儿童体外循环心脏手术后甲皱微循环变化的临床观察

报告３２例先心病儿童体外循环心内直视手术后甲皱微循环变化临床观测的结果。本组病人男１５例，女１７例；年龄１０．６±２．５岁；病种包括ＶＳＤ１２例，ＡＳＤ１５例，ＴＯ１５例。采用中度低温血液稀释非搏动性体外循环［ＣＰＢ］，ＣＰＢ时间５８．５±６．８ｍｉｎ；于术前、术后定时观测甲皱微循环、ＨＣＴ、ＴＰ及ＣＯＰ。结果显示，术中ＨＣＴ、ＴＰ及ＣＯＰ急剧下降（Ｐ＜０．０１），术后甲皱微循环管袢清晰度下降、数目减少，轮廓模糊，红细胞聚集，微血流呈粒流、粒缓流，这些改变于术后３～５天恢复正常。结论认为：ＣＰＢ心脏手术期间及术后早期，影响甲皱微循环的主要因素是血液稀释（ＨＣＴ）、ＣＯＰ、ＰＨ、温度、体外循环灌注损伤、红细胞聚集性增强及药物等；观测甲皱微循环可便捷地了解微循环的形态、流态及微血管周围状态变化的情况，并对临床用药提供参考。     

复圣散对高脂大鼠脑缺血复灌后红细胞变形性和血浆内皮素的影响

通过喂饲高脂饮食造成高脂血症大鼠动物模型 ,在此基础上利用线栓法复制双侧颈总动脉脑缺血再灌注模型 ,以激光衍射法测定红细胞变形性 ,以放射免疫法测定血浆内皮素 (ET)。结果 :高脂大鼠脑缺血再灌后 1d ,红细胞变形性明显降低 ,聚集性升高 ,血浆ET也呈升高趋势 ,与正常对照组有显著差异 (P <0 0 5) ;再灌后 7d ,除血浆ET含量外 ,各项指标恢复正常 ;而中药复圣散具有明显降低高脂大鼠脑缺血再灌后红细胞聚集性、改善红细胞变形能力和抑制血浆ET分泌的作用 ,相关分析表明红细胞变形性与血浆ET显著相关。提示中药复圣散可通过降低红细胞聚集性 ,提高其变形能力 ,同时减少血浆ET的过量释放 ,而改善脑微循环灌注 ,保护脑缺血性损伤。     

红细胞聚集性的影响因素及其临床意义

红细胞聚集性是红细胞固有的一种生理特性,其受血浆因素(血浆蛋白、大分子物质、麻醉剂、微聚体等)、细胞因素(血细胞比容、红细胞沉降速度、红细胞年龄、红细胞电荷、红细胞形状、红细胞膜修饰、红细胞变形性、红细胞膜氧化损伤、剪切力等)、生理及病理、外部环境因素等影响而发生不同变化。红细胞的适度聚集是维持体内循环或微循环灌注所必需的,但过度聚集会导致微循环灌注不良甚至静脉血栓形成等病理作用。因此,临床输血时应关注患者红细胞聚集性的变化对安全输血、最大限度发挥红细胞输注效能的影响。     

体外循环心脏术后并发压力性损伤预测模型的建立

目的构建体外循环心脏术后并发压力性损伤的预测模型。方法选取543例行体外循环心脏手术的病人作为研究对象,依据压力性损伤发生情况分为压力性损伤组（n=164）和非压力性损伤组（n=379）,使用单因素和多因素logistic回归分析体外循环心脏术后并发压力性损伤的危险因素,并据此建立列线图预测模型。结果单因素分析显示:2组病人不同年龄、贫血、前白蛋白水平、术中最低体温、体外循环时间和手术时间资料间差异均有统计学意义（P < 0.01）。多因素logistic回归分析显示:年龄≥60岁、贫血、前白蛋白水平 < 280mg/L、体外循环时间≥100min和手术时间≥4 h是体外循环心脏术后并发压力性损伤的独立危险因素（P < 0.05~P < 0.01）。列线图模型验证结果显示:C-index为0.714,校准曲线趋近于理想曲线,ROC曲线的AUC为0.702（95%CI:0.681~0.727）,在10%~70%范围内,列线图模型净获益。结论年龄≥60岁、贫血、前白蛋白水平 < 280mg/L、体外循环时间≥100min和手术时间≥4h会增加体外循环心脏术后并发压力性损伤的风险,根据危险因素构建的列线图模型能有效预测体外循环心脏术后并发压力性损伤的风险。     

体外循环下红细胞变形能力的变化

目的：观察体外循环手术对红细胞变形能力的影响。方法：采用核孔滤筛法测定心脏手术病人体外循环中红细胞变形能力的变化。结果：在术前病人ＲＣＤ就已降低（Ｐ〈０．０１）。体外循环中ＲＣＤ进一步下降，在体外循环结束时ＲＣＤ明显低于术前水平（Ｐ〈０．０５）。结论：心脏手术病人术前慢性心功能不全是术前ＲＣＤ降低的主要原因，体外循环中ＲＣＤ下降是由于包括机械接触，内环境改变和多种有害物质增多等多因素所致。     

体外循环心脏手术后精神障碍发生率及相关因素

目的研究外科ICU中体外循环心脏手术后精神障碍的发生率，并分析其相关因素。方法305例体外循环冠脉搭桥和瓣膜手术病人，术前统计年龄、性别、合并症及手术种类，体外循环期间统计最低红细胞压积及总转流时间，术后统计低氧血症、高血糖及电解质紊乱发生情况。术后第1d起用CAM-ICU量表观察病人精神变化。结果305例病人中，33例术后发生精神障碍，总发生率为10．82％。其中冠脉搭桥术后发生率为14．43％，心脏瓣膜术后为3．85％；年龄、术前合并糖尿病、冠脉搭桥手术、体外循环期间红细胞压积与术后精神障碍密切相关。结论冠脉搭桥手术病人术后精神障碍发生率较高；高龄、术前合并糖尿病、冠脉搭桥手术及体外循环期间红细胞压积过低与术后精神障碍的发生密切相关。     

糖尿病患者血液流变学分析

目的 :探讨糖尿病患者血液流变学异常变化的特点及机制。方法 :对 40例 2型糖尿病患者与 44例健康体检者进行血液流变学常规检测 ,分析其异常特点及形成机制。结果 :糖尿病患者血液流变学异常主要表现为红细胞变形性降低、聚集性增强、血液粘度增加 ,与对照组相比有显著性差异。结论 :增强红细胞变形能力、降低红细胞聚集性从而改善微循环是减少并发症的重要措施之一。     

氧自由基对红细胞流变性的影响

氧自由基对红细胞流变性的影响北京安贞医院心外科王盛宇（陈宝田，刘志伟审校）关键词红细胞变性，氧自由基，清除剂近年来，随着对氧自由基的研究深入发现氧自由基除对心脏本身结构、功能产生影响外，还对红细胞变形性及组织器官的微循环产生损伤［１］，导致血液粘度升...     

两种冠状动脉搭桥术式术后cTnI测定的临床观察体会

目的：研究在心脏不停跳与体外循环下冠状动脉搭桥术这两种术式，术后心肌肌钙蛋白I(cTnI)的测定以及阳性持续时间的观察，来判断心脏损伤程度的判定。方法：按照心脏不停跳与体外循环分组，分别测定术后即刻的cTnI，以及术后2周的阳性测定。结果：外循环下手术的患者明显延长。结论：根据cTnI的测定，说明在心脏不停跳下手术，较体外循环下手术，对于心肌细胞的损伤明显减少。     

体外循环心脏微循环研究方法和乌司他丁的作用

体外循环（cardio pulmonary bypass，CPB）是心脏手术重要的支撑技术，但由于CPB是一种非生理性的循环方式，因此对机体组织、器官有着不同程度的损伤。如何在CPB过程中实现有效的心肌保护，以最大限度地减少相关手术并发症？本文从心脏微循环功能的研究方法出发，对CPB中心脏微循环重要影响因子及乌司他丁在CPB中心肌保护方面的研究进展做一综述。     

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.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.