脑脊液容量对0.5%布比卡因脊麻的影响

为探索脑脊液容量对脊麻平面的影响，２４例拟行下腹部以下手术病人随机分为三组：Ⅰ组（ｎ＝８）为ＣＳＦ自由滴出２～３滴；Ⅱ组（ｎ＝７）抽出ＣＳＦ３ｍｌ；Ⅲ组（ｎ＝９）抽出ＣＳＦ５ｍｌ。所有病人均接受１０ｍｇ０．５％布比卡因，推注速度０．５ｍｌ／ｓ。结果表明，最高头向感觉阻滞平面分别为Ｔ１０．６±１．６７，Ｔ８．６±２．２２和Ｔ４．２±１．１６，Ⅲ组组显著高于Ⅰ、Ⅱ组（Ｐ＜０．０１）。结果提示人为减少ＣＳＦ容量有助于脊麻头向扩散。     

血液灌流对兔实验性内毒素血症的清除作用

对１８只家兔，通过结扎胆总管并注入标准大肠杆菌菌株建立急性胆管炎和内毒素血症动物模型，再经股动脉及股静脉插管建立活性碳灌流系统。经灌流后，血中平均内毒素水平从２．２４Ｅｕ／ｍｌ降至０．１７Ｅｕ／ｍｌ（Ｐ＜０．００１）、本实验结果提示：用活性碳灌流能够降低血液中内毒素水平，这为内毒素血症的治疗提供了一条可能的新途径。     

全身性非特异性免疫反应对大鼠睾丸功能的影响──Ⅱ.激素水平的变化

本实验以ＳＤ雄性大鼠为实验对象，采用碳粒血管内注射的方法，给动物造成一种全身性的非特异性免疫反应状态，以观察在这种状态下睾丸和垂体的激素分泌情况。动物经每天１次，共１０天的碳粒鼠尾静脉注射后，血浆睾酮的水平（０．８９６±０．３５８ｎｇ／ｄｌ，ｎ＝５）明显低于对照组（２．６５６±０．９９３ｎｇ／ｄｌ，ｎ＝７，Ｐ＜０．００５）；血浆ＬＨ（３．６７６±１．３５０ｍＩＵ／ｍｌ，ｎ＝９，４．６２７±２．５３９ｍＩＵ／ｍｌ，ｎ＝１０）两组比较无显著差异（Ｐ＞０．０５）；ＦＳＨ实验组（３．３６２±０．９２６ｍＩＵ／ｍｌ，ｎ＝９）与对照组相比明显降低（４．８９４±１．２３６ｍＩＵ／ｍｌ，ｎ＝１０，Ｐ＜０．０１）。实验组动物睾丸间质内ＡＣＰ阳性反应细胞增多，而β－羟基甾体脱氢酶反应消失。作者认为全身性的免疫反应既可以通过垂体也可以直接的作用于睾丸内的相关细胞，从而影响睾丸的功能。     

茵陈蒿承气汤配合乳头括约肌切开术治疗急性胆管炎内毒素血症的临床研究

为了探讨与分析茵陈蒿承气汤配合内镜乳头括约肌切开术对急性胆管炎内毒素血症的治疗作用机理，将２１例符合乳头切开指征，具有内毒素血症的急性胆管炎患者随机分为切开加中药组（ｎ＝１０）和单纯切开组（ｎ＝１１）。结果与单纯切开组相比，切开加中药组患者外周血中内毒素水平明显降低（治疗后第七日，４７．８０±１１．６２ｐｇ／ｍｌＶＳ３５．９２±８．３０ｐｇ／ｍｌ，Ｐ＜０．０５），丙二醛与Ｃ反应蛋白亦明显下降（Ｐ＜０．０５）；超氧化物歧化酶与补体Ｃ３水平升高显著（Ｐ＜０．０５）。认为茵陈蒿承气汤配合乳头切开治疗急性胆管炎内毒素血症疗效显著。     

颈内与肘静脉血中抗利尿激素和β—内啡肽含量的比较

目的：比较颈内静脉血和外周静脉血中抗利尿激素（ＡＤＨ）和β－内啡肽（β－ＥＰ）含量的差异。方法：应用放免法测定１７例患者麻醉前、气管插管后、手术中和手术后３０ｍｉｎ颈内静脉血与肘部静脉血的ＡＤＨ和β－ＥＰ水平。结果：颈内静脉血的血浆中ＡＤＨ平均含量（ｐｇ／ｍｌ）分别为１４２、１７３、３６７和１９２，β－ＥＰ平均含量（ｐｇ／ｍｌ）分别为３３２、４２７、８７６和４６３；肘静脉血的血浆中ＡＤＨ平均含量（ｐｇ／ｍｌ）分别为２８、３５、７８和３９，β－ＥＰ平均含量（ｐｇ／ｍｌ）分别为６８、８７、１８２和９６。肘静脉血中两种神经肽都显著低于颈内静脉血（Ｐ＜０．０１），但与颈内静脉血中ＡＤＨ和β－ＥＰ含量变化呈正相关（ｒ＝０．９１，Ｐ＜０．０１；ｒ＝０．８９，Ｐ＜０．０１）。结论：测定颈内静脉血中ＡＤＨ和β－ＥＰ含量更易反映出其动态的变化。     

恶性梗阻性黄疸时内毒素血症,肾功能损害及乳果糖治疗的临床研究

观察了３２例恶性梗阻性黄疸病人内毒素血症（ＥＴＭ）发生率及其与肾功能损害的关系．并对乳果糖对ＥＴＭ的治疗作用进行了随机性、前瞻性研究。治疗组术前１ｄ周围静脉血ＥＴＭ发生率为４１．２％．对照组为５３．３％（Ｐ＞０．０５）；术中分别为４７．１％及６０％（Ｐ＞０．０５）；术后ｄ３分别为４１．２％及８０％（Ｐ＜０．０５）．治疗组门静脉血ＥＴＭ发生率为４７．１％，对照组为８６．７％（Ｐ＜０．０５）。乳果糖治疗组无术后肾衰；对照组１例肾衰并死亡．乳果糖治疗组发生术后肾功能损害１例（５．９％），对照组５例（３３．３％）．Ｐ＝０．０６２．结果显示，恶性梗阻住黄疸病人术后肾功能损害的发生与ＥＴＭ密切相关．在梗阻未解除、高胆红素血症的状态下，术前口服乳果糖可明显降低门静脉及术后周围静脉血ＥＴＭ发生率．保护肾功能。     

血液灌流对兔实验性内毒素血症的清除作用

对１８只家兔，通过结扎胆总管并注入标准大肠杆菌菌株建立急性胆管炎和内毒素血症动物模型，再经股动脉及股静脉插管建立活性碳灌流系统。经灌流后，血中平均内毒素水平从２．２４Ｅｕ／ｍｌ降至０．１７Ｅｕ／ｍｌ（Ｐ〈０．００１）。本实验结果提示：用活性碳灌流能够降低血液中内毒素水平，这为内毒素血症的治疗提供了一条可能的新途径。     

不同配伍芬太尼术后硬膜外病人自控镇痛效应的比较

目的：采用硬膜外病人自控镇痛（ＰＣＥＡ）技术，对不同配伍芬太尼术后镇痛效应进行了研究。方法：１００例（ＡＳＡⅠ～Ⅱ级）手术病例随机分成三组，Ｆ组（ｎ＝２０）：用０．０００４％芬太尼＋０．１５％丁哌卡因；ＢＦ组（ｎ＝４０）：用Ｆ组药液＋０．０００９％丁丙诺啡；ＭＦ组（ｎ＝４０）：用Ｆ组药液＋０．００５％吗啡；采用双盲法对比观察。结果：术后２４小时三组病人ＶＡＳ评级Ｆ组最高（Ｐ＜０．０５），ＰＣＥＡ总按数／实进数（Ｄ／Ｄ）比值在０～２范围内的病例数，ＭＦ组≈ＢＦ组＞Ｆ组（Ｐ＜０．０５），提示ＭＦ、ＢＦ组镇痛效果较好。三组病人ＰＣＥＡ期间呼吸、循环无明显变化，恶心、呕吐等并发症较低（２．５％～５．０％），后两组有１０％～１５％病人嗜睡。结论：选择芬太尼和丁哌卡因行ＰＣＥＡ时，复合小剂量吗啡（０．００５％）或丁丙诺啡（０．０００９％）其镇痛效果更好。     

肝硬变门静脉高压症患者血肾上腺素,去甲肾上腺素浓度测定

作者使用高效液相色谱检测了肝硬变门静脉高压症患者（３８例）、原发性高血压患者（２４例）和对照病人（３４例）周围静脉血及上腔静脉、周围动脉、门静脉血肾上腺素和去甲肾上腺素浓度。肝硬变组及原发性高血压组患者周围血肾上腺素浓度分别为５７．５±３７．４ｐｇ／ｍｌ和５４．９±３９．９ｐｇ／ｍｌ，差异无显著意义，但与对照组（２３．５±１１．２ｐｇ／ｍｌ）相比浓度均有显著升高（Ｐ＜０．０１）。肝硬变组及原发性高血压组患者周围血去甲肾上腺素浓度分别为４５１．１±３８１．２ｐｇ／ｍｌ和５２４．３±２１ｐｇ／ｍｌ，与对照组相比（１８３．０±８３．３ｐｇ／ｍｌ）差异有极显著意义（Ｐ＜０．０１）。术中取上腔静脉、动脉和门静脉血分别比较肾上腺素和去甲肾上腺素浓度，除上腔静脉血肾上腺素浓度的差异有显著意义外（８３．７±４６．７ｐｇ／ｍｌ与２０７．２±５５．４ｐｇ／ｍｌ，Ｐ＜０．０５），其余差异均无显著意义。本研究结果表明肝硬变门静脉高压症患者存在着明显的儿茶酚胺类递质的代谢紊乱，其对患者全身及内脏血流动力学的影响与门静脉高压症发生发展的关系值得深入研究。     

布洛芬对创伤小鼠细胞免疫功能的影响

目的 选用前列腺素合成抑制剂布洛芬（Ｉｂｕ）对创伤后细胞免疫功能变化的作用。方法Ｂａｂｌ／ｃ小鼠行创伤性截肢手术后分为Ｉｂｕ组（腹腔注射Ｉｂｕ１ｍｇ／ｋｇ,ｎ＝２８）和生理盐水组（腹腔注射生理盐水０．５ｍｌ,ｎ＝２８）,正常小鼠作为对组。手术后１、３、５、７天分别每组取７只小鼠测其淋巴细胞增殖功能和自然杀伤细胞（ＮＫ细胞）活性。结果 创伤后小鼠脾脏淋巴细胞增殖功能明显下降（Ｐ〈０．０１）,于第７天     

烫伤豚鼠早期痂下水肿液内毒素水平的研究

为了探讨烧伤后早期痂下水肿液中内毒素的含量及其变化规律，通过建立豚鼠烫伤后早期痂下水肿液收集的动物模型，用鲎试剂偶氮基质显色法测定了烫伤后早期水肿液内毒素的含量及其变化趋势。研究结果表明：①烧伤后早期痂下水肿液内毒素水平明显升高；水肿液内毒素水平２４小时以后各时相点创面脓毒症组显著高于单纯烫伤组（Ｐ＜０．０１）。②烧伤后各时相点两组动物血浆内毒素与痂下水肿液内毒素之间存在着明显的相关关系（Ｐ＜０．０５）。③痂下水肿液内毒素含量和痂下组织细菌计数的对数值间存在着明显相关关系（Ｐ＜０．０５）。提示：内毒素为严重烧伤早期痂下水肿液的重要组成成份之一，其含量随伤后时间的增加而增加；内毒素水平与创面Ｇ－细菌感染程度有关，血浆内毒素与水肿液内毒素有关。     

Quantitative endotoxin determination in blood--chromogenic modification of the limulus amebocyte lysate test

A newly developed modification of the limulus amebocyte lysate test for quantification of endotoxin levels in blood is described. The chromogenic peptide carbobenzoxy-Gly-Gly-Arg-4-methyl-cumarinyl-7-amid proved to be most suitable. The liberated fluorescent dye is diazotized with N(1-naphtyl-)-ethylen-diamin-dihydrochloride. Using this statistically proved reliable and sensitive test, endotoxin serum levels of healthy persons and patients undergoing major surgical treatment were compared. In the postoperative phase endotoxin serum levels up to 0.5 ng/ml can be detected without clinical signs of septicemia. Healthy persons show endotoxin serum levels up to 0.08 ng/ml. In rats no difference of endotoxin serum levels was detected in the portal vein, and in arterial and venous blood. So a physiological endotoxin resorption from the intestine followed by a clearance during the liver passage seems to be doubtful in this species.     

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目的 观察大肠癌病人血循环中肿瘤细胞的存在与大肠癌的分期以及术后发生肝转移之间的关系。方法 以CEAmRNA为肿瘤细胞的标志物，利用RT-PCR检测了38例大肠癌病人的术前外周血、术中门静脉血和术后外周血中微转移的肿瘤细胞。结果 血循环中CEAmRNA的阳性检出率与大肠癌的Dukes分期密切相关，即使在Dukes A期的病人中也有术前外周血和术中门静脉血中CEAmRNA的表达阳性者（33.3%）。随访发现，血循环中尤其术后外周血中CEAmRNA呈阳性的大肠癌病人日后发生肝转移的机率大大高于CEAmRNA呈阴性的病人[5/9（55.6%)vs3/26(11.5%),P=0.024]。结论 检测大肠癌病人血循环中的肿瘤细胞对于准确评估大肠癌预后具有较为重要的临床意义。     

Measurement of operative plasma endotoxin levels in jaundiced and non-jaundiced patients

A study of portal plasma endotoxin levels was performed using a chromogenic limulus amoebocyte lysate (LAL) assay. The assay proved sensitive and reproducible. In only 1 of 25 healthy subjects was the systemic plasma endotoxin level above 100 pg/ml (equivalent Escherichia coli 0111B4). In 30 non-jaundiced patients undergoing surgery the mean (+SEM) portal plasma endotoxin level (60 + 9 pg/ml) was significantly higher (p less than 0.05) than the mean level in the systemic blood (46 + 6 pg/ml), supporting the concept of endotoxin absorption from the intestine into the portal blood. In 20 patients with obstructive jaundice undergoing surgery 42% of portal, 45% of inferior mesenteric and 35% of systemic venous plasma endotoxin levels were above 100 pg/ml. There were significantly higher levels in the portal (p less than 0.05) and inferior mesenteric (p less than 0.05) compared with the systemic blood. Neither the presence of malignancy nor the duration of surgery appeared to influence endotoxin absorption. The significance of raised plasma endotoxin levels in obstructive jaundice is discussed.     

ENDOTOXIN LEVELS IN DONORS AND RECIPIENTS DURING ORTHOTOPIC LIVER TRANSPLANTATION

Background : The hypothesis being tested in this paper is that endotoxin levels in donors and in recipients during liver transplantation influences postoperative outcome. Methods : Endotoxin levels in systemic venous and portal venous blood were measured in 46 adult donors and 44 adult recipients (47 liver transplants) during the period 1992–95. Endotoxin was measured using a modification of the Limulus amoebocyte lysate (LAL) assay. Results : In the donor, systemic endotoxin levels were above normal levels at 10.0 ± 1.3 pg/mL from the start and rose to 15.8 ± 2.9 pg/mL after dissection of the hilar structures, but fell to 10.6 ± 0.8 pg/mL just prior to the removal of the liver (control = 7.8 pg/mL). The mean portal venous endotoxin levels were 18.2 ± 3.4 pg/mL after dissection of the hilar structures and 12.6 ± 0.9 pg/mL after cannulation of the portal vein. In the recipients, the highest level in the portal venous blood occurred at the end of the anhepatic phase (46.5 ± 6.7 pg/mL). The systemic venous samples in the recipients were elevated to start with, but fell rapidly to 19.3 ± 1.5 pg/mL 24 h postoperatively, and to 13.2 ± 1.0 pg/mL by day 7. The endotoxin concentrations were higher in recipients who developed complications. Conclusions : Endotoxin is elevated throughout the recipient transplantation procedure and up to 7 days postoperatively. High levels of endotoxin at induction, the anhepatic phase and at certain time points correlated with patients who developed postoperative complications.     

Endotoxemia and enhanced generation of oxygen radicals by neutrophils from patients undergoing cardiopulmonary bypass

Plasma endotoxin concentrations and oxidative burst response of peripheral blood polymorphonuclear leukocytes were examined in 12 patients undergoing coronary artery bypass. The measurements were made just before the operation, 5 minutes after removal of the aortic crossclamp, and 24 hours after the operation. Endotoxin was quantitated by a combination of a sensitive Limulus amebocyte lysate assay and rocket immunoelectrophoresis measuring picogram amounts of endotoxin. Peripheral blood neutrophils were purified by a two-step dextran sedimentation and metrizoate sodium Ficoll (Lymphoprep., Nyegaard, Oslo, Norway) centrifugation. The oxidative burst response of these cells was measured for their ability to generate superoxide anion and was determined by a cytochrome c reduction assay. Preoperatively, all the plasma samples except one were free of endotoxin. The endotoxin levels reached 100 pg/ml 5 minutes after removal of the aortic crossclamp, and except in one sample they had decreased 24 hours after the operation. Studies on the generation of superoxide by neutrophils showed a decline in the response 5 minutes after removal of the aortic crossclamp and an enhancement of the response to f-Met-Leu-Phe by cells obtained from 11 of 12 patients 24 hours postoperatively. In vitro addition of bacterial lipopolysaccharide to blood from healthy individuals also enhanced the superoxide response of the neutrophils. We conclude that during cardiopulmonary bypass the circulating blood is contaminated by endotoxin and the neutrophils are primed for enhanced generation of oxygen radicals. The released oxygen radicals may be involved in the tissue damage observed in these patients.     

内毒素对血管内皮细胞分泌功能的影响

目的　探讨内毒素对脐静脉内皮细胞分泌功能的影响。方法　选择体外培养的人脐静脉血管内皮细胞（ＨＵＶＥＣ）为研究对象,分别用内毒素、Ｌ左旋精氨酸和硝基左旋精氨酸进行处理,并检测上清液中内皮素１（ＥＴ１）和一氧化氮（ＮＯ） 含量。结果　内毒素使ＥＴ１ 和ＮＯ 含量增加;ＮＯ 则使ＥＴ１的含量降低。结论　内毒素能导致人脐静脉内皮细胞损伤,使ＥＴ１ 和ＮＯ的合成和释放增加;ＮＯ则抑制ＥＴ１ 的合成和释放。     

A new method for the quantification of beta-glucan in plasma and its application in the diagnosis of postoperative infection

In order to correctly diagnose and treat severe postoperative infections, it may be critical to detect and differentiate between endotoxin derived from Gram-negative bacteria and/or beta-glucan derived from fungi. In addition to the chromogenic assay, the turbidimetric kinetic assay has been performed for the quantification of endotoxin in plasma using Limulus amebocyte lysate as previously reported. However, it is also known that beta-glucan triggers the coagulation of Limulus amebocyte lysate. In the present study, the differentiation of beta-glucan from endotoxin and its clinical application were studied. Endotoxin was able to be inactivated in plasma using one-tenth dilution by 10 per cent ethanol or distilled water, followed by heating at 100 degrees C for 120 min, without affecting the activity of coexisting beta-glucan. The treated sample was then subjected to the turbidimetric kinetic assay using Toxinometer ET-201. Using this method, as little as 30 pg/ml of beta-glucan in the plasma may be assayed separately, with the amount of circulating beta-glucan in the plasma of normal subjects being less than 50 pg/ml. On the other hand, in patients with a fungal infection, the amount of beta-glucan in their plasma was elevated significantly. Clinically, beta-glucanemia may often occur in severe postoperative infection even if fungi are not detected.     

Determination of blood endotoxin in severely burned patients and its clinical significance

Since October 1985 to June 1987, in 12 severely burned patients with endotoxemia was observed by using a quantitative endotoxin assay of limulus amoebocyte lysate (LAL) test with a chromogenic substrate. Among the 12 patients, 4 died and 8 survived. The average age of dead group was 31.8 years (19-45 years), mean TBSA was 63% (58-80%) and mean I 18.5%. The survival group average age of survival group was 27.5 years (18-39 years), mean TBSA was 58% (18-85%) and mean I 24.4% (6-56%). The plasma endotoxin concentrations of burn patients in dead group were 105-571 pg/ml, significantly higher than that of survival group (30-240 pg/ml) and healthy human (6.44 +/- 1.96 pg/ml). It was found that the increase of endotoxemia was closely related to burn wound sepsis, positive of blood culture, systemic disseminated septicaemia. Systemic use of sensitive antibiotics may increase the level of blood endotoxin in severe gram-negative bacillus infection. Polymixin-B is an exception.     

脾切除对大鼠血浆及肝肺组织中内毒素廓清的影响

目的 观察脾切除对血浆中内毒素清除的影响及内毒素在主要脏器的分布特征,探索脾切除后上反应与组织损害的发生机制。方法 雄性Ｗｉｓｔａｒ大鼠１１２只,随机分为有脾组（ｎ＝５６,行大网膜切除术,保留脾脏）、脾切除组（ｎ＝５６,行脾切除术）。术后１周静脉注射内毒素０．１ｍｇ／ｋｇ,分别于注射前、注射后１０ｍｉｎ、０．５、１．５、４、１２、２４ｈ活杀动物,测定血浆和肝、肺组织内毒素水平,同时检测肝、肺脏器功