肺感染致多器官功能障碍综合征血清瘦素浓度的变化

目的检测肺部严重感染所致多器官功能障碍综合征(MODS)、急性心肌梗死(AMI)和心律失常(AR)等危重症患者血清中瘦素(Leptin)及相关因子水平的变化,探讨Leptin在MODS发病及诊断中的可能意义。方法采用放射免疫分析法测定Leptin、脂肪酸结合蛋白(FABP)、转铁蛋白(Ferr)以及白细胞介素1β(IL1β)水平,采用酶联免疫吸附法(ELISA)测定C反应蛋白(CRP)水平。结果与正常对照组相比,Leptin水平在MODS、AMI和AR组均明显增高(P均<0.01);CRP和IL1β水平在MODS、AMI和AR组均显著增高(P<0.05或P<0.01),以MODS组患者增高更明显(P均<0.05);FABP和Ferr在3组患者中也均有明显上升趋势,特别是在MODS组中上升更多,但统计学上差异无显著性。结论肺感染所致MODS患者血清中Leptin水平明显上升,伴有CRP和IL1β同时升高,Leptin可能在MODS的发生和转归中发挥一定作用。     

Myocardial infarction with non obstructive coronary arteries (MINOCA): a whole new ball game

Introduction: MINOCA is a clinical syndrome that encompasses a subgroup of heterogeneous patients who present with myocardial infarction yet do not have any significant coronary artery obstruction on angiogram. As many as one in ten patients with acute myocardial infarction (AMI) will not have an occluded coronary artery, and the reported prevalence keeps rising, in part due to better recognition of this syndrome. Current guidelines offer several diagnostic algorithms but MINOCA remains largely under-recognised and little is known about whether patients might benefit from a more specific treatment modality.

Areas covered: We review pathogenesis, diagnosis, prognosis, and management of MINOCA.

Expert commentary: Due to the significant heterogeneity of MINOCA patients, a more efficient management strategy may solely rely on an individualized approach in order to improve outcomes.     

非ST段抬高的急性冠状动脉综合征患者心率震荡的临床分析——附21例报告

目的:研究非ST段抬高的急性冠状动脉综合征(non-ST segment elevation acute coronary syndrome,NSTEACS)患者的心率震荡特点,并评价心率震荡测量指标对预测NSTEACS危险性的价值.方法:21例NSTEACS为病例组,选择同期20名体格检查的健康人为对照组,比较两组的震荡起始和震荡斜率,同时分析震荡起始与左心室射血分数(left ventricular ejection fraction,LVEF)、肌钙蛋白I、每5 min平均正常窦性心搏间期的标准差(standard deviation of per-5 min averages normal number of intervals,SDANN)的相关性.结果:病例组震荡起始值显著高于对照组(-0.0139±0.0013、-0.0622±0.0368,P＜0.05);两组间震荡斜率值差异无统计学意义.震荡起始值与LVEF和SDANN呈负相关.结论:NSTEACS患者的心率震荡指标震荡起始较正常健康组明显增高,且与传统评价NSTEACS的危险性指标LVEF、SDANN有较好的相关性,震荡起始有可能作为预测NSTEACS患者危险性的指标.     

急性白血病患者合并医院感染调查

目的探讨急性白血病(AL)患合并医院感染的特点，分析引起医院感染的危险因素，为制订医院感染防治措施提供客观依据。方法对我院血液科2001年10月-2003年10月住院治疗的311例AL病例。填写统一的个案登记表。其中144例为医院感染组，167例无任何感染为非医院感染组，两组资料进行单因素卡方检验后，用非条件Logistic回归模型进行多元分析。结果医院感染发生率为46．3％，例次发生率为51．4％。感染部位以呼吸道、血液、口腔为主，感染部位不明患亦占一定比例。导致感染的病原菌以革兰阴性菌为主占46．6％，革兰阴性菌对亚胺培南-西司他丁、阿米卡星和头孢他啶较敏感．革兰阳性菌对万古霉素、阿米卡星较敏感。多因素分析结果筛选出年龄、糖皮质激素、外周血中性粒细胞绝对计数、化疗周期、住院天数、治疗阶段、近期感染和住院季节是医院感染的独立危险因素。结论AL医院感染发生率高，预防和控制医院感染是提高AL治疗水平和延长患生存期的重要方面。致病菌多数为条件致病菌、耐药率较高，病情复杂，进展迅速，预后凶险。年龄、糖皮质激素、外周血中性粒细胞绝对计数、化疗周期、住院天数、治疗阶段、近期感染和住院季节是AL医院感染的独立危险因素。     

Effects of vaporized perfluorohexane and partial liquid ventilation on regional distribution of alveolar damage in experimental lung injury

Objective To determine whether the patterns of distribution of histological effects of vaporized perfluorohexane (PFH) and partial liquid ventilation (PLV) differ significantly in acute lung injury. Design and setting Experimental study in an animal research laboratory. Subjects Eighteen pigs. Interventions After induction of acute lung injury by means of infusion of oleic acid animals were randomly assigned to PFH, PLV, or gas ventilation (GV) groups. Six hours thereafter animals were killed, and lung tissue samples were taken for analysis. Measurements and results Histopathological analysis revealed less damage with PFH than with GV or PLV in the nondependent and central regions. PFH and PLV showed less injury in the dependent regions than GV. GV and PFH were associated with less histological damage in the nondependent than the dependent regions, whereas PLV presented the opposite pattern. Morphometric analysis showed increased aeration in nondependent than dependent regions with PFH and GV. PLV led to more aeration in the periphery than in central areas. Conclusions PFH was associated with a more homogeneous attenuation of alveolar damage across the lungs, although this therapy had more pronounced effects in nondependent zones. PLV showed the opposite pattern, with more important reduction in alveolar damage in dependent lung regions. Interestingly, reduction in alveolar damage with PFH was as effective as with PLV in dependent zones. Our findings suggest that vaporized perfluorocarbon could be advantageous as adjunctive therapy in the treatment of acute lung injury. Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users. This work was supported by grant nos. AB 135/1-1 and HU 818/3-1 from the Deutsche Forschungsgemeinschaft (DFG), Bonn, Germany An erratum to this article can be found at     

氨溴索缓释胶囊治疗慢性支气管炎急性发作的疗效观察

目的观察氨溴索缓释胶囊辅助治疗慢性支气管炎的疗效。方法67例门诊患者分为两组,实验组34例,在常规治疗地基础上口服氨溴索缓释胶囊75mg/次,每日1次,连续服用7d;对照组33例,仅给予常规治疗,疗程7d。结果实验组有效率85.29%,对照组有效率75.76%,两组疗效差异有显著性（P〈0.01）。结论氨溴索缓释胶囊能有效治疗慢性支气管炎的急性发作。     

大黄素对全身炎性反应综合征时中性粒细胞凋亡异常治疗的研究

目的研究大黄素对全身炎性反应综合征(SIRS)时中性粒细胞即多形核白细胞(polymorphonuc lear neutro-ph il,PMN)凋亡异常的治疗作用。方法32例SIRS患者(均为急性胰腺炎)提取外周血PMN后分为四组,即对照组、大黄素治疗组、白细胞介素(IL)-10治疗组、地塞米松治疗组,分别培养24 h后观察两组的PMN凋亡情况(采用流式细胞仪和TUNEL方法定量检测)。结果对照组外周血PMN细胞凋亡率为(42±8)%,大黄素治疗组PMN细胞凋亡率为(54±10)%,两组比较差异有统计学意义(P<0.05);对照组凋亡指数(AI)为25±7,大黄素治疗组外周血PMN的AI为33±9,两组比较差异有统计学意义(P<0.005)。而IL-10治疗组、地塞米松治疗组与对照组比较则无明显变化。结论大黄素对SIRS患者外周血的PMN凋亡延迟有治疗作用。     

Testicular infarction becoming apparent after hernia reduction

Background: Testicular infarction from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. Objective: To report a case that describes the presentation, diagnosis, and management of testicular infarction in the setting of an incarcerated inguinal hernia. Case Report: A 2-month old boy was brought to the Emergency Department (ED) by his parents for vomiting, crying, and a left-sided scrotal swelling. An inguinal hernia was manually reduced successfully in the ED. Subsequently, scrotal ultrasound with color Doppler was obtained, demonstrating no blood flow to the left testis. The patient underwent a left orchiectomy and right orchiopexy with hernia repair. Discussion: Testicular injury can occur from torsion due to the effect of an incarcerated hernia or due to ischemia from cord compression. Delay in diagnosis and surgery risks testicular viability, therefore, surgery should not be delayed for imaging in the presence of strong suspicion of torsion. Conclusions: The diagnosis of testicular torsion is not always straightforward because many conditions may have a similar clinical presentation or may compromise testicular blood supply. This case is an unusual presentation of testicular infarction in the setting of an incarcerated inguinal hernia.     

巴曲酶治疗急性脑梗死的临床分析

目的：探讨巴曲酶治疗急性脑梗死的临床疗效。方法：将64例急性脑梗死患者随机分为两组，分别给予东菱克栓酶为主治疗 和川芎嗪+胞二磷胆碱为主治疗，观察临床疗效、纤维蛋白原及凝血酶原时间的变化，所获数据采用 x~2检验和 t 检验。结果：观察组 有效率93． 4%，对照组有效率80． 2%，两组基本痊愈和显效比较有显著差异(P＜0． 05) ，观察组血浆纤维蛋白原明显降低(P＜0． 05) 。 结论：巴曲酶治疗急性脑梗死效果肯定，能明显促进神经功能缺损的恢复，减少了并发症和后遗症，疗效优于对照组。