上消化道出血者血栓素A2和前列环素的变化

血栓素A_2(TxA_2)和前列环素(PGI_2)是花生四烯酸的主要代谢产物。大量研究证实,TxA_2与PGI_2的平衡失调,在许多循环障碍性疾病中起重要的病理介导作用。本文测定了TxA_2和PGI_2的稳定代谢产物血栓素B_2(TxB_2)和6-酮-前列腺素F_1α(6-Keto-PGF_1α)的血浆水平,以探讨TxA_2和PGI_2在上消化道出血(UGH)过     

次声对脑组织血栓素A2,前列环素代谢的影响

目的 探讨次声作用后脑皮层组织血栓素Ａ２（ＴＸＡ２）、前列环素（ＰＬＩ２）代谢改变及及代谢性谷氨酸受体拮抗剂ＭＣＰＧ的作用。方法 ４０只ＳＤ大鼠随机分为正常对照,次声作用１次、７次、１４次及代谢性谷氨酸受体拮抗剂ＭＣＰＧ治疗５组,采用第四军医大学研制的次声压力仓,用８Ｈｚ、１２０ｄＢ的次声按规定次数。每次作用２ｈ。采用蛋白定量和放免法行脑ＴＸＡ２、ＰＬＩ２稳定代谢产物血栓素Ｂ２（ＴＸＢ２）及６－酮     

急性心功能不全患者血清铁蛋白,血栓素A2和前列环素动态…

探讨血清铁蛋白、血栓素Ａ２和前列腺环素在急性心功能不全发病过程中的意义。测定２１例急性心功能不全患者治疗前和治疗后第７，１４天血清Ｆｔ，ＴＸＡ２及ＰＧＩ２的稳定代谢产物血栓素Ｂ２（ＴＸＢ２）及６－酮－前列腺素Ｆ１α（６－ｋｅｔｏ－ＰＧＦ１α）的含量。并选择１８例无心功能不全患者作为对照组观察。     

康复运动对冠心病患者血流动力学和前列环素、血栓素A2的影响

目的：研究康复运动对冠心病血流动力学和前列环素PGI2、血栓素TX-A2的影响。方法：选择冠心病患者，康复组(A组，n=31)，接受一两年的个体运动负荷程序训练，为对照组(B组，n=34)，进行每日少于半小时的散步，(1．5km)，然后作平板运动试验(TET)，比较TET前后两组患者的次极量平板运动当量(METsmax)、缺血阈(MET1)，运动中最高收缩压与最高心率乘积(RPP)、运动峰值收缩压(TSBP)；PGl2，TXA2的代谢产物6-Keto-PGFla、TXB2及其比值P／T。结果：A组较B组TSBP，METET1,METmax分别为11．4％、48．6％、34．9％，P&;lt;0．00l；RPP升高0．09％。B组TET后较前TXB2升高25．39％，P=0．008；两组TET前比较。A组P／T高32．8l％，P=0．0ll；两组TET后比较，A组TXB2低44．04％，P=0．02，且P／T高32．20％，P=0．032。结论：康复运动可以提高心肌缺血阈和功能贮量；冠心病患者通过循序渐进的有氧康复运动，可改善基础和次极量运动的TGI2-TXA2比例。     

肝硬化合并上消化道出血患者血浆中前列环素和血栓素A2含量的变化

目的观察肝硬化及合并上消化道出血患者血浆中前列环素（PGI2）和血栓素A2（TXA2）含量的变化,探讨其在肝病发生、发展中的临床意义。方法选取乙型肝炎后肝硬化患者48例,Chlid—pugh分级A级16例,B级18例,C级14例;合并上消化道出血组18例,无上消化道出血组30例。健康志愿者30名作为正常对照组。采用放射免疫法（RIA）分别测定其血浆中PGI2和TXA2的代谢产物6-酮-前列环素（6-Keto—PGF1a）和血栓素B2（TXB2）的含量,并进行统计学分析。结果Chlid—pugh分级A级患者血浆中6-Ke—to—PGF1a和TXB2含量分别为（108．8±34．2）ng/L和（87．5±19．3）ng／L,B级为（139．4d±38．3）ng／L和（106．6±20．7）ng／L,C级为（181．9±53．2）ng／L和（128．5±26．3）ng／L,对照组为（90．6±23．6）ng／L和（73．6±18．3）ng／L,经方差分析,各组之间差异有统计学意义（F值分别为5．12、4．63,P均〈0．01）;各组间经SNK—q检验比较,差异均有统计学意义（P均〈0．01）;血浆中6-Keto—PGF1a和TXB2含量在Chlid—pugh分级A、B、C级患者中逐级增高。肝硬化合并上消化道出血患者与单纯肝硬化患者血浆中6-Keto—PGF1a含量分别为（152．26±70．45）、（120．15±34．06）ng／L,TXB2含量分别为（110．09±50．32）、（99．01±25．23）ng／L,经两样本t检验差异均有统计学意义（t值分别为2．53、2．27,P均〈0．01）。结论PGI2和TXA2含量的变化参与并促进了肝硬化及其并发症上消化道出血的发生、发展。     

绝经前后妇女血浆血栓素A2和前列环素水平的变化

目的：为探讨绝经对妇女血浆血栓素A2(TXA2)和前列环素(PGI2）水平的影响。方法：将72例研究对象按月经情况分四组，即：月经正常组(Ⅰ)；月经紊乱组(Ⅱ)；绝经≤5年组(Ⅱ)；绝经>5年组(Ⅳ)。用同位素放射免疫方法集中测定各组妇女外周血浆TXA2、PGI2的稳定代谢产物血栓素B2(TXB2)及6-酮前列腺素F1。(6-K-PGF1α)的含量。结果：(1)各组妇女血浆TXB2及6-K-PGF1α水平无显性差异(P>0.05)；(2)各组妇女TXB2／6-K-PGF1α。的比值较恒定(1．04±0.05)。结论：绝经对妇女体内TXA2和PGI2的水平和稳定无明显影响。有血管舒缩不稳定症状(如潮热)的绝经前后妇女，由于其血浆TXA2／PGI2总保持动态平衡，故不会增加心血管疫病的发病风险。     

前列环素和血栓素A2在急性坏死性胰腺炎并发肾损害发病 …

目的：探讨前列环素（ＰＧＩ２）、血栓素Ａ（ＴＸＡ２）在急性坏死性胰腺炎并发肾损害发病机制中的作用。方法：Ｅ这结扎、胰腺被膜下注射５％牛磺胆酸钠复制急性坏死必谈在鼠模型,以放射免疫方法动态测定术后２４、４８小时肾静脉血浆和肾组织中血栓素Ｂ２（ＴＸＢ２）、ＰＧＩ２水平,并观察尿素氮（ＢＵＮ）、血肌酐（ＳＣｒ）的改变。结果：有着急性坏死性胰腺炎病程进展,肾静脉血浆和肾组织中ＴＸＢ２、６－酮－前列腺素,１     

老年高血压患者血栓素A2、前列环素与血液流变学的关系

目的 探讨老年高血压患者血栓素A2(TxA2)、前列环素(PGI2)与血液流变学的关系。方法 用放免法测定TxA2和PGI2的代谢产物血栓素B2(TxB2)、6—酮—前列腺素Flα(6—K—PGFlα)，用全自动血液流变仪测血液流变学，并与正常组作对照。结果老年高血压患者TxB2(147．43土82．28)ng／L、6—K—PGFlα(126．57土25．36)ng／L，正常组TxB2(55．11土16．32)ng／L、6—K—PGF1α(90．89土12．41)ng／L，血液流变学中的全血高切黏度、低切黏度、血浆黏度、纤维蛋白原均高于正常组，二者相比差异有显著意义(P＜0．05)。结论 提示老年高血压患者存在TxA2／PGI2失衡，并与血液流变学改变密切相关。     

Platelet activation with massive formation of thromboxane A2 during and after cardiopulmonary resuscitation

Objective: Hypoxia and ischemia cause endothelial cell damage with consequent platelet activation. The hypothesis that human cardiac arrest accelerates platelet activation and the formation of prostanoids was tested. Design: Prospective, observational cohort study. Setting: Emergency Department and general Intensive Care Unit in a city hospital. Interventions: Basic and advanced life support. Patients and participants: Forty-seven out-of-hospital cardiac arrest patients. The patients were classified into two groups, those who were resuscitated (n=18) and those who died (n=29). Measurements and results: Serial levels of platelet aggregation, thromboxane B₂ (TXB₂), 11-dehydro-TXB₂ and 6-keto-prostaglandin F₁ alpha (6-keto-PGF₁ alpha) were measured. The results of measurements and demographic data were compared between the groups. Platelet counts decreased at the end of cardiopulmonary resuscitation (CPR), the decrease of the platelet counts showed statistical significance especially in the patients who died (p<0.001). Platelet aggregation induced by adenosine diphosphate, epinephrine and collagen decreased to the lower limits of normal during and after CPR. Although high values of TXB₂ and 11-dehydro-TXB₂ continued throughout the study period in the resuscitated patients, 6-keto-PGF₁ alpha decreased to the normal range (22.7±3.6 pg·ml^–1, p<0.05) at 24 h after arrival at the Emergency Department. Conclusions: Platelet activation with the massive formation of thromboxane A₂ (TXA₂) occurs in patients with out-of-hospital cardiac arrest. Successful resuscitation is not associated with the balanced production of PGI₂ against the TXA₂ formation. Received: 15 February 1996 Accepted: 2 September 1996     

Derangements in blood glucose following initial resuscitation from in-hospital cardiac arrest: A report from the national registry of cardiopulmonary resuscitation

Study aims

Hyperglycemia is associated with poor outcomes in critically ill patients. We examined blood glucose values following in-hospital cardiac arrest (IHCA) to (1) characterize post-arrest glucose ranges, (2) develop outcomes-based thresholds of hyperglycemia and hypoglycemia, and (3) identify risk factors associated with post-arrest glucose derangements.

Methods

We retrospectively studied 17,800 adult IHCA events reported to the National Registry of Cardiopulmonary Resuscitation (NRCPR) from January 1, 2005 through February 1, 2007.

Results

Data were available from 3218 index events. Maximum blood glucose values were elevated in diabetics (median 226 mg/dL [IQR, 165–307 mg/dL], 12.5 mmol/L [IQR 9.2–17.0 mmol/L]) and non-diabetics (median 176 mg/dL [IQR, 135–239 mg/dL], 9.78 mmol/L [IQR 7.5–13.3 mmol/L]). Unadjusted survival to hospital discharge was higher in non-diabetics than diabetics (45.5% [95% CI, 43.3–47.6%] vs. 41.7% [95% CI, 38.9–44.5%], p = 0.037). Non-diabetics displayed decreased adjusted survival odds for minimum glucose values outside the range of 71–170 mg/dL (3.9–9.4 mmol/L) and maximum values outside the range of 111–240 mg/dL (6.2–13.3 mmol/L). Diabetic survival odds decreased for minimum glucose greater than 240 mg/dL (13.3 mmol/L). In non-diabetics, arrest duration was identified as a significant factor associated with the development of hypo- and hyperglycemia.

Conclusions

Hyperglycemia is common in diabetics and non-diabetics following IHCA. Survival odds in diabetics are relatively insensitive to blood glucose with decreased survival only associated with severe (>240 mg/dL, >13.3 mmol/dL) hyperglycemia. In non-diabetics, survival odds were sensitive to hypoglycemia (<70 mg/dL, <3.9 mmol/L).     

Comparison of epinephrine and dopamine during cardiopulmonary resuscitation

The effectiveness of epinephrine and dopamine for restoring spontaneous circulation after asphyxial or fibrillatory cardiac arrest was compared using a porcine model. Asphyxial arrest: 7 animals received 45 g/kg epinephrine, 7 animals 2.5 mg/kg dopamine, the remaining 7 animals received no drug treatment. All 7 animals given epinephrine could be resuscitated after 174±53 s, spontaneous circulation could be restored in only 3 of 7 animals given dopamine after 487±63 s and in none of the control animals could spontaneous circulation be established. Ventricular fibrillation: 7 animals were defibrillated without either mechanical measures or drug therapy. The following doses were given before defibrillation and after starting mechanical measures to separate groups of 7 animals each: 45 g/kg epinephrine, 2.5 mg/kg dopmaine, or no drug therapy. In the absence of either drug or mechanical measures and with mechanical measures only, spontaneous circulation could not be established in any of the cases. After administration of epinephrine, defibrillation and restoration of spontaneous circulation was achieved in 6 of 7 animals in 667±216 s, with dopamine, all the animals could be successfully resuscitated in the shorther time of 174±85 s. Epinephrine was found to be superior to dopamine in the treatment of asphyxial arrest whereas dopamine was found to be better in the management of ventricular fibrillation, probably by improving the balance between myocardial oxygen supply and demand.     

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

Objective

Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions.

Methods

This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback.

Results

We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited <5% leaning yet 20/108 (19%) demonstrated >20% compression leaning. When evaluating blocks of continuous compressions (>120 s), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (p < 0.001).

Conclusions

Chest compression leaning was common during resuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes.     

心肺复苏中血浆内皮素和超氧化物歧化酶水平的动态观察与分析

目的　探讨血浆内皮素 (endothelin ,ET)及超氧化物歧化酶 (superoxidedismutase,SOD)水平与心肺复苏 (cardiopulmonayresuscitation ,CPR)患者预后的关系。方法　 2 5例心搏骤停和心肺复苏患者 ,依复苏效果分为A组 (9例 ) ,心肺复苏 30min无效死亡 ;B组 (11例 ) ,复苏成功 ,自主循环建立 >2h ,但经抢救 2 4h后死亡 ;C组 (5例 ) ,复苏成功存活出院。三组患者于复苏即刻、 30min、 2h、 4h分别测定血中ET、SOD的浓度 ,比较三组患者上述指标的动态变化。结果　B、C两组随着CPR的进展ET、SOD的浓度逐渐降低 ,于CPR 2 4h差异具有显著性意义。C组ET水平下降速度比B组慢 ,而SOD水平下降速度比B组快。结论　在CPR过程中 ,ET功能衰竭是预后不良的指标 ,ET下降速度快提示预后较差。动态监测血中SOD浓度对评估心肺复苏期间患者再灌流损伤程度及代偿能力有参考价值 ,对预测抢救效果有一定的临床意义     

3796例院内心肺复苏患者的回顾性分析

目的 了解10年来院内心肺复苏（cardiopulmonary resuscitation,CPR）现状,探索如何提高CPR特别是脑复苏水平。方法 对本院1995至2004年记录完整的3796例患者资料进行院内CPR回顾性研究。对病例数量,疾病种类,CPR有关时程、实施地点、肾上腺素用量,心肺复苏成功率及脑复苏成功率等数据进行统计与分析。结果 CPR病例数量逐年上升,21～50岁年龄段构成比增长显著,而10岁以下病例逐年减少;1999年起,创伤后CPR病例数量超过心血管病而跃居首位;心脏停搏时间大于10min者CPR成功率明显低于10min内开始CPR者（P〈0．001）;全部病例CPR成功率为30．4％,24小时生存率3．6％,脑复苏成功率仅1．4％;CPR成功率与心脏停搏时间、肾上腺素用量、初期复苏地点等有关,ICU及手术室内CPR和脑复苏成功率相对较好,普通病房最低。结论 院内CPR成功率较低,脑复苏成功率则极低。主要原因是早期生命支持“生存链”未得到切实应用。普及、加强院前和院内复苏标准化训练,完善急诊医学体系建设和管理,是提高CPR成功率的根本途径。     

A survey of ventilation strategies during cardiopulmonary resuscitation

BACKGROUND: Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation (CPR). This study aimed to investigate the CPR ventilation strategies currently being used among physicians in Chinese tertiary hospitals.METHODS: A survey was conducted among the cardiac arrest team physicians of 500 tertiary hospitals in China in August, 2018. Surveyed data included physician and hospital information, and preferred ventilation strategy during CPR.RESULTS: A total of 438 (88%) hospitals completed the survey, including hospitals from all 31 Chinese mainland provinces. About 41.1% of respondents chose delayed or no ventilation during CPR, with delayed ventilations all starting within 12 minutes. Of all the respondents who provided ventilation, 83.0% chose to strictly follow the 30:2 strategy, while 17.0% chose ventilations concurrently with uninterrupted compressions. Only 38.3% respondents chose to intubate after initiating CPR, while 61.7% chose to intubate immediately when resuscitation began. During bag-valve-mask ventilation, only 51.4% of respondents delivered a frequency of 10 breaths per minute. In terms of ventilator settings, the majority of respondents chose volume control (VC) mode (75.2%), tidal volume of 6-7 mL/kg (72.1%), PEEP of 0-5 cmH₂O (69.9%), and an FiO₂ of 100% (66.9%). However, 62.0% of respondents had mistriggers after setting the ventilator, and 51.8% had high pressure alarms.CONCLUSION: There is a great amount of variability in CPR ventilation strategies among cardiac arrest team physicians in Chinese tertiary hospitals. Guidelines are needed with specific recommendations on ventilation during CPR.     

Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation

Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4-6 minutes from the time of collapse and must be followed within 10-12 minutes of the collapse by advanced life support in order to be effective.     

心肺复苏时血管加压素的应用研究

目的　研究血管加压素在心肺复苏中的疗效。方法　４８ 例心跳停搏患者随机分为４ 组,肾上腺素标准剂量组（ Ａ 组）１１ 例,肾上腺素大剂量组（ Ｂ组）１２ 例,血管加压素组（ Ｃ 组）１２ 例,肾上腺素＋ 血管加压素组（ Ｄ组）１３ 例,各组分别观察自主循环恢复率、存活率、自主循环恢复时间。结果　 Ａ 组、 Ｂ 组、 Ｃ 组、 Ｄ 组自主循环恢复率分别为１８２ ％ 、５８３ ％ 、２５ ％ 、６９２ ％ , Ｂ 组、 Ｄ 组明显高于 Ａ 组、 Ｃ 组; Ｄ 组存活率（４６２ ％ ） 显著高于 Ａ 组（９１ ％ ） 、 Ｂ 组（１６７ ％ ） 、 Ｃ 组（１６７ ％ ） ; Ｂ 组、 Ｄ 组的自主循环恢复时间明显短于其他两组。结论　心肺复苏期间,联合应用血管加压素和肾上腺素比单独应用血管加压素、肾上腺素能显著提高自主循环恢复率和存活率,缩短自主循环恢复时间。     

心肺复苏期间患者缺血-再灌流损伤的临床研究

目的：探讨心脏复苏期间患者缺血－再灌流损伤的机制,方法：20例心搏骤停行心肺复苏术患者,根据复苏后有无自主循环分为缺血组（8例）和再灌流组（12例）。并于复苏前,复苏后即刻,15min,30min时分别测定其血中丙二醛（MDA）和超氧化物歧化酶（SOD）的浓度,比较两组患者血中上述指标的动态变化,并设正常对照组,结果：再灌流组MDA浓度较心博骤停前明显增高,尤以30min时增高显著,且明显高于缺血组,SOD浓度较心搏骤停前明显下降,尤以复苏后即刻下降显著,且明显低于缺血组,缺血组实施心肺复苏术前后MDA,SOD浓度无明显变化。结论：MDA和SOD在缺血－再灌流损伤中起着重要作用。动态监测血中MDA,SOD浓度对评估心肺复苏期间患者的再灌流损伤程度有参考价值。