小肠淤血再灌注损伤的初步实验研究

目的研究淤血再灌注对大鼠小肠的损伤作用。方法SD大鼠20只,采用阻断门静脉60 min开放60 min的方法建立大鼠小肠淤血再灌注模型;于小肠淤血前、淤血60 min和再灌注60 min时分别取末段回肠标本,观察和比较各时间点小肠黏膜的损伤情况,同时测定肠组织中丙二醛(MDA)含量和髓过氧化物酶(MPO)活性的变化。结果淤血前肠黏膜基本正常,淤血60 min后肠黏膜出现损伤,但组织中MDA含量及MPO活性与淤血前相比无明显变化;再灌注60 min后肠黏膜损伤较淤血60 min时进一步加重,且组织中MDA含量及MPO活性亦显著增高。结论淤血后血流再灌注可致肠组织出现淤血再灌注损伤;脂质过氧化损伤及中性粒细胞浸润可能是参与肠组织淤血再灌注损伤的重要因素。     

甲基强的松龙对大鼠肠缺血再灌注损伤的保护作用

目的研究甲基强的松龙对大鼠小肠缺血再灌注肠黏膜损伤的保护作用,为扩展其临床新用途提供实验依据。方法通过建立大鼠小肠缺血再灌注模型,检测缺血再灌注1 h后血清和小肠组织的超氧化物歧化酶(SOD)和丙二醛(MDA)的含量,并观察小肠黏膜病理变化。结果小肠缺血再灌注后,血清及小肠组织中反映氧化损伤程度的MDA明显升高,抗氧化酶SOD则明显减少,小肠黏膜损伤,应用甲基强的松龙后能显著改善上述改变。结论甲基强的松龙对肠缺血再灌注引起的肠黏膜损伤具有明显保护作用。     

四氢化吡咯二硫代氨基甲酸酯对大鼠肠缺血再灌注损伤的影响响

目的：观察四氢化吡咯二硫代氨基甲酸酯（PTDC）对大鼠肠缺血再灌注后肠组织损伤的影响。方法：36只SD大鼠随机分为3组。每组12只。（1）缺血再灌注组（I／R组），暴露腹腔后夹闭肠系膜上动脉（SMA）60min。开放灌注120min；（2）PTDC组（P组），在肠缺血前5min静脉给予PTDC 100mg／kg；（3）假手术组（S组），仅暴露SMA，不行肠缺血再灌注及PTDC注射。所有动物于再灌注120min时处死，行肠组织苏木精-伊红染色观察肠损伤程度并评分：检测肠组织中丙二醛（MDA）含量及髓过氧化物酶（MPO）、谷胱甘肽过氧化物酶（GSH-PX）活性。结果：与S组相比，I／R组、P组GSH-PX活性明显降低（P〈0．01，P〈0．05），MDA含量、MPO活性及小肠损伤评分明显升高（P〈0．01．P〈0．05）。与I／R组相比，P组小肠损伤评分、MDA含量及MPO活性明显降低．GSH-PX活性明显升高（均P〈0．05）。结论：PDTC对大鼠肠缺血再灌注后的肠道有保护作用，该保护作用与抑制中性粒细胞浸润、减少脂质氧化程度及氧自由基有关。[著者文摘]     

依达拉奉对大鼠肠缺血再灌注损伤的保护作用

目的:研究依达拉奉对大鼠小肠缺血再灌注肠黏膜损伤的保护作用,为扩展其临床新用途提供实验依据。方法:通过建立大鼠小肠缺血再灌注模型,检测缺血再灌注1h后血清和小肠组织的超氧化物歧化酶(SOD)和丙二醛(MDA)的含量,并观察小肠黏膜病理变化。结果:小肠缺血再灌注后,血清及小肠组织中反映氧化损伤程度的MDA明显升高,抗氧化酶SOD则明显减少,小肠黏膜损伤,应用依达拉奉后能显著改善上述改变。结论:依达拉奉对肠缺血再灌注引起的肠黏膜损伤具有明显保护作用。     

甲基强的松龙对大鼠肠缺血再灌注损伤的保护作用

目的研究甲基强的松龙对大鼠小肠缺血再灌注肠黏膜损伤的保护作用,为扩展其临床新用途提供实验依据。方法通过建立大鼠小肠缺血再灌注模型,检测缺血再灌注1 h后血清和小肠组织的超氧化物歧化酶（SOD）和丙二醛（MDA）的含量,并观察小肠黏膜病理变化。结果小肠缺血再灌注后,血清及小肠组织中反映氧化损伤程度的MDA明显升高,抗氧化酶SOD则明显减少,小肠黏膜损伤,应用甲基强的松龙后能显著改善上述改变。结论甲基强的松龙对肠缺血再灌注引起的肠黏膜损伤具有明显保护作用。     

米贝拉地尔对大鼠肠缺血再灌注损伤的影响

[目的]观察米贝拉地尔(Mibefradit)对大鼠肠缺血再灌注后肠组织损伤的影响.[方法]复制SD大鼠肠缺血再灌注损伤模型.实验分为3组(n=10):假手术组(S组)、缺血再灌注组(I/R组)、Mibefradil干预组(M组).比较各组大鼠肠黏膜丙二醛(MDA)含量、超氧化物歧化酶(SOD)和过氧化氢酶(CAT)的活性变化;用Chiu氏评分法观察肠黏膜的损伤情况.[结果]与S、M组相比:I/R组MDA含量明显增高(P＜0.01和P＜0.05),SOD及CAT活性明显降低(P＜0.01和P＜ 0.05);与S组相比,I/R组和M组小肠损伤评分明显升高(P＜0.01和P＜0.05);但M组小肠损伤评分明显好于I/R组(P＜0.05).[结论]米贝拉地尔对大鼠肠缺血再灌注后的肠道有保护作用,该保护作用可能与减少活性氧物质及改善肠道微循环有关.     

缺血预处理对离体大鼠肺缺血再灌注氧化损伤的影响

目的 :研究缺血预处理 (IP)对离体大鼠肺缺血再灌注氧化损伤的影响。方法 :建立离体大鼠肺缺血再灌注损伤模型。 18只SD大鼠随机分为 3组 ,每组 6只。对照组 (Con)持续平衡灌注通气 60min ,无缺血 ;缺血再灌注组 (IR)缺血 45min ,再灌注 3 0min ;缺血预处理组 (IP)先给予连续 2次的 5min缺血、5min再灌注的预处理 ,再行缺血 45min和再灌注 3 0min。测定缺血前和再灌注末灌注液中丙二醛 (MDA)、超氧化物歧化酶 (SOD)和白细胞数量 ,测定再灌注末肺组织髓过氧化物酶 (MPO)活性、黄嘌呤氧化酶 (XOD)活性和湿 /干比 (W /D)。结果 :IR组再灌末MDA含量、MPO活性、XOD活性和W /D较Con组明显升高 (P <0 0 1) ,而SOD活性则显著下降 (P <0 0 1)。IP能明显减少再灌后MDA、MPO、XOD和W /D的增加 ,提高SOD的活性 (P <0 0 1)。结论 :IP能明显抑制离体大鼠肺缺血再灌注导致的氧化损伤。     

已酮可可碱对大鼠肠缺血/再灌注致肺损伤的保护作用

目的　探讨已酮可可碱对肠缺血 /再灌注致肺损伤的保护作用。方法　Wistar大鼠 4 0只随机分成 5组 :①假手术组 ;②肠缺血 /再灌注 2h组 ;③肠缺血 /再灌注 4h组 ;④肠缺血 /再灌注 2h PTX治疗组 ;⑤肠缺血 /再灌注 4h PTX治疗组。测定各组动物血清TNF -α水平 ,肺组织MPO、MDA活性及观察病理形态。结果　肠缺血 /再灌注致肺损伤组血清TNF -α水平及肺组织MPO、MDA活性明显高于假手术组 (P <0 0 5 ) ,肺组织损伤明显。PTX治疗后 ,血清TNF -α水平及肺组织MPO、MDA活性明显低于相应各时间点 (P <0 0 5 ) ,肺组织损伤减轻。结论　已酮可可碱对肠缺血 /再灌注致肺损伤有保护作用。     

乌司他丁对大鼠小肠缺血再灌注氧自由基抑制作用的研究

目的探讨乌司他丁(UTI)对小肠缺血再灌注(IR)损伤大鼠肠黏膜氧自由基损伤的保护作用及机制。方法采用雄性SD大鼠夹闭肠系膜上动脉致小肠缺血1 h,再灌注2 h,随机分为假手术对照组、缺血再灌注组(B组)、UTI组,假手术对照组仅开腹,UTI组于缺血后经颈静脉缓慢泵入UTI(5万单位/kg),缺血再灌注组给予等量等渗盐水,于各于再灌注后2 h检测血清及肠黏膜组织中超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)的含量,光镜观察肠黏膜组织学改变并评分。结果缺血再灌注组与手术对照组比较,小肠黏膜和血液中抗氧化酶活力明显下降(P<0.01),MDA水平明显升高(P<0.01);而UTI组与缺血再灌注组比较,小肠黏膜和血液中抗氧化酶活力明显升高(P<0.01),MDA水平明显下降(P<0.01)。光镜下观察缺血再灌注组小肠黏膜损伤程度明显重于UTI组(P<0.01)。结论乌司他丁能显著减少小肠缺血再灌注时氧自由基释放,对肠缺血再灌注氧自由基损伤有明显的保护和治疗作用。     

大鼠肠缺血再灌注损伤后肠黏膜免疫功能的变化与意义

目的 :观察大鼠肠缺血再灌注损伤后肠黏膜免疫功能的变化 ,并探讨其与肠源性细菌内毒素移位的关系。方法 :采用大鼠小肠缺血 45min再灌注模型 ,分别于再灌注后即刻、2h、6h、2 4h用免疫放射法测定肠黏膜组织中分泌型免疫球蛋白A(sIgA)的含量 ;四甲基偶氮唑盐微量酶反应比色法 (MTT)测定Peyer’s淋巴结 (PP)、上皮内淋巴细胞 (IEL)和固有层淋巴细胞 (LPL)增殖活力 ;无菌取肠系膜淋巴结行细菌培养 ,统计细菌移位率 ;取门静脉血检测内毒素。结果 :肠缺血再灌注后肠黏膜中sIgA含量及淋巴细胞增殖活性均明显下降 (P <0 0 1) ,血浆内毒素含量较再灌注前显著升高 (P <0 0 1) ;并于再灌注后 2h起出现肠系膜淋巴结细菌移位 ;肠黏膜内sIgA含量及肠道相关淋巴组织淋巴细胞增殖活力与肠源性细菌内毒素移位呈显著负相关 (r =-0 5 5 3～ -0 75 3 ,P <0 0 1)。结论 :肠缺血再灌注损伤后肠黏膜免疫功能下降 ,与肠外细菌内毒素移位的发生密切相关。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.