低分子肝素早期治疗脓毒症临床研究

18例脓毒症患者随机分为两组,对照组进行常规抗感染、液体复苏、控制血糖、基础病因治疗等,治疗组在常规治疗基础上加低分子肝素钙0.6 ml皮下注射,1次/12 h,疗程7 d.发现治疗组治疗后APACHEⅡ评分较治疗前及对照组治疗后明显下降;治疗组住ICU时间和28 d病死率低于对照组,但无统计学差异;两组治疗前后各凝血指标均无明显改变.认为低分子肝素用于脓毒症患者临床应用安全,是一种有前景的治疗手段.     

脓毒症患者高迁移率族蛋白-1的变化及应用卡巴胆碱进行体外干预的研究

目的 观察烧伤后脓毒症患者高迁移率族蛋白-1(HMGB-1)的变化,探讨卡巴胆碱对脂多糖刺激后单核细胞释放HMGB-1的影响及其作用机制.方法 取烧伤后脓毒症患者及正常献血员外周血,ELISA法检测HMGB-1含量.观察烧伤后脓毒症对HMGB-1的影响.取正常献血员外周血,分离获得单核细胞.实验分为6组:空白对照组的单核细胞仅加1640培养液;脂多糖组单核细胞仅加脂多糖刺激;烟碱预处理组和卡巴胆碱预处理组先用卡巴胆碱或烟碱预处理单核细胞5 min,再加入脂多糖刺激;阿托品+卡巴胆碱预处理组和α-银环蛇毒素+卡巴胆碱预处理组先在单核细胞悬液中加入阿托品或α-银环蛇毒素,5 min后给予卡巴胆碱.再5 min后给予脂多糖刺激.孵育48 h后取细胞培养上清液,ELISA法检测HMGB-1浓度.结果 烧伤后脓毒症患者HMGB-1的含量[(12.94±6.54)μg/L]明显增加,与正常献血员[(2.01±0.03)μg/L]比较差异有统计学意义(P<0.01).脂多糖单独刺激单核细胞时,HMGB-1含量[(9.39±1.37)μg/L]较对照组[(1.48±0.69)μg/L]明显升高(P<0.01).用卡巴胆碱或烟碱预处理细胞后,HMGB-l含量明显下降[(3.52±1.64)μg/L与(4.01±1.56)μg/L],与脂多糖单独刺激组比较差异有统计学意义(P<0.01).阿托品预处理细胞后,卡巴胆碱对脂多糖刺激下单核细胞释放HMGB-1的抑制作用无明显变化[(3.87±2.01)μg/L],而α-银环蛇毒素预处理细胞后,卡巴胆碱对HMGB-1的抑制作用明显减弱[(8.97±1.97)μg/L].结论 烧伤后脓毒症患者HMGB-1释放明显增加,卡巴胆碱能够减少单核细胞释放HMGB-1,其作用机制可能是通过N样胆碱能受体α-7亚基实现的.     

ω-3脂肪酸对脓毒症病人治疗的影响

目的:探讨ω-3脂肪酸对脓毒症病人的免疫调节和抗炎作用。方法:将18例病人随机分为鱼油治疗组和常规治疗组。鱼油治疗组病人为常规治疗加鱼油,并于治疗前和治疗后第5天用流式细胞仪检测单核细胞HLA-DR表达率,同时检测炎症反应指标,包括C反应蛋白(CRP)、IL-6和肿瘤坏死因子α(TNF-α),观察病情严重程度(APACHEⅡ评分)和氧合指数(PaO2/FiO2)的变化。结果:相对于常规治疗组,鱼油治疗组病人血清CRP、IL-6和TNF-α均明显下降;氧合指数改善;单核细胞HLA-DR表达率、APACHEⅡ评分较常规治疗组无显著性差异。结论:应用ω-3脂肪酸可使脓毒症病人血清炎症介质表达减少,但对单核细胞HLA-DR的表达未见调节作用。     

老年重叠综合征患者血清脑钠素水平的变化及其意义

目的观察单纯慢性阻塞性肺疾病（COPD）与COPD合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者,即重叠综合征（OS）患者体内血清脑钠素（BNP）水平的变化。方法回顾性分析2009年7月至2013年5月海军总医院呼吸内科住院患者113例,所有患者均经过完整的肺功能、动脉血气、超声心动图、夜间多导睡眠监测及血清BNP的检测。结果 COPD组（68例）与OS组（45例）患者的年龄、性别比例及身高体重指数（BMI）差异均无统计学意义（P〉0.05）;COPD组与OS组平均肺动脉压（m PAP）分别为（21.5±5.7）mm Hg和（29.2±6.3）mm Hg,OS组显著高于COPD组（P〈0.05）,而COPD组与OS组BNP平均浓度分别为（65.27±16.52）pm/ml与（98.59±27.38）pg/ml,两组比较差异也具有统计学意义（P〈0.05）。结论相对于单纯COPD患者,OS患者的平均肺动脉压和血清脑钠素水平更高。     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

氩氦刀对T739小鼠LA795皮下移植瘤坏死及细胞凋亡的影响

目的:研究氩氦刀冷冻消融对T739小鼠LA795肺腺癌皮下移植瘤坏死和细胞凋亡的影响. 评价氩氦刀冷冻治疗非小细胞肺癌的可行性及疗效. 方法:建立T739小鼠LA795肺腺癌皮下移植瘤动物模型. 氩氦刀冷冻后,光学显微镜观察冷冻坏死消融规律;末端标记法(TUNEL)原位检测周边冷冻损伤区带细胞凋亡,免疫组织化学法检查Bc1-2和Bax表达;Western Blot检测冰球周边冷冻损伤区Caspase-3表达及聚腺苷二磷酸核苷聚合酶(PARP)剪切活性. 结果:在冷冻中心区,细胞死亡以坏死为主,坏死呈现"双峰"效应:氩氦刀术后3 h出现第1次坏死高峰,坏死区域面积/肿瘤面积达(47±5.51)%;术后4 d出现第2次坏死峰,坏死区域面积/肿瘤面积达(68±4.69)%. 在周边冷冻损伤区,光镜形态学检查及TUNEL染色可观察到明确的细胞凋亡,术后8～16 h凋亡达高峰,凋亡率为(71±6.41)%. 免疫组化显示,Bcl-2蛋白表达在冷冻前后无明显变化,bax蛋白在冷冻后其表达上调. Western Blot结果显示:冷冻后冰球周边损伤区带Caspase-3和PARP剪切、激活. 结论:氩氦刀通过坏死和凋亡两种途径达到有效的消融. 冷冻消融可能通过Caspase途径诱导周边损伤区带细胞凋亡. 其凋亡机制有Bax蛋白参与,而与Bcl-2无关.     

T739小鼠LA795肺腺癌皮下移植瘤氩氦刀冷冻消融前后基因表达谱芯片分析

[目的]用基因芯片技术分析、筛选氩氦冷冻消融前后肺腺癌相关基因谱的差异表达。[方法]建立T739小鼠LA795肺腺癌皮下移植瘤动物模型,行氩氦刀冷冻消融。分别抽提、纯化冷冻前后肿瘤组织mRNA,逆转录Cy3、Cy5标记cDNA探针,应用小鼠表达谱芯片CSC-ME-10,分析差异表达的基因。[结果]发现氩氦刀冷冻治疗前后T739小鼠LA795肺腺癌皮下移植瘤组织有显著性表达差异的基因共有26个,治疗后17条表达降低,9条表达增高。[结论]氩氦刀冷冻消融前后T739小鼠LA795肺腺癌皮下移植瘤组织部分功能基因存在着显著的表达差异,多数差异表达的基因与细胞生长因子调节、代谢酶类以及转录因子等相关。     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

氢溴酸樟柳碱注射液对急性脑梗死患者NIHSS评分、改良Barthel指数和CTP参数的影响

目的观察氢溴酸樟柳碱注射液治疗急性脑梗死的临床疗效。方法将86例符合急性脑梗死诊断标准的患者随机分为治疗组和对照组,各43例,对照组仅采用常规治疗,治疗组在常规治疗的基础上加用樟柳碱注射液进行治疗,连用2周;于治疗前及治疗后14 d依据美国国立卫生院脑卒中量表(NIHSS评分)对2组患者神经功能缺损程度进行评价,在治疗后14、30、90 d采用改良Barthel指数(MBI)对患者进行日常生活活动能力(ADL)进行评分,同时采用CT灌注成像(CTP)分析治疗前及治疗后14 d梗死区rCBF(局部脑血流量)、rCBV(局部脑血容量)、TTP(达峰时间)和MTT(平均通过时间)指标水平的变化。结果 (1)在治疗后的14 d 2组患者NIHSS评分相比治疗前均下降,但治疗组显著优于对照组(P0.05);(2)治疗后14 d治疗组较对照组rCBV、rCBF均增加,TTP、MTT均缩短(P0.05);(3)在治疗后30 d、90 d 2组患者改良Barthel指数(MBI)相比治疗前均呈现好转,但治疗组效果显著优于对照组(P0.05)。结论氢溴酸樟柳碱序贯治疗急性脑梗死能明显改善神经功能缺损症状,且安全有效。     

纤维支气管镜在ICU机械通气患者中的应用

目的观察纤维支气管镜在重症监护病房（Intensive Care Unit,ICU）机械通气患者应用时的检查治疗作用及安全性。方法收录我院ICU病房2008年1月～2009年6月收治的35例行机械通气治疗的患者行纤维支气管镜检查治疗,对检查治疗前后各项指标的变化进行监测,包括平均动脉压、经皮血氧饱和度、心率变化。结果本组共行35例共42次纤支镜检查治疗,成功41次,包括：肺部感染24例;气管内支架置入术2例;肺不张4例;经明确诊断肺部肿瘤和食管-气管瘘各1例;出血2例;肺挫伤1例。行纤支镜检查治疗后,即刻平均动脉压、经皮血氧饱和度下降,心率增高,均有统计学意义（P〈0.05）,半小时后平均动脉压、经皮血氧饱和度、心率与术前相比无统计学意义（P〉0.05）,均无严重并发症。结论纤支镜在ICU机械通气患者中有较好的应用价值,且比较安全。