高海拔地区创伤后患者体液免疫的变化

目的：探讨亚高原地区创伤患者体液免疫的变化及临床意义。
方法：39例胸腹部创伤患者，分别在创伤后1，5，10 d测定外周血IgG，IgM，IgA，并与正常对照组进行对比分析。
结果：创伤后第1，5天 IgG,IgM,IgA变化不明显（P＞0.05），第10天IgG,IgM亦无变化（P＞0.05），但严重创伤组的IgA明显升高（P＜0.05）。
结论：亚高原地区创伤后，早期体液免疫抑制效应弱，创伤后第10天，外周血IgA浓度升高，外周血IgA浓度变化可作为高海拔地区创伤后患者体液免疫的变化的观察指标。

     

创伤性骨折中多项血生化指标的动态观察

目的探讨多项血生化指标连续检测在创伤骨折中的应用价值。方法选取我院2011年12月至2013年2月收治66例创伤性骨折患者,按损伤严重度分级AIS-ISS 90评分分为重伤组(n=42)和轻伤组(n=24),分别对两组患者的血生化指标进行连续性监测,比较两组患者各指标的差异。结果两组患者C-反应蛋白(C-Reactive protein,CRP)、葡萄糖、乳酸脱氢酶、肌酸激酶同工酶、免疫球蛋白G、免疫球蛋白M、补体C3及C4的水平均存在统计学差异(均为P0.05),且CRP、肌酸激酶同工酶、乳酸脱氢酶及葡萄糖与创伤程度呈明显相关性。结论对创伤骨折患者的多项生化指标进行连续性检测,对于骨折患者的伤情及预后有重要作用。     

急性创伤对端粒长度的影响

目的:探讨急性创伤发生及恢复过程中外周血单个核细胞的端粒长度变化。方法:根据ISS创伤评分将2012年9月至2013年11月收治的74例30~50岁急性创伤病人,男49例,女25例,根据创伤严重度评分分成轻伤组、重伤组、极度重伤组,分别于创伤入院当天、术后当天及出院当天留取外周血,以及128例正常对照组采血,用定量PCR方法检测外周血单个核细胞的端粒长度,比较不同创伤程度病人的端粒长度在创伤发生和恢复过程中的差异。结果:在急性创伤入院当天,轻伤组的端粒长度(1.158±0.193)与对照组端粒长度(1.098±0.136)无统计学差异(P>0.05)。重伤组创伤当天的端粒长度(0.902±0.313)较对照组端粒长度缩短,有统计学差异(P<0.01)。极度重伤组创伤当天的端粒长度(0.460±0.118)较对照组端粒长度明显缩短,有显著统计学差异(P<0.001)。重伤组病人的端粒长度在创伤当天的离散度较大。重伤术后当天端粒长度较创伤入院当天延长(P<0.05),但与出院无差异。轻伤和重伤病人出院时的端粒长度和正常对照组之间无明显统计学差异。结论:急性创伤病人中,部分重伤和极度重伤病人的端粒长度在创伤当天较对照组缩短,在出院时趋于正常。     

多发伤患者D-二聚体的变化及临床意义

目的：研究血浆D二聚体及纤维蛋白原在多发伤时的变化及临床意义。方法：以创伤严重程度等级（ISS）评分16分为界，将49例多发伤患者分为轻伤组（ISS≤16分）和重伤组（ISS〉16分），并以30例正常人为对照组，采用免疫胶体金法及仪器法检测了正常人和多发伤患者受伤第1、2及3天的血浆D-二聚体和纤维蛋白原浓度。结果：多发伤后血浆D-二聚体明显增高，且重伤组高于轻伤组（均P〈0．01），第2、3天明显低于第1天（P〈0．01），但仍高于对照组（P〈0．01）。纤维蛋白原重伤组第1天与对照组比较无统计学差异（P〉0．05），轻伤组明显高于对照组和重伤组（P〈0．01）。伤后第2、3天均嘎显高于第1天（P〈0．01），并且高于对照组（P〈0．01）。伤后第1、2、3天纤维蛋白原的含量与D-二聚体呈负相关（r=-0．591，r=0．548，r=-0．470，P〈0．01）。结论：多发伤患者存在高凝状态和继发性纤溶亢进，血浆D-二聚体的浓度与病情、病程密切相关。重型多发伤初期纤维蛋白原不增高与纤溶增强有关。     

创伤患者血清新喋呤的变化及临床意义

目的探讨创伤后血清新喋呤的变化规律及其临床意义.方法创伤患者41例,根据损伤严重度评分将患者分为3组轻伤组10例,重伤组16例,严重伤组15例.于入院后第1、3、7、14、21天取血测定血清新喋呤含量,并分析新喋呤水平与患者伤情、严重并发症及预后的关系.结果严重伤组新喋呤水平高于轻伤组(P＜0.05或P＜0.01),其均值与损伤严重度评分呈显著正相关(r=0.518,P＜0.05).自伤后第3天起创伤后并发多器官功能障碍综合征(MODS)者新喋呤水平持续升高,其中第3、7、14天与未出现MODS者相比差异有显著性意义(P＜0.05或P＜0.01).同时,严重创伤后死亡组患者新喋呤升高幅度亦明显大于存活组,患者死亡前其血清含量多超过50.0nmol/L(8/12,66.7%).结论创伤应激后体内新喋呤合成、释放增多,动态观察循环新喋呤改变可能有助于评价患者损伤程度、监测MODS病理过程和辅助判断预后等.     

D-二聚体对严重创伤的诊断价值

目的通过检查骨创伤患者术后血浆D-二聚体变化值,观察严重创伤后D-二聚体数据对诊断的价值。方法收集本院骨创伤患者120例,根据创伤和损伤严重程度（ISS）评分将120例骨创伤患者分为：轻度损伤组（ISS≤16）、中度损伤组（16〈ISS〈25）、重度损伤组（ISS〉125）,并将120例骨科创伤患者设为观察组;另取60例健康体检患者设为对照组,对比分析D-二聚体检测数值。结果观察组血浆D-二聚体和对照组相比显著升高,差异有统计学意义（P〈0．05）;创伤程度越重,术后1、3、5天血浆D-二聚体逐渐增高,差异也有统计学意义（P〈0．05）;骨折术后DVT与血浆D－二聚体呈正相关,P〈0．01。结论骨创伤患者血浆中D－二聚体检验值升高后逐渐降低,通过D-二聚体水平检测及动态监测可用于患者伤情的判断和骨折术后DVT的诊断和评估。     

创伤患者外周血淋巴细胞自噬变化及其与糖代谢的关系

目的 观察创伤患者外周血淋巴细胞的自噬变化规律以及与创伤后血精变化的关系.方法 根据损伤严重度评分(ISS)或简明损伤定级标准(MS)将创伤患者分为轻伤组、重伤组、严重伤组,同时设立健康对照组,分别于创伤后1、3、5、10 d采集外周血,采用密度梯度离心结合贴壁分离法分离创伤患者外周血淋巴细胞,应用激光共聚焦显微镜和透射电镜观察细胞自噬现象;将分离得到的淋巴细胞进行MDC染色并裂解,应用荧光分光光度计(激发光波长380 nm、发射光波长525 nm)测定荧光强度进行定量分析;于创伤后1、3、5 d检测患者血糖水平,分析创伤后自噬与血糖的相关性.结果 与健康对照组比较,创伤患者外周血淋巴细胞自噬水平明显升高,有显著变化(P＜0.01).结论 创伤后外周血淋巴细胞自噬水平与创伤严重程度、创伤后血糖成正相关.     

不同院前创伤评分联合血栓弹力图对骨折合并多发伤患者伤情评估中的应用价值探讨

目的 探讨不同院前创伤评分联合血栓弹力图对急诊骨折合多发伤患者伤情评估中的应用价值。方法 回顾性分析2018年1月至2021年12月中国人民解放军陆军第七十二集团军医院急诊科收治的多发伤患者162例临床资料，根据Crams评分将所有患者按照伤情情况分为重度创伤组（n=36）与轻度创伤组（n=126），对比两组急性生理学及慢性健康状况评分（APACHE-Ⅱ）、创伤严重程度评分（AISISS），同时分析两组血栓弹力图（TEG）指标[凝血反应时间（R）、血块形成速率（K）、血块生成率（α角）、最大宽度值（MA）、凝血综合指数（CI）]。分析不同院前创伤评分与血栓弹力图的相关性，绘制ROC曲线分析不同院前创伤评分联合血栓弹力图对急诊多发伤患者伤情评估中的应用价值。结果 轻度组Crams评分比重度组高，而APACHE-Ⅱ、AIS-ISS评分均较重度组低（P<0.05）。轻度组R、K值均小于重度组，而α角、MA及CI值均较重度组大（P<0.05）。Crams评分与R、K、CI呈负相关（r<0,P<0.05），与α角、MA呈正相关（r>0,P<0.005）。APA...     

创伤严重度改良评分法对2260例创伤患者的前瞻性研究

目的探讨创伤严重度改良评分法（RISS）的临床实用价值，根据RISS值界定损伤严重程度。方法运用RISS法对1997年1月～2002年12月收治的2260例创伤患者进行前瞻性评估分析。结果RISS值随损伤部位数量增加而增高，并与损伤程度、伤残及死亡率呈正相关（P〈0．01）。生存者RISS值平均为（12．82±8．51）分，死亡者RISS值平均为（34．47±14．88）分（P〈0．01）。单处伤RISS值最低[（11．12±8．20）分]，多处伤次之[（13．81±4．67）分]，多发伤RISS值最高[（18．23±11、75）分]（P〈0．01）。结论RISS法能客观准确地反映各类损伤的创伤严重度，RISS〈9分为轻伤，RISS 9—15分为中度伤，RISS 16—25分为重伤，RISS 26～35分为严重伤，RISS〉35分为危重伤。     

骨折患者血液检验指标与创伤程度的关系探讨

[目的]探讨创伤性骨折患者血糖、超敏C-反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)水平和创伤程度的关系。[方法] 2019年1月～2019年10月73例创伤性骨折患者,依据创伤严重程度(ISS)评分为轻度组36例、重度组28例和严重组9例;另选同期在本院健康体检者68例作为对照组。均行血糖、hs-CRP、Hcy检测,分析骨折患者以上指标和ISS评分的关系。[结果]骨折组各时间点的血糖、hs-CRP和Hcy水平均显著高于对照组(P0.05);骨折组术后第1 d血糖、hs-CRP和Hcy水平较术前上升,第3、7 d血糖、hs-CRP和Hcy水平均下降,差异有统计学意义(P0.05)。血糖、hs-CRP和Hcy水平依次为轻度组重度组严重组,差异有统计学意义(P0.05)。各时间点,骨折患者血糖、hs-CRP和Hcy水平均与ISS评分呈显著正相关(P0.05)。[结论]创伤性骨折患者血糖、hs-CRP和Hcy动态改变和机体创伤程度有关,可用作骨折伤情判断的有效指标。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.