固真方对~(60)Coγ射线照射大鼠神经内分泌及免疫系统的调节作用

作者以６．８Ｇｙ（６０）Ｃｏγ射线一次全身照射的大鼠为研究对象，以四君子汤作为对照，同步观察了（６０）Ｃｏγ射线照射后的大鼠下丘脑单胺类神经递质及其代谢产物的含量，血清促黄体生成激素，雌二醇、睾酮、血浆β－内啡肽和脾淋巴细胞免疫功能等方面的变化以及由首乌，肉苁蓉等补肾中药组成的固真方对这些变化的影响．结果发现：（６０）Ｃｏγ射线照射以后大鼠下丘脑单胺类神经递质及其代谢产物发生紊乱；血浆β－内啡肽浓度持续性增高；下丘脑－垂体－性腺轴功能亢进，脾淋巴细胞免疫功能低下，而固真方能不同程度地改善上述老年性改变．     

神经外科手术患者芬太尼-异丙酚-琥珀胆碱麻醉诱导时颅内压的变化

目的 评价神经外科手术患者芬太尼-异丙酚-琥珀胆碱麻醉诱导时颅内压（ICP）的变化。方法择期神经外科手术患者20例，采用硬膜外间隙穿刺针于L3.4或L2.3椎间隙行蛛网膜下腔穿刺，监测脑脊液压力（CSFP）。麻醉诱导时，静脉注射芬太尼2～3μg／kg，5min后以50mg／min静脉注射异丙酚2mg／kg，3min后静脉注射琥珀胆碱1．5mg／kg，达满意肌松后气管插管。记录麻醉诱导前（基础值）、注射芬太尼后5min、注射异丙酚后1、2、3min、肌颤时和气管插管后即刻CSFP。结果与基础值相比，注射异丙酚后1、2、3min及肌颤时CSFP均降低（P〈0．05），气管插管后即刻CSFP差异无统计学意义（P〉0．05）。结论神经外科手术患者芬太尼-异丙酚-琥珀胆碱麻醉诱导可降低ICP，且可避免气管插管引起的ICP升高。     

床旁临时起搏器作为AMI的常备急救设备及其在基层医院推广应用研究

目的 床旁临时起搏器作为急性心肌梗死（AMI）的常备急救设备的价值及其在基层医院推广应用的可行性研究。方法 回顾性研究分析2001-2003年间不能床旁植入临时起搏器与2004-2005年能床旁植入临床起搏器抢救AMI的住院病死率、心衰、心源性休克、2mo后再次住院发生率。临时起搏器植入术安全性的指标比较。结果 不能床旁植入临时起搏器组的住院病死率为14．58％，心衰发生率为27．08％，心源性休克发生率为12．5％，2mo后再次住院发生率为16．67％。床旁植入临时起搏器组的住院病死率为3．57％，心衰发生率为7．14％，心源性休克发生率为3．57％，2mo后再次住院发生率为3．57％，两组相比p〈0．01有显著性差异。而起搏器植入的安全性指标：起搏器植入成功率为100％，脱位率为10．7％，并发症发生率为14.3％，住院病死率3．57％。结论 床旁临时起搏器抢救AMI住院病死率低，心衰发生率、心源性休克发生率及2mo后再次住院发生率低，应作为AMI抢救的常备急救设备，另外床旁临时起搏器植入是安全的、有效的，成功率高，操作不难，在基层医院（二甲医院）可推广应用。     

我院2000-2004年医院感染革兰阴性杆菌耐药性趋势的研究

[目的]了解2000年～2004年院内感染革兰阴性杆菌分布及其耐药性。[方法]主要使用MicroScan-4微生物鉴定及药敏仪对2000年1月～2004年12月引起院内感染革兰阴性杆菌进行鉴定及药物敏感试验，结果录入Whonet5．3软件进行分析、统计。[结果]5年间，革兰阴性杆菌所致医院感染中，大肠埃希菌比例最高，在32．8％～38．1％之间，阴沟肠杆菌、不动杆菌比例呈上升趋势。细菌的耐药率在逐年上升，其中阴沟肠杆菌和鲍曼不动杆菌，耐药性高于其它革兰阴性杆菌（P〈0．05），对第三代头孢菌素耐药率分别达到60％～80％、40％～70％。对亚胺培南耐药的菌株日益增多。[结论]细菌的耐药性逐渐增强，阴沟肠杆菌、鲍曼不动杆菌成为非常重要的医院感染病原菌，医务工作者要重视医院感染，加强耐药性监测，合理使用抗生素。     

新生儿白细胞介素2、γ干扰素水平的研究

通过检测15例正常新生儿、8例早产儿和33例患病新生儿(13例患非感染性疾病,20例患感染性疾病)的白细胞介素2(IL-2)和γ干扰素(IFNγ)水平。并比较两者间的关系。结果发现新生儿IL-2、IFNγ的产生能力较正常成人降低,早产儿降低更明显;感染性疾病能使新生儿IL-2、IFNγ的产生减少,而非感染性疾病对之无明显影响;各组的IL-2和IFNγ同有明显的相关关系。提示评价新生儿的免疫状态应结合淋巴因子水平的测定,临床上对严重感染性疾病的治疗试用IL-2和IFNγ有潜在的重要作用。     

人胎黑质细胞的冷冻保存

采用台盼蓝染色法，观察了第３～６月人胎黑质细胞冷冻保存的细胞存活率，结果：①胎龄３～６月人胎黑质细胞冷冻保存后均可存活，但以胎龄３和４月细胞存活率较高。②液氮保存的细胞存活率不受保存时间的影响，而４℃保存的细胞存活率随保存时间的延长而逐渐降低。结果提示，液氮保存人胎黑质细胞的保存条件以胎龄３和４月为宜。     

晕得宁毒性的实验研究

晕得宁为复方中药制剂,济宁市第一人民医院耳科用于治疗美尼尔氏病疗效良好,我室对此方剂进行了毒理学研究。急性毒性实验表明,小鼠一次灌胃量达人用量的200倍(n=10),观察72小时,未见异常表现及死亡。亚急性毒性实验:实验组12只家兔(分成大、中、小剂量三组),连续给药三周,其观察指标包括体重、血常规、肝功(GPT)和肾功(BUN),与对照组(n=4)相比,均无异常(P>0.05);病理检查10兔正常,另2兔患有肺炎。其中1只病兔属大剂量组,于给药第20～21天出现腹泻并死亡,可能与方剂组成中半夏的毒性有关。作者认为晕得宁的毒性较小;鉴于半夏有毒,临床用药宜避免大剂量、长期应用。     

丁二酸酐交联羟基超支化聚(胺-酯)的反应及其交联膜的性质

以丁二酸酐(SA)为交联剂研究了端羟基超支化聚(胺-酯)(HPAE)的交联反应和交联膜的制备。结果表明:SA与HPAE的交联反应分为两个阶段,可以采用溶液法低温涂膜及高温交联得到HPAE/SA交联膜;改变SA的用量可控制膜的交联度,HPAE/SA交联膜的拉伸强度随SA用量的增大而提高,最高可达59.60 M Pa,膜表面的水接触角小于74.3°。     

正常人在静态和运动状态下"死腔/潮气"估测值和实测值的比较

目的研究正常人静态及运动状态下死腔/潮气(VD/VT)估测值和实测值的关系.方法23名受试者行心肺运动试验,同步实时测定摄氧量和二氧化碳排出量,分别在运动前及运动高峰时抽取动脉血,根据Bohr的公式,得出VD/VT实测值,同时再用呼气末CO2分压(PetCO2)代替PaCO2,计算VD/VT,得出VD/VT估测值.结果根据病史、体检、肺功能和运动前后的心电图判断23名受试者均为正常受试者.静态时的VD/VT估测值和VD/VT实测值分别为0.359±0.109和0.354±O.106,两者无显著性差异(P=0.710),相关分析显示两者高度相关(r=0.911,P＜0.001).运动高峰时的VD/VT估测值和VD/VT实测值分别为0.234±0.070和0.248±0.094,两者无显著性差异(P=0.748),相关分析表明两者显著相关(r=0.783,P＜0.001).与静态时比较,运动时估测和实测VD/VT均明显下降.结论对于正常成人,无论是在静态或最大运动状态下,可用无创方法计算VD/VT代替VD/VT实测值.     

The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy.

BACKGROUND AND PURPOSE: The potential risk of prolongation of treatment time in cervical cancer has been reported for many low-dose rate (LDR) studies, with an estimated loss of local control ranging from 0.3 to 1.6% per day of treatment prolongation. Since the treatment schedule for fractionated high-dose rate intracavitary brachytherapy (HDRICB) is not directly comparable with that for low-dose rate studies, this report aims to evaluate the adverse effect of treatment prolongation specifically for cervical cancer treated with HDRICB. MATERIAL AND METHODS: From September 1992 to December 1997, 257 patients diagnosed with uterine cervical cancer (35 Ib, 26 IIa, 122 IIb, 10 IIIa, 57 IIIb, 7 IVa), who underwent external radiotherapy combined with between two and four courses of HDRICB and a minimum of 3 years of follow-up (median 57 months), were analyzed. Treatment consisted of irradiation of the whole pelvis with 44-45 Gy consisting of 22-25 fractions by 5 weeks, with the dose boosted to 54-58 Gy (with central shielding) for patients diagnosed as FIGO stage IIb-IVa bilateral parametrial disease. HDRICB was performed using an Ir-192 remote afterloading technique at 1-week intervals. The standard prescribed dose for each course of HDRICB was 7.2 Gy to point A for three insertions (before July 1995), or 6.0 Gy to point A for four insertions (after July 1995). Total prescribed point A doses (external beam radiotherapy+HDRICB) ranged from 58 to 71.6 Gy (median, 65.6 Gy) for stage IB-IIA, while analogous dosage for larger lesions (stage IIb-IVa) ranged from 59 to 75.6 Gy (median, 65.6 Gy). Kaplan-Meier and multivariate analyses were used to test the effect of treatment time on pelvic control rate (PCR) and cause-specific survival (CSS) at 5 years. RESULTS: Median treatment time was 63 days. For all stages of disease, the 5-year CSS and PCR were significantly different comparing treatment times of less than and greater than or equal to 63 days [83% and 65% (P=0.004], 93% and 83% (P=0.02), respectively]. These associations were also significant for stage Ib/IIa [97% and 79% (P=0.01), and 100% and 87% (P=0.02), respectively), but not for stage IIb [75% and 72% (P=0.79), and 93% and 87% (P=0.83), respectively] or stage III [66% and 49% (P=0.2), and 83% and 72% (P=0.21), respectively]. Multivariate analysis identified three prognostic factors for CSS, stage (P<0.001), tumor response to external RT (P=0.001), and overall treatment time (OTT; P=0.006). Prognostic factors for pelvic failure were stage (P<0.001), tumor response to external RT (P=0.001), and OTT (P=0.03). Prolongation of treatment time resulted in a daily decrease in pelvic control rate of 0.67% overall, and 0.43% for stage Ib-IIa, 0.57% for stage IIb, and 0.73% for stage III patients. CONCLUSION: Analysis of the data from the current study demonstrates that the adverse effect of treatment prolongation was observed later in the treatment course for the high-dose rate (HDR) series compared to the LDR analog, however, treatment-time prolongation still negatively influenced the cause-specific survival and pelvic control rate for both dosage groups.