TRH与HAD单用及合用抗大鼠高原创伤失血性休克的作用

目的:在西藏拉萨进行现场实验,观察促甲状腺素释放激素(TRH)与5%NaCl/2.5%醋酸钠/6%右旋糖酐70(HAD)伍用对高原创伤失血性休克大鼠的治疗作用.方法:初进高原大鼠27只,分乳酸林格氏液对照组(8只),TRH治疗组(7只),HAD治疗组(6只)和TRH与HAD合用组(6只),大鼠右侧股骨粉碎性骨折加放血(维持动脉血压6.0 kPa 1 h)复制创伤失血休克模型,观察TRH(5 mg/kg),HAD(4 ml/kg)和两者合用对创伤失血性休克大鼠血流动力学指标和动物存活时间的影响,以等容量乳酸林格氏液作对照.结果:TRH、HAD单用或合用均能显著提升创伤休克大鼠血压,改善其左室内压(LVSP),左室内压最大变化速率(±dp/dtmax),实测心肌最大收缩速度(Vpm),心肌收缩向量环面积(Lo),明显延长休克动物的存活时间,合用效果稍优于TRH或HAD单用效果.结论:TRH、HAD均具有较好的抗高原创伤失血休克作用,两药可联合用于高原创伤休克的早期救治.     

TRH对肺挫伤合并休克犬心肺功能影响的实验研究

肺挫伤在胸部钝性创伤中甚为常见,多伴有内脏破裂导致失血性休克。对于肺挫伤应该限制液体输入,而对于失血性休克则应输入足够的液体,因此肺挫伤合并休克时在容量复苏上存在一定的矛盾。本研究将14只健康犬随机分为对照组和促甲状腺素释放激素(TRH)治疗组,采用BIM-Ⅱ型生物撞击机撞击右侧胸壁加股动脉放血来建立犬肺挫伤合并休克模型。TRH组用新型抗休克药物TRH进行治疗,在模型完成及其后1h、2h、3h各静注0.4％TRH2mg/kg、1mg/kg、1mg/kg、1mg/kg、4h后活杀。结果:1.活杀前TRH组与对照组相比,平均动脉压(76.6±5.7kPa,VS.39.4±16.5kPa,P<0.01),心指数(2.31±0.67L/min/m~2,VS.1.39±0.14L/min/m~2,P<0.01),每搏指数(14.4±2.9ml/beat/m~2,VS.7.8±1.5ml/beat/m~2,P<0.01)及心脏做功能力非常显著地增加;平均肺动脉压(12.7±1.4kPa,VS.12.7±0.4kPa,P>0.05),肺血管阴力(581.0±232.7dyne,sec,cm~(-5)VS.718.8±74.9dyne,sec,cm~(-5)P>0.05),周围血管阻力(6653.0±1493.7dyne,sec,cm~(-5)VS.4850.0±2099.8dyne,sec,cm~(-5),P>0.05)无显著差别,表明TRH能明显改善肺挫伤合并休克犬心脏功能和血液动力学,无明显的收缩肺血管作用。2.活杀前TRH组与对照组相比:     

TRH升压抗休克作用及其与延髓腹外侧区胆碱能机制的关系

正常血压兔侧脑室注射(ICV)促甲状腺素释放激素(TRH)后,平均动脉压(MAP)与脉压(PP)分别由给药前的12.6±1.0kPa与7.2±1.3k pa上升到16.3±1.4k Pa与8.4±2.4k Pa(P均<0.01);但心率(HR)却由给药前的282±56b/min减慢为236±76b/min(P<0.01)。失血性休克兔和中毒性休克兔ICV TRH后,MAP分别由给药前的7.2±1.2k Pa与5.1±2.1k Pa上升到13.5±2.0k Pa与10.3±1.4k Pa(P均<0.01);PP分别由给药前的4.5±1.4k Pa与2.1±0.4k Pa增加到7.2±2.3k Pa与4.4±1.2k Pa(P均<0.01);HR分别由给药前的224±39 b/min与220±20 b/min增加到238±42b/min与233±25 b/min(P均<0.01),动物存活时间延长。若在ICV TRH之前预先向延髓腹外侧区头端(rVLM)微量注射阿托品则可阻断TRH的升压效应。提示ICV TRH对失血性休克和中毒性休克兔均有明显的升压抗休克作用。TRH的升压效应可能需要VLM区胆碱能神经元功能的完整。     

生脉注射液对失血性休克大鼠的作用

目的观察生脉注射液对失血性休克大鼠血压、心电图、心率等的作用。方法大鼠用20%乌拉坦(5ml/kg)腹腔注射麻醉后,分离双侧颈动脉,一侧颈动脉迅速放血使血压降至40.8mmHg左右,并维持血压稳定10min,完成失血性休克模型的建立。另一侧做颈动脉插管,连接压力换能器,用来观察血压的变化,同时记录心电图。之后,静脉注射给药。结果生脉注射液能够明显提升失血性休克大鼠的收缩压、舒张压及平均动脉血压,改善休克状态,提高存活率。结论生脉注射液具有抗失血性休克作用。     

急进高原对米格列醇在大鼠体内药代动力学参数的影响

目的 探讨急进高原后高原环境对米格列醇在Wistar大鼠体内药代动力学参数的影响。方法 将12只大鼠随机分为平原组与高原组，两组大鼠分别给予5.25 mg/kg米格列醇灌胃，并分别于给药后5、10、15、30、60、90、120、240 min眼眶静脉丛采集血样。液相色谱-串联质谱法(liquid chromatography tandem mass spectrometry, LC-MS/MS)测定大鼠血浆中米格列醇浓度，采用WinNonlin 8.1软件计算药代动力学参数。结果 LC-MS/MS测定米格列醇血浆浓度在一定浓度范围内线性关系良好(r=0.996),日内精密度和日间精密度均小于10%且稳定性良好。与平原组大鼠相比，米格列醇在高原组大鼠体内的达峰血药浓度增加、平均滞留时间延长、半衰期延长、清除率减小、曲线下面积(area under the curve, AUC)增加(P均<0.05)。结论 急进高原后，米格列醇在大鼠体内吸收增加、代谢减慢，为进一步研究糖尿病患者高原环境下合理用药提供参考。     

小剂量高渗高胶液体对失血性休克兔平均动脉压电解质和血气分析影响的实验观察

目的 研究HOME注射液(高渗氯化钠羟乙基淀粉40溶液,HH40)复苏失血性休克兔对其平均动脉压、电解质和血气影响.方法 新西兰白兔36只随机等分为HH40组、NTS组、LRS组.采用Wiggcr's改良法制作失血性休克模型,休克60min后分别用5mg/kg的HH40、RTS、LRS复苏.于放血前、输液、输液后1 0min、6 0min、180min时分另q记录平均动脉压(MAP)、检测其动脉血的血气分析.电解质值.结果 HH40和HTS可以使休克免的MAP升高,并维持时间较长;动脉血氧分压(PaO2)有所回升,动脉血pH、血液碱剩余(BE),标准碳酸氢盐(SB)等指标下降趋势减慢,且给药后血Na+升高不明显.结论 HOME注射液是抢救失血性休克有效的新药.     

参附注射液对实验心源性休克犬血浆NO、iNOS及心肌iNOS mRNA的影响

目的 观察参附注射液对心源性休克犬血浆NO、iNOS含量及心肌iNOS mRNA的影响.方法 选择健康成年家犬15只,体质量(14.0±2.7)kg,雌雄不拘.完全随机分为参附组、模型组,并设假手术组(n=5),在结扎前,休克时,给药后30、60、120、180 min抽血,用比色法测血浆NO、iNOS的含量,180 min时取心肌组织,用RT-PCR法测心肌iNOSmRNA的表达,同时监测犬的心功能指标.结果 参附注射液能降低心源性休克时升高的NO[ (66.54±2.42) μmol/Lvs(45.31 ±3.39) μmol/L]、iNOS[(6.60±0.23)U/ml vs( 5.13±0.23)U/ml]水平(P＜0.01),并下调心肌iNOS mRNA的基因表达.参附注射液给药可显著增加心源性休克犬的CO和Cl,明显降低动物的TPVR.结论 参附注射液可以降低血浆中NO和iNOS的水平,抑制心肌iNOS mRNA的表达.     

PICCO监测在失血性休克合并肺水肿患者治疗中的应用价值分析

目的:探讨PICCO监测在失血性休克合并肺水肿患者治疗中的应用价值。方法:选取我院失血性休克合并肺水肿患者共36例,随机分为观察组和对照组。给予对照组常规中心静脉压监测,给予观察组PICCO监测。观察机械通气时间、乳酸值、MAP、PaO_2/FiO_2及APACHEⅡ评分。结果:观察组机械通气时间为(7.8±1.5)d、乳酸为(1.4±0.5)mmol/L、MAP为(79.9±5.2)mmHg、PaO_2/FiO_2为(258.3±22.7)及APACHEⅡ评分为(20.8±4.1)分,均优于对照组,组间比较有差异(P0.05)。结论:PICCO监测用于失血性休克合并肺水肿患者中,能够改善患者的肺功能,减轻患者承受的痛苦,具有较高的价值。     

失血性休克复苏后CO_2气腹对兔肝功能及肝血流量的影响

目的 探讨失血性休克复苏后CO2气腹状态下兔肝功能(hepatic function,HF)及肝血流量(hepatic blood flow,HBF)的变化.方法 制作中度(失血量12 ml/kg)及重度(失血量25 ml/kg)失血性休克复苏兔模型,复苏后建立CO2气腹,将50只新西兰白兔按失血量及CO2气腹压(5、10、15 mmHg)用随机数字表法分为6组.观察气腹前、气腹30 min、气腹2 h以及撤去气腹后30 min 4个时相点谷草转氨酶(aspartate aminotransferase,AST)和谷丙转氨酶(alanine aminotransferase,ALT)的变化,并应用彩色微球法检测HBF的变化.结果 气腹前重度休克组的AST和ALT较中度休克组显著增高(P＜0.05),HBF则呈降低趋势.中度休克组5 mmHg CO2气腹后30 min时AST、气腹2 h时ALT显著升高,而10 mmHg和15 mmHg气腹压30 min时AST和ALT明显增高(P＜0.05);重度休克组气腹后30 min时AST和ALT明显上升(P＜0.05).中度休克组5 mmHg和10 mmHg CO2气腹压2 h时HBF明显减少(P＜0.05),而15 mmHg气腹压30 min时HBF显著下降(P＜0.05);重度休克组气腹后30 min时HBF明显降低(P＜0.05).结论 中度及重度失血性休克复苏后,CO2气腹对肝功能的影响与失血量、气腹压力和气腹时间关系密切.     

胰岛素和油酸促进结肠癌皮下移植瘤生长的代谢组学研究

为探讨胰岛素及油酸对结肠癌血清代谢物的调节作用,建立结肠癌细胞HCT116皮下移植瘤模型.裸鼠随机分为4组,每组6只,分别为对照组(CON)、胰岛素组(INS,每日皮下注射胰岛素2.5 U/kg)、油酸组(OA,每日灌胃油酸2.0 g/kg)、胰岛素及油酸联合给药组(IO,每日皮下注射胰岛素2.5 U/kg、灌胃油酸2...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.