机械通气在胸部开放伤后海水灌入胸腔致急性肺损伤救治中的应用

目的探讨机械通气在胸部开放伤后海水灌入胸腔致急性肺损伤（ALI）救治中的应用。方法锐器致胸部开放伤后胸腔内灌注海水（35ml／kg）制备ALI成年杂交犬动物模型，随机分为未救治组、普通救治组、机械通气组，每组6只。未救治组在ALI出现后不实施任何救治措施，普通救治组给以鼻导管吸氧、胸腔闭式引流、静脉输入5％葡萄糖液等，机械通气组将普通救治组鼻导管吸氧改为机械通气。动态观察血气分析、血流动力学变化，检测外周血中炎症介质的变化。结果胸部开放伤后海水灌入胸腔可导致ALI，普通救治组PaO2虽有所升高但仍显著低于正常，机械通气能快速纠正低氧血症，两组在纠正高渗、高钠、高氯血症和改善血流动力学方面无显著差异。结论胸部开放伤后海水灌入胸腔引起严重ALI，机械通气具有良好的治疗效果。     

还原型谷胱甘肽联合甘草酸二铵对腹部开放伤后海水浸泡犬肝功能损伤的治疗作用

Objective To investigate effect of reduced glutathione and diammonium glycyrrhizinate on the treatment of hepatic damage in experimental dogs following open abdominal injuries coupled with seawater immersion. Methods Twenty-four dogs with open abdominal injuries were randomly divided into 3 groups: the control group (given with simple observation after 1.5 h seawater immersion); the routine treatment group (given routine care and fluid transfusion after 1.5 h seawater immersion) ; the hepatic treatment group (given routine are, fluid transfusion and hepatic treatment as well, after 1.5 h seawater immersion). Each group consisted of 8 dogs. Blood samples were taken at different time points to measure total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothromin time (PT), endotoxin, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and pathological examination was also made at the same time. Results For the control group, contents of TB, ALT, AST and LDH increased significantly and survival time was less than 24 hours. Contents of TB, ALT, AST and LDH of the routine treatment group also increased significantly, but survival time of all the experimental animals was mere than 24 hours. Reduced glutathione and diammonium glycyrrhizinate could reduce the extent of lesion quite significantly 12～24 hours following open abdominal injuries. Conclusions Reduced glutathione and diammonium glycyrrhizinate seemed to have good effects on the treatment and prevention against hepatic damage induced by trauma coupled with seawater immersion. It could be used as a primary means for the treatment of such kind of hepatic damage.     

以军事斗争卫勤准备为牵引 努力提高海上医疗救护能力

作者总结了医院开展海上卫勤战备训练的做法，在针对海上医疗救护的使命任务不断增强做好卫勤准备的责任感，紧扣海上医疗救护平台的特殊要求努力提高医院船医疗队救治能力，突破海上医疗救护技术的瓶颈制约积极开展海战伤救治技术及应用研究等方面，取得了明显效果。     

海水浸泡对腹部开放伤实验犬肝脏功能及形态学的影响

目的 探讨腹部开放伤后海水浸泡对实验犬肝功能及肝脏病理形态学的影响.方法 20只实验犬致伤后随机分为对照组(n=10)和浸泡组(n=10).对照组为单纯腹部外伤,浸泡组于致伤后置入人工配制的海水中.分别于致伤前(0h)及出水后4、8、12、16、20h取血测定总胆红素(TB)、ALT、AST、LDH、血氨(NH3)、凝血酶原时间(PT)、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、内毒素(ETX)水平,于24h处死动物对肝组织进行病理检查.结果 与对照组比较,浸泡组TB、ALT、AST和PT增高,16h后升高明显.浸泡组伤后4h和12h LDH明显高于对照组,伤后4h血NH3明显高于对照组(P＜0.05).TNF-α、IL-6和ETX的变化与肝功能的损害程度呈正比.与对照组比较,浸泡组肝脏的病理形态学改变明显.结论 海水浸泡可导致实验犬的肝功能损伤和肝细胞病理形态学变化.     

循证医学决策模式的建立与应用

循证医学决策模式是建立在对客观的医学研究证据，长期的临床工作经验，及不同患的医疗需求进行综合分析基础上的最佳医疗方案。其建立和应用对提高医疗质量，改善医疗服务质量具有重要意义。树立循证医学决策意识，建立循证医学决策系统，实施循证医学决策管理将为军队医疗系统实现全面品质管理提供可靠依据。     

还原型谷胱甘肽联合甘草酸二铵对腹部开放伤后海水浸泡犬肝功能损伤的治疗作用

Objective To investigate effect of reduced glutathione and diammonium glycyrrhizinate on the treatment of hepatic damage in experimental dogs following open abdominal injuries coupled with seawater immersion. Methods Twenty-four dogs with open abdominal injuries were randomly divided into 3 groups: the control group (given with simple observation after 1.5 h seawater immersion); the routine treatment group (given routine care and fluid transfusion after 1.5 h seawater immersion) ; the hepatic treatment group (given routine are, fluid transfusion and hepatic treatment as well, after 1.5 h seawater immersion). Each group consisted of 8 dogs. Blood samples were taken at different time points to measure total bilirubin (TB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothromin time (PT), endotoxin, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), and pathological examination was also made at the same time. Results For the control group, contents of TB, ALT, AST and LDH increased significantly and survival time was less than 24 hours. Contents of TB, ALT, AST and LDH of the routine treatment group also increased significantly, but survival time of all the experimental animals was mere than 24 hours. Reduced glutathione and diammonium glycyrrhizinate could reduce the extent of lesion quite significantly 12～24 hours following open abdominal injuries. Conclusions Reduced glutathione and diammonium glycyrrhizinate seemed to have good effects on the treatment and prevention against hepatic damage induced by trauma coupled with seawater immersion. It could be used as a primary means for the treatment of such kind of hepatic damage.     

分次灌注海水致兔呼吸窘迫综合征模型的建立

目的通过向兔气管插管内灌入海水，建立海水淹溺致急性呼吸窘迫综合征模型。方法14只新西兰大白兔被随机平分为C组（对照组，无任何处理）和S组（海水组，用海水灌注）。观察分次适量海水灌入气管插管后症状学、血气分析、血液动力学、血清中肿瘤坏死因子（TNF—α）和白细胞介素-6（IL-6）的变化。2h后给每组试验兔拍摄肺CT片，并观察其组织病理学变化。结果与C组相比，S组的O2和CO2指数显著降低（P〈0．01），呼吸动力学和血液动力学的情况明显恶化。TNF—α和IL-6增高，这一结果提示肺损伤发生于兔被海水灌注之后。另外，还发现模型兔有明显的肺水肿、肺泡隔断裂和炎性渗出。结论成功复制了既符合海水淹溺的实际情况，又符合国内外急性呼吸窘迫综合征诊断标准的海水淹溺致急性肺损伤动物模型。     

特布他林对海水淹溺型肺水肿兔肺组织炎症反应的抑制作用

目的探讨特布他林对海水淹溺型肺水肿兔肺组织炎症反应的影响。方法36只机械通气的麻醉新西兰兔随机分成正常组（N组）、对照组（C组）和特布他林治疗组（T组）。C组和T组经颈动脉注入4ml／kg的配方海水，20min后C组经颈动脉注入2ml生理盐水，而T、组则注入0．15mg／kg特布他林，N组除未注入配方海水外，其余处理同C组。观察肺泡灌洗液（BALF）中TNF-α计量和中性粒细胞计数，取部分右下肺常规病理学检查，并分别用RT-PCR和ELISA检测肺组织中TNF-α、IL-1β和IL-8的mRNA表达及蛋白含量。结果病理学观察显示C组的肺组织内有大量的炎性细胞浸润，肺泡隔断裂、肺泡破裂、相互融合、肺泡大量萎陷，肺泡内有出血及透明膜形成。T组的上述改变轻于C组。T组肺组织内TNF-α、IL-1β和IL-8的mRNA表达及蛋白含量均显著低于C组（P〈0．05），BALF中TNF-α和中性粒细胞计数减少。结论特布他林可以抑制海水淹溺型肺水肿兔肺组织的TNF-α、IL-1β和IL-8，从而减轻肺组织炎症反应。     

氩氦靶向治疗肺癌的基础研究与临床实践

目的：研究体内，外氩氦靶向治疗对肺癌的灭活作用。方法：观察体外细胞培养，动物实验及肺癌患者经氩氦刀治疗前后病理等方面的变化。结果：氩氦刀在空气及水中有快速降温及升温作用，距刀尖越近，温度变化幅度越大。且在水中能快速形成冰球。氩氦刀对体外培养的肺癌细胞有明显的破坏作用，在人体中也证实能灭活肿瘤细胞，部分小病灶能完全消失。在动物实验中可见，氩氦刀在肝组织中快速形成冰球，但对颈动脉无明显影响，在肺癌患者中也可见对上腔静脉，主动脉等大血管无严重副作用。结论：氩氦刀有快速升，降温作用，体内，外均能灭活肺癌细胞。     

血管钠肽对慢性低氧性肺动脉高压的治疗作用

目的：研究血管钠肽（vasonatrin peptide,VNP)、C型钠尿肽（C-type natriuretic peptide,CNP）和心房钠尿肽（atrial natriuretic peptide,ANP）对大鼠慢性低氧性肺动脉高压（hypoxic pulmonary hypertension,HPH）的治疗作用及其机理。方法：采用整体给药和离体血管灌流方法,测定肺血流动力学参数和离体肺动脉的等长张力变化。结果：VNP,CNP和ANP都能有效降低大鼠慢性HPH的平均肺动脉压（mPAP),P＜0．05－P＜0．01;除CNP外,VNP和ANF均能明显降低肺血管阻力（PVR）,P＜0．05－P＜0．01,其中VNP降低mPAP和PVR的作用明显大于CNP和ANP;VNP,CNP和ANP对体循环血压（mCAP）和心率（HR）均无明显影响,P＜0．05,VNP,CNP和ANP对离体肺动脉均有浓度依赖性舒张作用,但不受内皮细胞的影响;在浴槽内预先加入优降糖或心得安可显降低肺动脉对VNP和CNP的最大舒张反应（Rmax）,P＜0．05－P＜0．05,而对ANP却无明显影响。结论：VNP对大鼠慢性HPH具有显的治疗作用,它是一个新型的、强效的、非内皮依赖性的血管松驰多肽,较CNP和ANP更具有潜在的临床应用价值。