参麦对休克复苏时肠黏膜内一氧化氮、丙二醛及钙含量的影响

目的 :观察参麦注射液 (简称参麦 )对休克复苏期间肠黏膜内一氧化氮 (NO)、丙二醛 (MDA)及钙 (Ca2 + )含量的影响 ,探讨其肠黏膜保护作用机制。方法 :采用Lamson兔休克肠缺血再灌注模型 ,2 1只家兔随机分为对照组 (A组 )、单纯复苏组 (B组 )和参麦治疗组 (C组 )。C组于复苏同时首剂静注参麦 2 .1mg/kg ,随后持续泵入 7.5ml/kg·h ,直至观察结束。分别于放血前 (N)、休克 1h(S1)、再灌注 1h(R1)和 3h(R3 )观察参麦对乙状结肠黏膜内pH(pHi)及R3 时回肠黏膜NO、MDA及Ca2 + 含量的影响。结果 :C肠黏膜NO、MDA及Ca2 + 显著低于B组 (均为P <0 .0 5 ) ,其中Ca2 + 与A组无显著性差异 ,而NO及MDA含量高于A组 ,R1和R3 时肠 pHi明显高于B组 ;B组肠黏膜NO、MDA及Ca2 + 含量明显高于A组和C组 (P <0 .0 5 ) ,R1～R3 期间肠 pHi持续低水平。结论 :参麦减轻肠黏膜再灌注损伤与其改善黏膜灌注及氧合、抑制NO的产生或释放、降低氧自由基水平和防止钙超载有关。     

盐酸戊乙奎醚对失血性休克大鼠肠黏膜的保护作用

目的拟用失血性休克模型来研究盐酸戊乙奎醚是否对肠黏膜缺血再灌注损伤具有保护作用。方法将雄性SD大鼠随机分为四组(n=8):对照组、休克组、小剂量盐酸戊乙奎醚组(0.15 mg/kg)和大剂量盐酸戊乙奎醚组(0.30mg/kg)。盐酸戊乙奎醚或等量生理盐水在休克前30 min通过尾静脉注入大鼠体内。除对照组外,其他三组经15 min股动脉缓慢放血使大鼠平均动脉压达(40±5)mm Hg(1 mm Hg=0.133 kPa)诱发失血性休克,通过放血或输血维持大鼠休克状态60 min。休克结束30 min内输注大鼠自身血液和林格液(32 mL/kg)进行复苏。复苏4 h之后检测肠黏膜pH(pHi)、一氧化氮(NO)、超氧化物歧化酶(SOD)、丙戊二醛(MDA)及钙离子(Ca2+)的含量,并观察肠黏膜组织病理学改变。结果与休克组比较,大剂量盐酸戊乙奎醚组NO、MDA及Ca2+的含量显著降低;而SOD活性和pHi增高。与此相应的是肠黏膜细胞凋亡及组织病理学评分降低。结论大剂量盐酸戊乙奎醚对失血性休克大鼠肠黏膜具有保护作用,其机制可能与抑制细胞死亡和保存细胞抗氧化功能相关。     

大承气汤对失血性休克大鼠再灌注肠组织iNOS-NO-ONOO~-通路的影响

目的 观察失血性休克再灌注大鼠肠组织诱生型一氧化氮合酶(iNOS)、过氧亚硝基阴离子(ONOO-)体内生成标志物硝基酪氨酸(NT)的表达,探讨中药大承气汤对失血性休克大鼠肠组织损伤的防治作用及其可能机制.方法 SD大鼠24只,雌雄各半,体重180～200 g.实验随机分为3组(每组8只):正常组(仅手术,不放血)、模型组(模型+生理盐水1 mL/100 g体重灌胃)、大承气汤组(模型+大承气汤灌胃含生药2.0 g/mL,1 mL/100 g体重).大承气汤、生理盐水在实验前连续灌胃,2次/d,连续2 d,各组动物术前禁食24 h.复制重度失血性休克及复苏动物模型,造模完成后观察各组动物肠黏膜病理学变化,免疫组化法检测肠黏膜组织iNOS与NT的表达与分布.应用ImageJ软件对免疫组化显色结果进行拍照、灰度分析.结果 病理检查结果显示:正常组肠黏膜正常,模型组肠黏膜损伤最重,大承气汤组肠黏膜损伤明显减轻;模型组小肠黏膜组织iNOS阳性细胞平均灰度值及NT阳性细胞平均灰度值均高于大承气汤组(P<0.01).结论 (1)失血性休克再灌注后,肠组织iNOS-NO-ONOO-通路表达上调.(2)大承气汤能减轻大鼠失血性休克再灌注肠黏膜损害,其机制可能与抑制肠黏膜组织iNOS-NO-ONOO-通路激活有关.     

动静脉血气分析在重症胰腺炎患者早期预后判断中的临床价值

目的：研究动静脉血气分析在重症胰腺炎(SAP)患者早期预后判断中的临床价值。方法选取2012年9月至2014年9月收入我院ICU的SAP患者64例,以患者ICU住院10 d为终点事件,根据预后情况将所有患者分为存活组(好转或病情未恶化)及死亡组(患者死亡),其中,存活组36例,死亡组28例。所有患者进行常规ICU治疗,发病48 h内进行血气分析和电解质检查,并与APACHEⅡ评分结果比较。结果发病48 h内血气测定结果表明,存活组和死亡组的动脉血pH-静脉血pH (A-VpH)[(0.022±0.09) vs (0.031±0.015)]、动脉血CO2分压-静脉血CO2分压(A-VPCO2)[(8.68±1.35) vs (11.48±4.56)]比较差异有统计学意义(P<0.05),动静脉血pH [(7.35±0.06) vs (7.36±0.05)]及血PO2水平[(95.3±8.9) mmHg vs (95.9±9.1) mmHg]比较差异无统计学意义(P>0.05);与存活组比较,死亡组血动静脉PCO2[动脉：(35.3±3.0) mmHg vs (29.9±3.0) mmHg、静脉：(35.3±3.0) mmHg vs (29.9±3.0) mmHg]、血HCO3-[动脉：(23.8±1.2) mmol/L vs (20.2±1.9) mmol/L、静脉：(17.5±1.0) mmol/L vs (19.3±1.2) mmol/L]、血Lac水平[动脉：(2.7±0.9) mmol/L vs (4.1±1.7) mmol/L、静脉：(1.7±0.6) mmol/L vs (1.8±0.4) mmol/L]、血BE水平[动脉：(-1.7±1.2) mmol/L vs (-4.3±1.6) mmol/L、静脉：(1.9±1.2) mmol/L vs (2.1±0.9) mmol/L]比较差异具有统计学意义(P<0.05)。发病48 h内电解质测定结果表明,存活组和死亡组的K+[(3.71±0.69) mmol/L vs (3.79±0.70) mmol/L]、Na+[(135.60±7.88) mmol/L vs (134.32±7.94) mmol/L]、Cl-[(100.85±20.73) mmol/L vs (98.49±24.3) mmol/L]水平比较差异均无统计学意义(P>0.05);两组Ca2+水平均减少,与死亡组比较,存活组Ca2+显著降低[(1.47±0.50) mmol/L vs (1.22±0.38) mmol/L],差异具有统计学意义(P<0.05)。为进一步明确PCO2、血HCO3-、血BE对SAP患者预后的判断价值,ROC曲线统计PCO2、血HCO3-、血BE对SAP的预后的诊断正确率,得血BE及APACHEⅡ评分的ROC曲线面积最大,表明其诊断正确率最高。结论早期进行SAP患者的血气分析检测有利于及早判断预后,进行合理治疗。年龄越大,血BE结果负值越大的患者,其预后可能也差。     

红花对兔肠缺血再灌注损伤后微循环改善作用的研究

目的探讨红花对兔肠缺血再灌注损伤(IRI)时微循环的改善作用.方法将30只日本大耳兔随机分为假手术组(S组)、缺血再灌注组(IR组)和缺血再灌注+红花注射液组(SI组).制作在体兔IRI模型.观察和记录各组动物肠系膜微循环变化,包括微动脉管径(AD)、微静脉管径(VD)、微动脉流速(AFV)、微静脉流速(VFV)和白细胞黏附数,电镜下观察肠黏膜超微结构改变.结果 IR组肠系膜微动、静脉管径缩小,血流速度减慢,多数肠黏膜微结构破坏严重.SI组微动、静脉管径及血流速度明显改善,肠黏膜超微结构异常改变不同程度减轻.结论在兔肠IRI发生后使用红花注射液能有效改善肠系膜的微循环,从而对肠黏膜起到良好的保护作用.     

限制性液体复苏产兔失血性休克对肠缺血再灌注损伤的保护作用

目的应用产兔非控制性失血性休克模型,探讨限制性液体复苏对产兔肠缺血再灌注损伤的保护作用。方法 24只产后6 h的新西兰大白兔被随机分成4组,假休克组(P组)、休克未处理组(P0组)、传统液体复苏组(PNL组)、限制性液体复苏组(PLH组),建立未控制重度失血性休克模型,分别于休克30 min后接受不同的液体复苏方案,于休克后90 min接受手术止血和输血输液治疗。在实验结束后处死产兔,观察不同液体复苏方式对小肠组织超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量及肠粘膜形态损伤等情况。结果失血性休克时缺血再灌注损伤导致肠粘膜损伤加重、肠组织SOD活性降低及MDA含量上升,限制性输液能显著改善上述改变。结论限制性液体复苏较充分快速液体复苏显著缓解了肠组织缺血再灌注损伤。     

疏血通对兔股动脉血栓远端血清乳酸代谢影响

目的:观察疏血通对兔股动脉血栓远端血清乳酸代谢的影响。方法:建立兔股动脉血栓模型;分组:动脉组30只,生理盐水250 m L+疏血通10 m L,30 m L/h静脉滴注;对照组30只,生理盐水250 m L,30 m L/h静脉滴注;血气分析检测乳酸值。结果:实验组乳酸值(2.2±0.19)mmol/L显著低于对照组乳酸值(7.6±0.55)mmol/L(P0.05)。结论:疏血通可以显著减低兔股动脉血栓远端血清乳酸代谢。     

大承气汤对失血性休克再灌注肠组织iNOS-NO-ONOO-通路影响的实验研究

[摘要] 目的 观察失血性休克再灌注大鼠肠组织诱生型一氧化氮合酶(iNOS)、过氧亚硝基阴离子(ONOO-)体内生成标志物硝基酪氨酸(NT)的表达,探讨中药大承气汤对失血性休克大鼠肠组织损伤的防治作用及其可能机制。方法 SD大鼠24只,雌雄各半,体重180～200 g。实验随机分为3组（每组8只）：正常组（仅手术,不放血）、模型组（模型＋生理盐水1mL/100g体重灌胃）、大承气汤组（模型+大承气汤灌胃含生药2.0 g/mL,1 mL/100 g体重）。大承气汤、生理盐水在实验前连续灌胃,2次∕d,连续2 d,各组动物术前禁食24 h。复制重度失血性休克及复苏动物模型,造模完成后观察各组动物肠黏膜病理学变化,免疫组化法检测肠黏膜组织iNOS与NT的表达与分布。应用ImageJ软件对免疫组化显色结果进行拍照、灰度分析。结果 病理检查结果显示：正常组肠黏膜正常,模型组肠黏膜损伤最重,大承气汤组肠黏膜损伤明显减轻;模型组小肠黏膜组织iNOS阳性细胞平均灰度值及NT阳性细胞平均灰度值均高于大承气汤组 (P<0．01)。结论 ⑴失血性休克再灌注后,肠组织iNOS-NO-ONOO-通路表达上调。⑵大承气汤能减轻大鼠失血性休克再灌注肠黏膜损害,其机制可能与抑制肠黏膜组织iNOS-NO-ONOO-通路激活有关。     

大鼠全肝血流阻断再灌注对肠黏膜屏障的影响

目的：研究大鼠全肝血流阻断再灌注对肠黏膜屏障的影响。方法：60只SD大鼠,随机分成假手术组(A组)和全肝血流阻断再灌注处理组(B组),每组30只。采用阻断肝门及肝上、肝下下腔静脉20min复制大鼠全肝血流阻断再灌注模型,分别观察全肝血流阻断再灌注末(T0)、再灌注4 h (T1)肠道肉眼变化,检测T0、T1门静脉血血气、门静脉血D-乳酸、TNF-α含量,观察小肠黏膜光镜及电镜下组织结构及再灌注48 h大鼠生存率变化。结果：B组T0门静脉血PCO2明显升高,PO2,pH,HCO-3明显下降(P<0.05);T0,T1门静脉血D-乳酸,TNF-α及肠黏膜MDA含量明显升高(P<0.05),B组肠黏膜光镜及电镜下存在明显组织学损害,48h生存率明显低于A组(P<0.05)。结论：大鼠全肝血流阻断再灌注处理可导致肠黏膜屏障损害。     

PICCO监测在失血性休克合并肺水肿患者治疗中的应用价值分析

目的:探讨PICCO监测在失血性休克合并肺水肿患者治疗中的应用价值。方法:选取我院失血性休克合并肺水肿患者共36例,随机分为观察组和对照组。给予对照组常规中心静脉压监测,给予观察组PICCO监测。观察机械通气时间、乳酸值、MAP、PaO_2/FiO_2及APACHEⅡ评分。结果:观察组机械通气时间为(7.8±1.5)d、乳酸为(1.4±0.5)mmol/L、MAP为(79.9±5.2)mmHg、PaO_2/FiO_2为(258.3±22.7)及APACHEⅡ评分为(20.8±4.1)分,均优于对照组,组间比较有差异(P0.05)。结论:PICCO监测用于失血性休克合并肺水肿患者中,能够改善患者的肺功能,减轻患者承受的痛苦,具有较高的价值。     

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.     

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     

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.     

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.     

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…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.