VitE对严重烧伤病人早期中性粒细胞吞噬功能损伤的防治…

观察应用抗氧化剂ＶｉｔＥ对２２例大面各界深度烧伤病人早期中闰细胞吞噬功能损伤的防治作用。结果严重烧伤复苏后，非治疗组全血中超氧化物歧化酶（ＳＯＤ）含量下降，丙二醛（ＭＤＡ）值上升，中性粒细胞功能异常均较健康人组和ＶｉｔＥ治疗组显著：血浆过氧化脂ＭＤＡ高与中性粒细胞（ＰＭＮ）吞噬率，吞噬指数均呈显著负相关；而ＶｉｔＥ治疗组与对照比较可见，治疗组ＳＯＤ下降，ＭＤＡ上升，ＰＭＮ功能下降均见减轻。结果提示     

VitE对严重烧伤病人早期中性粒细胞吞噬功能损伤的防治作用

观察应用抗氧化剂ＶｉｔＥ对２２例大面积深度烧伤病人早期中性粒细胞吞噬功能损伤的防治作用。结果严重烧伤复苏后，非治疗组全血中超氧化物歧化酶（ＳＯＤ）含量下降，丙二醛（ＭＤＡ）值上升、中性粒细胞功能异常均较健康人组和ＶｉｔＥ治疗组显著：血浆过氧化脂质产物ＭＤＡ升高与中性粒细胞（ＰＭＮ）吞噬率，吞噬指数均呈显著负相关；而ＶｉｔＥ治疗组与对照组比较可见，治疗组ＳＯＤ下降，ＭＤＡ上升，ＰＭＮ功能下降均见减轻。结果提示，在严重烧伤早期复苏补液治疗中，应用自由基清除剂和抗氧化剂可防治严重烧伤后早期ＰＭＮ功能损伤程度，提高机体防御能力。有关适宜用药剂量尚待进一步探讨。     

严重烧伤大鼠中性粒细胞表面L选择素的表达

白细胞粘附在烧伤后炎症反应和脏器损害中起重要作用[1,2 ] 。粘附分子Ｌ选择素位于中性粒细胞、单核细胞等细胞上 ,它通过与分布在内皮细胞上的配体结合 ,介导白细胞-内皮细胞间粘附 ;通过与白细胞上配体结合 ,介导白细胞间粘附 ;并介导淋巴细胞归巢[2 -3 ] 。笔者采用流式细胞仪技术 ,对大鼠烧伤后不同复苏条件下ＰＭＮ上Ｌ选择素的表达进行了动态观察。一、材料和方法1.动物模型及分组 :12只ＳＤ大鼠于 10 0℃水中 12ｓ,造成背部 30 %Ⅲ度烧伤。随机分为早期复苏组 (ＢＥ组 )和延迟复苏组 (ＢＤ组 ) ,每组 6只。ＢＥ组在伤后 30、90ｍｉ…     

烧伤病人早期血清和创面水肿液对中性粒细胞凋亡的影响

目的 探讨烧伤病人早期血清、水泡液和痂下组织液对中性粒细胞(PMN)凋亡的影响。方法 采用伤后3d内重度以上烧伤患血清、24h内水泡液以及1周内Ⅲ度创面痂下组织液体外培养正常PMN,以正常血清作对照,应用流式细胞分析等方法观察PMN凋亡。结果 烧伤病人早期血清、水泡液和痂下液能抑制PMN凋亡,使PMN凋亡百分率下降、DNA断裂百分率降低,DAN凝胶电泳不出现细胞凋亡特有的“梯形带”;且痂下液与烧伤病人早期血清对PMN凋亡的抑制程度几乎相同,而水泡液的抑制作用稍弱于前两。结论 烧伤病人早期血清、水泡液和痂下组织液能抑制PMN凋亡。     

静脉输注维生素E对大鼠急性胆管炎时肝脏功能的保护作用

为观察急性胆管炎时脂质过氧化损害情况，以及维生素Ｅ（ＶＥ）乳剂对肝功能的保护作用，采用大鼠急性胆管炎模型，于模型和时及制作后２４小时膜静脉注入ＶＥ乳剂或空白乳剂，并于制作后４８小时活杀动物，取肝脏组织及血清检测丙二醛含量，超氧化物歧化酶活性及三磷酸腺苷含量。结果；与空白乳剂组比较，ＶＥ乳剂组肝组织及血清中ＭＤＡ和线粒体谷草转氨酶均显著降低，ＳＯＤ活性显著升高；感染肝叶肝脏组织ＡＴＰ含量亦显著高于空     

严重烧伤早期肺组织内中性粒细胞粘附扣留的实验研究

目的:通过动态测定烧伤大鼠肺组织髓过氧化物酶(MPO)活性及外周血中性粒细胞(PMN)含量,观察并分析烧伤早期肺组织内PMN粘附扣留的变化特征及其意义。方法:Wistar大鼠,随机分为立即复苏组和延迟复苏组,两组动物均分批在伤前及伤后24小时内动态取材,测定外周血PMN含量、MPO活性,并作肺组织病理学检查。结果:①两组动物伤后肺组织内MPO活性均逐渐增高,伤后8小时起维持较高水平,以延迟复苏组增高更为明显;②两组动物外周血PMN计数均于伤后0.5小时起迅速增加,于伤后2～4小时达到峰值后逐渐下降,并与MPO活性的变化趋势呈负相关;③肺组织病理学检查见肺组织内有大量的PMN粘附扣留,也以延迟复苏组为明显。结论:严重烧伤后早期肺组织内有大量的PMN粘附扣留,PMN粘附扣留可能是烧伤后早期肺脏功能损伤的重要原因。     

严重烧伤后中性粒细胞对血管内皮细胞形态与功能的影响及参麦注射液对其作用的实验研究

目的 了解严重烧伤后中性粒细胞(PMN)对血管内皮细胞形态与功能的影响及参麦注射液对内皮细胞的保护作用.方法 从健康体检者和烧伤患者(伤后6、24、48 h)静脉血中分离出PMN,与血管内皮细胞株ECV304体外共培养,采用噻唑蓝法检测ECV304细胞活力.放射免疫法检测培养上清液中内皮素1、一氧化氮(NO)的含量,并计算两者的比值(内皮素1/NO).另取伤后24 h血液标本与ECV304共培养,分别加入等渗盐水及0.5、2.0、8.0 g/L参麦注射液各100 μL,观察参麦注射液对上述指标及ECV304形态的影响.结果 与健康体检者比较,在伤后6 h的PMN刺激下ECV304活力明显下降、内皮素1含量明显上升(P＜0.01),伤后24 h的PMN刺激时尤为显著;而伤后6 h在PMN刺激下NO含量明显上升达峰值[(48.9±2.6)μmol/L,P＜0.01],伤后24,48 hPMN刺激ECV304的NO含量与健康体检者比较,无明显差异(P＞0.05);内皮素1/NO的变化趋势同内皮素1.加入不同浓度参麦注射液共培养后,可使内皮细胞活力明显上升、内皮素1含量明显下降、NO含量明显升高,其中中浓度参麦注射液可使体系中内皮细胞形态近似正常.结论 严重烧伤后PMN对血管内皮细胞形态、细胞活力、内皮素1/NO均有不同程度的影响,且以伤后24 h的PMN刺激最明显;参麦注射液可以改善上述情况,对严重烧伤后血管内皮细胞损伤具有保护作用.     

中性粒细胞在大鼠深Ⅱ度烧伤创面早期进行性损伤中的作用

目的 探讨中性粒细胞(PMNs)在大鼠深Ⅱ度烧伤创面早期进行性损伤中的作用。方法采用SD大鼠深Ⅱ度烫伤模型,检测烧伤后大鼠外周血PMNs数量、创面组织中髓过氧化物酶(MPO)活性、丙二醛(MDA)含量,Masson’s三色染色及抗Vimentin免疫组化染色显示创面坏死组织。结果 外周血PMNs伤后即刻增加,4h达高峰;创面组织MPO活性伤后24h达高峰;MDA含量伤后0．5h达最低,至48h才高于正常;组织学观察伤后48h坏死组织量显多于伤后24h。结论 PMNs导致的创面损伤集中发生在伤后24h后。提示阻断PMNs粘附以减轻深Ⅱ度烧伤创面早期进行性损伤,需在伤后4h内进行,而使用抗氧化剂则应在伤后24h内进行。     

Plasma and tissue vitamin E depletion in sheep with burn and smoke inhalation injury

Oxidants are involved in the pathogenesis of many disorders caused by burn and smoke inhalation; α- and γ-tocopherols are major tissue antioxidants, and their depletion should reflect oxidant injury. To determine whether plasma and tissue vitamin E levels would thus be depleted in severe burn, prepared sheep were randomly divided into the following groups: non-injured, burn- and smoke-exposed, burned only and smoke-exposed only. All were resuscitated with Ringer's lactate solution, mechanically ventilated and sacrificed at various time intervals. Immediately following injury plasma, lung, trachea, heart and liver tocopherols/lipids were measured and found to be significantly depleted except in the heart. Reduction of tissue γ-tocopherol appeared earlier than reduction of α-tocopherol. Thus animals receiving combined burn and inhalation injury underwent marked oxidative stress, suggesting that vitamin E might be depleted also in humans with burn and smoke inhalation injury, and that appropriate supplementation should be evaluated.     

Investigation and assessment of neutrophil dysfunction early after severe burn injury

BackgroundExtensive burn injury results in a complex immune response that is associated with mortality and prognosis. Studies on acquired immune and the development of sepsis in burn patients have been reported. However, one of the main cells in innate immune, neutrophil dysfunction in the burn shock stage has not been thoroughly characterized.MethodsNeutrophil chemotaxis, expression of neutrophil surface markers (P2X1 receptor, [P2RX1]), degranulation (myeloperoxidase [MPO], heparin-binding protein [HBP], matrix metalloproteinase-9 [MMP-9] and neutrophil elastase [NE]), oxidative burst capacity, neutrophil extracellular trap (NET) generation, phagocytosis and apoptosis were measured in 18 patients with major burns (≥30% total body surface area [TBSA]) within 48 h after burn injury. In addition, circulating neutrophils and vascular permeability in mice model with 30% TBSA third-degree burns were also observed and investigated.ResultsNeutrophil functions were reduced considerably in burn shock stage, which was characterized by decreased chemotaxis, phagocytosis and abnormal bactericidal function. Increased release of heparin-binding protein (HBP) and the expression of P2RX1 on the neutrophil surface are related to fluid leakage and decreased chemotaxis during burn shock stage, respectively. The combination of HBP concentration in plasma and P2RX1 expression on neutrophils gives a better prediction of neutrophil dysfunction in burn-injured patients.ConclusionNeutrophil dysfunction plays a key role in the development of burn injury. Targeting the restoration of neutrophil function may be a feasible therapeutic intervention to help reduce fluid loss during shock and the severity of subsequent infection.     

吸入一氧化氮对吸入性损伤患者心功能的影响

目的观察吸入一氧化氮(NO)对吸入性损伤患者心功能的疗效,初步探讨其作用机制. 方法选择12例烧伤伴中度以上吸入性损伤的成年患者,随机分为2组.对照组(C组)6例,按常规治疗;治疗组(T组)6例,行常规治疗+吸入体积分数1×10-6 的NO.两组患者均留置各种导管.于治疗前及治疗后6、12、24、48和72 h观察两组患者各项心功能指标和血浆内皮素(ET)及NO含量的变化,对T组患者ET、NO的变化进行相关性分析. 结果 T组心排出量(CO)和心搏出量(SV)在24 h后显著高于治疗前,其变化早于C组 (P﹤0.05～0.01).T组左室每搏功指数(LVSWI)和右室每搏功指数(RVSWI)与C组相比均改善较早,且两组RVSWI比较差异有显著性意义(P<0.05).与C组比较,T组ET水平明显降低(P﹤0.05～0.01),而血浆NO水平明显升高(P<0.01),此两项指标呈负相关(r＝-0.98,P<0.01). 结论吸入体积分数1×10-6的NO可以改善吸入性损伤患者的心功能,其机制可能是NO对肺血管平滑肌张力具有调节作用.     

Protective effects of melatonin and vitamin E in brain damage due to gamma radiation

Gamma radiation is known to cause serious damage in the brain, and many agents have been used for neuroprotection. In this study, lipid peroxidation levels and histopathological changes in brain tissues of whole-body irradiated rats with likely radiation injury were compared to those with melatonin and vitamin E protection. Forty rats in four equal groups were used. The control group received neither radiation nor medication. The remaining groups received doses of 720 cGy in two equal fractions 12 h apart. The second group received radiation but no medication, the third received radiation plus 100 mg/kg per day of vitamin E i.p., and the fourth received radiation plus 100 mg/kg per day of melatonin i.p. over 5 days. On the 10th postoperative day, all the rats were decapitated and specimens from parietal cortices were analyzed for tissue malondialdehyde (MDA) levels and histopathological changes. Increases in MDA were relatively well prevented by melatonin treatment but less so with vitamin E therapy. On histopathological examination, melatonin significantly reduced the rates of edema, necrosis, and neuronal degeneration, whereas vitamin E reduced only necrosis. Neither substance was capable of preventing vasodilatation. In conclusion, melatonin may be useful in preventing the pathological changes of secondary brain damage as a result of free oxygen radicals generated by irradiation.     

Platelet lipid peroxidation in haemodialysis patients: effects of vitamin E supplementation

In haemodialysis patients, increased concentrations of malonyldialdehyde and decreased vitamin E content indicate lipid peroxidation in the platelets from oxidative damage. The same process has been described in red blood cells and in mononuclear cells in peripheral blood. However, platelet aggregation is within normal limits and does not change after treatment with vitamin E. On the other hand vitamin E supplementation reverts completely the biochemical abnormality of the platelets.     

严重脓毒症时中性粒细胞迁移功能障碍发生机制的研究进展

背景 严重脓毒症时机体中性粒细胞不能及时从血液循环中到达受感染的炎症部位,有效清除入侵的病原微生物.目的 探讨严重脓毒症时中性粒细胞迁移功能障碍的潜在机制,提高脓毒症患者治愈率和生存率.内容 从细胞因子、气体分子、细胞表面受体和核受体等多方面对中性粒细胞迁移障碍的机制加以分析.趋向 随着对脓毒症时中性粒细胞迁移能力改变相关机制研究不断深入,有可能找到新的治疗方式纠正严重脓毒症时中性粒细胞趋化能力下降.     

严重烧伤早期心肌收缩性与钙转运功能变化

目的研究烧伤早期心肌肌浆网(SR)钙转运功能变化,探讨其在烧伤后心肌收缩功能下降发病中的作用。方法采用30％TBSAⅢ度烧伤大鼠模型,离体心脏灌流,测定伤前及伤后心肌室内压最大变化速率(±dp/dtmax)变化,制备心肌肌浆网,应用微孔滤膜过滤技术测定心肌SR~(45)Ca~(2 )转运功能改变。结果与对照组相比,烧伤组左心室±dp/dtmax明显降低(P<0.01),心肌SRCa~(2 )-ATPase活性及SR~(45)Ca~(2 )摄取初速度、摄取容量均明显降低(P<0.01),偶联率比对照值大幅度下降。结论烧伤后早期心肌肌浆网Ca(2 )转运功能严重障碍,其是烧伤后心肌收缩功能降低的重要因素之一。     

Vancomycin pharmacokinetics in patients with severe burn injuries

Vancomycin is used in patients with severe burns and methicillin-resistant Staphylococcus aureus (MRSA) infection. This study investigated vancomycin pharmacokinetics in people with burns in comparison to people without burns and examined the factors contributing to pharmacokinetic variability. This was a retrospective, case-control study of hospitalised burns patients compared with a control patient cohort administered vancomycin without burn injury. Vancomycin pharmacokinetic parameters were determined using therapeutic drug monitoring data and a population pharmacokinetic modelling approach employing a two-compartment pharmacokinetic model. The impact of patient characteristics on vancomycin clearance was explored. Vancomycin clearance was significantly higher (p < 0.001) in burns patients (5.9 ± 3.1 L/h, n = 37) when compared to control patients (3.4 ± 1.8 L/h, n = 33), as was estimated creatinine clearance, which was correlated to drug clearance in burns patients (r² = 0.64). There was no significant change in volume of distribution between patient groups. The majority of patients received a dosing regimen of 1 g twice daily, resulting in significantly (p = 0.004) lower serum trough concentrations in patients with burns (median, 6.4 mg/L; range, 0.2–22.3 mg/L) than control (median, 9.2 mg/L; range, 4.0–29.8 mg/L). Higher clearance and lower serum vancomycin concentrations in people with severe burn may increase the risk of suboptimal bactericidal action and the development of resistance highlighting the need for dosage individualisation.     

严重烧伤早期心肌收缩性与钙转运功能变化

目的研究烧伤早期心肌肌浆网（ＳＲ）钙转运功能变化，探讨其在烧伤后心肌收缩功能下降发病中的作用。方法采用３０％ＴＢＳＡⅢ度烧伤大鼠模型，离体心脏灌流，测定伤前及伤后心肌室内压最大变化速率（±ｄｐ／ｄｔｍａｘ）变化，制备心肌肌浆网，应用微孔滤膜过滤技术测定心肌ＳＲ４５Ｃａ２＋转运功能改变。结果与对照组相比，烧伤组左心室±ｄｐ／ｄｔｍａｘ明显降低（Ｐ＜０．０１），心肌ＳＲＣａ２＋－ＡＴＰａｓｅ活性及ＳＲ４５Ｃａ２＋摄取初速度、摄取容量均明显降低（Ｐ＜０．０１），偶联率比对照值大幅度下降。结论烧伤后早期心肌肌浆网Ｃａ２＋转运功能严重障碍，其是烧伤后心肌收缩功能降低的重要因素之一。