Lipid peroxidation and content of medium weight molecules in heart surgery with artificial blood circulation

Malonic dialdehyde (MDA), level of medium-weight molecules, and chemiluminescence (CL) of the blood were evaluated in 24 coronary patients during and after aorto-mammary-coronary bypass operations. Time course of MDA concentration, content of medium-weight molecules, and CL extinction rate were similar in all the patients, but the values were higher in the patients with a complicated course of the postoperative period. Significant difference in CL intensity at the beginning of total anesthesia in patients with uneventful and complicated course of the postoperative period recommend this method for prediction of reperfusion complications. In further studies we intend to determine the diagnostically significant differences in the studied parameters and to distinguish the most informative parameters for each stage, for more effective prevention of oxidative stress in cardiosurgical patients subjected to aortocoronary bypass operations.     

重型颅脑损伤合并多发伤的临床治疗

目的总结重型颅脑损伤合并多发伤的临床特点及诊治方法。方法对我科收治的316例重型颅脑损伤合并多发伤的进行回顾性分析。结果治愈184例,轻残19例,中残21例,重残9例,植物生存5例死亡79例。结论重型颅脑损伤合并多发伤应早期诊断、及时抢救,避免漏诊和误诊。对危及生命的损伤的抢救、重要脏器功能的维持、正确的手术时机、骨折早期手术内固定和ICU监护对成功救治有着重要作用。     

Levels of serum vitamin A, alpha-tocopherol and malondialdehyde in patients with non-alcoholic steatohepatitis: relationship with histopathologic severity

The aims of our study were to estimate serum levels of malondialdehyde (MDA), serum levels of vitamin A and alpha-tocopherol as antioxidants and determine relationship of these with histopathologic severity in patients with non-alcoholic steatohepatitis (NASH). Twenty-nine patients with biopsy-proven NASH were included to study. NASH were histopathologically scored for grading and staging. Serum MDA and vitamin A levels were increased in patients with NASH and simple steatosis as compared to healthy control group. Serum alpha-tocopherol levels measured in simple steatosis and NASH were significantly lower than in healthy control group. There was no significant difference between grade/stage 0-1 and grade/stage 2-3 in terms of MDA, vitamin A and alpha-tocopherol levels. Serum MDA and vitamin A levels are increased in simple steatosis and NASH. MDA, vitamin A and alpha-tocopherol levels in NASH were not associated with the histopathologic severity.     

Sustained high serum malondialdehyde levels are associated with severity and mortality in septic patients

Introduction

There is a hyperoxidative state in sepsis. The objective of this study was to determine serum malondialdehyde (MDA) levels during the first week of follow up, whether such levels are associated with severity during the first week and whether non-surviving patients showed higher MDA levels than survivors during the first week.

Methods

We performed an observational, prospective, multicenter study in six Spanish Intensive Care Units. Serum levels of MDA were measured in 328 patients (215 survivors and 113 non-survivors) with severe sepsis at days one, four and eight of diagnosis, and in 100 healthy controls. The primary endpoint was 30-day mortality and the secondary endpoint was six -month mortality. The association between continuous variables was carried out using Spearman’s rank correlation coefficient. Cox regression analysis was applied to determine the independent contribution of serum MDA levels on the prediction of 30-day and 6-month mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated as measures of the clinical impact of the predictor variables.

Results

We found higher serum MDA in septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001) of diagnosis than in healthy controls. Serum MDA was lower in surviving than non-surviving septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001). Serum MDA levels were positively correlated with lactic acid and SOFA during the first week. Finally, serum MDA levels were associated with 30-day mortality (HR = 1.05; 95% CI = 1.02-1.09; p = 0.005) and six-month mortality (hazard ratio (HR) = 1.05; 95% CI = 1.02-1.09; p = 0.003) after controlling for lactic acid levels, acute physiology and chronic health evaluation (APACHE)-II, diabetes mellitus, bloodstream infection and chronic renal failure.

Conclusions

To our knowledge, this is the largest series providing data on the oxidative state in septic patients to date. The novel finding is that high serum MDA levels sustained throughout the first week of follow up were associated with severity and mortality in septic patients.     

平均血小板容积、纤维蛋白原含量及血液流变学在青年脑梗死患者外周血中的变化

本研究旨在探讨平均血小板容积(MPV)、纤维蛋白原(FIB)含量及血液流变学改变与青年脑梗死患者梗死体积的相关性,为其临床早期诊断和治疗提供依据。根据头部CT或MRI病灶大小及神经功能受损程度将我院109例脑梗死患者(18-45岁)分为大梗死组(梗死体积>10 cm3)、中梗死组(梗死体积4-10 cm3)、小梗死组(梗死体积<4 cm3),30例健康查体正常人作为对照组,进行MPV、FIB及血液流变学指标检查,包括:全血黏度低切(Lηb)、全血黏度中切(Mηb)、全血黏度高切(Hηb)、血浆黏度值(ηP)、全血还原黏度低切(Lηr)、全血还原黏度中切(Mηr)、全血还原黏度高切(Hηr)、血沉方程K值(KVE)、红细胞积聚指数(EAI)、红细胞刚性指数(ERI)、红细胞变形指数(EDI)、红细胞电泳指数(EEI)、红细胞比容、血沉,共计16项指标。结果表明:各组脑梗死患者MPV、FIB含量和血液流变学指标均高于健康对照组(P<0.05);大梗死组MPV、FIB含量和血液流变学指标均高于小梗死组(P<0.05);各组脑梗死患者在病程恢复期MPV、FIB含量和血液流变学指标均有明显下降,但未达到健康对照组水平(P<0.05)。脑梗死体积与MPV、FIB含量及血液流变学水平呈正相关(r=0.36,0.29,0.48)。结论:青年脑梗死病情的严重程度与MPV、FIB及血液流变学水平密切相关,定期检查上述指标对预防青年脑梗死很有价值。     

轻度颅脑损伤患者认知功能变化分析

目的观察轻度脑损伤患者认知功能损害特征,寻求进行干预的可能性. 方法 58例轻度脑损伤患者在出院前 1周分别接受了中国成人韦氏智力测试量表( WAIS-RC)评估,并与正常人常模数据进行比较. 结果轻度脑损伤患者 WAIS-RC智测成绩中,知识( 18.0± 4.7)分,算术( 6.8± 2.4)分,数字广度( 9.1± 2.8)分,数字符号( 37.6± 19.4)分,填图( 9.9± 1.6)分,木块图( 30.1± 13.5)分,图形排列( 18.2± 3.7)分,图形拼凑( 19.4± 4.9)分明显低于正常人常模( t=2.130～ 2.379,P均 < 0.05).在按性别分组后,男性脑损伤患者的知识、算术、数字符号、填图、图形排列等分量表评分明显低于女性患者( t=1.976～ 2.257,P均 < 0.05).在按脑损伤分型分组后,脑挫裂伤患者的算术、数字广度、填图和图形排列等分量表评分均明显低于脑震荡组( t=2.055～ 2.287,P均 < 0.05). 结论轻度脑损伤患者常伴有明显的认知功能损害特征,后者又常与患者性别和临床分型密切相关.     

缺氧缺血性脑病新生儿的颅脑超声参数变化及与病情严重程度和预后的关系分析

目的 观察缺氧缺血性脑病新生儿(HIE)颅脑超声参数变化情况,并分析其颅脑超声参数变化与病情严重程度和预后的关系。方法 选取2022年2月-2022年11月本院新生儿重症监护病房收治的75例HIE患儿,根据其病情分度分为轻度组(38例) ,中度组(24例),重度组(13例)。并选取同期健康新生儿75例作为对照组。均于出生48h及72h分别行经颅彩色多普勒超声(TCD),收集其脑血流动力学相关参数,比较各组间差异。对HIE患儿进行28d的随访,再次进行TCD复查及预后评估,利用Peason相关性分析相关性。结果 出生48h 收缩期血流速度峰值(Vs)、舒张末期血流速度(Vd)、平均流速(Vm)：对照组>轻度组>中度组>重度组(均P<0.05);出生48h 阻力指数(RI)：对照组<轻度组<中度组<重度组(均P<0.05)。轻度组出生72h各参数均与对照组比较无差异(均P<0.05);出生72h Vs、Vd、Vm：对照组>中度组>重度组(均P<0.05);出生72h RI：对照组<中度组<重度组(均P<0.05)。预后不良者出生28d的新生儿行为神经测定(NBNA)量表评分、Vs、Vd、Vm均低于预后良好者,RI高于预后良好者(均P<0.05)。HIE患儿出生28d后的Vs、Vd、Vm均与NBNA评分呈正相关(r=0.493,0.434,0.432,P<0.05),RI与NBNA评分呈负相关(r=-0.478,P<0.05)。结论 HIE患儿TCD脑血流动力学参数Vs、Vd、Vm随着病情程度的加重呈降低趋势,RI呈升高趋势;TCD脑血流动力学参数监测可较为客观的反映HIE患儿脑血流灌注变化情况,且对其预后评价均具有一定的指导意义。     

Urine medium weight molecules in assessment of the kidney status in newborns

The results of examinations of 66 newborns were used to suggest a new approach for evaluating the curves of medium urea molecules (calculations of the relative area beneath the curve and of areas of the first and second maxima). Issues related with the impact excreted by medication, endogenous intoxication and by a direct lesion to the renal tissues on a level of medium urea molecules are under discussion.     

颅脑损伤后24h内血糖值与伤情程度和预后的关系

目的探讨重度颅脑损伤后24h血糖与格拉斯哥昏迷评分(GCS)的关系及其对预后的影响。方法将81例重度颅脑损伤患者(GCS≤8分)分为两组:A组31例(GCS 3～5分),B组50例(GCS 6～8分);测定入院12h和24h内血糖,出院时根据GCS预后评分表(GOS)标准分为:预后良好组49例(C组,GOS 4～5级),预后较差组32例(D组,GOS 1～3级)。结果 A组伤后12h血糖均值为(10.87±3.94)mmol/L,B组为(6.43±2.30)mmol/L,A组伤后24h血糖均值为(14.46±2.83)mmol/L,B组为(8.53±3.01)mmol/L,差异有统计学意义(P<0.01),GCS评分愈低者血糖值愈高,持续时间愈长,两者呈负相关;C组伤后12h血糖均值为(6.37±2.51)mmol/L,D组为(10.73±3.76)mmol/L;C组伤后24h血糖均值为(8.76±2.12)mmol/L,D组为(14.32±2.54)mmol/L,差异有统计学意义(P<0.01),血糖值高者预后较差。结论颅脑损伤后血糖值越高,持续时间越长,则伤情越严重,预后越差,及时有效地控制血糖能提高救治成功率。     

高敏C反应蛋白、丙二醛及P选择素在冠心病患者中的变化及相互关系

目的 探讨炎症、氧化应激及血小板在冠心病患者中的变化及相互间关系.方法 入选冠心痛患者67例,稳定型心绞痛组(SAP组)14例,不稳定型心绞痛组(UAP组)25例,急性心肌梗死组(AMI组)28例.另选取健康者20例作为对照组.分别应用免疫比浊法、比色法和酶联免疫吸附法检测血清高敏C反应蛋白(hsCRP)、血浆丙二醛(MDA)及P选择素浓度.结果 hsCRP水平在SAP组、UAP组、AMI组均高于对照组,(1.57±1.15)mg/L,(3.80±3.39) mg/L,(9.61±4.22)mg/Lvs (0.84±0.16)mg/L,除SAP组与对照组比较差异无统计学意义外,其他3组间差异均有统计学意义(P＜0.01).MDA浓度在SAP组、UAP组、AMI组均高于对照组,(9.66±2.08)μmol/L(13.31±3.01) μmol/L,(15.44±4.55) μmol/L vs(7.11±4.67)μmol/L,除SAP组与对照组比较差异无统计学意义外,其他3组间差异均有统计学意义(P＜0.01).P选择素水平在SAP组、UAP组、AMI组均高于对照组,(117.84±51.86)μg/L,(160.61±59.36) μg/L,(168.82±60.84) μg/L vs (92.91±44.74) μg/L,除SAP组与对照组比较差异无统计学意义外,其他3组间差异均有统计学意义(P＜0.01).hsCRP与P选择素呈正相关(r=0.603,P＜0.01);MDA与P选择素呈正相关(r=0.693,P＜0.01);hsCRP与MDA呈正相关(r=0.667,P＜0.01).结论 冠心病患者hsCRP、MDA及P选择素浓度从SAP组到UAP和AMI组逐渐升高,且呈正相关,提示三者间相互作用决定斑块稳定型及临床表现.     

血浆内皮素的变化与颅脑损伤程度及预后关系

目的　研究颅脑损伤后病人早期血浆内皮素 (ET)的动态变化及与脑损伤程度及预后的关系。方法　 5 0例颅脑损伤病人根据GCS评分为轻 (n =19)、中 (n =15 )、重 (n =16 )三组 ,在入院当日及第 3、 5、 7天用放射免疫法测定血浆ET水平。根据出院时GOS评分分为不良和良好两组。结果　入院当日病人血浆ET轻型和中型组轻度升高与正常对照组比较差别有意义 (P <0 0 5 ) ,重型组明显升高有显著意义 (P <0 0 1) ;第 3、 5、 7天轻型组逐渐降至正常水平(P >0 0 5 ) ,中型组逐渐升高 (P <0 0 0 1) ,第 7天略有回落 (P<0 0 1) ,重型组持续升高 (P <0 0 0 1)。血浆ET水平与GCS计分成明显负相关 (r=- 0 5 70 8,P <0 0 0 1)。预后不良和良好两组比较入院当日血浆ET差别有意义 (P <0 0 5 ) ,第 3、 5天 (P <0 0 1) 和第 7天差别更明显 (P <0 0 0 1)。结论　颅脑损伤病人血浆ET的变化与脑损伤程度相关 ,可作为判断伤情和预后的指标。     

Significance of determination of medium weight molecules in urine in normal pregnancy, in complicated pregnancy and in newborns with hypoxia

Women with normal gestation and with gestosis and diabetes and newborns exposed to chronic intrauterine hypoxia were examined in order to elucidate the diagnostic value of measuring the content of low- and medium-weight molecules (MWM) in the urine in some obstetrical and gynecological abnormalities. Urinary content of MWM was increased at late terms of pregnancy (25-40 weeks). In first-degree nephropathy and type I diabetes without vascular complications the content of MWM in the urine did not change. A drop of MWM level was observed in second-third-degree nephropathy and proteinuria, which can be attributed to impaired function of the kidneys. In healthy newborns no differences in MWM content were detected during the first day of life, but in newborns exposed to chronic intrauterine hypoxia MWM level was increased. Hence, measurement of MWM level in the urine can have prognostic significance in diseases involving gestosis and fetal hypoxia.     

捏脊与腹部按摩对重型颅脑损伤患者早期胃排空的影响

目的 观察捏脊与腹部按摩对重型颅脑损伤患者早期胃排空的影响。 方法 将30例患者随机分为治疗组和对照组各15例,2组均进行常规治疗。治疗组在入院后12h内给予捏脊与腹部按摩,早晚各1次;对照组不予捏脊与腹部按摩。2组在试验观察期间均不给予增强胃动力的药物和其它中医治疗。测定治疗组与对照组在入院第1天、第3天、第7天所测得胃半排空时间(T_1/2)。 结果 第1天2组胃半排空时间比较,差异无统计学意义;治疗组第3天及第7天的胃半排空时间均短于对照组。治疗组中第1天、第3天和第7天胃半排空时间两两比较,均有统计学意义。 结论 捏脊与腹部按摩能明显促进重型颅脑损伤患者早期胃排空。     

Effect of hyperventilation on the cerebral blood flow and metabolism in patients with craniocerebral trauma

Cerebral blood flow and metabolism were studied in 44 patients with acute severe craniocerebral injuries (contusions of the brain and removal of intracranial hematomas) with consciousness depression (moderate coma), hospitalized in intensive neurological care wards. Oxygen supply to the brain was repeatedly evaluated (acid-base status of the jugular vein blood, oxygen arterio-venous difference, oxygen extraction coefficient), oxymetry of the brain was repeatedly carried out, and vital functions were monitored over the entire period of disease. Cerebral blood flow was monitored by rheoencephalography, which helped timely detect the changes in cerebral blood flow in patients with craniocerebral injuries during different ventilation protocols used in intensive care. All studies were carried out during three stages: 1) initial stage, when the patients were brought to intensive neurological care wards after surgical intervention, and during normoventilation (paCO2 36-40 mm Hg; 2) moderate hyperventilation (paCO2 35-26 mm Hg); and 3) pronounced hyperventilation (paCO2 25-20 mm Hg). Specific changes in the cerebral blood flow during the acute period of craniocerebral injury were detected during different ventilation regimens in 2 groups of patients: group 1 with lethal outcomes and group 2 with positive changes.     

重症颅脑损伤患者下肢深静脉血栓形成原因分析及护理

目的:探讨重症颅脑损伤患者下肢深静脉血栓(LDVT)形成原因及护理方法.方法:回顾性分析12例重症颅脑损伤并发LDVT患者的临床资料.结果: 重症颅脑损伤患者并发LDVT与疾病发展、体位、静脉血管壁损伤、利尿脱水剂使用、年龄及其他因素有关.结论:做好LDVT的预防及护理,可提高治疗效果和患者生活质量.     

Changes in fatty acids content in blood red cells of patients with iron-deficiency anemia treated with sorbifer and mildronate

AIM: To study fractional composition of red cell membrane (RCM) lipids in patients with severe iron-deficiency anemia (IDA) complicated by myocardiodystrophy prior to treatment and after 1-month combined treatment with sorbifer and mildronate. MATERIAL AND METHODS: Fatty acid composition of RCM lipids was studied in 12 patients with severe chronic posthemorrhagic IDA complicated by myocardiodystrophy and in 15 healthy subjects. Extraction of lipids from blood red cells and methylation of fatty acids were performed according to K.M. Sinyak et al. (1976). Relative content of fatty acids was determined at chromatography. RESULTS: The study detected increased content of saturated fatty acids, especially palmitic and decreased content of unsaturated fatty acids especially fraction of omega6-polyunsaturated fatty acids: arachidonic and gamma-linolenic. CONCLUSION: Sorbifer in combination with mildronate improved fatty acid composition of blood red cells in patients with iron-deficiency anemia.     

Use of perfluothane as a component of neurorehabilitation therapy in the acute period in patients with craniocerebral injuries

The effects of perfluothane on the course of posttraumatic period are evaluated in patients with craniocerebral injuries. Forty patients were divided into 2 groups treated and not with perfluothane. Hemodynamics, hemostasis, gaseous exchange and lung ventilation functions, and neurological status were evaluated over the course of treatment. The data evidence a favorable effect of perfluothane on the course of the posttraumatic period in patients with craniocerebral injuries.     

The levels of nitrites and medium molecular-weight molecules in the blood of neonatal infants with posthypoxic cardiopathy

A hundred and four neonatal infants underwent clinical and functional studies in early neonatality. The levels of nitrites and medium molecular-weight molecules were determined in cardiologically healthy neonatal infants and children with posthypoxic cardiopathy. The magnitude of increases in biochemical parameters was found to be associated with clinical type of cardiopathy: their level significantly elevates in transient myocardial ischemia, their values achieve the maximum level in neonatal pulmonary hypertension and in the presence of functioning fetal communications.