喘可治雾化吸入辅助治疗支气管哮喘疗效观察

目的观察喘可治雾化吸入治疗支气管哮喘的疗效。方法选择支气管哮喘患者60例,随机分为治疗组和对照组各30例。治疗组在常规抗感染止咳的基础上使用喘可治加全乐宁雾化吸入,每日2次;对照组在常规抗感染止咳的基础上使用普米克令舒加全乐宁雾化吸入,每日2次。两组疗程均为1周,观察治疗前后咳嗽、喘息、肺功能改善情况、住院天数及6个月内支气管哮喘发作次数。结果治疗组患者临床症状、肺功能改善及住院天数与对照组无明显差异,但治疗组6个月内支气管哮喘发作次数明显少于对照组,具有统计学意义（P〈0．01）。结论喘可治雾化吸人治疗支气管哮喘效果明显,同时有增强呼吸道免疫力、减少支气管哮喘发作次数的作用,值得临床推广使用。     

Vascular and cardiac impairments in rats inhaling ozone and diesel exhaust particles

Background

Mechanisms of cardiovascular injuries from exposure to gas and particulate air pollutants are unknown.

Objective

We sought to determine whether episodic exposure of rats to ozone or diesel exhaust particles (DEP) causes differential cardiovascular impairments that are exacerbated by ozone plus DEP.

Methods and results

Male Wistar Kyoto rats (10–12 weeks of age) were exposed to air, ozone (0.4 ppm), DEP (2.1 mg/m³), or ozone (0.38 ppm) + DEP (2.2 mg/m³) for 5 hr/day, 1 day/week for 16 weeks, or to air, ozone (0.51 or 1.0 ppm), or DEP (1.9 mg/m³) for 5 hr/day for 2 days. At the end of each exposure period, we examined pulmonary and cardiovascular biomarkers of injury. In the 16-week study, we observed mild pulmonary pathology in the ozone, DEP, and ozone + DEP exposure groups, a slight decrease in circulating lymphocytes in the ozone and DEP groups, and decreased platelets in the DEP group. After 16 weeks of exposure, mRNA biomarkers of oxidative stress (hemeoxygenase-1), thrombosis (tissue factor, plasminogen activator inhibitor-1, tissue plasminogen activator, and von Willebrand factor), vasoconstriction (endothelin-1, endothelin receptors A and B, endothelial NO synthase) and proteolysis [matrix metalloprotease (MMP)-2, MMP-3, and tissue inhibitor of matrix metalloprotease-2] were increased by DEP and/or ozone in the aorta, but not in the heart. Aortic LOX-1 (lectin-like oxidized low-density lipoprotein receptor-1) mRNA and protein increased after ozone exposure, and LOX-1 protein increased after exposure to ozone + DEP. RAGE (receptor for advanced glycation end products) mRNA increased in the ozone + DEP group. Exposure to ozone or DEP depleted cardiac mitochondrial phospholipid fatty acids (DEP > ozone). The combined effect of ozone and DEP exposure was less pronounced than exposure to either pollutant alone. Exposure to ozone or DEP for 2 days (acute) caused mild changes in the aorta.

Conclusions

In animals exposed to ozone or DEP alone for 16 weeks, we observed elevated biomarkers of vascular impairments in the aorta, with the loss of phospholipid fatty acids in myocardial mitochondria. We conclude that there is a possible role of oxidized lipids and protein through LOX-1 and/or RAGE signaling.     

雾化吸入在慢性阻塞性肺疾病治疗中的应用研究进展

从用药、基质液、雾化吸入方式、体位、雾量、时间安排方面综述了有关雾化吸入在慢性阻塞性肺疾病(COPD)治疗中的研究现状.     

Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction

Introduction

In this study, we sought to examine whether pharmacological postconditioning with sevoflurane (SEVO) is neuro- and cardioprotective in a pig model of cardiopulmonary resuscitation.

Methods

Twenty-two pigs were subjected to cardiac arrest. After 8 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started. After successful return of spontaneous circulation (N = 16), animals were randomized to either (1) propofol (CONTROL) anesthesia or (2) SEVO anesthesia for 4 hours. Neurological function was assessed 24 hours after return of spontaneous circulation. The effects on myocardial and cerebral damage, especially on inflammation, apoptosis and tissue remodeling, were studied using cellular and molecular approaches.

Results

Animals treated with SEVO had lower peak troponin T levels (median [IQR]) (CONTROL vs SEVO = 0.31 pg/mL [0.2 to 0.65] vs 0.14 pg/mL [0.09 to 0.25]; P < 0.05) and improved left ventricular systolic and diastolic function compared to the CONTROL group (P < 0.05). SEVO was associated with a reduction in myocardial IL-1β protein concentrations (0.16 pg/μg total protein [0.14 to 0.17] vs 0.12 pg/μg total protein [0.11 to 0.14]; P < 0.01), a reduction in apoptosis (increased procaspase-3 protein levels (0.94 arbitrary units [0.86 to 1.04] vs 1.18 arbitrary units [1.03 to 1.28]; P < 0.05), increased hypoxia-inducible factor (HIF)-1α protein expression (P < 0.05) and increased activity of matrix metalloproteinase 9 (P < 0.05). SEVO did not, however, affect neurological deficit score or cerebral cellular and molecular pathways.

Conclusions

SEVO reduced myocardial damage and dysfunction after cardiopulmonary resuscitation in the early postresuscitation period. The reduction was associated with a reduced rate of myocardial proinflammatory cytokine expression, apoptosis, increased HIF-1α expression and increased activity of matrix metalloproteinase 9. Early administration of SEVO may not, however, improve neurological recovery.     

Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution

Background: This study compared the non‐invasive thoracic electrical bioimpedance Aesculon^® technique (TEB_Aesculon) with thermodilution (TD) to evaluate whether TEB_Aesculon may offer a reliable means for estimating cardiac output (CO) in humans. Material and method: Cardiac output was measured with TD and TEB_Aesculon in 33 patients, with a mean age ± SEM of 59 ± 2·7 years, that underwent right heart catheterization for clinical investigation of pulmonary hypertension or severe heart failure. Four to five CO measurements were performed with each technique simultaneously in 33 patients at rest, 11 during exercise and seven during NO inhalation. Result: Cardiac output correlated poorly between TEB_Aesculon and TD at rest (r = 0·46, P<0·001), during exercise (r = 0·35, P<0·013) and NO inhalation (r = 0·41, P<0·017). CO was higher for TEB_Aesculon than TD with 0·86 ± 0·14 l min^?1 at rest (P<0·001) and 2·95 ± 0·69 l min^?1 during exercise (P<0·003), but similar during NO inhalation, with a tendency (P<0·079) to be 0·44 ± 0·19 l min^?1 higher for TEB_Aesculon than TD. CO increased from rest to exercise for TEB_Aesculon and TD with 6·11 ± 0·6 l min^?1 (P<0·001) and 3·91 ± 0·36 l min^?1 (P<0·001), respectively; an increase that was higher (P<0·002) for TEB_Aesculon than TD. During NO inhalation, compared to rest, CO decreased for TEB_Aesculon with 0·62 ± 0·11 l min^?1 (P<0·002), but not significantly for TD with 0·21 ± 0·12 l min^?1 (P<0·11). Bland–Altman analysis showed a poor agreement between TEB_Aesculon and TD. Conclusion: TEB_Aesculon overestimated CO compared to TD with ～17% at rest and ～34% during exercise, but the techniques showed similar results during NO inhalation. CO, furthermore, correlated poorly between TEB_Aesculon and TD. TEB_Aesculon may at present not replace TD for reliable CO measurements in humans.     

Ontogenic characterization of gene expression in the developing neuroendocrine system of the chick

The neuroendocrine system consists of five major hypothalamic-pituitary hormone axes that regulate several important metabolic processes, and it develops in all vertebrates during embryogenesis. In order to define initiation and establishment of these five axes, mRNA expression profiles of hypothalamic releasing and release-inhibiting factors, their pituitary receptors, and pituitary hormones were characterized during the second half of embryogenesis and first week post-hatch in the chick. Axis initiation was defined as the age when pituitary hormone mRNA levels began to increase substantially, and establishment was defined as the age when mRNA for all components had reached maximum expression levels. The adrenocorticotropic axis appears established by e12, as there were no major increases in gene expression after that age. Hypothalamic thyrotropin-releasing hormone and pituitary thyroid-stimulating hormone β-subunit increased between e10 and e18, indicating establishment of the thyrotropic axis during this period. Pituitary growth hormone substantially increased on e16, and hypothalamic growth hormone-releasing hormone did not increase until e20, indicating that somatotropic axis activity is established late in embryonic development. Lactotropic axis initiation is evident just prior to hatch, as pituitary prolactin and vasoactive intestinal peptide receptor 1 did not increase until e18 and e20, respectively. Hypothalamic gonadotropin-releasing hormone 1 increased after hatch, and pituitary luteinizing hormone β-subunit expression remained low until d3, indicating the gonadotropic axis is not fully functional until after hatching. This study is the first to characterize major hypothalamic and pituitary components of all five neuroendocrine axes simultaneously and considerably increases our understanding of neuroendocrine system establishment during development.     

Ghrelin and reproductive disorders

Ghrelin is an important factor involved in most of the metabolic and hormonal signals which adapt the reproductive functions in conditions of altered energy balance. Moreover, the coordinated role of leptin and ghrelin appears in fact to have a specific role in the regulation of puberty. Systemic action of ghrelin on the reproductive axis involves the control of the hypothalamic-pituitary-gondal axis. In addition, it has been shown that ghrelin may directly act at a gonadal level in both females and males. Available data also demonstrate that sex steroid hormones and gonadotropins may in turn regulate the gonadal effect of ghrelin, as documented by studies performed in females with the polycystic ovary syndrome and in hypogonadal men. Notably, recent studies also confirm a potentially important role for ghrelin in fetal and neonatal energy balance, and specifically in allowing fetal adaptation to an adverse intrauterine environment.     

氧驱博利康尼联合爱全乐雾化治疗重症哮喘的疗效观察及护理

目的观察氧驱博利康尼联合爱全乐雾化对重症哮喘患者的临床疗效,探讨雾化吸人过程中的护理方法。方法将60例重度持续哮喘患者随机分为治疗组和对照组各30例,对照组仅给予基础治疗,治疗组在此基础上给予氧驱博利康尼联合爱全乐雾化吸人,观察两组的疗效并分析其护理在治疗中的重要作用。结果治疗组与对照组在气急缓解时间,哮呜音消失时间,甲强龙用量及应用天数方面差异有显著意义。结论氧驱博利康尼联和爱全乐雾化对重症哮喘的治疗起效快、疗效好,激素应用时间缩短,用量减少,通过规范的护理和指导,保证了治疗效果。     

雾化吸入利多卡因治疗哮喘急性发作疗效观察

目的观察雾化吸入利多卡因对中重度急性发作的支气管哮喘患者肺功能的影响,评价利多卡因治疗哮喘的疗效和安全性。方法将60例中重度急性发作期哮喘患者随机分为两组,在继续常规治疗基础上,治疗组雾化吸入利多卡因100mg,对照组雾化吸入生理盐水5ml。分别于吸入前、吸入后15min、30min、60min、90min测第1秒用力呼气量（FEV1）、峰值呼气流速（PEF）,评价临床疗效,记录不良反应。结果治疗组在吸入后30min、60min、90min的FEV1、PEF、有效率均高于对照组（P〈0.05）。吸入利多卡因后无严重不良反应发生。结论在常规治疗基础上,雾化吸入利多卡因能改善中重度急性发作哮喘患者的肺功能,缓解临床症状,不良反应少。     

基层医院静吸复合麻醉用于心内直视手术426例报告

目的总结426例心脏患者心内直视手术的麻醉处理体会。方法用咪达唑仑、芬太尼、依托咪酯、维库溴铵麻醉诱导行气管插管后机械通气,并间断吸入异氟醚维持。同时监测心率、有创动脉压、动态心电图、中心静脉压、体温、尿量、血糖、血氧饱和度、血气分析和电解质。维持良好的麻醉深度和心肌供耗氧平衡。结果 426例患者中除8例在停止体外循环后死亡外,其余418例麻醉平稳,术后顺利拔出气管导管,康复出院。有12例发生肺部并发症,经过治疗后痊愈。结论行体外循环下心内直视手术患者,选择静吸复合麻醉是安全的麻醉方法。