盐酸戊乙奎醚对瓣膜置换术患者体外循环前后白介素及肿瘤坏死因子的影响

目的观察盐酸戊乙奎醚对体外循环(CPB)瓣膜置换术患者血浆炎性因子的影响。方法选择择期体外循环下瓣膜置换术患者20例,随机分为盐酸戊乙奎醚组(A组,n=10)和对照组(B组,n=10)。A组于CPB前10min静注盐酸戊乙奎醚3mg,对照组给予等量生理盐水。分别于麻醉诱导前(T0)、CPB30min(T1)、主动脉开放后10min(T2)、CPB后3h(T3)、24h(T4)抽取桡动脉血,测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、和白细胞介素-10(IL-10)浓度。结果组内比较,B组TNF-α浓度于T3时点高于T0(P<0.01),而A组T1、T2时点TNF-α浓度较T0显著降低,其余时点与术前比较无明显变化。B组IL-6于T4时点高于A组(P<0.05),IL-10浓度明显低于A组。组间比较,B组TNF-α浓度于T1~T4各时点均高于A组(P<0.05)。结论盐酸戊乙奎醚可部分抑制CPB导致的炎性反应,对CPB术后全身炎性反应综合征有一定的预防作用。     

蛋白酶抑制剂对体外循环瓣膜置换术围术期胰岛素抵抗的影响

目的 研究体外循环心脏瓣膜置换术中蛋白酶抑制剂的应用对围术期胰岛素抵抗的影响。方法 选取2018 年5 月～2019 年5 月于我院行体外循环瓣膜置换术患者40 例,按随机数字表法分为乌司他丁组（U 组）和对照组（C 组）,每组各20 例。术中U 组于CPB 前给予乌司他丁1.2×104 U/kg 静滴,C 组予等量生理盐水。两组分别于CPB 前（T1）、CPB 15 min（T2）、主动脉开放后15 min（T3）、CPB 后15 min（T4）、手术结束时（T5）5 个时间点,抽取桡动脉血及冠状静脉窦血,比较两组间相应时间点血糖、胰岛素、血浆TNF-α 浓度、心肌葡萄糖净摄取量、胰岛素敏感指数的变化及其之间的关系。结果 C组患者血糖（桡动脉血糖和冠状静脉窦血糖）自CPB 开始后明显增高,U 组患者血糖自主动脉开放后15 min 显著增高,两组患者血糖均于CPB 后15 min 达峰值;与CPB 前比较,两组患者CPB 期间和CPB 后胰岛素、TNF-α 浓度较CPB 前均显著增加。T2～T5,U 组血糖、胰岛素及TNF-α 浓度均显著低于C 组相应时点;心肌葡萄糖净摄取量于CPB 15 min 时开始下降,说明心肌在CPB 期间对葡萄糖的摄取和利用发生障碍;胰岛素敏感指数均显著降低,差异有统计学意义（P＜0.001）。U 组心肌葡萄糖净摄取量明显高于C 组相应时点,表明U 组患者心肌对葡萄糖的利用较C 组有明显改善,差异有统计学意义（P＜0.05）。结论 体外循环心脏瓣膜置换术患者应用蛋白酶抑制剂可显著降低TNF-α 的分泌,减轻胰岛素抵抗,增加心肌对葡萄糖的摄取、利用,有利于术中心肌保护。     

乌司他丁对体外循环下瓣膜置换术患者TNF-α、MDA、PMN的影响

目的 观察体外循环(cardiopulmonary bypass,CPB)下瓣膜置换围术期应用乌司他丁药物对肺保护作用.方法 选择30例择期行心脏瓣膜置换术的患者随机分为乌司他丁组和对照组,每组15例.乌司他丁组给予乌司他丁12000 IU·kg-1于切皮后至CPB前缓慢静注半量,另半量加入预充液中随转机进入体内;对照组给予等量0.9%氯化钠注射液,用法同乌司他丁组.两组分别麻醉诱导后即切皮前(T1)、体外循环45min时(T2)、体外循环停机前5min(T3)、停机后6h(T4)及停机后2Ah(T5)5个时间点,T1～T3时间点即刻送动脉血检测中性粒细胞(PMN)值;分离血清检测T1～T3时点丙二醛(MDA)浓度和T1～T5时点TNF-α浓度.结果 两组CPB开始后血清TNF-α、MDA、PMN浓度逐渐升高,CPB停机前5min三者血清浓度达到高峰,CPB后24 h FNF-α仍维持在很高的水平;乌司他丁组T3～T5时点的血清TNF-α浓度及T2～T3时点的血清MDA浓度、PMN值低于对照组相同时点值,差异有统计学意义(P<0.05).结论 乌司他丁可降低体外循环心脏瓣膜置换术CPB期间血液PMN及血清TNF-α、MDA的表达,起到肺保护的作用.     

1,6-二磷酸果糖对体外循环促炎性细胞因子释放的影响

目的探讨1,6-二磷酸果糖(FDP)对体外循环术后促炎性细胞因子释放的影响.方法将20例二尖瓣瓣膜置换术的风湿性心脏病患者随机分为实验组10例,对照组10例.实验组在体外循环前及体外循环中分别静脉注射FDP 200mg/kg,对照组不用FDP.于手术开始前1 h、CPB结束后即刻、CPB结束后1 h分别抽取桡动脉血,测定血浆肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8).结果外循环前两组TNF-α、IL-6、IL-8水平均无差异,体外循环后即刻及后1h,两组患者TNF-α、IL-6、IL-8水平显著升高(P＜0.05),但实验组低于对照组(P＜0.01).结论在CPB时静注FDP可明显减少体外循环术后患者血中TNF-α、IL-6、IL-8的释放,表明FDP可减轻体外循环术后患者全身炎症反应.     

乌司他丁在体外循环中肺保护机制的研究

目的:探讨体外循环所引起的肺组织炎性损伤,研究术中应用乌司他丁(UTI)保护作用及可能的机制.方法:25例患者随机分为两组,实验组将乌司他丁2万U/kg于体外循环开始后,直接加入体外循环机中;对照组除用等量生理盐水替代乌司他丁外,其他条件相同.动态检测两组患者左右房中性粒细胞数(polymorphonuclear neutrophils,PMN)、血小板数(et);血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平;气道压力、肺泡氧合指数(OI).结果:①对照组主动脉开放心脏复跳后5 min左房PMN、Pt明显低于右房(P＜0.05);②体外循环(cardiopulmonary bypass,CPB)开始后,两组桡动脉血IL-6、TNF-α进行性升高,于主动脉开放心脏复跳后达最高,后逐渐下降,但仍高于CPB前,对照组增高更显著(P＜0.05).③CPB开始后,两组桡动脉血IL-10进行性增高,于主动脉开放心脏复跳后,达到最高,后逐渐下降,但仍高于CPB前,实验组增高更显著(P＜0.05).④两组患者肺泡氧合指数(OI)CPB后比麻醉诱导时增高,对照组升幅明显高于实验组(P＜0.05).⑤两组气道峰压、气道平台压在停CPB和手术结束后均有升高,但对照组升高更显著(P＜0.05),且对照组与实验组有显著差异(P＜0.05).结论:乌司他丁能通过抑制血小板、中性粒细胞的激活、肺内聚集和扣留,抑制炎症因子IL-6、TNF-α的产生,并能促进抗炎因子IL-10的释放,从而减轻体外循环后肺损伤和通气功能障碍,保护并改善术后肺功能.     

氨茶碱对体外循环炎性反应的作用

目的评价氨茶碱对体外循环(CPB)所致炎性反应的作用。方法选择心脏瓣膜置换术患者20例,随机分为氨茶碱组和对照组,每组10例。氨茶碱组于麻醉诱导后缓慢静脉注射氨茶碱(5mg/kg,5m in),随后按0.5mg/(kg.h)剂量经微量泵持续静脉注射,直到CPB结束。对照组:用等容量平衡液静脉注射。于CPB前、CPB结束后1 h、8 h、24 h测定肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、白介素-10(IL-10)的血浆浓度。结果CPB结束后1 h、8 h、24 h,对照组TNF-α明显高于CPB前及相同时点氨茶碱组的浓度(P<0.05);CPB结束后1 h、8 h,对照组IL-8明显高于CPB前及相同时点氨茶碱组的浓度(P<0.05);CPB结束后1 h,两组IL-10均增加,但氨茶碱组明显高于对照组(P<0.05)。结论氨茶碱可抑制CPB所致的炎性反应。     

盐酸戊乙奎醚对体外循环心脏手术患者肺功能的影响

目的:探讨盐酸戊乙奎醚对体外循环(CPB)下心脏手术患者肺功能的影响及可能机制。方法:24例CPB心脏手术患者随机分为对照组和盐酸戊乙奎醚组,于体外循环开始前30 min,分别注射0.9%氯化钠溶液5mL,和盐酸戊乙奎醚0.02 mg/kg。CPB前(T1)、主动脉开放后30 min(T2),CPB结束后4 h(T3)、CPB后24 h(T4)进行血气分析及检测血浆肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)水平,计算肺泡-动脉血氧分压差[P(A-a)DO2]和呼吸指数(RI)。结果:2组患者T2、T3、T4时点与T1时点相比,P(A-a)DO2、RI及血浆TNF-α和IL-6浓度均显著升高(P<0.05);盐酸戊乙奎醚组T2、T3、T4时点P(A-a)DO2和RI,及TNF-α和IL-6浓度较对照组均显著降低(P<0.05)。结论:盐酸戊乙奎醚对体外循环下心脏手术患者肺功能有一定的保护作用,其机制可能与其抑制TNF-α和IL-6有关。     

不同剂量异丙酚对体外循环患者肺功能的影响

目的:探讨不同剂量异丙酚在体外循环(CPB)心脏瓣膜置换术中对肺功能的影响。方法:选择42例在体外循环下行心脏瓣膜置换术的患者,随机分为对照组(C组)、异丙酚1组(P1组,2μg/mL)及异丙酚2组(P2组,4μg/mL)。P1、P2组气管插管后靶控输注异丙酚,直至手术结束。对照组术中不输注异丙酚。于CPB前(T1)、肺脏再灌注(腔静脉开放)后30 min(T2)、60 min(T3)、120 min(T4)各时间点抽取桡动脉血,检测血气、血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、细胞间黏附分子-1(sICAM-1)、丙二醛(MDA)的浓度及超氧化物歧化酶(SOD)的活性,并根据血气结果计算肺泡-动脉血氧分压差[P(A-a)O2]和呼吸指数(RI)。结果:3组患者T2～T4时P(A-a)O2和RI显著高于T1时(P<0.05),T2～T4时,异丙酚组P(A-a)O2、RI显著低于C组(P<0.05),且P2组明显低于P1组(P<0.05);T2～T4时,异丙酚组TNF-α、IL-6、sICAM-1、MAD浓度显著低于C组(P<0.05),且P2组明显低于P1组(P<0.05);异丙酚组SOD活性显著高于C组,且P2组明显高于P1组(P<0.05)。结论:在CPB期间,靶控输注异丙酚2μg/mL及4μg/mL均能明显抑制炎性因子的释放,减少氧自由基产生,增加机体清除氧自由基的能力,从而减轻CPB所致的肺损伤,有一定的肺功能保护作用,并呈剂量效应关系。     

右美托咪啶对瓣膜置换术患者血中炎症介质的影响

目的评价右美托咪啶(Dexmedetomidine)对体外循环(CPB)瓣膜置换术时患者血中炎症介质的影响。方法选择30例择期在CPB下行瓣膜置换术的患者作为观察对象,随机分为实验组和对照组,每组15例。实验组于麻醉诱导完成后以0.2μg.kg-1.h-1的速度静脉泵注右美托咪啶,对照组泵注等容积的生理盐水。分别于麻醉诱导后切皮前(T1)、CPB开始时(T2)、CPB开始后40min(T3)、停机2h(T4)、CPB结束后24h(T5)5个时间点采集桡动脉血,酶联免疫吸附(ELISA)法检测血清标志物肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)的水平。结果组间比较,在T1～T2时两组血清标志物比较差异无统计学意义(P>0.05),T3～T5时实验组TNF-α、IL-6均明显低于对照组(P<0.05或P<0.01),而IL-10明显高于对照组(P<0.01);组内对比,各组血清标志物在T3～T4时均明显增高(P<0.01),IL-6、IL-10在T5恢复至手术开始水平,TNF-α仍保持较高水平(P<0.05或P<0.01)。结论术中泵入右美托咪啶可有效地调节CPB瓣膜置换术时炎症介质的释放,从而抑制由此引起的炎症反应的程度。     

犬体外循环模型建立及麻醉处理

目的建立CPB实验动物模型,加强围手术期麻醉管理,探索肺功能保护方法 ,以减少术后并发症的产生。方法 20只实验犬全部用于建立实验动物模型。丙泊酚复合麻醉后,开胸;全血肝素化后,连接体外循环管道开始体外循环,微量泵入丙泊酚50～150μg/(kg·min)维持麻醉;监测麻醉诱导前(T0)、气管插管即刻(T1)、CPB前即刻(T2)、降温至32.0℃(T3)、阻断主动脉前即刻(T4)、阻断主动脉后2min(T5)、开始复温即刻(T6)、停CPB即刻(T7)及停CPB后15min(T8)9个时间结点的鼻咽温度、平均动脉压(mean arterial pressure,MAP)及心率(heart rate,HR)。结果体外循环期间各时点鼻咽温度均低于T0及T2(P0.05);T1、T2及体外循环期间各时点的MAP明显低于T0(P0.05),体外循环期间各时点的MAP低于T2(P0.05);T4的HR明显低于T0及T2(P0.05)。体外循环期间各时点MAP比较无统计学意义(P0.05)。结论犬体外循环模型建立的成败与手术技术和麻醉管理密切相关。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.