养血清脑颗粒对慢性脑供血不足患者血管内皮功能的改善及血栓前状态的影响

目的探讨养血清脑颗粒对慢性脑供血不足患者血管内皮功能障碍和血栓前状态的干预效果。方法90例慢性脑供血不足患者按就时间顺序分为A组（对照组）、B组（养血清脑颗粒组）、C组（联合用药组）各30例,分别观察3组患者用药前和用药3个月后一氧化氮（NO）、血管内皮素-1（ET-1）、纤维蛋白原（FIB）、组织型纤溶酶原激活物抑制物（PAI-1）和组织型纤溶酶原激活物（t-PA）的变化,及内皮依赖性血管舒张功能（EDD）、非内皮依赖性血管舒张功能（NEDD）的变化,并进行对比分析。结果B组、C组经过治疗后,NO水平升高,ET-1水平和FIB减低,t-PA活性增强,PAI-1活性降低,EDD显著改善,两治疗组间相比差异无统计学意义；两治疗组治疗后分别与对照组相比差异具有统计学意义。结论服用养血清脑颗粒能够有效改善慢性脑供血不足患者的血管内皮依赖性舒张功能及血栓前状态,可以作为脑血栓形成的一级预防治疗。     

血液流变学因素对缺血心肌冠脉流量的影响

选用长白猪８只于麻醉下开胸，于在体猪心上探讨心肌缺血时冠脉仍保留有部分扩张储备，而未被充分利用的机理。实验结果表明：降低左冠状动脉前降支（ＬＡＤ）内压至４．６７ｋＰａ时，由ＬＡＤ分别输入腺苷、山莨菪碱、生理盐水（２ｍｌ／ｍｉｎ），皆能诱发出明显的ＬＡＤ流量增加（Ｐ＜０．０５）。在维持ＬＡＤ内压不变，并持续分别输入上述三种溶液的同时，从ＬＡＤ远端取血测血液流变学指标，结果显示，输入生理盐水和山莨菪碱使红细胞压积降低，血浆粘度和全血粘度下降；心肌缺血时，冠脉内输注药物所诱发出的“冠脉扩张储备”部分是由于此种给药方式所引起的血液稀释及血液粘度下降的结果。它提示在冠脉狭窄时，血液粘度对狭窄远端的心肌血供可能是一个相当重要的因素，降低血液粘度可能并不亚于扩血管药物的作用。     

Effects of Phentolamine on Hemorrheology and Hemodynamics in Dogs with Acute Liver Damage

ＥｆｆｅｃｔｓｏｆＰｈｅｎｔｏｌａｍｉｎｅｏｎＨｅｍｏｒｒｈｅｏｌｏｇｙａｎｄＨｅｍｏｄｙｎａｍｉｃｓｉｎＤｏｇｓｗｉｔｈＡｃｕｔｅＬｉｖｅｒＤａｍａｇｅＤＡＮＺｉｌｉ（但自力）；ＺＨＡＮＧＷｅｎｙｉｎｇ（张文英）；ＬＩＳｈａｏｂａｉ（李绍白）（Ｉｎ...     

Heparin–coated circuit during cardiopulmonary bypass

A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint–attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.5) participated in the study. Ten patients were randomized to be treated with heparin–coated equipment (CBAS) and reduced i.v. heparin (1.5 mg kg^-1) while 10 patients treated with identical but noncoated equipment and full heparinization (3 mg–kg^-1) served in a Control group. A vacuum suction was used to collect the blood from the operating field and it was autotransfused at weaning from extracorporeal circulation (ECC). Blood samples were obtained from the venous (precircuit) and arterial (postcircuit) side. We used a new and very specific method for detection of C5a based on monoclonal antibodies. The concentration of C5a was low in both groups during the operation but a significant increase was seen on days 1 and 2. In the Control group there was an increase from 10.2 ngml^-1±1.2 to 27.5 ng ml^-1 ± 4.8 on day 2 and in the CBAS group from 10.7 ng ml^-1 ± 1.2 to 35.6 ng ml^-1 ± 11.6 on day 2 (NS between groups). The granulocytes and total leukocyte count increased at the end of ECC and was maintained at the elevated level throughout the study period. The amount of free haemoglobin was high in the autotransfused blood in both groups. The present results confirm the feasibility of reducing general heparin when using heparin–coated systems but the study does not support the superiority of such coating with regard to biocompatibility in short procedures with a Theologically optimized circuit. The potential benefit from reduced heparin and protamine has not been fully evaluated.     

Reduction in Internal Carotid Arterial Blood Flow Velocity in Children During Antiepileptic Drug Therapy with Clinical Dosages

Summary: We studied the effect of antiepileptic drugs (AEDs) on internal carotid artery (ICA) blood flow velocity, as an index of total cerebral blood flow (CBF). The subjects were 45 newly diagnosed children with febrile convulsion or epilepsy who were seizure-free for a period long enough not to affect the results. They had no neurologic deficit, received fixed monotherapy, and were examined by a noninvasive Doppler ultrasound method, in comparisonwith 13 age-matched normal volunteers with no AED. In 30 patients, the measurements were performed before and after AED administration [10 with phenobarbital (PB), 10 with carbamazepine (CBZ), and 10 with valproate (VPA)], and performed before and after AED discontinuation in the remaining 15 patients (all with PB). Normal volunteers underwent the two consecutive examinations with a mean interval equal to that of the entire patient group, and there was no difference in velocity values between the measurements. In patients receiving CBZ or VPA, a significant reduction was noted in blood flow velocity after drug administration. Although velocity values in the patients receiving PB did not change after drug administration, they were significantly increased after complete discontinuation. In the present study, a slight but significant reduction in CBF caused by AED administration at therapeutic doses in children was suggested.     

主动脉阻断期间含氧血持续肺动脉灌注的肺保护研究

目的评估体外循环主动脉阻断期间应用含氧血持续肺动脉灌注对肺功能的保护作用.方法选择杂种上海犬(上海农科院犬养殖厂)12只,体重7～12 kg.随机分成应用含氧血持续肺动脉灌注的实验组和对照组,分别测定体外循环前、结束即刻、结束后1 h的肺功能,体外循环术后2组左、右心房内血白细胞记数以及肺水含量的变化.体外循环转流前、后分别在右肺门处随机切取肺组织(3 cm×3 cm大小)送病理检查.结果术后实验组的肺功能明显改善,左、右心房血白细胞记数差异无显著性,肺水含量与对照组比较差异无显著意义.对照组显示肺泡间质明显水肿,肺泡内大量的中性粒细胞渗出,实验组保留了正常的肺组织结构.结论含氧血持续肺动脉灌注可减轻主动脉阻断期间肺组损伤,保护术后肺功能.     

婴幼儿先心病的体外循环研究

目的 :婴幼儿心内直视手术体外循环的研究。方法 :临床 115例婴幼儿分为体外循环管道不定型 (A组 )和体外循环管道定型 (B组 )两组。A组应用进口膜肺 35例 (5 7% ) ,鼓泡式氧合器 2 6例 (43% ) ,体外循环管道是临时改装。B组应用进口膜肺 4 9例 (91% ) ,鼓泡式氧合器 5例 (9% ) ,体外循环管道选择配置成型的婴幼儿管道 ,直径 6mm ,长度 10 0cm。结果 :两组患儿的年龄、体重无统计学差异 (P >0 0 1)。B组与A组相比 ,体外循环中晶体预充量由 (5 16± 172 )ml减少至 (40 0± 10 9)ml,差异性显著 (P <0 0 1)。总液量由 (933± 2 39)ml减少至 (6 2 5±171)ml,差异性显著 (P <0 0 1)。全血预充量由 (414± 183)ml减少至 (87± 10 6 )ml,差异性显著 (P <0 0 1)。两组稀释度无统计学差异 (P >0 0 1)。术后呼吸机辅助时间由 (2 4 4± 2 3 9)h缩短至 (13 2± 9 1)h ,差异性显著(P <0 0 1)。ICU时间由 (2 8± 1 5 )d缩短至 (1 6± 0 9)d ,差异性显著 (P <0 0 1)。全组 115例死亡 3例 (2 6 % )。结论 :选用优质婴幼儿膜肺 ,规范体外循环管道 ,总预充量控制在 5 0 0ml以下 ,保持较高的胶体渗透压是婴幼儿体外循环的关键     

失去肝动脉血液供应后大鼠肝门部胆管周围血管丛变化的三维构像研究

目的 探讨完全失去肝动脉血液供应后，大鼠肝门部胆管周围血管丛（PBP）的形态学变化。方法 将SD大鼠随机分为两组，对照组仅游离胆总管、门静脉、腔静脉和肝总动脉，不做切断；实验组结扎肝动脉，并切断肝十二指肠韧带除门静脉以外的其它组织，阻断其它侧支血管对肝门部胆管的血液供应。术后应用计算机对大鼠肝门部组织切片进行PBP三维可视化构建，并对PBP内层微血管进行定量分析，对胆管壁组织进行病理学检查。结果 实验组肝门部胆管分叉部位PBP平面结构显示胆管扩张，胆管壁明显增厚，壁内微血管尖细，排列紊乱，内层微血管密度减低；PBP立体构像显示空间结构紊乱，不规则，微血管细小，管壁不均匀增厚。与对照组相比，实验组肝门部PBP内层微血管总数明显减少（P〈0．01），肝门部PBP内层微动脉数也明显减少（P〈0．05）。实验组肝门部胆管壁呈慢性增生性炎症改变。结论 失去含氧量高的动脉血液供应时，PBP形态结构将会发生一系列改变，胆管壁组织也将发生相应的病理变化。     

Update on ascites and hepatorenal syndrome

Ascites is the most common complication occurring during liver cirrhosis. Even if a significant decrease in renal clearance may be observed in the first step of chronic active liver disease, renal impairment, at times complicated by the typical signs of hepatorenal syndrome, occurs only in patients with ascites, especially when tense and refractory. Experimental and clinical data seem to suggest a primary sodium and water retention in the pathogenesis of ascites, in the presence of an intrahepatic increase of hydrostatic pressure, which, by itself, physiologically occurs during digestion. Abnormal sodium and water handling leads to plasma volume expansion, followed by decreased peripheral vascular resistance and increased cardiac output. This second step is in agreement with the peripheral arterial vasodilation hypothesis, depicted by an increase in total blood volume, but with a decreased effective arterial blood volume. This discrepancy leads to the activation of the sympathetic nervous and renin-angiotensin-aldosterone systems associated with the progressive activation of the renal autacoid systems, especially, that of the arachidonic acid. During advanced cirrhosis, renal impairment becomes more sustained and renal autacoid vasodilating substances are less available, possibly due to a progressive exhaustion of these systems. At the same time ascites becomes refractory inasmuch as it is no longer responsive to diuretic treatment. Various pathogenetic mechanisms leading to refractory ascites are mentioned. Finally, several treatment approaches to overcome the reduced effectiveness of diuretic therapy are cited. Paracentesis, together with simultaneous administration of human albumin or other plasma expanders is the main common approach to treat refractory ascites and to avoid a further decrease in renal failure. Other effective tools are: administration of terlipressin together with albumin, implantation of the Le Veen shunt, surgical porto-systemic shunting or transjugular intrahepatic portosystemic stent-shunt, or orthotopic liver transplantation, according to the conditions of the individual patient.     

MAGNETIC RESONANCE IMAGING IN POSTERIOR CIRCULATION INFARCTION: IMPACT ON DIAGNOSIS AND MANAGEMENT

To compare the diagnostic yield of magnetic resonance imaging (MRI) with computed tomography (CT) in posterior circulation infarction, we used proton MRI with a 0.3 Tesla magnet and a 3rd generation CT scanner in 25 patients. Age-matched controls were compared in a blinded fashion. Seventeen patients (68%) showed relevant pathology on MRI not seen on CT, 11 with normal CT and six with more extensive lesions, chiefly in the brain stem. Evidence of abnormal vertebrobasilar blood flow was seen in 8/25 (32%) of patients, suggested by vascular high intensity signals on MRI. Two tissue and one flow abnormality were seen in the control group. MRI provides additional information concerning infarct site, extent and pathogenesis in posterior circulation infarction.