重症胰腺炎动物模型制作及发病机理的研究

为探讨胰腺炎的发病机理，作者采用大鼠（ｎ＝５８只）十二指肠结扎法和犬（ｎ＝４６条）胰管内注射自身胆汁法制作重症胰腺炎的动物模型。该模型接近人类急性胰腺炎的发病因素，方法可靠，操作简便，费用便宜。前者适用于小动物实验，后者宜于大动物实验。作者认为胰管内压力增高和微生物是急性胰腺炎的重要条件；胰酶激活始动时间早在胰管内胆汁和肠液的反流后，胰酶激活的主要部位在腺泡细胞。     

口腔颌面部严重创伤的麻醉处理

随着交通业与建筑业的迅速发展,发生口腔颌面创伤的概率日趋增多。本文就我们10年来收治的重度口腔颌面创伤患者的麻醉处理报道如下。1临床资料1.1一般资料本组口腔、颌面部严重创伤35例,男性21例,女性14例。创伤原因:车祸伤16例,爆炸伤7例,刀砍伤6例,坠落伤3例,其他3例。合并症:颅脑损伤12例,胸部损伤5例,腹部损伤4例,四肢驱干多发骨折及其他6例,伤后入院时间45min~180min。由于颌面部血运丰富,损伤严重,患者在入院时,口腔颌面、鼻腔有大量血液及分泌物喷出,软组织撕脱、裂伤、颌面部多处骨折,并存在创面严重污染,呼吸道不同程度梗阻。由于出血量多,大部分患者均有失血性休克表现血压(6.0~10.6)/(3.0~7.6)kPa,脉搏126bpm~168bpm,呼吸急促22次/min~38次/min。其中有11例伴有昏迷,3例伴有血气胸,SaO2在60%~82%。1.2急救措施迅速清理创面及口腔、鼻腔、呼吸道的血液、分泌物或异物,保证气道畅通。对有气道梗阻的患者放置鼻咽通气管,其中6例因情况紧急而行气管切开或插管,保证充分供O2;迅速开放2条~3条静脉通道,快速扩容积极抗休克;严密观察生命体征变化,保证...     

Reduced genital sensitivity in female patients with multiple system atrophy of parkinsonian type.

According to the consensus statement on the diagnosis of multiple system atrophy (MSA), erectile dysfunction is required for male patients to fulfil the urinary incontinence criterion. However, there is no equivalent item for female patients. We questioned 19 female patients with MSA of the parkinsonian type (MSA-P), 28 female patients with Parkinson's disease (PD), and 27 healthy controls on their genital sensitivity. A total of 47% of the MSA patients but only 4% of the PD patients and 4% of the control group admitted to reduced genital sensitivity, a highly significant difference (P < 0.001). Moreover, the appearance of reduced genital sensitivity in female MSA patients showed a close temporal relation to the onset of the disease. If these preliminary results can be confirmed and further specified in a larger sample, a historical item of reduced genital sensitivity in female patients might become a diagnostic feature for MSA, comparable to erectile dysfunction in male patients.     

人HLA半相合混合脐血在SCID小鼠移植的实验研究

目的：探讨不同供者来源脐血混合移植的可行性和植入特性。方法：分别将两份人HLA半相合混合脐血或单份脐血输入经亚致量照射后的严重联合免疫缺陷（SCID）小鼠，观察两组脐血在SCID小鼠体内的植入状况及多系造血重建特性。结果：混合脐血和单份脐血移植均可在受鼠体内植入，形成供－受混合嵌合体，并能重建多系造血，存活率和植入率无统计学意义（P＞0．05）。用多聚酶链反应－序列特异性寡核苷酸（PCR－SSO）探针检测人HLA－DQB1基因发现，HLA半相合混合脐血移植可有1份或2份脐血植入，其中造血祖细胞含量和体外克隆形成能力高者，更易于植入，造血重建特性与单一脐血移植比较无统计学意义。结论：HLA半相合人混合脐血可同时在SCID小鼠体内植入，形成来自供－受三者的多嵌合状态，并能重建造血及免疫功能。     

Splanchnic ischaemia and its role in multiple organ failure

Multiple organ failure remains the leading cause of death in the intensive care unit. Increasing numbers of investigators have focused their attention on the role of gastrointestinal tract in the pathogenesis of this syndrome. Their data indicate that inadequate gut perfusion leads to a measurable imbalance between oxygen delivery and the needs of the tissues, i.e., ischaemia. Gut ischaemia of sufficient duration impairs gastrointestinal tract barrier function, facilitating the passage of enteric bacterial endotoxin into the circulation. It has been hypothesized that production of tumor necrosis factor α, and other biologic mediators by endotoxin–stimulated macrophages, triggers a generalized and uncontrolled inflammatory response that ultimately leads to multiple organ failure.
Preliminary evidence suggests that survival can be improved significantly if gut ischaemia is promptly identifed and aggressively treated by administration of fluids and inotropic drugs, using gastric intramucosal pH as the therapeutic endpoint. Future studies are needed to determine whether additional treatment modalities can improve outcome once the inflammatory response has fully developed.     

先天性心脏病患儿术后多脏器功能障碍的预后分析

目的 探讨小儿先天性心脏病(先心病)术后多脏器功能障碍(MODS)预后情况及其影响因素,为对此类患儿进行针对性护理提供依据.方法 收集先心病术后并发MODS 77例患儿的临床资料.结果 11例放弃治疗出院,66例中44例救治存活,22例死亡.出现时间最早、累及最多的脏器为心脏;病死率最高的为累及中枢神经系统的患儿(57.69%),其次是累及血液系统的患儿(55.56%);患儿的病死率与累及脏器的数量呈显著正相关(P＜0.01).死亡患儿手术体外循环时间和主动脉阻断时间显著长于存活患儿(均P＜0.05),术中意外及术后心肺复苏发生率显著高于存活患儿(均P＜0.05).结论 先心病术后患儿应加强心功能监护,特别是体外循环时间＞120 min,主动脉阻断时间＞60 min及术中发生过意外情况、术后采取过心肺复苏术的患儿;尽早采取有利措施避免其他脏器功能受损是提高患儿存活率的关键.     

腹部多脏器损伤的救治

报告了腹部多脏器损伤１５８例的救治情况。致伤因素中交通事故和高空坠落伤占６７．０％，抢救存活１３２例，存活率８３．５％；死亡２６例，病死率１６．５％。作者分析了病死率与致伤暴力强、现场急救延误、就诊时间及受伤的脏器数的密切关系。作者认为院前救护、院内正确诊断、及时治疗、果断手术是抢救成功的重要环节；术中应仔细探查、止血，术后应注意防治多脏器衰竭的发生。     

利多卡因对重型颅脑损伤患者血浆降钙素基因相关肽、钙调素及预后的影响

目的 为观察利多卡因对重型颅脑损伤患血浆降钙素基因相关肽、钙调素水平及其预后的影响。方法 将64例重型颅脑损伤患按随机原则分成利多卡因治疗组和常规治疗组，分别测定治疗前及治疗开始后第2、4、7天血浆CGRP、CaM含量，伤后6个月进行预后判断并进行比较分析。结果 重型颅脑损伤后患血浆CGRP水平下降而CaM水平升高，利多卡因治疗后可使上述改变显减轻并显改善患预后(P＜0.05)。结论 重型颅脑损伤后血浆CGRP水平下降而CaM水平升高，参与了继发性脑损伤的病理生理过程，早期应用利多可因治疗可通过对CGRP和CaM水平的影响，减轻继发性脑损伤，发挥脑保护作用。     

痧斯病(SARS)

严重急性呼吸道综合征(severe acute respiratory syndrome，SARS)是由SARS相关冠状病毒(SCV)引起的一种新的烈性呼吸遗传染病。急性期重症病例肺部病变为严重的急性间质性渗出性炎，类似呼吸窘迫综合征的病理特征。肺外器官主要为出血坏死性炎。临床诊断是一个动态的过程，随着对SARS认识的加深，诊断标准将会不新完善。文中对命名进行了讨论，中文名建议用痧斯病。     

重症SARS的X线影像表现

目的探讨重症严重急性呼吸综合征(SARS)的X线表现.方法回顾性分析37例重症SARS患者的一系列X线胸片变化规律.结果重症SARS患者胸片表现为两肺阴影迅速进展,大部分区域受累.有3种表现类型:①19例表现为弥漫大片云雾状影,病灶无明显分界,肺纹理显示不清;②13例表现为弥漫棉团状密影,边缘模糊,肺纹理增粗;③5例表现为多发大团块密影,边缘模糊,可见支气管气相.如无合并症发生,对症治疗有效,1个月左右肺部阴影消失.6例肺部合并G-杆菌感染,5例合并纵隔气肿,出现合并症时,肺部阴影延迟吸收.结论重症SARS患者的X线影像为肺部密影快速进展至两肺大部分区域,易合并纵隔气肿及肺部感染.