非体外循环冠状动脉旁路移植术中血流动力学变化及处理

目的:观察非体外循环冠状动脉旁路移植术中的血流动力学变化,探讨维持血流动力学稳定的管理措施。方法:从我院择期行非体外循环冠状动脉旁路移植术的病人中选择60例病人。在围手术期记录以下各时间点的血流动力学数值:诱导后15min(T1)、前降支吻合时(T2)、左回旋支吻合时(T3)、右冠状动脉吻合时(T4)、术毕(T5)。结果:吻合前降支时,除心脏指数(CI)较基础值(诱导后15min)轻度下降,平均肺动脉压(mPAP)和肺循环阻力(PVR)较基础值轻度升高外(P均0.05),其他指标无明显改变。吻合右冠状动脉时,CI较基础值明显下降,心率(HR)、中心静脉压(CVP)、mPAP、PVR明显升高,体循环阻力(SVR)轻度升高(P均0.05)。吻合左回旋支时,CI、平均动脉压(MAP)、右心室射血分数(RVEF)较基础值显著下降,HR、CVP、mPAP、SVR、PVR、肺毛细血管楔压(PCWP)较基础值明显升高(P均0.05)。术毕各指标趋于正常,HR明显升高,mPAP和PVR稍升高,CI较术前明显升高(P0.05)。结论:非体外循环冠状动脉旁路移植术中OP-CAB吻合前降支时对血流动力学影响较小,而吻合右冠状动脉和左回旋支时对血流动力学有明显的影响,术毕各血流动力学指标趋于正常,心脏功能有改善。     

丹参酮ⅡA磺酸钠对急性心力衰竭患者血流动力学和血管内皮功能的影响

目的探讨丹参酮ⅡA磺酸钠对急性心力衰竭患者血流动力学和血管内皮功能的影响。方法选取2012年东风总医院收治的急性心力衰竭患者98例,按照随机数字表法分为对照组与观察组,每组49例。对照组患者在常规治疗基础上给予美托洛尔治疗,观察组患者在对照组治疗基础上给予丹参酮ⅡA磺酸钠治疗;7 d为1个疗程,两组患者均连续治疗两个疗程。比较两组患者治疗前和治疗24 h后血流动力学指标〔中心静脉压(CVP)、肺循环阻力(PVR)、体循环阻力(SVR)、平均肺动脉压(MPAP)〕,治疗前后心功能指标〔左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、每搏输出量(SV)、左心室射血分数(LVEF)〕和血管内皮功能指标〔内皮素1(ET-1)和一氧化氮(NO)〕,临床疗效及治疗期间不良反应发生情况。结果治疗前两组患者CVP、PVR、SVR、MPAP比较,差异无统计学意义(P0.05);治疗24 h后观察组患者CVP、PVR、SVR、MPAP低于对照组(P0.05)。两组患者治疗前后LVEDD、LVESD及治疗前SV、LVEF比较,差异无统计学意义(P0.05);治疗后观察组患者SV和LVEF高于对照组(P0.05)。治疗前两组患者血浆ET-1和NO水平比较,差异无统计学意义(P0.05);治疗后观察组患者血浆ET-1水平低于对照组,血浆NO水平高于对照组(P0.05)。观察组患者临床疗效优于对照组(P0.05);治疗期间两组患者均未出现严重不良反应。结论丹参酮ⅡA磺酸钠治疗急性心力衰竭的临床疗效确切,能有效改善急性心力衰竭患者血流动力学及血管内皮功能,且安全性较高。     

静脉注射利喜定(乌拉地尔)治疗老年充血性心力衰竭的临床观察

目的 观察利喜定（乌拉地尔）治疗充血性心力衰竭（CHF）的疗效.方法 选择CHF患者30例,给予利喜定静脉注射,用药前后测定患者心率（HR）、血压（BP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）、心排血量（CO）、体循环阻力（SVR）、肺循环阻力（PVR）、及心排指数（CI）,并观察CHF临床症状的变化.结果 30例患者中,有26例用药后出现MPAP、PCWP、SVR、PVR降低（P＜0.01）,CI增加（P＜0.05）,HR、BP无明显变化,CHF的临床症状改善,4例患者无效,总有效率为86.7%.无反射性心动过速等不良反应出现,副作用小.结论 利喜定能有效地改善CHF患者血流动力学与临床症状,不良反应小,疗效确切,是治疗CHF的一种理想药物.     

成人活体肝移植患者术中血流动力学变化观察

目的 探讨成人活体肝移植患者术中血流动力学的变化规律.方法 实施成人活体肝移植术的患者42例,记录并分析术中不同时刻的血流动力学指标变化情况.结果 切肝期血流动力学相对平稳;阻断后,平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺动脉毛细血管楔压(PCWP)和心排血量(CO)剧烈下降(P＜0.01),HR和每搏变异度(SVV)显著增加(P＜0.01);腔静脉开放后,除HR和SVV外所有指标均能恢复到阻断前水平;门静脉开放后,发生MAP和CO剧烈下降,而MPAP、CVP和PCWP显著升高,伴HR减慢,除HR外所有指标与阻断前有显著差异(P均＜0.01).结论 成人活体肝移植术中血流动力学变化以无肝期和新肝早期为著,与肝血管的阻断和开放以及再灌注综合征的发生有关.     

观察阿托伐他汀治疗肺动脉高压的初步疗效

目的评价国产阿托伐他汀钙治疗肺动脉高压(PAH)的疗效。方法入选2006年1月至2009年1月间在我院住院的43例PAH患者(包括先天性体肺分流导致的PAH 25例,特发性PAH 12例,结缔组织病相关的PAH6例)。患者随机分为两组:国产阿托伐他汀钙组(A组,21例)及常规治疗组(22例)。两组均接受常规治疗,A组加用国产阿托伐他汀钙20 mg/d。分别观察治疗前、治疗后6个月患者右心导管所测的肺动脉收缩压(SPAP),肺动脉舒张压(DPAP),平均肺动脉压(MPAP),肺毛细血管楔压(PCWP),六分钟步行试验距离,动脉血气分析指标,超声心动图及血生化指标的变化。结果 (1)A组治疗6个月后MPAP(78.48±14.56)mm Hg、PCWP(10.67±6.82)mmHg,均较治疗前[MPAP(78.71±12.25)mm Hg,PCWP(11.81±8.12)mm Hg]及常规治疗组6个月时[MPAP(78.91±13.72)mmHg,PCWP(10.81±7.26)mm Hg]有所降低(P>0.05)。(2)6分钟步行试验距离两组均有所延长,但均无统计学意义:A组治疗6个月后(416.62±16.70)m,治疗前为(412.90±18.59)m(P>0.05);常规治疗组治疗6个月后(415.81±24.90)m,治疗前为(412.14±16.47)m。(3)所有病人未出现明显不良反应(肌肉痛、肌酶及转氨酶升高等)。结论国产阿托伐他汀钙治疗6个月能使PAH患者MPAP、PCWP有所下降,此结果可能与样本量较小,治疗观察时间过短有关,尚需进一步研究。     

不同动脉压水平对老年感染性休克患者血流动力学组织灌注和代谢的影响

目的 观察应用去甲肾上腺素联合多巴酚丁胺(NE+Dobu)在小同平均动脉压(MAP)水平对老年感染件休克患者血流动力学、组织灌注和代谢的影响. 方法 感染性休克患者18例,充分液体复苏后为基础状态,应用NE+Dobu并随机调节剂量,使MAP分别维持在65、75、85mm Hg 3种水平状态,持续4 h,观察不同MAP水平的血流动力学、氧合指标、血乳酸、肾功能和胃黏膜二氧化碳分压变化. 结果 当MAP达75 mm Hg和85 mm Hg时,心脏指数(4.7±0.6和5.1±0.7)、体循环阻力指数(1162±278和1276±319)、氧输送[(697±53)ml·min-1·m-2和(711±68)ml·min-1·m-2]、氧摄取率[(0.28±0.02)%和(0.27±0.02)%],均较MAP为65 mm Hg时[4.0±0.6、1011±225、(634±70)ml·min-1·m-2、(0.25±0.02)%]明显增加(P<0.05);尿量分别为(98±43)ml/h和(91±54)ml/h,较65 mm Hg时(74±49)ml/h有明显增加,但仅MAP75 mmHg时,差异有统计学意义(P<0.05). 结论 老年感染性休克患者充分液体复苏后,应用NE+Dobu提高MAP达75 mm Hg时,可改善全身血流动力学和肾功能,对于老年感染性休克患者可能需要适当提高MAP.     

腹腔高压对呼吸力学及血流动力学的影响

目的:评估腹腔高压对呼吸力学及血流动力学的影响。方法:30例择期行腹腔镜胆囊切除术的患者,利用气腹建立腹腔高压人体模型,采用自身对照试验,分别观察腹腔高压前(T0,即腹腔压力正常时)、腹腔高压中(T1,即12 mm Hg腹腔内压维持10 min时)呼吸力学及血流动力学指标的变化。结果:与T0比较,T1气道峰压(Peak)、平台压(Plat)明显升高(均P0.05),但两者之差没有明显变化,同时呼吸系统顺应性显著降低(P0.05);中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)、每搏变异率(SVV)及外周血管阻力(SVR)明显升高(均P0.05),但每搏输出量(SV)明显降低(P0.05)。结论:腹腔高压显著改变患者的呼吸力学及血流动力学指标。     

重组人脑利钠肽联合硝普钠治疗急性失代偿性心力衰竭的疗效评价

目的观察国产重组人脑利钠肽(rh-BNP)联合硝普钠治疗急性失代偿性心力衰竭(ADHF)的疗效及安全性。方法选择ADHF住院患者200例,心功能(NYHA)Ⅲ~Ⅳ级,随机分为试验组(rh-BNP+硝普钠治疗)100例,对照组(硝普钠治疗)100例,分别静脉滴注48h。观察给药前后血流动力学改变、临床症状、心脏超声变化,记录不良事件。结果与对照组比较,试验组给药1h后平均肺毛细血管楔压[MPCWP,(19.09±3.33)mm Hg(1mm Hg=0.133kPa)vs(24.62±5.15)mm Hg,P<0.05]、平均肺动脉压[(26.71±2.92)mm Hg vs(35.67±4.22)mm Hg,P<0.05]、心输出量[(3.57±0.53)L/min vs(3.15±0.40)L/min,P<0.05]有显著差异。2组MPCWP和心输出量的差异持续至给药4h(P<0.05);试验组与对照组第1天(24h)总尿量比较有统计学差异[(2410.00±826.88)ml vs(2110.00±768.64)ml,P<0.05];试验组全身临床症状变化比例在给药1h高于对照组(99.0%vs 82.0%,P<0.05),试验组较对照组LVEF明显升高(P<0.05)。结论rh-BNP和硝普钠联合治疗ADHF能更快更显著改善患者的血流动力学指标,增加尿量,改善临床症状,提高LVEF,耐受性和安全性良好。     

急性肺血栓栓塞症犬模型的建立

目的通过股静脉注入自体血栓,建立急性肺血栓栓塞症犬模型。方法选择杂种犬22只,由股静脉注入条形自体血栓,制成肺血栓栓塞症模型。监测注栓前、注栓后、造模后2h、造模后3h的血流动力学,检测平均肺动脉压(mPAP)、肺血管阻力(PVR)、心输出量(CO);行肺动脉造影,并使用改良Miller指数(MMI)进行量化评分。结果注栓后mPAP、PVR较注栓前明显升高[(26.01±6.34)mm Hg vs(15.62±2.30)mm Hg,1mm Hg=0.133kPa;(695.30±238.68)dyn/(s·cm5)vs(281.24±93.39)dyn/(s·cm5),1dyn=10-5 N,P0.01)],CO较注栓前明显降低[(2.25±0.38)L/min vs(2.96±0.97)L/min,P0.01)]。造模后2h和3h血流动力学指标与注栓后比较,差异无统计学意义(P0.05)。注栓后MMI升至(17.23±6.47)分,与mPAP呈正相关(r=0.723,P0.01)。结论 40ml自体血体外形成血凝块经股静脉注入,能模拟急性肺血栓栓塞症血流动力学、影像学和病理学变化,是良好的急性肺血栓栓塞症犬模型。     

心脏移植术后早期静脉注射依诺前列环素(Iloprost)对血流动力学的影响

目的:通过在同种异体原位心脏移植术后早期病人静脉持续注射依诺前列环素(Iloprost),观察用药前后体／肺循环血流动力学变化,寻找对术前合并肺动脉高压的心脏移植病人术后治疗的有效方案。方法:7例术前合并肺动脉高压的同种异体原位心脏移植病人,当术后早期肺动脉收缩压大于45 mmHg(1 mmHg= 0．133 kPa)时,开始静脉持续注射依诺前列环素,共8例次。药物剂量平均为2．2μg／h(1-6μg／h),持续时间平均54小时(36-68小时)。监测并记录用药开始和停药时的心排血指数(CI)、射血分数(EF)、中心静脉压(CVP)、平均肺动脉压(MPAP)、舒张末期心室容量(EDV)、肺循环阻力(PVR)和体循环阻力(SVR)。结果:心排血指数、射血分数、中心静脉压、平均肺动脉压、舒张末期心室容量、肺循环阻力和体循环阻力用药前后均有显著性差异(P<0．05-0.01)。7例病人均存活。结论:静脉持续注射依诺前列环素可以有效的降低术前合并肺动脉高压的心脏移植病人术后早期的肺循环阻力和肺动脉压力,改善血流动力学指标。药物副作用小。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.