剖宫产术后硬膜外血肿并发脊髓损伤病人的护理

我科于2004年1月救治1例因羊水栓塞引起硬膜外血肿导致脊髓损伤的病人,针对病人存在或潜在的功能障碍和并发症采取了有效的干预。随着现代医学的发展,更多的脊髓损伤(spinal cordinjury,SCI)病人可存活下来,但绝大部分人留有重度残疾,生活质量受到严重影响[1]。因此,对SCI病人康复期存在或潜在的功能障碍和并发症采取干预性护理措施,可预防和减少脊髓功能的进一步损害,尽可能在较短时间内使病人达到生活自理,对其重返社会具有重要意义[2]。1病例介绍病人,32岁,孕40周,2004年1月10日因妊娠高血压综合征收住入院。11日03:40因胎儿宫内窘迫…     

脾脏钝伤的CT诊断

本文回顾性分析了３２例脾脏钝伤ＣＴ平扫的表现；对脾损伤进行ＣＴ分类；指出腹腔积血和脾周血块（“哨兵血块征”）在诊断脾损伤方面的作用。ＣＴ平扫诊断钝性脾脏损伤是一种敏感、可靠的方法，可帮助外科医生制订治疗方案。ＣＴ平扫诊断钝性脾损伤的灵敏度为９４％，诊断正确率为９１％     

电针对狗血浆与胃黏膜组织中NO和NOS的影响及其意义

目的　观察电针对狗幽门压力、胃黏膜血流量的调控作用及其与血浆、胃黏膜组织中一氧化氮 (NO) ,一氧化氮合酶 (NOS)水平变化的关系 ,以探讨电针对胃黏膜保护作用的机制。方法　将 2 0只狗随机分为 4组 :空白对照组、非经非穴组、上巨虚组、足三里组 (每组 5只 )。采用胃压测量仪、激光多普勒血流仪监测幽门压力、频率及胃黏膜血流量的变化 ,同步测定血浆及胃黏膜组织中NO ,NOS含量 ,并观察变化规律。结果　电针后足三里组幽门括约肌总压力、基础压下降、频率下降 (P <0 .0 5 ) ,胃黏膜血流量显著升高 (4 .5 1± 0 .73→ 6.90± 1.0 1,P <0 .0 1) ,血浆及胃黏膜组织中NO ,NOS含量显著升高 (P <0 .0 5 ) ,上巨虚组仅幽门括约肌总压力下降 ,血浆NO含量上升。但足三里组各项监测指标变化趋势更明显 ,其他组变化无显著性。结论　电针可使狗幽门压力、频率下降 ,使胃黏膜血流量增加 ,与影响幽门压力、胃黏膜血流量的某些活性物质的含量改变有关 ,并具有一定的经络和穴位特异性。     

The effect of MS-818, a pyrimidine compound,on the regeneration of peripheral nerve fibers of mice after a crush injury

One of the pyrimidine compounds, 2-piperadino-6-methyl-5-oxo-5,6-dihydro(7H)pyrrolo[3,4-d]pyrimidine (MS-818), has neurotropic effects in vitro. Therefore, we studied the effect of MS-818 on the regeneration of the peroneal nerve in C57BL/6J mice after a crush injury. Two test groups, which received a daily intraperitoneal injection of 5 mg/kg or 10 mg/kg MS-818, respectively, were compared with controls, which received daily intraperitoneal injections of physiological saline, over a 14-day period. The maximum foot-width ratio (crushed side/uncrushed side) was obtained on days 1, 8 and 14 after the crush injury, and the various morphometric parameters were evaluated at both 5 and 10 mm distal to the proximal portion of the crush site. The significant effects of MS-818 included a larger maximum foot width (P<0.04) and a greater number of unmyelinated axons per nerve at both levels (P<0.003) in both test groups than in controls. MS-818 had no significant effects on body weight, the increase of total transverse fascicular area after the crush injury, the total number of myelinated fibers with their size distributions, or the number of nuclei of Schwann cells and macrophages. Therefore, we conclude that MS-818 promotes axonal sprouting and elongation after a crush injury in mice.     

Guillain-Barré syndrome in South-West Stockholm, 1973–1991, 3. Clinicoepidemiological subgroups

Using hierarchical cluster analysis, applied to 47 cases of Guillain-Barre Syndrome (GBS) incident in South-West Stockholm (SWS) during the period from January 1973 to June 1992, we identified three major clinicoepidemiological subgroups. The first subgroup, 25.5% of the cases (26.7 ± 6.7 years), recorded a peak incidence at ages 20–29 years and presented significant differences from other subgroups, a high proportion of cases with onset at low age preceded by respiratory infection (83.3%) and with normal motor conduction velocity (50.0%). Also found, were less affected biological parameters, a rapidly progressive course and independence in gait at one month after onset. A second subgroup, 27.7% of cases, was severely affected, clinically and functionally. It consisted predominantly of young individuals (22.7 ± 11.1 years), with a high incidence (69.2% of cases) in autumn. A third subgroup, comprising 40.47; of cases, was older (61.1 ± 11.0 years) and, in general, also severely affected. The incidence of this form appeared to be invariant with time.     

罂粟碱对大鼠单胺神经递质的影响

本文报道用高效液相色谱-电化学检测器方法,研究了罂粟碱对大鼠脑内及心脏单胺神经递质代谢的影响。结果表明:罂粟碱能显著增加大鼠纹状体及边缘区多巴胺代谢物二羟苯乙酸(DOPAC)和高香草酸(HVA),升高约50-70%。5-羟色胺代谢物5-羟吲哚醋酸(5HIAA)增加约30%,而对脑及心脏内的单胺递质本身含量未见有明显影响。     

Hypoxia effects on vascular endothelial growth factor derived epithelial cells of nasal polyps]

OBJECTIVE: To understand the role of nasal mucous epithelial cells to hypoxia in early stage of nasal polyps(NP) formation. METHODS: Epithelial cells of NP and inferior turbinate (IT) were cultured without serum under normal oxygen and hypoxia, and stimulus of inflammatory cytokines. Erythropoietin (EPO) was regarded as hypoxia mark, and expression of vascular endothelial growth factor(VEGF) mRNA and protein derived from epithelial cells were detected respectively by in situ hybridization and ELISA. RESULTS: 1. Under hypoxia, EPO mRNA was expressed intensely in epithelial cells from NP and IT, and there was no significant difference between both of them. This result suggested that EPO might be regarded as a hypoxic mark. 2. The ability of producing VEGF mRNA increased with cytokines stimulation, especially under hypoxia. Protein level of VEGF from epithelial cells of NP and IT increased with cytokines stimulation, especially in hypoxia and was time-dependent. CONCLUSION: Epithelial cells actively produce vast VEGF under hypoxia. The VEGF induced by hypoxia of the mucosa in middle meatus is of importance in the formation of nasal polyps(NP) in early stage, which may be the major cause of NP formation in middle meatus.     

胸腰段脊柱脊髓损伤减压与固定相关问题探讨（附166例报告）

目的 对胸腰段脊柱脊髓，马尾神经损伤患者的外科治疗及几种内固定方法的疗效进行探讨。方法 对166例患者的治疗进行回顾分析。该组患者中椎体爆裂性骨折37例，椎体压缩骨折超二分之一109例，椎体骨折脱位14例，多节段或跳跃骨折6例，脊髓损伤按Frankel分级，A级59例，B级46例，C级42例，D级19例，治疗采用后路减压复位122例，前路减压复位，髂骨植骨融合44例。结果 术后123例获3-18个月随访，随访患者中随4例RF钉断裂，5例Harrington上钩脱落，6例棍断裂，其余患者内固定稳固，脊髓，马尾神经恢复，除35例仍为A级外，余脊髓神经功能恢复1-3个级别。结论 各种不同内固定可保持或增强脊柱的稳定，胸腰段脊柱脊髓损伤的外科治疗应根据骨折类型，脊髓及马尾神经损伤程度选择手术入路及内固定材料。     

二乙基亚硝胺诱导大鼠肝细胞癌过程中明胶酶的动态变化

目的：观察肝癌形成过程中明胶酶表达（蛋白及mRNA水平）的动态变化，探索明胶酶在肝癌生长浸润中的作用。方法：应用免疫组化法、明胶酶谱法和RT-PCR法对大鼠肝癌形成过程中各期明胶酶表达情况进行观察，并与正常对照组进行比较分析。结果：正常肝组织及肝硬化组织内明胶酶有表达，肝癌形成后主要在癌细胞内表达；明胶酶原在正常肝组织中有低表达，诱癌过程中呈持续增高趋势；明胶酶-2mRNA与其酶蛋白表达趋向一致。结论：在肝癌形成过程中明胶酶转录和翻译水平均呈持续增高趋势。     

桂枝的化学成分研究

目的：对桂枝的化学成分进行系统研究。方法：利用各种色谱技术进行分离纯化，并根据理化常数和光谱解析（UV，IR，MS，NMR）鉴定各化合物结构。从桂枝95％乙醇浸膏的氯仿和乙酸乙酯部分中，共分离得到11个化合物。结果：分别鉴定为：肉桂酸（I）、2－甲氧基肉桂酸（Ⅱ）、1，4－二苯基－丁二酮（Ⅲ）、香豆素（Ⅳ）、β－谷甾醇（Ⅴ）、丁香醛（Ⅵ）、5α，8α－过氧化麦角甾醇（Ⅶ）、2－甲氧基苯甲酸（Ⅷ）、6β－羟基－4－烯－3－豆甾酮（Ⅸ）、原儿茶酸（Ⅹ）、胡萝卜苷（Ⅺ）。结论：化合物Ⅱ、Ⅲ、Ⅷ为首次从天然界分离得到，化合物Ⅶ为首次从高等植物中分离得到，化合物Ⅵ、Ⅸ为首次从本属植物中分离得到。