肺切除术影响围手术期右心功能

目的 检测肺切除术后围手术期右心功能指标的变化,以指导临床治疗.方法 将肺切除病人45例分为肺楔形切除组(Ⅰ组,10例)、单肺叶切除组(Ⅱ组,19例)、双肺叶切除组(Ⅲ组,7例)及全肺切除组(Ⅳ组,9例).通过中心静脉压(CVP)测定、脉冲多普勒血流频谱及组织多普勒技术了解术前、术后5-7d、术后1个月的右心室前、后负荷及泵功能变化.结果 与术前相比,各种术式术后5～7d中心静脉压均无明显变化;Ⅰ组术后右心后负荷、泵功能较术前无明显改变;Ⅱ组、Ⅲ组及Ⅳ组术后5～7d右心后负荷增加,右心泵功能下降,Ⅳ组更为明显;术后1个月,Ⅱ组右心后负荷、泵功能恢复到术前水平,但Ⅲ组及Ⅳ组与术前相比仍有异常.结论 肺切除术后存在不同程度的右心功能下降.     

肺切除术影响围手术期右心功能

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.     

肺切除术影响围手术期右心功能

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.     

新疆犊牛肺炎病原分析和临床防控

为探索我区犊牛肺炎的流行原因、建立有效防控方法,本研究采用细菌学分离鉴定、药物敏感性试验、治疗案例和肺炎发展进程综合分析的方法对2010～2016年间14个奶牛场送检的57份肺炎病料进行研究,结果表明:化脓隐秘杆菌或荚膜A型巴氏杆菌单—病原的感染是导致新疆犊牛化脓性肺炎的主要原因,分离菌株对青霉素类、头孢类、氟喹诺酮类和氯霉素类抗茵药物(均敏感,据此,提出“及早发现,预防性治疗”的临床应对方案,使用阿莫西林、氟苯尼考和诺氟沙星等药物以肌内注射或口服的给药方式进行预防性治疗,经为期1年的临床应用,使犊牛肺炎的发病率显著下降,6个月龄内犊牛因肺炎造成的死亡、淘汰率被控制在5％以内,说明化脓隐秘杆菌、荚膜A型巴氏杆菌是引起新疆犊牛肺炎的主要病原,采取“及早发现,预防性治疗”的方案可显著降低犊牛肺炎造成的损失.     

地面玉米青贮压制及推广应用

随着奶牛养殖业的发展,玉米青贮的利用在降低成本、替代粮食方面起着非常重要的作用,是畜牧业发展的物质基础。它经济合理,适口性强,消化率高,营养丰富。地面玉米青贮的压制操作简单、方便省力、省钱、便于运输,可推广和应用。     

中华白蛉自体生殖的研究

现场及实验室研究结果表明我国黄土高原的大多数中华白蛉应属自体生殖品系。它们在羽化后吸血前,经交尾能依靠腹节内蓄积的脂肪体使卵泡发育,待卵产出后开始吸血。在25±1℃时,其生活史分快慢两型,快型从卵发育至成虫仅需44～50天。慢型须经四     

保留全瓣或后瓣的二尖瓣置换术治疗合并巨大左心室的瓣膜病疗效比较

35例合并巨大左心室瓣膜病患者,于体外循环下采用二尖瓣置换术。其中11例术中保留全部二尖瓣（保留全瓣组）,24例仅保留后瓣及其腱索、切除前瓣及其腱索（保留后瓣组）。术后1个月采用超声心动图测量两组患者手术前后左心室舒张末容积指数（LVEDVI）、收缩末期容积指数（LVESVI）、左心室舒张末直径（LVEDD）、收缩末期直径（LVESD）、左心室射血分数（EF）、短轴缩短率（FS）、每搏指数（SVI）。结果保留全瓣组手术后无早期死亡病例,发生严重心律失常1例;保留后瓣组手术后早期死亡1例,发生严重心律失常和低心室排血量综合征各1例。两组术后LVEDVI、LVESVI、LVEDD、LVESD均较术前明显缩小（P均〈0．01）,保留全瓣组LVEDVI、LVEDD较保留后瓣组低（P〈0．05）;EF、FS和SVI两组均优于术前（P均〈0．01）。认为合并巨大左心室的瓣膜病患者行二尖瓣置换术时宜保留全部二尖瓣结构。     

非体外循环心脏不停跳冠状动脉旁路移植同期室壁瘤切除对患者心功能的影响

目的探讨非体外循环心脏不停跳冠状动脉旁路移植(CABG)同期室壁瘤切除对患者心功能的影响。方法选取从2016年10月至2018年10月间于中国科学技术大学附属第一医院,住院接受非体外循环心脏不停跳冠状动脉(冠脉)旁路移植术同期室壁瘤切除术治疗的10例患者作为观察组。另取同期接受单纯非体外循环心脏不停跳冠脉旁路移植术治疗的10例患者作为对照组。比较两组患者在手术时间、术后呼吸机使用时间、ICU停留时间、住院时间以及两组患者手术前后心功能相关指标水平的差异。结果观察组患者手术时间、术后呼吸机使用时间、ICU停留时间、住院时间分别为(4.02±1.04)h、(18.02±1.42)h、(59.67±10.84)h、(11.74±0.85)d,与对照组的(4.33±1.01)h、(17.66±1.47)h、(60.32±10.72)h、(11.26±0.91)d相比均不明显,差异均无统计学意义(P均0.05)。术后观察组患者左室射血分数(50.01±4.08)%较术前(46.04±4.22)%明显升高,而左室舒张末期容积水平(57.24±4.55)ml较手术前(61.42±3.29)ml明显降低,差异有统计学意义(P均0.05)。结论非体外循环心脏不停跳下冠脉旁路移植同期室壁瘤切除有效改善患者的心功能,具有一定的临床推广价值。     

p38MAPK抑制剂CBS3830对糖尿病大鼠自体静脉移植内膜增生的影响及机制探讨

目的观察p38MAPK抑制剂CBS3830对糖尿病大鼠自体移植静脉内膜增生的影响,并探讨机制。方法 SD雄性大鼠30只,采用腹腔注射链脲佐菌素法建立糖尿病动物模型;将造模成功的26只随机分为两组,采用改良cuff法建立自体静脉移植模型,造模前1 h药物组经胃管灌入0.3 mg/ml的CBS3830 10 ml/kg,对照组同法给予等体积的CBS3830溶媒1%甲基纤维素。分别于术前及术后1、3、7 d采用ELSIA法检测大鼠血清TNF-α;于第7天处死动物并获取移植静脉标本,HE染色观察大鼠移植静脉内膜及中膜厚度。结果术后7 d,药物组大鼠血清TNF-α水平显著低于对照组（P〈0.05）,药物组内膜增生程度明显低于对照组。药物组内膜厚度为（33.6±1.34）μm、内膜厚度/中膜厚度为1.23±0.08,对照组分别为（38.5±1.50）μm、1.7±0.12,两组相比,P均〈0.05。结论 p38MAPK抑制剂CBS3830对糖尿病大鼠自体移植静脉内膜的增生有抑制作用,可能与其降低血清TNF-α水平有关。     

无创正压通气在心外科术后患者中的应用

目的:回顾性研究无创正压通气(NPPV)对心外科体外循环(CPB)术后出现急性呼吸衰竭(ARF)患者的安全性和有效性。方法:回顾本院心外科全麻CPB术后成年患者(年龄>16岁)450例,其中24例在拔管后出现ARF,根据ARF的病因分为6例肺炎、7例心源性肺水肿、11例CPB相关性肺损伤,比较NPPV使用前、后1h的氧合指数、心率、呼吸次数和动脉血pH,并用患者围手术期的临床特征作为参数来分析NPPV失败的预测因素。结果:NPPV平均使用时间(12.33±11.97)h,氧合指数、心率、呼吸次数和动脉血pH在使用前、后1h均明显改善(均P<0.01)。NPPV使66.67%的患者避免再次气管插管,其中对心源性肺水肿和CPB相关性肺损伤的疗效满意,成功率分别是85.71%和90.91%;而肺炎的患者均失败。所有患者均无NPPV并发症。有意义的单因素预测因素是NPPV治疗后1h的PaO2/FiO2<200,初次机械通气的时间和肺炎,多因素分析显示肺炎是预测NPPV失败的独立因素(OR0.063;95%CI 0.008～0.501)。结论:心外科CPB术后患者拔管后出现ARF,NPPV可以有效改善肺部氧合,减低再次气管插管的需要,但要严格选择病例。