双水平无创正压通气在慢性阻塞性肺疾病并发呼吸衰竭中的抢救作用

目的 观察双水平无创正压通气(BiPAP)在慢性阻塞性肺病(COPD)并发呼吸衰竭患者的抢救作用.方法 50例COPD伴Ⅱ型呼吸衰竭患者在常规治疗同时,用BiPAP呼吸机进行无创通气治疗,观察治疗前后的临床及动脉血气变化.结果 46例患者经机械通气治疗后意识恢复正常,动脉氧分压逐渐升高,动脉二氧化碳分压明显下降(P<0.01);1例放弃治疗,3例死亡.结论 BiPAP对COPD并呼吸衰竭疗效肯定,无严重不良反应. Abstract： Objective To estimate the efficacy of noninvasive positive pressure ventilation for chronic obstructive pulmonary disease (COPD) with severe respiratory failure. Methods Fifty cases of COPD with severe respiratory failure were treated by Bi-level noninvasive positive pressure ventilation and routine treatment. Observation was made on the clinical symptoms and changes of arterial blood gas before and after ventilation treatment. Results After ventilation, patients' symptoms of pulmonary encephalopathy and unconsciousness improved markedly and PaO2 improved significantly. Among forty-six cases, one patient dropped off and 3 cases died. Conclusions In COPD patients with severe respiratory failure, Bi-level positive airway pressure (BiPAP) noninvasive ventilation is effective with few serious complications.     

家庭无创正压通气在慢性阻塞性肺疾病稳定期患者中的疗效

目的 研究稳定期慢性阻塞性肺疾病并慢性呼吸衰竭患者家庭氧疗加用无创正压通气与单独应用家庭氧疗治疗的疗效.方法 慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者使用家庭氧疗加无创正压通气与单纯长期家庭氧疗患者比较在治疗1年中的病情恶化次数、住院次数、住院时间以及治疗前与治疗12个月后的血气指标和肺功能参数的变化和症状、体征.结果 随访12个月后,家庭氧疗加用无创正压通气治疗组病情恶化次数和住院次数均较单纯氧疗组明显减少.在治疗12个月随访时,家庭氧疗加用无创正压通气治疗组的动脉血氧分压(PaO2),动脉血二氧化碳分压(PaCO2),血液pH与单纯氧疗组比较均有显著改善,差异有统计学意义(P<0.05).结论 无创正压通气是慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者积极和有效的治疗措施. Abstract： Objective To study the clinical value of home non-invasive positive pressure ventilation(NIPPV) in patients with stable-phase chronic obstructive pulmonary disease(COPD)and chronic respiratory failure.Methods Stable COPD patients complicated with chronic respiratory failure received Bi-level positive airway pressure ventilation.The frequency of acute exacerbation,admissiontimes-admission expending,blood gas analysis were compared in these patients with those received long term oxygen therapy. Results After one year home non-invasive positive pressure ventilation,PaCO2,HCO-3 were decreased,while pH and PaO2 increased.Compared with patients received long term oxygen therapy,PaCO2 was greatly ameliorated and the frequency of acute exacerbation,admission times and admission expending declined.Conclusions Home non-invasive positive pressure ventilation will do good to COPD patients with hypercapnic respiratory failure during stable phase.     

阿魏酸钠对低氧性肺动脉高压大鼠肺血管平滑肌细胞Caspase-3,Bcl-2表达的影响

目的:探讨阿魏酸钠(SF)对低氧性肺动脉高压大鼠肺小动脉平滑肌细胞Caspase-3,Bcl-2表达的影响.方法:将21只Wistar大鼠随机分为对照组(n=7)、低氧组(n=7)及干预组(n=7)(胃饲SF并进行低氧处理).以常压低氧复制肺动脉高压模型,右心导管插入法检测平均肺动脉压(mPAP);分别称量大鼠右心室(RV)和左心室加室间隔(LV+S)的质量,计算出右心室肥厚指数RV/(LV+S);图像分析法测量肺小动脉管壁厚度和面积,计算出肺小动脉管壁厚度指标即管壁厚度占血管外径的百分比(WT%)和管壁面积占血管总面积的百分比(WA%);进行Caspase-3,bcl-2免疫组化染色,比较各组Caspase-3和bcl-2积分光密度值(IOD).结果:①与对照组比较,低氧组大鼠平均肺动脉压(mPAP)明显升高(P<0.05)、肺小动脉WT%,WA%以及RV/(LV+S)明显增加(P<0.05).与低氧组比较,干预组大鼠平均肺动脉压(mPAP)明显降低(P<0.05)、肺小动脉WT%,WA%以及RV/(LV+S)明显减少(P<0.05).②与对照组和低氧组分别比较,干预组Caspase-3IOD值均显著增高(...     

硫化氢对高肺血流性肺动脉高压大鼠平滑肌细胞线粒体 损伤的保护作用及其机制

目的：探讨硫化氢（H2S）对高肺血流性肺动脉高压大鼠肺动脉平滑肌细胞线粒体功能的影响,阐明其在高肺血流性肺动脉高压形成中的作用及其机制。方法：将27只大鼠随机分为假手术组、手术组和手术+硫氢化钠（NaHS）组,每组9只。行左肺切除术建立大鼠肺动脉高压模型。饲养35 d后,分别测定3组大鼠肺动脉平均压（mPAP）,检测右心室/体质量(RV/BW) 和右心室/（左心室+ 室间隔）［RV/(LV + S)］ 比值。检测各组大鼠血浆H2S水平和肺动脉组织中硫化氢还原酶（CSE）活性;测定线粒体总ATP酶、超氧化物歧化酶（SOD）、谷甘肽过氧化物酶（GSH-Px）活性和丙二醛（MDA）水平;透视电镜观察肺动脉平滑肌线粒
体超微结构。结果：与假手术组比较,手术组大鼠血浆H2S水平和肺动脉组织中CSE活性降低(P< 0.01);肺动脉组织线粒体膜肿胀,线粒体活力下降(P<0.01);线粒体中ATP 酶、SOD、GSH-Px 活性明显降低,MDA水平明显升高(P<0.01) 。与手术组比较,手术+NaHS组大鼠血浆H2S 水平和肺动脉组织中CSE 活性均升高( P< 0.01); 线粒体膜肿胀度减轻,活力有所恢复; 肺动脉组织中 ATP 酶、GSH-Px和SOD的活性明显升高( P< 0.01),MDA水平明显减少( P<0.01)。结论：H2S可增强线粒体ATP 酶、GSH-Px和SOD的活性,降低线粒体脂质过氧化水平,起到对大鼠肺动脉平滑肌的保护作用。     

左肺切除联合颈静脉注射脱氢野百合碱构建肺动脉高压小鼠模型的肺血管重构特点

  目的  比较左肺切除、颈静脉注射脱氢野百合碱、左肺切除联合颈静脉注射脱氢野百合碱三种方法构建肺动脉高压（PAH）小鼠模型的差异和肺血管重构的特点,寻找与临床发病机制接近的PAH动物模型,为深入研究重度PAH的发病机制提供良好的模型基础。  方法  取59只C57BL/6雄性小鼠（10～12周,24～30 g）,随机分为对照组（n=9）、左肺切除组（PE组,n=15）、颈静脉注射脱氢野百合碱组（MCTP组,n=15）和左肺切除联合颈静脉注射脱氢野百合碱组（P+M组,n=20）,通过检测右心室收缩压（RVSP）、右心室肥厚指数（RV/LV+S）、肺动脉中膜厚度百分比（WT%）、非肌性肺动脉肌化程度、新生内膜形成情况和血管阻塞评分（VOS）评价造模效果及肺血管重构的特点。  结果  ①与对照组比较,P+M组的RVSP、RV/LV+S、WT%、小肺动脉肌化程度均增加（P<0.01）;MCTP组表现为轻度的RVSP升高、右心室肥厚、中膜增厚和小肺动脉肌化程度增加（P<0.05）;PE组上述指标并无明显改变（P>0.05）。②P+M组腺泡内肺动脉可观察到新生内膜形成导致管腔明显狭窄,VOS为（1.25±0.80）分（P<0.001）,MCTP组和PE组均未观察到新生内膜形成,VOS为0分（P>0.05）。  结论  左肺切除联合颈静脉注射脱氢野百合碱可诱导小鼠形成重度PAH,该模型能较好模拟临床重度PAH的特征性病理改变,即新生内膜形成。     

Primary pulmonary artery chondrosarcoma: the use of different imaging modalities

Fewer than 300 patients with primary pulmonary artery sarcoma have been reported since 1923,when it was first described by Mandelstamm.1 The diagnosis of pulmonary artery sarcoma is difficult,and misdiagnosis as chronic pulmonary embolism often occurs.Herein,we reported a case of primary pulmonary artery chondrosarcoma.So far as we know,this patient served as the first case ever reported to receive computed tomography pulmonary angiography （CTPA）,gadolinium enhanced magnetic resonance imaging （MRI）,and positron emission tomography/computed tomography （PET/CT） before surgery.By these means,the utility of different imaging modalities for pulmonary artery sarcoma was well demonstrated.Keywords：primary pulmonary artery chondrosarcoma; computed tomography pulmonary angiography;magnetic resonance imaging; positron emission tomography     

参麦注射液治疗慢性肺源性心脏病的疗效观察及机理的探讨

目的　观测参麦注射液对慢性肺源性心脏病的临床疗效并探讨其机理。方法　选择 72例慢性肺源性心脏病患者 ,随机分成两组 ,试验前均评价心功能及监测动脉血气、右室压 (RVP)、平均肺动脉压 (mPAP)、全血高切粘度、全血低切粘度、血浆粘度、红细胞压积、纤维蛋白原、血红蛋白定量和红细胞计数等指标。治疗组在常规治疗的同时合并给予参麦注射液 5 0ml/d ,稀释后ivgtt,疗程 2周 :对照组只给予常规治疗。 2周后 ,复测上述指标 ,比较各组前后的变化。结果　 (1)参麦组心力衰竭纠正有效率和动脉血气改善的有效率显著高于对照组 (P <0 .0 5 )。 (2 )参麦组试验前后比较 ,右室压 (PVP)、平均肺动脉压 (mPAP)均明显下降 (P <0 .0 5 ) ;而对照组无显著性变化 (P >0 .0 5 )。 (3)参麦组试验前后比较 ,全血高切粘度、全血低切、血浆粘度、红细胞压积、纤维蛋白原、血红蛋白定量和红细胞计数等指标均明显下降 (P <0 .0 5 ) ;而对照组则无显著变化 (P >0 .0 5 )。结论　参麦注射液对慢性肺源性心脏病具有纠正心力衰竭、降低肺动脉及右心室压力、改善血液流变和动脉血气的作用     

快速床旁检测脑钠素对心力衰竭患者危险分层及预后的评价

目的通过快速床旁检测心力衰竭患者血中脑钠素(BNP),对比研究BNP对心力衰竭患者早期诊断、危险分层及预后评价的价值.方法入选2002年7月～2003年2月心力衰竭患者32例,非心力衰竭患者(心功能NYHAⅠ级)13例.即刻床旁抽血查血浆BNP浓度并行心脏超声检查.同时观察入院时血压、心率、肺部罗音和住院期间及出院后一个月内不良事件.结果(1)冠心病、高血压、风心病导致的心力衰竭患者的血浆BNP浓度都明显增高,但互相之间无明显差别;(2)BNP浓度增高程度与心力衰竭的严重程度成正相关;(3)BNP与左室射血分数(LVEF)呈显著负相关(相关系数为-0.76,P值＜0.001),与左室舒张末径(LVDD)呈显著正相关(相关系数为0.699,P值＜0.001).(4)BNP值为97.5pg/ml时,其预测心力衰竭的敏感性为90.6%,特异性为100%.(5)BNP浓度严重升高患者,死亡率及再住院率明显升高.结论快速床旁检测血浆中BNP浓度是早期诊断心力衰竭的一项重要的检查手段;血浆BNP浓度高低可能是对心力衰竭患者进行危险分层及预后评价的一项重要指标.     

New disease severity classification of patients with stable chronic obstructive pulmonary disease in Shanghai

Background The Global Initiative for Chronic Obstructive Lung Disease （GOLD） presented a new ABCD group classification of chronic obstructive pulmonary disease （COPD）.We aimed to examine the association of spirometric classification and the new GOLD classification with exacerbations,and to compare symptoms in different ways.Methods We investigated 848 patients with stable COPD from 24 hospitals.The annual frequencies of acute exacerbation and hospitalization were compared between the old and new classification.The symptom level was assessed using COPD assessment test （CAT） and modified British Medical Research Council （mMRC） questionnaire.Results A total of 848 patients were included in this study.According to spirometric classification,there were 32 patients of grade Ⅰ （3.8％）,315 of grade Ⅱ （37.1％）,366 of grade Ⅲ （43.2％）,and 135 of grade Ⅳ （15.9％）.According to GOLD 2011 classification,there were 59 patients of group A （7.0％）,172 of group B （20.3％）,55 of group C （6.5％）,and 562 of group D （66.3％）.In spirometric classification,the annual frequencies of acute exacerbation and associated hospitalization were respectively 1 （0-3） and 0 （0-2） for grade Ⅰ; 1 （0-5） and 0 （0-2） for grade Ⅱ; 2 （0-6） and 1 （0-3） for grade Ⅲ,and 3 （0-6） and 2 （0-3） for grade Ⅳ.In GOLD 2011,respectively 0 （0-3） and 0 （0-1） （group A）,1 （0-4） and 0 （0-3） （group B）,1 （0-5） and 0 （0-3） （group C）,and 3 （0-6） and 1 （0-3） （group D）.There were no significant difference between group B and C （Z=-1.347,P=0.178; Z=-0.772,P=0.440,respectively）.The coincidence rate using mMRC=1 and CAT=10 as cutoff points was 86.6％ （734/848,x=0.706）,compared with 77.9％ （661/848,K=0.60） using mMRC=2 and CAT=10.Conclusions Lung function test may be a better predictor of acute exacerbation and associated hospitalization of COPD.It is more appropriate to use mMRC=1 as cutoff point for assessing COPD sym     

Pulmonary artery injury management during pulmonary thromboendarterectomy

Pulmonary thromboendarterectomy （PEA） is the recommended treatment for chronic thromboembolic pulmonary hypertension （CTEPH）.1 Pulmonary artery injury is a major risk factor during PEA performed at less experienced surgical centers and is associated with adverse short-term consequences.In-hospital mortality may be as high as 15% in some PEA case series,with pulmonary artery injury and persistent pulmonary hypertension as the principal etiologies.2 Many techniques have been used to prevent pulmonary artery injury during PEA,but once the injury occurs,the prognosis is poor and may even result in death.Out of 202 PEA procedures performed at our surgical center,we successfully managed two cases of severe pulmonary artery injury and report our experience in the present case series.Keywords：chronic thromboembolic pulmonary hypertension; pulmonary thromboendarterectomy; pulmonary artery injury     

卡托普利对大鼠左向右分流模型肺小动脉重构的影响

目的观察血管紧张素转换酶抑制剂（ACEI）对肺循环容量负荷过重导致的肺血管重构的影响。方法采用腹主动脉一下腔静脉瘘制造大鼠容量负荷性肺动脉高压（PH）模型,并应用卡托普利进行干预,6周后观察各组肺动脉收缩压（PASP）、舒张压（PADP）、右室收缩压（RVSP）变化;心室重量变化;采用免疫组化染色比较肺血管平滑肌细胞（VSMC）α-平滑肌肌动蛋白（α-actin）及增殖细胞核抗原（PCNA）的阳性表达,比较15-50μm无肌性动脉肌性化程度以及肺小动脉50～100μm和101150μm血管厚度与血管外径之比（％WT）。结果手术组动物RVSP、PASP、PADP较对照组显著升高（P〈0．05）,手术＋卡托普利组RVSP、PASP、PADP均低于手术组（P〈0．05）;手术组RV／（LV＋S）、RV／BW、（LV＋S）／BW较对照组显著增加（P〈0．001）,而手术＋卡托普利组则较手术组明显降低（p〈0．01）,同对照组比较,手术组α-actin染色IOD值显著降低（P〈0．01）,而手术＋卡托普利组IOD值则高于手术组（P〈0．05）,手术组细胞PCNA阳性率显著升高（P〈0．01）,而手术＋卡托普利组低于手术组（P〈0．05）;手术组同其他两组比较,50～100μm、101～150μm血管％WT及15～50μm血管肌性化百分比显著增加（P〈0．01,）。结论卡托普利能有效地抑制肺动脉VSMC由收缩表型向合成表型转化,抑制VSMC的增生和肥厚,防止无肌性肺小动脉的肌性化,减缓PH肺血管重构进程,提示ACEI对左向右分流型先心病肺动脉高压有治疗前景。     

Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography

Background It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism.However,the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease.The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism （PE） severity using Mastora score.Methods This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography （CTPA）.The D-dimer level was noted.A pulmonary artery obstruction index （PAOI; Mastora score） ≥21.3% indicated severe obstruction of PE.A right ventricle/left ventricle （RV/LV） ratio 〉0.9 indicated RV dysfunction.Results The median D-dimer level and PAOI were 765 μg/L （95% C/：750-1 205 μg/L） and 16.77% （95% CI：16.32%-23.06%）,respectively.The D-dimer level was positively correlated with PAOI （r=0.417,P 〈0.000 1）.PAOI ≥21.3% was associated with high D-dimer levels （median,993 μg/L （95% C/：856-1 841 μg/L）,Z=-2.991,P=0.003）.The D-dimer level was correlated with the RV/LV ratio （r=0.272,P=0.024）.RV/LV ratios 〉0.9 were associated with high D-dimer levels （median,880 μg/L （95% CI：764-1 360 μg/L）,Z=-2.070,P=0.038）.PAOI was positively correlated with the RV/LV ratio （r =0.390,P=0.001）.After three months,both the PAOI and D-dimer levels decreased （Z=-7.009,P 〈0.000 1; Z=-6.976,P〈0.000 1,respectively）.Conclusion D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA,and can help monitor the therapeutic response.     

Evaluation of hawthorn extract on immunomodulatory biomarkers in a pressure overload model of heart failure.

BACKGROUND: Hawthorn extract (Crataegeus sp.) a botanical complementary and alternative medicine is often used to treat heart failure. The mechanism(s) by which hawthorn extract may treat heart failure is unknown but may include, theoretically, immunological effects. Therefore, the purpose of this study is to determine the effect of hawthorn extract on the immunomodulatory response in a pressure overload model of heart failure. MATERIAL/METHODS: A total of 62 male Sprague-Dawley rats were randomized to either aortic constriction + vehicle (AC; n=15), aortic constriction + hawthorn 1.3 mg/kg (HL, n=17), aortic constriction + hawthorn 13 mg/kg (HM, n=15), or aortic constriction + hawthorn 130 mg/kg (HH, n=15). Six months after surgical procedure animals were sacrificed and plasma samples obtained for the measurement of the following immunomodulatory markers: interleukin (IL) IL-1ss, IL-2, IL-6, IL-10; and leptin. RESULTS: The mortality rate following 6 months of aortic constriction was 40% in the AC group compared to 41%, 60%, and 53% for the HL, HM, and HH groups respectively (P>0.05 compared to AC). Aortic constriction produced a similar increase in the left ventricle/body weight ratio for all groups. Hawthorn extract had no effect on the immunomodulatory markers measured in this study, although there appeared to be a trend suggesting suppression of IL-2 plasma concentrations. CONCLUSIONS: In this animal model of heart failure, hawthorn extract failed to significantly affect the immunomodulatory response characterized after 6 months of pressure overload at a time when approximately 50% mortality was exhibited. Mechanisms other than immunological may better define hawthorn's effect in treating heart failure.     

尼可地尔对大鼠低氧性肺高压的影响

目的:探讨线粒体ATP敏感性钾通道开放剂(mitoKATPCO)尼可地尔(nicorandil)对大鼠低氧性肺动脉高压的影响?方法:将40只大鼠随机分成对照组(C组)?低氧组(H组)?低氧+尼可地尔组(N组)与低氧+尼可地尔+5-羟基葵酸盐组(HD组),后3组置于常压低氧仓内,每周6 d,每天8 h,持续4周后测定各组大鼠平均肺动脉压(mPAP),右心肥厚指数RV/(V+S),HE染色观察肺小动脉血管壁的病理变化并检测增殖相关抗原(PCNA)?结果:慢性缺氧可诱导大鼠mPAP及RV/(LV+S)升高,大鼠肺小血管增厚重构,PCNA表达增加,尼可地尔可显著抑制上述变化,且该效应可被线粒体KATP(mitoKATP)通道特异性阻断剂5-羟基葵酸盐阻断?结论:尼可地尔通过开放mitoKATP通道降低肺动脉压,拮抗右心肥厚,并抑制肺血管增殖重构,治疗低氧性肺高压?     

套管连接法建立大鼠左向右分流肺动脉高压模型

目的:制作大鼠颈部肺动脉高压动物模型。方法:将雄性Wistar大鼠随机分为实验组(n=15)熏对照组(n=10)。实验组大鼠右颈总动脉和颈外静脉用套管连接法连接。术后满16周测大鼠右心室及肺动脉压力,对肺组织行形态学观察。结果:实验组大鼠肺动脉和右心室收缩压与对照组比较差异有统计学意义(P<0.001);实验组大鼠右心室/体重及右心室/(左心室 室间隔)与对照组比较差异有统计学意义(P<0.001);组织切片见实验组大鼠肺动脉内膜层及肌层增厚,管腔狭窄。结论:套管连接法可成功制作大鼠左向右分流肺动脉高压模型。     

Role of voltage-gated potassium channels in pathogenesis of chronic pulmonary heart disease

The influence of hypoxia on the activity of voltage-gated potassium channel in pulmonary artery smooth muscle cells （PASMCs） of rats and its roles in the pathogenesis of chronic pulmonary heart disease were investigated. Eighty male Sprague-Dawley rats were randomly allocated into control group （n=10）, acute hypoxic group （n=10）, and chronic hypoxic groups （n=60）. The chronic hypoxic groups were randomly divided into 6 subgroups （n=10 each） according to the chronic hypoxic periods. The rats in the control group were kept in room air and those in acute hypoxic group in hypoxia envi- ronmental chamber for 8 h. The rats in chronic hypoxic subgroups were kept in hypoxia environmental chamber for 8 h per day for 5, 10, 15, 20, 25, and 30 days, respectively. The mean pulmonary arterial pressure （mPAP）, right ventricular hypertrophy index （RVHI）, and the current of voltage-gated potas- sium channel （IK） in PASMCs were measured. Results showed that both acute and chronic hypoxia could decrease the IK in PASMCs of rats and the I-V relationship downward shifted to the right. And the peak Ir density at ＋60mV decreased with prolongation of hypoxia exposure. No significant difference was noted in the density oflK （at ＋60 mV） and I-V relationship between control group and chronic hy- poxic subgroup exposed to hypoxia for 5 days （P〉0.05）, but there was a significant difference between control group and chronic hypoxic subgroup exposed to hypoxia for 10 days （P〈0.05）. Significant dif- ferences were noted in the IK density （at ＋60 mV） and I-V relationships between control group and chronic hypoxic subgroups exposed to hypoxia for 20 days and 30 days （P〈0.01）. Compared with con- trol rats, the mPAP and RVHI were significantly increased after chronic exposure to hypoxia for 10 days （P〈0.05）, which were further increased with prolongation of hypoxia exposure, and there were signifi- cant differences between control group and chronic hypoxic subgroups exposed to hypoxia for 20 days and 30 days （P〈0.01）. Both the mPAP and the RVHI were negatively correlated with the density OflK （r---0.89769 and -0.94476, respectively, both P〈0.01）. It is concluded that exposure to hypoxia may cause decreased activity of voltage-gated potassium channel, leading to hypoxia pulmonary vasocon- striction （HPV）. Sustained HPV may result in chronic pulmonary hypertension, even chronic pulmonary heart disease, contributing to the pathogenesis of chronic pulmonary heart disease.     

大鼠高肺血流性肺动脉高压形成中肺血管结构的变化

目的探讨大鼠高肺血流性肺动脉高压形成中肺血管结构的动态变化规律.方法80只雄性SD大鼠,随机分为分流组和对照组,每组40只.分流组大鼠经腹主动脉-下腔静脉穿刺术建立高肺血流动物模型,对照组大鼠除不作穿刺术外,其余手术过程同分流组.两组分别在术后1、3 d及1、4、8周经右心插管法测量肺动脉收缩压(SPAP)、肺动脉平均压(MPAP);取心脏组织,称量右心室与左心室 室间隔重量之比[RV/(LV SP)];取肺组织制作光学显微镜及电子显微镜标本,在光镜下观察肺小动脉中肌型动脉(MA)、部分肌型动脉(PMA)及非肌型动脉(NMA)构成比例及MA的相对中膜厚度(RMT)和相对中膜面积(RMA)的变化,电镜下观察肺小动脉超微结构的变化.结果与对照组比较,SPAP和MPAP在分流组术后1、3 d及4周时差异无显著性,分流术后1、8周时,SPAP、MPAP均显著高于对照组(P＜0.01);分流术后8周,RV/(LV SP)显著升高(P＜0.05);与对照组比较,分流术后1、3 d及1周时MA、PMA、NMA占肺小血管总数的百分比在两组之间差异无显著性,分流术后4、8周时大鼠MA、PMA占肺小血管总数的百分比明显增高(均P＜0.01),而NMA百分比明显降低(均P＜0.01);RMT、RMA在分流术后1、3 d及1、4周与对照组比较差异无显著性;分流术后8周时明显增高(P＜0.05).肺小动脉超微结构在分流术后3 d时仅为内皮细胞肿胀、体积增大;分流术后1周时,除内皮细胞结构改变外平滑肌细胞增大、内弹力层厚薄不均;分流术后4周时平滑肌细胞与内弹力层呈垂直生长,由收缩表型向合成表型转化;分流术后8周时细胞间见胶原纤维堆积.结论肺血管结构重建呈现明显的时间依赖性,内皮细胞肿胀出现最早,平滑肌结构改变次之,最后出现细胞外基质异常堆积.     

Effects of dietary magnesium on pulmonary vascular reactivity and chronic hypoxic pulmonary hypertension in rats

Summary The effects of dietary magnesium (Mg) on pulmonary vascular reactivity and chronic hypoxic pulmonary hypertension were assessed in rats. The rats were fed high magnesium (H-Mg) diet or a regular diet for two months before the start of normobaric hypoxia, 10±0.5 % O₂ ventilation, 8 h/day, for 14 days runnning. The plasma level of Mg was significantly increased in the H-Mg group as compared to the controls. Mean pulmonary arterial pressure, pulmonary vascular reactivity to hypoxia and pulmonary vascular resistance were significantly lower in the rats fed H-Mg diet than in those fed regular diet. The weight ratios of the right ventricle to the ending body weight (RV/EBW) and to the left ventricle plus iterventricular septum (RV/LV+S) in the rats fed H-Mg diet were remarkably lower as well. No difference was observed in blood viscosity and hematocrit between the H-Mg group and the hypoxic control. The above findings suggest that dietary Mg can attenuate basic pulmonary resistance and hypoxic pulmonary vasoconstriction, thereby preventing the development of chronic hypoxic pulmonary hypertension and right ventricular hypertrophy.     

B型钠尿肽前体对慢性阻塞性肺疾病患者撤机的指导意义

目的 分析B 型钠尿肽前体（ pro-BNP） 对需要机械通气的慢性阻塞性肺疾病（ 简称慢阻肺） 患者撤机时的指导意义。方法 回顾性分析了广州医科大学附属第一医院重症医学科从2011年4 月至2013 年11 月因慢阻肺急性加重合并呼吸衰竭需要有创机械通气患者共72 例, 所有患者经历最少1 次自主呼吸实验。根据是否成功通过第1 次自主呼吸实验（ SBT） 将患者分为2 组。其中成功组49 例, 失败组23 例。分别记录患者的性别、年龄、SBT 前APACHE Ⅱ评分、是否已经诊断心功能不全以及心功能不全的部位（ 左心、右心） 和类型（ 收缩性、舒张性） 以及撤机前pro-BNP。结果 两组患者间性别、年龄、APACHE Ⅱ评分比较均无显著性差异（ P 均〉0. 05） , SBT 成功组的pro-BNP 水平明显低于对照组, 两组间比较具有显著性差异（ P = 0） , 而两组患者间依靠心脏彩色超声诊断的心功能不全人数、部位以及性质比较均无显著性差异（ P 均〉0. 05） 。pro-BNP 的诊断价值描绘ROC 曲线表示, ROC 曲线下面积为0. 867, 95% 可信区间为0. 775 ～0. 959, 利用cut-off 法得出pro-BNP 对于预测SBT成功的预测值为〈 1 700 pg/mL, 特异性为89. 8% , 敏感性为73. 9% 。结论 pro-BNP 〈1 700 pg/mL可以作为预测慢阻肺患者SBT成功的预测值。     

Rho激酶在低氧大鼠肺小动脉表达的研究

目的探讨Rho激酶（ROCKⅠ和ROCKⅡ）在慢性低氧大鼠肺小动脉产生和表达的变化及其在低氧性肺动脉高压形成过程中的作用。方法将36只健康雄性SD大鼠随机分为正常组、低氧1d、3d、1周、2周和3周组,每组6只。低氧处理为常压间断低氧,每天8h,各低氧组分别低氧1d、3d、1周、2周和3周。采用微导管法测定大鼠平均肺动脉压（mPAP）。分离和称量大鼠右心室（RV）及左心室加室间隔（LV＋S）重量,计算出RV／（LV＋S）。应用免疫组化法测定大鼠肺组织Rho激酶蛋白的表达,原位杂交法测定Rho激酶mRNA的表达。结果大鼠mPAP、RV／（LV＋S）随低氧时间延长出现升高趋势（P〈0．05）。正常组与各低氧组的肺小动脉壁的管壁厚度占外径的百分比（WT％）和管壁面积占血管总面积的百分比（WA％）均随低氧时间的延长出现升高趋势,低氧3周组大鼠的WT％和WA％均高于正常组（P〈0．05）。ROCKⅠ、ROCKⅡ免疫组化阳性染色强度和ROCKⅠ mRNA、ROCKⅡmRNA原位杂交阳性染色强度随着低氧时间的延长均出现升高趋势,低氧3周组ROCKⅠ、ROCKⅡ免疫组化阳性染色和ROCKⅠmRNA、ROCKⅡmRNA原位杂交阳性染色均显著高于正常组（P〈0．05）。ROCKI免疫组化、ROCKⅠmRNA原位杂交、ROCKⅡ免疫组化及ROCKⅠmRNA原位杂交阳性染色强度均与mPAP、wA％和wT％呈正相关（r分别为0．404、0．267和0．263;0．500、0．263和0．260;0．490、0．295和0．286;0．579、0．251和0．254,P均〈0．05）。结论低氧可导致Rho激酶产生和表达增加。Rho激酶可能通过促进肺小动脉收缩和肺小动脉重构参与低氧性肺动脉高压的发生。