Changes of dipalmitoyl phosphatidyl choline after mechanical ventilation in patients with acute cerebral injury

Objective: To detect the levels of dipalmitoyl phosphatidyl choline (DPPC) in the sputum of the patients with acute cerebral injury without primary pulmonary injury after mechanical ventilation treatment. Methods: DPPC levels in sputum of 35 patients with acute cerebral injury but without pulmonary injury were detected with high performance liquid chromatography at the beginning of ventilation and 16-20 days, 21-40 days, and 41-60 days after ventilation, respectively. Results: There was no significant difference of the DPPC levels between 16-20 days after ventilation (3.36±0.49) and at the beginning of ventilation (3.37±0.58) (P>0.05). The mean levels of DPPC decreased significantly at 21-40 days (2.87 mg/ml±0.26 mg/ml, P < 0.05) and 41-60 days (1.93 mg/ml±0.21 mg/ml, P < 0.01) after ventilation compared with that at the beginning of ventilation. At the same period, the peak inspiratory pressure and the mean pressure of airway increased significantly, whereas the static compliance and the partial pressure of oxygen in artery decreased significantly. Among the 25 patients who received ventilation for more than 20 days, 8 (32%) had slightly-decreased partial pressure of oxygen in artery compared with that at the beginning of ventilation. Conclusions: Mechanical ventilation can decrease the DPPC levels, decrease the lung compliance and increase the airway pressure, even impair the oxygenation function in patients with acute cerebral injury. Abnormal DPPC is one of the major causes of ventilator-associated lung injury.     

Early changes of endothelin,nitric oxide and arginine—vasopressin in patients with acute cerebral injury

OBJECTIVE: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine-vasopressin (AVP) in patients with acute moderate or severe cerebral injury. METHODS: The early (at 24 hours after injury) plasma concentrations of ET, NO and AVP were measured with radioimmunoassay and Green technique in 48 cases of acute moderate (GCS8 in 21 cases) cerebral injury (Group A), in 42 cases of non-cerebral injury (Group B) and in 38 normal individuals (Group C), respectively. RESULTS: The early plasma concentrations of ET (109.73 ng/L+/-12.61 ng/L), NO (92.82 micromol/L+/-18.21 micromol/L ) and AVP (49.78 ng/L+/-14.29 ng/L) in Group A were higher than those in Group B (67.90 ng/L+/-11.33 ng/L, 52.66 micromol/L+/-12.82 micromol/L and 29.93 ng/L+/-12.11 ng/L, respectively, P<0.01) and Group C (50.65 ng/L+/-17.12 ng/L, 36.12 micromol/L+/-2.16 micromol/L and 5.18 ng/L+/-4.18 ng/L, respectively, P<0.001 ). The amounts of ET, NO and AVP in patients with severe cerebral injury were 116.18 ng/L+/-18.12 ng/L, 108.19 micromol/L+/-13.28 micromol/L and 58.13 ng/L+/-16.78 ng/L, respectively, which were significantly higher than that of the patients with moderate cerebral injury (92.33 ng/L+/-16.32 ng/L, 76.38 micromol/L+/-12.71 micromol/L and 36.18 ng/L+/-12.13 ng/L respectively, P<0.01 ). The early levels of ET, NO and AVP in Group A were negatively related to the GCS scales. The amounts of ET, NO and AVP were 126.23 ng/L+/-15.23 ng/L, 118.18 micromol/L+/-10.12 micromol/L and 63.49 ng/L+/-14.36 ng/L respectively in patients with subdural hematoma, which were significantly higher than those in patients with epidural hematoma (81.13 ng/L+/-12.37 ng/L, 68.02 micromol/L+/-13.18 micromol/L and 45.63 ng/L+/-12.41 ng/L respectively, P<0.01). The plasma concentrations of ET, NO and AVP in stable duration (at 336 hours after injury) in Group A and Group B were similar to those in Group C. CONCLUSIONS: ET, NO and AVP were related to the pathophysiological process that occurs in the early stage of acute cerebral injury and the values of ET, NO and AVP correlate positively with the clinical manifestations. The changes of plasma ET, NO and AVP can be regarded as important indices to assess the severity of acute cerebral injury.     

38例老年恶性肿瘤患者T淋巴细胞亚群变化分析

老年人免疫功能减退是导致肿瘤发生的重要原因。免疫功能减退主要表现在细胞免疫方面,特别是T细胞亚群在数量上和功能上发生改变时,就可能导致机体免疫功能紊乱而出现一些病理现象。为观察老年恶性肿瘤患者的细胞免疫功能,笔者对38例恶性肿瘤病人的T细胞亚群进行检测,并与30例老年慢性病人及16例健康老年人进行比较,旨在探讨老年恶性肿瘤与T细胞的关系,现报告如下。     

严重脑外伤心电图心肌酶谱改变的临床意义

检测58例严重脑外伤的心电图、心肌酶谱，有81％（47／58）心电图异常和74％（43／58）心肌酶港变化同时存在。与疾病的预后关系密切。其中死亡15例心肌酶谱持续增高直至死亡，心电图表现为Q－T间期延长，室早、室速，ST—T改变。生存的43例，两者的变化随病情而演变，病情严重，心电图表现心肌损害，心律失常严重，心肌酶论持续升高，病情好转两者趋向正常。因此，严重脑外伤后心电图和心肌酶谱的变化可作为判断伤情、预后和治疗效果的一个重要指标。     

血清DNA-p RIA对诊断肺癌的临床意义

血清DNA-p RIA是一种新的广谱的恶性肿瘤标志物,对诊断恶性肿瘤具有广谱性和诊断符合率高的特点。本文测定肺癌病人血清58例,其阳性率占82.76％(48例);检测肺部良性疾病病人血清160例作对照,阳性率4.38％(7例)(P<0.01),又测定100例正常人血清,阳性率为0(P<0.001),提示血清DNA-p RIA对诊断肺癌具有极为重要的临床意义。     

不同年龄健康人群肠道微生态差异比较

目的 分析不同年龄健康人群肠道微生态的差异,探讨年龄与肠道菌群组成变化的相关性.方法 收集少年组、成年组和老年组健康人群的粪样,对其主要菌群进行细菌培养和计数,采用荧光定量PCR技术分析其主要菌群在属水平上的定性和定量变化,计算其反映肠道定植抗力的指标B/E值(双歧杆菌与肠杆菌数值比).结果 粪便细菌培养结果显示,成年组和老年组的双歧杆菌数量较少年组明显减少(均P＜0.01),乳酸菌数量也明显减少(分别为P＜0.01、P＜0.05);老年组类杆菌和肠杆菌数量较少年组和成年组均显著增加(均P＜0.01);成年组和老年组肠球菌数量较少年组明显增加(分别为P＜0.05、P＜0.01),老年组与成年组比较也明显增加(P＜0.05);老年组的B/E值(0.88±0.13),较少年组(1.15±0.15)和成年组(1.01±0.20)显著减少(均P＜0.05).用荧光定量PCR检测双歧杆菌、类杆菌、肠杆菌数量及B/E值结果差异同细菌培养结果相符;荧光定量PCR检测少年组与老年组的乳酸菌数量差异、少年组与成年组的肠球菌数量差异较培养结果更为显著(定量PCR结果P＜0.01;培养结果P＜0.05).结论 随着年龄的增长,肠道双歧杆菌和乳酸菌数量明显减少,类杆菌、肠杆菌、肠球菌数量显著增加,肠道定植抗力也不断下降.     

骨质疏松症靶向治疗的研究和应用

骨质疏松症是一种常见疾病,是由于骨质和骨微结构的系统性破坏所导致。该病好发于老年人,尤其是绝经后妇女。随着对骨细胞分子生物学认识的不断深入,研究者揭示了骨形成过程中成骨细胞和破骨细胞之间的关键信号系统,并以此为靶点研发出了新的治疗方法。最新治疗策略的目标是抑制额外的骨吸收以及增加新生骨的形成。最有前景的新开发药物包括Denosumab(破骨细胞形成关键信号因子的单克隆抗体)、Odanacatib(破骨细胞蛋白酶——组织蛋白酶K的特异性抑制剂)以及两种内源性骨形成抑制剂(硬化蛋白和Dickkopf-1的抗体)。该文将讨论这些治疗策略的基本原理,并探讨它们的应用前景。     

唑来膦酸与阿仑膦酸钠对老年骨质疏松症骨密度和骨代谢指标的影响

正随着人类寿命的延长和老龄化社会的到来,骨质疏松症已成为人类重要的健康问题。骨质疏松导致的骨折已成为威胁老年人的一个致命杀手,和高血压、糖尿病及血脂代谢异常一并成为四大慢性流行病。全世界约有2亿骨质疏松患者,中国至少有9 000万骨质疏松患者~([1])。骨质疏松症在65岁以上人群中的发病率约为56%,每年因骨质疏松而并发骨折的患者约为12%~([2])。老年人骨折可引发或加重心脑血管并发症,导致肺部感染、褥疮等多种并发症     

无创正压通气对急性肺水肿疗效的观察

目的观察无创正压通气对急性肺水肿低氧血症的疗效。方法选择15例心源性或非心源性急性肺水肿所致的低氧血症患者,进行无创正压通气,并行心电监护、有创动脉血压、血氧饱和度、呼吸频率、血气分析、尿量等指标的监测。结果15例急性肺水肿患者存活14例,死亡1例,抢救成功率93.33％。治疗2小时后患者由烦躁转入安静,心率、呼吸频率减慢,氧分压明显提高,通气前后比较P＜0.05。结论无创正压通气,通过调节压力支持和呼气末正压水平,可降低肺间质和肺泡的渗出水肿,促进肺泡复张,改善通气血流比率,有利于气体弥散,从而提高动脉氧分压和氧饱和度。     

心血通治疗老年脑梗死的临床价值

我科于 1998年 10至 1999年 6月选择 6 0岁以上老年脑梗死病人 6 6例 ,分为心血通治疗组 36例和对照组 30例 ,观察心血通治疗老年脑梗死的有效性和安全性。1　材料与方法1 1　研究对象　选择无溶栓指征的老年脑梗死病人 6 6例 ,年龄 6 0～ 90岁 ,平均 74 12岁。分为心血通治疗组 36例和常规治疗对照组 30例。老年脑梗死易患因素、梗死部位及ＧＣＳ评分情况见表 1、2、3。表 1　老年脑梗死易患因素组　别高血压糖尿病房　颤肺心病长期卧床小　计治疗组 1 2 1 3 7 3 1 36对照组 9 1 0 82 1 30合　计 2 1 2 3 1 5 5 2 66表 2　老年脑梗死部位组…