深低温对吸入麻醉药的MAC,心脏麻醉指数和心肌稳定性的影响

目的:研究深低温对吸入麻醉药MAC、心脏麻醉指数和心肌稳定性的影响。方法:新西兰白兔40只,随机分为氟烷、安氟醚、异氟醚和七氟醚组。采用夹尾试验法测定常温下(38℃±0.5℃)的最低肺泡有效浓度(MAC)。行体表降温后测定深低温下(23℃±0.5 ℃)的MAC。维持深低温增加吸入性麻醉药的浓度,同时用50Hz、25V电压胸外电击心脏。记录出现室颤或室性心律失常时的肺泡呼气末吸入麻醉药浓度。结果:从38℃到23℃兔体温每降低1℃,MAC下降值为:氟烷5.1％、安氟醚3.6％、异氟醚4.4％、七氟醚4.3％;氟烷、安氟醚、异氟醚和七氟醚心脏麻醉指数分别为4.4、3.18、6.25和4.6,异氟醚明显高于其它麻醉药;麻醉药浓度8MAC以内安氟醚和氟烷发生室颤的机率(100％)明显高于七氟醚和异氟醚(40％)。结论:异氟醚是深低温麻醉的最佳选择用药,而安氟醚则不宜用于低温麻醉。     

单宁酸处理带瓣牛颈静脉的生物学评价

目的从生物学角度评价单宁酸处理的带瓣牛颈静脉是否符合国家医用材料的要求。方法带瓣牛颈静脉经单宁酸处理后按国家医用材料的要求进行浸提液的制备、细胞毒性试验、过敏试验、皮内刺激试验、原发性皮肤刺激试验、溶血试验、急性全身毒性试验及热原试验等生物学评价试验。试验方法均参照《医用有机硅材料生物学评价试验方法》GB／T16175-1996。结果培养的L-929小鼠成纤维细胞经含浸提液的培养基培养后形态良好，增值旺盛，材料细胞毒性评级为0～1。无皮肤刺激反应和过敏反应，皮内刺激试验PⅡ（原发性刺激指数）为0．4，和阴性对照组差异无统计学意义。全身毒性实验受试动物未出现毒性症状。溶血试验溶血率0．7％，符合国家标准（〈5％）。热原试验经中国药品生物制品检定所检定，单宁酸处理后带瓣牛颈静脉无热原（样品批号：060802017）。结论单宁酸处理的带瓣牛颈静脉符合国家医用材料的要求，可以植入人体。     

Construction of Eukaryotic Expression Plasmid of Human PRX3 and Its Expression in HEK-293FT Cells

To construct the eukaryotic expression plasmid of human PRX3 and measure its expression in the HEK-293FT cells, the full-length coding region of human PRX3 was cloned by PCR and inserted into the eukaryotic expression vector pcDNA4-Xpress (A). HEK-293FT cells were transiently transfected with the recombinant plasmid. Western blot and immuofluorescence were used to detect the expression of the fusion protein. In the experiment, restriction analysis identified the construction of the recombinant plasmid and the inserted sequence was identical with that published on GenBank. Western blot and immunofluorescence confirmed the expression of the recombinant protein in transfected HEK-293FT cells. It was concluded that the eukaryotic expression plasmid of human PRX3 was constructed successfully and the recombinant could he expressed efficiently in HEK-293FT cells, which provides a sound basis for the further study on human PRX3.     

Monitoring effects of α-human atrial natriuretic polypeptide (α-hANP) on left ventricular function in patients with essential hypertension with a cardiac probe

The effects of -hANP on left ventricular function were studied with a cardiac probe in ten patients with essential hypertension. Our data showed that intravenous administration of -hANP significantly elevated left ventricular function. At 5 min, the elevation of EF, RCO, ER, RSV, PFR were 13.23% (P<0.02), 12.7 (P<0.02), 0.618 (P<0.02), 0.133 (P<0.05), 0.283 (P<0.01), respectively. At 10 min, the increase of EF, ER, were 11.07% (P<0.02) and 0.233 (P<0.01), respectively. Atriopeptin significantly reduced systolic and diastolic blood pressure from 2 min to 20 min (P<0.001–0.05).Supported by IAEA Grant No. 4062/RI/RB     

小儿心脏术后急性呼吸窘迫综合征的预防及治疗

为探讨小儿心脏术后急性呼吸窘迫综合征（ARDS）的临床发病特点及治疗对策,对23例ARDS患儿（包括早期发病8例、迟发15例）采用：①限制吸气峰压≤35cmH2O(3.43kPa);②早期应用呼气末正压（PEEP）8-12cmH2O(0.78-1.18kPa);③反复性侧卧体位等措施。结果23例中1例（1/23）继发感染、急性肾功能衰竭死亡;并发气胸2例（2/23）;严重肺不张3例（3/23）;痰培养阳性5例（5/23）。结果显示：对ARDS高危患儿应慎重选择早期拔管指征;对诊断明确者应用低容量限压通气配合体位变换可减少并发症、提高治愈率。     

THE VALUE OF 99mTc-MIBI MYOCARDIAL PERFUSION SPECT IMAGING IN DETECTING CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR DISEASE BEFORE OPERATION

Objective. The aim of this study was to detect coronary artery disease using ^99mTc-MIBI myocardial perfusion imaging in patients with valvular disease. Methods. Thirty patients with valvular disease confirmed by echocardiography underwent ^99mTc-MIBI myocardial perfusion imaging using multiSPECT lh after stress test (exercise, dipyridamole or dobutamine test) and were performed coronary angiography within 1 month before valvular operation. Results. For 29 out of the 30 patients, the results of ^99mTc-MIBI myocardial perfusion imaging were similar with those of coronary angiography, the concordance rate was 96.7 % and the negative predictabili-ty was 100%. Conclusion. ^99mTc-MIBI myocardial perfusion imaging is a reliable non-invasive method for detecting coronary artery disease in patients with valvular disease and so as to draw up suitable operation programs for them.     

Quantitative analysis of technetium 99m 2-methoxyisobutyl isonitrile single-photon emission computed tomography and isosorbide dinitrate infusion in assessment of myocardial viability before and after revascularization

Background

Assessment of viable myocardium in territories of hypoperfused myocardium is important for predicting functional recovery after revascularization. This study was designed to evaluate quantitative analysis of ^99mTc-labeled 2-methoxyisobutyl isonitrile (MIBI) myocardial perfusion imaging combined with isosorbide dinitrate (ISDN) infusion to detect myocardial viability in patients with chronic coronary artery disease before and after revascularization.

Methods and Results

Twenty-seven consecutive patients with previous myocardial infarction and left ventricular dysfunction (left ventricular ejection fraction 35.2%±13.5%) referred for coronary artery bypass (CABG) were studied with ^99mTc-labeled MIBI single-photon emission computed tomograpy at rest and during ISDN infusion before CABG followed by resting imaging after CABG. Quantitative analysis was performed with circumferential profiles. Left ventricular function (global and regional) was assessed by radionuclide ventriculography before and after CABG. Out of 212 abnormal perfusion segments with resting ^99mTc-labeled MIBI SPECT, 99 segments (47%) showed improved uptake of ^99mTc-labeled MIBI during ISDN infusion. The mean ratio of myocardial uptake was 0.58±0.25 (resting 0.53±0.23; p<0.05). After CABG, of 212 segments with hypoperfusion, 108 segments (51%; p>0.05 vs ISDN) showed improved uptake of ^99mTc-labeled MIBI. The mean ratio of myocardial uptake was 0.60±0.26 (resting 0.53±0.23; p<0.05). The concordance between the improvement of post-CABG wall motion and that of pre-CABG ISDN perfusion imaging was 83%, between the improvement of wall motion and perfusion imaging after CABG 94%, and between the improvement of pre-CABG ISDN and post-CABG perfusion imaging 83%, respectively.

Conclusion

ISDN infusion can improve the uptake of ^99mTc-labeled MIBI in hypoperfused myocardium and increase the efficiency of ^99mTc-labeled MIBI in the detection of viable myocardium in patients with previous myocardial infarction and left ventricular dysfunction.     

中国部分中年人群糖尿病患病率、知晓率、治疗率及控制率现况调查

目的描述中国14组中年人群空腹血糖受损（IFG）患病率、糖尿病（DM）患病率、知晓率、治疗率、控制率现状及其近年的变化趋势。方法1998年对14组35～59岁人群进行整群抽样调查，测定空腹血糖并询问DM史及治疗史，用于现况研究。对其中4组曾在1993—1994年进行相同调查的人群进行变化趋势研究。结果14组人群IFG和DM年龄标化患病率分别为0．5％～15．6％（平均4．8％）和0．2％～10．6％（平均4．3％），无性别差异，城市高于农村（P〈0．01），年龄越大患病率越高（P〈0．01）。DM知晓率、治疗率、控制率分别为0％～46．2％（平均33．3％）、0％～46．2％（平均27．2％）和0％～15．4％（平均9．7％）；女性大于男性（P〈0．01），城市高于农村（P=0．031）．年龄越大上述三率越高（P〈0．05），与文化程度无显著关联。在DM知晓者中治疗率平均为81．6％，在治疗者中控制率平均为35．6％，且男女、城乡、年龄组问差异无统计学意义。1993-1994年到1998年4组人群DM患病率平均由3．8％上升到4．6％（P=0．037），知晓率、治疗率、控制率有上升趋势但变化无统计学意义（P〉0．05）。结论中国14组中年人群DM患病率两性之间差异无统计学意义．地区之间差异明显，近年呈上升趋势。DM知晓率、治疗率、控制率总体处于较低水平。解决DM人群防治的关键是改善检出机会和提高治疗效果两个环节。     

吸烟和体质指数与肺癌发病的前瞻性研究

目的探讨吸烟和不同体质指数(BMI)水平对肺癌发病的影响。方法1974、1979和1980年,经统一培训的调查人员采用问卷形式对北京首都钢铁公司5137名年龄≥18岁男性工人进行心血管疾病基线调查,于1982、1987、1993和2001年随访,采用Cox比例风险回归模型分析吸烟和不同BM I水平与肺癌发病的关系。结果以1974、1979和1980年资料作为基线,进入队列950、1163和3024人,共5137人。以肺癌发病作为观察终点,共随访了103715人.a,实际随访4986人,失访151人,每个观察对象平均随访20.8a,随访率97.06%。此期间发生肺癌106人,其中97人已死亡,肺癌发病率为102.2/10万人.a。肺癌组年龄、吸烟率、饮酒率均高于非肺癌组,BM I低于非肺癌组,差别有统计学意义(P<0.05)。调整了年龄等因素后,大量吸烟可增加患肺癌的相对危险度(RR),差别有统计学意义(P<0.01)。随着BM I的增加,肺癌发病率逐渐降低。调整年龄等因素后,吸烟工人中的肺癌发病RR随BM I升高顺序依次为1.00,0.57和0.33;剔除随访5a新发的10名肺癌患者后,吸烟工人的肺癌发病RR依次为1.00,0.52和0.33,均呈随BM I增加而发病危险降低的趋势,但差别无统计学意义(P>0.05)。工人按吸烟与否和不同BM I分组,经调整年龄、饮酒情况后,以吸烟+低体重组为参照,不吸烟+正常体重组、不吸烟+超重和肥胖组、吸烟+正常体重组与吸烟+超重和肥胖组肺癌发病R R分别为0.25(95%CI:0.08～0.84,P<0.05),0.16(95%CI:0.04～0.74,P<0.05),0.45(95%CI:0.46～1.24,P>0.05)和0.23(95%CI:0.07～0.77,P<0.05)。结论吸烟和低体重人群增加肺癌发病危险,戒烟和保持正常体重是预防肺癌的重要措施。