川芎嗪对实验性肺纤维化肺泡巨噬细胞释放肿瘤坏死因子的影响

目的探讨川芎嗪防治大鼠肺纤维化的机制。方法将48只SD大鼠一次性气管内注入博莱霉素A5(BLMA5)制备肺纤维化模型,随机分为模型对照组及实验组各24只,在实验的d3、d7、d14、d28分批处死后进行支气管肺泡灌洗并收集灌洗液(BALF);另取8只为空白对照组,于实验的d28一次性处死计数细胞总数及分类计数,采用ELISA法测定肺泡巨噬细胞(AM)培养上清液中肿瘤坏死因子α(TNFα)水平。结果模型对照组各期BALF细胞计数及AM培养上清液TNFα含量较空白对照组明显增高(P<0.05,P<0.01),实验组较模型对照组明显降低(P<0.05,P<0.01)。结论抑制TNFα释放可能是川芎嗪防治大鼠肺纤维化的机制之一。     

皮尔复腹腔灌注预防肠粘连的实验研究

目的探讨皮尔复腹腔灌注预防肠粘连的作用. 方法用80只白兔,采用4种不同方法建立腹腔粘连模型,随机在腹腔内灌注皮尔复液或生理盐水,比较粘连发生率. 结果实验动物粘连形成率皮尔复组7/40,对照组36/40（P＜0.04）. 结论皮尔复液腹腔灌注可以预防腔粘连的发生.     

Immune responses in mice to oral administration of attenuated Salmonella typhimurium expressing Helicobacter pylori urease B subunit by a lavage technique

Objective： To determine whether attenuated Salmonella typhimurium producing Helicobacter pylori （Hp） urease subunit B（UreB）can elicit specific immune responses against Hp in mice tested by a lavage technique. Methods： Attenuated Salmonella typhimurium producing Hp UreB immunized orally Balb/c mice twice at a 3-week interval. After 12 weeks, mice intestinal secretions were obtained without harm by administering a lavage solution intragastrically. The mice intestinal secretions of immune group were also directly washed out after the mice were killed. The antibody responses were evaluated by using serum and intestinal fluid with ELISA assay. Results： The multiple oral immunizations with SL3261/pTC01-UreB induced significantly Hp-specific mucosal IgA response as well as serum IgG response. The IgA was also consistently higher in the intestinal fluid obtained by the lavage solution than by direct washout. In addition, no obvious side effects and changes in gastric inflammation were observed in mice. Conclusion： The attenuated Salmonella typhimurium expressing Hp UreB may be used as an oral vaccine against Hp infection. And the lavage technique is an ideal method in the study of mucosal immune responses.     

氨烧伤合并重度吸入性损伤的临床治疗

目的：探讨氨烧伤合并重度吸入性损伤的临床治疗方法。方法：回顾分析该院自1998年1月至2004年4月收治的IS例氨烧伤合并重度吸人性损伤患者的临床治疗经过。合理补液、早期足量使用抗生素、诊断明确后即行气管切开并辅以机械通气、休克期后纤维支气管镜直视下支气管肺泡灌洗、短程应用肾上腺皮质激素等是其主要的治疗措施。结果：本组15例患者中治愈14例，好转1例，无死亡，治愈率为93．3％。结论：抓早、抓好各项治疗措施，重视并发症的防治可提高此类患者的治愈率。早期气管切开和支气管肺泡灌洗至关重要。     

纤维支气管镜在开胸术后肺不张中的应用

目的探讨纤维支气管镜吸痰与支气管灌洗术在开胸术后肺不张、肺部感染患者中的应用价值.方法分析48例术后肺不张、肺部感染患者,在监护条件下,行纤维支气管镜吸痰和灌洗术,并根据痰培养药物敏感试验结果选择抗生素治疗并评价效果.结果全组患者纤维支气管镜吸痰和灌洗术后恢复良好,合并肺部感染者均得以控制,无严重并发症发生.结论对开胸术后并发肺不张、肺部感染患者,行纤维支气管镜吸痰和灌洗术,能正确指导抗生素应用,是安全可行的治疗手段.     

纤支镜支气管肺泡灌洗加注抗生素治疗呼吸机相关性肺炎的护理研究

目的 探讨床边纤支镜支气管肺泡灌洗加注抗生素治疗呼吸机相关性肺炎的疗效、安全性及护理配合。方法 对中心ICU中48例呼吸机相关性肺炎患者应用纤支镜反复气道灌洗和注药。操作过程中不停用呼吸机，且将呼吸机参数吸氧浓度（FiO2）提高至80％～100％。常规监测患者临床情况、通气换气功能及呼吸力学指标。结果 灌洗注药后患者体温下降，外周血白细胞、痰液量明显减少，X线胸片明显改善。灌洗后气道峰压（PIP）明显下降（P〈0．01），PO2和SaO2、呼吸系统顺应性明显增加（P〈0．05）。结论 纤支镜支气管肺泡灌洗加注抗生素是一种安全有效治疗呼吸机相关性肺炎的措施，充分的术前准备、术中良好的心理护理、有效的麻醉方式、医生的娴熟技巧、护士及病人的密切配合是提高灌洗成功率、保证疗效、减少并发症的关键。     

Effect of fluticasone on the elastase:antielastase profile of the normal lung

BACKGROUND: Excessive elastolytic activity contributes to the pathogenesis of several inflammatory respiratory diseases. The effect of glucocorticoids, which are potent anti-inflammatory agents, on the elastase:antielastase balance of the human respiratory tract is unclear, as studies on patients and in vitro have yielded inconsistent results. DESIGN: To clarify this, bronchoalveolar lavage and lavage fluids from the upper and central airways were collected from 10 healthy, nonsmoking volunteers before and after a 2-week course of inhaled fluticasone propionate (2 x 500 micrograms day-1). Concentrations of two neutrophil elastase inhibitors, alpha-1-proteinase inhibitor (PI) and secretory leukoproteinase inhibitor (SLPI), as well as neutrophil elastase (NE) activity and NE inhibitory capacity (NEIC) were quantified in all lavage fluids. RESULTS: Concentrations of SLPI were highest in the proximal airways and decreased distally. Neutrophil elastase inhibitory capacity activity followed the same gradient and correlated positively and consistently with SLPI, suggesting that this inhibitor makes an important contribution to the regulation of elastolytic activity in the healthy human respiratory tract. Inhaled fluticasone propionate had no effect on any component of the elastase:antielastase balance at any level of the respiratory tract, even though circulating cortisol levels were reduced in all subjects, confirming subject compliance and adequate pulmonary delivery of the drug. CONCLUSION: This lack of action in the respiratory tract may contribute to the ineffectiveness of inhaled glucocorticoids in respiratory conditions characterised by excessive elastolytic activity.     

实验性胎粪吸入性肺炎一氧化氮吸入干预的研究

目的探讨在不同氧浓度下吸入CD11b不同浓度一氧化氮(nitric oxide, NO)对实验性胎粪吸入性肺炎肺损伤及肺中性粒细胞表面粘附分子CD11b表达的影响,为对该病是否适宜早期NO吸入干预提供实验室依据.方法建立胎粪吸入性肺炎模型兔,对常频机械通气下的胎粪吸入性肺炎家兔在21%或100%的氧浓度下分别给予6×10-6、10×10-6、20×10-6的NO干预12 h,通过图像分析处理测量肺泡间隔平均距离,病理切片检查评估肺损伤程度;测定肺组织髓过氧化物酶(myeloperoxidase, MPO)活性,并采用流式细胞术检测肺泡灌洗液中性粒细胞表面粘附分子CD11b的表达.结果在相同氧浓度下,NO吸入能显著改善氧合.病理结果表明,各干预组和非干预组均可见严重的中性粒细胞浸润到肺间质,轻到中度的肺出血、肺水肿、肺透明膜形成以及中性粒细胞移行到肺泡腔,各吸入NO干预组上述病理变化均有减轻趋势.相同氧浓度下10×10-6、20×10-6的NO 吸入干预组肺MPO活性分别显著低于非干预组(P均<0.05);100%氧浓度下20×10-6NO干预组MPO活性显著低于21%氧浓度下同一NO干预组[(1.4±0.3) U/g vs (2.0±0.1) U/g,P<0.05].在21%或100%氧浓度下,10×10-6、20×10-6NO干预组与非干预组间肺泡灌洗液中性粒细胞CD11b的表达(平均荧光强度)差异显著,表现为NO吸入后CD11b表达显著降低(P均<0.05);在不同氧浓度下同一NO浓度干预组之间差异均无显著意义.各组肺泡间隔距离及肺湿/干重比、平均动脉压差异无显著意义,高铁血红蛋白含量在正常范围之内. 结论 NO吸入可以通过抑制肺组织中性粒细胞粘附分子CD11b的表达而减轻中性粒细胞在肺组织的扣留及MPO的活性,起到潜在的抗炎作用.对胎粪吸入性肺炎,早期吸入NO进行干预可望减轻肺损伤,其合适的NO吸入浓度可能是(10～20)×10-6.     

Electrical impedance tomography: a method for monitoring regional lung aeration and tidal volume distribution?

Objective To demonstrate the monitoring capacity of modern electrical impedance tomography (EIT) as an indicator of regional lung aeration and tidal volume distribution.Design and setting Short-term ventilation experiment in an animal research laboratory.Patients and participants One newborn piglet (body weight: 2 kg).Interventions Surfactant depletion by repeated bronchoalveolar lavage, surfactant administration.Measurements and results EIT scanning was performed at an acquisition rate of 13 images/s during two ventilatory manoeuvres performed before and after surfactant administration. During the scanning periods of 120 s the piglet was ventilated with a tidal volume of 10 ml/kg at positive end-expiratory pressures (PEEP) in the range of 0–30 cmH₂O, increasing and decreasing in 5 cmH₂O steps. Local changes in aeration and ventilation with PEEP were visualised by EIT scans showing the regional shifts in end-expiratory lung volume and distribution of tidal volume, respectively. In selected regions of interest EIT clearly identified the changes in local aeration and tidal volume distribution over time and after surfactant treatment as well as the differences between stepwise inflation and deflation.Conclusions Our data indicate that modern EIT devices provide an assessment of regional lung aeration and tidal volume and allow evaluation of immediate effects of a change in ventilation or other therapeutic intervention. Future use of EIT in a clinical setting is expected to optimise the selection of appropriate ventilation strategies.     

Prognostic Significance of the Cytologic Features of Free Cancer Cells in the Peritoneal Cavity of Patients with Gastric Cancer

The aim of this study was to determine whether the cytologic features of cancer cells in the peritoneal lavage fluid from patients undergoing surgery for gastric cancer affect prognosis. A total of 141 patients with stage III–IV gastric cancer were enrolled in this study. Among 111 patients without peritoneal metastasis (P0), 43 were noted to have positive peritoneal cytology (P0/CY1). These patients were subclassified into two groups according to the cluster formation of cancer cells in the cytology specimen, namely, 17 with cluster formation and 26 without cluster formation. The clinicopathologic parameters and survival rates were compared between these two groups. Among the P0/CY1 patients, no significant difference in clinicopathologic features existed between patients with or without the cluster formation of cancer cells. However, the survival rate of patients without cluster formation was significantly higher than that of those with cluster formation. Furthermore, the survival curves of patients without cluster formation was similar to that of the P0/CY0 patients with stage IV cancer. Subclassification according to the presence or absence of the cluster formation of cancer cells may be useful for predicting the outcome of patients with positive cytology after surgery for advanced gastric cancer. Received: March 9, 2001 / Accepted: July 17, 2001