药物相关性中暑6例

临床上，一些抗胆碱药、拟交感神经药、抗精神失常药等药物可导致患者体温升高，增加中暑危险。医师应当对这些药物保持警惕，对使用这些药物的患者进行相关宣教，或者换用其他药物，或改变药物剂量，以最大限度地减少药物相关性中暑的发生。     

毒鼠强中毒的治疗方法研究

本文从彻底清除体内毒物、积极控制癫痫大发作、积极防治多脏器功能衰竭综合征(MODS)及营养支持治疗等方面,对毒鼠强中毒的治疗措施进行了总结,表明毒鼠强中毒的治疗在血液净化方式的选择、抗惊厥药物的使用、防治MODS的具体治疗措施等方面依然存在一些问题,需要进一步研究并规范。     

急性冠脉综合征患者行心肌肌钙蛋白I定性检测的意义及护理

目的掌握心肌肌钙蛋白I(cTnI)定性测定的意义及方法,提高急性冠脉综合征(ACS)早期诊断率。方法对怀疑ACS患者在发病<6h、6~72h、>72h于床边采血进行cTnI、肌红蛋白(Mb)及肌酸激酶同工酶(CK-MB)测定。结果发病≤72h cTnI阳性率低于和显著低于Mb、CK-MB(P<0·05,P<0·01),>72h高于和显著高于Mb、CK-MB(P<0·05)。结论cTnI为ACS特异性指标,床边cTnI定性测定有利于提高ACS诊断率,行cTnI检测的同时应积极救治患者。     

γ-氨基丁酸对急性毒鼠强中毒小鼠的实验治疗研究

目的观察不同剂量γ-氨基丁酸(GABA)对急性毒鼠强(TET)中毒小鼠的治疗作用,为其用于临床治疗提供实验基础.方法通过小鼠急性毒性实验观察染毒即刻以及染毒10 min后分别给予低剂量和大剂量GABA行解毒治疗,并观察各组小鼠脑组织细胞的病理学改变.结果GABA能有效缓解急性毒鼠强中毒小鼠症状,减轻惊厥发作,延缓抽搐出现,降低中毒小鼠的病死率.中毒后即刻用药治疗比10 min后用药治疗效果较好.在小鼠对GABA治疗最大耐受量范围内,即刻大剂量GABA治疗比小剂量GABA治疗急性毒鼠强中毒疗效好.结论GABA对急性毒鼠强中毒小鼠有明显治疗作用,提示GABA有望成为临床上救治急性毒鼠强中毒的优良解毒剂,但在GABA对毒鼠强解毒的具体的量效关系方面尚需进一步探讨.     

卡托普利对百草枯致急性肺损伤的保护作用

Objective To establish paraquat(PQ)induced acute lung injury models induced by paraquat (PQ), and to study the protective effects of angiotension converting enzyme inhibitors (ACEI) with eaptopril (CAP) on the PQ posioning. Method All experiments were made in the central laboratory of Union Hospital. Human umbilical vein endothelial cells (HUVECs) were incubated with different concentration of paraquat and captopril to establish experimental models. Half of cell survival rate detected with MTF assay to judge whether the model was successful or not. Three groups were divided according to the different drug. application: normal control group without any drug intervetion, PQ group exposed to paraqnat with the concentration of 400 μmol/L and CAP group additionally exposed to captopril with concentration of 10 μmoL/L, which was repartifioned to three groups (CAPA, CAPB and CAPC) according to the different intervention time. The supematant was collected to measure the concentration of malondialdehyde(MDA) and superoxide dismutase(SOD) after PQ injury for 24 hours, cy-tochrome C detected by immunocytochemistry and apoptosis detected by flow cytometry. Data were expressed as mean±standard error of the mean (x±s). Statistical 'analysis was carried out with the soft SPSS 16.0. Results MTr assay detected the concentration & time of PQ intervention and the data of CAP groups, using the single-re-season variance analysis, F value were 56.734,172.025, P < 0.01 respectively, thus to suecessfidly construct the PQ model and determine the concentration of CAP intervention groups. Relative to the PQ group, MDA as well as levels of cytochrome C of the CAP group were significantly decreased (t = 5.913,3.945,-3.426, P <0.01); while SOD were markedly increased (t = 5.463,-2.292,-1.297, P < 0.01). It also showed that captopril markedly decreased PQ induced the rate of HUVECs apoptosis, the percentagen of PQ group apoptosis was 46.1%, while CAP groups apoptnsis were 4.3 %, 9.2% and 17 % respectively. Conclusions Captopril has the ability to scavenge reactive oxygen species, and to protect against the paraquat induced lung toxicity on HUVECs, which pro-vide the infonnafion for basic research and clinical treatment of PQ posioning.     

急性冠脉综合征患者行心肌肌钙蛋白Ⅰ定性检测的意义及护理

目的掌握心肌肌钙蛋白Ⅰ(cTnI)定性测定的意义及方法,提高急性冠脉综合征(ACS)早期诊断率.方法对怀疑ACS患者在发病＜6 h、6～72 h、＞72 h于床边采血进行cTnI、肌红蛋白(Mb)及肌酸激酶同工酶(CK-MB)测定.结果发病≤72 h cTnI阳性率低于和显著低于Mb、CK-MB(P＜0.05,P＜0.01),＞72 h高于和显著高于Mb、CK-MB(P＜0.05).结论cTnI为ACS特异性指标,床边cTnI定性测定有利于提高ACS诊断率,行cTnI检测的同时应积极救治患者.     

The Antidotal Effects of High-dosage γ-Aminobutyric Acid on Acute Tetramine Poisoning as Compared with Sodium Dimercaptopropane Sulfonate

To investigate the therapeutic effect of nigh-dosage γ-aminobutyric acid （GABA） on acute tetramine （TET） poisoning, 50 Kunming mice were divided into 5 groups at random and the antidotal effects of GABA or sodium dimercaptopropane sulfonate （Na-DMPS） on poisoned mice in different groups were observed in order to compare the therapeutic effects of nigh-dosage GABA with those of Na-DMPS. Slices of brain tissue of the poisoned mice were made to examine pathological changes of cells. The survival analysis was employed. Our results showed that both high-dosage GABA and Na-DMPS could obviously prolong the survival time, delay onset of convulsion and muscular twitch, and ameliorate the symptoms after acute tetramine poisoning in the mice. Better effects could be achieved with earlier use of high dosage GABA or Na-DMPS. There was no significant difference in prolonging the survival time between high-dose GABA and Na-DMPS used immediately after poisioning. It is concluded that high-dosage GABA can effectively antagonize acute toxicity of terarnine in mice. And it is suggested that nigh-dosage GABA may be used as an excellent antidote for acute TET poisoning in clinical practice. The indications and correct dosage for clinical use awaits to be further studied.     

急诊医学教学中培养医学生“降阶梯”式思维的探讨

目的 培养临床医学专业学生建立“降阶梯”式急诊思维方式.方法 以华中科技大学同济医学院2007级五年制临床医学专业80名学生为研究对象.随机选取其中的40名学生作为实验组,实施“降阶梯”式思维方式教学;另外40名学生作为对照组,仍然按照传统急诊教学方法进行教学.教学结束后比较两组学生的出科考核成绩.结果 实验组学生的出科考试成绩显著优于对照组学生的考试成绩,P＜0.05.急诊医学教学中,围绕培养医学生“降阶梯“式思维教学较传统教学能够提高急诊医学教学质量.结论 为了适应急诊医学的发展需要,我们应当重视在急诊临床教学工作中对学生急诊医学新思维——“降阶梯”式思维的培养.     

大剂量γ-氨基丁酸和二巯基丙磺酸钠对急性毒鼠强中毒小鼠的实验治疗对比研究

目的观察大剂量γ-氨基丁酸（GABA）对急性毒鼠强（TET）中毒小鼠的治疗作用，并与二巯基丙磺酸钠（Na—DMPS）解毒效果相比较，为其临床应用提供实验基础。方法通过小鼠急性毒性实验观察染毒即刻以及染毒10min后分别给予大剂量GABA和二巯基丙磺酸钠的解毒作用。同时观察各组小鼠脑组织细胞病理学改变．结果高剂量GABA与Na—DMPS治疗急性毒鼠强中毒小鼠，二者均能有效缓解急性毒鼠强中毒小鼠症状、降低中毒小鼠的病死率，中毒后即刻用药治疗比10min后用药治疗效果较好。另外，Na—DMPS即刻治疗组在延长急性中毒小鼠强直发作潜伏期方面的治疗效果蹙倪于大剂量GABA。结论大剂量GABA对急性毒鼠强中毒小鼠有明显治疗作用，但在GABA对毒鼠强解毒的具体的量效毫系方面尚需进一步探讨。     

百草枯对人Ⅱ型肺泡上皮细胞氧化应激状态的影响

目的：探讨百草枯（PQ）对人Ⅱ型肺泡上皮细胞氧化应激状态的影响。方法：体外培养人Ⅱ型肺泡上皮细胞A549细胞,用不同浓度（100、200、400、600、800、1000和1200μmol／L）的百草枯进行不同时间（4、8、16、24、48和72h）的干预,用MTT法检测细胞存活率以筛选出半数死亡浓度和半数死亡时间作为试验的干预点,生化比色法测定细胞内的NADPH/GSH／SOD／MDA水平,DCFH—DA法检测细胞内活性氧水平。结果：与正常对照组相比,在半数死亡浓度的百草枯在半数死亡时间内干预A549细胞,细胞内的NADPH、GSH和SOD水平均明显下降（P〈0．05）,细胞内MDA和活性氧水平明显增高（P〈0．05）。结论：PQ导致A549细胞内还原当量水平下降,氧化应激损伤增强,细胞抗氧化能力下降,并引起细胞脂质过氧化损伤。