兔红细胞免疫功能在高压氧治疗后的变化及其临床意义

目的探讨高压氧(HBO)治疗对红细胞免疫功能的影响.方法20只家兔HBO治疗(在0.15 Mpa下吸纯氧≥99.6%2 h)前1天及连续HBO治疗10 d后的第1、第5、第10天,采用酵母菌花环试验测定红细胞C3b受体花环率(RCR)及红细胞促中性粒细胞吞噬率(ERPN).结果与HBO治疗前比较,HBO治疗结束后第1天,RCR及ERPN均显著增高,P＜0.01;HBO治疗结束后第5天,RCR及ERPN开始下降,P＜0.05,仍有显著差异,HBO治疗结束后第10天,RCR及ERPN进一步下降接近HBO治疗前水平,P＞0.05,无显著差异.结论HBO治疗能显著提高红细胞免疫功能.     

神经元特异性烯醇化酶在新生儿HIE及高压氧治疗的临床研究

目的：动态观察神经元特异性烯醇化酶在新生儿缺氧缺血性脑病（HIE）时及高压氧治疗前后水平的变化,以探讨在临床中的意义。方法：应用双抗体夹心法测定HIE病人于入院24h,3d,5d及高压氧治疗前后血清中NSE浓度与对照组比较。结果（1）ME患者24h,3d时血清NSE水平显著高于对照组,P＜0．05,5d时与对照组无差异,P＝0．756。（2）24h血清NSE含量显著高于3d,5d,P=0.0002,3d时血清NSE含量显著高于5d,P=0.038。（3）高压氧治疗后血清中NSE含量显著降低,P＝0．027,结论（1）HIE时血清中NSE含量明显增高,且其升高程度与病情危重程度密切相关。（2）高压氧对治疗HIE有较好的效果,且可改善预后,但一个疗程以不超过五次为宜。     

Postprandial impairment of resistance vessel function in insulin treated patients with diabetes mellitus type-2.

Reduced postischaemic reactive hyperaemia, is considered a marker of impaired resistance vessel function. Acute postprandial hyperlipidaemia has been shown to induce vascular dysfunction. In the present study, the impact of postprandial hyperglycaemia on resistance vessel reactivity was investigated in insulin treated type-2 diabetic patients. The study was performed in 16 insulin treated type-2 diabetics (eight male/eight female, age 47 +/- 3 years, HbA1c 7.2 +/- 0.2) and 16 controls. Reactive hyperaemia was measured in the forearm by venous occlusion plethysmography after 5 min of ischaemia in the fasting state and 90 min after a test meal. In diabetics, blood glucose increased from 8.7 +/- 1.1 to 15.3 +/- 1.0 mmol l-1 (P<0.001) postprandially. This resulted in (i) a significant increase of resting blood flow (3.4 +/- 0.3 to 4.8 +/- 0.4 ml min-1 100 ml-1, P<0.01) and (ii) in a reduced peak reactive hyperaemia (52.3 +/- 7.4 to 36.8 +/- 4.3 ml min-1 100 ml-1, P<0.005). In controls, a similar effect of the meal on resting flow was observed but reactive hyperaemia was unaltered. In the absence of a test meal, basal flow as well as peak reactive hyperaemia remained unchanged in diabetic as well as in non-diabetic subjects. Our data provide evidence that in the postprandial state resistance vessel reactivity becomes reduced in insulin treated type-2 diabetic patients.     

高压氧在肢体创伤术后辅助治疗疗效观察

目的探讨高压氧辅助治疗对肢体创伤术后促进组织修复的临床治疗价值。方法将268例肢体创伤术后的患者分成两组,其中对照组136例,采用常规治疗。治疗组132例,采取在常规治疗的基础上辅助高压氧治疗。结果治疗组的治愈率为73．48％,高于对照组的57.35％（P〈0．05）;治疗组的显效率为22．72％,高于对照组的19．12％（P〈0．05）;治疗组的总有效率为96．2％,高于对照组的76．47％（P〈0．05）。结论肢体创伤术后辅助高压氧治疗,可明显减轻组织的炎症反应及感染,改善微循环,减轻组织水肿,促进创伤肢体愈合,提高治愈率。     

妊娠糖尿病营养治疗的研究

妊娠糖尿病系高危妊娠,它严重危害母儿的健康。近年来,随着我国社会经济发展及人们生活方式的改变,妊娠糖尿病患者不断增加。而营养治疗作为妊娠糖尿病治疗的基础,越来越受到人们的重视。营养治疗包括：营养宣教、饮食治疗、血糖监测、产后管理等内容。适宜的营养治疗可以控制血糖,减少孕期并发症的发生,改善妊娠结局。     

Exocrine pancreatic function in diabetes mellitus

An investigation of serum immunoreactive trypsin concentration and pancreatic isoamylase activity in patients with diabetes mellitus has shown that exocrine pancreatic deficit is maximal in insulin dependent diabetics, intermediate in those controlled with sulphonylureas, and absent in patients controlled with biguanides or diet or both. A significant correlation between the serum concentrations of both these pancreatic enzymes and C peptide was found. Serum pancreatic enzyme concentrations were not related to glycosylated haemoglobin concentrations, the dosage of insulin, or the age of onset of diabetes. The concentration of immunoreactive trypsin was found to be low in most of the insulin dependent diabetics in whom this enzyme was measured at the time of the clinical onset of diabetes. Thus exocrine pancreatic deficit in diabetes closely parallels the endocrine beta cell deficit and occurs concurrently with, or antedates, the clinical presentation of type I diabetes. It is therefore possible that in type I diabetes similar mechanisms are entailed in the pathogenesis of impaired endocrine and exocrine pancreatic function.     

高压氧治疗用于烧伤患者皮瓣移植术后创面愈合治疗效果的Meta分析

目的探讨烧伤创面经皮瓣移植术后应用高压氧治疗创面愈合治疗效果的Meta分析。 方法检索自建库以来至2019年7月25日烧伤患者皮瓣移植术后高压氧治疗的相关文献,数据库包括PubMed、Cochrane library、中国知网、维普中文科技期刊全文数据库、万方医学网、中国生物医学文献数据库等,并提取相关试验数据,纳入Meta分析。由2位研究人员独立按照纳入与排除标准实施文献筛选和数据收集。结局指标：皮片存活率、血氧饱和度、皮温、肿胀消退时间、皮肤红润时间以及皮瓣移植术后HBO的治疗时机。应用Revman 5.3软件进行荟萃分析。 结果纳入研究的12项研究偏倚风险均不确定。其中,对皮瓣移植术后HBO治疗与术后常规治疗的临床对照研究纳入11篇文献,根据不同干预措施分为实验组和对照组。2组皮片成活率比较,差异有统计学意义[RR＝1.30, 95%CI(1.23, 1.37),P<0.0001];2组血氧饱和度比较,差异有统计学意义[MD＝19.94, 95%CI(18.16, 21.72),P<0.0001];2组皮温比较,差异有统计学意义[SMD＝3.27,95%CI (2.66, 3.89),P<0.0001];2组肿胀消退时间比较,差异有统计学意义[MD＝-3.76,95%CI(-4.43, -3.18),P<0.0001];2组皮肤红润时间对比,差异有统计学意义[MD＝-4.56,95%CI(-5.28, -3.84),P<0.0001 ]。对皮瓣移植术后HBO治疗时机的研究共纳入5篇文献,根据术后高压氧治疗开始时间,分为术后立即行高压氧治疗组,术后10～48 h内行高压氧治疗组与术后48 h后行HBO治疗组,3组有效率比较,差异有统计学意义(P<0.00001),术后立即行高压氧治疗组皮瓣存活率高于术后10～48 h内行高压氧治疗组和术后48 h后行HBO治疗组[RR＝1.07、1.23,95%CI(1.01,1.13)、95%CI(1.12,1.25),P＝0.02、<0.0001];术后10～48 h内行高压氧治疗组和术后48 h后行HBO治疗组比较差异有统计学意义[RR＝1.14,95%CI (1.03,1.27),P＝0.01]。 结论烧伤患者皮瓣移植术后应用高压氧治疗,与传统的常规治疗相比,可以提高患者的皮片存活率,增强创面的血氧饱和度,保持创面皮温正常。同时还可以减轻创面红润时间,缩短肿胀时间,改善皮瓣的缺氧状态,增强移植皮瓣的生长活力,改善组织创面微环境。皮瓣移植术后立即内开始使用高压氧治疗,其效果优于24 h内和48 h后使用高压氧治疗。故高压氧辅助治疗可显著提高皮瓣存活率,术后应尽早使用。     

A role for oxygen-induced osmosis in hyperbaric oxygen therapy.

The principles of gas-induced osmosis, demonstrated in the 1970s, have been applied to the very large steady-state gradients of O2 arising between arterial blood and hypoxic tissue during hyperbaric oxygen (HBO) therapy to produce a fluid 'pump' in the desired direction for resolving accompanying oedema. Thus, in soft-tissue injuries, an oxygen-induced fluid pump would break the vicious cycle between ischaemia, hypoxia and oedema at the point of oedema rather than hypoxia, as hitherto assumed. This osmotic mechanism enables the successes of HBO therapy in hypoxic disorders to be reconciled with early failures in such areas as hyperbaric radiotherapy, where substitution of O2 for N2 in inspired air was clearly not reflected at the tissue level. This argument also applies to the success of HBO in treating air embolism and decompression sickness over simple compression. The oxygen pump would seem to offer a more plausible explanation for the success of HBO therapy than theories based upon O2 delivery by the circulation, especially when considering cardiovascular reflexes to elevated PaO2 and the marginal increase in blood O2 content upon switching to HBO from normobaric oxygen breathing.     

硫酸软骨素酶ABC联合高压氧预处理对脊髓损伤大鼠后肢运动功能的影响

目的探讨硫酸软骨素酶ABC(ChABC)联合高压氧预处理对成年大鼠脊髓损伤后不同时期后肢运动功能及腓肠肌运动终板内乙酰胆碱酯酶(AChE)含量的影响。方法雌性成年Wistar大鼠80只,体重250～300g,随机分为假手术组(Sham组)、脊髓损伤组(SCI组)、高压氧预处理组(HBOP组)、高压氧预处理后硫酸软骨素酶ABC治疗组(HBOP+ChABC组)各20只。采用脊髓半横断法制作模型,分别于伤后3d、7d、14d和28d随机选取5只大鼠,采用BBB评分(Basso,Beattie and Bresnaban score)法进行行为学观察,评分后经灌注固定,取大鼠患侧下肢腓肠肌,进行酶化学染色并应用Image-Pro Plus 6.0图像分析系统测量腓肠肌中AChE染色阳性部位平均光密度值(AOD值)。结果 Sham组大鼠BBB评分及AChE活性明显高于SCI组(P<0.01),HBOP组与HBOP+ChABC组在术后14d之后BBB评分明显高于SCI组(P<0.05),CHABC+HBOP组在术后28天BBB评分高于HBOP组(P<0.05)。HBOP组患侧腓肠肌AchE活性高于SCI组,HBOP+ChABC组高于HBOP组(P<0.05)。结论高压氧预处理可以改善大鼠患肢的运动功能和提高AChE的活性,联合硫酸软骨素酶ABC作用更强。     

高压氧对小鼠脑缺血再灌注损伤的保护作用

目的探讨高压氧（HBO）对脑缺血再灌注小鼠神经元的保护作用。方法选取昆明小鼠27只，采用无创微动脉夹阻断双侧颈总动脉血流的方法建立脑缺血再灌注模型。采用HE染色、透射电镜观察脑缺血再灌注小鼠神经元的损伤及HBO干预后的改变，结果光镜显示3组小鼠额叶皮层及海马有不同程度的神经细胞变性、坏死；实验组与对照组异常细胞数比较羞异有统计学意义（P〈0．05）：同组小鼠的皮质和海马比较差异无统计学意义（P〉0．05）。电镜观察显示再灌注后额叶皮质及海马有不同程度的神经元变性、坏死，实验组损害明显减轻，与对照组比较差异有统计学意义（P〈0．05）；同组小鼠的皮质和海马损伤程度比较差异无统计学意义（P〉0．05）。结论HBO治疗可对小鼠脑缺血再灌注损伤具有保护作用．可促进损伤的修复。