孕妇血清一氧化氮水平与胎膜早破和绒毛膜羊膜炎的关系

目的 探讨血清NO水平与胎膜早破(PROM)及绒毛膜羊膜炎的关系.方法 将78例胎膜早破孕妇按照实际情况分为早产合并胎膜早破(pPROM)组33例和足月胎膜早破(tPROM)组45例,50例临产前剖宫产的胎膜完好孕妇为正常对照组,分析比较3组血清NO水平,观察3组发生绒毛膜羊膜炎的情况及绒毛膜羊膜炎患者血清NO水平.结果 pPROM组和tPROM组血清NO水平相近,均高于正常对照组,差异有统计学意义[(85±26)μmol/L、(83±21)μmoL/L比(60±16)μmoL/L,P＜0.05];pPROM组和tPROM组绒毛膜羊膜炎发生率高于正常对照组,差异有统计学意义[33.3%(11/33)、31.1%(14/45)比4.0%(2/50)];绒毛膜羊膜炎患者血清NO水平明显高于非绒毛膜羊膜炎患者,差异有统计学意义[(109±39)μmol/L比(73±33)μmol/L,P＜0.05].结论 血清NO水平的增高可能预示绒毛膜羊膜炎及胎膜早破的存在.

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Objective To study the relationship between the level of nitric oxide(NO) in blood and premature rupture of membranes (PROM) and chorioamnionitis. Methods The 78 cases of premature rupture of membranes were divided into two groups according to the actual situation. The group of preterm premature rupture of membranes (pPROM) included 33 patients and the full-term premature rupture of membranes (tPROM) group had 45 patients. Fifty intact membranes' pregnant women who chose cesarean section before labor were selected as the normal control group. The levels of serum NO and the occurrence of chorioamnionitis were analyzed and compared among the three groups. Results The blood serum NO level was similar in PROM group and tPROM group but higher than that of the normal control group[(85 ±26)μmol/L, (83±21)μmol/L vs (60 ±16)μmol/L, P＜0.05]. The incidence of chorioamnionitis in PROM group and tPROM group was higher than that of the normal control group. The blood serum NO level of chorioamnionitis group was higher than that of the non-chorioamnionitis group [(109 ± 39)μmol/L vs (73 ± 33) μmol/L, P＜0. 05]. Couclusion The level of blood serum NO may predict PROM and chorioamnionitis.     

出血性疾病患者血浆血栓调节蛋白检测的临床意义

目的 探讨出血性疾病患者血浆血栓调节蛋白(TM)含量变化与临床病情的关系.方法 用双抗体夹心酶联免疫吸附法(ELISA)检测50例出血性疾病患者[其中过敏性紫癜25例,免疫性血小板减少症(ITP)25例]血浆TM含量,同样方法检测健康对照组40例,比较3组的TM水平.结果 过敏性紫癜患者血浆TM含量[(32.55±7.48)μg/L]明显高于健康对照组[(20.4±7.72)μg/L](t=6.90,P<0.01);ITP患者血浆TM水平[(20.29±10.15)μg/L]未见明显升高(P>0.05);过敏性紫癜治疗好转组血浆TM含量[(20.15±8.02)Ixg/L]明显下降(t=6.46,P<0.01),而无效和复发组患者血浆TM含量分别为[(33.76±8.36)μg/L]和[(34.06±10.06)μg/L],与好转组比较差异有统计学意义(P<0.01).结论 血浆TM水平的检测有助于对过敏性紫癜和ITP的鉴别诊断.过敏性紫癜患者血浆TM含量与临床病情变化密切相关,可作为了解病情、观察疗效、判断预后的指标之一.

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Objective To investigate the relationship between plasma thrombomodulin(TM)concentration and clinical condition in hemorrhagic disease.Methods Enzyme-linked immunoabsorbent assay(ELISA)was a-dopted to detect the plasma TM concentration of 50 patients(25 were allergiC purpura,the other 25 were idiopathicthrombocytopenia purpura)and 40 healthy people in control group.Results The plasma TM concentration of aller-sic purpura group[(32.55±7.48)μg/L]was significantly higher than that of control group[(20.40±7.72)μg/L](P<0.01).The plasma TM concentration of the idiopathic thrombocytopenia purpura(ITP)group was not increasing[(20.29±10.15)μg/L](P>0.05).The plasma TM concentration of the improved allergic purpura group [(20.15±8.02)μg/L]decreased signiflcanfly(P<0.01),while that of the inefficient group[(33.76±8.36)μg/L]and relapse group[(34.06±10.06)μg/L]increased significantly(P<0.01).Conclusions Plasma TM concentration detection helps diagnose two types of hemorrhagic disease.The plasma TM concentration of the allergic purpura is closely related with the clinical situation,therefore it call be used as one of the indexes for learning the state of the disease,observing the curative effect and estimating prognosis.     

垂体中叶素对去甲肾上腺素诱导乳鼠心肌细胞凋亡的影响

目的 观察垂体中叶素(IMD)对去甲肾上腺素(NE)诱导的乳鼠心肌细胞凋亡的影响.方法 20孔原代培养的乳鼠心肌细胞完全随机分为5组,各4孔:正常对照组、NE组、IMD组、降钙素基因相关肽(CGRP)8-37组和肾上腺髓质素(ADM)22-52组.NE组加入1×10-6mol/L NE,IMD组在加NE前30 min加入1×10-8mol/L IMD,CGRP8-37组和ADM22-52组在加IMD前30 min分别加入1×10-7mol/L CGRP8-37与1×10-7mol/L ADM22-52.采用流式细胞仪检测心肌细胞凋亡率并测定半胱氨酸天冬氨酸蛋白酶(Caspase)-3活性.结果 与正常对照组比较,NE组心肌细胞凋亡率和Caspase-3活性均升高[分别为(31.95±6.33)%比(8.70±3.92)%,(2.97±0.20)%比(1.00±0.15)%,均P＜0.05];IMD组的凋亡率和Caspase-3活性[分别为(11.57±4.69)%、(1.34±0.18)%]比NE组明显降低(P＜0.05);CGRP8-37组和ADM22-52组细胞凋亡率[分别为(21.84±5.48)%、(23.43±6.54)%]和Caspase-3活性[分别为(2.15±0.23)%、(2.31±0.26)%]比IMD组明显增高(P＜0.05).结论 IMD通过与CGRP受体和ADM受体结合抑制乳鼠心肌细胞凋亡,对NE诱导的心肌细胞损伤具有防护作用.

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Objective To investigate the effect of intermedin (IMD)on neonatal rat cardiomyocytes apoptosis induced by noradrenaline (NE). Methods Totally 20 cultured neonatal rats cardiomyocytes were randomly divided into S groups:control group, NE group, IMD group,calcitonin-gene-relatedpeptide(CGRP)8-37 group and adrenal medulla(ADM)22-52 group. Cultured cardiomyocytes were given 10-6 mol/L NE. At 30 min before administration of NE, IMD was added into the culture fluid in IMD group. CGRP8-37 or ADM22-52 were added at 30 min before IMD administration in CGRP8-37 group and ADM22-52 group respectively. Cardiomyocvte apoptotic rate (AR) and Caspase-3 activity were detected. Results Compared with control group, AR and Caspase-3 activity increased in NE group[(31.95±6.33)% vs (8.70±3.92)%,(2.97±0.20)% vs (1.00±0.15)% ,P＜0.05]. AR and Caspase-3 activity decreased significantly in IMD group compared with NE group(P＜0.05). AR and Caspase-3 activity were higher in CGRP8-37 group and ADM22-52 group than those in IMD group (P＜ 0. 05). Conclusion IMD can attenuate cardiomyocyte apoptosis induced by NE through CGRP receptor and ADM receptor.     

2型糖尿病患者糖化血红蛋白达标与血脂的相关性研究

目的 了解2型糖尿病患者糖化血红蛋白(HbAlc)达标对血脂的影响,探讨糖脂代谢的关联性.方法 完全随机抽取上海市殷行社区95例2型糖尿病患者的糖化血红蛋白、血脂,按HbAlc≤6.5%和HbAlc≥7.0%分成2组,其中HBAlc达标组34例,HbAlc未达标组45例,比较2组的血脂情况,同时进行HbAlc与血脂的相关性分析.结果 未达标组患者TC,TG,HDL-C,LDL-C明显高于达标组[分别为(5.42±1.04)mmol/L比(5.06±1.07)mmol/L、(2.90 ±1.59)mmol/L比(2.03±1.48)mmol/L、(1.09±0.14)mmol/L比(1.05±0.17)mmol/L、(3.16±0.58)mmol/L比(2.92±0.62)mmol/L],且TG升高有统计学意义(P<0.05).达标组TC,TG,LDH-C达标率明显高于未达标组[分别为5例(14.7%)比3例(6.7%)、17例(50.0%)比10例(22.2%)、6例(17.6%)比3例(6.7%),P<0.05].单因素分析结果表明HbAlc与TC、TG、LDH-C呈正相关(r=0.208、0.438、0.222,均P<0.05).结论 降低HbAlc可有效降低,TC、TG、LDL-C,同时HbAlc达标可以明显提高TG的达标率,2型糖尿病患者应定期监测HbAlc,控制HbAlc在正常水平.

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Objective To understand the influence of lipid by up to standard type 2 diabet glycated hemogloobin and to discuss the relationship of saccharide metabolism and lipid metabolism.Methods Ninty-five patients with type 2 diabetes in Shanghai Yin-line Community were divided into two groups(HbAlc≤6.5 and HbAlc>7.0),the level of blood lipid in the two groups were compared.Meanwhile,95 patients in the glycosylated hemo globin and the corre8ponding blood were analyzed. Results TC,TG,HDL-C,LDL-C of substandard group [(5.42±1.04)mmoL/L vs(5.06±1.07)mmol/L,(2.90±1.59)mmol/L vs(2.03 ±1.48)mmol/L,(1.09±0.14)mmoL/L vs(1.05±0.17)mmol/L,(3.16 ±0.58)mmol/L vs(2.92±0.62)mmol/L,respectively J were higher than those in standard group.TG of substandard group was significantly elevated(P<0.05).The standard rate of TC,TG,HDL-C in standard group were higher than those in substandard group[5 cases(14.7%)vs 3 cases(6.4%),17 cases(50.0%)vs 10 cases(22.2%),6 cases(17.6%)vs 3 cases(6.7%),P<0.05].Univariate analy8is showed that HbAlc and TC,TG,LDH-C was positively correlated(r=0.208,0.438,0.222,both P<0.05).Conclusions HbAlc reduction can effectively reduce TC,TG,LDL-C,while the standard of HbAlc can significanty improve the standard rate of TG.Type 2 diabetes should have regular monitoring of glycated hemoglobin and HbAl c should be controlled at normal levels.     

急性淋巴细胞白血病患者血清瘦素表达水平的研究

目的 研究急性淋巴细胞白血病(ALL)患者血清瘦素水平变化的临床意义.方法 选取ALL患者及健康成人各20例,分别以放射免疫法测定其血清瘦素水平,并在化疗2个周期后再次测定ALL患者血清瘦素水平.结果 ALL组化疗前血清瘦素水平明显低于健康对照组[(19.2±4.5)μg/L比(33.9±6.2)μg/L,P<0.05].ALL组化疗后血清瘦素水平[(28.9±5.5)μg/L]明显高于化疗前(P<0.05).结论 ALL患者血清瘦素水平较健康成人低,经化疗缓解后,其血清瘦素水平明显增高.血清瘦素水平可作为判断ALL治疗效果的有效指标之一.

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Objective To investigate the level of plasma leptin in patients with acute lymphoblastic leukemia (ALL) , and to compare the difference of plasma leptin levels in patients with ALL respectively before and after chemotherapy in order to discuss the relationship between ALL and plasma leptin level. Methods There were 20 cases in ALL group and 20 normal persons in control group. We examined the expression of the levels of leptin in plasma with ALL patients respectively before (group A) and after 2 circles chemotherapy (group C) and normal persons (group B) using radioimmunoassay method. Results The leptin levels of group A and B were( 19. 2 ± 4.5) n,g/L and (33.9 ±6. 2) p,g/L respectively with significant statistical difference. The leptin levels of group A and C were(19.2 ±4.5)μg/L and (28.9 ±5.5)μg/L respectively. Conclusions The plasma leptin level in patients with ALL is lower than that in normal persons. After chemotherapy the plasma leptin level is markedly higher than before. The leptin level of plasma can be used as a helpful indicator to evaluate the therapeutic effect of patients with ALL.     

甲状腺疾病患者血清可溶性细胞间黏附分子-1测定的临床意义

Objective To explore the contents and clinical significance of soluble intracellular adhesion molecule-1 ( sICAM-1 ) in patients with single goitre,Graves'and Hashimoto disease. Methods The contents of sICAM-1 in 100 cases of simple goiter group, Graves disease (GD) group 250 cases, Hashimot group 50 cases and 100 normal control were examined by sICAM-1 Radioimmunoassay(RIA) method,and the results were analyzed. Results There were no significant difference of sICAM-1 contents between ( 170.43 ± 34. 23 ) μg/L in normal control group and ( 182.48 ± 40.05) μg/L in simple goiter group( t = 1. 104, P ＞ 0. 05 ); The contents of slCAM-1 in GD group and HT group [( 279.93 ± 86.69) μg/L、 (250.36 ± 81.56) μg/L] were higher than the control group( t = 2.310,2. 210, all P ＜0. 05) ;The sICAM-1 contents in 3 species.methods after treatment [( 178.95 ±59.78) μg/L, ( 185.65 ±53.25)μg/L, (259.41 ± 71.46) μg/L)] were significantly lower than before treatment [(316.53 ± 66.13) μg/L, (277.79±64.30)μg/L,(285.71 ±72.14)μg/L](t=2.312,2.278,2.328,all P ＜0.05);After the Graves'patients were treated and their thyroid function were normal,their serum sICAM-1 levels( 251.92 ± 77.75 )μg/L were lower than that( 329.34 ± 90.47 ) μg/L in relapse Graves'group( t= 2.412 ,P ＜ 0. 05). Conclusion sICAM-1 RIA can be used as a parameter in diagnosing autoimmune thyroid diseases and in evaluating effects of therapy,stopping medicine or the relapse of Graves' disease.     

青年女性冠心病患者血清尿酸与冠状动脉病变的关系

目的 探讨青年女性冠心病患者血清尿酸水平与冠状动脉病变程度的关系.方法 回顾性分析2002年1月至2011年1月于我院住院经冠状动脉造影明确诊断冠心病的青年女性患者183例的临床资料.根据冠状动脉造影结果,记录为单支病变变组(123例)、双支病变组(38例)和三支病变组(22例).观察冠心病危险因素与冠状动脉病变程度的关系.结果 ①在单支、双支和三支病变组,血清尿酸水平竺差异有统计学意义[分别为(263.88±66.08)、(263.99±71.39)、(312.62+75.86)μmol/L,P<0.05].②双支、三支病变组lnTG、TC及LDL-C水平明显高于单支病变组[分别为(0.44±0.56)、(0.62±0.46)mmol/L比(0.29±0.46)mmol/L,(4.68±1.37)、(5.60±1.53)mmol/L比(4.14±0.93)mmol/L,(2.87±1.15)、(3.76±1.28)mmol/L比(2.48±0.74)mmol/L,均P<0.05].③Logistic回归分析显示,影响冠状动脉多支病变的独立危险因素依次为TG、LDL-C水平(P<0.05);而尿酸水平不是冠状动脉多支病变的独立危险因素.结论 青年女性的血清高尿酸水平与冠心病患者冠状动脉的病变程度有一定的相关性.

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Objective To study the relation between serum uric acid and the severity of coronary artery le-sion in young women. Methods One hundred and eighty-three young women patients underwent coronary angiogra-phy between January 2002 and January 2011 were selected. According to the results of coronary angiography, they were divided into three groups: the single, double and triple vessel lesions. The relation between body mass index (BMI) , systolic blood pressure( SBP) , diastolic blood pressure(DBP) , heart rates(HR) , serum uric acid(UA) , fasting blood glucose(FBG) , triglyceride(TG) , total cholesterol(TC), high density lipoprotein cholesterol(HDL-C) , low density lipoprotein cholesterol (LDL-C) with severity of coronary artery disease (CAD) were analyzed. Results The UA level in the triple vessel lesions group was significantly higher than that in the single and double vessel le-sions group[(312.62±75.86)μmol/L vs(263.88±66.08) ,(263.99±71.39) μmol/L, P<0.05]. In the mul-tiple vessel lesions group, lnTG, TC and LDL-C were significantly higher than those in the single vessel lesions group[(0.44±0.56) , (0.62 ±0.46)mmol/L vs(0.29±0.46)mmol/L;(4.68±1. 37) , (5. 60±1.63)mmol/L vs(4.14 ±0.93)mmol/L;(2. 87 ± 1.15) , (3. 76 ± 1.28)mmol/L vs(2. 48±0. 74)mmol/L] , but there was no significant difference of UA between the two groups. According to Logistic regression analysis, the factors related with the multiple vessel lesions CAD was TG, LDL-C(P<0.05) , meanwhile the UA was not an independent risk factor. Conclusion In young women patients, high UA level is related to severe coronary artery vessel lesions.     

复方米非司酮配伍米索前列醇终止早孕的临床观察

Objective To observe the curative effect and safety of compound mifepristone combined with misoprostol on the termination of early pregnancy.Methods 151 women who ask for termination dearly pregnancy were randomly divided into two groups, observation group taking compound Mifepristone combined with Misoprostol, while control group taking Mifepristone combined with Misoprostol.Results The complete abortion rate in the observation group were higher than that of the control group(96.0% vs 89. 5%),and the failure, rate in the observation group were lower than that of the control group(1.3% vs 3.9%), the time of gestational sac diseharge in the observation group were shorter than in the control group[(3.7± 1.2)h vs (4.1 ±1.5)h], but there were no obvious difference between these two groups(P > 0.05).The time of bleeding post-abortion in the observation group were significantly shorter than in the control greup[(12.3±3. 6)h vs (17.1 ±4.7)h](P< 0.01). There were no significant difference on the rate of side effects between these two groups(P> 0.05).Conclusions Compound Mifepristone combined with Misoprostol is effective on the termination of early pregnancy with small bleeding post-abertion.     

临床路径管理模式在单病种医疗质量管理中的作用研究

目的 探讨临床路径(CP)管理模式在单病种医疗质量管理中的作用.方法 2008年7月至2010年6月收治腹股沟疝患者84例,均行无张力疝修补术,住院过程接受CP管理的患者36例为观察组,其余未接受CP管理的患者48例为对照组1.同时,既往相等时间段内行腹股沟疝无张力疝修补术且能随访到的患者48例为对照组2.观察组所在科室组织、设计、实施腹股沟疝无张力疝修补术CP管理.观察组分别与2个对照组进行平均住院日、术前住院日、住院费用、总药费、药品收入占医院总收入的比例(药收比)、并发症发生率、治愈率、患者满意度评分及投诉率等医疗相关指标的比较.结果 所有患者均手术成功,成功率100%,投诉率为0.观察组平均住院日、术前住院日均明显短于对照组1和对照组2[分别为(6.3±1.6)d比(8.9±3.1)、(9.6±5.7)d,(2.0±0.7)d比(2.5±1.3)、(2.9±1.9)d],并发症发生率明显降低[0比22.9%、14.6%],患者满意度评分明显增高[(99.3±2.0)分比(90.1±14.3)、(91.3±12.6)分],差异有统计学意义(均P<0.05).观察组总药费及药收比较对照组1明显减少,平均住院费用较对照组2明显减少,差异有统计学意义.结论 实施CP管理,可优化诊疗流程,规范医疗行为,提高医疗工作效率,合理利用医疗资源,提高医疗质量.

Abstract：

Objective To explore the effects of clinical pathway ( CP) management model in medical quality management of single disease. Methods From July 2008 to June 2010, 84 cases of inguinal hernia were treated by tension-free hernioplasty. The observation group receiving CP management had 36 cases of inguinal hernia tension-free hemioplasty according to the standard of single disease and other patients were assigned to control group 1. Meanwhile 48 cases of inguinal hernia tension-free hernioplasty were followed as control group 2 which did not have the management of CP. The differences of health-related indicators, such as the average length of hospital stay, the days waiting for surgery, hospital costs, general medicine costs, drug income ratio, recovery ratio, complication ratio, patient satisfaction scores and complaints ratio, were analyzed. Results The average length of stay and the days waiting for surgery in observation group was significantly shorter than those the control group 1 and group 2 [(6.3±1.6)dvs (9.6±5.7),(8.9±3.1)d;(2.0±0.7)dvs (2.9 ±1.9) ,(2.5 ± 1.3)d] ;the incidence of complications decreased[0 vs 14. 6% (7/48) , 22. 9% (11/48)] and patient satisfaction scores increased[(99. 3 ± 2.0) vs (91.3 ± 12.6) , (90.3 ± 14.3)]. On the other hand, the general medicine costs and drug-income ratio in the observation group were much lower than those in control group 1 and the average hospital cost in the observation group was much lower than that in control group 2. All differences between the observation group and the control groups were statistically significant. Conclusion Adopting CP management can optimize treatment process, standardize medical care, improve health care efficiency and actualize rational use of medical resources.     

比索洛尔对充血性心力衰竭患者髓过氧化物酶和超敏C反应蛋白的影响

目的 探讨用β受体阻滞剂比索洛尔对充血性心力衰竭（CHF）患者心血管炎症标志物髓过氧化物酶（MPO）、超敏C反应蛋白（hs-CRP）水平以及心功能的影响.方法 按纽约心脏病协会（NYHA）分级标准,96例CHF患者分为Ⅱ～Ⅳ级,完全随机分为常规治疗组（地高辛＋血管紧张素转换酶抑制剂＋利尿剂,n=46）和比索洛尔组（比索洛尔＋常规治疗组药物,n=50）,所有受试者分别于治疗前和随访6个月后测定外周血中MPO、hs-CRP的水平并行心脏彩色多普勒超声检测心功能.结果 常规治疗组及比索洛尔组的CHF患者外周血中MPO、hs-CRP的水平治疗后较治疗前均有明显下降[（38.6±6.4）μg/L比（46.4±7.6）μg/L,（32.5±5.4）μg/L比（47.2±6.6）μg/L;（7.8±1.3）mg/L比（10.2±1.6）mg/L,（6.6±1.5）mg/L比（9.9±1.4）mg/L,P＜0.05],左心室射血分数[（45.3±7.1）%比（38.3±8.7）%;（48.4±6.6）%比（37.5±9.8）%]明显增加（P＜0.05）,心功能明显改善.但比索洛尔组较常规治疗组在心功能改善和MPO、hs-CRP的水平下降方面更明显,差异有统计学意义（P＜0.05）.结论 比索洛尔是一种高选择性β受体阻滞剂,能有效抑制CHF患者神经内分泌的过度激活,控制CHF患者的临床症状,改善预后.     

骨科新入院患者营养状况调查分析

目的 了解骨科新入院患者营养不良发生情况,为骨科营养不良患者在入院后进行营养支持和治疗提供理论依据.方法 选取骨科新入院128例患者,进行问卷调查、人体学测量及实验室检查.患者在性别方面分为男性组（82例）和女性组（46例）,在疾病性质方面分为骨折组（82例）和骨肿瘤组（46例）.骨折组分为外伤性骨折组（54例）和病理性骨折组（28例）,骨肿瘤组分为骨良性肿瘤组（19例）和骨恶性肿瘤组（27例）.结果 骨科新入院128例患者中确定为营养不良的有42例（32.8％）,存在发生营养不良风险的有66例（51.6％）,营养状况良好的有20例（15.6％）.不同性别患者中男性组血红蛋白高于女性组[（135 ±25）g/L比（122±18） g/L],差异有统计学意义（P＜0.05）.病理性骨折患者的上臂围、总蛋白、清蛋白、前白蛋白和血红蛋白5项指标均低于外伤性骨折患者[（26 ±4）cm比（28±4）em、（6.5±0.7） g/L比（7.2±0.7）g/L、（3.6±0.6）g/L比（4.8 ±0.5） g/L、（169±62） g/L比（210±62） g/L、（119±24） g/L比（138±22）g/L],差异均有统计学意义（均P＜0.05）;骨恶性肿瘤患者的总蛋白、清蛋白、前白蛋白和血红蛋白4项指标均低于骨良性肿瘤患者[（6.5±0.7）g/L比（7.2 ±0.7） g/L、（3.5±0.6）g/L比（4.5±0.5） g/L、（176±60）g/L比（208 ±61） g/L、（122±24） g/L比（137±21） g/L],差异均有统计学意义（均P＜0.05）.结论 本研究发现我院骨科新入患者的营养状况非常差,男性患者营养不良发生率高于女性患者,病理性骨折患者和骨恶性肿瘤患者的营养不良发生率分别高于外伤性骨折患者和骨良性肿瘤患者.     

快速康复外科技术对结直肠癌患者免疫功能的影响及应用效果

目的探讨快速康复外科技术在结直肠癌患者围手术期对机体免疫功能的影响及应用效果。方法将入选的60例拟接受手术治疗的结直肠癌患者随机分为快速康复组（A组）和传统治疗组（B组）,每组30例。比较两组患者术前和术后第1、3、7天血清免疫球蛋白IgA、IgM、IgG和C反应蛋白（CRP）水平,并对两组患者住院时间、治疗费用、首次排气时间、并发症等进行比较。结果A组和B组术后第3天血清IgA、IgG和IgM分别为[（1．55±0．35）g/L与（1．22±0．40）g／L,P〈0．05;（9．88±1．98）g／L与（9．01±2．35）g／L,P〈0．05;（0．89±0．22）g／L与（0．81±0．30）g/L,P〈0．05];A组和B组术后第1、3、7天的血清CRP水平分别为[（51±12）g／L与（83±10）g／L,P〈0．05;（136±16）g／L与（169±17）g／L,P〈0．05;（57±10）g／L与（80±9）g／L,P〈0．05]。A组和B组术后首次排气时间[（3．2±0．7）d与（4．8±0．6）d,P〈0．05]、住院时间[（7．6±1．1）d与（9．0±0．8）d,P〈0．05]以及住院费用[（13250±1800）元与（16356±2315）元,P〈0．05];A组术后并发症发生率较B组低（P〈0．05）。结论快速康复外科的应用能够减轻对患者机体的免疫损伤,有效促进术后胃肠道功能的恢复,降低并发症发生率,缩短住院时间,节省住院费用。     

缺血预适应在缺血性脑卒中患者神经功能中的保护作用

目的　研究缺血预适应在缺血性脑卒中患者神经功能中的保护作用及疗效。方法　选取2019年6月至2021年6月聊城市第三人民医院收治的110例缺血性脑卒中患者,进行前瞻性随机平行对照研究,采用随机数字表法将患者分为A组和B组,每组55例。A组男23例,女32例;年龄52～74（62.78±4.77）岁;B组男27例,女28例;年龄51～73（61.48±4.59）岁。B组采用常规药物治疗,A组在B组的基础上采用远隔缺血后适应治疗。比较两组临床疗效,治疗前、治疗3个月后美国国立卫生研究院卒中量表（NIHSS）、日常生活能力Barthel指数（BI）评分及梗死灶体积、血清S100蛋白（S100β）、神经元特异性烯醇化酶（NSE）、新喋呤（Npt）、半乳糖凝集素3（GAL3）、血液流变学指标（血浆黏度、全血高切黏度、全血低切黏度、纤维蛋白原）水平。计数资料采用χ²检验,计量资料采用t检验。结果　治疗3个月后,A组临床总有效率为94.55%（52/55）,高于B组的81.82%（45/55）,两组比较,差异有统计学意义（χ²=4.274,P=0.039）;治疗3个月后,A组NIHSS评分为（9.74±1.83）分,低于B组的（12.25±2.82）分,BI评分为（75.26±5.38）分,高于B组的（62.47±6.02）分,两组比较,差异均有统计学意义（t=5.496、11.748,均P<0.001）;治疗3个月后,A组梗死灶体积为（3.35±1.02）cm³,缩小幅度优于B组［（3.79±1.11）cm³］,差异有统计学意义（P<0.05）;治疗3个月后,A组全血低切黏度为（5.08±0.79）mPa·s、全血高切黏度为（4.22±0.51）mPa·s、血浆黏度为（1.17±0.34）mPa·s、纤维蛋白原为（2.86±0.34）g/L,均低于B组的（6.63±1.02）mPa·s、（4.85±0.62）mPa·s、（1.36±0.40）mPa·s、（3.53±0.42）g/L,两组比较,差异均有统计学意义（均P<0.05）;治疗3个月后,A组血清S100β为（1.37±0.38）μg/L、NSE为（15.28±3.37）μg/L、Npt为（6.95±1.78）nmol/L、GAL3为（9.68±2.27）g/L,均低于B组的（1.74±0.46）μg/L、（19.72±4.73）μg/L、（9.07±2.24）nmol/L、（11.94±3.04）g/L,两组比较,差异均有统计学意义（均P<0.05）。结论　缺血预适应辅助治疗缺血性脑卒中患者可进一步提升疗效,可有效改善患者日常生活能力及神经功能,缩小梗死灶体积,调节血液流变学状态,促进病情恢复。     

氯沙坦对糖尿病肾病患者血清VEGF、MMP-9表达的影响

目的研究氯沙坦对糖尿病肾病患者血清血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)表达的影响。方法选取2014年5月至2015年4月本院收治的72例糖尿病肾病患者,根据抽签法分为观察组和对照组,每组36例。对照组为常规药物治疗,观察组在此基础上加以氯沙坦进行治疗,100 mg/次,1次/d,疗程均为3个月。比较两组患者治疗前后血清VEGF、MMP-9、肾功能、血生化指标变化。结果治疗后,观察组、对照组的血清VEGF表达为(72.21±8.21)、(102.34±11.32)ng/L,MMP-9分别为(58.45±8.01)、(80.54±9.75)ng/L,两组比较差异有统计学意义(P<0.05);两组血肌酐分别为(154.43±8.32)、(184.32±9.54)μmol/L,尿素氮为(10.32±1.23)、(12.46±1.87)mmol/L,24 h尿蛋白为(0.78±0.08)、(1.12±0.12)g/24 h,两组比较差异有统计学意义(P<0.05);两组空腹血糖分别为(4.35±0.57)、(5.75±0.92)mmol/L,三酰甘油为(1.76±0.13)、(2.12±0.22)mmol/L,总胆固醇为(4.21±0.32)、(4.86±0.43)mmol/L,两组比较差异有统计学意义(P<0.05)。结论氯沙坦能明显降低糖尿病肾病患者血清VEGF、MMP-9表达,有利于患者临床症状的改善,安全性高。     

血必净注射液对急性呼吸窘迫综合征患者肾上腺皮质功能影响的前瞻性研究

目的研究血必净注射液对急性呼吸窘迫综合征（ARDS）患者肾上腺皮质功能状态的影响。方法采用前瞻性研究方法,将重症监护病房（ICU）收治的急性呼吸窘迫综合征（ARDS）患者随机分为血必净组和对照组,对照组按照常规治疗,血必净组在常规治疗基础上加用血必净注射液100ml,每日两次,治疗7d。分别于纳入研究当日及研究结束时（第8日）静脉注射促肾上腺皮质激素250μg,放免法测定注射前、注射后30min,60min血浆皮质醇水平（TO,T30,T60）,计算T30或T60的最大值与110的差值（ATmax）,以△T．max≤284．4nmol／L作为相对肾上腺皮质功能不全诊断标准。记录治疗前后APACHEII评分,急性肺损伤Murray评分,器官功能障碍Marshall评分,记录ACTH反应性（△Tmax）,肾上腺皮质功能不全发生率,并检测外周血白介素6（IL-6）,白介素10（IL-10）水平变化。结果治疗后血必净组Murray评分[（1．7±0．9）比（1．9±0．6）,P〈0．05）]及器官功能障碍Marshall评分[（2．9±2．7）比（6．3±4．1）,P〈0．01],外周血IL-6[（3．4±1．9）ng／L比（8．9±10．2）ng／L,P〈0．01],IL—10[（1．5±0．8）ng／L比（4．2±4．8）ng／L,P〈0．01]及肾上腺皮质功能不全发生率（46．7％比80．6％）明显低于对照组,△Tmax[（328．4±278．3）μmol／L比（172．8±110．8）μmol／L]高于对照组（P均〈0．01）。结论血必净注射液降低ARDS肾上腺皮质功能不全发生率,改善脏器功能状态。     

抗纤冲剂对慢性肾功能衰竭患者血清结缔组织生长因子的影响

目的探讨抗纤冲剂对慢性肾功能衰竭患者血清结缔组织生长因子（CTGF）的影响。方法70例慢性肾功能衰竭患者按就诊顺序分为2组。每组35例,对照组常规治疗。治疗组在常规治疗的基础上加用抗纤冲剂,1包／次,3次／d疗程均为3个月。观察临床表现,症状缓解时间。CTGF在治疗前后被测定。结果治疗组治疗后GF为[（0．52±O．24）×10^-6mg／L];对照组治疗后CTGF为（0．76±0．29）×10^-6mg／L,较治疗前[（0．98±0．38）×10^-6mg／L]低（P〈0．05）,较治疗前[（0．97±0．35）×10^-6]mg／L低（P〈0．05）,2组治疗后比较差异有统计学意义（P〈0．05）。2组比较差异有统计学意义（P〈0．05）。结论抗纤冲剂改善症状和体征可能通过改善CTGF而达到。     

基质金属蛋白酶-9与急性缺血性脑卒中的相关性研究

目的 通过检测急性缺血性脑卒中患者血浆基质金属蛋白酶-9( matrix metalloproteinase-9,MMP-9)水平变化,探讨其在急性缺血性脑卒中发生发展过程中的作用和意义.方法 选择急性缺血性脑卒中患者162例为研究对象,未卒中患者100例作对照,血浆MMP-9检测采用酶联免疫法.结果 (1)急性缺血性...     

体外循环不阻断升主动脉低温心室颤动左心室引流技术对心肌保护作用的实验研究

目的 检测内皮素、NO、丙二醛和超氧化物歧化酶(SOD)血液学指标及心肌组织局部内皮素受体A( ETA) mRNA的表达,评价体外循环不阻断升主动脉低温心室颤动左心室引流技术对心肌的保护作用,探讨更好的心肌保护方式。方法 建立体外循环动物模型,实验动物分为对照组（停跳组）及实验组（心室颤动组）,体外循环前、体外循环1h、体外循环2h、体外循环结束后1h4个时间点分别抽取静脉血,同时于各时间点分别钻取左心室壁局部心肌组织100 mg。测定血浆内皮素、NO、丙二醛和SOD水平。用逆转录聚合酶链反应方法检测心肌ETA mRNA的表达。结果 随体外循环时间延长,2组内皮素、丙二醛水平均有升高。于体外循环2h和体外循环结束后1h两个时间点,对照组内皮素、丙二醛水平明显高于实验组[(70.27±7.03)ng/L比(56.53±12.11)rig/L,(106.36±6.61)ng/L比(72.71±12.72) rig/L; (4.71±1.31) μmol/L 比(3.32±0.82) μmol/L,(8.27±1.99) μmol/L比(4.38±1.02) μmol/L,均P＜0.01];2组NO、SOD平均呈下降趋势,但实验组下降和缓,在后两个时间点,对照组NO、SOD水平明显低于实验组[(28.57±9.20)μmoVL比(45.36±16.59)μmol/L,(12.14±7.03)μmol/L比(47.50±17.18) μmol/L; (7.23±2.59) μg/L比( 17.69±7.96) μg/L,(2.78±0.88) μg/L比(18.52±10.30) μg/L,P＜0.05或P＜0.01];2组ETA mRNA的表达水平均有升高,对照组升高幅度比实验组要高,体外循环1h、2h和体外循环结束后1h差异明显[(0.35±0.01)比(0.28±0.05),(0.49±0.05)比(0.31±0.04),(0.67±0.05)比(0.38±0.07),P＜0.01]。结论 体外循环不阻断升主动脉低温心室颤动左心室引流技术对心肌具有良好保护作用。     

B超引导在脑外伤有创机械辅助通气患者肠内营养策略中的应用研究

目的　探讨B超引导在脑外伤有创机械辅助通气患者肠内营养（EN）策略中的应用。方法　选取2019年11月至2021年5月入住连州市人民医院重症医学科（ICU）的脑外伤有创机械通气患者共72例,随机数字表法分为参照组（36例）和试验组（36例）。参照组男24例,女12例,年龄（46.28±7.64）岁;试验组男26例,女10例,年龄（47.07±7.22）岁。两组患者均于入院后24～72 h内留置鼻胃管行EN治疗,参照组采用传统根据临床经验制定的EN方案,试验组采用改良的B超胃窦单切面法为指导制定有创呼吸机的EN方案。比较两组患者治疗前及治疗14 d后营养指标［血清总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）、血红蛋白（Hb）］,比较治疗后达到目标喂养量的时间、ICU停留时间、呼吸机使用时间,并统计EN相关并发症（返流、腹胀、腹泻、呼吸机相关肺炎、EN中断）的发生率。计量资料应用t检验,计数资料应用χ²检验或Fisher确切概率法。结果　治疗后,试验组血清TP、Alb、PA、Hb水平均优于参照组［（59.14±7.22）g/L比（55.65±7.19）g/L,（38.09±7.18）g/L比（34.16±7.53）g/L,（192.56±22.18）mg/L比（182.73±22.45）mg/L,（107.11±3.22）g/L比（105.28±3.47）g/L］（均P<0.05）。试验组患者达到目标喂养量的时间、ICU停留时间、呼吸机使用时间均较参照组明显缩短［（2.29±0.42）d比（3.68±0.47）d,（9.18±1.20）d比（11.25±1.23）d,（8.01±0.52）d比（10.17±0.55）d］（均P<0.001）。试验组腹胀、腹泻、呼吸机相关肺炎及EN中断发生率分别为5.56%（2/36）、5.56%（2/36）、2.78%（1/36）、8.33%（3/36）,均低于参照组的22.22%（8/36）、27.78%（10/36）、25.00%（9/36）、27.78%（10/36）,差异均有统计学意义（均P<0.05）。结论　应用以超声监测为导向的胃肠营养可有效降低脑外伤有创机械通气患者EN并发症的发生率、改善患者营养状态及预后相关指标,值得推广与应用。