ObjectiveTo introduce a new medical heat preservation device, and to explore the application value and effectiveness in replantation of severed fingers. MethodsThe medical heat preservation device was design, water was used as the heating medium, and temperature was set and controlled by microcomputer. Between November 2010 and January 2014, 421 cases undergoing replantation of severed fingers were divided into 2 groups. Within 9 days after operation, the medical heat preservation device was used in 210 cases (experimental group), and the conventional heat lamp was used in 211 cases (control group). There was no significant difference in gender, age, injury cause, the interval between injury and admission, injury finger side, and operation time between 2 groups (P>0.05). The vascular crisis rate, success rate of replantation of severed fingers, comfort, sleep quality, and the influence on roommates were compared. ResultsThe comfort and the influence on roommates were good in 188 cases (89.52%) and 201 cases (95.71%) in the experimental group, which were significantly higher than those in the control group (25/211, 11.85%; 145/211, 68.72%). According to Pittsburgh sleep quality index (PSQI) for sleep quality, the results were good in 105 cases, fair in 85 cases, and poor in 20 cases in the experimental group; the results were good in 45 cases, fair in 95 cases, and poor in 71 cases in the control group. Blood vessel crisis occurred in 35 cases (16.67%) of the experimental group, which was significantly lower than that in the control group (76/211, 36.02%) (P<0.05). The survival rate of replantation in the experimental group (196/210, 93.3%) was significantly higher than that in the control group (181/211, 85.78%) (P<0.05). Significant differences were found between 2 groups (P<0.05) in above indexs. ConclusionMedical heat preservation device for replantation of severed fingers can improve the comfortable degree of patients and the quality of sleep, increase the survival rate of finger replantation, and reduce the occurrence of vascular crisis after operation.
目的：通过经外周静脉穿刺中心静脉置管（PICC）或锁骨下静脉置管与前臂静脉留置针在血液病患者并发深部真菌感染时应用两性霉素B中的比较，探讨如何减少患者静脉炎及并发症发生率和再次静脉穿刺的发生率，从而提高患者生活质量。方法：80例血液病患者分为两组，40例PICC置管或锁骨下静脉置管组为A组，40例前臂静脉留置针为B组，记录静脉炎、疼痛发生情况、留置时间。结果：A组留置时间30～68天，B组留置时间1～5天；A组静脉炎率5%，B组静脉炎率45%；A组疼痛率5%，B组疼痛率35%；结论：在血液病患者并发深部真菌感染时应用两性霉素B治疗中，选用PICC置管或锁骨下静脉置管效果明显优于前臂静脉留置针，值得临床推广。
目的：探讨尿毒症维持性血透(MHD)患者营养不良、炎症与脂质代谢紊乱三者间的相关关系，以及对心血管并发症的预测。方法:测51例尿毒症维持性血透患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白(Apo)A1、ApoB、脂蛋白（a）LP(a)、白蛋白(ALB)、C反应蛋白(CRP)、血清铁蛋白（SF），与30例正常人进行对照研究。结果：MHD患者TG、LDL、ApoB、LP(a)、CRP、SF显著增高,HDL、ApoA1、ALB显著降低(P＜0.05)；随着透析时间的延长，各项检测指标变化进一步加重；且心血管事件发生者血清CRP和LP(a)明显增高，ALB明显降低，血脂紊乱更显著。相关性分析：ALB与HDL、ApoA1正相关，与CRP、LP(a)、TC、TG、ApoB负相关；CRP与LP(a)、TC、TG、ApoB、LDL、SF正相关，与HDL、ApoA1负相关，P均＜0.05。结论：MHD患者存在明显的脂质代谢紊乱、炎症和营养不良，三者的相互促进和影响可能是心血管事件发生的危险因素。
探讨血液灌流（HP）对急性药物中毒患者血中毒物的清除作用及临床疗效。方法：收集我院2002年7月～2006年12月住院的鼠药（主要为毒鼠强、四亚甲基二砜四胺）和部分药物中毒患者69例，其中34例按常规给予洗胃、解毒、排毒、保肝、利尿或呼吸支持等综合治疗（非HP组），35例在综合治疗基础上同时给予HP。通过观察灌流前后的临床疗效。结果：HP组35例中死亡3例，生存率91.4%，非HP组34例中死亡5例，生存率85.3%（P＞0.05）。HP组病程明显缩短（P＜0.05）。HP后患者意识清醒及抽摔停止时间较非HP组显著提前。通过对清除率的计算发现：不同药物的清除效果有差异，其中氮卓类清除效果好，清除率为（91.6±12.5）%。结论：HP能不同程度清除体内毒物，可明显缩短病程、减少并发症，对于急性重度中毒可望提高生存率。
Objective To determine the value of detection of micrometastasis in peripheral blood to hepatocellular carcinoma （HCC） metastasis or recurrence． Methods Reviewed the related literatures, the methods and significances of the detection of HCC micrometastasis in peripheral blood were analyzed. Results Currently, there are mainly two methods, hematogenous dissemination cell detection and HCC specific mRNA biomarker detection, for detection of HCC micrometastasis in peripheral blood. Theoretically, although they are considered as early detections of HCC metastasis or recurrence, researches still not have a abroad agreeable conclusion from different studies. After adjusting and improving the methods and detection time, different studies also have not gotten a quite consistent conclusion. Conclusion There is a great significance in detection of HCC micrometastasis in peripheral blood to understanding the mechanisms of HCC metatasis and recurrence, and also to improving the clinical therapy. Theoretically and practically, the method should be improved for facilitating the mechanism research of HCC metastasis and recurrence, and the application of detection.
【Abstract】Objective To study the influence of early hemofiltration on plasma concentrations of proinflammatory cytokines TNF-α and IL-1β and their transcription levels in severe acute pancreatitis (SAP) pigs. Methods The model of SAP was induced by retrograde injection of artificial bile into pancreatic duct in pigs. Animals were divided randomly into two groups: SAP hemofiltration treatment group (HF group, n=8) and SAP no hemofiltration treatment group (NHF group, n=8). TNF-α and IL-1β plasma concentrations were measured by ELISA. Their transcription levels in the tissues of pancreas, liver and lung were assayed by semi-quantitative reverse transcription polymerase chain reaction. Results After hemofiltration treatment, the plasma concentrations of TNF-α and IL-1β increased gradually but were lower than those of NHF group at the same time spot 〔at 6 h after hemofiltration treatment, (618±276) pg/ml vs (1 375±334) pg/ml and (445±141) pg/ml vs (965±265) pg/ml, P＜0.01〕. At 6 h after hemofiltration treatment, the transcription levels of TNF-α and IL-1β in tissues of pancreas, liver and lung were lower than in NHF group (57.8±8.9 vs 85.7±17.4, 48.0±8.1 vs 78.1±10.2, 46.2±9.6 vs 82.4±10.5; 55.9±9.0 vs 82.2±15.7, 40.6±9.2 vs 60.0±10.6, 35.7±9.8 vs 58.1±9.3, P＜0.01). Conclusion Early hemofiltration can reduce TNF-α and IL-1β plasma concentrations and transcription levels in SAP pigs.
目的 探讨5例特重型胰腺炎的特点及治疗方法。方法 我院2001年8月至2003年8月共收治特重型胰腺炎患者5例。其中入院后18 h内心跳、呼吸骤停3次的重症急性胰腺炎（SAP）1例，治疗以及时血液滤过和心、肺、脑复苏为重点； SAP并发胰性脑病2例，以大剂量维生素B1的补充，或足量补给浓缩红细胞为治疗重点； 并发多个器官功能障碍的暴发性胰腺炎（FAP）2例，治疗重点是血液滤过和防治多器官功能衰竭的级联放大反应，其中1例以高渗性糖昏迷为主要表现，治疗重点是内稳态的纠正，血液滤过，重要器官功能维护。结果 5例特重型胰腺炎患者均治愈，平均住院时间为32.2 d。结论 器官功能的复苏和维护、外科ICU监护、短时血液滤过、内稳态的纠正、中西药综合治疗及病因、对症的个体化治疗是特重型胰腺炎的重要治疗措施。