冠状动脉造影正常的急性心肌梗死患者的临床特点

目的：探讨冠状动脉造影（CAG）正常的急性心肌梗死（AMI）患者的发生机制及临床特点。方法：分析2000年6月至2001年10月86例AMI患者的CAG结果及冠心病相关危险因素。结果：86例中CAG正常者8例，年龄（39＋11．4）（25－52）岁；多无心绞痛史、高血压史、糖尿病史、血脂异常史及家族史；以情绪波动、精神压抑、大量吸烟、饮酒史者居多。结论：冠状动脉痉挛、血栓自溶或溶栓治疗后血栓消失是其主要发生机制；冠状动脉正常的AMI患者其貌似正常，实属高危人群，应高度重视。     

脑肿瘤患者手术前后T细胞亚群及NK细胞活性的变化

目的 探讨脑肿瘤患者手术前后细胞免疫功能的变化及其临床意义。方法 采用单克隆抗体酶标法对22例脑肿瘤和12例脑内血肿患者手术前后不同时期的T细胞亚群及NK细胞活性进行动态监测。结果 脑肿瘤CD3^ 、CD4^ ,CD10^16 56和CD4^ /CD8^ 比值较对照组均有不同程度降低。而胶质瘤组较其余两组明显下降。34例患者术后4期CD3^ ,CD4^ ,CD16 56^ 比值均发生变化。胶质瘤组在术后1至2周明显低于其余两组。术后3至4周才逐渐恢复至正常水平。结论 脑肿瘤患者细胞免疫功能被抑制。且恶性胶质瘤较良性肿瘤更为明显，手术应激能导致T细胞亚群及NK细胞活性变化。脑肿瘤切除术后细胞免疫功能呈现暂时抑制至逐渐恢复的过程。     

青年急性冠脉综合征冠脉造特点及随访

目的:探讨青年急性冠状动脉综合征(ACS)冠状动脉(冠状)造影特点及其与远期心脏事件的关系。方法:比较青年ACS与老年ACS患者冠脉病变程度、范围,并进行心脏事件随访。结果:78例青年ACS患者有冠脉病变74例(94.9％),单支病变46例(58.9％);171例老年ACS患者有冠脉病变166例(97.1％),单支病变41例(23.9％)。平均随访9个月,青年ACS患者发生心脏事件者10例(12.8％),其中心绞痛再入院6例(7.7％);老年ACS患者发生心脏事件者47例(27.5％),其中心绞痛再入院30例(17.5％),两组比较差异有显著性(P<0.05)。结论:ACS患者冠状动脉粥样硬化青年时期之前已经发生,ACS预后与冠脉病变程度和年龄呈正相关。     

Epidemiology of acute diarrhea in children living in Sicily

A longitudinal survey (February 1984 - January 1985) on the incidence of acute diarrhea episodes in a sample of 8,164 children (aged 0–12 years) living in southeastern Sicily was carried out by means of weekly telephone interviews with doctors practising in the territory. The incidence rate was 0.479 (0.472–0.485 95% C.I.) per child per year and the frequency of episodes was significantly higher (p < 0.001) in children aged 0–4 years (0.86). Diarrhea was more frequent in industrial areas than in rural ones, and almost half (45.1%) of the total episodes had a mild course. No death from diarrhea occurred and admission to hospital was reported for 8.4% of all cases.Corresponding author.     

完全性左束支传导阻滞伴快速心房纤颤并急性左心衰竭的抢救

目的总结完全性左束支传导阻滞伴快速心房纤颤并急性左心衰竭的治疗经验,以提高抢救成功率.方法对经抢救治疗的完全性左束支传导阻滞伴快速心房纤颤并急性左心衰竭9例(16次)患者进行治疗方面的回顾分析.结果9例(16次)患者14次抢救成功,成功率87.0%,但复发率较高,预后较差,有5例患者在抢救时或出院后1～2年内猝死.结论该组患者经传统"强心、利尿、扩血管",控制心房纤颤、心室率等治疗是远远不够的.应在未发生肺泡性肺水肿及心源性休克之前,尽早尽快地应用血管扩张剂及联合应用小剂量非洋地黄类正性肌力药物,并维持治疗24～72 h.其中以酚妥拉明加多巴胺和(或)多巴酚丁胺效果可能较佳,血管扩张剂硝酸酯类不及α-受体阻滞剂酚妥拉明疗效明显.     

Intracoronary thrombolysis: Organizational prerequisites,technique, and results

Reestablishing myocardial perfusion during evolving myocardial infarction may limit the ultimate extent of infarction if viable myocardial tissue is present when recanalization of the occluded vessel is achieved. This will result in improved left ventricular function and decreased mortality. In addition to their therapeutic benefits, recanalization procedures have contributed greatly to our knowledge of acute myocardial infarction. It has been demonstrated that myocardial infarction most often occurs after thrombotic occlusion of a coronary artery. This has settled a controversy that has preoccupied cardiologists for decades. Selective intracoronary administration of fibrinolytic agents is followed by recanalization in approximately 80% of cases. Therapeutic failures are attributable to occlusion caused by other factors, to inactivation of streptokinase by high antibody concentrations, and to insufficient concentrations of streptokinase at the thrombus as a results of unfavorable flow conditions. This study is dedicated to Prof. Dr. Med. Horst Schmutzler on the occasion of his 60th birthday.     

335例术后全身炎症反应综合征的临床分析

【目的】了解手术创伤对术后全身炎症反应综合征 (SIRS)的影响。【方法】搜集外科重症监护室 (SICU) 335例患者的术后资料 ,分析不同手术组SIRS发病率 ;手术时间、失血量与SIRS持续时间的关系 ;SIRS持续时间与术后并发症的关系。【结果】术后SIRS发病率为 75 8% ,大手术高达 92 4 % ;无并发症患者失血量与SIRS持续时间呈正相关 (r1=0 783,P<0 0 1) ,手术时间与SIRS持续时间呈正相关 (r2 =0 398,P <0 0 1) ;随着SIRS持续时间延长 ,并发症发病率显著增高 (P<0 0 5 )。【结论】术后SIRS发生、发展与手术创伤密切相关 ;监测SIRS进程有助于及早发现并发症     

老年骨髓炎患者的围术期护理

目的探讨老年骨髓炎患者围术期护理的体会及经验。方法对32例老年骨髓炎患者围术期护理经验进行分析和总结。结果全组32例患者通过手术治疗及合理护理措施均得到治愈，无褥疮、肺部及泌尿系感染等并发症发生。结论老年骨髓炎患者体质差，合并症多，护理需认真、细致，并且根据术前、术中、术后按不同病情制订个案护理计划，预防并发症，能有效地提高手术成功率。     

Thyroid Hormone in the Treatment of Post-transplant Acute Tubular Necrosis (ATN)

Delayed graft function (DGF) in cadaver kidney transplants is a common problem and is often due to acute tubular necrosis (ATN). DGF in transplants may have a deleterious effect on long-term graft survival. Since thyroid hormone has been shown to hasten recovery from ATN in experimental models, we designed a trial to determine if a defined course of triiodothyronine (T3) would improve the short- or long-term outcome of patients with DGF in cadaveric transplants. A prospective, randomized, placebo controlled, double blind trial of T3 was carried out in patients with DGF in cadaveric renal transplants. End-points were percentage requiring dialysis, percentage recovering function, time to recovery and length of hospital stay. Long-term outcomes were percentage grafts functioning at 1 year and mean serum creatinine at 1 year. Forty-four patients were randomized to receive either T3 or placebo. Three patients were dropped from each group when early biopsies disclosed that DGF was due to rejection. The groups were well matched by age, cold ischemia time of the graft, and percentage reactivity to a random panel of antigens. Baseline thyroid function studies, including T3, reverse T3 (rT3), and thyroid stimulating hormone (TSH) levels, were similar between the two groups and typical of 'euthyroid-sick syndrome'. T3 had no effect on percentage requiring dialysis, time to recovery, percentage recovering function, or length of stay. At 1 year follow-up, graft function was similar in both groups and significantly lower than that seen in patients with good initial function. Thyroid hormone, given early in the course of DGF in cadaver kidney recipients, had no effect on the course of DGF. Long-term graft function is impaired in patients who experience post-transplant DGF compared to those who have good initial function.     

青菜的保鲜贮藏研究

目的 :延长青菜在冷藏条件下的贮藏期 ,解决海军舰艇冷藏库蔬菜贮藏期短的问题。方法 :使用塑料袋、纸箱、塑料筐为包装材料 ,塑料袋内充O3 负离子对青菜在 2℃和 9℃条件下进行保鲜贮藏。结果 :2℃条件下塑料袋包装青菜贮藏期延长至 2 5d ,腐烂率小于 5 .9%。结论 :使用塑料袋包装青菜 ,适宜的贮藏温度为 2℃。