急性重型胰腺炎脂质过氧化物、SOD代谢变化及中西医结合治疗对其代谢影响

应用中西医结合治疗急性重型胰腺炎，测定治疗前、后重型胰腺炎病人血浆脂质过氧化物及红细胞内ＳＯＤ代谢变化。结果表明：急性重型胰腺炎病人血浆ＬＰＯ明显高于轻症病人（Ｐ＜０．０１），轻症病人高于健康人（Ｐ＜０．０５），而红细胞内ＳＯＤ的变化与之相反（Ｐ＜０．０５）。中西医结合治疗可降低重症病人血浆ＬＰＯ，提高红细胞ＳＯＤ的水平。     

肾移植前后超氧化物歧化酶及脂质过氧化物活性的动态观察

对３２例肾移植患者手术前后血浆中超氧化物歧化酶（ＳＯＤ）及脂质过氧化物（ＬＰＯ）活性进行动态观察，并对ＳＯＤ及ＬＰＯ与血肌酐（Ｃｒ）、尿素氮（ＢＵＮ）和免疫抑制剂环孢素Ａ（ＣｓＡ）的关系进行相关分析。结果表明：术前及术后前期ＳＯＤ水平明显高于正常人（Ｐ＜０．０５），ＬＰＯ水平术前及术后后期亦显著升高（Ｐ＜０．０５）。术后２个月，患者肾功能逐渐恢复，ＳＯＤ下降至正常水平。此外，ＳＯＤ与Ｃｒ、ＢＵＮ之间存在良好的相关性（Ｐ＜０．０１），故移植术后ＳＯＤ、ＬＰＯ活性测定不仅对研究肾移植过程中再灌注损伤有重要意义，亦可做为肾功恢复的指标之一。     

急性重型胰腺炎脂质过氧化物,SOD代谢变化及中西医？…

应用中西医结合治疗急性重型胰腺炎，测定治疗前、后重型胰腺炎病人血浆脂质过氧化物及红细胞内ＳＯＤ代谢变化。结果表明：急性重型胰腺炎病人血浆ＬＰＯ明显高于轻症病人（Ｐ〈０．０１），轻症病人高于健康人（Ｐ〈０．０５），而红细胞内ＳＯＤ的变化与之相反（Ｐ〈０．０５）。中西医结合治疗可降低重症病人血浆ＬＰＯ，提高红细胞ＳＯＤ的水平。     

胃癌患者一氧化氮,超氧化物歧化酶及脂质过氧化物的变化

目的：研究胃癌患者一氧化氮、超氧化物歧化酶及脂质过氧化物的变化。方法：检测５１例胃癌患者（患者组）和５０例健康成人（对照组）血浆一氧化氮（Ｐ－ＮＯ）含量、红细胞超氧化物歧化酶（Ｅ－ＳＯＤ）活性、血浆过氧化脂质（Ｐ－ＬＰＯ）及红细胞过氧化脂质（Ｅ－ＬＰＯ）。结果：与对照组相比,患者组的Ｐ－ＮＯ、Ｐ－ＬＰＯ及Ｅ－ＬＰＯ平均值均显著升高（Ｐ〈０．００１）,Ｅ－ＳＯＤ值显著降低（Ｐ〈０．００１）。结论：提     

儿茶素治疗黄褐斑疗效观察及机理初探

目的为治疗黄褐斑寻找一种新的方法。方法口服及外用儿茶素，并检测治疗前后患者血中过氧化脂质（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）、还原型谷胱甘肽（ＧＳＨ）、谷胱甘肽过氧化物酶（ＧＳＨＰｘ）。结果儿茶素治疗效果与复方氢醌霜组接近（Ｐ＞０．０５），治疗前血浆ＬＰＯ较正常人显著增高（Ｐ＜０．０１），氧自由基清除剂水平相对降低，治疗后ＬＰＯ水平显著降低（Ｐ＜０．０５），氧自由基清除剂水平增高。结论儿茶素可通过调节氧自由基系统，提高机体抗氧化能力来减轻色素沉着。儿茶素为天然产物，无毒副作用，对皮肤无刺激，是治疗黄褐斑较有前景的一种物质。     

人肾细胞癌组织中氧自由基及其抗氧化酶活性的初步研究

通过对２１例肾细胞癌组织及正常肾组织中脂质过氧化物（ＬＰＯ）含量、超氧化物歧化酶（ＳＯＤ）和谷胱甘肽过氧化物酶（ＧＳＨ－ＰＸ）活力测定，发现肾细胞癌组织中ＬＰＯ含量高于正常肾组织（Ｐ＜０．０５）；肾细胞癌组织中ＳＯＤ和ＧＳＨ－ＰＸ活力低于正常肾组织（Ｐ＜０．０５，Ｐ＜０．０１），并且ＬＰＯ和ＧＳＨ－ＰＸ变化与肾细胞癌分期有关。结果提示，氧自由基及其抗氧化酶可能参与肾细胞癌的发生和发展。     

心脏瓣膜置换术围术期动脉血及冠脉血TNF-α、SOD、LPO及CK-MB的变化

目的 观察进行体外循环（ＰＢ）病人围术期动脉血和冠脉血肿瘤坏死因子（ＴＮＦ－α）、超氧化物歧化酶（ＳＯＤ）、脂质过化物（ＬＰＯ）及肌酸激酶－ＭＢ（ＣＫ－ＭＢ）的变化。方法 １３例病人分别于ＣＰＢ前、升主动脉开放后５ｍｉｎ、３０ｍｉｎ、术毕、术后６ｈ、术后１８ｈ采集动脉和冠状窦血样本,测定血浆ＴＮＦα、ＬＰＯ的浓度及ＳＯＤ、ＣＫ－ＭＢ的活性和动脉血气,测算不同时间点的肺泡动脉氧分压差（ＰＡ－ａＤＯ２）,心肌ＴＮＦ－α的净释出量（冠状窦内血液ＴＮＦα含量减去动脉血含量）。结果 血液的ＴＮＦα水平在开放升主动脉后至术毕前明显增高（Ｐ〈０．０５）,ＣＰＢ期间心肌ＴＮＦα净释出量明显增高（Ｐ〈０．０５）;ＬＰＯ在开放升主动脉后明显升高且持续到术后６ｈ（Ｐ〈０．０５）,其峰值在开放升主动脉后５ｍｉｎ;ＳＯＤ含量逐渐下降并在     

术前应激麻醉和手术对红细胞内Cu—Zn—SOD含量的影响

目的和方法：采用放射免疫法观察了２０例全麻和１５例硬膜外麻醉患者手术前１日、麻醉前、麻醉后和术毕红细胞内Ｃｕ－Ｚｎ－ＳＯＤ含量的变化。结果：以术前１日为对照，入手术室后麻醉前两组红细胞内Ｃｕ－Ｚｎ－ＳＯＤ含量均显著升高（Ｐ＜０．０１）。麻醉后及术毕，全麻组Ｃｕ－Ｚｎ－ＳＯＤ降至术前１日水平；硬膜外组虽有下降，但其值仍显著高于术前１日水平（Ｐ＜０．０５）。结论：麻醉前患者的精神紧张可引起红细胞内Ｃｕ－Ｚｎ－ＳＯＤ含量非常显著的增高，而麻醉和手术后Ｃｕ－Ｚｎ－ＳＯＤ含量下降与麻醉抑制了应激反应和Ｃｕ－Ｚｎ－ＳＯＤ消耗增加有关。提示手术中维持病人适当的应激能力可能对病人更为有利。     

改良极化液治疗对冠心病非心脏手术患者心血管参数及SOD的影响

冠心病非心脏手术１４６例随机分成改良极化液组及对症治疗组，观察ＨＲ、ＭＡＰ、ＳＴ－Ｔ改变、心律失常率及红细胞ＳＯＤ活性的影响。结果表明应用改良极化液者麻醉、术中及术毕ＨＲ、ＭＡＰ基本平稳、ＳＴ－Ｔ改变及心律失常率逐渐下降，ＳＯＤ明显升高。而对症治疗组ＭＡＰ、ＳＯＤ值与麻醉前比较均有降低，ＳＴ－Ｔ改善不明显，ＨＲ、心律失常率明显升高。麻醉后各参数两组比较均有显著差异及非常显著差异（Ｐ＜０．０５～０．０１），提示改良极化液能提高ＳＯＤ的活性及具有稳定内环境、抗心律失常、改善心肌缺血的作用。     

电子顺磁共振技术检测烧伤大鼠早期血浆NO变化的研究

为探讨烧伤早期（７２小时内）血浆ＮＯ含量变化，采用雄性Ｗｉｓｔａｒ大鼠ＴＢＳＡ３５％烫伤模型，分为正常组（Ａ组）、ＬＰＳ组（脂多糖注射组，Ｌ组）、单纯烧伤组（Ｂ组）、脂多糖＋烧伤组（ＬＢ组）。分别于伤后１，３，８，１２，２４，４８，７２小时应用Ｈｂ－ＮＯ自旋捕集技术，在７７Ｋ低温测试了血浆ＮＯ浓度的变化规律，及其所产生的ＮＯ量与波谱三重峰信号强度的关系。结果表明：①Ｂ组大鼠伤后不同的时间内血浆ＮＯ与伤前值比较有降低趋势，但除伤后１２小时组与伤前比较有显著意义（Ｐ＜０．０５）外，其它各组均无显著差异（Ｐ＞０．０５）。②ＬＰＳ组血浆ＮＯ的产生，与Ａ组比较有显著差异（Ｐ＜０．０５）。ＬＢ组与伤后同时间Ｂ组比较有显著或非常显著意义（Ｐ＜０．０５或０．０１）。提示大鼠早期烧伤后经ＬＰＳ攻击后可产生过量的ＮＯ，这对于研究烧伤感染、内毒素血症有着重要的现实意义。     

Inhibition of endogenous superoxide dismutase with diethyldithiocarbamate in acute island skin flaps

Oxygen free radicals have been implicated in postischemic tissue damage in a variety of experimental models including the island skin flap. Previous studies have demonstrated that supplementing animals with exogenous superoxide dismutase (SOD), a free radical scavenger, improves tissue survival in island flaps. No studies to our knowledge have attempted to inhibit endogenous SOD in a skin flap model. In this experiment 20 control rats demonstrated a 12.00% flap necrosis 7 days after a modified ventral island skin flap was raised. A second group of 20 rats were supplemented with exogenous SOD (50,000 U/kg 30 minutes preoperatively and 12 hours postoperatively) and demonstrated a statistically significant decreased flap necrosis of 5.28%. A third group of 20 rats received diethyldithiocarbamate (DDC, 0.5 gm/kg 12 hours preoperatively), an agent previously shown to inhibit SOD, and demonstrated a statistically significant increased flap necrosis of 19.77%. In a final group of 20 rats the effect of DDC was overcome by supplementation with exogenous SOD, obtaining a flap necrosis of 8.35%. Our results add further support to the importance of SOD and oxygen free radicals in postischemic tissue damage by demonstrating increased tissue necrosis with inhibition of endogenous SOD. This suggests that there is a baseline degree of SOD activity in ischemic areas working to preserve tissue. It appears that the copper-containing species of SOD found primarily in the cytoplasm plays a pivotal role in preservation of postischemic tissue.     

重症急性胆管炎引发肺损伤时脂质过氧化作用的实验研究

动态检测兔重症急性胆管炎（ＡＣＳＴ）模型发病过程中肺组织脂质过氧化物（ＬＰＯ）和ＶｉｔＥ含量，结合肺功能和肺组织学的检测，发现发病６小时肺组织ＶｉｔＥ明显下降（Ｐ＜０．０１），且随时间延长呈进行性下降；肺ＬＰＯ至１２小时时明显上升，２４小时时急剧上升，同时肺组织超微和显微结构出现类似成人呼吸窘迫综合征改变。血ＰＯ２至２４小时时方明显下降，而ＰＣＯ２明显上升。肺ＬＰＯ升高与肺ＶｉｔＥ呈负相关，与肺组织损伤程度呈正相关。作者认为ＡＣＳＴ引发急性肺损伤与内毒素引起的氧自由基释放，从而引发肺泡毛细血管内皮细胞的脂质过氧化损害有关，而肺组织抗氧化物质的不足可能是促进肺损伤的因素之一。     

The biochemical basis of secondary ischemia.

In this study rat epigastric island flaps were used as a model to investigate selected tissue biochemical changes occurring during secondary ischemia. It was hypothesized that free radical damage, depletion of free radical scavengers, depletion of ATP, and increased edema might explain differences in flap survival between partial (venous obstruction) and total (arteriovenous obstruction) ischemia and decreased flap survival with increasing ischemia time. Flaps were given 2 hr or primary ischemia, 8 hr of normal perfusion, then secondary ischemia of 0, 2, 4, 8, or 12 hr with either arteriovenous obstruction or venous obstruction. Biochemical analysis of the skin was performed after 0, 24, or 96 hr reperfusion. Only minor differences were found between arteriovenous and venous ischemia for any of five biochemical parameters, despite a previous finding that venous ischemic flaps are more susceptible to necrosis. Levels of xanthine oxidase and malonyldialdehyde (both indices of free radical generation) increased with ischemia time. Levels of superoxide dismutase (a free radical scavenger) correspondingly decreased. Tissue levels of ATP decreased after ischemia and recovered to normal for shorter but not for longer ischemia times after 96 hr of reperfusion in parallel with flap survival. Edema increased immediately after the ischemic insult but decreased once the tissue became necrotic. These results imply roles for free radicals, ATP, and edema in secondary ischemia, but do not distinguish between arteriovenous and venous secondary ischemia.     

乳腺癌根治术后创面不加压包扎对预防皮瓣坏死的影响

目的探讨乳腺癌术后皮瓣坏死的发生原因及预防措施。方法回顾性分析2006年1月～2010年12月郑州人民医院280例乳腺癌手术患者的临床资料,其中创面加压包扎140例,创面不加压包扎140例。结果乳腺癌根治术后创面加压包扎皮瓣坏死29例,发生率为20.71%,创面不加压包扎皮瓣坏死15例,发生率为10.71%。结论乳腺癌根治术后创面不加压包扎是预防皮瓣坏死的一种方法。     

皮瓣转移结合负压抽吸治疗乳腺癌术后上肢淋巴水肿

目的 探讨一种治疗乳腺癌根治术后上肢淋巴水肿的手术方法。方法 2001～2002年我们采用侧胸壁皮瓣或背阔肌肌皮瓣转移结合上肢负压抽吸治疗10例单侧乳腺癌根治术后上肢淋巴水肿患者。结果 术后所有患者上肢周径均有不同程度减小，核素淋巴管造影显示淋巴回流有显著改善。术后随访3～18个月，疗效稳定。结论 皮瓣转移结合负压抽吸可以有效地治疗乳腺癌根治术后淋巴水肿。     

中西医结合疗法抗自由基损害的临床观察

本研究用生物化学方法，观测了我院外科病人在治疗过程中，血浆脂质过氧化物（ＬＰＯ）及超氧化物歧化酶（ＳＯＤ）的变化，及中药对这两个指标的影响。结果发现，中西医结合疗法在抗自由基损害方面起着一定的作用。     

Effect of superoxide dismutase for improvement of survival of ischemic reperfused island skin flap]

Using a rat model, we evaluated the effect of SOD on the survival of ischemic reperfused island skin flaps. In experiment 1, the oxygen free radical concentration in the flaps was measured by the technique of ESR. The results showed that the oxygen free radical concentration in ischemic reperfused flaps was significantly higher than in the corresponding control flaps (P less than 0.001). In experiment 2, the flaps were perfused with SOD (2000 U in 1 ml saline) before reperfusion after 8 hours of ischemia. Seven days after operation, the area of flap survived in the test group was significantly larger than in the control group (P less than 0.0005). The obtained data demonstrated that the generation of oxygen free radical increases with time during ischemia reperfusion in island skin flap and the role of oxygen free radical in tissue injury following ischemia and reperfusion. The use of SOD can enhance the survival of ischemic island skin flap.     

Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy

Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap after skin-sparing mastectomy is becoming an increasingly performed procedure in patients with ductal carcinoma in situ, early invasive breast cancer, and prophylactic mastectomy. Through a periareolar approach, it is possible to remove the breast parenchyma along with the nipple areola complex, preserving almost all the original skin envelope and the inframmamary fold. The TRAM flap is used to recreate the volume and shape of the original breast. This technique has higher quality and easier reconstruction. The major disadvantages, extensive scar and donor site skin color mismatch, are reduced to a minimum level because the former is limited at the natural border of the nipple areola and the latter can be effectively concealed with proper nipple reconstruction. Thirty-one patients with a mean age of 39 years (range, 26-50 years) who had undergone unilateral or bilateral mastectomy for early breast cancer and immediate breast reconstruction with the pedicled TRAM flap were retrospectively reviewed. Requirements for the skin-sparing mastectomy technique include suitability of donor site tissue for autologous tissue, early breast cancer or ductal carcinoma in situ, and adequate size and shape matching of the contralateral breast. There was no observed local recur- rence during the follow-up period (mean, 20 months; range, 11-30 months). Complications at the recipient site include mastectomy skin flap partial necrosis in 2 patients and cellulitis of the transferred flap in 1 patient. No total or partial flap necrosis was observed. One patient developed abdominal bulging 1 month after the operation, during the administration of chemotherapy. All reconstruction was considered very satisfactory from an aesthetic perspective by the surgeon and the patient. The nicer aesthetic result with oncological safety is achieved with immediate breast reconstruction with the TRAM flap after skin-sparing mastectomy. The risk of local recurrence is not higher compared with more radical surgical techniques.     

乳腺癌根治术后皮瓣修复创面缺损的护理体会

目的:探讨应用皮瓣修复乳腺癌根治术后皮瓣缺损的护理疗效。方法:对8例乳腺癌根治术后皮瓣修复患者做好术前心理护理,术后转移皮瓣的观察护理及康复锻炼。结果:8例患者手术均获成功,切口均一期愈合。结论:加强围手术期护理是确保乳腺癌根治术后转移皮瓣成功的关键。     

乳腺癌根治术预防皮缘坏死及积液40例的体会

目的探索乳腺癌根治手术中及术后避免皮瓣坏死及皮下积液的方法。方法对40例乳腺癌根治手术,采用皮下注射生理盐水和蒸馏水混合液,组织剪游离皮瓣并止血,同侧腋窝注射溶脂液,溶脂后结扎腋窝淋巴管,清除腋窝淋巴结;应用较细的硅胶管螺旋式剪侧孔,置于术野边缘一圈,距皮缘3 cm处缝皮瓣至胸壁,采取小负压持续吸引,免除胸带及皮外加压包扎。结果40例乳腺癌根治术,仅1例行皮瓣转移患者有少许皮瓣坏死外,其余均为一期愈合。结论乳腺癌根治术彻底止血、保护皮缘血供、术后有效引流、避免皮肤过度加压是预防了皮瓣坏死、皮下积液的有效措施。