重症监护室多发肋骨骨折患者胸腔镜内固定治疗时机分析

目的分析不同手术时机胸腔镜内固定对重症监护室(ICU)多发肋骨骨折(MRF)患者机体免疫因子、炎症因子、氧化应激因子、并发症以及骨折愈合的影响,评估不同手术时机的利弊。方法回顾性分析2017年12月-2021年2月该院105例行胸腔镜内固定治疗的MRF患者的临床资料,据手术时机不同分为观察组(发病72 h内进行手术)和对照组(发病≥72 h进行手术),对比两组患者手术指标和术后短期恢复情况,记录术后7 d相关损伤指标、免疫因子、炎症因子和氧化应激因子水平,记录并发症发生率和术后3个月骨折愈合情况。结果与对照组比较,观察组下床时间和拔管时间更早,疼痛时间和住院时间更短,术后合并伤程度评分更高,损伤严重程度评分(ISS)更低,差异均有统计学意义(P<0.05);术后7 d,两组患者CD4^(+)、CD3^(+)和CD4^(+)/CD8^(+)升高,且观察组高于对照组,两组患者CD8^(+)降低,且观察组低于对照组,差异均有统计学意义(P<0.05);术后7 d,两组患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、晚期氧化蛋白产物(AOPP)和丙二醛(MDA)降低,且观察组低于对照组,差异均有统计学意义(P<0.05);观察组并发症总发生率(3.64%)低于对照组(28.00%),差异有统计学意义(P<0.05);术后3个月观察组愈合率(87.27%)高于对照组(68.00%),差异有统计学意义(P<0.05)。结论与发病72 h后行胸腔镜内固定术比较,更早治疗能使ICU中的MRF患者术后恢复更快,能更快缓解机体应激、疼痛和炎症反应,减少胸肺损伤,解除免疫抑制,降低并发症发生率。

Physicochemical Properties and Gastric Mucosa Irritation of Cantharidin-hydroxypropyl-β-cyclodextrin Inclusion Complex

Objective To increase the solubility and relieve the mucous irritation of cantharidin (CA) by preparing cantharidin-hydroxypropyl-β-cyclodextrin (CA/HP-β-CD) inclusion complex. Methods The inclusion complex was prepared by co-evaporation method and characterized by differential scanning calorimetry (DSC), X-ray diffractometry (XRD), and nuclear magnetic resonance (NMR). Results The disappearance of CA as well as the shift of exothermic peaks shown in DSC results indicated the complexation phenomenon. XRD results showed that the crystalline CA pattern had disappeared, and in NMR results, H-5 shifted from δ 3.731 to 3.695 after complexation and H-2 shifted from δ 3.626 to 3.598, which suggested that part of the drug had entered the HP-β-CD cavity to form an inclusion complex. The solubility increased 10.3 times after complexation and the mucous irritation of CA was relieved remarkably. Conclusion Through complexation with HP-β-CD, the solubility and dissolution rate of CA are improved significantly, and the irritation of musous is relieved.