大鼠胰腺导管上皮细胞体外分离与定向分化

目的分离和纯化大鼠的胰腺导管上皮细胞，在体外培养并诱导其向胰岛细胞定向分化。方法采用胶原酶逆行灌注法消化、密度梯度离心结合不同细胞贴壁差异性分离和纯化胰腺导管上皮细胞；以角蛋白-19（CK-19）免疫细胞化学染色进行鉴定；用RMPI1640＋含体积分数为10％的胎牛血清（FBS）培养基培养促进胰导管上皮细胞增殖，1周后，更换无血清培养基DMEM／F12并加入角朊细胞生长因子等进一步促进其增殖，细胞达80％汇合时传代，加入高糖及尼克酰胺促进胰导管上皮细胞向胰岛细胞定向分化；对胰岛样结构行双硫腙染色。结果CK-19染色结果证实所获细胞绝大多为导管上皮细胞。体外培养中导管上皮细胞24h开始贴壁，14-21d达80％融合并形成细胞克隆，第28d胰岛细胞样结构形成，且被双硫腙染成猩红色。结论采用密度梯度离心结合差异贴壁法可获得纯化的大鼠胰腺导管上皮细胞，在体外培养与诱导分化条件下可生成胰岛样结构。     

分离培养汗腺导管部细胞的新方法

目的 探讨建立汗腺导管部细胞分离的新技术.方法 成人仞厚皮片和薄中厚皮片标本(n=10)剪碎后用Ⅱ型胶原酶消化12 h,吸取并转移汗腺导管到培养皿中贴壁培养.应用流式细胞仪、免疫组织化学染色和逆转录-聚合酶链式反应(RT-PCR)以及蛋白印迹(Western Blot)分析检测培养细胞的汗腺特异标志CEA、CK8、CK18、CK19抗原表达,并用膜片钳技术检测培养细胞膜上阿米洛利(amiloride)敏感Na~+离子通道,用t检验比较分析两组间实验数据.结果 汗腺导管贴壁48 h后,围绕汗腺导管出现单层扁平的上皮细胞,生长2～4周融合成片.流式细胞学检查示原代培养汗腺导管细胞与原代培养汗腺细胞在癌胚抗原(CEA)阳性率[(90.26±1.12)%vs.(89.70±1.43)%]和细胞角蛋白8(CK8)阳性率[(94.41±1.84)%vs.(93.65±1.63)%]上,差异无统计学意义(P>0.05).形态学染色汗腺导管细胞抗CEA、CK8、CK18、CK19染色均为阳性.RT-PCR表明原代培养汗腺导管细胞表达CEA、CK8、CK18、CK19基因,Western Blot清晰显示CEA条带,CK8、CK18、CK19蛋白条带.膜片钳检测表明原代培养汗腺导管细胞膜上存在amiloride敏感Na~+离子通道.无血清表皮细胞EpiLife培养基在汗腺导管细胞生长过程中抑制成纤维细胞生长.结论 从仞厚皮片和中厚皮片分离培养汗腺导管部细胞的方法较传统的分离方法具有简便快速的优点,EpiLife培养基可抑制培养过程中成纤维细胞的生长,可以在体外建立最佳汗腺导管细胞模型.     

糖尿病小鼠胰腺干细胞转分化为胰岛样细胞

目的 观察链脲佐菌素所致糖尿病小鼠胰腺干细胞是否能转分化为胰岛样细胞.方法 以链脲佐菌素建立糖尿病小鼠模型,分离培养其胰腺导管上皮细胞,经体外扩增及诱导培养后,以细胞免疫化学方法检测PDX1表达,行STZ染色和葡萄糖刺激的胰岛素释放试验鉴定其功能.结果 糖尿病小鼠胰腺干细胞经体外培养和诱导分化后,PDX1阳性,并形成胰岛样细胞团;胰岛样细胞对高糖刺激(15.0 mmol/L)的胰岛素释放较低糖(5.6 mmol/L)时增加了1.4倍(37.2±11.2比25.9±7.6,t =2.830,P＜0.05),DTZ染色阳性.结论 链脲佐菌素所致糖尿病小鼠胰腺干细胞在体外培养条件下可转分化为胰岛素分泌细胞.     

成人胰腺干细胞转分化为胰岛的研究

目的：通过对成人胰腺干细胞转分化为胰岛过程的研究以便更深入了解及改进胰腺干细胞分离、培养、鉴定方法。方法：成人胰腺组织经胶原酶消化后,用密度梯度离心法将胰腺外分泌细胞、导管上皮细胞和胰岛分离、纯化,导管上皮细胞即具有转分化潜能的干细胞,在体外先后以CMRL1066和无血清DMEM／F12培养液共培养27d,在培养的不同时间点取样本于光镜和电镜下观察细胞形态学变化及干细胞特异性转录基因PDX－1,CK－19蛋白等单抗的免疫组化染色,并测定培养液中的淀粉酶和胰岛素含量。结果：上述方法可获得大量以往在胰岛分离时丢弃的胰腺导管上皮细胞。经体外一定条件的培养后,第1天即可见PDX－1,CK－19阳性细胞,胰腺导管上皮细胞迅速分裂增殖并转变为有分化能力的干细胞继而转分化为三维结构的胰岛细胞。培养27d后,平均每克胰腺组织可生成760个胰岛。结论：成人胰腺的导管上皮具有干细胞潜能并可在体外转分化为大量具有内分泌功能的胰岛,用此方法获得大量的胰岛可能为克服胰岛移植的供体短缺提供一条新的途径。     

成人胰腺干细胞分离及转分化为胰岛的研究

目的 通过对成人胰腺干细胞分离和转分化为胰岛过程的研究以便更进一步了解及改进胰腺干细胞分离、培养、鉴定方法。方法 成人胰腺组织以胶原酶消化，密度梯度离心法获得纯化的胰腺外分泌细胞、导管上皮细胞和胰岛。导管上皮细胞在体外共培养27d，观察细胞形态学变化及干细胞特异性转录基因PDX—1，CK—19蛋白等的表达。结果 上述方法可获得大量胰腺导管上皮细胞。体外培养第1天即可见PDX—1，CK—19阳性细胞，胰腺导管上皮细胞迅速分裂增殖并转变为有分化能力的干细胞继而转分化为三维结构的胰岛细胞。培养27d后，平均每克胰腺组织可生成760个胰岛。结论 用改进的方法可获得大量成人胰腺导管上皮细胞，并可在体外转分化为大量具有内分泌功能的胰岛，可能为克服胰岛移植的供体短缺提供一条新途径。     

猪胰岛的分离与纯化

目的 探索大规模猪胰岛细胞分离纯化的方法.方法 联合器官切取,胶原酶P主胰管灌注,COBE2991细胞分离机及HCA-Ficoil纯化猪胰岛细胞.通过双硫腙(DTZ)染色,倒置显微镜下计数胰岛细胞的数量和纯度,胰岛素释放试验检测胰岛细胞的分泌功能.结果 消化后平均每条胰腺可平均获得(275 000±20 895)胰岛细胞当量(IEQ),纯化后平均为(230 350±26 679)IEQ,平均每克胰腺组织可获得(2710±229)IEQ,纯化后胰岛细胞平均纯度为(50.2±1.95)%.纯化后的胰岛细胞对胰岛素释放刺激反应良好,高糖(16.7 mmol/L)时胰岛素的释放量为低糖(3.3 mmol/L)时的4.74倍(P≤0.001).结论 成功建立了猪胰岛细胞分离、纯化的方法,纯化的猪胰岛细胞具有良好的生物活性.     

三维微重力培养大鼠胰岛细胞的实验研究

目的　应用三维微重力组织培养对大鼠胰岛细胞的存活率及分泌功能进行研究。方法将大鼠胰岛细胞分离消化后分别进行二维普通培养 (Ⅰ组 )及三维微重力条件培养 (Ⅱ组 ) ,应用双硫腙 (DTZ)染色法 ,对胰岛细胞进行特异性染色鉴定 ;采用AO PI双染色法对两组培养 3d、7d、14d的胰岛细胞存活率进行检测 ;应用放射免疫法检测两种不同培养方法培养液中胰岛素分泌水平。结果　DTZ染色后胰岛呈桔红色 ,清晰可见。培养 7d和 14d时 ,Ⅱ组胰岛细胞存活率分别为(0 90 0 0± 0 0 10 7) %和 (0 80 38± 0 0 0 92 ) % ,均明显高于Ⅰ组 (P <0 0 1)。胰岛素测定结果表明 ,培养 7d时 ,Ⅱ组胰岛素水平为 (70 875± 0 31)mU/L ,Ⅰ组胰岛素水平为 (41 2 4 6± 0 35 )mU/L ,二者差异有显著意义 (P <0 0 1)。在培养的 14d、2 1d和 30d时 ,Ⅱ组胰岛素的分泌水平也均高于Ⅰ组(P <0 0 1)。结论　三维微重力培养组的胰岛细胞存活率及胰岛素分泌功能都优于二维普通培养组。     

大鼠胰岛分离纯化技术的改良及活性研究

目的胰岛的纯度和活性对胰岛移植治疗糖尿病的疗效有很大影响。探讨一种大鼠胰岛分离纯化的新方法,以获得高纯度、高产量、活性好的胰岛。方法选取健康成年雄性SD大鼠10只,体重250～300g,逆行胆总管灌注Ⅴ型胶原酶溶液,38℃水浴消化约15min后,采用两种方法纯化胰岛细胞:A组采用Ficoll400不连续密度梯度液,B组采用Ficoll-PaqueTMPLUS溶液。行双硫腙(dithizone,DTZ)染色鉴定胰岛并计算胰岛当量(islet equivalent quantity,IEQ)、胰岛纯度,锥虫蓝染色检测胰岛活性。取B组胰岛用海藻酸钠-聚左赖氨酸-海藻酸钠(alginate/poly-L-lysine/alginate,APA)包裹制备胰岛微囊,体外静止葡萄糖刺激胰岛素释放实验检测微囊化和未微囊化胰岛的生物学活性。结果DTZ染色示胰岛呈猩红色,有圆形、椭圆形和不规则形,胰岛边缘清晰,大部分直径为50～300μm。A、B组IEQ值分别为338.04±76.61和834.80±54.00,比较差异有统计学意义(P0.05)。A、B组胰岛纯度分别为88.31%±2.67%和95.63%±1.96%,差异无统计学意义(P0.05)。A、B组胰岛活率分别为67.40%±5.15%和86.05%±2.52%,差异有统计学意义(P0.05)。胰岛APA微囊囊形呈完整圆形,大小均匀,微囊直径为1.5～2.0mm,每个微囊中包裹1～3个胰岛。葡萄糖刺激释放胰岛素实验显示,未微囊化胰岛和微囊化胰岛在低糖下的胰岛素分泌浓度分别为(5.53±1.64)ng/mL和(4.76±0.26)ng/mL,高糖下分别为(11.95±2.07)ng/mL和(14.34±3.18)ng/mL,高糖刺激下胰岛素释放量为低糖刺激的2倍多,差异有统计学意义(P0.05);两组的刺激指数分别为2.16±0.30和3.01±0.59,差异无统计学意义(P0.05)。结论Ficoll-PaqueTMPLUS溶液作为纯化液分离纯化胰岛的方法具有操作简便、胰岛产量高、纯度高等优点,获得的胰岛经微囊化或未微囊化体外培养均有良好活性。     

人胎儿皮肤皮脂腺细胞和外泌汗腺细胞的分离培养及鉴定

目的建立人胎儿皮肤皮脂腺、外泌汗腺细胞的体外分离培养与鉴定方法。方法通过分离人胎儿皮肤皮脂腺腺体和外泌汗腺腺管,以DMEM/F12(1∶1)为基础培养基,分别添加不同浓度的胎牛血清、表皮生长因子、L-谷氨酰胺、氢化可的松、霍乱毒素、青霉素、链霉素、重组人表皮生长因子、三碘甲状腺氨酸、胰岛素、转铁蛋白、亚硒酸钠作为皮脂腺细胞培养基及外泌汗腺细胞培养基,置入37℃、体积分数5%CO2孵箱中进行原代及传代培养。倒置相差显微镜下观察人胎儿皮肤皮脂腺、外泌汗腺细胞的形态及变化,并进行细胞克隆形成率测定。采用油红染色和细胞角蛋白(CK)4.62、上皮膜抗原(EMA)免疫组织化学染色对传代培养的皮脂腺、外泌汗腺细胞进行鉴定。结果分离的人胎儿皮脂腺腺体和外泌汗腺腺管可以在体外贴壁生长繁殖;其皮脂腺细胞的克隆形成率为2.7%,明显低于人胎儿角质形成细胞(8.0%,P<0.01).人外泌汗腺细胞的克隆形成率为7.3%,与人胎儿角质形成细胞(7.7%)比较差异无统计学意义(P>0·05).油红染色显示,皮脂腺细胞含有少量脂质小滴,CK4.62、EMA免疫组织化学染色均为阳性;外泌汗腺细胞CK7、CK19免疫组织化学染色均为阳性。结论用酶消化法和显微分离法可体外分离人胎儿皮肤皮脂腺、外泌汗腺细胞,两者均具备上皮细胞的标志和生物学特点,但皮脂腺细胞增殖速度较为缓慢。     

芬太尼抑制体外培养大鼠胰岛动态条件下葡萄糖刺激胰岛素分泌

目的 研究芬太尼对体外培养大鼠胰岛动态条件下葡萄糖刺激胰岛素分泌的抑制作用.方法 根据芬太尼浓度将SD大鼠胰岛随机均分为四组:Ⅰ组((0.3 ng/ml)、Ⅱ组((3.0 ng/ml)、Ⅲ组(30 ng/ml)和Ⅳ组(0 ng/ml).每组胰岛分别按以下3种方式与药物共同培养24 h:单独与芬太尼,芬太尼+0.1 μg/ml纳洛酮和芬太尼+1 μg/ml纳洛酮.每组设6个培养孔,每孔加入胰岛30IEQ,重复3次.检测胰岛细胞活力.动态培养条件下葡萄糖刺激胰岛素释放试验按以下方法进行:先加入2.8mmol/L葡萄糖(低糖)培养液培养,分别于10 min(第一分泌时相)和60 min(第二分泌时相)吸取上清液,然后加入16.7mmol/L(高糖)的培养液继续培养,分别于10 min和60 min吸取上清液,测定胰岛素含量.结果 四组胰岛细胞活力差异无统计学意义.第一和第二分泌时相单独芬太尼培养下,Ⅱ组和Ⅲ组低糖和高糖刺激胰岛素释放量明显低于Ⅳ组(P<0.01),且Ⅲ组高糖刺激胰岛素释放量最低(P<0.05).第一和第二分泌时相芬太尼+0.1 μg/ml纳洛酮培养下,Ⅱ组和Ⅲ组低糖和高糖刺激胰岛素释放量仍明显低于Ⅳ组(P<0.01),且Ⅲ组高糖刺激胰岛素释放量仍最低(P<0.05).第一和第二分泌时相芬太尼+1 μg/ml纳洛酮培养下,各组胰岛素释放量差异无统计学意义.结论 高浓度芬太尼抑制体外培养大鼠胰岛素的分泌,并且对鼠胰岛细胞具有一定的损伤作用.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.