感染性休克病人不同中医证型与微循环改变的关系

Objective: To investigate the correlation between different Chinese medicine (CM) syndromes and variations in microcirculation in septic shock patients. Methods: seventy Septic shock patients were divided into four groups: heat damaging qi-yin group (HDQY, 23 cases); yin exhaustion and yang collapse group (YEYC, 26 cases); excessive heat in Fu organ group (EHFO, 10 cases); and heat damaging nutrient-blood group (HDNB, 11 cases). Sublingual microcirculation parameters were observed by sidestream dark-?eld (SDF) imaging and scored by Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and the Sequential Organ Failure Assessment (SOFA), and parameters of microcirculation perfusion variations and prognoses were analyzed. Results: Compared with those with qi-yin heat damage, perfused vessel density (PVD) in other groups decreased dramatically (P<0.05), and APACHE Ⅱ scores increased signi?cantly (P<0.05). In addition, the recovery time was prolonged substantially (P<0.05), and the mixed venous oxygen saturation (SVO2) decreased (P<0.05). Blood lactic acid increased signi?cantly (P<0.05), and the mixed SVO2 decreased (P<0.05), in the YEYC group. Compared with the thermal injury camp blood group, sublingual microcirculation parameter variations showed no obvious difference in the YEYC and EHFO groups (P>0.05). There were signi?cant positive correlations between CM syndromes and APACHE Ⅱ scoring in different groups (r=0.512, P<0.05). There were negative correlations between PVD and APACHE Ⅱ scoring (r=–0.378, P=0.043), the proportion of perfused vessels (PPV) and APACHE Ⅱ scoring (r=–0.472, P=0.008), as well as between the microvascular ?ow index (MFI) and APACHE Ⅱ scoring (r=–0.424, P=0.023) in different patients. Conclusion: Sublingual microcirculation may serve as a clinical diagnostic parameter of the patient condition, as well as being a prognostic indicator.     

阿托伐他汀对慢性心衰患者甲襞微循环、心室重塑及sCD40L、ET、CGRP、VEGF的影响研究

目的:探讨阿托伐他汀对慢性心衰患者甲襞微循环、心室重塑及sCD40L、ET、CGRP、VEGF的影响。方法:选取2010年10月～2012年3月于本院进行常规治疗的53例慢性心衰患者为对照组,同期采用常规治疗联合阿托伐他汀进行治疗的53例患者为观察组,后将两组患者治疗前及治疗后3个月、6个月的甲襞微循环、心室重塑指标及血清sCD40L、ET、CGRP、VEGF水平进行比较。结果:观察组治疗后3个月与6个月甲襞微循环、心室重塑指标及血清sCD40L、ET、CGRP、VEGF水平改善幅度均大于对照组,P均<0.05,均有显著性差异。结论:阿托伐他汀对慢性心衰患者甲襞微循环、心室重塑及sCD40L、ET、CGRP、VEGF的影响较为明显,可有效改善慢性心衰患者的综合状态。     

Rat pial microvascular responses to melatonin during bilateral common carotid artery occlusion and reperfusion

The present study assessed the in vivo rat pial microvascular responses induced by melatonin during brain hypoperfusion and reperfusion (RE) injury. Pial microcirculation of male Wistar rats was visualized by fluorescence microscopy through a closed cranial window. Hypoperfusion was induced by bilateral common carotid artery occlusion (BCCAO, 30 min); thereafter, pial microcirculation was observed for 60 min. Arteriolar diameter, permeability increase, leukocyte adhesion to venular walls, perfused capillary length (PCL), and capillary red blood cell velocity (V(RBC) ) were investigated by computerized methods. Melatonin (0.5, 1, 2 mg/kg b.w.) was intravenously administered 10 min before BCCAO and at the beginning of RE. Pial arterioles were classified in five orders according to diameter, length, and branchings. In control group, BCCAO caused decrease in order 2 arteriole diameter (by 17.5 ± 3.0% of baseline) that was reduced by 11.8 ± 1.2% of baseline at the end of RE, accompanied by marked leakage and leukocyte adhesion. PCL and capillary V(RBC) decreased. At the end of BCCAO, melatonin highest dosage caused order 2 arteriole diameter reduction by 4.6 ± 2.0% of baseline. At RE, melatonin at the lower dosages caused different arteriolar responses. The highest dosage caused dilation in order 2 arteriole by 8.0 ± 1.5% of baseline, preventing leakage and leukocyte adhesion, while PCL and V(RBC) increased. Luzindole (4 mg/kg b.w.) prior to melatonin caused order 2 arteriole constriction by 12.0 ± 1.5% of baseline at RE, while leakage, leukocyte adhesion, PCL and V(RBC) were not affected. Prazosin (1 mg/kg b.w.) prior to melatonin did not significantly change melatonin's effects. In conclusion, melatonin caused different responses during hypoperfusion and RE, modulating pial arteriolar tone likely by MT1 and MT2 melatonin receptors while preventing blood-brain barrier changes through its free radical scavenging action.     

Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry

Introduction

The aim of this study was to evaluate pulp oxygenation levels (%SpO₂) in patients with malignant intraoral and oropharyngeal tumors treated by radiotherapy (RT).

Methods

Pulp oxygenation levels were measured by pulse oximetry. Twenty patients were selected, and two teeth of each participant (n = 40) were analyzed, regardless of the quadrant and the area irradiated, at four different time points: TP1, before RT; TP2, at the beginning of RT with radiation doses between 30 and 35 Gy; TP3, at the end of RT with radiation doses between 60 and 70 Gy; and TP4, 4 to 5 months after the beginning of cancer treatment.

Results

Mean %SpO₂ at the different time points were 93% (TP1), 83% (TP2), 77% (TP3), and 85% (TP4). The Student's t test showed statistically significant differences between TP1 and TP2 (P < .01), TP3 (P < .01), and TP4 (P < .01). TP3 was also statistically significantly different when compared with TP2 (P < .01) and TP4 (P < .01). No statistically significant difference could be observed between TP2 and TP4.

Conclusions

Because the mean %SpO₂ before RT was greater than during and after therapy and values obtained 4 to 5 months after the beginning of RT were close to the initiation of RT, pulp tissue may be able to regain normal blood flow after RT. If the changes in the microcirculation of the dental pulp were indeed transitory, preventive endodontic treatment or extraction in patients who are currently undergoing or recently received RT and who show negative signs of pulp sensitivity may not be necessary for pulpal reasons.     

Lipid-apheresis improves microcirculation of the upper limbs

Lipid-apheresis (LA) is thought to improve microcirculation. However, limited data are available on the effects on peripheral microcirculation. We investigated upper limb microcirculation of 22 patients undergoing regular LA on a weekly basis before and after LA. Using standardized semiquantitative scales, we analyzed blood flow, vasomotor function, and erythrocyte aggregation by capillary microscopy. In addition, capillary blood flow in quiescence and under heat and cryo-stress was evaluated by photoplethysmographic and laser Doppler anemometry. Moreover, levels of vasoactive mediators adrenalin, noradrenalin, endothelin-1 (ET-1), atrial natriuretic peptide (ANP), asymmetrical dimethyl-arginine (ADMA), as well as total protein and fibrinogen were measured. We found a significant increase in blood flow, the number of perfused capillaries and an improvement of erythrocyte aggregation by capillary microscopy. Using laser Doppler anemometry, we were able to show that this increase was predominantly located in the superficial layer capillaries (Δ44.53 ± 135.81%, n.s.) and less so in deeper layer arterioles (Δ2.75 ± 24.84%, n.s.). Vascular response to heat and cryo stress was also improved after LA but failed to reach significance. LA significantly reduced levels of epinephrin (-33 ± 39.2%), ANP (-28.8 ± 20.2%), ADMA (-74.1 ± 23%), and fibrinogen (-45.4 ± 19.7%) when comparing before LA and after LA values. In summary, we found an improvement in the microcirculation of the upper limbs under LA, which may result from a decrease of vasoconstrictors, improvement of vasomotor function, and a decrease in blood viscosity or erythrocyte aggregation.     

超负荷量氯吡格雷对急诊冠状动脉介入治疗患者心肌微循环再灌注的影响

目的:观察急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介人治疗(PCI)术前应用大负荷量氯吡格雷对术后心肌微循环灌注及心脏功能的影响.方法:64例成功接受急诊PCI的STEMI患者随机分为氯吡格雷300 mg组和600 mg组.比较两组间的基础临床状况和造影情况、结果以及术后心肌呈色显像(Blush)3级获得率、ST抬高总和回落百分比(sumSTR%)、心功能以及胎盘生长因子(PIGF)、可溶性CD40配体(sCD40L)的变化.结果:术后氯吡格雷600 mg组的Blush 3级获得率明显高于300 mg组(50.0%∶21.88%,P<0.05),ST段抬高总和回落百分比显著下降[(70.90±9.51)∶(60.70±15.06)%,P<0.05],左室射血分数(LVEF%)明显增加[(70.96±9.51)∶(65.27±9.85)%,P<0.05],PIGF较300 mg组显著下降[(14.37±1.32)∶(15.85±1.71)ng/L,P<0.05],sCD40L较300 mg组显著下降[(4.93±0.71)∶(5.68±0.77)μg/L,P<0.05].结论:急性ST段抬高型心肌梗死患者急诊PCI术前给予超负荷量氯吡格雷可以改善PCI术后的心肌微循环灌注,改善心功能状况.     

Dynamic changes in cerebral microcirculation and hypoxia in the early stages of diffuse axonal injury

This study demonstrated that damage to the cerebral microvasculature,the formation of microthrombi and swelling of vascular endothelial cells occur early and peak 12 hours after injury in a rat model of diffuse axonal injury.Moreover,these pathological changes were most evident in the cerebral cortex.Cerebral microcirculatory dysfunction peaked later and had a shorter duration than axonal injury.In addition,the radioactive imaging agent,99Tcm-4,9-diaza-2,3,10,10-tetramethyldodecan-2,11-dione dioxime,was used to visualize the dynamic changes that occur in tissue with cerebral hypoxia.The results demonstrated that cerebral hypoxia occurs at an early stage in diffuse axonal injury.Cerebral hypoxia was evident 12 hours after injury and declined slightly 24 hours after injury,but was significantly higher than in the control group.The pathological changes that underpin microcirculatory dysfunction did not occur at the same time as axonal injury,but did occur simultaneously with neuronal injury.Cerebral hypoxia plays a key role in promoting the secondary brain injury that occurs after diffuse axonal injury.     

Skeletal muscle interstitial O2 pressures: bridging the gap between the capillary and myocyte

The oxygen transport pathway from air to mitochondria involves a series of transfer steps within closely integrated systems (pulmonary, cardiovascular, and tissue metabolic). Small and finite O₂ stores in most mammalian species require exquisitely controlled changes in O₂ flux rates to support elevated ATP turnover. This is especially true for the contracting skeletal muscle where O₂ requirements may increase two orders of magnitude above rest. This brief review focuses on the mechanistic bases for increased microvascular blood‐myocyte O₂ flux (V?O₂) from rest to contractions. Fick's law dictates that V?O₂ elevations driven by muscle contractions are produced by commensurate changes in driving force (ie, O₂ pressure gradients; ΔPO₂) and/or effective diffusing capacity (DO₂). While previous evidence indicates that increased DO₂ helps modulate contracting muscle O₂ flux, up until recently the role of the dynamic ΔPO₂ across the capillary wall was unknown. Recent phosphorescence quenching investigations of both microvascular and novel interstitial PO₂ kinetics in health have resolved an important step in the O₂ cascade between the capillary and myocyte. Specifically, the significant transmural ΔPO₂ at rest was sustained (but not increased) during submaximal contractions. This supports the contention that the blood‐myocyte interface provides a substantial effective resistance to O₂ diffusion and underscores that modulations in erythrocyte hemodynamics and distribution (DO₂) are crucial to preserve the driving force for O₂ flux across the capillary wall (ΔPO₂) during contractions. Investigation of the O₂ transport pathway close to muscle mitochondria is key to identifying disease mechanisms and develop therapeutic approaches to ameliorate dysfunction and exercise intolerance.