儿茶酚胺类药物对感染性休克兔胃肠灌注的影响

Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.     

双侧侧脑室外引流并脑脊液置换术治疗原发性脑室出血23例

我科自1995年1月至2005年1月共收治原发性脑室出血23例，经双侧侧脑室外引流并脑脊液置换术冶疗取得较好效果，现报道如下。     

正中神经与肌皮神经的交通支及其临床意义

目的观察正中神经与肌皮神经之间的交通支，探讨其临床意义。方法对72侧防腐固定尸体解剖，对正中神经、肌皮神经之间的交通支进行测量与观察，并对不同类型交通支的结果进行比较。结果13人，16侧肢体存在18支交通支，出现率22．2％，男性与女性相比出现率高且差异显著，左右肢体的出现率无显著差异。其中肌皮神经从正中神经低位发出的有2支，正中神经-肌皮神经的交通支（Ⅰ型）与肌皮神经-正中神经的交通支（Ⅱ型）相比起、止点低，交通支较长，但直径细（Ⅰ型14．2～23．0cm，止点为11．0～21．5cm，长度为2．5～10．7cm，直径为0．55～2．15mm；Ⅱ型起点为0～17．ocm，止点为12．0～24．0cm，长度为1．9～8．4cm，直径为0．76～2．60mm）但两者差异无统计学意义（P〉0．05）。结论正中神经与肌皮神经之间存在着交通支，并起着一定的功能，手术时应注意加以保护，避免损伤。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

腔隙性脑梗死和动脉粥样硬化血栓性脑梗死患者微量蛋白尿的研究

目的明确脑梗死患者微量蛋白尿(MA)阳性率及腔隙性脑梗死(lacunar infarction,LI)和动脉粥样硬化血栓性脑梗死(atherothrombotic infarction,AI)患者MA阳性率是否存在差别。方法采用竞争性放射免疫分析方法对未合并肝肾功能不全等影响尿蛋白排泄率(UAER)检测结果的83例LI和78例AI患者,以及40例原发性高血压对照者进行UAER测定。统计脑梗死患者MA的阳性率,比较合并高血压的LI、AI与高血压对照组MA阳性率。结果161例脑梗死患者MA阳性率为42·9%;单纯合并高血压病史的45例LI患者和34例AI患者MA阳性率分别为51·1%和58·8%,均高于高血压对照组(P<0·05),但两组间比较无统计学意义。结论脑梗死患者呈现MA高发率;合并高血压病史的LI和AI患者MA阳性率无差别;MA会增加脑梗死的发生风险。     

MAGE-A3抗原肽负载树突状细胞诱导乳腺癌患者免疫应答的研究

目的研究MAGE-A3抗原肽负载对乳腺癌患者树突状细胞(DC)的功能的影响,探讨其是否可以在体外诱导特异性细胞毒性T淋巴细胞(CTL)应答.方法体外培养HLA-A2乳腺癌患者外周血来源的DC,并经孵育携带MAGE-A3抗原肽,用以刺激CTL,用3H-TdR渗入法检测抗原肽负载前后DC刺激同种淋巴细胞增殖能力(MLR),并用乳酸脱氢酶(LDH)释放法检测CTL对靶细胞的杀伤效应.结果DC:T为1:10时,单纯DC组刺激能力显著高于抗原肽负载组DC(DC-P)(P＜0.05),但当DC:T低于1:20时后DC-P组刺激能力显著强于单纯DC组(P＜0.05).DC-P组和单纯DC组所激发的CTL对细胞株MCF-7,Sk-Br-3,MDA-MB-435s的杀伤活性有显著性差异,而对细胞株Raji无显著性差异,DC-P组对细胞株MCF-7,Sk-Br-3,MDA-MB-435s的杀伤活性明显高于对细胞株Raji的杀伤活性.结论负载MAGE-A3抗原肽的DC在体外可以诱导乳腺癌患者特异性的CTL免疫应答,为临床以DC为基础的过继免疫治疗的应用提供理论基础.     

99Tcm-DMSA肾皮质显像诊断小儿肾发育不良

目的 探讨^99Tc^m—二巯基丁二酸(DMSA)肾皮质显像诊断小儿肾发育不良的价值。方法 疑为肾发育不良患儿29例，行常规^99Tc^m—DMSA肾皮质显像和腹部B超检查。图像分析：将发育不良肾分为0～4级。结果 ^99Tc^m—DMSA肾皮质显像示29例患儿中24例为单侧肾发育不良，其中11例1级，7例2级，6例3级，余5例患肾未显影为0级，结合其他：检查诊断为肾发育不良。患肾分肾功能为0～24．9％(平均6．3％)。29例患儿中24例患肾肾皮质显像诊断为肾发育不良，5例患肾未显影，由其他影像学方法确诊，诊断灵敏度为82．76％。29例中19例经手术治疗，病理检查证实为肾发育不良。结论 ^99Tc^m—DMSA肾皮质显像诊断肾发育不良灵敏度高、可靠，可确定发育不良肾部位和判断肾功能。     

IL-2与IFN-α联合激活的白血病缓解期骨髓对白血病细胞的净化作用

目的：体外研究白细胞介素Ⅱ(IL-2)和α-干扰素(IFN-α)联合激活对白血病缓解期骨髓自然杀伤细胞(NK)和淋巴因子激活的杀伤细胞(LAK)活性的影响，以及对白血病细胞(K562细胞)的净化作用，并观察其对正常造血的影响。方法：标准4h^51Cr释放实验测定激活的白血病缓解期骨髓的细胞毒作用；集落培养法和逆转录多聚酶链反应检测激活的白血病缓解期骨髓对K562细胞的净化作用。结果：IL-2和INF-α单用虽均能增强白血病缓解期骨髓的NK活性和诱导LAK细胞的产生，但两者联合激活的白血病缓解期骨髓的NK和LAK活性，明显优于IL-2和IFN-α的单用(P＜0．05)。在体外净化实验中两种细胞因子均能激活白血病缓解期骨髓细胞对K562细胞的净化作用，但两种联合作用最强，且bcr／abl融合基因检测为两者联合组33．33％(4／12)，Rt-pcR法，而IL-2作用次之为66．67％(8／12)，最后是IFN-α为91．67％(11／12)。两种细胞因子中以IFN-α单用对CFU-GM的抑制有一定影响(P＜0．01)，而IL-2和两者联合对激活骨髓的CFU-GM无明显影响。结论：IL-2能激活白血病缓解期骨髓的NK细胞的活性和诱导LAK细胞的产生，IFN-α能增强IL-2激活白血病缓解期骨髓对白血病细胞的净化作用。     

急性实验性脑出血大鼠缺血皮质区炎性因子的表达

目的　研究急性脑出血大鼠血肿周围与对侧缺血皮质细胞凋亡以及 HSP70与 NF-κB表达。方法　将大鼠随机分为正常组与模型组。用 型胶原酶立体定位法复制出血性卒中动物模型 ,术后 1、3、7d分别进行 HE染色、TUNEL染色、HSP70与 NF-к B免疫组化反应。结果　脑出血后 1 d于血肿周围缺血半暗区可见大量坏死细胞 ,HSP70与 NF-к B表达增强 ,出血对侧皮质细胞以凋亡改变为主 ,均于 3 d达高峰 ,7d仍有升高。结论　急性脑出血大鼠的缺血性损害于双侧均可见到 ,以血肿侧严重 ,损伤于 3 d达高峰 ,7d持续存在 ,脑出血后的继发性损害持续存在。     

SARS死亡病例的实验室检查特点

目的：了解严重急性呼吸综合征(SARS)死亡病例的临床特点，为SARS重症病例的诊断、治疗及预后判断提供帮助。方法：对我院2003年1月至4月底收治的102例确诊非典患者中的5例死亡病例的流行病学及实验室检查资料进行回顾性分析。结果：死亡病例均为男性，平均49岁，从发病到入院平均7．6d，从住院到确诊平均1．2d；从住院到死亡平均14．4d，从发病到死亡平均为22d。死亡病例粒细胞总数和百分比均明显升高，多数患者淋巴细胞计数和百分比降低(4／5)，血红蛋白均呈进行性下降。死亡患者除已见报道的ALT、AST、LDH、CK升高及低钙血症外，GLU均明显高于正常而ALB均明显降低；大多数患者TP、PA等多项生化指标均出现明显下降而脱氧血红蛋白百分率(HHb)明显上升，同时伴有低磷、低镁血症。结论：SARS死亡病例多项实验室指标均会出现明显异常，动态监测这些指标有助于SARS患者的诊断、治疗及预后判断。