264例急性中重度中毒临床与流行病学分析

目的分析我院264例急性中、重度中毒患者流行病学及临床特点,为急性中毒防治工作提供科学依据。方法对2008年6月～2011年6月温州医学院附属第二医院264例急性中重度中毒患者性别、年龄、脏器损伤情况等12项内容进行回顾性分析。结果所调查患者男女比例1.9∶1,高发年龄段为20～49岁,主要为无业人员(34.8%),中毒原因以自杀为主(164例),毒物类型前三位依次是有机磷农药(32.6%)、抗精神药物(12.2%)和镇静安眠药(11.5%),中、重度中毒患者比例1.7∶1,多脏器功能障碍发生率35.6%,最常受累器官为肺(38.6%)和脑(36.0%),中毒死亡率5.3%。结论本研究提供了该院急性中、重度中毒流行病学及临床特点的基本资料,为本地区急性中毒防治工作提供有用信息。     

血必净注射液对创伤弧菌脓毒症大鼠肺组织诱导型一氧化氮合酶及一氧化氮的影响

目的 研究血必净注射液对创伤弧菌脓毒症大鼠肺组织诱导型一氧化氮合酶(iNOS)活性和一氧化氮(NO)含量的影响及意义.方法 将110只清洁级SD大鼠按随机数字表法分为正常对照组、模型组和血必净组.皮下注射创伤弧菌悬液制备创伤弧菌脓毒症模型.分别于术后1、6、12、24、48 h活杀10只动物,留取肺组织,检测iNOS活性、NO含量、髓过氧化物酶(MPO)活性,并观察肺组织病理变化.结果 模型组肺组织iNOS活性(U/mg)在染菌后1、6、12、24 h(分别为12.57±3.20、22.17±7.29、19.73±6.23、14.37±3.78)均明显高于正常对照组(6.69±1.87,均P<0.01);血必净组6、12、24 h iNOS活性(分别为14.97±3.48、15.15±5.46、10.28±4.13)明显低于同时间点模型组(P<0.05或P<0.01).模型组肺组织NO含量(μmol/g)在染菌后1、6、12、24、48 h(分别为14.53±3.82、31.52±7.01、41.32±7.28、32.82±5.42、24.82±6.01)均显著高于正常对照组(4.94±1.48,均P<0.01);血必净组肺组织NO含量在12 h、24 h(分别为30.93±5.19、25.25±4.67)与同时间点模型组比较均明显下调(均P<0.01).模型组肺组织MPO活性(U/g)在染菌后1、6、12、24 h(分别为1.21±0.32、2.11±0.28、2.05±0.24、1.07±0.36)也明显高于正常对照组(0.55±0.18,均P<0.01);血必净组MPO活性在6 h、12 h(分别为1.69±0.47、1.37±0.42)与同时间点模型组比较明显下调(均P<0.01).染菌后24 h,模型组大鼠肺组织损伤明显,血必净组大鼠肺损伤较模型组有所减轻.结论 iNOS和NO参与了创伤弧菌脓毒症肺损伤的病理生理学过程;血必净注射液干预治疗能显著下调肺组织iNOS活性及NO生成,减轻创伤弧菌感染所致的肺损伤.     

老年急腹症患者的临床特点与救护

目的 探讨老年急腹症的临床特点与救护经验.方法 回顾性分析2005年1月～2010年1月在本院急诊科接诊并经治疗的154例老年急腹症的临床资料.结果 手术92例,其中急诊手术71例,占总比例46.1％,保守治疗62例,治愈139例,死亡5例,分诊失误31例,占总比例20.1％.结论 熟悉老年急腹症的特点,应重视老年急腹症患者的心理护理与并发症的护理.     

血必净注射液对创伤弧菌脓毒症大鼠肺组织Toll样受体4及核转录因子-κB表达的影响

目的 观察血必净注射液对创伤弧菌脓毒症大鼠肺组织Toll样受体4(TLR4)mRNA表达和核转录因子-κB(NF-κB)活性的干预作用.方法 将110只SD大鼠随机分为正常对照组、模型组、血必净干预组,后两组再分为染菌后1、6、12、24、48 h亚组,每组10只大鼠.于大鼠左后肢皮下注射创伤弧菌悬液制备创伤弧菌脓毒症模型;血必净组于染菌后0.5 h腹腔注射血必净注射液4 ml/kg.各时间点处死大鼠取肺组织,检测肺组织湿/干重比值(W/D比值)、TLR4 mRNA表达、NF-κB活性和肿瘤坏死因子-α(TNF-α)含量.结果 模型组大鼠肺组织W/D比值于染菌后6、12、24、48 h明显高于正常对照组,而血必净组24 h、48 h较模型组明显减小(均P<0.05).模型组大鼠肺组织TLR4 mRNA表达在染菌后6、12、24 h明显高于正常对照组,而血必净组6 h较模型组明显减少(均P<0.05).模型组大鼠肺组织NF-κB活性在染菌后1、6、12 h明显高于正常对照组,而血必净组1 h、6 h较模型组明显降低,24 h、48 h较模型组明显升高(均P<0.05).模型组大鼠肺组织TNF-α于染菌后1、6、12、24 h明显高于正常对照组,而血必净组12 h较模型组明显降低(均P<0.05).结论 TLR4-NF-κB通路参与了创伤弧菌脓毒症肺损伤的早期病理生理过程;血必净注射液能抑制TLR4-NF-κB活化,减轻创伤弧菌脓毒症大鼠肺损伤.     

脓毒症大鼠肺高迁移率族蛋白B1的表达及意义

目的 观察创伤弧菌脓毒症大鼠肺组织HMGB1表达和肺损伤的动态变化,并探讨HMGB1在创伤弧菌脓毒症肺损伤中作用.方法 温州医学院生命科学院实验室,清洁级SD大鼠60只,随机分为正常组(A组,n=10)和创伤弧菌脓毒症组(B组,n=50),采用大鼠左下肢皮下注射创伤弧菌悬液(浓度为6×108cfu/mL,剂量为0.1 mL/100 g)制作大鼠创伤弧菌脓毒症模型),B组于染菌后1、6、12、24、48 h后活杀(各时间点n=10),采用逆转录聚合酶链式反应(RT-PCR)和蛋白免疫印迹(Western blot)分别检测大鼠肺组织HMGB1基因与蛋白的表达,检测肺含水分数和光镜观察肺组织病理变化,数据采用单因素方差分析,并用LSD法进行组间两两比较,P＜0.05为差异有统计学意义.结果 B组染菌后12 h(1.161±0.358,P=0.013)、24 h(1.679±0.235,P=0.000)及48 h(1.258±0.274,P=0.004)大鼠肺组织HMGB1 mRNA表达量较A组(0.652±0.177)明显增高(P＜0.05),并于24 h达到高峰;与A组(0.594±0.190)比较,B组HMGB1蛋白表达量于感染后6 h(1.408±0.567,P=0.026)(P＜0.05)逐渐增加,24 h达到高峰(2.415±1.064,P=0.000);与A组(0.699±0.054)比较,B组大鼠肺含水分数于感染后6 h(0.759±0.030,P=0.001)、12 h(0.767±0.023,P=0.000)、24 h(0.771±0.043,P=0.000)和48 h(0.789±0.137,P=0.000)明显增大(P＜0.05),呈逐渐递增趋势;感染后12 h,大鼠肺内血管明显充血,间质水肿并伴炎性浸润,且逐渐加重,到48 h肺泡腔塌陷明显,肺泡间隔分界不清.结论 大鼠创伤弧菌脓毒症可导致肺脏损伤,HMGB1的表达增加可能是创伤弧菌脓毒症大鼠肺组织损伤的机制之一.

Abstract：

Objective To observe the dynamic changes of high mobility group protein B1 ( HMGB1 )expression in the lung of rats with Vibrio vulnificus sepsis so as to unravel the role of HMGB1 in lung injury.Methods Sixty rats of clean grade were randomly divided into normal control group ( A group, n = 10) and Vibrio vulnificus sepsis group (B group, n =50). Sepsis model was made in rats with subcutaneous injection of Vibrio vulnificus with concentration of 6 × 108 cfu/ml in dose of 0. 1 ml/100 g into left lower limb.The rats of group B were sacrificed 1 h, 6 h, 12 h, 24 h and 48 h after infection for taking lung tissues to detect the water content of lung and to observe the histopathological changes in lung under light microscope.The expression of HMGB1 mRNA and the level of HMGB1 protein in the lungs were detected by RT-PCR and Western blot, respectively. Data were analysed with ANOVA and LSD method for comparison between groups, and P ＜0.05 was considered statistically significant. Results Compared with the group A (0.652±0. 177), the expressions of HMGB1 mRNA in lung of rats of group B were significantly higher in 12 hours (1. 161 ±0.358, P=0.013), 24 hours (1.679 ±0.235, P =0.000) and 48 hours (1.258 ±0.274, P=0.004) and reached the peak in 24 h. Compared with group A (0.594 ±0. 190), the level of HMGB1 protein in rats of group B 6 h after infection ( 1. 408 ± 0. 567, P = 0. 026) was significantly increased (P＜0.05), and it reached peak in 24 h (2.415 ± 1.064, P =0.000) after infection. Compared with group A (0.699 ± 0.054), the lung water contents in rats of group B were significantly increased in 6 h (0.759±0.030, P=0.001), in 12 h (0.767 ±0.023, P =0.000), in 24 h (0.771 ±0.043, P=0.000) and in 48 h (0.789 ±0.137, P=0.000) after infection. Compared with group A, the pathological changes in the lung of rats in group B showed clearly marked pulmonary vascular congestion, interstitial edema and inflammatory cell infiltration, and those changes became more and more serious until alveolar sacs entirely collapsed and the boundaries of the alveolar septa could not be clearly identified in 48 h. Conclusions Vibrio vulnificus sepsis leads to the lung injury of infected rats, and the increase in the expression of HMGB1 mRNA in lung might be one of the mechanisms of lung injury in rats with Vibrio vulnificus sepsis.     

脓毒症大鼠肺基质金属蛋白酶-2/9表达与血必净干预

目的 观察创伤弧菌脓毒症大鼠肺基质金属蛋白酶(MMP)-2/9和组织型金属蛋白酶抑制剂(TIMP)-1/2的动态表达及血必净干预.方法 温州医学院生命科学院实验室,清洁级SD大鼠110只,随机(随机数字法)分为正常对照组(A组,n=10)、创伤弧菌脓毒症组(B组,n=50,采用大鼠左下肢皮下注射创伤弧菌悬液制作创伤弧菌脓毒症大鼠模型)及血必净干预组(C组,n=50,感染后0.5 h腹腔注射血必净4 mL/kg).B、C组大鼠于染菌后1,6,12,24,48 h麻醉后活杀,留取右肺标本.观察大鼠行为学变化,采用考马斯亮蓝法测肺通透性,采用逆转录-聚合酶链式反应(RT-PCR)法测肺MMP-2/9,TIMP-1/2 mRNA的表达,免疫组化法和双抗体夹心酶联免疫吸附法(ELISA)测肺MMP-2/9和TIMP-1/2的表达.数据采用单因素方差分析,并用LSD-t法进行组间两两比较,以P＜0.05为差异有统计学意义.结果 B组和C组肺通透性显著高于A组,C组显著低于B组.B组和C组MMP-2/9,TIMP-1/2mRNA显著升高,B组分别于6 h(0.344±0.108),6 h(1.230±0.377),12 h(0.523±0.098),12 h(0.280±0.070)达高峰(P＜0.05),C组分别于12 h(0.256±0.074),6 h(0.968±0.225),12 h(0.746±0.316),12 h(0.356±0.035)达高峰(P＜0.05),C组MMP-2/9mRNA升高趋势显著低于B组(P＜0.05),TIMP-1/2mRNA显著高于B组(P＜0.05).B组和C组MMP-2/9,TIMP-1/2蛋白也升高,B组分别于12 h(0.692±0.191),12 h(0.061±0.017),24 h(1384.42±91),24 h(41.04±3.60)达高峰(P＜0.05);C组分别于24 h(0.217±0.065),12 h(0.045±0.013),24 h(1617.22±103),24 h(47.66±3.58)达高峰(P＜0.05);C组MMP-2/9蛋白升高趋势低于B组(P＜0.05),TIMP-1/2蛋白早期与B组差别不大,后期显著高于B组(P＜0.05).结论 MMP/TIMP比例失衡是创伤弧菌脓毒症大鼠肺损伤机制之一,血必净可促进MMP/TIMP比例恢复平衡,对创伤弧菌脓毒症大鼠肺损伤具有保护作用.

Abstract：

Objective To detect the expression of MMP-2/9 and TIMP-1/2 in the lung of Vibrio vulnificus sepsis rats and observe the intervention of Xuebijing injection. Method One hundred and ten SD rats of clean grade were randomly(random number) divided into normal control group (group A, n = 10),Vibrio vulnificus sepsis group (group B, n = 50. Sepsis was reproduced in rats with subcutaneous injection in left lower limb with Vibrio vulnificus) and Xuebijin intervention group ( group C, n = 50. Rats were intraperitoneal(ip) with the dose of Xuebijing 4mL/kg at the time of 30 min later after infection). The rats in group B and C were sacrificed at 1 h, 6 h, 12 h, 24 h, 48 h after infection, the expression of MMP-2/9 and TIMP-1/2 were examined by PCR, Immunohistochemistry or ELISA methods, the lung permeability were measured by Coomassie Brilliant Blue method. Experimental data used single factor analysis of variance, and between groups by LSD method for pairwise comparison,P ＜0.05 statistically significant difference. Results The lung permeability increased both in group B and C compared with group A,and in group B were relatively higher. The lung MMP-2/9, TIMP-1/2mRNA expression in groups B and C compared with in group A was markedly higher, and reached the peak at 6 h(0. 344 ± 0. 108 ),6 h ( 1. 230 ± 0.377 ), 12 h (0.523 ±0.098),12 h(0.280±0.070) (P＜0.05) in group B while at 12 h(0.256 ±0.074),6 h(0.968±0.225) ,12 h(0.746 ±0. 316) ,12 h(0.356 ±0.035) (P ＜0. 05) in group C; the MMP-2/9mRNA expression in group C decreased(P＜0. 05) compared with the group B while the TIMP-1/2mRNA expression increased(P＜0. 05). The lung MMP-2/9, TIMP-1/2 protein expression in groups B and C compared with the group A(0.345±0.109) also increased, and the peak was at 12 h (0. 692 ± 0. 191 ), 12 h (0. 061 ±0.017) ,24 h(1384.42 ±91) ,24 h(41.04 ±3.60)in group B while at 24 h(0. 217 ±0.065) ,12 h(0. 045± 0. 013 ) ,24 h ( 1617.22 ± 103 ) ,24 h (47.66 ± 3.58 )in group C, the MMP-2/9 protein expression in group C was lower than in group B(P＜0.05), the TIMP-1/2 protein expression in group C was similar to in group B early while marked increased(P＜0.05)later. Conclusions MMP/TIMP imbalance was one of the mechanisms of the lung injury in the rats with Vibrio vulnificus sepsis, Xuebijing could restore the balance of MMP/TIMP ratio.     

轮叶党参EST-SSR标记的开发及在党参属中的应用

目的开发EST-SSR标记,分析其在党参属及近缘属种间的通用性。方法利用MISA软件对轮叶党参在NCBI公布的EST序列进行SSR位点查找,Primer 3.0软件设计引物,经PCR扩增和琼脂糖凝胶电泳对引物进行初步筛选,聚丙烯酰胺凝胶电泳对所筛选的引物进行多态性检测。结果共查找到204个EST-SSR位点,总长5 263 bp,平均长度25.80 bp,出现频率为22.97%,其中单核苷酸、二核苷酸和六核苷酸重复占比最多,分别为36.8%、24.8%和15.3%。单核苷酸、二核苷酸、六核苷酸中的主要重复基元类型是A、TG和CAGCTC/GTGGCA。共设计引物112对,以党参为模板,能够扩增出清晰稳定条带的引物有67对,有效引物比率59.82%,其中27对能扩增出多态性条带,多态引物比率24.11%。随机选取5对引物对党参属及桔梗共12份材料进行PCR扩增,聚类结果将党参属和桔梗属分为2大类。结论研究筛选出的EST-SSR标记能够在党参属及近缘属内进行区分鉴别,研究结果为党参种质鉴别、遗传多样性分析及资源的评价利用等提供了重要技术手段。     

急性百草枯中毒大鼠肺组织炎症因子表达的变化及意义

目的 观察急性百草枯(PQ)中毒大鼠肺组织中炎症因子表达的变化,探讨早期及晚期炎症因子在急性PQ中毒肺损伤中的作用.方法 50只雄性SD大鼠随机分为2组:正常对照组(10只,生理盐水腹腔注射),PQ染毒组(40只,腹腔注射体积分数为1%的PQ溶液,20 mg/kg).PQ组于染毒后6 h及1、3、7 d处死,正常对照组于处理后1 d处死,检测肺组织中肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、高迁移率族蛋白-1(HMGB-1)mRNA的表达,并观察大鼠的中毒表现及肺组织的病理改变.结果 PQ染毒组大鼠肺组织病理表现为早期充血水肿明显,大量炎性细胞浸润.与正常对照组相比,PQ染毒组大鼠肺组织中TNF-α、IL-10、HMGB-1 mRNA的表达在各时间点均有不同程度升高.PQ染毒组6 h和1 d时TNF-α mRNA表达分别为0.740±0.100和0.584±0.049,1、3 d时IL-10mRNA表达分别为0.551±0.016和0.524±0.010,6 h及1、3 d时HMGB-1 mRNA表达分别为0.695±0.060、0.87±0.154和0.819±0.188,与对照组比较,均明显升高,差异均有统计学意义(P<0.05或P<0.01).结论 大鼠急性PQ中毒后肺组织中TNF-α、IL-10及HMGB-1 mRNA的表达明显上调,早期及晚期炎症因子均参与PQ急性中毒肺损伤的致病过程.     

脓毒症大鼠肺基质金属蛋白酶-2/9表达与血必净干预

Objective To detect the expression of MMP-2/9 and TIMP-1/2 in the lung of Vibrio vulnificus sepsis rats and observe the intervention of Xuebijing injection. Method One hundred and ten SD rats of clean grade were randomly(random number) divided into normal control group (group A, n = 10),Vibrio vulnificus sepsis group (group B, n = 50. Sepsis was reproduced in rats with subcutaneous injection in left lower limb with Vibrio vulnificus) and Xuebijin intervention group ( group C, n = 50. Rats were intraperitoneal(ip) with the dose of Xuebijing 4mL/kg at the time of 30 min later after infection). The rats in group B and C were sacrificed at 1 h, 6 h, 12 h, 24 h, 48 h after infection, the expression of MMP-2/9 and TIMP-1/2 were examined by PCR, Immunohistochemistry or ELISA methods, the lung permeability were measured by Coomassie Brilliant Blue method. Experimental data used single factor analysis of variance, and between groups by LSD method for pairwise comparison,P ＜0.05 statistically significant difference. Results The lung permeability increased both in group B and C compared with group A,and in group B were relatively higher. The lung MMP-2/9, TIMP-1/2mRNA expression in groups B and C compared with in group A was markedly higher, and reached the peak at 6 h(0. 344 ± 0. 108 ),6 h ( 1. 230 ± 0.377 ), 12 h (0.523 ±0.098),12 h(0.280±0.070) (P＜0.05) in group B while at 12 h(0.256 ±0.074),6 h(0.968±0.225) ,12 h(0.746 ±0. 316) ,12 h(0.356 ±0.035) (P ＜0. 05) in group C; the MMP-2/9mRNA expression in group C decreased(P＜0. 05) compared with the group B while the TIMP-1/2mRNA expression increased(P＜0. 05). The lung MMP-2/9, TIMP-1/2 protein expression in groups B and C compared with the group A(0.345±0.109) also increased, and the peak was at 12 h (0. 692 ± 0. 191 ), 12 h (0. 061 ±0.017) ,24 h(1384.42 ±91) ,24 h(41.04 ±3.60)in group B while at 24 h(0. 217 ±0.065) ,12 h(0. 045± 0. 013 ) ,24 h ( 1617.22 ± 103 ) ,24 h (47.66 ± 3.58 )in group C, the MMP-2/9 protein expression in group C was lower than in group B(P＜0.05), the TIMP-1/2 protein expression in group C was similar to in group B early while marked increased(P＜0.05)later. Conclusions MMP/TIMP imbalance was one of the mechanisms of the lung injury in the rats with Vibrio vulnificus sepsis, Xuebijing could restore the balance of MMP/TIMP ratio.     

身体约束等级技术评估方案应用于ICU患者的效果分析

目的分析身体约束等级技术评估方案应用于ICU患者的效果分析。方法将98例ICU患者按照随机数字表法分为研究组和对照组,每组49例。研究组患者实施基于身体约束等级技术评估方案;对照组患者实施传统身体约束管理护理程序。记录并比较两组患者的身体约束时间、身体约束发生率、非计划性拔管发生率、皮肤损伤发生率。结果研究组身体约束时间短于对照组,身体约束、非计划性拔管、皮肤损伤的发生率均低于对照组（均P＜0.05）。结论基于身体约束等级技术评估方案能降低ICU患者身体约束发生率和皮肤损伤发生率。