单肺通气前静脉注射依达拉奉对肺功能的作用

目的 探讨单肺通气前静脉注射依达拉奉对肺功能的保护作用.方法 择期行单肺通气开胸手术患者46例,随机分为依达拉奉组（E组,n=23）和对照组（C组,n=23）.所有患者行双腔支气管插管并机械通气,E组在行单肺通气前5 min静脉滴注依达拉奉0.5 mg/kg,C组以同等量生理盐水相同速度静脉注射.分别于设定的时间点采血进行血气分析,计算呼吸指数（RI）并记录患者术后留置气管导管时间、ICU病房留观时间及术后住院时间.结果 与T0时比较,两组T1时和T2时Pmean和RI升高,PaO2降低 （P〈0.05）;与C组比较,E组T1、T2时RI、Pmean降低和PaO2升高（P〈0.05）.且E组术后留置气管导管时间明显缩短.结论 单肺通气前静脉输注依达拉奉可减轻患者肺功能的损害,具有肺保护作用.     

依达拉奉联合丹参注射液治疗急性脑梗死的疗效观察

目的观察依达拉奉治疗急性脑梗死的疗效。方法我院2010年1月—2011年3月住院治疗的急性脑梗死患者80例,随机分成对照组和观察组,每组各40例,两组均常规用丹参注射液30ml＋0.9%氯化钠溶液250ml静脉滴注,1次/d;口服阿司匹林0.1g,1次/d;根据病情使用降血压、降血糖药和脱水剂,保持水和电解质平衡。治疗组加用依达拉奉30mg＋0.9%氯化钠溶液250ml静脉滴注,2次/d,连续治疗7～14d。结果依达拉奉治疗组与对照组ESS评分和日常生活能力（BARTHE）指数BI有显著性差异;治疗后两组疗效比较有显著性差异。结论 依达拉奉联合复方丹参注射液治疗急性脑梗死疗效显著,值得推广。     

依达拉奉联用辛伐他汀对急性脑梗死患者高敏C反应蛋白及血脂的影响研究

目的观察依达拉奉联用辛伐他汀对急性脑梗死患者高敏C反应蛋白（hs-CRP）及血脂的影响。方法 135例急性脑梗死患者随机分为辛伐他汀组常规组和依达拉奉联用辛伐他汀组。常规组在常规基础治疗上加用辛伐他汀20mg口服。联用组加用0.9%氯化钠溶液100ml＋依达拉奉30mg静脉滴注,2次/d,其余治疗同常规组。比较两组的hs-CRP及血脂和NIHSS评分。结果两组患者血清hs-CRP的浓度均显著下降（P〈0.05）,但依达拉奉联用辛伐他汀组下降更明显（P〈0.05）。联用组NIHSS显著下降（P〈0.05）。而两组血脂水平下降幅度差异无显著性（P〉0.05）。结论依达拉奉联用辛伐他汀治疗急性脑梗死患者,在不影响辛伐他汀降脂作用的同时,还能更有效降低hs-CRP水平,减轻了神经系统的损害。     

依达拉奉对单肺通气患者血浆SP-D、TNF-α和IL-8的影响

目的 观察依达拉奉对术中单肺通气患者血浆中肺表面活性物质相关蛋白D（SP-D）、TNF-α及IL-8水平的影响,探讨依达拉奉的肺保护作用.方法 选择ASA Ⅰ～Ⅱ级需行单肺通气肺叶切除的肺癌患者30例,随机分成依达拉奉组（Y组）和对照组（C组）各15例.患者均行双腔支气管插管并行机械通气;麻醉诱导后,Y组给予依达拉奉0.5 mg/kg加入生理盐水100 mL中,30 min内静滴;C组给予等量生理盐水静滴.两组分别在麻醉诱导后切皮前（T0）、单肺通气60min（T1）、术后2 h（T2）抽取静脉血4 mL,测定SP-D、TNF-α、IL-8及丙二醛（MDA）、超氧化物歧化酶（SOD）水平.结果 两组T1、T2的SP-D、TNF-α、IL-8水平明显高于To（P均＜0.05）,Y组T2的SP-D、TNF-α、IL-8水平明显低于C组（P均＜0.05）;T1、T2时Y组SOD明显高于C组（P均＜0.05）,MDA明显低于C组（P均＜0.05）.结论 依达拉奉能够有效减轻开胸手术单肺通气患者的炎症反应,具有肺保护作用.     

依达拉奉治疗急性脑梗死合并糖尿病的疗效研究

目的对照观察依达拉奉治疗急性脑梗死合并糖尿病患者的临床疗效及安全性。方法选取急性脑梗死合并糖尿病患者80例,随机分成两组,治疗组用依达拉奉注射液30mg加0.9%氯化钠溶液100ml静脉滴注,2次/d,共14d;对照组不用依达拉奉,其余治疗两组相同。两组基础用药相同：丹参注射液＋拜阿司匹林片。结果治疗第14天,治疗组ESS、MBI评分分别为（73.8±15.9）分、（56.2±26.8）分;对照组ESS、MBI评分分别为（61.4±18.1）分、（47.1±28.9）分,两组比较有显著性差异。治疗组有2例出现肾功能损害,停药后肾功能恢复正常,治疗组、对照组各有1例脑梗死灶内少量出血,不良反应两组比较无显著性差异。结论依达拉奉治疗急性脑梗死合并糖尿病患者安全有效,但原有肾病者使用时需慎重。     

依达拉奉对肺叶切除术肺癌患者围术期炎性细胞因子和自由基的影响

目的探讨依达拉奉对肺叶切除术肺癌患者的效果及意义。方法将24例行肺叶切除术的肺癌患者随机分为观察组和对照组各12例。两组均静脉注射咪唑安定0．03mg／kg、芬太尼3μg／kg,吸入8％七氟醚。麻醉诱导后,观察组加依达拉奉0．5mg／kg;对照组予等量生理盐水。麻醉维持相同。两组均于麻醉后切皮前（T1）、单肺通气60min（T2）、膨肺后60min（T3）、术后1h（T4）、24h（T5）测定血清中TNF-α、IL-6、IL-8、超氧化物歧化酶（SOD）活性及丙二醛（MDA）浓度。结果两组TNF-α、IL-6、IL-8和MDA于他均明显升高（P〈0．05）,至T4时达峰值（P〈0．05）;与对照组比较,观察组血浆TNF-α和MDA浓度于12～4均明显降低（P〈0．05）,IL-6、IL-8浓度于耶明显降低,持续至T4（P〈0．05）。SOD活性在单肺通气后各时点无明显变化;对照组SOD活性在T2-4较明显低于基础值及观察组（P均〈0．05）。结论依达拉奉可减少氧自由基产生,抑制肺叶切除术的肺癌患者围术期全身性炎症反应,有利于改善患者预后。     

依达拉奉治疗急性重型颅脑损伤的临床疗效观察

目的探讨依达拉奉对急性重型颅脑损伤的疗效及安全性。方法 80例急性重型颅脑损伤患者随机分为两组,对照组40例,给予常规治疗,依达拉奉治疗组40例,在常规治疗的基础上24h内给予依达拉奉注射液30mg加入0.9%氯化钠溶液250mL中静脉滴注,2次/d,连用14d。记录两组患者治疗前及治疗后14d的格拉斯哥昏迷评分（GCS）、脑水肿程度及治疗后3个月的格拉斯哥预后量表（GOS）评分。结果两组患者治疗前后GCS评分、脑水肿程度及3个月的GOS评分间差异均有统计学意义（P〈0.05）。结论早期应用依达拉奉治疗急性重型颅脑损伤可以减轻脑水肿,促进脑神经功能的恢复,降低病残率,不良反应小,安全性高。     

依达拉奉联合巴曲酶治疗不同时间脑梗死的疗效观察

目的探讨依达拉奉联合巴曲酶治疗不同时间脑梗死的疗效及安全性。方法选择脑梗死患者共100例,随机分为治疗组（50例）与对照组（50例）两组再分别按发病到开始治疗的时间间隔分成3个亚组,A组≤3d,3d〈B组≤7d,7d〈C组≤10d。治疗组给予依达拉奉30mg加入0.9%氯化钠溶液100ml中静脉滴注,2次/d,连用10d,并给予巴曲酶首次10BU,第2、3次各5BU加入0.9%氯化钠溶液250ml静脉滴注,隔日1次,共3次为1个疗程。对照组单用巴曲酶,用法同治疗组。结果治疗组与对照组比较,治疗前后神经功能缺损改善明显,治疗组总有效率高于对照组,且发病时间越短,显效率越高,疗效越好。结论依达拉奉联合巴曲酶治疗脑梗死有效、安全,建议早期应用。     

依达拉奉复合氯胺酮预处理对肺癌单肺通气患者围术期炎性细胞因子平衡的影响

目的观察依达拉奉复合氯胺酮预处理对肺癌单肺通气患者围术期炎性细胞因子平衡的影响。方法将择期拟行肺叶切除术肺癌患者48例随机分为对照组、依达拉奉组、氯胺酮组、联合组各12例。四组均先行麻醉诱导,依达拉奉组于诱导后予依达拉奉0.5 mg/kg,氯胺酮组于诱导前予氯胺酮0.5 mg/kg,联合组于诱导前予氯胺酮,诱导后予依达拉奉,剂量同前两组,对照组诱导前后予等量生理盐水。单肺通气时双腔管非通气侧开放,与大气相通,呼吸参数不变。于切皮前即刻、膨肺后60 min、术后60 min取四组血样测定TNF-α、IL-6和IL-10水平。结果依达拉奉组、氯胺酮组、联合组TNF-α、IL-6水平均明显低于对照组,IL-10水平明显高于对照组;依达拉奉组IL-10水平明显高于氯胺酮组;联合组TNF-α、IL-6水平均明显低于依达拉奉组及氯胺酮组,IL-10水平明显高于依达拉奉组;P均<0.05。联合组TNF-α/IL-10、IL-6/IL-10值均明显低于其他三组。结论依达拉奉复合氯胺酮预处理能更有效地抑制促炎性细胞因子生成、维持围术期促炎性细胞因子和抗炎性细胞因子相对平衡,有利于患者预后恢复。     

依达拉奉对急性颅脑外伤手术患者血清S100B水平及MMSE评分的影响

目的 探讨依达拉奉的脑保护作用及机制.方法 将30例颅脑外伤急性行开颅血肿清除术的患者随机分为观察组与对照组各15例,术中两组予相同药物维持静脉麻醉,手术切皮时观察组开始静脉滴注依达拉奉30 mg,30 min内输注完毕.麻醉诱导前、手术开始后1、4 h及手术结束后24 h分别测定两组血清S100B水平;术后随访6个月比较两组手术前后MMSE评分.结果 观察组S100B蛋白手术开始后及术后显著低于对照组(P＜0.05);两组手术1、4 h及术后24 h均明显升高(P＜0.05).观察组术后MMSE评分明显高于对照组(P＜0.05).术后24 h S100B蛋白水平与术后6个月MMSE评分呈显著负相关(r=-0.946,P＜0.05).结论 依达拉奉用于急性脑损伤患者可明显改善症状,促进脑细胞恢复;其机制可能为降低S100B水平.     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.