成批烧伤的综合救治

目的 总结成批烧伤综合救治的经验.方法 总结解放军第一八七医院烧伤科2002年10月至2013年2月救治的7批共计73例烧伤患者,治疗措施：建立烧伤救治网进行程序化协作组织管理;制订及执行专业的救治方案：早期快速有效的液体循环复苏、早期切痂及防治感染、早期肠道营养及内脏器官功能保护、早期心理干预和肢体功能锻炼等.结果 73例患者中除1例烧伤总面积85％体表总面积（TBSA）、Ⅲ度创面75％TBSA患者于伤后5d死于呼吸窘迫综合征,1例烧伤总面积95％ TBSA、Ⅲ度创面90％ TBSA纵火自焚患者于伤后13 d放弃治疗外,余71例患者全部痊愈出院.结论 烧伤专科救治技术力量“前伸”,建立多部门程序化组织管理,采用专业的综合救治方案,能够提高成批烧伤患者的治愈率,降低死亡率,尽早心理干预治疗和康复治疗,能减轻患者的心理障碍,减少患者的功能畸形和残弃,减轻家庭和社会负担.     

成批烧伤患者31例的救治体会

目的 总结成批烧伤的救治经验。方法 回顾性的总结2000年11月～2005年11月收治的7批31例成批烧伤患者的被救治经验和体会。结果 7批31例病人中治愈29例，治愈率93．55％。结论 组织、早期、专科、多学科联合治疗等救治成批烧伤，可以取得满意的效果。     

延迟入院的严重烧伤患者的救治分析

近年来，随着社会经济的发展和严重烧伤治疗技术的普及，许多早期处理不佳的严重烧伤患者得以各种途径转至我院。这些患者病情和治疗经过复杂，治疗也非常棘手，必须根据不同情况采取强力的和更为积极的综合对策方能使患者转危为安，救治成功。笔者回顾了2003年12月至2008年12月北京积水潭医院烧伤科救治的早期治疗延迟的严重烧伤患者12例，现报道如下。     

成批热水泥烧伤的治疗

目的总结成批热水泥烧伤救治经验。方法组织专科技术力量处理成批烧伤病人入院的复杂过程，休克期尿量维持在50～80ml／h。中重度吸入性损伤采取早期气管切开，大面积深度烧伤病人早期大面积切痂削痂自体微粒移植术。结果本组18批108例热水泥烧伤病人中104例平稳渡过休克期，为96．3％，气管切开32例，41例治愈。早期大面积切削痂微粒移植术33例。早期切痂植皮率30．5％。108例病人中103病人治愈，治愈率95．3％。结论病人入院过程复杂，必须组织得力，抢救治疗得当，病人休克期渡过平稳，中重度吸入性损伤早期气管切开，早期大面积切削痂植皮是成功抢救治愈成批热水泥烧伤病人的关键，可取得满意效果。     

危重烧伤整体观救治的应用研究

目的观察采用中西医结合方法的整体观救治理念对危重烧伤救治成功率及烧伤后畸形发生率的影响。方法在危重烧伤病程上应用早期治疗与晚期治疗相统筹考虑,烧伤创面处理与全身治疗相结合,创面覆盖与机体脏器保护相结合,烧伤治疗与康复治疗相结合等一系列综合的治疗原则,对危重烧伤的早期急救与中晚期创面修复、伤后重要脏器保护、后期功能康复等方面进行观察。结果危重烧伤用中西医结合方法的整体观理念进行救治后成功率明显提高,LD50由5年前的TBSA86.8%上升到98.4%。烧伤后畸形的发生率明显下降。结论中西医结合的整体救治观在危重烧伤的救治中效果确切,不但提高抢救了成功率,而且降低了伤后的畸形发生率。     

成批煤尘燃爆烧伤的临床治疗

煤尘燃爆烧伤常见于煤矿井下工作人员,由于工作环境因素影响,多为多人成批烧伤,多合并吸入性损伤。重度吸人性损伤是烧伤早期死亡率高和影响预后的一个重要因素,及时诊断和治疗是救治成功的关键。若现场急救不及时,临床治疗措施不当,救治成功率将降低。我们对53例患者进行临床救治,现报道如下。     

急诊烧伤患者入院早期处置及护理

总结急诊烧伤患者的早期入院处置及护理要点。对我院2013年1月~2014年3月收治的各种原因烧伤的患者加强入院早期处置及护理，建立早期救治处置流程，加强风险意识，培训护士救治及专科护理能力，提高烧伤早期救治的成功率，提升专科技术水平和护理质量，增加患者满意度。规范的早期救治处置流程、专业的护理，有效缩短住院周期，降低烧伤并发症及死亡率，提高了急诊烧伤病员的抢救成功率。     

成批烧伤合并复合伤的救治分析

目的探讨成批烧伤合并复合伤伤员早期分流转运、多专业联合救治的经验,提高救治成功率。方法回顾分析新疆维吾尔自治区人民医院2008年至2010年收治的5批50例烧伤合并复合伤伤员的临床资料,采取积极分流转运、早期气管切开、及时有效的液体复苏、防治感染、保护脏器功能、营养支持以及修复创面等综合措施救治上述伤员。结果伤员的抢救组织严密,应用飞机包机转运分流过程安全顺利。本组伤员中1例伤后4h死于重度肺爆震伤,1例伤后6h死于重度颅脑损伤,2例分别于伤后33d、40d死于全身多脏器功能衰竭,46例顺利治愈出院。结论多专业联合救治可以提高烧伤合并复合伤患者的诊断和救治成功率。制定合理的成批烧伤救治应急预案,配备有力的后勤保障以及政府部门的重视和大力支持有助于提高成批伤员的救治成功率。     

三度烧伤面积≥90％极重度伤员救治经验

目的总结三度烧伤≥90％病人抢救经验。方法选择1966年～2002年烧伤三度面积≥90％的病例，主要采取以及时正确的补液为主的综合方法复苏；中重度吸人性损伤伤员早期行气管切开术，保持气道通畅；积极扶植机体，正确处理创面，合理使用抗生素和必要的消毒隔离制度，防治烧伤感染和脏器并发症；三度创面处理的原则：尽早地清除坏死组织，及时、切实地封闭创面，自体皮和异体（种）皮结合，异体皮开窗嵌皮法和微粒、皮浆移植大张异体（种）皮覆盖术，以及肠内营养摄人和功能恢复治疗。结果48例病人16例救治成功，7例可以生活自理。结论及时正确的复苏是抢救的基础，切实有效的封闭创面是抢救成功的关键。防治感染与脏器并发症贯穿治疗的全过程。     

10例小面积化学烧伤的临床救治经验与教训

目的 总结10例小面积化学烧伤救治的经验与教训,为进一步提高化学烧伤临床救治的成功提供参考.方法 对武汉市第三医院烧伤科2007年7月救治的3例因交通事故导致蚀刻液烧伤,2010年5月救治的4例因交通事故导致的浓硫酸烧伤,以及2011年7月救治的3例因检修氢氟酸管道时发生泄露而烧伤的三批共计10例小面积化学烧伤患者的院前急救、院内救治时机、抢救措施以及患者的预后情况进行分析.结果 三批10例小面积化学烧伤患者中有2例因蚀刻液烧伤死亡,1例因氢氟酸烧伤死亡,1例浓硫酸烧伤而致双眼失明,面部严重毁损,1例因硫酸吸入致吸入性损伤,肺功能严重受损,其他5例患者均治愈.结论 化学烧伤不同于单纯的烧烫伤,除能造成局部组织损伤外,还可以因吸收化学毒素而危及生命.治疗时除常规的创面处理外,还要早期长时间大量清水冲洗,立即查明化学物质的成分及性质,作对症处理.对较复杂的化学烧伤及化学物质中毒,使用连续肾脏替代治疗（CRRT）是挽救患者生命的有效方法.     

The clinical significance of a pathergy reaction in patients with Behcet's disease

This study was done to evaluate the frequency, intensity, and specificity of a positive pathergy reaction (PR) in Behcet's disease (BD) patients, to clarify an association between the PR and the clinical features or disease severity, and to assess whether patients with pustule formation at the venous puncture site (PFVPS) without positive PR could be regarded as a positive reaction. The PR was tested in 64 BD patients, 74 disease controls, and 20 healthy controls. Venous PR was performed in 8 BD patients with PFVPS. Follow-up PR was done in 14 patients with positive reaction during inactive phase. The PR was positive in 35.9% of BD patients, in 1 patient among disease controls, and in none of healthy controls. The pustule formation was observed in one BD patient. There was no statistical significance between positive PR and the clinical variables. The mean clinical activity score of BD patients with positive PR was similar to patients with negative reaction. Venous PR was positive in 7 patients. The follow-up PR was positive in 2 patients during inactive phase. Conclusively the positive PR appeared to be specific for BD, and was not associated with the clinical variables or disease severity, but was usually found during active phase in cases with positive reaction. The PFVPS in patients with negative PR might be considered to be positive.     

The metabolism of C1 inhibitor and C1q in patients with acquired C1-inhibitor deficiency

The metabolism of 125I-labeled C1 inhibitor (C1INH) and C1q was studied in five patients with B cell lymphoproliferative disorders, C1INH deficiency, and angioedema. C1INH catabolism was markedly accelerated in these patients. The fractional catabolic rate (FCR) was 0.053 of the plasma pool per hour compared to that of normal subjects (0.025) or patients with hereditary angioneurotic edema (HANE) (0.035). The catabolism of two dysfunctional proteins Wel and Ta was studied. Protein Wel was catabolized at an accelerated rate (0.041) compared to that in patients with HANE (0.029) or in normal subjects (0.020). In contrast, the FCR of protein Ta was 0.012, which is similar to that in normal patients and in patients with HANE. The extravascular to plasma ratio (E/P) of the normal C1INH in patients was 1.55 compared to 0.60 in normal patients. This is consistent with the rapid extravascular sequestration of the C1INH. The synthesis rate of the C1INH was 0.29 mg/kg/hr in patients that is similar to that in control subjects. The metabolism of C1q was studied in two normal control subjects and three patients. The FCR of C1q was 0.051 in patients compared to 0.023 in control subjects. The E/P was increased in patients (2.8) compared to E/P in control subjects (0.6). The acquisition of C1INH deficiency results from increased consumption of C1INH in vivo.     

上消化道出血住院患者临床特征分析

目的 分析我院上消化道出血患者病因情况,比较中青年和老年患者上消化道出血临床特征,总结上消化道出血患者的治疗和预后情况,为临床工作提供一定的指导。方法 回顾性分析2013年5月~2014年4月我院收治的上消化道出血患者的临床资料。观察上消化道出血患者发病季节,发病原因,比较老年患者与中青年患者住院时间、入院时Blatchford评分、输血情况,回顾患者治疗和预后情况。结果 上消化道出血一年四季均可发病,其中4、11、12月份为发病高峰期,占全年总出血人数的33.00%。胃溃疡患者多集中在老年患者,而十二指肠溃疡患者多集中在中青年患者。老年患者的住院天数比中青年患者住院天数长,差异有统计学意义（P＜0.05）。老年患者中,中高危患者比率高于中青年患者（88.23% vs 72.34%）,差异有统计学意义（P＜0.05）。入院时老年患者Blatchford评分9（8,11）约等于中青年患者9（5,11）。入院时老年患者输血比例高于中青年患者（9.80% vs 7.45%）,但差异无统计学意义（P＞0.05）。60例消化性溃疡患者有2例需行介入止血治疗,1例患者因胃溃疡合并胆管癌去世,其余保守治疗后好转。结论 老年患者上消化道出血主要病因为胃溃疡,中青年患者主要病因为食管胃底静脉曲张破裂出血。老年患者住院时间、输血人次和中高危患者比率均高于中青年患者。     

Somatic Serogroups, Capsular Types, and Species of Fecal Klebsiella in Patients with Ankylosing Spondylitis

The purpose of the present study was to find out whether patients with ankylosing spondylitis (AS) carry fecal Klebsiella strains that belong to serotypes or species specific for AS. Somatic serotypes (O groups), capsular (K) serotypes, and biochemically identified species were determined for fecal klebsiellae isolated from 187 AS patients and 195 control patients. The controls were patients with fibromyalgia or rheumatoid arthritis. The 638 isolates of Klebsiella that were obtained represented 161 strains; 81 from AS patients and 80 from the controls. The average number of Klebsiella strains per patient was 1.7 for the AS group and 1.5 for the control group. The most common O group was O1, which was observed for isolates from 23 of 187 AS patients and 24 of 195 control patients. Next in frequency was group O2, which was observed for isolates from 17 AS patients and 15 control patients. Regarding the K serotypes, 59 different types were identified, revealing a heterogeneous representation of Klebsiella strains, without a predominance of any serotype. By biochemical identification, Klebsiella pneumoniae was the most frequently occurring species, being found in 45 AS patients and 45 control patients. Next in the frequency was K. oxytoca, which was observed in 26 AS patients and in 29 control patients. K. planticola and K. terrigena occurred in only a minority of patients. Altogether, when analyzed either separately or simultaneously according to O groups, K serotypes, and biochemically identified species, no evidence of the existence of AS-specific Klebsiella strains was obtained. These findings do not indicate participation of Klebsiella in the etiopathogenesis of AS.     

Assessment of Toll-like receptor-4 gene polymorphism on pyelonephritis and renal scar

The aim of this study was to evaluate the effect of the TLR-4 gene TLR4 c.896A相似文献   

Coronary angiography in patients over 80 years of age: indications, results, consequences

Due to the continuous increase of elderly individuals in the society the cardiologist has to deal with elderly patients more often. The apparative expenditures and the invasive procedure require a critical consideration of benefits and risks prior to performing coronary angiography in these patients. The indication and frequency of coronary angiography in patients with eighty years or above were investigated. Furthermore, the results of angiography, the risks of the procedure and the therapeutic consequences were evaluated. The whole study population consisted of 2,500 consecutive patients (1,557 men, 943 women), who underwent coronary angiography at our institution from January 1st to November 16th in 1998. A retrospective analysis of 66 coronary angiographies (3%) in 61 patients (26 men, 35 women) aged 80 years or older was performed. Among these 61 patients, 51 were referred because of suspected coronary artery disease. Due to the clinical presentation a high percentage (42 patients = 82%) was classified as having unstable angina. 10 patients were referred due to valvular heart disease. Single-vessel disease was found in 14, two-vessel disease in 5 and multi-vessel disease in 28 patients, respectively. Percutaneous coronary intervention was performed in 17 patients, among these were 9 patients with multi-vessel disease and PTCA of the culprit lesion, and 3 patients underwent bypass surgery. Medical therapy was decided as to 28 patients. Aortic valve replacement was performed in 2 of 9 patients with aortic stenosis. The clinical appearance of coronary artery disease in elderly patients was mostly unstable angina, explaining the need for intervention. Coronary angiography disclosed multi-vessel disease in 55% of patients. A revascularization procedure could be performed at least in 43% of patients with multi-vessel disease.     

Prognosis in pre-and postmenopausal patients with endometrial adenocarcinoma

The prognosis in 41 pre- and 143 postmenopausal patients with endometrial adenocarcinoma during two time periods were compared.A significantly shorter interval from 1st symptom to diagnosis was found in postmenopausal patients. The percent of patients diagnosed in stage I did not differ significantly between the two groups, but there was a significant, although small, excess of postmenopausal patients diagnosed in stages III–IV.A significantly more favourable survival in premenopausal patients was found and the same trend was observed when the effect of age, stage at diagnosis and operability were taken into consideration. The possibility that this could be related to hormonal and immunological factors is raised.A significantly better survival of patients diagnosed during the second period was observed and is attributed to improved planning and methods of treatment.     

腹腔镜卵巢肿瘤摘除术64例临床分析

目的 探讨腹腔镜卵巢摘除术的手术效果。方法 回顾性分析64例腹腔镜卵巢摘除术患者的临床资料。结果 64例病人均手术成功，治愈出院。结论 腹腔镜手术损伤小，术后恢复快，住院时间短，值得推广。     

Etiologic role of unapparent exposure in cat allergy

To determine the importance of unnoticed exposure to cat, we studied 20 patients with a history of respiratory allergy. All the patients had a positive prick test to cat dander extract, and none of them kept cats as pets. The prick test was carried out with a dander extract from cat at a concentration of 100 BU/ml. The specific IgE was determined by the commercially available Pharmacia CAP System. We carried out a conjunctival challenge test. The concentration of Fel d I was quantified in dust samples from the patients' homes by a commercially available method. The patients were reassessed in order to establish a relation between exposure and symptoms, and concealed allergen sources. Sixteen patients, showed significant levels of Fel d I in their homes (mean of 3.35 μg g of dust). The conjunctival challenge test was positive in 15 patients. These patients showed an exposure mean of 0.4 μg/g of dust. The mean levels of specific serum IgE were higher in those patients with a positive challenge than in those with a negative challenge ( P = 0.0145). In nine reassessed patients, a relation was established between natural exposure and the onset of the symptoms. A possible hidden allergen source was established in 11 patients. Hidden exposure to cat allergen may play a role in the symptomatology of many atopic patients, and investigation of sensitization to Fel d I should be included in the routine allergologic evaluation of all patients with asthma or perennial rhinitis.     

Reappearance and recovery of alpha rhythm after eye opening

To obtain more informations from routine EEG recording, we studied changes in alpha rhythm after eye opening that had been almost disregarded hitherto. The study was carried out on 26 normal controls and 137 patients with four categories of diseases including 52 patients with psychiatric diseases, 8 with trifling neurological symptoms, 68 with defined organic brain diseases, and 9 with headache without defined organic cause. Following routine EEG recording, each subject was asked to keep their eyes opened for three minutes. The major changes in alpha rhythm after eye opening were composed of two patterns; "reappearance" and "recovery". The reappearance was defined as appearance of 5 or more alpha waves in series; and the recovery, as the amount and amplitude of the alpha rhythm became equal to those of the back ground alpha-rhythm which was seen while their eyes were kept closed. The reappearance was noticed in 84.6% of normal controls and in 89.1% of all patients. In patients with organic brain diseases, the reappearance was seen in 88.2%, while it was in 68.6% of the patients without organic brain disease. The recovery was noticed in 34.3% of all patients (p less than 0.01), while it was only in 15.4% of normal controls. The incidence of the recovery in the patients with organic brain diseases was 41.2%, the value of which was significantly higher than that of the rest of patients (28.8%, 15 out of 52 patients, p less than 0.05). These patients with the recovery tended to show slower frequency and higher amplitude in the back ground alpha-rhythm than the patients without recovery.