不同年龄组严重多发性创伤的病情特点与转归分析

目的 探讨不同年龄组严重多发伤患者的病情和预后特点，为进一步提高救治水平提供经验。方法回顾最近3a急诊ICU收治的年龄〉18周岁、创伤严重度评分（ISS）≥16分、ICU住院时间〉24h的146例严重多发伤患者的资料。根据年龄分为老年（≥60岁）、中年（40～59岁）和青年（18～39岁）三组，比较各组的一般情况、损伤严重度、急诊手术、继发感染、脏器功能不全、呼吸机使用时间、ICU住院时间和最终预后；比较各组治愈出院者的上述指标。结果各组的一般情况、致伤原因、损伤程度、急诊手术情况差异无显著性，但老年组的APACHEⅢ评分明显高于另两组；老年组入院24h的心率、中性粒细胞绝对值和动脉血氧分压低于另两组；各组继发感染、脏器功能不全、呼吸机使用时间、ICU住院时间比较差异无显著性，年龄越轻，预后越好；治愈出院者中以青年组损伤和病情最为严重。结论创伤时机体的影响随年龄增加而加重，预后明显变差，要特别重视老年创伤的救治，有必要建立专门的创伤救治体系。     

Prevalence of hypertension among schoolchildren aged 13-18 years in Gemlik, Turkey

Arterial hypertension is the permanent elevation of blood pressure(BP). Previous studies have documented that hypertension maybegin in adolescence, perhaps even in childhood. The purposeof this study was to determine the prevalence of hypertensionamong adolescents in the Gemlik Research and Training Area,Turkey. Between January and March 1994, all secondary and highschool students aged 13–18 years were included in thisstudy. An elevated BP was defined according to the Report ofthe Second Task Force on Blood Pressure Control in Children.Of the 3,641 students screened, 262 (7.2%) had elevated systolicand/or diastolic BP, 161 (4.4%) students had significant hypertensionand 101 (2.8%) students had severe hypertension. We found thatsystolic and diastolic BP increased with age, height and weight.BP measurements should be included in physical examinationsas part of the continuing care of the child.     

β3肾上腺素能受体阻断剂对扩张型心肌病大鼠心功能的影响

目的研究选择性β_3肾上腺素能受体(β_3-AR)阻断剂SR59230A对扩张型心肌病大鼠心功能的影响。方法雄性Wistar大鼠72只,随机取14只分为对照组(Nor-C)和用药组(Nor-T),每组7只。其余大鼠应用异丙基肾上腺素制备心力衰竭(简称心衰)模型后,存活大鼠随机分为心衰组(HF-C,8只)和心衰用药组(HF-T,9只)。Nor-T组与HF-T组给予2 mmol/L的SR59230A 0.3 ml尾静脉注射,Nor-C组与HF-C组给予同等剂量生理盐水。血流动力学指标测定后,留取左心室心肌组织,测定内皮源性一氧化氮合酶(eNOS)mRNA、β_3-AR蛋白表达以及cGMP水平。结果Nor-T组与Nor-C组比较,大鼠左心室压力最大上升速率(dp/dt_(max))及左心室压力最大下降速率(dp/dt_(min))绝对值显著增高(P<0.05);左心室收缩末期压力(P_(ES))有上升趋势,左心室舒张末期压力(P_(ED))有下降趋势,但差异无统计学意义(P>0.05);左心室等容舒张时间常数(Tc)显著缩短(P<0.05)。HF-T组较HF-C组dp/dt_(max)、dp/dt_(min)绝对值及P_(ES)显著升高(P<0.05或<0.01);而P_(ED)、Tc则明显减低(P<0.05)。HF-C组与Nor-C组比较,eNOS mRNA及β_3-AR蛋白表达显著增加(P<0.01);而Nor-T组与Nor-C组、HF-T组与HF-C组间差异无统计学意义(P>0.05)。HF-C组较Nor-C组心肌cGMP水平显著增加(P<0.01);Nor-T组与HF-T组cGMP水平分别低于Nor-C组与HF-C组(P<0.05或<0.01)。结论①β_3-AR阻断剂SR59230A可以改善大鼠心功能,尤其以心衰大鼠为著;②心衰时β_3-AR、eNOS表达增加,心肌cGMP水平增高;③β_3-AR阻断剂改善心功能的作用机制主要是通过抑制cGMP水平实现的。     

葛根素对子痫前期大鼠脑保护作用

目的探讨葛根素(puerarin)对子痫前期孕鼠脑保护作用及机制。方法将30只孕鼠随机分为:空白(control)、模型(model),低、高剂量预防组(LDP,HDP),低、高剂量治疗组(LDT,HDT)。皮下注射亚硝基左旋精氨酸甲酯(L-NAME)建模。质谱分析仪测定血清叶酸(FA)浓度,硝酸还原本酶法测定血一氧化氮(NO)浓度,血液流变仪测量血液粘度;取额叶皮质,免疫组化检测核转录因子(NF-κβ)活化;末端脱氧核酰转移酶介导的脱氧尿苷三磷酸/4',6-二脒基-2-苯基吲哚(TUNEL/DAPI)双染法检测神经元凋亡。结果治疗组较模型组血浆FA、NO浓度、血液粘度、NF-κβ活化存在差异,神经细胞凋亡显著减轻(P0.05)。结论葛根素对子痫前期大鼠有明显的脑保护作用。     

Evaluation of shigellosis in a Turkish children''s hospital

BACKGROUND: The aim of the present study was to evaluate cases of Shigella and determine the pattern of antimicrobial resistance of shigella species in central Turkey. METHODS AND RESULTS: One hundred and ninety-eight patients with shigella gastroenteritis presenting to Sami Ulus Children's Hospital from June 2002 to December 2002 were included in the study. The clinical and laboratory data of the patients with shigellosis were collected by chart review. Male/female ratio was 1.35 and mean age was 4.83 +/- 3.2 years (range: 1-16 years). Shigella sonnei (83.3%) was the most common serogroup. This was followed by S. flexneri (10.1%), then S. dysenteria (5.1%), and S. boydii (1.5%). The antibiotic susceptibility of the shigella strains was determined. Most strains of Shigella species were resistant to trimethoprim-sulfamethoxazole (90.4%). All strains were found to be sensitive to ciprofloxacin (100%). Ampicillin susceptibility was 86.4% and cefotaxim (and/or ceftriaxon) susceptibility was 98%. CONCLUSION: Ampicillin is the drug of choice in the treatment of shigella infection in this region of Turkey. Cefotaxim or ceftriaxon was the second choice of antibiotics. Thus, Shigella is an important etiologic agent of diarrhea in Turkey. To determine the antibiotic susceptibility of the Shigella strains and appropriate empiric antibiotic treatment in Turkey, further studies will be needed.     

脂多糖与阿司匹林对应激所致大鼠行为性抑郁的对照研究

目的观察阿司匹林及细菌脂多糖对大鼠应激所致的行为性抑郁影响。方法将72只SD雄性大鼠随机分为对照组和应激组。应激组大鼠在16d内接受小同类型的应激，制备应激性抑郁症模型。采用开场试验检测大鼠的行为性抑郁，用甲基噻唑基四唑比色法测定淋巴细胞转化。结果慢性应激大鼠从第7～14天出现总活动路程、总活动时间和中区活动时间减少，呈现明显的行为性抑郁。腹腔注射细菌脂多糖(100μg／kg)可加重应激引起的行为性抑郁，并加强应激大鼠血清对正常淋巴细胞转化的抑制作用，导致正常大鼠的总活动路程显著缩短。阿司匹林(50mg／kg)对正常大鼠无显著性影响，但可减轻大鼠的行为性抑郁和应激大鼠血清对正常淋巴细胞转化的抑制作用。结论腹腔注射细菌脂多糖加重应激大鼠的行为性抑郁，阿司匹林可减轻大鼠的行为性抑郁。     

多排螺旋CT对十二指肠恶性肿瘤的诊断价值

目的 探讨多排螺旋CT表现对十二指肠恶性肿瘤的诊断价值.方法 回顾性分析54例经病理证实的原发性十二指肠恶性肿瘤的多排螺旋CT表现.结果 54例十二指肠恶性肿瘤中,49例腺癌、4例间质瘤和1例淋巴瘤.多排螺旋CT表现为息肉或小结节影（63%）、肠壁不规则增厚强化（22.2%）、较大软组织肿块（14.8%）.出现周围组织侵犯的9.2%,出现远处转移的3.7%.结论 多排螺旋CT与后期三维重建对十二指肠恶性肿瘤有很好的诊断作用.     

右美托咪啶对七氟醚麻醉患儿麻醉恢复期躁动的影响

Objective To investigate the effect of dexmedetomidine on agitation during recovery from sevoflurane anesthesia in children. Methods Three hundred ASA Ⅰ or Ⅱ children, aged 4-7 yr, weighing 16-30kg, scheduled for elective ear-nose-throat operation under general anesthesia, were randomly divided into 2 groups ( n = 150 each) : control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine 0.5 μg/kg in 20 ml was infused intravenously over 10 min before anesthesia induction in group D, while equal volume of normal Saline was infused in group C. Anesthesia was induced with inhalation of 8 % sevoflurane 5 min after the end of administration . The children were tracheal incubated and mechanically ventilated. Anesthesia was maintained with inhalation of 2 % -3 % sevoflurane. BIS was maintained at 40-60 during operation. The recovery time and agitation within 2 h after operation were recorded. Results There was no significant difference in the recovery time between the two groups ( P > 0.05) . The incidence of agitation was significantly lower in group D than in group C ( P <0.05 ) . Conclusion Dexmedetomidine can reduce the occurrence of agitation during recovery from sevoflurane anesthesia in children.     

CT和MRI对鼻咽癌T分期比较研究

目的：比较592例鼻咽癌患者的CT、MRI资料，探讨MRI及CT对鼻咽癌92福州分期和02UICC／AJCC分期的不同影响。方法：分析592例治疗前进行CT／MRI检查并经病理证实为鼻咽癌的患者。比较MRI和CT检查的差异性所导致分期不同。结果：MRI分期结果较CT晚，92福州分期CT中T1＋T2比例达59．4％，MRI中为39．9％（P=0．000）；02UICC／AJCC分期中T1＋T2比例达61．0％，MRI中为46．6％（P=0．001）。两种分期相比，92分期T4期比例为32．4％，02UICC／AJCC分期T4期比例为22．0％（P=0．001）。结论：较CT对鼻咽癌T分期的诊断具有优越性，92分期和02UICC／AJCC分期在T分期上差异不大。