Endothelial Regulation of Vascular Repair: Role of bFGF in Paracrine Pathways

Vascular repair following injury is mediated by both endothelial and smooth muscle cells often through paracrine pathways. Basic fibroblast growth factor (bFGF) is present at sites of vascular injury. The role of bFGF in regulating reendothelialization through an effect on centrosome redistribution in cell migration is discussed. The role of bFGF in neointimal formation, especially as it relates to smooth muscle cell proliferation, is reviewed. It is concluded that bFGF appears to be an important agent regulating the early responses of the artery wall to injury. Presented in part at the Molecular Endocrine Pathology Symposium at the International Academy of Pathology XXI International Congress, Budapest, Hungary, October 20–25, 1996.     

The effect of baricity of intrathecal bupivacaine for elective cesarean delivery on maternal cardiac output: a randomized study

BackgroundHemodynamic instability during spinal anesthesia for cesarean delivery is associated with adverse maternal and fetal outcomes. Plain and hyperbaric bupivacaine are commonly used for cesarean delivery, however, their distinctive pharmacologic properties may affect maternal hemodynamic profiles differently. The aim of this study was to compare hemodynamic profiles using a suprasternal Doppler cardiac output (CO) monitor in healthy term parturients randomized to receive plain or hyperbaric bupivacaine for cesarean delivery.MethodsOne hundred-and-sixty-eight healthy parturients scheduled for elective cesarean delivery were randomly assigned to receive 10.9 mg of intrathecal 0.5% plain or hyperbaric bupivacaine, both with 0.2 mg morphine. The primary outcome was CO change after spinal anesthesia. Secondary outcomes were the incidence of hypotension, vasopressor use, and conversion to general anesthesia.ResultsThe mean (±SD) CO at baseline, 1 min and 5 min after spinal anesthesia, and after placental delivery was 4.6 ± 1.2, 5.4 ± 1.3, 5.1 ± 1.4, and 6.4 ± 1.7 L/min in the plain bupivacaine, and 4.5 ± 1.1, 5.2 ± 1.3, 4.9 ± 1.3, and 6.2 ± 1.9 L/min in the hyperbaric bupivacaine group. There were no significant differences in CO, mean arterial pressure, or systemic vascular resistance. Incidences of hypotension, vasopressor and supplemental analgesic use, and conversion to general anesthesia, were not different between groups.ConclusionsCardiac output changes after plain or hyperbaric bupivacaine were not different in term parturients undergoing spinal anesthesia for cesarean delivery. Further studies comparing block quality and the rate of conversion to general anesthesia are required.     

冠状动脉架桥术麻醉及围手术期处理

目的 :介绍 1997年 4月至 1999年 10月我院 180例冠脉架桥手术 (CABG)患者麻醉特点及处理原则。方法 :采用小剂量咪唑安定 ,阈下值氯胺酮 ,常规剂量芬太尼诱导 ,异氟醚、异丙酚持续镇静的麻醉方法 ,分析180例接受CABG手术的患者的临床资料及麻醉用药情况和术中血流动力学状况。结果 :本组麻醉诱导平稳 ,循环稳定 ,体外循环时间平均 115min ,升主动脉阻断时间平均 5 5min。围术期死亡率 0 6 % (1例死于鱼精蛋白过敏 )。患者术后清醒时间 46h ,拔管时间平均 14h。结论 :即使是在严重冠心病患者 ,采用多种小剂量镇静药及大剂量芬太尼诱导、维持的麻醉方法 ,能获得平稳的麻醉诱导和维持以及稳定的血流动力学状态 ,从而有效防止围手术期低血压和心律失常造成的心肌缺血和围手术期心肌梗死的发生。     

Acute systemic and antiischemic effects of epanolol in patients with coronary artery disease

Summary Antiischemic effects of ₁-blocking agents are based on intrinsic negative inotropic and chronotropic properties. Partial ₁-agonistic activity, although useful in preserving cardiac function, may counteract such antischemic properties by modulating the intrinsic negative cardiac effects of beta-blockade. To investigate the acute hemodynamic and antiischemic profile of epanolol, a cardioselective ₁-antagonist and partial agonist, 20 patients with left coronary artery disease underwent two incremental atrial pacing tests, 45 minutes before (APST I) and 15 minutes after (APST II) 4 mg intravenous epanolol, administered over 5 minutes. Additional measurements were carried out at 1, 3, 5, 10, and 15 minutes after epanolol, at basal and fixed heart rates. Epanolol immediately reduced heart rate with a maximum of 10% at 15 minutes and decreased contractility (Vmax) by 7% (both p<.05), whereas cardiac output fell temporarily by 9% (p<.05). Other hemodynamic parameters did not change, except for a significant 11% reduction in myocardial oxygen demand. Despite comparable pacing conditions, both the double product and contractility decreased significantly less during APST II, resulting in a 17% lower myocardial oxygen consumption (p<.05). Myocardial ischemia was markedly reduced, indicated by normalization of lactate metabolism [lactate extraction 16±7% vs. –7±8% (APST I)], less ST depression (21%), and modulation of LV end-diastolic pressure postpacing (all p<.05 vs. APST I), whereas angina was absent or less in 14 patients. None of the patients reported an adverse effect. Thus, under resting conditions intravenous epanolol induces moderate, short-lasting negative chronotropic and inotropic effects, but does not alter cardiac pump function or vascular resistance, reflecting its additional ₁-agonistic properties. Alternatively, during pacing it still reduces ischemia through negative inotropic effects and diminishes myocardial oxygen demand, reflecting its ₁-antagonistic profile.     

雷公藤多甙和消炎痛对蛋白尿病人肾脏作用的临床研究

目的　研究雷公藤多甙 (TripterigiumWilfordiiGlycosides ,TWG)对蛋白尿患者肾血流动力学的作用 ,并与消炎痛比较 ;方法　TWG组和消炎痛组各 1 5例病人 ,治疗前后分别检测尿蛋白定量、肾小球滤过率 (GFR)、肾有效血浆流量 (ERPF)和肾血管阻力 (RVR) ;结果　两组患者尿蛋白排泄均显著减少 ,TWG组治疗后RVR、GFR、ERPF无显著性变化 ,而消炎痛组RVR升高、ERPF下降、GFR无显著性下降 ;结论　消炎痛减少尿蛋白排泄伴ERPF降低和RVR升高 ,而TWG减少尿蛋白排泄而不伴ERPF和RVR变化。     

胰原性区域性门脉高压症血流动力学的临床研究

目的：研究胰原性区域性门脉高压症静脉血流动力学改变。方法：利用彩色多普勒及直接测量法测量血流动力学及脾静脉压力。结果：门静脉、肠系膜上静脉的血管直径、平均流速在两组间无差异。实验组脾静脉直径扩张,流速降低且静脉压力明显升高（Ｐ＜０．０５）。结论：胰原疾病可导致区域性门脉高压,正确的治疗方法是行脾脏切除术。     

Peroperative cardiovascular stability during brainstem surgery. The use of high-dose methylprednisolone compared to dexamethasone. A retrospective analysis

BACKGROUND: In neurosurgical procedures within brainstem structures, corticosteroids are routinely administered to prevent oedema and to reduce intraoperative trauma. After replacing the routine administration of dexamethasone (DX) by high-dose methylprednisolone (MP) during surgery for tumours within brainstem structures, a decreased incidence of intraoperative haemodynamic instability events was observed. To test this hypothesis, a retrospective analysis was performed. METHODS: Peroperative data of 62 surgical procedures of brainstem tumours were retrospectively analysed with respect to haemodynamic instability requiring changes in surgical strategy and/or emergence medication with vasoactive drugs. Severe changes in haemodynamic parameters were defined as a significant increase or decrease in heart rate and/or mean arterial blood pressure greater than 30% compared to baseline values. From 1988 to 1994, intravenous dexamethasone was given peroperatively in 33 patients. After a bolus of 1 mg kg(-1) body weight (BW) 30 min preoperatively, 0.2 mg kg(-1) were given every 4 h. From 1994 until now, methylprednisolone was administered instead of dexamethasone in 29 patients. After an initial bolus of 30 mg kg(-1) BW immediately before surgery, 5.4 mg kg(-1) h(-1) were given 23 h postoperatively. RESULTS: The results of this retrospective analysis suggest that the number of operations with episodes of bradycardia, arterial hypotension (P<0.05), tachycardia and arterial hypertension (P<0.005) was significantly decreased in the group of patients treated with high-dose methylprednisolone. CONCLUSION: The retrospective analysis of the clinical data showed that the routine use of high-dose methylprednisolone was associated with a decreased incidence of haemodynamic instability in a selected group of patients undergoing brainstem surgery. This finding has to be proven in prospective double-blind controlled studies.     

生脉注射液治疗原发性低血压临床观察

目的:探讨生脉注射液治疗原发性低血压的疗效及其对血液动力学的影响。方法:采用随机单盲法,将78例原发性低血压患者分为2组,其中40例用生脉注射液治疗作为治疗组,38例以维生素C静脉滴注为对照组,两组均连续用药4周。结果:治疗组的显效率和总有效率分别为45.0%和95.0%;对照组为2.6%和10.5%,两组比较差异非常显著(P<0.01)。生脉注射液治疗后患者收缩压、舒张压、心排出量、心脏指数和射血分数均明显增加,与治疗前比较有非常显著性差异(P<0.01)与对照组比较亦有非常显著性差异(P<0.01)。治疗期间生脉注射液组未见不良反应。结论:生脉注射液是治疗原发性低血压的一种有效而安全的药物。     

上胸段硬膜外阻滞和药物治疗对心绞痛患者的影响

目的对比观察上胸段硬膜外阻滞（TEA）和药物治疗对顽固性心绞痛（RAP）患者血流动力学及Q—Td主要指标的影响。方法选择内科治疗RAP患者印例随机分为两组，A组（n=30）采用TEA，T3-4或T4-5间隙穿刺，外接患者自控镇痛泵（PCA），首次量为1％利多卡因5mL，阻滞平面T1-5；48h内持续恒速泵入0．125％布比卡因2mL／h维持。记录TEA治疗前、后的血压、心率、视觉模拟评分（VAS）和即时心电图等变化情况，计算心肌耗氧RPP指数，即二相乘积（D—P）。B组（n=30）常规给予硝酸酯类、钙通道阻滞剂、β受体阻滞剂及硝酸甘油治疗。结果A组患者经TEA治疗后收缩压和舒张压较B组明显下降（P＜0．05），心率未见明显变化，D—P降低；A组患者Q—Td、校正的Q—T离散度（Q—Tcd），JT离散度（J-Td）和校正后的JT离散度（J—Tcd）较治疗前明显下降。结论上胸段硬膜外阻滞治疗顽固性心绞痛优于单纯药物治疗，是治疗顽固性心绞痛的有效方法之一。