白细胞去除对内毒素血症犬凝血功能及肺损伤的影响

目的 观察白细胞去除后凝血纤溶系统的变化,探讨这一变化对肺损伤的影响及其可能机制.方法 用内毒素(LPS)2 mg/kg建立内毒素血症犬模型.30只雄性杂种犬采用随机数字表法分为LPS组(L组)、伪白细胞去除对照组(S组)、白细胞去除治疗组(T组),每组10只.L组只给予LPS输注,不行白细胞去除(leukocytapheresis,LCAP);S组在LPS输注后12～14 h间行伪白细胞去除;T组在LPS输注后12～14 h间行LCAP.动态观察每组动物外周血活化蛋白C(activated protein C,APC)、可溶性血栓调节蛋白(soluble thrombomodulin,sTM)及纤溶酶原激活物抑制物-1(plasminogen activator inhibitor-1,PAI-1)在输注LIPS前及输注后2,6,12,14,16,24及36 h的变化.结果 (1)T组动物在14,16 h时血清APC水平[(50.805±4.422)μg/ml、(40.480±2.993)μg/,l]分别高于L组[(45.881 ±4.024)μg/,l、(35.935±4.057)μg/ml)(P<0.05);(2)T组在14,16 h时sTm水平[(9.688±0.914)μg/ml、(10.492±0.865)μg/ml]分别低于L组[(11.005±0.854)μg/ml、(12.04±O.954)μg/ml)(P<0.05);(3)T组在14,16 h时PAI-1水平显著低于L组(P<0.05);(4)T组急性肺损伤发生率显著低于L组(2/10:7/10,P<0.05).结论 LPS诱导的内毒素血症早期存在凝血纤溶功能异常,白细胞去除能改善凝血纤溶功能,可能是白细胞去除减少急性肺损伤发生率的作用机制之一.

Abstract：

Objective To observe the effect of leukocytapheresis(LCAP)on the coagulation,fibrinolysis system and lung injury in the endotoxemia dog and explore the mechanism in the endotoxin-induced lung injury dog. Methods Endotoxemia-induced model in dogs was established by administration of lipopolysaccharide(LPS,2 mg/kg).Separation of the leucocytes wag performed with the automated continuous flow blood cell separators.A total of 30 male mongrel dogs were randomly divided into LPS group(group L,only injected with LPS,with no LCAP),sham LCAP group(group S,received sham LCAP at 12-14 hours after administration of LPS)and LCAP treatment group(group T,received LCAP at 12-14 hours after administration of LPS),10 dogs per group.The dynamic changes of the activated protein C(APC),soluble thrombomodulin and plagminogen activator inhibitor-1 in the serum were measured at 0 hour before LPS administration,at 2,6,12,14,16,24 and 36 hours after administration of LPS.Results Through LCAP,there found the following four results:(1) the APC level in the serum of the group T wag(50.805±4.422)μg/ml and(40.480±2.993)μg/ml at 14 hours and 16 hours respectively,which were significantly higher than(45.881±4.024)μml and(35.935±4.057)μg/ml in the group L(P<0.05).(2)The expressions of soluble thrombomadulin in the group T was (9.688±O.914)μml and(10.492±O.865)μg/ml at 14 hours and 16 hours respectively,which was statistically lower than(11.005±0.854)μg/ml and(12.04±0.954)ug/ml in the group L(P<0.05).(3)Thelevel of plagminogen activatorinhibitor-1 in the group T was lower than that in the group the group T Wag statistically lower than that in the group L(ALI/ARDS occurred in 2 and 7 dogs of the groups T and L respectively within 36 hours after infusion of LPS.P<0.05). Conclusions At the decrease the incidence of acute lung injury partly due to its role in improving the function of coagulation and fibrinolysis.     

门静脉高压症病人围手术期血小板和凝血因子及纤溶变化的临床意义

研究表明 :凝血机制与肝功能密切相关 ,肝脏合成和调节大多数凝血和纤溶因子。门静脉高压症( PHT)时食管静脉曲张破裂出血 ,首次出血死亡率高达 5 0 % ,手术治疗是控制出血和预防其再次破裂出血的有效手段 ,但手术是否会诱发 DIC的发生与发展 ,已日益受到诸多学者的重视。本文旨在探讨肝硬化合并 PHT的不同 Chlid分级患者围手术期血小板数、凝血因子和纤溶指标变化的临床意义。1　材料与方法1 .1　病例及分组1 .1 .1　门静脉高压症组 :2 1例肝炎后肝硬化伴门静脉高压症患者 ,男 1 7例 ,女 4例 ,年龄 39～ 46岁 ,平均 45岁。肝功能分级 …     

重症减压病血管内皮及凝血纤溶系统变化的实验研究

目的观察实验兔发生重症减压病过程中血管内皮及凝血纤溶系统相关指标的变化,分析重症减压病致死的可能机制。方法14只新西兰白兔,在0·55MPa下停留35min,再升至0·7MPa停留35min,于4min内匀速减压出舱。检测加压前、高压停留中、减压后兔血浆内皮素-1(ET-1)、血管性血友病因子(vWF)、纤维蛋白原(FIB)、D-二聚体(D-Dimer)、凝血因子Ⅷ(FⅧ)活性、纤溶酶原(PLG)、纤溶酶抑制物(PL-IN)、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)等指标。比较减压后存活动物与死亡动物以上指标变化的特点。结果8只兔于减压后30min内死亡,6只存活且观察24h后未遗留任何减压病症状。0·55MPa下停留30min后,兔血浆ET-1由加压前的1·33±0·33pg/ml升至2·74±0·87pg/ml;vWF活力由2·62±0·69%升至3·64±1·48%。与高压停留中比较,快速减压后死亡组兔FIB减少量为0·92±0·12g/L,D-Dimer减少量为55·63±12·12ng/ml,均明显大于存活组(P<0·01)。结论实验兔于高压停留阶段已有血管活性物质释放,快速减压后凝血激活程度更强,纤维蛋白原消耗更多,而继发性纤溶反应较弱的动物死亡的可能性更大。     

肺挫伤复合内毒素血症肺损伤模型的建立及其早期肺炎症反应变化

目的 建立一种可用于实验研究的急性肺损伤（ALI）模型,观察其早期肺炎症反应特点,并探讨此模型下肺炎症反应与肺损伤伤情的关系。方法 首先以生物撞击机复制肺挫伤模型。经尾静脉注射内毒素（LPS）,复制内毒素血症肺损伤模型;用同样的方法实施胸部撞击伤,然后注射LPS,建立肺挫伤复合内毒素血症肺损伤模型;观察三个模型下的死亡率、动脉血氧分压（PaO2）、肺含水率（RLW）及肺泡灌洗液（BALF）内多形核白细胞（PMN）和炎性介质变化。结果 肺挫伤复合内毒素血症肺损伤模型的48小时死亡率为57.5%,显著高于肺挫伤和内毒素血症肺损伤模型的死亡率;本模型致伤后早期PaO2降低和RLW升高程度均较其它两种模型明显,BALF内PMN计数和炎性介质水平出现显著变化,变化程度较其它两组明显。结论 肺挫伤复合内毒素血症肺损伤模型是一种严重的ALI模型,此模型的肺组织发生了明显的炎症反应;BALF中炎性介质于致伤后早期出现明显变化,创伤后早期肺炎症反应水平影响肺损伤程度及预后的重要因素。     

不同人群血液流变学和凝血纤溶的“脱适应”变化的观察

本文对长期居住在海拔2260m的三组不同人员(自身队员、60岁以上老年人、西宁退休人员)、先后进入到平原的苏州、上海地区、在其前后进行了血液流变学、血凝机制、血小板粘附率、体外血栓形成、纤溶酶原等改变,结果表明,长期移居高原的人,进入到平原后,虽然时间短,但上述指标已有改变,表现在HCT、ηb的下降,高凝状态改善,纤溶亢进减轻,这是“脱适应”的变化,是对氧供环境正常后的一种“再适应”改变,但有些指标改变不明显,除因返回平原时间短外,老年人与中青年人比较,其“脱适应”变化较迟钝。     

内镜下黏膜剥离术后菌血症及内毒素血症的临床研究

目的：分析内镜下粘膜剥离术后患者发生菌血症及内毒素血症的情况,探讨预防性使用抗生素的必要性。方法选取102例行胃部内镜下粘膜剥离术的患者,于患者术前、术后立即、术后2d进行细菌血培养及血清内毒素检测,并在术后第2d检测白细胞计数以及C反应蛋白。结果2例血培养结果出现阳性,采样时间点分别为术后立即、术后2d,培养出的细菌分别为丙酸杆菌属及产气肠杆菌,血培养阳性的2例患者未出现血流感染的临床症状;29%的患者C反应蛋白在术后2d高于1.0mg/L,且术后立即、术后2d的内毒素水平与术后2d的C反应蛋白水平具有相关性。结论内镜下粘膜剥离术后患者发生菌血症的风险较低,术后发生的白细胞计数、C反应蛋白升高与手术引起的内毒素血症有关。常规ESD术前预防性使用抗生素非必需。     

内毒素血症时肝组织内血小板活化因子及其受体的变化与肝损伤的关系

目的　研究内毒素血症时肝组织、肝细胞、枯否氏 (Kupffer)细胞血小板活化因子 (PAF)与PAF受体的变化及其与肝组织损伤的关系。方法　实验分在体和离体两部分。在体实验设 3组 :对照组 (Ⅰ组 )、内毒素血症组 (Ⅱ组 )、内毒素血症并苦银杏内酯B(GinkgolideB)预处理组 (Ⅲ组 )。Ⅰ组及Ⅱ、Ⅲ组动物分别于内毒素处理后 1、3、5、8小时等时相点活杀取材 ,测定组织PAF、丙二醛 (MDA)、三磷酸腺苷 (ATP)含量以及肝组织PAF受体的特征。离体实验设对照组和内毒素血症组 ,二组动物分别于内毒素处理后 1、3、5、8小时等时相点行肝脏原位灌流分离肝细胞、肝枯否氏细胞 ,测定胞内及培养上清液中的PAF含量 ,同时测定不同细胞表面PAF受体的特征。结果　内毒素血症时 ,肝组织PAF、MDA含量均明显增加 ,ATP的水平显著降低。内毒素血症时 ,肝组织、肝细胞、枯否氏细胞PAF受体的亲和力变化均不明显 ,但于 8小时时相点 ,肝组织、枯否氏细胞PAF受体结合位点有较明显的增加 ,最大结合力分别 =(19.93± 2 .34)fmol/mg .p、(2 .15±0 .2 7)fmol/mg .p。用PAF受体拮抗剂GinkgolideB预处理后 ,肝组织中PAF的水平未受明显影响 ,MDA含量显著降低 ,ATP水平有较明显的改善。结论　内毒素血症时 ,PAF可能通过其相应的胞膜受体直接参与     

结肠途径治疗对中暑犬炎症因子及内毒素血症的影响

目的研究结肠途径治疗(肠疗)对中暑犬血清酶、炎症因子及内毒素血症的影响。方法建立高温中暑犬的动物模型,将犬随机分为两组(肠疗组、常规治疗组),比较两组的降温时间,测定中暑前、中暑后6、24、48 h的血丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)和肌酸磷酸激酶(CK),测定上述时点血白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及内毒素(ET)水平,进行统计学分析。结果与常规治疗组相比,肠疗组降温时间明显缩短(P<0.01),ALT、AST、CK明显降低(P<0.05),IL-1β、IL-6、TNF-α和ET水平显著下降(P>0.05)。结论肠疗可加快高温中暑犬降温速度,促进血清酶恢复,清除血清炎症因子,减轻内毒素血症。     

急性高容量血液稀释对机体纤溶活性的影响

目的　观察和比较应用羟乙基淀粉 (HES)或低分子右旋糖酐进行急性高容量血液稀释 (acutehypervolemichemodilution ,AHHD)后纤溶活性的变化 ,为临床血液替代治疗提供实验依据。方法　 6 0例择期脊柱手术病例随机分为 6 %羟乙基淀粉 (H组 )和低分子右旋糖酐 (D组 ) ,每组 30例。于手术前 ,以 0 .3ml/(kg .min)的速度分别输入HES或右旋糖酐 4 0进行AHHD ,比较两组患者手术中出血量、循环功能、围术期异体血输入量 ,并检测稀释前、稀释后 2、2 4小时全血Hct,t PA活性 ,D Dimer含量。结果　AHHD后 ,患者术中血液循环功能稳定 ,围术期输血量减少 ,Hct明显降低。H组血浆t PA活性略增高 ,D Dimer含量无明显变化 ;D组t PA活性升高 ,D Dimer含量降低。结论　AHHD可以有效地维持术中血液循环功能的稳定 ,提高患者对失血的耐受性 ,减少异体血输入量。     

Effects of Viscoseal, a synovial fluid substitute, on recovery after arthroscopic partial meniscectomy and joint lavage

This was a pilot, single blind, randomised, controlled study in patients requiring partial meniscectomy. The aim was to assess whether replacing the synovial fluid lost during arthroscopy with a hyaluronic acid-containing synovial fluid substitute (Viscoseal) would reduce the severity and duration of post-operative symptoms during the 4 weeks post-surgery, in comparison to the standard arthroscopy procedure alone. Fifty patients were randomly assigned to either undergo arthroscopic partial meniscectomy alone (control group: n=25) or to receive 10 ml Viscoseal into the joint at the end of the procedure (Viscoseal group: n=25). Forty patients (20 per group) completed the study. Despite the small patient population in this pilot study, some interesting results were obtained. On Day 1 after surgery, the mean values for pain at rest (VAS) increased in both groups but this increase was lower in the Viscoseal group (8.9±23.1 mm) than in the standard therapy group (20.0±25.9 mm) (Mann–Whitney statistic MW-S: P=0.0525) and remained in favour of Viscoseal for the first 3 days after surgery. Joint swelling decreased to a greater extent in the Viscoseal group with an observed superiority at Day 7 (MW-S: P=0.1187) and a proven superiority at Days 12 (MW-S: P=0.015) and 28 (MW-S: P=0.0072). Diclofenac intake was lower in the Viscoseal group from Day 3 to Day 28 with a proven superiority (LB-CI > 0.5) in favour of Viscoseal on Days 3 (MW-S: P = 0.0093), 4 (MW-S: P= 0.0075), and 7 (MW-S: P = 0.0195) indicating that the product had an NSAID-sparing effect. Viscoseal was safe and well-tolerated and no adverse reactions occurred during the study. These findings indicate that Viscoseal may be useful as a synovial fluid substitute after arthroscopy.     

肺泡蛋白沉积症的多层螺旋CT表现及肺泡灌洗术后改变

目的:探讨27例肺泡蛋白沉积症(PAP)及22例支气管肺泡灌洗术(BAL)后患者的MSCT的表现,旨在提高对本病诊断、鉴别诊断及评价灌洗术后的效果.方法:对27例全部经病理证实的PAP进行回顾性分析,MSCT上观察病灶的形态、范围、边缘及对比灌洗术前后的变化,分析PAP的MSCT表现.结果:PAP在MSCT上表现多样化,可见地图征19例,碎石路征15例,肺水肿样5例,肺实变征7例,伴有微小结节2例,间质纤维化3例;BAL术后20例可显著改善.结论:MSCT能直观显示PAP的影像特征,对诊断有较高的准确性,亦可评价PAP严重程度及随访BAL术后效果.     

烧伤延迟复苏时大鼠心肌细胞线粒体呼吸功能的变化

目的:观察严重烧伤延迟复苏时大鼠心肌细胞线粒体呼吸功能的变化。方法:88只大鼠随机分为正常对照组(A组)、即时复苏组(B组)和延迟复苏组(C组),B组和C组造成20％总体表面积Ⅲ度烧伤,并测定伤后1h,3h,6h,24h,48h线粒体呼吸Ⅲ、Ⅳ态及呼吸控制率(RCR);测定线粒体呼吸链NADH-CoQ还原酶、琥珀酸脱氢酶活力。结果:①烧伤后B、C组心肌细胞线粒体RCR和NADH-CoQ还原酶显著低于A组(P<0．05);C组显著低于B组(P<0．05);②B组心肌细胞线粒体RCR和NADH-CoQ还原酶活力复苏3小时代偿性增高,但后期进一步降低;③伤后3小时内,B、C组心肌细胞线粒体内琥珀酸脱氢酶活力无显著降低(P >0．05);复苏后期显著低于A组(P<0．05),C组显著低于B组(P<0．05)。结论:严重烧伤大鼠延迟复苏时会加重心肌细胞线粒体呼吸功能损伤。     

Pulmonary alveolar proteinosis in a child: HRCT findings before and after bronchoalveolar lavage

We demonstrate the high-resolution computed tomography (HRCT) findings of pulmonary alveolar proteinosis in a child before and after bronchoalveolar lavage. The CT pattern in our case differs from the pattern described in previous reports. We found a more homogeneous distribution of the pulmonary changes and a “crazy paving” pattern. High-resolution CT may be helpful in the differential diagnosis of this rare disease and in the follow-up of the pulmonary changes after bronchoalveolar lavage. Received 16 July 1997; Revision received 19 January 1998; Accepted 21 January 1998     

苏乐康胶囊对60Coγ线照射犬外周血象的影响

次全身照射(6.5Gy)犬, 经苏乐床胶囊治疗厨外周血白细胞、淋巴细胞、血小板和网职红细胞照后最低值和实验结束时恢复到最高值均高于巳知升白组对照组：其中苏乐康胶囊治疗疽血小板最高值与对照组比较差异非常显着(P<0.001).组织帝粤学检查进一步证实了苏廷康胶囊确实有保护和促进辐射损伤动物骨髓造血功能的恢复作用。淋巴缅胞ANAE染色反应表明苏乐隶胶囊具有抑制辐射引起的Ts细胞下降, 降低辐射所致免疫损伤和提高机体免疫功能作用。     

支气管肺泡灌洗液4种新型肿瘤标志物检测对周围型肺癌的诊断价值

目的 探讨支气管肺泡灌洗液(BALF)和血清中4种新型肿瘤标志物热休克蛋白90α(HSP90α)、谷胱甘肽S转移酶P1(GSTP1)、泛素特异性肽酶8(USP8)、几丁质酶3样蛋白1(CHI3L1)在周围型肺癌诊断中的临床价值.方法 采用酶联免疫吸附法检测100例周围型肺癌住院患者及50例肺部良性疾病患者BALF和血清中HSP90α、GSTP1、USP8、CHI3L1的浓度.分析4种肿瘤标志物含量与不同细胞类型、患者年龄、肺癌分期之间的相关性,以及对周围型肺癌的诊断敏感性和特异性.结果 肺癌患者BALF中HSP90α平均浓度显著高于肺部良性疾病显著(P＜0.05),诊断敏感性为77.0％,特异性为82.0％;肺癌患者血清中HSP90α平均浓度与肺部良性疾病患者比较差异无统计学意义(P＞0.05).肺癌患者BALF中CHI3L1平均浓度显著高于肺部良性疾病显著(p＜0.05),诊断敏感性为72.0％,特异性为80.0％;肺癌患者血清中CHI3L1平均浓度与肺部良性疾病患者比较差异无统计学意义(P＞0.05).小结节肺癌(原发病灶≤1cm)患者BALF中HSP90α及CHI3L1平均浓度与肺部良性疾病患者比较差异无统计学意义(P＞0.05).肺癌患者BALF及血清中USP8、GSTP1平均浓度与肺部良性疾病患者比较差异无统计学意义(P＞0.05).肺癌患者BALF及血清中4种肿瘤标志物浓度与年龄、肺癌分型(腺癌或鳞癌)、肺癌分期(Ⅰ-Ⅳ期)等因素无相关性;CHI3L1在肺癌患者BALF中的浓度与原发灶直径有一定相关性(P＜0.05),Pearson相关系数为0.203;其他3种肺癌标志物在BALF、血清中的浓度与肿瘤原发灶直径无相关性.结论 检测BALF中HSP90α及CHI3L1浓度对周围型肺癌的诊断有一定价值,且优于血清肿瘤标志物.     

乙酰半胱氨酸溶液对急性肺损伤肺泡灌洗液中炎性因子及肺表面活性蛋白的影响

目的 探讨乙酰半胱氨酸溶液对急性肺损伤肺泡灌洗液(bronchoalveolar lavage fluid,BALF)炎性因子及肺表面活性蛋白的影响.方法 选取2017-02至2020-01医院收治的急性肺损伤患者100例,随机分为对照组和观察组,每组50例,两组入院后均行支气管肺泡灌洗,并均给予机械通气,对照组给予常...     

Myocardial flow and function after regional beta-blockade in exercising dogs

This study was designed to examine the contribution of beta 1- and beta 2-adrenergic receptors in modulating coronary blood flow and cardiac function in exercising dogs. Dogs were chronically instrumented to measure left circumflex flow velocity (CFV), heart rate, regional left ventricular function [systolic shortening, (%S) and maximum velocity of shortening (dL/dt(s)max)], and global left ventricular function [left ventricular pressure (LVP and dP/dtmax)]. Exercise significantly increased LVP (31 +/- 4%), dP/dtmax (130 +/- 17%), heart rate (116 +/- 20%), %S (28 +/- 6%), dL/dt(s)max (89 +/- 23%), and CFV (91 +/- 25%). Regional injection of the non-selective beta-blocker propranolol (1.0 mg) into the circumflex artery during exercise was associated with decreases in LVP (-8 +/- 3%), dP/dtmax (-17 +/- 3%), %S (-15 +/- 4), dL/dt(s)max (-13 +/- 4%), and CFV (-22 +/- 4%). Selective beta 1-receptor blockade with atenolol (1.0 mg, i.c.) was associated with similar decreases in LVP (-7 +/- 3%), dP/dtmax (-33 +/- 4%), %S (-12 +/- 3%), dL/dt(s)max (-17 +/- 2%), and CFV (-18 +/- 3%) during exercise. In contrast, selective beta 2-receptor blockade with ICI 118551 (250 micrograms, i.c.) produced significant decreases in only CFV (-11 +/- 2%) during exercise. Thus, the data suggest that the reductions in myocardial contractile function and flow after regional beta-blockade are primarily due to a decrease in myocardial beta 1-receptor stimulation. In addition, there apparently is a small involvement of either coronary vascular or pre-synaptic beta 2-receptors in mediating the coronary vascular flow response during exercise.     

Changes in regional and overall lung function after bronchography

This investigation compares the effects of unilateral bronchography on classical pulmonary function parameters (spirometry, CO transfer, flow-volume curve, and arterial blood gases) and radioisotopic measurements by means of ^99mTc-labeled microspheres and ^81mKr.The regional changes of ventilation and perfusion were quantified by a radioisotopic index, which was established for each zone of interest: explored lung and unexplored lung.The quantitative study of regional perfusion and ventilation reveals significant reduction of ventilation for lung bases, but not for lung apices. The radioisotopic measurements show a reduction of perfusion parallel to the reduction of ventilation. There is no significant correlation between traditional pulmonary function parameters and isotopic indices. Radioisotopy proved a sensitive tool for investigation of unilateral alterations.Partly presented at the joint meeting of the S.E.P.C.R. working groups on gas exchange and regional lung function, Brussels Sept. 1978 and at the Krypton 81m meeting — London Nov. 1978