连续性静脉-静脉血液滤过联合机械通气治疗ARDS的临床观察

目的　观察连续性静脉 -静脉血液滤过 (CVVH)联合机械通气治疗ARDS患者的临床疗效。方法　选择入住ICU符合ARDS诊断标准的患者 4 0例 ,随机分为 2组 :A组 2 1例 ,采用常规治疗 +机械通气 ;B组 1 9例 ,采用常规治疗 +机械通气 +CVVH。分别观察 2组患者在使用呼吸机时间、氧合指数、吸入氧浓度、动脉血氧分压、PEEP水平、心率、血压及病死率等方面的差别。结果　A、B两组患者在病因、年龄、性别、APACHEⅡ评分及平均脏器功能障碍数等方面相似 ,B组患者加用CVVH后 ,各项指标经统计学处理显示 :病死率 ,B组与A组比较 ,差异有显著性意义 (P <0 0 5 ) :其他指标与A组比较 ,差异均有高度显著性意义 (P <0 0 1 )。结论　CVVH疗法可有效清除ARDS患者血管外肺水和各种应激激素、致炎介质 ,明显改善了ARDS患者肺部氧合功能及血流动力学指标 ,提高了抢救成功率     

急性重症胆管炎的介入治疗

目的讨论经皮经肝穿刺放置引流管(简称PTCD)减压引流治疗急性重症胆管炎(简称AOSC)的可行性及疗效.方法 1996年3月～2001年4月行PTCD治疗AOSC病人15例,男10例,女5例,胆石症术后8例,胆管癌2例,胰腺癌3例,胆道畸形2例,其中4例放置了胆道内支架.结果 15例病人技术成功率100%,无1例出现穿刺置管所致的严重并发症.病情缓解后针对病因有8例行手术治疗痊愈,4例不能手术的肿瘤患者植入了胆道内支架,1例于置管后3d死于多脏器功能衰竭,2例置管引流病情稳定后因各种原因放弃继续治疗,保留引流管自动出院.结论 PTCD可有效降低胆管压力,缓解病情,降低AOSC的死亡率,为进一步的病因治疗创造条件.     

腹腔镜在急性肠梗阻手术治疗中的应用

目的:评价腹腔镜在急性肠梗阻手术治疗中的价值。方法:对腹腔镜急性肠梗阻手术的适应证、禁忌证、手术方式、注意事项、手术并发症及优缺点等进行了总结与分析。结果:腹腔镜手术已成功地用于治疗由既往腹部手术后粘连、内疝(包括膈疝)、腹壁疝、肠扭转等所引起的急性肠梗阻。结论:腹腔镜急性肠梗阻手术仍是一种探索性的手术,可以代替开腹手术治疗选择性的急性肠梗阻。对于梗阻原因不明者,腹腔镜手术是一种即可以明确梗阻原因,又可以同时进行有效治疗的方法。     

Oral and subcutaneous sumatriptan in the acute treatment of migraine: an open randomized cress-over study

In an open, randomized cross-over study in 124 patients, we compared the efficacy, safety and patient preference of oral and subcutaneous sum triptan in the acute treatment of migraine. Patients were treated for 3 attacks or 3 months and then crossed over. Primary clinical efficacy was defined as a reduction in headache severity on a four-point self-rating scale from severe (3) or moderate (2) to mild (1) or none (0), or mild (1) to none (0). Efficacy was evaluated 2 h after the administration of subcutaneous and 4h after the administration of oral sumatriptan. Subcutaneous sumatriptan was significantly more effective than oral sumatriptan in relieving headache (over all three attacks 78% vs 61% improvement), improving clinical disability (55% vs 41 % improvement) and relieving nausea (69% vs 53%), vomiting (72% vs 32%) and phono- or photophobia (67% vs 49%). Median time to recurrence was shorter after subcutaneous (12.5 h) than after oral sumatriptan (18 h); the number of patients experiencing a recurrence was similar Patients reported more adverse events after subcutaneous sumatriptan (1.32 per attack) than after the oral form (0.85 per attack), but all adverse events were mild to moderate in intensity and of short duration. Patient opinion was more often positive after subcutaneous sumatriptan. These results may be useful in counselling patients to choose between the available marketed formulations of sumatriptan.     

硝基胍的毒性研究

目的对硝基胍的毒性进行研究,为制订卫生标准提供依据.方法包括急性毒性试验、蓄积毒性试验及亚慢性毒性试验.结果硝基胍大鼠经口LD50为8 066 mg/kg,小鼠经口LD50为10 044 mg/kg,蓄积系数大于5.3.亚慢性毒性试验中,高剂量组雄性大鼠在染毒第3周和第8周,体重有明显的负增长(P＜0.05);高剂量组雄性大鼠睾丸脏器系数明显高于对照组(P＜0.05);红细胞免疫功能测定结果显示,中、高剂量组大鼠红细胞受体花环率分别为10.00±2.37和7.50±2.66,明显低于对照组(P＜0.05,P＜0.01).其余各项指标未见明显改变.结论硝基胍属于微毒级毒物,轻度蓄积,亚慢性毒性试验对动物有一定的影响.     

A simple method for screening assessment of acute toxicity of chemicals

We proposed a simple method for screening assessment of acute oral and dermal toxicity using only three rats and mice of each sex at each dose level. Animals were first treated with chemicals at a dose of 2000 mg/kg and were carefully observed for compound-related morbidity and mortality. If none of the animals died, the following toxicity tests were suspended. If some of the animals died, toxicity tests at doses of 200 and 20 mg/kg were performed. The approximate LD₅₀ values calculated by this method showed little difference between two separate laboratories and were in good agreement with LD₅₀ values reported in the literature. Our toxicological data also showed that LD₅₀ values were about 2–2.5 times the MNLD (maximum non lethal dose) in acute oral and dermal toxicity. This meant that a chemical could be regarded as having an LD₅₀ of about 4000 mg/kg or higher when there was no mortality at the dose of 2000 mg/kg. A chemical with such low toxicity would not require further testing for lethal effects. Therefore, this simple method combining the fixed-dose procedure with the limit test is suitable for determination of approximate LD₅₀ values of chemicals and for screening for necessity for classical full LD₅₀ test using many animals.This work was supported by a grant from Ministry of Health and Welfare in Japan (No. 467 and 511)     

急性肠系膜静脉血栓形成16例临床分析

目的　分析急性肠系膜静脉血栓形成 (ASMVT)的临床特征和诊断方法。方法　对北京友谊医院 1985年 10月至 2 0 0 2年 10月确诊的 16例ASMVT的临床资料进行分析 ,并结合文献 ,总结ASMVT的临床特征和诊断方法。结果 16例ASMVT患者 ,年龄 19～ 6 4岁 (平均 4 5 9岁 )。主要症状有腹痛 ( 16 / 16 )、腹胀 ( 16 / 16 )、呕吐 ( 10 / 16 )、发热 ( 8/ 16 ) ,主要体征有腹部膨隆 ( 16 / 16 )、腹膜刺激征( 16 / 16 )。误诊率 75 % ( 12 / 16 ) ,死亡率 4 4 % ( 7/ 16 )。结论　ASMVT的临床表现有一定的特征 ,早期彩色超声检查、诊断性腹腔穿刺、结合CT或肠系膜上动脉造影异常发现可对ASMVT做出正确的诊断 ,早期手术可以降低死亡率     

急性脑梗死血压和颅压的控制

脑梗死急性期对血压和颅压的控制极为重要，若措施得当，可大大降低病死率和致残率。笔者结合临床工作经验总结体会如下：脑梗死急性期对血压和颅压的控制极为重要，若措施得当，可大大降低病死率和致残率，笔者结合临床工作经验总结体会如下。