目的 探讨血必净注射液对SAP大鼠TLR4信号通路介导肠黏膜屏障功能障碍的影响。方法 24只SD大鼠随机分成空白组(n=8)、对照组(n=8)和治疗组(n=8)。对照组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射制备SAP模型,空白组采用等量生理盐水逆行注射。治疗组在造模3 h后经鼠尾静脉注射血必净注射液(3 mL/kg)。三组大鼠造模后观察24 h,然后处死取胰腺和小肠组织送病理检查,采用荧光RT-PCR技术检测TLR4和NF-κB表达水平,采用ELSIA法检测血清TNF-α、IL-6、淀粉酶(AMS)及二胺氧化酶(DAO)水平,比较三组大鼠各项指标。结果 对照组和治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平均高于空白组(P>0.05),治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平低于对照组(P＜0.05)。结论 血必净注射液通过干预SAP大鼠TLR4信号通路,降低小肠组织TLR4和NF-κB的表达,减轻小肠组织的炎症反应,对肠黏膜屏障具有一定的保护作用。

Objective To investigate the effect on intestinal mucosal barrier dysfunction (IBF) of Xuebijing injection mediated by Toll-like receptor 4 (TLR4) signal pathway in rats of severe acute pancreatitis (SAP). Methods 24 Sprague Dawley (SD) rats were randomly divided into Sham group (n=8), control group (n=8) and treatment group (n=8). The SAP model was established by retrograde injection of 4.5% sodium taurocholate into the biliopancreatic duct in control group and treatment group, while control group was injected with the same amount of saline. In treatment group, Xuebijing injection (3 mL/kg) was injected via tail vein after 3h of modeling. All rats were monitored and sacrificed after 24 hours of modeling. Samples of pancreas and intestine were collected for pathologic determination. A fluorescent RT-PCR was used to determine the expression of TLR4 and NF-κB of small intestine. The serum levels of TNF-α, IL-6, amylase (AMS) and diamine oxidase (DAO) were measured by using ELISA. All parameters of three groups were compared. Results The expression of TLR4 and NF-κB of small intestine in control group and treatment group were higher than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). The expression of TLR4 and NF-κB of small intestine in treatment group were lower than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). Conclusion Xuebijing injection may not only reduce the expression of TLR4 and NF-κB of small intestine, but also alleviate the inflammation reaction of small intestine by interfering with TLR4 signal pathway, which may have a protective effect on intestinal mucosal barrier in SAP rats.

目的 探讨健康教育路径联合集束化护理模式在预防脑卒中患者便秘的效果观察。方法 随机选择神经外科收治的脑卒中患者120例,分为实验组与对照组,各60例,其中对照组给予常规护理,而实验组在常规护理基础上应用健康教育路径联合集束化护理模式。比较两组患者便秘发生率、便秘措施落实率、患者满意度、及患者入院前后的健康教育知识知晓率的比较。结果 实验组便秘发生率明显低于对照组,便秘护理评估率,护理措施落实率,病人满意度明显高于观察组,患者入院后的健康教育知识知晓率明显升高(P<0.05),具有统计学意义。结论 健康教育路径联合集束化护理模式能有效的降低脑卒中患者便秘发生率,提高预防便秘发生护理措施落实率,提高患者满意度,提高患者舒适度。

瘦素(leptin)是由控制各种生理过程的脂肪组织合成和分泌的一类激素,通过作用于靶细胞膜上的瘦素受体并经信号传导在各器官和系统中发挥一系列生物学效应。肾脏是高血压常见的靶器官之一。相关研究表明,瘦素在高血压肾损害中发挥作用,其机制可能与氧化应激及其炎症反应有关。本文以瘦素对高血压肾损害及其相关机制作一综述,并探讨瘦素对高血压肾损害发病机制研究进展。

Leptin which is a kind of synthesis and secretion of hormone that participates in various physiological processes is the role of the leptin receptor on the target cell membrane and the signal transduction through a series of biological effects in different organs and systems. Kidney is one of the common target organs of hypertension, and related research shows that leptin plays a role in hypertensive kidney damage, whose mechanism may be related to oxidative stress and its inflammatory reaction. The paper reviewed leptin on renal damage in hypertension and its related mechanisms, to explore the leptin on renal pathogenesis of hypertension research progress.

尼可地尔是一种ATP敏感型钾离子通道开放剂,同时兼有类硝酸酯作用,具有舒张冠脉和外周血管及通过缺血预适应对心脏起保护作用等双重功效,主要用于抗心绞痛的治疗。介于尼可地尔这种特殊结构及其作用机制能否降低急性心肌梗死患者PCI术后无复流的发生率及改善临床预后,目前临床研究仍在探索中。现就尼可地尔的作用机制、模拟的药物预适应作用、及综合作用与急性心肌梗死的关系做一综述,评估尼可地尔作为辅助药物在AMI行介入治疗中的作用及临床预后,指导临床用药。

Nicorandil is an ATP-sensitive potassium (K-ATP) channel opener, meanwhile has an effect like nitrate, has dual actions including coronary and peripheral vasodilatation and cardioprotective effects through ischemic preconditioning, mainly for the treatment of anti-angina. Whether the specific structure of nicorandil and its mechanism can reduce the incidence of no-reflow in patients with acute myocardial infarction (AMI) after PCI and improve the clinical prognosis, the current clinical research is still under investigation. We will expound mechanisms of nicorandil, drug preconditioning and its comprehensive effect. The role of nicorandil in the interventional therapy of AMI was reviewed to guide clinical medication.

目的 分析比较经皮微创椎弓根钉内固定和传统开放式手术治疗脊椎骨折的优劣差异。方法 本研究选择我院2015年2月—2016年6月收治的脊椎骨折患者72例,按照治疗方法的不同将全部患者分成对照组(36例)和实验组(36例),两组患者分别给予传统开放式手术治疗和经皮微创椎弓根钉内固定治疗,对两组患者的临床疗效进行观察分析。结果 在手术时间、手术出血量、切口长度以及住院时间方面,实验组患者均优于对照组(P＜0.05);实验组患者术后的血清肌酸激酶活性低于对照组患者(P＜0.05);治疗后两组患者椎体前缘高度、Cobb's角均优于治疗前(P＜0.05),但是组间比较差异无统计学意义(P＞0.05)。术后两组患者均没有发生椎间隙感染、神经损伤、切口感染等并发症。结论 在对脊椎骨折患者进行治疗时,经皮微创椎弓根钉内固定治疗和传统开放式手术治疗的临床疗效比较类似,但是和传统开放式手术相比较,经皮微创椎弓根钉内固定治疗对患者的损伤更加轻微,术后恢复时间更短。

目的 评价血清异常凝血酶原(PIVKA-Ⅱ)检测在原发性肝癌中的诊断价值。方法 收集在我院收治的住院病人及健康体检人群血清标本共968份,其中原发性肝癌组202例,慢性乙型肝炎组385例,肝硬化组62例,脂肪肝组117例,其它消化系统疾病组93例,健康对照组109例。化学发光法分别检测标本中AFP和PIVKA-Ⅱ水平。分别以健康对照组和慢性肝病组为对照,计算AFP和PIVKA-Ⅱ单独检测和联合检测对原发性肝癌的诊断性能(敏感度、特异度、Kappa值以及ROC曲线等)。结果 原发性肝癌组血清AFP和PIVKA-Ⅱ水平均高于其他各组(P<0.05)。AFP和PIVKA-Ⅱ单独检测和联合检测诊断原发性肝癌的敏感度分别为64.36%、95.05%、97.52%;以健康组为对照,AFP和PIVKA-Ⅱ单独检测和联合检测对原发性肝癌的诊断特异度分别为97.25%、98.17%、96.33%, Kappa值分别0.910、0.917、0.937,ROC曲线下面积分别为0.908、0.987、0.992;以慢性肝病组为对照,AFP和PIVKA-Ⅱ单独检测和联合检测对原发性肝癌的诊断特异度分别为80.67%、92.38%、76.95%, Kappa值分别0.654、0.831、0.621,ROC曲线下面积分别为0.801、0.976、0.963。结论 血清PIVKA-Ⅱ在原发性肝癌的中诊断价值优于AFP,其与AFP的联合检测可提高原发性肝癌的诊断敏感度。

目的 研究腹腔镜腹膜前疝修补术(TAPP)治疗腹股沟疝的微创性。方法 纳入我院96例腹股沟疝患者为研究对象,按随机数表法分为观察组和对照组各48例,观察组予以TAPP法进行治疗,对照组予以平片无张力修补术(Lichtenstein手术)。比较两组术中出血量、手术时间、术后进食时间、术后下床时间、住院时间及手术费用的差别,分析术后两组疼痛程度,同时观察术后并发症及复发情况。结果 观察组术中出血量少于对照组,术后进食时间、下床时间及住院时间短于对照组,手术时间长于观察组,手术费用高于对照组(P<0.05)。观察组疼痛程度为低于对照组(P<0.05)。随访1年,两组均无患者复发。观察组术后并发症发生率为14.58%低于对照组35.42%(P<0.05)。结论 TAPP治疗腹股沟疝临床疗效高,创伤小,恢复快,可降低术后疼痛感,具有微创性。

目的 探讨腹腔镜下输卵管积水既往手术史对血清AMH和卵巢储备功能的影响。方法 选择2016年1月—2016年12月期间在中山市博爱医院生殖内分泌科就诊拟行体外受精—胚胎移植术患者,按照既往的输卵管积水的不同处理方式将患者分为腹腔镜下双侧输卵管切除术组(A组,n=52)、腹腔镜下双侧输卵管开窗术组(B组,n=71)、双侧输卵管阻塞或通而不畅而无积水组(C组,n=96),比较各组在促排卵首日AMH、以及AFC、FSH、LH、E2、孕酮的差异,比较各组Gn治疗时间和用量,以及注射HCG日的成熟卵泡数的差异。结果 A组的AMH、LH低于B组和C组(P<0.05),而B组和C组间AMH、LH差异无统计学意义(P>0.05)。A组AFC水平低于C组(P<0.05),而E2水平高于C组(P<0.05)。A组的FSH高于B组和C组(P<0.05),B组和C组间FSH差异无统计学意义(P>0.05)。三组间孕酮差异无统计学意义(P>0.05)。A组的注射HCG日的成熟卵泡数低于B组和C组(P<0.05),而B组和C组间成熟卵泡数差异无统计学意义(P>0.05)。A组Gn用量高于B组和C组(P<0.05),而B组和C组间Gn用量差异无统计学意义(P>0.05)。三组间Gn治疗时间差异无统计学意义(P>0.05)。结论 通过AMH等指标检测,腹腔镜输卵管切除术会降低患者的卵巢储备功能,而开窗术则影响相对较小,对有生育要求的妇女应考虑行输卵管开窗术等方式以保护卵巢功能。

目的 应用不同冲洗液对慢性创面上应用的封闭负压吸引装置进行冲洗,对比两种冲洗方法的优劣,为临床应用提供参考。方法 对比两组冲洗液冲洗后创面肉芽组织生长情况,疼痛度,堵管率,住院天数,细菌培养及药敏试验结果等情况。结果 呋喃西林组对比于生理盐水组能更好的促进肉芽组织生长[(9.41±1.12) vs (7.76±0.67)],能缩短患者平均住院日[(29.44±1.88) vs (32.79±1.74)]d,但是对于减轻疼痛度、降低堵管率方面两者效果相当(P＞0.01)。同时细菌培养显示创面感染以革兰阴性菌为主,呋喃西林组细菌检出率低于生理盐水组(62.5% vs 82.5%);呋喃西林组部分细菌对呋喃西林产生耐药性,而生理盐水组这种情况较之少见(68% vs 36.36%)。结论 ①呋喃西林冲洗在促进肉芽组织生长,缩短平均住院日方面优于生理盐水组。②两种方法均能有效防止引流管的堵塞情况。③呋喃西林冲洗可降低细菌检出率,但能使部分细菌产生对呋喃西林的耐药性。

Objective: To compare the effects of two different liquid in negative pressure wound therapy for chronic wounds, provide the reference for clinical application. Methods: The growth of granulation tissue, pain degree, plugging rate, average hospitalization days, bacterial culture and drug sensitivity test results were compared after the two liquid was used. Results: Nitrofural group compared with the saline group can promote the growth of granulation tissue[(9.41±1.12) vs (7.76±0.67)], shorten the average days of hospitalization[(29.44±1.88) vs (32.79±1.74)]; but for the relief of pain degree and the plugging rate, the effects was similar(P＞0.01, the difference was not significant). At the same time, bacterial test showed that there were almost gram-negative bacteria, bacteria detection rate (62.5%) in Nitrofural group was less than that in the saline group (82.5%); Nitrofural group has more nitrofurazone resistant bacteria(68%), and the saline group performs not the same(36.36%). Conclusion: ① Furacilin irrigation could promote the growth of granulation tissue, shorten the average hospitalization days. ②The two methods can effectively prevent the blockage of the drainage tube. ② Furacilin irrigation can reduce the detection rate of bacteria, but cannot prevent the resistance of nitrofurazone.

目的 探讨蛛网膜下腔注射布比卡因与舒芬太尼预防剖宫产术中寒战效果的影响。方法 选取我院拟行剖宫产手术的产妇158例随机分为对照组(n=79)和观察组(n=79),两组均行蛛网膜下腔注射麻醉下的剖宫产术,对照组给予麻药为质量浓度为5 g/L的布比卡因,观察组为质量浓度为5 g/L的布比卡因+小剂量舒芬太尼,观察两组术中预防寒战效果。结果 观察组寒战发生率(16.64%)低于对照组(39.25%)(P<0.05);MAP、HR组内各时间点间有差异(P<0.05),组间同时间点比较无差异(P>0.05);观察组牵拉痛程度轻于对照组(P>0.05);两组新生儿1min Apgar评分和5min Apgar评分无差异(P>0.05);观察组产妇不良反应发生率为6.33%,与对照组的12.66%比较,无差异(P>0.05)。结论 剖宫产术进行蛛网膜下腔注射布比卡因和舒芬太尼,对预防产妇术中寒战的效果的具有积极影响。