部分液体通气联合伊洛前列素治疗兔油酸型急性肺损伤

目的观察部分液体通气(partial liquid ventilation,PLV)联合气道内给予血管扩张药伊洛前列素对急性肺损伤(acute lung injury,ALI)兔肺气体交换、肺力学方面的影响.方法健康大白兔24只,用油酸混合兔血清复制成ALI模型后随机分为3组.各组采用不同治疗方法:常规机械通气组(conventional mechanical ventilation,CMV);部分液体通气组(PLV);联合组为PLV 雾化吸入伊洛前列素(iloprost).分别监测各组治疗前后各时相点PaO2、PaCO2及肺静态顺应性(Cstat)、肺动脉平均压(pulmonary arterial pressure,PAP)的变化.结果联合组PaO2从(104±16)mmHg升高到(236±38)mmHg(P＜0.05),肺动脉平均压从(22±5)mmHg降低到(16±3)mmHg(P＜0.05).联合组PaO2的升高及PAP的降低优于CMV组和PLV组.结论部分液体通气联合雾化吸入伊洛前列素不仅对于改善ALI肺氧合功能优于单纯部分液体通气,还可减低部分液体通气对肺血流动力学的影响,降低肺动脉高压.     

俯卧位通气对急性肺损伤家兔氧合及血液动力学的影响

目的:观察俯卧位通气对急性肺损伤(ALI)家兔的影响.方法:健康日本大耳白兔,麻醉后仰卧位固定,给以容量控制通气.经静脉注射油酸制成ALI模型,模型制成即通气模式中加入呼气末正压(PEEP).对照组动物实验全过程保持仰卧位;实验组动物在ALI模型制成后60min,由仰卧位转为俯卧位.观察动物动脉血氧分 压(PaO2)、动脉血二氧化碳分压(PaCO2)、心率、平均动脉压、肺顺应性变化.结果:实验组动物在俯卧位通气后,PaO2升高(P＜0.05);PaCO2、肺顺应性及心率、血压的数值与该组仰卧位时比较没有明显变化(P＞0.05),而且实验组与对照组在各相同时间点上述参数比较差别也不明显(P＞0.05).结论:俯卧位通气可以明显改善Au家兔的PaO2,对肺顺应性和体循环无明显影响.     

不同单肺通气模式对呼吸功能及七氟醚FA/FI的影响

目的通过观察开胸手术患者,探讨不同单肺通气模式对肺顺应性、肺内分流、动脉血氧合以及吸入麻醉药七氟醚FA/FI变化趋势的影响,为临床麻醉选择合适的通气方式提供理论依据。方法选择30例首次择期行开胸肺叶切除术需单肺通气(one-lung ventilation,OLV)的肺癌患者,随机分为A、B和C3组。A组(定容通气组):VT=8 ml/kg,Rf=12次/min,PEEP=0;B组(定压通气组):先将患者进行VCV单肺通气,参数设置同A组,气道压稳定后,在气道峰压相同的条件下,更改通气模式为PCV,Rf=12次/min,PEEP=0;C组(小潮气量+PEEP组):VT=6 ml/kg,Rf=16次/min,PEEP=5 cm H2O。分别于双肺通气(total lung ventilation,TLV)后10 min及OLV后20、45、70 min四个时间点记录患者生命体征、气道压,并采集桡动脉血和颈内静脉血各l ml行血气分析。OLV 20 min时,以挥发罐浓度1.5%七氟醚吸入,20 min后停止吸入,期间记录七氟醚肺泡浓度和吸入浓度比(FA/F)I。结果 (1)单肺通气后,各组患者气道峰压明显升高,顺应性下降,动脉血氧分压降低,肺内分流率明显增高。(2)B组在最初的8minFA/FI上升最快,C组最慢,A组介于两者之间。随着吸入时间的延长,三组曲线接近并趋于一致。结论单肺通气时,定压通气模式有助于提高肺顺应性,但最终三种通气模式吸入麻醉药的FA/FI在各时间点无差异。     

单肺通气时延长吸气时间对肺顺应性和肺内分流的影响

目的 探讨吸呼比1:1(I:E=1:1)对侧卧位单肺通气患者肺顺应性和肺内分流的影响.方法 选择46例年龄20-65周岁,ASAI-II级,全麻机械通气胸腔镜下行肺叶切除或食管癌根治术的患者,随机分为两组(n=23),对照组(C组,I:E=1:2)和实验组(E组,I:E=1:1).机械通气期间在单肺通气后开始调整吸呼比.取平卧双肺通气后15min(t0)、侧卧单肺通气后30min(t1)、60min(t2)三个时间点,检测动脉血气并记录呼吸参数,计算肺顺应性及肺内分流率.结果 两组气道峰压、气道平台压及肺内分流率与t0相比,均在t1、t2时明显增加(P<0.001);而动脉氧合、肺顺应性均有所下降(P<0.001),差异有统计学意义.与C组相比,E组的气道峰压和气道平台压明显降低(P<0.001),肺顺应性提高(P<0.001),肺内分流减少(P=0.021),动脉血氧分压(P=0.034)和血氧饱和度(P=0.03)明显增加,差异均具有统计学意义.结论 侧卧位单肺通气期间,采用I:E=1:1较I:E=1:2,有利于降低气道峰压及气道平台压,提高肺动态顺应性;减少肺内分流,相对改善动脉氧合.     

BIPAP通气模式对重症手足口病合并神经源性肺水肿患儿呼吸功能的影响

目的探讨双水平气道正压(BIPAP)通气模式对重症手足口病合并神经源性肺水肿患儿呼吸功能的影响。方法选取2017年3月至2018年8月收治的86例重症手足口病合并神经源性肺水肿患儿,根据随机数字表分为对照组和观察组各43例。两组均采用同步间歇指令通气(SIMV)+呼气末正压(PEEP)治疗,治疗30 min后,对照组治疗模式不变,观察组更改为BIPAP通气模式,对比两组呼吸功能、动脉血气分析指标及机械通气时间。结果治疗后,两组Pplat、气道峰压、肺顺应性、PaCO_2及PaO_2/FiO_2均改善(P<0.05),且观察组Pplat、气道峰压及PaCO_2水平较对照组低,肺顺应性及PaO_2/FiO_2水平较对照组高(P<0.01);观察组机械通气时间较对照组短(P<0.01)。结论重症手足口病合并神经源性肺水肿患儿采取BIPAP通气模式治疗可有效改善呼吸功能及氧合,缩短患儿机械通气时间。     

不同通气模式在Coopdech封堵管行单肺通气中的比较

目的:通过三种通气模式在支气管封堵管行单肺通气中的应用比较,为临床提供参考.方法:30例患者,随机分为三组.I组采用定容通气;II组采用定压通气;III组采用小潮气量+PEEP.于侧卧位双肺通气10min(T0),侧卧位单肺通气20 min(T1)、40 min(T2)、60 min(T3)四个时间点采集动脉血和混合静脉血,行血气分析并计算肺内分流率(Qs/Qt)和肺动态顺应性(Cldyn).结果:三组患T1、T2、T3时间点各指标与T0时比较有统计学差异,但II组肺动态顺应性降低的幅度比I组和III组小;III组肺内分流率增高幅度比I组和II组小.III组的气道压与I组和II组比较,升高明显较小.结论:在Coopdech封堵管行单肺通气中,在吸气压力设置与定容模式的气道峰压一致时,定压模式改善肺动态顺应性优于定容模式;但定容模式较定压模式肺内分流率升高少,有更好的通气血流比.小潮气量加合适的PEEP,不仅能比定容模式更好地减少肺内分流率,而且能通过降低气道压力和剪力对肺泡造成的损害,在单肺通气时减少对肺的损伤.     

肺开放策略治疗重症急性呼吸窘迫综合征的临床分析

目的 探讨肺开放策略治疗重症急性呼吸窘迫综合征(ARDS)的临床价值.方法 回顾性分析18例重症ARDS患者采用压力控制通气模式,预设吸气压40～45 cmH2O,通气频率15～20次/min,吸呼比1.5～2:1,FiO2 80%～100%.外加呼气末正压(PEEP)25～30 cmH2O持续约1 min后,均在20 cmH2O时维持约15～30 min,同时降低吸气压达到潮气量稳定、动脉血气指标理想(PaCO2 PaO2＞400 mmHg).肺完全开放后逐渐降低吸气压和PEEP到最佳水平,继续进行肺保护性通气.动态观察肺开放策略实施前后动脉血气指标、中心静脉压(CVP)和平均动脉压(MAP)的变化.结果 18例重症ARDS患者采用肺开放策略治疗,肺的顺应性明显提高,氧合功能障碍明显改善,有效率为83.3%.结论 肺开放策略治疗重症ARDS明显改善了患者的氧合功能,对血流动力学影响小,安全有效地提高了抢救成功率.     

肺开放策略对体外循环术后呼吸功能的影响

目的:研究肺开放策略(OLC)对体外循环(CPB)手术后呼吸功能的影响。方法:选择24例心内直视手术患者,随机分成常规机械通气组(CMV)、早期肺开放组(EOL)、晚期肺开放组(LOL),EOL组在气管插管后实施肺开放策略,LOL组到达ICU后30 min实施肺开放策略;分别于术前、CPB后及到ICU后120、240、360 min记录各项呼吸指标:吸氧浓度、气道峰压、实际潮气量、呼气末气道正压(PEEP)等并同时测动脉血气,计算氧合指数和动态肺顺应性。结果:CMV组CPB后及到ICU后120、240 min肺动态顺应性较术前明显下降(P<0.01),氧合指数CPB后各时段较术前明显下降(P<0.01);EOL组肺动态顺应性CPB后未见下降;LOL组经实施肺开放后肺动态顺应性、氧合指数逐渐上升,但在到ICU 120 min前肺动态顺应性仍低于EOL组(P<0.05);维持肺开放的最低PEEP LOL组高于EOL组(P<0.01)。结论:OLC可减轻CPB相关的肺损伤,早期实施OLC优于晚期实施OLC。     

妇科腹腔镜手术中压力和容量控制通气对呼吸动力学的影响

目的探讨在妇科腹腔镜手术的全麻中应用压力控制通气(PCV)和容量控制通气(VCV)对呼吸力学的影响。方法择期行妇科腹腔镜手术的患者30例,ASA Ⅰ级,随机分为PCV组和VCV组,术中观察气道峰压、气道平台压、胸肺顺应性和血气变化。结果两组患者的气道峰压、平台压及PaCO2均明显高于气腹前,胸肺顺应性则明显降低,而在气腹后,PCV组的气道峰压和平台压要显著低于VCV组,胸肺顺应性及PaCO2的变化无显著差异。结论在腹腔镜手术中选用压力控制通气模式将对预防肺的气道压力伤有一定意义。     

不同通气策略对老年患者腹部手术静态肺顺应性及氧合的影响

目的研究3种不同通气策略(常规潮气量、低潮气量及低潮气量+小PEEP)对老年患者腹部手术机械通气时静态肺顺应性及氧合的影响。方法选择年龄>60岁、ASAⅠ~Ⅱ级的老年腹部择期手术患者90例,根据机械通气方式不同,随机分为3组,常规潮气量组(Ⅰ组)、低潮气量组(Ⅱ组)、低潮气量+PEEP(Ⅲ组),于插管后麻醉机械通气3 min(T0)、1 h(T1)、2 h(T2)、3 h(T3)4个时点记录计算Ppeak(气道峰压)、Pplat(气道平台压)、Cs(静态肺顺应性),并且同一时点抽取动脉血进行血气分析,计算患者的OI(氧合指数)。结果 3组静态肺顺应性和氧合指数均随着时间延长呈下降趋势(P<0.05);组间比较,Ⅰ组低于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组和Ⅲ组之间比较差异无统计学意义(P>0.05);3组Ppeak、Pplat均随着时间呈上升趋势(P<0.05),组间比较,Ⅰ组高于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组和Ⅲ组之间比较差异无统计学意义(P>0.05)。结论与常规潮气量相比,小潮气量(6 ml/kg)通气及小潮气量加小PEEP(5 cm H2O)能改善老年患者术中静态肺顺应性及氧合。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.