高张盐水/6%羟乙基淀粉对创伤失血性休克大鼠早期肺损伤和中性粒细胞CD11b表达的影响

小容量高张盐水（HTS）复合高胶体渗透压溶液可更有效、更持久地保持血液动力学的稳定,比单纯HTS更能提高休克复苏后的生存率[1]。本研究拟探讨7.5％氯化钠/6％羟乙基淀粉用于复苏创伤失血性休克时对早期肺损伤的保护作用及其可能的机制。     

热休克预处理对预防中性粒细胞对静脉缺血-再灌注性皮瓣的损害作用研究

目的：探讨热休克预处理减少中性粒细胞对岛状皮瓣损伤作用机制。方法：在SD雄性大鼠上建立腹壁浅血管为蒂的岛状皮瓣热缺血模型,采取腹壁浅静脉血检测1、3、7天的中性粒细胞的凋亡和坏死比例,7天后检测皮瓣坏死率。结果：热休克预处理组在1、3、7天细胞的凋亡和坏死比例较对照组明显减少,不同时间段的组间差别均有统计学意义（P〈0.05）。而7天后的皮瓣坏死率比较也有统计学意义（P〈0.05）。结论：热休克预处理能够预防中性粒细胞对皮瓣的损伤作用。     

阿霉素诱导热休克蛋白72对大鼠肝脏冷缺血-再灌注损伤的保护作用

目的观察阿霉素（DXR）预处理诱导大鼠肝脏热休克反应在肝脏长时间冷缺血一再灌注损伤中对肝细胞的保护作用。方法供体大鼠术前按1mg／kg由外周静脉注射DXR（DXR组）,对照组注射生理盐水。48h后行肝脏原位冷灌注,获取肝脏后将其在4℃UW液中保存48h,然后行原位肝移植,再灌注1、3h。逆转录-聚合酶链反应法测定肝组织肿瘤坏死因子-α（TNF-α）mRNA、中性粒细胞化学趋化性细胞因子（CINC）mRNA、巨噬细胞炎症蛋白-2（MIP-2）mRNA的表达,蛋白质印迹法测定肝组织热休克蛋白72（HSP72）、核转录因子-κB（NF-κB）的表达,测定血清谷丙转氨酶、TNF-α、CINC、MIP-2水平。同时观察7d生存率。结果DXR组TNF-α mRNA、CINCmRNA、MIP-2mRNA的表达均低于对照组。DXR组HSP72表达显著,对照组基本无表达;DXR组NF-κB无表达,对照组显著表达。DXR组血清TNF-α、CINC、MIP-2显著低于对照组（P〈0．05）。DXR组7d生存率为50％,对照组为0（P〈0．05）。结论DXR预处理大鼠供肝可使肝脏长时间冷缺血-再灌注损伤显著减轻;HSP72的诱导可抑制NF-κB激活导致的炎症反应,对肝实质细胞提供保护作用。     

转录因子Egr-1在失血性休克复苏后肝脏损伤中的作用

目的研究转录因子Egr-1在失血性休克复苏（HS/R）后肝脏损伤中的作用.方法利用Egr-1野生型（WT）和基因封闭型（KO）小鼠复制失血性休克复苏模型.取肝组织,RT-PCR法测定肝组织中TNF-α、IL-6、G-CSF、ICAM-1 mRNA的表达变化.通过检测肝组织中MPO的含量、血清ALT水平和组织学检查,评估肝脏炎症细胞浸润和损伤程度.结果失血性休克2.5 h＋复苏4 h后,Egr-1 KO小鼠肝组织中TNF-α、IL-6、G-CSF、ICAM-1 mRNA的表达水平明显低于Egr-1WT组;Egr-1 KO组失血性休克复苏后肝组织炎性浸润和损伤程度减轻,表现为血清ALT水平低,肝组织中MPO含量低,病理损伤轻.结论本实验结果表明转录因子Egr-1参与了失血性休克复苏后肝脏炎症反应基因表达的调节,在失血性休克复苏后的肝脏损伤中起一定的作用.     

失血性休克免疫学研究进展

严重出血是软组织或骨创伤患者的常见并发症，亦可发生在大手术过程中。当今外科诊疗技术的进步，提高了此类患者复苏的成功率和短期存活率，但后期继发破血症仍很常见。大量实验研究表明，无明显组织损伤的失血性休克可以导致严重的免疫抑制。现将国内外的年来对单纯失血性休克复苏后机体免疫系统的变化及可能原因和免疫调节方面的实验研究进展综述如下。     

利多卡因对失血性休克大鼠肺损伤的保护作用

目的 探讨利多卡因对失血性休克大鼠肺损伤的保护作用。方法 80只雄性Wistar大鼠建立失血性休克模型后,随机分为四组,假手术组(Ⅰ组,n=8)、休克组(Ⅱ组,n=8)、生理盐水组(Ⅲ组,n=32)、利多卡因组(Ⅳ组,n=32)。Ⅰ组于假手术后,Ⅱ组于休克60 min,Ⅲ、Ⅳ组分别于复苏开始后2、4、8、12 h,测定中性粒细胞(PMNs)表面粘附分子CD11b/CD18表达、肺组织中髓过氧化物酶(MPO)活性,并采用光镜和透射电镜观察肺组织的病理学改变。结果 与Ⅰ组比较,Ⅲ组、Ⅳ组复苏后各时点PMNs表面CD11b/CD18表达均升高(P<0.01),Ⅱ组差异无显著性(P>0.01),Ⅱ组、Ⅲ组、Ⅳ组复苏后各时点肺组织中MPO活性升高(P<0.05或0.01)。与Ⅲ组比较,Ⅳ组复苏后同一时点、Ⅰ组、Ⅱ组PMNs表面CD11b/CD18表达及肺组织中MPO活性降低(P<0.01)。结论 小剂量利多卡因可以抑制失血性休克大鼠PMNs表面CD11b/CD18的表达,减少PMNs在肺组织中的浸润,从而减轻肺损伤。     

创伤后大鼠胰岛素信号转导与葡萄糖转运关系的研究

目的 探讨创伤后大鼠骨骼肌组织中胰岛素受体后信号转导通路的变化及其与葡萄糖转运能力之间的关系.方法 通过对大鼠实施小肠部分切除手术建立创伤模型,观察胰岛素受体后信号转导通路上关键蛋白--胰岛素受体底物-1(IRS-1)和蛋白激酶B(PKB又名Akt)的含量及磷酸化状态的改变.采用3H标记葡萄糖示踪法检测创伤后骨骼肌葡萄糖转运能力的变化,并分别测定大鼠骨骼肌组织中葡萄糖转运蛋白-4(GLUT-4)的mRNA和蛋白表达水平.结果 两组大鼠骨骼肌组织中IRS-1和PKB/Akt蛋白总量没有明显差异,但是创伤组骨骼肌中酪氨酸位点磷酸化的IRS-1蛋白含最较对照组下降了31%(P=0.018),而丝氨酸位点磷酸化的IRS-1蛋白含量较对照组增加了63%(P=0.000),相应的创伤组骨骼肌中磷酸化的PKB/Akt蛋白含量较对照组下降了48%(P=0.000).创伤组大鼠骨骼肌对葡萄糖的转运能力明显低于对照组(P<0.01).两组大鼠骨骼肌中GLUT-4 mRNA和蛋白总量的表达没有明显差异(P=0.805和P=0.702),但是创伤组大鼠骨骼肌细胞膜上的GLUT-4蛋白含量明显少于对照组(P=0.028).结论 创伤后大鼠骨骼肌组织中IRS-1蛋白酪氨酸位点磷酸化减弱而丝氨酸位点磷酸化增强,导致下游PKB/Akt蛋白活性降低,从而使得骨骼肌细胞膜上GLUT-4分布减少以及对葡萄糖的转运能力降低,这可能是导致大鼠创伤后胰岛素抵抗的机制之一.     

肝肺撞击伤伴失血后CO2气腹对兔动脉血气影响的实验研究

目的探讨肝肺撞击伤伴失血后二氧化碳（CO：）气腹对兔动脉血气的影响及其机制。方法制作创伤性失血兔模型，按不同失血量（6ml／kg、12ml／kg、22ml／kg）及C02腹压（5mmHg、10mmHg、15mmHg）将75只新西兰大白兔按随机数字表分为9组（每组6只）。观察建立气腹前、气腹0．5h、2h及撤去气腹后0．5h呼吸频率（RR）、动脉血气（ABG）的变化和死亡率。结果大白兔在建立气腹前：随失血量的增加，RR、PaCO2上升显著；pH值先升高后降；PaO2则持续下降。大白兔在建立CO2气腹后：随时间延长，5mmHg、10mmHg压力组的RR先增后降；pH值、PaO2持续下降，PaCO2持续升高，而且在相同失血量的情况下各组间的pH值、PaO2随压力升高而降低，15mmHg气腹组RR及PaCO2显著高于其他组。在相同压力条件下，5mmHg、10／11／11Hg气腹压力组随失血增多RR加快、PaCO2增高，pH值、PaO2下降。撤去气腹后0．5h，各组内RR、PaO2、pH、PaCO2值向正常恢复。结论一定气腹压力（〈10mmHg）对创伤伴失血（〈12ml／kg）自主呼吸兔ABG的影响是可逆的；而高气腹压力（15mmHg）或大白兔失血量在12ml／kg以上时建立气腹将引起致死性后果。     

核因子-κB"圈套"策略对创伤性炎症大鼠肝脏炎症介质IL-6的作用研究

目的探讨核因子-κB（NF-κB）靶向性寡核苷酸（oligodeoxynucleotides,ODN）“圈套”策略对创伤性炎症大鼠肝脏炎症介质IL-6的影响.方法Wistar大鼠96只,随机分成生理盐水对照组、创伤性炎症组、“圈套”ODN组和变异“圈套”ODN组.运用凝胶阻滞实验检测创伤性炎症术后肝脏组织NF-κB的活性及合成“圈套”ODN的体外竞争抑制,用RT-PCR和ELISA法检测大鼠肝脏组织IL-6的mRNA水平和蛋白水平.结果大鼠创伤性炎症术后3 h肝脏NF-κB的活性开始升高,在术后12 h达高峰.肝脏组织IL-6 mRNA水平和蛋白水平也明显上升,与肝脏NF-κB的活性改变一致,“圈套”ODN在体外能有效地抑制NF-κB活性.“圈套”ODN治疗后大鼠肝脏组织IL-6的mRNA水平和蛋白水平均明显下降,肝脏功能明显好转,而变异“圈套”ODN却没有效果.结论NF-κB“圈套”策略通过特异性抑制NF-κB活性,可以有效地抑制创伤性炎症大鼠肝脏炎症介质IL-6的释放.     

神经毒素在脊髓损伤中的作用

目的 探讨神经毒素兴奋性氨基酸（ＥＡＡ）和神经肽在脊髓损伤的作用。方法 应用高效液相色谱法检测脊髓损伤后伤段组织中谷氨酸（Ｇｌｕ）天门冬氨酸（Ａｓｐ）两种ＥＡＡ的含量变化；应用放射免疫分析技术测定脊髓损伤段组织中神经肽之一强腓肽ＤｙｎＡ１－１３含量的变化；观察了蛛网膜下腔注射Ｇｌｕ，ＤｙａｎＡ１－１３兴奋性氨基酸受体拮抗剂３－（２－羧基哌嗪）丙基－１－磷酸（ＣＰＰ），ＤｙｎＡ１－１３抗血清（Ａｎ－     

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目的 确定创伤性失血性休克（ＨＴＳ）病人死亡和并发症发生的高危因素。方法 分析在创伤ＩＣＵ和急诊部（ＥＤ）内ＨＴＳ病人,确定病死率、感染、器官功能障碍（ＯＤ）的发生率和与此有关的预测指标。结果 １４３例ＨＴＳ病人２８％在入院后２ｈ内死亡,１０％死于２－２４ｈ６％在２４ｈ后死亡;５６％生存。生存〉２４ｈ病人４７％发生感染和２４％发生ＯＤ;最初２４ｈ内复苏时增加晶体液输入,病死率升高。结论 创伤失血致     

Animal study on lung injury caused by simulant segmented shock waves

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Compound injection of Radix Hedysari to promote peripheral nerve regeneration in rats

OBJECTIVE: To study the effect of compound injection of Radix Hedysari on peripheral nerve regeneration in rats. METHODS: Seventy-five healthy adult SD male rats, weighing 150 g, were randomized into 5 groups (15 rats in each group). The bilateral sciatic nerves of the rats were exposed and clamped with a smooth clamp to make an injury area of 2 mm. After clamp operation Group 1 was injected with compound injection of radix Hedysari (CIRH) 1.5 ml/day, Group 2 with CIRH 1.0 ml/day, Group 3 with CIRH 0.5 ml/day, Group 4 with nerve growth factor (NGF) 50 U/day, and Group 5 was taken as the control group without any management. The bilateral sciatic nerve was taken out at 3 days, 1, 2 and 4 weeks after clamping, stained with osmic acid and observed microscopically. The myelinated nerve fibers were counted. The nerve conduction velocity was determined 2 and and 4 weeks before sample taking the sciatic nerve function index was measured 4 weeks before sample taking. RESULTS: The results of nerve conduction velocity, the myelinated nerve fiber count and the sciatic functuion index in the CIRH treated groups were better than those in the control group. The results of the nerve conduction velocity and the myelinated nerve fiber count at 2 weeks and the nerve conduction velocity at 4 weeks in Group 1 were better than those of Group 4. Biological observation showed that degenerated and necrotic myelin sheath in CIRH treated Groups at 2 and 4 weeks decreased remarkably compared to the NGF treated group. CONCLUSIONS: CIRH can promote regeneration of peripheral nerves and absorption of degenerated and necrotic injured nerves. It has the same effect as NGF.     

The utility of a shock index ≥ 1 as an indication for pre-hospital oxygen carrier administration in major trauma

Introduction and aims

The use of intravenous oxygen carriers (packed red blood cells (PRBC), whole blood and synthetic haemoglobins (HBOCs) for selected pre-hospital trauma resuscitation cases has been reported, despite a lack of validated clinical indications. The aim of this study was to retrospectively identify a sub-group of adult major trauma patients most likely to benefit from pre-hospital oxygen carrier administration and determine the predictive relationship between pre-hospital shock index (SI) [pulse rate/systolic blood pressure] and haemorrhagic shock, blood transfusion and mortality.

Methods

A retrospective review of adult major trauma patients recorded in The Alfred Trauma Registry was conducted. Patients were included if they received at least 1 L of pre-hospital crystalloid and spent over 30 min in transit. The association of shock index and transfusion was determined. Patients were further sub-grouped by mode of transport to determine the population of trauma patients who could be included into prospective studies of intravenous oxygen carriers.

Results

There were 1149 patients included of whom 311 (21.9%) received an acute blood transfusion. The SI correlated well with transfusion practice. A SI ≥ 1.0, calculated after at least 1 L of crystalloid transfusion, identified patients with a high specificity (93.5%; 95% CI: 91.8–94.8) for receiving a blood transfusion within 4 h of hospital arrival. While patients transported by helicopter had higher injury severity and blood transfusion requirement, there were no difference in physiological variables and outcomes when compared to patients transported by road car.

Conclusions

A shock index ≥ 1.0 is an easily calculated variable that may identify patients for inclusion into trials for pre-hospital oxygen carriers. Shocked patients have high mortality rates whether transported by road car or by helicopter. The efficacy of pre-hospital intravenous oxygen carriers should be trialled using a shock index ≥ 1.0 despite fluid resuscitation as the clinical trigger for administration.     

周围神经损伤的B超诊断

目的探讨Ｂ超对周围神经损伤的诊断价值。方法对１１例尸体标本和３０名健康自愿者的周围神经作Ｂ超检查，两者进行对照后获得人体正常周围神经的声像图。临床应用４２例周围神经损伤，于术前行Ｂ超检查，并用术中病理学检测结果来证实其诊断价值。结果正常周围神经的纵切面表现为中等回声管状结构，内有线性平行回声；横断面呈圆形或椭圆形内有点状回声。神经完全或部分损伤时，其连续性完全或部分中断，损伤区为无回声或低回声，近端有稍增强的神经瘤回声影。当神经粘连或受压时，神经走行弯曲，周围组织回声发生改变，神经界限不清晰。Ｂ超诊断与病理检测结果的符合率达８１％。结论Ｂ超对周围神经损伤有较好的诊断学价值