目的 探讨体外循环手术前后患者血清HMGB₁、CK、CK-MB、LDH、LD₁、AST水平变化及意义。方法 采用ELISA法检测57例体外循环患者手术前后血清HMGB₁表达水平,采用临床常规方法检测血清中CK、CK-MB、LDH、LD₁、AST水平。对体外循环手术前后血清HMGB1表达水平与CK、CK-MB、LDH、LD₁、AST的水平进行比较与相关分析。结果 体外循环手术患者HMGB₁、CK、CK-MB、LDH、LD₁、AST水平在手术后0.5小时、24小时、48小时、72小时均高于手术前(P<0.05);HMGB₁、CK、CK-MB、LD₁、AST水平在手术后24小时达高峰,LDH水平高峰出现于手术后48小时,其他各指标渐渐下降。体外循环手术阻断时间延长,则HMGB₁、CK、CK-MB、LDH、LD₁、AST水平升高。体外循环手术后患者血清中HMGB₁表达水平与CK、CK-MB、LDH、AST指标呈正相关关系(P<0.05)。结论 体外循环手术后患者血清HMGB₁、CK、CK-MB、LDH、LD₁、AST水平升高,HMGB1参与了心肌的缺血再灌注损伤过程。

Objective To investigate before extracorporeal circulation and after HMGB₁, CK, CK-MB, LDH, LD₁, AST levels and significance in serum of patients. Methods 57 cases before extracorporeal circulation surgery and after, the levels of HMGB₁ were detected by ELISA,while the levels of CK and CK-MB and LDH and LD₁ and AST were detected by using conventional methods of clinical. Difference of HMGB₁ and CK, CK-MB, LDH, LD₁ and AST levels were compared. The relationship were been analyzed on the patients before extracorporeal circulation surgery and after. Results In extracorporeal circulation surgery, HMGB₁, CK, CK-MB, LDH, LD₁, AST levels after surgery in 0.5 hours, 24 hours, 48 hours,72 hours were higher than before surgery (P<0.05); HMGB₁, CK, CK-MB, LD₁, AST levels peaked at 24 hours aftersurgery, LDH levels was peaked at 48 hours after surgery, and then gradually declined. Extracorporeal circulation blocking was prolonged, the levels of HMGB₁ and CK and CK-MB and LDH and LD₁ and AST were elevated. After extracorporeal circulation surgery in serum the levels of HMGB₁ expression and CK,CK-MB,LDH, AST indicators showed a positive correlation(P<0.05). Conclusion The levels of HMGB₁, CK, CK-MB, LDH, LD₁ and AST were elevated after extracorporeal circulation surgery. HMGB₁ was involved in myocardial ischemia and reperfusion injury.

KOA是临床上最常见,发病起源于关节软骨的慢性退行性关节疾病。近年来,应用黄芪治疗KOA的报道不断增多,并且开展了大量的机制研究。本文综述了黄芪在KOA治疗中的应用现状及研究进展,同时指出从PPAR-γ信号通路探索黄芪干预KOA的具体分子机制具有积极的理论和实践意义。

神经元特异性烯醇化酶(neuron-specific enolase, NSE)是糖酵解途径中一种重要的同工酶;特异性位于神经元和神经内分泌细胞中。小细胞肺癌(small cell lung cancer,SCLC)细胞浆内含有神经内分泌颗粒,具有神经内分泌分化的特征,为恶性程度高的神经内分泌系统肿瘤。因此,NSE是SCLC诊断中最敏感的肿瘤标志物,在SCLC的临床诊断、治疗、预后均有重要应用价值,科学合理联合检测肿瘤标记物,将能为临床诊疗工作提供有力的帮助。

目的 探讨社区老年高血压病人直立性低血压的药物影响。方法 通过对辖区内897例社区老年高血压病人开展体检,将年轻老年和老老年高血压两组分为直立性低血压组和非直立性低血压组两组。分析降压药物对社区老年高血压病人直立性低血压的影响。结果 OH组的降压药物使用率稍高于非OH组的降压药物使用率,经统计分析P>0.05。OH组联合两种以上及联合三种以上降压药物使用率略高于非OH的药物使用率, P>0.05。利尿剂OH发生率稍高于其他组的OH发生率,P>0.05。结论 社区老年高血压OH的发病可能与目前常用的5大类降压药物无关。

目的 探讨光棒引导与传统喉镜气管插管在不稳定型颈椎骨折患者中的应用效果。方法 不稳定型颈椎骨折患者80例,按照随机数字表法随机分成光棒引导组和传统喉镜组各40例,记录两组患者的插管时间、插管总成功率,入室安静后(T0)、诱导后插管前(T1)、气管插管后即刻(T2)、气管插管后3 min(T3)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、血浆去甲肾上腺素(NE)、肾上腺素(E) 和血管紧张素Ⅱ(ATⅡ)的变化和插管时气道并发症。结果 两组间插管时间(光棒组29.63±11.04s vs.喉镜组62.41±19.49 s)有统计学意义(P<0.001)。两组插管总成功率无统计学意义(P=0.305)。光棒组T2、T3时刻SBP、DBP、HR 、NE、E和ATⅡ均低于喉镜组(P<0.001)。光棒组气道并发症低于喉镜组无统计学意义(P>0.05)。结论 光棒引导气管插管较传统喉镜气管内插管插管时间短,对血流动力学和应激激素水平影响较轻。

目的 了解CHPS患儿经胃镜下幽门肌切开术治疗后幽门部黏膜近期各种并发症的发生情况及对预后的影响。方法 选取2006—2012年我院新生儿科确诊的34例CHPS患儿。以超细胃镜进入十二指肠乳头处,使用电切刀按上行性方向,沿幽门管纵轴切割肥厚狭窄的幽门管黏膜及环形肌以解除幽门部梗阻。术后第1、3、6月复查胃镜。结果 34例CHPS患儿共行胃镜下幽门肌切开术48次,均未发生胃及幽门穿孔、撕裂等严重并发症。24例患儿术后通过胃镜进行了复查,胃镜见幽门部及黏膜改变主要有黏膜充血肿胀、切口未完全愈合、切口疤痕形成、幽门部息肉形成等。结论 经胃镜下幽门肌切开术是一种安全性较高的治疗CHPS的新技术。术后黏膜充血肿胀、切口未完全愈合等幽门部黏膜改变的发生率随时间下降。切口疤痕形成并未影响幽门功能。

目的 研究比较低流量异氟烷与七氟烷麻醉在小儿腹腔镜手术中的麻醉效果。方法 选取在我院进行腹腔镜手术治疗的小儿患者120例作为研究对象,随机分为异氟烷和七氟烷两组,每组各60例,分别采用低流量异氟烷和七氟烷进行麻醉,比较两组患儿的相关麻醉参数,以及入睡、苏醒、拔管时间和不良反应情况。结果 两组患儿的不同时期脉搏氧饱和度、心率、呼气末二氧化碳浓度比较无差异(P＞0.05);七氟烷组患儿的不同时期的平均动脉压具有较强的稳定性,而异氟烷组患儿在诱导期间、手术过程中平均动脉压降低,差异有统计学意义(P＜0.05)。结论 在小儿腹腔镜手术过程,采用低流量七氟烷进行麻醉,可以使手术过程中血流动力学更加稳定,缩短术后拔管时间,减少术后不良反应发生,更易满足小儿腹腔镜手术的麻醉要求。

Objective To investigate efficacy between low flow isoflurane and sevoflurane in pediatric laparoscopic surgery. Methods 120 cases of children underwent laparoscopic surgery in our hospital were randomly divided into two groups. 60 patients in isoflurane group were given low-flow isoflurane anesthesia; 60 patients in sevoflurane group were given low-flow isoflurane anesthesia. Heart rate (HR), mean arterial blood pressure (MAP), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) at different period, sleep and awakening time, extubation time, and adverse reactions of two groups were observed. Results Heart rate (HR), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) of two groups at different period had no significantly difference (P>0.05). Mean arterial blood pressure (MAP) of two groups at different period had significantly difference (P<0.05). The sleep time and recovery time of two groups had no significant difference (P>0.05). The extubation time of sevoflurane was significantly lower than isoflurane group (P<0.05). The adverse reaction rate of sevoflurane was significantly lower than isoflurane group (P<0.05). Conclusion Low flow isoflurane and sevoflurane can be used in pediatric laparoscopic surgery, and the efficacy of sevoflurane is better.

目的 探讨OAB与CP/CPPS的症状及诊断的重叠情况,为临床诊疗提供参考。方法 151例中青年男性患者入选为研究对象,按OAB及CP/CPPS的定义及诊断标准将其分为OAB组、CP/CPPS组及OAB+CP/CPPS组,并对OAB+CP/CPPS组进行诊断性治疗对研究对象进行明确诊断;根据年龄分为:18~25岁组、26~35岁组和36~49岁组,比较各年龄组患者OAB及CP/CPPS的重叠情况;对各组患者的临床症状进行分析比较,了解其重叠情况。结果 在151例研究对象中,可诊断为OAB、CP/CPPS、OAB+CP/CPPS的分别有62例(41.06%)、32例(21.19%)、57例(37.75%),因此OAB与CP/CPPS的诊断重叠率为37.75%,明显大于CP/CPPS患者的诊断率;各年龄组间诊断重叠率无差异(P>0.05);症状的重叠方面,OAB+CP/CPPS组有尿急、尿频、夜尿症、急迫性尿失禁、尿不尽感、排尿困难、泌尿生殖系疼痛和或不适症状的分别为57例(100.00%)、50例(87.72%)、21例(36.84%)、2例(3.51%)、12例(21.05%)、2例(3.51%)、57例(100.00%),其中,尿急、尿频及泌尿生殖系疼痛或不适症状的重叠率最高;OAB+CP/CPPS组经诊断性治疗后诊断为OAB患者约61.40%,而CP/CPPS患者为38.60%。结论 OAB与CP/CPPS两者间有相当高的重叠率且远高于CP/CPPS的诊断率,在OAB与CP/CPPS两者诊断重叠的患者中为OAB的可能性更大。

Objective To explore symptoms and diagnosis of overlap between OAB and CP/CPPS, providing reference for clinical treatment. Methods 151 cases of young men were enrolled in the study. According to the definition and diagnostic criteria of OAB and CP/CPPS, we divided the study subjects into OAB group, CP/CPPS group and OAB+CP/CPPS group. And OAB+CP/CPPS group would get a two-week diagnostic treatment to study a clear diagnosis. We also divided the subjects into 18-25 age group, 26-35 year-old age group and 36-49 group according to the age, comparing the overlap of OAB and CP/CPPS in different age groups. The symptoms of the subjects in each group were analyzed to compare and study the overlap. Results Among these 151 cases, 62 cases (41.06%) can be diagnosed as OAB, 32 cases (21.19%) as CP/CPPS, 57 cases (37.75%) as OAB+CP/CPPS. Therefore, OAB and CP/CPPS diagnostic overlap was 37.75%, significantly higher than the diagnosis of CP/CPPS patients; no significant difference (P>0.05) among all age groups diagnostic overlap rate; overlapping terms of symptoms, OAB + CP/CPPS group urgency, urinary frequency, nocturia, urgency incontinence, urine not the flu, difficulty urinating, or genitourinary pain and discomfort were 57 cases (100.00%), 50 cases (87.72%), 21 cases (36.84%), 2 cases (3.51%), 12 cases (21.05%), 2 cases (3.51%), 57 patients (100.00%), which overlap ratio urgency, frequency, and genitourinary pain or discomfort was high; OAB+CP/CPPS group after diagnosis diagnostic treatment of OAB patients was about 61.40%, while CP/CPPS patients was 38.60%. Conclusion There is high overlap rate between OAB and CP/CPPS, which is much higher than the diagnostic rate of CP/CPPS. It is likely to have an OAB when a patient is diagnosed as OAB or CP/CPPS at the same time.

目的 探讨肝脏脂肪变性对肝脏切除手术安全性及预后的影响。方法 选取2012年1月—2014年12月在我院接受肝切除术治疗的肝癌患者172例,根据HE染色结果,172例患者中无脂肪变性106例(对照组),轻度脂肪变性42例(轻度组),中重度脂肪 24例(中重度组),比较各组患者基本资料(性别、年龄等)、手术情况、生化指标、术后并发症、住院时间等。结果 三组患者体重指数(BMI)差异有统计学意义(P＜0.05),中重度组BMI最高,为(26.94±3.14)kg/m²;中重度组患者手术时间、术中出血量、输注红细胞和肝门阻断时间分别为(182.39±42.17)min、(553.07±50.22)mL、(1.18±0.34)U和(20.15±6.07)min,均高于其他两组(P＜0.05);中重度组患者重度并发症发生率为45.83%,高于对照组和轻度组的9.43%和9.52%(P＜0.05);中重度组住院时间和ICU时间分别为(23.06±7.30)d和(3.71±1.03)d,高于其他两组(P＜0.05)。结论 轻度肝脏脂肪变性对手术基本无影响,而中重度脂肪变性会增加手术时间和出血、重度并发症发生较多,不利于手术的安全性以及预后。

Objective To explore the effect of liver steatosis on liver resection safety and the prognosis. Methods Selected from January 2012 to December 2014 in our hospital liver resection of 172 cases of liver cancer patients, according to the results of HE staining, 172 patients without fatty degeneration in 106 cases (control group), 42 cases of mild steatosis (mild steatosis group), 24 cases of severe fatty (moderate and severe steatosis group),observed each group patients the clinical characteristics, surgery situation, biochemical index, postoperative complications, hospitalization time, etc. Results Body mass index(BMI)of patients in the three groups difference was statistically significant (P<0.05), moderate and severe steatosis group had the highest BMI (26.94±3.14)kg/m²; in moderate and severe steatosis group, surgery time, intraoperative bleeding volume, infusion of red blood cells and hepatic portal occlusion time were (182.39±42.17) min, (553.07±50.22) ml, (1.18±0.34) U and (20.15±6.07) min. They were significantly higher than that of the control group and mild steatosis group (P<0.05); moderate and severe steatosis patients with severe complication rate was 45.83%,significantly higher than that in the control group and the mild steatosis 9.43% and 9.52%. The difference was statistically significant (P<0.05); In moderate and severe steatosis group, hospitalization time and ICU were (23.06±7.30) d and(3.71±1.03) d, significantly higher than that in the control group and the mild steatosis group(P<0.05). Conclusion Mild liver steatosis have no effect on the surgery, severe liver steatosis may increase the surgery time and bleeding, severe complications occurred more, is not conducive to the safety of the surgery and prognosis.

目的 通过建立大鼠泛耐药铜绿假单胞菌肺炎模型,对其进行联合用药,观察疗效,以便为治疗泛耐株引起的感染提供理论基础。方法 选择体外药敏实验中各药物组合同时有效的一株铜绿假单胞菌建立小鼠肺炎模型,于感染后6小时给药,对照组腹腔注射0.5 mL生理盐水,治疗组分别用头孢他啶+阿米卡星+环丙沙星以及头孢他啶+阿米卡星+环丙沙星+氨氯地平两组用药方案连续治疗三天后,根据肺组织匀浆细菌计数及病理结果评价疗效。结果 体内药敏试验显示用药组不管有无氨氯地平干预,对细菌的清除作用与对照组比较差异有统计学意义(P﹤0.05),而两用药组之间比较,差异无统计学意义。结论 对泛耐药铜绿假单胞菌感染后肺炎模型,联合应用体外单药药敏试验耐药的抗菌药后对细菌仍有一定的清除作用,但加入氨氯地平干预未显示有明显的治疗效应。