大黄对多器官衰竭大鼠肠粘膜屏障的保护作用

目的：探讨大黄对多器官衰竭大鼠肠粘膜屏障的保护作用。方法：６０只大鼠随机分为对照组，生理盐水治疗组和大黄治疗组，以酵母多糖Ａ制作多器官衰竭模型，观察肠道细菌移位，血浆内毒素水平，肠粘膜的病理变化，结果：大黄治疗组血及内脏中细菌移居数量减少，血浆内毒素水平低，小肠病理损害轻，并有杯状细胞增生，结论：大黄对多器官衰竭大显肠粘膜屏障有保护作用。     

The role of endotoxin in the pathogenesis of experimental multiple system organ failure: a preliminary report.

In this study, an animal model of multiple system organ failure (MSOF) in rabbits, engendered by feeding E. coli prior to severe hemorrhagic shock, was used for the purpose of investigating 1) the relationship between lipopolysaccharide (LPS) and MSOF, and 2) the effectiveness of Re-LPS antiserum in preventing MSOF. The results showed that endotoxemia occurred very early, and its degree correlated well with that of organ dysfunction. Re-LPS antiserum administration abated the toxic effects and lowered the incidence of MSOF. These results suggest that sequential analysis of circulating LPS levels may be useful for the early diagnosis of MSOF, and that gut-derived endotoxin might play an important role in the pathogenesis of experimental MSOF.     

多器官功能衰竭中急性肾衰的腹透治疗

对１５例不适合作血透治疗的多脏器功能衰竭中的急性肾功能衰竭患者，于确立诊断后２４ｈ内立即行间歇性腹膜透析治疗。除３例因呼吸循环衰竭死亡外，１２例患者于半月内肾功能恢复或基本恢复。认为对不适合血液透析的多脏器衰竭中的急性肾功能衰竭患者，腹膜透析具有较好的效果。     

Bacterial translocation and multiple system organ failure in bowel ischemia and reperfusion.

Portal circulation was reduced to 50-60% for one hour by partial occlusion of the superior mesenteric artery for the purpose of studying the relationship between reperfusion injury, bacterial translocation and multiple system organ failure. Forty dogs were divided randomly into four groups, and 1 x 10(10)/kg E. coli O111B4 were fed to each animal 12 hours before operation. Group I constituted the controls, in which sham operations were performed. The experimental procedure was completed in all the animals of the other three groups. Rubia yunnanensis, an anti-oxidant, was given to group III. Amikacin was given to group IV. The results showed that group II was characterized by bacteremia, hypoxemia, and hypotension as compared with group I. The levels of superoxide dismutase (SOD) in the whole blood were markedly lowered and malondialdehyde (MDA) values significantly elevated in group II after reperfusion compared with group I. Plasma levels of anaphylatoxin C5a and B2 (TXB2) were significantly raised in group II beginning with the reperfusion when compared with groups I, III and IV. Pathological changes in the intestine, liver and lung were remarkable only in group II, including acute necrosis of the intestinal mucosa, granulocyte infiltration, hemorrhage and edema of the lung, degenerative changes of myocardial and hepatic cells, and bacterial invasion of the blood, liver and lung. These results suggested that bowel ischemia and reperfusion may promote gut barrier failure and bacterial translocation, then contribute to the development to multiple system organ failure (MSOF) by allowing bacteria or endotoxin normally contained within the gut to reach the portal and systemic circulations where it fuels the septic process. Oxygen free radicals, anaphylatoxin and thromboxane may be potential factors in the development of gut barrier failure and MSOF.

     

器官衰竭中白细胞凋亡的研究

目的 探讨细胞凋亡百分率与多系统器官衰竭(MOF)的预后关系.方法采用对照双盲法流式细胞仪检测MOF患者外周血淋巴细胞与单核粒细胞的凋亡早期、凋亡性死亡百分率.结果①MOF患者淋巴细胞、单核粒细胞凋亡早期和凋亡性死亡率高于对照组(P＜0.05);②MOF患者单核粒细胞凋亡性死亡百分率与器官衰竭数目成正相关;③单核粒细胞凋亡总百分率、器官衰竭数与MOF患者死亡成正相关.结论 MOF患者外周血单核粒细胞凋亡异常增加,并且与衰竭器官数目和死亡正相关.     

肺结核并发多脏器功能衰竭

目的　探讨肺结核并发多脏器功能衰竭（ ＭＯＦ）的原因及预后。方法　回顾性总结１２４７ 例肺结核并发多脏器功能衰竭的发生率与病死率。结果　Ⅳ型肺结核并发多脏器官功能衰竭的发生率明显高于Ⅱ型、Ⅲ型肺结核（ Ｐ＜ ０．００１）,发生率为５．４ ％ 。其中并发呼吸衰竭的病死率为４７．８ ％ ,并发肾功能衰竭的病死率为６２ ．５％ ;并发２ 个脏器功能衰竭的病死率为３８．９ ％ ,３ 个脏器功能衰竭的病死率４０ ．６％ ,≥４ 个脏器功能衰竭的病死率为７０．６％ 。结论　病死率随受损脏器的增多而增高,主要原因是继发感染、缺氧和休克。     

高龄多器官功能衰竭患者甲状腺功能的变化

1临床资料2003-10/2004-12住院老年多器官功能衰竭患者46例,全部为男性,年龄(79±5)岁.2个器官功能衰竭为A组15例,年龄(77±6)岁;3个以上器官功能衰竭为B组20例,年龄(79±7)岁;死亡为C组11例,年龄(78±4)岁;无重要脏器功能衰竭的老年患者20例为对照组,年龄(78±6)岁,全部为男性.以上受试对象均无甲状腺疾病病史,未用影响甲状腺功能的药物.清晨空腹安静状态下抽取静脉血2mL用放免法测定TT3,TT4,FT3,FT4及TSH,药盒由天津DPC公司提供.ABC3组TT3(nmol/L)和FT3(pmol/L)水平均减低,C组减低最明显,分别为1.7±0.4和3.9±0.9,1.3±0.4和…     

急性颈髓损伤并发多系统器官衰竭的临床分析

目的：探讨急性颈髓损伤并发多系统器官衰竭（ＭＳＯＦ）发病因素及其类型，为防治伤后ＭＳＯＦ提供依据。方法：对３０３例急性外伤性颈髓损伤并发ＭＳＯＦ的３２例患者进行回顾性分析。结果：颈髓损伤并发ＭＳＯＦ的诱因为肺部感染，高热，水电解质平衡紊乱，低蛋白血症，颈髓损伤患者ＭＳＯＦ的发生率为１０．５６％，ＭＳＯＦ患者的死亡率为７８．１３％（２５／３２），结论：消除ＭＳＯＦ的诱因及对可能发生或发生功能不全的器     

重症哮喘并发器官功能衰竭的护理与观察

目的:研究哮喘患者并发器官功能衰竭的护理体会。方法:总结重症哮喘发生多器官功能衰竭(MOF)12例、单器官功能衰竭(OF)19例、双器官功能衰竭(DOF)12例的病因、临床表现、监护指标、护理观察等,探讨若干有待解决的问题。结果:重症哮喘易出现MOF、OF、DOF,主要原因为机体严重缺氧,引起微循环障碍及炎症介质等因素导致全身内循环紊乱。针对其发生器官功能衰竭的重症哮喘患者的护理工作,加强心理护理,消除紧张情绪,严密观察病情,及时沟通医生,防止并发症,是增加治愈率、降低死亡率的关键。结论:呼吸重症监护(RICU)在危重救治中发挥重要的作用。     

氨溴索对实验性肺不张的保护作用

目的：探讨氨溴索对实验性肺不张的保护作用。方法：雄性实验用中国小型猪18只,随机分成对照组（C组）、肺不张组（M组）及氨溴索处理组（T组）,各6只。M组及T组小型猪的右主支气管下端置入镍钛合金封堵器,T组小型猪在放入封堵器后当天即予氨溴索针静脉注射（每次30 mg/kg,每日3次）,CT扫描确定肺不张的形成。在肺不张形成后的第3天3组动物均行支气管灌洗,处死动物,收集右下肺组织行光镜病理学检查,收集灌洗液行二棕榈酸磷脂酰胆碱（DPPC）浓度、表面活性物质相关蛋白A（SP-A）浓度及大、小聚集体（LA、SA）比值检测,再次行CT检查比较肺不张面积的大小。结果：M组呈典型的肺不张病理学及CT改变,DPPC、SP-A浓度及LA/SA比值均明显下降,而T组肺不张病理学及CT改变明显减轻,肺不张面积明显减小,DPPC、SP-A浓度及LA/SA比值均较M组明显增高。结论：氨溴索对实验性肺不张具有保护作用,其机制可能为氨溴索可增加肺泡表面活性物质的表达,抑制LA向SA转换,从而减轻肺不张的程度。     

可溶性TNFR-Fc融合蛋白对大鼠MODS的保护作用

目的 :观察肿瘤坏死因子 (TNF)及肿瘤坏死因子受体 (TNFR)与多器官功能障碍综合征 (MODS)的关系 ,探讨可溶性肿瘤坏死因子受体 - Fc融合蛋白 (s TNFRp75 - Fc)在 MODS中的保护效果及作用机制。 方法 :将 4 8只雄性 SD大鼠随机分为正常组、模型组、给药组 ,通过创伤 +感染二次打击 ,建立“双相迟发”大鼠 MODS模型 ,在模型基础上动物复苏时静滴 0 .4mg/ kg s TNFRp75 - Fc作为给药组。采用 Western印迹技术 ,对各组大鼠主要器官细胞膜表面 TNFR表达量进行分析。结果 :给药组动物主要器官损害指标明显减轻 (P<0 .0 5 ) ,MODS发生率 (4 3.7% )和病死率 (12 .5 % )与模型组 (10 0 .0 %、5 0 .0 % )相比均显著降低 (P<0 .0 5 )。s TNFRp75 - Fc显著抑制血浆中 TNF-α活性。正常组 TNFR1和 TNFR2均为低水平表达 ,MODS模型鼠的两种 TNFR表达较正常组明显增强 ;给予 s TNFRp75 - Fc后各器官中两种 TNFR水平均明显下降。结论 :TNF-α及TNFR的表达在 MODS的发生发展过程中起十分重要的作用 ,外源性 s TNFR的应用可能减少细胞膜 TNFR的表达。实验证明 s TNFRp75 - Fc可以对 MODS模型动物起到明显保护作用     

血必净注射液对危重症患者多器官功能的保护作用及相关细胞因子的影响

目的:探讨血必净注射液对危重症患者多器官功能保护的机制并观察疗效。方法:将52例危重症患者随机均分为血必净组和对照组。2组常规治疗相同,包括抗感染、对症及营养支持治疗等,外伤患者给予相应的处理以及手术治疗,如病情需要予以呼吸机辅助呼吸。血必净组加用血必净注射液50 m l,每天2次静脉滴注,共10天。分别于治疗第1天和治疗后第4、10天测定患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)、IL-8等炎性介质及血清生化指标。结果:2组患者治疗后4、10天的血清TNF-α和IL-6、IL-8水平均较治疗前下降,而血必净组均较对照组下降更显著(P<0.01);2组血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮、乳酸脱氢酶、肌酸激酶及其同工酶均较治疗前明显降低,且血必净组较对照组下降明显(P<0.01)。结论:血必净注射液对危重症患者的肝脏、肾脏、心脏功能有较好的保护作用。     

急性白血病并发多系统器官功能衰竭的危险因素

目的探讨急性白血病（ＡＬ）并发多系统器官功能衰竭（ＭＳＯＦ）的危险因素。方法通过对ＡＬ并发脏器衰竭的相关病死率、脏衰竭数目与相关病死率及各类型ＡＬ合并脏器衰竭病死率的分析，寻找ＡＬ合并ＭＳＯＦ的易患因素。结果ＡＬ合并ＭＳＯＦ３８例中，以中枢神经系统衰竭发生频度最高（４４％），衰竭器官的数目与病死率呈线性相关。ＡＬ合并ＭＯＳＦ存在一些易患因素。结论ＡＬ并发ＭＳＯＦ与高龄、原有严重器质性疾病、并发严重感染、显著的血液学异常及复发型ＡＬ有密切关系。     

The relationship between organ perfusion pressure and multiple organ failure during mechanical left ventricular assist.

The purpose of this study was to analyze the relationship between hemodynamics, especially the organ perfusion pressure (OPP = mean aortic pressure-mean right atrial pressure) and multiple organ failure (MOF) in cardiac patients receiving left ventricular mechanical assists (LVA). The subjects were 33 patients who had undergone left ventricular mechanical assists in the Department of Cardiovascular Surgery, Fukushima Medical College Hospital, from March 1985 through March 1990. OPP significantly correlated with the levels of GOT, total-bililubin (TB), BUN and serum-creatinin (s-Cr), oxygenation index (OI) and respiratory index (RI). The cardiac index and left and right ventricular stroke work indices, in comparison with OPP, did not significantly correlate with any of the above laboratory tests. These results indicate that OPP is a simple and reliable index to recognize, and also to prevent MOF during LVA. It was also found that OPP should be maintained at a level higher than 65mmHg to protect the liver, kidneys and lungs.     

L-NAME对实验性自身免疫性心肌炎的保护作用

目的观察NG-硝基-L-精氨酸甲酯(L-NAME)对实验性自身免疫性心肌炎(EAM)Lewis大鼠模型的治疗效果,并探索可能的治疗机理。方法 20只Lewis大鼠建立EAM动物模型:双足底注射心肌C蛋白片段和完全弗氏辅佐剂的油状混合物,腹腔注射百日咳毒素。大鼠随机等分为治疗组和模型对照组,每组各10只。治疗组腹腔注射5 mg·kg-1·d-1L-NAME,从免疫注射术后第1天开始连续20 d,1次/d。对照组相同时间内给予相同剂量生理盐水腹腔注射。治疗结束后第1天处死动物,心脏取材,进行系列检测。其中组织病理学石蜡切片苏木素-伊红(HE)染色检测心肌炎症分级,免疫组织化学染色检测T淋巴细胞浸润,天狼星红染色检测心肌胶原纤维含量,硝酸还原酶法检测NO水平,明胶酶谱法检测胶原酶活性。结果与对照组比较,L-NAME治疗组心肌炎症级别下降[(3.42±0.31)vs(2.51±0.22),P<0.01]、T淋巴细胞浸润数目减少[(28.2±4.6)vs(13.2±1.9),P<0.01]、心肌间质纤维化级别下降[(2.33±0.26)vs(1.14±0.17),P<0.01]、血清NO水平降低[(68.34±8.61)μmol/L vs(45.71±6.53)μmol/L,P<0.01],明胶酶活性降低[(254 526±4 729)vs(184 712±3 869),P<0.01]。结论 L-NAME抑制EAM病理发展过程,其机制可能与通过降低NO水平和明胶酶活性,从而降低心肌炎症细胞浸润,延缓心肌间质纤维化有关。     

雌激素对实验性自身免疫性脑脊髓炎的保护作用

目的 检测雌激素在小鼠实验性自身免疫性脑脊髓炎(EAE)中的预防性治疗作用并初步探讨其体内作用机制.方法 用髓鞘少突胶质细胞糖蛋白(MOG35-55)和完全弗氏佐剂(CFA)免疫C57BL/6J小鼠制备EAE模型;雌激素于建模始每日皮下注射50 μmol/L进行治疗,通过发病指数评分、脊髓病理分析、炎症因子水平检测,并应用流式细胞仪(FACS)及实时荧光定量PCR(qPCR)评价治疗效果;进一步通过分析小鼠脾细胞及脊髓相关功能分子CD4/PD-l、CD19/PD-L1、CD4/CD25/Foxp3、CD19/CD21/CD23及CD 19/CD5/CDl dhigh的表达变化,探讨雌激素可能的作用机制.结果 雌激素预防性治疗可有效延缓EAE小鼠的发病,减轻脱髓鞘病变.病理结果显示,雌激素治疗能减少小鼠脊髓组织炎性细胞的浸润,同时下调外周炎性因子TNF-a及IL-17A的分泌表达(P＜0.01);与模型组相比,雌激素治疗下调T淋巴细胞表面活化分子CD69的表达(P＞0.05)并可显著上调CD4+T细胞表面PD-1的表达(P＜0.05);同时,雌激素治疗后PD-1的配体CD19+B细胞表面PD-L1的表达明显上调(P＜0.01),脾细胞中CD19+CD21highCD23low(P＜0.01)及CD19+CD5+CD1dhigh(P＜0.01)的比例也有不同程度的升高,但对脾细胞中CD4+CD25Toxp3*的表达无明显作用.结论 雌激素预防性治疗可延缓EAE小鼠的发病进程,其作用机制可能与上调PD-1/PD-L1通路并上调调节性B细胞水平有关.     

Survial from acute renal failure with and without multiple organ dysfunction.

A 10-year retrospective analysis has been carried out of 114 patients dialysed for acute renal failure. Fifty-eight patients, predominantly suffering from multiple organ failure, required treatment in an Intensive Therapy Unit (ITU); 56 less severely ill patients were treated in a Renal Unit. Overall survival in the former group was 36% and in the latter group 63%. In the first 5 years of the study, survival in the ITU patients was 31% and in the second 5 years, was 38% in spite of a trend towards increased severity of illness. These results challenge the view that haemodialysis is rarely worth-while in patients with multiple organ failure, and suggest that current management techniques have improved prognosis. The most important adverse factors continue to be old age, sepsis and gastrointestinal disease.