人工肝血浆置换联合血液滤过治疗猪急性肝衰竭实验研究

目的建立大动物急性肝功能衰竭动物模型,用于评价非生物型组合人工肝治疗效果。方法将中国实验小型猪12头随机分为对照组(n=6)与治疗组(n=6),静脉注射D-氨基半乳糖(1.2 g/kg)诱导建立急性肝衰竭动物模型。治疗组动物在给药后24 h及48 h分别进行2次血浆置换联合血液滤过治疗,对照组未行任何干预措施。观察比较2组动物生存时间、生化指标、颅内压与病理变化的差异。结果治疗组的生存时间较对照组明显延长,2组分别为(112.5±14.7)h和(67.9±9.4)h(P<0.01),治疗组多项生化指标、颅内压、细胞因子、组织病理等都较非治疗组动物有不同程度改善(P<0.05~0.01)。结论血浆置换联合血液滤过的非生物型组合人工肝治疗,能显著延长急性肝衰竭动物模型的生存时间,降低颅内压,改善生化、病理指标与近期预后,可作为肝脏移植和药物治疗的有效辅助手段。     

非生物型组合人工肝治疗急性肝衰竭实验研究

目的:建立大型动物急性肝功能衰竭动物模型,用来评价非生物型组合人工肝治疗效果。方法:将中国实验小型猪28头随机分为对照组(n=13)与治疗组(n=15),应用D-氨基半乳糖1·2g/kg静脉注射诱导建立急性肝衰竭动物模型。给药48小时后治疗组给予血浆置换联合血液滤过治疗,对照组未实行任何干预措施。观察比较两组动物生存时间、生化指标、颅内压与病理变化。结果:治疗组的生存时间较对照组明显延长,两组分别为128·7±11.3小时和67·9±9.4小时(p<0.01),治疗组多项生化指标、炎性细胞因子、颅内压、组织病理等都比同期非治疗组动物有不同程度改善(p<0.05~0.01)。结论:血浆置换联合血液滤过的非生物型组合人工肝治疗,能显著延长急性肝衰实验动物生存时间,降低颅内压,改善生化、病理指标与近期预后,可作为肝脏移植和药物治疗的有效辅助手段。     

研究治疗人工肝前后急性肝衰竭动物细胞的实验性变化

目的为进一步研究人工肝血浆置换与血液过滤联合治疗前后对急性肝衰竭动物细胞因子的实验变化影响。方法选取2012年4-10月在实验室中的小型猪32只,随机将这些小型猪分成治疗组与对照组两组。治疗组19只。对照组13只,按照两组小型猪的重量分别为其提供1．2g的D-氨基半乳糖,治疗组在48h后为小型猪提供血浆置换与血液过滤联合治疗,对照组中的小型猪没有使用任何手术治疗方式。对比观察两组小型猪在治疗前后细胞因子变化情况。结果人工肝治疗后,治疗组中小型猪的生存时间明显比对照组长,P〈0．01,差异有统计学意义。同时间段,治疗组小型猪的肿瘤坏死因子-α（TNF-α）、白介素细胞-8（IL-8）、白介素细胞-6（IL-6）有短暂性减少,和对照组相比较,P〈0．05,差异有统计学意义。结论对人工肝进行1次治疗,可以暂时使炎性因子减少,控制急性肝衰竭发展,但不能阻止病情继续发展。     

用猪肝细胞型混合生物人工肝支持系统治疗肝衰竭的初步研究

目的 对培养猪肝细胞型混合生物人工肝支持系统治疗肝衰竭的可行性进行初步评价。方法 采用自行研制的以新生实验小型猪肝细胞为基础的混合生物人工肝支持系统，对5例慢性重型肝炎患者进行体外人工肝支持，综合评价其临床疗效和安全性。结果 5例患者经混合人工肝支持后，肝衰竭均得到不同程度的控制，表现为临床症状和肝衰竭相关指标好转，肝性脑病改善。最终2例好转出院，1例经肝移植存活，2例 死亡，死亡原因与不良反应无关。结论 猪肝细胞型混合生物人工肝系统可用作重型肝炎肝衰竭的辅助支持和治疗。     

复方氨基酸冲剂(肝氨要素)对实验性急性肝衰竭的保护作用

以D-氨基半乳糖诱发大鼠急性肝衰竭为动物模型,观察了复方氨基酸冲剂(肝氨要素)对急性肝衰竭的保护作用。结果显示,复方氨基酸冲剂能明显阻止肝衰竭动物的体重和食量下降、凝血时间延长及血清谷-丙转氨酶活性升高,显著提高血清总蛋白和白蛋白含量及血清BCAA/AAA比值,纠正血清氨基酸谱紊乱,增加动物存活数,减轻肝性脑病的症状及体征。结果提示,复方氨基酸冲剂对急性肝衰竭有明显保护作用。     

人工肝支持系统治疗急性肝衰竭的病理研究

目的研究人工肝支持系统(ALSS)治疗急性肝衰竭的效果。方法将11只实验小型猪分为治疗组(n=6)和对照组(n=5),均给予D-氨基半乳糖,建立急性肝衰竭模型;治疗组48 h后经人工肝血浆置换结合血液滤过联合治疗。观察2组的一般情况、生存时间、生化指标和肝脏病理学变化。结果治疗组经人工肝治疗72 h后,一般状况有所改善,生存时间为(128.7±11.3)h,与对照组〔(67.9±9.4)h〕相比差异有统计学意义(P<0.01)。治疗组的丙氨酸转氨酶(ALT)、总胆红素(TBil)、凝血酶原时间(PT)与同组治疗前和对照组相比均有明显改善(P<0.01)。2组增殖细胞核抗原(PCNA)的阳性表达率比较差异有统计学意义(P<0.05)。治疗组与对照组的HE染色标本相比,肝脏坏死区域明显缩小,未发现明显淤胆。结论人工肝治疗急性肝衰竭效果显著,可以减少坏死区,提高肝细胞再生率,延长存活时间。     

手术干预式肝衰竭动物模型的研究现状

肝衰竭是肝脏的各项功能绝对或相对不足导致机体代谢功能发生严重紊乱而出现的临床综合征。肝衰竭发生于许多严重的肝脏疾病过程中,预后不良。而临床常用治疗方法局限性较大,需不断对其发病机制、治疗方法等进行探索。但探索过程中离不开合适的动物模型,目前肝衰竭动物模型通过制作方式大致可分为手术干预式动物模型和非手术干预式动物模型。非手术干预式动物模型多采用肝损害药物等导致实验动物出现肝衰竭。该文主要讨论通过手术干预导致实验动物出现肝衰竭的动物模型。     

人工肝实验研究 Ⅱ.人工肝治疗家犬急性肝衰竭的疗效

我们继1981年用手术法建立家犬急性肝衰竭模型之后,进一步将此模型应用于人工肝实验性治疗,以估价人工肝治疗急性肝衰竭的疗效。现报道如下。 材料与方法 实验对象 从我院动物场分批挑选健康家犬12只作为实验对象,其中雄性10只,雌性2只,体重9.51～13.5公斤,平均11.54±1.1公斤。 实验方法 将实验家犬12只随机分为两组,治疗组6只,平均体重12±0.84公斤,对照组6只,平均体重11±1.16公斤。两组均用手术法(结扎肝动脉与门静脉后作门腔静脉吻合)建立急性缺血性肝坏死肝昏迷模型,并于术后6小时开始进行血液灌流,持续2小时后止。灌流     

人工肝实验研究——Ⅱ.人工肝治疗家犬急性肝衰竭的疗效

我们继1981年用手术法建立家犬急性肝衰竭模型之后,进一步将此模型应用于人工肝实验性治疗,以估价人工肝治疗急性肝衰竭的疗效。现报道如下。材料与方法一、实验对象从我院动物场分批挑选健康家犬12只作为实验对象,其中雄性10只,雌性2只,体重9.51～13.5 kg,平均11.54±1.1 kg。二、实验方法将实验家犬12只随机分为两组,治疗组6只,平均体重12±0.84 kg,对照组6只,平均体重11±1.16 kg。两组均用手术法(结扎肝动脉与门静脉后作门腔静脉吻合)建立急性缺血性肝坏死肝昏迷模型,并于术后6小     

OX40在急性肝衰竭大鼠肝组织中的表达及意义

目的观察共刺激分子(costimulatory molecule)OX40在急性肝衰竭(acute liver failure,ALF)大鼠肝组织中表达的变化,探讨OX40在急性肝衰竭发病机制中的作用。方法雄性SD大鼠,随机分为正常对照组、急性肝衰竭(ALF)模型组。急性肝衰竭组:腹腔同时注射D-氨基半乳糖(D-GalN)800mg/kg和脂多糖(LPS)8微克/只,在D-GalN和LPS注射后6、12、24、48h 4个时间点留取大鼠血及肝脏标本。全自动生化仪检测血清ALT、AST水平。苏木素-伊红(HE)染色下观察肝组织变化。RT-PCR法检测大鼠肝组织OX40mRNA表达。Western blot法检测肝组织OX40蛋白表达。结果肝衰竭组血清ALT和AST水平在12h升高最明显,24h开始下降。肝衰竭组肝组织OX40mRNA水平至12h达峰值,之后逐渐下降,与对照组比较,各时间点差异具有统计学意义(F=29.970,162.975,62.476,25.124,P<0.05)。肝衰竭组OX40蛋白的表达于12h达到最大值,与对照组相比,差异有统计学意义(F=17.240,169.298,88.289,74.984,P<0.05)。结论 OX40在急性肝衰竭过程中呈上升趋势,于12h达高峰,提示OX40可能在急性肝衰竭过程中发挥重要作用。     

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.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.