Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

肌蒂移植术治疗陈旧性脊髓损伤(附56例报告)

作者采用肌蒂移植术治疗胸腰段陈旧性脊髓损伤56例.脊髓功能恢复率提高至Franke 1个等级以上者占76.8%(43/56).本文讨论了肌蒂移植术对陈旧性脊髓损伤的适应证.安徽省宿州市骨伤科医院淮北煤矿基建局医院     

对聘用合同护士的思考和建议

20世纪90年代军队医院由于受编制所限，首先聘用合同护士。进入21世纪，面对激烈的医疗市场竞争，大部分公立医院为减少人力成本，也开始以低薪聘用合同护士。由于专业所限及就业难度加大，使越来越多合同护士走上医院的护理岗位。合同护士的地位、待遇和使用与正式护士存在较大差别。据《健康报》报道，安徽省卫生厅医政处对该省60家医院合同护士调查显示：仅有1．66％的合同护士和正式护士享有同样的待遇。[第一段]     

重组人干扰素α2b雾化吸入联合远红外止咳贴治疗小儿毛细支气管炎的临床效果

目的观察重组人干扰素α2b雾化吸入联合远红外止咳贴治疗毛细支气管炎的效果。方法选取2018年3月至2020年3月玉林市妇幼保健院收治的80例毛细支气管炎患儿,采用随机数字表法分为观察组与对照组,每组各40例。对照组给予常规综合治疗,观察组在常规综合治疗的基础上给予氧气驱动雾化吸入α2b干扰素联合远红外止咳贴治疗。比较两组治疗后的临床疗效、临床症状消失时间、住院时间以及肺部功能。结果观察组临床总有效率高于对照组,差异有统计学意义(P<0.05);观察组喘憋消失时间、咳嗽消失时间、肺部啰音消失时间、体温恢复正常时间、住院时间均短于对照组,差异有统计学意义(P<0.05);观察组治疗后潮气量、达峰时间比、达峰容积比均高于对照组,差异有统计学意义(P<0.05)。结论雾化吸入干扰素α2b联合远红外止咳贴治疗毛细支气管炎对提高治疗有效率,缩短临床症状消失时间、住院时间,改善肺功能具有重要作用,值得临床推广使用。     

无锡市肾综合症出血热宿主动物调查初报

对无锡市肾综合症出血热宿主动物调查结果表明:鼠类携带HFRS病毒阳性率5.77％。检出带病毒鼠4种,即小家鼠、黄胸鼠、褐家鼠、黑线姬鼠,其带病毒率分别为8.82％(3/34)、1.64％(1/61)、6.67％(2/30)、9.68％(3/31)。另外,经统计学分析,郊区带病毒鼠阳性明显高于市区(P<0.01)。加强灭鼠,严格控制疫区鼠密度是降低人群肾综合症出血热发病率的关键。     

骨肉瘤的远处骨转移(附5例报告)

目的：探讨骨肉瘤远处骨转移的临床表现，诊治过程及预后情况．方法：对我科1993年6月～1999年9月收治的5例骨肉痛发生远处骨转移患者进行回顾性分析总结结果：5例中3例为多发骨转移灶，2例为单发骨转移灶：4例合并肺转移，1例合并淋巴结、心包转移．经随访4～36个月，平均15.4个月，4例死亡，1例生存，结论：骨肉瘤的远处骨转移均为超关节的血行转移，两处以上骨转移灶者的生存期低于单发骨转移灶者，合并其它脏器转移者预后更差化疗加适宜的手术是治疗此类患者较有效的方法。     

高龄高危肺癌患者外科治疗（附41例报告）

目的:为了探讨高龄高危肺癌患者的外科治疗经验.方法和结果:作者对1989年6月～1997年5月手术切除的41例高龄高危肺癌患者进行分析,由于强化围术期管理和正确处理并发症,取得了满意的治疗效果,全组无住院死亡.作者强调积极术前准备,创造有利手术条件,选择合理手术方法,加强术后心功能保护及呼吸道管理,特别是环甲膜穿刺注药刺激咳嗽排痰,气管镜检查吸痰、抗菌素药液支气管灌洗及酌情合理使用呼吸机等.结论:上述措施均为扩大手术适应范围安全度过手术难关创造了十分有利的条件.     

正交试验法优选痛经颗粒水提工艺

目的:优化痛经颗粒中芍药苷的最佳提取工艺.方法:以白芍中芍药苷的提取率和浸膏得率为指标,采用L9(34)正交试验法优选痛经颗粒中芍药苷的最佳提取工艺.结果:优选的最佳提取工艺为:第1次加10倍量的水,煎煮1.5 h,第2次加8倍量的水,煎煮1.5 h,第3次加6倍量的水,煎煮0.5 h.结论:该水提工艺设计合理,芍药苷...     

壮医针挑治疗哮喘120例

目的:研究壮医针挑疗法治疗支气管哮喘的临床疗效。方法:选择符合纳入标准的支气管哮喘患者120例,按治疗前病情严重程度分级,运用分层随机对照原则分配,分为壮医针挑组(治疗组)和西医治疗组(对照组)各60例。治疗组在应用抗喘药物治疗的基础上,采用壮医针挑疗法治疗,对照组应用常规西药抗炎、解痉平喘、应用激素治疗。分别观察对比两组治疗前后肺功能、哮喘症状、体征的改变。结果:两组患者经治疗后肺功能、哮喘症状、体征改善程度自身与治疗前比较有显著性差异(P<0.01),而治疗组有效率85%,对照组有效率71.67%,两组治疗有效率比较(χ2=2.406,P=0.121,P>0.05)无显著性差异。结论:支气管哮喘采用壮医针挑疗法治疗,与应用西医抗喘药物治疗效果相同,但壮医针挑疗法在减轻毒副作用,降低医疗成本等指标上占优势。     

表面麻醉下白内障超声乳化人工晶状体植入

目的：探讨表面麻醉白内障超声乳化及人工晶状体植入术的安全性及有效性。方法：观察128例（148眼）单用表面麻醉白内障超声乳化及人工晶状体植入术的麻醉和手术效果及并发症.结果：患者均能很好地配合手术顺利完成，仅2眼因结膜瘢痕，出现较明显的疼痛。术后1天及1周视力≥0．5者分别为81．97％及92．62％，无严重的并发症。结论：表面麻醉白内障超声乳化是安全有效的，二者结合使手术更快捷、安全、术后恢复更快。