研究健脾渗湿方对高尿酸血症大鼠模型尿酸盐转运蛋白OAT3表达的影响,揭示其治疗高尿酸血症的作用机制。方法:40只大鼠随机分为正常对照组、模型对照组、苯溴马隆组和健脾渗湿方组,每组10只。采用酵母饲料加腺嘌呤诱导高尿酸血症大鼠模型,灌胃给药14 d后,检测高尿酸血症大鼠肾脏病理损伤,免疫组化法检测尿酸盐转运蛋白OAT3的表达情况。结果:健脾渗湿方组高尿酸血症模型大鼠肾脏的损伤程度显著改善,且对尿酸盐转运蛋白OAT3具有显著的上调作用。结论:上调尿酸盐转运蛋白OAT3,可能是健脾渗湿法治疗高尿酸血症的作用机制之一。

Objective:To study the effects of jianpi shenshi formula on the expression of urate transporters OAT3 in hyperuricemia model rats to reveal its molecular mechanism in the treatment of hyperuricemia.Methods:40 rats were randomly divided into the normal control group,the model control group,the benzbromarone positive group and the Jianpi Shenshi Formula group.The hyperuricemia rat models were induced by yeast feed and adenine and given intragastric administration for 14 days.HE staining method was used to detect the renal pathological damage of hyperuricemia rats and immunohistochemistry method was used to detect the expression of urate transporter OAT3.Results:Jianpi shenshi formula could not only improve the renal pathological damage of hyperuricemia rats but also up-regulate the urate transporter OAT3.Conclusion:The up-regulation of urate transporter OAT3 might be one of the mechanisms of jianpi shenshi formula in the treatment of hyperuricemia.

介绍几种急危重症诊治中的疑难电解质异常现象及治疗方法，主要内容有脂肪超载综合征中的假性低钠血症，毛细血管渗漏综合征和抗利尿激素分泌异常综合征中的低钠血症，高血糖昏迷中的转移性低钠血症，高渗疗法时血清钠与渗透浓度间隙监测，高钾血症抢救措施，顽固性高钾血症中的低醛固酮血症，隐匿性中毒相关低钾血症和高钙血症时心电图特征性Osborn波，以减少临床误诊误治，为急诊医师提高危重病救治水平提供指导。

This paper discusses the diagnosis and treatment for several phenomenon of the difficult electrolyte abnor-malities in acute and critically ill patients. The main contents include the fat overload syndrome with hyponatremia, hyponatre-mia in the capillary leak syndrome and syndrome of inappropriate antidiuretic hormone secretion, transferred hyponatremia in high blood sugar coma, monitoring of serum sodium and osmotic pressure gap for hypertonic treatment, hyperkalemia rescue measures using sequential, hypoaldosteronemia for the refractory hyperkalemia, hypokalemia associated with concealed poison-ing, and hypercalcemia with ECG Osborn wave, which are instructive for reducing the misdiagnosis rate and improving the res-cue level for critically ill patients.

目的：分析慢性心功能不全合并低钠血症发生的原因,探讨防治对策。方法：回顾性分析我院2008年1月~2011年12月收治的慢性心功能不全合并低钠血症患者35例的临床资料。结果：其中轻度11例,中度14例,重度10例,合并低钠性脑病1例。其中13例患者经口服补钠,12例患者应用生理盐水进行补液,10例患者采用高渗钠进行补液。经治疗本组35例患者中,34例患者(3~14)d化验指标恢复正常,患者的心功能明显的到改善,1例患者因抢救无效而死亡。结论：饮食因素、医源性因素以及内分泌因素是慢性心功能不全者合并低钠血症发生的主要因素,临床较常见,轻中度低钠血症经及时治疗预后好,重度低钠血症有可能引起死亡,应引起临床医师高度重视。

Objective:To analyzed the causes of chronic heart failure with hyponatremia, and advances some corresponding countermeasures.Methods:A retrospective analysis of 35 cases of chronic heart failure patients with hyponatremia clinical data.in our hospital from January 2008~December 2011.Results:11 cases of mild, 14 cases of Moderate, 10 cases of severe, 1 case was complicated with hyponatremia encephalopathy.13 cases of oral sodium, 12 cases of normal saline for fluid resuscitation, 10 cases of hypertonic sodium replacement. After treatment, the group of 35 cases, 34 cases of the assay index returned to normal about(3~14)days, The patient''s heart function improved obviously, One case died due to rescue invalid.Conclusion:Leading to chronic heart failure combined hyponatremia main factors were dietary factors, iatrogenic factors and endocrine factors,were Very common in clinical, Mild-to-moderate hyponatremia after treatment timely ,the Prognosis was good, Severe hyponatremia may be caused

目的：探讨内镜下十二指肠乳头括约肌柱状气囊扩张术（endoscopic papillary balloon dilatation，EPBD）用于胆总管结石取石术中的疗效及安全性。方法：回顾分析应用 EPBD 治疗的76例胆总管结石患者的临床资料。结果：76例患者中73例成功取出胆总管结石，成功率96．1％，平均手术时间（30±12）min；无肠穿孔发生；术中发生活动性渗血5例，经局部喷洒去甲肾上腺液或黏膜下注射1∶10000肾上腺素液后成功止血；术后并发急性胰腺炎1例，高淀粉酶血症8例，均经保守治疗痊愈；平均住院时间（3±0．5）d。结论：采用 EPBD 行胆总管结石取石术具有安全、操作时间短、创伤小、恢复快、并发症少等优点。

Objective:To explore the efficacy and security of endoscopic papillary balloon dilatation(EPBD)in lithotomy of common bile duct stones.Methods:The clinical data of 76 patients with common bile duct stones who underwent EPBD were retrospectively analyzed.Results:The common bile duct stones were successfully removed in 73 of the 76 patients.The success rate was 96.1% while the mean operative time was (30±12)min.There was no intestinal perforation.Five cases suffered intra-operative active bleeding which was successfully stopped by topical spraying norepinephrine or submucosal injection of 1∶10000 epinephrine.One case was complicated by postoperative acute pancreatitis while eight cases had hyperamylasemia.All the cases above were cured by conservative treatment.The average length of hospital stay was (3±4.5)d.Conclusions:The application of EPBD is safe in lithotomy of common bile duct stones,which has the advantage of short operative time and small trauma, quick recovery and

目的 评价不同液体容量复苏对内毒素血症大鼠肺毛细血管内皮细胞水通道蛋白1(AQP-1)表达的影响.方法 健康清洁级雄性SD大鼠50只,体重250～ 300 g,6～8周龄.采用随机数字表法,将其分为5组(n=10):对照组(C组)、内毒素血症组(LPS组)、氯化钠溶液容量复苏组(NS组)、6％羟乙基淀粉130/0.4溶液容量复苏组(HES组)和高渗氯化钠羟乙基淀粉40溶液容量复苏组(HSH组).经股静脉注入LPS 5 mg/kg制备内毒素血症模型.于造模10 min后,经股静脉注入各组所对应的液体,以15 ml/kg恒速输注6h.于造模后即刻、3、6h时采集股动脉血样,用ELISA法测定血清TNF-α浓度,并行血气分析,记录PaO2和乳酸(Lac)浓度,计算氧合指数.造模6h时处死取肺组织,用免疫组化法测定肺毛细血管内皮细胞AQP-1表达,测定肺湿干重(W/D)比值,HE染色观察肺组织病理学结果,行肺损伤评分.结果 与C组比较,LPS组、NS组、HES组和HSH组W/D比值、血清TNF-α、Lac浓度、肺损伤评分升高,AQP-1表达下调,PaO2和氧合指数降低(P＜0.05).与LPS组比较,NS组、HES组和HSH组W/D比值、血清TNF-α、Lac浓度、肺损伤评分降低,AQP-1表达上调,PaO2和氧合指数升高(P＜0.05).与NS组比较,HES组和HSH组W/D比值、血清TNF-α、Lac浓度、肺损伤评分降低,AQP

Objective To evaluate the effects of volume resuscitation with different fluids on expression of aquaporin 1 (AQP-1) in pulmonary capillary endothelial cells of endotoxemic rats.Methods Fifty pathogen-free male Sprague-Dawley,rats,weighing 250-300 g,aged 6-8 weeks,were randomly divided into 4 groups (n =10 each):control group (group C),lipopolysaccharide group (group LPS),NaCl group (group NS),6％ hydroxyethyl starch 130/0.4 group (group HES) and hypertonic hydroxyethyl starch 40 group (group HSH).Sepsis was induced with LPS 5 mg/kg injected via the femoral vein.At l0 min after the model was successfully established,the corresponding fluids were infused into the femoral vein at a constant speed (15 ml/kg over 6 h) via a pump.At 0,3 and 6 h after LPS administration,blood samples were collected from the femoral artery for measurement of serum tumor necrosis factor-α (TNF-α) concentrations and for blood gas analysis.PaO2 and lactate (Lac) concentrations were recorded and oxyge