新疆维吾尔自治区喀什地区疏附县学生溺水高危行为危险因素分析

目的 了解新疆维吾尔自治区喀什地区疏附县中小学生溺水高危行为的发生情况以及危险因素,为制定预防溺水政策和干预措施提供依据。方法 采用整群随机抽样方法,抽取疏附县布拉克苏乡和乌帕尔镇28所小学及2所初中,对小学一年级至初中二年级的所有学生进行问卷调查。结果 共14 543人纳入分析。有23.9%的中小学生在近12个月内发生过溺水高危行为,更高的游泳水平、性格内向、较强的好奇心、和同学相处较差、和家人相处较差、学校附近有开放性水域、家附近有开放性水域是溺水高危行为的危险因素。结论 应加强对中小学生心理和高危行为的关注,加强学生的溺水相关知识和技能培训,同时注意学校及社区开放性水域的管理与干预。     

海水淹溺性肺损伤机制的研究进展

溺水是重要的公共安全问题,是全球意外死亡三大原因之一。肺损伤是溺水患者最常见的并发症之一,其主要表现为严重的呼吸困难和低氧血症,近1/3的患者最终进展为急性肺损伤或急性呼吸窘迫综合症。肺泡上皮细胞是肺泡-毛细血管屏障重要组成部分,淹溺导致其结构和功能的完整性直接破坏促进了肺水肿的发生,同时肺毛细血管通透性增加,中性粒细胞和单核细胞等大量渗出聚集加剧肺内炎症反应。此外,机体氧化应激、细胞间连接和通讯等肺外机制也可导致肺损伤。本文就海水淹溺性肺损伤的相关机制研究进展进行了综述。     

海水淹溺肺水肿兔血浆MDA和SOD的变化

目的 :观察海水淹溺肺水肿 (PE SWD)兔血浆中丙二醛 (MDA)和超氧化物歧化酶 (SOD)变化规律 ,探讨上述两项指标发生变化的原因和机制。方法 :用核黄素光照法和硫代巴比妥酸法 ,对PE SWD兔动脉血浆MDA和SOD进行定量检测和动态观察。结果 :灌海水后 30min ,MDA和SOD较灌海水前均显著升高 ,尔后两者均逐渐下降 ,但仍远远高于灌海水前。结论 :PE SWD发生发展过程中 ,MDA的损害性作用使肺泡表面活性物质表面特性发生改变 ,影响了正常的呼吸功能 ,并掩盖了SOD的保护性作用。     

HFJV联合药物治疗兔海水淹溺肺水肿

目的：观察高频喷射通气（HFJV）联合4种药物治疗海水淹溺肺水肿（PE-SWD）的效果并探讨其作用机制。方法：用海水灌注的方法诱导PE-SWD模型,采用HFJV联合地塞米松、东莨菪碱、尼莫地平和果糖二磷酸钠4种药物进行治疗,观察记录相关的生理、生化指标。结果：HFJV联合4种药物治疗能明显改善PE-SWD相关指标。结论：HFJV联合4种药物治疗能有效治疗PE-SWD,可作为其基础治疗。     

Forensic analysis of diatom in the spleen and heart in Sprague-Dawley rats

Post-mortem diagnosis of drowning is a real challenge, especially in a decomposed body. The diatom test is considered a reliable scientific assessment in several countries including China. The lungs, liver, and kidneys are usually used in the diatom test, whereas the spleen and heart are rarely reported. In our study, we set up five water samples with different concentrations of diatoms. One-hundred and twenty adult SD rats were employed, assigned to the Drowning Group (DG), Post-mortem Submersion Group (PSG), Drowning Control Group (DG-Control), and Post-mortem Submersion Control Group (PSG-Control). Rats in DG and PSG were submerged in water samples, respectively. After the microwave digestion and vacuum filtration method for diatom enrichment, the diatom numbers were counted. The results showed no diatom was found in either the DG-Control or PSG-Control group. Although significant differences in the diatoms number were found between the DG and PSG groups, the heart and spleen revealed no significant differences. These two organs equally had high specificity and low sensitivity. Based on our data, we concluded that the heart and spleen can be used for the diagnosis of drowning, and detection of diatoms in systemic circulation organs may be more suitable for the diatom test, especially when exogenous contamination is avoided.     

Potential use of pericardial cTnI,Mg2+ and Ca2+ in the forensic investigation of seawater drowning in Greece: An initial assessment

The investigation of drowning constitutes one of the biggest problems in forensic practice. Elevated cardiac troponin I (cTnI) levels in biological fluids have been associated with myocardial damage, whereas increased Mg²⁺ and Ca²⁺ levels were found in cases of seawater drowning. The aim of this study was to examine the diagnostic utility of postmortem determination of cTnI, Mg²⁺ and Ca²⁺ in the pericardial fluid, in differentiating between cases of seawater drowning related to myocardial injury and those brought about by other causes. This study included 76 cases selected during a 2-year period from medicolegal autopsies. The cases were divided into three groups, according to the cause of death established based on macroscopic and microscopic evidence. The groups were: 1) seawater drowning (n = 23), 2) seawater drowning with histological evidence of myocardial infarction (n = 28), and 3) myocardial infarction unrelated to drowning (n = 25). cTnI was determined with an enzyme immunoassay; Mg²⁺ and Ca²⁺ with standard colorimetric assays. Pericardial cTnI levels were significantly lower in group 1 compared to groups 2 and 3. In contrast, pericardial Mg²⁺ and Ca²⁺ levels were both significantly higher in groups 1 and 2 compared to group 3. Our results suggest that the postmortem determination of pericardial cTnI levels may be useful in detecting previous myocardial damage as a contributory factor in death from seawater drowning and provide independent confirmation of the usefulness of pericardial Mg²⁺ and Ca²⁺ levels for differentiating between seawater drowning and fatal acute myocardial injury unrelated to the former.     

创伤合并海水浸泡及海水淹溺的文献计量学分析

目的 分析创伤合并海水浸泡及海水淹溺相关文献的分布,揭示研究现状.方法 选用中国生物医学文献数据库,检索相关文献,利用Foxpro编程分析发文时间、主题、文献类型、作者、作者单位、刊出期刊和省市分布.结果 检索到创伤合并海水浸泡及海水淹溺相关文献共436篇,其中52.06%为基金论文,2004年为发文高峰期;未形成该研究领域的核心作者群,5人以上合著占全部文献的51.15%;前10位主题词为肺水肿、动物模型、创伤、肺、腹部损伤、血气分析、烧伤、出血性休克、血流动力学、低温;研究的人员和单位主要分布在北京、广东和重庆等地.结论 1994年以来对创伤合并海水浸泡及海水淹溺导致的海水浸泡伤进行了广泛深入的研究,并取得了较大的进展.今后,需要继续完善基础性研究,在临床相关伤病的救治中检验相关救治方法 ,进一步积累资料,为今后可能的大范围应用创造条件.     

不同剂量地塞米松对兔海水淹溺性肺水肿细胞因子变化的影响

目的：探讨地塞米松对兔海水淹溺性肺水肿（PE-SWD）模型的治疗作用及其对血清IL-8、TNF-α及IL-10的影响。方法：40只家兔随机分为对照组（CG,10只）和不同剂量（0.05 mg/kg、0.2 mg/kg、1.0 mg/kg）地塞米松治疗组（DG1、DG2、DG3,各10只）。用酶联免疫法（ELISA）测定淹溺前及淹溺后30、120 min血清中IL-8、TNF-α及IL-10的含量,并进行动脉血气分析。结果：与CG组比较,DG2、DG3组PaO2升高（P〈0.05）,IL-8、TNF-α含量显著下降（P〈0.01）,IL-10含量明显增加（P〈0.01）;DG2组与DG3组比较,PaO2、IL-8、TNF-α、IL-10无明显变化（P〉0.05）。结论：较大剂量地塞米松能减轻肺损伤,其机制可能与抑制IL-8、TNF-α的释放,增加IL-10的生成有关。但增加剂量（1 mg/kg）并不能增加治疗效果。     

NF—κB、TNF—α在淹溺大鼠脑组织中的表达及其与脑损伤的相关性

目的:探讨淡水淹溺后大鼠脑组织中细胞因子NF-κB、TNF-α的表达及其与淹溺应激引起脑损伤之间的关系。方法:Wistar大鼠70只,其中正常对照(Ⅰ组)、溺水致死(Ⅱ组)、溺水后存活(Ⅲ组)3h、6h、12h、24h、40h各10只,剥取脑组织固定、切片,HE染色后光镜下观察形态学改变;SABC免疫组化法检测各组大鼠脑组织中NF-κB、TNF-α的表达。结果:Ⅰ组脑组织结构清晰,无水肿、出血、坏死病灶;Ⅱ组脑实质疏松,小血管周隙增宽,部分神经细胞体积增大变性;Ⅲ组随溺水后存活时间的推移,脑损伤程度逐渐加重,其中24h脑水肿最重,40h个别脑实质小灶性液化性坏死。Ⅱ组脑指数明显高于Ⅰ组(P<0.05),并高于Ⅲ组,与3h、6h、12h差异有统计学意义(P<0.05)。与Ⅰ组相比,Ⅲ组6h时NF-κB表达显著增加(P<0.05);12h时TNF-α表达显著增加(P<0.05)。结论:淡水淹溺后存活大鼠发生脑损伤时NF-κB和TNF-α高表达,提示NF-κB、TNF-α与淹溺应激所致脑损伤有关。