胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

神经源性肺水肿

神经源性肺水肿(neurogenic pulmonary ede-ma,简称NPE)临床上不多见,起病急,治疗困难,死亡率高,是神经外科中呼吸障碍的一种类型。1992-05～1997-01我院共收治此类患者9例,现报告如下:     

重庆城乡育龄妇女中介生育率变量研究

影响妇女生育率的直接因素,如妇女已婚比、避孕及人工流产等的定量分析是卫生人口统计分析中的重要内容。本文应用美国人口学者Bongaarts提出的中介生育率变量模型就重庆城乡妇女生育率直接影响因素作一定量研究     

增生性玻璃体视网膜病变基质金属蛋白酶的定量研究

目的:研究增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)玻璃体中基质金属蛋白酶(matrix metalloproteinases,MMPs)的表达,探讨MMPs在PVR病理过程中的作用。方法:PVR患者采用标准三切口巩膜扁平部玻璃体切割术(pars plana vitrectomy,PPV),取未稀释的玻璃体21只眼,PPV术后复发的玻璃体腔液20只眼,意外死亡的正常人玻璃体10只眼,采用明胶酶谱分析法定量分析MMP-2和MMP-9活性水平。结果:PVR玻璃体有MMP-2活性水平增高,与正常玻璃体比较差异有显著性意义(P<0.05)。21眼PVR玻璃体中13只眼有MMP-9活性水平增高,平均(171.52±13.17)扫描单位。20眼PPV术后PVR复发的玻璃体腔液19只眼有MMP-9活性水平增高,平均(156.01±37.21)扫描单位。正常人玻璃体无MMP-9的表达。结论:PVR玻璃体有MMP-2和MMP-9活性水平增高,MMP-9活性水平增高可能与术后PVR复发有关。眼科学报2003;19:130-132。     

DSA单帧双期成像法在肝癌栓塞治疗中的应用

探讨肝癌栓塞治疗中 DSA成像的新方法。 1肝动脉加门静脉像 ,将 mask分别设在肝动脉早、中、晚期和实质期 ,对应的减影像设在门静脉期。 2肝动脉双期像 ,将 m ask设在肝动脉早期 ,对应的减影像设在肝动脉中、晚期和实质期。结果发现 :腹腔动脉 DSA单帧双期成像 37例次 ,肝动脉 DSA单帧双期重建 33例次。提示 :DSA单帧双期成像法有利于指导肝癌栓塞治疗的操作 ,提高超选择性肝内动脉插管成功率 ,缩短手术时间。     

青光眼术后白内障超声乳化手术探讨

青光眼术后白内障患者常因眼部条件较差,青光眼所至视功能损害情况难以测定,往往给决定是否手术带来一定困难。为了探讨超声乳化手术对此类患者的治疗价值,我院自１９９８年１月至１９９８年８月应用超声乳化术治疗青光眼术后白内障３８例,获得较满意疗效,现报告如下...     

异丙酚对老年病人机械通气的镇静效果分析

目的观察异丙酚对老年病人机械通气的镇静效果。方法将48例需机械通气的病人按年龄平均分两组,A组为老年病人(年龄≥60岁),B组为非老年病人(年龄<60岁),气管插管前按1.5mg/kg给异丙酚,然后改用微量注射泵持续静注异丙酚1~4mg/(kg.h)。镇静持续时间为(25.3±6.4)h。结果镇静和停药后神志恢复时间两组无显著性差异(P>0.05);两组病人用药前后R,SaO2,PaO2和PaCO2均有明显改善(P<0.05),组间差异无显著意义;用药后两组病人血压和心率无明显变化(P>0.05)。结论异丙酚用于老年病人机械通气的镇静是安全有效的。     

巨大纵隔血管瘤切除1例

骆××,男,54岁,住院号75758。因间歇性右胸痛一年余而入院。入院后查体:右侧肋间饱满,右胸叩诊实音,右中下肺呼吸音消失。X线胸片示:肿物呈半球形突向右侧胸腔,占据右胸腔2/3以上,边缘清楚,密度均匀,侧位片示肿物紧贴胸骨后靠前下纵隔。手术经有前外侧切口第四肋间进胸,剪断切口上下两肋肋软骨扩大切口,见肿     

阴茎海绵体X线电影造影术及其在诊断静脉性阳萎中的应用

使用X线电影造影术对140例临床疑静脉性阳萎病人进行检查。结果：精神性阳萎（造影正常）35例。另105例中，背深静脉漏34例，占32.4％；脚静脉漏17例，占16.2％；龟头尿道海绵体漏18例，占17.1％；阴茎背浅静脉漏4例，占3.8％；混和性静脉漏32例，占30.5％。我们认为罂粟碱注入试验是目前诊断静脉性阳萎的一种最佳筛选方法；阴茎海绵体静脉阻力测定可证实静脉漏的存在；摄影野应包全阴茎静脉系统，同时应多方位观察，以确定病变的部位。     

34例早产儿支气管肺发育不良相关临床高危因素分析

目的探讨早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的相关临床高危因素、病因、了解BPD发病机制,为BPD的防治提供参考。方法以本院新生儿重症监护室2009年1月1日-2013年12月31收治接受呼吸器辅助呼吸(包括经鼻持续气道正压通气和气管插管机械通气)的505例存活早产儿为研究对象,对导致早产儿BPD的相关临床高危因素进行统计分析。结果 BPD多发生于胎龄小于32周,出生体重1 500g的早产儿,BPD与胎龄小、极低和超低出生体重,出生时重度窒息,长时间机械通气、新生儿败血症,动脉导管未闭等因素相关。结论预防早产及重度窒息,规范窒息复苏流程,避免长时间有创机械通气,积极控制感染、关闭动脉导管可减少BPD的发生。