心理干预对冠心病患者内皮功能的影响

目的观察心理干预对冠心病（CHD）患者血管内皮功能的影响。方法430例CHD患者随机分为观察组235例和对照组195例,两组患者均给予常规调节血脂、抑制血小板聚集等治疗,治疗组在常规治疗的同时实施支持性心理干预,观察治疗前后两组患者的血管内皮功能变化情况。采用肱动脉超声检查动脉功能进行评价。结果观察组肱动脉管径、血流速度、血流量和扩张性增加,血流阻力降低,肱动脉内膜．中膜厚度变薄;与对照组比较血管内皮功能指标改善明显（P〈0．05）。在反应性充血状态下,观察组肱动脉管径、血流速度、血流量增加,血流阻力降低;而对照组血流速度、血流量、血流阻力、肱动脉管径等指标与治疗前差异无统计学意义（P〉0．05）。结论心理干预可以明显改善CHD患者的血管内皮功能,有助于CHD的治疗。     

七氟烷吸入麻醉复合呼气末正压通气对老年患者呼吸功能的影响

七氟烷是一种血气分配系数较低的吸入麻醉药,苏醒迅速平稳,临床应用广泛.但吸入麻醉药可能改变肺内血流分布,导致通气/血流比值失调和肺内分流量增加.且老年患者肺部术前常存在不同程度的改变,表现为肺部总顺应性降低、肺泡表面活性物质减少等[1].呼气末正压通气(PEEP)在一定程度上增加肺内功能余气量,可纠正不同区域气体分布不均的情况,改善肺通气/血流比值.本研究探讨PEEP在老年患者七氟烷吸入麻醉中对呼吸功能的影响.     

社区脑卒中及脑血管血流动力学与体重指数的关系

目的探讨脑卒中和脑血管血流动力学与体重指数的关系。方法随机抽取广东省恩平市东门、青云、西门、东安4个社区900例≥40岁体重正常、超重、肥胖的居民,分为正常体重组(520例),超重组(320例),肥胖组(60例)。调查其体重指数及腰围、臀围、血压等测量,并测量脑血管血流动力学,探讨脑卒中相关危险因素的情况。结果高血压、糖尿病发病率随体重指数上升而增加(P0.05);脑血管血流动力、脑血管功能总分则随体重指数上升而降低(P0.05)。结论肥胖和超重可致脑血流动力学异常,增加卒中风险。     

实验性低血压脑死亡动物模型早期肝内血流分布及氧代谢的变化

突发性脑死亡后的心肺功能通常发生两个时相的改变:早期与脑疝有关的全身高血流动力相和后期表现为局部低灌流的低血流动力相。脑死亡后的高血流动力相以局部血流灌注增加为特征,被肝内毛细血管血流缓冲并维持在低血流动力相的基值水平。这些内脏血流的改变,即使在严重的低血压时期也不能明显提高氧消耗。研究人员选用成年狗10     

增强型体外反搏在心脏康复中的应用

体外反搏是一种安全、有效、无创的体外辅助循环装置,其通过增加血流切应力、改善血管内皮功能等方面起到抗动脉粥样硬化、改善循环、增加运动耐量、促进侧支循环等效应,在心脏康复治疗中发挥着不容忽视的作用。该文就体外反搏原理、作用机制、临床应用及相关机制等方面进行阐述。     

白川降压胶囊对麻醉犬血流动力学的影响

目的研究白川降压胶囊对麻醉犬血流动力学的影响。方法采用有创血流动力学实验方法,观察不同剂量白川降压胶囊对麻醉犬血流动力学的影响。结果白川降压胶囊大剂量(每公斤体质量0.18g)可明显降低麻醉犬收缩压、舒张压和平均动脉压,并有降低外周血管阻力及冠状动脉阻力、增加冠脉血流量的作用。结论白川降压胶囊有明显降低麻醉犬血压和改善心脏功能的作用。     

舒张性心力衰竭超声心动图评价

目的：探讨超声心动图在评价左心室舒张功能应用价值。方法采用飞利浦 IE-33对1279例临床诊断为充血性心力衰竭的成年患者进行超声心动图检查,评价其左心室舒张功能。结果左室舒张功能不全时,弛张功能减退和心肌僵硬度增加,可通过多普勒超声测量二尖瓣口和肺静脉血流的流速图型中多项血流动力学指标的动态变化来评价。结论左室舒张功能的评价是不可孤立进行的,需要不同的超声心动图和多普勒参数综合分析。     

姜黄素对新西兰大白兔脑缺血再灌注损伤保护作用及缺氧诱导因子-1α表达的影响

<正>姜黄素是从姜科植物姜黄中提取的一种色素,也存在其他姜科植物中[1]。现代研究发现姜黄素可以抑制炎症反应、抗氧化、抗类风湿的作用,其通过抗氧化、清除自由基、诱导细胞间信息传递、抑制增殖、增加免疫力等多种生物样作用,起到防癌抗癌、预防心血管疾病、提高免疫功能和延缓衰老等作用。脑缺血再灌注损伤是脑缺血后脑组织恢复血流时所产生的损伤因子随血流再灌注脑细胞所引起的一种严重损伤的病理生理过程或现象,这其     

早期肠内营养在ICU重症患者的疗效分析

<正>重症监护室(ICU)的危重患者因为严重感染、创伤或者应激等原因使得机体存在高分解代谢,患者会出现营养不良、免疫功能降低、脏器功能损害,病死率增加。肠内营养(EN)和肠外营养(PN)相比较,前者更符合人体生理需求,是改善与维持危重患者最经济的措施。EN支持可直接为肠黏膜提供必需的营养素,增加肠黏膜血流,预防消化道溃疡、临床感染和肠功能衰竭的发生。我院采用两种营养支持方法治疗60例危重症患者,现将结果报道如下。     

血标本放置时间对血浆乳酸值的影响

乳酸是机体无氧条件下糖酵解的终产物,乳酸生成过量或利用不足是造成乳酸中毒的主要原因。高乳酸血症最常见的原因是组织血流低灌注时无氧酵解增加带来的乳酸生成增加加重代谢性酸中毒,常并发于感染、休克、呼衰、心衰以及肝肾功能障碍等常见危重病症,因此在某些病理情况下乳酸的检测非常重要。     

肠道菌群对高血压的作用

肠道微生物对机体的健康起重要作用,肠道菌群失调不仅引起胃肠道疾病,还对包括高血压在内的心血管疾病等造成影响。研究表明,用益生菌或其发酵产品干预后,可以调节肠道微生态,高血压状态也得以改善。关于益生菌降压的机制,有产生肽类等降压物质,改善血管氧化和炎症水平,短链脂肪酸的作用,肠道菌群与神经系统相互作用等。深入研究肠道菌群与高血压的关系,为高血压的营养治疗提供了一种新途径。     

First-Pass Accumulation of Salicylic Acid in Gut Tissue After Absorption in Anesthetized Rat

Purpose. The purpose of this paper is to report the study on the first-pass accumulation kinetics of salicylic acid (SA) in gut tissue after absorption by simultaneously analyzing drug contents in the lumen, gut tissue, and blood in anesthetized rats. Methods. Sodium salicylate (5.4 mg as SA) in 0.4 ml normal saline was administered into a closed 10-cm jejunal loop. Drained mesenteric blood from the loop area was collected every minute, while lost blood was replaced through infusion of oxygenated blood from donor rats. At 3, 10, 20, 40, or 60 min after dosing, SA remaining in lumen, accumulating in gut tissue, and appearing in blood were analyzed by HPLC. All the data were fitted into a linear two-consecutive (lumen and gut tissue) first-order kinetic model. Results. After absorption, significant amounts of SA accumulated in gut tissue before appearing in blood, e.g., at 3 or 20 min after dosing, 74.4 or 54.4% of absorbed SA accumulated in gut tissue, respectively. Practically all administered SA was recovered. The estimated mean absorption time from the lumen and mean transit time in gut tissue of SA were 20.4 and 18.5 min, respectively. Conclusions. The above results indicate that gut tissue may act as a reservoir for drug accumulation during the first pass after oral absorption. Thus, the rate of transport of drug into blood circulation after oral administration may significantly differ from the true rate of absorption through the gut membrane. The potential transport resistance from gut tissue to blood should probably be considered in the modeling of GI absorption.     

κ阿片受体介导的降血压作用

目的观察κ阿片受体激动剂U50488H对大鼠血压的影响并探讨其作用机制。方法监测正常大鼠心率(HR)、动脉压(ABP)、左心室内压(LVP)及左室的收缩(+dp/dtm ax)和舒张功能(-dp/dtm ax)等血流动力学指标和尿量的变化;分离正常大鼠腹主动脉,测定血管张力的变化。结果在整体水平,静脉注射U50488H可降低大鼠HR、ABP、LVP及±dp/dtm ax;而且可增加大鼠的尿量。在离体水平,U50488H对大鼠腹主动脉具有明显的剂量依赖性舒张作用;以上效应均可被选择性κ阿片受体阻断剂nor-BNI所阻断。结论激动κ阿片受体可引起降压作用,抑制心肌收缩力、舒张血管和利尿是其降压的主要机制。     

Effects of U74006F, a novel inhibitor of lipid peroxidation, in stunned reperfused canine myocardium.

U74006F, a novel 21-amino steroid is a potent inhibitor of iron-mediated lipid peroxidation and has been shown to be of therapeutic benefit in central nervous system ischemia. As oxygen radicals have been implicated in the development of postischemic myocardial dysfunction, we examined the efficacy of U74006F to enhance the recovery of function in a canine model of stunned, reperfused myocardium. Twenty-six dogs were randomized to either a vehicle (n = 11), U74006F (n = 10), or U74006F-paced group (n = 5). U74006F (6 mg/kg i.v.) was administered 15 min prior to coronary artery occlusion. Myocardial blood flows were measured by the microsphere technique, and function data were obtained by sonomicrometry. Both U74006F-treated groups demonstrated a significant increase in posterior wall thickening as compared to the vehicle treatment (U74006F-paced, 27.0 +/- 12.8%; U74006F, 22.4 +/- 11%; vehicle, -13.5 +/- 9.9%, p less than 0.001 following 3 h of reperfusion). Enhanced function recovery was accompanied by lower heart rates in the U74006F-treated group following reperfusion (treated versus vehicle, 109 +/- 6.7 versus 131 +/- 8.8 beats/min, p = 0.004). The U74006F-paced group was maintained at the same rate as the vehicle group, with no diminution in function recovery compared to the unpaced group. No effects in systemic hemodynamics or nutrient blood flow were evident as a function of drug treatment. We conclude that pretreatment with U74006F enhances the recovery of function in stunned canine myocardium via the inhibition of oxygen radicals and lipid peroxidation products. This activity suggests that this compound represents a new therapeutic adjunct in reperfusion and recanalization therapies.     

硫唑嘌呤致骨髓抑制及肝损害

1例22岁男性,患肾病综合征3年。因疾病复发使用强的松龙40mg加硫唑嘌呤50mg,2次/d治疗。治疗前血常规和肝功能均正常。治疗2个月后,ALT升至110U/L,遂将硫唑嘌呤剂量改为50mg,1次/d,强的松龙维持原剂量,并加用保肝药物治疗,但肝功能持续异常。3个月后出现高热、头痛、轻度黄疸、全血细胞减少和肝损害加重。血常规：WBC1.40×10^9/L,L0.9657,RBC1.09×10^12/L,Hb35g/L,PLT19.20×10^9/L;肝功能：ALT386U/L,AST303U/L,γ-GT147U/L,TBil102μmol/L,DBil78μmol/L。停用硫唑嘌呤,并给予抗感染、保肝和输血等治疗。30d后患者症状减轻,黄疸渐退,血常规、肝功能恢复正常,出院。     

Reteplase for dysfunctional hemodialysis catheter clearance

STUDY OBJECTIVE: To evaluate the efficacy of reteplase administration in clearing hemodialysis catheters. DESIGN: Open-label, uncontrolled, observational trial. SETTING: University medical center. PATIENTS: Thirty-four patients with end-stage renal disease undergoing long-term hemodialysis. INTERVENTION: Patients had dual-lumen, cuffed, tunneled dialysis catheters placed for long-term vascular access. Reteplase 3 U was instilled into each catheter lumen (total dose 6 U) in the first 20 episodes, 2 U in each catheter lumen (total dose 4 U) in the next 20, and 0.5 U in each catheter lumen (total dose 1 U) in the final 45. MEASUREMENTS AND MAIN RESULTS: Over 12 months, 85 episodes of catheter dysfunction were documented. Catheter dysfunction was defined as absence of flow from the catheter lumen, inability to aspirate heparin from the lumen, blood flow rates below 150 ml/minute, or venous pressure greater than 250 mm Hg at blood flow rates below 200 ml/minute. Reteplase was instilled into the catheter lumens and allowed to dwell there until the next hemodialysis session. Successful catheter recanalization was defined as return of aspiration and infusion function allowing dialysis to be completed at blood flow rates above 300 ml/minute. Reteplase restored catheter function in 74 (87%) instances of catheter dysfunction. In the first 40 episodes in which 4- or 6-U doses were given, catheter function was restored in 36 instances (90%). There was no difference in restoration of catheter function between 4 U (18/20, 90%) and 6 U (18/20, 90%). In the last 45 cases in which 1 U was administered, function was restored in 38 catheters (84%). Mean overall dwell times were not different between the first 40 (32 +/- 7 hrs) and the last 45 episodes (33 +/- 10 hrs). The overall mean duration of catheter patency was 45 +/- 39 days. Durations of patency in the three dose groups were not significantly different (44 +/- 38, 46 +/- 40, 45 +/- 39 days). No patient suffered adverse effects related to reteplase. CONCLUSION: Reteplase installation in dysfunctional hemodialysis catheters was effective in restoring catheter function in 87% of episodes. A dose of 1 U appears to be as effective as 4 and 6 U.     

Targeting nitric oxide in the gastrointestinal tract.

This review discusses the contributions of the three nitric oxide (NO) synthase (NOS) isozymes neuronal NOS (nNOS), endothelial NOS (eNOS) and inducible NOS (iNOS) to the function and diseases of the gastrointestinal tract. Small (nanomolar) quantities of NO produced by calcium-dependent nNOS play a physiological role in peristalsis and sphincter function of the intestine. Decreased nNOS function can result in aperistalsis and obstructive sphincters. NO produced by eNOS dilates mucosal blood vessels and prevents leukocyte aggregation, and is therefore essential for the maintenance of mucosal blood flow. Absence of eNOS-derived NO results in an increased susceptibility of the gastrointestinal tract to injury. Selective NO delivery by gene therapy or NO-donating compounds may offer new therapeutic options in motility disorders of the gut and the prevention of mucosal injury. The effects of large (micromolar) amounts of NO as produced by iNOS are less well understood. Large amounts of NO can increase gut permeability, induce apoptosis and stimulate intestinal secretion, while NO can also kill bacteria, block apoptosis and reduce inflammation by inhibiting activation of nuclear factor-kappaB (NFkappaB). Lumenal donation of NO could therefore block NFkappaB activation and be a treatment option in inflammatory conditions of the bowel.     

Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery - a double-blind study

Aliment Pharmacol Ther 2011; 33: 50–63

Summary

Background Infection following abdominal operation remains a major factor affecting the morbidity of patients after surgery. Aim To determine the effects of perioperative administration of probiotics on the gut barrier function and the surgical outcome in patients undergoing elective colorectal surgery. Methods One hundred patients with colorectal carcinoma were randomly divided into the control group (n = 50) and the probiotics group (n = 50). The probiotics were given orally for 6 days preoperatively and 10 days post‐operatively. Outcomes were measured by bacterial translocation, gut permeability, the effect on the faecal microbiota, and the clinical outcomes such as infectious‐related complications and gut defecation function. Results Compared with the control group, probiotics group had increased transepithelial resistance (P < 0.05), reduced transmucosal permeation of horseradish peroxidase and lactulose/mannitol ratio, reduced bacterial translocation (P < 0.05), decreased ileal‐bile acid binding protein (P < 0.05) and positive rate of blood bacterial DNA (P < 0.05) and an enhanced mucosal tight junction protein expression. They had decreased blood enteropathogenic bacteria and increased faecal bacterial variety. The post‐operative recovery of peristalsis, incidence of diarrhoea, and infectious‐related complications were also improved. Conclusion Probiotics can improve the integrity of gut mucosal barrier by benefiting the faecal microbiota, and decreasing infectious complications in patients with colorectal cancer undergoing colorectomy.     

Pharmacological modulation of gut mucosal and large vessel blood flow

BACKGROUND: Constipation, diminished gut blood flow, ischaemic colitis and drug therapy may be associated. AIM: To study the effect of constipating medication on, and the regulation of, gut blood flow. METHODS: 24 healthy females (mean age 30) received, in a double-blind, three-way crossover study: (i) placebo, (ii) ipratropium 40 microg by inhalation (positive control known to reduce rectal mucosal blood flow) and (iii) oral loperamide 4 mg. Mucosal blood flow was measured at the splenic flexure and rectum using laser Doppler flowmetry. Blood flow in the superior and inferior mesenteric arteries was measured by trans-abdominal Doppler ultrasound. RESULTS: Ipratropium decreased rectal mucosal blood flow by 16% (P=0.009) and splenic flexure mucosal blood flow by 8% (P=0.075). Loperamide caused no change in rectal (P=0.40) or splenic flexure mucosal blood flow (P=0.73). Neither treatment changed superior or inferior mesenteric artery blood flow. Splenic flexure mucosal blood flow showed a positive correlation with rectal mucosal blood flow (r=0.69; P<0.0001). CONCLUSIONS: Vasoactive agents may reduce gut mucosal blood flow in the absence of reduced large vessel flow. Constipating drugs do not necessarily reduce gut blood flow. Rectal mucosal blood flow correlates with splenic flexure mucosal flow, and potentially may be used as a more convenient surrogate for studying splenic flexure blood flow.     

The effects of Ginkgo biloba extracts on the pharmacokinetics and pharmacodynamics of donepezil

The effects of ginkgo supplementation on the steady-state plasma concentration of donepezil and the activity of cholinesterase in red blood cells and cognitive function were examined. Fourteen inpatients with Alzheimer's disease received donepezil 5 mg/day, supplemented with extracts of Ginkgo biloba 90 mg/day for 30 days. Blood samples were collected before and during ginkgo supplementation and 30 days after its discontinuation, together with an assessment of cognitive function. Plasma drug concentration was measured using high-performance liquid chromatography (HPLC), and cholinesterase in red blood cells was measured using Ellman methods. Cognitive function was evaluated using the Mini-Mental Scale Examination (MMSE). Plasma concentration of donepezil during ginkgo supplementation (mean +/- SD [95% confidence interval]; 24.4 +/- 12.6 ng/mL [17.1-31.7 ng/mL]) was not significantly different from that before ginkgo supplementation (22.7 +/- 10.3 ng/mL [16.8-28.7 ng/mL]) or that 4 weeks after its discontinuation (25.0 +/- 12.9 ng/mL [17.6-32.4 ng/mL]). There was no significant difference between cholinesterase in red blood cells before ginkgo supplementation (1.75 +/- 0.21 U [1.63-1.87 U]), during ginkgo supplementation (1.91 +/- 0.27 U [1.76-2.07 U]), and 4 weeks after its discontinuation (1.83 +/- 0.29 U [1.66-2.00 U]). Ginkgo supplementation did not alter MMSE scores throughout the study. The present study shows that ginkgo supplementation does not have major impact on the pharmacokinetics and pharmacodynamics of donepezil.