创伤弧菌是一种在一定盐分（0.7%~1.6%）和适宜的温度（20~40 ℃）中才可生长的革兰阴性嗜盐性条件致病弧菌，入侵门户主要为消化道黏膜或皮下筋膜。人食用被创伤弧菌污染的海产品易患原发性脓毒症，即使救治及时，病死率仍高达50%[1]；若皮肤有伤口的人接触被该菌污染的水域，导致伤口感染创伤弧菌，严重者需大面积清创甚至截肢[2]。创伤弧菌感染好发于夏秋季（每年的4至10月份），多见于热带、亚热带沿海城市与地区。近几年，随着全球气候变暖、海上作业活动增加、新鲜海产品远距离销售增多以及海边旅游的普遍，创伤弧菌的感染病例逐年增多[3,4]。为提高对本病的认识及救治成功率，现对浙江大学医学院附属第一医院象山分院2015年8月至2020年2月收治的7例创伤弧菌感染所致脓毒症病例资料进行介绍。

目的 探究重组人促血小板生成素(rhTPO)对健康人肝细胞株L02的影响.方法 以健康人肝细胞株L02为研究对象,通过不同剂量rhTPO[对照组(0 U rhTPO)、低剂量组(150 U rhTPO)及高剂量组(750 U rhTPO)]处理L02细胞,观察各组L02细胞的存活率.采用Western-blotting检测各组细胞[A组(0 U rhTPO)、B组(15 U rhTPO)、C组(150 U rhTPO)及D组(1500 U rhTPO)]的细胞外信号调节激酶(ERK)及其磷酸化产物(p-ERK)蛋白的表达水平,并采用荧光定量PCR检测ERK信使RNA(mRNA)表达水平.结果 各组L02细胞存活率的比较,差异有统计学意义(F=8.843,P=0.016).进一步两两比较发现,低剂量组及高剂量组的存活率均显著高于对照组[(107.9±4.0)％、(112.0±1.6)％、(100.0±2.5)％],且高剂量组细胞的存活率更高(P均<0.05).各组L02细胞间ERK蛋白及ERK mRNA表达水平的比较,差异均无统计学意义(F=1.140,P=0.392;F=0.437,P=0.733),而各组L02细胞间p-ERK蛋白表达水平的比较差异有统计学意义(F=31.400,P<0.001),且B组、C组及D组细胞的p-ERK蛋白表达水平均显著高于A组细胞(P均<0.05),而B组、C组及D组细胞p-ERK蛋白表达水平两两比较,差异均无统计学意义(P均>0.05).结论 rhTPO可通过激活ERK促进L02细胞数量增殖.

Congestive heart failure(CHF) is a clinical syndrome involving multiple organs,in which changes of gastrointestinal system function have aroused widespread concern.Gastrointestinal tract will prime lowly,gastrointestinal mucosa will have ischemia and hypoxia,intestinal barrier will have dysfunction,and intestinal bacteria will shift and intestinal endotoxemia will appear when heart failure occurs.Endotoxin activates the release of cytokines and inflammatory mediators in vivo,which can further cause intestinal barrier dysfunction and increase myocardial damage,thus forming a vicious circle,further deteriorating heart failure.Research at home and abroad has found,early intervention and treatment for heart failure combined with gastrointestinal dysfunction has a good effect in improving heart failure symptoms and preventing heart failure progress.

Objective To investigate the protective effect of neurotensins on inflammatory responses in mice with LPS-induced acute lung injury. Methods 100 specific-pathogen free C57BL/6 mice (20-25 g, 6-8 weeks, 50 males and 50 females) were obtained from the Shanghai Laboratory Animal Center (SLAC) (Shanghai, China). All animals were randomly divided into five groups:① Normal control group: mice were treated with 60 μl PBS intratracheally;② LPS-induced acute lung injury group: mice were treated with 60 μg LPS intratracheally;③ 20 mg/kg neurotensins treated ALI group: mice were subjected to LPS-induced ALI and treated with 20 mg/kg Nts via tail vein injection 1 hour after LPS challenge;④ 40 mg/kg neurotensins treated ALI group: mice were subjected to LPS-induced ALI and treated with 40 mg/kg Nts via tail vein injection 1 hour after LPS challenge;⑤ 80 mg/kg neurotensins treated ALI group: mice were subjected to LPS-induced ALI and received 80 mg/kg Nts treatment via tail vein injection. The severity of lung injury, MPO acitvity, neutrophils infilatration, lung edema, and pro-inflammatory cytokines concentration in BALF were assessed 24 hours after ALI. Results Compared with the control group of mice, LPS induction significantly increased the severity of lung injury, including the lung edema, inflammatory cell infiltration, and the production of inflammatory cytokines in BALF (TNF-α, IL-6, IL-1β, and MCP-1). However, Neurotensins treatment obviously attenuated the lung injury caused by LPS induction, including the lung edema, the infiltration of inflammatory cells , and the secretion of inflammatory cytokines (TNF-α, IL-6, IL-1β, and MCP-1). Meanwhile, the protective effect is dosage dependent. Conclusion Neurotensins have a protective effect on LPS-induced acute lung injury in mice, and the protective mechanisms may be related to block the tachykinins mediated inflammatory pathways activation. Key words: Neurotensins; Tachykinins; Inflammatory response; Acute lung injury

Objective To evaluate the efficacy of recombinant human thrombopoietin (rhTPO) in patients with severe sepsis and thrombocytopenia. Methods Sixty-six patients with severe sepsis and hrombocytopenia between October 2013 and September 2015 were divided into the experiment group (35 cases) and control group (31 cases). All patients received primary treatment and infection control. And patients in the experiment group received rhTPO 300 U· kg-1·d-1 by hypodermic injection, and withdraw when platelet count (PLT)≥50 × 109/L, and the course did not exceed 14 d. Levels of PLT, C-reactive protein and alanine aminotransferase (ALT) were detected before and after the treatment on 1, 2, 3, 5, 7, 9 ans 14 d. The platelet transfusion cases, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), the time of temperature dropped to normal, time of clinical symptom disappearance, pulmonary imaging recovery time, 28-day fatality rate and length of ICU stay were compared between the two groups. The adverse reactions were recorded, and the activated partial thromboplastin time, levels of ALT, C-reactive protein and total bilirubin were compared before and after treatment in the experiment group. Results The PLT only increased markedly on 3 and 5 d after treatment in the experiment group as compared with those in the control group [(56 ± 19) × 109/L vs. (42 ± 18) × 109/L, t=3.112, P<0.05; (67 ± 22) × 109/L vs. (54 ± 21) × 109/L, t=2.520, P<0.05]. The platelet transfusion rate in the experiment group was much lower than that in the control group (5/35 vs. 11/31,χ2=4.022, P=0.045). However, the APACHEⅡ scores (t=0.692, P<0.05), the time of temperature dropped to normal (t=0.510, P<0.05), time of clinical symptom disappearance (t=0.262, P<0.05), pulmonary imaging recovery time (t=0.685, P<0.05), 28-day fatality rate ( χ2= 0.001, P < 0.05) and length of ICU stay (t=0.637, P<0.05) all showed no significant differences between the two groups after treatment. Meanwhile, there was no adverse reactions happened, and the activated partial thromboplastin time (t=0.697, P<0.05), levels of ALT (t=0.478, P<0.05), C-reactive protein (t=0.110, P<0.05) and total bilirubin (t=1.634, P<0.05) in the experiment group also showed no significant differences before and after the treatment. Conclusions The use of rhTPO combined with conventional treatment in patients with sepsis-associated thrombocytopenia is safe. It can significantly enhance the platelet count, reduce platelet transfusion and improve patient's prognosis.

目的：探讨胰岛素强化治疗对体外循环心脏直视手术患者预后的影响及其机制。

Objective Study the effect and mechanism of intensive insulin therapy on patients undergoing open heart surgery with cardiopulmonary bypass .Methods 100 nondiabetic patients undergoing open heart surgery with cardiopulmonary bypass were randomly divided into two groups:one with intensive insulin therapy (50 patients) and the other with conventional treatment (50 patients).The blood glucose and plasma insulin levels of patients were measured before anesthesia and 0h,6h, 12h,24h and 48h after the patients were sent to SICU and the Results of these two groups were compared .The mechanism of intensive insulin therapy was discussed.Results Plasma insulin level of the intensive insulin therapy group is much higher than that of the conventional treatment group ( P<0.05or P<0.01 ) .Intensive insulin therapy can reduce mechanical ventila -tion time and shorten postoperative ICU stay ( P<0.05) .Concl usion Intensive insulin therapy can improve the recovery of patients undergoing open heart surgery with cardiopulmonary bypass .

肺移植是治疗终末期肺病的唯一方法,移植肺失功是肺移植领域面临的重大问题,但再次移植的预后并不能令人满意,近年来,再次肺移植得到进一步发展,合理选择再移植的适应证及完善的围手术期管理使成功率得到进一步提高,本文综述目前国际上再次肺移植的适应症及相关影响因素所做的研究。

Objective By detecting the difference of expression level on PAC-1 and CD62p before and after the treatment of Shenmai injections in the patients with acute serious chronic pulmonary heart disease,the clinical therapeutic effect and possible role of the Shenmai injections in the treatment of the chronic pulmonary heart disease are studied and analyzed.Methods All of 60 patients with acute serious chronic pulmonary heart disease were randomly divided into treatment group and control group.Conventional treatment was taken for both of them,while the treatment group had additional application of Shenmai injections.By collecting venous blood samples before and after the treatment,positive rates of PAC-1 and CD62p were measured using the flow cytometry,and the difference of them were compared between two groups.Meanwhile,the clinical therapeutic effect of two groups and the difference of the blood rheology before and after the treatment were also observed.Results The positive expression rate of PAC-1 and CD62p of the patients in treatment group declined from(72.63±5.62)% and(52.81±7.42)% to(58.42±5.49)% and(42.19±5.46)%,with significant statistical differences;while the control group had no above changes.The total effective rate of the treatment group and control group were found as 80.0% and 63.3% separately,with significant differences(P0.05),and the influence of the blood rheology in treatment group was significantly higher in the control group(P0.05).Conclusion The Shenmai injections can significantly improve the clinical therapeutic effect of the patients with acute serious chronic pulmonary heart disease,the mechanism of action can be in relation with reducing the expression of PAC-1 and CD62p,and inhibiting the platelet activity.

<正>肺移植是治疗终末期肺病唯一有效的方法,但各种原因导致的移植物失功是肺移植临床面临的重大问题,再移植是提高该类受者长期生存的唯一选择。浙江大学医学院附属第一医院在2011年8月3日对1例55岁因特发性肺间质纤维化行单肺移

Objective To evaluate the validity of cardiac output measurement with the modified carbon dioxide Fick(mCO2F) method.Mechanical ventilated and critically ill patients with unstable hemodynamics were studied and analyzed.Compared with the cardiac output results of the patients that using invasive Swan-Ganz pulmonary artery catheter(PAC) method and pulse indicated continuous cardiac output(PiCCO) method as well as mCO2F method,correlation analysis of the three was illustrated.Methods All 34 mechanical ventilated and critically ill patients were divided into two groups.In the state of complete sedation when cardiac output was measured,9 patients using mCO2F method(QmCO2F) and PAC method(QPAC) simultaneously,while the rest 25 were measured with mCO2F method(QmCO2F) and PiCCO method(QPiCCO).When steady state was reached,QmCO2F was measured,being compared with QPAC and QPiCCO at 0h and 4h moment respectively.Gas analysis was also performed for central venous blood samples and mixed venous blood samples simultaneously when cardiac output was measured with PAC method.Results Significant coherence was observed between QmCO2F and QPAC,QmCO2F and QPiCCO.There was no statistical difference in partial carbon dioxide pressure(PCO2) between central venous blood samples and mixed venous blood samples(P>0.05),with good correlation found in PCO2 from two different venous samples at 0h and 4h moment(r=0.780;0.696,P<0.05).Correlation between QmCO2F and QPAC at two moment was observed(r=0.939;0.908,P<0.01) so as correlation between QmCO2F and QPiCCO(r=0.791;0.745,P<0.01).Conclusion There was good correlation between cardiac output measurement using mCO2F method and thermodilution techniques,which suggestes that cardiac output can be reliably measured in mechanical ventilated patients using mCO2F method.And this method may be cost-effective with no risk of additional morbidity or mortality.

<正>急性肾损伤是心脏术后显著增加发病率、病死率及医疗费用的严重并发症,是影响术后患者长期生存的独立危险因素[1],而一旦其发生,再进行临床治疗及肾脏替代治疗已无法改善预后。有文献报道需肾脏替代治疗的急性肾损伤的发生率约1%,但病死率增加60%,并且带来巨大的经济负担[2]。近年来有文献报道,即使血肌酐轻度增高亦是增加患者ICU住院日、总住院日及病死率的独立危险因素[3]。因此研究预测急性肾损伤的指标并进行早期临床干预意义极大,本文复习了最新文献,对预测心脏术后急性肾损伤的相关因素及预防策略作一阐述。

对入我院的急性2,4-二硝基苯酚中毒17例患者的临床资料进行回顾性分析.急性2,4-二硝基苯酚中毒的患者除一般急性中毒临床表现外,心律失常发生率高.其中5例患者出现窦性心动过速(29.4％),14例患者出现窦性心动过缓(82.4％),1例患者出现短阵室性心动过速(5.9％),3例患者出现室性早搏(17.6％).经积极治疗后,患者心律失常消失,未遗留心电异常.提示2,4-二硝基苯酚急性中毒的患者入院后应常规行心电图、动态心电图、心电监护等有关心电变化的检查监测.治疗上除了行血液灌流清除毒物、护肝保肾外,需根据患者出现的心律失常进行积极处理.

目的分析老年病人心脏直视术后合并呼吸机相关性肺炎(VAP)的发病危险因素和病原学特点。方法对我院外科重症加强治疗病房(SICU)2008年10月至2010年3月间收治的心脏直视手术后机械通气超过48 h的41例老年患者进行回顾性分析,根据发生VAP与否将其分为非VAP组及VAP组。对两组患者的临床资料进行分析,筛选VAP发病的可能危险因素。结果老年病人VAP总发生率为2.1%,死亡率22.2%,单因素分析:两组病人体外循环时间,机械通气时间,围术期输血量,SICU住院天数,氧合指数(PaO2/F iO2)差异有统计学意义。多因素回归分析显示:体外循环时间和机械通气时间与VAP的发生明显相关。VAP组病人痰培养分离出26株病原菌,其中革兰阴性杆菌占73.1%,革兰阳性球菌占7.7%,真菌占19.2%,耐药情况较严重。结论心脏术后VAP的发生率高,死亡率也较高,必须针对相关因素采取积极的防治措施,根据病原学和药敏结果合理应用抗生素,才能缩短机械通气时间,改善心脏术后VAP患者的预后。

<正>急性重症病毒性心肌炎(acute severe viral myocarditis,ASVMC)是指各种病毒感染后引起的严重、广泛的急性心肌损害,突出表现为致命性心律失常、心力衰竭和(或)心源性休克,甚至猝死。该疾病起病急、进展快,如不及时诊断、治疗,预后凶险。本次研究将收治的14例ASVMC患者的临床特点、诊治及预后分析如下。

<正>谵妄是老年患者术后常见的并发症,术后谵妄使患者并发症增多、死亡率增高、住院时间延长、增加家庭和社会的负担。研究预防和治疗老年患者术后谵妄意义重大。研究表明,镇静药物的使用对患者术后谵妄的发生率有影响[1]。丙泊酚是重症监护病房(intensive car eunit,ICU)常用的镇静药物,本文拟研究丙泊酚不同镇静深度对体外循环术后老年患者谵妄发生率的影响。

Objective To explore the mechanism of pleural complications and its effect on prognosis after heart-lung transplantation. Methods Prognosis analysis was conducted by observing two patients who underwent the heart-lung transplantation in our hospital. And related articles were reviewed to elucidate the pathogenesis of pleural complication. Results Both of the two patients suffered from pneumothorax and hemothorax after heart-lung transplantation. One of them also got pleural effusion. Conclusions Hemothorax and continuing air leakage in the acute pleural complications are positively related with the mortality, while the relationship between further pleural complications and the mortality can not be observed.

Objective To investigate the protective effect of Shenmai injection (SM) on cardiac function of patients undergoing valve replacement under cardio-pulmonary bypass Methods One hundred and twenty patients undergoing valve replacement operation under cardio-pulmonary bypass were randomly divided into the SM group and the control group (60 in each group). Intravenous infusion of 1ml/kg SM was given to patents in SM group after operation, and equal volume of normal saline was given to the controls instead. The following indices were observed: (1) the hemodynamic changes and ventricular premature beat (VPB) in 48h; (2) the dosage of vaso-active drugs and lidocaine used in 48h. Results The mean arterial pressure and heart rate in the SM group after operation were higher than those in the control group (102.8±21.0 vs 98.3±18.8)mmHg, (78.6±12.7 vs 75.8±12.7 bpm), (t=2.04 and 2.11,both P0.05) , while the central venous pressure was lower than those in the control group (8.78±1.65 vs 9.23±1.88)mmHg, (t=2.23,P0.05). The dosage of vaso-active drugs dopamine, dobutamine and sodium nitroprusside used during and after operation was lower in the SM group than those in the control group (13.78±6.40 vs 18.81±9.36)mg/kg, (14.58±5.80 vs 19.11±8.37)mg/kg, (1.87±1.61 vs 2.14±1.54)mg/kg, (t=2.12, 2.36 and 2.47, P 0.05). Conclusion SM has certain protective effects on the cardiac function of patients undergoing valve replacement operation under cardio-pulmonary bypass.

长期以来医学界常重视长OT综合征危害的研究,忽视对短QT预后不良的研究,近期较多证据表明,缩短的QT间期能够增加致命性心律失常发生的危险性.2000年Gussak等[1]提出了短QT综合征(SQTS)的名称.该疾病是一种新型遗传性综合征,是以缩短的QT间期和昏厥、阵发性房颤或致命性室性心律失常为特点的新的临床综合征.该综合征常影响年轻、健康、无器质性心脏疾病的个体.其临床表现多变,轻者无任何症状,或仅有心悸头晕,重者晕厥和猝死.近几年的研究揭示SQTS为遗传异质性疾病,迄今为止发现了SQTS的三个基因分型即SQTS1、SQTS2和SQTS3.这三种不同的基因类型均为编码不同钾通道亚单位的基因功能获得性突变.

AIM To investigate the effects of ulinastatin on the release of proinflammatory cytokines in patients undergoing open heart operation.METHODS Twenty eight patients undergoing elective open heart surgery with cardiopulmonary bypass(CPB) were randomly divided into 2 groups: ulinastatin group (group U,n=14) and control group(group C,n=14).In group U,ulinastatin 12 000 U·kg~(-1) was received intravenously after anesthesia induction,but in group C,instead of normal saline.Blood samples were withdrawn from central vein for the measurements of interleukin-6(IL-6) and interleukin-8(IL-8),after anesthesia induction(T_0),30 min following champing(T_1),reperfusion 1h(T_2),reperfusion 3 h(T_3) and reperfusion 6 h(T_4).RESULTS The levels of IL-6,IL-8 showed no difference between groups after anesthesia induction(P>0.05).After CPB,the levels of IL-6 and IL-8 increased compared with the T_0 and T_1(P<0.05) in both groups.Compared with those in group C,the level of IL-6 and IL-8 in the group U were lower significantly(P<0.05) in the time at T_2,T_3,and T_4.CONCLUSION Ulinastatin may significantly inhibit the proinflammatory cytokine(IL-6,IL-8) release and protect the organ from inchemia-reperfusion injury.