胸腺肽α1对烫伤延迟复苏大鼠单核细胞Ia抗原的影响

目的:研究烫伤延迟复苏后大鼠单核细胞表面Ia抗原变化规律及应用胸腺肽α1对单核细胞表面Ia抗原的影响。方法:将104只成年雄性Wistar大鼠随机分为正常对照组(8只)、单纯烫伤组(48只)和胸腺肽α1治疗组(48只)。正常对照组不作烫伤处理;其它组均造成30%TBSAⅢ度烧伤延迟复苏模型。分别于6h、1d、2d、3d、7d和14d处死动物,取血分离单核细胞,流式细胞仪检测Ia抗原表达率。结果:大鼠烫伤延迟复苏后单核细胞Ia抗原表达率降低,其中6h、和1d时间点Ia抗原表达率严重降低,3d、7d和14d时间点开始有所恢复,但明显低于正常大鼠(P均<0·01)。给予胸腺肽α1后3d、7d和14d时间点单核细胞Ia抗原表达率与单纯烫伤组比较明显提高(P均<0·01)。结论:严重烧伤延迟复苏后,单核细胞抗原递呈功能减弱,免疫功能障碍。胸腺肽α1作为一种免疫增强剂可明显改善烧伤延迟复苏后单核细胞抗原递呈功能。     

经气管导管套囊注入利多卡因减轻气道反应的临床观察

目的观察经气管导管套囊给予2%利多卡因是否能减轻拔管时的心血管和气道反应以及长期的不良反应。方法随机选择105例患者分为对照组（CS组）、生理盐水组（S组）和利多卡因组（L组）3组,分别向套囊内注射空气、生理盐水和利多卡因,观察患者的基础生命体征以及手术结束即刻、拔管时、拔管后1、3、5和10min的HR、SBP、MAP。随访术后24h不良事件的发生率。结果拔管即刻各组患者的生命体征均有升高,且即刻、1、3min的数值与基础值相比差异有统计学意义（P〈0.01或P〈0.05）;但除了拔管后10min以外的其它时点利多卡因组的数值均较其它两组低（P〈0.05）。拔管后5min利多卡因组的生命体征与基础值比较无显著差异（P〉0.05）。L组的呛咳病例数较C组和S组低（P〈0.05）,而C组和S组无统计学差异（P〉0.05）。24h后L组的咽痛和咳嗽病例数也较C组（P〈0.01）和S组少（P〈0.05）,而C组和S组也有显著差异（P〈0.05）;3组患者在声嘶和气道梗阻等严重并发症方面发生率均很低,且无显著差异（P〉0.05）。结论经气管导管套囊给予利多卡因能明显减少患者围拔管期的血流动力学波动和呛咳,且术后的咽痛、咳嗽等不良反应更少。     

Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P＜0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P＜0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

重度烧伤并发消化道大出血四例

2002—2003年,笔者单位共收治重度烧伤并发消化道大出血患者 4例,均为男性,年龄 5 ~54岁。患者伤后曾在当地卫生所或医院行静脉补液治疗(成分及用量不详),创面外敷湿润烧伤膏 (北京光明创疡研究所 )或自制中草药,伤后2—9d转入笔者单位。烧伤总面积 25% ~92%,其中Ⅲ度15% ~     

不同性状激光微孔脱细胞真皮构建活性基质的研究

目的：探讨不同性状激光微孔脱细胞真皮构建活性基质的可行性。方法：将激光微孔猪脱细胞真皮分成两组即干燥组和湿润组，每组36片。将成纤维细胞悬液分别滴加在两组真皮表面，培养不同时间点后，每组分别随机留取6个孔的培养液，采用双抗体夹心ELISA法测定上清液中人TGF-β1、bFGF含量。结果：随着培养时间的延长，TGF-p。和bFGF分泌量逐渐增多，第8天达到稳定水平，第10、12天与第8天的含量比较差异无统计学意义（P〉0．05）；各时间点干燥组各因子的含量均高于湿润组（P〈0．05）。结论：激光微孔猪脱细胞真皮可用为支架构建活性基质，其冷冻干燥后更有利于成纤维细胞的粘附与增殖。     

严重烧伤大鼠早期切痂植皮后骨骼肌泛素转录的变化

目的　探讨大鼠严重烧伤早期切痂后骨骼肌蛋白降解率变化的内在机制。方法　应用大鼠 30 %Ⅲ度背部烫伤模型 ,随机分为伤前、单纯烧伤、早期切痂和非早期切痂组 ,切痂组分别于伤后 1天和 4天行切痂手术 ,采用无创技术和骨骼肌充分氧供离体孵育系统测定伸趾长肌肌纤维蛋白降解率 ,Northernblot方法测定伸趾长肌组织中泛素转录表达的变化。结果　伸趾长肌肌纤维蛋白降解率在伤后各时间点均显著增加 (P<0 0 1) ,早期切痂组较非早期切痂组在伤后 2、4、5天显著降低 (P <0 0 5 ,P <0 0 1)。泛素转录表达在伤后均显著增加 ,但早期切痂组呈持续下降的趋势。蛋白降解率与泛素转录表达间呈显著正相关 (r=0 94 78,P <0 0 5 )。结论　烧伤早期切痂可降低骨骼肌蛋白的高分解代谢反应 ,与泛素 蛋白酶体途径活性下降有关     

卡巴胆碱对烧创伤后肠道功能障碍影响的研究

目的观察肠道内给予卡巴胆碱对兔肠部分缺血再灌注(I/R)损伤及重度烧伤患者肠道功能障碍的影响。方法将50只大白兔制成肠部分I/R损伤模型后,随机分为肠部分I/R损伤组(25只)、卡巴胆碱组[25只,于肠系膜上动脉(SMA)阻断后1h肠内注入3g/L卡巴胆碱(3μg/kg)]；另取25只设为假手术组,仅分离SMA,不阻断；取5只作为正常对照组,不致伤,处死后留取标本待测。检测兔SMA阻断前后及肠道内给予卡巴胆碱后肠黏膜的血流量。各致伤组均在处理后2、4、6、8、24、48、72h留取静脉血测定其血浆二胺氧化酶(DAO)活性及D-乳酸和D-木糖含量。并行葡聚糖蓝排出实验,以检测胃肠道吸收功能。同时选择大面积烧伤[烧伤总面积(84±12)%TBSA]患者8例,在患者肠呜音＜2次/min或腹胀明显时,口服1g/L卡巴胆碱(15μg/kg),观察给药后每分钟肠鸣音次数及腹胀情况。结果SMA阻断后肠部分I/R损伤组肠黏膜血流量为(48±6)PU,较正常对照组[(102±5)PU]明显减少,而肠道内注入卡巴胆碱后1h血流量增至(77±3)PU。肠缺血后肠部分I/R损伤组血浆DAO活性及D-乳酸含量开始升高,处理后24h达峰值[(4．63±0．27)U/ml、(7．9±2．4)mg/L],以后逐渐下降,但仍高于正常对照组[(0．89±0．14)U/ml、(2．0±1．1)mg/L,P＜0．05]。卡巴胆碱组的变化基本同肠部分I/R损伤组,但变化幅度较小；而假手术组则无明显变化(P＞0．05)。在给予D-木糖后2h,肠部分I/R损伤组血浆D-木糖含量显著降低,但处理后6h肠部分I/R损伤组及卡巴胆碱组明显升高,以后逐渐下降；假手术组略有波动。SMA处理后2h肠部分I/R损伤组葡聚糖蓝未见排出,处理后6h其运动距离逐渐增加,但处理后24h其运动距离仍明显短于正常值(P＜0．05),48～72h基本恢复正常；卡巴胆碱组注入葡聚糖蓝后即可见其排出,其运动距离明显增加,处理后6h达峰值(43±6)cm,以后逐渐缩短接近正常(28±3)cm。给药前患者肠呜音较弱(1．6±1．1)次/min,给药后10 min明显增强为(6．9±1．7)次/min,30 min时为(8．3±2．4)次/min,给药后1h患者肠鸣音仍较活跃,为(6．1±1．3)次/min。给药后2h患者腹胀明显减轻,其中有6例患者开始排便。结论肠内给予卡巴胆碱可增加兔肠黏膜血流量,改善其肠道运动、吸收、屏障功能；大面积烧伤患者口服卡巴胆碱,可改善其肠道功能障碍。     

腰-硬联合麻醉对剖宫产产妇呼吸参数的影响

目的：探讨腰-硬联合麻醉对剖宫产产妇呼吸功能的影响。方法：30例美国麻醉医师学会（ASA）Ⅰ～Ⅱ单胎足月孕妇,在腰-硬联合麻醉下行剖宫产术,用面罩紧闭法测量孕妇在人室后平卧位（T1）,麻醉完成后仰卧即刻（T1）、5rain（T2）、10min（T3）,胎儿取出后1min（T4）、5min（T5）和10min（T6）时的呼吸频率（RR）、潮气量（VT）、分钟通气量（VE）、呼气末二氧化碳分压（PETCO2）、1秒率（V1．0）、呼吸比（E：I）等参数的变化。结果：与基础值（T0）相比较,PETCO2于各个观察时间点均明显降低（P〈0．01）;T1、T2、T6时VE明显降低;T1时的VT亦降低（P〈0．05）。结论：腰-硬联合麻醉能使剖宫产产妇的VE、PETCO2明显降低,缓解产妇的过度通气,降低其氧耗量,且不会对产妇呼吸功能产生不利影响。     

山羊烧伤和脓毒症中能量代谢动态变化的实验研究

目的观察和分析烧伤早期和脓毒症状态下的能量代谢动态变化及其影响因素.方法以山羊烧伤和脓毒症为模型检测血流动力学、静息能量消耗(REE)、血内毒素、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)水平及有关代谢激素的水平,监测血糖、血乳酸及氨基酸谱的动态变化.结果(1)烧伤早期充分复苏的情况下REE即显著升高,随着合并内毒素血症的确立,REE升高更为显著(352.5±17.6)J*h-1*m-2;(2)烧伤及烧伤合并内毒素血症的情况下,血中内毒素、TNF-α、IL-6、IL-8水平显著增高,在时相上与REE的升高相平行;(3)在烧伤后氧输送和氧耗量短暂下降,随休克复苏及脓毒症的确立逐渐升高,组织氧摄取率在烧伤早期短暂增高,之后则基本恢复正常水平;(4)血清胰岛素、胰高血糖素、皮质醇等代谢相关激素水平在伤后均高于伤前;(5)血乳酸、血糖、尿3-甲基组氨酸在烧伤后和脓毒症中均显著高于伤前水平.结论在烧伤尤其是合并脓毒症的情况下,机体存在显著的代谢增强过程.其与炎症介质(TNF-α、IL-6、IL-8的过度释放)有关,并受相关代谢激素的调控.该模型较好地反映烧伤和脓毒症中以高代谢为特征的机体代谢紊乱过程.