丹参多酚酸盐对急性敌敌畏中毒大鼠的心肌保护作用

目的：观察丹参多酚酸盐对急性有机磷中毒（acute organophosphorus pesticides poisoning,AOPP）心肌的保护作用。方法：Sprague Dawley（SD）大鼠24只,随机分成3组,均予以气管切开接呼吸机辅助通气,中毒组予以腹腔注射敌敌畏（dichlor-vos）60mg/kg;治疗组在腹腔注射敌敌畏的同时予以腹腔注射丹参多酚酸盐10mg/kg,对照组仅注入同等量的0.9%氯化钠液。1h后留取血样测血清丙二醛（MDA）、超氧化物岐化酶（SOD）、心肌钙蛋白T（cardiac troponin T,CTnT）水平。取左心室心肌组织用原位缺口末端标记（TUNEL）法染色,检测凋亡指数（apoptotic index,AI）。结果：与中毒组比较,治疗组血清CT-nT、MDA值显著降低,SOD值显著升高（P〈0.01）。心肌细胞凋亡指数显著下降（P〈0.01）。结论：AOPP时有显著的氧化应激反应和细胞凋亡发生。应用丹参多酚酸盐可减轻氧化应激反应,降低血清CTnT水平,减少心肌细胞凋亡,有保护心肌作用。     

法舒地尔对敌敌畏中毒大鼠急性肺损伤时血浆肿瘤坏死因子α和白细胞介素-6水平的影响

目的：探讨法舒地尔（Fasudil）对敌敌畏中毒大鼠急性肺损伤时血浆肿瘤坏死因子α（TNF-α）和白细胞介素-6（IL-6）水平的影响。方法：Sprague Dawley大鼠30只,随机分成对照组、敌敌畏（dichlorvos,DDVP）中毒组、法舒地尔干预组3组,每组10只,均予以气管切开接呼吸机辅助通气。6h后留取血样用酶联免疫吸附分析（ELISA）法测血浆TNF-α、IL-6水平。取左肺下叶组织,HE染色观察病理学改变。结果：与对照组比,中毒组和干预组大鼠血浆TNF-α、IL-6水平均显著升高（P〈0.01）,肺组织HE染色有炎症细胞浸润;与中毒组比,干预组TNF-α、IL-6升高程度显著降低（P〈0.05）,肺损伤程度较轻。结论：法舒地尔能降低敌敌畏中毒大鼠血浆TNF-α、IL-6水平,能显著减轻肺损伤的病理损害,对大鼠敌敌畏中毒性急性肺损伤有明显的保护作用。     

亚低温对大鼠心肺复苏后脑水肿及血清s100β蛋白表达的影响

目的：通过观察亚低温时大鼠脑水肿及血清s100β蛋白水平的变化,探讨低温持续时间对脑复苏的影响。方法：采用改良的窒息法制备大鼠复苏模型,50只SD大鼠随机分为假手术组、常温组和亚低温组。分别于自主循环恢复（ROSC）后1.5h、3h、6h、12h测定血清s100β含量及脑组织含水量。结果：亚低温组脑组织含水量低于常温组,脑组织含水量亚低温6h时为78.91±0.13%,显著低于常温组80.52±0.87%（P〈0.05）。亚低温组1.5h、3h时s100β蛋白水平分别为1.98±0.49ng/mL、2.86±1.50ng/mL,较常温组4.36±1.14ng/mL、5.60±1.22ng/mL显著下降（P〈0.05）;但ROSC后6h、12h时亚低温组和常温组比较s100β蛋白水平无显著差异（P〉0.05）。结论：亚低温能明显减轻脑水肿及神经系统损伤,具有良好的脑保护作用,但这种脑保护作用在ROSC6h后有所减弱。     

急性敌敌畏中毒大鼠的早期心肌损伤

目的 研究急性敌敌畏(dichlorvos,DDVP)中毒导致的早期心肌损伤表现.方法 Sprague Dawley(SD)大鼠24只,随机(随机数字法)分成对照组和中毒组两组,每组12只.采用右侧颈动脉置管术动态监测有创血流动力学指标;测定血清肌钙蛋白T(cardiac troponin T,CTnT)和心房利钠肽(brain natriuretic peptide,BNP)水平;观察心肌组织病理学改变.结果 ①中毒组自身前后对照:中毒1 h内,心率(heart rate,HR)和室内压上升段最大变化率(maximum ascending rates of left ventricular pressure,+dp/dtmax)均有显著下降;室内压下降段最大变化率(maximum descending rates of left ventricular pressure,-dp/dtmax),左室舒张末压(1eft ventricular end diastolic pressure,LVEDP)有显著升高(P＜0.01).其中均以7 min时改变最显著.②中毒组与对照组比,血清CTnT值显著升高(P＜0.01),血清BNP值差异无统计学意义(P＞0.05).③中毒组心肌HE染色存在病理学损害.结论 急性有机磷中毒(acute organophosphorus pesticides poisoning,AOPP)其早期可导致大鼠心肌损伤,血流动力学紊乱,心功能受抑.CTnT可作为早期评价AOPP心肌损伤的指标,而BNP在AOPP诊治中的意义不大.

Abstract：

Objective To investigate the myocardial injury in the early stage of acute dichlorvos poisoning in rats. Method A total of 24 Sprague Dawley rats were randomly (random number) divided into control group(n = 12) and poisoning group(n = 12). Hemodynamic variables were monitored by using an arterial cannula inserted into right arteria carotis communis. Serum levels of cardiac troponin T(CTnT) and brain natriuretic peptide (BNP) were measured. Myocardial tissue was observed with HE stain under microscope. Results The rats of poisoning group showed that the heart rate (HR) and maximum ascending rates of left ventricular pressure(+ dp/dtmax)were significant decreased in an hour after poisoning (P ＜0.01). The maximum descending rates of left ventricular pressure(-dp/dtmax)and left ventricular end diastolic pressure (LVEDP)were markedly increased (P＜0. 01) and reached peak in 7 minutes in the poisoning group. Compared with the control group, cardiac troponin T obviously changed in rats poisoned with dichlorvos in the first hour. BNP was not affected after poisoning(P ＞ 0. 05). Myocardial damage was found in the poisoning rats.Conclusions Myocardial injury and heart failure occurred in the early stage of acute organophosphorus pesticides poisoning(AOPP) in rats. CTnT could play a major role in AOPP while BNP might not be involved in.     

先天性二叶式主动脉瓣畸形并发感染性心内膜炎致多脏器栓塞一例

患者男,70岁,因反复发热,腰背痛进行性加重2个月,失语1d来院。患者2008年10月6日起出现发热,体温最高39.7℃,伴有右侧腰痛,无明显咳嗽、咳痰,无腹泻等其他不适,查体除双侧扁桃体Ⅰ度肿大外,无特殊表现。外院查血常规示WBC10.7×10^9/L,N86.5%,超声示双肾和输尿管未见异常。给予阿奇霉素0.5g,乳酸左氧氟沙星0.6g静滴qd,3d后改为头孢曲松钠3．0g，乳酸左氧氟沙星0．6g静滴qd，治疗1周后发热无改善，故至龙华医院住院治疗。查血常规WBC升高，     

急性Stanford A型主动脉夹层术后死亡因素分析

Objective To assess the risk factors of the in-hospital mortality of acute type A aortic dissection after operation. Method From January 2003 to June 2008,185 patients, 144 males and 41 females, with acute type A aortic dissection operated on were enrolled. The average age of patients was (49.46 ± 11.04 ) years old.The patients' demographics, history, clinical features, and some laboratory examinations were reviewed. Univariate and multivariate analysis followed by logistic regression analysis were carried out to identify the predictors of inhospital mortality. Results The in-hospital mortality rate was 9.1%. The results of univariate and multivariate analyses as follows: pre-operation positive neurological symptom (Univariate OR = 5.084,95%CI:1.792 -14.426, P = 0.002; Multivariate OR = 5.538,95%CI: 1.834 - 16.721, P = 0.002, respectively), hypotension (Univariate OR = 6.986,95%CI:1.510- 32.323,P =0.013; multivariate OR = 1.998,95%CI:0.315-12.679,P = 0.463, respectively) and renal failure (Univariate OR = 3.594,95%CI:1.237 - 10.438,P =0.019; Multivariate OR = 3.254,95%CI:1.034- 10.242, P= 0.044, respectively). Conclusions There are two predictors, pre-operation positive neurological symptom and renal failure, of pre-hospital mortality found in current analyses. Our results may improve the regimen made by cardiac surgeons and emergency doctors so as to help patients and their relatives to make correct decision.     

急性有机磷中毒的心脏损害

有机磷酸酯是抑制胆碱酯酶的化合物,主要用作杀虫剂;自杀或不经意食入、职业接触、恐怖事件,战争等均可导致急性有机磷中毒.其临床表现为腺体分泌过度等毒蕈碱样症状和肌肉痉挛等烟碱样症状,以及焦虑、癫痫发作等中枢神经系统中毒症状.在心血管系统,常可并发严重的心律失常,心肌损伤和心力衰竭,是有机磷中毒致死的主要原因之一.近年来,急性有机磷中毒的心脏损害已逐渐引起了研究者的重视.     

急性有机磷农药中毒中间综合征17例分析

目的：探讨急性有机磷农药中毒中间综合征（IMS）的临床特点及临床处理对策。方法：对17例急性有机磷农药中毒中间综合征患者的临床资料进行分析。结果：IMS出现在中毒后1～5d，经积极救治17例中完全治愈13例，好转1例，死亡3例。结论：中间综合征以对症支持治疗为主。急性期应用阿托品的同时，及早、足量、重复应用肟类复能剂以及适时应用机械通气可有效防治中间综合征。