吡格列酮对大鼠创份性脑损伤后炎症因子抑制作用的研究

Objective To observe the effects of peroxisome proliferator activated receptor-γ (PPAR-γ) and its activator pioglitazone on the expression of the inflammatory cytokines after traumatic brain injury (TBI) in rats and explore its mechanism. Methods Adult SD rats were randomized into normal control (n=10), sham-operated (n=10), TBI model (n=12) and pioglitazone treatment (n=12) groups. Impact brain injury was induced in the later two groups and 18 h after the injury, normal saline and pioglitazone at the daily dose of 20 mg/kg were given, respectively. The rats in the sham-operated group received identical treatment to the model group but without TBI. Seven days later, the brain tissue was collected and the cerebral water contents were measured. RT-PCR and Western blot were performed to detect the mRNA and protein expressions of PPAR-γ, regulated upon activation normal T cell expressed and secreted (RANTES) and macrophage migration inhibitory factor (MIF). Results Cerebral water content of the TBI model group was markedly increased as compared with that of the control and sham-operated groups (P<0.05). The expressions of PPAR-γ, RANTES and MIF significantly increased after TBI, and pioglitazone treatment resulted in further activation of PPAR-γ but markedly down-regulated RANTES and MIF expressions (P<0.05). Conclusion Pioglitazone offers protective effect against sustained brain edema and inflammation after TBI possibly by lowering the expressions of such inflammatory cytokines as RANTES and MIF in the brain tissue.     

男性不育与精子凋亡关系的研究

目的探讨男性不育与精子凋亡的关系。方法采用计算机辅助精液分析对正常生育组（n=20）,不育组（n=60）男性进行精液参数检测,瑞-吉染色检测精子凋亡情况。结果在不同人群中精子凋亡均有一定发生率,正常生育组为（3.52±2.11）%,不育组为（18.26±9.34）%,两者差异极显著（P〈0.01）,并且精子凋亡与精子密度、精子活力以及精子正常形态率呈显著负相关（P〈0.05）。结论精子凋亡与男性不育存在着十分密切的关系,精子凋亡增加,可能是少精症、弱精症和畸形精子症患者不育的原因之一。     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

瑞芬太尼联合异丙酚用于无痛人工流产术的安全性和可行性研究

目的观察瑞芬太尼联合异丙酚用于无痛人工流产术的安全性和可行性.方法选择早孕6～10周自愿行人工流产术的孕妇90例,随机分成3组(n=30),瑞芬太尼组(R组),瑞芬太尼 异丙酚组(RP组)和异丙酚组(P组).术中以不同的药物联合及不同的药物剂量静脉输注,并观察受术者的循环、呼吸情况、镇痛效果和不良反应.结果 R组静脉注射瑞芬太尼后,受术者均有不同程度的呼吸抑制,呼气末二氧化碳分压(ETCO2)逐步增高(P＜0.01),血压无明显变化(P＞0.05),心率明显减慢(P＜0.05),术中有6例诉疼痛,5例诉头晕,3例诉肌颤等;RP组受术者给药前、后血压间差别无显著性意义(P＞0.05),而心率和呼吸明显减慢(P＜0.01);P组受术者用药后血压和心率均较用药前显著下降(P＜0.05),均有一过性呼吸暂停,而后逐步出现深大呼吸,潮气量(VT)、呼吸频率(RR)和分钟通气量(MV)显著高于术前水平(P＜0.01),ETCO2 低于术前水平(P＜0.01).3组受术者镇痛效果间差别无显著性意义(P＞0.05).结论单纯瑞芬太尼和异丙酚用于无痛人工流产术镇痛效果较好,但不良反应较多.瑞芬太尼联合异丙酚静脉注射,镇痛效果较好,有协同作用,循环系统稳定,呼吸抑制相对较轻,不良反应少,术后清醒快,其用于无痛人工流产术具有可行性和实用性,但需加强呼吸管理.     

不同浓度七氟醚吸入对患者镇静程度和麻醉深度的影响

目的研究吸入不同浓度七氟醚全麻诱导对患者镇静程度和麻醉深度的影响。方法选择本院60例择期行妇科腹腔镜手术的患者(ASAⅠ-Ⅱ级),采用随机双盲对照方法,研究比较3组患者吸入七氟醚4%(A组)、6%(B组)和8%(C组)浓度的诱导时间、诱导质量、镇静程度和麻醉深度的差异。并记录睫毛反射消失时间、患者入睡时间、不良事件发生率,同时记录患者的平均动脉压(MAP)、心率(HR)、脑电双频谱指数(B IS)、听觉诱发电位指数(AAI)和警觉与镇静评分(OAA/S评分)。结果C组睫毛反射消失时间为(45.5±4.4)s要明显短于A组(78.1±8.3)s和B组(55.2±6.9)s(P<0.05),患者入睡时间C组(93.0±10.7)s也明显快于A组(148.4±13.8)s和B组(102.0±8.9)s(P<0.05)。OAA/S评分为3分时,C组的B IS值为(74.1±3.8),AAI值为(37.2±4.2);C组诱导前后MAP下降和HR增快,且部分患者波动较大(P<0.05)。C组呼吸暂停发生率(30%)要高于A组和B组(P<0.05)。结论单纯吸入七氟醚诱导患者入睡快,临床推荐吸入浓度为6%,其可提供良好的麻醉质量,且血流动力学平稳,不良反应小。     

双料喉风散加鲜蛋清治疗放射性食管炎

在胸部肿瘤放疗中,放射性食管炎经常发生。近年来我科用双料喉生散加鲜蛋清治疗放射性食管炎,取得较好疗效。现报告如下: 1 病例分组 60例放疗中发生放射性食管炎患者随机分为治疗组和对照组各30例。治疗组:双料喉风散1g分十等份,一份加鲜蛋清一个、加强地松10mg(压成粉末)拌匀,早晚各服一次。对照组:氢氧化铝凝胶10ml加强地松10mg,早晚各服一次。     

对本地段内学龄前儿童的预防保健管理

花桥第二社区卫生服务中心覆盖的地段范围有10个社区，根据卫生部六位一体的要求，承担对社区居民的医疗、保健、慢病管理、科普、宣教等任务。现就预防保健方面来归纳总结一下对学龄前儿童的管理。     

立止血在广泛全宫切除术中应用的体会

目的 :观察立止血 (Reptilase ,Re)对广泛全宫切除手术中失血量及用血量的影响。方法 :选择行广泛全宫切除手术病人 30例 ,随机分为两组分别于切皮前 1 0min静注Re2 0 0 0U ,并以Re 1 0 0 0U静脉滴注维持 (R组 ,n =1 5 )及相应给予Re溶剂作空白对照 (C组 ,n=1 5 ) ;记录术中失血量、用血量、应用麻黄素次数及术中、术后血尿发生情况。结果 :R组术中失血量、用血量、应用麻黄素次数及术中、术后血尿发生率均低于C组 (P <0 .0 5～ 0 .0 1 ) ;手术时间也略低于C组。结论 :Re术中应用立止血效果确切 ,能明显减少手术失血量及用血量 ,相应输血并发症降低 ;手术时间也有所缩短 ,值得推广应用     

咪唑安定和/或小剂量芬太尼病人自控镇静的临床研究

目的:探讨咪唑安定病人自控镇静(PCS)的可行性和安全性及比较咪唑安定合用小剂量芬太尼在硬膜外麻醉中PCS的临床效应.方法:50例(ASA Ⅰ～Ⅱ)择期行下腹部手术或下肢手术的病人随机分为两组:组Ⅰ(n＝25),0.05%咪唑安定;组Ⅱ(n＝25),0.05%咪唑安定+0.005%芬太尼,采用Graseby-3 300 PCA泵,选择负荷剂量+PCS(LP模式),其中L:1 ml,P:1 m g/次,锁定时间为1 min.结果:①PCS开始10 min后焦虑程度显著低于术前1天和手术当天的水平,达到了抗焦虑和镇静作用;②两组病人PCS均能达到自己满意的镇静深度,但个体之间存在显著的差异;③硬膜外麻醉期间PCS生命体征基本平稳,组Ⅰ并发症发生率显著高于组Ⅱ,追加芬太尼的人次也显著高于组Ⅱ.结论:PCS是临床给药的一种新方法,咪唑安定在硬膜外麻醉中PCS安全可行,且以合用小剂量芬太尼为佳.     

前列腺摘除术后患者自控镇痛的临床观察

前列腺增生症是男性老年的常见病,病情发展到最后往往需要手术治疗,而术后常伴有刀口痛和膀胱阵发性痉挛痛,以及膀胱冲洗引流渗血较多。患者手术当晚难入睡,常要求肌注止痛剂。我们采用不同配伍的联合镇痛液进行患者自控镇痛(PCA)效应比较,现总结如下。