氨基酸负荷对梗阻肾的肾功能和肾储备功能的影响

为寻求预测梗阻肾肾功能的新方法，用氨基酸负荷（ＡＬ）对２５例双肾积水患者进行肾储备功能测定，并对负荷前后肾小球滤过率（ＧＦＲ）、有效肾血浆流量（ＥＲＰＦ）、肌酐清除率（Ｃｃｒ）、滤过分数（ＦＦ）、ＧＦＲ百分比上升率（％ＧＦＲ）进行比较性研究，以求预测肾功能恢复的客观指标。结果表明：ＡＬ能提高ＧＦＲ、ＥＲＰＦ值，通过Ｃｃｒ对比研究，进一步表明ＧＦＲ增值能反映肾储备功能的变化，增值越高恢复越快，反之亦然。结果认为：肾储备功能的测定可预测肾功能恢复情况，并对肾积水疾病的手术方式选择有一定的指导作用     

镍作业工人细胞免疫功能、血清硒和过氧化脂质含量的变化

９６名镍作业工人测定结果：非特异酯酶阳性细胞百分率（ＡＮＡＥ＋％）为７６．８％±８．０％，Ｔ细胞亚群ＣＤ２、ＣＤ４、ＣＤ８阳性细胞百分率（ＣＤ＋２％、ＣＤ＋４％、ＣＤ＋８％）及ＣＤ＋４／ＣＤ＋８比值分别为６５．６％±１０．５％、５６．３％±１２．１％、３４．３％±８．２％和１．７６±０．６；酵母多糖刺激的外周血多形核白细胞化学发光（ＰＭＮ－ＣＬ）本底和峰值分别为４８±２３和３０７３±６８４ＣＰＳ／１０６ＰＭＮ；血清硒和丙二醛含量分别为１．２２±０．２３和４．７６±０．８８μｍｏｌ／Ｌ。与非镍作业的地区对照组比较，Ｔ细胞ＣＤ＋８％增高，ＣＤ＋４／ＣＤ＋８比值下降，化学发光的本底值降低，峰值增加，血清Ｓｅ含量下降，丙二醛含量升高。分析镍作业工人工龄与后三项指标变化的关系，工龄大于２０年与小于１０年有统计学上明显差别。这些观察指标为镍作业人员医学观察增加新的监护指标提供依据。     

感染性心内膜炎手术时机的初步探讨

本文报道了15例感染性心内膜炎（IE）的外科治疗结果。左心IE9例，其中3例合并风湿性心脏病。右心IE6例，均合并先天性室间隔缺损（VSD）。活动性IE13例，静止期IE2例。右心IE的手术方法是修补VSD，剥除三尖瓣上的赘生物并涂以0.5％活力碘，环缩三尖瓣环。左心IE的处理方法为瓣膜置换。手术死亡2例。本文着重对手术时机进行了讨论。     

Surgical treatment of primary small cell carcinoma of the esophagus. Clinical analysis of 11 cases]

545 cases of esophageal carcinoma were confirmed histologically and by esophagoscopic biopsy between Jan. 1982 and May 1990. Primary small cell carcinoma was identified in 19 cases. Of 11 patients confirmed operatively, 5 had oat cell carcinoma, 4 combined oat cell carcinoma and 2 intermediate cell carcinoma. The mean overall survival period was 13.9 months. The longest survival period was 27 months. The prognosis of primary small cell carcinoma was poorer than that of squamous carcinoma of the esophagus because of its propensity of spread and metastasis. Once the diagnosis of small cell carcinoma was established, surgery was undertaken as early as possible. For patients who had lymph node metastasis at the time of diagnosis, we recommended surgical treatment plus systemic chemotherapy after operation. To increase the resection rate, it is important to do chest CT scan, bronchiofiberscopy and B-type ultrasonography before operation.     

Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia

PURPOSE: During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (A-line ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon. METHODS: Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (F(ET)ISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg*kg(-1), 0.1 mg*kg(-1), 0.2 mg*kg(-1) or saline was administered in a randomized, double-blind design. The AAI and bispectral index (BI(hx)) were monitored throughout the study and analyzed off-line. RESULTS: BI(hx) was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg*kg(-1) did not differ significantly from the corresponding mean recorded from 15 min to 20 min after F(ET)ISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg*kg(-1) or 0.2 mg*kg(-1), AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017). CONCLUSIONS: Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while BI(hx) is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation.     

先天性一侧肺动脉缺如的电子束CT诊断

目的 评价电子束CT(EBCT)诊断先天性一侧肺动脉缺如的价值。方法 对经平片、超声心动图检查后拟诊为肺血管疾病或原发性肺动脉高压的患者行EBCT检查，EBCT诊断先天性一侧肺动脉缺如的11例患者入选，并与超声心动图、核素通气灌注扫描、心血管造影的检查结果作进一步的比较及评估。结果 单发一侧肺动脉缺如4例，均为女性成年人。合并多发心血管畸形7例，其中合并复杂畸形3例，均为男性儿童和左肺动脉缺如；合并单发心血管畸形4例，其中3例为右肺动脉缺如。结论 (1)儿童时期明确诊断的一侧肺动脉缺如多合并有心血管畸形，且左肺动脉缺如多见，成年人明确诊断的单发一侧肺动脉缺如多为右肺动脉缺如。(2)EBCT对先天性一侧肺动脉缺如的诊断有较高的实用价值，较之多普勒超声更为准确，与心血管造影各具独特优势，但EBCT为无创检查是其特点。     

多孔β-TCP/rhBMP-2人工骨在小鼠体内的诱导成骨和早期降解行为的研究

目的 将多孔β—磷酸三钙和重组人的骨形成蛋白—2复合物，植入小鼠肌肉内，观察复合物的骨诱导能力和早期降解行为。方法 将多孔β—磷酸三钙／人骨形成蛋白—2复合物植入25只小鼠右侧大腿后侧肌肉内，单纯多孔β—磷酸三钙植入左侧为对照，分别于72h、1、2、3、4周取材，进行组织学和扫描电镜观察。结果 72h可见幼稚软骨，1周见成熟软骨，2周见编织骨和少量板层骨，3周和4周成熟的板层骨生成，对照组则无骨或软骨生成。2周开始间充质细胞和纤维组织长入材料，3～4周将材料包裹分割，同时可见多核巨细胞反应及吞噬现象，这些是降解早期组织学改变。结论 多孔β—TCP／rhBMP—2复合人工骨显示了良好的生物相容性，有强大的骨诱导能力，有希望作为新型骨移植替代材料用于临床。     

美维松对膈肌功能的影响

目的：研究不同剂量美维松对膈肌和拇收肌的抑制时程与恢复过程。方法：３０例ＡＳＡⅠ级的成年手术患者，按美维松用量分成两组，Ⅰ组：０．１６ｍｇ／ｋｇ，Ⅱ组：０．２０ｍｇ／ｋｇ，每组１５例。同步测定跨膈肌压（Ｐｄｉ）和拇收肌对连续四次刺激（ＴＯＦ）反应的Ｔ１（ＡＰＴ１）及ＴＯＦｒ值。结果：显示两组ＡＰＴ１最大抑制相近，是Ｐｄｉ的１．７倍。Ｐｄｉ达到最大抑制及恢复到７５％的时间比ＡＰＴ１快得多。结论：提示美维松对膈肌收缩功能的抑制比拇收肌差，但恢复迅速。     

rhTPO 对60Co 照射小鼠造血系统影响的研究

目的为了检测ＴＰＯ的体内活性及其对血小板减少的治疗作用，寻找用以治疗辐射及化学药物等所致骨髓损伤造成的血小板减少与缺乏，缓解临床上的出血症状，降低死亡率的一种新途径。方法本实验应用基因工程的方法重组了人的ＴＰＯ，取昆明种正常雄性，经一次５．０Ｇｙ６０Ｃｏγ射线全身照射小白鼠为动物模型，通过对外周血血象的观察，及小鼠骨髓造血祖细胞培养的检测，研究了ｒｈＴＰＯ在体内对６０Ｃｏ全身照射处理小鼠的造血系统的影响。结果实验表明，ｒｈＴＰＯ能够减轻照射对小鼠外周血血小板及骨髓造血祖细胞中巨核系祖细胞的影响，并有促进其早期恢复的作用，且这种作用是量效相关的。结论提示，ＴＰＯ是巨核细胞系统较特异的正调控因子，具有促进巨核细胞增殖发育和刺激血小板生成的作用，是临床治疗骨髓组织损伤引起的血小板减少和缺乏及贫血的有希望的生物治疗药物。     

九十年代中国人群的膳食与营养状况

九十年代中国人群的膳食与营养状况葛可佑，翟风英，闽怀成，程列，王青，贾凤梅（中国预防医学科学院营养与食品卫生研究所，北京１０００５０）人群的膳食营养状况在一定程度上可以反映一个国家的经济发展和社会文明程度。世界上大多数发达国家及若干发展中国家都在有计...