重症创伤患者ICU后综合征心理障碍影响因素分析

摘要 目的：探究重症创伤患者ICU后综合征（PICS）心理障碍影响因素。方法：本次研究纳入60例重症创伤患者,按照是否存在PICS分为对照组（20例）和PICS组（40例）。进行不同治疗情况PICS心理障碍影响因素单因素分析。PICS心理障碍患者急性生理与慢性健康状况评分系统（APACHEII）和医院焦虑和抑郁量表（HADS）评分、Ogawa改良创伤评分系统、匹兹堡睡眠质量指数量表（PSQI）评分进行单因素分析,并进行PICS心理障碍的相关性分析,PICS心理障碍影响因素Logistic回归分析。结果：（1）PICS组年龄<30比例较对照组升高,30-50患者比例较对照组降低（P<0.05）。PICS组文化程度文盲和小学患者比例较对照组升高,初中和高中及以上患者比例较对照组降低（P<0.05）。（2）PICS组手术、手术时间1~3 h和＞3 h、ICU时间10~14 d、镇静药物和有创机械通气患者比例较对照组升高（P<0.05）。（3）PICS组APACHEII评分<20和20~25患者比例较对照组降低,APACHEII评分25~30和＞30患者比例较对照组升高（P<0.05）;PICS组HADS评分<5和5~15患者比例较对照组降低,HADS评分15~25和≥25患者比例较对照组升高（P<0.05）;PICS组得分低于9分的轻度损伤者和得分10~16分的中度损伤的患者比例较对照组降低,得分≥17分为重度损伤的患者比例较对照组升高（P<0.05）;PICS组得分≤7分的睡眠质量较好的患者比例较对照组降低（P<0.05）,得分>7分的睡眠障碍的患者比例较对照组升高（P<0.05）。（4）PICS组年龄、手术时间、ICU时间、APACHEII评分、HADS评分、PSQI得分以及创伤指数评分较对照组升高（P<0.05）;（5）PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEII评分、HADS评分、创伤指数评分以及PSQI评分相关（P<0.05）。结论：PICS组年龄、手术时间、ICU时间、APACHEII评分和HADS评分较对照组升高;PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEII评分、HADS评分、创伤指数评分以及PSQI评分相关。     

不同剂量乌司他丁联合微量推注泵美罗培南对重症肺炎患者的疗效及血管生成素2的影响

摘要 目的：探讨与分析不同剂量乌司他丁联合微量推注泵美罗培南对重症肺炎患者的疗效及血管生成素-2的影响。方法：2019年1月到2022年2月选择在本院诊治的重症肺炎患者78例作为研究对象,将其分为研究组与对照组各39例,两组都给予美罗培南微量推注治疗,研究组与对照组分别给予高剂量与低剂量的乌司他丁治疗,连续应用7 d,观察患者的疗效及血清血管生成素2表达变化情况。结果：研究组的ICU住院时间、退热时间、炎症吸收时间与痰液颜色改变时间较对照组少（P<0.05）。研究组的治疗总有效率较对照组高（P<0.05）。两组治疗后的血清白细胞介素-6（IL-6）、白细胞介素-17（IL-17）含量明显低于治疗前(P<0.05),研究组治疗后的血清IL-6、IL-17含量也明显低于对照组（P<0.05）。两组治疗后的血清血管生成素-2含量低于治疗前,治疗后研究组血清血管生成素-2含量低于对照组（P<0.05）。结论：高剂量乌司他丁联合微量推注泵美罗培南在重症肺炎患者的应用能抑制血清血管生成素-2的表达,也可抑制血清IL-6、IL-17的表达,从而能提高治疗效果,促进改善患者的临床症状,有利于患者康复。     

吻合皮下静脉的带蒂皮瓣修复四肢皮肤软组织缺损的效果分析

摘要 目的：探讨与分析吻合皮下静脉的带蒂皮瓣修复四肢皮肤软组织缺损的效果。方法：选择2018年12月到2021年12月在本院创伤造成的四肢皮肤软组织缺损60例患者作为研究对象,将其随机分为吻合皮下静脉带蒂皮瓣组与传统带蒂皮瓣组各30例。吻合皮下静脉带蒂皮瓣组给予吻合皮下静脉的带蒂皮瓣修复治疗,传统带蒂皮瓣组给予常规直接覆盖创面修复治疗。结果：所有患者都顺利完成手术,吻合皮下静脉带蒂皮瓣组围手术指标时间均较传统带蒂皮瓣组少（P<0.05）。吻合皮下静脉带蒂皮瓣组术后3个月的总有效率为96.7 %,高于传统带蒂皮瓣组的76.7 %（P<0.05）。吻合皮下静脉带蒂皮瓣组术后3个月的并发症发生率较传统带蒂皮瓣组低（P<0.05）。吻合皮下静脉带蒂皮瓣组术后6个月的感觉功能恢复情况好于传统带蒂皮瓣组（P<0.05）。结论：吻合皮下静脉的带蒂皮瓣能促进患者的创面愈合,提高治疗效果,减少并发症,加快恢复患者的四肢皮肤软组织缺损。     

重症肺炎患儿俯卧位与仰卧位机械通气的临床效果比较及其脱机结局的影响因素分析

摘要 目的：比较重症肺炎患儿俯卧位与仰卧位机械通气的临床效果,并分析其脱机结局的影响因素。方法：选择2020年5月~2021年12月期间在我院重症监护室（ICU）住院的重症肺炎患儿120例作为研究对象。根据机械通气体位方式的不同将患儿分为仰卧组（n=52）和俯卧组（n=68）,对比仰卧组、俯卧组的临床症状改善时间和血气分析指标[动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、平均动脉压（MAP）]。记录仰卧组、俯卧组的死亡例数、脱机成功和脱机失败例数,计算死亡率、脱机失败发生率。采用单因素及多因素Logistic回归分析脱机失败的影响因素。结果：俯卧组的发热消失时间、肺部啰音消失时间、呼吸改善时间短于仰卧组（P<0.05）。两组治疗5 d后 PaO₂、MAP较治疗前升高,PaCO₂较治疗前下降（P<0.05）;俯卧组的PaO₂、MAP高于仰卧组,PaCO2低于仰卧组（P<0.05）。两组患儿死亡率组间对比未见统计学差异（P>0.05）。俯卧组的脱机失败率低于仰卧组（P<0.05）。在120例患儿中,死亡7例,根据重症肺炎患儿脱机结局将剩余113例分为脱机成功组（n=72）和脱机失败组（n=41）,脱机失败组、脱机成功组在年龄、急性生理与慢性健康评分系统II（APACHE II）评分、病程、先天性病史、D-二聚体（D-D）、白蛋白（ALB）、血乳酸、脑尿钠肽（BNP）方面对比有统计学差异（P<0.05）。多因素Logistic回归分析结果显示：年龄偏小、APACHE II评分偏高、D-D偏高、ALB偏低、先天性病史均是重症肺炎患儿脱机结局的影响因素（P<0.05）。结论：与仰卧位相比,俯卧位机械通气用于重症肺炎患儿可获得更好的临床效果和脱机成功率,且患儿的脱机结局受到年龄、APACHE II评分、D-D、ALB、先天性病史的影响。     

Interpersonal violence between 18th century Native Americans and Europeans in Ohio

During the winter of 1778-1779, a garrison of 176 individuals lived within the walls of a Revolutionary era stronghold named Ft. Laurens on the banks of the Tuscarawas River, near the present-day town of Bolivar, Ohio. At least 21 individuals were buried in the fort's cemetery during its occupation, 13 of whom were supposedly killed and scalped by Native Americans while gathering firewood and foraging horses. The purpose of this study is to build on previous work by Sciulli and Gramly ([1989] Am J. Phys. Anthropol. 80:11-24) by adding a more detailed analysis of the traumatic lesions, in order to better understand what happened to the victims. Lesions were analyzed based on type, location, and dimensions, as well as their overall pattern on the skeleton. Results indicate that multiple blows to the cranium were common. Out of 12 observable crania, the order of blows could be determined in only one case. Eleven of 12 of the observable crania from ambush victims and four of the seven nonambush victims exhibited lesions consistent with scalping. Evidence of postcranial trauma was noted on four individuals: one was an ambush victim, and the other three were killed at other times. No evidence of gunshot wounds was found.     

Differential Response of Neural Cells to Trauma-Induced Free Radical Production In Vitro

CNS trauma has been associated with an increase in free radical production, but the cellular sources of this increase or the mechanism involved in the production of free radicals are not known. We, therefore, investigated the effects of trauma on free radical production in cultured neurons, astrocytes and BV-2 microglial cells. Free radicals were measured with the fluorescent dye DCFDA following in vitro trauma. At 30 and 60 min following trauma, there was a 132% and 64% increase, respectively, in free radical production in neurons when compared to controls. In astrocytes, there was a 94% and 133% increase at 30 and 60 min, respectively. Microglial cells, however, displayed no significant increase in free radicals at 30, 60 or 120 min following trauma. Since trauma can induce the mitochondrial permeability transition (MPT), a process associated with mitochondrial dysfunction, we further investigated whether cyclosporin A (CsA), an agent known to block the MPT, could prevent free radical formation following trauma. In neurons CsA did not block free radical production at 30 min but blocked it by 90% at 60 min. In contrast, in astrocytes CsA completely blocked free radical production at 30 min but did not block it at 60 min. Our results indicate that a differential sensitivity to trauma-induced free radical production exists in neural cells; that the MPT may be involved in the production of free radical post-trauma; and that the CsA-sensitive phase of free radical production is different in neurons and astrocytes.     

Dental and general health in a population of wild ring-tailed lemurs: a life history approach

Data are presented on dental and general health for seven groups of wild ring-tailed lemurs, Lemur catta, from the Beza Mahafaly Reserve, in southern Madagascar. As part of a study of population demography, adults were captured, collared, and tagged, and biometric measurements, dental casts, and analyses of dental and general health were made. Results indicate that patterns of dental health vary by individual, age, sex, and habitat. Prime adults show more dental attrition than young adults. Prime males living in more marginal habitats show greater mean attrition than those living in richer habitats. Dental damage, specifically to the toothcomb, indicates that mechanical stresses to this region may include the initial harvesting of foods, in addition to grooming. Males exhibit more evidence of past trauma, including scars and chipped teeth. These results indicate that environmental as well as social factors, such as female dominance, may lead to sex differences in health patterns among lemurs.     

Molecular cloning, expression, purification, and mass spectrometric characterization of 3C-like protease of SARS coronavirus

Severe acute respiratory syndrome (SARS) is an acute respiratory illness, which has broken out in China. It has been known that SARS coronavirus (SARS_CoV) is a novel human coronavirus and is responsible for SARS infection. Belonging to one of the major proteins associated with SARS_CoV, SARS 3C-like protease (SARS_3CL(pro)) functions as a cysteine protease engaging in the proteolytic cleavage of the viral precursor polyprotein to a series of functional proteins required for coronavirus replication and is considered as an appealing target for designing anti-SARS agents. To facilitate the studies regarding the functions and structures of SARS_3CL(pro), in this report the synthetic genes encoding 3CL(pro) of SARS_CoV were assembled, and the plasmid was constructed using pQE30 as vector and expressed in Escherichia coli M15 cells. The highly yielded ( approximately 15mg/L) expressed protease was purified by use of NTA-Ni(2+) affinity chromatography and FPLC system, and its sequence was determined by LC/MS with the residue coverage of 46.4%.     

Synthesis and Characterization of N,N-Dichlorinated Amino Acids: Taurine,Homotaurine, GABA and L-Leucine

Epilepsy, trauma and other circumstances leading to hyperexcitable conditions in the CNS tend neurochemically to be associated with excessive stimulated release of glutamic acid and/or a failure of GABA modulated inhibition. Somewhat to a lesser extent, taurine and its homologue homotaurine, have also been shown to antagonize the excitatory actions of glutamic acid. Here we report the successful synthesis and isolation in pure form of N,N-dichlorinated GABA, taurine, homotaurine and leucine. These compounds are much more lipophilic than their parent compounds and may therefore more readily penetrate the blood-brain barrier systems into the neural tissue, where they can be easily dechlorinated. Very preliminary biological testing shows that this may indeed occur. The synthesis and purification methodology will likely also be applicable to a number of other amino acids as well as certain peptides or selected proteins.     

复杂性眼外伤患者玻璃体切割围手术期护理体会

目的:玻璃体切割术是眼科手术中比较复杂精细显手术,主要应用于治疗眼外伤导致的玻璃体出血,玻璃体浑浊,复杂性视网膜脱离以及增殖性玻璃体视网膜病变。本文主要探讨玻璃体切割术治疗复杂性眼外伤患者的围手术期护理的临床效应。方法:总结作者所在科室多年来护理眼外伤患者的临床经验,对2013年3月至2013年7月入院的75例(75只眼)复杂性眼外伤患者进行悉心的术前心理护理,完善的用药指导,充分的术前准备,术后特殊卧位的指导,预防并发症的护理及出院指导。结果:术后视力提高57例(76.0%),视力不变13(17.3%)例,视力下降5例(6.7%),28例眼内异物患者均经手术顺利取出异物。相关手术并发症经医护人员的对症治疗后均得到有效控制。患者术后满意度达98%以上,医生满意度达100%。结论:复杂性眼外伤患者玻璃体切割手术围手术期进行全方位的护理服务,对促进病人康复起到至关重要的作用。