胎粪吸入综合征的治疗进展

胎粪吸入综合征(MAS)是由于胎儿宫内窘迫或产时窒息排出胎粪,吸入后发生的肺部疾病.国外统计,活产儿中羊水胎粪污染率为10%～15%,羊水胎粪污染的新生儿只有5%发生MAS;30%的MAS患儿需行机械通气,病死率为3%～5%[1].MAS的特点是气道阻塞半阻塞导致肺不张、肺气肿,从而出现通气/血流比例紊乱及气漏.吸入胎粪所致呼吸道炎症反应导致酸中毒、低血氧、高碳酸血症,肺表面活性物质(PS)被抑制.窘迫导致肺血管重塑及肺动脉高压和肺损伤.MAS是引起新生儿呼吸衰竭的主要原因之一[2].     

氨茶碱治疗新生兔重度胎粪吸入时的病理改变

目的观察氨茶碱在治疗新生兔重度胎粪吸入时的病理改变。方法将24只日龄20～30d的新生兔随机分为灌入胎粪后实施同步间歇指令通气、应用氨茶碱组(氨茶碱组)、灌入胎粪后实施同步间歇指令通气组(氨茶碱对照组)、胎粪灌入后不予通气组(通气对照组)以及灌生理盐水不予通气组(空白对照组),氨茶碱组在胎粪灌注后0.5和2.5h静脉给予氨茶碱(2.0mg/kg),各组分别于灌后6h处死。观察湿干重比及肺组织病理评分,光镜下观察肺损伤程度。结果氨茶碱组与氨茶碱对照组湿干重比值间差异有统计学意义(P<0.05)。氨茶碱组与氨茶碱对照组肺损伤评分差异有统计学意义(P<0.05)。氨茶碱对照组肺组织炎性细胞加多且弥漫性水肿较重。结论氨茶碱可减轻重度胎粪吸入新生兔的肺水肿和肺损伤。     

高频振荡通气对胎粪性急性肺损伤的影响

目的胎粪性急性兔肺损伤模型通过高频振荡通气(HFOV)干预,观察其肺组织病理变化,探讨HFOV的应用价值和基础理论.方法28只健康新西兰兔随机分对照组(n=6)、常频组(n=7)、高频组(n=9)和正常组(n=6),机械通气6 h后对兔肺进行病理学检查.结果HFOV组的炎性细胞浸润、水肿及小气道损伤均比常频组轻,各组均未见肺透明膜形成.结论针对胎粪性急性肺损伤,HFOV比常频通气可能更有利减轻肺组织损伤,提示临床治疗胎粪吸入综合征时HFOV可能比常频通气更具优越性.     

高频振荡通气对胎粪性急性肺损伤的影响

目的胎粪性急性兔肺损伤模型通过高频振荡通气(HFOV)干预,观察其肺组织病理变化,探讨HFOV的应用价值和基础理论.方法28只健康新西兰兔随机分对照组(n=6)、常频组(n=7)、高频组(n=9)和正常组(n=6),机械通气6 h后对兔肺进行病理学检查.结果HFOV组的炎性细胞浸润、水肿及小气道损伤均比常频组轻,各组均未见肺透明膜形成.结论针对胎粪性急性肺损伤,HFOV比常频通气可能更有利减轻肺组织损伤,提示临床治疗胎粪吸入综合征时HFOV可能比常频通气更具优越性.     

新生兔重度胎粪吸入模型的制备

目的观察不同浓度胎粪悬混液对新生兔的影响,建立合适的机械通气胎粪吸入模型。方法 21只新生兔,随机分成25mg/ml浓度组,45mg/ml浓度组,65mg/ml浓度组以及对照组,分别由气管导管注入胎粪悬混液4ml/kg（对照组注入等量生理盐水）,达到通气指征后,予以机械通气。观察各组8h内病死率、胎粪灌入前及胎粪灌入后30min肺顺应性（Cydn）、血气、氧合指数、肺组织大体病理情况及肺损伤病理评分。结果 25mg/ml组肺损伤小,8h内均未达到机械通气指征;45mg/ml组均在0.5h到机械通气指征,肺损伤较小;65mg/ml组在0.5h均达到机械通气标准,其病理显示肺损伤严重,实变及出血灶较大,病死率高。结论 45mg/ml组达到机械通气指征的时间较理想,肺损伤程度适中,适合做为机械通气模式等相关研究的重度胎粪吸入模型。     

比例辅助通气与持续正压通气在幼兔胎粪吸入模型上的应用比较

目的比较比例辅助通气(PAV)与持续正压通气(CPAP)在幼兔胎粪吸入模型应用的相关指标。方法将24只幼兔随机分为PAV组、CPAP组和氧疗组,每组各8只。三组幼兔均予气管插管后注入4mL/kg的45mg/mL胎粪混合物,PAV组和CPAP组在胎粪灌入后10min实施通气;氧疗组给予头罩吸氧治疗,初调吸入氧浓度(FiO2)为0.5,观察治疗3h后兔的呼吸频率(RR)、心率(HR)、血气等指标的变化。结果三组间胎粪吸入新生兔的RR、HR、血气分析的数值比较差异有统计学意义;PAV组与CPAP和氧疗组比较差异有统计学意义(P<0.05);CPAP组和氧疗组比较差异无统计学意义(P>0.05)。结论 PAV对幼兔胎粪吸入综合征(MAS)模型的治疗效果优于CPAP。     

胎粪吸入综合征的治疗进展

胎粪吸入综合征(MAS)是由于胎儿宫内窘迫或产时窒息排出胎粪,吸入后发生的肺部疾病。国外统计,活产儿中羊水胎粪污染率为10%~15%,羊水胎粪污染的新生儿只有5%发生MAS;30%的MAS患儿需行机械通气,病死率为3%~5%[1]。MAS的特点是气道阻塞半阻塞导致肺不张、肺气肿,从而出现通气/血流比例紊乱及气漏。吸入胎粪所致呼吸道炎症反应导致酸中毒、低血氧、高碳酸血症,肺表面活性物质(PS)被抑制。窘迫导致肺血管重塑及肺动脉高压和肺损伤。MAS是引起新生儿呼吸衰竭的主要原因之一[2]。1吸出胎粪、支气管灌洗国内报道活产儿中羊水胎粪污染率约9%…     

DW-3000呼吸机所致老年大鼠急性肺损伤模型的建立

目的 建立DW-3000呼吸机所致老年大鼠急性肺损伤的动物模型.方法 将20只健康老年雄性SD( Sprague Dawley,SD)大鼠随机分为2组(A组为致伤组,B组为对照组),实施麻醉和气管术切开后,吸入空气进行机械通气,通气时间4h.A组大潮气量通气(30mL/kg),B组小潮气量通气( 8mL/kg).根据动脉血气结果计算氧合指数、肺系数.测定支气管肺泡灌洗液( BALF)中IL-1β、IL-8含量及肺组织匀浆中丙二醛(MDA)总抗氧化能力(T-AOC)水平.观察肺组织病理学改变.结果 A组大鼠氧合指数较B组显著下降,肺系数较B组显著增高.A组大鼠BALF中IL-1β、IL-8[( 123.4±7.31) ng/L,(68.10±10.20)ng/L]含量较B组[(54.70±8.04)ng/L,( 37.70±7.10) ng/L]显著增高.A组大鼠肺组织匀浆中MDA水平较B组显著增高,T-AOC水平较B组显著下降.病理学结果,A组大鼠肺组织中可见较多的炎性细胞浸润和肺泡壁结构的破坏.结论 DW-3000呼吸机大潮气量通气4h后,能够造成老年大鼠的急性肺损伤.     

降低内毒素对大鼠肝肺综合征肺损伤的作用

目的:探讨氧氟沙星降低内毒素对大鼠肝肺综合征的肺损伤保护作用。方法:结扎SD大鼠胆总管,建立肝肺综合征(HPS)动物模型。将大鼠分成3组(每组10只),假手术组:分离大鼠胆总管,腹腔注射生理盐水2ml;HPS模型组:结扎大鼠胆总管,腹腔注射生理盐水2ml;氧氟沙星组:结扎大鼠胆总管后腹腔注射左旋氧氟沙星(20mg/kg体重)。6周后检测血清内毒素,血、腹水、胆汁培养需氧或厌氧菌,血气分析,测定门静脉压力,肺干重/湿重比,肺灌洗液和肺组织匀浆中髓过氧物酶含量及丙二醛浓度,并评价肺组织病理变化。结果:与HPS模型组比,氧氟沙星组血浆内毒素浓度显著下降[(59±6.2vs268±35.6)ng/L,P<0.01],门静脉压力[(19.28±2.3vs17.80±2.18)cmH2O,P<0.01]、肺组织肺干重/湿重比(5.1±0.7vs4.9±0.7,P<0.01)、肺髓过氧物酶[(0.40±0.10vs0.24±0.03)U,P<0.01]和丙二醛[(0.32±0.05vs0.22±0.03)μmol/L,P<0.01]含量均有显著降低,肺组织炎症改变明显减轻。结论:降低内毒素可以减轻肝肺综合征的肺损伤。     

依达拉奉对急性肺损伤的治疗作用及其机制探讨

目的探讨自由基清除剂依达拉奉对急性肺损伤大鼠模型的保护作用。方法将32只SD大鼠随机分为C组(生理盐水+生理盐水,n=8)、E组(生理盐水+依达拉奉,n=8)、LPS组(脂多糖+生理盐水,n=8)和LPS+E组(脂多糖+依达拉奉,n=8),各组经尾静脉注入LPS和依达拉奉或等体积生理盐水。6 h后麻醉大鼠并行动脉血气分析及肺病理学检查,检测血浆中肿瘤坏死因子α(TNF-α)和白介素6(IL-6)及肺组织中丙二醛(MDA)和NO水平。结果与C组相比,LPS组出现明显的肺损伤改变、动脉血氧分压显著下降[(99.37±4.35)mmHg vs(60.11±8.41)mmHg,P<0.01]、血浆中TNF-α[(3.89±0.53)pg/mL vs(11.95±1.97)pg/mL,P<0.01]和IL-6[(4.73±0.91)pg/mL vs(41.25±7.11)pg/mL,P<0.01]显著升高,肺组织中MDA[(2.06±0.42)nmol/mg vs(8.91±2.03)nmol/mg,P<0.01]和NO[(3.97±0.87)nmol/mg vs(8.74±2.01)nmol/mg,P<0.01]也显著升高;与LPS组相比,自由基清除剂依达拉奉使肺组织中MDA[(8.91±2.03)nmol/mg vs(3.76±0.68)nmol/mg,P<0.01]和NO[(8.74±2.01)nmol/mg vs(3.53±0.71)nmol/mg,P<0.01]显著降低,显著减轻急性肺损伤(ALI)大鼠的肺损伤程度,提高动脉血氧分压[(60.11±8.41)mmHg vs(85.69±6.41)mmHg,P<0.01],并使血浆中的TNF-α[(11.95±1.97)pg/mL vs(5.65±1.09)pg/mL,P<0.01]和IL-6[(41.25±7.11)pg/mL vs(11.06±1.27)pg/mL,P<0.01]显著降低。结论自由基清除剂依达拉奉能减轻急性肺损伤的病理生理变化,其机制在于依达拉奉能有效清除自由基并减少致炎因子的释放。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.