重组人生长激素在重型颅脑损伤中的应用

目的探讨重组的人生长激素(rhGH)在重型颅脑损伤患者中的应用价值。方法46例重型颅脑损伤患者在肠内、肠外营养支持的基础上分成rhGH组与对照组,rhGH组伤后第7天每日皮下注射思增8IU,共10d。应用后第7、14日检测血清总蛋白、白蛋白、转铁蛋白及前白蛋白。结果rhGH组(n=20)第14天血清总蛋白、白蛋白、转铁蛋白及前白蛋白浓度高于对照组(n=26)(P<0.05)。结论重型颅脑损伤患者应用rhGH能改善机体对营养底物的利用率,促进蛋白合成、减轻重型颅脑损伤后低蛋白血症。     

Blood platelets in severely injured burned patients

Unbelievable decrease of blood-platelet in the severely burned patients during the treatment of skingrafting caused two patients to unexpected death. From the records of changes of platelet number, a certain ‘platelet curve’ was made. By observing the curve, our treatments of skingrafting were carried out during the stable period and from then on we had no death cases.     

Antibody-dependent neutrophil-mediated parasite killing in non-lethal rodent malaria

The effects of administrating recombinant human granulocyte colony-stimulating factor (rhG-CSF) and passively transferring immune serum on infection with an attenuated variant of Plasmodium berghei XAT (Pb XAT), in severe combined immunodeficiency (SCID) mice were examined. In immune competent (C.B-17) mice, the attenuated parasite infection was inevitably self-resolving and degenerating forms inside erythrocytes appeared, coinciding with the drop in parasitaemia, whereas SCID mice were unable to control parasite growth and all the mice died. Continuous administration with rhG-CSF caused neutrophilic granulocytosis in both SCID and C.B-17 mice. The effect of rhG-CSF on the infection in C.B-17 mice was to suppress the course of the parasitaemia at an early phase whereas it had no effect in SCID mice. When immune serum was transferred on the day of infection, the prepatent period was prolonged two days in both SCID and C.B-17 mice. When administration with rhG-CSF was combined with transfer of immune serum, SCID mice showed four days delay in patency and degenerating parasites were seen during the course of parasitaemia, although the infection was ultimately fatal. C.B-17 mice similarly treated showed a seven day delay in the onset of the patent parasitaemia which was of a lesser magnitude and shorter in duration compared with control mice. On the other hand, when C.B-17 mice were splenectomized three weeks before infection and then treated with rhG-CSF and immune serum, no degenerating parasites were seen during the infection and all mice died with high parasitaemias. These results show that antibody-dependent neutrophil-mediated parasite killing may occur in the spleen of mice infected with P. berghei XAT.     

老年急性重症胆管炎的外科治疗(附76例分析)

目的：探讨老年急性重症胆管炎(ACST)的外科治疗。方法：总结60岁以上老年ACST76例，根据病程分段统计手术后并发症率和死亡率。结果：病程在1天以内手术者，并发症率为10．0％，死亡率为0；1～3天手术者，并发症率为21．9％，死亡率为6．3％；3天以上手术者，并发症率为64.3％，死亡率为28．8％。三组之间比较有显著差异(P＜0．01)。结论：老年人ACST治疗上应早期手术，解除胆道梗阻，建立通畅的胆道引流；手术应简捷，尽量缩短手术时间。     

Prediction of severe postoperative complications in patients admitted to neuroanaesthesia

The purpose of this study was to identify factors which will predict the risk of severe postoperative complications in individual patients in a neurosurgical unit. Eleven risk factors were investigated in 363 neurosurgical patients, of whom 40 (11%) developed postoperative complications requiring mechanical ventilation for more than 24 h in an intensive care unit, 16 were found to be severely disabled or in a vegetative state at follow-up 1 month after admission, and 28 patients died. By applying stepwise, logistic regression analysis to the patient's data, we were able to select two significant risk variables, i.e. the Glasgow Coma Scale (GCS) 8 or less preoperatively and emergency anaesthesia. The presence of GCS 8 or less on the consciousness scale was associated with postoperative complications in approximately 40% of the cases. Emergency patients with severe neurological damage had the greatest risk of postoperative complications (93%). Fatal outcome for patients with postoperative complications was seen in 40% of the cases.     

应用联合减压术治疗中晚期脑疝疗效观察

目的　观察联合减压术治疗特重型颅脑损伤合并嵌顿性脑疝的效果。方法　将 97例格拉斯哥昏迷评分 (GCS) 3～ 5分的特重型颅脑损伤合并嵌顿性脑疝患者随机分为两组 ,分别采用联合减压术 (46例 )与常规骨瓣开颅术 (5 1例 )治疗 ,术后两组均经常规治疗。随访 1～ 32个月 ,平均 7个月。比较两组患者临床疗效、颅内压变化及并发症发生率。结果　联合减压治疗组有效率为 80 .4 % (37/ 4 6例 ) ,其中恢复良好、中残2 7例 (占 5 8.7% ) ,重残 10例 (占 2 1.7% ) ,死亡 9例 (占 19.6 % ) ;常规骨瓣开颅术对照组有效率为 33.4 %(17/ 5 1例 ) ,其中恢复良好、中残 6例 (占 11.8% ) ,重残 11例 (占 2 1.6 % ) ,死亡 34例 (占 6 6 .6 % ) ,两组有效率和病死率比较差异均有显著性 (P均 <0 .0 1)。联合减压治疗组患者颅内压下降速度和程度优于常规骨瓣开颅术对照组 (P<0 .0 5 )。联合减压治疗组患者的急性脑膨出、切口疝、切口脑脊液漏、外伤性癫疒间及术后枕叶脑梗死发生率均明显低于常规骨瓣开颅术对照组 (P<0 .0 5或 P<0 .0 1) ,但两组术后颅内感染发生率差异无显著性 (P>0 .0 5 )。结论　联合减压术治疗特重脑损伤合并嵌顿性脑疝患者的疗效优于常规骨瓣开颅术。     

治疗老年重症呼吸衰竭42例临床分析

目的：探讨机械通气联合支气管肺泡灌洗（BAL）在治疗老年重症呼吸衰竭的作用。方法：选择常规治疗后病情无缓解的重症老年呼吸衰竭患者42例。建立人工气道行钡械通气治疗12～24h后，低氧血症纠正不理想，气道压力偏高，痰多者，应用加温至37℃生理盐水加庆大霉素、地塞米松及爱全乐经纤支镜行BAL，吸除呼吸道粘稠分泌物，每日一次，连续3—5天。结果：42例患者中，37例通气24h，经支气管肺泡灌洗后，气道压力下降，临床症状好转，缺氧及二氧化碳滞留得到改善，病原菌得到明确，成功脱机出院。结论：对老年重症呼吸衰竭在机械通气的基础上联合支气管肺泡灌洗是治疗呼吸衰竭安全有效的重要措施，值得临床应用。     

重型颅脑损伤开颅术中急性脑膨出的防治

目的探讨重型颅脑损伤开颅术中急性脑膨出的原因及对策。方法对120例重型颅脑损伤开颅术中急性脑膨出的原因、对策及预后进行回顾性分析。结果（1）迟发血肿65例，其中同侧脑内血肿10例，硬膜外血肿8例，对侧硬膜外血肿21例，硬膜下血肿10例，脑内血肿9例，大脑纵裂血肿7例；（2）急性弥漫性脑肿胀40例；（3）外伤性大面积脑梗死15例；（4）复合伤患者有30例。合并胸部、腹部及四肢骨折，有明显的低血压和低血氧症状；（5）术中操作不当，误诊误治10例。结论重型颅脑损伤开颅术中急性脑膨出的主要原因有迟发性颅内血肿，弥漫性脑肿胀，严重脑水肿，广泛脑梗死，术中操作不当，对病情的误诊误治，麻醉问题等。根据不同的原因进行正确处理，可以降低急性脑膨出的重残率及病死率。     

复杂性严重胰腺外伤的外科综合治疗

目的 探讨复杂性严重胰腺外伤的抢救和治疗.方法 本组12例患者采取外科手术、胃造瘘和空肠造瘘、腹腔置管冲洗、深静脉高营养等综合治疗.结果 抢救成功10例,死亡2例.结论 复杂性重度胰腺外伤的患者,准确判断伤情,不断调整治疗方案;选择合理的手术方式和手术时机,胃造瘘和空肠造瘘,深静脉高营养是治疗的关键,胰周的通畅引流和灌洗是抢救治疗成功保证.     

A randomized pilot study in Type 1 diabetes complicated by severe hypoglycaemia, comparing rigorous hypoglycaemia avoidance with insulin analogue therapy, CSII or education alone.

AIM: To determine potential for amelioration of recurrent severe hypoglycaemia without worsening in overall control in individuals with long-standing Type 1 diabetes (T1DM). METHODS: Twenty-one people with T1DM characterized by altered hypoglycaemia awareness and debilitating severe hypoglycaemia were randomized in a pilot 24-week prospective study to optimized analogue therapy (ANALOGUE; lispro/glargine); continuous subcutaneous insulin infusion therapy (CSII; lispro); or re-education with relaxation of blood glucose targets on existing conventional insulin regimen (EDUCATION). Glycaemic profiles and duration of biochemical hypoglycaemia were measured by continuous subcutaneous glucose monitoring and self-monitored blood glucose. RESULTS: Further severe hypoglycaemia was prevented in five participants (71%) in each group (P = 0.06). Incidence of severe hypoglycaemia was: 0.6 (ANALOGUE), 0.9 (CSII), and 3.7 (EDUCATION) episodes per patient year. Restoration of hypoglycaemia awareness was confirmed by validated questionnaire in three (43%) ANALOGUE, four (57%) CSII and five (71%) EDUCATION patients. Glycated haemoglobin (HbA1c) was significantly improved in the ANALOGUE group between weeks 0 and 24 (8.6 +/- 1.1 vs. 7.6 +/- 0.8%; P = 0.04 for change). Non-significant improvement was seen in the CSII group (8.5 +/- 1.9 vs. 7.4 +/- 1.0%; P = 0.06). No change in HbA1c was seen in the EDUCATION group (8.5 +/- 1.1 vs. 8.3 +/- 1.0%; P = 0.54). There were no episodes of diabetic ketoacidosis or any other adverse events in any group. CONCLUSIONS: In this pilot randomized trial comparing optimized ANALOGUE, CSII or EDUCATION alone in unselected individuals with recurrent severe hypoglycaemia, we show potential for restoring hypoglycaemia awareness and preventing further severe hypoglycaemia with concomitant improvement in glycaemic control in ANALOGUE and CSII groups.