目的:评估抗血栓治疗(ATT)对急诊胆囊切除患者围手术期及术后并发症的影响.方法:回顾性分析148例急性胆囊炎行急诊胆囊切除患者临床资料,其中接受抗血栓治疗67例为ATT组,未接受抗血栓治疗81例为非ATT组.比较两组围手术期相关指标及术后出血并发症发生率.结果:ATT组行开放胆囊切除术占比高于非ATT组(64.2％vs 46.9％),非ATT组行腹腔镜手术占比高于ATT组(53.1％vs 35.8％),腹腔镜转为开放手术率高于ATT组(14.8％vs 14.8％),差异均有统计学意义(P<0.05).ATT组术中出血量多于非ATT组[(98(4,600)mL vs 50(1,70)mL],输血率(16.6％vs 3.7％)高于非ATT组,术后住院时间长于非ATT组[(11(1,76)d vs 9(2,20)d],差异均有统计学意义(P<0.05),但两组手术时间、术中大量出血发生率比较,差异均无统计学意义(P>0.05).ATT组发生术后显著并发症12例(17.9％),严重并发症7例(10.4％),分别高于非ATT组的4例(4.9％)和1例(1.2％),差异均有统计学意义(P<0.05).非ATT组未发生术后出血并发症,ATT组有4例(6.0％)发生出血并发症,分别为小肠出血、肝包膜下血肿、引流管口出血和病因不明的腹腔出血,均予以保守治疗.该4例患者均同时接受抗血小板和抗凝治疗,其中2例服用二联抗血小板药物.结论:单药抗血小板治疗患者行急性胆囊切除术较安全,二联、多联抗血小板药物或联合抗凝治疗患者需谨慎处理,以免发生术后出血并发症.

目的 探讨血清可溶性Klotho(sKlotho)、肝细胞生长因子(HGF)水平与体外心肺复苏后发生急性肾损伤(AKI)的关系.方法 选取2018年1月—2021年12月江苏大学附属昆山医院急诊医学科收治体外心肺复苏后自主循环恢复患者93例,根据是否发生AKI分为AKI组49例和无AKI组44例,再根据AKI分期将AKI组分为1期亚组13例、2期亚组26例、3期亚组10例.检测患者血清sKlotho、HGF、尿素氮(BUN)、肌酐(SCr)水平,Logistic回归分析心肺复苏后AKI的影响因素,绘制受试者工作特征曲线(ROC)分析血清sKlotho、HGF预测心肺复苏后AKI的价值.结果 AKI组血清sKlotho水平低于无AKI组,血清HGF、BUN、SCr水平高于无AKI组(t/P=10.792/<0.001、10.312/<0.001、11.742/<0.001、17.615/<0.001).血清sKlotho水平3期亚组<2期亚组<1期亚组,血清HGF水平3期亚组>2期亚组>1期亚组(F/P=85.837/<0.001、74.698/<0.001).AKI患者血清sKlotho水平与BUN、SCr水平呈负相关(r=-0.405、-0.432,P均<0.01),HGF水平与BUN、SCr水平呈正相关(r=0.338、0.398,P均<0.01).肾上腺素使用剂量高、血清HGF高是心肺复苏后AKI的危险因素,血清sKlotho高是心肺复苏后AKI的保护因素[OR(95％CI)=2.024(1.354～3.025)、1.567(1.255～1.955)、0.535(0.388～0.736)].血清sKlotho、HGF水平预测心肺复苏后AKI的曲线下面积为0.750、0.736,二者联合预测的曲线下面积为0.896,高于单项预测(Z=4.872、4.474,P均<0.01).结论 心肺复苏后发生AKI患者血清sKlotho水平下降,HGF水平增高,且与AKI发生及肾损伤严重程度有关,是心肺复苏后AKI的潜在预测指标.

目的 探究ABCD3-I评分联合血栓弹力图对短暂性脑缺血发作(TIA)后发生急性脑梗死(ACI)的预测价值.方法 选取2018年3月—2021年4月江苏大学附属昆山医院收治的确诊为TIA的164例患者为研究对象,统计TIA患者发病后1周内ACI发生情况,并分为发生组(18例)和未发生组(146例).对比发生组和未发生组临床资料.Logistic多因素回归分析影响TIA患者ACI发生的危险因素.制作受试者工作特征曲线(ROC),以曲线下面积(AUC)评价ABCD3-I评分联合血栓弹力图对TIA患者ACI发生的预测价值.结果 TIA患者发病后1周内ACI发生率为10.98％.发生组发作持续时间、发作次数、颅内动脉狭窄程度重度占比、ABCD3-I评分、血凝固角、最大振幅均高于未发生组(P<0.05),发生组反应时间、凝血时间则均低于未发生组(P<0.05).Logistic回归分析结果显示,重度颅内动脉狭窄、ABCD3-I评分、反应时间、凝血时间均为影响TIA患者ACI发生的危险因素(P<0.05).ROC分析显示,ABCD3-I评分、反应时间及凝血时间预测TIA患者ACI发生的最佳截断点分别为6.26分、5.35 min、1.56 min,ABCD3-I评分、反应时间及凝血时间联合的特异度为97.95％,高于ABCD3-I评分、反应时间及凝血时间单独进行预测的特异度,且联合预测TIA患者ACI发生的AUC为0.816,高于ABCD3-I评分、反应时间及凝血时间单独预测TIA患者ACI发生的AUC(P<0.05).结论 ABCD3-I评分、血栓弹力图两者联合对TIA后发生ACI具有一定的预测价值,可作为临床评估TIA后发生ACI的重要参考指标.

目的 探讨氧化槐果碱对人肝癌SMMC-7721细胞增殖和凋亡的影响,并探讨其可能介导的信号通路.方法 将人肝癌SMMC-7721细胞分为对照组、氧化槐果碱处理组(2、4、8、16、32 mmol/L).将梯次浓度氧化槐果碱作用于肝癌细胞后培养48 h;采用倒置显微镜观察细胞形态变化;采用CCK8法检测不同浓度氧化槐果碱对细胞增殖的影响,采用流式细胞术检测氧化槐果碱对细胞凋亡的影响,通过免疫印迹法检测氧化槐果碱对肝癌细胞B细胞淋巴瘤/白血病-2(Bcl-2),Bcl-2相关X蛋白(Bax)及转录激活因子(STAT)3、STATS表达水平的影响,分析氧化槐果碱对肝癌SMMC-7721细胞可能的作用.结果 氧化槐果碱呈剂量依赖性抑制肝癌SMMC-7721细胞的增殖,并且诱导细胞凋亡.并呈剂量依赖性上调促凋亡Bax的表达,下调抗凋亡蛋白Bcl-2、STAT3、STAT5的表达.结论 氧化槐果碱对人肝癌SMMC-7721细胞有抑制增殖、诱导凋亡的作用,可能是通过酪氨酸激酶(JAK)/STAT信号通路下调STAT3、STAT5蛋白激酶表达,从而上调促凋亡Bax基因表达,下调抗凋亡Bcl-2基因表达.

Objective To observe the effects of dexamethasone on liver function,serum inflammatory factors and immune function in patients with primary liver cancer after hepatectomy.Methods 89 patient undergoing hepatectomy were randomly divided into the observation group (47 cases) and the control group (42 cases).The control group was given conventional treatment,and the observation group was given additional dexamethasone 10 mg every day for 3 days based on conventional treatment.The differences of liver function (ALT,AST,TBIL,ALP),serum inflammatory factors (TNF-α,CRP,IL-6,IL-8),immune function (CD3+,CD4+,CD8+ and CD4+/CD8+) and postoperative morbidity between the two groups were compared.Results There were significant differences of ALT,AST,TBIL,ALP between the two groups (P＜0.05).The levels of ALT,AST and TBIL in the two groups were showed first increasing then decreasing trends with increasing time,but ALP was on the contrary (P＜0.05).The differences of those items in patients between the two groups were statistically different (P＜0.05).There were significant differences of the levels of TNF-α,CRP,IL-8、IL-6 in patients between the two groups (P＜0.05).All of those items in the two groups were showed first decreasing then decreasing trend with time (P＜0.05),and the shifting trends of those items in patients between the groups were all statistically different (P＜0.05).There were no significant differences of the CD3+,CD4+,CD8+ and CD4+/CD8+ in patients between the two groups (P＜0.05).CD3+,CD4+ and CD4+/CD8+ of the two groups were presented decreasing trend over time,but CD8+ was on the opposite (P＜0.05).The shifting trend of those items in the patients between the two groups were not statistically different (P＞0.05).The intestinal function recovery time and hospitalization time of the observation group were lower than those of the control group,with statistically significant difference (P＜0.05).There were no significant differences in postoperative morbidity between the two groups (P＞ 0.05).There were no statistically differences of the 1 year and 2 year survival rates in patients between the two groups (P＞0.05).Conclusion The short term and proper application of dexamethasone can play an important role in protecting liver and anti-inflammation in patients at the perioperative period of hepatectomy.It also helps to recuperation and dose not obviously increase the immunosuppression and postoperative morbidity.

Objective To observe the effect of acyl-CoA carbrolase (ACC) antisense oligonucleotide (ASODN) on steatosis of HL-7702 hepatocytes.Methods The specific phosphorothioate modified ACC targeting ASODN were designed and synthesized by a computer software.Normal HL-7702 hepatocytes were cultured in vitro using intravenous lipid emulsions,a large number of triglyceride was induced in hepatocytes within 48 h,and a model of fatty liver cells in vitro was successfully formed.ACC-ASODN was transfected into the hepatocyte model by liposome method.The blank group (HL-7702 cells),model group (fatty liver cells of model) and low and high concentrations of the two experimental groups (5,10 μmol · L-1 ACC-ASODN) were set up.ACC-ASODN was transfected into fatty liver cell model 24 h later.ACC activity was determined by radioisotope technology.The malonyl coenzyme A content was determined by HPLC.The carnitine palmitoyltransferase Ⅰ (CPT Ⅰ) activity was determined by radioisotope technique.The level of triacylglycerol(TG) was determined by automatic analyzer.Results The value of the liver cell ACC activity (U) in blank group,model group and experimental-L,-H groups were respectively 0.74,0.33,0.20,0.18.The value of the intracellular content (nmol · L-1) of malonyl CoA in above four groups were respectively 14.3,12.4,7.5,6.8.The value of CPT Ⅰ (U) in above four groups were respectively 1.33,1.47,3.85,3.95;the value of TG conten(mmol · L-1) in above four groups were respectively 0.20,0.52,0.37,0.28.Compared with blank group,the factors in model group had significant differences(all P ＜ 0.05).Compared with model group,the factors in experimental-L,-H groups had significant differences (all P ＜ 0.01).Conclusion ACC-ASODN acts on hepatocytes,and by inhibiting the activity of ACC,the content of TG is decreased,and the steatosis of hepatocytes is alleviated.

目的 观察复杂性肝癌的手术切除效果,并探讨其影响因素.方法 收集2006年3月至2014年2月昆山市第一人民医院收治的复杂性肝癌患者60例,对患者的肿瘤部位及大小、人肝血流阻断、切除方式、出血量、引流等方面进行回顾性分析.用Kaplan-Meier法计算患者生存率,应用COX模型进行多因素分析.结果 术后患者中出现胸腔积液18例,胆瘘6例,腹腔感染2例,膈下积液2例.患者的HbsAg与术后2年或3年生存率无关(P>0.05).单因素分析发现,患者的肝硬化程度、门静脉癌栓、肿瘤合并包膜及术中出血量等因素均与预后有关(P<0.05);多因素分析结果显示,胆管癌栓、AFP、肿瘤大小、术中输血量(血浆)、术前Child-Pugh分级、第一肝门阻断时间、术时(麻醉时间)等对患者术后生存率无影响(P>0.05),肿瘤子灶或卫星灶、肝硬化程度、门静脉癌栓(一级分支)、术中出血、肿瘤包膜、肝静脉癌栓量等对患者术后生存率均有影响(P<0.05).结论 复杂性肝癌的手术切除明显提高患者的生存率,肿瘤子灶或卫星灶、肝硬化程度、门静脉癌栓(一级分支)、术中出血、肿瘤包膜、肝静脉癌栓量是影响患者术后生存率的因素.

[ABSTRACT]Objective:Through the combination with hemocoagulase and pantoprazole on gastrointestinal bleeding,to observe the changes of serum BUN,LPO,NO,TNF-,hs-CRP alpha and cortisol levels,explore the mechanism of combina-tion.Methods:A total of 1 10 cases of upper gastrointestinal bleeding in our hospital were selected and divided into the control group and the observation group,55 cases for each group.Patients were Treated with bed rest,fasting,intravenous nutrition, oxygen,and according to the individual situation actively supplement blood capacity,and the control group were treated with 40 mg intravenous pantoprazole treatment,2 times 1 day;the patients in the observation group were treated with 2KU hemo-coagulase injection based on the treatment of control group,2 times of intravenous injection per day,and all patients were trea-ted for 3 days,and then the BUN (blood urea nitrogen),LPO (LPO),NO (nitric oxide),TNF-α(TNF alpha),hs-CRP (high sensitivity C reactive protein)and cortisol (cortisol)were detected.Results:(1)There were no significantly differences of the serum levels of BUN、LPO、NO of the two groups before treatment (P > 0.05 ).After treatment,the serum levels the two groups were significantly lower than before treatment,and LPO,BUN,NO levels in the observation group were significantly better than the control group ,the difference was significant (P <0.05);(2)There were no significantly differences of the ser-um levels of TNF-α、hs-CRP、cortisol of the two groups before treatment (P >0.05).After treatment,the serum levels the two groups were significantly lower than before treatment,and TNF-α、hs-CRP、cortisol levels in the observation group were signifi-cantly better than the control group ,the difference was significant (P <0.05 ).Conclusion:The treatment of patients with combined use of hemocoagulase and pantoprazole on gastrointestinal bleeding,can significantly improve the serum levels of BUN,LPO,NO,TNF-,hs-CRP and alpha cortisol levels,and further illustrates the synergistic effect of the combination,al-so shows that the combination of two drugs for patients with upper gastrointestinal bleeding can be improve the symptoms of hemorrhage,reduce inflammation and stress,improving the treatment effect.

ObjectiveTo investigate the clinical effect of Deproteinised Calf Blood Serum Injection combined with Sodium Ozagrel and Sodium Chloride Injection in treatment of senile acute cerebral infarction.Methods Patients (81 cases) with senile acute cerebral infarction in the First People's Hospital of Kunshan from October 2014 to January 2016 were randomly divided into control group (40 cases) and treatment group (41 cases). Patients in the control group were iv administered with Sodium Ozagrel and Sodium Chloride Injection, 80 mg added into normal saline 250 mL, once daily. Patients in the treatment group were iv administered with Deproteinised Calf Blood Serum Injection on the basis of the control group, 30 mL added into normal saline 250 mL, once daily. Patients in two groups were treated for 15 d. After treatment, the clinical efficacies were evaluated, and levels of Hcy, S100B, and MMP-8, NIHSS scores, and mRS scores in two groups were compared.Results After treatment, the clinical efficacies in the control and treatment groups were 77.50% and 92.68%, respectively, and there was difference between two groups (P < 0.05). After treatment, the NIHSS scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the NIHSS score in the treatment group was significantly lower than that in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of Hcy, S100B, and MMP-8 in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment for 90 d, the mRS scores in the treatment group were lower than those in the control group, and there was difference between two groups (P < 0.05). Conclusion Deproteinised Calf Blood Serum Injection combined with Sodium Ozagrel and Sodium Chloride Injection has clinical curative effect in treatment of senile acute cerebral infarction, can improve brain function and prognosis, and regulate the levels of Hcy, S100B, and MMP-8, which has a certain clinical application value.

目的 研究无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效.方法 选取2012年1月至2014年12月昆山市第一人民医院急诊医学科收治的AECOPD合并Ⅱ型呼吸衰竭患者47例.根据随机、对照的原则分为观察组(n=24)和NIPPV组(n=23),其中观察组给予常规抗感染、祛痰、平喘、持续低流量吸氧等治疗;NIPPV组在常规治疗的基础上加用NIPPV治疗.对比治疗24h、72h后患者的血气分析、心率及呼吸次数等指标.结果 与治疗前相比,两组患者在治疗后的第24小时和72小时,呼吸次数、心率、动脉血二氧化碳分压(PaCO2)和乳酸(Lac)显著降低(P＜0.05),动脉血氧分压(PaO2)和pH显著上升(P＜0.05);而且与第24小时相比,第72小时的各值改善更为明显(P＜0.05).两组患者在治疗后第72小时的N末端前脑钠肽(NT-proBNP)值也有显著下降(P＜0.05).与观察组相比,NIPPV组患者的呼吸次数、心率、PaCO2、Lac、pH、PaO2和NT-proBNP均有更为显著的改善(P＜0.05).此外,NIPPV组较观察组住院天数与住院费用明显减少(P＜0.05).结论 NIPPV在治疗AECOPD合并Ⅱ型呼吸衰竭患者中疗效显著,值得临床推广应用.

Objective To study the efficacy and safety of enteral nutrition by nasal jejunum nutrient canal on severe head injury patient. Methods Patients with severe head injury were divided into enteral nutrition by nasal jejunum nutrient canal group (N+EN group), nasogastric tube group (S+EN group) and total parenteral nutrition group (TPN group). The differences of curative effects, PA, ALB, TP, IgG, IgA and IgM were compared. Results The ICU hospitalization time, mortality and out-lung infection in N+EN group and S+EN group were significantly lower than in TPN group (P<0.05). The ICU hospitalization time and mis-aspiration rate in N+EN group were significantly lower than those in S+EN group (P<0.05). The post-therapy PA, ALB, TP, IgG, IgA and IgM in N+EN group were significantly higher than those in S+EN group (P<0.05). Conclusion Enteral nutrition by nasal jejunum nutrient canal on severe head injury patient has good curative effects and safety, which is better than nasogastric tube and total parenteral nutrition.

目的：观察纳洛酮注射液联合葛根素治疗急性重度酒精中毒的临床疗效。方法：将2013年1月至2013年12月我院急诊科诊治的符合急性重度酒精中毒诊断标准的10O例患者随机分为两组，研究组(n=53)用纳洛酮注射液联合葛根素治疗，对照组(n=47)仅用纳洛酮注射液治疗．比较两组开始治疗至神志清醒和至症状消失的时间。结果：研究组和对照组自治疗至神志清醒时间和至症状消失时间分别为(2.6±1.1)h和(3.7±1.5)h，(11.5±2.5)h和(15.4±3.2)h，P均<0.05。结论：盐酸纳洛酮联合葛根素治疗急性重度酒精中毒临床疗效显著，值得临床推广使用。

目的:分析急诊急性血小板减少性紫癜病例的病因,提高预警价值,避免误诊,漏诊,降低死亡率。方法:收集2003-2007年12例急诊科急性血小板减少性紫癜的病例,分析原发病致血小板急性减少的原因。结果:急诊科急性血小板减少性紫癜病因临床统计有重症肺炎、肝素相关性血小板减少症、急性肝炎、多器官衰竭,尿毒症、传染性单核细胞增多症、安乃近中毒、感染性休克。结论:急性血小板减少性紫癜为首发症状的临床病例危重,病因复杂,常造成诊断上的困难,临床医生只有及时找到病因,对症治疗才能避免不良后果。临床医生遇到血小板减少性紫癜时,要从多方面考虑,做到早诊断、早治疗。