谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

225例甲状腺非典型腺瘤病理组织学及免疫组化研究

目的：观察甲状腺非典型腺瘤的病理学特点,分型及免疫学表型。方法：HE染色光镜观察组织学特点并分型,免疫组化（S－P法）检测bcl-2,p53,PCNA表型,结果：225例巨检分为：孤立型168例,占75％,多结节型52例,占23％,隐匿型5例,占2％,光镜下组织学分为：腺泡状型180例,占80％,弥漫型34例,占15％,小梁状型11例,占5％,细胞形状学以下不规则型为主,占55％（124／225）,梭形细胞型占30％（67／225）,透明细胞型占10％（23／225）,畸异细胞型占5％（11／225）,免疫组化bcl-2,p53,PCNA在腺泡状,弥漫型,小梁 型中的阳性表达率分别为82．8％,24．5％,75．3％,81．4％,23．5％,76．5％,83．5％,25．1％,76．0％。三组间无显著差异（P＞0．05）,与滤泡状腺瘤比较有显著差异（P＜0．01）,与滤泡状癌比较无显著差异（P＞0．05）,结论：甲状腺非典型腺瘤组织学和细胞学均分为三型,生物学行为系原位癌。     

甲状腺非典型腺瘤生物学特性及免疫组化研究

目的 :探讨甲状腺非典型腺瘤免疫组化表型与生物学特性的关系。方法 :采用免疫组化S P法 ,检测bcl 2、p5 3、PCNA的表达 ,并与单纯腺瘤和滤泡状癌对照研究。结果 :非典型腺瘤bcl 2、p5 3、PCNA阳性表达率分别为 82 8% (2 3/ 2 8)、2 5 % (7/2 8)、76 5 % (2 1/ 2 8) ,与腺瘤差异有显著性 (P <0 0 1) ,与滤泡状腺癌差异无显著性 (P >0 0 5 )。结论 :甲状腺非典型腺瘤似原位癌 ,手术治疗效果良好 ,罕见复发 ,无转移     

断流术与分流术后门静脉高压性胃病的胃粘膜变化

为了解断流与分流两种手术后门静脉高压性胃病的胃粘膜变化，笔者将１９９４－０１～１９９７－０６住院１０７例肝硬变门静脉高压症中的３６例门静脉高压性胃病患者随机分为断流术组２０例与分流术组１６例，胃镜观察手术前后胃粘膜损害的变化情况。结果表明，断流组术后胃粘膜病变程度较术前加重（Ｐ＜００５），而分流组则明显改善（Ｐ＜００５），但后者对肝功能的损害较前者的明显。     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

谷氨酰胺和生长激素对门静脉高压症患者术后营养、免疫和炎症反应的影响

Objective This study was conducted to evaluate the effects of postoperative glutamine and growth hormone on the nutritional status,immune function,and inflammatory responses of patients undergo-ing portal hypertension surgery.Methods This study was designed as a prospective,randomized and con-trolled clinical trial.Forty-two patients undergoing portal hypertension surgery were randomly divided into 2 groups:experimental group (receiving an immune enhancing parenteral nutrition by adding glutamine and re-combinant human growth hormone,n = 22),and control group (receiving an isocaloric and isonitrogenons standard parenteral nutrition,n = 20).Parenteral nutrition providing 125 kJ · kg-1·d-1 was initiated 3 days after surgery in both groups and last for 7 days.Blood samples were obtained on day 0th,3rd,and 10th.Host nutritional status was evaluated by measuring levels of prealbumin and transferrin,immunity was evalu-ated by measuring levels of CD4,CD8,CD4/CD8,IgG,IgM and IgA,and the inflanunatory responses was determined by assessing IL-2,TNF-α and C-reactive protein (CRP) levels.Results Ten days after opera-tion,among patients receiving an immune enhancing parenteral nutrition,the serum prealbumin was (193.84±39.78)mg/L,transferrin was (2.07±0.51)mg/L,CD4 was (33.7±5.5)%,CD4/CD8 was (1.17±0.32),IgG was (13.94±1.09)g/L and IL-2 was (368.12±59.25) pg/mL.They were signifi-cantly higher than those of the control group (P < 0.05).The TNF-α concentrations was (321.12±81.42)pg/mL and CRP was (32.2±15.2)mg/mL which were significantly lower than those of the control group (P < 0.05).Conclusion Postoperative administration of immune enhancing parentearl nutrition in patients undergoing portal hypertension surgery can improve nutritional status and immune function,and modulate inflammatory response is also better than standard one.     

大黄在预防创伤后呼吸机相关性肺炎中的价值

目的观察应用大黄预防创伤后呼吸机相关性肺炎(VAP)的临床效果。方法将86例并发成人呼吸窘迫综合征并行机械通气的危重创伤患者,按收住创伤重症监护病房的时间分成2组,其中大黄治疗组44例,非大黄治疗组42例,比较两组VAP发病率。结果非大黄治疗组发生VAP19例(19/42),大黄治疗组发生VAP11例(11/44),差异具有显著性(P<0.05)。结论大黄能显著降低危重创伤患者VAP的发病率,可以用于创伤后VAP的防治。     

县级二甲医院综合性ICU的建设与发展

重症监护治疗病房(InstensiveCareUniteICU)是将危重病人集中管理的病区配备有专业医护人员及各种先进的医疗监测和治疗手段,其主要的任务就是及时有效地抢救、维持危重病人的生命。ICU的特点:(1)病人来自多个临床学科,(2)可对各种危重病人的生命体征进行连续、定量、定向监测,因而可实现及早诊断与处理,(3)具有各种先进的治疗手段,(4)专业医师与各临床专科医师的协同诊治,(5)现代管理所带来的高质量和高效率。因此,ICU的建设和发展已成为医院现代化建设与管理不可缺少的重要组成部分。     

胃大部切除毕罗Ⅱ式吻合术后输出襻梗阻的诊治

胃大部切除毕罗Ⅱ式吻合术后输出襻梗阻的诊治９１医院外一科（山东兖州２７２０００）周晋生薛重毫薛绪潮蒋小春孙奇胃大部切除毕罗Ⅱ式吻合术是普外常见手术，随着操作技术的提高，术后严重并发症已较为少见，但术后输出襻梗阻时有发生，其诊治有一定特殊性。本院自１９...     

胃去动脉术治疗急性胃粘膜病变大出血16例报告

目的 探讨胃去动脉术治疗急性胃粘膜病变大出血的效果。方法 对１６例经内科治疗无效的急性胃粘膜病变大出血者结扎胃左右动脉和胃网膜左右动脉。结果 全部即刻止血，无再出血，死亡１例。其中随访１２例，时间１０个月￣８月，未发现并发症。临床分析提示，低血压、肝功能损害、严重感染、酸中毒、尿毒症等是急性胃粘膜病变的危险因素。结论 胃术操作简单、安全、效果确定、创作小、不失为急性胃粘膜病变大出血内科治疗失败后可