急性脑梗死患者血浆 Fg、DD和vWFAg 的检测及临床意义

目的：探讨检测急性脑梗死（ACI）患者纤维蛋白原（Fg）、D‐二聚体（DD）和血管性血友病因子抗原（vWF Ag ）的临床价值。方法选取94例ACI患者作为脑梗死（A ）组,检测治疗前后Fg、DD和vWF Ag变化;同期94例非血栓性疾病患者作为对照（B）组。分析三项指标对ACI的诊断价值。结果 A组治疗前血浆 Fg、DD和vWF Ag值高于B组（P＜0．05）,治疗后降低（P＜0．05）。取Fg＞4.5 g／L、DD＞131μg／L、vWF Ag＞142％为截断值,Fg、DD和vWF Ag诊断ACI的特异度分别为90％、78％和77％,灵敏度分别为21％、50％和82％,准确性分别为60％、65％和80％。结论检测血浆Fg、DD和vWF Ag对ACI诊断均有一定临床价值,以vWF Ag的准确性最高。     

急性中毒患者血浆和肽素检测的临床意义

目的探讨和肽素检测对急性中毒患者病情评估的价值。方法 ELISA法检测175例急性中毒患者(中毒组)和30例健康志愿者(对照组)血浆和肽素含量,予急性生理学及慢性健康状况评分系统(APACHE)Ⅱ评分。记录患者30d病死率,比较死亡组和存活组血浆和肽素水平及APACHEⅡ评分。采用受试者工作特征(ROC)曲线评估血浆和肽素水平及APACHEⅡ评分对患者死亡的预测价值。结果 (1)死亡组患者血浆和肽素水平及APACHEⅡ评分高于对照组和存活组(P<0.01),血浆和肽素水平与APACHEⅡ评分呈正相关(r=0.71,P<0.01)。(2)血浆和肽素水平和APACHEⅡ评分的ROC曲线下面积分别为0.748和0.665,95%可信区间分别为0.649-0.847和0.528-0.801。(3)血浆和肽素水平分界值为18.5pmol/L时,其预测死亡的灵敏度为81.0%,特异度为35.1%;APACHEⅡ评分分界值为7.5分时,其预测死亡的灵敏度为66.7%,特异度为44.8%。结论急性中毒患者血浆和肽素水平升高。联合血浆和肽素水平检测和APACHEⅡ评分有助于评估急性中毒患者的预后。     

Acute and sub-chronic toxicity studies of honokiol microemulsion

The purpose of this study was to investigate the acute and sub-chronic toxicity of honokiol microemulsion. In the acute toxicity tests, the mice were intravenously injected graded doses of honokiol microemulsion and were observed for toxic symptoms and mortality daily for 14 days. In the sub-chronic toxicity study, rats were injected honokiol microemulsion at doses of 100, 500, 2500 μg/kg body weight (BW) for 30 days. After 30 days treatment and 14 days recovery, the rats were sacrificed for hematological, biochemical and histological examination. In the acute toxicity tests, the estimated median lethal dosage (LD₅₀) was 50.5 mg/kg body weight in mice. In the sub-chronic toxicity tests, the non-toxic reaction dose was 500 μg/kg body weight. In each treatment group, degeneration or/and necrosis in vascular endothelial cells and structure change of vessel wall can be observed in the injection site (cauda vein) of a few animals while there were no changes in the vessels of other organs. The overall findings of this study indicate that the honokiol microemulsion is non-toxic up to 500 μg/kg body weight, and it has irritation to the vascular of the injection site which should be paid attention to in clinical medication.     

鱼油脂肪乳对脓毒症并发严重急性胃肠损伤病人的免疫调理作用

目的:观察鱼油脂肪乳(FO)对严重脓毒症并发急性胃肠损伤Ⅲ级(AGIⅢ级)病人的疗效和免疫调理效果。方法:根据标准纳入AGIⅢ级病人78例,采用随机号码表将病人分为治疗组和对照组。治疗组病人在胃肠外营养(TPN)液中加入FO 10 g/d,24 h持续静脉注射。在TPN中加入中长链脂肪乳50 g与FO为5∶1。对照组不加FO。结果:治疗组病人60 d死亡11例(26.8%),对照组18例(48.6%)。57例病人(73%)为腹腔感染,其中治疗组病人28 d和60 d病死率均低于对照组。CD3总T淋巴细胞百分比低于对照组;辅助/诱导T淋巴细胞百分比低于对照组,而治疗第7天两组CD3总T淋巴细胞百分比、辅助诱导T淋巴细胞百分比均无统计学差异。39例病人存在感染性休克,其中治疗组28 d和60 d病死率均低于对照组;CD3总T淋巴细胞百分比、Ig G、Ig A水平均低于对照组,治疗第7天各项指标差异仍不显著。结论:FO可改善严重脓毒症并发急性胃肠损伤病人的免疫功能,从而降低病死率。     

替罗非班在ST段抬高型急性冠脉综合征介入治疗围手术期中的应用价值研究

目的:分析替罗非班在ST段抬高型急性冠脉综合征介入治疗围手术期中的应用价值。方法:选择接受介入治疗的ST段抬高型急性冠脉综合征患者,并随机将其分为接受常规治疗的对照组和接受替罗非班治疗的观察组,并检测治疗前后患者的血小板CD40L表达、血清CRP水平以及心血管事件发生等情况。结果:1治疗后,观察组患者的血小板CD40L表达强度明显低于对照组患者,差异有统计学意义(t=3.281,P<0.05);2给药后1 d、1周和4周观察组患者的血清CRP水平均明显低于对照组患者,差异有统计学意义(t=2.183,t=2.748,t=4.719;P<0.05);3接受药物治疗后,观察组患者介入治疗后心血管事件发生率明显低于对照组,差异有统计学意义(x2=6.493,P<0.05)。结论:围术期替罗非班治疗可以有效降低患者的血小板表达及炎症水平,减少不良心血管事件的发生,具有积极的临床意义。     

急性生理学及慢性健康评估II系统在临床重症监护中的应用

急性生理学及慢性健康评估II(APACHE II)系统是目前临床重症监护病房(ICU)应用广泛且极具权威的危重患者病情评价系统。APACHE II能够正确判断患者疾病严重程度及评估患者预后,分值越高病情越重,且预后越差,病死率越高,已成为世界上应用最为广泛的危重病预后评价系统。追溯APACHE II系统的历史发展以及在重症监护领域的应用现状,对其应用的局限性进行回顾和探讨,提示在临床重症监护中充分利用APACHE II系统的优势,克服其局限性使之更好的为临床服务,使危重病评分系统在重症监护工作中得到更广泛更合理的应用,以提高危重患者的救治水平和重症监护水平。     

Evaluation of three physiologically based pharmacokinetic (PBPK) modeling tools for emergency risk assessment after acute dichloromethane exposure

Introduction

Physiologically based pharmacokinetic (PBPK) models may be useful in emergency risk assessment, after acute exposure to chemicals, such as dichloromethane (DCM). We evaluated the applicability of three PBPK models for human risk assessment following a single exposure to DCM: one model is specifically developed for DCM (Bos) and the two others are semi-generic ones (Mumtaz and Jongeneelen).

Materials and methods

We assessed the accuracy of the models’ predictions by simulating exposure data from a previous healthy volunteer study, in which six subjects had been exposed to DCM for 1 h. The time-course of both the blood DCM concentration and percentage of carboxyhemoglobin (HbCO) were simulated.

Results

With all models, the shape of the simulated time course resembled the shape of the experimental data. For the end of the exposure, the predicted DCM blood concentration ranged between 1.52–4.19 mg/L with the Bos model, 1.42–4.04 mg/L with the Mumtaz model, and 1.81–4.31 mg/L with the Jongeneelen model compared to 0.27–5.44 mg/L in the experimental data. % HbCO could be predicted only with the Bos model. The maximum predicted % HbCO ranged between 3.1 and 4.2% compared to 0.4–2.3% in the experimental data. The % HbCO predictions were more in line with the experimental data after adjustment of the Bos model for the endogenous HbCO levels.

Conclusions

The Bos Mumtaz and Jongeneelen PBPK models were able to simulate experimental DCM blood concentrations reasonably well. The Bos model appears to be useful for calculating HbCO concentrations in emergency risk assessment.     

宣肺聪耳汤辅助治疗急性分泌性中耳炎的107例临床报告

目的：探讨宣肺聪耳汤辅助治疗急性分泌性中耳炎的临床应用效果。方法：选择我院2013年3月～2015年3月收治的急性分泌性中耳炎患者共107例作为研究对象,随机分为治疗组（n=55）和对照组（n=52）。对照组患者单纯采用常规方法进行治疗,如中耳穿刺、口服抗生素、吉诺通胶囊等;治疗组患者在对照组基础上联合宣肺聪耳汤进行治疗。统计并记录两组患者治疗前后的电测听情况,比较两种治疗方法临床总有效率和不良反应发生率。结果：治疗后两组患者的电测听值均较治疗前明显降低,治疗组为（9.17±2.46）,对照组为（19.56±4.72）,治疗组的降低幅度显著高于对照组;治疗组显效38例,有效14例,无效3例,总有效率为94.55%（52/55）,仅4例发生不良反应,不良反应发生率为7.27%（4/55）,对照组显效15例,有效26例,无效11例,总有效率为78.85%（41/52）,共12例发生不良反应,不良反应发生率为23.08%（12/52）,两组患者在电测听值、总有效率以及不良反应发生率方面比较差异均具有统计学意义（P<0.05）。结论：宣肺聪耳汤应用于急性分泌性中耳炎的治疗,可显著改善患者的听力,提高临床疗效,降低不良反应发生率,效果显著优于常规治疗,值得在临床上推广。