外源性一氧化氮吸入治疗肺动脉高压的实验研究

目的 :探讨吸入一氧化氮 (NO)对肺动脉高压动物的肺、体循环压力及肺血管结构重组逆转的影响。　　方法 :实验组 6只 ,对照组 4只。实验组的 6只高动力型肺动脉高压模型犬 ,采用面罩法间断吸入 NO[4 0 ppm(1ppm=1/ 10 6 ) ]1周。观察吸入 NO后肺动脉平均压、体动脉平均压和肺血管阻力及动脉血气变化 ;图像分析法测定肺小血管中膜厚度 ;监测外周血高铁血红蛋白含量。　　结果 :吸入 NO后肺动脉平均压、肺血管阻力明显降低 (P<0 .0 1) ,而体动脉压无变化 ,氧分压升高 ,二氧化碳分压降低。吸入 NO前后肺小血管中膜厚度无明显变化 (P>0 .0 5 )。高铁血红蛋白均低于正常值 15 g/ L。　　结论 :吸入 NO能选择性降低肺动脉压而不影响体动脉压 ,明显改善氧合 ,但对肺血管病理学改变无明显影响 ;吸入NO(40 ppm) 1周未见有明显蓄积毒性作用。     

吸入一氧化氮对慢阻肺所致慢性肺心病急性发作期血流动力学影响

报告浓度为40ppm的一氧化氮(NO)吸入对COPD所致的慢性肺心病急性发作期血流动力学影响。结果表明:吸入浓度为40ppm的NO20分钟,可使肺动脉平均压(PAPM)下降16.65±8.39％;肺血管阻力指数(PVRI)下降25.94±0.50％。体循环压力及阻力无明显影响。心输出指数(CI)及每搏指数(SI)增加。PaO_2及SaO_2较吸入前提高,肺血分流率下降16.33±0.30％(P<0.05),氧供需比例得到改善。提示吸入NO对肺心病急性发作期有较理想的血流动力学效应。     

吸入一氧化氮联合西地那非治疗全腔静脉肺动脉连接术后早期肺动脉高压临床安全性的观察

目的:观察并评价吸入一氧化氮联合西地那非治疗全腔静脉-肺动脉连接术(TCPC)后早期肺动脉高压(PAH)的安全性。方法:分析2010年1月至2014年12月,阜外心血管病医院采取吸入一氧化氮(i NO)联合西地那非治疗的56例TCPC术后,早期合并PAH患儿的临床资料,PAH的诊断标准为:1术前平均肺动脉压力(m PAP)≥13mm Hg(1mm Hg=0.133k Pa);2术后早期循环不稳、中心静脉压(CVP)≥15mm Hg或跨肺压差(TPG,即中心静脉压与左心房压的压力差值)≥10mm Hg。男性37例,女性19例,平均年龄(63.3±23.9)m,平均体质量(17.5±4.1)kg,术前平均肺动脉压力(m PAP)(14.7±1.5)mm Hg,平均左心室射血分数(63.1±6.3)%,术前经皮氧饱和度(79.2±7.3)%,术前血红蛋白含量(180.1±24.6)g/L。分别记录治疗开始前、治疗开始后24小时的各项血流动力学和呼吸功能指标,定期监测二氧化氮(NO2)、高铁血红蛋白(Met Hb)含量、血小板及肝肾功能。结果:56例TCPC术后早期合并PAH患儿经i NO联合西地那非治疗后,循环逐步稳定,容量需求、胶体入量及血管活性药评分减少,CVP从(15.2±3.2)mm Hg降至(11.2±2.2)mm Hg,TPG从(10.8±2.5)mm Hg降至(5.8±1.8)mm Hg,氧合指数从(203±77)mm Hg升至(278±90)mm Hg。i NO联合西地那非治疗期间,NO2浓度均<1ppm,平均0.3(0.1,0.5)ppm;Met Hb均在3%以下,平均(1.5±0.5)%,均属于安全范围;无患儿出现血小板减少、肝肾功能异常及明显不良反应的表现。结论:吸入一氧化氮联合西地那非在TCPC术后早期PAH患儿中应用是安全可行的。     

西地那非与前列腺素E1治疗猪肺动脉高压

目的 比较西地那非和前列腺素E1对幼猪肺动脉高压模型的影响.方法 体质量约5 kg实验用健康幼猪24只,用经气管内吸入胎粪法诱发幼猪产生肺动脉高压,2 h后建立急性缺氧性肺动脉高压模型.随机将幼猪分成4组:对照组,不给予任何药物治疗:西地那非组,静脉注射枸橼酸西地那非(2 mg/kg)、前列腺素E1组,持续静脉滴注前列腺素E120 ng/(kg·rain)至实验结束;合用组同时给予西地那非组和前列腺素E1.结果 吸入胎粪2 h后,记录动物的肺动脉压、肺血管阻力(pulmonary vascular resistance,PVR)和体循环血管阻力(systemic vascular resistance,SVR).发现肺动脉压、PVR和PVR/SVR均随时间明显增加.施加药物干预以后,西地那非组与合用组的上述指标均明显迅速下降,并且心输出量和心脏指数明显提高;前列腺素E1组肺动脉压、PVR以及PVR/SVR下降程度不如西地那非组明显,心输出量、心脏指数无改善:对照组的肺动脉压、PVR以及PVR/SVR无下降.结论 西地那非降低肺动脉压和肺血管阻力,改善心功能,同时对体循环血流动力学无不良影响;在本实验用量,西地那非扩张肺血管和降低肺血管阻力的作用比前列腺素E1强;两者联合应用没有发生协同降低肺动脉压作用.     

吸入伊洛前列素和纯氧在肺动脉高压急性肺血管扩张试验中的对比研究

目的:本研究通过对先天性心脏病(CHD)合并重度肺动脉高压(PAH)患者在心导管术中行急性肺血管扩张试验,评估吸入纯氧和吸入伊洛前列素对血流动力学的影响,为合理选择和应用血管扩张药物提供依据。方法:本研究选择CHD合并重度PAH患者为研究对象,在心导管术中测定基础状态、吸氧试验后、吸入伊洛前列素药物试验后血流动力学参数,并进行比较。结果:本研究入选71例简单CHD合并重度PAH患者,中位年龄15岁(1.5~44岁)。在吸氧试验和药物试验后,血流动力学参数均有明显改善。在吸氧后肺动脉平均压由(78.30±10.30)mm Hg(1mm Hg=0.133k Pa)降至(75.85±10.41)mm Hg,(P<0.01),肺血管阻力指数由(23.30±9.51)WU·m~2降至(16.52±8.47)WU·m~2。在吸入伊洛前列素后,肺动脉平均压降至(74.37±9.95)mm Hg(P<0.01),肺血管阻力指数降至(19.49±8.75)WU·m~2(P<0.01),主动脉平均压无明显变化(P>0.01),无严重不良反应发生。不同于药物试验,在吸氧试验中增加氧分压测定和校正可以有效减少误差。在判断肺血管反应性时,吸氧试验阳性率高于药物试验。结论:对于CHD合并重度PAH患者,吸入纯氧和伊洛前列素均可安全、有效的应用于急性肺血管扩张试验药物,但吸氧试验需要氧分压的校正。在本研究中吸氧试验阳性率要高于药物试验。     

氢气对体外循环肺损伤的影响

目的观察体外循环时吸入2%氢气对体外循环(CPB)肺损伤的影响。方法将Beagle犬随机分为两组:体外循环组(对照组),体外循环维持2 h,体外循环结束后继续观察2 h;氢气组,实验全程吸入氢气1 L/min。实验过程中在体外循环前(T0)、体外循环结束时(T1)、体外循环结束后15 min(T2)、60 min(T3)及120 min(T4)记录中心静脉压(CVP)、肺动脉压(PAP)及肺毛细血管楔压(PCWP),采动脉血行血气分析计算氧合指数(PaO2/FiO2)。采集血标本监测血浆肿瘤坏死因子(TNF-α)、白细胞介素6,白细胞介素8的变化。实验结束时监测支气管肺泡灌洗液(BALF)蛋白含量、白细胞计数,测定肺组织丙二醛(MDA)、超氧化物歧化酶(SOD)、髓过氧化物酶(MPO)及肺组织湿干重比(W/D),并对肺组织进行光镜及电镜观察。结果与对照组相比,氢气组肺动脉压(PAP)、外周血管阻力(PVR)及氧合指数PaO2/FiO2有明显改善,差异有统计学意义(P<0.05)。氢气能够显著降低炎症因子(TNF-α、IL-6和IL-8)释放,减轻组织氧化损伤(MDA、MPO及W/D低于对照组组,而SOD显著高...     

肺血管阻力与体外循环后肺动脉高压的关系

目的观察先天性心脏病术前肺血管阻力(Rp)、肺动脉/体循环压(Pp/Ps)、肺循环/体循环血流(Qp/Qs)比值与术中肺/体循环压力比值(Rp/Ps)间的关系,评估Rp对术中肺动脉高压危象的预测作用,及其对术中应用一氧化氮(NO)的指征作用.方法本组患儿共46例,术前心导管检查证实均为先天性心脏病伴肺动脉高压,并拟行心脏直视手术.术前用药及麻醉方法基本相同.术前Rp、Pp/Ps、Qp/Qs值在心导管检查时由Fick公式计算.体外循环(CPB)结束前分别在肺动脉及升主动脉直接测定肺动脉压(Pp)和体循环压(Ps),计算出术中Pp/Ps,并将其与术前Rp、Pp/Ps、Qp/Qs值分别进行相关分析.结果术前Rp值与CPB脱机时的Pp/Ps比值呈正相关(r2=0.86,P<0.05 ,n=46),而术前Pp/Ps比值和Qp/Qs比值则与CPB脱机时的Pp/Ps比值无明显关系.术前Rp<7.0Wood unit m2的病例术中均未发生肺动脉高压危象.发生肺动脉高压危象的4例中,术前Rp值平均为(12±2.6)Wool unit m2(7.4～15).结论术前Rp可有效的预测CPB后肺动脉高压危象的发生,并可作为术中使用NO吸入治疗的指征.     

吸入一氧化氮在心脏外科围术期应用的研究进展

吸入一氧化氮 (NO)治疗肺动脉高压 (PH)是近年来发展的急救医疗技术 ,经气道连续吸入的 NO气体分子能选择性地作用于肺内阻力性小血管 ,使血管平滑肌松弛 ,选择性地降低肺血管阻力 (PVR)和肺动脉压 (PAP) ,提高肺血流量 ,改善肺通气 -灌流比例 ,提高血氧 ,改善分流 ,并且对体循环压无影响[1] 。作者就近年来有关吸入 NO在心脏外科 PH围术期应用研究的研究进展作一综述。1　吸入 NO的临床给予方法NO的吸入装置比较经典的是采用机械通气时 ,将 NO接入到呼入气体内。输送 NO的吸入回路必须保证精确地输送 NO,同时保证 NO的低浓度。…     

NO对先天性心脏病合并肺动脉高压术后肺氧合的影响

先天性心脏病 (先心病 )合并肺动脉高压 ( PH)是心血管外科围手术期的难题之一[1] 。本文在先心病伴中、重度 PH患者术后予以小剂量 NO吸入治疗 ,并观察治疗前后血流动力学、血气和氧合变化 ,以评价 NO对合并 PH先心病患者肺氧合的效应 ,并为其术后过渡期治疗提供依据。1　资料与方法1 .1　临床资料　先心病合并中度或重度 PH(中度 :肺动脉收缩压 /体循环收缩压为 0 .45～ 0 .75 ;重度 :肺动脉收缩压 /体动脉收缩压 >0 .75 )患者 39例 ,随机分为两组 :1治疗组 2 9例 ,其中男 1 7例、女 1 2例 ,年龄 4个月至 36岁。室间隔缺损 1 1例 ,房…     

肺动脉高压非药物治疗新进展

<正>肺动脉高压(pulmonary hypertension,PH)是一组严重的进行性肺动脉重塑性疾病,往往造成肺血管阻力(pulmonary vascular resistance,PVR)增加、右心室衰竭,最终导致患者死亡。PH被定义为通过右心导管测量,平均肺动脉压(mean pulmonary arterial pressure,m PAP)在静息状态下升高至≥25mm Hg (1 mm Hg=0. 133 k Pa)。患者一旦被诊断为PH,1年和5年生存率分别为86. 3%和61. 2%,中位生存期仅为7年~([1-2])。目前药物是治疗PH的主要方法,针对药物治疗效果不佳的患者,应考虑联合非药物治疗策略,在此综述如下。1.康复训练和体育锻炼。2009年,ESC/ERC指南鼓励肺动脉高压(pulmonary     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.