阻断肝门对循环有酸碱平衡影响的研究

研究２３例肝叶切除术患者在阻断肝门前、后血流动力学、酸、碱平衡、脂质过氧化物（ＬＰＯ）的变化。结果：阻断肝门后循环及酸碱平均变化幅度不大，肝脏缺血，再灌注过程中ＬＰＯ显著增加，并加重肝损害。     

犬后肢再灌注后过氧化脂质与肝脏超微结构的改变

报告３６只犬后肢再灌注后血中ＬＰＯ值的改变以及肝脏超微结构变化。ＬＰＯ值在阻断９０分钟以上，则逐步增加，其肝细胞损害亦如此。而地塞米松可有效的防止自由基对细胞的损害。３６只犬随机分为 ６组，均用成巴比妥钠 ３０ｍｇ／ｋｇ肌注麻醉。 １～４组分别用无创伤血管钳，钳闭阻断股动脉、静脉３０、６０、９０、１２０分钟。５组阻断前给地塞米松０．２５ｍｇ／ｋｇ，再阻断１２０分钟。６组对照组。各组均于阻断前及开放后５、１０、１５、３０、６０分钟取股静脉血进行ＬＰＯ测定。结果３、４组ＬＰＯ值显著增高。５组采用地塞米松其值上升不如３、４组明显，于术后第３、５、８天取肝作电镜观察，在３、４组可见肝细胞线粒体、内质网等细胞器病变。     

间断性和持续性肝缺血再灌注对线粒体功能的影响

间断性和持续性肝缺血再灌注对线粒体功能的影响孙经建张柏和吴孟超陈汉钱光相作者采用大鼠肝缺血再灌注损伤模型，观察肝线粒体功能，以及肝组织内钙离子、脂质过氧化物（ＬＰＯ）和超氧化物歧化酶（ＳＯＤ）含量的变化，旨在比较间断性与持续性肝血流阻断对上述指标的影...     

间断性阻断肝血流对线粒体功能的影响及机理探讨

目的 探讨间断性和持续性阻断肝血流对线粒体功能的影响及其作用机理。方法 实验大鼠分为持续阻断组、间断阻断组和假处理组,检测其肝线粒体功能、肝组织内钙和脂质过氧化物（ＬＰＯ）含量,以及超氧化物歧化酶（ＳＯＤ）活性。结果 与间断性阻断肝血流相比,持续性缺血再灌注后大鼠肝线粒体呼吸控制比率（ＲＣＲ）、磷氧比值（Ｐ／Ｏ）、氧化磷酸化效率（ＯＰＲ）和ＳＯＤ活性均显著下降,其值分别为３．０４±０．１７对２．０     

过氧化脂质对淋巴细胞功能影响的实验研究

体外观察了过氧化亚油酸（ＬＯＯＨ）对淋巴细胞的影响，并进一步观察烧伤后体内过氧化脂质（ＬＰＯ）水平变化及淋巴细胞功能变化，以探讨烧伤免疫抑制的机制。体外实验采用正常小鼠脾淋巴细胞与ＬＯＯＨ一起培养或温育，测定增殖反应、ＩＬ－２及ＬＰＯ。体内实验采用小鼠１１％～１２％ＴＢＳＡⅢ度烧伤模型测定脾淋巴细胞功能以及血浆、肝、脾中ＬＰＯ。结果表明：ＬＯＯＨ可抑制淋巴细胞增殖反应及ＩＬ－２生成、诱发淋巴细胞脂质过氧化，ＶｉｔＥ可减轻ＬＯＯＨ的这些作用；烧伤后体内ＬＰＯ水平明显升高、脾淋巴细胞增殖反应及ＩＬ－２生成明显降低，ＶｉｔＥ组或ＳＯＤ组的这些变化与正常组相比，无显著性差别。提示：烧伤后体内脂质过氧化亢进以及ＬＰＯ增多可能是烧伤免疫抑制的机制之一。     

肝静脉阻断后肝癌,癌周及肺组织中血管内生长因子受体1,2的？…

目的 研究肝癌肝静脉阻断后肝脏及远隔器官组织血管内生长因子受体１及受体２的表达，探讨肝静脉阻断对肝癌生长及侵袭、转移的影响。方法 以Ｗｉｓｔａｒ大白鼠肝癌模型为材料，采用ＳＵＰＥＲＶＩＳＩＯＮ免疫组化方法观察肝静脉阻断后肝癌、癌周、临近肝叶（肝左中叶）及肺组织血管内生长因子受体１（Ｆｌｔ－１）及血管内皮生长国受体２（Ｆｌｋ－１／ＫＤＲ）的表达变化。结果 肝静脉阻断后肝癌、癌周组织Ｆｌｔ－１的表达较     

复温对大鼠移植肝脏抗氧自由基损伤的研究

目的　探讨复温对抗氧自由基损伤,保护移植肝脏的作用。方法　建立下腔静脉内置管法大鼠自体原位肝移植模型。在再灌流前对移植肝脏用不同温度进行复温,动态观察肝组织中脂质过氧化物（ＬＰＯ） 含量和超氧化物歧化酶（ＳＯＤ） 活性的变化,并同步观察肝细胞光镜和透视电镜下的形态学变化。结果　再灌流后与复温后比较ＬＰＯ有显著升高,ＳＯＤ 有明显下降（ Ｐ＜０ ．０１） 。用３６ ℃复温组与其他各复温组比较可明显减少ＬＰＯ的升高和ＳＯＤ 的下降（Ｐ＜ ０．０５）;同步病理也证明用３６ ℃复温可明显减轻肝细胞的损伤。结论　复温可间接抑制氧自由基的产生,减轻再灌流损伤,能够达到保护肝细胞的作用。     

温血灌注与冷晶体心脏停搏液灌注对心肌酶学的影响

目的比较温氧合血连续灌注与冷晶体心脏停搏液间断灌注心肌酶学变化,探索更有效的心肌保护方法。方法将阻断时间在６０分钟以上１６例患者随机分为温血灌注组（Ａ组）和冷晶体灌注组（Ｂ组）,每组８人。分别于主动脉阻断前和主动脉阻断６０分钟后取部分心肌组织测定其超氧化物歧化酶（ＳＯＤ）和脂质过氧化物（ＬＰＯ）并进行对比分析。结果阻断前和阻断后２组ＳＯＤ和ＬＰＯ含量无差异,阻断后Ｂ组ＳＯＤ含量比阻断前显著降低（Ｐ＜０．０１）;而阻断后ＬＰＯ含量明显增高（Ｐ＜０．０１）。结论温血连续灌注能有效减轻心肌缺血与再灌注损伤,满足心肌需氧代谢,保持停搏心肌抗氧化系统稳定     

人体常温下阻断和恢复入肝血流后肝组织病理与超微结构的临床研究

采用常温下阻断入肝血流后行肝切除手术２０例，并同时于不同时间及恢复血流后切取肝脏微型标本行光镜及电镜检查。结果显示：一次性阻断肝门３０分钟以内者，其肝脏病理及超微结构的损伤性变化是可复性的，即使肝硬变者阻断４０分钟以内术后恢复仍顺利     

体外循环下心肌缺血再灌注后LPO,SOD活性及同工酶变化

２１例择期心内直视手术患者，以阻断主动脉不同时间分为三组（每组７例，阻断４５分钟之内为１组，４５～９０分钟为２组，９１分钟以上为３组）。观察在有心肌保护的特殊条件下，心肌缺血再灌注后ＬＰＯ、ＳＯＤ活性及同工酶的变化。结果：再灌注后３、３０、６０分钟与再灌注前比较，ＬＰＯ持续上升，（ＳＯＤ性及同工酶）ＳＯＤ１持续下降；缺血时间愈长，上升或下降的程度愈重，三组之间比较差异显著或非常显著。结果表明：在有心肌保护的特殊条件下，心肌缺血再灌注后仍存在一定程度的再灌注损伤，且随心肌缺血时间延长，再灌注后损伤愈重。     

The Effect of Segmental Epidural Analgesia on Maternal and Foetal Acid-base Balance, Lactate, Serum Potassium and Creatine Phosphokinase during Labour

Maternal and foetal acid-base balance, Pao₂, lactate, potassium and creatine phosphokinase (CPK) were studied during the course of 28 induced labours. Every second mother received segmental epidural analgesia during the first stage of labour (epidural group), while the remaining mothers (who were given pethidine for pain relief, if necessary) acted as a control group. In the epidural group the patients had only minimal changes in acid-base balance and lactate concentration during the first stage. During the second stage lactate concentration increased. In the control group, on the other hand, the acid-base balance showed signs of hyperventilation and lactic acid accumulation during the first stage. The potassium changes were quite minimal and were not significantly different between the groups. The CPK level did not change during labour, but 2 and 4 h after delivery it was significantly elevated in both groups. The foetal acid-base balance, potassium, lactate and Pao₂ values revealed no differences between the groups at any time. The CPK level in umbilical venous blood was significantly higher in the epidural group.     

肠管破裂伤经海水浸泡后的水、电解质变化的实验研究

目的　分析开放性腹部损伤并肠管破裂伤合并海水浸泡后水、电解质和酸碱平衡的变化 ,为海战时开放性腹部损伤并肠管破裂伤的早期救治提供理论依据。方法　成年杂种犬 2 6只 ,制作开放性腹部损伤并肠管破裂伤动物模型。随机分为海水浸泡组 (海水组致伤后浸泡于人工海水 ,n =10 )、对照组 (致伤后不浸泡 ,n =10 )和生理盐水浸泡组 (生理盐水组 ,致伤后浸泡于生理盐水 ,n =6)。观察三组的水、电解质、酸碱平衡的变化规律 ,并进行对比分析。结果　海水组出现明显的水、电解质及酸碱平衡紊乱 ;对照组和生理盐水组水、电解质及酸碱平衡在致伤前后无明显变化。结论　海水浸泡是导致开放性腹部损伤并肠管破裂伤员体液代谢紊乱的主要因素     

硬膜外阻滞下腹腔镜胆囊切除术时酸碱平衡及呼吸功能的变化

观察硬膜外阻滞下腹腔镜胆囊切除术(LC)患者血液酸碱平衡及呼吸功能的变化。结果表明,硬膜外阻滞者LC时可出现一过性高碳酸血症和代谢性酸中毒,因患者处于清醒状态,可通过代偿性加强呼吸,在一定程度上排出腹腔内吸收的二氧化碳气体,使气腹后体内酸碱恢复正常,所以,硬膜外阻滞下行LC是安全可行的。     

Acid-base balance in acute renal failure and renal replacement therapy

The approach to acid-base balance based on the concept of strong ions, initially proposed by Stewart, is briefly overviewed. The anion gap and the strong anion gap are both discussed. Comments are made on the strong ion difference of fluids administered to patients and their impact on acid-base status will be commented. Renal failure patients have an altered acid-base balance; most commonly, a mixed type of metabolic acidosis (hyperchloraemic, and of a high anion gap) is observed. The consequences of renal metabolic acidosis are described. Finally, the impact of renal replacement therapy on acid-base balance is exposed; different modalities of renal replacement are considered in regard to their alkalinizing performance.     

Stewart and beyond: new models of acid-base balance

The Henderson-Hasselbalch equation and the base excess have been used traditionally to describe the acid-base balance of the blood. In 1981, Stewart proposed a new model of acid-base balance based upon three variables, the "strong ion difference" (SID), the total weak acids (ATot), and the partial pressure of carbon dioxide (Pco2). Over 20 years later, Stewart's physiochemical model still remains largely unknown. In this review, we will present both the traditional and the Stewart models of acid-base balance and then derive each using an "ion equilibrium method." Modern theories of acid-base balance may be useful toward the understanding of complex acid-base disorders.     

葛根素对糖尿病足患者血管活性物质平衡的影响

目的：探讨葛根素对糖尿病足（DF）患者内皮细胞功能及其血管活性物质平衡关系的影响。方法：应用葛根素治疗糖尿病足,对患者治疗前后血浆ET、CGRP、SOD、LPO、TXB2和6－K－PGI2进行检测及其疗效评定。结果：DF患者治疗前ET、LPO、TXB2明显增高,CGRP、SOD、6－K－PGI2明显降低。经葛根素治疗后以上指标均有改善,但以ET、LPO、TXB2显著性降低为主。结论：葛根素具有抑制ET、LPO和TXB2的分泌,增加CGRP、SOD、6－K－PGI2的含量,调节血管舒缩功能平衡的作用。     

Randomized trial of different intraabdominal pressures and acid–base balance alterations during laparoscopic cholecystectomy

BACKGROUND: Experimental and clinical studies document risks of acid-base balance alterations toward acidosis and hypercapnia during intraperitoneal carbon dioxide insufflation. The aim of this study was to assess the influence of different insufflation pressures on arterial blood gas changes and acid-base alterations during laparoscopic cholecystectomy and immediately postoperatively. METHODS: Thirty patients were randomized to receive either 10 or 15 mmHg insufflation pressure. Anesthesia was standardized for both groups. The following parameters of acid-base balance were recorded: pH, pCO2, pO2, base excess (BE), HCO3. Suitable data were analyzed by the Mann-Whitney U-test. RESULTS: Pneumoperitoneum with carbon dioxide caused a decrease in pH toward acidosis that was either respiratory or mixed in origin. There were no statistically significant differences in acid-base balance alterations between the two groups of patients. CONCLUSIONS: Carbon dioxide pneumoperitoneum causes alterations of the acid-base balance, mostly of respiratory or mixed type. Lowering of the insufflation pressure from 15 to 10 mmHg does not contribute to the elimination of acid-base balance alterations during laparoscopic cholecystectomy.     

The combination of etomidate and fentanyl as a short acting and introduction anaesthesia in the dog in experimental medicine (author's transl)

The effects of a combination of etomidate (1.0 mg/kg bw) and fetanyl (0.005 mg/kh bw) on haematology, blood gases, acid-base balance and haemodynamics were investigated in 8 mongrel dogs. The only significant change in haematology was leucopenia. Blood gas values and acid-base balance initially showed a depression of respiration and a tendency to slight metabolic acid dosis. Decreased heart rate caused diminution of cardiac output, while systemic and pulmonary resistance as well as stroke volume were not altered significantly.     

Postoperative metabolic acidosis: use of three different fluid therapy models

Intraoperative fluid administration is considered an important factor in the management of metabolic acidosis following surgical procedures. The aim of this study was to compare three types of intraoperative infusional models in order to evaluate their effect on acid-base changes in the immediate postoperative period as calculated by both the Henderson-Hasselbach equation and the Stewart approach. Forty-seven patients undergoing left hemicolectomy were enrolled in the study and assigned randomly to receiving 0.9% saline alone (Group A, n=16), lactated Ringer's solution alone (Group B, n=16) or 0.9% saline and Ringer's solution, 1:1 ratio (Group C, n=15). Arterial blood samples were taken before operation (t0) and 30 min after extubation (t1) in order to measure the acid-base balance. The results showed a metabolic acidosis status in Group A patients, whereas Group B exhibited metabolic alkalosis only by means of the Stewart method. No difference was found in Group C between the time points t0 and t1 when using either the Henderson-Hasselbach equation or using the Stewart model. We conclude that saline solution in association with Ringer's solution (1:1 ratio) appears to be the most suitable form of intraoperative fluid management in order to guarantee a stable acid-base balance in selected surgical patients during the immediate postoperative period.     

Effect of glutathione augmentation on lipid peroxidation after spinal cord injury

Lipid peroxidation (LPO) is considered a major factor in damage spread after spinal cord injury (SCI). Therapies that limit LPO after SCI have demonstrated some utility in clinical trials, but more effective treatments are needed. In the present study the effects of augmenting SC levels of the endogenous antioxidant glutathione (GSH) on LPO after SCI were studied in a rat contusion injury model. A significant decrease in GSH occurred 1h after SCI which was paralleled by increases of 123% in malondialdehyde (MDA) and >500% in the 4-hydroxyalkenals (4-HA's), two LPO products. SC irrigation with gamma-glutamylcysteine (GC) preserved GSH and reduced 4-HA's below naive levels but had no effect on MDA. By 24 h after SCI, MDA returned to naive levels but 4-HA's were still elevated. Once again, GC treatment reduced 4-HA's. 4-HA's are much more reactive than MDA and are considered among the most toxic LPO products. These results suggest that (1) conditions after SCI may favor particular branches of the LPO pathway leading to differential LPO product levels, (2) MDA measurement is not by itself an adequate test for the presence or magnitude of LPO after SCI, (3) binding of GSH to 4-HA's may be an important mechanism by which the GSH system confers protection against LPO after SCI, and (4) SC GSH can be augmented after trauma by local irrigation with GC. These results also suggest that GSH augmentation may be an effective strategy for curtailment of LPO-mediated damage in acute phase SCI.