近端联合远端收肌管阻滞在全膝关节置换术患者术后镇痛和早期功能康复中的应用

目的 探讨近端联合远端收肌管阻滞在全膝关节置换术患者术后镇痛和早期功能康复中的应用。方法 选取2019年1月至2020年12月在解放军总医院第六医学中心择期行单侧全膝关节置换术患者90例,按随机数字表法分为3组,每组30例。A组为对照组,于超声引导下行股神经联合腘窝上坐骨神经阻滞;B组为近端联合远端收肌管阻滞组,于超声引导下分别行收肌管近端和远端阻滞;C组为右美托咪定联合收肌管阻滞组,于超声引导下将罗哌卡因与右美托咪定混合液分别注射至收肌管近端和远端。比较3组患者术后6 h(T₁)、12 h(T₂)、24 h(T₃)和48 h(T₄)时静息VAS评分,术后T₃和T₄时运动VAS评分,48 h内羟考酮和氟比洛芬酯使用情况;以及术后24 h(T₃)、48 h(T₄)和72 h(T₅)膝关节活动范围(ROM)和股四头肌肌力;记录3组患者术后首次直腿抬高≥10 cm时间,术后首次下床活动时间,术后7...     

血清总胆汁酸测定在胆石症诊治中的应用

目的：探讨胆汁酸（ＴＢＡ）测定在胆石症诊治中的应用价值。方法：酶法测定１０７例胆石症病人和３９例正常人血甭ＴＢＡ,并与ＡＬＴ和ＡＬＰ进行比较分析。结果：与对照组比较,胆石症病人血清ＴＢＡ升高,伴发炎症或胆汁淤积时差异显著：ＴＢＡ在反映胆道炎症和胆汁淤积症方面分别与ＡＬＴ、ＡＬＰ有正相关关系。结论：血清ＴＢＡＩ 胆石症诊治中有一定参考价值。     

全髋关节置换术治疗成人发育性髋关节发育不良的难点及处理策略

发育性髋关节发育不良（developmental dysplasia of the hip, DDH）是成人继发性髋关节骨关节炎的最常见病因之一,早期干预不及时或治疗不当常引起髋关节严重畸形,晚期致残率较高。全髋关节置换术（total hip arthroplasty, THA）是治疗晚期成人DDH较有效的方法,但是由于髋臼和股骨近端解剖形态病理性异常使THA手术难度较大。本文就DDH的分型、手术难点及处理策略等结合近年来相关文献报道进行综述,以期为THA治疗成人DDH提供一定的理论依据。     

武汉市旅店业卫生间三大卫生用品消毒前后细菌污染调查

目的了解武汉市旅店业卫生间用品的卫生状况。方法随机采样监测了武汉市１０家旅店卫生间三大卫生用品（坐便器座垫、浴池、洗面盆）消毒前后细菌污染情况。结果武汉市旅店业卫生间三大卫生用品细菌污染较严重;消毒处理后,细菌总数均值虽有降低但仍较高,并可检出大肠菌群。结论旅店卫生间清洗消毒工作不力,亟待加强     

Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty

BACKGROUND: After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. METHODS: Thirty-seven patients, scheduled for total knee arthroplasty, were randomly assigned to three treatment groups: in group 1 (EPI) patients received bolus doses of morphine via an epidural catheter; in group 2 (IA) an intraarticular bolus of 1 mg of morphine was applied at the end of the operation with subsequent use of a patient-controlled analgesia (PCA) pump; group 3 (Control), in which only PCA was provided, served as control for both analgesic procedures. Main outcome measures included visual analogue pain scales, total morphine consumption, and stress hormones. RESULTS: No statistically significant differences in visual analogue pain scales could be detected between the three groups. Application of intraarticular morphine did not reduce the amount of analgesics required for postoperative analgesia as compared to intravenous analgesia alone. Application of epidural morphine significantly suppressed beta-endorphine release, but did not significantly influence other stress hormones as compared to the control group. CONCLUSION: Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.     

大豆皂甙抑瘤效应及对荷瘤鼠免疫功能的影响

为了从兔疫学角度探讨大豆皂甙的抑瘤机理,采用T淋巴细胞功能和淋巴因子测定法及细胞毒技术,研究了大豆皂甙对荷瘤鼠肿瘤生长的抑制作用及对荷瘤鼠免疫功能的影响.结果表明,大豆皂甙明显抑制荷瘤鼠肿瘤细胞的生长,促进荷瘤鼠脾和胸腺细胞的增殖反应及脾T淋巴细胞IL-2的分泌,增强LAK和NK肿瘤杀伤细胞的活性.提示大豆皂甙是一种良好的抑制肿瘤细胞生长的免疫调节剂.     

Peripheral total parenteral nutrition employing a lipid emulsion (Intralipid): complications encountered in pediatric patients.

The clinical records of 180 pediatric patients who received Intralipid via peripheral veins at a single institution (1964-1977) were retrospectively analyzed, with particular reference to the complications of this form of therapy. Intralipid was used in a dose range of 2--4 g/kg/day in order to supply 40% of the daily calorie requirements. The patients were neonates, infants, children, and adolescents with a wide range of clinical diagnoses. Local complications associated with Intralipid therapy were minimal. Transient elevations in serum enzyme levels (SGOT, SGPT, and LDH) were observed in 4% of patients, but all of these returned to the normal range after cessation of therapy. Ten patients had histologic evidence of cholestasis, the significance of which is discussed. The lipid emulsion was employed in patients with preexisting hyperbilirubinemia with concomitant resolution of jaundice. Intralipid was administered to patients with known severe thrombocytopenia (secondary to sepsis or myelosuppression) with return of the platelet counts to normal levels during the course of infusion therapy. The use of Intralipid in patients with established sepsis did not delay its response to conventional surgical or antibiotic therapy. There were no instances of the "overloading" syndrome observed.     

Three-dimensional imaging of mitral and tricuspid annuli for total artificial heart implantation

The establishment of a method to clarify the three-dimensional interrelations among the mitral annulus, tricuspid annulus, ascending aorta, and main pulmonary artery, which constitute the interface between the human and total artificial heart (TAH), is essential to the design of the TAH. In a previous study based on transverse magnetic resonance (MR) images of a live human heart, reconstructed images of mitral and tricuspid annuli were found to be deformed. The present study of cadaver and beating hearts revealed that the optimal conditions for atrioventricular annular reconstruction of a beating heart with electrocardiogram-gated MR imaging include use of four-chamber imaging, 5 mm slice thickness, and a slice interval ranging from 5 to 7 mm. Under these conditions, the mitral and tricuspid annuli of 3 beating hearts were reconstructed successfully. It was recognized that during the systolic phase the mitral and tricuspid annuli move anteriorly, leftward and downward, and that in late systole the right lateral margin of the tricuspid annulus is close to the sternum.     

Stoffwechseluntersuchungen unter ergometrischer Belastung bei total duodenopankreatektomierten Patienten

Zusammenfassung Ein Jahr nach totaler Duodenopankmatektomie wurde bei 6 Patienten die exokrine Pankreainsuffizienz geprüft. Diese kann durch orale Gabe von wenigstens 10 g Pankreatin kompensiert werden. Gegenüber 7 Normalpersonen und 6 Typ 1-Diabetikern hatten die Duodenopankreatektomierten unter körperlicher Belastung höhere arterielle Spiegel von Lactat und freiem Glycerin als Ausdruck einer gestörten hepatischen Gluconeogenese bei fehlendem pankreatischem Glucagon. Ihre körperliche Leistungsfähigkeit war auffallend schlecht. Catecholamine stiegen unter körperlicher Belastung nur gering an, Wachstumshormone gar nicht. Diese Resultate sprechen gegen die totale Duodenopankreatektomie als Therapie der chronischen Pankreatitis.

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Metabolic investigations under ergometric strain in patients with total duodenopancreatectomy

Summary One year after total duodenopancreatectomy a clinical and laboratory evaluation including exhaustive bicycle ergometry was performed in 6 male patients. The insufficiency of the exocrine pancreas can be compensated by at least 10 g pankreatin per day. During physical exercise patients had higher arterial values of lactate and free glycerol after duodenopancreatectomy than 7 healthy individuals and 6 diabetic patients type 1. This metabolic overreaction was due to a deficiency of pancreatic glucagon and resulted in an impaired hepatic gluconeogenesis. There was no detectable increase in growth hormones and only a small one in catecholamines. The physical condition of patients after duodenopancreatectomy was clearly worse.

Diese Arbeit ist Herrn Prof. Dr. Dr. h.c. Hans Erhard Bock zum Geburtstag gewidmet     

比色法测定消癌平注射液中总酚酸的含量

目的　建立消癌平注射液中总酚酸的含量测定方法。方法　以绿原酸为对照品 ,比色法测定。结果　绿原酸回归方程为A =35 8.1 4×C - 5 .3879(r=0 .9993,n =9)。在 2 0 .5～ 32 8μg范围内呈线性关系 ,平均回收率为 1 0 0 .4 8% ,RSD =1 .70 %。结论　所用方法简便、准确、快速 ,可作为该制剂的定量方法