体外循环围手术期患者甲状腺功能改变的临床研究

目的 :探讨体外循环围手术期甲状腺功能的改变。方法 :采用放射免疫分析法 ,连续测定 45例低温体外循环心内直视手术患者围手术期甲状腺激素的动态变化。结果 :2组患者三碘甲状腺原氨酸 (T3)、游离 T3(FT3)从转流前〔T3: 组 (1.32± 0 .77) nmol/ L , 组 (1.0 4± 0 .72 ) nm ol/ L ;FT3: 组 (2 .92± 0 .94) pmol/ L , 组 (2 .6 1± 0 .80 ) pmol/ L〕至术后 48小时〔T3: 组 (1.2 6± 0 .34 ) nmol/ L , 组 (1.2 3± 0 .0 3) nm ol/ L ;FT3: 组 (2 .81± 0 .86 ) pm ol/ L , 组 (1.83± 0 .31) pm ol/ L〕,各时相值明显低于术前〔T3: 组 (1.77± 0 .6 3) nmol/ L , 组 (1.5 7± 0 .32 ) nm ol/ L;FT3: 组 (3.2 9± 1.36 ) pmol/ L, 组 (4.75± 1.15 ) pmol/ L〕,P<0 .0 5或 P<0 .0 1。T4在整个手术期无明显改变 ,与术前比较 P均 >0 .0 5。FT4各时相值较术前略有上升 ,但 P均 >0 .0 5。TSH各时相无明显改变。结论 :体外循环围手术期对患者甲状腺功能有一定的抑制作用 ,可发生 T3降低 ,对心脏直视手术后的功能恢复产生一定影响 ,故围手术期间适当给予患者 T3治疗 ,有利于促进机体功能的恢复。     

重症急性胰腺炎肺损伤与肺微循环及炎症介质变化的相关性研究

目的　探讨重症急性胰腺炎 (SAP)时肺损伤与肺微循环、血清白介素 - 1β(IL - 1β)及磷脂酶A2 (PLA2 )变化的关系。方法　SD大鼠 6 4只 ,随机分成对照组与SAP组。 5 %牛磺胆酸钠胰腺被膜下均匀注射制成SAP模型。采用放射性生物微球技术在制模后 2h及 12h分别测定肺血流量 ,同时观察血清IL - 1β水平与PLA2 活性及肺组织学改变。结果　SAP组制模后 2h、12h肺血流量〔(2 75± 0 4 4 )、(2 4 3± 0 4 2 )mL·min-1·g-1〕均较对照组〔(3 5 5± 0 5 1)、(3 5 1± 0 37)mL·min-1·g-1〕明显降低 (P =0 0 0 4、0 0 0 0 ) ;血清IL - 1β〔(0 78± 0 13)、(0 83± 0 2 0 ) μg/L〕、PLA2 〔(94 2 9± 9 96 )、(10 3 71± 14 4 0 )U/L〕均较对照组〔(0 32± 0 0 6 )、(0 33± 0 0 7) μg/L ,(6 5 2 7± 10 5 2 )、6 6 6 3± 9 81)U/L〕明显增高 (P均 =0 0 0 0 ) ;肺组织学损伤在 2h、12h均较对照组明显加重 (P =0 0 0 4、0 0 0 1)。SAP后 2h、12h肺损伤与肺血流量、血清IL - 1β及PLA2 均密切相关 (P =0 0 4 4～ 0 0 0 1)。结论　SAP大鼠肺微循环障碍和IL - 1β、PLA2 的过度激活是造成SAP肺损伤的重要原因。     

甲状腺功能对急性心肌梗死患者预后及左心室功能影响的临床研究

目的 :探讨血清三碘甲状腺原氨酸 (T3)、甲状腺素 (T4)水平与急性心肌梗死 (AMI)患者预后及其左室功能的关系。方法 :42例 AMI患者 ,发病 72小时内检测总 T3(TT3)、总 T4(TT4)、游离 T3(FT3)、游离 T4(FT4)及促甲状腺激素 (TSH) ,此后 ,每周监测 1次 ,连续 4周。发病 4～ 5周内 ,彩色多普勒测定左室功能。观察好转组与预后不良组血清 T3、T4的差异及其对左室功能的影响。同时检测 30例陈旧性心肌梗死 (OMI)患者TT3、TT4、FT3、FT4及 TSH进行对照观察。结果 :AMI早期好转组患者血清 TT3(0 .79± 0 .2 8) nmol/ L、TT4(5 7.13± 18.42 ) nmol/ L、FT3(3.32± 0 .89) pmol/ L ,预后不良组患者血清 TT3(0 .5 8± 0 .2 5 ) nmol/ L、TT4(4 6 .2 5± 17.5 6 ) nmol/ L、FT3(3.11± 0 .78) pmol/ L ,均有不同程度的降低 ,好转组与预后不良组间无显著差异(P>0 .0 5 )。 FT4好转组为 (15 .6 6± 5 .49) pm ol/ L,预后不良组为 (13.96± 6 .0 5 ) pm ol/ L,TSH好转组为 (4 .37± 2 .5 2 ) m U/ L,预后不良组为 (2 .5 6± 2 .19) m U/ L,均正常。病程第 4周末预后不良组及好转组血清 TT3、TT4、FT3 分别为 (1.11± 0 .2 8) nmol/ L、(5 7.2 5± 18.5 6 ) nmol/ L、(3.41± 0 .79) pm ol/ L 及 (2 .33± 0 .32 ) nmo     

参麻益智胶囊对痴呆大鼠一氧化氮和一氧化氮合酶的影响

目的:证实参麻益胶囊治疗血管性痴呆的药效以及探讨其作用机制。方法:采用颈内动脉注射同种大鼠微血栓悬液制作大鼠血管痴呆(多发性脑梗死)动物模型,设立参麻益智胶囊高、中、低剂量组和阳性药、模型及正常对照组,连续给药6周后,测定血浆、脑组织的一氧化氮含量及一氧化氮合酶(NOS)活性。结果:①模型对照组大鼠血浆中的一氧化氮含量(71.6±24.3)μmol/L和NOS活性(135.9±35.8)nmol/(L·s)明显高于正常对照组(45.5±17.0)μmol/L和(59.3±32.2)nmol/(L·s),P<0.01。②模型对照组大鼠脑组织中的一氧化氮含量(261.0±30.0)μmol/g和NOS活性(66.8±7.2)nmol/(g·s)明显高于正常对照组(191±39)μmol/g和(52.2±2.8)nmol/(g·s),P<0.05。③参麻益智胶囊高、中、低剂量组大鼠血浆中的一氧化氮含量分别为(52.6±15.3),(56.0±17.9),(56.3±12.3)μmol/L和NOS活性(71.9±31.2),(99.7±26.5),(93.0±35.7)nmol/(L·s)明显低于模型对照组(P<0.01)。④参麻益智胶囊高、中、低剂量组大鼠脑组织中的一氧化氮含量和NOS活性明显低于模型对照组(P<0.01)。结论:参麻益智胶囊可降低血管性痴呆大鼠血浆、脑组织中一氧化氮含量及NOS活性。     

多发伤早期血小板计数变化及其对预后的影响

目的 :探讨多发伤后早期外周血小板计数的变化规律及其临床意义。方法 :选择伤后 4 8h内的 90例多发伤者 ,连续观察入院后即刻、2 4、72、12 0和 16 8h的生命体征各指标及血小板、白细胞等变化 ,记录伤后器官功能变化、并发症及创伤严重等级评分 (ISS)和急性生理学与慢性健康状况 (APACHE )等评分。结果 :伤后患者血小板计数总体呈下降趋势 ,72 h为低谷 ,12 0 h基本恢复正常。血小板降低组较血小板正常组伤情重〔 ISS评分为 (2 9.6 0± 9.80 )分比 (2 2 .30± 12 .0 0 )分 ,P<0 .0 5 ;APACHE 评分为 (4 4 .5 0± 15 .30 )分比(30 .6 0± 10 .6 0 )分 ,P<0 .0 5〕、器官功能不全发生率高 (83.9%比 6 2 .7% ,P<0 .0 5 ) ;血小板降低并死亡组血小板下降时间早〔(30 .1± 10 .3) h比 (5 1.3± 14 .8) h,P <0 .0 5〕,持续低值时间长〔(6 3.7± 11.0 ) h比 (5 4 .2±13.4 ) h,P<0 .0 5〕。结论 :多发伤后血小板呈消耗性降低 ,血小板快速下降和持续低值者提示预后不佳。     

血肿消对高血压性脑出血患者的预防性肾保护作用

目的 :研究中西医结合方法对高血压性脑出血的预防性肾保护作用。方法 :采用随机方法 ,将 90例高血压性脑出血患者分为血肿消加多巴胺组、多巴胺组、普通内科组 ,每组 30例。 3组甘露醇用法相同 (2 5 0 m l,6 h 1次 ) ,其他常规治疗相同。前两组分别加用血肿消和多巴胺 ,连用 2 8d。观察 3组患者的临床疗效、脑血肿吸收率、治疗前后的肾功能变化和急性肾损害发生率。结果 :3组间临床疗效、肾功能损害发生率均有明显差异(P均 <0 .0 5 ) ,血肿消加多巴胺组总有效率 96 .6 7% ,治疗后血尿素氮 (5 .72± 0 .5 8) mm ol/ L,血肌酐 (91 .0 0±2 0 .1 1 ) μmol/ L,肾损害发生率 3.33% ,病死率 0 ,优于多巴胺组〔分别为 90 .0 0 %、(6 .90± 5 .35 ) m mol/ L、(98.31± 37.6 6 ) μmol/ L、6 .6 7%和 0〕,多巴胺组优于普通内科组〔分别为 6 3.33%、(7.80± 3.6 7) m mol/ L、(1 4 8.6 2± 4 2 .0 2 ) μmol/ L、2 6 .6 6 %和 6 .6 7%〕。血肿吸收率 3组分别为 (95 .6 0± 1 6 .2 1 ) %、(87.1 0± 1 2 .70 ) %和 (76 .35± 1 4 .36 ) % ,P<0 .0 5。结论 :血肿消能有效预防甘露醇所致的肾损害 ,可促进血肿吸收 ,提高临床治愈率 ,降低病死率 ;合用多巴胺效果更好     

单光子发射计算机断层照相机检测心肌挫伤后右心室功能变化

目的 :探讨心肌挫伤 (MC)后右心室功能的变化规律。方法 :采用单光子发射计算机断层照相机(SPECT)检测中度至重度 MC模型兔右心室功能。结果 :右心室射血分数 (EF)、1/ 3射血分数 (1/ 3 EF)、1/ 3射血率 (1/ 3 ER)在伤后 2 4小时〔分别为 0 .2 9± 0 .0 4、0 .2 7± 0 .12和 (53 7± 12 3 )× 10 - 2 / s〕仍然明显低于伤前〔分别为 0 .3 9± 0 .0 7、0 .3 7± 0 .10和 (788± 175)× 10 - 2 / s〕,P<0 .0 5;高峰充盈率 (PFR)在伤后 2小时下降明显〔(12 54± 188)× 10 - 2 / s比 (1874± 62 4 )× 10 - 2 / s,P<0 .0 5〕,然后开始上升 ,2 4小时为 (2 0 14± 787)× 10 - 2 / s,与伤前比较差异不显著 (P>0 .0 5) ;1/ 3充盈分数 (1/ 3 FF)在伤后 0 .5小时下降明显 (0 .4 4± 0 .16比 0 .2 6±0 .0 7,P<0 .0 5) ,而 1/ 3充盈率 (1/ 3 FR)上升明显〔(974± 4 0 2 )× 10 - 2 / s比 (12 4 7± 886)× 10 - 2 / s,P<0 .0 5〕,伤后 2小时又明显下降 ,8小时恢复〔分别为 0 .50± 0 .0 3和 (860± 168)× 10 - 2 / s〕,P均 >0 .0 5;PFR/ PER、1/ 3 FR与 1/ 3 ER比值在伤后 0 .5小时即开始下降 (分别为 0 .91± 0 .4 3和 0 .82± 0 .65,P<0 .0 5) ,PFR/ PER在伤后 2 4小时 (0 .98± 0 .50 )恢复至伤前水平 ,1/ 3     

黄芪对急性脑损伤后一氧化氮合酶活性的抑制作用

背景黄芪在机体免疫功能调节中具有重要作用,而在对急性颅脑损伤干预中是否具有神经元保护作用,且其发挥作用的途径何在?目的观察黄芪对脑损伤后脑组织一氧化氮合酶活性的影响.设计随机对照的实验.单位兰州军区神经外科研究所.对象实验于2001-09/12在兰州军区神经外科研究所实验室完成.取健康雄性SD大鼠54只,随机分为3组脑损伤组(n=24),黄芪组(n=24),对照组(n=6),损伤组与黄芪组均分为伤后0.5,2,6和24 h4个时间点,每个时间点6只动物.方法脑损伤组和黄芪组制备脑损伤模型,对照组仅开骨窗,不致伤.黄芪组致伤后立即腹腔注射黄芪200 mg/kg,用化学定量法检测大鼠脑损伤后不同时间点脑组织中一氧化氮合酶的活性.主要观察指标各组大鼠脑组织中一氧化氮合酶活性.结果54只大鼠全部进入结果分析.脑损伤组、黄芪组大鼠在伤后0.5 h一氧化氮合酶活性较对照组升高[46.44±13.45)(43.15±12.43),(40.46±12 85)nkat/L,P＜0.05],伤后2 h达高峰[(67.49±22.45),(64.26±19.78)nkat/L,P＜0.01],伤后6 h开始下降[(63.46±24.68),(52.91±21.36)nkat/L,P＜0.01],伤后24 h降至基础水平[(41.23±12.57),(40.92±12.25)nkat/L,P＞0.05].黄芪组在伤后2,6 h一氧化氮合酶活性较损伤组明显降低(P＜0.01,0.05).结论颅脑损伤后,受损脑组织中一氧化氮合酶活性呈节段性升高,黄芪可通过抑制损伤后脑组织中一氧化氮合酶活性,起到保护创伤神经元的作用.     

诺和龙和拜唐苹对2型糖尿病降糖作用的临床疗效比较

目的　比较诺和龙和拜唐苹对 2型糖尿病的临床疗效。方法　将单纯饮食加运动控制不满意的 2型糖尿病患者 6 2例 ,随机分成诺和龙组 30例 ,拜唐苹组 32例 ,疗程 12周。结果　诺和龙对降空腹血糖的疗效率高于拜唐苹组 (有效率为 93% ,72 % ) ,P值均 <0 .0 5 ;而拜唐苹对餐后 2小时血糖的疗效高于诺和龙 (有效率分别为 77% ,97% ) ,P值均 <0 .0 5。两组均能降低糖化血红蛋白 (Hb A1 C) ,诺和龙组从 (9.5 7± 1.36 ) %降至 (7.0 4± 0 .77) % (P<0 .0 1) ;拜唐苹组从 (9.6 5± 1.32 ) %降至 (7.0 5± 0 .6 1) % (P<0 .0 1) ,两组相比较降低 Hb A1 C的幅度无统计学意义 (P>0 .0 5 )。诺和龙组空腹 C肽由 (0 .72± 0 .2 3) nm ol/L增高至 (0 .79± 0 .2 7) nmol/L (P>0 .0 5 ) ,餐后 2小时 C肽由 (2 .4 7± 0 .4 9)nmol/L升至 (4.14± 0 .92 ) nmol/L (P<0 .0 1) ;拜唐苹组无明显变化。结论　诺和龙是通过刺激胰岛素分泌达到降糖作用。两种降糖药物对甘油三酯均有不同程度降低 ,对体重指数无影响 ,对肝、肾功能无影响     

一氧化氮合酶抑制剂L-精氨酸对创伤性休克大鼠存活率的影响

目的　探讨一氧化氮合酶 (NOS)抑制剂左旋精氨酸 (L Arg)对创伤性休克大鼠存活率的影响。方法　通过外力致大鼠双侧股骨骨折 ,建立创伤性休克模型。复苏时分别给予非选择性 NOS抑制剂 L 硝基精氨酸甲酯 (L NAME) 10 m g/kg、选择性诱导型 NOS(i NOS)抑制剂氨基胍 (AG) 10 0 m g/kg和一氧化氮(NO)合成底物 L Arg10 0 mg/kg;观察给药前后血流动力学及组织氧分压变化 ,并记录存活时间和存活率。结果　与休克对照组〔分别为 (18.78± 4 .6 4 ) h和 10 %〕比较 ,L NAME组大鼠存活时间和 2 4 h存活率均无显著变化〔分别为 (2 3.80± 9.0 9) h和 4 0 % ,P均 >0 .0 5〕;AG组和 L Arg组大鼠存活时间均显著延长〔分别为 (2 8.72± 6 .2 5 ) h和 (30 .6 4± 8.77) h,P均 <0 .0 1〕,2 4 h存活率提高 (均为 80 % ,P均 <0 .0 1)。结论　选择性 i NOS抑制剂 AG及 L Arg对创伤性休克具有保护作用。     

Abnormal brain activity in prefrontal brain regions in abstinent marijuana users

We used PET (15)O and a modified version of the Stroop task to determine if 25-day abstinent heavy marijuana (MJ) users have persistent deficits in executive cognitive functioning (ECF) and brain activity. Performance on a modified version of the Stroop task and brain activity was compared between 25-day abstinent, heavy marijuana users (n = 11), and a matched comparison group (n = 11). The 25-day abstinent marijuana users showed no deficits in performance on the modified version of the Stroop task when compared to the comparison group. Despite the lack of performance differences, the marijuana users showed hypoactivity in the left perigenual anterior cingulate cortex (ACC) and the left lateral prefrontal cortex (LPFC) and hyperactivity in the hippocampus bilaterally, when compared to the comparison group. These results suggest that marijuana users display persistent metabolic alterations in brain regions responsible for ECF. It may be that marijuana users recruit an alternative neural network as a compensatory mechanism during performance on a modified version of the Stroop task. These differences in brain activity may be a common denominator in the evolution of maladaptive behaviors such as substance abuse and other neuropsychiatric disorders.     

脑胶质瘤中肿瘤干细胞的体外傲射敏感性

背景：目前放疗治疗脑胶质瘤效果不理想,可能因素有很多.目的：探讨脑胶质瘤中肿瘤干细胞的体外放射敏感性.方法：取脑胶质瘤细胞,接种于含生长因子的无血清培养基中培养,取细胞活力最强的位点扩增3-5代的肿瘤球细胞,给予不同X射线剂量照射,检测其细胞活力,以确定最适的放疗剂量.结果与结论：胶质瘤中不同部位的肿瘤细胞增殖活力有差异;8 Gy以上X射线剂量对脑肿瘤干细胞具有显著的杀伤作用.说明脑胶质瘤具有异质性,部位不同,脑肿瘤干细胞增殖活力不同;不同的放疗剂量对脑肿瘤干细胞有不同的影响.     

Effect of brain cooling on brain ischemia and damage markers after fluid percussion brain injury in rats

Although systemic cooling had recently been reported as effective in improving the neurological outcome after traumatic brain injury, several problems are associated with whole-body cooling. The present study was conducted to test the effectiveness of brain cooling without interference with the core temperature in rats after fluid percussion traumatic brain injury (TBI). Brain dialysates ischemia (e.g., glutamate and lactate-to-pyruvate ratio) and injury (e.g., glycerol) markers before and after TBI were measured in rats with mild brain cooling (33 degrees C) and in the sham control group. Brain cooling was accomplished by infusion of 5 mL cold saline via the external jugular vein under general anesthesia. The weight loss was determined by the difference between the first and third day of body weight after TBI. The maximum grip angle in an inclined plane was measured to determine motor performance, whereas the percentage of maximal possible effect was used to measure blockade of proprioception. The triphenyltetrazolium chloride staining procedures were used for cerebral infarction assay. As compared with those of the sham-operated controls, the animals with TBI had higher values of extracellular levels of glutamate, lactate-to-pyruvate ratio, and glycerol in brain and intracranial pressure, but lower values of cerebral perfusion pressure. Brain cooling adopted immediately after TBI significantly attenuated the TBI-induced increased cerebral ischemia and injury markers, intracranial hypertension, and cerebral hypoperfusion. In addition, the TBI-induced cerebral infarction, motor and proprioception deficits, and body weight loss evaluated 3 days after TBI were significantly attenuated by brain cooling. We successfully demonstrate that brain cooling causes attenuation of TBI in rats by reducing cerebral ischemia and injury resulting from intracranial hypertension and cerebral hypoperfusion. Because jugular venipuncture is an easy procedure frequently used in the emergency department, for preservation of brain function, jugular infusion of cold saline may be useful in resuscitation for trauma patients.     

Fatigue scores in patients with brain metastases receiving whole brain radiotherapy

Purpose

Whole brain radiotherapy (WBRT) is a treatment strategy used commonly to relieve burdensome symptoms and improve quality of life (QOL) in patients with multiple brain metastases. The purpose of this study is to determine changes in fatigue score following WBRT as it is a common symptom experienced in this population.

Methods

Fatigue and overall QOL scores were collected prospectively in patients for up to 3 months post-WBRT by several questionnaires at different times including the following: Edmonton Symptom Assessment System (ESAS), Brain Symptom and Impact Questionnaire (BASIQ), Spitzer Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), EORTC brain module (EORTC QLQ-BN20?+?2), EORTC QLQ-C15-PAL, and Functional Assessment of Cancer Therapy—General (FACT-G). Questionnaires were grouped for analysis by Wilcoxon Signed Rank test according to the scale of ranking into 0–10, 1–4, and 0–4.

Results

Thirty-six patients were interviewed with the ESAS or BASIQ. The median age was 65 years old, and median Karnofsky Performance Status (KPS) was 70. There was a significant increase in fatigue score from baseline to month 1 (p?=?0.02), and months 2 and 3 had no significant change. There was a significant correlation between fatigue and overall QOL score at baseline and month 1 (p?=?0.01, p?<?0.0001), respectively. Two hundred and twenty-eight patients were surveyed with Spitzer, C15-PAL, BN20?+?2, QLQ-C30, or FACT-G. Median age was 64 years old and median KPS was 80. Compared to baseline, fatigue score was significantly higher at month 1 (p?<?0.0001) and month 2 (p?=?0.001), with no significant change at month 3. Significant correlation was found between fatigue and overall QOL at baseline, months 1, 2 (p?<?0.0001), and 3 (p?=?0.0009). For all groups, there was no significant change in fatigue score between patients with or without dexamethasone (Dx), except for the fatigue changed score of the group with scale 0–4.

Conclusions

Fatigue was significantly increased from baseline to month 1 in all patients, and most patients experienced no difference in fatigue if they were receiving Dx. Increased fatigue was significantly related with decreased overall QOL.