自体血液回收技术对红细胞膜ATP酶的影响

目的　探讨血液回收技术对红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性的影响。方法　将 2 4例患者麻醉前静脉血、术野回收原血及回收红细胞血液标本采用沈茂星法测定红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性 ,并予统计分析。结果　经血液回收技术处理后的红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性与术野回收原血值比较均有显著降低 (P<0 0 5 )。结论　自体血液回收技术能使红细胞膜Na+ K+ ATP酶和Ca2 + Mg2 + ATP酶活性明显降低。     

复方电解质洗涤回收红细胞对酸碱平衡和凝血功能的影响

目的观察复方电解质洗涤回收红细胞对红细胞携氧能力、酸碱平衡和凝血功能等的影响。方法 40例手术患者随机分为两组,每组20例,分别采用复方电解质注射液(A组)和复方乳酸钠(R组)回收自体血,检测血液回收前、输注完毕动脉血pH值、乳酸(Lac)、血氧饱和度50%时的氧分压(P50)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(Fib)浓度。结果自体血输注后15min,R组pH值较输注前降低(P0.05),R组Lac水平升高较A组更为显著(P0.05),R组P50值明显升高(P0.05)。两组P50值与pH值输注前后变化有相关性(P0.05)。输注后15min两组PT、APTT较输注前均延长;Fib明显降低(P0.05)。结论复方电解质注射液洗涤回收红细胞有利于稳定酸碱平衡,防止血Lac水平升高,改善红细胞携氧能力,但对凝血功能的影响没有优势。     

丙泊酚预处理对大鼠心肌缺血-再灌注损伤心肌细胞膜ATP酶活性的影响

目的 研究丙泊酚预处理对大鼠心肌缺血-再灌注损伤心肌细胞膜ATP酶活性及心肌组织形态学的影响.方法 40只雄性SD大鼠随机分成五组,每组8只:对照组(C组),缺血-再灌注组(IR组),丙泊酚1组(P1组),丙泊酚2组(P2组),丙泊酚3组(P3组).各组于再灌注60 min后立即取左室心尖部心肌,检测心肌匀浆中心肌细胞膜Na+-K+-ATP、Ca2+-Mg2+-ATP酶活性;光镜下观察心肌组织形态学变化.结果 IR时心肌细胞膜Na+-K+-ATP、Ca2+-Mg2+-ATP酶活性与C组相比明显下降(P<0.01);O1、P2、P3组心肌细胞膜Na+-K+-ATP、Ca2+-Mg2+-ATP酶活性与IR组相比明显升高,但仍低于C组(P<0.05).结论 丙泊酚可以减轻大鼠心肌缺血-再灌注损伤,其机制可能与恢复心肌细胞膜Na+-K+-ATP、Ca2+-Mg2+-ATP酶活性有关.     

乌司他丁对体外循环下心内直视手术患者红细胞的保护作用

目的观察乌司他丁对体外循环(CPB)下心内直视手术患者红细胞的保护作用。方法20例择期行瓣膜置换术的风湿性心脏病患者,随机分为乌司他丁组(U组)和对照组(C组),每组10例。U组2万U／kg乌司他丁于切皮后锯胸骨前经颈内静脉缓慢给予半量,另半量加入预充液中,经转机进入体内。C组用等量生理盐水,用法同U组。分别于诱导后切皮前(T1)、转流15min(T2)、主动脉开放后15min(T3)、主动脉开放后30min(T4)、术毕24h(T5)抽取动脉血,测定血浆丙二醛(P-MDA)、红细胞丙二醛(E-MDA)水平、红细胞膜超氧化物歧化酶(E-SOD)、Na+-K+-A1P酶、Ca2+-Mg2+-ATP酶活性。结果与T1比较,C组T2-5时P-MDA、E-MDA水平升高,T2时E-SOD活性升高,T3-5时E-SOD浓度降低(P<0.01),U组T3,4时P-MDA、E-MDA水平升高(P<0.01);与C组比较,U组T2-5时P-MDA、E-MDA水平升高,T3-5时E-SOD活性升高(P<0.05或0.01)。与T1比较,两组T2时Na+-K+-ATP酶、Ca2+-Mg2+-ATP酶活性升高,C组T3-5时这两种酶活性降低(P<0.01);U组T2-5时这两种酶活性高于C组(P<0.05或0.01)。结论CPB期间,乌司他丁通过减轻红细胞膜脂质过氧化反应,对CPB下心内直视手术患者红细胞起到一定的保护作用。     

七氟醚后处理对大鼠心肌缺血再灌注时Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶活性的影响

目的 评价七氟醚后处理对大鼠心肌缺血再灌注时Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶活性的影响,探讨其减轻心肌缺血再灌注损伤的机制.方法 健康雄性Wistar大鼠45只,体重250～280 g,随机分为3组(n=15):假手术组(S组)、缺血再灌注组(I/R组)和七氟醚后处理组(Spo组).I/R组和Spo组采用结扎左冠状动脉前降支30 min时进行再灌注的方法制备心肌缺血再灌注模型,S组仅在左冠状动脉前降支下穿线.Spo组再灌注前1 min开始吸入2.5%七氟醚持续5 min.于再灌注2 h时取心肌组织,测定心肌梗死体积、Na+-K+-ATP酶活性和Ca2+-Mg2+-ATP酶活性.结果 与S组比较,I/R组心肌梗死体积扩大,心肌组织Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的活性降低(P＜0.05);与I/R组比较,Spo组心肌梗死体积缩小,心肌组织Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的活性升高(P＜0.05).结论七氟醚后处理可提高Na+-K+-ATP酶和Ca2+-Mg2+-ATP酶的活性,从而减轻大鼠心肌缺血再灌注损伤.     

银杏叶提取物EGb 761对失神经骨骼肌Na+-K+-ATP酶活性的影响

目的观察银杏叶提取物(ginkgo biloba extract,EGb 761)对失神经肌肉Na+-K+-ATP酶活性的影响.方法选用SD大鼠16只,按术后注射药物的不同随机分为银杏叶提取物组(实验组)和生理盐水组(对照组).显露左侧坐骨神经,切断并切除0.5 cm神经段.分别将神经远、近端反折后结扎.术后两组分别经腹腔注射EGb 761(100 mg/kg-1*d-1)和同体积的生理盐水.术后6周取左侧小腿三头肌,测定其Na+-K+-ATP酶活性.结果实验组失神经肌肉Na+-K+-ATP酶的活性优于对照组,两者差异有显著性意义(t= 2.51,P < 0.05).结论银杏叶提取物能改善大鼠失神经骨骼肌Na+-K+-ATP酶的活性,表明其对失神经肌萎缩有一定的保护作用.     

氯胺酮对大鼠大脑皮质和丘脑突触体ATP酶活性的影响

目的 动态观察氯胺酮对大鼠大脑皮质和丘脑Na+-K+ATP酶和Ca2+-ATP酶活性的影响。方法 SD大鼠32只,随机分为四组:对照组、麻醉组、恢复I组和恢复Ⅱ组。对照组给予腹腔注射生理盐水10 ml·kg-1,10 min后断头;其它三组均为腹腔注射氯胺酮100 mg·kg-1。其中麻醉组在大鼠翻正反射消失后断头;恢复I组在大鼠翻正反射恢复后断头;恢复Ⅱ组在大鼠完全清醒后断头。在生理盐水冰面上分离双侧大脑皮质和丘脑,以分光光度法测大脑皮质和丘脑Na+-K+-ATP酶和Ca2+-ATP酶活性。结果大鼠腹腔注射氯胺酮后,其大脑皮质的Na+-K+-ATP酶和Ca2+-ATP酶活性分别较对照组降低32.8％和26.2％(P<0.05);丘脑的Na+-K+-ATP酶和Ca2+-ATP酶活性也分别较对照组降低31.4％和24.5％(P<0.05);大鼠翻正反射恢复后和动物完全清醒后两种ATP酶活性的变化与对照组相比差异均无统计学意义(P>0.05)。结论 Na+-K+-ATP酶和Ca2+-ATP酶活性的改变在氯胺酮全麻作用机制中可能起重要作用。     

不同电解质溶液用于体外循环心脏手术血液洗涤的效果

目的评价不同电解质溶液用于体外循环心脏手术血液洗涤的效果。方法选体外循环下心脏手术患者60例, 年龄18～80岁, 体重50～100 kg, 预计术中需要输注库存血4～6 U。采用随机数字表法分为3组(n=20):复方电解质注射液组(A组)、碳酸氢钠林格液组(B组)和生理盐水组(C组), 分别采用复方电解质注射液、碳酸氢钠林格液和生理盐水对库存血和回收的自体血进行洗涤。于洗涤前和洗涤后即刻, 取库存血和自体血行血气分析, 采用比色法检测红细胞渗透脆性, 采用ELISA法检测2, 3-二磷酸甘油酸(2, 3-DPG)浓度。结果与洗涤前比较, 3组洗涤后库存血Glu、Lac、K+浓度和红细胞渗透脆性降低, Na+浓度升高, 自体血Glu和Lac浓度降低, 红细胞渗透脆性升高, 库存血和自体血2, 3-DPG浓度升高(P<0.05);与C组比较, A组和B组洗涤后库存血和自体血Na+和Cl-浓度降低, K+浓度升高, 红细胞渗透脆性降低, 2, 3-DPG浓度升高(P<0.05);与A组和C组比较, B组洗涤后库存血和自体血BE升高(P<0.05)。洗涤后B组库存血和自体血...     

肢体缺血预处理对大鼠肝脏缺血再灌注致心肌损伤的影响

目的 探讨单侧后肢缺血预处理对大鼠肝脏缺血再灌注致心肌损伤的影响.方法 成年雄性Wistar大鼠72只,体重200～250 g,随机分为3组(n=24),假手术组(S组)仅暴露肝门;肝脏缺血再灌注组(IR组)肝脏缺血60min后恢复灌注;后肢缺血预处理组(LIP组)阻断右侧后肢动脉、静脉和肌间侧支血流10 min后恢复灌注,30 min后建立肝脏缺血再灌注模型.于肝脏再灌注即刻、1、6 h各处死8只大鼠,测定血清脑钠素(BNP)浓度和心肌细胞膜Na+-K+-ATP酶活性,观察心肌超微结构.结果 与S组比较,IR组和LIP组心肌细胞膜Na+-K+-ATP酶活性降低,血清BNP浓度升高(P＜0.05或0.01).与IR组比较,LIP组心肌细胞膜Na+-K+-ATP酶活性升高(P＜0.05),心肌病理损伤程度减轻.结论 单侧后肢缺血预处理可减轻大鼠肝脏缺血再灌注致心肌损伤的程度.     

缝隙连接在兔失血性休克复苏诱发肺损伤中的作用

目的 评价缝隙连接在兔失血性休克复苏诱发肺损伤中的作用.方法 健康家兔24只,体重1.5～2.2 kg,经股动脉放血制备失血性休克模型.随机分为2组(n=12),传统治疗组(A组)静脉输注乳酸钠林格氏液1.5 ml·kg-1·min-1 30 min(T3);辛醇组(B组)静脉输注乳酸钠林格氏液1.5 ml·kg-1·min-1 30 min(T3),同时腹腔注射99.5%辛醇5 mmol/kg.然后两组回输全部放血及等放血量的乳酸钠林格氏液后静脉输注乳酸钠林格氏液2.5 ml·kg-·h-1 150 min(T4).于放血前(T1)、模型制备成功即刻(T2)、T3、T4时记录左心室收缩压(LVSP)和HR,记录复苏期间兔的病死情况.于T时处死,测定肺组织Na+-K+-ATP酶和Ca2+-ATP酶的活性,计算肺通透性指数和肺湿重/干重(W/D)比,光镜下观察肺组织病理学结果.结果 与A组比较,B组T3时HR和LVSP降低,T4时LVSP升高,HR降低,Na+-K+-ATP酶和Ca2+-ATP酶活性升高,肺通透性指数降低,肺组织W/D比和病死率降低(P＜0.05或0.01).B组肺组织病理学损伤程度较A组明显减轻.结论 缝隙连接参与了兔失血性休克复苏诱发肺损伤.     

Epidural for labour analgesia--bupivacaine + fentanyl vs bupivacaine + fentanyl + epinephrine

A prospective and randomized study was conducted on 50 full term parturients undergoing labour analgesia at Panna Dai Hospital, R.N.T. Medical College, Udaipur. The parturients were allocated in two groups: group BF (n = 25) received an epidural injection of bupivacaine (0.15%; 15 mg) + Fentanyl (0.0002%); 2 microg/ml); group BEF (n = 25) bupivacaine (0.15%; 15 mg) + Fentanyl (0.0002%; 2microg/ml) + Epinephrine (1.7 microg/ml; 1:600,000). Subsequent top up (same as bolus) was administered at VAS > or = 3. Comparison between the two groups showed no significant difference in onset of analgesia, number of top up doses, degree of motor block and parturients acceptance. The difference in duration of analgesia with addition of epinephrine (93.00 +/- 29.00 min : BEF group; V/S 86.00 +/- 27.00 Min : BF group) did not show any statistical significance between the two groups. Ambulation was achieved in 100% of parturients from both study groups. The incidence of spontaneous delivery was 92% in each group. Parturients in group BEF demonstrated a higher incidence of side effects like nausea and vomiting (4% v/s 0%); hypotension (4% v/s 0%); paresis (8% v/s 0%) and retention of urine (12% v/s 8%) as compared to BF group. To conclude, the addition of epidural epinephrine (1:600,000) to bupivacaine and fentanyl does not affect the duration or quantity of labour analgesia.     

LC+LCBDE+PDC与ERCP+EST+LC治疗胆囊结石合并胆总管结石的对比研究

目的 探讨腹腔镜胆囊切除术联合胆总管探查一期缝合(LC+LCBDE+PDC)与内镜下胆管取石联合腹腔镜胆囊切除术(ERCP+EST+LC)两种手术方式治疗胆囊结石合并胆总管结石的疗效比较.方法 回顾性分析2017年5月至2019年5月郑州大学附属郑州中心医院135例胆囊结合并胆总管结石的患者临床资料,76例行LC+LC...     

Raynaud + Sklerodermie

Ohne Zusammenfassung Mit Mitteln derWilliam G.-Kerckhoff-Stiftung Bad Nauheim, wofür auch an dieser Stelle gedankt wird.     

Extracorporeal photochemotherapy is accompanied by increasing levels of circulating CD4+CD25+GITR+Foxp3+CD62L+ functional regulatory T-cells in patients with graft-versus-host disease

BACKGROUND: Extracorporeal photochemotherapy (ECP) produces clinical improvements in refractory/resistant graft-versus-host disease (GvHD). Immunological mechanisms of ECP are still under investigation. METHODS: We have evaluated the changes in frequency and immunophenotype of circulating regulatory T cells (T-regs) in 10 patients undergoing allogeneic hematopoietic stem cell transplantation, receiving ECP for acute (n=4) or chronic (n=6) GvHD. T-regs were monitored for expression of surface CD4, CD25, GITR, CD45RO, CD62L and intracytoplasmic Foxp3. T-regs were sorted by fluorescence-activated cell sorting to perform functional assays by interferon (IFN)-gamma enzyme-linked immunospot and real-time quantitative polymerase chain reaction (RQ-PCR) to measure Foxp3, transforming growth factor (TGF)-beta, and interleukin (IL)-10 mRNA. RESULTS: ECP was accompanied by a significant increase of CD4+CD25+ T-regs after six procedures, increasing from 8.9% to 29.1% of total CD4 (P<0.05), with a simultaneous increase of glucocorticoid induced tumor necrosis factor receptor expression on CD4+CD25+ cells (from 15% to 40.8%, P<0.05). This increase was sustained after 12 procedures. T-regs expressed high levels of CD62L, CD45RO, and Foxp3. Sorted CD4+CD25+ T-regs were potently inhibitory toward the CD4+CD25- fraction, when matched with an allogeneic target (IFN-gamma secretion was reduced by 79%). Trans-well experiments showed that cell-to-cell contact was necessary to exert inhibitory activity. RQ-PCR revealed a significant expression of Foxp3 in CD4+CD25+ T-regs, but there was virtually no detection of TGF-beta and IL-10. GvHD improved in all patients, allowing tapering or discontinuation of immunosuppressive drugs. CONCLUSION: Our study shows a time correlation between ECP and increasing percentages of circulating functional T-regs. Albeit suggestive, our results need to be confirmed on larger series to determine the actual role of T-reg in mediating the clinical effect of ECP.