老年长时间嵌顿疝5例手术体会

1.临床资料:5例均为女性,平均年龄65.8岁,平均嵌顿时间128小时。直疝2例,股疝3例。1例伴右侧腹股沟、大腿根部及大阴唇皮肤坏死。5例均经手术治愈出院。 2.手术方法:硬膜外麻醉,先经患侧下腹部直切口进腹腔,在距疝口 5～10cm处切断肠管,近端行肠减压后,端端吻合。再于疝环口周围环形离断腹膜,腹膜后稍行剥离,缝合切口腹膜层,把坏死肠管、疝囊与腹腔隔离。后将变性坏死的疝囊及周围组织彻底切除。     

马来酸麦角新碱联合缩宫素预防宫缩乏力性产后出血的疗效观察

目的 观察马来酸麦角新碱注射液联合缩宫素注射液预防宫缩乏力性产后出血的临床疗效。方法 选取2019年1月-2019年3月就诊于湘乡市人民医院分娩的产妇586例作为研究对象,按照用药情况分为观察组（295例）和对照组（291例）。对照组在胎儿娩出后使用缩宫素注射液,阴道分娩产妇肌肉注射10 IU,剖宫产宫体注射20 IU后;另取缩宫素10 IU加入500 mL葡萄糖溶液中缓慢静滴。观察组在对照组用药基础上使用马来酸麦角新碱注射液,即胎儿娩出后,阴道分娩产妇肌肉注射10 IU缩宫素和0.2 mg麦角新碱,剖宫产宫体注射20 IU缩宫素和0.2 mg麦角新碱后;另取缩宫素10 IU加入500 mL葡萄糖溶液缓慢静滴。观察两组患者产后2 h、24 h出血量及产后出血发生率,比较两组额外止血措施的使用情况及不良反应。结果 治疗后,对照组产后出血发生率为13.4%,观察组为2.7%,两组比较差异有统计学意义（P<0.05）。治疗后,观察组产后2 h、产后24 h出血量均明显少于对照组,差异具有统计学意义（P<0.05）。治疗后,观察组额外使用宫缩剂的比例为8.5%,显著低于对照组的19.2%,差异具有统计学意义（P<0.05）。治疗期间,观察组恶心的发生率为18.0%,高于对照组的13.1%,两组比较差异有统计学意义（P<0.05）。结论 马来酸麦角新碱联合缩宫素对于预防宫缩乏力性产后出血效果显著,且安全性良好。     

温阳益气方对脾肾阳虚型便秘疗效和生存质量的影响

目的:探讨温阳益气方对脾肾阳虚型便秘患者临床症状及生存质量的影响。方法:采用随机、对照的临床试验方法,治疗组和对照组各纳入24例患者,疗程为4周,观察两组治疗前后PAC-QOL积分及症状评分的变化。结果:温阳益气方治疗组总有效率为70.83%,莫沙必利组总有效率为41.60%;两组疗后PAC-QOL积分均较治疗前降低;治疗组在躯体不适、担心与焦虑和满意度3个方面及总分方面与对照组比较,有统计学差异(P<0.05);症状评分比较方面,治疗组各组症状评分均较治疗前下降,有统计学差异(P<0.05);两组治疗后比较,其中治疗组对排便费力程度和排便时间的改善程度优于对照组(P<0.05)。结论:温阳益气方临床治疗脾肾阳虚型便秘有较好的疗效,能明显改善脾肾阳虚型便秘患者临床症状,提高生存质量。     

灌注法构建小肠黏膜全层去细胞外基质

背景：对于解剖层次复杂的细胞外基质,单纯浸泡法则很难达到理想的去细胞效果。 目的：观察灌注法去细胞技术制备小肠黏膜全层去细胞外基质的效果。 方法：采用灌注法去细胞技术,经成年雄性新西兰大白兔小肠黏膜上动脉灌注去离子剂后处理获得小肠 黏膜全层去细胞外基质。采用MTT法检测小肠黏膜全层去细胞外基质浸提液(实验组)或含体积分数20% 小牛血清的DMEM(对照组)与1 月龄新西兰大白兔骨髓间充质干细胞共培养后的细胞相对增殖率。 结果与结论：①大体观察：小肠黏膜上动脉经灌注30 min 后变得苍白透明,经2 h 灌注后肠段变得苍 白剔透,清楚可见脉管纹理。②组织学与扫描电镜观察：灌注法构建的小肠黏膜全层去细胞外基质的去 细胞程度均匀,胶原纤维未受损,孔隙多,孔隙率为(86.72±2.98)%。③MTT 检测实验：培养2,4,7 d, 实验组细胞A 值明显高于对照组细胞A值(P < 0.05),且实验组细胞相对增殖率均>1。表明采用灌注法 构建小肠黏膜全层去细胞外基质可操作性强,安全性好,且小肠黏膜全层去细胞外基质对骨髓间充质干 细胞无毒性,并有一定的促生长作用。     

脑源性多器官功能衰竭

Ｎｅｕｒｏｇｅｎｉｃｍｕｌｔｉｐｌｅｏｒｇａｎｆａｉｌｕｒｅ脑源性多器官功能衰竭是由于脑的急性功能损害后所引起的脑以外２个或２个以上的器官功能衰竭［１］。本病发病机制复杂,死亡率高,但经过治疗在脑功能好转后,受损害的器官也有部分能好转。引起脑源性器官...     

重组沙门菌表达结核分枝杆菌ESAT-6及其特异性免疫应答分析

Objective To determine the immune responses induced by recombinant Salmonella ty-phimurium expressing the secreting antigen ESAT-6 of Mycobacterium tuberculosis. Methods ESAT-6 cod-ing gene was cloned and identified by PCR and sequencing. Prokaryotic expression plasmid pYA33-esat car-rying the ESAT-6 coding sequence was constructed firstly and electro-transformed into an attenuated strain X4550 of Salmonella typhimurium, the recombinant bacteria was named as X4550(33-esat). C57BL/6 mice were immunized intranasally (I. N) with 108 CFU recombinant bacteria at day 0 and 18. Cells from spleen, lung, mesenteric lymph node (MLN) and Peyer's patch (PP) were collected from mice after second immu-nization, and the specific IFN-γ-secreting cells and IL-4-secreting cells were detected by ELISPOT assay u-sing ESAT-6 peptide as stimulus. Furthermore, CTL effects were in vivo evaluated by CFSE assay. Results The results showed that cellular immune responses specific for ESAT-6 could be detected by ELISPOT assay. In lung and PP cells, immune responses against ESAT-6 were biased toward Th1 type, the frequency of IFN-γ-secreting cells was much higher than that of IL-4-secreting cells. In splenocytes and MLN cells, the anti-gen specific immune responses acted as Thl and Th2 balance, the frequency of IFN-γ-secreting cells was close to that of IL-4-secreting cells. CFSE assay indicated that recombinant bacteria could induce the high level of CTL effects specific for ESAT-6 peptide. Conclusion These results suggested that recombinant Sal-monella typhimurium X4550(33-esat) not only can induce cellular immune responses, but also can elicit specific CTL responses after I. N immunization. It also provided the useful information for the control of infec-tious disease of tuberculosis.     

重组沙门菌表达结核分枝杆菌ESAT-6及其特异性免疫应答分析

Objective To determine the immune responses induced by recombinant Salmonella ty-phimurium expressing the secreting antigen ESAT-6 of Mycobacterium tuberculosis. Methods ESAT-6 cod-ing gene was cloned and identified by PCR and sequencing. Prokaryotic expression plasmid pYA33-esat car-rying the ESAT-6 coding sequence was constructed firstly and electro-transformed into an attenuated strain X4550 of Salmonella typhimurium, the recombinant bacteria was named as X4550(33-esat). C57BL/6 mice were immunized intranasally (I. N) with 108 CFU recombinant bacteria at day 0 and 18. Cells from spleen, lung, mesenteric lymph node (MLN) and Peyer's patch (PP) were collected from mice after second immu-nization, and the specific IFN-γ-secreting cells and IL-4-secreting cells were detected by ELISPOT assay u-sing ESAT-6 peptide as stimulus. Furthermore, CTL effects were in vivo evaluated by CFSE assay. Results The results showed that cellular immune responses specific for ESAT-6 could be detected by ELISPOT assay. In lung and PP cells, immune responses against ESAT-6 were biased toward Th1 type, the frequency of IFN-γ-secreting cells was much higher than that of IL-4-secreting cells. In splenocytes and MLN cells, the anti-gen specific immune responses acted as Thl and Th2 balance, the frequency of IFN-γ-secreting cells was close to that of IL-4-secreting cells. CFSE assay indicated that recombinant bacteria could induce the high level of CTL effects specific for ESAT-6 peptide. Conclusion These results suggested that recombinant Sal-monella typhimurium X4550(33-esat) not only can induce cellular immune responses, but also can elicit specific CTL responses after I. N immunization. It also provided the useful information for the control of infec-tious disease of tuberculosis.     

股骨髓腔内止血在全髋关节置换术中的应用

目的探讨股骨髓腔内使用微孔多聚糖止血球止血,对于减少全髋关节置换术失血的安全性和有效性。方法选择初次单侧人工生物型假体全髋关节置换患者90侧。采用抛硬币法随机分为试验组(术中股骨髓腔内止血),对照组(不予股骨髓腔内止血)两组。两组均常规使用氨甲环酸(术前30 min,1g/100 mL静脉滴注,术毕术区灌注0.5 g/50 mL,术后6 h,1g/100 mL,静脉滴注)止血基础上,股骨髓腔内选用微孔多聚糖止血球止血。手术均采用后外侧入路(改良Gibson入路),由同一术者完成。结果术中股骨髓腔内止血组的总出血量、术中出血量、隐性失血量、术后引流量均显著少于对照组,差异有统计学意义(P0.05),两组均无输血患者,均未发生感染,均有一例患者发生深静脉血栓,两组患者术后半年均无假体松动,术后半年患者髋关节功能评分(Harris评分)差异无统计学意义。结论试验表明股骨髓腔使用微孔多聚糖止血球止血,能有效、安全地减少初次单侧人工生物型假体全髋关节置换的出血。     

三种疗法治疗小面积深度烧伤的对比分析

目的探讨小面积深度烧伤应用换药、中厚皮覆盖及皮瓣修复治疗的效果.方法对临床138例小面积深度烧伤患者的治疗方法与结果进行对比分析.结果138例患者全部治愈出院.手术治疗效果明显优于保守换药治疗,其中以局部皮瓣转移效果最佳.结论从病程、伤处瘢痕、外观、功能等方面分析,局部皮瓣转移术是治疗小面积深度烧伤的首选方法,优于手术植皮及换药治疗.