小剂量肝素静滴治疗慢性喘息型支气管炎40例疗效观察

近期我科采用小剂量肝素静滴治疗慢性喘息型支气管炎急性发作 ,获得满意效果 ,报告如下。资料与方法 :本组 4 0例慢性喘息型支气管炎急性发作患者 (全国慢性支气管炎临床专业会议 ,广州 ,1997) ,男 2 4例 ,女 16例 ,年龄 2 3～ 78岁。将其分为治疗组与对照组 ,每组 2 0例。全部病例均有慢性咳嗽、咳痰、喘息等症状 ,听诊肺部有哮鸣音。两组采用吸氧、纠正酸碱及水电解质失衡 ,抗感染、氨茶碱解痉平喘、保持气道通畅等综合疗法。治疗组在此基础上给予肝素钠每次 1mg/ kg加入生理盐水 10 0 ml静滴 ,每日 1次 ,1～ 2小时滴完 ,疗程 3～ 7天 ,用…     

Protective effects of erythropoietin on endotoxin-related organ injury in rats

Summary： The protective effect of erythropoietin （EPO） on tissues following ischemia and reperfusion injuries remains poorly understood. We aimed to investigate the effect of EPO in preventing en- dotoxin-induced organ damage. Rat model of multiple organ failure （MOF） was established by tail vein injection of 10 mg/kg lipopolysaccharide （LPS）. Recombinant human EPO treatment （5000 U/kg） was administered by tail vein injection at 30 min after LPS challenge. Twenty-four h after EPO treatment, changes in serum enzyme levels, including aspartate aminotransferase （AST）, alanine transaminase （ALT）, blood urea nitrogen （BUN） and creatinine （Cr）, were evaluated by biochemical analysis. Serum levels of tumor necrosis factor-tx （TNF-ct） were determined by using immunoradiometric assay. Histological examination of tissue sections was carried out by hematoxylin and eosin staining, while ul- trastructure evaluation of organ tissues was assessed by transmission electron microscopy. Protein ex- pression levels were detected by using Western blotting. EPO treatment showed a modest effect in pre- venting LPS-induced elevation of AST, ALT, BUN, Cr, and TNF-ct levels, and in protecting against LPS-induced tissue degeneration and injured ultrastructure in the lung, liver, and kidney. Moreover, LPS promoted phosphorylation of alanine aminotransferase （AKT） and increased nuclear factor-r,B （NF-rB） activation in the lung, liver, and kidney （P〈0.05 vs. control）. However, EPO treatment significantly de- creased the LPS-induced pAKT up-regulation in these tissues （P〈0.05 vs. LPS treatment alone）. The present study demonstrates that EPO may play a protective role against LPS-induced MOF by reducing the inflammatory response and tissue degeneration, possibly via the phosphatidylinositol 3-kinase/AKT and NF-r,B signaling pathways.     

Decreased Number of CD14+TLR4+ Monocytes and Their Impaired Cytokine Responses to Lipopolysaccharide in Patients with Chronic Kidney Disease

This study aimed to examine the number of circulating Toll-like receptor 4(TLR4) + CD14+ monocytes in patients with different stages of chronic kidney disease(CKD), their responses to lipopolysaccharide(LPS), and to explore the potential association of the number of TLR4+CD14+ monocytes with clinical laboratory measures. The numbers of TLR4+CD14+, LPS-stimulated TNF-?+CD14+ and interleukin(IL)-6+CD14+ monocytes were determined by flow cytometry in 9 patients with stage 3 CKD, 11 with stage 4 CKD, 16 with stage 5 CKD, and 19 healthy controls(HCs). Their laboratory tests were performed by routine methods and the potential association among these measures was analyzed by Pearson’s correlation analysis. The numbers of CD14+, CD14+TLR4+, LPSstimulated TNF-?+CD14+ and IL-6+CD14+ monocytes in patients with CKD were significantly less than those of HCs(all P<0.05), and were negatively associated with patient disease severity. The number of CD14+TLR4+ monocytes was positively correlated with estimated glomerular filtration rate(e GFR, P<0.001) and the levels of hematocrit(P<0.01), but negatively correlated with the levels of blood urine nitrogen, serum creatinine, and C-reactive protein(P<0.001 for all), in the CKD patients. Our data indicate that significant reduction in the number of TLR4+ monocytes and their impaired responses to LPS may be associated with the progression of CKD in Chinese patients.     

老年糖尿病患者血清果糖胺、血糖的变化及临床意义

目的 探讨老年糖尿病(DM)患者血清果糖胺(Fructosamine，FTS)和血糖(GLU)的变化及临床意义。方法 对68例老年DM患者及30例健康老年人血清中FTS和GLU水平进行检测。结果 老年DM患者血清中FTS和GLU明显高于正常对照组(P＜0．01)，血清FTS的水平与过去一段时间内GLU的平均水平成正比，不受瞬间血糖波动的影响。结论 FTS可以反映一段时间内老年DM患者血糖的平均水平，较GLU更有其稳定性，检测其变化，对DM的诊断、监控和管理有一定的意义。     

新生儿缺氧缺血性脑病rCBF显像分级诊断与预后研究

目的：通过预后探讨局部脑血流（rCBF）断层显像分级论断新生儿缺氧缺血性脑病（HIE）的临床价值。方法：对32例HIE患儿行rCBF显像，根据放射性分布情况将显像结果分为0、I、Ⅱ、Ⅲ级；随访全部对照3－6年，正常记0分，有癫痫表现记1分，智力低下记2分，脑瘫记3分；将各级得分进行比较。结果：HIE并发症发生率为25％（8／32），Ⅲ级平均得分（0．5分）明显高于0（0分）、I（0．07分）、Ⅱ（0．5分）级（t=5.89、10.82、4．27，P＜0．01），I、Ⅱ级间差异有显著性（t=2.79,P＜0．05）。结论：rCBF显像能客观反映HIE的严重程度，有较高的预后预测价值，可作为临床分度诊断的标准之一。     

胫前伤口的观察与护理体会

目的观察胫前伤口的愈合情况及护理体会。方法收集门诊诊治的240例胫前伤口患者,分别进行彻底清创、抗感染、换药、植皮或理疗等处理,同时治疗合并症。结果148例14天左右痊愈,86例在40～150天后逐渐愈合,但仍有6例通过植皮才好转。结论早期彻底清创、抗感染、换药、理疗及处理相应合并症可促进伤口的愈合。     

楔状缺损充填术后调治疗的临床观察

目前,力对楔状缺损形成所引起的作用已逐渐被人们认识[1~3],但充填术后对患牙进行调处理,以去除楔状缺损的主要致病因素,是否会减少充填失败率,缺少临床观察。作者自2001年来对200颗患牙充填后进行对比观察,现报告如下。1临床资料1.1一般资料患者男26例,女24例,年龄50~60岁,牙列完整,无缺失牙,咬关系良好,无偏侧咀嚼。牙磨损严重,无牙周疾患。选择楔状缺损位于釉牙骨质界的作为观察对象,选择的患牙缺损一般深约1mm,龈向宽度约2mm。每位患者选择4颗患牙,其中2颗作为调磨组,另外2颗作为对照组。1.2充填方法用95%的酒精小棉球先清洗楔…     

Differences in pathological characteristics and laboratory indicators in adult and pediatric patients with Henoch-Schönlein purpura nephritis

We aimed to investigate the differences in renal histopathological changes and laboratory parameters between adult and pediatric patients with Henoch-Schönlein purpura nephritis (HSPN), and to analyze the correlation between laboratory parameters and renal histopathological grading. A total of 139 patients diagnosed with HSPN between September 2010 and December 2014 at the First Hospital of Jilin University, China, were retrospectively reviewed. The clinical and pathological characteristics were examined and compared between the adult and the pediatric patients. A majority of adult (75.0%) and pediatric (66.2%) patients were categorized as pathological grade III HSPN. Adults having crescent lesions, interstitial fibrosis and renal artery involvement significantly outnumbered child counterparts (all P<0.05). Pathological grading showed a positive correlation with 24-h urine protein (r=0.307, P=0.009), microalbuminuria (r=0.266, P=0.000) and serum globulin (r=0.307, P=0.014), and a negative correlation with serum albumin (r=0.249, P=0.037) in pediatric patients with HSPN. Among adult patients with HSPN, histopathological grading showed a positive correlation with 24-h urine protein (r=0.294, P=0.015), microalbuminuria (r=0.352, P=0.006), α1-microglobulin (r=0.311, P=0.019) and immunoglobulin G (r=0.301, P=0.023) in urine, and serum creatinine (r=0.292, P=0.018). Further, a negative correlation between serum albumin and pathological grading was also observed (r=0.291, P=0.018). In conclusion, the severity of renal pathological lesions in HSPN patients is well reflected by the levels of proteinuria. Adult patients have more severe renal histopathological changes than pediatric patients.     

乌司他丁对全身炎症反应综合征大鼠肺脏的保护作用

对比研究乌司他丁（UTI）对全身炎症反应综合征（SIRS）大鼠血清及肺组织中炎症因子的影响，探讨其对肺脏的保护作用。     

脂肪栓塞综合征9例临床分析

脂肪栓塞综合征（Fatembclismsyn4rome，FES）是创伤尤其是长骨骨折或骨盆骨折的严重并发症。其生理病理复杂，发病机理尚未完全明了。临床上主要表现为呼吸困难、意识障碍。治疗上重点是呼吸支持、改善呼吸功能，早期诊断，及时救治。FES发病率虽然不高，但病情重，死亡率高，故对其应引起足够的重视。我院自1993年《月～1995年8月收治9例此病患者，现将临床诊治经验报告如下。1临床资料FES患者9例，均为男性，年龄ZI岁～58岁，7例为车祸所致外伤，1例为坠楼后外伤，1例为打伤。8例为股骨骨折，l例为骨盆骨折。9例中有6例合并胜排骨骨…