肠系膜下动脉造影和纤维结肠镜检查诊断与治疗缺血性肠炎

目的 探讨肠系膜下动脉造影及纤维结肠镜检查对缺血性肠炎的病因诊断和诊断价值.方法 对49例经结肠镜及活检明确诊断者,再行肠系膜下动脉造影以确定其病因,其中3例还加做肠系膜上动脉造影以判断全身疾病对该病有否影响.结果 49例肠镜检查发现有不同程度的局部黏膜充血、水肿、接触性出血.活检结果:有炎性细胞浸润,黏膜下出血,水肿及多纤维素血栓和含铁血黄素沉着.病变均位于左半结肠.肠系膜下动脉造影发现,3例主干完全阻塞并有侧支循环形成,31例主干有不同程度狭窄,动脉床显影不满意.另15例肠系膜下动脉床不显影或显影不满意.3例主干完全阻塞者加作肠系膜上动脉造影,结果未发现任何异常.结论 肠系膜下动脉造影及纤维结肠镜检查对缺血性肠炎的诊断和判明其病因有肯定作用.     

人参皂苷Rg2对内毒素性微循环障碍的影响

目的　观察人参皂苷Rg2 对内毒素性微循环障碍的影响。方法　用大肠杆菌内毒素建立微循环障碍模型 ,分别观察动物肠系膜或耳部微动脉管径和血流状态。结果　人参皂苷Rg2 5、1 0mg/kg ,iv,山莨菪碱 2 5mg/kg均明显增加大鼠肠系微循环血流速度 ,抑制微动脉收缩 ,人参皂苷作用强度略高于山莨菪碱 ;人参皂苷Rg2 0 .85、1 .7mg/kg能使家兔耳廓微动脉明显扩张 ,血流速度也有所增加。 结论　人参皂苷Rg2 有明显的改善微循环障碍作用     

显微录像系统观察川芎嗪对血瘀证家兔的活血化瘀作用

目的在活体情况下,用摄录像系统显微观察川芎嗪对实验性血瘀证家兔肠系膜微血管微循环的影响。方法采用活体恒温微循环灌流结合显微录像电视放大技术,分别观测血瘀证前后家兔肠系膜微血管口径、血流速度、单位面积肠系膜血流量、微血管开放数量、白细胞与血管内皮细胞黏附力变化、血液流动状态等的改变以及川芎嗪对上述指标的影响。结果川芎嗪可以通过改善血流状态、扩张血瘀症时缩小的微血管管径,增加微血管的开放数量,加快微血管内血流速度,减少白细胞黏附和组织液的生成等多种方式,改善局部缺血状态增加微循环灌注。结论改善肠系膜微循环、增加血液灌注是川芎嗪发挥活血化瘀作用的病理基础。     

机械通气治疗急性脑干血管病变合并呼吸衰竭的临床观察

目的探讨急性脑干血管病变合并呼吸衰竭者的临床特点及机械通气治疗的疗效。方法收集我院ICU收治的37例急性脑干血管病变合并呼吸衰竭的患者,均在早期经口气管插管,接呼吸机辅助呼吸,其余治疗包括脱水降颅压、实施脑保护、营养支持对症治疗等。观察呼吸机治疗前后动脉血气的变化,并比较分析脑干梗死组和脑干出血组的预后。结果37例急性脑干血管病变患者,脑干梗死21例,脑干出血16例,两组患者机械通气前与机械通后24h、48h的血气指标相比,差异有统计学意义(P0.01)。脑干梗死组病死率38.1%,脑干出血组死亡率75.0%(P0.05)。结论机械通气治疗急性脑干血管病变合并呼吸衰竭患者,脑干梗死患者预后优于脑干出血患者。     

急性下消化系动脉出血的介入诊疗价值和影响因素

目的:探讨血管造影、经导管栓塞术在急性下消化系动脉出血中的诊疗价值及影响出血诊断和栓塞疗效的因素.方法:回顾性分析血管造影和经导管栓塞术治疗39例急性下消化系动脉大出血病例.记录术前、后输血量、血压变化和血红蛋白改变.随访3.6 mo,评价技术成功、临床成功、迟发性出血和并发症.结果:栓塞术前,39例患者中26例输注红细胞悬液,术后仅4例患者(术前Hb均<40 g/L)输注红细胞悬液.肠系膜上、下动脉(2级血管)开口造影,出血阳性诊断率31%;空肠、回肠、回结肠、结肠动脉和边缘动脉等(3级)分支血管开口造影,出血阳性诊断率69%(27/39).总血管造影出血阳性率100%.即刻有效栓塞率达92%,栓塞的技术成功率和临床成功率分别为100%和89.7%.手术操作和栓塞所致动脉痉挛,一过性腹部隐痛4例,2例对症处理后缓解,2例自行缓解.3 d后的肠镜检查,4例患者显示出栓塞区肠黏膜红斑,周围水肿、苍白,但无1例患者出现严重并发症.结论:血管造影、经导管栓塞术是急性动脉性下消化系出血定位诊断和安全、有效的急诊治疗手段.血管造影出血的阳性诊断率和栓塞治疗的疗效受多种因素影响.     

经导管动脉栓塞治疗急性十二指肠溃疡大出血29例

目的:评价急诊经导管动脉栓塞术(emergency transcatheter arterial embolization,ETAE)治疗十二指肠溃疡大出血的有效性和安全性.方法:收集1997-01/2007-11我院ETAE治疗的十二指肠溃疡动脉性大出血的29例患者资料.分别行腹腔干动脉、胃十二指肠动脉造影.以明确出血动脉,采用明胶海绵颗粒或条经造影导管或微导管栓塞胃十二指肠动脉或其出血分支动脉,ETAE后均行肠系膜上动脉造影,排除侧支循环对溃疡区域供血.分析ETAE的技术成功率和临床成功率,内镜观察十二指肠球部动脉栓塞区黏膜改变.结果:导管位于腹腔干动脉造影,出现造影剂外渗7例,出血阳性率24%;胃十二指肠动脉造影,造影剂外渗、涂抹肠黏膜19例,出血阳性率65.5%;3例内镜明确诊断十二指肠溃疡,但胃十二指肠动脉造影出血阴性.1例ETAE后,有肠系膜上动脉的胰十二指肠前下、后下弓动脉侧支供血,再予以微导管栓塞肠系膜上动脉上述两分支动脉.ETAE即刻止血26例,技术成功率90%;ETAE后30 d内未再出血27例,2例饮酒再出血,再行ETAE,临床成功率93%.5例出现一过性剑突下隐痛,未作处理自行缓解.19例患者ETAE术后内镜检查,10例ETAE前已查内镜者7例治疗后复查内镜,显示动脉栓塞区域的十二指肠黏膜呈苍白改变,无缺血坏死病例.结论:明胶海绵颗粒或条行ETAE是急诊治疗十二指肠溃疡性动脉出血的迅捷、有效和安全手段.     

人参二醇皂苷对急性血瘀大鼠肠系膜微循环和血栓形成的影响

目的探讨人参二醇皂苷（Panaxdiols Saponin,PDS）活血化瘀的药理作用。方法皮下注射肾上腺素加冰水冷浴法制备大鼠急性血瘀模型,舌下静脉注射给药,观察PDS对大鼠肠系膜微循环及体外血栓各指标的影响。结果PDS10,20 mg/kg剂量组均能明显加快微动脉、微静脉血流速度,增加微血管管径、血管数、和血管开放数,改善血液流态,并能抑制体外血栓的形成（P〈0.05;P〈0.01）。结论PDS能明显改善血瘀型大鼠肠系膜微循环障碍,抑制血栓的生成,具有较好的活血化瘀作用。     

恩施板党对烧伤大鼠微血管反应性及抗氧化酶的影响

目的 探讨恩施板党对烧伤大鼠微血管反应性及抗氧化酶的影响.方法 采用膏状固体酒精灼烧法复制大鼠烧伤模型,将SD大鼠分为对照组、烧伤组和恩施板党治疗组,在烧伤组和党参治疗组背部皮肤造成大鼠体表面积(BSA) 20％深Ⅱ度烧伤模型,恩施板党治疗组大鼠给予恩施板党治疗.观察大鼠烧伤后肠系膜微动脉血管管径、血流速度和血液中超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)活性和活性氧(ROS)含量的变化.结果 恩施板党能使烧伤后肠系膜微动脉血管管径缩小(P＜0.05),血液流速增快(P＜0.05),SOD、GSH-Px和CAT活性显著增强,ROS含量明显降低(P＜0.01).结论 恩施板党可明显改善烧伤大鼠肠系膜微循环,增强抗氧化能力.     

37例肠系膜血管病变致消化道出血的回顾性分析

目的总结肠系膜血管病变致消化道出血的临床诊治经验,提高此类疾病的早期诊断水平及临床疗效。方法回顾性分析2010年1月至2016年12月第三军医大学大坪医院野战外科研究所收治的37例肠系膜血管病变所致消化道出血患者的临床表现、诊断方法、治疗措施及疗效。结果肠系膜上动脉血管栓塞18例,肠系膜上动脉夹层动脉瘤11例,肠系膜下动脉血管栓塞3例,肠系膜上静脉血栓形成、狭窄4例,肠系膜下静脉血栓形成1例。18例患者肠镜均见结肠黏膜充血、肿胀、溃疡形成。行内科药物保守治疗患者21例;经血管介入治疗13例;外科手术治疗3例;1例患者因肠穿孔后合并感染性休克死亡,其余患者临床症状均完全改善。结论肠系膜血管病变致消化道出血多发生于合并伴有动脉硬化、心血管疾病、肝硬化、胰腺病史的患者,临床表现缺乏特异性,CT影像及血管重建技术在诊断中起到重要作用;早期诊断、合理抗凝及血管介入治疗尤为重要,多数患者预后良好。     

脑干出血患者肠黏膜屏障功能变化

<正>脑出血占急性脑血管病的20%~30%,年发病率(60~80)人/10万人口,其中脑干出血占脑出血的10%以上〔1〕。创伤、休克可致肠道黏膜损伤,脑干出血作为一种应激反应是否同样对患者肠黏膜造成损伤,国内外尚未见报道。本研究对脑干出血患者不同病程血清D-乳酸(LAC)、二胺氧化酶(DAO)进行检测,探讨其是否存在肠道屏障功能损伤及损伤程度、持续时间。1资料和方法     

Analysis of the mechanisms of rabbit＇s brainstem hemorrhage complicated with irritable changes in the alvine mucous membrane

AIM: To explore the dynamic changes in the pressure of the lateral ventricle during acute brainstem hemorrhage and the changes of neural discharge of vagus nerve under the load of intracranial hypertension, so as to analyze their effects on the congestive degree of intestinal mucous membrane and the morphologic changes of intestinal mucous membrane. METHODS: An operation was made to open the skull to obtain an acute brainstem hemorrhage animal model. Microcirculatory microscope photography device and video recording system were used to determine the changes continuously in the caliber of jejunal mesenteric artery during brainstem hemorrhage and the changes with time in the congestion of jejunal mucosal villi. We used HE stain morphology to analyze the changes of duodenal mucosal villi. A recording electrode was used to calculate and measure the electric discharge activities of cervical vagus nerve. RESULTS: (1) We observed that the pressure of lateral cerebral ventricle increased transiently during acute brainstem hemorrhage; (2) The caliber of the jejunal mesenteric artery increased during brainstem hemorrhage. Analysis of red color coordinate values indicated transient increase in the congestion of jejunal mucous membrane during acute brainstem hemorrhage; (3) Through the analysis of the pathologic slice, we found enlarged blood vessels, stagnant blood, and transudatory red blood cells in the duodenal submucous layer; (4) Electric discharge of vagus nerve increased and sporadic hemorrhage spots occurred in duodenal mucous and submucous layer, when the lateral ventricle was under pressure. CONCLUSION: Brainstem hemorrhage could cause intracranial hypertension, which would increase the neural discharge of vagus nerve and cause the transient congestion of jejunal mucous membrane. It could cause hyperemia and diffused hemorrhage in the duodenal submucous layer 48 h after brainstem hemorrhage.     

耳-体穴电针对家兔胆道功能的调节及迷走神经的作用

目的:探讨耳-体穴电针对胆道系统疾病的治疗及迷走神经在调节胆道系统功能中的作用.方法:建立家兔实验性胆总管结石症的模型;以家兔胆汁流量、胆道压力及奥狄氏括约肌(oddi)肌电为指标,观察迷走神经对胆道系统功能的影响;以20Hz频率电针耳穴"胰胆区"及体穴"胆俞"30min,观察各项指标的变化.结果:结石症家兔因结石的存在,诱发了胆汁流量、胆道压力、oddi括约肌放电病理性增加,oddi括约肌肌电从有规律发放转变为无序的爆发性发放(胆汁流量、胆道各部位压力分别为15.50±5.10vs11.35±4.06,41.26±2.31vs16.70±2.33,41.30±2.56vs16.70±2.43,52.80±3.10vs29.33±3.73,均P<0.01);耳-体穴电针的调节作用促使胆石症模型家兔的胆汁流量进一步增加,以利结石排出(针后立即及针后30min依次为17.25±7.29,18.16±5.05vs15.66±5.66,P<0.05,P<0.01),针后30min胆道上端压力稍有增加(43.58±1.77vs42.00±1.70,P<0.01),但胆总管压力和oddi括约肌张力皆降低(前者40.03±0.77vs41.25±1.72,P<0.05;后者48.25±2.91vs53.50±3.20,P<0.01),并恢复节律性放电;耳-体穴电针对去除迷走神经的胆石症家兔胆道功能的即时调整作用不明显,但停电针30min后可见胆汁流量增加,胆总管压力和oddi括约肌张力降低(均P<0.05).结论:迷走神经对维持家兔的正常胆道系统功能是必须的;耳-体穴电针主要通过迷走神经对胆道功能失常动物发挥及时的、快速的调整作用,可能有体液途径对胆道系统功能发挥缓慢的、持久的调整作用.     

A bioptic study of gastrointestinal mucosa in cholera patients during an epidemic in Southern Italy

A histological biopsy study of gastric and jejunal mucosa of eight acute cholera patients during an epidemic in Southern Italy was carried out. The study demonstrated in all patients an intact epithelial lining of gastric and jejunal mucosa, a moderate degenerative process of enterocytes, presence of inflammatory lesions manifested by edema, vascular congestion, mononuclear cell infiltrate of lamina propria, and discharge of goblet-cells mucus. These changes reverted to normal in a few days. The authors emphasize that, contrary to cholera patients of Asiatic areas in whom an underlying chronic spruelike enteropathy is very common, the histological picture observed in Western patients may be considered more specific sinceVibrio cholerae acts upon a normal intestinal mucosa.     

显微血管减压术治疗责任血管为小脑后下动脉的舌咽神经痛

目的 探讨显微血管减压术治疗原发性舌咽神经痛(GNP)的技术要点及其疗效。方法 回顾性连续纳入2011年7月至2016年10月,首都医科大学宣武医院神经外科采用显微血管减压术治疗原发性GNP患者18例。所有患者术前接受MR血管成像(MRA)检查,明确舌咽和迷走神经与周围血管的解剖关系,其中17例采用枕下乙状窦后入路,1例采用远外侧入路;对患者均未行神经根丝切断术。结果 18例患者术前均有典型的舌根、咽部、扁桃体或外耳道深部等部位的发作性剧烈疼痛。术前MRA提示并且在术中证实,患者的责任血管均为小脑后下动脉主干或其分支。术中直视下将责任血管移离舌咽神经和迷走神经的出脑干区,确保血管与神经不再相互接触。手术无致残致死,无脑脊液漏、颅内感染等并发症。术后所有患者均得到随访,随访期为1~62个月。其中17例患者疼痛症状完全消失,疼痛数字量表评分(NRS)为0分;1例疼痛未缓解,出院时NRS评分同术前的8分。3例患者术后出现轻微的声音嘶哑、咽部不适,随访期内逐渐缓解。结论 显微血管减压术是治疗GNP安全、有效的方法,小脑后下动脉是最为常见的责任血管,术前影像学检查、术中明确减压非常重要,对舌咽神经和迷走神经切断需慎之又慎。     

Functional significance of coactivation of vagal and sympathetic cardiac nerves.

Simultaneous recording of activity in the vagal and sympathetic supplies to the heart has revealed that in reflexly and centrally evoked activity these two "antagonists" do not necessarily change action reciprocally. Coactivation occurs in chemoreceptor reflexes and related reactions, upon stretching of the sinoatrial nodal region of the right atrium and when certain hypothalamic regions are stimulated. The objective of the present work was to assay the physiological importance of coactivation of the two potentially antagonistic cardiac nerves in anesthetized dogs. Output from the heart was monitored by recording volume flow in the thoracic aorta just below the aortic arch; cardiac contractility was measured as left ventricular dp/dt. Tape recordings of vagus and sympathetic nerve activity during chemoreceptor and baroreceptor reflexes, during reciprocal and nonreciprocal changes produced by hypothalamic stimulation, and during hypoxia and hypercapnia were used to trigger stimulators feeding a stimulus per action potential to cardiac vagus and sympathetic nerves after central connections were cut. The vagus stimulation alone produced a decrease in aortic blood flow; stimulation of the sympathetic nerve alone resulted in increased aortic blood flow. Simultaneous stimulation of vagus and sympathetic, however, produced an even greater cardiac output (measured by aortic blood flow). Intermediate degrees of heart rate and strength of myocardial contraction were maintained in coactivation. Obviously, an association of increased vagus and sympathetic actions, which can be effected reflexly or by action of higher centers, is of physiological benefit. In control reactions that relate cardiac function to body need, both reciprocal and synergistic actions (coactivation) of cardiac nerves are used.     

侧脑室钻孔引流术结合LCFD术治疗老年脑室出血的临床研究

目的 探讨侧脑室钻孔引流术结合腰大池持续引流术(lumbar cistern countinue drainage,LCFD)治疗老年脑室出血的有效性,并分析术后并发颅内感染的Logistic的危险因素.方法 前瞻性选取本院2015年9月至2020年3月接诊的老年脑室出血患者88例,按照随机数字表法将患者分为对照组和研...     

Effect of chronic myocardial infarction on vagal cardiopulmonary baroreflex

Sensory endings in the left ventricle are damaged by acute myocardial infarction. The goal of our experiments was to determine whether reflexes that originate in the heart are impaired by chronic myocardial infarction. Inferoposterior (n = 11) or anterior (n = 10) infarction was produced in dogs by ligation and intracoronary injection of rapidly hardening latex into either the proximal left anterior descending or left circumflex coronary arteries. Four weeks after infarction, the changes in renal sympathetic nerve activity induced by phenylephrine infusion, hemorrhage, and volume expansion were assessed before and after sinoaortic baroreceptor denervation. The results in infarct dogs were compared with the results in 11 sham-operated dogs. With arterial baroreceptors intact, baroreflex sensitivity (defined as the percent change in renal nerve activity per millimeter of mercury change in mean pulmonary artery wedge pressure) was similar in all groups of dogs. Following sinoaortic denervation, dogs with anterior and inferoposterior infarction had impaired responses to volume expansion. The responses during hemorrhage were abolished in dogs with inferoposterior infarction. We conclude that chronic myocardial infarction impairs reflexes that originate in the heart in response to changes in cardiac filling pressures.     

Severe intracranial bleeding mimicking acute inferior myocardial infarction with right ventricular involvement

Electrocardiographic (ECG) changes and wall motion abnormalities of the left ventricle have been observed in patients with severe intracranial hemorrhage. However, ECG evidence of an acute myocardial infarction in this setting is extremely rare but may have important therapeutic consequences. We report the case of a 45-year-old female who became unconscious with respiratory insufficiency after an endoscopic retrograde cholangiopancreaticoscopy with ECG changes consistent of an inferior myocardial infarction with right ventricular involvement. Immediate coronary angiography revealed normal coronaries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial computer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a patient. A rapid diagnostic evaluation has to be initiated to rule out a myocardial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy.     

The hepatic vagus nerve and the neural regulation of insulin secretion

Despite considerable evidence that vagal neural efferent pathways between brainstem and pancreatic islets may alter the secretion of insulin, afferent pathways which might affect this system have received little attention. In the present work we have examined the effects on plasma insulin concentration of several treatments designed to alter the neural activity of the hepatic vagus nerve, a major afferent pathway between the liver and the medulla. The hepatic vagus nerve was acutely sectioned or stimulated electrically in separate experiments in rats. In a third experiment, glucose or 3-O-methylglucose was given ip to stimulate or inhibit, respectively, the hypothetical hepatic glucoreceptors. The effects of these treatments were assessed by measuring arterial or portal plasma insulin concentrations. Anesthesia and its possible secondary inhibitory effects on insulin secretion were avoided by a spinal sectioning of the rats in the cervical region, before experimentation. Acute section of the hepatic vagus nerve between the liver and the main anterior vagal trunk caused an increase in both arterial and portal plasma insulin concentrations. Stimulation of the central end of the nerve suppressed the concentration of the hormone in both the arterial and portal plasma relative to sham-stimulated controls. Section of the celiac vagal branches to the pancreas abolished these changes. Intraperitoneal glucose enhanced arterial insulin more in sham-vagotomized than in hepatic-vagotomized rats. After 3-O-methylglucose was given ip, the response was the opposite: insulin rose more in the arterial plasma of the hepatic-vagotomized animals than in those sham vagotomized. These results suggest that the hepatic vagus nerve plays a role in the regulation of insulin secretion. They are consistent with the hypothesis that afferent fibers in this nerve exert a tonic inhibition on the brainstem centers of an efferent vagal pancreatic neuroendocrine system.     

Preganglionic vagus nerve fibers also enter the greater curvature of the stomach in rats and ferrets

The efferent gastric vagus nerve fibers appear to enter the stomach by several routes. For example, the rate of gastric acid secretion is directly affected by the nerves of the greater curvature of the stomach. Specifically, acid secretion decreases abruptly after division of the gastroepiploic nerve(s). To determine whether efferent vagus nerve fibers are contained in the gastroepiploic nerve(s), horseradish peroxidase, a protein that undergoes retrograde axonal transport, was applied to these nerves; the brainstem locus of the nuclei of the vagus nerves was examined 2 days later. Typical peroxidase labeling was observed in the dorsal motor nucleus of the vagus nerve in 5 of 6 rats and 3 of 3 ferrets; the hypothesis that efferent vagus nerves enter the greater curvature of the stomach was thus supported in two vertebrate species. These previously unrecognized nerves should be considered in the interpretation of experimental and clinical phenomena.