亚低温对重型颅脑伤患者血清细胞因子的影响

目的 探讨亚低温治疗对重型颅脑损伤患者血清中肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-1β、IL-6、IL-8的影响及临床意义。方法 选择符合条件的重型颅脑损伤患者[格拉斯哥昏迷评分（GCS）3～8分]共23例，于伤后24h内行亚低温治疗，控制直肠温度33～35℃，持续5d；对照组20例（GCS3～8分）。采用酶联免疫吸附法（ELISA）监测两组患者外周血清TNF-α、IL-1β、IL-6、IL-8在伤后第1，2，3，4天的动态变化。结果 亚低温治疗组患者血清TNF-α、IL-1β、IL-6、IL-8浓度较常规治疗组明显降低（P〈0．05）。结论 亚低温通过降低重型颅脑损伤患者血清中细胞因子的水平，减少了患者多器官功能障碍综合征的发生。     

高压氧血颈动脉灌注治疗重型颅脑损伤的临床研究

目的研究高压氧血颈动脉灌注在重型颅脑损伤治疗中的作用。方法对22例重型颅脑损伤患者于伤后约3．5d行高血氧颈动脉灌注治疗，监测灌注前、中、后的脑组织氧分压（PbtO2）、二氧化碳分压（PbtCO2）、pHbt值变化以及伤后3个月格拉斯哥预后评分（GOS）的情况。结果患者高血氧颈动脉灌注治疗后比治疗前的PbtO2升高（P〈0．05）。与对照组相比，患者的PbtO2升高，3个月后的GOS改善（P〈0．05）。结论高血氧颈动脉灌注在重型颅脑损伤的早期治疗中起着积极和重要的作用。     

纳洛酮不同剂量、不同给药方式对急性重型脑伤患者脑功能的影响

目的：通过定量脑电图监测，探讨急性重型脑伤纳洛酮治疗不同给药方式对脑功能的影响。方法：选择受伤后12小时内入院的急性脑损伤58例，按伤情轻重分为GCS3－5分、GCS6－8分组。选用不同剂量、不同给药方式：2mg或4mg静推（A或B组），4．8mg/d或0．3mg(kg.d）持续静滴（C或D组），用定量脑电图监测，观察用药前、用药后10、30分钟、1、2、4小时脑电总功率值的变化。结果：GCS6－8分组：A组或B组纳洛酮用药10分钟后总功率值明显高于用药前（P＜0．01），2小时后明显下降；C、D组用药后1小时或30分钟后总功率值明显高于用药前,明呈持续性升高，多数时段P＜0．01。GCS3－5分组，纳洛酮用药后总功率值增加与用药前比较无统计学差异，P＞0．05。结论：重型脑伤急性期纳洛酮治疗宜选用首剂负荷量法。     

亚低温对完全性脑缺血再灌注后丙二醛含量和超氧化物歧化酶活性的影响

目的：观察完全性脑缺血再灌注后全脑亚低温对脑组织丙二醛（ＭＤＡ）含量和超氧化物歧化酶（ＳＯＤ）活性的影响．方法：将１７只犬随机分为三组：非缺血对照组、缺血对照组和亚低温治疗组，采用谭秀娟等建立的心脏停跳复苏动物模型，于心肺复苏后４小时取脑组织测定ＭＤＡ含量和ＳＯＤ活性．结果：全脑缺血１０分钟后再灌流４小时，脑组织ＭＤＡ含量明显上升（Ｐ＜０．０１），ＳＯＤ活性下降（Ｐ＜０．０１）；而３４℃亚低温治疗组与缺血对照组比较，ＭＤＡ含量明显下降（Ｐ＜０．０１），ＳＯＤ活性上升（Ｐ＜０．０１）．结论：完全性脑缺血再灌注后全脑亚低温可抑制脑内脂质过氧化反应，保护脑组织自身抗氧化能力，有利于脑复苏．     

亚低温治疗重度弥漫性轴索伤的临床研究

目的 旨在探讨亚低温对重度弥漫性轴索伤（DAI）的治疗作用及患者颅内压、预后的关系。方法 本组观察了80例重度弥漫性轴索伤,在常规治疗的同时,对60例亚低温治疗。80例重度DAI患者分为亚低温和常温两组,所有患者均行颅内压监护5－7天。全部患者于伤后3个月行GOS评分判断预后。结果 在亚低温组,其颅内压明显低于对照组（P＜0．05）;亚低温组的死亡率为26．7％,而常温治疗组为55％（P＜0．05）。结论 重度DAI后,不仅应及时诊断,而且要尽早应用亚低温治疗、尽早降温。亚低温治疗有明显降低颅内压的疗效。亚低温治疗可以明显提高重度DAI患者的生存率和生存质量,降低DAI的死亡率和伤残率。     

亚低温治疗对重型颅脑损伤脑脊液乳酸及酸碱平衡的影响

目的　对重型颅脑损伤患者在亚低温治疗过程中的脑脊液PO2 、PCO2 、pH值、乳酸水平及动脉血pH值进行监测分析 ,探讨亚低温治疗对重型颅脑损伤脑脊液酸碱平衡的影响。方法　收集 4 2例重型颅脑伤 (GCS≤ 8分 )患者 ,平均年龄 4 1 .7岁。亚低温组于伤后 1 2小时内实施亚低温治疗 (32～ 34℃ ) ,时程 3～ 5天 ;对照组给予常规治疗。两组均于降温前、降温 2 4、4 8、72小时各时段测定脑脊液PO2 、PCO2 、pH值、乳酸水平及动脉血pH值 ,并进行统计学分析。结果　脑温及体温的变化对血pH值影响不大。血pH值大致波动在正常范围 ,而脑脊液pH值始终低于正常。各时段的脑脊液pH值均明显低于血pH值 (P <0 .0 5 )。亚低温组和对照组在降温前时段 ,脑脊液PO2 、PCO2 、乳酸水平无显著性差异 (P >0 .0 5 ) ;降温 2 4、4 8、72小时时段 ,亚低温组脑脊液PO2 、PCO2 、乳酸水平明显低于对照组。结论　亚低温治疗在降低重型颅脑损伤 (GCS≤ 8分 )患者脑脊液PO2 的同时 ,也降低了脑脊液PCO2 、乳酸水平 ,但不能改善脑脊液的低pH值状态     

重型颅脑损伤亚低温治疗的临床效果观察

目的观察重型颅脑外伤后应用亚低温治疗的护理方法。方法54例重型颅脑外伤患者分为治疗组和对照组,两组病人入院后均行吸氧、脱水、利尿、手术、止血、抗炎等常规治疗,治疗组在常规治疗的基础上行亚低温治疗。结果治疗组有效率为85．18％,对照组有效率59．25％,治疗组明显优于对照组,差异具有显著性（P〈0．05）。结论亚低温具有脑保护作用,对于重型颅脑损伤患者重视护理,能提高患者的生存率。     

亚低温对重型颅脑伤患者血糖和糖代谢相关激素水平的影响

目的　研究亚低温治疗对重型颅脑损伤患者糖代谢相关激素的影响及其意义。　方法　亚低温治疗组选择符合条件的重型颅脑损伤患者（GCS3～8分）共24例,于伤后24h内行亚低温治疗,控制直肠温度33～35℃,持续3～5d;对照组21例（GCS3～8分）。两组患者伤后急性期（＜48h）清晨空腹抽取静脉血标本,采用放射免疫分析法检测血清中胰岛素、皮质醇及生长激素含量。　结果　对照组患者血糖值为(10.25±4.18)mmol/L,皮质醇为(424.67±125.85)ng/L;亚低温组患者血糖值为(8.40±3.75)mmo/L,皮质醇为(290.71±110.50)ng/L,两组比较差异均有显著性意义（P＜0.01）。两组患者胰岛素和生长激素无明显变化。　结论　亚低温治疗能够减轻糖代谢相关激素紊乱,降低高血糖,改善预后。     

亚低温治疗重型颅脑伤患者的临床疗效(论著摘要)

亚低温治疗重型颅脑伤患者的临床疗效（论著摘要）江基尧朱诚卢亦成张光霁于明琨陈左权梁玉敏高国一文淑华俞美定董萍笔者报告我科１９９４年１０月～１９９５年４月收治的４６例重型颅脑伤患者，其中２２例经亚低温治疗，取得显著疗效．一、临床资料１．病例：４６例重型...     

重型颅脑创伤患者亚低温治疗中颈静脉血氧饱和度持续监测的应用

目的探讨重型颅脑创伤（severe traumatic brain injury，sTBI）患者亚低温治疗中（mild hypothermia treatment，MHT）持续颈静脉血氧饱和度（jugularn venous oxygen saturation，SjvO2）监测的意义。方法对36例sTBI患者进行持续脑组织氧分压（PbtO2）、颅内压和SjvO2监测，并对监测结果及PbtO2与SjvO2的相关性进行分析。结果（1）36例sTBI患者在伤后24h内、36h和48hPbtO2与颅内压呈负相关（r=-0．978，P〈0．05），颅内压与SjvO2呈负相关（r=-0．947，P〈0．05），PbtO2与SjvO2呈直线正相关（r=0．965，P〈0．05）。（2）SjvO2降低患者比SjvO2正常患者预后差，而SjvO2异常增高患者的预后比SjvO2降低患者的预后更差；在一定范围内，随着SjvO2的增加，患者预后明显改善（P〈0．05）。结论SjvO2能监测大脑半球氧代谢状况，且对指导患者治疗及判断预后具有重要意义。     

Relationship between brain tissue oxygen tension and CT perfusion: feasibility and initial results

BACKGROUND AND PURPOSE: Monitoring of intraparenchymal brain tissue oxygen tension (P(br)O(2)) is an emerging tool in neurocritical care. The purpose of this study was to determine if there is a relationship between CT perfusion (CTP) imaging parameters and P(br)O(2). METHODS: Nineteen patients underwent continuous P(br)O(2) monitoring with probes placed to target white matter in the cerebral hemisphere. Twenty-two CTP studies were performed at the level of the oxygen electrode, as identified on concurrent nonenhanced CT. CTP analysis software was used to measure mean transit time (MTT) and cerebral blood volume (CBV) and to derive cerebral blood flow (CBF) for a region of interest (ROI) surrounding the oxygen probe. For correlation, P(br)O(2) levels and other physiologic parameters were recorded at the time of CTP. RESULTS: P(br)O(2) values at the time of CTP were 2.7-54.4 mm Hg, MTT was 1.86-5.79 seconds, CBV was 1.18-8.76 mL/100 g, and CBF was 15.2-149.2 mL/100 g/min. MTT but not CBV or CBF was correlated with P(br)O(2) (r = -0.50, P = .017). MTT, CBV, or CBF were not correlated with other physiologic parameters, including mean arterial pressure, cerebral perfusion pressure, intracranial pressure, and fraction of inspired oxygen. On multivariable analysis, only P(br)O(2) was independently associated with MTT. CONCLUSION: CTP assessment of ROI surrounding an oxygen probe in the intraparenchymal brain tissue is feasible and showed a significant correlation between P(br)O(2) and MTT. Further studies are warranted to determine the role of CTP in assessing acute brain injury and whether it can be used to prospectively identify brain regions at risk for tissue hypoxia that should be targeted for advanced neuromonitoring.     

Effects of intracellular pH, blood, and tissue oxygen tension on T1rho relaxation in rat brain.

The effects of intracellular pH (pH(i)), paramagnetic macroscopic, and microscopic susceptibility on T(1) in the rotating frame (T(1rho)) were studied in rat brain. Intracellular acidosis was induced by hypercapnia and pH(i), T(1rho), T(2), diffusion, and cerebral blood volume (CBV) were quantified. Taking into account the CBV contribution, a prolongation of parenchymal T(1rho) by 4.5% was ascribed to a change in tissue water relaxation caused by a one unit drop in pH(i). Blood T(1rho) was found to prolong linearly with blood oxygenation saturation (Y). The macroscopic susceptibility contribution to parenchymal T(1rho) was assessed both through BOLD and an iron oxide contrast agent, AMI-227. The T(1rho) data from these experiments could be described by intravascular effects with insignificant effects of susceptibility gradients on tissue water. Tissue oxygen tension (PtO(2)) was manipulated and monitored with microelectrodes to assess its plausible contribution to microscopic susceptibility and relaxation. Parenchymal T(1rho) was virtually unaffected by variations in the PtO(2), but T(1) was shortened in hyperoxia and T(2) showed a negative BOLD effect in hypoxia. It is demonstrated that pH(i) directly modulates tissue T(1rho), possibly through its effect on proton exchange; however, neither BOLD nor PtO(2) directly influence tissue T(1rho). The observations are discussed in the light of physicochemical mechanisms contributing to the ischemic T(1rho) changes.     

组织张力对组织胶原排列结构的影响

目的 研究组织张力的变化对胶原排列结构的影响,探讨组织结构和力学性质的关系. 方法 通过倒置相差显微镜、HE染色及透射电镜观察三种不同张力的胶原凝胶中成纤维细胞(fibroblast,Fb)的细胞形态、走行方向及胶原的排列结构;免疫荧光检测Fb中α平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)的表达及排布. 结果 倒置相差显微镜、HE染色及透射电镜观察发现,单层培养基质(monolayer gels,MG)及锚着基质(anchored gels,AG)张力高,张力分布各向异性,Fb呈长梭形,极性明显,胶原纤维沿细胞长轴平行排列,尤以MG更为明显;游离基质(floating gels,FG)张力低,张力分布各向同性,Fb为多角形或星形,胶原纤维呈网状排列;免疫荧光检测显示,MG及锚着基质中Fb表达大量沿细胞长轴排列的α-SMA,尤以MG明显,游离基质中Fb少有α-SMA表达.MG及锚着基质中Fb细胞形态、走行方向、α-SMA的表达及胶原的排列结构近似于肉芽组织,游离基质则近似于正常皮肤组织或重塑完成后的创面组织. 结论 皮组织的组织结构与组织的力学性质是相对应的,组织的排列结构是组织力学性质的体现,两者是不可截然分开的.     

氧张力与软骨组织工程

氧足细胞成活和调节细胞代谢的重要因素。软骨组织一直被认为是一种缺氧组织,正常关节软骨没有血管供应,其氧供只能依靠周围滑液的渗透作用。目前软骨组织工程种子细胞基本采用标准氧培养环境,氧张力为20％～21％,距体内正常软骨细胞和间充质干细胞氧张力环境有很大差距。本文综述了近年来有关氧张力对软骨细胞和间充质十细胞生物学作用的研究进展。     

Conjunctival oxygen tension at high altitude

Transconjunctival oxygen tension (PcjO2) was studied using a hypobaric chamber and during mountaineering excursions. Measurements obtained during acute chamber exposures (15-20 min) at sea level, 1829 m (6,000 ft), 3048 m (10,000 ft), 4267 m (14,000 ft) and return to sea level were (means +/- SEM): 60.1 +/- 2.7, 49.1 +/- 1.8, 38.3 +/- 2.4, 27.4 +/- 1.5, and 61.1 +/- 2.8 mm Hg, respectively (n = 13). The ratio of PcjO2 to arterial blood oxygen tension (PaO2) did not change in a consistent manner between sea level and 4267 m; PcjO2 was 74 +/- 6.9% of PaO2. The 16 subjects participating in the mountaineering phase of the study revealed similar means at sea level and 1829 m (57.4 +/- 2.4 and 46.3 +/- 1.9 mm Hg respectively), but a smaller decrement was observed at 3048 m (43.0 +/- 1.6 mm Hg). The difference between mountain and chamber values may be accounted for by a partial acclimatization to altitude brought about by longer exposure on the mountain excursions. A comparison between PcjO2 and transcutaneous oxygen tension during the chamber study suggests that a greater precision and sensitivity is obtained with measurement of oxygen tension at the conjunctival site. PcjO2 measurement is a non-invasive reflection of PaO2 which is suitable for continuous monitoring during hypoxia studies.     

Traumatic subarachnoid-pleural fistula causing tension pneumocephalus

Uncommon subarachnoid-pleural fistula can be caused by a blunt or penetrating trauma and can also occur after a thoracal or neurosurgical operation, ending to a progredient pneumocephalus. Clinical findings might be an enlarging tension pneumocephalus without a cranial fracture, but in most times they will be overlayed by other accompanied injuries, neurologic symptoms can dominate, also rapidly filling clear pleural effusions with obscure cause. Oppurtune identification of the reason of the pneumocephalus and mostly early surgical intervention prevent neurological deficit, CNS infection and other complications.