严重延迟复苏烧伤休克患者血浆脑钠肽的变化

Objective To observe the early change in plasma brain natriuretic peptide (BNP) level in burn patients with long delayed fluid resuscitation of burn shock and its clinical significance.Methods Thirty-six burn patients with second and third degree of burn covering 32%- 92% total body surface area were enrolled for the study, among them 10 patients were complicated with serious heart failure (heart failure group), and 26 patients rallied from shock after delayed fluid resuscitation without heart failure (stable group).The level of plasma BNP, lactate dehydrogenase (LDH), MB isoenzyme of creatine kinase (CK-MB), and left ventricle ejection fraction (LVEF) were determined at admission and 3 hours after hospitalization, and 24, 48, 72, 168 hours after the injury in both groups with electrochemiluminescence (ECL).Results Compared with stable group, the plasma BNP level (ng/L) of heart failure group at 3 hours after hospitalization, and 24, 48, 72 hours after the burn injury increased significantly (3 hours after hospitalization: 1 521.38±121.11 vs.391.36±63.27, 24 hours after burn: 2 516.86±193.25 vs.360.79±146.56, 48 hours after burn: 1 587.76±169.23 vs.398.92±77.46, 72 hours after burn: 974.45±166.33vs.283.43 ± 68.15, all P＜ 0.01), the level of LVEF lowered significantly (3 hours after hospitalization;0.33±0.03 vs.0.58±0.09, 24 hours after burn: 0.36±0.09 vs.0.60±0.10, 48 hours after burn: 0.35±0.08 vs.0.62±0.11, 72 hours after burn: 0.39±0.10 vs.0.64±0.10, all P＜0.05).The levels of LDH (μmol·s-1·L-1)in stable group were 2.87±0.50 at admission,3.02±0.43 3hours after hospitalization,4.02±0.87 24 hours after burn, 6.90±0.87 48 hours after burn, 3.64±0.75 72 hours after burn, 2.670.45 168 hours after burn while in heart failure group, they were 2.97±1.40, 3.84±0.37, 4.29±0.45,8.50±0.38, 3.84±0.62, 2.30±0.38, respectively;and CK-MB (U/L) in stable group were 59.12±13.75at admission, 70.39 ±10.72 3 hours after hospitalization, 79.29 ±17.27 24 hours after burn, 67.44 ±12.7748 hours after burn, 30.28± 7.13 72 hours after burn, 21.44 ±3.15 168 hours after burn while in heart failure group, they were 65.76 ± 16.38, 81.46 ± 7.92, 86.43 ± 14.19, 72.53 ± 11.27, 36.39 ± 6.18,22.85±7.26, respectively.No statistically significant difference was found in changes in both LDH and CK-MB between two groups (all P＞0.05).Conclusion Determination of the plasma BNP is a simple and useful method in detecting heart failure during resuscitation of shock after a serious burn injury.     

急性前壁心肌梗死伴心力衰竭患者急诊经皮冠状动脉介入治疗围手术期应用重组人B型钠尿肽的心肾保护效应

Objective To evaluate the protective effect of recombinant human B-type natriuretic peptide (rhBNP) on cardiac and renal functions in heart failure (HF) patients as a result of acute anterior myocardial infarction (AAMI) in peri-operative period of primary percutaneous coronary intervention (pPCI).Methods One hundred and twenty-six patients with AAMI-HF were enrolled into this study.All patients undertaken pPCI were randomly assigned to the rhBNP group (n=62) or the control group(n=64).rhBNP or nitroglycerin was intravenously administered on the basis of conventional treatment from first day of admission to 24 hours after pPCI in both groups.Heart rate (HR), systolic blood pressure (SBP), B-type natriuretic peptide (BNP), estimated lomerular filtration rate (eGFR) and heart function were observed.All patients were followed up for 30 days for the observation of main adverse cardiac events (MACE).Results The HR was significantly decreased compared with that at admission in rhBNP group, but such condition was not found in the control group.The SBP was reduced obviously in both groups.The plasma level of BNP, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDD) were improved significantly at different time points compared with those before administration in both groups.The improvement of above parameters in rhBNP group was more significant than that in the control group[BNP (ng/L) 30 hours after pPCI: 303.5±128.4 vs.354.0± 133.6, 14 days after pPCI:157.8±78.6 vs.201.1±91.7; LVEF 1dayafter pPCI: 0.420±0.052 vs.0.378±0.055, 14 days after pPCI:0.444±0.050 vs.0.393±0.055, 30 days after pPCI: 0.469±0.053 vs.0.413±0.052; LVEDD (mm) 1 day after pPCI: 53.5±4.4 vs.57.6±4.4, 14 days after pPCI: 49.6±5.1 vs.53.4±4.6, 30 days after pPCI: 46.5±4.4 vs.50.2±4.8, P＜0.05 or P＜0.01].The eGFR was reduced obviously 1 day after pPCI than that at admission in both groups, and eGFR recovered to baseline 3 days after pPCI.The level of eGFR was significantly increased 7 days and 14 days after pPCI than that at admission, but there was no difference between rhBNP group and control group.The incidence of contrast-induced nephropathy showed a lowering tendency in the rhBNP group than that in the control group[19.4% (12/62) vs.29.7% (19/64),P=0.178].The incidence of ventricular arrhythmias was obviously lowered 7 days after pPCI in the rhBNP group than that in the control group[48.4% (30/62) vs.75.0% (48/64), P＜0.01].The rate of MACE was lower in rhBNP group than that in control group in 30 days[12.9% (8/62) vs.26.6% (17/64), P＜0.05].Conclusion Administration of rhBNP can effectively improve the heart function in AAMI-HF patients undergoing pPCI, and it lowered the incidence of MACE in 30 days, without influence on renal function, and it can reduce the incidence of contrast-induced nephropathy.     

脓毒症早期血清白细胞介素-18和10在疾病严重程度及预后评估中的价值研究

Objective To observe the dynamic changes in levels of serum interleukins (IL-18, IL-10)in the early stage of sepsis, and to appraise their values in the evaluation of severity and prognosis of sepsis.Methods Prospective randomized controlled study was conducted. Thirty-eight patients with sepsis who stayed longer than 72 hours in intensive care unit (ICU) from December 2009 to August 2010 were enrolled as sepsis group. At the same time, 20 patients without sepsis served as control group. The patients were classified as survival (n=12) or death group (n = 26) according to 28-day survival. The clinical laboratory examination data were recorded at 24, 48, 72 hours after admission to the ICU, and venous blood was obtained at the same time. The IL-18, IL-10 levels were determined by enzyme-linked immunosorbent assay (ELISA). Results The vital signs, blood routine, liver function, renal function, coagulation function,arterial blood gas, and electrolyte showed no significant difference between sepsis group and control group 24, 48, 72 hours after admission, the levels of IL-18 were lowered, IL-10 elevated, the IL-18/IL-10 ratio was lowered in the sepsis group, and all of them were higher than control group at each time point. The levels of IL-18, IL-10 in death group of patients with sepsis were all higher than those of survival group at 24, 48, and 72 hours [IL-18 (ng/L): 108. 36± 18. 54 vs. 91. 66±21. 49, 92.13±28. 92 vs. 54.16±31.76,91. 78 ± 17. 33 vs. 76. 04 ±22.09; IL-10 (ng/L): 99. 42 ± 12.10 vs. 77. 20 ±9. 47, 103. 39 ± 17. 24 vs.67.88±18.90, 118. 99 ±11. 20 vs. 99. 20± 12. 46, P＜0. 05 or P＜0. 01]. IL-18/IL-10 ratios were all lowered in both non-survivors and survivors with sepsis at 24, 48, 72 hours, while the differences were not statistically significant (1. 09±0. 19 vs. 1. 20±0. 32, 0. 92±0. 18 vs. 0. 98±0. 29, 0. 78±0.15 vs. 0. 77±0. 23, all P＞0. 05). Conclusion The levels of serum IL-18, IL-10 were all elevated in the early stage of patients with sepsis, and in non-survivors they were higher than those of survivors. With the progress of the illness, IL-18 showed a lowering tendency, while IL-10 showed an elevation. The levels of serum IL-18 and IL-10 may be valuable in evaluating the severity of sepsis and prognosis of patients with sepsis.     

胸外按压器械AutoPulse在急诊科心搏骤停的应用及对血气和N末端B型钠尿肽的影响

Objective To investigate the value of AutoPulse in the patients with cardiac arrest (CA)in emergency department.Methods Patients with CA seen in the Emergency Department of Chaoyang Hospital, Affiliated to Capital Medical University from September 2008 to August 2009 were divided into standard manual external chest compression group (n= 42) and mechanical chest compression group with AutoPulse (n = 43), based on the method of the external chest compression.Tracheal intubation was performed and mechanical ventilation instituted in all the patients.Other rescue measures, such as intravenous infusion of fluids, electrocardiogram, electric shock for defibrillation were performed following the cardiopulmonary guideline of 2005.The patients with restoration of spontaneous circulation in 20 minutes were excluded.Among patients with resuscitation over 20 minutes, there were 29 cases in AutoPulse group and 28 cases in standard manual external chest compression group.The blood gas and N-terminal B-type natriuretic peptide (NT-proBNP) from the blood samples obtained from the femoral artery 20 minutes after resuscitation were determined, and the survival rate at 2 hours and 24 hours in both groups was recorded.Results Twenty minutes after cardiopulmonary resuscitation, the Ph value and the arterial partial pressure of oxygen (PaO2) of the AutoPulse group (n= 29) were significantly higher than those of the standard manual external chest compression group[n = 28, Ph value: 7.142 ± 0.134 vs.7.010 ± 0.136, PaO2(mmHg, 1mmHg=0.133kPa): 71.92±9.59 vs.65.61±7.66, both P＜0.01], the arterial partial pressure of carbon dioxide (PaCO2) and NT-proBNP were significantly lower than those of the standard manual external chest compression group[PaCO2(mm Hg): 39.43±14.09 vs.51.07±16.31, NT-proBNP (ng/L): 548.18 ± 256.93 vs.699.40 ± 303.35, P＜0.01 and P＜0.05].The 2-hour survival rate in AutoPulse group was higher than that in the standard manual external chest compression group, the disparity of the two groups was statistically significant[74.4% (32/43) vs.52.4% (22/42), P＜0.05].Though the 24-hour survival rate of AutoPulse group was higher than that of the standard manual external chest compression group, the difference was not statistically significant[9.3% (4/43) vs.4.8% (2/42), P＞0.05].Conclusion The device of AutoPulse can improve the tissue perfusion in patients with CA.Though this device may give rise some benefit in resuscitation for a short time, there is no decisive improvement in term of outcome of the patient.     

Study on adenovirus mediated antisense p38α fragment gene in suppressing apoptosis of the myocardium of neonatal rat by burn serum and hypoxia

Objective To investigate the relationship between the activation of p38 mitogen-activated protein kinase (p38MAPK) in the myocardium and the apoptosis in the presence of burn serum and hypoxia. Methods Ventricular myocardium isolated from neonatal rats were employed in this study, and they were divided into three groups as the normal control group, with the myocardium grew naturally; burn serum+ hypoxia group, in which the myocardium was stimulated by the serum collected from the rat 6 hours after burn injury involving 40% of total body surface area (TBSA), and at the same time exposed to 1%O2, 5% CO2, and 94 %N2; antisense blocking group, in which rats were pretreated by AD-antisense (AS) p38α, then exposed to the same conditions as burn serum+hypoxia group.The phosphorylation of p38 in the myocardium was determined by Western blotting.The level of myocardium apoptosis was determined by DNA ladder and flow cytometry.Results Compared with normal control group, the level of phosphorylation of p38 (gray value) was markedly increased (8.68±0.14 vs.3.21±0.05, P＜0.01＝ after being exposed to burn serum and hypoxia, and at the same time myocardium apoptosis was strikingly increased[(50.367±0.451)% vs.(2.063±0.111)%, P＜0.01＝.When the myocardium was transfected by AD-ASp38α, the phosphorylation of p38 (gray level) was decreased remarkably (5.46±0.16 vs.8.68±0.14, P＜0.01＝, the rate of the apoptosis was lowered remarkably[(13.200 ± 0.121 ) % vs.(50.367 ± 0.451)%, P ＜ 0.01]. Conclusion Burn serum combined with hypoxia can induce apoptosis of the myocardium by activating p38MAPK;blockage of p38MAPK signal transduction pathway may lessen the damage of the myocardium in early period of severe burn.     

急性冠状动脉综合征患者血浆晚期蛋白氧化产物升高的机制及意义

Objective To examine the advanced oxidation protein products (AOPP) in patients with acute coronary syndrome(ACS) and discuss the relationship between oxidative stress with the development of atherosclero-sis(AS). Methods Plasma were collected in 59 acute myocardial infarction (AMI) patients including 35 patients underwent selective PCI,24 patients underwent emergency PCI,43 unstable angina pectoris(UA) patients and 10 non-coronary artery disease (non-CAD) patients. All cases underwent coronary angiography (CAG). Plasma was collected immediately,post-24 hours and post-48 hours after admission. AOPP was determined by measurements of absorbance (A) at 340 nm under acidic conditions via spectrophotometry. Results AOPP was (236.42±30.41) ( n = 35 ), ( 207.84±29.50 ) mmol/L ( n = 35 ), ( 227.79 ± 35.18 ) mmol/L ( n = 31 ) respectively immediately, post-24 hours and post-48 hours after admission in AMI ( selective PCI ), ( 239.95 ±39.94 ) mmol/L ( n = 43 ), (175.92 ±29.46) mmol/L(n =38) ,and (156.54 ±28.29) mmol/L(n =35) in UA group and (57.41 ± 13.60) mmol/L( n = 9 ), (56.11 + 11.90) mmol/L ( n = 10 ) and ( 61.75 ± 12.28 ) mmol/L ( n = 8 ) in non-CAD group. Compared with normal group ( without CAD ) , significantly higher plasma AOPP was detected in AMI ( selective PCI) and UA patients ( P < 0.05 ). AOPP level was significantly increased in AMI selective PCI patients as compared with that of emergency PCI group immediately and post-24 hours after admission( P <0.01 ) ,and post-48 hours after admission( P < 0.05 ), but there was no statistical significance between emergency PCI and UA group( P > 0.05 ). Conclusions Oxidative stress is an important step in the development of atherosclerosis, and the higher levels of AOPP in ACS patients show that AOPP may be as good markers in these patients.     

高脂血症性重症急性胰腺炎临床特征分析

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.     

高脂血症性重症急性胰腺炎临床特征分析

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.     

高脂血症性重症急性胰腺炎临床特征分析

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.     

高脂血症性重症急性胰腺炎临床特征分析

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.     

脓毒症大鼠小肠功能变化的研究

目的　探讨脓毒症大鼠小肠屏障、吸收、通透及其蠕动功能的变化。方法　以 Wistar大鼠缺血再灌注复合内毒素血症制备动物模型。将动物随机分为正常对照 ( N)、肠系膜上动脉夹闭 1h后再灌注 1h( I/ R1)、2 h( I/ R2 )和 4 h( I/ R4 )以及再灌注 2 h后复合内毒素 2 h( I/ RL)共 5个组。分别测定各组动物血或小肠组织二胺氧化酶 ( DAO)、D 乳酸、D 木糖水平及肠蠕动 ,同时进行小肠普通光镜检查。结果　 I/ R1、I/ R4和 I/ RL组血浆 DAO活性均显著升高 ( P均 <0 .0 5 ) ,小肠组织 DAO在 I/ R2和 I/ RL 组均显著降低( P均 <0 .0 5 ) ,从 N、I/ R1、I/ R2、I/ R4到 I/ RL,各组血浆 DAO和小肠 DAO的相关分析可见呈高度负相关( r= 0 .90 9,P<0 .0 0 1) ;I/ R 1、I/ R 2和 I/ RL组血浆 D乳酸均显著升高 ( P均 <0 .0 5 ) ;与 N组比较各组肠传输速度显著加快 ( P均 <0 .0 5 ) ;I/ R 1和 I/ RL组血中 D木糖浓度较 N组高 ,3h后仍高于 N组 ;血 DAO浓度与血 D乳酸浓度变化相关 ( r=0 .5 5 9,P<0 .0 5 )。结论　缺血再灌注后小肠的屏障、吸收、通透和蠕动功能均有不同程度的改变 ;缺血再灌注复合内毒素血症时再次加速或加重了小肠屏障、吸收、通透和传输功能的变化     

浙江省岱山县居民死因分析

目的 为掌握浙江省岱山县海岛地区居民健康状况和主要疾病死亡原因,评价居民健康水平,为政府和相关部门制定疾病预防控制策略提供参考依据.方法 对岱山县1986 -1988年和2009-2010年两个时期居民死亡资料进行比较分析,采用国际疾病分类法进行编码,以2000年全国标准人口构成比进行死亡率标化.结果 岱山县两个...     

Achievements in hip joint surgery in adults in Poland

The treatment of diseases and injuries of the hip joint in both children and adults has been a major area of interest for surgeons treating injuries and non-traumatic conditions of the organs of locomotion. The work of prominent Polish surgeons and orthopaedists has contributed to progress in this branch of medicine over the last century.     

论护理工作中的“慎独”与“慎众”

"慎独"一词出自《礼记·中庸》中"莫见乎隐,莫显乎微,故君子慎其独也"。即当君子独处,无人监督的时候,总是小心谨慎地不做任何不道德的事情。"慎众"则是指在许多人违反原则时,君子却不随波逐流,不盲目