磁共振增强造影剂过敏反应的预防及护理

目的探讨磁共振增强造影剂不良反应的预防及护理。方法分析11例患者在注射造影剂后出现不良反应的临床表现、预防治疗及护理情况。结果9例出现轻微不良反应,临床症状主要表现为头痛、恶心、呕吐、局部皮肤荨麻疹等。2例严重不良反应,临床症状表现为喉头水肿、呼吸困难,喘憋严重、小便失禁,在经过抗过敏、抗休克治疗后,无一例死亡。结论在应用磁共振造影剂时,应做好注射前准备及造影剂不良反应的预防与护理,有利于减少不良反应或过敏率的发生,减轻过敏症状。     

国产八氟丙烷微泡造影剂左心室超声显像效果研究

目的评价八氟丙烷微泡超声造影剂(C3F8)的左心室超声显像效果。方法7头实验猪分别接受低剂量(0．002ml／kg)和高剂量(0．02ml／kg)C3F8静脉注射，观察造影剂注射前后左心室显影等级、左室内膜边界改善效果和Simpson法左室射血分数测定，同时评价其对实验猪的心率、呼吸的影响。结果C3F8注射后左室显影等级强度和内膜边界增强节段数均显著改善，部分心肌也可以显影；对心率和呼吸未见明显影响。结论经静脉注射C3F8可使得左心室显影明显增强，显著改善左心室内膜边界显示，安全性好。     

CT增强扫描中造影剂不良反应的预防及护理

随着CT扫描技术的广泛应用，造影剂的使用越米越多，特别是螺旋CT的出现，对造影剂的要求日益增加，但在使用碘造影剂的过程中及结束后呵发生不良反应，这些不良反应的产生原因各不相同，引起的症状轻重不一，严重者可危及生命。在心脏及大血管MSCT成像中，造影剂较常规CT增强使用的剂量要大，流率要高。非离子型造影剂的使用虽大大降低了碘造影剂不良反应的发生率，但偶有少数患者可能发生严重反应。因此合理使用造影剂，了解其理化性能、毒副作用及发生不良反应后的及时处理是CT工作人员必须掌握的知识。     

护理相关因素对CT增强肺动脉造影诊断亚段肺动脉栓塞的影响

目的 探讨在肺栓塞(PE)CT增强肺动脉造影检查中影响亚段肺动脉栓塞诊断的几种护理因素,优化护理配合方案,提高诊断水平。方法 回顾性分析行CT增强肺动脉造影检查和ECT肺通气／灌注扫描的PE患者32例,根据造影剂注射部位的不同将患者随机分为A组(经右肘静脉)和B组(经左肘静脉)各16例,观察两组患者造影剂在肺动脉的充盈状况;根据患者的心率(100／min以上或以下)及呼吸(20／min以上或以下)各分成两组,观察心率和呼吸频率对血管显示清晰度的影响。结果同一层面、同一时相A组造影剂在亚段肺动脉显示清晰度优于B组;心率和呼吸频率对血管显示清晰度有较大影响。结论 注射造影剂以穿刺右侧肘静脉为优;恰当的心理护理,适度调节心率和呼吸频率可明显提高亚段PE的检出率,是保证检查顺利完成的关键。     

高机械指数联合高剂量造影剂行心肌声学造影的安全性研究

目的探讨高机械指数（MI）超声辐照联合高剂量国产超声造影剂心肌声学造影,对大鼠血流动力学及组织器官损伤情况的影响。方法20只正常SD大鼠,经颈静脉注射全氟丙烷人血白蛋白微球注射剂（1ml／kg）,在造影模式下调节MI至最大（MI=1．9）,采用R波触发,每6个心动周期一次。造影前后分别监测心率、心电图、血压、肌钙蛋白T,结束后取大鼠心、肝、肾进行病理检查。结果大鼠心率、血压、肌钙蛋白T测值在造影前后无明显变化（P〉0．05）;造影后心脏病理检查见轻微损伤（心肌纤维稍变粗,胞浆呈细颗粒状;间质血管扩张充血）,肝、肾未见异常结构改变;一只大鼠在注射造影剂的过程中出现室性期前收缩,注射结束5min后恢复正常。结论在常规超声条件下高MI及高剂量造影剂心肌声学造影对正常实验大鼠血流动力学无明显影响,肌钙蛋白T升高不明显,病理示心肌轻微损伤,偶致短暂室性早搏,但短时间内可恢复正常。本实验证实,高MI联合高剂量国产声学造影剂行心肌声学造影对于正常大鼠是安全的。     

新型多聚体超声造影剂的初步实验研究

目的观察自制新型多聚体超声造影剂的基本特性及其对实验犬左心室及心肌增强显像的效果。方法扫描电镜观察微泡大小形态及粒径分布，Coulter计数仪测定微泡浓度，4只杂种犬其中2只制成前壁心肌梗死模型，经股静脉0．5ml团注新型多聚体超声造影剂观察犬左室及心肌显影效果，同时监测心率技呼吸频率。结果该新型多聚体造影剂为含空气的冻干粉剂，平均粒径1．5μm，100％的微泡粒径小于8μm，通过周围静脉注射使左心室腔产生明显的增强显像，其中左心室2 以上程度的显影占总注射次数的92％，肺转运时间为2～3个心动周期。左心室显影峰值出现在左心室显影后3～5个心动周期，持续高强度显影15s以上，触发成像模式可屺心肌显像同时能检测梗死区心肌。造影过程中未见明显的心率、呼吸及心电图改变。结论新型多聚体超声造影剂可以获得良好的左心室及心肌增强显像，对实验犬的心率、呼吸无明显影响。     

胆囊痛牵涉区的定位

目的:根据由胆囊机械扩张刺激和化学性刺激引起血浆外渗出现的部位,确定胆囊痛的牵涉区. 方法:先经家兔胆囊底部放置导管.静脉注入伊文斯蓝,待其在血浆中均匀分布后分组实验,观察皮肤渗出斑并同时记录动物呼吸和心率的变化,测量皮肤渗出斑内染料的含量. 结果:动物在机械扩张胆囊和化学刺激胆囊时呼吸加快和心率增加,血浆外渗所致的伊文斯蓝渗出点主要集中在肩胛间区,且该区皮内染料含量明显高于其他部位(P＜0.01). 结论:胆囊伤害性刺激可以使肩胛间区皮肤出现明显的血浆外渗,推测该部位可能是胆囊痛的牵涉区.     

一种新型超声造影剂JD-95实时器官显影的实验研究

目的 :一种新型超声造影剂JD 95的实时器官显影效果及其安全性的检测。方法 :6只实验犬以微量注射泵静脉滴注 0 1ml (kg·min)至 0 3ml (kg·min)不同剂量新型超声造影剂JD 95 ,进行实时心肌、肝脏、肾脏声学造影 ,监测心率、左室收缩功能及血气指标。结果 :声学造影显示能够得到良好的图像 ,心率、左室收缩功能及血气指标均未见明显变化 (P >0 0 5 )。结论 :新型超声造影剂JD 95可以获得良好的心肌、肝脏、肾脏声学造影效果 ,对实验犬无影响     

64层螺旋CT冠状动脉造影检查562例的护理

总结562例64层螺旋CT冠状动脉造影检查的护理。护理重点为检查前做好心理护理、饮食护理、碘过敏试验,掌握适应证和禁忌证,进行屏气训练,控制心率在理想范围;检查时做好造影剂注射护理、呼吸指导;检查后加强穿刺静脉护理、碘造影剂反应观察。562例造影均成功。     

全氟显声学显像效果的研究

目的：以Optison和5％声振人血白蛋白注射液为对照，评价新一代超声造影剂全氟显的声学显像效果。方法：全氟显设置低、中、高三个剂量组，Optison剂量设置与前者相同，5％声振人血白蛋白注射液仅设高剂量组。观察造影剂注射前后左室显影等级及内膜边界改善的效果，同时评价其对实验犬心,率、血压的影响。结果：全氟显左室显影等级强度、内膜边界增强节段数均高于5％声振人血白蛋白注射液，但与同剂量Optison组间无差异。三种造影剂对实验犬心率、血压未见明显影响。结论：全氟显经静脉注射后可实现左室腔显影增强，提高内膜边界识别。 该造影剂与Optison性能相似，优于5％声振人血白蛋白注射液。     

反复快速皮肤扩张可促进皮瓣表皮生长因子及增殖细胞核抗原的表达

背景：针对目前临床常用的常规扩张法与快速扩张法的不足,提出了反复快速皮肤扩张法。目的：观察反复快速皮肤扩张对皮瓣表皮生长因子、增殖细胞核抗原表达的影响。方法：雄性新西兰大白兔随机分为3组：反复快速扩张组、快速扩张组、常规扩张组。结果与结论：扩张维持第2,3周,反复快速扩张组皮瓣表皮生长因子表达显著高于快速扩张组、常规扩张组（P〈0.05）。除扩张维持第3周外,其余各时间段,反复快速扩张组成纤维细胞增殖细胞核抗原染色阳性率均显著高于其他两组（P〈0.05）。扩张维持第4周,反复快速扩张组表皮细胞增殖细胞核抗原染色阳性率显著高于其他组（P〈0.05）。提示反复快速皮肤扩张可能通过促进组织细胞合成与分泌皮瓣表皮生长因子,促进了扩张皮肤中成纤维细胞及表皮细胞的增殖。     

Effects of mental relaxation and slow breathing in essential hypertension

OBJECTIVES: To compare mental relaxation and slow breathing as adjunctive treatment in patients of essential hypertension by observing their effects on blood pressure and other autonomic parameters like heart rate, respiratory rate, peripheral skin temperature, electromyographic activity of the frontalis muscle and skin conductance. METHODS: One hundred patients of essential hypertension either receiving antihypertensive drugs or unmedicated were selected randomly. Various parameters were recorded during the resting state and then during mental relaxation and slow breathing for 10 min each, separated by a quiet period of 15 min. All parameters were recorded again after mental relaxation and slow breathing. Changes in various parameters observed after mental relaxation and slow breathing were analyzed and compared. RESULTS: Both mental relaxation and slow breathing resulted in a fall in systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate and electromyographic activity with increase in peripheral skin temperature and skin conductance. Slow breathing caused a significantly higher fall in heart rate (p<0.05), respiratory rate (p<0.001), systolic blood pressure (p<0.05) and diastolic blood pressure (p<0.01). Increase in peripheral skin temperature (p<0.05) and reduction in electromyographic activity (p<0.05) occurred more with mental relaxation. No significant differences were seen between increases in skin conductance (p>0.2) observed with both the modalities. CONCLUSIONS: Even a single session of mental relaxation or slow breathing can result in a temporary fall in blood pressure. Both the modalities increase the parasympathetic tone but have effects of different intensity on different autonomic parameters.     

不同剂量甲基强的松龙治疗手足口病并发脑膜脑炎疗效观察

目的 比较不同剂量甲基强的松龙治疗手足口病并发脑膜脑炎的疗效,方法将100例重症手足口病并发脑膜脑炎患儿随机分为两组,小剂量组50例（甲基强的松龙1～2mg/kg/d.静脉滴注,连用3～5d）和大剂量组50例（甲基强的松龙10～20mg/kg/d,静脉滴注,连用3d,再根据病情减量）.治疗后,比较两组患儿的发热持续时间、神经系统症状和体征恢复时间、住院天数及生命体征和血糖值.结果 两组患儿在发热持续时间、神经系统受累持续时间、住院时间等方面比较差异无统计学意义（P〉0.05）;而大剂量组患儿的心率、呼吸频率、血压和血糖均明显高于小剂量组,差异有统计学意义（P〈0.05）.结论 联合应用大剂量甲基强的松龙治疗手足口病并发脑膜脑炎相比小剂量法未明显改善患儿的临床症状及缩短病程,大剂量应用可增加患儿药物不良反应.     

Partial liquid ventilation in severely surfactant-depleted, spontaneously breathing rabbits supported by proportional assist ventilation

OBJECTIVE: We hypothesized that partial liquid ventilation (PLV) would improve oxygenation in nonparalyzed, surfactant-deficient rabbits breathing spontaneously while supported by proportional assist ventilation (PAV). This ventilation mode compensates for low pulmonary compliance and high resistance and thereby facilitates spontaneous breathing. DESIGN: Randomized trial. SETTING: University animal research facility. SUBJECTS: Twenty-six anesthetized New Zealand white rabbits weighing 2592 +/- 237g (mean +/- sd). INTERVENTIONS: After pulmonary lavage (target Pao2 <100 mm Hg on mechanical ventilation with 6 cm H2O of positive end-expiratory pressure [PEEP] and an Fio2 of 1.0), rabbits were randomized to PAV (PEEP of 8 cm H2O) with or without PLV. PLV rabbits received 25 mL/kg of perfluorocarbon by intratracheal infusion (1 mL/kg/min). Pao2, Paco2, tidal volume, respiratory rate, minute ventilation, mean airway pressure, arterial blood pressure, heart rate, pulmonary compliance, and airway resistance were measured. Evaporated perfluorocarbon was refilled every 30 mins in PLV animals. After 5 hrs, animals were killed and lungs were removed. Lung injury was evaluated using a histologic score. MAIN RESULTS: Pao2 and compliance were significantly higher in PLV rabbits compared with controls (p <.05, analysis of variance for repeated measures). All other parameters were similar in both groups. CONCLUSIONS: PLV improved oxygenation and pulmonary compliance in spontaneously breathing, severely surfactant-depleted rabbits supported by PAV. The severity of lung injury by histology was unaffected.     

反复快速皮肤扩张可促进皮瓣表皮生长因子及增殖细胞核抗原的表达

背景:针对目前临床常用的常规扩张法与快速扩张法的不足,提出了反复快速皮肤扩张法。目的:观察反复快速皮肤扩张对皮瓣表皮生长因子、增殖细胞核抗原表达的影响。方法:雄性新西兰大白兔随机分为3组:反复快速扩张组、快速扩张组、常规扩张组。结果与结论:扩张维持第2,3周,反复快速扩张组皮瓣表皮生长因子表达显著高于快速扩张组、常规扩张组(P<0.05)。除扩张维持第3周外,其余各时间段,反复快速扩张组成纤维细胞增殖细胞核抗原染色阳性率均显著高于其他两组(P<0.05)。扩张维持第4周,反复快速扩张组表皮细胞增殖细胞核抗原染色阳性率显著高于其他组(P<0.05)。提示反复快速皮肤扩张可能通过促进组织细胞合成与分泌皮瓣表皮生长因子,促进了扩张皮肤中成纤维细胞及表皮细胞的增殖。     

Mediation systems in bacterial lipopolysaccharide-induced hypotension and disseminated intravascular coagulation. I. The role of complement

We have studied the role of complement in lipopolysaccharide (LPS)- induced hypotension and disseminated intravascular coagulation (DIC) by comparing the effects of injection of three preparations of LPS from E. Coli 0111:B4, S. minnesota Re595, and S. marcescens. Injections of nonlethal doses of these LPS preparations into normal rabbits produced decreases in mean arterial blood pressure during a 5-h period. When rabbits treated with cobra venom factor (CoF) to deplete C3 were injected with the various LPS preparations, mean arterial pressures fell at a rate and extent essentially identical to that observed in normal rabbits. Rabbits genetically deficient in C6 also demonstrated LPS-induced hypotensive changes. Only minimal, or no changes in plasma C3 levels or serum CH50 values were detected in normal rabbits after LPS injection. Hypotensive changes were also induced in rabbits when complement was rapidly activated by intravenous injection of CoF. In contrast to the hypotension induced by LPS, the fall in arterial pressure associated with the consumption of complement was short lived and required the rapid consumption of considerable amounts of C3. The occurrence of DIC noted in normal rabbits injected with each preparation of LPS was not inhibited in either rabbits treated with cobra factor or in C6-deficient rabbits. The DIC was most pronounced after injection of Re595 and S. marcescens LPS. Injection of the various LPS preparations produced a rapid disappearance of circulating neutrophils and mononuclear cells, which occurred with the same kinetics and to the same extent in normal, CoF-treated, and C6- deficient rabbits. Injection of either Re595 LPS or S. marcescens LPS produced a biphasic disappearance of circulating 51Cr-platelets. In contrast, injection of 0111:B4 LPS affected only slightly the rate of disappearance of 51Cr-platelets. Depletion of C3 by cobra factor treatment had no effect on the disappearance of platelets in animals injected with 0111:B4. In marked contrast cobra factor treatment greatly reduced the initial rapid disappearance of platelets in rabbits injected with either Re595 or S. marcescens LPS, but had no effect in the secondary disappearance phase.     

Effects of haemodialysis on heart rate variability in chronic renal failure

The influence of haemodialysis (HD) on the heart rate variability (HRV) was investigated in nine non-diabetic patients on maintenance haemodialysis. The R-R intervals were measured in recordings during spontaneous quiet breathing and during controlled deep breathing before and after a single HD session. The HRV was expressed as the standard deviation of the mean R-R interval in 3 min ECG recordings. Heart rate variability is the irregularity in the heart rate mainly caused by autonomic control mechanisms. The long-term HRV during quiet breathing was statistically significantly (p less than 0.05) higher after the HD than before. The HRV in the intermediate frequency range of 0.075-0.125 Hz was also significantly increased by the HD. This suggests that some metabolic agents interfering with the heart rate regulation are removed by the haemodialysis, and as a result a better function of the autonomic cardiac control is achieved in uraemic patients.     

Stimulation of heart rate by insulin: uninfluenced by beta-adrenergic receptor blockade in rabbits.

Intravenous injection of insulin increased heart rate approximately 20% in six alloxan-diabetic rabbits. Blood glucose concentrations after insulin did not decrease below the fasting level of non-diabetic animals and none of the rabbits had signs of hypoglycermia. Intravenous injection of saline or insulin solvent had no effect on heart rate. The stimulatory effect of insulin on heart rate was not influenced by autonomic nervous blockade by propranolol or by propranolol plus atropine.     

急性肺损伤早期抗凝疗法的研究

采用骨髓提取液（BME）静脉注射建立家兔急性肺损伤的动物模型。实验组在实验过程中使用肝素进行抗凝治疗，对照组不进行抗凝治疗。两组动物同时观察生命体征、血液气体分析、X线胸片、及肺病理学检查，分析早期抗凝疗法对急性肺损伤以及由此继发的全身脏器损害的影响。实验结果表明：早期抗凝对肺局部病变影响不大（P＞0．05），但能明显提高致伤动物的7h存活率（P＜0．01）。表明：1）ARDS的死亡原因不完全取决于肺脏局部的病变程度，可能与肺外脏器的继发性损害有关。2）早期使用肝素抗凝可以减轻全身的损害，提高生存率。     

Studies of the effect of bacterial endotoxins on rabbit leucocytes. I. Effect of intravenous injection of the substances with and without induction of the local Shwartzman reaction

Intravenous injection into rabbits of bacterial endotoxins results in an inhibition of migration of leucocytes from the buffy coat of their blood in tissue culture or in "slide cell" preparations. This effect was demonstrable 5 minutes after the intravenous injection and persisted for from 6 to 12 hours after the injection. It is as marked in rabbits receiving only a single intravenous injection of endotoxin as in those previously prepared intradermally and developing a severe local Shwartzman reaction on intravenous injection. The preparation of the skin for the Shwartzman reaction does not in itself result in appreciable changes of leucocyte migration. The production of the effect depends upon some action in vivo, since leucocytes of uninjected rabbits migrate normally from the buffy coat in plasma substrates to which large concentrations of endotoxin are added in vitro. The inhibitory effect, as observed in these experiments, also depends upon the added influence of centrifugation. Leucocytes from a rabbit receiving endotoxin intravenously migrate normally from uncentrifuged lung or spleen fragments and migrate normally in blood on the warm stage prior to centrifugation. Identical centrifugation does not affect leucocytes from uninjected animals. The heparin inhibition of the local Shwartzman reaction does not alter this effect of endotoxins on leucocytes. Its possible role in the production of leucopenia and of the local Shwartzman reaction is briefly discussed.