固尔苏治疗NRDS前后血管内皮分泌功能的改变

目的 :研究肺表面活性物质 (PS)治疗新生儿呼吸窘迫综合征 (NRDS)前后血管内皮分泌功能变化及可能的治疗机理。方法 :用PS制剂固尔苏治疗 18例NRDS患儿 ,于治疗前 3 0min ,治疗后 1、 6、 12、 2 4h ,用硝酸还原酶法测定NO (一氧化氮 )、放射免疫法测定ET (内皮素 )、 6 K PGF1α (6 酮前列环素 )。结果 :固尔苏治疗后患儿NO、 6 K PGF1α明显升高 ,ET明显下降 ,与治疗前比较有显著性差异 (P <0 0 1)。治疗后 1、 6、 12、 2 4hNO、6 k PGF1α、ET各组间两两比较无明显差异 (P >0 0 5 )。结论 :PS治疗NRDS的机理可能是通过改善血管内皮功能发挥作用 ,为用外源性NO吸入和静注前列环素辅助治疗NRDS提供可能的实验依据。     

Effect of external high-frequency oscillation on severe cardiogenic pulmonary edema

Effective gas exchange can be maintained in animals without endotracheal intubation using external high-frequency oscillation (EHFO). The aim of this study was to evaluate the effect of EHFO in patients with respiratory failure due to severe cardiogenic pulmonary edema. Seven patients were ventilated with EHFO for 2h at 60 oscillations·min⁻¹, with a cuiras pressure of 36 cmH₂O (−26 to +10) and an inspiratory to expiratory ratio of 1:1, with EHFO. Blood gas values and hemodynamic parameters were measured. Significant increases were noted in cardiac index (2.3±0.5 to 2.5±0.5 l·m⁻²;P<0.05), stroke volume index (24±7 to 28±8 ml·m⁻²;P<0.05), and arterial O₂ pressure (Pao₂) (70±4 to 95±23 mmHg;P<0.01) without a change in pulmonary artery wedge pressure at 1 h after EHFO. The respiratory rate decreased from 28±3 to 22 ±3 breaths·min⁻¹ at 5 min after the termination of EHFO (P <0.01). Arterial CO₂ pressure (Paco₂) did not, however, decrease. Increased stroke volume without a change in pulmonary artery wedge pressure (preload) suggests either improved inotropic function of the left ventricle or reduced left ventricular afterload with EHFO. The use of EHFO may be effective not only for gas exchange but also for left ventricular function in patients with severe cardiogenic pulmonary edema.     

肺静脉异常连接X线诊断 (附11例报告)

目的:提高X线对肺静脉异常连接的诊断准确性,为手术治疗提供可靠的依据。材料与方法:回顾性分析了11例肺静脉异常连接的X线胸片和病理生理改变,男3例,女8例,年龄8—34岁。从血液动力学变化分析了“8”字征,镰刀综合征等X线典型征象。结果:11例中完全性肺静脉异常连接4例,部分性7例。按部位分心上型6例;心内型4例;心下型1例。肺静脉异常连接或多或少合并房间隔缺损,法鲁氏三联症,以及右肺和肺动脉发育不全。结论:肺静脉异常连接的X线征象十分复杂而多变,因此,术前的仔细观察和精心判别对于手术治疗是非常重要的。     

Two cases of fatal air embolism in children undergoing scoliosis surgery

Venous air embolism during surgery is a rare but important complication and can be rapidly fatal. We present two cases of fatal air embolism in the prone position occurring in small children undergoing surgery for progressive scoliosis.
Venous air embolism is a rare complication in the prone position. This is thought to be because in this position there is virtually no gravitational gradient between the site of surgery and the right atrium.
The possible sites of entry of air and ways that this may be minimized are discussed.     

高压氧中毒对小鼠肺毛细血管细胞色素氧化酶活性的影响

采用超微结构细胞化学和计算机图象定量分析方法，测量计算了高压下氧中毒小鼠肺毛细血管线粒体、线粒体细胞色素氧化酶二维形态学和三维立体学参数。结果表明，小鼠暴露于０．５ＭＰａ高压氧后，肺毛细血管线粒体二维形态学和三维立体学参数的值没有发生变化，但线粒体细胞色素氧化酶的活性明显降低。     

彩色超声引导下腔静脉滤器置入术30例临床分析

目的介绍超声引导下腔静脉滤器置入新方法及其对深静脉血栓形成后肺栓塞的预防作用。方法 2 0 0 2年 5月至 2 0 0 3年 7月对 30例下肢深静脉血栓形成 (其中 4例入院时出现肺栓塞 )患者在彩色超声引导下实施下腔静脉滤器置入术 ,其中 15例在滤器置入术后立即实施下肢深静脉取栓术 ,另外 15例行保守治疗。结果本组 30例均获成功 ,经 1～ 14个月平均 6个月的随访 ,除 1例出现滤器闭塞外 ,余无任何并发症及肺栓塞的发生 ,曾出现肺栓塞者滤器置入后未再发生肺栓塞。结论彩色超声引导下腔静脉滤器置入术可有效地预防深静脉血栓形成后肺栓塞的发生     

肺血管流动参数的CT相关测量研究

目的：探讨活体肺血管分支几何学和流动状态参数的特征。方法：在63例正常人胸部螺旋CT图像上测量20l0套两分支的血管横径，计算Z值和雷诺数，分析并判断不同横径血管内血液的流动状态。结果：Z值与标本数据比较有显著不同；雷诺数随血管横径的增大而增大，但不超过l000。结论：2—4mm的正常肺小血管内雷诺数＜l000，流动为层流。     

64层螺旋CT三联检查在急性胸痛诊断中的应用

目的探讨64层螺旋CT（MSCT）三联检查显示急性胸痛患者肺动脉、胸主动脉和冠状动脉病变的能力及其临床应用价值。方法70例患者进行64层MSCT回顾性心电门控肺动脉、胸主动脉和冠状动脉联合检查。采用多平面重组（MPR）、最大密度投影（MIP）、曲面重组（CPR）及容积再现（VR）多种重组技术显示肺动脉、胸主动脉和冠状动脉，评价成像质量能否满足临床诊断需要。结果平均扫描时间（8．5±1．0）s，总对比剂用量100ml。肺动脉和主动脉增强后CT值均≥200HU者占95．7％（67／70）；冠状动脉显影图像质量优的节段占85．8％（720／839），图像质量良的节段占8．6％（72／839），图像质量差的节段占5．6％（47／839）。共检出冠状动脉狭窄≥50％者20例，肺动脉栓塞2例，主动脉夹层2例。结论64层MSCT三联检查能够在8s左右1次扫描完成肺动脉、胸主动脉和冠状动脉检查，图像质量可以满足临床诊断需要，在急性胸痛病因诊断中具有很高的临床应用价值。     

C57BL/6J和C3H/HeN小鼠放射性肺损伤进程的比较研究

目的比较C57BL/6J和C3H／HeN两种小鼠放射性肺损伤进程的异同。方法采用20Gy^60Coγ射线照射C57BL/6J和C3H／HeN两种小鼠复制动物模型，应用天狼猩红染色、羟脯氨酸含量测定、免疫组织化学等方法检测Ⅰ、Ⅲ型胶原分布、羟脯氨酸含量、纤连蛋白（FN）、层粘连蛋白（LN）和α-平滑肌肌动蛋白（α—SMA）表达变化。结果照后1、3和6个月C57BL/6J小鼠肺组织病变经历炎症期、增生期和纤维化期，胶原沉积增多，照后1和3个月FN表达明显高于对照组（P〈0．01），照后6个月逐渐减少，LN表达在照后呈渐进性增加，α-SMA表达比C3H／HeN强；照后1、3和6个月C3H／HeN小鼠肺组织主要表现为间质性炎症改变，FN表达于照后1、3和6个月与对照组相比无明显变化，LN表达于照后1和3个月明显增强，6个月逐渐减少。结论20Gy^60Coγ射线照射成功复制易，抗放射性肺纤维化动物模型。C57BL/6J小鼠发生放射性肺纤维化，以胶原沉积增多出现早且显著为特征；C3H／HeN小鼠未发生放射性肺纤维化。     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.