创伤性泌尿系出血的急诊动脉栓塞治疗

目的探讨经导管选择性动脉栓塞在创伤性泌尿系出血急诊治疗中的价值. 方法 1998年1月～2003年6月对27例创伤性泌尿系出血根据损伤出血部位行数字减影血管造影检查,明确出血动脉,明胶海绵颗粒或弹簧钢圈栓塞靶动脉. 结果 23例一次栓塞成功止血,2例2次栓塞后止血,2例栓塞失败改行其他治疗方法.栓塞后不良反应为发热16例,局部疼痛、恶心、呕吐14例,1例髂内动脉栓塞出现一过性臀部疼痛. 结论选择性动脉栓塞是治疗创伤性泌尿系出血的有效措施,具有创伤小、见效快的优点,为进一步治疗创造条件.     

护理干预对蛛网膜下腔出血患者便秘的影响

目的探讨护理干预对蛛网膜下腔出血患者便秘的影响。方法采用随机分组，实验组采取护理干预措施，对照组采取神经内科护理常规。结果2组患者排便情况、便秘相关反应比较差异显著。结论护理干预减少蛛网膜下腔出血患者便秘的发生，提高抢救成功率。     

肝外伤157例临床治疗分析

目的 提高对不同类型肝外伤的诊断和治疗水平。方法 回顾性总结1990年9月至2002年1月我中心收治的157例肝外伤患者，包括非手术治疗32例，手术治疗125例。结果 非手术治疗32例，完全治愈28例，4例死亡。手术治疗125例，完全治愈107例，死亡18例，总治愈率85．9％(135／157)，病死率14．1％(22／157)，其中9例死于多发性创伤合并多器官功能衰竭(MOF)，8例死于肝内大血管损伤引起的出血，5例死于术后并发症。结论肝外伤病情危重，临床表现复杂，早期正确诊断、及时和合理的手术治疗是减少死亡率提高救治水平的关键，积极抗休克，实行重症监护和防治并发症等非常重要。血流动力学稳定的患者可行非手术治疗。     

Presumed vestibular hemorrhage secondary to warfarin

Hemorrhage secondary to anticoagulant therapy is well documented. We report a patient who presented with acute vertigo and unilateral deafness while on warfarin and was found to have a probable hemorrhage in the labyrinth, identified on MRI.     

小肠广泛切除术后高胃泌素血症与结肠代偿性变化的关系

观察大鼠小肠广泛切除术后血清胃泌素和结肠粘膜代偿性改变的动态变化规律,发现术后14天内血清胃泌素稍低于正常组,从第14天开始血清胃泌素升高加快,至21天时差异有显著性意义(P<0.05),第28天时差异有非常显著性意义(P<0.01).血清胃泌素变化与术后结肠粘膜DNA、RNA变化呈正相关关系(P<0.001),提示高胃泌素血症可能是引起小肠广泛切除术后结肠粘膜代偿性变化的主要因素之一.     

脐带夹对防止脐部感染和出血的临床与实验研究

目的应用国产脐带夹用于农村山区破伤风高发区，并经离体试验验证其可靠性。方法经湖南、江西、广西等省基层接生员临床应用、并与当地同期或前一年未用夹者进行对照；同时经离体脐带用脐带夹、气门芯或纱线结扎阻断血管后进行金黄色葡萄球菌和破伤风毒素通透试验以及测试承受气压程度试验。结果1年临床使用2296例中，无1例发生破伤风和败血症。可靠性试验结果证明，粗纱线结扎最差，气门芯虽优于前者，但不如脐带夹。结论该脐带夹由于夹持力持久有力，细菌、毒素难以通过、安全可靠，因此能降低新生儿“病从脐入”的发病率和死亡率，有利干优生优育的贯彻．这是一项花费少、收效大的简而易行的适宜技术，值得推广。     

透明质酸在脑出血和腔隙性脑梗塞中病理作用的探讨

本文对５７例急性脑出血和脑腔梗患者及３５例对照组血清透明质酸（ＨＡ）含量进行了测定，并与相应的临床指标（病程、血压及神经功能缺损评分等）、血液生化指标（血糖、血脂、纤维蛋白原及血液流变学等）和影像学指标进行了相关分析。结果表明：脑出血和脑腔梗组的ＨＡ含量明显高于对照组，腔梗组明显高于出血组（Ｐ＜０．０１）。脑出血组ＨＡ含量与纤维蛋白原含量呈明显负相关，与其它指标无相关性。而脑腔梗组ＨＡ含量与纤维蛋白原及其它指标均无相关性。     

外源性五羟色胺大鼠肺出血模型及其与浓度关系

目的　通过外源性五羟色胺 (5 -HT)气管滴入建立新生大鼠肺出血模型及其与浓度关系 .方法　模型制作 :日龄 4～ 5天Wistar二级大鼠 5 0只 ,随机分为 4组 :生理盐水对照组 (A组 )及 3种不同浓度外源性 5 -HT实验组(B、C、D组 ) :经气管导管分别滴入生理盐水和不同浓度 5 -HT ,4小时后处死 ,观察肺大体及组织病理改变 ,将肺出血程度分为 5级 :Ⅰ正常 ;Ⅱ肺水肿 ;Ⅲ点状肺出血 ;Ⅳ局灶性肺出血 ;Ⅴ弥漫性肺出血 ,选择出制作肺出血模型的最佳的浓度 .结果　不同浓度 5 -HT气管内滴入均能引起不同程度肺出血 ,但随着浓度增加 ,B、C、D三组间的肺出血程度无差异 (p >0 .0 5 ) ,其中D组死亡率 30 % ,对照组及B组和C组均无死亡 ,死亡鼠肺为弥漫性出血 .结论　 5 -HT可致大鼠肺出血 ,以 1× 10 -5mol/ml浓度为宜 ,随着 5 -HT浓度增加 ,大鼠死亡率增加 ,但肺出血发生率无差异     

A low molecular weight heparin in hemodialysis

Summary The purpose of our study was to check whether the dosage recommended for the low molecular weight heparin tested here, i.e., 50% of the corresponding unfractionated heparin dose, is adequate to prevent clot formation in the extracorporeal system. Sixteen dialysis treatments of 4–5 h were given to each of six chronic dialysis patients. In dialyses 1, 2, 15 and 16 unfractionated heparin (initial dose 35 IU/kg, continuous dose 20 IU/kg/h) was given, and in dialyses 3–14 low molecular weight heparin (initial dose 17.5 anti-Xa U/kg, continuous dose 10 anti-X U/kg/h). At these dose levels of low molecular weight heparin, clot formation occurred in the extracorporeal system in five of the six patients, despite the fact that the plasma anti-Xa level of 0.5 U/ml recommended by the manufacturer had been attained. For this reason the continuous dose of low molecular weight heparin had to be raised to approx. 80% of the corresponding continuous dose of unfractionated heparin. A plasma anti-Xa level of 0.7 U/ml is necessary to prevent extracorporeal clot formation.Abbreviations anti-Xa U Anti-factor Xa unit - aPTT Activated partial thromboplastin time - AT III Antithrombin III - IU International unit - LMWH Low molecular weight heparin - UFH Unfractionated heparin     

Hyperglycemic and Hyperosmolar Responses to Graded Hemorrhage

Changes of the arterial plasma osmolality and of the glucose concentration were followed during a 30 min period of graded hemorrhagic hypotension (80, 50, and 30 mmHg) in the cat. Bleeding evoked a significant plasma hyperosmolality at all three hypotension levels and the responses were quantitatively related to the degree of hypotension. An approximate steady state increase in the arterial plasma osmolality was reached about 20 min after the start of the bleeding and it then averaged 8, 20, and 25 mOsm/kg H₂O at 80, 50, and 30 mmHg, respectively. Bleeding also evoked an increase in the plasma glucose concentration, which almost entirely accounted for the observed hyperosmolality, especially at 80 and 50 mmHg. In late stages of hypotension at 30 mmHg, elevated plasma lactate and potassium concentrations contributed to the overall hyperosmolality. — Previous hemorrhagic hypotension experiments at 50 mmHg (Järhult 1975 b) have shown that hyperosmolality serves as an important regulator of the plasma and extracellular fluid volumes during bleeding. The present results indicate that such an osmolar compensatory mechanism is operating over wide ranges of hemorrhagic hypotension.