重症胆管炎23例临床治疗分析

目的：探讨急性重症胆管炎患者的手术时机和死亡原因。方法：回顾性分析23例急性重症胆管炎患者的治疗及预后情况。结果：死亡2例（手术死亡及传统治疗死亡各1例）。早期大剂量短期应用糖皮质激素患者休克得到纠正率85％，明显高于未用糖皮质激素患者休克纠正率50％。结论：急性重症胆管炎患者应在出现休克和（或）精神症状之前手术，对已出现休克的患者，应先给予充分的保守治疗，待病情稳定后再手术。贻误手术时机，严重合并症如多器官功能衰竭及高龄是死亡的主要原因。     

PBL在泌尿外科教学查房中的应用

以问题教学为基础的教学(Prob lem-Based Learn ing,PBL)是将整个教学过程纳入到真实的临床问题中,并围绕若干问题,在教师的指导下完成教学的方式[1-2]。长期以来在我国的高等教育中,一直采用“填鸭式”教学,它往往缺乏活力,缺乏时代的气息,教材内容重复,知识成旧,忽视因材施教     

不同情期大鼠血浆神经降压素含量的变化

本文试图阐明不同情期大鼠血浆神经降压素含量的变化。血浆神经降压素以无水乙醇提取后采用放射免疫分析法测定。间情期、动情前期和动情期大鼠血浆内神经降压素样免疫活性物质的含量依次分别为92.1±7.7ng/L,118.0±9.4ng/L 和144.3±10.2ng/L。动情期大鼠血浆神经降压素样免疲活性物质的含量较间情期大鼠有极显著差异(P<0.01)。     

A preliminary study of radioimmunoimaging by 131I-COC183B2 monoclonal antibody in patients with epithelial ovarian cancer.

Monoclonal antibody 131I-COC183B2, developed in our laboratory and proved to fit for human treatment was injected intraperitoneally or subcutaneously in 13 patients. In 8 cases with i.p. injection the disease corresponded with the image, i.e. 3 primary ovarian epithelial cancers showed positive images, 1 ovarian Krukenberg tumor was negative and the other 4 negative images included 1 uterine myoma and 3 ovarian teratomas. In the subcutaneous injection group, 4 cases had ovarian carcinoma, surgery and chemotherapy. Two negative images corresponded with the clinical status-in good health, another negative case had metastatic left supraclavicular lymph node due to ovarian mucinous adenocarcinoma. The last negative image in this group was a case of benign ovarian teratoma which was proved after surgery. The 1 positive case was waiting to be proved by a scheduled third operation. The computer scintigram calculation of T/NT was 5.35 to 13.7. The results suggest that this monoclonal antibody can be used for radioimmunoimaging for the localization of ovarian carcinoma, which is not only helpful for clinical staging and differential diagnosis but is also a good follow-up method.

     

胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes(T2DM).Methods Bone fracture patients with T2DM were randomly divided into three groups:continuous subcutaneous insulin infusion group(insulin aspart,group CSII,n=20),glargine treatment group(insulin aspart+insulin glargine,group GA,n=20),and NPH treatment(insulin aspart+rh-insulin,group NA,n=20).The levels of fasting plasma glucose(FPG)and the 2 hours postprandial glucose(2h PG),blood glucose fluctuation(BGF),insulin dosage(ID),good effective time(GET),incidence of hypoglycemia,dawn phenomenon and infection,average time of stitches removal(ATSR),average hospitalized length(AHL)of three groups were compared.Results FPG and 2hPG,ID in group CSII[(6.32±1.18)mmol/L,(7.72±1.53)mmol/L,(35.40±1.60)IU]and group GA [(6.25±0.88)mmol/L,(7.32±1.17)mmol/L,(36.20±0.80)IU]were significantly lower than those of group NA [(7.44±1.36)mmol/L,(8.52±0.76)mmol/L,(40.50±2.40)IU,all P<0.05],simulaneously,BGF,GET incidence of complications,ATSR,AHL of group CSII and GA were significantly lower than those of group NA(all P<0.05).There were not significant difference between group CSII and group GA.Compared with group CSII,group GA had less costs in-hospital and better practicability.Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively,safely,rapidly and stablely control hyperglycemia.and might be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.     

神经内结缔组织增生与三叉神经脱髓鞘的关系

目的探讨三叉神经痛（trigeminal neuralgia，TN）患者三叉神经患支内结缔组织改变与神经脱髓鞘的关系。方法对手术切取的TN患者三又神经患支标本及对照标本行髓鞘染色，在光镜及电镜下观察神经横截面形态改变，并采用图像分析仪进行半定量测量。结果形态观察及图像分析结果都显示TN患者三叉神经患支明显脱髓鞘，神经内结缔组织显著增生，F检验证实二者存在显著线性正相关。结论TN患者三叉神经惠支内神经内结缔组织增生，可能是TN发生的重要机制之一。     

早期短程应用美洛培南治疗严重烧伤的临床对比研究

目的研究早期短程应用美洛培南对严重烧伤的治疗效果。方法前瞻性地选择特重度以上烧伤患者49名。治疗组21名伤后24h应用美洛培南3～5天。对照组28名，伤后24h应用头孢三、四代抗生素3～5天。观察患者SIRS、创面脓毒血症、MODS发生率，死亡率及治愈好转率。结果治疗组SIRS发生率与对照组比较无差异，创面脓毒血症、MODS发生率及死亡率显著低于对照组，治愈好转率明显高于对照组。结论早期短程应用美洛培南可以减少创面脓毒血症、MODS的发生，降低死亡率，提高严重烧伤患者的治愈好转率，对SIRS的发生率影响不大。     

肱骨近端骨密度的测量及其与年龄和体质量指数的相关性研究

目的 建立一种肱骨近端骨密度(BMD)的测量方法,研究肱骨近端BMD与年龄和体质量指数(BMI)的关系,探讨肱骨近端BMD在预报骨质疏松症的敏感性.方法 选择绝经后健康女性志愿者,使用Hologie DELPHI-A双能X射线骨密度仪及本研究设计的肩部定位器和前臂定位器测虽肱骨近端BMD.研究第一部分包括30名忐愿者,每人连续测量右侧肱骨近端BMD 2次,根据测量结果计算短期精密度RMS SD和RMS CV;第二部分包括92名志愿者,记录其年龄、身高、体重,测量右侧肱骨近端BMD,分析肱骨近端BMD与年龄和BMl的相关性.结果 本研究肱骨近端BMD测量方法的短期精密度:RMS SD=0.011 g/cm2,RMS CV=2.4%.本研究92名志愿者平均(60.2±6.4)岁,平均身高(159.5±5.4)cm,平均体质晕(59.4±7.5)kg,平均BMI 23.3±2.7,平均肱骨近端BMD(0.543±0.083)g/cm2,肱骨近端BMD 同年龄呈负相关,同BMI无显著相关.结论 本研究建立了一种测苗肱骨近端BMD的方法;年龄越人肱骨近端BMD越低;由于BMI对BMD的影响会掩盖骨质的丢失,而非负重区域即肱骨近端会最大程度地减少BMI对BMD的影响程度.     

颊脂肪垫瓣在修复口腔颌面部缺损中的应用

目的探讨颊脂肪垫瓣在修复口腔颌面部缺损的应用和效果.方法将颊脂肪垫形成一蒂在后方的颊脂肪垫组织瓣转移至缺损区,在无张力下与创缘缝合,表面轻轻用碘仿纱布缝线包压法固定.用以修复口腔颌面部的良恶性肿瘤手术或损伤留下的缺损以及口腔上颌窦瘘共18例.其中修复腭部缺损2例,上颌骨切除后缺损7例,颊黏膜癌切除后缺损3例,颊部良性肿瘤切除后缺损4例,磨牙后区黏表癌切除后缺损1例,封闭拔牙后口腔上颌窦瘘1例.结果术后10 d去除碘仿纱布,见颊脂肪垫轻度水肿,2～4周后水肿明显消退,颊脂肪垫表面逐渐上皮化,6～8周内表面完全上皮化,3个月后再生黏膜与正常口腔黏膜相似.全部病例效果满意,无感染、坏死等并发症发生.结论带蒂颊脂肪垫瓣修复口腔颌面部缺损,方法简单、易行,效果满意,值得推广.     

低潮气量治疗在机械通气肺结核术后合并呼吸衰竭患者中的应用

目的 探讨低潮气量维持通气对肺结核术后合并呼吸衰竭患者的应用价值。方法 在有效的抗结核、抗感染治疗的基础上，对32例肺结核术后合并呼吸衰竭患者进行低潮气量（6～8ml／kg）机械通气治疗，观察疗效及并发症。结果 呼吸衰竭治愈31例，死亡1例，治愈率96．9％，无明显并发症。结论 低潮气量维持通气对肺结核术后合并呼吸衰竭患者的治疗是安全的，且疗效显著。