临床医学科研设计、衡量、评价(DME)专题讲座 第四讲 病因学的研究及其评价

从广义上说,病因是指与疾病发生有关的直接的和间接的因素;从狭义上说,是指疾病发生的必不可少的直接原因。人类的生命现象是借适应反应以保持体内平衡,而疾病现象则是这种平衡的破坏,我们可把引起体内平衡破坏的一切条件都归之于病因的范围。病因学研究中常用的术语“危险因素”一词正是指一些与某特定疾病有密切联系、人们暴露接触后会增加得该病危险性的因素。在疾病的致     

腹腔镜规则性左肝外侧叶切除术15例

目的探讨腹腔镜左肝外侧叶切除术的可行性。方法2004年12月-2006年8月对病灶位于左肝外侧叶原发性肝细胞癌10例，肝海绵状血管瘤3例，结肠癌肝转移2例，腹腔镜下应用电刀或超声刀、线性切割器等切除左肝外侧叶。结果15例均在完全腹腔镜下行规则性左肝外侧叶切除，无中转开腹。手术时间65—120rain，平均100min；术中出血量50—100ml，平均80ml。肿瘤全部完整切除，无破裂，完整取出标本的边界距肿瘤切缘1cm以上，术后病理证实切端未见癌细胞侵犯。术后无出血及胆漏，术后腹腔引流管3—4d。术后住院3—5d。12例肝癌术后随访1-20个月，平均12．5月，未见肝内复发及手术切口肿瘤种植，所有患者均健康存活。结论腹腔镜规则性左肝外侧叶切除可行、安全。     

兔肢体爆炸伤合并海水浸泡后在不同复温速率及维持浅低体温下机体炎症反应的特征

Objective To investigate effects of different rewarming rates and maintenance of light hypothermia on inflammatory response in rabbits after limb blast injury, coupled with seawater immersion. Methods First, the model of limb blast injury coupled with seawater immersion was reproduced [the animals were immersed to low body temperature of (31.0±0.5℃)]. Then, 24 adult rabbits were randomly divided into group Ⅰ [the rapid rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (8.94±0.93)℃/h], group Ⅱ [the slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (3.88±0.22)℃/h], group Ⅲ [another slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (2.18±0.12)℃/h], and the H group [the hypothermia group, n =6, rewarmed to (34 - 35)℃ at a rate of (4.49±0.66)℃/h and kept at that temperature till termination of the experiment]. Regulation of ambient temperature and warm transfusion were used to restore body temperature to target levels and maintained there for 6 hours. Blood samples were taken at 5 different times, I.e. Pre-injury time(T0), post-immersion time (T1), the time when rewarming started (T2), 3 h after rewarming (T3), and 6 h after rewarming (T4). Tissue samples from heart, liver, intestinum, lung and kidney were also collected. Levels of TNF-α (tumor necrosis factor-α), IL-1β (interleukin-1β) and IL-6 (interleukin-6) in plasma and MPO (myeloperoxidase) in homogenate were detected. Results Following rewarming, TNF-α, IL-1β, IL-6 concentrations in the plasma of the animals in group Ⅰ and group H were significantly higher when compared with those of the animals in group Ⅱ and group Ⅲ (P<0.05, P<0.01), and MPO activity in homogenate was significantly higher when compared with that of the animals in group Ⅱ and group Ⅲ(P<0.01, P<0.05), and no statistical difference could be seen between group Ⅱ and Ⅲ (P>0.05). Conclusions Rapid rewarming and maintenance of light hypothermia could obviously elevate TNF-α, IL-1β, IL-6 concentrations in plasma and MPO activity in homogenate, following limb blast injury coupled with hypothermia induced by seawater immersion, while slow rewarming (with a rewarming rate of 2-4℃/h) could significantly inhibit TNF-α, IL-1β, IL-6 levels and PMN activity.     

两种单静脉法与传统Amplatzer法治疗动脉导管未闭

目的探讨两种单静脉入路法和动静脉双入路法治疗PDA各自的优缺点及最佳适应症,为PDA患者选择合理介入治疗方法提供依据。方法103例PDA患者经三种不同介入方法治疗,其中单静脉入路超声法37例,单静脉入路造影法14例,动静脉双入路法52例。PDA的位置、形态、大小经不同方法观察,单静脉超声法经超声观察,单静脉造影法在PDA内或降主动脉近PDA口外造影观察,动静脉双入路在主动脉弓降部侧位造影观察。选择合适型号的Amplatzer伞经股静脉建立的轨道进行封堵。术后15 min经胸超声及心脏听诊判断有无分流。术前、术后均行血流动力学测定,术后3 d、1个月复查超声心动图,观察大动脉水平有无分流及动脉导管未闭再通。结果103例患者全部一次封堵成功,技术成功率100%。术中操作平均透视时间(10.45±4.35)min,心导管检查测肺动脉收缩压由术前轻度增高[(33.2±3.11)mmHg]降为正常[(22.03±5.3)mmHg]。术后即刻所有患者心前区双期连续性杂音消失,术后无残余分流,无任何并发症发生,随访1个月未发生动脉水平分流及动脉导管再通。结论单静脉入路Amplatzer封堵器治疗动脉导管未闭简化了手术程序,不用或减少造影剂用量,缩短了操作透视时间,手术成功率高,疗效可靠,值得推广应用。     

开放性创伤应用人体破伤风免疫球蛋白的临床观察

人体破伤风免疫球蛋白(HTIG)是预防和治疗破伤风的一种新制剂，笔者总结了2002年以来我科在开放性创伤中应用HTIG预防破伤风的体会，报告如下。     

西医常规疗法加葛根素注射液用于治疗脑梗塞49例临床分析

脑梗塞是我国中老年人常见病和多发病，致残率很高。并且发病率有逐年上升的趋势。近几年已成为严重威胁我国中、老年人身体健康的重大疾病。为了探讨有效的治疗方法，提高治愈率，降低致残率，我们在采用西医常规治疗的基础上加用葛根素注射液治疗，临床疗效明显，并有效减轻了致残程度。现将西医常规疗法加葛根素与单纯应用西医常规疗法治疗脑梗塞进行比较分析，报告如下：     

一种西门子新型X线机的综合性能与安装

本文叙述西门子型号为Polydoros 80/100的新型X线主机,该主机采用微电脑控制技术、光纤维传输技术及中频技术,X射线剂量精度高,影像质量优良,故障率低,是一种技术较为成熟的X线主机,也是当今西门子公司产品的主流机种。该机的安装调试具有一定难度,本文同时针对这一问题进行讨论,并总结归纳出一套安装调试全过程。     

郎格罕细胞／树突状细胞在人食管癌抗瘤免疫中的作用

抗原呈递细胞（ＡｎｔｉｇｅｎＰｒｅｓｅｎｔｉｎｇＣｅｌ，ＡＰＣ）是能捕捉、加工处理抗原并将抗原呈递给特异性淋巴细胞的一类免疫细胞。它们包括巨噬细胞及树突状细胞（ＤｅｎｄｒｉｔｉｃＣｅｌｓ，ＤＣ）等，而与食管粘膜上皮关系密切的是ＤＣ。ＤＣ是一簇来源于骨...