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切开洗胃抢救重度有机磷中毒11例体会

The Clinical Efficacy of Specially-made “Yinchen Chaiping Tang” Decoction in Treating Chronic Hepatitis B

目的　观察茵陈柴平汤治疗重度慢性乙型肝炎的疗效及不良反应。 方法　2009年3月－2010年3月，选择采用茵陈柴平汤联合常规保肝药物治疗50例重度慢性乙型肝炎患者（治疗组），并与50例仅用常规保肝药物治疗的重度慢性乙型肝炎患者（对照组）进行比较，观察治疗2、4周时的临床症状、肝功能及凝血酶原活动度等指标的变化。 结果　治疗2、4周时，治疗组在肝功能及凝血酶原活动度等指标均有显著改善，无严重不良反应；4周时，治疗组的症状缓解率（84%）明显高于对照组（66%）；其总有效率（96%）亦高于对照组（80%）。 结论　茵陈柴平汤治疗重度慢性乙型肝炎具有较好的临床疗效，且无严重不良反应。

APPLICATION OF VACUUM SEALING DRAINAGE IN SEVERE SKIN CLOSED INTERNAL DEGLOVING INJURY

【Abstract】 Objective To investigate the effectiveness of the vacuum sealing drainage (VSD) technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury (CIDI). Methods Between July 2008 and April 2011, 16 patients with severe skin CIDI were treated. There were 11 males and 5 females, aged 17-56 years (mean, 28 years). Injury was caused by traffic accident in all cases. The time between injury and operation was 2-8 hours (mean, 5 hours). Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases. The range of skin exfoliation was 5%-12% (mean, 7%) of the body surface area with different degree of skin contamination. After thorough debridement, exfoliative skin was made split middle thickness skin graft for in situ replantation, and then VSD was performed. Results After 7 days of VSD therapy, graft skin survived successfully in 14 cases; partial necrosis of graft skin occurred in 2 cases, and was cured after thorough debridement combined with antibiotics for 7 days. All patients were followed up 6-18 months (mean, 12 months). The appearance of the limb was satisfactory without obvious scar formation, and the blood supply and sensation were normal.The joint function was normal. Conclusion For patients with severe skin CIDI, VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb, promote replantation skin survival, and shorten healing time of wound. The clinical effectiveness is satisfactory.

新型主动脉旁与主动脉内球囊反搏对羊重度急性心力衰竭辅助的实验研究

Objective To compare the assisting function between a new paraaortic counterpulsation device (PACD) and the intraaortic balloon pump (IABP) in acute severe heart failure in sheep. Methods Eight healthy adult small fattailed sheep were chosen in our study. The selfmade PACD (with a stroke volume of 55 ml) was anastomosed to the descending aorta through a valveless graft, and an intraaortic balloon (with a stroke volume of 40 ml) was placed in the descending aorta for the purpose of counterpulsation assisting. Acute severe heart failure model was established by snaring coronary artery branches. The hemodynamic changes of both devices were recorded during, before and after the counterpulsation assisting. Results Eight heart failure sheep models were successfully set up. Cardiac output (CO), pulmonary capillary wedge pressure (PCWP), mean arterial pressure (MAP) and left ventricular end diastolic presssure (LVEDP) after the heart failure were significantly different compared with basic value (t=-8.466, 34.083, 25.767, -5.219, P=0.000). After IABP and PACD assisting, the mean aortic diastolic pressure (MADP) didn’t significantly or did increase (38.34±7.13 mm Hg vs. 38.42±6.81 mm Hg, P=0.418; 38.34±7.13 mm Hg vs.54.14±10.13 mm Hg, P=0.001), and the degree of increasing between the two methods showed a significant difference (P=0.010); LVEDP didn’t significantly decrease (7.43±2.54 mmHg vs. 7.32±2.14 mm Hg, P=0.498; 7.43±2.54 mm Hg vs. 6.53±1.91 mm Hg, P=0.821), and there was no significant difference between the two methods in the change (P=0.651); the coronary sinus flow (CSF) didn’t significantly or did increase (86.63±7.71 ml/min vs. 87.04±6.53 ml/min, P=0.981; 86.63±7.71 ml/min vs. 110.52±11.03 ml/min, P=0.000), and there was a significant difference in the change of CSF between the two methods (P=0.000). IABP didn’t significantly decrease the left carotid artery flow (LCAF) (131.07±21.26 ml/min vs. 128.36±20.38 ml/min, P=0.689), while PACD increased it (131.07±21.26 ml/min vs. 151.29±18.37 ml/min, P=0.008), and there was a significant difference in the change of pressure waveform between the two methods (P=0.002). The thrombus, thrombosis and ischemic necrosis were not found in the hematosac of PACD, artificial blood vessels, heart, lung, liver or kidney of the animal. No apparent abnormalities of the pathohistological sections were detected under optical microscope. Conclusion IABP has no assisting function for the heart of animal with severe heart failure. However, PACD can improve hemodynamic parameters like MADP, returned blood volume in the coronary artery and perfusion volume into the brain, which may become a promising implantable device for severe heart failure.

IMPLANTING HUMAN SPLENIC LYMPHOCYTES INTO SEVERE COMBINED IMMUNODEFICIENCY MICE TRANSPLANTED WITH TISSUE ENGINEERED SKINS

Objective The immunogenicity of tissue engineered skins is still vague, though it has been appl ied cl inically for several years. To observe the evidence of immunologic rejection of tissue engineered skins transplanted to severe combined immunodeficiency (SCID) mice, which are implanted human splenic lymphocytes to construct human immunesystem. Methods Tissue engineered skins and acellular dermic matrix were constructed in vitro. Twenty SCID mice, aging4-6 weeks and weighing 16-17 g, were randomly divided into four groups equally (n=5). The tissue engineered skins, human foreskins from circumcision and acellular dermic matrix were transplanted to groups A, B, and C, respectively; group D was used as a control. After 2 weeks of transplanting, 3 × 107 human splenic lymphocytes were injected into every SCID mouse intraperitoneally. After 4 weeks, the morphology, histology, immunohistochemistry and human IgG immunofluorescence were used to observe immunologic rejection. Results Group A showed that transplanted tissue engineered skins had the bilayer structure of dermis and epidermis, which was similar to the normal human skin structure. Group B showed that the transplanted human foreskins still retained normal structure of human skin. Group C showed that acellular dermic matrix were located in situ and had no sign of degradation. After injecting human splenic lymphocytes into the SCID mice, no inflammatory cells infil itration were observed basically in groups A, C, and D; the inflammatory cells infil itration of group B were significantly higher than that of other 3 groups (P lt; 0.05). The results of anti human keratin 14 monoclonal antibody (mAb) staining and anti human type IV collagen mAb staining were positive in group A; no positive cells for CD3, CD4, and CD8 were observed in groups A, C, and D; and many positive cells for CD3, CD4, and CD8 were observed in group B. The results of IgG immunofluorescence staining was negative in group A, C, and D, and positive in the great vessel wells of group B. Conclusion The immunogenicity of tissue engineered skins is very weak, and tissue engineered skins would not be rejected by host immune system after transplantation.

妊娠高血压并发HELLP综合征的护理

目的 总结妊娠高血压并发溶血、肝酶升高及血小板减少综合征（HELLP）的发病率、临床特征及护理。 方法 分析2007年1月-2009年4月12例患HELLP综合征孕产妇资料。 结果 HELLP综合征发生率占重度子痫前期和子痫的8.33%（12/144），占同期住院分娩的0.15%（12/7 793）。91.67%（11/12）发生在产前。12例中引起产前子痫2例，眼底血管改变8例，视网膜出血3例，胎儿窘迫4例，胎盘早剥2例，子宫卒中1例，DIC 1例，严重腹水1例，妊高征心脏病1例，早期心衰1例，急性肾衰2例，脑出血1例，腹壁下血肿1例。经积极有效的治疗及精心的护理，无一例孕产妇及围产儿死亡。 结论 充分认识HELLP综合征的特殊临床表现，重视动态监测血常规、血小板、外周血涂片，肝肾功能，严密监护生命体征，准确记录尿量和尿色是早期发现妊娠高血压并发HELLP综合征的重要环节，有助于早诊断早治疗，加强病情观察，采取有效的护理措施，尽快终止妊娠，是改善母婴预后降低母婴病死率的关键。

Treatment of 32 Cases of Severe Hemorrhoids Underwent PPH with Local Anesthesia

目的　探讨在局部麻醉下行痔上黏膜环形切除钉合术（procedure for prolapse and hemorrhoids，PPH）治疗重度内痔的可行性及临床应用价值。方法　笔者所在医院科室从2005年起对32例Ⅲ度及Ⅳ度脱垂性内痔（含1例混合痔）患者均采用苯巴比妥＋氢溴酸东莨菪碱＋利多卡因肛管直肠环形局部浸润麻醉行PPH术，对其麻醉效果、手术时间、术中及术后疼痛、尿潴留、术后感染、肛门狭窄、住院时间、治疗满意度等进行分析。结果　32例患者均顺利完成手术，有1例术中改行低位连续硬膜外麻醉，1例辅加镇静剂及镇痛剂。术后28例对疼痛能耐受，4例需镇痛药物；1例患者有肛门坠胀感；所有患者伤口均一期愈合，无尿潴留、术后感染、出血、肛门狭窄等并发症发生；31例对疗效满意，有1例感肛门坠胀，行温水坐浴及痔疮膏纳肛治疗1周后缓解。住院时间3～6d，平均4d。32例患者均进行有效随访，随访时间2～4个月，平均3个月，无大便失禁或复发，肛门控便能力均可。结论　局部麻醉下行PPH术治疗重度内痔是一种安全可行的手术方法，麻醉操作护理简单，疗效确切，术后并发症少，术后恢复快，并可减少医疗费用。

Transcatheter aortic valve replacement for pure severe native aortic valve regurgitation with high surgical risk: a case report

Pure native aortic valve regurgitation (NAVR) is one of the common heart valve diseases, and the prognosis of symptomatic chronic NAVR is poor. Although transcatheter aortic valve replacement (TAVR) is currently an "off-label" procedure, it remains the option for patients with high risk for surgery. In this case, an 81-year-old man with multiple comorbidity and high Society of Thoracic Surgeons score, the risk for surgery is rather high. Through the preoperative evaluation by the multidisciplinary heart team, considering that the patient had calcification at the junction of annulus, as well as mild aortic stenosis, after careful consideration, 29# Venus A-Valve was chosen. After the procedure, the symptoms were obviously improved and the follow-up effect was good. Due to various causes of NAVR, great anatomical variation of annulus, little calcification of aortic valve, and lack of anchor point and other problems, the procedure to treat NAVR with TAVR is still difficult. At the same time, there are few valve systems developed for the anatomical characteristics of aortic regurgitation valve. TAVR in the treatment of patients with high risk for surgery still requires long-term practice and technical development.

无创正压通气治疗重度支气管哮喘疗效分析

目的 观察无创双水平气道正压通气( BiPAP) 治疗重度支气管哮喘的疗效。方法 29 例重度支气管哮喘患者随机分为研究组( 15 例) 和对照组( 14 例) 。研究组在常规药物治疗基础上, 早期给予BiPAP 呼吸机治疗。比较两组患者治疗前和治疗4 h、治疗24 h 后动脉血气变化。结果研究组有14 例治疗4 h后临床症状和体征明显好转, 治疗有效率为93. 3% ; 1 例因呼吸衰竭加重, 改用气管插管机械通气治疗。对照组治疗4 h后有10 例临床症状和体征好转, 治疗有效率为71. 4% , 4 例无明显好转, 2 例改用BiPAP 呼吸机治疗。研究组未改变治疗方式的14 例经治疗4 h、治疗24 h 后血气分析的改善均优于未改变治疗方式的10 例对照组( P lt;0. 05) 。结论 早期应用BiPAP 呼吸机治疗重度支气管哮喘能迅速改善动脉血气分析指标, 使用安全有效。

The surgical treatment strategy and perioperative management of patients with heart valve disease complicated with severe chronic heart failure

ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.