最新外刊康复医学文献题录选登

YuDT ,ChaeJ ,WalkerME ,KirsteinsA ,ElovicEP ,FlanaganSR ,HarveyRL ,ZorowitzRD ,FrostFS ,GrillJH ,Feld steinM ,FangZP .Intramuscularneuromuscularelectricstimulationforpoststrokeshoulderpain :amulticenterran domizedclinicaltrial.ArchPhysMedRehabil,2 0 0 4 ,85 :6 95 70 4 .BrashearA ,McAfeeAL ,KuhnER ,FyffeJ .BotulinumtoxintypeBinupper limbpoststrokespasticity :adouble blind ,placebo controlledtrial.ArchPhysMedRehabil,2 0 0 4 ,85 :70 5 9.GranlundM ,ErikssonL ,Ylv啨ｎＲ.Uti…     

《中国危重病急救医学》1993年第5卷作者索引

(按第一作者姓氏汉语拼音顺序为序) B白春学,等.(5):295. (6):374.白玉峰,等.(5):305.包铭.(l):49. C蔡娟,等.(4):233.蔡久英,等.(5):272.曹书华,等.(2):111.曹;和林.(5):309.巢桂芳.(4):240.陈红.(3):189.陈珍.(4):195.陈汝岱,等.(4):241.陈基岱,等.(6):325.程裕德,等.(4):25 1. D戴稼禾,等.(1):60. (2):124. (3):188. (4):253. (5):3 15. (6):38 1.邓森,等.(4):235.丁志平,等.(l):23. F范金茹,等.(l):17.范亚平,等.(l):58.范玮玮,等.(6):354.方立夫,等.(l):41.冯喜增,等.(2):67.冯赛华,等.(3):156. G高晋健,等.(2):118.高红,等.(3):144.…     

《中国循证医学杂志》第三届编委会成员名单

名誉主编(HonoraryEditor2in2Chief):黄洁夫(HUANG Jie2fu)名誉顾问(HonoraryAdviser):殷大奎(YIN Da2kui),M.Roy Schwarz主编(Editor2in2Chief):李幼平(LIYou2ping)副主编(Vice Editor2in2Chief):刘鸣(LIU M ing),胡大一(HU Da2yi)编委(MembersofEditorialBoard)(按字母顺序或按拼音顺序排列Being arranged alphabetically or by pinyin)Drummond Rennie(USA),M ichel J.Clarke(UK),DavidMoher(Canada),FredricM.W olf(USA),GillGyte(UK),GordonGuyatt(Canada),Graeme J.Hankey(Australia),JamesP.Neilson(UK…     

结核性胸膜炎236例临床分析

本资料收集我院 1997～ 2 0 0 0年收治的 2 3 6例结核性胸膜炎患者的临床资料 ,进行回顾性分析 ,总结如下 :1　临床资料1.1　一般资料 :2 3 6例中男性 14 2例 ,女性 94例 ,年龄 18～ 76岁 ,平均 42 .6岁。临床表现 :咳嗽 72例 ( 3 0 .5 %) ,胸痛 5 3例 ( 2 2 .4%) ,气急 2 0 3例 ( 86%) ,发热 83例 ( 3 5 .2 %) ,消瘦 3 6例 ( 15 .2 %)。1.2　影像学资料 (B超、X线 ) :左侧胸腔积液 15 8例 ( 66.9%) ,右侧胸腔积液 71例 ( 3 0 %) ,双侧积液 7例 ( 3 .1%)。胸腔大量积液 161例 ( 68.2 %) ,中等量积液 67例 ( 2 8.3 %) ,少量积液 8例 ( 3 .5 …     

852例机测QT离散度正常值分析

目的　报告计算机自动测量 QT离散度指标的正常值范围并进行简单分析。方法　采用 Marquette公司 12导联同步心电记录仪及其 QTguard系统 ,对 85 2例健康成年人的 QT离散度指标进行测定。结果　 1均值及其 95 %可信限范围分别为 :GQTd( 2 5 .2 6± 10 .3 1) ms;GQTcd:( 2 9.2 6± 13 .83 ) ms;PQTd:( 18.18± 11.2 0 ) ms;PQTcd:( 2 1.46± 13 .5 0 ) ms;PQTPd:( 2 2 .66± 12 .60 ) ;PQTPcd:( 2 4.11± 13 .5 3 ) ;GQTPd:( 2 9.79± 13 .2 2 ) ms;PQTPcd:( 3 2 .0 4± 14 .60 ) ms。 2所有指标均与年龄无关。 3心率、GQTd、GQTPd、QT存在性别差异 ,但以心率校正后则无性别差异。结论　使用校正 QT离散度指标不需要考虑性别和年龄差异     

青年临界无症状高血压患者的冠脉血流储备

目的 :了解青年无症状临界高血压患者是否有冠状动脉功能异常。方法 :经食管超声 ( TEE)研究组 :2 0例正常人组 ,平均年龄 ( 39± 3)岁、血压 ( 15 .3± 1.7) k Pa/ ( 9.3± 1.1) k Pa;组 :17例无症状临界高血压患者 ,平均年龄 ( 36± 4)岁、血压 ( 18.1± 3.1) k Pa/ ( 11.1± 1.3) k Pa的冠状动脉血流储备 ( CFR)。以潘生丁静注后和静息时舒张期的最大血流速度比率 ( D/ R PDV)和收缩期最大血流速度比率 ( D/ R PSV)作为 CFR指标。结果 :两组受检者静息时的 PDV无显著差异 ( 43± 10 ) mm/ s vs ( 46± 8) mm/ s p>0 .0 5 )。静注潘生丁后组 的 D/R PDV、 D/ R PSV较组 明显减少 ,两组之间有显著差异 ( D/ R PDV:2 .2 5± 0 .36 vs 2 .86± 0 .42、 D/ R PSV:2 .0± 0 .2 6 vs 2 .5 6± 0 .41,p<0 .0 5 )。结论 :青年无症状临界高血压患者冠脉血储备能力降低     

脑卒中心理障碍的康复治疗

Nowintroducingclinicalcommonrehabilitativetreatmentsofmentaldisturbanceasfollowing:Mainmanifestationofmentaldisturbance:(1)Invariousmentaldisturbanceofposthemiplegicpatients,depressivepsycholo-gyismostcommon.(2)Psychologyofself-abased(3)Psychologyofimpatience(4)Psychologyofobstinate.Rehabilitativetreatmentsofmentaldisturbance:(1)Mentalsupportingtreatment:Thismethodisapplicabletovariouspos-themiplegicpatientswithmentaldisturbance,especiallytopes-simisticanddesperatepatients.Theconcretepractic…     

性传播疾病性慢性前列腺炎423例病原学检测

目的 :为研究性传播疾病 (STD)引起的慢性前列腺炎的病原学特点。方法 :对STD性慢性前列腺炎患者 42 3例进行了病原体检测 ,结果显示 :单一病原体感染 2 38例 (5 6 .2 6 % ) ,其中 ,CT阳性 115例 (2 7.19) ,UU阳性 71例(16 .78% ) ,NG阳性 5 2例 (12 .2 9% ) ,混合病原体感染 1     

肺复张对肺内/外源性急性呼吸窘迫综合征模型犬呼吸生理和肺形态学影响的比较

目的 探讨以压力-容积(P-V)曲线为导向的肺复张(RM)策略对肺内/外源性急性呼吸窘迫综合征(ARDSexp/ARDSp)模型犬呼吸生理和肺形态学的影响.方法 将24只健康杂种犬按随机数字表法均分为两组,分别以静脉注射油酸0.1 ml/kg复制ARDSexp模型,以气管内注入盐酸2 ml/kg复制ARDSp模型.每种模型再随机均分为肺保护通气策略(LPVS)组和LPVS+RM组.LPVS组采用LPVS进行机械通气(MV);LPVS+RM组先进行以P-V曲线为导向的RM,RM采用压力控制通气(PCV),压力上限为高位转折点(UIP),呼气末正压(PEEP)为低位转折点(LLP)+2 cm H2O(1 cm H2O=0.098 kPa),维持60 s后再按LPVS进行MV.两组MV时间均为4 h.观察动物基础状态(成模前)及RM前后的氧合指数(PaO2/FiO2)、呼吸力学指标变化;采用低流速法记录准静态P-V曲线并计算UIP、LIP ;根据肺CT比较不同肺充气区容积占全肺容积的百分比.结果 成模前和RM前两组PaO2/FiO2及UIP、LIP比较差异均无统计学意义.RM后4 h,两种模型LPVS+RM组PaO2/FiO2和肺顺应性(Crs)均较同模型LPVS组显著升高[ARDSexp模型PaO,/FiO2(mm Hg,1 mm Hg=0.133 kPa):263.9±69.2比182.8±42.8,Crs(ml/cm H2O):11.3±4.2比9.7±3.7;ARDSp模型PaO2/FiO2(mm Hg):193.4±33.5比176.4±40.2,Crs(ml/cm H2O):10.1±3.9比9.0±3.9,P＜0.05或P＜0.01],气道压力明显低于同模型LPVS组[ARDSexp模型吸气峰压(PIP,cm H2O):24.1±7.4比30.2±8.5,气道平台压(Pplat,cm H2O):19.1±7.3比25.6±7.7;ARDSp模型PIP(cm H2O):26.6±8.4比29.6±10.3,Pplat(cm H2O):21.9±7.3比25.1±8.4,P＜0.05或P＜0.01];且ARDSexp模型改善程度较ARDSp模型更为显著(P＜0.05或P＜0.01).两种模型LPVS+RM组肺组织闭合区和充气不足区所占比例均较同模型LPVS组明显减少,正常充气区所占比例明显增加[ARDSexp模型闭合区:(9.9±3.1)%比(16.3±5.2)%,充气不足区:(10.2±4.2)%比(23.4±6.7)%,正常充气区:(76.2±12.3)%比(57.5±10.1)%;ARDSp模型闭合区:(14.3±4.8)%比(1 8.2±5.1)%,充气不足区:(17.4±6.3)%比(24.1±5.9)%,正常充气区:(63.2±10.7)%比(54.6±11.3)%,P＜0.05或P＜0.01];且ARDSexp模型各充气区所占比例改善程度均明显优于ARDSp模型(均P＜0.05).结论 对于不同原因ARDS,以P-V曲线为导向的RM均具有增加肺氧合、改善肺顺应性和肺组织通气的作用,且对ARDSexp的治疗效果明显优于ARDSp.

Abstract：

Objective To determine effects of recruitment maneuver (RM) guided by pressure-volume (P-V) curve on respiratory physiology and lung morphology in canine models of acute respiratory distress syndrome of pulmonary or extrapulmonary origin (ARDSp and ARDSexp). Methods Twenty-four healthy dogs were randomly divided into two groups with 12 dogs each: ARDSexp and ARDSp. Each dog in ARDSexp group was injected with oleic acid 0. 1 ml/kg through femoral vein, and each dog in ARDSp group received hydrochloric acid 2 ml/kg via trachea. Subsequently, dogs with both models were randomly subdivided into lung protective ventilation strategy (LPVS) group and LPVS+RM group, respectively. Dogs in LPVS group were given LPVS only without RM. RM guided by P-V curve was performed in LPVS+RM group followed by LPVS and pressure controlled ventilation (PCV) mode was selected. Phigh was set at upper inflection point (UIP) of the P-V curve, positive end-expiratory pressure (PEEP) was set at lower inflection point (LIP)+2 cm H2O (1 cm H2O=0. 098 kPa), and the duration of RM was 60 seconds. The duration of mechanical ventilation (MV) in both subgroups was 4 hours. The oxygenation index (PaO2/FiO2), relative lung mechanical indexes were measured in two ARDS models before establishment of ARDS model, and before and after RM. The UIP and LIP were calculated with P-V curve. The percentage of different volume in ventilation of lung accounting for total lung volume was compared by CT scan.Results The PaO2/FiO2, UIP and LIP did not showed significant differences among all groups before ARDSand before RM. PaO2/FiO2 and respiratory system compliance (Crs) were significantly elevated in LPVS+RM group of both models 4 hours after RM compared with corresponding LPVS group [PaO2/FiO2(mm Hg,1 mm Hg=0. 133 kPa) of ARDSexp model: 263. 9±69. 2 vs. 182.8±42. 8, Crs (ml/cm H2O) of ARDSexp model: 11.3±4. 2 vs. 9. 7±3. 7; PaO2/FiO2(mm Hg) of ARDSp model: 193. 4±33.5 vs. 176. 4±40. 2, Crs (ml/cm H2O) of ARDSp model: 10.1±3.9 vs. 9.0±3.9, P＜0. 05 or P＜0.01], and the airway pressure was significantly declined compared with corresponding LPVS group [peak inspiratory pressure (PIP),cm H2O) of ARDSexp model: 24. 1±7. 4 vs. 30. 2±8. 5, plateau pressure (Pplat, cm H2O) of ARDSexp model: 19.1±7.3 vs. 25.6±7.7; PIP (cm H2O) of ARDSp model: 26.6±8.4 vs. 29.6±10.3, Pplat (cm H2O) of ARDSp model: 21.9±7. 3 vs. 25.1±8.4, P＜0. 05 or P＜0. 01]. Moreover, PaO2/FiO2, Crs,PIP and Pplat were improved better in ARDSexp model than ARDSp model (P＜ 0. 05 or P＜ 0. 01).Compared with LPVS maneuver, RM plus LPVS maneuver could significantly decrease the proportion of closure and hypoventilation region, and increase the proportion of normal ventilation region in both models [closure region of ARDSexp model : (9.9±3.1) % vs. (16. 3± 5. 2) %, hypoventilation region of ARDSexp model: (10. 2±4.2)% vs. (23. 4±6. 7)%, normal ventilation region of ARDSexp model: (76. 2±12. 3)%vs. (57.5±10. 1)%; closure region of ARDSp model: (14.3±4. 8)% vs. (18. 2±5.1)%, hypoventilation region of ARDSp model : (17.4±6. 3) % vs. ( 24. 1 ± 5. 9) 0%, normal ventilation region of ARDSp model :(63. 2 ± 10. 7 ) % vs. ( 54. 6±11.3 ) %, P ＜ 0. 05 or P ＜ 0. 01]. All of the ventilation regions were better improved with ARDSexp model than ARDSp model (all P＜0. 05). Conclusion RM guided by P-V curve could help obtain better oxygenation, improve pulmonary compliance and lung ventilation in ARDSexp and ARDSp, and better treatment effects are seen in ARDSexp dogs than ARDSp dogs.     

2008年16卷中文关键词索引

AA3细胞株(6):1279ABO基因(2):240ABO血型(2):421,425;(4):919ABO血型不合(2):364AGM区(3):584AMG531(5):1232AML1-ETO(1):44A s2O3(6):1288AS-PCR(2):416atm基因(5):1242阿霉素(1):61;(3):555;(4):790;(5):1165;(6):1283癌基因(2):282氨磷汀(1):192;(5):1103BB(A)型(2):421B7.     

肺癌层黏连蛋白及其受体表达的临床研究

目的 :探讨肺癌组织层黏连蛋白 (LN)及其受体 (LN -R)的表达和肿瘤转移及预后关系。方法 :采用免疫组织化学技术在 4 2例肺癌患者中研究LN和LN -R的表达。结果 :Ⅰ期患者LN(5 8.30 % )表达高于Ⅱ期 (14 .30 % )及Ⅲ～Ⅳ期 (37.5 2 % )患者 ;无淋巴结肺癌转移患者LN表达率 (6 6 .6 6 % )明显高于有淋巴结转移患者 (2 4 .2 0 % )。有淋巴结肺癌转移患者LN -R表达率 (84 .80 % )明显高于无淋巴结转移患者 (2 2 .2 2 % ) ,这些差异均有统计学意义 (P <0 .0 1)。结论 :LN及其受体 (LN -R)表达在肺癌组织的恶性生物学行为相关 ,可能是临床治疗和预后估计的有用指标。     

国外最新文献题录（二）

VerplanckeD,SnapeS,SalisburyCF,JonesPW,etal.Arandomizedcontrolledtrialofbotulinumtoxinonlowerlimbspasticityfollowingacuteacquiredseverebraininjury.ClinRehabil,2005,19(2):117125.JonesA,TillingK,WilsonBarnettJ,etal.Effectofrecommendedpositioningonstrokeoutcomeatsixmonths:arandomizedcontrolledtrial.ClinRehabil,2005,19(2):138145.WangRY,ChenHI,ChenCY.EfficacyofBobathversusorthopaedicapproachonimpairmentandfunctionatdifferentmotorrecoverystagesafterstroke:arandomizedcontrolledstudy.Clin…     

高渗盐水联合羟乙基淀粉治疗严重脓毒症的研究

目的 评价7.5%高渗盐水(HS)联合6%羟乙基淀粉(HES)130/0.4对严重脓毒症患者早期液体复苏的效果.方法 采用前瞻性随机对照研究.选取江汉大学附属医院重症监护病房(ICU)135例严重脓毒症患者,入ICU时随机分成3组,每组45例.HS+HES组输注7.5%HS后输注6%HES 130/0.4 500 ml,再输注平衡液HES组输注6%HES 130/0.4后输注平衡液;平衡液组(RL组)仅输注平衡液.比较3组患者入ICU后6 h、24 h平均动脉压(MAP)、氧合指数(PaO2/FiO2)、动脉血乳酸、乳酸清除率、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、输液量、尿量以及多器官功能障碍综合征(MODS)发生率和住院病死率.结果 入ICU后6 h,HS+HES组MAP[mm Hg(1 mm Hg=0.133 kPa):68.7±3.0]、PaO2/FiO2(mm Hg:262.2±17.4)、乳酸清除率[(21±4)%]较HES组[MAP:63.8±3.5,PaO2/FiO2:252.0±21.2,乳酸清除率:(11±2)%]和RL组[MAP:62.6±3.6,PaO2/FiO2:248.4±17.0,乳酸清除率:(9±1)%]显著增高(均P＜0.01),动脉血乳酸(mmol/L:3.5±0.7)较HES组(4.1±0.7)和RL组(4.0±0.7)显著下降(均P＜0.01);APACHE Ⅱ评分(分:13.2±1.9)与HES组(14.0±1.6)无明显差异,但显著低于RL组(15.2±1.7,P＜0.01).入ICU后24 h,HS+HES组PaO2/FiO2(mm Hg:303.3±17.3)显著高于HES组(282.9±21.1)和RL组(268.9±15.2,均P＜0.01),但3组间MAP、动脉血乳酸、乳酸清除率和APACHE Ⅱ评分均无差异.人ICU后6 h、24 h,HS+HES组输液量(ml,6 h:1 877.8±215.2,24 h:5 475.6±208.8)显著低于HES组(6 h:2 505.6±276.2,24 h:6 383.3±287.4)和RL组(6 h:3 496.7±325.5,24 h:7 439.6±229.6);尿量(ml,6 h:294.2±36.9,24 h:2 793.8±37.1)显著高于HES组(6 h:248.9±25.3,24 h:2 248.9±25.3)和RL组(6 h:178.9±14.8,24 h:2 000.4±147.0,均P＜0.01).HS+HES组MODS发生率(6.7%)远低于RL组(28.9%,P＜0.05),与HES组(17.8%)无差异(P＞0.05);3组间病死率无显著差异(HS+HES组2.2%,HES组4.4%,RL组8.9%,均P＞0.05).结论 7.5%HS联合6%HES 130/0.4能提高严重脓毒症患者早期液体复苏的效果,降低MODS发生率.

Abstract：

Objective To evaluate the effect of 7. 5% hypertonic saline(HS)and 6% hydroxyethyl starch (HES)130/0.4 on early fluid resuscitation for severe sepsis. Methods Prospective randomized control trial was carried out in intensive care unit(ICU)of the Affiliated Hospital of Jianghan University. One hundred and thirty-five patients with severe sepsis were randomly divided into three groups, each group consisted of 45 patients. Patients in HS+HES group received lactated Ringer solution following 4 ml/kg of 7. 5%HS and 6%HES 130/0. 4 500 ml, those in HES group received lactated Ringer solution following 6%HES 130/0.4500 ml, and those in the lactated Ringer group(RL group)received lactated Ringer solution only. Mean arterial pressure(MAP), oxygenation index(PaO2/FiO2), arterial lactate(Lac), lactate clearance rate,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score, fluid infusion volume, urine output as well as incidence of multiple organ dysfunction syndrome(MODS), and mortality were compared among three groups at 6 hours and 24 hours after ICU admission. Results At 6 hours after ICU admission, MAP [mm Hg(1 mm Hg=0. 133 kPa): 68. 7±3. 0], PaO2/FiO2(mm Hg: 262.2±17.4), lactate clearance rate [(21±4)%]in HS+HES group were significantly higher than those in HES group[MAP: 63. 8±3.5,PaO2/FiO2: 252.0 ± 21.2, lactate clearance rate:(11± 2)%]and RL group[MAP: 62.6 ± 3. 6, PaO2/FiO2 :248. 4±17.0, lactate clearance rate:(9± 1)%, all P＜0. 01]. Arterial Lac in HS+HES group(mmol/L:3. 5±0. 7)was significantly lower than that in HES group(4. 1±0. 7)and RL group(4. 0±0. 7, both P＜0. 01). There was no significant difference in APACHE Ⅱ score between HS+HES group(13. 2±1.9)and HES group(14.0±1.6), and the APACHE Ⅱ score in HS+HES group was significantly lower than that in RL group(15. 2 ± 1.7, P＜ 0. 01). At 24 hours after ICU admission, PaO2/FiO2(mm Hg: 303.3 ± 17.3)was significantly higher in HS+HES group than that in HES group(282.9 ± 21.1)and RL group(268. 9 ±15.2,both P＜ 0.01). There was no significant difference in MAP, arterial Lac, lactate clearance rate and APACHE Ⅱ score among three groups. At 6 hours and 24 hours after ICU admission, fluid infusion volume in HS+HES group(ml, 6 hours: 1 877. 8±215. 2, 24 hours: 5 475.6±208.8)was markedly less than that in HES group(6 hours: 2 505.6±276.2, 24 hours: 6 383. 3±287.4)and RL group(6 hours: 3 496. 7±325.5, 24 hours: 7 439.6±229.6), yet urine output in HS+HES group(ml, 6 hours: 294.2±36.9,24 hours: 2 793.8 ±37.1)was significantly higher than that in HES group(6 hours: 248.9 ± 25. 3,24 hours: 2 248. 9±25. 3)and RL group(6 hours: 178. 9±14.8, 24 hours: 2 000. 4±147.0, all P＜0. 01).The incidence of MODS in HS+HES group(6.7%)was statistically lower than that in RL group(28. 9%,P＜0. 05), while no obvious difference was found between HS+HES group and HES group(17.8%, P＞0. 05). There was no significant difference in mortality among three groups(HS+HES group: 2.2%, HES group: 4.4%, RL group: 8.9%, all P＞0. 05). Conclusion 7.5%HS and 6%HES 130/0. 4 could improve the effect of early fluid resuscitation on severe sepsis, and it could lower the incidence of MODS.     

活性氧代谢与心脏疾病

活性氧是由氧形成,含氧而且性质活泼的几种物质的总称.它包括1.自由基:超氧化物阴离子自由基(·O_2~-)与氢氧自由基(·OH);2.过氧化物:过氧化氢(H_2O_2)与脂质过氧化物(ROOH);3.单线态分子氧(1O_2).近年来研究表明,活性氧代谢与心脏疾病密切相关.一、生物体内的活性氧代谢1.活性氧的生成(1)氢氧自由基:近年来认为该自由基是O_2获得三个电子的反应产物:     

重型颅脑损伤患者医院感染分析及其护理

目的　为探讨重型颅脑损伤后医院感染危险因素 ,以采取有效控制措施。方法　回顾性汇总分析 1 999年 1月～ 2 0 0 3年 1 2月重型颅脑损伤监测资料。结果　重型颅脑损伤医院感染发生率为 (2 9.33% ) ,例次率为 (35 .5 8% )。感染部位以肺部感染 (4 8.6 5 % ) ,尿路感染 (2 3.6 5 % )多见。病原菌以G-杆菌为主。单因素分析表明 ,重型颅脑损伤患者医院感染发生与侵入性操作 (OR :2 7.82 ,95 %CI:1 7.86～ 4 1 .5 3)、脑出血 (OR :2 1 .75 ,95 %CI :1 5 .78～ 4 1 .1 2 )、平均住院日 (OR :5 .76 ,95 %CI:4 .85～ 8.74 )、血糖 (OR :4 .5 8,95 %CI :1 .98～ 3.97)等因素有关。结论　对病情重 ,住院时间长 ,应用抗菌药物治疗和实施了侵入性诊疗操作的重症颅脑损伤患者 ,应采取相应护理对策 ,预防医院感染的发生。     

宫内缺血缺氧性脑损伤新生大鼠脑组织中微管相关蛋白2 mRNA的表达

目的:观察宫内缺血缺氧性脑损伤(hypoxia ischemia brain damage,HIBD)新生鼠脑组织中微管相关蛋白2(microtubule associated protein-2,MAP-2)表达的变化.方法:通过钳夹右侧子宫内动脉造成胎鼠HIBD动物模型,采用逆转录-聚合酶链反应(RT-PCR)方法,动态观察脑组织中MAP-2 mRNA水平变化.结果:各实验组MAP-2 mRNA随着缺血时间的延长而表达减弱,其中缺血20 min(A3组)、25 min(A4组)以及30 min(A5组)的MAP-2 mRNA灰度扫描值较对照组(B3、B4、B5组)明显降低,差异有显著性(P＜O.05).结论:HIBD可造成新生鼠脑组织中MAP-2转录水平的下降.     

血管紧张素Ⅱ对自发性高血压大鼠外周血单个核细胞NADPH氧化酶2表达的影响

目的:探讨血管紧张素Ⅱ(AngⅡ)对自发性高血压大鼠(SHR)外周血单个核细胞NADPH氧化酶2(NOX2)表达的影响.方法:分离SHR外周血单个核细胞并进行培养,将细胞随机分为4组(n=6):空白对照组、Ang Ⅱ(10-8 mol/L)组、Ang Ⅱ(10-7 mol/L)组和Ang Ⅱ(10-6 mol/L)组.RT-PCR检测NOX2 mRNA的表达,Western blot检测NOX2蛋白的表达.结果:与空白对照组相比,Ang Ⅱ(10-8、10-7mol/L)组NOX2 mRNA的表达差异无显著性(P>0.05),而NOX2蛋白的表达升高(P<0.01),Ang Ⅱ(10-6mol/L)组NOX2mRNA及蛋白的表达均明显升高(P<0.01).结论:Ang Ⅱ可以促进高血压外周血单个核细胞NOX2的激活.     

大剂量丙种球蛋白联合小剂量糖皮质激素治疗重症血小板减少性紫癌的临床研究

目的 :评价大剂量丙种球蛋白 (HDIG)联合小剂量糖皮质激素在治疗危重症免疫性血小板减少性紫癜 (ITP)的作用。方法 :75例患者按就诊顺序随机分组。大剂量丙种球蛋白联合小剂量糖皮质激素组 (HDIG组 ) 38例 ,给予丙种球蛋白 0 .4 g· kg- 1 · d- 1 5 d,泼尼松 0 .5 mg· kg- 1 · d- 1 2 8d;糖皮质激素组 (激素组 ) 37例 ,给予泼尼松 1～ 2 mg· kg- 1· d- 1 2 8d。结果 :HDIG组中显效 2 5例 (6 5 .8% ) ,良效 9例 (2 3.7% ) ,进步 2例(5 .3% ) ,无效 2例 (5 .3% ) ,总有效率为 94 .7% ;激素组中显效 2 3例 (6 2 .2 % ) ,良效 9例 (2 4 .3% ) ,进步 3例(8.1 % ) ,无效 2例 (5 .4 % ) ,总有效率为 94 .6 %。两组治疗后血小板计数 (BPC)均较治疗前明显上升 (P均 <0 .0 1 ;BPC峰值数 HDIG组明显高于激素组〔(2 1 2 .5 6± 90 .2 5 )× 1 0 9/ L 比 (1 2 7.2 6± 81 .2 6 )× 1 0 9/ L,P<0 .0 1〕;达峰值时间 HDIG组明显短于激素组〔(7.80± 4 .5 0 ) d比 (2 7.0 0± 9.32 ) d〕。结论 :大剂量丙种球蛋白联合小剂量糖皮质激素治疗 ITP可明显缩短血小板上升至安全水平的时间     

控制性肺膨胀对急性呼吸窘迫综合征肺静态顺应性曲线低位转折点的影响

目的 :探讨控制性肺膨胀 (SI)对急性呼吸窘迫综合征 (ARDS)肺静态顺应性曲线低位转折点压力(Pinf)的影响。方法 :30只家兔利用肺泡灌洗法建立 ARDS模型 ,并随机分为 SI组和非 SI组 ,观察 SI后 2小时动物的 Pinf、肺气体交换和肺机械力学特征改变。结果 :SI组动物 SI前 Pinf为〔(0 .90± 0 .14 ) k Pa,1k Pa=10 .2 0 cm H2 O〕,SI 2小时后 Pinf降到 (0 .6 1± 0 .14 ) k Pa(P=0 .0 2 0 ) ;非 SI组机械通气 2小时前后 Pinf无明显改变 ,P>0 .0 5。 SI组动物机械通气 2小时后动脉血氧分压 (Pa O2 )和氧饱和度 (Sa O2 )分别为 (2 4 .2 0±8.79) k Pa(1k Pa=7.5 m m Hg)和 0 .96 7± 0 .0 2 4 ,显著高于非 SI组〔分别为 (10 .80± 1.13) k Pa和 0 .76 8±0 .0 76 ,P<0 .0 5〕。 SI组动物机械通气 2小时后动态肺顺应性 (Cydn)为 (12 .2 4± 1.5 3) ml/k Pa,显著高于非 SI组〔(9.80± 0 .82 ) ml/k Pa〕。结论 :SI具有促进肺泡复张、降低 Pinf水平的效应 ,实施 SI后应重新调整呼气末正压 (PEEP)水平。     

急性心肌梗死早期再灌注对心室肌易损性的电生理影响

目的 :根据急性心肌梗死 (AMI)早期再灌注心室易损性改变 ,探讨 AMI早期再灌注心律失常的机制。方法 :采用 S1 S2程控电刺激方法同时测定家兔心室易损期 (VVP)、室颤阈 (VFT)、舒张阈 (DT)、有效不应期 (ERP)和强度间期曲线 (SIC)等电生理指标。结果 :AMI早期缺血对照组 VVP(47.6 5± 1 5 .94) ms,VFT(0 .2 9± 0 .1 7)μJ,DT(3.0 2± 0 .5 3) V,ERP(1 4 1 .73± 1 4 .98) m s;AMI早期再灌注组分别为 (85 .37± 2 0 .6 5 ) ms、(0 .1 6± 0 .1 3)μJ、(2 .2 5± 0 .48) V和 (1 1 2 .6 6± 1 3.6 1 ) ms;2组比较 :早期缺血再灌注后各指标与早期缺血对照组各指标间差异非常显著 (P均 <0 .0 1 ) ,表明 AMI再灌注后较缺血后 VVP延长 ,VFT下降 ,ERP缩短 ;AMI早期再灌注组 SIC下移。结论 :AMI早期再灌注室性心动过速和 (或 )心室颤动的产生与折返有关。