氧合血心脏停搏液保护心肌的研究

为了寻求临床上更为安全实用的心肌保护方法,对冷晶体心脏停搏液间断灌注 和浅低温氧合血,常温氧合血心脏停搏液持续灌注两种方法保护心肌的作用进行了比较研究。方法：应用冷昌体心脏停搏液间断灌注（ＣＣＣ组）浅低温事务 氧合血心脏停搏液持续灌注心肌保护方法,观察了心脏瓣膜直视手术４８例患者术后主要并发症,起搏器的使用情况,测定了主要心肌酶,肌酸激酶（ＣＫ）肌酸激酶同功酶（ＣＫ－ＭＢ）、乳酸脱氢酶同功酶（ＬＤ     

环氧交联牛心包材料内皮化的抗钙化作用研究

研究生物材料内皮化延缓钙化的效果 ,从材料学上改进生物瓣性能 ,提高其耐久性打下基础。方法 ,将环氧交联的牛心包材料体外内皮化后同时进行犬股动脉间位移植和腹部皮下包埋 ,与单纯戊二醛处理者和单纯环氧处理进行钙化程度对比。结果 :钙含量测试结果以内皮化环氧交联材料皮下包埋最低 ,未内皮化材料中以环氧处理者钙含量较低。结论 :环氧交联牛心包材料确可实现体外快速内皮化 ,生物材料的内皮化“活化”有赖于表面全部被自体存活内皮细胞覆盖才能实现 ,完全的内皮化确有抗钙化效果 ,两种动物模型研究生物材料抗钙化和内皮化时各有优缺点     

肺、食管手术患者术后感染细菌调查

目的了解肺、食管手术后感染的致病菌分布和药物敏感性。方法监测951例肺、食管择期手术患者的术后感染致病菌和药敏情况,以及术后气管导管端痰液和胸腔引流管端胸水培养的意义。结果食管手术感染致病菌主要是绿脓杆菌、不动杆菌、凝固酶阴性葡萄球菌、甲型链球菌等。肺手术感染以金黄色葡萄球菌、甲型链球菌、不动杆菌、肺炎克雷伯氏菌为主。凝固酶阴性葡萄球菌、肠杆菌、绿脓杆菌、嗜麦芽窄食单胞菌耐药率高。结论细菌的抗生素耐药十分普遍,气管导管端痰液和胸腔引流管端胸水培养有助于术后抗生素的选择。     

从医院现代化管理看检验医学未来发展

本文从医院现代化管理的角度对检验医学的发展予以展望。阐述了要符合现代化医院管理的要求,临床检验部门应该对现有的组织构架予以重塑与整和,完善临床实验室认可和质量管理体系,加强与临床医学的沟通,以及将循证医学的理论运用其中将有助检验医学在未来的发展和提高。     

冷生理盐水支气管内灌注结合肺切除治疗危及生命的大咯血

作者采用冷生理盐水支气管内灌注止血的方法,同时配合肺叶切除,使危及生命的大咯血病人抢救成功率得到明显提高。本方法具有简便,止血效果确切、可靠,远期疗效好的优点,是一种值得应用的方法。     

模拟缺血再灌注后心肌细胞胰岛素抵抗机制的初步研究

Objective Recent.studies have found a strong association of insulin resistance, which might occur during ischemia reperfusion in vitro in the experimental dogs, with disturbed function of cardiomyocytes. Obvious acute insulin resistance, along with glucose dysmetabolism in the reperfused cardiomyocytes, was furher observed in the study performed with ischemia-reperfused ventric- ular myocytes of rats. We tried to investigate preliminarily the molecular mechanisms of insulin resistance in the cardiomyocytes after ischemia reperfusion. Methods An experimental model of insulin-stimulated ischemia reperfusion (SI/R) was created by isolating cardiomyocytes from adult rats. Glucose uptake of the cardiomyoctyes was evaluated with isotope-labeling technique. Glucose trans- porter 4 (GLUT4) translocation induced by insulin was investigated with Western blot analysis, and the intracellular level of free Ca2+ ([Ca2+]I) was measured quantitatively with Ca2+ indicator Fura-2. Results Insulin can stimulated glucose uptake by cardiomyo- cytes, indicating that these cells were insulin-sensitive. Cardiomyocytes were demonstrated notable acute insulin resistmce during reperfusion. Insulin-stimulated GLUT4 translocation in the cardiomyocytes 15 minutes after reperfusion was 72.2% of that in the con- trol group(P<0.05), in which the GLUT4 content in plasma membrane remained unchanged. The finding suggested that a disturbed GLUT4 translocation might happen in the cardiomyocytes during insulin-stimulated ischemia-reperfusion. Calcium overload was identi- fied in the cardiomyocytes with ischemia reperfusion. At 15 minutes of reperfusion, [Ca2+]I was significantly higher in the reperfused cardiomyocytes than that in the control cardiomyocytes[(318.66±23.06)vs(130.70±0.82) nmol/L, P<0.05], and kept at a higher level [(177.79±17.46) nmol/L] at 60 minutes of reperfusion (P<0.05, vs control). Partial correlation analysis revealed a negative correlation of[Ca2+]I with insulin-induced ghcose uptake in the cardiomyoctyes (r = -0.557,P=0.006). Conclusion Disturbed GLUT4 translocation and decreased intrinsic activity may be important molecular mechanisms for the development of insulin resistance in the cardiomyocytes of rat during insulin-simulated ischemia reperfusion,. [Ca2+]I overload may account for the de- creased intrinsic activity d GLUT4.     

晶体心脏停搏液导致冠状动脉内皮损害

临床上使用心脏停搏液预防缺血停跳中的心肌损伤已经积累了丰富的经验。以往人们很少注意心胜停搏液对冠状动脉内皮的作用。本文通过动物卖验比较了三种心脏停搏液对冠状动脉内皮细胞的作用。     

加强等级医院建设 促进医院发展

介绍该院加强等级医院建设的进程及体会。创建工作分为1994年以前,1995～1997年两个阶段,各个阶段有各个阶段的工作重点和措施。认为达标是形式,发展才是实质。在“三甲”医院成熟的管理体系和良好的运作模式基础上,要加强认识和实践上的主动性,找准医院建设的立足点,通过二者的有效结合,进一步加强医院的内涵建设,推动医院的发展。     

环氧交联牛心包心瓣膜材料①体外内皮化的实验研究

目的：为了探索生物心瓣膜材料的抗钙化措施，笔者作了血管内皮细胞（ＥＣ）在ＰＣ牛心包材料上生长特性的研究。方法：ＰＣ牛心包材料，漂洗后用二种不同的粘附蛋白预衣被，种植犬的血管ＥＣ，未衣被组作为对照。结果：Ｆｉｂｒｏｎｅｃｔｉｎ（（ＦＮ）及Ｌａｍｉｎｉｎ（Ｌａ）组，经７～１０天培养，心包片上ＥＣ形成单层，而未衣被组ＰＣ心包片上无细胞生长。结论：１）ＰＣ牛心包材料的确具有细胞毒性。２）经Ｌａ及ＦＮ的衣被，ＰＣ牛心包生物材料达到了体外内皮化的要求，其中以Ｌａ效果最佳，与ＦＮ相比，两者有显著性差异（Ｐ＜０．０５）。