盐酸戊乙奎醚对体外循环下心脏瓣膜置换术肺功能的保护作用

目的：探讨盐酸戊乙奎醚对体外循环下心脏瓣膜置换术肺功能的保护作用。方法选择2012年6月至2014年6月我院接诊的100例需行心脏瓣膜置换术的患者进行研究。随机分为观察组和对照组各50例。观察组患者麻醉诱导时推注0.02 mg/kg盐酸戊乙奎醚,体外循环预充液加入0.04 mg/kg盐酸戊乙奎醚。对照组患者麻醉诱导时推注等量生理盐水,体外循环预充液加入等量生理盐水。比较两组患者麻醉切皮前(T1)、CPB开始后30 min (T2)、CPB开始后1 h (T3)、CPB开始后1.5 h (T4)时间点的白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、阻力指数(RI)和肺泡动脉氧分压差[P(A-a)DO2]。结果两组患者在T1时的IL-6、TNF-α、RI和P(A-a)DO2指标比较差异均无统计学意义(P>0.05);观察组患者T2、T3、T4时间点的IL-6、TNF-α、RI和P(A-a)DO2均低于对照组,二者比较差异均有统计学意义(P<0.05);观察组的住院时间、拔引流管时间和ICU治疗时间均短于对照组,肺部感染发生率低于对照组,差异均有统计学意义(P<0.05)。结论盐酸戊乙奎醚对体外循环下心脏瓣膜置换术肺功能的保护作用良好,能显著改善患者的肺功能,值得临床推广。     

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。     

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。     

盐酸戊乙奎醚复合乌司他丁对行开胸术患者术后认知功能的影响及机制研究

目的 探讨盐酸戊乙奎醚复合乌司他丁对行开胸术患者术后认知功能的影响.方法 将120例行开胸肺癌根治术患者分为盐酸戊乙奎醚复合乌司他丁组(HU组)、盐酸戊乙奎醚组(H组)、乌司他丁组(U组)和对照组(C组).采集动脉血检测氧合指数(OI)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6和IL-8,检测血清中S-100β和神经元特异性烯醇化酶(NSE)水平,评估简易精神状态评价量表(MMSE)评分.结果 与H组和U组相比,HU组T3～4时TNF-α均降低,T2～4时IL-6和IL-8均降低,而OI升高(P＜0.05);与H组和U组相比,HU组患者T5～8时血清S-100β和NSE水平均降低(P＜0.05);与H组和U组相比,HU组患者T6～7时MMSE评分升高(P＜0.05).结论 盐酸戊乙奎醚复合乌司他丁可减轻开胸术单肺通气时炎症反应,改善术后认知功能.     

盐酸戊乙奎醚对体外循环机体炎症反应的影响

目的研究盐酸戊乙奎醚对体外循环(CPB)机体炎症反应的影响。方法选择40例择期行体外循环瓣膜置换术的风湿性心脏病患者,按随机数字表分为盐酸戊乙奎醚组(P组)和生理盐水对照组(C组),每组20例。P组诱导和预充液中使用盐酸戊乙奎醚,对照组则使用生理盐水,分别于麻醉诱导前(T0),CPB开始后30min(T1),主动脉开放10min(T2),CPB结束后2h(T3),抽取动脉血,测定血浆白介素(IL)-6、肿瘤坏死因子(TNF)-α的浓度,并观察术后肺炎发生率、全身炎症反应综合征(SIRS)发生率、有无谵妄等临床指标。结果组内比较,P组和C组在T2、T3时,IL-6浓度均高于T0、T1(P<0.05);P组TNF-α浓度在T3时低于T1和T2(P<0.05)。组间比较,在T2、T3时,P组IL-6浓度低于C组(P<0.05);TNF-α浓度各时间点差异无统计学意义(P>0.05)。肺炎发生率和SIRS发生率P组均低于C组(P<0.05)。结论应用盐酸戊乙奎醚能一定程度上抑制细胞因子的释放,对CPB术后SIRS和肺部并发症有一定的防治作用。     

盐酸戊乙奎醚预处理对体外循环下法洛四联症根治术患儿心肌损伤的影响

目的:观察盐酸戊乙奎醚预处理对体外循环(CPB)下法洛四联症根治术患儿心肌损伤的影响。方法:选取择期行CPB下法洛四联症根治术的患儿共100例,采用随机数字表法将患儿分为P组和C组,每组各50例。P组患儿于其颈内静脉穿刺成功后即刻静脉注射盐酸戊乙奎醚0.04 mg/kg;C组患儿于相同时间点静脉注射等容量生理盐水。于麻醉诱导前(T_0)、诱导后10 min(T_1)、复温至36℃(T_2)、CPB停机后1 h(T_3)、术毕(T_4)及术后24 h(T_5)时抽取两组患儿颈内静脉血以检测其血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6和8(IL-6、IL-8)的水平,并进行比较。分别于T_0~T_5时抽取两组患儿的桡动脉血,以测定其血浆心肌肌钙蛋白T(cTnT)浓度。结果:与C组患儿比较,P组患儿T_2~T_5时的血清TNF-α、IL-6、IL-8水平及血浆cTnT浓度均呈显著降低(P<0.05),差异有统计学意义。结论:盐酸戊乙奎醚预处理可减轻CPB下法洛四联症根治术患儿的心肌损伤程度。     

盐酸戊乙奎醚预防心脏手术心肺转流期间肠黏膜屏障功能损伤

目的:观察心脏手术心肺转流期间肠黏膜屏障功能的改变,探讨盐酸戊乙奎醚对肠黏膜屏障功能损伤的防治作用及其可能机制。方法:选择择期体外循环下心脏瓣膜置换手术患者30例,随机分为盐酸戊乙奎醚0.04mg/kg组15例(P组)和对照组15例(C组)。P组于切皮前10min静脉注射相应剂量的药物,而对照组则静注等容量生理盐水。分别于切皮前(T1)、CPB开始30min(T2)及主动脉开放后30min(T3)抽取桡动脉血,测定去甲肾上腺素(NE)和肾上腺素(E)水平。结果:两组T2、T3时患者NE、E水平显著高于T1值(P0.05);两组T2、T3时比较差异有统计学意义(P0.05)。结论:心脏手术患者CPB期间可发生肠黏膜屏障功能损伤,预防性应用合适剂量盐酸戊乙奎醚可以减轻损伤,其机制可能与盐酸戊乙奎醚可降低CPB期间应激反应有关。     

不同剂量盐酸戊乙奎醚对小儿体外循环后肺保护作用的研究

通过观察不同剂量盐酸戊乙奎醚对小儿先心病肺动脉高压体外循环(CPB)后细胞因子释放及肺功能的影响,探讨其肺保护作用的机制,得出结论:CPB前应用0.04 mg/kg盐酸戊乙奎醚能有效抑制细胞因子TNF-α、IL-6的释放,减轻CPB后急性肺损伤,具有一定的肺保护作用.     

盐酸戊乙奎醚联合保护性肺通气模式在食管癌根治术中的应用效果

目的观察食管癌根治术患者单肺通气(OLV)期间盐酸戊乙奎醚联合保护性肺通气模式对肺内分流及炎性因子的影响。方法选取60例择期行食管癌根治手术的患者,随机分为3组,常规通气组(N组)和保护性通气组(P组),盐酸戊乙奎醚联合保护性通气组(PHC组),各20例。于单肺通气前、单肺通气后30、60 min,双肺通气后桡动脉采血做血气分析,观察Pa O2、Pa CO2、PH、Fi O2等数据,并计算肺内分流率(Qs/Qt),同时收集静脉血观察IL-8和TNF-α水平。结果与N组相比,P组和PHC组T1~T2时点Ppeak均明显降低(P<0.05);P组和PHC组T1~T2时点肺内分流均明显降低(P<0.05);与N组和P组相比,PHC组血浆T1~T3时点和TNF-α水平明显下降(P<0.05),PHC组血浆T2~T3时点IL-8水平明显下降(P<0.05)。结论单肺通气期间,盐酸戊乙奎醚联合保护性通气模式可有效减轻肺损伤。     

盐酸戊乙奎醚对硫化氢急性中毒性心血管损伤的疗效观察

目的 观察盐酸戊乙奎醚对硫化氢急性中毒所致心血管损伤的临床疗效.方法 收集32例硫化氢急性中毒患者,将其随机分为观察组和对照组各16人,观察组给予盐酸戊乙奎醚+常规治疗,对照组给予常规治疗.记录患者30min、24h,3d及7d血清心肌酶谱;用ELISA法测定患者上述时间肿瘤坏死因子-α(TNF-α)、白介素8(IL-8)等血清炎症因子含量.结果 观察组血清心肌酶谱、炎症因子TNF-α、IL-8含量明显低于对照组(P<0.05),心电图心肌损伤性ST、T波改变明显改善(P<0.05).结论 盐酸戊乙奎醚可以减轻硫化氢急性中毒引起的心血管损伤并改善心血管功能.     

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.