乌司他丁对心脏瓣膜置换术患者炎性因子的影响

目的研究乌司他丁在体外循环（cardiopulmonreal bypass,CPB）心脏瓣膜置换手术中对炎性细胞因子以及炎症反应的影响。方法选择择期体外循环下行瓣膜置换术病人36例,随机分为乌司他丁组（U组）和对照组（C组）,每组18例。U组给予乌司他丁1．2×10^4U／kg,C组予与等容量生理盐水。分别于麻醉诱导前（T1）,CPB开始后1h（T2）,CPB停止后1h（T3）,CPB停止后24h（T4）抽取动脉血,用酶联免疫吸附（ELISA）法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。结果两组病人血浆TNF-α、IL-6和IL-10的浓度,在T2～T4各时点与CPB前比较均明显增加（P〈0．05）;T2-T4时点U组血浆TNF—α和IL-6浓度明显低于C组（P〈0．01）,IL-10浓度明显高于C组（P〈0．05）。结论乌司他丁能抑制CPB过程中促炎细胞因子TNF—α和IL-6的释放,促进抗炎细胞因子IL-10的释放,调节促炎因子和抗炎因子之间的平衡,从而减轻体外循环期间炎症反应。     

乌司他丁对体外循环心内直视手术中炎性细胞因子的影响

目的 观察乌司他丁在体外循环心内直视手术中对炎性细胞因子水平的影响.方法 30例体外循环心内直视手术患者随机分为乌司他丁组(U)和对照组(C),每组各15例.乌司他丁组(U)总量给予乌司他丁12000 IU/kg,分别在体外循环前静脉滴入半量,体外循环机内加入半量.对照组(C)用等量的生理盐水.分别在切皮前(T1)、体外循环开始后30 min(T2)、体外循环停止(T3)、体外循环结束后2h(T4)、体外循环结束后4h(T5)、体外循环结束后24 h(T6)采集血标本,测定血清中的肿瘤坏死因子(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10).结果 两组T2、T3、T4、L、T6各时间点TNF-α、IL-2、IL-6、IL-8、IL-10均明显高于T1(P＜0.01或P＜0.05),而U组TNF-α、IL-2、IL-6、IL-8明显低于C组(P＜0.01或P＜0.05),IL-10均明显高于C组(P＜0.01或P＜0.05).结论 体外循环导致白细胞激活,大量炎性介质释放和自由基产生,激发全身炎症反应综合症.乌司他丁应用于体外循环心内直视手术中可以减少TNF-α、IL-2、IL-6、IL-8的释放,促进抑炎细胞因子IL-10的分泌,从而减轻有效地降低由于CPB引发的炎症反应,减轻心肌的缺血再灌注损伤,起到保护心肌的作用.     

抑肽酶和乌司他丁在体外循环中抗炎作用的比较

目的 比较抑肽酶和乌司他丁在心脏手术体外循环(extracorporeal circulation,ECC)中的抗炎作用.方法 选择60例心脏瓣膜置换手术患者,ASAⅡ-Ⅲ级,按随机数字表法分为乌司他T组(U组)、抑肽酶组(A组)和空白对照组(C组),每组20例.于ECC前15 min(T1)、开放升主动脉后10 min(T2)、ECC结束后30 min(T3)、ECC结束后60 min(T4)4个时点取颈内静脉血测定下列指标:血浆IL-6、IL-8、IL-10及肿瘤坏死因子-α(TNF-α)浓度.分析3组各时点炎性因子的变化.结果 3组血浆IL-6、IL-8、IL-10、TNF-α浓度在T2、T3、T4时点均明显高于T1时点(P<0.01);血浆IL-6、IL-8、TN-α浓度在T1、T2、T3、T4时点U组明显低于A、C组(P<0.05,P<0.01),A组明显低于C组(P<0.05);血浆IL-10浓度在T2、T3、T4时点U组、A组明显高于C组(P<0.05,P<0.01),U组明显低于A组(P<0.05).结论 乌司他丁和抑肽酶在ECC中都能抑制炎性因子的产生,并可上调抗炎因子表达.乌司他丁在抑制炎性因子的产生方面强于抑肽酶,而抑肽酶上调抗炎因子表达的作用优于乌司他丁.两者都可有效抑制ECC诱发的炎性反应.     

乌司他丁对食管癌根治术中肺损伤的保护作用

目的 探讨乌司他丁在全麻食管癌根治术单肺通气(OLV)中的肺保护作用及其机制.方法 全麻OLV下食管癌根治术患者40例,随机分为乌司他丁组(A组)和对照组(B组),每组20例.A组OLV开始后,静脉泵注乌司他丁10 000 IU/kg,1 h内注完;B组给予等量生理盐水.两组分别在麻醉诱导后(T0)、OLV 后1 h(T1)、OLV 后2 h(T2)、术后2 h(T3)及术后24 h(T4)5个时点采集动脉血,检测HMGB1、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)浓度.结果 两组T0时点的HMGB1、TNF-α、IL-6 、IL-8、IL-10的血清浓度无明显差异(P＞0.05);两组病人T1、T2、T3、T4时点与T0比较HMGB1、TNF-α、IL-6 、IL-8、IL-10血清浓度显著升高,差异具有统计学意义(P＜0.05);与B组相比,A组T1、T2、T3、T4时点HMGB1、TNF-α、IL-8水平显著降低(P<0.05),IL-10水平明显升高(P<0.05).结论 乌司他丁显著增加食管癌根治术OLV患者血清IL-10的浓度,抑制HMGB1、TNF-α、IL-6 、IL-8浓度的升高,在食管癌根治术OLV过程中起肺保护作用.     

乌司他丁对幼猪深低温低流量体外循环心脏手术肾损伤的影响

目的：评价乌司他丁对幼猪深低温低流量体外循环（CPB）心脏手术肾损伤的影响.方法：北京长白幼猪15例,分为乌司他丁组（U组,n=5）、对照组（C组,n=5）和假手术组（S组,n=5）.U组和C组麻醉后正中开胸,常规建立CPB,体温降至25℃后,开始低流量循环（50 mL·kg-1·min-1）,主动脉阻断120 min后开放,停机后观察120 min,U组在CPB开始和循环开放即刻分别给予乌司他丁1.2万IU·kg-1,C组给予等量0.9％氯化钠溶液.S组麻醉后单纯开胸.实验动物在麻醉诱导后即刻（T1）、U组和C组在停机后5 min（T2）、120 min （T3）取静脉血,检测胱抑素C（CysC）、血肌酐（SCr）、尿素氮（BUN）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）.三组动物在实验结束时,测尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）,取肾组织行病理检查.结果：三组动物均完成至实验结束.三组动物在T1时点的CysC、SCr、BUN、IL-6、TNF-α差异均无统计学意义（均P＞0.05）;在T2时点,U组的CysC、SCr、BUN、IL-6、TNF-α此C组分别降低12.50％（P＞0.05）、2.97％（P＞ 0.05）、0.37％ （P＞ 0.05）、26.28％ （P＜ 0.05）、10.81％ （P＜0.05）;在T3时点,U组的CysC、SCr、BUN、IL-6、TNF-α分别比C组降低24.37％（P＜0.05）、17.20％（P＜0.05）、16.82％（P＜0.05）、18.12％（P＜0.05）、8.57％（P＞ 0.05）.与C组相比,U组尿NAG降低51.17％ （P＜0.05）.C组和U组均可见肾损伤,U组较轻,S组未见肾损伤.结论：深低温低流量CPB心脏手术对幼猪存在肾损伤,乌司他丁可通过抑制炎症反应来达到对抗肾损伤（肾保护）的作用.     

乌司他丁对胰腺缺血-再灌注损伤大鼠血清炎性因子TNF-α和IL-1β的影响

目的探讨乌司他丁是否能抑制胰腺缺血再灌注损伤大鼠炎性因子的释放.方法SD大鼠72只随机分为假手术组、缺血再灌注组和乌司他丁组.分别检测胰腺缺血再灌注0、6、12h及24h血清中肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）的变化.结果缺血再灌注组的各时点TNF-α含量明显高于假手术组和乌司他丁组（P〈0.05）;缺血再灌注组和乌司他丁组的IL-1β含量在6h、12h、24h较假手术组明显增加（P〈0.05）,但乌司他丁组增高水平明显低于缺血再灌注组（P〈0.05）.结论乌司他丁可以抑制胰腺缺血再灌注损伤大鼠炎性因子的释放,对大鼠胰腺缺血再灌注损伤有保护作用.     

乌司他丁对体外循环冠脉搭桥手术围术期炎症反应的影响

目的:探讨乌司他丁对体外循环冠脉搭桥手术(CABG)围术期炎症反应的影响.方法:择期行CABG患者40例,随机分为对照组(C组,n=20)和乌司他丁组(U组,n=20).U组于体外循环(CPB)前静脉滴注乌司他丁1.5×10~4 U/kg,C组于相同时间静脉滴注生理盐水.分别于麻醉诱导前(T1)、CPB1h(T2)、CPB后1h(T3)、CPB后24 h(T4)检测血浆肿瘤坏死因子(TNF-α)、白细胞介素(IL)-6、IL-10和中性粒细胞弹性蛋白酶(NE)的浓度.比较两组患者手术后的恢复情况.结果:与T1相比,2组患者在T2,T3,T4时点TNF-α,IL-6,IL-10及NE的浓度均明显升高((P<0.05);U组在T2,T3,T4的TNF-α,IL-6及NE浓度均明显低于C组(P<0.05),而IL-10的浓度明显高于C组(P<0.05).U组患者术后肺、肾及脑功能明显优于C组(P<0.05),心、肝功能及ICU停留时间无明显差异(P>0.05).结论:乌司他丁能够减轻体外循环冠脉搭桥手术围术期炎症反应,减少术后并发症.     

乌司他丁对肝癌切除术患者炎症反应的影响

目的观察乌司他丁在肝癌切除术中的抗炎效应。方法将美国麻醉医师协会体格情况分级Ⅰ～Ⅱ级行肝癌切除术的40例患者按随机数字表法分为乌司他丁组和生理盐水组,每组20例。实施静脉吸入复合全身麻醉诱导插管后,乌司他丁组以乌司他丁10 000 U.kg-1溶于20 mL生理盐水中,生理盐水组给予等量的生理盐水,于切皮即刻20 min内经外周静脉持续恒速泵入。分别于术前(T1)、术后(T2)、术后6 h(T3)、术后24 h(T4)抽取中心静脉血,分离血清后采用LiquiChip液相蛋白芯片系统检测血清细胞因子白细胞介素(IL)-6、IL-8、IL-10和肿瘤坏死因子-α(TNF-α)水平。结果组间比较显示,2组T1时IL-6、IL-8、IL-10及TNF-α比较差异均无统计学意义(P>0.05);2组间同一时间的IL-8、TNF-α水平差异均无统计学意义(P>0.05);T2、T3、T4时乌司他丁组的IL-6水平低于生理盐水组(P<0.05),IL-10水平高于生理盐水组(P<0.01),差异均有统计学意义。组内比较显示,2组各时点之间TNF-α水平差异均无统计学意义(P>0.05);T2、T3、T4时乌司他丁组和生理盐水组的IL-6、IL-8、IL-10水平均高于T1时点,差异有统计学意义(P<0.01);且IL-6、IL-8水平均随时间推移而升高,差异有统计学意义(P<0.05);而T2、T3、T4时点之间IL-10水平差异无统计学意义(P>0.05)。结论肝癌切除术中存在炎症反应,乌司他丁可抑制血清促炎因子的生成,同时可促进抗炎因子的产生。     

乌司他丁对后腹腔镜手术细胞因子及肾功能的影响

目的 探讨乌司他丁对后腹腔镜手术患者术中、术后细胞因子及肾功能的影响。 方法 40例全麻下行后腹腔镜手术患者随机分为乌司他丁组(U组, 20例) 和对照组(C组, 20例)，U组于麻醉前及术后1d各静脉滴注乌司他丁20万u，检测两组患者麻醉开始前（T0）、气腹后30 min (T1) 、解除气腹后10 min(T2)、术后1d(T3)时白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、半胱氨酸蛋白酶抑制剂C(Cys C)、尿α1-微球蛋白（α1-MG）。结果 U组T1,T2,T3时 IL-6升高水平较C组明显降低，IL-10升高水平较C组明显升高，Cys C及α1-MG升高水平较C组明显降低。结论 乌司他丁能明显改善后腹腔镜术术中、术后细胞因子的释放，减轻后腹腔镜术对肾功能的影响。 【关键词】乌司他丁 细胞因子 肾功能 后腹腔镜     

乌司他丁联合参麦注射液治疗急性胰腺炎相关肺损伤的临床研究

目的 观察乌司他丁联合参麦注射液对急性胰腺炎相关急性肺损伤的临床治疗效果.方法 选取急性胰腺炎相关肺损伤患者60例,随机分为乌司他丁＋参麦组（US组）、乌司他丁组（U组）和对照组（C组）,每组20例.C组给予常规治疗,U组在常规治疗基础上每日静脉滴注乌司他丁（6000U/kg）,US组在常规治疗基础上每日静脉滴注乌司他丁（6000U/kg）和参麦注射液（0.6ml/kg）.分别于治疗前、治疗后第3、7天行动脉血气分析,计算氧合指数,测定血清TNF-α、IL-1β和IL-6浓度.结果 与C组比较,U组和US组治疗后3和7天血清TNF-α、IL-1β和IL-6浓度下降,治疗后7天氧合指数升高（P＜0.05）;与U组比较,US组治疗后7天血清TNF-α、IL-1β和IL-6浓度下降,氧合指数升高（P＜0.05）.结论 乌司他丁联合参麦注射液能进一步抑制炎性介质释放,减轻急性胰腺炎相关肺损伤.     

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…     

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.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

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.