中性粒细胞活化在海水淹溺致肺损伤中的作用

目的 探讨中性粒细胞活化在海水淹溺致肺损伤中的作用.方法 36只新西兰兔随机分成6组:0(对照)、1、3、6、12、24 h组,每组6只动物.海水组经气管插管灌注2 mL/kg海水.观察不同时间点血气分析和支气管肺泡灌洗液(BALF)中性粒细胞计数及百分比的变化,计算肺通透指数(LPI);以生化法检测髓过氧化物酶(MPO)、丙二醛(MDA)含量,以酶联免疫吸附法(ELISA)分析中性粒细胞弹性蛋白酶(NE)活性,同时进行病理学检查,并计算肺病理评分(LPS).结果灌注海水后氧合指数迅速低至300 mm Hg 以下,持续时间长达6 h(P<0.01).肺大体标本以灌注后3 h瘀血水肿最严重,体积最大.显微镜下炎症细胞浸润以6~12 h最突出,肺泡间隔宽度随时间延长而加重.各时间点BALF中性粒细胞计数及百分比,肺组织NE、MPO、MDA含量,LPI及LPS均显著高于对照组(P<0.05或P<0.01),多于3~12 h达高峰.各指标间均有显著相关性(P<0.05或P<0.01).结论 中性粒细胞是SWD-ALI早期主要的炎症效应细胞,氧化应激反应与NE释放协同参与了肺组织损伤.中性粒细胞募集和活化在SWD-ALI发生发展中起重要作用.     

淡水近乎淹溺23例救治体会

目的：研究淡水近乎淹溺患者的临床表现、救治措施以及患者的预后。方法：回顾性分析2000-2006年期间收住的23例淡水近乎淹溺患者的临床资料。结果：23例住院患者平均年龄45．7（14～67）岁,男女之比为2．3：1。15例（65％）患者淹溺发生在自家周围。8例（35％）患者淹溺被救后行复苏治疗。常见的并发症为吸入性肺炎20例（87％）,急性肺损伤16例（70％）,症状性癫痫7例（31％）。14例（61％）患者痊愈出院,9例（39％）患者出院时遗留神经系统、呼吸系统的后遗症或者死亡。结论：本研究表明淡水近乎淹溺患者预后差。维持患者呼吸功能,减轻肺损伤．及早有效的脑复苏,限制液体入量以及维持水、电解质平衡是重要而且有效的措施。     

海水淹溺性急性肺损伤兔几种细胞因子的动态变化

目的 探讨TNF-α、IL-1β、IL-6 、IL-8、IL-10等细胞因子在海水淹溺性ALI中的作用.方法 36只新西兰兔随机分成六组:0(对照组),灌注1、3、6、12、24 h组,每组6只动物.灌注组经气管插管灌注2 mL/kg海水.不同时间点观察各组动物血气分析的变化.计算肺湿干质量比(W/D)、肺通透指数(LPI).以ELISA法检测肺组织和血清中TNF-α、IL-1β、IL-6 、IL-8、IL-10表达水平,同时进行病理学检查,并计算肺病理评分.结果 灌注海水后氧合指数迅速低至300以下,持续时间长达6 h.W/D值于S3h达高峰,肺通透指数以S6h组数值最高.各时间点肺组织和血清中TNF-α、IL-1β、IL-8、IL-10均显著高于对照组(P<0.05或P<0.01).TNF-α、IL-1β、IL-10高峰在6 h,IL-8高峰在12 h.血清IL-6于1 h后持续在最高水平,肺组织IL-6浓度仅在6 h时升高(P<0.05).肺大体标本于灌注后3 h瘀血水肿最严重,体积最大.显微镜下炎症细胞浸润于6～12 h最突出,肺泡间隔宽度随时间延长而加重.肺病理评分1 h时已显著高于对照组(P<0.01),6 h达最高.LPI,肺组织和血清TNF-α、IL-1β、IL-8、IL-10及血清IL-6表达与肺损伤程度呈正相关(P<0.05或P<0.01),TNF-α与IL-1β、IL-10以及血清IL-6亦密切相关.结论 TNF-α、IL-1β、IL-6、IL-8、IL-10等细胞因子以协同或拮抗的方式参与了海水淹溺性ALI的病理过程,全身性炎症反应和抗炎反应的失衡在海水淹溺性ALI发生发展中可能起重要作用.     

胸部开放伤海水浸泡致急性肺损伤的实验研究

目的：探讨胸部开放伤涨水浸泡致急性肺损伤的特点,为研究救治方案提供依据。方法：实验动物致伤后随机分为对照组（１０只）、海水浸泡组（１０只）和生理盐水浸泡组（５只）。对照组为单纯胸外伤,后２组动物于致伤后分别置入人工配制的海水或生理盐水中,于伤前及入水后０．５、１、２、３和４小时取血测定肿瘤坏死因子－α（ＴＮＦ－α）和白介素－１β（ＩＬ－１β）变化,同时监测血流动力学、呼吸系统和动脉血气变化。动物活     

地塞米松对海水淹溺性肺损伤兔肺水肿吸收的影响

目的探讨地塞米松对海水淹溺性肺损伤兔的肺泡钠水转运系统及肺水肿的影响。方法新西兰兔随机分成对照组(CG)和地塞米松治疗组(BG)。CG兔(n=12)的气管内灌注4 ml/kg海水,DG兔(n=12)在CG的基础上静注1 mg/kg地塞米松。肺水肿用血管外肺水含量指数(EVLWI)监测。给药3 h收集肺组织标本,分别用RT-PCR和Western印迹检测肺组织中钠离子通道-α亚单位mRNA(α-ENaC mRNA)和钠钾泵-α1亚单位(NKA-α1)蛋白的丰度以及水解法检测NKA活性。结果DG的EVLWI显著的低于CG[(0．508±0．089)vs．(0．648±0．102),P＜0．05],而α-ENaC mRNA和NKA-α1蛋白的丰度均显著的高于相应的CG(P＜0．05,P＜0．05),NKA活性也显著的高于CG(P＜0．05)。结论地塞米松可增加肺泡钠水转运系统的表达或活性,并减轻海水灌注肺损伤兔的肺水肿。     

海水中脑出血后淹溺抢救成功一例

1病例简介 患者,女性,66岁,退休干部。于2008-07-07上午10时许在海水中游泳时发生淹溺,被人发现救到岸边,行简单心肺复苏后,约10时18分送入我院急救中心。     

儿童淡水溺死心肺复苏术

儿童淡水溺死心肺复苏术韩会民，鲁铭新，王德全，王树春全世界每年淡水淹溺死亡约１４万人，美国每年约７０００人，为意外致死的第４个主要原因，占意外死亡总数的１／１５，找国尚未见统计。由溺水导致呼吸、心跳停止，处于临床死亡状态称为“溺死”；呼吸停止、心跳未...     

胸部开放伤后胸腔海水浸泡致犬急性肺损伤的救治研究

目的 探讨肺保护性通气联合己酮可可碱对胸部开放伤后胸腔内海水致急性肺损伤（ALI）的救治疗效。方法 用胸部开放伤后胸腔内灌注海水制备犬ALI模型。将24条犬随机分为未救治组（A组）、普通救治组（B组）、肺保护性通气组（C组）和肺保护性通气＋己酮可可碱组（D组）。分别于致伤前、致伤6h及救治2h和4h监测各组动物的动脉血气分析、血流动力学、血浆渗透浓度和血钠、血氯的变化；收集外周静脉血和支气管肺泡灌洗液（BALF）检测肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和IL-8含量。结果 B组救治2h和4h后动脉血氧分压（PaO2）及氧合指数（PaO2／FiO2）仍低于正常水平，C组和D组恢复正常；B、C和D组血流动力学指标以及高渗、高钠、高氯血症在救治2h和4h后较A组显著改善。C组外周血TNF—α及D组外周血TNF—α、IL～8和BALF中IL-6、IL-8水平在救治后显著低于A组和B组；D组外周血TNF-α及BALF中IL-8水平亦显著低于C组。结论 应用肺保护性机械通气治疗胸腔海水致ALI可以起到良好的呼吸支持作用，己酮可可碱能有效的抑制肺内、外炎症反应。     

鞭毛蛋白在脓毒症并发急性肺损伤中的研究进展

鞭毛蛋白是细菌鞭毛的主要成分,是脓毒症发病过程中强有力的前炎性致炎因子,能和TRL5结合并使之活化,激活NF-κB等转录因子,引起多种趋化因子和黏附分子分泌。在健康的志愿者中,血浆中鞭毛蛋白的浓度低于ELISA<0.1μg/mL的检测水平,而在脓毒症的患者中,血浆中鞭毛蛋白的浓度为(7.06±0.14)μg/mL,并且外周血鞭毛蛋白的水平和脓毒症持续的时间、肺损伤的程度、肺泡肺小动脉氧张力差值呈明显的正相关,和白细胞的减少程度也有相关的趋势。     

老年急性肾损伤与急性肺损伤相互作用及治疗策略

急性肾损伤(acute kidney injury,AKI)是系统性疾病,临床常合并急性肺损伤(acute lung injury,ALI),死亡率高,尤其见于老年患者.AKI与ALI通过多种因素介导相互作用、相互损伤,从而使死亡率急剧增高.本文主要关注老年AKI和Au相互作用的相关机制,探讨治疗策略,期待可以积累经验深化认识,改善患者预后.     

NF-κB在急性坏死性胰腺炎相关性肺损伤中的表达改变及乌斯他丁的治疗作用

目的:研究NF-κB在急性坏死性胰腺炎(ANP)相关性肺损伤中的表达改变情况及乌斯他丁的治疗作用机制。方法:采用逆行胰胆管牛磺胆酸钠(TAC)注射方法建立大鼠ANP肺损伤模型。SD大鼠分为假手术组(SO组),ANP生理盐水对照组(ANP组)和乌斯他丁治疗组。各组于术后3,6,12h剖杀,检验NF-κB的表达情况及肺组织髓过氧化物酶(MPO)活性和TNF-α的变化及肺组织的病理学改变。结果:相对于SO组,ANP组大鼠从3h开始,MPO及TNF-α增高,NF-κB表达于3h增高,6h达到高峰,给予乌斯他丁治疗后,肺损伤各指标均有不同程度降低(P0.05),NF-κB表达明显降低(P0.05)。结论:ANP相关肺损伤与NF-κB的激活有关,乌斯他丁通过下调NF-κB表达对ANP相关性肺损伤起保护作用。     

Survival after multiple nail gun injuries to the brain,lung, and heart: a case report and a review of the literature

Most nail gun injuries involve the extremities and result from work-related accidents. Injuries to the brain or thorax are relatively rare, and cases with injuries to both regions are even rarer and often lethal. Initial evaluation, resuscitation, and surgical planning can be challenging for emergency physicians and surgeons. We present the details of a man with multiple nail gun injuries to the brain, lung, and heart following a suicide attempt. The patient presented to the emergency department in shock. After immediate resuscitation, emergent sternotomy, and subsequent craniotomy, he was discharged without significant morbidity. According to the literature, this is the only reported case involving multiple nail gun injuries to the brain, lungs, and heart. The mortality rate of multiple nail gun injuries involving the head and chest is approximately 20%. Rapid evaluation, immediate resuscitation, and appropriate imaging and surgery are crucial for increasing survival and achieving a good prognosis. Emergency sternotomy for cardiac injury is the foremost priority, and the timing of craniotomy depends on the patient’s vital sign status and whether brain injury is evident.A preprint of this article is available online: DOI: 10.21203/rs.3.rs-35448/v1.     

Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury

Purpose  To evaluate the effects of frequency and inspiratory plateau pressure (Pplat) during recruitment manoeuvres (RMs) on lung and distal organs in acute lung injury (ALI). Methods  We studied paraquat-induced ALI rats. At 24 h, rats were anesthetized and RMs were applied using continuous positive airway pressure (CPAP, 40 cmH₂O/40 s) or three-different sigh strategies: (a) 180 sighs/h and Pplat = 40 cmH₂O (S180/40), (b) 10 sighs/h and Pplat = 40 cmH₂O (S10/40), and (c) 10 sighs/h and Pplat = 20 cmH₂O (S10/20). Results  S180/40 yielded alveolar hyperinflation and increased lung and kidney epithelial cell apoptosis as well as type III procollagen (PCIII) mRNA expression. S10/40 resulted in a reduction in epithelial cell apoptosis and PCIII expression. Static elastance and alveolar collapse were higher in S10/20 than S10/40. Conclusions  The reduction in sigh frequency led to a protective effect on lung and distal organs, while the combination with reduced Pplat worsened lung mechanics and histology. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. The work was supported by Centres of Excellence Program (PRONEX-FAPERJ), Brazilian Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho, Rio de Janeiro State Research Supporting Foundation (FAPERJ), S?o Paulo State Research Supporting Foundation (FAPESP).     

单侧肺滴入酸后急性肺损伤的研究

目的：观察酸滴入侧的急性肺损伤（ＡＬＩ）的形成及对测肺有无损伤形成。方法：１８只新西兰兔随机分为生理盐水（ＮＳ）滴入对照组和盐酸入损伤组。以向右肺内滴入ＮＳ或ＨＣｌ后的血气、气道压力、动静态顺应性、肺湿／干比（Ｗ／Ｄ）和支气管肺泡灌洗液（ＢＡＬＦ）中总蛋白（ＴＰ）、总磷脂（ＴＰＬ）、饱和磷脂占总磷脂比（ＤＳＰＣ／ＴＰＬ）及肺组织形态学来判断有无ＡＬＩ及其严重程度。结果：损伤组在酸滴入后ＰａＯ２较基     

Association between urokinase haplotypes and outcome from infection-associated acute lung injury

Objective Alterations in coagulation, including elevated pulmonary and systemic concentrations of urokinase, are frequent in patients with acute lung injury (ALI). Urokinase potentiates neutrophil activation and contributes to the severity of pulmonary injury in preclinical models of ALI. The objective of this study was to examine associations between polymorphisms and haplotypes of urokinase with risk for and outcomes from ALI. Design Prospective cohorts of healthy European-American adults and those with infection-associated ALI. Setting Academic medical centers participating in NIH funded studies of low tidal volume ventilation for ALI. Patients Controls were 175 healthy European-American subjects. Patients were 252 individuals with infection-associated ALI, prospectively followed for 60 days for mortality. Interventions Genetic polymorphisms and haplotypes in the urokinase gene were determined. Measurements and main results Six polymorphisms, rs1916341, rs2227562, rs2227564, rs2227566, rs2227571, and rs4065, defining 98% of all urokinase haplotypes, were analyzed. There were no statistically significant associations between any single urokinase polymorphism or haplotype and risk for developing ALI. In contrast, there was a statistically significant relationship between the CGCCCC haplotype and both 60-day mortality and ventilator-free days that remained present in a multivariate analysis controlling for age and sex (p = 0.033 for 60-day mortality and < 0.001 for ventilator-free days). Conclusions These results identify a specific urokinase haplotype as a genetic risk factor for higher mortality and more severe clinical outcome in patients with infection-associated ALI. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Supported by NIH grant R01 HL76206.