乙酰胆碱对家兔颈动脉窦神经化学感受性单位自发电活动的…

１５只家兔的颈动脉体－窦神经标本，记录了３３个窦神经中化学感受性传入单位的电活动。实验结果：①大部分单位放电频率较低且不规则，少部分单位的放电频率高而规则；②在灌渡液内加入乙酰胆碱（ＡＣｈ）２０μｇ／ｍｌ后，１６个单位的自发放电频率由１．２６±０．３１ｉｍｐ／ｓ减至０．７７±０．１９ｉｍｐ／ｓ（Ｐ〈０．０５）。③在灌流液中加入尼古丁（１、３、５、１０和１５μｇ／ｍｌ）后，１０个单位的自发放电频率，     

颈动脉体化学感受器瘤（附三例临床报告）

本报告３例经手术和病理证实的颈动脉体化学感受器瘤。１例行肿瘤切除，２例连同颈外动脉一并切除。提出本病部位特殊，强调术前颈总动脉压迫训练、脑电图检查、选择性脑血管造影对诊断及了解患侧大脑侧支循环是否建立，对手术方式选择是防止术后脑部严重并发症和死亡的重要性。并结合有关献提出作在术中的一些看法。     

颈动脉体瘤外科治疗的护理

颈动脉体瘤外科治疗的护理东巧云，赵润琴附属二院（０５００００）关键词颈动脉体瘤；化学感受器；护理学颈动脉体瘤是发生于颈动脉体的化学感受器瘤，临床少见，常伴有神经系统受侵。我院１９８１年１０月～１９９４年１２月手术切除１２例，现将护理体会介绍如下。１术...     

颈动脉体的生理和病理功能

 外周颈动脉体化学感受器在介导低动脉血氧、高碳酸血症和酸中毒等信号过程中发挥着重要作用。它将信号传到中枢引起化学感受性反射,是低氧通气反应以及低氧血症引起循环系统一系列反应的关键。众所周知,外周和中枢化学感受器的交互作用在机体通气反应调节中至关重要,而且,颈动脉体的化学感受器活动在运动时的通气反应和体液调节中及高原地区慢性低氧所致的通气习服反应中起重要作用。在疾病状态下,如高血压、睡眠呼吸障碍(包括阻塞性睡眠呼吸暂停)和充血性心力衰竭的患者以及动物疾病模型中,化学感受器的活动及其反射的敏感性都显著提高。颈动脉体在生理状况下维持着机体的血氧稳定,在病理状况下参与了疾病的发展。因此,颈动脉体的细胞和分子调节机制可用来解释许多疾病的病理生理过程。     

无机磷酸盐溶液对家兔颈动脉体化学感受器的作用

在三种脑制备家兔模型上观察了用无机磷酸盐刺激颈动脉体化学感受器所引起的行为和心血管活动效应。结果表明:①无机磷酸盐刺激脑组织完整兔颈动脉体化学感受器不产生任何效应;②无机磷酸盐刺激高位去大脑兔颈动脉体化学感受器可引起一系列典型的防御反应表现;③无机磷酸盐刺激脑桥制备兔颈动脉体化学感受器可引起动脉血压升高,下肢血管收缩和心动过缓反应。提示无机磷酸盐可以兴奋家兔颈动脉体化学感受器,在高位去大脑兔可诱发出典型的防御警觉反应。     

乙酰胆碱对家兔颈动脉窦神经化学感受性单位自发电活动的影响

１５只家兔的颈动脉体窦神经标本，记录了３３个窦神经中化学感受性传入单位的电活动。实验结果：①大部分单位放电频率较低且不规则，少部分单位的放电频率高而规则；②在灌流液内加入乙酰胆碱（ＡＣｈ）２０μｇ／ｍｌ后，１６个单位的自发放电频率由１．２６±０．３１ｉｍｐ／ｓ减至０．７７±０．１９ｉｍｐ／ｓ（Ｐ＜０．０５）。③在灌流液中加入尼古丁（１、３、６、１０、和１５μｇ／ｍｌ）后，１０个单位的自发放电频率，由０．６０±０．２１ｉｍｐ／ｓ分别增加到０．９６±０．２１、１．１９±０．３０、１．２４±０．２９、１．４８±０．４１和１．８２±０．３９ｉｍｐ／ｓ，有明显的剂量依赖性（ｒ＝０．９４，Ｐ＜０．００１）。④阿托品（１０μｇ／ｍｌ）可阻断ＡＣｈ的作用，筒箭毒（１．０μｇ／ｍｌ）可阻断尼古丁作用，但对自发放电均无显著影响。上述结果提示，ＡＣｈ在颈动脉体化学感受性功能方面可能仅起调质的作用。     

颈动脉体损伤对COPD大鼠模型呼吸调控功能的影响

目的:探讨颈动脉体化学损伤对慢性阻塞性肺疾病（COPD）大鼠呼吸运动的影响。方法:根据随机数字表法，将30只Wistar大鼠分为两组，COPD组20只:用烟熏联合LPS气道内注药法建立大鼠COPD模型；对照组10只:同等条件饲养但不进行烟熏，气道内滴注生理盐水。实验组8周造模成功后，颈部正中切开暴露双侧颈动脉体（CB），用双氧水浸润的滤纸条包裹颈总动脉分叉部，造成CB化学损伤；对照组在用同样方法分离暴露双侧颈总动脉后，用NS滤纸条包裹，对CB进行假损伤处理。分别记录每组大鼠呼吸频率、呼气间期、吸气间期、吸呼比等呼吸生理指标及血气分析结果，并进行统计学分析。造模结束后取所有大鼠双侧CB行病理学观察。结果:呼吸生理指标:CB损伤前COPD组呼吸频率明显高于对照组（t=3.186，P=0.004），CB损伤后COPD组呼吸频率更低（t=-3.266，P=0.003）、吸气时间更长（t=3.989，P<0.001）、吸呼比更高（t=6.103，     

Eight cases of carotid body tumor diagnosed by Bmode ultrasonic imaging

This paper reports that 8 patients with carotid body tumors were diag-nosed by B-mode ultrasonic imaging.Among them,only 3 were originally clinicallydiagnosed as having the disease.The features of carotid body tumors in the 8cases,seen by B-mode ultrasonogram,are described.It is considered thatultrasonography of carotid body tumors is specific,trauma-free,accurate andsimple,and it may be an important method in identifying and diagnosing the dis-ease.     

颈动脉体瘤的外科治疗

目的:探讨颈动脉体瘤(CBT)的诊断和外科治疗方法.方法:分析我院2001年4月～2003年10月收治的8例CBT的临床资料及手术结果.结果:8例CBT术前均经颈部超声及颈动脉造影术证实;8例均经手术治疗,其中颈外动脉与CBT同时切除1例,其余7例行外膜下剥离切除术.无手术死亡, 术后随访1个月～24个月,无术后颅神经损伤.结论:颈部超声检查是CBT简便有效诊断方法,颈动脉造影术是CBT的诊断和术前评估最有效和重要的手段,手术是CBT的首选和有效的治疗手段.准确的术前评估,正确的手术方法选择和手术顺序是手术成败的关键.     

颈动脉体瘤的CT多平面成像诊断

目的：探讨颈动脉体瘤的CT多平面成像表现。方法：对8例经手术病理证实为颈动脉体瘤的临床资料进行回顾性分析。结果：8个颈动脉体瘤均位于颈动脉分叉水平，术前行CT平扫和高分辨CT增强扫描并行多平面成像（MPR）处理。CT平扫表现为软组织密度肿块，呈圆形或卵圆形，边缘清楚，增强扫描肿瘤明显强化，MPR显示颈动脉分叉扩大，其中2例肿瘤向上侵犯颅底并经颈静脉孔侵入颅后窝桥小脑角区。结论：高分辨CT增强扫描加多平面成像是诊断颈动脉体瘤及其周围侵犯关系的安全、可靠的检查方法之一。     

颈动脉体瘤的影像学诊断

目的 探讨CT、MRI、DSA检查在颈动脉体瘤诊断中的价值.方法 病理证实的10例颈动脉体瘤,其中4例行MRI T1WI、T2WI及对比增强MRA,6例行CT平扫加增强扫描,10例均行DSA和TBO试验.结果 10例术前CT、MRI、DSA均诊断为颈动脉体瘤,与临床及病理诊断符合率为100%.10例病变均位于颈动脉分叉处.CT平扫主要表现为均匀性低密度球形病灶,CT值25～37 Hu.MRI的特征为T1WI、T2WI均为高信号,中心有流空信号,MRA均清楚显示出病变的部位、大小、形态及血流动力学的特点.DSA表现为肿瘤包绕颈动脉,颈动脉分叉角度增大,肿瘤均匀染色,可显示供血动脉.结论 CT、MRI和DSA均有特征性表现,诊断比较容易,若将三种方法优化组合,可优势互补,为制定最佳手术方案提供科学、准确而全面的依据.     

颈动脉体瘤的诊断及外科治疗

目的 探讨颈动脉体瘤的诊断及外科治疗。方法 回顾性分析了1983年1月-2002年6月间我院收治的38例患者的41个颈动脉体瘤的临床资料。结果 38例患者术前均常规行B超及血管造影,诊断符合率分别为95％和98％。手术切除肿瘤38个,其中12例行颈外动脉切断、颈内动脉部分缺损修补、动脉体瘤切除术;11例行颈外动脉切断、动脉体瘤切除术;8例行单纯瘤体切除术;6例行颈外动脉切断、颈内动脉重建术;1例行动脉体瘤切除,颈内、颈外、颈总动脉部分切除术。结论 对于可疑颈动脉体瘤患者,术前应常规行B超及颈部血管影像重建。早期、一次手术切除及术中颈内动脉血供重建是治疗及降低手术并发症的关键。     

颈动脉体瘤81例临床分析

目的探讨颈动脉体瘤(CBT)的诊断与治疗方法。方法81例CBT患者,42例采用单纯瘤体切除,24例行瘤体与颈内、外动脉一并切除,未做颈动脉重建;8例瘤体切除,同时行颈内动脉修补;5例行CBT摘除术,并颈内动脉吻合;2例行瘤体与颈内外动脉切除,同时行颈内动脉重建。结果81例术后随诊1～13 a,平均11 a;81例无手术死亡,72例肿瘤完全切除,预后良好;9例大部切除,其中3例死亡(1例死于心脏病,1例死于颅底转移,1例死于肺转移);其余患者最后1次随访均健在。术后发生脑卒中瘫痪1例,5例出现脑神经并发症,舌神经损伤25例。结论CBT应尽早手术治疗,根据肿瘤与颈动脉的关系选择适宜术式。     

Significance of the preoperative guidance of dual-source CT in carotid body tumor

Background Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor （CBT） patients. The aim of this study was to explore the value of dual-source CT （DSCT） cerebral and carotid angiography in CBT diagnosis.Methods DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions （MPR）,maximum intensity projection （MIP） and volume rendering （VR）. All patients were subjected to color Doppler flow imaging （CDFI） examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery.Results DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions （1 case had multiple bilateral CBTs）. The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery （ICA, ECA） were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases （4 tumors） showed arterial phase homogeneous enhancement; 5 cases （6 tumors） had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings.Conclusions DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.     

Recurrent malignant carotid body tumor: report of one case and review of the literature

Carotid body tumor (CBT) is a rare tumor, which is composed of chromaffin cells, groups of cells associated with the autonomous system, occurring at the carotid bifurcation. This tumor grows slowly, usually with a history of several years and seldom undergoes malignant transformation. The majority of CBT are benign, only few cases of malignant CBTs were reported in the literature.1-3 Over a period of 10 years (1993-2004), 28 patients with CBT were diagnosed and surgically treated in the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Stomatology, Shanghai Jiaotong University, only one was proven both clinically and histopathologically to be malignant CBT. This paper reports this unusual patient with recurrent malignant carotid body tumor as well as cervical lymph node metastases and reviews the relevant literature.