介绍脓毒症目前存在的问题.详细阐述脓毒症相关生物标志物、诊断价值及预后方面,指出该生物标志物可以作为早期诊断及判断预后的重要指标.

Chronic obstructive pulmonary disease(COPD)is a common clinical respiratory disease,which is characterized by persistent airflow limitation,with high morbidity and death worldwide,bringing great economic and psychological pressure to patients.If COPD patients have respiratory tract infection,it is easy to progress to acute exacerbation of chronic obstructive pulmonary disease(AECOPD),which requires timely and effective treatment.At this time,the indicators related to the prognosis of COPD can greatly improve the sensitivity of clinicians,and lay a foundation for early identification of risk factors and assessment of individual death risk,timely intervention and assistance in clinical treatment.Therefore,the research on prognostic markers of COPD has become a hot spot,and some indicators of renal function and blood lipid are related to the prognosis of COPD.In view of this,this article reviews the new progress of renal function and blood lipids related to COPD,aiming to provide help for the diagnosis,treatment and prognosis of the disease.

目的 以间斑寇蛛毒素致急性肾损伤的实验大鼠为模型,从病理角度研究不同剂量的蛛毒致大鼠肾损伤的程度.方法 采集蛛毒粗毒后注射到大鼠体内,每小时观察中毒反应,24 h后观察肾功能变化,处死后进行肾脏组织病理学实验.结果 蛛毒剂量达到10 ug/kg时,实验大鼠即产生了明显的神经毒反应,随着蛛毒剂量的增加实验大鼠肾脏逐渐表现出肾小囊及肾小管间质出血、水肿、肾小球坏死、肾小管内皮细胞呈空泡样变性、肾皮质部呈玻璃样改变、肾髓质部无完整的肾小球结构及玻璃样改变的连续病变特征;然而肾功能各项指标如尿素氮、尿酸、肌酐及电解质钾、钠、钙、氯也无变化(P>0.05),但各剂量蛛毒组的尿蛋白均显著升高(3+)(P<0.01).结论 新疆间斑寇蛛的蜘蛛坏死毒素,较小剂量就可使大鼠表现出尿蛋白的大量升高,这与肾组织的病理性坏死直接相关,虽未表现出肾衰的特征,可能是与急性期的相关指标未来得及变化有关.

目的:探讨益气活血方治疗冠心病不稳定型心绞痛血瘀证疗效及对患者血清可溶性细胞间黏附分子1(sICAM-1)、内皮素(ET)、一氧化氮(NO)的影响.方法:选择104例冠心病不稳定型心绞痛血瘀证患者为研究对象,随机分为对照组和观察组各52例.对照组采用常规方案治疗,观察组在对照组的基础上采用益气活血方治疗,两组均治疗4周.观察两组治疗前后中医症候评分、血清sICAM-1、ET、NO水平,比较两组硝酸甘油停减率、心电图改善情况、中医症候疗效以及治疗期间不良反应发生情况.结果:两组患者治疗后血瘀证中医症状评分、血清sICAM-1、ET水平均降低(P<0.05),且观察组更低(P<0.05);观察组硝酸甘油停减率比对照组高(88.46％与69.23％,P<0.05);两组心电图改善总有效率相近(P>0.05);两组治疗后血清NO水平均升高(P<0.05),且观察组更高(P<0.05);观察组中医症候总有效率比对照组高(90.38％与75.00％,P<0.05);两组治疗期间不良反应发生率相近(P>0.05).结论:益气活血方联合常规方案治疗冠心病不稳定型心绞痛血瘀证患者,可改善患者的临床症状,疗效显著,提高硝酸甘油停减率,改善血管内皮功能.

目的 探讨双罐串联血液灌流在救治重度镇静催眠类药物中毒的清除效果.方法 分析并收集2017年12月至2019年12月新疆医科大学第二附属医院急诊科收治的重度镇静催眠类药物中毒的住院患者51例,向患者家属知情告知并取得同意后将试验对象分为双罐组23例、单罐组28例.结果 单罐组及双罐组治疗后除收缩压外余各项指标氧分压、二氧化碳分压、肝功能、肌酸激酶同工酶、平均住院时间等均较治疗前改善,且双罐组较单罐组治疗效果明显,差异有统计学意义(P<0.05).结论 早期行双罐串联血液灌流有利于持续清除体内毒素成分,对救治镇静催眠类药物中毒有积极作用.

目的 探讨小切口甲状腺切除术联合甲磺酸阿帕替尼在甲状腺瘤患者中的临床应用效果及对血清肿瘤特异性生长因子的影响.方法 选取我院收治的甲状腺瘤患者100例,随机分为两组,对照组应用小切口甲状腺切除术,研究组使用小切口甲状腺切除术联合甲磺酸阿帕替尼进行治疗,对比两组患者临床效果以及对血清肿瘤特异性生长因子的影响.结果 治疗后研究组患者的临床疗效显著优于对照组(P<0.05);研究组患者的血清肿瘤特异性生长因子水平明显低于对照组(P<0.05);研究组患者的生活质量明显优于对照组(P<0.05);研究组患者的疾病控制率明显优于对照组(P<0.05).结论 应用小切口甲状腺切除术联合甲磺酸阿帕替尼治疗甲状腺瘤患者的临床效果显著,对患者的血清肿瘤特异性生长因子具有一定影响,安全性较高,值得在临床推广及应用.

目的 通过间斑寇蛛毒致急性肾脏损伤的大鼠模型实验,观察肾损伤的病理形式及超微结构,探讨间斑寇蛛毒素造成急性肾损伤机制.方法 雄性SD大鼠随机分为生理盐水注射的对照组(n=32)、间斑寇蛛毒素(300μl/kg)注射的实验组(n=32),在实验组有了明显中毒征象后,分别在0 h、6 h、12 h、24 h处死实验组及对照组大鼠,对肾脏组织行病理和透射电镜检查.结果 实验组在6 h可见肾小囊及肾小管水肿的病理特征,12 h、24 h时间点则进一步观察到肾小囊内大量出血,部分肾单位内肾小管上皮细胞脱落,脱落的上皮细胞核溶解,肾小管管壁正常结构消失.透射电镜在6h时明显观察到肾小球血管内壁有明显的复合物沉积,12 h、24 h时间点进一步观察到上皮细胞足突的消失,内质网吞噬体大量增加,滤过膜间隙增大,基膜及内皮细胞的脱落.对照组在0h、6h、12h、24h均未出现肾小囊及肾小管水肿,肾小囊内无出血,肾小管上皮细胞无脱落,肾小球血管内壁无复合物沉积,上皮细胞足突未消失,滤过膜间隙正常,基膜及内皮细胞无脱落.结论 间斑寇蛛毒素可导致急性肾损伤甚至衰竭,中毒后的24 h内逐渐加重,肾脏内的部分结构出现病理坏死的现象,可为斑寇蛛毒致急性肾损伤的救治提供理论依据.

Objective:To explore the risk factors and prognosis of patients with upper gastrointestinal hemorrhage (UGH) complicated with acute cerebral stroke.Method:By investigated the clinical data of 244 cases of acute cerebral stroke and divided into two groups,respectively according to gender、age、nationality、history of hypertension、history of chronic ulcer、GSC score、the type of cerebral stroke、the position of bleeding、the amount of bleeding.Compared with the incidence rate of UGH,all the cases were divided into two groups according to complicate with UGH or no,and compared their pulmonary infection rate and fatality rate.Result:The rates of age ＞70 years old、the third stage hypertension、GCS score (3-8)、the blood loss volume ＞ 25 ml incidence in the observation group was significantly higher than that of the control group,the rates of complicate with UGH pulmonary infection rate and fatality rate was higher than those without UGH.The difference was statistically significant (P＜0.05).Conclusion:The rates of age＞70 years old、the third stage hypertension、the lower of GCS score (3-8) are high risk of acute cerebral stroke combined with upper gastrointestinal hemorrhage (UGH),and shows a bad prognosis.

Objective To investigate serum thyroid hormone and inflammatory factor levels of patient with severe bacterial pneumonia and to analyze their correlation.Methods A total of 63 patients with severe bacterial pneumonia admitted during January 2015 and October 2016 were selected as observation group,and other 63 healthy people taking medical examinations at the same period were selected as control group.Serum thyroid hormone and inflammatory factor levels and prognosis were observed in two groups,and the correlation between serum thyroid hormone and inflammatory factor levels was analyzed in observation group.Results In observation group,serum triiodothyronine (T3),thyroxine (T4),free triiodothyronine (FT3) and thyroid stimulating hormone (TSH) levels were significantly lower,while serum high sensitivity C-reactive protein (hs-CRP),tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) levels were significantly higher than those in control group (P ＜ 0.05).In observation group,T3,T4,FT3 and TSH levels were significantly lower,while serum hs-CRP,TNF-α and IL-6 levels were significantly higher in death cases than those in survival patients (P ＜ 0.05).T3,T4,FT3 and TSH levels were negatively correlated with serum hs-CRP,TNF-oα and IL-6levels in patients with severe bacterial pneumonia (P ＜ 0.05).Conclusion The lower thyroid hormone level of patient with severe bacterial pneumonia is,the more severe the disease is,and the prognosis is worse.

目的:观察在急救医学的教学中(心肺复苏,急救技术,症状学,中毒,电击伤等章节)引入CBL教学模式,观察教学效果.方法:在2011～2012年级本科急救医学教学中,随机选取一个大班(约90人)这些学生已完成基础医学课程和内、外科相关临床课程.随机分为十组,每组9人,其中五组为对照组,即采用传统的LBL教学方法;另外五组,采用CBL教学法.由相同教师授课.对经过不同的教学模式培养的同学进行理论考试,操作考试,及病历书写等对维度的考核,及问卷调查,用医学统计法对考核的结果给予分析.结果:比较两组学生理论考试、技能考核成绩,调查学生对CBL教学方法的认可程度.结果实验组电击伤与心肺复苏的理论考试成绩分别为(77.17±5.78)和(84.67±4.70)分,心肺复苏技能成绩为(80.08±4.83)分.对照组的成绩分别为(73.87±5.67)和(81.71±5.37)分,心肺复苏技能成绩为(76.65±5.76)分,(P＜0.05)与观察组相比有统计学意义.结论:CBL教学方法能够提高学生的自学能力,提高学生对知识的综合应用能力,提高了学生对知识的综合运用能力,提高学生的临床思维能力.

Objective To evaluate the prognosis value of eosinophila (EO)in patient with ventilator associated pneumonia (VAP).Methods Totally 53 VAP patients with duration ≥ 28 days from December 2013 to April 2015 were enrolled and divided into death group (30 cases) and survival group (23 cases) according to the prognosis.The level of EO on the day of diagnose,1-7,10,14,17,20 d after diagnosis and the last 3 days before cut-off were compared between groups.Results At all the time points,the EO value in death group were all significantly lower than those in survival group [(31 ±24) × 106/L vs (49 ±36) × 106/L,(29 ±24) × 106/L vs (53 ±37) × 106/L,(33 ±25) × 106/L vs (53 ±44) × 106/L,(32 ± 26) × 106/L vs (48 ±37) × 106/L,(27 ±21) ×106/L vs (54 ±42) × 106/L,(27 ±21) × 106/L vs (54 ±40) × 106/L,(23 ± 17) × 106/L vs (64 ±46) × 106/L,(23 ±20) ×106/L vs (65 ±47) × 106/L,(21 ± 18) × 106/L vs (68 ±39) × 106/L,(22 ± 18) × 106/L vs (66 ± 40) × 106/L,(20 ±21) × 106/L vs (70 ±36) × 106/L,(23 ± 19) × 106/L vs (74 ± 31) × 106/L,(17 ± 16) × 106/L vs (85 ±34) × 106/L,(19 ± 16) × 106/L vs (79 ±26) × 106/L,(10 ± 12) × 106/L vs (91 ±23) × 106/L] (P ＜0.05),and the difference increased along with the course of disease.On the day of diagnosis,during the first 7 days of the course,during the first 10 days of the course and the whole course,the cut-off value of EO in predicting death was 55 × 106/L,55 × 106/L,56 × 106/L,33 × 106/L,respectively,with sensitivity of 0.435,0.478,0.478,0.913 and specificity of 0.800,1.000,1.000,0.867.Conclusion EO is correlated with the prognosis of VAP and can be used as a predictive indicator of prognosis;after 10 days of treatment with antibiotic,the therapy regimen should be adjusted in time if EO ＜ 56 × 106/L indicating poor effect.

Objective To observe the protein expression of calcium-activated inwardly rectifying potassium channel (IK1) in spinal cord neuron in rat pain model induced by Latrodectus tredecimguttatus venom.Methods Totally 36 male SD rats were randomly divided into control group(4 rats) and toxin group (32 rats);rats in toxin group were given subcutaneous injection of 10,40,100,300 μl/kg Latrodectus tredecimguttatus venom at toes of right rear foot,respectively 8 rats for each concentration.Times of paw-withdrawal reactions were observed 15 min after injection.After 24 h,all rats were executed and spinal cord of 4-5 lumbar vertebra were sampled.Hematoxylin-eosin(HE) staining method was used to observe the structure of spinal cord neuron;streptomyces avidin-peroxidase link(SP) method was used to observe the protein expression of IK1;real-time fluorescent quantitative polymerase chain reaction(PCR) was used to detect mRNA expression of IK1.Pearson correlation test was used to analyze the correlation between paw-withdrawal reactions and the concentration of Latrodectus tredecimguttatus venom.Results Times of paw-withdrawal reactions 15 min after the injection of Latrodectus tredecimguttatus venom in 10,40,100,300 μl/kg toxin groups were (43.7 ± 15.5),(64.3 ± 9.1),(69.3 ±19.0),(91.3 ±34.6)times respectively;Pearson correlation test showed positive correlation between paw-withdrawal reactions and the concentration of venom(r2 =0.548,P ＜ 0.05).Spinal cord neuron numbers of IK1 protein positive expression in control group and 10,40,100,300 μl/kg toxin groups were (2.0 ± 1.0),(5.0 ±2.0),(6.0 ± 1.0),(6.0 ± 2.0),(7.0 ± 1.0) respectively;neuron numbers of IK1 protein positive expression in 4 toxin groups were all significantly higher than control group(P ＜ 0.05);neuron numbers in 40,100,300 μl/kg toxin groups were significantly higher than those in 10 μl/kg group(P ＜ 0.05);differences of IK1 protein positive expression neuron number among 40,100,300 μl/kg toxin groups were not significant (P ＞ 0.05).Relative quantities of IK1 mRNA expression in spinal cord in control group and 10,40,100,300 μl/kg toxin groups were (0.56 ± 0.16),(0.62 ± 0.27),(1.27 ± 0.10),(1.53 ± 0.29),(1.61 ± 0.86) respectively;IK1 mRNA expressions in 4 toxin groups were all significantly higher than those in control group(P ＜0.05);IK1 mRNA expressions in 40,100,300 μl/kg toxin groups were significantly higher than those in 10μl/kg group(P ＜ 0.05);differences of IKI mRNA expression relative quantity between 40,100,300 μl/kg groups were not significant (P＞ 0.05).Conclusions Latrodectus tredecimguttatus venom can cause acute pain effect,which is concentration dependent.The mechanism of pain transmission is related to calcium-activated IK1 mRNA and protein expressions in spinal cord neuron.

目的:观察预先注射葡萄糖酸钙、吗啡、安痛定对间斑寇蛛毒致痛大鼠行为学及致痛因子表达的影响,评估葡萄糖酸钙对抑制间斑寇蛛毒致痛作用的疗效.方法:将雄性SD大鼠120只随机分为钙剂实验组、吗啡对照组和安痛定对照组,实验组大鼠预先尾静脉注射葡萄糖酸钙溶液,吗啡和安痛定对照组大鼠分别预先皮下注射吗啡和安痛定溶液,随后三组大鼠分别足底注射4种浓度的间斑寇蛛毒素,记录三组大鼠不同时间缩足次数,并应用免疫组织化学分析大鼠脊髓致痛因子P2X3受体、P物质、CGRP的表达水平.结果:(1)当毒素浓度为10 μl/kg,15 min时,吗啡的镇痛作用优于安痛定,而钙剂镇痛效果最差;1h时,吗啡及安痛定的镇痛效果较15 min时明显,钙剂的作用更优于吗啡及安痛定(P＜0.05).毒素浓度为300 μl/kg,15 min、30 min时钙剂的镇痛作用优于吗啡和安痛定(P＜0.05).(2)钙剂组大鼠脊髓背角神经元中P2X3受体的表达显著低于吗啡及安痛定组;P物质在三组实验大鼠脊髓背角神经元、神经胶质细胞的表达均为阴性;钙剂和安痛定相比于吗啡抑制CGRP表达的作用更强.结论:在不同毒素浓度和不同时间下,钙剂和吗啡、安痛定的镇痛效果各有优劣,钙剂通过抑制P2X3受体及CGRP的表达进而抑制疼痛的作用较吗啡及安痛定更强,三种镇痛药物均可抑制P物质的表达.

间斑寇蛛（Latrodectus tredecimguttatus spiders）以“黑寡妇”闻名于世，是世界剧毒蜘蛛之一[1]，该蜘蛛能释放剧毒毒素，蜘蛛的螫肢（上腭）刺破人的皮肤后，毒液可经螯肢侵入人体引起中毒。被其蛰伤后会引起全身剧痛，并且会发生肝、脑、肾、心、肺等单个或多个脏器功能性或器质性病变，甚至死亡[1-5]。近些年来，在新疆各地区频繁出现间斑寇蛛蛰伤人畜事件，因此间斑寇蛛成为研究的热点。研究者从间斑寇蛛的分布及特征开始，对间斑寇蛛毒素的采集方法、成分、活性和功能以及蛰伤患者的临床表现和防治逐渐展开了深入的研究，本文主要对这些方面进行了综述，为以后更好的研究间斑寇蛛毒素和间斑寇蛛的防治奠定基础。

宽恕教育对于医学生的身心健康、精神世界的完善有着十分重要的影响,宽恕教育可以培养医学生豁达和包容的心境,促进医学生和谐性格的形成,有助于医学生在工作岗位上养成良好的医德,有助于改善目前存在的不良医疗风气,构建良好的医患关系。

Objective This study was designed to observe behaviors of rats which were given calcium gluco-nate intravenously after the rats were poisoned by the toxic components from Latrodectus tredecimguttatus spiders and the analgesia function of calcium gluconate was evaluated .Methods 80 male SD rats which had been injected with calcium gluconate beforehand were randomly divided into five groups ,and then they were given spider toxin and formalin with low dose (10 μL/kg) ,sub-medium dose (40 μL/kg) ,medium dose (100 μL/kg) ,and high dose (300 μL/kg) respectively .The nociceptive response and flinching times were observed and recorded .Results (1) The flinching times were more frequent in sub-medium dose group and high dose group than those in formalin group in 15 minutes ,however ,less frequent than those in formalin group in 30 minutes (P<0 .05) .(2) The fliching times caused by pain had significant positive correlation with concentration of spider toxin (r2 = 0 .597 , P < 0 .05 ,r2 = 0 .426 , P <0 .05) .(3) The flinching times were reduced in the calcium gluconate treatment group (P <0 .05) .Conclusion The pain caused by Latrodectus tredecimguttatus spiders toxin was more intense than that caused by formalin in 30 minutes .However ,it was relieved after 30 minutes .Therefore ,the pain caused by Latrodectus tredeci-mguttatus spiders toxin could be relieved significantly when the calcium gluconate were given beforehand .

目的 观察新疆间斑寇蛛粗毒液致死大鼠后肾脏的病理表现.方法 选取SD大鼠60只,雌雄各半,随机均分为正常组、300 μl/kg毒素剂量组、400 μl/kg毒素剂量组.分别给予皮下注射生理盐水及各剂量毒素后,留取肾脏,进行病理切片,光学显微镜观察.结果 300 μl/kg毒素剂量组,肾小球肾小囊内可见多量红细胞渗出,肾小管可见间质点状或片状出血,肾小管上皮肿胀；400 μl/kg毒素剂量组,肾小球可见大量红细胞渗出,比300 μl/kg组明显,肾小管可见间质出血,部分肾小管上皮脱落,部分肾小管出血坏死,两组均有少许慢性炎症细胞浸润.结论 新疆间斑寇蛛粗毒液致大鼠死亡后,可造成肾损害,且损害程度与浓度呈正相关.

<正>急性心肌梗死(acute myocardial infarction,AMI)的治疗目前已经取得很大进展,患者短期及长期预后不断改善,但仍是临床常见的危急重症,发病率日渐增高,死亡率仍然很高。多年来的流行病学研究显示,循环血中白细胞计数与冠心病之间有着

目的:探讨ACOP患者血白细胞变化及抗生素的有效应用意义.方法:随机选取2004年2月-2010年4月在我院确诊为ACOP的患者120例,按照不同患者中毒情况的不同分为轻、中、重3组,均在入院的第1、3、7天进行静脉抽血检验.结果:重度中毒患者与轻度、中度中毒患者相比,差异无统计学意义(P>0.05),在入院的第1、3,7天均具有统计学意义(P<0.05);中度中毒患者与轻度相比,入院第1、3天具有统计学差异(P<0.05).结论:ACOP患者血液中 CRP、WBC、N的水平与中毒程度正相关,作为抗生素的适当使用重要参考指标.

OBJECTIVE To observe the clinical efficacy of Qi-zheng Qing-peng plaster in treating acute closed soft tissue injury in limbs.METHODS Eighty-four subjects were randomly divided into two groups:control group and observation group;the curative effect was observed and analyzed.RESULTS After the treatment: the total effective rate was 97.62% in observation group,and 85.71% in control group respectively(P0.05);the total apparently effective rate was 42.86% in observation group,and 19.05% in control group respectively(P0.05).CONCLUSION Qi-zheng Qing-peng plaster had good effect on acute closed soft tissue injury in limbs.