2014年 · 第94卷第11期

Parkinson's disease (PD) is a common neurodegenerative disease in middle-aged and elderly people. At present, the etiology and pathogenesis are unknown. The main pathological features were the absence of dopaminergic neurons in the dense part of substantia nigra and the appearance of Lewy bodies in the residual neurons. In the past, it was believed that PD was mainly characterized by motor symptoms such as bradykinesia, resting tremor and myotonia. In recent years, it has been found that some non-motor symptoms such as anosmia, REM sleep behavior disorder (RBD) and constipation also appear more in all stages of PD patients, and these non-motor symptoms are not improved by dopaminergic drugs^[1,2]。 When determining the treatment plan for patients with Parkinson's disease, it is necessary to conduct a comprehensive evaluation of patients in order to facilitate long-term standardized management. To achieve this goal, some new evaluation methods need to be explored.

A 50-year-old female was transferred from an external hospital due to sting of head and neck by swarm bees for 1 d with hematuria and anuria for 6 h. Being in good health. Admission: Multiple bee sting wounds on the head and face, local skin necrosis. Shortness of breath, wet rales audible in both lungs. Physical examination of nervous system: slightly irritable, bilateral pupils D =3 mm, and normal muscle strength and tone of limbs. After admission, HGB and PLT decreased progressively. Urine analysis showed dark red urine, BLD + + +, PRO +, blood UN 17.18 mmol/L, Cr 273.1 μ mol/L, which was considered to be myolysis and red blood cell destruction caused by bee venom, blockage of renal tubules, leading to renal dysfunction and proteinuria; Coagulation function APTT 163.3 s was significantly prolonged; The myocardial enzyme spectrum of CK 16 435 IU/L, CK-MB 293 IU/L were significantly increased, and the blood BNP was 1 712 ng/L. It was considered that myocardial injury and muscle injury caused by bee sting injury were also considered. After admission, he was given high-dose hormone administration, plasma exchange once, CRRT treatment for 6 days, intermittent component blood transfusion and organ support therapy. After the 5th day, the coagulation function, electrolyte and blood gas analysis were normal, and the liver and kidney functions improved compared with before. However, in the early morning of the 7th day, the patient suddenly experienced a decrease in heart rate and slower breathing, followed by respiratory and cardiac arrest. Immediately, cardiopulmonary resuscitation was performed, and the patient recovered his spontaneous heart rhythm. CT examination of the brain showed hematoma in the right occipital lobe and left parietal lobe (Figure 1), the patient's family gave up treatment, and the patient died.

A 51-year-old female was diagnosed with Raynaud's disease in Jiaxing No.1 Hospital because her hands were pale and painful for 7 years after being cold. Had been treated with radiofrequency thermal ablation of the thoracic sympathetic nerve and had a recurrence 6 months later. This time, thoracic sympathetectomy is proposed under thoracoscope. Examination at admission: General condition is good, blood pressure, heart rate, respiration and oxygen saturation are in the normal range. Chest auscultation can hear a systolic murmur of grade 2 to 3 at the left margin of the sternum. The abdomen was flat and soft, without tenderness and mass. Examination of limbs and nervous system was normal. Hands are cold, and the end of the left middle finger is black and painful. Color ultrasound showed atrial septal defect and pulmonary hypertension. Improve all preoperative examinations and preparations. The patient was routinely performed right internal jugular vein puncture and catheterization (ARROW single-lumen catheter) before anesthesia induction. The operation went smoothly. Hands warm after surgery. On the 5th postoperative day, the internal central jugular vein catheter was proposed to be removed. The patient took the recumbent position, routinely disinfected the local area, removed the sutures, and slowly removed the internal jugular vein catheter. When the end of the catheter left the skin, the puncture port was pressed with gauze for 1 min, then fixed with ordinary adhesive tape, and the patient was instructed to lie down. Three minutes later, the patient suddenly suffered from confusion, inability to respond to calls, shortness of breath, and convulsions, which could palpate the pulsation of the great arteries. Endotracheal intubation was performed after the mask was pressurized and oxygenated. Blood pressure was 158/108 mmHg (1 mmHg =0.133 kPa), heart rate was 119 beats/min, both pupils were equal size and round, and right side light response was slow. Emergency CT of the head showed intracranial air embolism (Figure 1)。 After being transferred to ICU for 3 hours, the tracheal intubation was removed and hyperbaric oxygen therapy was performed. The next day, the patient became conscious, hoarse, left hemiplegic, and muscle strength of upper and lower limbs grade 0; Right lower limb muscle strength level 4. Hyperbaric oxygen therapy was administered twice daily for 1 week and then changed to once daily. After 1 week, he was transferred to the neurology department and 2 weeks later to the rehabilitation department. He had hoarseness, left hemiplegia, left lower limb muscle strength grade 1 and left upper limb muscle strength grade 0. Right lower limb muscle strength level 4. The hoarseness disappeared after 30 days, and the muscle strength of the patient's left upper limb was grade 4, and the muscle strength of both lower limbs was grade 5. After 35 days, the patient was able to walk independently.

As a classic drug for the treatment of acute promyelocytic leukemia (APL), arsenic trioxide (As₂O₃) in solid tumors and some autoimmune diseases has attracted much attention. Previous studies have suggested that As₂O₃The mechanisms of action in the treatment of tumor diseases such as leukemia mainly include promoting cell differentiation, inducing apoptosis and inhibiting tumor angiogenesis. It has currently been found that As₂O₃It is not only a cytotoxic anti-tumor drug, but also has an immunomodulatory effect. Now As₂O₃The research progress on immunomodulatory effects is summarized below.

hyperbaric oxygen (HBO) has been widely used clinically to treat a variety of diseases, including cerebral air embolism, decompression sickness, carbon monoxide poisoning, brain injury, crush injury, radiation injury, diabetic foot ulcer, etc. In addition to the therapeutic effect, the study also found that after a certain regimen of hyperbaric oxygen exposure in advance, that is, hyperbaric oxygen preconditioning (HBOPC), the body can produce endogenous protective effect under the subsequent stimulation of some adverse factors. This protective effect exists in various tissues and organs such as brain, spinal cord, myocardium, liver, lung, small intestine and skeletal muscle, and its specific mechanism is not very clear at present.