急性毒鼠强中毒患者血清心肌酶的动态变化与统计学分析

目的:观察急性毒鼠强中毒患者心肌酶的变化及其临床意义.方法:动态观察155例急性毒鼠强中毒患者的临床表现、心肌酶活力、心电图,使用SPSS12.0统计软件进行统计学处理.结果:155例急性毒鼠强中毒患者.实验室检查发现:天冬氨酸转氨酶、肌酸磷酸激酶、乳酸脱氢酶、肌酸激酶同功酶、ECG异常率分别为81.8%、90.9%、73.2%、77.5%、51.7%.心肌酶均值第1天升高,第2～4天达到最高峰,出现1～6 d的峰值平台期后恢复正常.轻、中、重度中毒患者心肌酶活力的各时点对应比较,差异有统计学意义(P＜0.01).抽搐越重,酶活力越高,升高持续时间越长,ECG异常率越高.结论:毒鼠强中毒患者血清心肌酶升高由骨骼肌、心肌等组织损伤引起,这种损伤是可逆的.血清心肌酶水平可以作为反映病情的重要指标之一.     

百草枯中毒致肺损伤:基因水平的改变和抗体的应用

百草枯(Paraquat,PQ),又名对草快,商品名为克芜踪,化学名是1,1'-二甲基4,4'-联吡啶阳离子盐,属联吡啶类广谱除草剂,广泛地用于农业生产.     

乌拉地尔与硝苯地平治疗高血压急症的疗效对比

钙离子拮抗剂硝苯地平（心痛定）和α受体阻断剂乌拉地尔（压宁定）已广泛用于高血压急症,并取得较好疗效［１～３］;但是近年来,有些学者认为硝苯地平治疗高血压急症可能增加病死率,而对硝苯地平治疗高血压急症提出了质疑［１］。本研究在１９９６年７月至１９９７年２月间,对６４例高血压急症患者,分成乌拉地尔静滴治疗组与硝苯地平含服治疗组,观察比较它们的降压疗效、副作用及一月内病死率,现报道如下。１材料与方法１１对象６４例高血压急症患者,男３４例,女３０例,年龄２８～８１岁（６０岁以上者４０例）,平均６４．５岁。治疗前收缩…     

卡托普利对百草枯致急性肺损伤的保护作用

Objective To establish paraquat(PQ)induced acute lung injury models induced by paraquat (PQ), and to study the protective effects of angiotension converting enzyme inhibitors (ACEI) with eaptopril (CAP) on the PQ posioning. Method All experiments were made in the central laboratory of Union Hospital. Human umbilical vein endothelial cells (HUVECs) were incubated with different concentration of paraquat and captopril to establish experimental models. Half of cell survival rate detected with MTF assay to judge whether the model was successful or not. Three groups were divided according to the different drug. application: normal control group without any drug intervetion, PQ group exposed to paraqnat with the concentration of 400 μmol/L and CAP group additionally exposed to captopril with concentration of 10 μmoL/L, which was repartifioned to three groups (CAPA, CAPB and CAPC) according to the different intervention time. The supematant was collected to measure the concentration of malondialdehyde(MDA) and superoxide dismutase(SOD) after PQ injury for 24 hours, cy-tochrome C detected by immunocytochemistry and apoptosis detected by flow cytometry. Data were expressed as mean±standard error of the mean (x±s). Statistical 'analysis was carried out with the soft SPSS 16.0. Results MTr assay detected the concentration & time of PQ intervention and the data of CAP groups, using the single-re-season variance analysis, F value were 56.734,172.025, P < 0.01 respectively, thus to suecessfidly construct the PQ model and determine the concentration of CAP intervention groups. Relative to the PQ group, MDA as well as levels of cytochrome C of the CAP group were significantly decreased (t = 5.913,3.945,-3.426, P <0.01); while SOD were markedly increased (t = 5.463,-2.292,-1.297, P < 0.01). It also showed that captopril markedly decreased PQ induced the rate of HUVECs apoptosis, the percentagen of PQ group apoptosis was 46.1%, while CAP groups apoptnsis were 4.3 %, 9.2% and 17 % respectively. Conclusions Captopril has the ability to scavenge reactive oxygen species, and to protect against the paraquat induced lung toxicity on HUVECs, which pro-vide the infonnafion for basic research and clinical treatment of PQ posioning.     

急诊医学一体化教学模式的研究与实践

本文介绍了急诊医学一体化教学模式的研究背景及实施方法并对其效果进行了评价。实施急诊医学一体化教学模式，可以有效地将急诊医学课程教学与实习教育在时间上和空间上统一，将急诊医学教学与急诊医疗体系统一，将急诊医学教学与社会实践统一，从而有利于提高临床实习质量，有利于急诊医学人才的培养。     

口服超常剂量降压药治疗急性主动脉夹层并发高血压的临床观察

目的:评价口服超常剂量降压药治疗急性主动脉夹层并发高血压患者的临床疗效及不良反应。方法:49例急性主动脉夹层并发高血压患者,根据使用降压药的剂量分为常规剂量组和超常剂量组。记录2组患者治疗前后血压、心率以及药物不良反应的发生情况。结果:常规剂量组与超常剂量组的患者治疗后血压、心率较治疗前均叫显下降;2组不良反应的发生率相似。结论:用超常剂量的降压药治疗主动脉夹层并发高血压是安全而有效的。     

机械通气在重症脑出血患者并呼吸衰竭中的治疗作用

脑出血是常见病、多发病,病情危重,致残率和死亡率都很高.脑出血早期最常见的死亡原因是中枢性呼吸衰竭.机械辅助呼吸是治疗呼吸衰竭的一种手段,能够为病因治疗赢得时间,为挽救患者的生命创造机会.本文通过48例脑出血并发呼吸衰竭的治疗观察,分析机械通气在高血压脑出血合并急性呼吸衰竭中的治疗作用.     

美托洛尔治疗充血性心力衰竭的疗效观察

对３８例经强心、利尿、扩管治疗无改善且伴快速室率的慢性充血性心力衰竭（ＣＨＦ）加用美托洛尔治疗，结果显示其血浆儿茶酚胺由７．３１±１．４１减至３．７１±０．７６ｎｍｏｌ／Ｌ；肾上腺素由３．３９±１．３１减至２．４０±０．７０ｎｍｏｌ／Ｌ，去甲肾上腺素由５．５５±１．５９减至２．０６±０．９４ｎｍｏｌ／Ｌ，心率由１０８．８４±１４．７８减至６９．５４±８．７２次／分，心功能改善总有效率达９７．４％，且副作用少。提示：凡常规治疗后效果不佳并伴有快心室率的ＣＨＦ患者，美托洛尔可作为抗心力衰竭的联合治疗药物。     

The Antidotal Effects of High-dosage γ-Aminobutyric Acid on Acute Tetramine Poisoning as Compared with Sodium Dimercaptopropane Sulfonate

To investigate the therapeutic effect of nigh-dosage γ-aminobutyric acid （GABA） on acute tetramine （TET） poisoning, 50 Kunming mice were divided into 5 groups at random and the antidotal effects of GABA or sodium dimercaptopropane sulfonate （Na-DMPS） on poisoned mice in different groups were observed in order to compare the therapeutic effects of nigh-dosage GABA with those of Na-DMPS. Slices of brain tissue of the poisoned mice were made to examine pathological changes of cells. The survival analysis was employed. Our results showed that both high-dosage GABA and Na-DMPS could obviously prolong the survival time, delay onset of convulsion and muscular twitch, and ameliorate the symptoms after acute tetramine poisoning in the mice. Better effects could be achieved with earlier use of high dosage GABA or Na-DMPS. There was no significant difference in prolonging the survival time between high-dose GABA and Na-DMPS used immediately after poisioning. It is concluded that high-dosage GABA can effectively antagonize acute toxicity of terarnine in mice. And it is suggested that nigh-dosage GABA may be used as an excellent antidote for acute TET poisoning in clinical practice. The indications and correct dosage for clinical use awaits to be further studied.     

急性百草枯中毒肺损伤治疗新进展

自1962年百草枯作为干燥剂和落叶剂广泛应用于农业生产，致每年成千上万的人死于百草枯中毒。至今尚缺少特异性的解毒药。过去的40年中治疗百草枯中毒主要策略为改变百草枯代谢动力学。现对近年百草枯中毒若干机制和治疗方面研究的进展作一综述，着重介绍百草枯中毒后，在减少吸收和促进排出百草枯、清除氧自由基和诱发内皮细胞产生还原型谷胱甘肽、促进炎症缓解和减少炎细胞浸润、增加肺泡表面活性物质、减少肺纤维化等方面的研究新进展。