盐酸戊乙奎醚对大鼠创伤性急性肺损伤时细胞凋亡的影响

目的 探讨盐酸戊乙奎醚对大鼠创伤性急性肺损伤时细胞凋亡的影响.方法健康雄性SD大鼠54只,体重225～275kg,采用随机数字表法,将大鼠随机分为对照组(C组)、创伤性急性肺损伤组(ALI组)和盐酸戊乙奎醚组(P组),每组18只.采用自制胸部撞击器撞击大鼠胸壁的方法制备创伤性急性肺损伤模型.P组分别于撞击后即刻、撞击后12 h时腹腔注射盐酸戊乙奎醚2 mg/kg.分别于撞击后3、12、24 h时各组随机取6只大鼠处死取肺,光镜和电镜下观察肺组织病理学结果,TUNEL法测定凋亡细胞,计算凋亡指数,免疫组化法检测Bax和Bcl-2的表达.结果 与C组比较,ALI组和P组各时点肺组织细胞凋亡指数、Bax和Bcl-2的表达水平升高,Bcl-2/Bax比值降低(P＜0.05);与ALI组比较,P组各时点肺组织细胞凋亡指数和Bax表达水平降低,Bcl-2的表达水平和Bcl-2/Bax比值升高(P＜0.01).P组肺组织病理学损伤程度较ALI组减轻.结论 盐酸戊乙奎醚可通过抑制细胞凋亡减轻大鼠创伤性急性肺损伤.

Abstract：

Objective To investigate the effect of penehyclidine hydrochloride on the cell apoptosis in lung tissues in a rat model of traumatic acute lung injury (ALI) .Methods Fifty-four SD rats weighing 225-275 kg were randomly divided into 3 groups ( n = 18 each) : control group (group C) , ALI group, penehyclidine hydrochloride group ( group P) . Traumatic ALI was induced by dropping a self-made impact device on the chest of anesthetized rats according to the technique described by Raghavendran et al. Intraperitoneal penehyclidine hydrochloride 2 mg/kg was injected immediately after blunt chest trauma and at 12 h after blunt chest trauma in group P. Six rats in each group were sacrificed at 3, 12 and 24 h after blunt chest trauma and the lung tissues collected for microscopic examination and determination of cell apoptosis (by TUNEL) and expression of Bax and Bcl-2 (by immuno-histochemical staining) . The apoptosis index was calculated. Results The apoptosis index and expression of Bax and Bcl-2 were significantly higher, while the ratio of Bcl-2/Bax was significantly lower at each time point in groups ALI and P than in group C ( P ＜ 0.05) . The apoptosis index and Bax expression were significantly lower,while the Bcl-2 expression and ratio of Bcl-2/ Bax higher at each time point in group P than in group ALI.The microscopic examination showed that penehyclidine hydrochloride injection significantly attenuated the pathologic changes. Conclusion Penehyclidine hydrochloride can reduce the traumatic ALI through inhibiting the cell apoptosis in rat lung tissues.     

ICU中中心静脉置管术的临床应用

加强治疗病房(intensive care unit,ICU)收治对象为来自各临床科室的危重患者,病情急,救治工作强度大,良好的静脉通路是危重患者生命支持必不可少的条件.中心静脉置管术不仅可以建立一个有效而稳固的快速补液、输血及输注各种抢救药物的静脉通道,也可以协助进行血流动力学监测.近年来中心静脉置管术已成为ICU中必不可少的抢救手段之一.现将中心静脉置管术的穿刺方法、临床应用、临床并发症及预防措施等总结如下.     

川芎嗪对大鼠急性胸部撞击伤所致肺组织细胞异常凋亡抑制作用的机制研究

目的:探讨川芎嗪对大鼠急性肺部撞击伤所致异常凋亡抑制作用及其机制。方法:健康雄性SD大鼠72只,随机分为正常对照组(C组,n=24)、肺部撞击伤模型组(T组,n=24)、川芎嗪治疗组(L组,n=24)。C组无特殊处理,L组在撞击后立即腹腔注射川芎嗪80mg/kg 1次。细胞凋亡原位检测(TUNEL)法测定肺组织内细胞凋亡;检测肺水肿程度和肺血管通透性以检测肺功能改变,免疫组织化学检测肺组织Bcl-2、Bax和Caspase-3的表达;光镜和电镜下观察肺组织病理改变。结果:T组肺组织内细胞凋亡指数及肺组织损伤程度明显增高(均P<0.05);肺血管通透性增强(P<0.05),肺水肿程度增加(P<0.05);Caspase-3、Bax、Bcl-2表达较C组升高(P<0.05),Bcl-2/Bax比值降低。L组相对于T组肺组织内细胞凋亡指数及肺组织损伤程度降低(P<0.05),肺血管通透性破坏降低(P<0.05),肺水肿程度减轻(P<0.05);Caspase-3、Bax表达下降(P<0.05),而Bcl-2表达增强,Bcl-2/Bax比值增加(P<0.01)。结论:川芎嗪可通过抑制肺组织细胞凋亡减轻肺损伤,其机制可能是提高Bcl-2/Bax的比值,降低Caspase-3的表达水平来实现的。     

Effect of Radix Paeoniae Rubra on the expression of HO-1 and iNOS in rats with endotoxin-induced acute lung injury

Objective: To investigate the effect of Radix Paeoniae Rubra (RPR) on the expression of heme oxygenase (HO-1) and induced nitric oxide synthase (iNOS) in endotoxin-induced acute lung injury in rats and its protective mechanism. Methods: Forty Wistar rats were divided randomly into 5 groups with 8 rats in each group: saline control group (NS group), lipopolysaccharide group ( LPS group), RPR-treatment group, RPR-prevention group and Hemin group. The effect of RPR on protein content, the ratio of neutrophiles in bronchoalveolar lavage fluid, malondialdehyde ( MDA ) content in the lung and the activity of serum NO were observed. Arterial blood was drawn for blood-gas analysis. The expression of HO-1 and iNOS in lung tissues was detected by immunohistochemitry and morphometry computer image analysis. The histological changes of the lung were observed under light microscope. Results: Compared with that in NS group, the expression of HO-1 and iNOS was markedly increased in LPS group (P<0.01). In RPR-treatment, RPR-prevention , and Hemin groups, the expression of iNOS was significantly lower, while the expression of HO-1 was higher than that in LPS group (P<0.05). The protein content, the ratio of neutrophiles in bronchoalveolar lavage fluid, the content of MDA and the activity of serum NO in LPS group were significantly higher than those in NS group (P<0.01). There was a significant decrease in the level of arterial bicarbonate and partial pressure of oxygen in the LPS group (P<0.01); these parameters of lung injury however, were significantly lower in RPR-treatment. RPR-prevention, and Hemin groups than LPS group (P<0. 05 or P< 0.01). The pathologic changes of lung tissues were substantially attenuated in RPR-treatment, RPR-prevention, and Hemin groups than LPS group. Conclusions: The high expression of HO-1 reflects an important protective function of the body during lipopolysaccharide-induced acute lung injury. The protective effect of RPR on lipopolysaccharide-induced acute lung injury is related to the inhibition of iNOS expression and the induction of HO-1 expression.     

IL-12和IL-15对外周血CIK细胞增殖和对SMMC-7721肝癌细胞杀瘤效果研究

目的观察常规培养条件下添加白细胞介素(IL)-12、IL-15对细胞因子诱导的杀伤(CIK)细胞增殖的影响,观察不同细胞因子组合培养的CIK细胞的杀瘤作用,为高效率、高质量体外制备肿瘤患者自体CIK细胞制剂提供新思路。方法首先筛选出IL-2、IL-12、IL-15最佳添加水平;然后采集健康献血员外周血,分离出单个核细胞后,根据添加的细胞因子种类和组合类型进行分组:A组(IL-2常规培养组)、B组(IL-2~+IL-12组)、C组(IL-2~+IL-15组)、D组(IL-2~+IL-12~+IL-15组)、E组(细胞因子空白对照组);各组单个核细胞分别在培养第0、5、10、15、20天,采用全自动血球计数仪进行CIK细胞计数,锥虫蓝染法检测细胞活性,流式细胞技术检测细胞膜CD3、CD8、CD56阳性率,MTS法测定CIK细胞对肝癌SMMC-7721细胞的杀瘤效果。结果B、C、D组培养第10、15、20天后CIK细胞增殖倍数均明显高于A组(P0.05);D组培养第10、15、20天CIK细胞增殖倍数均分别明显高于C组(P0.05)。B、C、D组培养第15、20天CIK细胞膜CD3~+CD8~+、CD3~+CD56~+百分比均分别明显高于A组(P0.05);D组培养第15、20天CIK细胞膜CD3~+CD8~+、CD3~+CD56~+百分比均分别明显高于B组(P0.05)。在效靶比5∶1时,各组培养第10、15、20天的CIK细胞对肝癌SMMC-7721细胞的杀伤率均明显高于A组(P0.05);D、C组培养第10、15、20天CIK细胞对肝癌SMMC-7721细胞的杀伤率分别明显高于B组(P0.05)。结论 IL-12、IL-15均可促进CIK细胞增殖,IL-15在促进CIK细胞增殖的同时还能增强CIK细胞杀伤肝癌SMMC-7721细胞的活性。     

参附注射液对小儿心脏手术体外循环期间胃肠道的保护作用

目的观察参附注射液(SF)对小儿心脏手术体外循环期间胃肠道是否具有保护作用并探讨其可能机制。方法择期心内直视手术患者30例,随机分为对照组和SF组,SF组于切皮时静注SF 0.5 m l.kg-1,再取1.0 m l.kg-1用生理盐水稀释成100 m l,用G rasby泵以0.004 m l.kg-1.m in-1速度持续注入,对照组则输入等量生理盐水。分别于于切皮前(S0)、主动脉开放1 h(R1)、2 h(R2)后测定胃黏膜pH(pH i)、血浆二胺氧化酶(DAO)、血浆内毒素(LPS)水平。结果S0时2组患者胃pH i及血浆DAO、LPS水平比较差异无统计学意义(P>0.05),R1和R2时,pH i值显著低于S0值(均P<0.01)、DAO、LPS水平显著高于S0值(均P<0.01);SF组R1和R2时pH i值显著高于对照组(P<0.01),血浆DAO、LPS水平显著低于对照组(均P<0.01),血浆DAO、LPS水平与胃pH i显著负相关(P<0.01)。结论SF对体外循环心脏手术病人胃肠道具有保护作用,其可能机制为SF可改善胃肠黏膜灌注和氧合,减轻肠黏膜上皮细胞损伤,保护黏膜屏障功能。     

利用DRG和加权秩和比法评价麻醉医师绩效

目的探索建立一套科学的麻醉医师绩效评价体系，为麻醉医师绩效考核提供参考。方法提取湖北省某三甲医院2019年出院患者病案首页数据，通过手术麻醉管理系统和电子病历系统完善麻醉信息，利用CN-DRG分组器获取 DRG指标，从医院内部OA系统获得麻醉医师信息，采用加权秩和比法对麻醉医师进行绩效评价。结果116名麻醉医师中，19人分为优档，79人分为中档，18人分为差档。3档间差异有统计学意义（F=161.967，P<0.001）。结论该麻醉医师绩效评价体系较为合理、客观，能够有效评价麻醉医师劳动付出，其评价结果可为麻醉科绩效考核、学科建设和精细化管理提供依据。     

miR-93在结肠癌组织中的表达及其对结肠癌细胞增殖和凋亡的影响

目的研究分析miR-93在结肠癌组织中的表达,探讨其在结肠癌细胞增殖、细胞周期及凋亡中的意义。方法采用TagMan MGB探针法定量分析101例结肠癌组织及癌旁组织miR-93的表达;利用反义技术降低结肠癌细胞SW480和LoVo的miR-93的表达;采用MTT比色法检测细胞增殖的改变;利用流式细胞技术检测结肠癌细胞周期和凋亡情况。结果在101例结肠癌组织中,53.47%(54/101)的结肠癌组织miR-93表达明显高于癌旁组织(P<0.05);反义miR-93转染结肠癌细胞SW480和LoVo后,miR-93的表达明显降低,细胞生长受到明显抑制,主要停滞在G0/G1期,早期凋亡明显增加。结论 miR-93在结肠癌组织中表达上调。降低其表达能明显抑制SW480和LoVo细胞的生长和诱导细胞早期凋亡。     

内镜下治疗消化道息肉316例

目的总结内镜下治疗消化道息肉临床经验。方法收集2010年1月-2011年6月我院316例消化道息肉患者（548枚息肉）资料,分析热活检钳、圈套器、氩离子凝固术等不同治疗方法切除息肉成功率及并发症。结果548枚消化道息肉均成功切除,采用热活检钳切除107枚,圈套器切除362枚,氩离子凝固术切除79枚,术后无1例穿孔,并发迟发性出血1例。结论内镜下治疗消化道息肉治疗效果肯定,安全性高,并发症少。