机械通气对海水淹溺肺水肿兔肺组织学的影响

目的：观察常规机械通气(CMV)和高频喷射通气(HFJV)治疗兔海水淹溺肺水肿(PE—SWD)后肺组织病理学改变。方法：应用CMV和HFJV对14只PE—SWD新西兰大白兔进行救治，着重观察治疗前后肺组织病理学的改变。结果：PE—SWD兔HE染色见肺泡及肺间质水肿明显，多数肺泡腔内见均匀红染；肺泡壁毛细血管充血扩张，有肺透明膜形成；可见局灶性肺不张、气肿；肺间质、肺泡腔内见较多炎细胞浸润。CMV、HFJV治疗组上述病变明显减轻，CMV组减轻更明显。结论：机械通气治疗后，PE—SWD兔肺组织水肿、炎细胞浸润等病理学改变有明显改善。     

高压氧、机械通气对海水淹溺肺水肿兔肺组织学及呼吸功能的影响

目的　观察高压氧 (HBO)、机械通气对海水淹溺肺水肿 (PE- SWD)兔肺组织学及呼吸功能的影响。方法　将 2 4只实验动物随机分为 PE- SWD组、HBO治疗组、机械通气治疗组。在不同时间点观察动脉血气分析、呼吸频率、呼吸动力学指标 ,实验结束后进行肺组织病理学检查。结果　 HBO治疗组、机械通气治疗组各相同时间点 Pa O2 明显高于 PE- SWD组 (P<0 .0 1) ;HBO治疗组除个别时间点外 ,p H、Pa CO2 在整个治疗过程中变化不明显 ;机械通气治疗后 p H的变化规律略与 PE- SWD组相同 ,但治疗结束时仍低于其他组 (P<0 .0 1) ,Pa CO2 始终维持在一个较高的水平 (P<0 .0 1)。两种治疗都减轻了肺损伤程度 ,在降低气道峰压、提高肺顺应性方面两治疗组之间比较 ,差异无显著性意义 (P>0 .0 5 )。结论　 HBO和机械通气治疗可明显纠正 PE- SWD时的低氧血症 ,减轻肺损伤程度 ,改善呼吸功能。     

高频喷射通气治疗海水淹溺肺水肿兔时对肺毛细血管内皮细胞色素氧化酶活性的影响观察

细胞色素氧化酶 (cytochrom e oxidase,CYTO)是细胞线粒体 (m itochondria,MIT)内膜上的电子传递蛋白 ,是呼吸链的组成成份 ,起传递电子、传递氧的作用。我们在高频喷射通气 (high- frequency jet ventilation,HFJV)对海水淹溺肺水肿(pulm onary edema after seawater drowning,PE- SWD)的治疗研究中 ,观察了肺毛细血管内皮 CYTO受到的影响 ,为临床应用 HFJV救治海水淹溺肺水肿提供实验依据。一、材料与方法1.动物及分组 :选用雄性纯种新西兰兔 2 8只 (由江苏省农科院动物实验中心提供 ) ,随机数法分为正常对照组(normal control …     

兔海水淹溺肺水肿时肺损伤及其机理研究(论著)

目的：观察急性海水淹溺所致肺损伤并探讨其发生机理。方法：向兔肺内灌入海水造成急性淹溺肺水肿模型。采用全自动血气分析仪和计算机图像分析系统，对兔动脉血气、酸碱等６项指标和肺毛细血管内皮细胞Ｎａ＋－Ｋ＋－ＡＴＰ酶等９项参数进行自动检测和定量测量。结果：灌海水后兔动脉血ｐＨ、ＰａＯ２、血氧饱和度（ＳＯ２）、实际碳酸氢盐（ＡＢ）和碱剩余（ＢＥ）等５项指标明显降低（Ｐ＜０．０１）。ＰａＣＯ２在灌海水后１０～３０分钟呈短暂性升高。在海水淹溺肺水肿（ＰＥ－ＳＷＤ）组中，肺毛细血管内皮细胞Ｎａ＋－Ｋ＋－ＡＴＰ酶活力显著降低，肺泡Ⅰ、Ⅱ型上皮细胞和肺毛细血管内皮细胞内Ｃａ２＋沉淀颗粒明显增加。结论：低氧血症和代谢性酸中毒可认为是海水淹溺后肺损伤发生的主要原因，细胞内钙超载和肺内Ｎａ＋－Ｋ＋－ＡＴＰ酶活力降低与ＰＥ－ＳＷＤ的发生发展密切相关，应引起临床医生的高度重视     

部分液体通气对兔海水淹溺型肺水肿的气体交换和病理组织学的影响

目的　观察部分液体通气 (PLV)与常规机械通气 (CMV)对海水淹溺型肺水肿 (PE SWD)家兔肺组织损伤程度的影响。方法　健康成年雄性新西兰兔 2 4只 ,经气管插管注入海水制成PE SWD模型后 ,随机分为 3组 (n =8) :阳性对照组 (PE) ;常规机械通气组(CMV) ,即常规通气(CMV) +呼气末正压 (PEEP)治疗 ;部分液体通气组 (PLV) ,即肺内注入全氟萘烷 (FDC) +CMV +PEEP。治疗180min,分别观察各组治疗前后动脉血PaO2 、PaCO2 、血浆肿瘤坏死因子α(TNF α)及肺病理组织学的变化。结果　PLV组治疗后PaO2 明显改善 ,较CMV组稳定 ;肺泡腔渗出减少 ;肺水肿、肺不张等轻于CMV组 ;TNF α水平低于PE组 (P <0 0 5 ) ,但与CMV组比较差异不明显。结论　PLV可明显改善PE SWD家兔的动脉血气情况 ,减轻肺组织损伤。     

外周血淋巴细胞三磷酸腺苷酶活力测定

本文报道了外周血淋巴细胞三磷酸腺苷酶(ATP酶)细胞化学测定法.分析了在Gomori介质中测定ATP酶活力的主要影响因素.确定了最适实验条件.根据淋巴细胞膜及胞浆内色素颗粒的着色强度将ATP酶活力划分为5种类型(以分型的百分数表示ATP酶的活力).用此方法初步观察了家兔、狗及慢粒白血病患者经γ线全身照射后外周血淋巴细胞ATP酶活力的改变.结果表明,家兔经2.0Gy全身照射后ATP酶活力3型约为照前的3.5倍;狗经6.5Gy照射后,除3型明显升高外,4型也从0升至2.5;而慢粒白血病患者经首次0.1Gy照射后,ATP酶活力4型即明显升高,约为照前的3.7倍.     

迅速减压对兔肺超微结构的影响

目的 研究迅速减压对兔肺超微结构的影响。方法 将30只新西兰白兔随机分为慢上升减压组和迅速减压组，用透射电镜观察兔肺超微结构的变化。结果 迅速减压组兔肺Ⅰ型及Ⅱ型肺泡细胞膜结构不清，细胞间连接松散，Ⅱ型肺泡细胞内发现肿胀的线粒体及扩张的粗面内质网，肺泡壁毛细血管扩张充血，血管内皮细胞肿胀，通透性增加。当减压峰值大于9．8kPa(1000mmH2O)时变化更为明显。结论 迅速减压能引起肺脏损伤，减压峰值越大，结构破坏就越重。     

糖尿病红细胞膜(Na,K)-ATP酶的初步研究

本文对21例健康人及10例糖尿病患者红细胞膜ATP酶活力进行了检测,同时测定了糖尿病患者血糖及血浆胰岛素(INS)水平,结果,糖尿病患者红细胞膜(Na,K)-ATP酶的活力比健康人低67.1%,P<0.01。与血糖及血浆INS测定值经统计处理,二者无相关性,相关系数分别为:r=0.075及r=0.113,P>0.05。本法批内CV=3.8％。实验结果提示,糖尿病患者红细胞膜结构可能有一定的异常。     

海水浸泡软组织火器伤伤口局部应用吲哚美辛的实验研究

目的探讨吲哚美辛在海水浸泡火器伤伤口局部应用对浸泡组织活力的影响.方法以高速钢球射击兔后肢,伤后将致伤兔浸泡于海水中1小时,出水后将吲哚美辛生物陶瓷缓释体放置于伤口内,测定伤前及浸泡后火器伤组织肿瘤坏死因子(TNF)、一氧化氮(NO)、ATP、Na+-K+-ATP酶活性.采用激光多普勒法测定伤区的血流量.结果吲哚美辛能明显减少浸泡后24小时内伤口内TNF、NO生成,增加ATP含量以及Na+-K+-ATP酶活性,提高组织灌流.浸泡后36小时内上述变化逆转,继发损伤加重.结论吲哚美辛应用于浸泡火器伤伤口能在浸泡后24小时内抑制伤口过度炎症反应,减轻继发损伤.     

C-EPO预处理对创伤性脑损伤合并海水淹溺大鼠肺组织Nrf2/GPX4通路及铁死亡的影响

目的探究氨甲酰化促红细胞生成素(C-EPO)对创伤性脑损伤(TBI)合并海水淹溺(SWD)大鼠肺组织核因子E2相关因子2(Nrf2)/谷胱甘肽过氧化物酶4(GPX4)通路及铁死亡的影响。方法选取72只SD大鼠按随机数字表法分为假手术(sham)组、TBI+SWD组、C-EPO组和C-EPO+ML385(Nrf2抑制剂)组各18只(其中每组6只大鼠为备用)。采用控制性皮质撞击(CCI)颅脑致伤法+气管内泵入海水法(3 ml/kg)建立TBI+SWD大鼠模型。每24 h腹腔注射50 μg/kg的C-EPO。Nrf2抑制剂采用ML385, 30 mg/kg, 1次/d。对各组大鼠进行神经功能评分与肺组织含水量测定, HE染色观察肺形态, 普鲁士蓝染色观察肺组织中铁沉积情况, 分光光度计法测定肺组织中铁、丙二醛(MDA)、谷胱甘肽(GSH)含量及GPX4活性, qPCR法检测肺组织中Nrf2 mRNA和GPX4 mRNA表达水平。结果 4组大鼠造模后24 h神经功能评分差异有统计学意义(F=21.30, P<0.001), TBI+SWD组、C-EPO+ML385组大鼠神经功能评分均低于...     

Virtual pulmonary arterioscopy in pulmonary embolic disease

16 slice multidetector CT provides virtual endoscopic views of the inside of arteries, or any other hollow structures. This is performed non-invasively using post-processing of three-dimensional isotropic image data sets, acquired during standard CT examinations. These virtual endoscopic views are simultaneously correlated with the standard multiplanar reconstructions, with the ability to navigate a virtual camera through the hollow structure under study. Normal and abnormal volume rendered images of the pulmonary arteries are presented in correlation with the multiplanar reformats. The abnormal images show the volume rendered appearances of acute and chronic pulmonary embolic disease. It is also postulated that this technique has a problem solving role in the differential diagnosis of chronic mural emboli from extravascular structures such as adjacent lymph nodes or bronchiolar impaction. This technique may also have a role in medical education, providing clinicians and medical students with interactive three-dimensional representations of disease processes.     

The relationship between pulmonary artery pressure and pulmonary artery diameter in pulmonary hypertension

The pulmonary arteries dilate in response to many factors, principally increased pressure and flow. In patients who have pulmonary arterial hypertension but no increase in flow, we have compared main pulmonary artery size at computed tomography with pulmonary haemodynamic data obtained during right heart catheterisation. In patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension, dilatation correlated with raised pulmonary vascular resistance and reduced cardiac output but not with mean arterial pressure. In patients with chronic lung disease no correlations were shown though a trend between raised pressure and size was observed. We speculate that pulmonary artery compliance is an important factor which determines the degree of dilatation in response to raised pressure. Estimations of pressure cannot be made from measurements of pulmonary artery size without knowledge of the underlying lung disease.     

Computed tomography pulmonary angiogram diagnosis of pulmonary embolism

Over the last decade, contrast-enhanced spiral CT has been established as a non-invasive alternative to catheter angiography and is now regarded as the first-line imaging investigation for the diagnosis of pulmonary embolism (PE). The reported sensitivities for the diagnosis of PE of spiral CT vary from 45 to 100% and the specificities vary from 78 to 100%. Prospective outcome studies have shown a high negative predictive value for a single-detector spiral CT for PE. Patients' outcomes were not adversely affected in these studies when anticoagulation was withheld after a negative CT pulmonary angiogram. The main limitation of single-detector spiral CT has been its limited ability to detect isolated subsegmental PE. However, multidetector spiral CT allows evaluation of pulmonary vessels down to sixth-order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as the first-line imaging investigation for the diagnosis of PE.     

Unusual pulmonary angiographic findings in suspected pulmonary embolism

Pulmonary arteriography is most commonly performed to diagnose pulmonary embolism. A variety of clinical entities, however, may mimic pulmonary embolism both clinically and scintigraphically. Five patients with abnormal pulmonary arteriograms resulting from diseases other than pulmonary embolism are presented. The clinical, radiographic, and pathologic findings and long-term follow-up in these patients are described. Awareness of the angiographic patterns seen in these unusual cases is important in the differential diagnosis of pulmonary thromboembolism.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.