菜花耳的手术治疗

目的探讨菜花耳的手术治疗方法。方法本组6例7只菜花耳，根据Bruns等的解剖学研究及Ohlsen等的实验结果作为手术治疗的指导原则进行手术治疗，切除新生纤维软骨层及受累的软骨膜，保留背侧正常软骨膜及薄层软骨，同时重塑外耳沟回。结果对7只菜花耳经手术治疗获得满意疗效，随访6个月至1年，均未见复发。结论手术治疗菜花耳，对新形成的纤维软骨层及受累的软骨膜必须彻底切除，才能获得良好疗效。     

菜花状耳畸形的治疗

菜花状耳在普通人群中极为罕见。但在摔跤，柔道或拳击运动员中却较为常见。当外耳廓软骨反复受到暴力牵拉或直接击打时，耳软骨与软骨膜之间产生血肿，血肿机化后纤维组织增生和收缩，耳廓显著增厚而皱缩；也可系继发化脓性感染形成软骨膜炎未获妥善治疗的结果。如反复损伤，演变，最后耳正常解剖形态儿近完全消失，     

同种异体耳移植的模型建立

目的 建立同种异体耳移植的动物模型.方法 以青紫蓝兔和日本大耳白兔为实验动物.以耳大动脉、耳大静脉及外侧耳缘静脉为蒂,获得单侧(右)全耳,应用显微外科微血管吻合技术进行异体移植.其中青紫蓝兔为受体,日本大耳白兔为供体.实验共选用15对(青紫蓝兔和日本大耳白兔各15只)动物,随机分为两组:A组,对照组(n=5对),行自体兔耳离断回植术;B组,实验组(n=10对)行同种异体耳移植术.动、静脉吻合均选用端端吻合技术.术后观察移植耳存活、急性排异发生情况及供体组织的病理分级.结果 ①通过1%甲紫溶液灌注显示应用此方式获得的游离耳模型,在以耳大动脉、耳大静脉及同侧耳缘静脉为蒂供血后,可以保证耳移植后的存活.②A组自体移植复合组织瓣存活30 d以上.③B组异体移植复合组织瓣全部发生排斥反应.结论 建立的同种异体兔耳移植模型可重复性强,是进行相关研究的良好模型.     

家兔耳廓血肿模型的建立与应用初探

目的 建立家兔耳廓血肿模型,观察血肿的发生、吸收过程,研究血肿形成的组织层次和清除方法,及其对预防菜花耳畸形发生的意义.方法 将10只健康新西兰兔随机分为A、B、C、D、E5组,A组为对照组,B～E组为实验组.实验组以重物从高处落下,撞击耳廓固定范围,重复3～6次,直至形成较大血肿为止.对血肿形成后1h、4d和血肿基本吸收过程进行观察,制作病理切片观察组织层次,并行血肿引流实验,观察穿刺抽吸与切开引流的效果.以正常耳廓为对照组.结果 实验组兔耳廓均有血肿形成,组织学显示:血肿位于皮肤与软骨之间,软骨内未见血肿;4d时可见新生毛细血管及成纤维细胞增生,基本吸收时有纤维组织增生;切开血肿剥除,血凝块清除比较彻底.结论 通过撞击易于制作耳廓血肿模型,血肿发生在皮下的结缔组织内,波动明显的血肿,应采用切开清除血凝块法治疗,有预防菜花状耳畸形之效果.     

家兔血吸虫病模型的建立及其特点

腹部敷贴法感染尾蚴，建立家兔血吸虫病模型。５个月后经病理解剖证实均感染成血吸虫病，实验室检查发现病肝组织过氧化物歧化酶活力显著下降，血浆白蛋白降低，γ－ＧＴ和铜蓝蛋白明显增高，用彩色多普勒测定，门脉血流量显著增加，自由门静脉压从１．３０３７ｋＰａ升到２．２５４ｋＰａ．光镜下见肝门管区有新旧不等的虫卵结节，Ｖ．Ｇ染色标本见门管区有大量红染的胶原纤维，肝界板破坏，形成不完全分隔的多小叶性结节。本研究表     

家兔持续硬膜外治疗模型的建立

目的为持续硬膜外阻滞的实验研究提供稳定可靠的动物模型。方法以家兔为研究对象,自制硬膜外导管,常规硬膜外穿刺法穿刺置管,用特殊措施固定、保护导管,硬膜外造影鉴别模型成功否和药液分布范围,治疗期特殊管理保障导管安全及防止硬膜外腔感染。结果硬膜外穿刺成功率90％,导管持续置入不影响家兔存活,硬膜外腔感染发生率为6．7％。结论本研究证实了模型的可行性,此模型损伤小、成功率高、稳定性好,排除了一些前人方法不能避免的实验混杂因素。     

稳定病理性瘢痕模型的建立

目的:通过比较两种病理性瘢痕动物模型——裸鼠瘢痕模型和兔耳瘢痕模型的稳定性并对制作方法进行改进,为病理性瘢痕研究中选择有效的动物模型提供依据.方法:分别采用改良保留表皮(带表皮人瘢痕组织移植1周后剪除移植组织上方的裸鼠皮肤)、去除表皮(去除瘢痕组织表皮后移植)的方法分别在皮下移植人增生性瘢痕和瘢痕疙瘩制作裸鼠瘢痕模型.分别采用去除软骨膜及软骨、保留软骨膜及软骨、去除软骨膜保留软骨3种术式制作兔耳瘢痕模型,观察各瘢痕模型的效果、模型稳定时间和病理学改变来评价模型质量.结果:裸鼠组可快速并稳定地复制增生性瘢痕及瘢痕疙瘩的病理生理特点,且改良保留表皮增生性瘢痕或瘢痕疙瘩移植组的稳定时间(15周和20周)及增生程度明显优于去除表皮的增生性瘢痕及瘢痕疙瘩移植组(模型稳定时间为8周和10周);兔耳组可观察到去除软骨膜保留软骨组瘢痕稳定时间(1 5周)及增生程度明显优于另外两组(模型稳定时间分别为9周和10周).结论:裸鼠瘢痕模型的制作以改良保留表皮移植术式为最佳,兔耳瘢痕模型的制作则以去除软骨膜保留软骨术式为最佳.     

家兔活体部分胰腺移植模型的建立

目的：建立一种家兔活体部分胰腺移植的模型。方法：供体手术：将带脾的胰体尾部游离下来，经原位灌注后取下胰体尾部并安置脾动静脉袖套。受体手术：将供胰动、静脉分别与受体颈总动脉、颈外静脉行端端吻合。结果：12只供体家兔术后1周均成活，空腹血糖处于正常范围。糖尿病受体家兔术后空腹血糖恢复正常大于3d9只。移植胰存活时间平均为11.4d。结论：建立了简单、稳定的家兔活体部分胰腺移植模型。     

建立更加稳定和有效的兔耳瘢痕模型

目的：建立更加稳定和有效的兔耳瘢痕模型。方法：选用16只新西兰大耳白兔,分别在兔耳腹侧中段作1cm×1cm的全层皮肤缺损共192个,以形态学、瘢痕增生指数及羟脯氨酸（HPr）的含量变化对创面愈合后形成的增生块,进行动态组织病理学、细胞增殖活性及胶原纤维合成等检测。结果：兔耳腹侧中段创面可产生类似于人类的增生性瘢痕,其发生率为91．5％,增生块最长持续时间可达120多天。结论：采用本实验的模型复制方法,可以得到更加稳定和有效的兔耳增生性瘢痕。     

兔耳增生性瘢痕模型建立方法的探讨

目的:探讨手术方法对兔耳瘢痕模型建立的影响。方法:建立三种兔耳皮肤创伤愈合模型,A组在切除兔耳皮肤的同时,切除皮下软骨及软骨膜;B组切除皮肤及软骨膜但保留软骨;C组只切除皮肤,保留软骨及软骨膜。对创伤愈合过程进行形态学和组织学观察,并在镜下测量瘢痕突出皮肤的高度。结果:①A、B、C三组平均创面愈合时间分别为(10.4±1.0)天、(17.8±1.6)天、(11.4±1.3)天,三组之间统计学比较有显著差异;②A、C两组伤后4～5天肉芽组织充满创面,B组在伤后第10天,肉芽组织开始在坏死软骨下向中心生长;③A、B、C三组瘢痕隆起高度为(1.20±0.56)mm、(1.68±0.73)mm、(1.15±0.50)mm,B组与A、C组统计学比较有显著差异。结论:保留软骨,切除皮肤和软骨膜能获得较大的瘢痕,可用于瘢痕治疗性实验;切除软骨形成瘢痕较小,可用于观察创面外用药物对瘢痕形成的影响。     

经动脉与静脉采血行血液稀释式自体血回输的对比观察

目的比较经动脉与静脉采血行血液稀释式自体血回输的效果。方法将行血液稀释式自体血回输的择期手术患者189例按时间先后分为对照组(97例)和观察组(92例)。对照组行静脉采血,观察组经动脉采血,监测两组患者采血前后血压、心率、SpO2变化;比较两组采血时间、一次穿刺采血成功率。结果两组患者采血前、采血后15min、30min平均动脉压、心率、SpO2变化比较,差异无统计学意义(均P>0.05);观察组一次穿刺采血成功率显著高于对照组,采血时间显著短于对照组(P<0.05,P<0.01)。结论经动脉采血可在保证安全的前提下,缩短采血时间,提高一次采血成功率。     

原发性肝癌患者门静脉血及外周静脉血T细胞亚群和IL-2R表达的对比研究

一般认为，癌症患者全身免疫功能处于低下状态。但有关文献的报道，多是通过测定外周静脉血的体液免疫和细胞免疫指标进行研究的。我们知道，在全身具有免疫功能的器官中，肝脏、脾脏及腹腔淋巴结占有重要的地位。这些器官的免疫状态直接影响到全身及局部的免疫防御功能。在原发性肝癌患者中，其内脏器官免疫功能如何，文献中研究较少。为此，我们自1995年3～8月进行了这方面的临床研究。l材料与方法1.1研究对象1．1．1原发性肝癌组共14例。年龄26～74岁。平均48．07岁。按1977年全国肝癌协作组通用诊断标准，属一期2例，二期10例、三期2例…     

Application of the mixed venous blood concentration equation in desflurane anesthesia

BACKGROUND: We have previously proposed an equation derived from Fick's law and Lin's concept of effective blood concentration (EBC) to calculate the mixed venous blood concentration (MVBC) of isoflurane. Desflurane has a lower blood/air partition coefficient than isoflurane and, as such, promotes a faster induction and recovery from anesthesia. In this study, we investigated the application of the MVBC equation to predict the MVBC of desflurane. METHODS: We maintained anesthesia with a fixed inspired concentration (CI) of desflurane (10%) during cardiac anesthesia in 11 patients. In order to measure the real concentrations of desflurane in mixed venous blood, pulmonary arterial blood samples were collected at different time points via a Swan-Ganz catheter for gas chromatographic-mass spectrometric determination. The relationship between the calculated concentrations and the actual blood sample concentrations of desflurane in mixed venous blood was investigated. Lin's EBC method was also used and the results were compared with those of MVBC. RESULTS: The calculations from our derived MVBC equation and the actual blood concentrations showed a similar kinetic pattern; the concentration levels were approximately the same and correlated well (r = 0.89) during anesthesia. However, the EBC method failed to accurately estimate the actual blood concentrations. CONCLUSIONS: The results demonstrate that our equation, but not the EBC method, may be useful for estimating pulmonary blood concentrations of desflurane. The clinical significance and the importance of the method merit further investigation.     

Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum

Background: We investigated changes in portal venous blood flow (PVBF) during carbon dioxide (CO₂) pneumoperitoneum to evaluate the effects of different insufflation profiles and body positions. Methods: An established rat model was extended by implanting a portal vein flow probe that would enable us to measure PVBF for 60 min [t₀–t₆₀] in animals subjected to a CO₂ pneumoperitoneum with an intraabdominal pressure (IAP) of 9 mmHg. Forty-eight male Sprague-Dawley rats were randomized into the following four experimental and two control groups: decompression group D1 (n = 8), desufflation for 1 min every 14 min; decompression group D2 (n = 8), desufflation for 5 min, after 27 min; position group P1 (n = 8), 35° head-up position; position group P2 (n = 8), 35° head-down position; negative control group C1 (n = 8), no insufflation; positive control group C2 (n = 8), constant IAP of 9 mmHg for 60 min. Results: Pneumoperitoneum and body positions, respectively, reduced PVBF [t₁–t₆₀] significantly (p < 0.001) by 32.0% C2, 32.8% D1, 31.1% D2, 40.8% P1, and 48.5% P2, as compared to PVBF at t₀ in each group. There was a significant difference in PVBF reduction between P1 and P2 and also between C2 and both P1 and P2 (p < 0.04). Conclusions: CO₂ pneumoperitoneum reduces PVBF significantly (>30%). Extreme body positions (35° tilt) significantly intensify PVBF reduction. PVBF reduction is significantly more dramatic in subjects placed in a 35° head-down position. Short desufflation periods did not improve mean PVBF, but it may have beneficial immunological and oncological effects that warrant further investigation. Presented at the annual meeting of the European Association for Endoscopic Surgery (EAES), Lisbon, Portugal, 2002.     

Changes of blood flow,oxygen tension,action potential and vascular permeability induced by arterial ischemia or venous congestion on the spinal cord in canine model

It is generally considered that the genesis of myelopathy associated with the degenerative conditions of the spine may result from both mechanical compression and circulatory disturbance. Many references about spinal cord tissue ischemic damage can be found in the literature, but not detailed studies about spinal cord microvasculature damage related to congestion or blood permeability. This study investigates the effect of ischemia and congestion on the spinal cord using an in vivo model. The aorta was clamped as an ischemia model of the spinal cord and the inferior vena cava was clamped as a congestion model at the 6th costal level for 30 min using forceps transpleurally. Measurements of blood flow, partial oxygen pressure, and conduction velocity in the spinal cord were repeated over a period of 1 h after release of clamping. Finally, we examined the status of blood‐spinal cord barrier under fluorescence and transmission electron microscope. Immediately after clamping of the inferior vena cava, the central venous pressure increased by about four times. Blood flow, oxygen tension and action potential were more severely affected by the aorta clamping; but this ischemic model did not show any changes of blood permeability in the spinal cord. The intramedullar edema was more easily produced by venous congestion than by arterial ischemia. In conclusions, venous congestion may be a preceding and essential factor of circulatory disturbance in the compressed spinal cord inducing myelopathy. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:139–146, 2012     

静脉瘀血对静脉动脉化皮瓣微循环的影响

目的研究静脉瘀血对静脉动脉化皮瓣微循环的影响。方法 30只新西兰大白兔随机分为 A、B、C 3组,A 组为动脉皮瓣,B 组为静脉动脉化皮瓣,C 组为静脉瘀血的静脉动脉化皮瓣,每组各10只。术后30分钟,1,2,3,4,5小时分别应用显微电视系统通过耳窗对各组皮瓣微循环进行动态观察,7天后记录皮瓣成活情况。结果静脉瘀血的静脉动脉化皮瓣微循环血流缓慢,微血栓逐渐增多,皮瓣成活率低。结论静脉瘀血可破坏静脉动脉化皮瓣静脉系统的代偿机制,影响皮瓣血液灌流,从而导致皮瓣成活率下降。     

血糖仪测量静脉全血血糖的准确性研究

目的探讨血糖仪测定毛细血管血糖、静脉全血血糖与生化仪测定静脉血浆血糖之间的差异及相关性,探讨应用血糖仪测定静脉全血血糖的准确性。方法应用强生稳豪0型血糖仪测定790份糖尿病患者的手指毛细血管血糖（CBG）及静脉全血血糖（VBG）,N时用已糖激酶法测定静脉血浆血糖（VPG）。分别比较CBG与VPG、VBG与VPG的相关性和差异性。结果CBG、VBG与VPG之间呈正相关（均P〈0．01）;在不N的血糖范围内,CBG、VBG与VPG之间一致性好（P〉0．05）;CBG低于VPG（P〈0．05）。结论血糖仪测定的毛细血管血糖、静脉全血血糖值与生化结果相关性、一致性好,均可用于床旁血糖监测,而在需采集静脉血的情况下可用静脉血代替末梢血测量血糖不影响测量准确度,可减轻患者痛苦。     

Transplantation of a whole ear allograft by immunological induction of donor-specific tolerance by bone marrow transplantation: An experimental study in rabbits

Previous studies in our laboratory have shown that giving bone marrow cells through the portal vein or intraosseous route is likely to be beneficial to tolerance of induction of allografts in rabbits. Using this model, we tested whether a less severe regimen for conditioning of the host can prevent rejection of allografts. Rabbits were given a single intraosseous injection of donor bone marrow cells and total body irradiation (7 Gy) and transplantation of skin and ear allografts. Mean skin allograft survival for this treatment was 88 days, which was similar to the results of our earlier study. A donor ear was accepted for more than a year with no signs of rejection. These results suggest that a single intraosseous injection of donor bone marrow cells is sufficient for induction of donor-specific tolerance in rabbits and that immunosuppressive agents may not be needed.     

第1和第2滴手指末梢血与静脉血血糖值的比较分析

目的 探讨第1滴和第2滴手指末梢血与患者静脉血糖值的差异,为临床采集末梢血测定血糖提供参考。方法 测定210例住院患者的空腹血糖,分别将手指末梢第1滴、第2滴血糖检测值与静脉血血糖值进行比较。结果 血糖浓度分层统计结果显示,当静脉血血糖值2.2~7.0 mmol/L时,末梢第1滴血、第2滴血的血糖值显著高于静脉血血糖值（P<0.05,P<0.01）;当静脉血血糖值>7.0 mmol/L时,末梢血与静脉血的血糖值差异无统计学意义（P>0.05）。整体组间比较,末梢第2滴血与静脉血血糖值比较差异有统计学意义（P<0.01）。Bland-Altman分析结果显示,第1滴、第2滴血与静脉生化血糖检测结果、末梢第2滴血与末梢第1滴血检测结果之间显著相关（均P<0.01）;末梢第1滴血与静脉血糖检测结果的一致性较高。结论 使用便携式血糖仪监测血糖时,若按正规操作,可以使用第1滴末梢血检测血糖值,当血糖值>7.0 mmol/L时,末梢第1滴血与第2滴血均可反映即时静脉血糖值。     

Central and mixed venous blood oxygen correlate well during acute normovolemic hemodilution in anesthetized pigs

Background : Central venous oxygen saturation (S_cvO₂) and oxygen tension (p_cvO₂), obtained from the superior vena cava, correlate well with mixed venous (pulmonary arterial) oxygen saturation (S_vO₂) and tension (p_vO₂) when the hematocrit is normal. The present study was undertaken to assess whether extreme hemodilution affects this relation. Methods : We compared mixed and central venous blood during graded arterial desaturation (inspired fraction of oxygen (F_IO₂) between 1.0 and 0.10) in 10 hemodiluted pigs, and in 10 pigs with normal hematocrit (control), during fentanyl-ketamine-pancuronium anesthesia and mechanical ventilation. Results : Arterial oxygen saturation decreased from 100% at F_IO₂=1.0 to 44 ± 12% at F_IO₂=0.10 (mean ± SD). Venous oxygen saturation ranged from 3.5% to 97.3%. The regression coefficient between S_vO₂ and S_cvO₂ was 0.97 (R²= 0.93, bias -2.4 ± 5.8%) in the hemodiluted and 0.99 (R²= 0.97, bias -3.0 ± 5.0%) in the control group. Venous oxygen tension values ranged from 0.5 kPa to 9.5 kPa, and the regression coefficient for oxygen tension was 0.94 (R²= 0.89, bias -0.20 ± 0.47 kPa) in the hemodiluted and 0.99 (R²= 0.97, bias -0.43 ± 0.48 kPa) in the control group. The regression coefficient for pH was 0.95 in the hemodiluted and 0.98 in the control animals. Conclusion : The findings indicate that also during hemodilution monitoring of central venous blood oxygen may be as useful as monitoring of mixed venous blood oxygen.