瘦素对大鼠气道平滑肌β_2肾上腺素能受体表达的影响

目的观察瘦素(LP)对大鼠气道平滑肌细胞β2肾上腺素能受体(β2-AR)表达的影响,探讨LP参与哮喘发病的机制。方法组织贴块法原代培养大鼠气道平滑肌细胞(ASMCs),随机分为空白对照组(A组),LP 50 ng/L组(B组),LP 100 ng/L组(C组),LP 200 ng/L组(D组)及LP拮抗剂组(LP 200 ng/L+LP拮抗剂200 ng/L)(E组)分别干预24 h,采用Western印迹法及实时荧光半定量RT-PCR测瘦素受体(Ob-R)及β2-AR的表达。结果与A组相比,B、C、D组Ob-R表达明显升高,而β2-AR表达下降,证实LP可以上调Ob-R的表达并抑制β2-AR的表达;E组Ob-R表达较B、C、D组下降(P<0.05),与A组相比(P>0.05);E组β2-AR表达较B、C、D组升高(P<0.05),与A组相比(P>0.05)。结论 LP呈浓度依赖抑制大鼠气道平滑肌细胞β2-AR的表达。     

国产与进口奥氮平治疗精神分裂症的成本效益分析

摘 要 目的： 比较国产与进口奥氮平治疗精神分裂症的药物经济学价值,为临床合理用药提供参考依据。方法: 200例精神分裂症患者随机分为A、B两组,每组100例,分别使用国产与进口奥氮平片治疗8周,评定患者病情、不良反应、社会功能、生活质量和日常生活能力的变化,并进行成本 效益分析。结果:两组治疗后阳性与阴性症状量表(PANSS)、社会功能缺陷筛查量表(SDSS)、精神分裂症病人生活质量量表(SQLS)和日常生活能力量表(ADL)评分均较治疗前显著下降(P<0.01),同期对照比较,两组间差异均无统计学意义(P>0.05); A组在治疗后第2、4周末副反应量表(TESS)评分均高于B组(P<0.01); 两组效益相当,A组成本显著低于B组(P<0.01),效益/成本比值显著高于B组(P<0.01)。结论: 国产奥氮平片治疗精神分裂症的疗效和安全性与进口产品相当,但治疗成本相对较低,具有更好的药物经济学价值。     

慢性硬膜下血肿钻孔引流术后并发硬膜下张力性气颅的防治

2002年12月～2007年7月,我们对126例慢性硬膜下血肿(CSDH)患者采用钻孔引流术治疗,其中6例并发硬膜下张力性气颅(SDTP),经及时处理均获得较满意结果.现报告如下.     

经脐单切口腹腔镜下高位结扎术治疗精索静脉曲张

目的探讨经脐单切口腹腔镜下高位结扎术治疗精索静脉曲张(VC)的临床效果。方法回顾分析2009年4月至2010年1月我院行经脐单切口腹腔镜下高位结扎术治疗精索静脉曲张的45例VC患者临床资料,其中左侧29例,无单纯右侧患者,双侧16例,共61侧;年龄22～49岁,平均32±13岁。结果所有患者均顺利完成手术,手术时间20～45min,平均28±7min,术中出血少,未出现周边器官及血管损伤并发症,术后脐部手术切口愈合,手术疤痕不明显,术后1～3d出院。结论经脐单切口腹腔镜下高位结扎术治疗精索静脉曲张疗效可靠,术后切口美观,体现了微创治疗的优势。     

经尿道双极等离子体电切治疗高危前列腺增生症:附200例报告

目的评价经尿道双极等离子体电切治疗高危前列腺增生症的临床效果。方法对200例高危前列腺增生症患者行经尿道等离子切除术,并对其临床资料进行分析。结果手术时间15~115min,平均失血量90ml,围手术期无患者死亡,无电切综合征发生,无永久性尿失禁。随访3~72个月,排尿功能恢复满意。国际前列腺症状(IPSS)评分由术前28.5分下降至术后平均7.6分。生活质量评分(QOL)由术前5.0分下降到术后平均2.4分。最大尿流率由术前7.2ml/s上升到术后平均18.5ml/s。结论经尿道双极等离子体电切治疗高危前列腺增生症是一种安全有效的方法,但术前充分治疗合并症,使其达到麻醉和手术前要求,术中术后注意监控,及时治疗合并症对保证围手术期安全至关重要。     

实验室认可中生化样品唯一性标识的建立和溯源

取自受检者的样品,包涵了受检者的特有信息,承载在统一的样品容器中,应建立符合受检者特征的唯一性标识,用以区别、确认结果。生化分析由于受检样品多,涉及面广,处理复杂,样品唯一性标识的建立和溯源的重要性尤为突出。1生化样品的特点与唯一性标识的必要性1.1样品涉及各类人群     

支气管镜检查中利多卡因毒性致抽搐1例报道及分析

Objective To increase the knowledge of airway topical anesthesia in lidocaine.Methods We analyzed a lymphoma patient which was induced convulsion by lidoeaine for topical anesthesia in airway,and retrospectively analyses the side-effect and clinical application and pharmacokinetics on the basis of the relevant documents.Results The patient,female,1 9 years old,was in hospital for progressive dyspnea during a month.For right trachelophyma she had accepted right cervical thyroid and superior mediastinum resection a month ago,and postoperatively pathology prompted diffuse large B-cell lymphoma in sub-cervical and anterosuperior mediastinum,lymphocytic thyroiditis.After hospitalization we considered that dyspnea was caused by the lymphoma which relapsed and oppressed the trachea.To establish the diagnosis and assessment the airway's condition the bronchoscopy was been done bedside the support of the high frequency jet ventilator.The liver and renal function were normal inspected by plasma biochemistry preoperative,and the method of airway topical anesthesia was instilling 2%lidocaine.The inferior segment of trachea about 40 mm from eminence was external pressure narrow,and the ITlueous membrane was asperity,and the extreme narrow segment was lip-like which caliber was 4×10 mm that the bronchoscopes could pass it by force.The right and left main bronchus opening was external pressure narrow and the distant part was unobstructed no neoplasm,The whole dosage of lidocaine was 300 mg.The operative procedure was successful and no short breath aggravated,and the SPO2 was above 92%.When the tracheal stent was repaired (about 10 min after the first drip of lidocaine) the patient was obnubilation and tonic seizure.After oral trachea cannula by bronchoscope guidance and assisted ventilation by compressing saccule and diazepam 10 mg IV,the convulsion stopped and the mind was clear 5 min later.The electrocardio-detection prompted that the heart rhythm was sinus rhythm and the HR was 150 times/min during the whole process.After the convulsion stopped the femoral artery plasma concentration of lidocaine was 7.76 mg/L which showed poisoning by lidocaine.Conclusions Lidocaine has been the most frequently used medicine for local anesthesia in flexible bronchoscopy.However,its severe side effects have been reported in clinical application.The primary reason of side effect is extra local absorption of lidocaine.It is the important intervention to increase the safety of bronchoscope which inhibits the local absorption of lidocaine.     

纳洛酮两种方案治疗重型颅脑损伤的效果比较

目的观察早期大剂量应用纳洛酮治疗重型颅脑损伤的临床效果。方法重型颅脑外伤病例150例,随机分为观察组和对照组各75例,常规治疗的基础上对照组应用盐酸纳洛酮4mg静脉滴注,1日1次,共10d;观察组入院即静脉推注4mg,后以0.4mg/（kg.d）,3d后改为0.2mg.d^-1持续静脉滴注,7d后2-6mg/（kg.d）,共10d。结果观察组与对照组比较入院3d内呼吸次数和心律异常改善、颅内压低、脑水肿程度轻（P〈0.05）;入院第十天GCS评分高,3个月后G0S分级高（P〈0.05）。两组未发现明显不良反应。结论早期大剂量使用纳洛酮安全性高,可获得较为理想的疗效,提高患者的生存质量。     

广泛心肌梗塞误诊为急性腰扭伤1例

1病例报告患者,男,38岁。因剧烈腰痛3小时入院。患者3小时前在持重物上楼时突发腰痛,在家口服去痛片2片症状无好转,腰痛渐重,呈持续性刀割样,直立受限,伴有轻度的胸闷憋气,余无其它症状。当地诊所诊为急性腰扭伤,给予手法复位后,症状加重,急来我院急诊科就诊,查体：神志不清,BP7／5kPa,心音低,律不齐,率＜40次／min,腹（一）,心电图提示：广泛性前壁心肌梗塞。经积极抢救,病情逐渐加重于人院后3小时死亡。2讨论心肌梗塞以剧烈腰痛为主要症状者较少见,且病人较年轻,既往无明显冠心病症状,发病前有搬重物史,故被误诊…     

地龙促进大白兔背部创伤伤口收缩的实验研究

目的：通过地龙对动物伤口模型的收缩作用的实验，探讨地龙的促伤口愈合作用。方法：在新西兰大白兔背部伤口模型上用药，于伤后５，７，１０，１４ｄ进行肉眼观察，并取肉芽组织，分别做免疫组化ＡＢＣ染色和电镜观察。分别用ｂＦＧＦ和ＰＢＳ做阳性对照和阴性对照。结果：用药组肉芽组织中含大量肌纤维母细胞，合成功能活跃，细胞内肌动蛋白较多，伤口收缩明显，与阴性对照相比有显著性差异，伤口修复较快。结论：地龙可促进肉芽组织中肌纤维母细胞增生，合成功能活跃，分泌伤口收缩的重要物质———肌动蛋白较多，有利于伤口的收缩，对伤口的愈合有促进作用。