液体治疗对机体免疫功能的影响

液体治疗是临床上重要的辅助治疗手段，尤其对严重创伤、失血性休克、感染性休克等。等渗晶体液可影响中性粒细胞(PMN)等炎性细胞的功能，上调肺、肝脏等部位炎性细胞Bax等基因的表达水平，促进其凋亡。高张盐水(HTS)可影响MAPK的磷酸化，干扰p38 MAPK信号转导，在失血性休克机体的促炎、抗炎反应平衡中有着重要作用。而中分子量的羟乙基淀粉(HES)对PMN表面CD11b／CD18等分子的表达水平、PMN活化与黏附、单核细胞吞噬功能及T细胞功能等的作用研究报道不一。液体治疗对机体免疫功能影响的临床意义尚有待于进一步明确。     

肝癌射频消融治疗对机体免疫功能的影响

射频消融(RFA)是近年发展起来的一种治疗肿瘤新技术,不仅能直接灭活肿瘤,治疗后还能增加肿瘤局部和外周血中免疫细胞数量及抗肿瘤功能,提高机体免疫力可能是治疗肿瘤的另一种作用.资料显示RFA引起免疫功能提高的可能原因有:(1)RFA直接杀死恶性肿瘤,减轻甚至清除肿瘤负荷,使肿瘤导致免疫抑制缓解,利于机体免疫功能的恢复.(2)经灭活的肿瘤留于体内,形成肿瘤细胞"疫苗",能诱导特异性CTL(细胞毒性T细胞)的产生,增强细胞免疫功能.(3)射频治疗作为热凝固治疗,产生热效应而使肿瘤细胞表面抗原簇暴露或肿瘤抗原改变,增强肿瘤抗原性.(4)肿瘤的热疗原位灭活产生热休克蛋白,尤其HSP70参与肿瘤抗原呈递给T细胞,激发T淋巴细胞介导的机体细胞免疫.(5)射频本身产生热量导致局部炎症反应,引起炎症细胞浸润,使细胞介导的免疫反应增强.     

含乳酸晶体液对肝移植术中病人动脉血乳酸浓度的影响

目的 探讨三种不同晶体液输入对非转流原位肝移植术中病人动脉血乳酸和酸碱平衡的影响。方法 全麻下非转流经典原位肝移植术中病人90例，男78例，女12例，年龄16-67岁，体重45～87kg，随机分为3组，术中分别静脉输入乳酸林格氏液（LR组）、生理盐水（NS组）和醋酸林格氏液（PA组）。术中胶体液和血液制品的输入根据血压（BP）、中心静脉压（CVP）和血红蛋白等进行调节。于麻醉前、门静脉阻断时、无肝期30min、门静脉开放前即刻和下腔静脉开放后5min、30min、手术结束时采动脉血测pH、剩余碱（BE）和乳酸（LA）。结果 三组晶体、胶体液和血液制品输入量差异无统计学意义（P〉0．05）。与麻醉前相比，三组pH于无肝期前均下降并持续至术毕（P〈0．05），BE在无肝期30min明显下降（P〈0．05），LA浓度自无肝期前开始升高并持续至术毕，新肝开放后升高尤为显著，约相当于麻醉前3倍水平（P〈0．01）。各时点三组问上述各指标差异无统计学意义。结论 非转流原位肝移植术中输入乳酸林格氏液，对动脉血LA升高的趋势无显著影响。     

腹腔镜手术对机体免疫功能影响的研究进展

腹腔镜手术 (ＬａｐａｒｏｓｃｏｐｉｃｏｐｅｒａｔｉｏｎＬＯ)技术正在世界各地迅速推广 ,范围不断扩大 ,从胆囊切除术扩展至多学科、多病种的治疗 ,包括感染性疾病和肿瘤在内。以往的研究已证明ＬＯ对于机体免疫功能的影响比开腹手术要小 ,近来的研究着眼于机制以及一些新技     

人工血浆代用品对凝血功能的影响

不同的人工血浆代用品对人体凝血功能可产生不同的影响。明胶类制剂在以往的临床应用中未见凝血功能的异常改变,但近年来在离体实验中发现其对凝血功能不利的一面;右旋糖酐虽在休克早期有一定的应用价值,但其对凝血功能的显著影响在很大程度上限制了它的应用;高分子量高取代级羟乙基淀粉对凝血功能可产生明显影响,临床应限量使用;中分子量低取代级羟乙基淀粉对机体凝血功能无明显抑制,且具有独特的堵塞毛细血管漏作用,临床应用日益受到关注。     

淀粉类与明胶类血浆代用品对免疫功能的影响

胶体类血浆代用品因其较高的分子量,可在血管腔留存较长的时间,维持有效血浆胶体渗透压,从而有效扩充血容量及改善微循环状态.与晶体液相比,其血流动力学更稳定,被广泛应用于创伤、失血、感染及其他原因所致的血容量降低、休克等情况.鉴于人血白蛋白的缺乏与价格昂贵,右旋糖酐、明胶类、淀粉类等人工血浆代用品相继出现,并且不断发展改进.目前明胶类与淀粉类是临床上常用的两类人工血浆代用品.     

高强度聚焦超声治疗晚期胰腺癌对机体免疫功能的影响

目的：探查高强度聚焦超声治疗胰腺癌对机体细胞免疫功能的影响。方法：应用HIFUNIT-9000型治疗仪对65例Ⅲ～Ⅳ期的胰腺癌病人进行治疗；VAS法评估治疗前后病人疼痛程度的改变；超声、CT观察治疗前后肿瘤大小及影像学特征的改变；流式细胞仪检测治疗前后病人外周血T淋巴细胞亚群的变化。17例未行HIFU治疗的中晚期胰腺癌病人作为对照。结果：65例病人治疗后，疼痛减轻52例（80．0％），治疗后评分疼痛下降程度明显大于对照组（P〈0．01）；56例（86．1％）治疗后肿瘤癌组织多普勒B超显示血供减少；CT证实HIFU组治疗前、后肿瘤增长幅度小于对照组（P〈0．05）；外周血γδT细胞及CD4^＋／CD8^＋比例均高于治疗前（P〈0．05）。结论：HIFU治疗晚期胰腺癌不仅安全有效，还可增强机体的抗肿瘤免疫功能。     

腹腔镜手术对机体免疫功能影响的研究进展

外科手术所致的应激反应会造成机体免疫功能的改变，常表现为术后免疫功能的抑制。这一抑制程度与外科手术应激的严重程度密切相关。因此，“微创手术”的开展减少了手术对机体的创伤，在一定程度上减轻了机体应激反应。虽然腹腔镜手术在一定程度上维持了机体内环境的稳定，但其仍可对免疫系统产生一定的影响，本文就此予以综述。     

术后镇痛对机体免疫功能的影响

手术创伤和术后疼痛引起机体免疫功能的改变.有效的术后镇痛可减轻机体的应激反应,减轻免疫抑型,利于机体早日康复.此篇综述了不同的镇痛药物、不同的镇痛方式(包括静脉镇痛,硬膜外镇痛和多模式镇痛)对机体术后免疫功能的影响.     

Contrasting Effects of Colloid and Crystalloid Resuscitation Fluids on Cardiac Vascular Permeability

Background: Fluid extravasation may lead to myocardial edema and consequent reduction in ventricular function. Albumin is presumed to interact with the endothelial glycocalyx. The authors' objective was to compare the impact of different resuscitation fluids (human albumin, hydroxyethyl starch, saline) on vascular integrity.

Methods: In an isolated perfused heart model (guinea pig), Krebs-Henseleit buffer was augmented with colloids (one third volume 5% albumin or 6% hydroxyethyl starch 130/0.4) or crystalloid (0.9% saline). Perfusion pressure and vascular fluid filtration (epicardial transudate formation) were assessed at different flow rates. After global, stopped-flow ischemia (37[degrees]C, 20 min), hearts were reperfused with the same resuscitation fluid additives. In a second series, the authors applied the respective perfusates after enzymatic digestion of the endothelial glycocalyx (heparinase, 10 U over 15 min).

Results: Both 5% albumin and 6% hydroxyethyl starch decreased fluid extravasation versus saline (68.4 +/- 5.9, 134.8 +/- 20.5, and 436.8 +/- 14.7 [mu]l/min, respectively, at 60 cm H2O perfusion pressure; P < 0.05), the corresponding colloid osmotic pressures being 2.95, 5.45, and 0.00 mmHg. Digestion of the endothelial glycocalyx decreased coronary integrity in both colloid groups. After ischemia, a transient increase in vascular leak occurred with Krebs-Henseleit buffer containing hydroxyethyl starch and saline, but not with albumin. The authors observed no difference between intravascular and bulk interstitial colloid concentration in the steady state. Notwithstanding, electron microscopy revealed an intact endothelial glycocalyx and no interstitial edema in the albumin group.     

Effects of Mild Perioperative Hypothermia on Cellular Immune Responses

Background: Unintentional perioperative hypothermia is a common complication of anesthesia and surgery associated with adverse effects on several systems, including impaired wound healing and more frequent wound infections. Mild hypothermia affects various immune functions. In the current study, the authors sought to determine whether immune alterations in the perioperative period might be induced, at least in part, by impaired thermoregulation during this period.

Methods: Sixty patients undergoing abdominal surgery were randomly assigned to two thermal care groups: routine care or forced-air warming. The patients' anesthetic care was standardized. Venous blood samples were collected 90 min before induction of anesthesia and immediately, 24 h, and 48 h after surgery. White cells were separated and frozen. Peripheral blood mononuclear cells were used to test cytokine production (interleukins [IL] -1 [small beta, Greek], -2, and -6; tumor necrosis factor-[small alpha, Greek] [TNF-[small alpha, Greek]), mitogens-induced proliferation, and natural killer NK cell cytotoxicity. Plasma cortisol levels were also determined.

Results: Patients in the normothermia group maintained normal body core temperature, whereas temperature decreased by approximately 1 [degree sign]C in the hypothermia group. Mitogenic responses were suppressed in cells from patients in the hypothermia but not in the normothermia group 24 and 48 h after surgery. Proinflammatory cytokine (IL-1 [small beta, Greek], IL-6, TNF-[small alpha, Greek]) production increased in both groups, although the production of IL-1 [small beta, Greek] was significantly higher in the normothermia group 24 h after surgery. Production of IL-2 was suppressed in the hypothermia but not in the normothermia group at 24 h.     

Clinical Benefits After the Implementation of a Protocol of Restricted Perioperative Intravenous Crystalloid Fluids in Major Abdominal Operations

Background  Perioperative fluid replacement is a challenging issue in surgical care. The purpose of the present study was to investigate the effect of two different perioperative hydration protocols on the outcome in patients undergoing major abdominal operations. Methods  This was a prospective study involving 61 patients (42 men/19 women; mean age: 52 years; age range: 18–81 years) who underwent major abdominal operations. The study had two distinct phases: before (conventional group; administered 30–50 ml/kg per day of crystalloid fluids; n = 33) and after the implementation of a protocol of restricted use of intravenous fluids (restricted group; administered less than 30 ml/kg per day of crystalloid fluids; n = 28). The total volume of intravenous crystalloid fluids infused was recorded until postoperative day (POD) 4. Morbidity, mortality, and the length of postoperative hospital stay were the main clinical variables. Results  Mortality was 4.9% (p > 0.05 between groups). Intravenous therapy in the restricted group was terminated earlier (p < 0.001) and the patients received 2.4 l less crystalloid fluid than did those in the conventional group from POD 1 through POD 4 (p < 0.001). The adoption of the restricted protocol shortened the postoperative hospital stay by 2 days (p = 0.02) and diminished the morbidity by 25% (p = 0.04). Conclusions  Restriction of perioperative intravenous crystalloid fluid is associated with reductions in morbidity and length of postoperative hospital stay after major abdominal operations.     

Effects of Different Catecholamines on the Dynamics of Volume Expansion of Crystalloid Infusion

Background: The authors studied the influence of [alpha], [beta], and dopaminergic catecholamines on blood volume expansion in conscious normovolemic sheep before, during, and after a bolus infusion of a crystalloid.

Methods: A 0.9% NaCl bolus (24 ml/kg in 20 min) was infused in four paired experiments each: no drug, dopamine infusion (50 [mu]g [middle dot] kg-1 [middle dot] min-1), isoproterenol infusion (0.1 [mu]g [middle dot] kg-1 [middle dot] min-1), and phenylephrine infusion (3 [mu]g [middle dot] kg-1 [middle dot] min-1). Blood volume expansion was calculated by the dilution of blood hemoglobin concentration.

Results: Dopamine had little effect on peak blood volume expansion (12.7 +/- 0.9 ml/kg) compared with 0.9% NaCl (13.0 +/- 2.7 ml/kg); in contrast, isoproterenol augmented blood volume expansion (18.5 +/- 1.8 ml/kg), and phenylephrine reduced blood volume expansion (8.9 +/- 1.4 ml/kg). Two hours after the 0.9% NaCl bolus, sustained blood volume expansion was greatest in the isoproterenol protocol (12.2 ml/kg), whereas the dopamine protocol (6.8 ml/kg) remained similar to the control protocol (4.1 ml/kg), and the phenylephrine protocol had a net volume loss (-1.9 ml/kg). Some blood volume expansion differences were attributed to changes in renal function as phenylephrine infusion increased urinary output, whereas isoproterenol was associated with antidiuresis. However, dopamine caused diuresis and sustained augmentation of blood volume.     

Idiotype Networks and the Control of Immune Responses

Recently Neils Jerrie proposed that the immune system is regulated by an internal network of idi-otypes (ids) and anti-ids. While this is perhaps a somewhat esoteric concept, it has come to have major influence on the way in which biologically oriented immunologists think about the immune system. I will therefore present here a brief summary of the current state of knowledge in this area and a sketch my personal view of the operation of this putative id network.     

Toll样受体和免疫应答

Toll样受体是最初发现于控制胚胎背腹体轴形成的一种Ⅰ型跨膜受体,后来发现在脊椎动物免疫应答中起中心作用。 现就Toll样受体家族的结构、信号转导通路、在天然免疫中的识别及控制获得性免疫应答中的作用等作一综述。