腹水回输治疗尿毒症腹水和透析性低血压反应（附2例报告）

尿毒症终末期行维持性血液透析病人易合并顽固性大量腹水。１９９６年６月～１９９８年６月,我们用自体腹水回输联合血液透析的方法〔１〕,对２例尿毒症终末期病人共进行３５次治疗,效果满意,现报告如下。１　临床资料１．１　一般资料２例病人均为尿毒症终末期行维持性血液透析者,均为男性,年龄５８,６５岁。接受透析时间２年,合并大量腹水时间９０,１５０ｄ．２例病人均轻度营养不良,每日尿量＜１００ｍＬ．１例合并心力衰竭,１例合并轻度肝硬化。腹水经用利尿剂、输注清蛋白及血浆制品、放腹水,序贯透析等治疗无效。超滤耐受…     

五味子乙素对二氧化硅致大鼠肺损伤的保护作用

目的 探讨五味子乙素(schisandrin B,Sch-B)对二氧化硅致大鼠肺损伤的保护作用.方法 将64只大鼠随机分为对照组、染矽尘组、Sch-B干预组.非暴露气管法建立大鼠二氧化硅矽肺模型,灌胃给予Sch-B 80 mg/kg/d.药后3、7、14和21 d,对照组、染矽尘组和Sch-B干预组分别随机安乐死4、6和6只大鼠,取其肺组织,测定肺系数;光镜观测其病理8切片;紫外分光光度计检测大鼠肺组织匀浆中羟脯氨酸(hydroxyproline,HYP)、丙二醛(malondialdehyde,MDA)、谷胱甘肽(glutathione,GSH)的含量变化.结果 Sch-B对矽肺病理形态学有明显的改善作用,可以降低染矽大鼠的肺系数,降低肺组织匀浆中HYP和MDA含量,提高GSH含量,与染矽尘组比较,具有统计学差异(P<0.05或P<0.01).结论 Sch-B可以提高机体的抗氧化能力,对二氧化硅致大鼠肺损伤具有保护作用.     

二尖瓣置换术后机械瓣失灵的早期识别及处理--附5例临床分析

瓣膜置换术是目前外科治疗瓣膜病最常用的方法,且以机械瓣置入为多.由于多种原因可造成机械瓣失灵而致严重临床后果,因此机械瓣失灵的早期识别和及时外科干预特别重要.     

个旧市儿童呼吸道感染常见病毒检测及分析

目的检测并分析个旧市儿童呼吸道病毒感染流行情况。方法采用直接免疫荧光法对2384例患儿进行RSV、FLUA、FLUB、PIV1、PIV2、PIV3、ADV病毒抗原检测,并分析结果。结果2384例呼吸道感染患儿中呼吸道病毒阳性353例,阳性率为14.81%。不同季度患儿的呼吸道病毒合计阳性率有显著差异(P<0.05),一季度和四季度的阳性率高于其他季度。不同季度患儿的RSV、FLUA、FLUB、PIV3阳性率有显著差异(P<0.05)。结论儿童RSV感染的阳性率最高,一季度和四季度是儿童呼吸道病毒感染高发期。     

CD4＋ T淋巴细胞亚群在急性肾损伤发病机制中的作用

急性肾损伤（ acute kidney injury,AKI）,亦称为急性肾衰竭（ acute renal failure,ARF）,是危急重症住院患者常见的并发症。由于其发病率日趋增高,随之发展为慢性肾脏病乃至终末期肾脏病不断增加,增加了死亡风险,已成为肾科、重症监护医师极具挑战的重要医学课题[1,2]。休克,败血症,器官移植,心血管科及造影剂、化疗、抗生素、中草药等药物,诸因素已成为参与、促使AKI发生发展的主要原因[3]。 AKI发病机制复杂,尚不明确。目前研究发现除与肾毒性、缺血缺氧、肾小球血流动力学的改变、急性肾小管坏死、阻塞、间质性损害、氧化应激等相关外[3,4],免疫介导的炎性反应机制在AKI发病中备受关注[5]。而作为天然免疫与适应性免疫系统之间的桥梁--T细胞,尤其CD4＋T细胞亚群（ Th1、Th2、Th17、Treg）介导炎性免疫起关键性作用,有望成为AKI干预治疗的新靶点。因此AKI发病机制的研究对本病的预防与治疗具有重要意义,本文就近年来CD4＋T细胞亚群在AKI发病机制中的研究做一综述。     

3D腹腔镜与普通腹腔镜、开放根治性膀胱切除+肠道原位新膀胱术围手术期疗效的比较

目的 比较3D腹腔镜根治性膀胱切除术(3D-LRC)、腹腔镜根治性膀胱切除术(LRC)和开放根治性膀胱切除术(ORC)的疗效及围手术期并发症的发生差异.方法 回顾性分析大理白族自治州人民医院2008年9月至2020年6月行膀胱根治性切除术(RC)的患者资料,共148例,其中行ORC术62例、行LRC术32例、行3D-L...     

Effect of schisandrin B on lung mRNA expression of transforming growth factor-β1 signal transduction molecule in rat lungs exposed to silica

Objective To investigate the effects of schisandrin B (Sch-B) on expression of transforming growth factor-β1 (TGF-β1) and signal transduction molecule mRNA in rat lungs exposed to SiO2,and explore the intervention mechanism of Sch-B on pulmonary fibrosis induced by SiO2. Methods Ninety six Wistar rats were randomly divided into control (normal saline) group, SiO2 group and SiO2 plus Sch-B group.The rats were exposed to SiO2 by direct tracheal instillation to establish the silicotic animal models. SiO2 group and SiO2 plus Sch-B group were treated with 1ml SiO2 (50 mg/ml) for each rat From the first day after model establishment, SiO2 plus Sch-B group were orally given Sch-B (80 mg/kg) a day, control group and silica group were orally given olive oil. On the 3rd, 7th,14th and 28th days after treatment, 8 rats in each group were sacrificed and samples were collected. The histo-pathological examination of lung was performed by HE staining. The expression levels of TGF-β1 、TGFβR Ⅱ and Smad4 mRNA in the lung tissues were detected by RT-PCR. Results The results of histo-pathological examination showed that in SiO2 group, lung tissues were injured obviously; the alveolar inflammation with alveolus interval edema and inflammation cell infiltration appeared on the 3rd and 7th days; the alveolus interval became thicker, became thicker, fibroblast and collagen matiix increased markedly on 14th day; the alveolar structure was damaged, alveolar wall thickened obviously,collagen aggradation and pulmonary fibrosis displayed on 28th day. The alveolar inflammation and pulmonary fibrosis in SiO2 plus Sch-B group were significantly less than those in SiO2 group. The expressions levels of TGF-β1、TGFβR Ⅱ and Smad4 mRNA (TGF-β1: 1.03±0.31 、1.33±0.39、1.08±0.26、0.82±0.16,TGF-βR Ⅱ:0.65 ±0.11、0.80 ±0.16、0.83 ±0.24、0.62 ±0.15, Smad4: 0.87 ±0. 15、0.68 ±0.11、0.78 ±0.19、0.30 ±0.08) in SiO2group were significantly higher than those in the control group (TGF-β1:0.59±0.22、0.55 ±0.25、0.56±0.20、0.55 ±0.12,TGR-βR Ⅱ:0.28 ±0.13、0.31 ±0. 15、0.34 ±0.15、0.27 ±0.09,Smad4:0.23 ±0.11、0.40 ±0. 12、0.39 ±0.12、0.18±0.06)(P＜0.01 or P＜0.05), but the expression level of TGF-β1 mRNA was the highest on the 7th day. The expression levels of TGF-β1 and Smad4 mRNA (TGF-β1: 0.68 ±0.28、0.88 ±0.25、0.75 ±0.11、0.61 ±0. 14,Smad4:0.25 ±0.12、0.45 ±0.09、0.44 ±0.07、0.21 ±0.04) in SiO2 plus Sch-B group were significantly lower than those in SiO2 group (P＜0.01 or P＜0.05),but there were no significant differences of the TGFβR Ⅱ mRNA expression levels between SiO2 group and SiO2 plus Sch-B group. Conclusion Sch-B can reduce the pulmonary fibrosis induced by SiO2 through inhibition of the mRNA express of TGF-β1 and Smad4 in the lung tissue, modulating the TGF-β1/Smad4 signal transduction pathway and inhibiting the target gene activation.     

低钙透析液对维持性血液透析患者难治性高血压的影响

目的探讨低钙透析液对血液透析患者难治性高血压的影响。方法选取合并难治性高血压的维持性血液透析患者26例,采取自身对照的方法,先后应用钙浓度为1．75mmol／L（DCa2＋1．75）及1．25mmol／L（DCa2＋1．25）的透析液各连续进行20次透析,观察每次开始透析后0h、1h、2h、3h及透析结束时的血压,并分别与20次透析前后观察一般临床指标及血清总钙（Ca2＋）、磷（P3＋）、钙磷乘积及全段甲状旁腺激素（iPTH）的变化。结果与常规采用DCa2＋1．75比较,采用低钙透析液（DCa2＋1．25）进行透析,患者的血压降低,尤其在第3小时及透析结束后．差异有统计学意义（P〈0．05）;血钙、钙磷乘积降低（P〈0．05）,其他临床指标差异无统计学意义（P〉0．05）。结论低钙透析液对维持性血液透析患者难治性高血压的控制有利。     

NPY在雌性大鼠间脑不同脑区的差异性分布

目的观察神经肽Y(NPY)免疫反应阳性物质在成年雌性大鼠间脑不同脑区的分布。方法采用亲合免疫组织化学SABC法。结果NPY免疫反应阳性神经元集中分布于下丘脑弓状核。NPY免疫反应阳性纤维密集分布于丘脑室旁核和下丘脑弓状核、室旁核、室周核等处。实验中见下丘脑弓状核和丘脑室旁核有纤维伸入第三脑室室管膜内。结论NPY的分布呈现出性别差异,NPY可能通过“脑-脑脊液神经体液回路”发挥重要功能。     

充血性心力衰竭患者焦虑障碍的临床研究

目的　探讨充血性心力衰竭 (CHF)患者焦虑障碍的发生率及抗焦虑治疗的效果。方法　用汉密尔顿焦虑量表HAMA评估 80例CHF患者 ,对伴有焦虑障碍者用苯二氮 艹卓 类治疗。结果　 80例患者中焦虑障碍的发生率 17.5 % ;治疗好转率 85 .7% ;治疗后HAMA评分数较治疗前明显减少 ,有非常显著性差异 (P <0 .0 1)。结论　焦虑障碍在CHF中的发病率高 ,抗焦虑治疗效果好。