瑞芬太尼预处理对大鼠肝脏缺血再灌注损伤的影响及机制

目的研究瑞芬太尼预处理对大鼠肝脏缺血再灌注损伤的保护作用及其可能的作用机制。方法健康SD大鼠96只,随机分为Sham组(S组)和缺血组,缺血组包括缺血再灌注组(I/R组)、瑞芬太尼预处理组(RPC组)、p38丝裂原活化蛋白激酶(p38MAPK)阻滞剂SB203580(SB)+RPC组。各组分别于再灌注末抽取静脉血、处死大鼠,收集肝组织。观察血清中谷丙转氨酶(ALT)、谷草转氨酶(AST)水平;ELISA法检测血清肿瘤坏死因子α(TNF-α)及IL-1β水平;TUNEL法测定肝细胞凋亡情况;HE染色观察肝组织病理学改变;Western blotting法测定肝组织p38MAPK及其磷酸化组分pp38MAPK的表达水平。结果与S组相比,I/R组血清ALT、AST、TNF-α及IL-1β水平均明显升高,出现明显肝组织损伤,肝细胞凋亡增加;与I/R组相比,RPC组血清ALT、AST、TNF-α及IL-1β水平均明显下降,组织病理学损伤明显减轻,肝细胞凋亡减少,肝组织pp38MAPK表达明显升高;应用p38MAPK阻断剂SB203580,肝损伤加重。结论瑞芬太尼预处理通过激活p38MAPK通路,使p38MAPK磷酸化,减轻炎症因子的产生,对大鼠肝脏缺血再灌注损伤起保护作用。这种保护作用可以被SB 203580阻断。     

库普弗细胞介导乳化异氟醚预处理对大鼠肝缺血再灌注损伤的保护作用

目的 探讨乳化异氟醚预处理对大鼠肝脏缺血再灌注损伤的保护作用,并且证明这一作用由库普弗（Kupffer）细胞介导。方法 将SD大鼠32只,制成肝脏缺血再灌注损伤模型,随机分为脂肪乳剂对照组（C组）、库普弗细胞阻断对照组（KC组）、乳化异氟醚预处理组（IP组）和库普弗细胞阻断后乳化异氟醚预处理组（IK组）,每组8只,观察肝脏缺血30rain再灌注2h后血清中丙氨酸转氨酶（AIJT）、天门冬氨酸转氨酶（AST）、肝细胞匀浆丙二醛（MDA）、超氧化物歧化酶（SOD）和肝组织病理学改变。结果 与C组相比,IP组肝脏缺血再灌注后血清ALT和AST含量显著降低,肝细胞匀浆MDA含量减少,SOD含量增加,肝组织病理学损害明显减轻;而KC组和IK组与C组相比肝脏缺血再灌注后血清ALT和AST含量,肝细胞匀浆MDA、SOD含量,肝组织病理学损害均无明显变化。结论 乳化异氟醚预处理对肝脏缺血再灌注损伤有保护作用,并且这一作用由库普弗细胞介导。     

缺血预处理对大鼠肝缺血再灌注肾损伤的影响

【目的】探讨缺血预处理对大鼠肝缺血再灌注肾损伤的影响及可能机制。【方法】30只SD大鼠,随机分为假手术对照组(Sham组)、肝缺血再灌注组(IR组)和缺血预处理组(IPC组),每组10例。Sham组仅分离肝门区;IR组用无损伤血管夹夹闭门静脉和肝动脉的分支,阻断肝左、中叶血流,缺血40 min,再灌注6 h;IPC组先缺血5 min,再灌注5 min,然后操作同IR组。肝缺血再灌注6 h,断头处死大鼠,于下腔静脉抽取血样并取左肾和左肝。血样离心测定血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)和肌酐(Cr)的含量。左肾一半制成匀浆,测定肾组织匀浆超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)的含量,另一半和左肝观察组织病理改变。【结果】与Sham组比较,IR组和IPC组ALT、AST、BUN、Cr、MDA、TNF-α和IL-6含量升高,SOD含量降低(P<0.05),肾组织病理损伤明显;与IR组比较,IPC组ALT、AST、BUN、Cr、MDA、TNF-α和IL-6含量降低,SOD含量升高(P<0.05),肾组织病理损伤减轻。【结论】缺血预处理对肝缺血再灌注导致的肾损伤有保护作用,其保护机制可能与减少氧自由基的释放和抑制炎症反应有关。     

四君子汤联合缺血预处理对大鼠肝脏缺血再灌注损伤保护作用的研究

目的探讨四君子汤联合缺血预处理（ischemia preconditioning,IPC）对大鼠肝脏缺血再灌注损伤的保护作用及机制。方法将SD大鼠100只随机分成假手术组、空白对照组、四君子汤预处理组、IPC组、四君子汤预处理＋IPC组。肝脏缺血再灌注术后检测血清天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）;检测肝细胞原位凋亡;检测肝组织中丙二醛（MDA）和超氧化物歧化酶（SOD）。结果四君子汤预处理＋IPC组ALT和AST水平与空白对照组、四君子汤预处理组、IPC组三组比较,明显降低,差异有统计学意义（P〈0.05）。四君子汤预处理组及IPC组ALT和AST水平与空白对照组比较,明显降低,差异有统计学意义（P〈0.05）。四君子汤预处理组、IPC组、四君子汤预处理＋IPC组三组中肝细胞凋亡指数和MDA水平均显著低于空白对照组,差异有统计学意义（P〈0.05）。四君子汤预处理＋IPC组中SOD水平显著高于其余四组,差异有统计学意义（P〈0.05）。四君子汤预处理组、IPC组SOD水平显著高于空白对照组,差异有统计学意义（P〈0.05）。结论四君子汤联合IPC,在大鼠肝脏缺血再灌注时减轻过氧化损伤,抑制细胞凋亡,从而起到保护作用。     

Study on the Protective Effect of Limb Ischemic Preconditioning Against Liver Ischemia-Reperfusion Injury in Rabbits With Cirrhosis

目的 探讨肢体缺血预处理( LIPC)对肝硬化兔肝缺血再灌注损伤(HIRI)是否有保护作用及其可能的作用机制.方法 建立稳定的新西兰兔肝硬化模型,将28只肝硬化兔随机分为4组,分别为假手术组(Sham 组)、缺血-再灌注组(IR组)、肝脏缺血预处理组(IPC组)、肢体缺血预处理组(LIPC组),每组7只,各组处理结束(再灌注2 h)后取血测肝功能ALT、AST水平,取肝组织测定MDA、SOD的含量.结果 LIPC、IPC组肝硬化兔血清的ALT、AST水平显著低于IR组,差别有统计学意义(P＜0.05);且与IR组相比,LIPC、IPC组兔肝组织MDA显著降低(P＜0.05),而SOD活性明显增加(P＜0.05).LIPC组与IPC组无论是血清ALT、AST水平,还是肝组织MDA、SOD的含量差异均无统计学意义.结论 LIPC能够减轻氧自由基介导的脂质过氧化反应对肝脏的IR损伤,加速自由基的清除,对伴有肝硬化的肝脏IRI也有明显的保护作用.这为伴肝硬化的患者行肝脏手术的围手术期处理中如何减轻术后肝脏IR损伤,加快患者术后肝功能的恢复提供了新的视角.     

大蒜素对大鼠肝缺血再灌注损伤的保护作用及机制研究

目的:观察大蒜素对大鼠肝缺血再灌注损伤的保护作用及大蒜素对肝缺血再灌注后肝脏细胞凋亡和p53、bcl-2蛋白的影响。方法:SD大鼠,随机分为假手术组、缺血再灌注组(I/R组)和I/R加大蒜素处理组。肝脏缺血再灌注后,分别观察血清中谷丙转氨酶(ALT)、谷草转氨酶(AST)及乳酸脱氢酶(LDH)丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性的变化;HE染色光镜下观察肝细胞的病理形态学变化;TUNEL染色观察细胞凋亡的情况;免疫组化观察肝组织bcl-2、p53蛋白含量变化。结果:经大蒜素处理后,与缺血再灌注组相比较,血清中ALT、AST、LDH、MDA含量均降低,而SOD活性增高(P<0.05);肝细胞形态学异常改变明显减轻;肝凋亡细胞减少,p53蛋白降低,bcl-2蛋白表达增加。结论:大蒜素可能通过拮抗脂质过氧化反应,清除自由基的生成,调节bcl-2、p53蛋白发挥抗凋亡作用,从而减轻缺血再灌注所造成的肝脏损伤。     

七氟烷和异氟烷对肝脏缺血再灌注损伤的影响

 【目的】探讨七氟烷和异氟烷预处理对大鼠肝脏缺血再灌注损伤(I/R)的保护作用及机制。【方法】96只SD大鼠随机分为假手术对照组(Sham)、肝脏缺血再灌注组(IR)、七氟烷预处理(Sev)和异氟烷预处理组(Iso),于肝脏缺血30min,再灌注30min、120min测各组大鼠血清中谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)的含量以及肝脏组织中谷胱甘肽(GSH)、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。【结果】肝脏缺血再灌注后IR、Sev和Iso组血清ALT、AST和LDH含量均显著升高,肝组织SOD和GSH显著降低,而MDA明显升高,和Sham组相比有显著差异(P<0.01);Sev、Iso组和IR组比较,ALT、AST、LDH和MDA降低,而SOD和GSH显著升高(P<0.05或P<0.01),其中Sev组比Iso组效果更为明显(P<0.05或P<0.01)。【结论】七氟烷和异氟烷对肝脏缺血再灌注损伤有一定的保护作用,这可能与其抑制氧自由基生成,减少脂质过氧化有关。     

二氮嗪对黄疸大鼠肝脏缺血再灌注损伤的影响

目的:研究二氮嗪对梗阻性黄疸肝脏的缺血再灌注损伤是否有保护作用。方法:采用胆总管结扎法制作梗阻性黄疸模型,雄性S-D大鼠60只,分5组:缺血再灌注损伤组(对照组),缺血30 min和再灌注120 min:GSH活性氧(清除剂)处理组,缺血再灌注前10 min静脉注射GSH 50 mg/kg;二氮嗪预处理组(A、B、c)缺血再灌注前10 min分别静脉注射1 mg/kg、5 mg/kg、10 mg/kg。结果:与时照组相比,二氮嗪预处理各组血清中ALT、AsT、LDH含量,细胞内MDA含量和SOD活性,肝细胞凋亡指数差异无显著性(P>0.05),而GSH组与对照组相比,各组血清中ALT、AST、LDH含量,细胞内MDA含量和SOD活性,肝细胞凋亡指数差别具有显著性(P<0.05)。结论:二氮嗪预处理对大鼠梗阻性黄疸肝脏缺血30 min再灌注120 min无保护作用,GSH预处理对大鼠梗阻性黄疸肝脏缺血再灌注损伤能提供保护作用。     

复方丹参对兔肝脏热缺血再灌注损伤保护作用的实验研究

目的 探讨复方丹参对兔肝脏热缺血再灌注损伤的保护作用及其相关机制.方法 采用Pringle's肝脏缺血再灌注模型,48只SD大鼠随机分成三组:假手术组(A组),肝脏缺血冉灌注组(B组)和复方丹参预处理组(c组).测定各组缺血30 min(T1)、再灌注120 min(T2)肝功能(ALT、AST)、肝组织的抗氧化能力(SOD)、脂质过氧化产物丙二醛(MAD)含量、肝指数(湿重/干重%),比较肝组织形态学改变.结果 (1)T1、T2相,B、C组与A组比较肝组织损害重:ALT、AST均升高(P<0.05);肝组织匀浆SOD含量降低;MDA含量升高(P<0.05);肝脏水肿程度上升(P<0.05);肝组织出现不同程度的病理学改变.2)在T1、T2相,C组与B组比较肝组织损害轻:ALT、AST均较低(P<0.05);肝组织匀浆SOD含量高,MDA含量减少(P<0.05);肝脏水肿程度较轻(P<0.05);肝组织出现较轻的病理学改变.结论 复方丹参通过改善肝脏微循环状况,改善缺血肝脏组织的能量代谢,提高肝组织抗氧化能力,减少肝脏细胞的变性坏死程度而对肝脏热缺血再灌注起保护作用.     

二氮嗪对黄疸大鼠肝脏缺血再灌注损伤的影响

目的：研究二氮嗪对梗阻性黄疸肝脏的缺血再灌注损伤是否有保护作用。方法：采用胆总管结扎法制作梗阻性黄疸模型，雄性S—D大鼠60只，分5组：缺血再灌注损伤组（对照组），缺血30min和再灌注120min；GSH活性氧（清除剂）处理组，缺血再灌注前10min静脉注射GSH50mg／kg；二氮嗪预处理组（A、B、C）缺血再灌注前10min分别静脉注射1mg／kg、5mg／kg、10mg／kg。结果：与对照组相比，二氮嗪预处理各组血清中ALT、AST、LDH含量，细胞内MDA含量和SOD活性，肝细胞凋亡指数差异无显著性（P〉0．05），而GSH组与对照组相比，各组血清中ALT、AST、LDH含量，细胞内MDA含量和SOD活性，肝细胞凋亡指数差别具有显著性（P〈0．05）。结论：二氮嗪预处理对大鼠梗阻性黄疸肝脏缺血30min再灌注120min无保护作用，GSH预处理对大鼠梗阻性黄疸肝脏缺血再灌注损伤能／提供保护作用。     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.