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酚苄明减弱失血性休克大鼠虹膜去甲肾上腺素荧光强度
各种休克都有大量儿茶酚胺释放,如去甲肾上腺素(norepinephrine,NE)和肾上腺素都兴奋α-受体,引起血管收缩,组织低灌注.对α-受体阻断剂治疗休克持有不同观点,为揭示休克不同时期α-受体阻断剂对组织NE含量的影响,我们观察失血性休克大鼠虹膜交感神经膨体去甲肾上腺素荧光强度的变化.
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失血性休克患者的液体复苏策略分析
失血性休克是临床上常见的一种休克类型,通常由于大失血引起机体循环血量骤减而发生,大多继发于创伤或其他疾病.对于失血性休克患者,传统复苏方法往往要求:快速、充分、正压、复温、复苏,即主张在失血性休克发生后快速给予大量液体,恢复有效血容量,并使用正性肌力或血管活性药物以尽快恢复血压,维持血压在正常水平,保证器官组织灌注,保持机体正常体温,防止休克的进一步发展.但是,目前医学界对液体复苏时机、采用何种液体复苏、复苏原则等问题,均存在较大争议.为此,本文对失血性休克患者的液体复苏策略进行简略的分析.
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血糖仪测定失血性休克病人血糖值可靠性研究
创伤后机体会发生一系列应激性变化,其中交感神经-肾上腺髓质的兴奋会导致血糖的应激性升高.且血糖增高值与疾病预后有一定的关系,血糖越高预后越差[1],故合理控制血糖是抢救危重症病人的有利措施.准确快速地提供血糖值对治疗至关重要,笔者对106例创伤性休克病人行快速血糖测定与静脉血血糖测定相比较,探讨两者之间的关系,为临床治疗提供准确数据.
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1例失血性休克病人的急救护理
进行性肌营养不良是一种遗传性疾病,其主征为随意肌原发变性、逐渐进行使病肌衰弱萎缩,终至不能运动,可有心脏受累[1]而导致心脏储备功能下降.我院收治1例进行性肌营养不良病史9 a的患儿,因进食不当出现上消化道出血,继发失血性休克,住院后经积极的抗休克、止血、防止感染、输血等综合治疗,患儿贫血改善,无不良反应出院.
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开展卫生部"十年百项计划"推广项目培训的思考
卫生部面向农村和城市社区推广医药卫生适宜技术十年百项计划(以下简称"十年百项计划")自1991年起实施,已推广适宜技术200余项,取得了较好的社会效益,有效解决了我国农村和城市社区卫生工作的一些重大问题,有力地促进了农村和城市社区医疗卫生技术水平和服务质量的提高."高渗氯化钠溶液治疗失血性休克技术"在2001年经卫生部批准列入"十年百项计划",目前已在多个省市得到推广和应用.在开展该项目推广培训中,笔者切切实实地感到,如何保证项目的培训和推广效果,值得思考和总结.
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重视高渗氯化钠溶液治疗失血性休克技术在基层医院的推广工作
近年来,创伤的发生率呈上升趋势,受害者多为年轻人,其致死率和致残率很高.有文献报告,创伤是45岁以下人类死亡的第1位原因,是所有人类死亡的第3位原因.死亡绝大多数发生在创伤后1小时内,即所谓的"黑色时间"内,致死的主要原因是严重创伤后失血性休克.研究表明,通过创伤后早期的正确处理,可明显减少创伤的死亡率,其中失血性休克的复苏是救治的关键环节,而基层医院或院前急救单位往往是该项任务的主要实施者.
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Effects of GLP on Intestinal Mucosal Injury and the Change of TNF-αContent in Hemorrhagic Shock Rabbits
Objective To observe the intestinal mucosal injury and the change of TNF-αcontent in rabbits with hemor-rhagic shock / reperfusion ( HS-R) and the effects of ganoderma Lcidum polysaccharide ( GLP) on them. Methods 30 rabbits were made into hemorrhagic shock, then reperfused with different liquids. These rabbits were divided by random number table into three groups:sham operation group ( Sham group) , reperfusion with normal saline group ( NS group) , reperfusion with 1% GLP group ( LS group) . Bacterial translocation of blood and TNF-αcontent in serum were respectively observed at the time before shock, 40 min after shock, 40 min and 90 min after. TNF-α content in intestinal mucosa and the degree of intestinal mucosal injury were examined at 90 min post-resuscitation. Results ① With the extension of reperfusion time, the positive rate of blood bacteria increased gradually in NS group, which was significantly higher than that of Sham group and LS group (P<0. 05), meanwhile the degree of intestinal mucosal injury in NS group was more se-vere than that of Sham group and LS group too (P<0. 05). ②TNF-αcontent in serum of NS group and LS group were in-creased obviously compared with that before shock and in Sham group (P<0. 05). TNF-αcontent in serum was further in-creased after reperfusion with NS, which was distinctly higher than that in LS group. TNF-αcontent in intestinal mucosa of NS group was significantly higher than that in LS group and Sham group too (P<0. 05). Conclusion GLP can protect in-testinal mucosa against HS-R injury, and its effects may relate with the change of TNF-αin hemorrhagic shock rabbits.
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It is very difficult for doctor to treat patient with persistent hypotension in the late stage of shock. The aim of present study was to elucidate the reason for lower vasoreactivity in severe shock. Irreversible hemorrhagic shock of rat was reproduced and the vasoreactivity of arteriole in spinotrapezius muscle to norepinephrine (NE) was measured. The resting membrane potential of isolated arterial strips was detected with a microelectrode. The effect of NO on the membrane potential and intracellular [Ca2+]i level in isolated arteriolar smooth muscle cells (ASMCs) was determined with fluorescent probes under confocal microscope. KATP channel of ASMCs was measured with patch clamp method. It was shown that membrane hyperpolarization appeared in arteroles 2 h post hemorrhage, while the resting potential was increased from (-36.9±6.3) mV of control value to (-51.0±9.1) mV with the NE threshold increased to 15 times more than preshock value. The hyperpolarization of ASMCs was closely related to vascular hyporeactivity (correlation coefficient 0.96, P<0.01). The hyperpolarization was enhanced by lack of ATP, increase in H+,and OONO- in ASMCs. Single KATP channel conducatance, mean open time and open probability was increased in ASMCs, and the increased [Ca2+]i level of ASMCs stimulated by NE was reduced to 50% of normal value. The vasoreactivity, blood pressure and survival rate could be improved by the treatment of glybenclamide and NaHCO3. The study indicates that hyperpolarization of ASMCs is a major reason for lower vasoreactivity in severe shock, since it inhibits the voltage dependent Ca2+ channel (POC) with the reduction of NE stimulated [Ca2+]i increase. The decrease in ATP and increase in H+, and OONO- in ASMCs involves in the activation of KATP channel, leading to the ASMCs hyperpolarization.
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Xinmailong injection solution was invented at 1988 by prof. Li Shunan in Dali medical college. It was made from the material which has high biological activeness to the cardiac and vascular system. During the experimental shock caused by excessive loss of blood in monkey and dog, it was found by ECG that the T-wave of anterion lead on left chest elevated and became high and sharp after acute blood loss. Arterial blood pressure dropped to 8-5.3 kPa for dog and 8-5.3-2.7 kPa for monkey, changes of T-wave all recovered to near normal level after xinmailong solution was injected intravenously (0.05-0.2 mL/kg). These Results implied that xinmailong might improve the ischemia of myocardium induced by hemorrhagic shock.
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Objective: To explore a way of guiding diagnosis and treatment of blunt and penetrating diaphragm injuries. Methods: According to injury violence, 46 chest trauma patients with diaphragm rupture were divided into two groups: a blunt injury group and a penetrating injury group. The injury condition and trauma scores between the two groups were compared and analyzed. Results: The incidence of blunt diaphragm injuries was lower than that of penetrating injuries (1.78% vs 8.53%, P<0.05). In the blunt injury group most patients had multiple injuries. Penetrating injuries developed more quickly than blunt injuries, and resulted in hemorrhagic shock in the early period. Trauma scores showed that there was no significant difference in the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and thoracic Abbreviated Injury Scale (AIS) between the two groups (P>0.05), but the blunt injury group had lower Glasgow Coma Scale (GCS) and abdominal AIS than the penetrating group (P<0.05). Conclusions: Blunt and penetrating diaphragm injuries have different clinical characteristics. So they should be dealt with differently to reduce the incidence of complication and improve prognosis.