Effect of hyperoxia on neurogenic plasma protein extravasation in the rat dura mater

OBJECTIVE: We aimed to study the effect of normobaric hyperoxia on neurogenic inflammation of the rat dura mater. BACKGROUND: Inhalation of 100% oxygen is a first-line therapy for the treatment of acute cluster headache (CH). However, the mechanisms underlying the antinociceptive effect of oxygen are poorly understood. Sumatriptan, which is also effective in aborting CH attacks, is known to inhibit neurogenic inflammation of the dura mater. We hypothesized that hyperoxia reduces dural plasma protein extravasation in the model of electrically stimulating the rat trigeminal ganglion. METHODS: Unilateral stimulation of the trigeminal ganglion was performed in anesthetized male Sprague-Dawley rats. We assessed plasma protein extravasation (PPE) in the ipsilateral dura mater under normoxic (group 1) and hyperoxic conditions (group 2: pO(2) 200 mmHg; group 3: pO(2) 300 mmHg; group 4: pO(2) 400 mmHg). The study results were compared to the effect of sumatriptan (300 microg/kg) on dural PPE. RESULTS: Under normoxic conditions, the calculated extravasation ratio was 1.72 +/- 0.2. Hyperoxic treatment (groups 2, 3, 4) significantly attenuated dural PPE. At oxygen levels of 400 mmHg, the PPE ratio was 1.14 +/- 0.2 (P < .01). After IV application of sumatriptan (300 microg/kg), PPE was nearly abolished (PPE ratio: 1.06 +/-0.17). CONCLUSION: Our findings demonstrate that hyperoxia is able to inhibit dural PPE. Hyperoxia may play an anti-inflammatory role in neurogenic inflammation, but further studies are needed to clarify whether this effect is either caused by prejunctional mechanisms or by modulation of the vascular permeability at postcapillary venules.     

生物型人工硬脑膜修补硬脑膜缺损

背景：修复硬脑膜的完整性对于脑膜瘤患者的手术预后非常重要。目的：探讨生物型人工硬脑膜在大型凸面硬脑膜瘤修复中的应用价值。方法：回顾性分析56例因肿瘤侵蚀导致硬膜缺损的大型凸面脑膜瘤病例,术中采用人工硬脑膜修复硬膜缺损的临床疗效、并发症及随访结果。结果与结论：除2例并发局部积液,1例出现术侧少量硬膜下积液,1例出现迟发性硬膜外血肿外,其余病例均无脑脊液漏、颅内感染、癫痫、组织排异等不良反应发生。术后复查头颅CT及MR,证实植入人工硬膜的部位未见异常影像学改变。5例患者修复后3个月行颅骨修补,发现人工硬脑膜与正常硬脑膜融合良好,无粘连及炎症反应发生。说明生物型人工硬脑膜能够较好地重塑颅腔原有解剖层次,保护脑皮质,显著降低各种并发症的发生。     

Cerebral dura mater and cephalalgia: relationships between mast cells and catecholaminergic nerve fibers in the rat

The aim of the present study was to examine whether mast cells have the same variations as the related catecholaminergic nerve fibers. Chemical sympathectomy or surgical removal of right superior cervical ganglion induced a rapid decrease of fluorescence in both nerve fibers and mast cells, as confirmed by quantitative analysis (nerve fibers 19±1.1 vs 1.3±0.6; mast cell 10.8±1.9 vs 2.1±0.3). The results of quantitative analysis after nerve fiber stimulation (electrical), however, showed an increase of the fluorescence in both the nerve fibers and the mast cells (nerve fibers 43.4±2.4; mast cells 18.6±1.6). Moreover, we found that the basal zone is more innervated (regarding catecholaminergic nerve fibers) than the apical one, and that the fluorescence level decreases passing from the vasal zone to the perivasal and intervasal zones, Further studies are needed in order to clarify the role of fluorescent nerve fibers and mast cells of cerebral dura mater in cephalalgia.     

Adrenergic, cholinergic and peptidergic nerve fibres in dura mater involvement in headache?

Nerve fibres containing noradrenaline, acetylcholinesterase, vasoactive intestinal polypeptide and substance P were demonstrated in the dura mater of guinea-pigs using histochemical and immunohistochemical methods. These fibres accompanied blood vessels of all size, indicating a vasomotor role. In addition, some nerve fibres were observed without any obvious relation to the blood vessels. The rich supply of nerve fibres to the various parts of the dura mater may possibly be of importance in the pathogenesis of some types of headache.     

自体阔韧带替代人工硬脑膜修补后颅窝硬膜缺损的临床分析

目的探讨自体阔韧带替代人工硬脑膜修补后颅窝硬膜缺损的临床应用效果。方法回顾分析2005～2009年我院后颅窝疾病的临床患者30例。结果于后颅窝手术前即开始取下阔韧带,手术时间不超过10min,最后均能达到水密、减张缝合后颅窝硬膜的目的。无一例患者有不良反应,均按期出院。结论本文采用患者自体阔韧带替代人工硬脑膜,无任何排斥免疫反应,极大降低了治疗费用。其操作简单,安全性高,实用性强,应用此项技术极大降低患者的治疗费用,提高治疗效果,有效缓解家庭负担和社会负担,值得临床应用。     

硬脊膜不完整修补术后持续硬膜外镇痛护理

目的:探讨硬脊膜撕裂修补术后患者使用持续硬膜外镇痛的护理方法。方法:对30例硬脊膜不完整修补术后持续硬膜外镇痛患者加强心理护理,严密观察病情变化,减少并发症。结果:本组术后均无疼痛或仅感轻微疼痛,镇痛效果满意,且并发症少而轻,均痊愈出院。结论:对硬脊膜不完整术后持续硬膜外镇痛患者加强围术期护理是保证镇痛效果的关键。     

Combined management in the treatment of epidoxorubicin extravasation

Inadvertent extravasation during intravenous antitumor therapy is not an unusal complication and can cause damage ranging from minor erythema to severe local necrosis. The appropriate management of these iatrogenic accidents as a part of supportive care in oncology has been addressed by several experimental studies, but there has been little clinical study and no coclusive evidence on the best therapeutic strategies to adopt. The case reported here of a patient suffering from severe softtissue injury caused by extravasation of epidoxorubicin demonstrates the usefulness of a combined management (medical, surgical and rehabilitative) in the appropriate care of extravasation.     

Effects of carbamazepine on plasma extravasation and bronchoconstriction induced by substance P, capsaicin, acetaldehyde and histamine in guinea-pig lower airways

Summary— We evaluated the in vivo effects of the pretreatment with carbamazepine (CBZ) at different doses (10, 20 and 40 mg/kg p.o.) on the Evans-blue extravasation and on bronchoconstriction induced by different substances in guinea-pig tracheal tissue. The drug dose-dependently inhibited the extravasation induced by substance P (SP), capsaicin and acetaldehyde, but not that induced by histamine. At the highest dose (40 mg/kg) CBZ inhibited the bronchoconstriction induced by SP, capsaicin and acetaldehyde, but not that produced by histamine administration. The in vitro study with guinea-pig tracheal preparation indicates that the drug does not interfere with the binding of SP to its receptors. Our results suggest that CBZ exerts a protective activity against the pro-inflammatory action of SP.     

水凝胶敷料早期处理不同药物外渗的效果比较

目的：探讨水凝胶敷料早期处理不同药物外渗的方法和效果。方法选择化疗药物外渗、高渗药物外渗及血管活性药物外渗患者各12例,即刻采用舒康博G水凝胶敷料封贴处理,每3天更换1次敷料,观察期14 d,观察处理前后红肿或水肿及疼痛缓解情况,比较水凝胶敷料对3类药物外渗处理处理的效果。结果与处理前比较,3组患者处理后7d红肿或水肿及疼痛情况均明显改善,差异有统计学意义（ P＜0．01）,14 d效果更理想。水凝胶敷料对不同类型药物外渗的处理效果依次为高渗药物外渗处理效果最佳,起效最快;其次为血管活性药物外渗,发泡剂型化疗药物外渗处理效果不佳。结论水凝胶敷料早期处理药物外渗能消肿减痛,连续使用14 d效果最佳,不同药物外渗的处理效果也不同,需要进一步研究对发泡剂型化疗药物外渗的处理方法。     

品管圈活动在减少输液外渗中的效果评价

目的:运用品管圈活动法对输液外渗的不良事件进行分析,采取综合护理干预措施,减少输液外渗的再发生。方法:成立品管圈活动小组,用自行研制的调查表随机进行横断面调查,对2012年1~6月输液外渗24例进行分析并查找原因,于2012年7~12月输注高渗性营养液和细胞毒性药物时,采取输液前预防、外渗后指导和相关知识教育跟进的三维综合护理干预措施,对比干预前后输液外渗发生率。结果:干预后输注高渗性营养药,护士选择输注工具和部位正确率明显提高,输液外渗明显减少。结论:通过开展品管圈活动,提高了静脉输液的安全性,减少了输液外渗病例,达到预期干预效果,值得在临床推广使用。     

CGRP outflow into jugular blood and cerebrospinal fluid and permeance for CGRP of rat dura mater

BackgroundCalcitonin gene-related peptide (CGRP) is released from activated meningeal afferent fibres in the cranial dura mater, which likely accompanies severe headache attacks. Increased CGRP levels have been observed in different extracellular fluid compartments during primary headaches such as migraine but it is not entirely clear how CGRP is drained from the meninges.MethodsWe have used an in vivo preparation of the rat to examine after which time and at which concentration CGRP applied onto the exposed parietal dura mater appears in the jugular venous blood and the cerebrospinal fluid (CSF) collected from the cisterna magna. Recordings of meningeal (dural) and cortical (pial) blood flow were used to monitor the vasodilatory effect of CGRP. In a new ex vivo preparation we examined how much of a defined CGRP concentration applied to the arachnoidal side penetrates the dura. CGRP concentrations were determined with an approved enzyme immunoassay.ResultsCGRP levels in the jugular plasma in vivo were slightly elevated compared to baseline values 5-20 min after dural application of CGRP (10 μM), in the CSF a significant three-fold increase was seen after 35 min. Meningeal but not cortical blood flow showed significant increases. The spontaneous CGRP release from the dura mater ex vivo was above the applied low concentration of 1 pM. CGRP at 1 nM did only partly penetrate the dura.ConclusionsWe conclude that only a small fraction of CGRP applied onto the dura mater reaches the jugular blood and, in a delayed manner, also the CSF. The dura mater may constitute a barrier for CGRP and limits diffusion into the CSF of the subarachnoidal space, where the CGRP concentration is too low to cause vasodilatation.     

超声联合CT泌尿系成像在尿外渗诊断中的临床价值

目的 评价超声联合CT泌尿系成像（CTU）在尿外渗诊断中的临床应用价值.方法 回顾性分析 11例尿外渗患者的超声及CTU影像资料,并结合临床最终诊断总结其影像特征.结果 11例尿外渗患者超声表现为肾周被膜下的新月型无回声区;CTU表现为肾周间隙各种形态的囊性病灶,囊腔充满液体密度,以圆形、椭圆形多见,占据肾周大部分,部分延伸到后腹膜;增强后早期无对比剂充填,延迟期见对比剂充填.对于病因诊断,超声发现结石5例,输尿管上段肿瘤2例,肾外伤2例.CTU发现结石3例,输尿管上段肿瘤2例,肾外伤2例,下腹部肿物压迫输尿管2例.结论 超声结合CTU可明确诊断尿外渗,评价尿外渗程度及蔓延范围,明确尿外渗病因.     

不同剂量左布比卡因腰硬联合麻醉用于剖宫产术的临床观察

目的探讨左布比卡因腰硬联合麻醉用于剖宫产的最佳剂量。方法选择足月初产妇行剖宫产手术患者160例随机分为四组,分别给予等比重0.5%左布比卡因1 ml复合硬膜外2%利多卡因3 ml(A组)、等比重0.5%左布比卡因1.5 ml(B组)、2 ml(C组)、2.5 ml(D组)进行腰硬联合麻醉,每组40例。术中连续监测生命体征并记录麻醉前(T0)及麻醉后1 min(T1)、5 min(T2)、10 min(T3)、15 min(T4)、30 min(T5)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)值;观察并记录给药后的麻醉效应,并发症的发生率及新生儿Apgar评分情况。结果痛觉消失时间、痛觉恢复时间和运动阻滞恢复时间B、C、D组与A组分别比较均有统计学差异(P<0.05)。与T0时比较,B组平均动脉压(MAP)在T2、T3时,C、D组HR、MAP在T1、T2、T3、T4时均降低(P<0.05)。与A组比较,B组MAP在T2、T3时,C、D组MAP、HR在T1、T2、T3、T4时均降低(P<0.05)。术中四组产妇的SpO2除D组在T2、T3时有所降低外,均维持在98%以上,四组新生儿出生后各时间点Apgar评分均>8分。A组与B、C、D组比较,患者术中低血压、恶心呕吐、呼吸抑制、追加2%利多卡因例数、麻黄碱用量差异有统计学意义(P<0.05)。结论剖宫产手术行0.5%左布比卡因1.0 ml蛛网膜下腔阻滞复合硬膜外追加2%利多卡因3 ml对剖宫产患者循环影响最小,并能最大限度减少不良反应的发生。     

持续质量改进在静脉输液患者预防药物外渗中的应用

目的探讨持续质量改进(continuons quality improvement,CQI)在预防患者静脉输液药物外渗的效果。方法采用配对的方法,将748例在消化内科住院的患者分为两组,观察组422例,采用CQI护理管理方法预防患者静脉输液药物外渗;对照组326例,采用传统护理管理方法预防患者静脉输液药物外渗。比较两组患者药物外渗情况。结果观察组患者药物外渗发生率为6.2%,对照组患者药物外渗发生率为24.9%,两组比较,P<0.001,差异具有统计学意义。结论 CQI可有效减少患者静脉注射药物外渗发生率,确保患者用药安全,使患者治疗质量得到保障,提高护理管理质量,值得临床推广应用。     

循证护理在预防肿瘤患者化疗药物外渗中的应用

目的探讨循证护理预防肿瘤患者化疗药物外渗的应用效果。方法将94例应用化疗药物的肿瘤患者随机分为对照组和观察组各47例,化疗过程中对照组实施常规护理,观察组实施循证护理。观察2组化疗药物外渗情况,比较2组并发症发生情况、护理满意度及护理前后生活质量评分。结果观察组化疗药物外渗发生率2.13%,显著低于对照组12.77%(P0.01);静脉炎、胃肠道反应、口腔黏膜损害等并发症发生率也显著低于对照组(P0.05或P0.01);观察组护理满意度为91.49%,显著高于对照组61.70%(P0.01);与护理前比较,观察组5个功能量表评分及总体健康评分均升高,均显著高于对照组护理后(P0.01)。结论循证护理可有效降低化疗药物外渗的发生,减少相关并发症,提高肿瘤患者的护理满意度及生活质量。     

MRI 硬膜囊区域划分测量和中央型腰椎管狭窄症临床相关性分析

目的：采用区域划分法将腰椎MRI中硬膜囊划分为三个区域,测量其面积,且评估与中央型腰椎管狭窄症（LSCS）的临床相关性。方法本项目共有LSCS病例资料126例,自愿完成VAS、ODI问卷和行走距离调查,且行腰椎MRI检查,T2WI横断面影像中,测量整个硬膜囊的面积,然后将硬膜囊分为左、中、右三个区域,分别测量这三个区域的面积。组间和组内差异用方差分析,所有影像学测量数据和患者基本资料用Spearman检验（rs值表示）,和VAS、ODI、行走距离关系用Pearson检验（r值表示）,P＜0.05有统计学意义,rs值和r值绝对值越接近1,关联性越强。结果所有测量数据的组间和组内均无差异（P＞0.05）,整个硬膜囊面积、硬膜囊中间部分面积与VAS、ODI评分均无意义（P＞0.05）,左侧硬膜囊的面积与腰疼VAS评分（r＝-0.397）、ODI评分（r＝-0.404）有一定的关联（P＜0.05）,右侧硬膜囊面积和腰疼VAS评分（r＝-0.422）、腿疼VAS评分（r＝-0.392）、ODI评分（r＝-0.423）、行走距离（r＝-0.393）均有一定的关联（P＜0.05）,当左右两侧硬膜囊面积在0～25 mm2区间,和 ODI联系变得更加紧密（r＝-0.621,-0.625;P＜0.05）。结论区域划分测量法可以提高影像学和LSCS临床关联性,腰椎MRI中整个硬膜囊面积无明显LSCS临床相关性,硬膜囊左右两侧区域和LSCS临床之间有紧密联系。     

护理干预对降低碘对比剂外渗不良事件发生率的效果评价

目的 通过对碘对比剂发生外渗不良事件的原因进行分析比较,使护理管理者及时制订行之有效的解决方案,采取相应的防范措施,确保患者生命安全.方法 选择600例注射碘对比剂进行CT增强扫描检查的患者,将2009年5月至2010年4月收治的300例患者作为对照组,实施常规护理措施;将2010年5月至2011年4月收治的300例患者作为实验组,实施有效的针对对比剂外渗的防范措施.将2组注射碘对比剂后出现护理不良事件的发生率进行比较.结果 实验组实施一系列防范措施后,碘对比剂外渗的发生率为2％,显著低于对照组的10％.结论 通过实施一系列的防范措施,降低了碘对比剂护理不良事件的发生率,保障了患者的生命安全,明显降低了护理缺陷及护理投诉次数,提高了护理服务质量.