygen, meropenem, and selective nitric oxide synthase inhibitor in experimental acute pancreatitis

Despite the new diagnostic and therapeutic advancements, acute pancreatitis has still high rate of morbidity and mortality. We aimed to evaluate the effects of hyperbaric oxygen (HBO) therapy alone or combined with S-methylisothiourea (SMT), and meropenem (MER) therapy in an experimental rat model of acute necrotizing pancreatitis. Rats were randomly divided into 8 groups, and acute pancreatitis was induced in all groups except group 1. Treatment protocols were saline for group 2, SMT for group 3, SMT + MER for group 4, SMT + HBO for group 5, HBO for group 6, HBO + MER for group 7, and MER for group 8. All surviving animals were killed 48 hours after the induction of pancreatitis, and specimens were collected. Oxidative stress parameters, histopathologic scores and amylase levels were better in treatment groups than in the positive control group (group 2). The most favorable results were obtained in HBO treatment groups, especially in HBO + MER group (group 7). Our results indicate that adding HBO therapy to the antibiotic therapy will decrease oxidative stress parameters, serum amylase levels, and histopathological score. We suggest that adding the HBO therapy as an adjunctive to the treatment protocol of acute necrotizing pancreatitis may yield improvement in the morbidity and mortality of the disease.     

Synbiotic control of inflammation and infection in severe acute pancreatitis: a prospective, randomized, double blind study

BACKGROUND/AIMS: Experimental and clinical studies demonstrated that probiotics containing lactobacilli significantly improve the outcome of acute pancreatitis. In a prospective, randomized, double-blinded study the role of "Synbiotic 2000", a new synbiotic composition with high colony forming unit (CFU) was evaluated in the treatment of severe acute pancreatitis. METHODOLOGY: Patients with severe acute pancreatitis were randomized into two groups. Nasojejunal feeding was commenced within 24 hours after admission in both groups and continued for at least seven days. The first group of patients received four different lactobacilli preparations with 1010 CFU, respectively, and prebiotics containing four bioactive fibers (inulin, beta-glucan, resistant starch and pectin) in addition. Patients in the second (control) group received only prebiotics. RESULTS: 62 patients with severe acute pancreatitis completed the study. Altogether 8 patients died. Lower incidence of multiorgan failure (MOF), septic complications and mortality were detected in the first group compared to the control, but the differences were not significant statistically. The total incidence of systemic inflammatory response syndrome (SIRS) and MOF were significantly different between the two groups (8 vs. 14; p < 0.05). Furthermore, the number patients recovering with complications were significantly less in the first group receiving modern synbiotic therapy compared to the control (p < 0.05). Finally, lower rate of late (over 48 hours) organ failure was detected in the first versus the control group (3.0% vs. 17.2%). CONCLUSIONS: The results suggest that early nasojejunal feeding with synbiotics may prevent organ dysfunctions in the late phase of severe acute pancreatitis. In addition, the data also indicate that the infection of pancreatic necrosis may be associated with early phase organ failure.     

双歧杆菌预防重症急性胰腺炎感染疗效观察

目的 评价双歧杆菌是否可减少重症急性胰腺炎严重感染的发生率。方法 40例符合重症急性胰腺炎诊断标准的患者随机分为两组，均给予早期肠内营养。对照组给予灭活双歧杆菌1周，治疗组给予双歧杆菌1周。结果 治疗组有2例患者出现严重感染，对照组有8例出现严重感染，两组比较有统计学差异（P〈0．05）；对照组平均住院时间为32．4d、治疗组为25．4d。无统计学意义（P〉0．05）。结论 肠内营养补充双歧杆菌可有效减少重症急性胰腺炎严重感染的发生率。     

Application of endoscopic sphincterotomy in acute pancreatitis with fluid collection： A prospective study

AIM: To elucidate the role of endoscopic sphincterotomy (EST) in the treatment of acute pancreatitis. METHODS: Ninety patients with acute pancreatitis were randomly divided into two groups: EST group and control group. All the patients underwent pancreatitis routine therapy, additionally the EST group was treated with EST and endoscopic naso-bile drainage (ENBD).The time of disappearance of abdominal symptoms and signs, normalization of amylase, hospitalization and absorption of acute fluid was recorded for all patients. RESULTS: The time of disappearance of abdominal pain, normalization of blood and urine amylase and hospitalization was significantly shorter in EST group than in control group. The ratios of disappearance of fluid in mild acute pancreatitis patients was significantly higher in EST group (51.52%, 84.85%, 90.91%,93.94%) than in the control group (0%, 30.30%, 69.70%, 72.73%, P<0.01 or P<0.05). When the ratios of reduction of fluid in severe acute pancreatitis patients of the EST group were compared (8.33%, 58.33%, 83.33%, 91.67%) with those in the control group (0%, 8.33%, 25% and 41.67%), there were significant differences. CONCLUSION: The effect of EST+ENBD on acute pancreatitis with fluid is rather good.     

甘遂治疗重症急性胰腺炎腹内高压的疗效观察

目的 观察中药甘遂辅助治疗重症急性胰腺炎(SAP)并发腹腔间隔室综合征(ACS)的疗效.方法 收集SAP并发ACS患者16例,按随机数字表法分为甘遂组和对照组.对照组按常规行禁食、抗休克、抗感染、营养支持等治疗,甘遂组在对照组治疗方案基础上加用甘遂.对比两组临床和实验室指标、结果甘遂组腹痛缓解时间、肠呜音恢复时间、血淀粉酶恢复正常时间及体温、白细胞计数恢复正常时间分别为(7.6±2.3)d、(6.1±3.1)d、(5.9±3.3)d、(5.2±3.2)d、(6.3±2.1)d,较对照组的(1 1.7±2.1)d、(11.2±2.3)d、(10.2±2.7)d、(9.2±3.5)d、(11.1±3.3)d有显著差异(P＜0.01);治疗后第3、4、5天两组病例腹内压差异显著[(19.8±3.1)cmH2O对(23.7±2.9)cmH2O、(12.3±2.7)cmH2O对(21.3±1.5)cmH2O、(8.2±3.1)cmH2O对(17.3±2.3)cmH2O,P值均＜0.05].结论 胰腺炎与中医结胸证有密切相关性,甘遂能够有效降低SAP所致的腹内高压.