教学医院应重视实习生医患沟通能力的培训

随着医学模式的转变,打破了长期以来在医学实践中以病论病的纯生物模式,要求医生不仅要了解疾病,还要了解病人心理人格特征、社会因素、个体差异,与病人建立和谐、平等、相互依赖的平等关系,才能实现治疗目的,而良好的沟通能力是实现这种关系的重要手段.为将医学生培养成为自信而又善于与人交流的医务人员,我们认为沟通技能方面的教育应成为实习医生综合素质培养的重要内容.     

186例空气灌肠复位治疗小儿肠套叠的X线诊治分析

目的分析小儿乙肠套叠的X线表现，提高空气灌肠复位成功率。方法回顾分析186例小儿急性肠套叠的临床及X线表现，并经灌肠诊断性治疗。结果186例小儿急性肠套叠，空气灌肠复位率85％。肠套叠复位成功率随病程的延长而降低。结论及时发现小儿肠套叠有助于提高空气灌肠治疗小儿急性肠套叠的复位成功率。     

冻存后人脐血DC介导的食管癌细胞瘤苗实验研究

目的：探讨杂交瘤技术制备脐血树突状细胞（DC）和食管癌细胞的融合瘤苗在低温冻存后的生物学特性及特异性CTL活性。方法：分离脐血CD34^＋干细胞诱导扩增为成熟DC，与EC109细胞经聚乙二醇（PEG）法融合；免疫磁珠法筛选EC109-DC；鉴定瘤苗表型；-80℃低温冰箱冻存融合细胞EC109-DC，3周后融冻；观察融冻瘤苗表型及致瘤性；MTT法测定瘤苗诱导淋巴细胞增殖能力及体外特异性免疫应答能力。结果：融冻后疫苗体外半悬浮生长；同时高表达FR和CD80；融冻后瘤苗接种小鼠体内未见肿瘤形成；未冻存和冻存后融合疫苗EC109-DC活化的T淋巴细胞，可产生针对EC109细胞的特异性杀伤作用。结论：冻存未破坏融合疫苗的完整性；融冻后瘤苗无体内致瘤性，安全可靠；-80℃低温冰箱短期冻存对EC109-DC融合疫苗生物学特性及特异的CTL活性无明显影响，可望为DC疫苗提供简单可行的保存方法。     

烧伤与肠内营养

严重烧伤后机体在各种细胞因子、激素作用下呈高代谢状态，病人循环中的儿茶酚胺、糖皮质激素、胰高血糖素及胰岛素水平的改变促进了蛋白水解和脂肪分解，释放出大量的氨基酸、甘油和游离脂肪酸进入全身循环中。由于烧伤引起胰高血糖素、胰岛素相对比的改变，氨基酸被大量消耗于糖原异生，酮体生成下降；而大量增加的游离脂肪酸，最终被肌肉细胞通过环氧合酶和脂肪氧合酶代谢再次被转化为二十烷类复合物。从烧伤后的第一天开始，病人的能量需求达到了生理的极限；有的甚至超过了正常人能量需求的一倍。由于代谢的需求，大量的蛋白质被消耗用来产生整体所需能量；同时由于烧伤创面、消化道蛋白的丢失，这些增进的蛋白需求常引起病人的氮负平衡；BelbaMK等估计严重烧伤病人每天氮的丢失可达到40g，相当于300g的蛋白质；最终导致严重的营养不良。本就近年来这方面的研究成果及肠内营养支持的进展作一综述。     

冻融人脐血树突状细胞瘤苗的生物学特征

目的 利用杂交瘤技术制备脐血树突状细胞和食管癌细胞融合瘤苗,低温冻存,研究冻融后融合瘤苗的生物学特征.方法免疫磁珠法分离脐血CD34 干细胞,多种细胞因子联合诱导扩增为成熟树突状细胞(DC).聚乙二醇(PEG)融合DC与食管癌细胞EC109,免疫磁珠法筛选阳性克隆EC109-DC为融合瘤苗.-80℃低温冻存;流式细胞术鉴定冻融前后融合瘤苗免疫表型;绘制冻融后融合瘤苗生长曲线;四甲基偶氮唑盐(MTT)法测定EC109-DC融合瘤苗诱导T淋巴细胞体外特异性抗肿瘤免疫应答能力. 结果 融冻后融合瘤苗EC109-DC可在体外继续培养成长,高表达CD80、CD83、CD86,增殖活性较新鲜融合瘤苗稍低,但两者相比无统计学意义(P>0.05);融冻后融合瘤苗EC109-DC体外能诱导CTL细胞对EC109食管癌细胞的产生特异杀伤作用,其活性与新鲜融合瘤苗相比,差异无统计学意义(P>0.05). 结论 融冻后融合瘤苗EC109-DC仍保存其刺激免疫细胞活化的分子表型,可望为食管癌-DC融合瘤苗的保存方法提供一定的实验依据.     

异基因造血干细胞移植后急性移植物抗宿主病的诊治

目的：探讨异基因造血干细胞移植后并急性移植物抗宿主病(aGVHD)的特点及有效防治。方法：2例(急性粒细胞白血病、急性粒单细胞白血病各1例)采用改良的马利兰、环磷酰胺方案进行预处理后，输注供者骨髓血或外周血干细胞。1例(慢性粒细胞白血病)予马法兰 阿糖胞苷 环磷酰胺 足叶乙甙方案预处理，回输外周血干细胞。aGVHD的预防均用环胞菌素A、甲氨蝶呤，出现GVHD后加用甲基强的松龙治疗。结果：移植后均获造血重建，发生较为严重的aGVHD2例。结论：联合各种免疫抑制剂，能有效防治GVHD，使患者获得长期造血重建。     

国产恩丹西酮和枢复宁预防白血病化疗消化道反应的疗效及成本—效？…

了解国产恩丹西酮预防白血病化疗消化道反应的疗效及恩丹西酮同枢复宁成本－效益的比较。方法１０例能坚持化疗的小儿白血病患者,各使用恩丹西酮和枢复宁预防消化道反应１３０例次,比较两者的疗铲及治疗成本。结果恩丹西酮和枢复宁预防白血病人化疗哎吐的有效率分别是９４．６２％和９６．１５％,预防恶性的有效率分别是８５．４％和８６．９％,两者的有效无显著性差异。使用恩丹西酮的成本－效益优于枢复宁,次有效费用降低３４     

吸入性损伤犬部分液体通气后一氧化氮含量的改变

部分液体通气 (ＰＬＶ)用于治疗急性肺损伤、成人或新生儿呼吸窘迫综合征 ,能改善氧分压和肺顺应性 ,国外已用于Ⅱ、Ⅲ期临床试验[1] 。本研究以吸入性损伤犬为模型 ,观察部分液体通气后其体内一氧化氮 (ＮＯ)含量的改变。材　料　与　方　法健康杂种犬 12条 ,体重 (10 .0 0± 1.0 5 )ｋｇ ,雌雄不拘 ,随机分为治疗组和对照组 ,每组 6条。质量浓度 30 ｇ/Ｌ戊巴比妥静脉麻醉 (1ｍｌ/ｋｇ) ,取仰卧位 ,气管插管 ,接呼吸机 (美国Ｂｉｒｄ 84 0 0型 )。按文献 [2 ]制作蒸气吸入性损伤犬模型。伤后 1ｈ ,给氧浓度调整为 0 .6 0并保持恒定。伤后 …     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.