还原型谷胱甘肽对体外循环下心肌缺血再灌注损伤的影响

对15例心脏直视手术患者给予还原型谷胱甘肽(GSH),观察在心肌缺血再灌注过程中血浆过氧化脂质(LPO)、红细胞超氧化物歧化酶(SOD)含量动态变化,并以15例同种病人作为对照,发现对照组于再灌注期血浆LPO显著升高,红细胞SOD显著降低;GSH组血浆LPO显著低于对照组,红细胞SOD显著高于对照组。提示外源性GSH有可能减轻心肌缺血再灌注损伤。     

西洋参茎叶三醇组皂苷对缺血再灌注损伤心肌的保护作用

目的　探讨西洋参茎叶三醇组皂苷 (PQTS)对缺血再灌注损伤心肌的保护作用及机制。方法　采用大鼠离体心脏Langendorff灌流模型 ,观察PQTS对缺血再灌注心肌组织中SOD活性、LPO水平及再灌注性心律失常的影响。结果　PQTS(30、1 0 0、30 0 μg/ml)可以不同程度地降低心肌组织中LPO含量、提高心肌SOD活性水平 ,并抑制再灌注性心律失常的发生。结论　PQTS对缺血再灌注损伤心肌的保护作用与抑制心肌脂质过氧化反应有关     

硝苯地平和维生素C对心肌缺血-再灌注中血浆LFO和红细胞SOD的影响

观察硝苯地平和维生素C对体外循环心脏直视手术病人心肌缺血-再灌注过程中血浆LPO和红细胞SOD含量的影响,并与常规手术病人进行对比,发现在再灌注过程中,对照组血浆LPO含量升高,红细胞SOD含量降低,硝苯地平组和维生素C组上述指标无明显变化。表明硝苯地平具有清除氧自由基和抗脂质过氧化作用,效果与维生素C相同。     

心肌肽素在心脏手术中对心肌的保护作用的临床研究

目的:考察心脏瓣膜替换术和冠状动脉旁路移植术(CABG)患者在体外循环停跳液中使用心肌肽素的安全性及对心肌的保护作用。方法:选择心脏瓣膜替换术患者44例(瓣膜替换组,又随机分为对照患者、用药患者各22例),CABG患者65例(CABG组,又随机分为对照患者33例、用药患者32例)。2组用药患者在麻醉后,静脉滴注心肌肽素1 mg/kg,30分钟给药完毕;第1次灌注时在停跳液中一次性加入心肌肽素2 mg/kg。2组对照患者给予相应的甘露醇。观察围术期血流动力学,心肌组织形态学,心肌酶学及肌钙蛋白含量的变化。结果:所有受试患者均顺利完成试验,未见明显不良反应,均康复出院。CABG组心肌组织形态学:用药患者在用药前心肌组织病变分值较对照患者显著升高(P<0.01),而用药后较对照患者显著降低(P<0.01);用药患者体外循环后心肌组织病变分值较体外循环前显著降低(P<0.01);而对照患者体外循环后心肌组织病变分值较体外循环前显著升高(P<0.01)。瓣膜替换组心肌组织形态学:体外循环前心肌组织病变分值用药患者虽高于对照患者,但无统计学意义;体外循环后用药患者显著低于对照患者(P<0.01);体外循环后对照患者心肌组织病变分值较体外循环前显著升高(P<0.01),用药患者虽有降低,但无统计学差异(P>0.05)。结论:心肌肽素在心脏瓣膜替换术和CABG患者体外循环停跳液中使用是安全的,而且对心肌有一定保护作用。     

几种贫血疾患血液过氧化脂质、超氧化物歧化酶及谷胱甘肽过氧化物酶的测定及意义

本文报道22例三种不同类型贫血的血清过氧化脂质(LPO)、红细胞超氧化物歧化酶(SOD)、全血谷胱甘肽过氧化物酶(GSH-PX)测定结果。血清 LPO 在再障、溶贫及缺铁性贫血均呈显著性增加(P<0.001～0.01),其增加程度与贫血基本病因的严重度有关;各类贫血的 SOD活力与正常人无明显差异;GSH-PX 在各型贫血呈非常显著性降低(P<0.001)。溶贫患者在疾病活动阶段,LPO 明显增加,SOD 显著降低,提示脂质过氧化物对红细胞膜的损害效应。文中对 LPO、SOD、GSH-PX 变化机制及意义进行了讨论。     

脂质过氧化与充血性心力衰竭

对50例充血性心力衰竭患者(CHF)及44例健康者进行了血过氧化脂质(LPO)、超氧化物歧化酶(SOD)的检测。结果发现,心力衰竭患者的LPO、血清及红细胞内SOD活力较对照组显著升高;随着心力衰竭加重,LPO、SOD皆增加,SOD/LPO比值下降,LPO含量与心功能呈显著负相关,心力衰竭改善,LPO及SOD减少,SOD/LPO上升。这表明脂质过氧化增强在CHF的发生发展过程中可能起着重要的促进作用,LPO、SOD动态变化可作为判断心力衰竭程度的参考指标。     

心脏手术患者围术期血浆血管加压素浓度变化研究

目的通过对体外循环、不同手术方式等多因素影响围术期血浆血管加压素(AVP)浓度变化的研究,阐明其变化规律。方法选取40例体外循环心内直视手术患者作为研究对象。分别测定术前,体外循环20min,术后2h、24h、72h血浆AVP浓度,以不同术式(心脏停跳、心脏不停跳)、不同体外循环时间分组,然后进行资料统计分析。结果体外循环20min时血浆AVP浓度达高峰,术后72h恢复到术前水平;术后2h心脏停跳组显著高于心脏不停跳组;体外循环>40min组高于体外循环≤40min组。结论体外循环(CPB)是刺激机体应激反应产生AVP最强有力的诱因。术后早期血浆AVP浓度的升高程度与体外循环时间呈正相关。心脏停跳手术方式更能刺激机体在术后早期产生高水平的血浆AVP。心脏不停跳心内直视手术方式能减少对机体的损伤,减轻心肌缺血再灌注损伤。     

病毒性肝炎患者血清自由基指标变化及百令胶囊疗效观察

采用生物化学方法检测了 4 7例病毒性肝炎患者的血清自由基指标〔超氧化物歧化酶( SOD)、脂质过氧化物 ( L PO)、黄嘌呤氧化酶 ( XOD)〕变化 ,并与用百令胶囊治疗后以上指标变化进行比较。结果治疗前 SOD活性降低 ,LPO和 XOD升高 ;治疗后 SOD升高 ,明显高于对照组。LPO和 XOD下降 ,显著低于对照组。提示自由基及脂质过氧化物升高与病毒性肝炎的发生及发展密切相关 ,百令胶囊治疗后机体抗氧化能力增强     

体外循环心脏瓣膜置换术患者围手术期PON1与SOD、MDA的变化及相关性

目的：研究体外循环（CPB）心脏瓣膜置换术患者围手术期对氧磷酶1（PON1）与超氧化物岐化酶（SOD）和丙二醛（MDA）的变化及相关性。方法：随机选取我院30例行CPB心脏瓣膜置换术的风湿性心脏瓣膜病患者，于心脏停搏前及恢复心脏血氧灌注后采集患者右心房组织，使用Real-time PCR检测PON1 mRNA的表达；分别于术前30min、术后1h和术后3d采集患者外周静脉血，采用ELISA试剂盒检测血清PON1活性，黄嘌呤氧化酶法检测血清SOD水平，硫代巴比妥酸法检测血清MDA水平，并就血清PON1活性与SOD和MDA水平进行Pearson相关性分析。结果：患者恢复心脏血氧灌注后心肌组织PON1的表达显著低于心脏停搏前（P<0.05）。相较于术前，患者术后1h的血清PON1和SOD水平均显著降低，MDA水平显著升高（P<0.05）；术后3d的血清PON1和SOD水平均显著升高，MDA水平显著降低（P<0.05）；血清PON1水平与SOD水平呈显著正相关（P<0.05），PON1水平与MDA水平呈显著负相关（P<0.05）。结论：PON1参与了CPB心脏瓣膜置换术缺血再灌注过程，血清PON1活性与SOD和MDA显著相关，PON1可能是反映心肌缺血再灌注中氧化应激损伤的潜在指标。     

5种类型老年冠心病患者血液自由基相关成分的变化及其发生机制

对隐性冠心病、心绞痛、心肌梗塞、心肌硬化和心律失常5种类型冠心病患者血液SOD、GSH-Px、CAT、GSH、T-AO、LPO和GSH—Px/LPO比值等自由基相关成分进行分析检测。结果表明,84例冠心病患者与48例健康对照组比较,SOD、GBH—Px、GSH、T—AO及GSH—Px/LPO比值均显著降低(P<0.01);LPO或MDA则显著增高(P<0.01);CAT数值略高,但无统计学意义。提示自由基相关成分的变化可作为冠心病早期诊断或辅助诊断的指标,并在判断其临床类型,分析其病变程度及估计预后方面有一定的临床意义。     

Are leukocytosis and lipid peroxidation involved in ischemic or reperfusion injury in cardiac surgery?

We have studied the hypothesis that free-radical generation during cardiac surgery could explain partly the pathophysiology of ischemic or reperfusion injury during cardiopulmonary bypass (CPB). Ten patients undergoing cardiac surgery using CPB were prospectively studied. Malondialdehyde (MDA) was measured as a marker of free-radical-induced lipid peroxidation (LPO) using the thiobarbituric acid method, and leukocytes were counted during ischemia and reperfusion. Both MDA and leukocytes increased significantly, especially after starting reperfusion. There was significant correlation between LPO and leukocytosis (r = 0.8, p less than 0.005). It is concluded that free radicals generated during ischemia and reperfusion lead to an increase of LPO, which is shown for the first time to be associated with leukocytosis in cardiac surgical patients. The implication of this observation is of importance for the treatment strategy using free-radical scavengers in reducing the harmful effects of ischemia and reperfusion in cardiac surgery.     

Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass

OBJECTIVE: The occurrence of a systemic inflammatory reaction during cardiac surgery with cardiopulmonary bypass (CPB) has been well established, and the heart itself has been shown to release inflammatory mediators after ischemia. The hypothesis of the present study was that the lungs are also a site of inflammatory responses during early reperfusion. METHODS: In 20 consecutive patients undergoing coronary artery bypass grafting, blood was simultaneously drawn from the right atrium (RA) and the pulmonary vein (PV) before CPB and at 1 min, 10 min, and 20 min of reperfusion. The levels of interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-alpha were determined, as well as the adhesion molecules CD41 and CD62 on platelets and CD11b and CD41 on leukocytes. As a measure of the pulmonary release, ratios of PV and RA levels were calculated. RESULTS: Before CPB, the concentrations of cytokines tended to be lower in the PV compared with the RA. At 1 min of reperfusion, no significant concentration increases were found in the PV. At 10 min of reperfusion, the PV/RA ratio (mean +/- SEM) for IL-6 was 2.06 +/- 0.37 and 1.24 +/- 0.15 for IL-8 (p = 0.02 and p = 0.04, respectively, compared with the pre-CPB ratios of 0.89 +/- 0.4 and 0.99 +/- 0.2). At 20 min of reperfusion, PV/RA ratios for IL-6 (1.95 +/- 0.37) and IL-10 (0.99 +/- 0.4) were higher than before CPB (0.89 +/- 0.04, p = 0.05 and 0.85 +/- 0.06, p = 0.03, respectively). Adhesion molecule counts on platelets and polymorphonuclear neutrophils (PMNs) tended to be higher in the PV than in the RA before CPB. At 1 min of reperfusion, the PV/RA ratio of CD41 on monocytes (0.89 +/- 0.04) and of CD41 on PMNs (1.05 +/- 0.05) was less than before CPB (1.24 +/- 0.08, p = 0.0002 and 1.55 +/- 0.14, p = 0.0002). At 10 min and 20 min of reperfusion, similar changes were found. CONCLUSIONS: The observed changes indicate an inflammatory response of the lungs. Proinflammatory cytokines are increased in pulmonary venous blood. At the same time, activated blood cells are retained in the pulmonary circulation. This may contribute to pulmonary dysfunction almost routinely observed after CPB.     

针灸治疗类风湿关节炎的临床研究

目的　了解针灸治疗类风湿关节炎 (RA)的疗效 ,并探讨其消炎镇痛作用机制。方法　将 45例RA患者随机配对以 1∶2分为针灸组 (30例 )和消炎痛组 (15例 )。观察其疗效并测定部分患者治疗前后超氧化歧化酶 (SOD)、脂质过氧化物酶 (LPO)的改变和亮脑啡肽 (LEK)的变化。结果　针灸组与消炎痛组治疗RA疗效相似 (P >0 0 5 ) ,治疗前后的关节肿胀指数、关节压痛指数、晨僵、握力、红细胞沉降率 (ESR)、类风湿因子 (RF)均下降。治疗前后SOD和LPO降低 ,而LEK明显升高。结论　针灸治疗RA具有消炎镇痛作用 ,其机制可能与亮脑啡肽升高 ,调节自由基代谢有关 ,同时发现针灸治疗能使ESR明显下降 ,RF滴度下降 ,可能还有免疫调节作用     

经食道超声心动图在体外循环心脏手术麻醉中的应用研究

目的探讨经食道超声心动图(TEE)在体外循环(CPB)心脏手术麻醉中的应用效果。方法选择2019年2月至2021年2月在肇庆市第二人民医院实施CPB心脏手术的心脏病患者35例。其中主动脉瓣置换12例,二尖瓣置换+主动脉瓣置换10例,二尖瓣置换13例。术前、术中均进行TEE监测,评价手术效果,观察心脏复跳后以及CPB停机前的气体量分级,以及术前(T₀)、术中10 min(T₁)、术中30 min(T₂)、术中60 min(T₃)患者乳酸、平均动脉压(MAP)水平的变化。比较手术前后患者每搏量(SV)、面积减少分数(FAC)、心脏指数(CI)、速度时间积分(AVTI)。结果术后35例患者瓣叶均可以正常活动,未发现瓣周漏,心脏复跳至CPB停机平均为(25.26±5.01) min,无并发症发生。35例患者心脏复跳后,有27例患者左心房存在不同程度的气体,其中1级12例,2级10例,3级5例; CPB停机前只有6例为1级。在T₀、T₁、T₂、...     

红景天甙对脑缺血再灌注脑组织NO代谢的影响

为探讨红景天甙在大鼠急性脑缺血及缺血再灌注阶段对一氧化氮（NO）代谢的影响,为临床应用提供依据,于大鼠4血管结扎的急性脑缺血再灌注模型实验不同阶段给予红景天甙,观察血清和脑皮质中NO、自由基变化及脑组织含水量等指标。结果显示缺血组和再灌注各组大鼠脑组织含水量比对照组明显增多;脑内及血清LPO、NO等显著升高,与对照组比较差异显著（P＜0．01）;SOD水平降低。用药后各组上述指标均有改善。认为红景天甙可通过抗自由基功能影响NO代谢并保护神经细胞。     

休克／再灌注肝损伤中氧自由基的作用

采用电子自旋共振（ｅｌｅｃｔｒｏｎｓｐｉｎｒｅｓｏｎａｎｃｅ，ＥＳＲ）及自旋捕捉技术直接测定兔休克／再灌注不同时限肝组织内氧自由基（ｏｘｙｇｅｎｆｒｅｅｒａｄｉｃａｌｓ，ＯＦＲ）含量的变化，同时观察肝组织内脂质过氧化物（ｌｉｐｉｄｐｅｒｏｘｉｄｅ，ＬＰＯ）含量，超氧化物岐化酶（ｓｕｐｅｒｏｘｉｄｅｄｉｓｍｕｔａｓｅ，ＳＯＤ）及血清ＡＬＴ活性的变化。结果示，ＯＦＲ易被自由基捕捉剂ＰＢＮ（α－ｐｈｅｎｙｌ－ｔｅｒｔ－ｂｕｔｙｌｎｉｔｒｏｅｎｅ）捕捉，并可通过ＥＳＲ而检测。ＯＦＲ在休克１．５小时后即有明显增高，再灌注１５和３０分钟后增高更为显著，ＬＰＯ、ＳＯＤ于再灌注后才分别有显著增高和降低，ＡＬＴ休克１．５小时后即有大幅度增高。ＬＰＯ、ＡＬＴ与ＯＦＲ有良好的线性正相关，ＳＯＤ与ＯＦＲ有良好的线性负相关，提示兔休克／再灌注肝损伤可能由ＯＦＲ介导。     

高血压病与脂质过氧化的关系及药物干预的研究

观察５９例高血压病（ＥＨ）患者血过氧化脂质（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）水平以及尼群地平和卡托普利降压治疗后的变化。结果表明：ＥＨ患者血浆ＬＰＯ较正常组显著升高，血浆ＳＯＤ／ＬＰＯ和红细胞ＳＯＤ显著降低，并且ＬＰＯ、ＳＯＤ与平均动脉压呈显著相关性；降压治疗后，两服药组血浆ＬＰＯ均显著下降，尼群地平组血浆ＳＯＤ／ＬＰＯ显著升高，卡托普利组血浆ＳＯＤ显著升高。提示脂质过氧化损伤可能参与ＥＨ的形成过程。     

High mobility group box 1 levels in on and off-pump cardiac surgery patients

High mobility group box 1 (HMGB1), which has properties similar to those of proinflammatory cytokines, is released from activated immune cells and necrotic cells. It is known that cardiopulmonary bypass (CPB) induces systemic inflammation and aortic cross-clamping induces myocardial ischemia. This study was conducted to clarify whether HMGB1 is released in CPB-supported cardiac surgery in comparison to off-pump coronary artery bypass grafting (OPCAB) where CPB is not used.Nineteen adult patients undergoing cardiac surgery involving CPB (CPB group) and 5 OPCAB patients (OPCAB group) were included in this study. Plasma concentrations of proinflammatory cytokines including HMGB1 were measured before, during, and after cardiac surgery. The plasma HMGB1 level was significantly increased at one hour after aortic declamping in the CPB group and at 30 minutes after revascularization in the OPCAB group. The peak HMGB1 level was slightly higher in the CPB group than that in the OPCAB group. These values decreased toward baseline value after surgery in both groups. TNF-α and IL-1β were not detectable throughout the study period in either group. IL-6 and IL-10 increased after aortic declamping in the CPB group and after coronary revascularizations in the OPCAB group.Based on these results, we conclude that the major factor involved in the increase in HMGB1 level might be myocardial ischemia/reperfusion during cardiac surgery. Activation of immune cells, altered tissue perfusion, and pulmonary ischemia and reperfusion could be additional factors that increase the HMGB1 level in CPB-supported cardiac surgery.     

再次停搏温血灌注在体外循环手术心脏复苏困难治疗中的应用

目的观察含磷酸肌酸的氧合温血低钾停搏液诱停加体外循环（CPB）温血持续灌注治疗心脏复苏困难的疗效。方法 30例CPB下心脏复苏困难的心脏瓣膜手术患者,随机分为观察组和对照组,各15例。观察组再次阻断升主动脉,灌注含磷酸肌酸（10 mmol/L）的氧合温血低钾停搏液7 ml/kg使心脏再次停波,持续灌注温血,然后开放升主动脉。对照组采用CPB辅助加电击除颤。结果两组患者均复苏成功。两组主动脉阻断时间无显著差异,CPB时间和辅助循环时间实验组明显低于对照组（P〈0.05）,实验组复跳后多巴胺最大剂量和术毕CK-MB水平均明显低于对照组（P〈0.05）。结论 含磷酸肌酸的氧合温血低钾停搏液诱停加CPB温血持续灌注治疗心脏复苏困难疗效满意。