盐酸戊乙奎醚对感染性休克大鼠心肌抗氧化机制研究

目的 探讨盐酸戊乙奎醚（长托宁）对感染性休克大鼠心肌保护的抗氧化机制.方法 将48只SD雄性大鼠随机分为3组,采用盲肠结扎穿孔术（CLP）制备感染性休克模型.长托宁治疗组（P）静脉给予长托宁O.45mg·kg-1（2g/m1）,假手术组（C）、模型组（S）均给予等量生理盐水,并监测各组的心率（HR）和平均动脉压（MAP）,于术后6h和20h将动物处死,取心肌组织测定超氧化物歧化酶（SOD）及丙二醛（MDA）含量,并在光镜及电镜下观察心肌组织病理改变.结果 P组HR,MAP变化较平稳,MDA仅轻度增高,SOD明显升高,与S组比较,差异有显著性（P＜0.01）.光镜与电镜结果均显示P组心肌病理变化在同一水平均较S组轻.结论 长托宁可降低感染性休克大鼠心肌MDA水平,增加SOD活性,对心肌具有保护作用.     

连续颈丛阻滞用于颈椎手术的临床观察

目的观察连续颈丛阻滞用于颈椎前路手术的可行性及临床效果。方法36例颈椎前路手术均采用一点法颈深丛神经阻滞,用静脉留置针穿刺成功后,先注入2%利多卡因与0.5%布比卡因复合液3~5ml(含1/20万肾上腺素),注药后退出针芯,将外套管与三通相连接。观察患者有无呼吸困难和全脊麻反应,每3~5min再追加局麻药复合液3~5ml,初量平均为(13.6±1.73)ml。术中视手术时间经三通间断追加局麻药。静脉滴入咪唑安定0.05~0.1mg/kg辅助镇静,麻醉期间连续监测心电图(ECG)、血压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)和呼吸频率(RR)的变化。11例病人术后留置套管1~2天,用于术后镇痛。结果颈丛阻滞起效时间为2~3min,阻滞完善时间为10~15min,麻醉效果均较满意,麻醉后呼吸和循环变化差异无显著性意义(P>0.05)。结论应用静脉留置针行连续颈丛阻滞,取材方便,操作简单,效果可靠,是长时间、较复杂颈椎前路手术的一种较好的麻醉方法。     

没有胃肠道穿孔的新生儿气腹

气腹象征着胃肠道穿孔,通常须及时剖腹探查。但在个别情况下,没有胃肠道的穿孔也能发生气腹,重度呼吸窘迫新生儿肺间质含气便能发生气腹。气腹究竟是内科性的还是外科性的,术前须作出鉴别诊断,因为危重的呼吸窘迫新生儿不能耐受不必要的剖腹探查术。作者报告10例气腹,均没有胃肠道穿孔。新生儿气腹常由空腔脏器穿孔引起。胃和十二指肠溃疡穿孔、特发性胃坏死、继发于坏死性小肠结肠炎的小肠结肠坏死、小肠闭锁、肠扭转、胎粪性肠梗阻、巨结肠或美克尔氏憩室,均需外科手术治疗;但     

原发性三叉神经痛周围支撕脱后疗效观察

我们自1986年应用此法治疗原发性三叉神经痛420例,资料完整60例,现报道如下: 资料及方法一、60例中男性36例,女性24例。二、手术方法:1.眶下法(20例)常规眶下神经撕脱术     

甲灭酸肾病

止痛药性肾病,常由长期大量服用含非那西汀及其它止痛药(如阿司匹林)合剂引起。作者报导6例在用甲灭酸(mefenamic acid)治疗后发生的非少尿性肾衰。病人 6例老年妇女中,5例因厌食、恶心、腹泻,随后多尿和脱水入院,另1例(例6)在眼科手术后指定服甲灭酸。在症状出现之前,各例均每天服1～2g甲灭酸2～6周,治疗肌肉与关节的疼痛。     

五联非药物疗法治疗椎动脉型颈椎病疗效观察

目的：观察五联非药物疗法治疗椎动脉型颈椎病的疗效。方法：将600例椎动脉型颈椎病患者随机分为治疗组（300例）和对照组（300例）,治疗组采用颈椎牵引、中频治疗、电针、TDP照射、推拿等五联非药物疗法治疗,对照组则给予口服西比灵和全天麻片,3个疗程后观察两组患者的临床疗效、不良反应发生情况及复发情况。结果：治疗组治愈率、总有效率均高于对照组（P〈0.05）,复发率低于对照组（P〈0.05）;两组患者均未发生明显不良反应。结论：五联非药物疗法治疗椎动脉型颈椎病疗效显著,安全性高,患者乐于接受,值得临床推广应用。     

急诊腹腔镜胆囊切除术治疗急性胆囊炎体会

目的:总结行急诊腹腔镜胆囊切除术在急性胆囊炎临床治疗中的效果.方法:选取本院在2006年至2015年收治的无明显手术禁忌急性胆囊炎患者206例作为临床对象,进行急诊腹腔镜胆囊切除术,术中给予放置引流管,术后抗炎治疗.结果:经临床手术的治疗之后,在206例临床患者之中术后产生胆漏1例,出血1例,实施相关治疗之后已痊愈.结论:急诊腹腔镜胆囊切除术存在手术风险,在操作过程中必须是有熟练的操作技能,在分离时凡是有季节状结构用结扎夹夹闭,胆囊三角分离困难,解剖不清时应顺利进行肝胆之间切开分离,找到胆囊颈,再沿胆囊颈进行分离胆囊管,注意胆囊管内囊性结石要给予取尽.     

麻醉学专升本教育对本科教育的启示做好临床技能训练教学

麻醉学专业3＋2专升本教育,具有较完整的理论-实践-理论的认知过程．临床边实践边教学的教学模式较单纯课堂教学形象,容易被学生掌握。借鉴专升本教育的特点。在本科教育中,应用PBL课程模式,将临床技能训练与理论教学相融合,同时将临床技能训练与模拟训练、动物实验和临床见习相融合,适应现代医学发展,并取得了一定效果。     

新型冠状病毒肺炎疫情下综合性医院动态设置缓冲病房和病区的实践

基于国务院应对新型冠状病毒肺炎（简称“新冠肺炎”）疫情联防联控机制处置常态化疫情防控和局部疫情暴发期间的工作模式、防控技术指南、诊疗方案、专家共识,综合性医院在新冠肺炎疫情常态化防控期间通过设置缓冲病区、在新冠肺炎疫情局部暴发期间通过设置综合缓冲病区,实现肿瘤化疗、急危重症、孕产妇、血透等患者的100%医疗救治,零医务人员、患者和陪护人员感染,收治入缓冲病区或综合缓冲病房患者相比急诊入院患者的平均入院时间均明显缩短,降低了院内交叉感染的风险,完善了急危重症患者的医疗救治工作机制。     

Expression of intercellular cell adhesion molecule 1 and matrix metalloproteinase 9 in endometrium of pregnant mice with long-term exposure to low concentration of sevoflurane北大核心

BACKGROUND: Epidemiological studies have found that female workers who are exposed to waste sevoflurane for a long time have reduced fertility and increased incidence of abortion and fetal deformity. OBJECTIVE: To imitate the working environment of long-term exposure to waste sevoflurane and investigate the mechanism of embryo implantation disorder induced by low-concentration sevoflurane exposure by observing the expression of intercellular adhesion molecule 1, integrin β1, P-selectin, and matrix metalloproteinase 9 in endometrium of pregnant mice exposed to low concentrations of sevoflurane, attempting to provide a basis for clinical safe drug use and occupational protection and to lay a foundation for further research on the mechanism of inhalation anesthetics on embryo implantation at gene and molecular levels. METHODS: Forty female Kunming mice and sixteen male Kunming mice, aged 6 weeks, weighting (20±2) g, were caged separately. Forty female mice were randomly divided into experimental group and control group. Mice in the experimental group were exposed to 0.1% sevoflurane, 6 hours per day, while those in the control group were exposed to the air. Thirty days later, the female mice in estrus were caged with mature male mice at a rate of 2:1. Whether the female mice were pregnant was observed at 7:00 am on the second day after mating. The pregnant mice were kept independently in the original condition (n ≥ 8 pregnant mice in each group). Mouse uterus on day 4.5 of gestation was removed and sliced for histological observation. The expression of intercellular adhesion molecule 1, integrin β1, P-selectin, and matrix metalloproteinase 9 in endometrial tissue was detected by immunohistochemistry and statistically analyzed. The average integrated absorbance value of positive reactants was calculated. RESULTS AND CONCLUSION: In the experimental and control groups, 17 and 15 female mice were respectively found in estrus; 12 and 10 female mice respectively were found vaginal plugs after mating. Five and two female mice were found pseudopregnant on day 4.5 of gestation in the experimental and control groups, respectively. Therefore, there were 7 and 8 pregnant mice in the experimental and control groups, respectively, and the vacant value in the experimental group was replaced by the average value obtained in the same group, which would be subsequently used in the controlled trial. Immunohistochemical results showed that the endometrium (glandular epithelial cells, luminal epithelial cells and stromal cells) of all pregnant mice were positively stained brownish yellow, but the expressions of intercellular adhesion molecule 1, integrin β1, P-selectin, and matrix metalloproteinase 9 (0.019±0.007, 0.017±0.007, 0.015±0.005, 0.012±0.005) in the experimental group were significantly lower than those in the control group (0.032±0.014, 0.025±0.008, 0.021±0.007, 0.023±0.005) (P < 0.05). All these findings indicate that long-term exposure to 0.1% sevoflurane may affect the adhesion of mouse embryos to endometrium and the embryo implantation, which may be related to the inhibitory effects of sevoflurane on the expressions of intercellular adhesion molecule 1, integrin β1, P-selectin, and matrix metalloproteinase 9, causing the imbalance in endometrial immunoregulation, the invasion of trophoblast cells into the endometrium and the inhibition of endometrial decidualization, and miscarriage and bleeding due to damaged vascular endothelium. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.