缺血预适应远程保护作用在缺血脊髓的实验研究

目的探讨双后肢缺血预适应(IPC)对兔脊髓缺血/再灌注损伤远程保护作用.方法采用肾下腹主动脉阻断法,建立脊髓缺血/再灌注模型.IPC组先用止血带结扎兔双后肢根部5 min,松开5 min,重复三次,15 min后再阻断腹主动脉35 min后开放灌注,缺血组阻断腹主动脉35 min后开放灌注.术后进行神经功能评分,观察脊髓标本的病理学改变及细胞凋亡情况.测定脊髓组织中IL-8的水平.结果神经功能评分IPC组在各时间点明显高于缺血组,组织病理学变化各时间点明显好于缺血组,凋亡细胞数及IL-8水平明显低于同时间点缺血组.结论双后肢IPC通过调动机体内源性抗损伤机制对缺血脊髓发挥远程保护作用.     

缺血预处理对兔脊髓缺血再灌注损伤的延迟保护作用

目的:脊髓缺血再灌注损伤机制复杂,各种单一药物保护作用有限。为此探讨缺血预处理(ischemicpreconditioning,IPC)对兔脊髓缺血再灌注损伤的延迟保护作用。方法:将大白兔随机分为3组。缺血组和IPC组各30只,采用肾下腹主动脉阻断法,建立脊髓缺血再灌注模型;假手术组10只,手术开始步骤同其他两组,但不做肾下腹主动脉阻断即缝合伤口。IPC组先阻断腹主动脉5min,开放10min,重复3次,48h后阻断腹主动脉35min后开放灌注,缺血组阻断腹主动脉35min后开放灌注。于术后4,8,24,48h,7d分别进行神经功能评分,观察脊髓标本的病理学改变,细胞凋亡情况及脊髓组织中白细胞介素()的水平测定。8IL-8结果:各时间点假手术组所有动物神经功能正常。缺血再灌注8,24,48h,7d神经功能Jacobs评分,缺血组分别为(1.90±1.65),(1.34±1.76),(0.71±0.75),(0.61±0.57)分,IPC组分别为3.50±1.46),((3.80±1.60),(3.77±1.75),(3.50±1.29)分,两组比较差异有非常显著性意义(t=3.98～11.12,P<0.01)。IPC组组织病理学变化各时间点明显好于缺血组,凋亡细胞数明显低于同时间点缺血组。再灌注8,24,48hIL-8水平,缺血组分别为(5877.32±530.406015.49±441.55),),((5050.49±271.22pg/g,IPC组为()5086.34±284.16,5215.61±411.66,)()(4385.86±23     

缺血前和缺血后联合应用丙泊酚对兔脊髓缺血再灌注损伤的保护作用

目的探讨缺血前和缺血后联合应用丙泊酚对兔主动脉阻断脊髓缺血性损伤的影响。方法 24只日本大白兔随机双盲均分为三组:假手术组、缺血再灌注组、丙泊酚保护组。缺血再灌注组采取主动脉阻断40min建立脊髓缺血损伤模型,丙泊酚保护组于主动脉阻断前10min及再灌注即刻分别以微量输液泵持续静脉输注丙泊酚(30mg/kg溶于30ml0.9%氯化钠注射液,以3ml/min的速度泵注),另外两组以同样方法静脉泵注等容量0.9%氯化钠溶液作对照。术后行后肢神经功能评分、脊髓组织病理学改变检测、丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性测定。结果与假手术组、丙泊酚保护组比较,缺血再灌注组日本大白兔后肢神经功能评分和脊髓组织病理学有显著改变(P<0.01);缺血再灌注组脊髓中MDA水平显著高于假手术组,丙泊酚保护组脊髓中MDA水平显著低于缺血再灌注组(P<0.01);与假手术组比较,缺血再灌注组脊髓中SOD活性明显减弱(P<0.01),丙泊酚保护组脊髓中SOD活性明显强于缺血再灌注组;假手术组与丙泊酚保护组的所有参数均无统计学差异。结论丙泊酚缺血前和缺血后联合应用对兔脊髓缺血再灌注损伤有良好的保护作用,并可能与其具有较强的抗过氧化反应作用有关。     

多次缺血预处理对兔脊髓缺血性损伤后脊髓功能和形态学的影响

目的观察多次缺血预处理(IPC)对兔脊髓缺血再灌注损伤的保护作用。方法24只日本大白兔随机分为假手术组(A组)、缺血再灌注组(B组)和IPC保护组(C组),各组均为8只。A组不阻断主动脉,B组左肾下阻断主动脉45min,C组左肾下阻断主动脉5min,开放5min,反复4次后再阻断主动脉45min。术后进行后肢神经功能评分和针电极肌电图(EMG)的描记及脊髓组织形态学改变的观察。结果B组同A、C组相比,后肢EMG亦有显著性病理改变(P<0.01)。结论多次IPC对家兔脊髓缺血再灌注损伤具有快速保护作用。     

氯胺酮预处理对兔脊髓缺血性损伤的保护作用

目的观察氯胺酮预处理对兔脊髓缺血再灌注损伤的保护作用。方法24只日本大白兔随机分为假手术组(A组)、缺血再灌注组(B组)和氯胺酮预处理组(C组),各组均为8只。A组不阻断主动脉,B组左肾下阻断主动脉45min,C组左肾下阻断主动脉前10min及开放后即刻静推氯胺酮30mg·kg-1。术后进行后肢神经功能评分和针电极肌电图(EMG)的描记及脊髓形态学改变的观察。结果B组分别同A、C组相比,神经功能和病理学评分均显著性偏低(P<0.01),且同C组相比,后肢EMG亦有显著性病理改变(P<0.01)。C组1只动物发生迟发性瘫痪。结论氯胺酮预处理对家兔脊髓缺血再灌注损伤具有一定的保护作用。     

多次缺血预处理对兔脊髓缺血性损伤时金属元素的影响

背景缺血预处理对主动脉手术的脊髓缺血性损害有良好的保护作用,但是脊髓缺血预处理保护作用的机制尚未完全阐明.目的探讨多次缺血预处理对兔脊髓缺血再灌注损伤的保护作用及其机制.设计以实验动物为研究对象,完全随机对照实验研究.单位一所大学医院的麻醉科.材料实验于2002-09/12在武汉大学人民医院麻醉学研究室完成.24只日本大白兔随机双盲分为假手术组、缺血再灌注组和缺血预处理保护组,每组8只.干预假手术组不阻断主动脉,缺血再灌注组阻断主动脉45 min,缺血预处理保护组阻断主动脉5 min,开放5 min,反复4次之后再阻断45 min.主要观察指标术后第7天检测脊髓组织金属元素(钙,镁,铜,锌)的浓度.术后观察后肢神经功能的评分、后肢针电极肌电图和脊髓组织病理学的改变.结果缺血再灌注组脊髓组织钙,铜的浓度较假手术组显著性升高(P＜0.05或0.01),镁,锌的浓度则显著性降低(P＜0.05).缺血再灌注组脊髓组织钙、锌的浓度分别较缺血预处理保护组显著性升高或降低(P＜0.01).缺血再灌注组后肢神经功能评分均显著性低于假手术组和缺血预处理保护组(P＜0.05或0.01),脊髓病理学和后肢肌电图亦较缺血预处理保护组有显著性病理改变(P＜0.01).结论多次缺血预处理对兔脊髓缺血再灌注损伤具有显著而又快速的保护作用,其保护机制与维持缺血区域钙,镁,铜,锌离子的平衡有关.     

多次缺血预处理对兔脊髓缺血性损伤后脊髓功能和形态学的影响

目的 观察多次缺血预处理（IPC）对兔脊髓缺血再灌注损伤的保护作用。方法 24只日本大白兔随机分为假手术组（A组）、缺血再灌注组（B组）和IPC保护组（C组），各组均为8只。A组不阻断主动脉，B组左肾下阻断主动脉45min，C组左肾下阻断主动脉5min，开放5min，反复4次后再阻断主动脉45min。术后进行后肢神经功能评分和针电极肌电图（EMG）的描记及脊髓组织形态学改变的观察。结果 B组同A、C组相比，后肢EMG亦有显性病理改变（P＜0．01）。结论 多次IPC对家兔脊髓缺血再灌注损伤具有快速保护作用。     

法舒地尔对家兔脊髓缺血再灌注损伤的保护作用

目的:探讨法舒地尔对脊髓缺血再灌注损伤的保护作用。方法:家兔30只,随机分为法舒地尔组20只和空白对照组10只,采用腹主动脉夹闭法制备脊髓缺血再灌注损伤模型,用腹腔注射法给法舒地尔组注射法舒地尔,空白对照组注射生理盐水,共14d,检测家兔血清自由基水平,治疗结束后采用Jacobs法对家兔后肢运动功能评分,评估后肢肌电图。结果:治疗后法舒地尔组家兔双后肢Jacobs评分明显高于空白对照组(P<0.001),血清丙二醛(MDA)、超氧化物岐化酶(SOD)、一氧化氮(NO)水平低于空白对照组(P<0.05或0.001),后肢运动诱发电位潜伏期(N1及P1)亦明显短于对照组(P<0.001)。结论:法舒地尔能减轻家兔脊髓缺血再灌注损伤。     

远程预处理对兔脊髓缺血再灌注损伤的保护作用(英文)

目的:探讨远程预处理对兔脊髓缺血再灌注损伤的保护作用。方法:20只成年雄性新西兰大白兔随机分成2组(各组n=10),即对照组和远程预处理(RPC)组。所有动物脊髓缺血前1h戊巴比妥钠麻醉动物(30mg/kg,iv)。RPC组动物麻醉后进行双后肢短暂缺血2次(充气式压力止血带环扎双后肢,压力26.6kPa,阻断10min,松开10min,再阻断10min),最后一次缺血后再灌注30min,阻闭肾下腹主动脉20min,制作兔脊髓缺血模型。对照组动物不进行双后肢短暂缺血,其余同RPC组。再灌注后4,8,12,24和48h分别对动物后肢运动功能评分。再灌注48h后,处死动物取脊髓(L5～7),石蜡包埋切片行组织病理学观察。结果:RPC组神经功能评分在各时间点均明显高于对照组(P=0.000);与对照组相比,RPC组脊髓前角正常神经细胞数明显增多(P=0.000),且神经功能评分与脊髓前角正常神经细胞计数之间有显著相关性(r=0.868,P<0.01)。结论:远程预处理对兔脊髓缺血再灌注损伤有显著的保护作用。     

依达拉奉及法舒地尔对兔脊髓缺血再灌注损伤的保护作用

目的:探讨依达拉奉及法舒地尔对脊髓缺血再灌注损伤的保护作用。方法:家兔40只,随机分为依达拉奉组及法舒地尔组各20只,采用腹主动脉夹闭法制备脊髓缺血再灌注损伤模型,依达拉奉组腹腔注射依达拉奉,法舒地尔组注射法舒地尔,疗程均为14 d,采用Jacobs运动功能评分评估家兔下肢运动功能,免疫组织化学方法评估脊髓损伤的病理变化以及Caspase-3表达情况,肌电图评估下肢运动诱发电位潜伏期。结果:2组Jacobs评分差异无统计学意义(P0.05)。治疗14 d后,依达拉奉组MEP潜伏期N1、P1短于法舒地尔组,Caspase-3阳性表达低于法舒地尔组,差异有统计学意义(P0.05)。结论:与法舒地尔相比,依达拉奉对脊髓缺血再灌注损伤的保护作用更加显著。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.