中药心因性应激反应调节药物研究(Ⅰ)——情可舒胶囊的药理学作用观察

目的 :研究情可舒胶囊的药理学作用。方法 :参照文献相应的药理学方法进行。结果 :情可舒胶囊不影响正常小鼠的探究行为 ,可提高小鼠高空应激条件下的协调运动能力 ,抑制小鼠的隔离性攻击行为和“失望”(不动 )行为 ,提高小鼠的耐缺氧能力 ,增强阈下剂量戊巴比妥钠的催眠作用 ,保护 RWIS对小鼠非特异性免疫功能的损害和对大鼠心肌及胃粘膜的损伤。结论 :情可舒胶囊具有显著的心因性应激反应调节作用 ,是一个较理想的心因性应激反应调节药物。     

N-甲基-D-天门冬氨酸受体及其调控的钙内流在大鼠感染性脑损伤中的变化

为探讨Ｎ－甲基－Ｄ－天门冬氨酸（ＮＭＤＡ）受体及其调控的钙内流在感染性脑损伤发病机制中的作用，采用Ｆｕｒａ－２／Ａｍ荧光法检测大鼠大脑皮质突触体内游离钙浓度（［Ｃａ＋＋］ｉ）。结果表明，注射百日咳杆菌组的［Ｃａ＋＋］ｉ较对照组显著增加（Ｐ均＜０．０１），并与注菌时间呈正相关关系（４小时ｖｓ０．５小时和２４小时ｖｓ４小时，Ｐ＜０．０５和＜０．０１）。ＮＭＤＡ受体的非竞争性拮抗剂ＭＫ－８０１预处理组（ＭＢＰ）的［Ｃａ＋＋］ｉ、脑含水量和伊文思蓝含量均较注菌组显著减少（Ｆ值分别为７２．２５、１６．８９、１４．３６，Ｐ＜０．０１和＜０．０５），并以２４小时［Ｃａ＋＋］ｉ减少最为明显（Ｐ＜０．０１）。提示ＮＭＤＡ受体调控的神经元内钙超载在感染性脑损伤、尤其在迟发性脑损伤的发病机制中起着重要作用。     

家兔急性缺氧后左心室舒张功能和心肌细胞内钙转运及能量代谢的研究

为探讨急性缺氧对家兔左心室舒张功能、心肌细胞内钙转运和能量代谢的影响。将２３只家兔分为对照组（６只）、吸入５％低氧混合气的缺氧１组（Ｈ１）（１２只）、吸入１０％低氧混合气的缺氧２组（Ｈ２）（５只），用心导管法测定左心室压力下降最大速率（ＬＶｄｐ／ｄｔｍａｘ）和压力下降时间常数（Ｔ值）；测定心肌肌浆网（ＳＲ）钙ＡＴＰ酶活性、心肌ＳＲ摄钙量、心肌组织ＡＴＰ和磷酸肌酸（ＣｒＰ）。结果，缺氧后ＬＶｄｐ／ｄｔｍａｘ下降，Ｔ值延长；缺氧组心肌ＳＲ钙ＡＴＰ酶活性及摄钙量下降；心肌线粒体钙含量升高；心肌组织ＡＴＰ和ＣｒＰ下降，心肌组织ＡＴＰ与线粒体钙含量呈负相关。提示，急性缺氧可引起左心室舒张功能障碍并影响心肌ＳＲ钙转运和心肌能量代谢。     

喉癌组织恶性度与颈淋巴结转移关系

采用五因素评点法对４０例喉鳞癌进行组织学和临床方面的研究。结果表明，组织恶性度与Ｔ分期无相关性，浸润方式弥散及恶性度高（评分≥１１）的肿瘤发生颈淋巴结转移率显著高于有完整肿瘤边界者及恶性度低（评分≤１０）者。提示喉癌组织恶性度在预测颈淋巴结转移上有实用价值，可临导临床治疗方案的选择。     

颈静脉球变异与中耳,内耳疾病的关系

由于耳神经外科学及诊断学的发展，人们在实践中逐步认识到颞骨存在一些重要的解剖变异，特别是高分辩CT及MRI技术的应用使得颈静脉球（JB）变异在耳神经外科学和放射影像学研究中引人注目。本文对JB变异的解剖特点、变异类型及临床意义，尤其是与中耳、内耳疾病的关系作一综述。1JB的解剖变异起自颈静脉孔的颈内静脉是乙状窦的直接延续，其第一段逐渐膨胀形成突人鼓室底部的球状物，即JB。在某种意义上，JB也是乙状窦与颈内流脉的结合部，它位于颌骨的颈静脉窝。正常人群中大多数右侧乙状窦与JB比左侧粗，右侧颈静脉孔亦比左侧大。…     

喉全切除发音重建术远期疗效分析

One hundred and twenty-five patients received voice rehabilitation operations following total laryngectomy over the period from August 1977 to December 1994. Among them, 119 were male and 6 were female, the eldest was 70 years old and the youngest 30 years old, and the average age was 55.3 years. Clinical staging was as follows: stage II, 2 cases; stage III, 45 cases; stage IV, 66 cases; and recurrence, 12 cases. The voice rehabilitation operations included pharynx-trachea anastomosis 18 cases and trachea-esophagus fistulization 107 cases. One hundred and fourteen patients were followed-up for 13 months to 18 years. The 3, 5, and 10 year survival rates were 78.2%, 61.4%, and 40.5% respectively. The effective rates of voice rehabilitation according to hearing voice distance were 84.6%, 81.1%, and 67.5% 3 weeks, 1 year, and 5 years respectively after operation. The causes of failure were closure of fistula 15 cases; food aspiration 8 cases and unknown 3 cases. The clinical value, advantages and disadvantages of voice rehabilitation, and the time to evaluate the effect of voice rehabilitation were discussed.     

肿瘤合并颈动脉切除术的探讨

肿瘤固着于颈动脉在临床实践中并非少见，如能将肿瘤与受累动脉一并切除，仍不无救治机会。通过体外或体内对患侧颈动脉压迫训练，促使大脑侧枝循环的建立，并采用脑血管造影或／和经颅多普勒血流检测仪（ＴＣＤ）检测证实合格后，可将肿瘤及受累段颈动脉作整块切除。本文报告１９８７～１９９５年间，我们按上述方法给７位患者施行本术，取得较好的效果，无手术死亡及脑血管并发症。     

扁桃体周脓肿感染途径的探讨

为探讨扁桃体周脓肿的真正发病机理、感染途径，对连续诊治的１３１例扁周脓肿患者进行研究。其中８３例患侧的扁桃体被切除，切除之扁桃体外侧面均平整。通过８３例组织学观察，扁桃体上极表面既无扁桃溃破亦无脓瘘，邻接扁桃体上方之软腭粘膜下发现有感染及／或纤维化的小唾液腺（Ｗｅｂｅｒ腺），这些与扁桃体相邻的腺体在其他非扁周脓肿患者则显示正常形态与结构。从而认为扁桃体周围的化脓性感染可能与Ｗｅｂｅｒ腺有关，而非急性扁桃体炎。主张早期扁桃体切除术治疗扁周脓肿，目的在于获得充分引流。     

Individualizing Hearing Preservation in Acoustic Neuroma Surgery

Surgical series of hearing preservation in acoustic neuroma usually emphasize a team's results with one particular technique. This report reviews acoustic neuroma outcomes of individualizing the surgical approach to patient and tumor characteristics. This study reviews 60 consecutive hearing preservation acoustic neuroma surgeries in a total series of 330 acoustic neuromas. Tumor sizes ranged from 0.3 to 4 cm in patients ranging from 23 to 74 years of age. Middle fossa surgery was performed in 57%, retrosigmoid in 43%. Overall, measurable hearing was preserved in 77%, and useful hearing in 67%. Among middle fossa cases, 85% had measurable and 74% had useful hearing. Among retrosigmoid surgeries, 65% had measurable hearing and 58% had useful hearing. Overall, long-term facial nerve function was excellent (grade I or II) in 90% and poor (grade V or VI) in 2%. There was one case of bacterial meningitis(2%), and cerebrospinal fluid leaks requiring surgery occurred in four patients (7%). The hearing preservation and other outcome parameters in this series compare favorably with other reports. We believe that individualizing the surgical approach to the patient's tumor characteristics and clinical features contributed to the high rate of hearing preservation.     

基础直立倾斜试验对儿童不明原因晕厥的诊断研究

为探讨基础直立倾斜试验对不明原因的晕厥患儿的诊断价值，应用直立倾斜试验（倾斜角度６０度，试验持续时间４５分钟）对４２例不明原因的晕厥患儿进行诊断研究，并以１３名正常小儿作对照。结果：基础直立倾斜试验在不明原因晕厥患儿的阳性率为６７％，对照组阳性率为０。诊断敏感度、特异度及诊断价值分别为６７％、１００％及７４％。阳性反应诱发时间为２２±１２分钟。在２８例阳性反应患儿中，１５例为血管抑制型反应，表现为血压明显下降，心率增快；３例为心脏抑制型反应，表现为心率明显下降，血压不变；１０例为混合型反应，其血压、心率均明显下降。提示：基础直立倾斜试验可较好地、客观地对血管迷走性晕厥进行诊断。