65例日龄42天婴儿脑干听觉诱发电位均值调查

目的了解屯溪区正常婴儿脑干听觉诱发电位(ABR)的均值分布,制定正常衡量标准,探讨性别、不同侧耳朵对ABR的影响,为进一步做好婴儿ABR听力测试,早期发现听力损失,早期干预,提供科学数据。方法分析68例42天正常婴儿的4.77ms、Ⅳ5.88ms、Ⅴ6.86ms,峰间期(IPL)分别为Ⅰ~Ⅲ2.81ms、Ⅲ~Ⅴ2.09ms、Ⅰ~Ⅴ4.91ms。女性PL较男性短,不同侧耳朵对ABR无影响。结论本资料基本接近正态分布;所得均值可以用于本地区42天正常婴儿听力筛查的衡量标准。     

热应激反应对中性粒细胞凋亡及呼吸爆发功能的影响

目的观察体外诱导热应激反应对中性粒细胞凋亡及呼吸爆发功能的影响。方法18例健康者中性粒细胞每例随机分为三份。其中1份作为对照组,其余2份分别应用热休克或氯化镉诱导热应激反应后与培养液共同孵育,并分别作为热休克组和氯化镉组。于热应激反应诱导后0、2、3、4、6 h,运用PCR技术和流式细胞仪分别测定各组中性粒细胞热休克蛋白(HSP70)的表达及呼吸爆发功能;于热应激反应后24 h,应用荧光染色法和流式细胞仪DNA倍体分析法观察、检测细胞凋亡情况。结果热休克组和氯化镉组热应激诱导后各时段中性粒细胞HSP70表达及24 h的细胞凋亡率均明显高于对照组(P<0.01);热休克组和氯化镉组热应激诱导后4 h和6 h时,中性粒细胞活性氧生成明显低于对照组(P<0.01)。结论热应激反应促进中性粒细胞凋亡并减少活性氧释放。提示热应激反应可能参与机体的抗炎作用机制。     

快速老化小鼠的听功能和耳蜗毛细胞的增龄性变化

目的:研究快速老化小鼠听觉功能和耳蜗毛细胞的增龄性变化。方法:选1,3,5,7,9月龄的快速老化小鼠亚系1(Senescence accelerated mouse/prone1,SAMP1)作为实验组,而同龄抗快速老化亚系1(Senescence accelerated mouse/resistance1,SAMR1)作为SAMP系的正常对照组。分别观察其听觉脑干反应阈值以及耳蜗毛细胞损失情况等方面的增龄性变化。结果:听功能改变:第7,9月龄SAMP1小鼠的脑干反应阈值较同龄SAMR1小鼠明显增高(P<0.05);耳蜗形态学改变:耳蜗铺片、毛细胞计数显示第7,9月龄SAMP1小鼠外毛细胞较同龄SAMR1小鼠明显缺失(P<0.05)。结论:SAMP1小鼠随月龄增长耳蜗外毛细胞缺失、听功能减退,7,9月龄SAMP1小鼠出现明显的衰老特征,表现出听功能明显低下,可作为老年聋动物模型用于耳聋的相关研究。     

外伤性十二指肠破裂诊治体会

在腹部外伤中,由于十二指肠大部分位于腹膜后,损伤的发病率很低,约占整个腹部创伤的3.7%~5%,损伤较多见于十二指肠二、三部(3/4以上)。十二指肠损伤的诊断和处理存在不少困难,病死率和并发症发生率相当高,且极易误诊和漏诊,伤后早期死亡原因主要是严重合并伤,尤其是腹部大血管伤;后期死亡则多因诊断不及时和处理不当引起十二指肠瘘致感染、出血和衰竭。我院自2001年至2006年期间共收治8例,现报告如下。1一般资料该组病例全为男性,年龄在12岁~52岁之间,腹部撞伤5例,压扎伤2例,刀伤1例,均在受伤后2h~4h入院,破裂伤5例,横断伤3例,其中有1例损伤较重,裂口周径达4/5,均有局部血肿及腹腔积血及污染,临床表现有腹痛、呕吐、腹膜炎体征、休克及腹部穿刺抽出血性混浊液体,均有手术探查指征。2诊断十二指肠破裂早期症状不典型,易误诊及漏诊,目前基层医院诊断主要靠病史及腹部X线平片及CT、口服造影剂从损伤处溢出可帮助诊断,有时术前诊断不明确,但有明显的探查指征,术中发现有十二指肠破裂(此组2例患者是在术中发现的),主要体征是上腹部肌紧张及腹膜炎体征,腹穿阳性均膜后有胆汁渗出,气体存在是诊断的可靠标志。3治疗方法及结果术...     

前路减压、植骨及内固定治疗胸腰椎爆裂骨折

目的探讨胸腰椎爆裂骨折前路减压固定的可能性。方法2001年5月￣2005年1月,收治32例胸腰段骨折合并脊髓损伤患者。其中T1212例,L117例,L23例。按Franke1分级评定:A级6例,B级5例,C级7例,D级14例。手术均行前路减压内固定术。结果32例术后影像学检查胸腰椎生理弧度基本恢复正常。均获随访10～51个月,平均17.9个月。神经功能除2例脊髓完全损伤无恢复外,其余均有不同程度改善。未出现钢板螺钉松动断裂、继发性脊柱后突及节段性不稳等并发症。结论前路减压内固定修复重建严重胸腰椎爆裂骨折,具有减压彻底、植骨充分及内固定牢固等特点,有助于椎体高度恢复和神经功能改善。     

Alterations of the Respiratory Burst of Polymorphonuclear Leukocytes from Diabetic Children A Chemiluminescence Study

ABSTRACT. The respiratory burst of polymorphonuclear leukocytes was investigated in 24 children with insulin dependent diabetes mellitus and 24 healthy controls. This oxygen dependent, membrane associated process generates a number of toxic oxygen metabolites which are implicated in the pathogenesis of endothelial damage. The activity of polymorphonuclear leukocytes was studied in terms of luminol amplified chemiluminescence. It was found that the resting luminol amplified chemiluminescence activity of isolated polymorphonuclear leukocytes from diabetic children was significantly higher than that of controls (342000±174000 cpm vs. 165000±82000 cpm, p <0.01). The addition of respiratory burst inhibitors caused a significant reduction of basal chemiluminescence (> 80%). When the ratio of phorbol myristate acetate stimulated activity to basal activity was calculated and used as an activation index, it was found to be significantly reduced in diabetics relative to controls (4.29 ± 2.46 vs. 8.34±3.21, p<0.01). These observations suggest that increased release of toxic oxygen metabolites from polymorphonuclear leukocytes in diabetic subjects may play a role in the development of diabetic angiopathies.     

豚鼠听觉通路不同平面毁损的ABR频域分析

对１５只正常豚鼠的ＡＢＲ时域波形和频谱特征以及对１８只豚鼠通过脑干核团立体定位技术，毁损听觉通路各不同部位后的时域波形及频谱改变进行了分析。实验证明：正常豚鼠９０ｄＢＳＰＬ短声诱发的ＡＢＲ，呈现波Ⅰ、Ⅱ、Ⅲ、Ⅳ，通过平均功率谱分析，ＡＢＲ频谱范围在５０～２０００Ｈｚ，有３个谱能量集中区，ｆ０主峰中心频率为１８７．４７±２７．６８Ｈｚ，ｆ１为６９５．８２±１０３．４０Ｈｚ，ｆ２为１１０３．６７±８１．５５Ｈｚ。听觉通路不同部位毁损后，除影响一个时域主波形外，每个核团还不同程度地影响两个或两个以上波的形成。频谱图改变，有几个共同特点：（１）各谱峰中心频率向低频偏移；（２）谱分析带宽明显缩窄，高频截止区也向低频移动；（３）谱峰能量全面下降，甚至有的谱峰消失；（４）随毁损平面上行，谱能量损失减少，谱峰向低频区移动的程度降低。大多数核团对ｆ１有贡献，听神经及低位脑子对ｆ２的合成贡献较大，因此，应该认为ＡＢＲ频谱特征是整个听觉通路各部位的综合效应。     

Growth hormone increases circulating neutrophil activation and provokes lung microvascular injury in septic peritonitis rats

BACKGROUND: Growth hormone (GH) has been shown to increase mortality in critical illness, illustrating the need for better understanding of GH treatment. The neutrophil is a key mediator in producing organ injury following shock and trauma and is regulated by GH. Therefore, the purpose of the present study was to examine the effects of GH on circulating neutrophil activation and subsequent lung injury induced by sepsis in rats. MATERIALS AND METHODS: Sepsis was induced in male Wistar rats via cecal ligation and puncture (CLP). Recombinant human growth hormone (1 IU/kg) was given subcutaneously right after CLP with an additional injection at 12 h after CLP. CD11b expression and an oxidative burst of neutrophils were detected using flow cytometric analysis. Lung myeloperoxidase activity was determined as an index of tissue neutrophil accumulation. Lung microvascular injury was assessed by quantitating extravasation of Evan's blue dye into lung parenchyma. RESULTS: Growth hormone significantly increased sepsis-induced expression of CD11b and sepsis-induced circulating neutrophil activation. Also growth hormone increased neutrophil accumulation in lungs induced by sepsis. Lung microvascular injury was aggravated by growth hormone treatment in septic rats. CONCLUSIONS: It is worthwhile to rethink GH administration in critical illness and further studies are required to determine the safety and clinical benefits of GH administration in critical illness.     

畸变产物耳声发射对2968例新生儿听力筛查的临床分析

目的探讨畸变产物耳声发射(DPOAE)与听性脑干反应(ABR)联合应用用于新生儿听力筛查的可行性。方法应用Bio-logic自动耳声发射仪对2968例新生儿进行听力筛查,经3次筛查不合格的新生儿应用GSI诱发电位仪进行检查,并随机抽样60例120耳新生儿连续进行1~5d跟踪筛查。结果2968例新生儿有2852例分别于出生的1~5d及5d~1个月(提前出院而延筛),经1~3次DPOAE筛查通过,通过率为96.09%。116例未通过,经ABR检测有5例不合格,假阳性率为3.74%。出生在第2天、第3天通过率相差显著(P<0.01),第3天以后通过率之间差别无统计学意义(P>0.05)。结论DPOAE测试具有方便、快速、无创、客观等优点,筛查时间以生后第3天及3d以后为宜。但其只能反映耳蜗功能,不能用来诊断听神经或中枢听觉通路病损,同时由于假阳性率较高,对未通过DPOAE筛查者不能立即作出听力损伤的结论。ABR测试为比较可靠的新生儿听力筛查工具,联合DPOAE和ABR听力筛查技术,使其相互补充,能提高新生儿听力筛查的精确性、可靠性。     

58名听力障碍儿2次听觉脑干反应听力随访

目的:了解新生儿听力筛查异常儿的听力发育变化,并探索新生儿听力普遍筛查的有效模式。方法:应用听觉脑干反应(Aud itory B rainstem Response,ABR)诊断技术对205名新生儿听力筛查异常儿在3个月时进行听力测试,并做高危因素回顾性调查;ABR异常者,6个月时做第2次ABR测试。结果:有58名听力障碍儿参加了第2次ABR复诊。该58名听力障碍儿ABR初诊时听力损失耳共计96只,平均听阈值为60.6±12.0 dBnHL;ABR复诊时平均听阈值下降到48.0±11.7dBnHL,差异有极其显著性意义(P<0.001)。其中,25名非高危儿与33名高危儿相比较,他们在ABR初诊、ABR复诊时听力损失耳的平均听阈以及前后听阈下降的平均差值均无显著性意义(P>0.05)。结论:对新生儿听力筛查异常儿在6个月时ABR复诊后再对其中的听力障碍儿推荐配戴助听器等干预措施在目前的中国国情下是经济可行的。