急性缺血性卒中的亚低温治疗研究进展

脑缺血神经细胞损伤的保护措施一直是临床和基础研究的重点。但迄今为止,仍然缺少令人满意的措施。缺血性脑血管病的发病机制复杂,亚低温作为一种脑保护疗法,可干预脑缺血的多个病理生理学环节,对脑缺血及再灌注损伤起到保护作用。目前国际医学界将低温划分为轻度低温(33~35℃)     

IPC、IT与EPO在脑缺血耐受发生机制中的作用

一次或多次短暂的、非致死性的脑缺血刺激，即所谓缺血预处理（isehemic precondition，IPC），能让脑组织对随后发生严重的、甚至致死性的缺血产生耐受，这就是脑对抗缺血的一种自身性保护现象，又称为缺血耐受（isehemic tolerance phenomenon，IT）。然而，将IPC人为地直接用于有脑缺血隐患的人体上显然是不现实的。如果将研究证实在IT过程中确有作用的内源性神经保护介质及其制剂提供给病人，触发IPC，也许是切实可行的。最近有人提出了药物预处理、化学预处理等概念，试图通过模拟体内具有神经保护作用的内源性物质，发挥IT保护脑细胞作用。     

大剂量甲基强的松龙对大鼠急性脊髓损伤后神经细胞凋亡的影响

脊髓损伤后功能恢复不良的主要原因是原发损伤后一系列进行性继发损害导致了神经元不可逆的结构改变。甲基强的松龙（MP）具有多方面的神经保护作用，对急性脊髓损伤的疗效已被大量研究证实，不仅可以减轻脊髓水肿，而且能阻止或减轻脊髓神经细胞凋亡。我们应用大鼠急性脊髓损伤（SCI）动物模型，观察大剂量甲基强的松龙对损伤脊髓神经细胞凋亡的影响，并比较不同时间窗用药效果的差异。     

该如何保护好您的“救心药”

硝酸甘油对于心脏病患者来说可算是救命药了，查阅硝酸甘油片剂说明书，一般会注明药片的有效期为1年，可在临床实践中，不少医生发现，硝酸甘油片剂药效下降很快，甚至开封后3个月基本就无效了。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

试论患者的身体权及其法律保护

由于医疗行为领域侵犯患者身体权的行为具有隐蔽性以及人们对患者身体权的认识不足,导致了医疗行为领域中患者的身体权未得到足够的关注.文章对患者身体权的概念、身体权与健康权的区别与联系,及医学领域侵害患者身体权的几种常见行为方式进行探讨,同时阐述了身体权的法律保护形式及侵害身体权应承担的民事责任.     

"缘对缘"技术在瓣膜成形术中的应用

随着心肌保护、体外循环技术及术后管理的进步，二尖瓣置换的手术成功率及远期疗效均有明显的提高。进行性发展的二尖瓣关闭不全会引起左心房及左心室扩大，左室充盈压升高及左室后负荷减低；若不及时治疗，病变会引起心功能不全，心力衰竭甚至猝死。对于二尖瓣关闭不全，二尖瓣成形术仍是首选的治疗方法。二尖瓣成形能维持心脏的几何形态，保护心室功能，明显降低手术死亡率，降低术后心内膜炎及血栓发生率，具有良好的长期生存率，治疗效果明显优于二尖瓣置换术。     

血红素抑制内皮细胞损伤的形态学观察

目的 探讨血红素对人脐静脉内皮细胞氧化应激损伤的保护作用。方法 将培养的人脐静脉内皮细胞进行分组：对照组、损伤组、血红素组。观察各组细胞在光、电镜下形态学的改变。结果 在光镜下，血红素组细胞的生长状态明显优于损伤组；在电镜下，损伤组细胞核固缩，而血红素组细胞核幼稚，核仁明显。结论 在人脐静脉内皮细胞中，血红素对过氧化氢所造成的氧化应激损伤有明显的保护作用。     

芪桂益脉灵对大鼠冠脉结扎诱发心律失常及心肌细胞保护作用的影响

1　材料　动物 :Wistar种大白鼠 ,雌雄不拘 ,2 0 0～ 2 5 0g由黑龙江中医药大学动物实验中心提供。药品试剂 :芪桂益脉灵由黄芪 10 0g、桂枝2 0g、苦参 2 0g、三七 15g、黄连 7 5g、龙齿 2 0g、党参 5 0g、麦冬 15g、五味子 15g、炒枣仁 2 0g 10味中药组成 ,经水煎浓缩 ( 1 2 5g生药 /ml)供实验用。生化指标测定 :SOD、MDA、ATP酶试剂盒 ,购于南京建成生物工程研究所 ,国产。心肌组织凋亡细胞检测 :凋亡位末端检测试剂盒 ,德国宝灵曼公司。光学摄影显微镜 :日本Olympus。2　方法　取大鼠 2 1只 ,随机分为 3组。假手术组 (灌服同体积生…     

急性呼吸窘迫综合征机械通气时压力-容量曲线的应用

急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)是一种临床常见的危重症，以严重低氧血症、肺顺应性降低、肺毛细血管通透性增高等为特征。机械通气作为治疗ARDS的一种重要手段，其重要性是不言而喻的，但由于近年来对机械通气所致肺损伤(ventilator—induced lung injury，VILI)认识的不断加深，使人们注意到在ARDS患者接受机械通气以改善氧合的同时，如何避免VILI的发生成为一个重要的课题。而对压力／容量曲线(pressure／volumecurve，P／V曲线)进行分析，可更好地理解ARDS的病理生理，并为肺保护策略提供依据。