A型主动脉夹层术后脑部并发症危险因素分析

目的 对160例在深低温停循环(DHCA)结合脑灌下行A型主动脉夹层手术术后脑部并发症危险因素进行相关分析.方法 160例病人中男106例,女54例;年龄17～76岁,平均(56±13)岁.131例采用腋动脉插管选择性脑灌注(SCP),29例采用上腔静脉逆行性脑灌注(RCP).对所有术前、术中相关因素行单因素及多因素分析.结果 平均体外循环(CPB)(188±57)min,脑灌注(36±16)min.住院死亡16例.8例发生永久性神经功能障碍(PND),多因素分析示,与PND相关的危险因素有术前肾功能不全(OR=11.71,P=0.005)、伴有冠心病(CAD)(OR=7.35,P=0.035)、伴有脑血管病(CVD)OR=13.39,P=0.021)、术后低心排出量综合征(OR=22.21,P=0.008);32例发生暂时性神经功能障碍(TND),年龄>70岁(OR=1.17,P=0.042)是TND的相关危险因素.结论 安全时限内的脑灌注时间、脑灌注方式不影响神经系统并发症,神经系统并发症主要取决于病变本身的严重性和全身各器官功能状态.做好全身各器官的综合保护是脑保护的重要保障.     

犬的体外循环模型建立和管理

目的 总结22条犬的体外循环实验模型建立和管理的经验。方法 健康杂种家犬22条，雄性12条，雌性10条。建立中低温阻断停跳和常温不阻断不停跳的体外循环模型。并于体外循环开始前及转流中，进行激活全血凝固时间(ACT)、血细胞压积(Hct)和血气监测。结果 转流过程中Het、PaO2、PaCO2和BE均在正常范围。结论 建立一个正确的体外循环模型是该动物实验成功的必要因素。     

姜黄素对2型糖尿病肾病大鼠肾脏的保护作用

目的:观察姜黄素对2型糖尿病肾病(DN)大鼠肾脏的保护作用。方法:雄性SD大鼠,除空白组外均给予高脂高糖饲料,50d后腹腔注射STZ 30mg/kg建立2型DN大鼠模型,造模成功后,随机分为模型组、姜黄素低、高剂量组,给药30d,称重、检测大鼠血糖及血清肌酐(CRE)和尿素氮(BUN)水平;取右肾做HE染色,观察大鼠肾组织病理学变化。结果:姜黄素各剂量组可显著性增加大鼠的体重(P0.05或P0.01);姜黄素高剂量组血糖显著降低(P0.01);姜黄素低、高剂量组CRE和BUN值显著性降低(P0.05或P0.01);HE染色显示,与模型组比较,姜黄素低、高剂量组大鼠肾脏组织形态有显著性改善。结论:姜黄素可增加2型糖尿病肾病模型大鼠的体重,降低血糖、CRE和BUN,改善模型大鼠肾脏病理损伤,有一定肾脏保护作用。     

不同茯苓提取物对急性肝损伤小鼠的保护作用

目的 研究茯苓不同提取部位对四氯化碳（carbon tetrachloride,CCl4）所致急性肝损伤的保护作用,并探讨其可能的作用机制。方法 〖JP2〗将120只昆明小鼠随机分为正常组,模型组,阳性药物组（水飞蓟素100 mg/kg）,茯苓水提物低、中、高剂量组（30、60、120 mg/kg）,茯苓醇提物低、中、高剂量组（25、50、100 mg/kg）以及茯苓多糖低、中、高剂量组（10、20、40 mg/kg）,连续灌胃两周后腹腔注射0.5% CCl4溶液诱发小鼠急性肝损伤。模型复制12 h后处死小鼠,检测血清中谷氨酸氨基转移酶（alanine aminotransferase,ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase,AST）和肝组织中超氧化物歧化酶（superoxide dismutase,SOD）、丙二醛（malondialdehyde,MDA）及白细胞介素-1β（interleukin-1β,IL-1β）、白细胞介素-6（interleukin-6,IL-6）和肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）水平;苏木精-伊红染色观察肝组织病理切片。结果 各给药组肝组织病理损伤减轻。与模型组比较,各给药组小鼠ALT、AST、MDA、IL-1β、IL-6和TNF-α水平均显著降低（P<0.05）,SOD活性显著升高（P<0.05）,且茯苓多糖的作用呈剂量依赖性,以茯苓多糖高剂量组最接近阳性药物组。结论 3种茯苓提取物对CCl4诱导的小鼠肝损伤均具有不同程度的保护作用,以茯苓多糖效果最为显著,其机制可能与增强肝脏抗氧化能力及减轻炎症有关。     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

TAVI术中紧急体外循环病例及规范修订

目的修订TAVI紧急体外循环规范。方法对完成经导管主动脉瓣植入术135例中, 5例术中因各种原因紧急建立体外循环行外科手术治疗。体外循环采用浅低温或者常温,中度血液稀释,使用Del Nido心脏停搏液行心肌保护。结果 5例患者平均体外循环时间为81.0±33.4 min,平均主动脉阻断时间为34.0±35.8 min,术后无相关并发症,均康复出院。根据体外循环中出现的相关问题建立并持续修订了相关规范。结论需要充分认识体外循环快速建立能力对TAVI手术的安全保障作用。     

HPLC法测定不同产地首乌延寿片中2,3,5,4''''-四羟基二苯乙烯-2-O-β-D-葡萄糖苷的含量

目的 建立HPLC对首乌延寿片定量的分析方法.方法 采用HPLC法测定2,3,5,4'-四羟基二苯乙烯-2-O-β-D-葡萄糖苷的含量.结果 2,3,5,4'-四羟基二苯乙烯-2-β-D-葡萄糖苷对照品线性范围在0.073 5～0.441 μg,样品平均回收率为95.0%,RSD为2.37%.结论 方法简便、准确、专属性强,能有效的控制首乌延寿片的质量.     

竭蛭胶囊白矾铝在大鼠骨骼中蓄积问题的实验研究

目的探讨竭蛭胶囊中白矾铝在骨组织的蓄积问题。方法在竭蛭胶囊大鼠6个月长期毒性试验中,除观察所规定的指标外,采用铬天青分光光度法测定了大鼠骨铝含量。结果给药3个月、6个月及停药2周各给药组大鼠股骨铝含量,与同期对照组比较均无显著性差异。大、中、小剂量组和空白组在给药3个月、6个月和停药2周监测股骨铝含量变化不大,三者间比较亦无显著性差异。竭蛭胶囊对动物的体重、摄食量、血液学、血液生化学、脏器系数及心电图等均无明显影响,对心、肝、脾、肺、肾、脑、脊髓、胃、十二指肠、回肠、结肠、肠系膜淋巴结、甲状腺、胸腺、胰腺、肾上腺、子宫、卵巢、乳腺、胸骨髓、膀胱、脊神经等主要脏器或组织无明显的病理性损害。结论竭蛭胶囊连续给药6个月白矾铝在大鼠骨骼未见铝大量蓄积,亦未见明显的长期毒性反应。     

HPLC法测定不同产地首乌延寿片中2，3，5，4＇-四羟基二苯乙烯-2-O-β-D-葡萄糖苷的含量

目的建立HPLC对首乌延寿片定量的分析方法。方法采用HPLC法测定2，3，5，4L四羟基二苯乙烯-2-O-β-D-葡萄糖苷的含量。结果2，3，5，4＇-四羟基二苯乙烯-2-O-β-D-葡萄糖苷对照品线性范围在O．0735～0．441μg，样品平均回收率为95．0％，RSD为2．37％。结论方法简便、准确、专属性强，能有效的控制首乌延寿片的质量。