骨髓输液在PICU的应用探讨

目的　探讨骨髓输液在PICU的适应证、方法及临床效果。方法　选择PICU危重症建立静脉通道困难患儿 30例 ,采用 7号骨穿针或 7～ 9号头皮针于胫骨粗隆下 1～ 2cm穿刺、固定 ,接入医嘱液体 ,记录穿刺所需时间、入液速度及生命体征变化、并发症等。结果　 2 8例 1次成功 ,2例用头皮针者有堵塞 ,换针后重新穿刺成功 ,穿刺、固定到接入液体平均时间 (30± 10 )s。速率 :一般压力 (8± 3)ml (kg体重·h) ,加压下 (17± 6 )ml (kg体重·h) ,所有病例均达到了医嘱要求。骨髓输液持续时间 3～ 2 2h ,无 1例出现并发症。结论　骨髓输液在PICU危重症抢救中可迅速建立液体通道 ,争取抢救时间。头皮针比骨髓穿刺针易于固定 ,使用更方便     

胫骨平台骨折合并内侧副韧带损伤的诊治体会

[目的]探讨胫骨平台骨折伴膝内侧副韧带损伤的诊断及治疗方法。[方法]回顾性分析本院1996年1月~2005年12月期间收治的52例胫骨平台骨折合并重度内侧副韧带损伤病例,并对有随访的49例(保守治疗21例,手术治疗28例)进行分析。[结果]随访10个月~9年(平均1.7年),按照Schatzker分型:Ⅱ型39例,Ⅲ型6例,Ⅵ型4例。骨折均切开复位内固定,对韧带损伤的治疗分为2组,保守治疗组21例,膝关节功能:优11例,良9例,差1例。手术治疗组28例,Ⅰ期修复19例:优17例,良2例。Ⅱ期修复9例:优5例,良3例,差1例。[结论]胫骨平台骨折合并内侧副韧带损伤Ⅰ期修复效果理想。     

Toxic effects of Fusarium mycotoxin butenolide on rat myocardium and primary culture of cardiac myocytes.

Mycotoxin toxicosis has been implicated in the etiopathogenesis of Keshan disease (KD), an endemic cardiomyopathy prevailing in some regions of China. Butenolide (4-acetamido-4-hydroxy-2-butenoic acid gamma-lactone, CAS No. 16275-44-8), a mycotoxin produced by several Fusarium species such as Fusarium tricinctum and Fusarium graminearum, is frequently detected from the cereals in the endemic areas of KD. The present study is undertaken to investigate whether this mycotoxin can induce myocardial damage. Exposure of primary culture of cardiac myocytes to butenolide resulted in significant cytotoxicity, manifested by changes in cell morphology and decreases in cell viability. Consistent with the in vitro findings, distinct myocardial toxicity in vivo was observed after administration of rats by gavage with butenolide (10 and 20 mg/kg/day) for 2 months, and the myocardial injuries were characterized by focal necrosis of myocardium and fragmentation of myofiber. Butenolide also induced significant oxidative damage to the myocardium in vitro evidenced by a concentration-dependent lipid peroxidation in the myocardial homogenates, whereas antioxidants superoxide dismutase (SOD), N-acetylcysteine (NAC) and glutathione (GSH) provided significant protections against this oxidative effect. Taken together, these results clearly reveal that butenolide possesses the potential to induce myocardial toxicity. The present findings may reinforce the hypothesis that toxicosis by mycotoxins is one of the etiological factors for KD.     

肝移植术后胆道并发症的介入治疗

目的 探讨原位肝移植术后胆道并发症的介入治疗疗效。方法 回顾性分析我院2002年6月至2005年9月诊治的173例原位肝移植患者的临床资料。结果 术后出现胆道并发症14例（8．1％），其中胆管狭窄6例．胆管狭窄合并胆漏1例，胆泥淤积或结石3例，肝断面胆漏2例（劈离式肝移植患者），T管拔除后胆漏1例，Oddi括约肌功能失常1例。除1例胆道狭窄再次行肝移植，因发生严重感染导致肝功能衰竭死亡外．其余患者经介入治疗均获得满意的效果。结论 介入治疗是诊断和治疗肝移植术后胆道并发症的首选方法。     

恶性肿瘤术后下肢深静脉血栓形成26例

下肢深静脉血栓形成(DVT)是恶性肿瘤患者手术后严重的并发症之一,发生率明显高于非肿瘤患者。1998年1月~2004年8月,我们共收治恶性肿瘤术后下肢DVT患者26例,现报道如下。1临床资料1.1一般资料本组26例,男14例,女12例,年龄34岁~84岁,平均51.2岁,均经术后病理证实为恶性肿瘤,其中     

甲磺酸罗比卡因与盐酸罗比卡因用于硬膜外阻滞的效应比较

目的 评价甲磺酸罗比卡因用于硬膜外阻滞的效应和安全性。方法 45例择期行下腹或下肢手术病人,随机分别接受用甲磺酸罗比卡因(8.94 mg/ml,观察组)或盐酸罗比卡因(7.5mg/ml,对照组)施行的硬膜外阻滞。观察两组在感觉阻滞、运动阻滞、镇痛和肌肉松弛方面的效果,同时观察用药前后肝肾功能变化。结果 观察组和对照组感觉阻滞平面达到T6以上的病例分别为84.3％和76％(P>0.05),Bromage≥3级的病例分别90％和92％(P>0.05)。两组感觉阻滞平面固定时间、Bromage达到最大级别时间、最大级别维持时间和运动阻滞维持时间均无显著性差异(P>0.05)。两组镇痛及肌松满意率无显著性差异。观察组术中2例发生低血压,2例发生心动过缓,而对照组仅1例发生低血压。两组术后24 h天冬氨酸氨基转移酶(AST)、天冬氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)均在正常范围。结论 甲磺酸罗比卡因与盐酸罗比卡因行硬膜外阻滞的效应基本相同,且无明显毒性。     

Association of the expressions of platelet-derived growth factor receptor and c-Fos with the biological characteristics of bladder cancer.

OBJECTIVE: To elucidate the relation of platelet-derived growth factor receptor (PDGFR) and c-Fos protein expressions with human bladder transitional epithelial cell carcinoma (BTCC). METHODS: The expressions of PDGFR and c-Fos were investigated in 11 normal bladder tissue samples, 14 adjacent non-carcinoma tissues and 43 BTCC tissues by means of SP immunohistochemical technique. RESULTS: The c-Fos expression was found in the cell nuclei and cytoplasm, and PDGFR in the nuclear membrane, cytoplasm, and cellular membrane. PDGFR and c-Fos were detected in 81.40% and 48.83% of the BTCC tissues respectively, at the rates both significantly higher than those in normal and adjacent non-carcinoma tissues (P<0.05). Correlation between the expression of c-Fos and the tumor grading was noted (P<0.05). The expressions of PDGFR and c-Fos in tumor blood vessels were significantly higher than those in normal vessels. CONCLUSIONS: The expressions of PDGFR and c-Fos might be involved in the development of BTCC, possibly related to the angiogenesis of the tumors. c-Fos expression can indicated the cell proliferative status of the BTCC.     

腹腔镜胆总管切开取石术后内置管引流与T管引流临床研究

目的 :比较分析腹腔镜胆总管切开取石术后内置管引流与T管引流两种方法对患者康复的影响。方法 :回顾性总结分析 1999年以来行腹腔镜胆总管切开取石术后内置管引流的 2 6例患者临床疗效 ,并与同期行T管引流的 31例患者进行了比较。结果 :内置管引流组术后无胆汁丢失 ,较T管引流组痛苦小、胃肠功能恢复快。两组比较 ,手术时间无明显差异 ,术后开始进食时间分别为 13.8± 3.4,35 .5± 6 .8h ,(P <0 .0 5 ) ,恢复肠蠕动时间为 30 .5± 5 .6 ,43.8± 7.4h ,(P <0 .0 5 ) ,抗生素平均使用天数 3.5± 0 .6 ,6 .4± 1.1d ,(P <0 .0 5 ) ,术后输液量 45 5 0± 5 84,135 0 0± 12 5 0ml,(P <0 .0 1) ,术后平均住院日 4.6± 1.7,9.6± 2 .4d ,(P <0 .0 1) ,平均住院费用 815 0± 910 ,5 0 0± 12 70元 (P <0 .0 5 ) ,恢复日常工作时间 12 .8± 2 .5 ,2 7.4± 6 .9d ,(P <0 .0 5 )。结论 :腹腔境胆总管探查、内置管引流术后胆总管一期缝合避免了T管引起的并发症 ,大大减轻了患者的痛苦 ,缩短了输液时间和住院时间 ,减少了抗生素的用量 ,值得推广应用。     

Ureteral obstruction caused by L-asparaginase-induced pancreatitis in a child with acute lymphoblastic leukemia.

L-asparaginase, an effective antileukemia and antilymphoma agent, is toxic to many organ systems. We report a case of ureteral obstruction caused by L-asparaginase via the inflammatory complication of acute pancreatitis. The patient was an 11-year-old boy with acute lymphoblastic leukemia. Six days after completing a 4-week induction therapy containing 9 doses of L-asparaginase, severe left abdominal pain developed. Abdominal computed tomography showed phlegmon formation anterior to the pancreatic head and in the left posterior pararenal space. The strands of inflammatory soft tissues encased the upper third of the left ureter, causing left hydroureter and left hydronephrosis. The ureteral obstruction resolved after insertion of a double-J catheter that remained in place for 66 days. This case suggests that L-asparaginase may play a role in the pathogenesis of ureteral obstruction in children receiving chemotherapy.