体外循环中肺动脉灌注混合乌司他丁的低温含氧血和间断肺通气的肺保护作用

目的：观察持续肺动脉灌注4℃低温含氧血混和乌司他丁以及间断肺通气对体外循环（cardiopulmonarybypass,CPB）肺损伤的保护作用。方法：50例心脏手术及大血管手术患者随机分为肺保护组25例,对照组25例。CPB期间肺保护组经主肺动脉持续灌注4℃混和鸟司他丁的低温合氧血及给予间断肺通气;对照组常规进行心脏、大血管手术。分别在麻醉诱导期、转流结束即刻、转流结束后6、12、24小时取桡动脉血,应用放射免疫法测定肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）和白细胞介素-8（IL-8）水平;记录术后呼吸机支持时间。结果：术后肺保护组呼吸机支持时间明显低于对照组（P〈0．01）,2组患者在体外循环后TNF—α、IL-6和IL-8水平开始升高,24小时仍高于术前（P〈0．01）,但肺保护组TNF-α、IL-6、IL-8水平上升幅度在各时间点均低于对照组（P〈0．05或P〈0．01）。结论：经肺动脉持续灌注混和乌司他丁的低温含氧血及间断肺通气对CPB肺损伤有良好的保护作用。     

体外循环中含氧血持续肺动脉灌注的肺保护作用

目的：探讨体外循环（CPB）期间含氧血持续肺动脉灌注对心脏瓣膜置换患者的肺保护作用。方法：30例行二尖瓣置换术患者随机分为肺灌注组（n=15)，对照组（n=15)。肺灌注组患者CPB术中采用含氧血肺动脉持续灌注，对照组常规行二尖瓣置换术，未行肺动脉灌注。记录CPB时间、主动脉阻断时间、术后呼吸机辅助时间、ICU监护时间。分别于术前、CPB结束及术后0，6h测算氧合指数、肺静态顺应性变化。CPB停机后30min，取患者右上肺组织，观察组织形态学变化。结果：肺灌注组患者术后呼吸机辅助时间及ICU监护时间短于对照组（P<0.05）。肺灌注组患者CPB结束和术后0，6h的氧合指数及肺静态顺应性高于对照组（P<0.05）。肺组织活检病理结果显示，对照组肺间质水肿明显，肺间质大量炎性细胞浸润，肺灌注组无明显病理改变。结论：CPB术后存在肺损伤，CPB中含氧血持续肺动脉灌注可减轻肺损伤。     

乌司他丁用于肺动脉灌注后对肺功能的影响

目的：探讨肺动脉灌注含乌司他丁低温肺保护液后患者肺功能的影响。方法：择期二尖瓣置换手术病人60例,随机分成两组,每组30例,乌司他丁组（乌司他丁0．5万u／kg,加入4℃舍氧冷血灌注液中进行肺动脉根部灌注）;对照组（4℃合氧冷血灌注液进行肺动脉根部灌注）。检测体外循环（CPB）前、CPB后1／2、6h的肺泡氧和指数（OI）、呼吸指数（RI=A—aD02／Pa02）。结果：（1）体外循环后1／2h实验纽与对照组OI、RI差异无统计学意义,但较术前升高有统计学意义（P〈0．01）;（2）体外循环后6h实验组OI、RI组明显低于对照组,差异显著（P〈0．01）。结论：乌司他丁能通过抑制炎症因子TNF—a的产生,促进抗炎因子IL-10的释放,调整机体促炎系统及抗炎系统动态平衡,从而抑制白细胞的激活、肺内聚集,减轻体外循环后肺损伤和通气功能障碍,减轻肺损伤,改善术后肺功能。     

肺动脉灌注去白细胞肺保护液对体外循环肺的保护作用

目的 探讨肺动脉灌注去白细胞肺保护液对体外循环(CPB)肺的保护作用及其机制.方法 将30例CPB下行二尖瓣置换术患者随机分为3组:去白细胞肺保护组(A组)、普通肺保护组(B组)及对照组(C组),每组10例.A组CPB期间经肺动脉灌注低温去白细胞肺保护液;B组CPB期间经肺动脉灌注低温肺保护液,C组患者常规行瓣膜置换术.监测3组患者术中主动脉阻断时间、CPB时间、术前术后平均肺动脉压力(PAPm)、气道阻力(AR)及静态肺顺应性(CLS)的变化、术后呼吸机辅助时间、ICU监护时间和住院时间以及术后并发症发生情况等;测定3组患者CPB前和CPB后0、6、12、24 h血清丙二醛(MDA)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)的变化.结果 3组患者手术顺利,均痊愈出院,无术后并发症.3组术中主动脉阻断时间、CPB时间、术后ICU监护时间、住院时间及CPB前血清MDA、IL-6、TNF-α含量比较,差异均无统计学意义(均P＞0.05);A、B组的术后呼吸机辅助时间、CPB后0、6、12、24 h呼吸指数(RI)、氧合指数(OI)、血清MDA、IL-6、TNF-α及术前、术后PAPm、CLS、AR变化与C组比较差异均有统计学意义(均P＜0.05);临床及生化指标在A、B组比较差异均无统计学意义(均P＞0.05).结论 CPB期间肺动脉灌注去白细胞肺保护液可明显减轻CPB肺损伤,与单纯CPB期间经肺动脉灌注低温肺保护液比较,两者肺保护效果无明显差别.     

体外循环犬单肺缺血再灌注损伤模型的建立

目的 建立体外循环单肺缺血再灌注损伤动物模型.方法 6只健康杂种犬阻断左肺动脉,终止左肺血供及通气,造成左肺缺血,并循体外循环60 min后开放左肺动脉,恢复左肺血供及通气形成再灌注损伤,左肺再灌注2.5h后结束实验,右肺全程维持血供及通气.于CPB前（T1）、阻断左肺动脉并循60 min（T2）、再灌注2.5h（T3）三个时间点观察肺组织病理学变化并进行评分,对比肺动态顺应性（CD）、氧和指数（OI）、呼吸指数（RI）变化比例.结果 ①病理学变化：CPB后左、右肺组织见大量炎性细胞浸润,肺泡间隔增宽,肺泡壁断裂甚至坏死;左肺病理改变较右肺严重;②病理切片评分：CPB后左、右肺病理评分逐渐升高;T1时点左、右肺组织评分无差异,T2、T3时点左肺评分明显高于右肺;③CD、OI、RI变化比例：CPB后CD、OI明显下降,RI明显升高;左肺CD、OI下降程度、RI升高程度较右肺明显.结论 本实验动物模型建立成功,能全面地模拟临床心脏手术过程,对CPB肺保护相关研究有着积极的推动作用.     

低温洗涤红细胞肺保护液对体外循环术后肺保护作用的研究

目的:探讨体外循环(cardiopulmonarybypass,CPB)术中采用低温洗涤红细胞肺保护液实施肺动脉灌注对肺的保护效果。方法:随机选取20例风湿性单纯二尖瓣病变合并中度肺动脉高压的患者,分为肺动脉灌注组和对照组(每组各10例)。灌注组在主动脉阻断后,经肺动脉根部间断灌注低温洗涤红细胞肺保护液,测定两组患者围术期的机械通气时间、肺血管阻力、白细胞比值(静脉血/动脉血)、肺循环血浆MDA含量。结果:体外循环术后灌注组机械通气时间显著低于对照组(P<0.05);各时点肺血管阻力、白细胞比值(静脉血/动脉血)、肺循环血浆MDA含量均显著低于对照组(P<0.01)。结论:低温洗涤红细胞肺保护液肺动脉灌注对体外循环术后肺损伤有明显的保护作用.     

自体肺与人工肺体外循环对肺影响的对比研究

目的　探讨自体肺体外循环 (CPB)与人工肺CPB对肺的影响。方法　选择健康杂种犬 16只 ,体重 (15± 1)kg,随机分为实验组和对照组。实验组 ,利用杂种犬自体肺作为氧合器。对照组利用鼓泡肺作为氧合器 ,两组CPB均进行 1h ,CPB结束后 ,通过测量动脉血氧分压 ;右心房、左心房白细胞记数 ,并计算其比值 ;肺动脉压 ;肺标本病理学检查 ,了解肺损伤的情况。自体肺组在整个CPB期间连续监测肺动脉压。结果　自体肺组CPB后右心房、左心房白细胞比值、肺动脉压低于人工肺组 ;动脉血氧分压高于人工肺组 ,自体肺组在整个CPB过程中 ,肺动脉压低于 2 0mmHg,且肺动脉压维持平稳。肺标本组织学检查示 :自体肺组肺损伤较人工肺组轻。结论　自体肺CPB技术在CPB过程中能提供满意的氧合 ;而且较人工肺能获得更好的肺保护作用。     

肺动脉灌注低温肺保护液抑制肺组织细胞凋亡的研究

目的探讨体外循环（cardiopulmonary bypass,CPB）期间肺动脉灌注低温肺保护液对肺组织细胞凋亡的影响。方法将20例风湿性二尖瓣病变患者随机分为肺保护组和对照组,每组10例。2组患者均在CPB下行单纯二尖瓣人工机械瓣置换术。肺保护组CPB期间经肺动脉灌注低温肺保护液,对照组CPB期间经肺动脉灌注等量生理盐水。监测2组患者CPB术后0、6、122、4 h呼吸功能,取动脉血1 mL进行血气分析,计算氧合指数。同时于CPB术前及停止CPB术后分别取2组患者右下肺组织（1.0 cm×1.0 cm×1.0 cm）活检标本,原位DNA末端标记法（TUNEL法）检测肺组织细胞凋亡情况。结果肺保护组CPB术后0、6、12、24 h氧合指数均高于对照组（P〈0.01或P〈0.05）。2组CPB术后肺组织细胞凋亡率均较CPB术前明显增多（P均〈0.01）。肺保护组、对照组CPB术后肺组织细胞凋亡率分别为（10.46±1.96）%、（18.68±1.34）%,2组比较差异有统计学意义（P〈0.01）。结论（1）常规低温CPB术可以诱导肺组织细胞的细胞凋亡。（2）CPB期间经肺动脉灌注低温肺保护液可显著抑制肺组织细胞的凋亡,减轻CPB肺损伤,提示其具有肺保护作用。     

综合肺保护措施防治法洛四联症根治术后灌注肺的疗效

目的：探讨综合肺保护措施防治法洛四联症（TOF）根治术后灌注肺的疗效。方法：选取TOF患者221例,分为综合治疗组124例和常规治疗组97例。综合治疗组术中间断膨肺、间断肺动脉内灌注低温肺保护液、持续肺动脉引流,术后采取延长呼吸机辅助时间、呼气末正压、侧支封堵等措施;常规治疗组不使用上述措施。结果：综合治疗组氧合指数（OI）在体外循环术后4、8、12及24 h均显著高于常规治疗组,差异有统计学意义（P〈0.05）。结论：综合肺保护措施可减少肺部渗出、促进血液氧合、提高OI,防治TOF术后灌注肺疗效确切、可靠。     

缺血预处理对体外循环犬肺损伤的保护作用

目的 探讨缺血预处理（IP）对体外循环（CPB）犬肺损伤的保护作用.方法 健康杂种犬N =12,随机均分为两组,对照组（C组）和IP组（Y组）,麻醉后行双腔气管插管,开胸建立CPB肺缺血再灌注损伤模型.C组在左肺行缺血再灌注,Y组在阻断左肺动脉前进行IP.于CPB前（T1）、阻断左肺动脉前（T2）、停机时（T3）、停机后2h（T4）取肺组织称湿、干重及行光镜学检查.在T1、T3、T4时点取动脉血行血气分析计算呼吸指数（RI）和氧合指数（OI）.结果 ①湿、干重比：组内随着时间的延长逐渐升高（P＜0.05）;组间Y组T3、T4时点明显低于C组（P＜0.05）;②病理学变化及评分：组内T3、T4时点病理评分明显高于T1时点（P＜0.05）.组间Y组T3、T4时点评分明显低于C组（P＜0.05）;③RI和OI的变化：组内随时间推移RI逐渐升高,OI则降低（P＜0.05）;组间Y组T3、T4时点RI明显低于C组,OI则相反（P＜0.05）.结论 IP可降低CPB犬RI,提高其OI,改善犬的肺功能,对犬CPB肺损伤有一定的保护作用.     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.