重型颅脑损伤早期肠内营养的临床研究

目的　探讨重型颅脑损伤早期肠内营养的合理性与临床价值。方法　GCS≤ 8的重型颅脑损伤患者随机分为两组 :A组 32例 ,早期肠内营养 ;B组 36例 ,早期全胃肠外营养。两组营养支持均在伤后或术后 2 4小时开始 ,观察两组患者营养状况 ,胃肠道并发症及其他并发症的发生率及预后。结果　EEN组的营养状况优于TPN组 ,胃肠道并发症及其他并发症的发生率低于TPN组 (P <0 .0 5) ,预后亦较TPN组有明显改善 (P<0 .0 5)。结论　重型颅脑损伤后早期肠内营养可改善患者营养状况 ,减少并发症的发生 ,并改善预后。     

Treatment of Vitamin B12 Deficiency after Gastric Surgery for Severe Obesity

Background: Vitamin B₁₂ deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B₁₂ from protein foodstuffs and to a failure of absorption of crystalline vitamin B₁₂ in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin B₁₂ was most effective in treating vitamin B₁₂ deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B₁₂ < 100 pmol L ⁻¹, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m⁻². Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received 350 μg per day of crystalline vitamin B₁₂ and all increased their serum vitamin B₁₂ levels to over 100 pmol L⁻¹. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B₁₂-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B₁₂ levels were greater than 150 pmol L⁻¹ after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2% after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B₁₂ after gastric surgery for obesity to correct low serum vitamin B₁₂ levels in 95% of patients.     

The extracellular versus intracellular mechanisms of inhibition of TCR-triggered activation in thymocytes by adenosine under conditions of inhibited adenosine deaminase

The absence or low levels of adenosine deaminase (ADA) in humans result in severe combined immunodeficiency (SCID), which is characterized by hypoplastic thymus, T lymphocyte depletion and autoimmunity. Deficiency of ADA causes increased levels of both intracellular and extracellular adenosine, although only the intracellular lymphotoxicity of accumulated adenosine is considered in the pathogenesis of ADA SCID. It is shown that extracellular but not intracellular adenosine selectively inhibits TCR-triggered up-regulation of activation markers and apoptotic events in thymocytes under conditions of ADA deficiency. The effects of intracellular adenosine are dissociated from effects of extracellular adenosine in experiments using an adenosine transporter blocker. We found that prevention of toxicity of intracellular adenosine led to survival of TCR-cross-linked thymocytes in long-term (4 days) assays, but it was not sufficient for normal T cell differentiation under conditions of inhibited ADA. Surviving TCR-cross-linked thymocytes had a non-activated phenotype due to extracellular adenosine-mediated, TCR-antagonizing signaling. Taken together the data suggest that both intracellular toxicity and signaling by extracellular adenosine may contribute to pathogenesis of ADA SCID. Accordingly, extracellular adenosine may act on thymocytes, which survived intracellular toxicity of adenosine during ADA deficiency by counteracting TCR signaling. This, in turn, could lead to failure of positive and negative selection of thymocytes, and to additional elimination of thymocytes or autoimmunity of surviving T cells.     

重型病毒性肝炎并发症及影响预后的因素分析

目的　研究重型病毒性肝炎 (重肝 )的并发症及影响预后的主要因素。方法　对 116例重肝的有关临床资料进行统计分析。结果　 116例重肝有 88例 (75 9% )存在并发症 ,常见的依次为肝性脑病 (6 8 1% )、上消化道出血 (5 4 2 % )、感染 (48 3% )及肝肾综合征 (31 9% )。存在并发症组死亡率 (80 7% )明显高于无并发症组(14 4% ) ,P <0 0 1,出现肝肾综合征及 3个以上并发症者全部死亡。血清总胆红素越高 ,凝血酶原活性越低、总胆固醇越低 ,其病死率越高 ,甲胎蛋白 (AFP)升高者 ,预后较好。结论　重肝的预后与并发症的出现、总胆红素水平、凝血酶原活性、总胆固醇、甲胎蛋白有关。     

Vertical Banded Gastroplasty-Gastric Bypass with and without the Interposition of Jejunum: Preliminary Report

Background: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. Methods: As a modification of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding excess weight loss and complications of the gastric pouch during the first year after surgery were compared. Results: Age, sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding from the staple-line. Conclusions: These preliminary data suggest that complications of the gastric pouch can be reduced by interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are pending.     

影响重症急性胰腺炎预后的主要因素

目的 :探索重症急性胰腺炎分度和治疗方案对预后的影响。方法 :回顾性分析 1983年— 1998年间176例重症急性胰腺炎患者临床资料 ,根据胰腺出血坏死程度、腹水量及胰外受侵范围 ,将重症急性胰腺炎分为 4度 ,分析各度治愈率和采用不同方案的治疗效果。结果 : 度治愈率为 10 0 % , 度 69.3 % , 度 5 3 .1% , 度2 7.3 %。除 度、 度间差异不明显 ( P>0 .0 5 )外 ,其余各度之间均有明显差异 ( P<0 .0 5 )。 度中切除术组疗效明显差 ( P<0 .0 5 )。结论 :影响预后的主要因素 :1胰腺坏死程度 ,坏死越重 ,预后越差。 2治疗方法的选择 ,治愈率以切除组最差 ( 2 8.6% ) ,清除术组 68.4 % ,非手术组 82 .4 % ,因而 ,保守治疗列为首选治疗方案     

血浆置换治疗重型肝炎疗效观察

目的 评价应用血浆置换治疗重型肝炎的临床疗效。方法 对48例重型肝炎患在综合保肝治疗基础上给予血浆置换治疗。结果 早期好转率85．71％，中期好转率33．33％，差异具有显性。结论 血浆置换是重肝较为安全有效的治疗手段，早期应用效果尤佳。     

前列地尔治疗老年急性重症胆管炎50例

目的 :观察前列地尔治疗老年急性重症胆管炎 (ACST)的疗效。方法 :ACST患者 96例 ,均给予抗休克、抗感染和手术治疗 ,其中治疗组 5 0例 ,同时加用前列地尔注射液 10 μg于 0 .9%氯化钠注射液 10mL中 ,iv ,qd ,疗程 1周 ;对照组 46例 ,给予全肠外营养。结果 :治疗组疗效优于对照组 ,血浆蛋白升高明显 ,严重并发症发生率和病死率低 ,两组均差异有显著性 (P <0 .0 5 )。结论 :前列地尔联合全肠外营养是治疗老年ACST重要的、有效的支持方法。     

SARS患者白细胞、淋巴细胞和乳酸脱氢酶水平分析

目的：研究严重急性呼吸综合征(SARS)患者白细胞、淋巴细胞和乳酸脱氢酶变化，探讨其与肺损伤的关系。方法：测定SARS患者激素治疗前后白细胞、淋巴细胞和血清乳酸脱氢酶含量并与健康正常人(对照组)进行比较；将SARS患者依据临床重症诊断标准分为重症组和普通组进行以上指标的比较。结果：SARS患者的白细胞、淋巴细胞绝对值均比对照组显著减少，乳酸脱氢酶明显高于对照组；经过7～10d激素治疗后的SARS患者白细胞、乳酸脱氢酶数量显著提高，淋巴细胞绝对值无显著变化。以上3项指标重症组明显高于普通组。结论：SARS患者白细胞数量、淋巴细胞绝对值显著降低，但可恢复正常；糖皮质激素治疗仅能使白细胞数量增多，而淋巴细胞绝对值未见明显改善。SARS患者的血乳酸脱氢酶升高，其水平与肺损伤的活动性相关。     

前列地尔治疗重症病毒性肝炎肝硬化所致氮质血症

目的 :探讨前列地尔对重症病毒性肝炎 (以下简称重型肝炎 )、肝硬化所致氮质血症的疗效。方法 :3 0例重症肝炎、肝硬化所致氮质血症患者随机分成两组 ,治疗组和对照组各 15例。在护肝、利尿等综合治疗的基础上 ,治疗组加用前列地尔 10 μg ,对照组加用多巴胺 2 0mg ,两组药物均溶于 10 %葡萄糖注射液 2 5 0mL中静脉滴注 ,qd ,疗程均为 4周。结果 :治疗组有效率 60 .0 % ,对照组有效率 3 3 .3 % (P <0 .0 5 )。治疗组血清肌酐、尿素氮、总胆红素比对照组下降明显 ,Na+比对照组上升明显 ,差异均有显著性 (P <0 .0 5 )。结论 :前列地尔对重症肝炎、肝硬化所致氮质血症有较好疗效。