目的 探讨床旁血液净化在危重烧伤患者中的应用.方法 回顾分析我院血液净化中心2005年～2009年应用床旁血液净化方法,对20例伴有急性肾功能衰竭(ARF)的危重烧伤患者实行间断性CRRT治疗的资料.患者平均年龄42.2岁±10岁,平均烧伤面积为63.8%TBsA±13.7%TBSA;所有患者都需要机械式呼吸支持,大部分患者并发脓毒症,甚至是多器官功能障碍综合征(MODS),平均ARF出现的时间是10.8 d±9 d.20例患者均与脓毒症相关,其中:低血压14例,需用血管加压药者6例;4例患者属于非少尿型肾功能衰竭.接受CRRT治疗的主要原因包括:氮血症(20/20)、液体过载(12/20)、高钾血症(6/20)、高钠血症(18/20)和/或酸中毒(2/20).使用Prisma系统Muhiflow-100滤器、前稀释,先后行100余次CRRT治疗(包括病情平稳后接受间断性滤过透析治疗).14例患者使用了肝素1.25 mg/h～5.00 mg/h,6例患者未用抗凝剂.患者在刚收进烧伤科时,血清尿素氮和肌酐浓度分别为7.1 mmol/L±2.3 mmol/L和116.1 tunol/L±38.2 Izmol/L,当CRRT治疗开始时,血清尿素氮和肌酐浓度已上升至34.8 mmol/L±9.2 mmol/L和398.24 μmol/L±286.3μmol/L.16例患者同时接受肠内和肠外营养支持,4例患者只接受肠外营养支持.结果 8例生还者肾功能全都恢复正常,在出院时,血清肌酐浓度是80.1 μmol/L±11.1 μmol/L.在CRRT治疗期间,20例患者均没有发生明显并发症.结论 CRRT有如下优势:(1)维持体内水、电解质和酸碱平衡,有效地保证了内环境的稳定;(2)保证营养支持及其它药物治疗的实施;(3)对血流动力学影响很小,且在低血压时也可应用;(4)对发热患者还可以起到降温作用;(5)有效地清除毒素并降低氧耗.连续性血液净化是抢救危重烧伤患者的重要治疗手段之一,虽然危重患者病死率高,但是它能够延长危重患者的生命却是公认的.功能上由替代转化为支持,是一种概念上的突破.随着血液净化技术的不断完善,它将成为危重病医学的发展趋势.

AIM To investigate effects of low frequency pulsing electromagnetic fields on the proliferation, apoptosis and NO secreting function of endothelial progenitor cells(EPCs)from bone marrow intervened by C-reactive protein(CRP). METHODS EPCs were isolated from bone marrow blood of rat by density gradient centrifugation and were divided into ten groups: control group, 12 mg/L CRP group, and groups of CRP with 0.2 mT 2 h, 4 h;0.6 mT 2 h, 4 h;1.0 mT 2 h, 4 h;and 1.4 mT 2 h, 4 h. MTT assay was used to detect the effect of CRP on the multiplication ability of EPC and flow cytometry was used to detect the apoptosis caused by CRP. NO content was measured in the cell culture medium by nitrate reductase method. RESULTS CRP of 12 mg/L inhibited proliferation and NO secreting function and induced apoptosis of EPCs (P0.05). In 0.6 mT 4 h group and 1.0 mT 2 h group, proliferation and NO secreting function of EPC was significantly higher than that in CRP group (P0.05), whereas apoptosis of EPCs was significantly lower than that in CRP group (P0.05). There was no difference in EPCs proliferation, apoptosis and NO secreting function between other groups and CRP group. CONCLUSION CRP of 16 mg/L inhibits proliferation and NO secreting function and induces apoptosis of EPCs. 0.6 mT 4 h and 1.0 mT 2 h of low frequency pulsing electromagnetic fields antagonize the effects of CRP on EPCs, increase the proliferation and NO secretion and decrease apoptosis of EPCs, with on intensity-dependence.

AIM To study the effects of endothelin-1 on proliferation, cell cycle and NO secreting function of endothelial progenitor cells from rat bone marrow. METHODS Mononuclear cells were collected from rat bone marrow by density gradient centrifugation, cultured with medium 199 and were identified to be EPC on day 6 by DiⅠ-ac-LDL and FITC-UEA-Ⅰ double staining. Different concentrations of ET-1 (group A, 0 mol /L; group B, 10-9 mol /L; group C, 10-8 mol/L; group D, 10-7 mol /L; group E, 10-6 mol /L) were added into culture medium to detect the effect on EPC. MTT assay was performed to detect the effect of ET-1 on the multiplication ability of EPC and Flow cytometry was employed to detect the cell cycle. NO content was measured in the cell culture medium by nitrate reductase method to find the promotion of ET-1 on cell functions. RESULTS Compared with that in the control group (group A, 0.405±0.017), the proliferation of EPC greatly enhanced in ET-1 group (group C, 0.434±0.016; group D, 0.463±0.015; group E, 0.473±0.015)(n=8, P<0.01). The amount of EPC in ET-1 group in G0/G1 phase (group C, 57.28%±3.65%; group D, 44.99%±3.19%; group E, 40.29%±3.74%) was significantly lower than those in control group (group A, 70.55%±1.37%)(n=5, P<0.01). Compare with that in the control group (20.04%±1.64%)(9.41%±0.81%), the amount of EPC in ET-1 group in S phase (group C, 26.75%±2.87%; group D, 32.79%±2.41%; group E, 35.74%±2.94%) and in G2/M phase (group C, 15.96%±1.71%; group D, 22.22%±2.22%; group E, 23.64%±2.86%) increased (n=5, P<0.01). Compare with that in the control group(group A, 7.45±2.41), NO secreting function of EPC increased in ET-1 group (group C, 11.70±1.80; group D, 15.69±1.86; group E, 16.89±1.55)(n=8, P<0.01). Group B showed no or only minor difference as compared with control group. CONCLUSION ET-1 stimulates EPC proliferation, promotes the division and multiplication of EPC and enhances the NO secretion capacity.

AIM:To study the effects of endothelin-1(ET-1) on apoptosis and cell cycle of endothelial progenitor cells(EPC) from rat bone marrow. METHODS:Mononuclear cells were collected from rat bone marrow by density gradient centrifugation,cultured with Medium 199,and were identified by Di Ⅰ-acetylated low-density lipoprotein(Di Ⅰ-ac-LDL) and FITC-ulex europaeus agglutinin-Ⅰ(FITC-UEA-Ⅰ) double staining. EPCs collected at 5th day of culture were divided into 2 groups:Control group and ET-1 group (100 μmol/L),then were continuously incubated for different periods(24,48,72,96 h). The EPCs apoptosis and cell cycle were analyzed by flow cytometry(FCM). RESULTS:The EPCs apoptosis rate was higher in ET-1 group than in control group at 24,48,72,96 h(P<0.01). Compared with 48 h ET-1 group,the EPCs apoptosis rate decreased in 72 h and 96 h ET-1 groups (P<0.05,P<0.01). The amount of EPCs in 24 h,48 h,72 h,96 h ET-1 groups in G0/G1 phase were significantly lower than those of control group(P<0. 01). Compared with the 24 h,48 h,72 h,96 h control group,the amount of EPCs in 24 h,48 h,72 h,96 h ET-1 groups in S phase and in G2/M phase were significantly increased(P<0.01). CONCLUSION:ET-1 can significantly stimulate both the proliferation and apoptosis of EPCs. With the prolongation of intervention duration,the impact on the proliferation becomes more prominent.

身高、体重、体重指数(body mass index,BMI)不仅被用于评价一个地区儿童青少年生长发育水平,同时也是评价居民营养健康状况的重要指标.随着社会经济的发展,人们生活水平的不断提高,青少年学生高能量食品的摄入不断增多,加上运动量减少,超重和肥胖已逐步成为影响我国学牛健康的主要问题.我们通过西安市城区1 596例2007年应届高中毕业生的体检,了解其超重与肥胖情况.

目的探讨内皮素-1（ET-1）对大鼠骨髓内皮前体细胞（EPC）增殖、细胞周期及一氧化氮（NO）分泌功能的影响。方法采用密度梯度离心法获取大鼠骨髓单核细胞,在M199培养液中培养扩增EPC并进行鉴定。不同浓度ET-1（A组:0mol/L、B组:10-9mol/L、C组:10-8mol/L、D组:10-7mol/L、E组:10-6mol/L）作用于EPC,MTT法检测ET-1对EPC增殖能力的影响,流式细胞仪检测ET-1对EPC细胞周期的影响,硝酸还原酶法检测细胞培养液中NO含量的变化,观察ET-1对EPC的NO分泌功能的影响。结果与对照组（A组,0.405±0.017）相比,ET-1浓度C组（0.434±0.016）、D组（0.463±0.016）、E组（0.473±0.015）EPC增殖能力显著增高（n=8,P＜0.01）。EPC的G0/G1期细胞百分数C组（57.28±3.65）%、D组（44.99±3.19）%、E组（40.29±3.74）%较对照组（70.55±1.37）%明显降低（n=5,P＜0.01）,EPC的S期细胞百分数C组（26.75±2.87）%、D组（32.79±2.41）%、E组（35.74±2.94）%较对照组（20.04±1.64）%明显升高（n=5,P＜0.01）,EPC的G2/M期细胞百分数C组（15.96±1.71）%、D组（22.22±2.22）%、E组（23.64±2.86）%较对照组（9.41±0.81）%明显升高（n=5,P＜0.01）。EPC培养液中NO含量（μmol/L）ET-1浓度C组（11.70±1.80）、D组（15.69±1.86）、E组（16.89±1.55）较对照组（7.45±2.41）明显增加（n=8,P＜0.01）。B组检测结果与对照组相比,各项指标均无统计学差异。结论ET-1能够促进EPC的增殖,促进细胞向S期和G2期的转化,并提高细胞NO分泌功能,可能参与缺血性疾病的血管再生过程。

AIM: To investigate the effects of low frequency pulsing electromagnetic field on proliferation and nitric oxide(NO) secretion of rat bone marrow-derived endothelial progenitor cells(EPCs).METHODS: Total mononuclear cells(MNCs) were isolated from rat bone marrow by density gradient centrifugation,and then plated on fibronectin-coated culture dishes.After 4 d,the adherent cells were collected and exposed to low frequency pulsing electromagnetic field(0.6 mT,15 Hz) every day.The collected cells were divided into control group and different time point groups(0.5,2,4 and 8 h).After 3 d exposure,proliferation capacity was measured by MTT assay,cell cycle was detected by flow cytometry(FCM),and NO secretion of EPCs was measured by the Griess assay.RESULTS: Compared with control group(0.37±0.07),0.5 h(0.37±0.06) and 2 h(0.40±0.09) exposure groups showed no statistical difference(P>0.05),while 4 h and 8 h exposure groups showed higher EPC proliferation capacity [A490 nm: 4 h,(0.45±0.03) vs(0.37±0.07),P<0.05;8 h,(0.49±0.08) vs(0.37±0.07),P<0.01].Except 0.5 and 2 h exposure groups,4 and 8 h groups showed statistically significant difference in proliferation index as compared with control group(P<0.05).NO was produced more and more with the exposure time going on.CONCLUSION: Low frequency pulsing electromagnetic field can increase the proliferation and NO secretion of EPCs over time.

1 临床资料 病例1:患者,女,54岁,因低热伴咳嗽咯黄色黏痰5 d ,血常规检查白细胞,中性82%,胸透见左下肺片状高密度模糊影,诊断为左下肺炎,因患者有青霉素过敏史,采用氧氟沙星200 mL,静脉注射,1次/d,约10 min后患者心慌、恶心、面色苍白、呼吸急促、四肢湿冷,脉搏细弱. 脉搏98次/min,血压82/40 mmHg,诊断为过敏性休克.

充血性心力衰竭(CHF)患者体内交感神经系统及肾素-血管紧张素-醛固酮(RAS)等系统功能亢进,内皮素(ET-1)和心房钠尿肽(ANP)等血管收缩性因子分泌增多,可使心功能不全进一步恶化[1].给予CHF患者应用血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)可以阻断肾素-血管紧张素-醛固酮等系统[2,3],但有些患者因ACEI的副作用(如血管性水肿和顽固性咳嗽)而无法耐受.ARB与ACEI相比较,作用相当而副作用较少,因此用于治疗CHF有其相应优势.目前关于ARB对CHF患者血浆ET-1和ANP影响的研究较少,因此,本研究观察ARB类缬沙坦对CHF患者血浆ET-1和ANP水平的影响.

1 临床资料 患者,男,75岁. 3年前无明显原因出现胸闷、气短,双下肢水肿,当地诊所给予地高辛、安体舒通、消心痛等药治疗,上述症状略有减轻,为进一步诊治来我处. 查体:神清,一般情况尚可,生命体征平稳,心界不大,心率80次/min,律齐,心音低钝,各瓣膜听诊区未闻及病理性杂音. 胸部正位片示肺野清晰,心影向左扩大,肋膈角锐利.

0引言 我军的医疗保障制度是在战争年代供给制基础上形成的公费医疗保障制度.随着军队现代化建设的不断推进,我军原有体制下形成的医疗保障制度的弊端渐显突出,已越来越不能适应我军现代化建设和发展的需要.因此,实行军队医疗保障制度改革就成为新军事变革发展和我军现代化建设的必然要求.军队医疗保障制度改革是一项庞大而复杂的系统工程,涉及到所有军人、军队职工及其家属的切身利益,中央军委、总部对此一直持非常慎重的态度,因而它也是军队后勤保障制度各项改革中较晚推出的一项.在济南战区进行军队医疗保障制度改革(简称医改,下同)先行试点和沈阳、兰州、济南战区进行医改扩大试点(简称医改扩试,下同)工作的基础上,2004年,军队医改方案正式在全军组织实施.总体上说,这次军队医改工作遵循了一要积极,二要稳妥的原则.笔者作为本单位医改工作的组织者之一,有幸参与了军队医改工作的全过程,对这次医改工作中存在的问题和一些不足之处有一些较直接的感觉和较肤浅的认识,下面就此进行一些浅析.