吸入NO治疗急性缺氧性肺动脉高压的实验研究

了解ＮＯ吸入治疗急性缺氧性肺动脉高压的效果以及不同模式吸入ＮＯ对血流动力学的影响。给１０条杂种犬吸入１２％氧和８８％氮混合气建立缺氧性肺动脉高压的动物模型，采用自身对照法，观察吸入（２５￣３０）×１０＾－６ＮＯ前后血流动力学的变化以及换用不同通气模式对以上各指标的影响。吸入１２％氧和８８％氮混合气３０ｍｉｎ后平均肺动脉压上升至基础值的２０６．１３％，吸入ＮＯ１￣２ｍｉｎ内平均肺动脉压开始下降，５ｍ     

吸入一氧化氮和静滴前列腺素E1对急性肺动脉高压的治疗效应

目的：探讨吸入一氧化氮(NO)和静滴前列腺素E1(PGE1)对急性肺动脉高压的治疗作用。方法：通过静脉持续滴注血栓素类似物U46619复制犬急性肺动脉高压实验模型,观察静滴小剂量PGE1 10ng/（min.kg）,大剂量PGE1 50ng/（min.kg）和吸入体积分数为4.0×10-5 NO及合并PGE1 10ng/（min.kg）对急性肺动脉高压的血流动力学影响。结果：小剂量PGE1使肺动脉平均压（MPAP）下降(17±8)％,体动脉平均压（MSAP）下降(19±10)％,心排量（CO）明显改善［(1.21±0.25)L/min vs （1.83±0.27）L/min, P<0.01］;大剂量PGE1使MPAP下降(29±7)％,MSAP下降(41±11)％,CO呈明显下降趋势［(1.21±0.25) L/min vs（1.04±0.38）L/min,P<0.05］;吸入NO 4.0×10-5以后,MPAP下降(23±6)％,而 MSAP无明显变化,CO上升不明显［(1.34±0.17)L/min vs （1.43±0.24）L/min,P<0.05］;吸入NO 4.0×10-5合并小剂量PGE1后,MPAP下降(31±7)％,MSAP下降(14±9)％,CO明显改善［(1.34±0.17)L/min vs（2.01±0.34）L/min,P<0.01］。结论：吸入NO合并小剂量的PGE1不仅能明显降低肺动脉压,而且可适当扩张体循环血管,改善心功能,有利于各组织的血液灌注,是一种较为理想的治疗方案。     

饮红茶对大鼠慢性缺氧性肺动脉高压的影响

慢性缺氧过程中，饮红茶的大鼠（HT组）平均肺动脉压（Ppa）为2.50±0.20kPa，肺血管阻力（PVR）为2824.80±658.69kPa·s~(-1)／L，均显著低于缺氧对照组（Ppa为2.97±0.25kPa，PVR为3763.46±529.62kPa·s~(-1)／L），而HT组肺血管对急性缺氧的反应性（22.50±6.16％）则显著强于缺氧对照组（10.65±3.80％）。结果表明，长期饮红茶可防止大鼠慢性缺氧性肺动脉高压的形成。     

β-受体阻断剂对门肺高压患者运动能力及血流动力学的不良影响

背景与目的：已有研究提示β-受体阻断剂可能对肺动脉高压患有害。然而并未对应用β-受体阻断剂患的影响进行评价。研究对象为因预防静脉曲张出血而服用β-受体阻断剂的门肺高压患，研究目的在于了解β-受体阻断剂对这些患运动能力和肺血流动力学的影响。方法：10例连续就诊的中重度门肺高压（肺动脉压52±10mmHg）患纳入该研究，在患服用β-受体阻断剂的基线期及停药后2±1个月，分别对患进行6min步行测试和右心导管插入术检查。结果：在停用β-受体阻断剂后，9／10例患的6min步行距离增加，整体增加幅度为79±78m（P=0．01）。心输出量增加28％（P〈0．01）而平均肺动脉压未改变，结果导致肺血管阻力降低了19％（P〈0．01）。心输出量的增加是由于心率增加了25％（P〈0．01），而每搏输出量没有改变（P=0．65）。运动耐受力的提高与变时性反应（最大心率与静息心率之差）的增加有关，在6min步行测试中从18±9次／min增至34±12次／min（P〈0．01）。     

低体温对肺循环的影响

本文观察了低体温时实验动物肺循环的变化,并初步探讨了气道动力学对其影响。结果发现:低体温时动物平均肺动脉压及肺血管阻力均显著上升,分别从基础值1.41±0.04kPa和36.00±2.31kPa·s/L上升到1.83±0.12 kPa和106.92±11.91kPa·s/L,低体温前后肺动脉嵌压无明显变化,心输出量减少。低体温时动物肺通气量显著减小,从对照值7.63±0.79 L/min降至4.53±0.59L/min,但动脉血气值无显著变化,肺动态顺应性变化不明显,肺组织形态结构无显著变化。提示:低体温时肺动脉收缩,导致肺血管阻力加大是肺高压形成的原因。低体温时肺血管的收缩反应与肺低通气无关。     

PRVG结合小剂量NO对先天性心脏病术后肺动脉高压治疗的研究

目的观察压力调节容积控制通气(PRVC)联合一氧化氮(NO)吸入疗法对心脏手术后肺动脉高压患者的治疗作用.方法12例心脏手术后肺动脉高压患者随机采用间歇正压通气(SIMV)、SIMV+NO、PRVC和PRVC+NO进行治疗.于治疗前及治疗后30 min观察血流动力学,气体交换及肺功能改变,并于NO吸入前后记录血浆高铁血红蛋白(MetHb)含量.结果各组治疗前参数无明显差异(P＞0.05).治疗后30min,SIMV和pRVC组对血流动力学无明显影响;PRVC组肺静态顺应性(Cst)显著增加(P＜0.05).在NO吸入后,SIMV及PRVC组平均动脉压(MAP)明显升高,平均肺动脉压(mPAP)分别由(34±4)mmHg、(38±8)mmHg降至(26±3)mmHg和(21±5)mmHg,且差异有显著性(P＜0.05);同时,PRVC+NO组Cst和氧合指数(PaO2/FiO2)明显增加(P＜0.05);上述指标在SIMV、SIMV+NO组则无明显变化.此外,NO吸入后MetHb虽有升高,但均在正常范围.结论与SIMV+NO相比,PRVC+NO能进一步降低心脏手术后肺动脉高压患者的mPAP,增加其Cst及PiO2/FiO2.     

左旋精氨酸对吸入一氧化氮降低肺动脉高压的延长作用

目的观察一氧化氮底物左旋精氨酸（Ｌ一ａｒｇ）延长吸入一氧化氮（ＮＯ）选择性降低肺动脉高压过程中的作用。方法８只猪麻醉后制成急性缺氧性肺动脉高压模型,在 Ｓｗａｎ－Ｇａｎｚ导管和动脉导管监测下吸入 ＮＯ（１２— １５ｐｐｍ）的过程中静脉注入 Ｌ－ ａｒｇ（共 １０ｇ）,观察停用 ＮＯ后体循环和肺循环血流动力学的变化情况。结果单纯吸入 ＮＯ能选择性降低急性缺氧性肺动脉高压,肺动脉压力从 ４ ２± ０ ４ｋＰａ降至 ２． ５± ０ ．５ｋＰａ（１ｋＰａ＝ ７．５ｍｍＨｇ, Ｐ＜ ０．０１）,肺血管阻力从 ５６±２５ｋＰａ·ｓ·Ｌ－１降至３１±１３ｋＰａ·ｓ·Ｌ－１（Ｐ＜０．０１）,但持续时间短;ＮＯ吸入加静脉注射Ｌ－ａｒｇ没有使肺动脉压进一步下降,但能显著延长吸入ＮＯ对肺动脉压的降压时间（２０倍）,对体循环血压则无影响。结论提供内源性ＮＯ的底物Ｌ－ａｒｇ能延长ＮＯ的降压作用,提示急性缺氧时ＮＯ的生成可能有相对不足。     

前列腺素E1与氨力农治疗肺动脉高压疗效比较

目的：比较前列腺素E1与氨力农在缺氧性肺动脉高压动物治疗中，对血流动力学和血气分析的作用。方法：测定缺氧性肺动脉高压的小猪用前列腺素E1治疗前后的血流动力学和血气分析的变化，并与用氨力农治疗作比较。结果：用前列腺素E1后，猪肺动脉压比治疗前显著下降（P＜0．01），心搏指数增加（P＜0．05），而血气分析及血压与治疗前比较无变化（P＞0．05）。与氨力农组各项指标比较无差异（P＞0．05）。结论：前列腺素E1与氨力农均能显著降低缺氧性肺动脉高压的肺动脉压，增加心输出量，疗效相仿。     

双向腔肺动脉吻合术后肺血流灌注不足患儿吸入NO的疗效观察

目的探讨双向腔肺动脉吻合术（BCPS）术后肺血流灌注不足患儿吸入一氧化氮（NO）的疗效。方法采用美国Ohemda公司NO吸入治疗仪，通过呼吸机吸入NO2．5～20．0／百万，监测血流动力学和呼吸功能指标，定期监测NO2、高铁血红蛋白（MetHb）含量。结果吸入NO后，中心静脉压，跨肺压，肺泡-动脉氧分压差，呼吸指数降低（P〈0．01）；动脉血氧饱和度，动脉血氧分压与吸入氧浓度之比上升（P〈0．01）。NO2和MetHb含量分别为（0．1±0．2）百万和（1．1±0．3）％，均在安全范围内。术后3d复查血小板为（231±84）×10^9／L。未出现血小板减少。术后近期并发低氧血症20例，其中18例改善；低心输出量综合征（低心排）4例；2例颜面部水肿、8例上半身水肿，均改善。术后24h内再手术4例（由全腔肺动脉吻合术改为双向腔肺动脉吻合术）。死亡2例，病死率5％，死亡原因为低心排、低氧血症。结论外源性吸入NO用于BCPS术后肺血管阻力暂时性增高的患儿，可改善其肺血流灌注和氧合功能，减少低心排的发生，是一种安全且有效的选择性肺血管扩张剂。     

硫酸镁及腺苷对狗急性缺氧性肺动脉高压的影响

给狗静脉输注含硫酸镁生理盐水,肺体循环的阻力及压力均呈剂量依赖性降低,输注Mg-SO_4 4 mg/(kg.min)30 min后,肺血管阻力由给药前的 93.0±5.7降至 76.5±6.5 kPa·s~(-1)/L,体血管阻力则由 938.0±53.0降至 791.0±79.0 kPa·s~(-1)/L;并伴有动脉血浆TXB_2 浓度下降。硫酸镁还可抑制缺氧性肺血管收缩反应(HPV),输注 MgSO_4 1 mg/(kg.min)30 min后虽然基础 PVR无变化,但缺氧所致△PVR％降至18.2±8.5％,明显低于给药前(40.1±8.4％);但对动脉血浆6-酮(keto)-PGF_(1α)及TXB_2 变化无影响。腺苷降低肺、体血管阻力,但因心输出量增加使肺动脉压升高;腺苷对HPV没有影响。     

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.