益脑冲剂对实验性脑血栓大鼠脑功能障碍的影响

观察了益脑冲剂对实验性多发性脑梗塞大鼠血栓形成及血栓所致的学习记忆功能障碍的影响，结果表明，本方可减轻大鼠脑血栓的形成，降低脑毛细血管通透性，改善血栓所致的学习记忆障碍，其作用机理可能与本方能够抑制血小板聚集，改善血液流变性，延长凝血时间有关。     

小儿抽动秽语综合征常用辨证论治

多发性抽动症又称抽动秽语综合征(TS),中医无其相应的病名,历代中医学者将本病归于"瘿疯"、"慢惊风"、"抽搐"、"警惕肉"、"肝风证"等范畴,对其论述,多数也是通过其发作表现证候及其舌脉进行分型及辨证论治,尚无统一的定论.现将该病常采用的辨证论治方法综述如下.     

创伤所致主动脉假性动脉瘤的诊治体会

目的　总结创伤所致主动脉假性动脉瘤的诊治经验。方法　回顾分析 11例本病的临床症状、影像学表现及传统经胸手术和血管腔内带膜支架植入术的疗效。结果　 11例均经影像学检查得到确诊。未手术 2例中 1例死亡、1例出院后失访 ,传统经胸手术 2例和血管腔内带膜支架植入 7例手术均获成功 ,术后恢复良好。结论　治疗创伤患者是要警惕并发本病 ,现有影像学检查均可发现本病。假性动脉瘤一般不能自愈 ,确诊后应及时手术。传统经胸手术的疗效明确 ,而血管腔内带膜支架植入因微创、疗效好、并发症少 ,值得倡用。     

水通道蛋白4与创伤性脑水肿的研究进展

上个世纪80年代末，Agre领导的研究组在红细胞上克隆了第一个水通道蛋白（ aquaporin, AQP ） ,证明了该蛋白具有极强的水通透性，开创了水跨膜运转研究的新领域。到目前为止，在哺乳动物中共发现11种AQP，即AQP0～AQP10，其中AQP4是脑内主要的AQP。近几年来关于AQP在创伤性脑水肿中的作用的研究主要集中于AQP4，表明它在脑水肿的病理生理变化中发挥重要的作用。笔者就其相关的研究进展进行综述。     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

聪圣胶囊对拟缺血再灌注大鼠原代培养皮层神经细胞的保护作用

目的：研究聪圣胶囊对大鼠原代培养皮层神经细胞拟缺血再灌注损伤的影响。方法：采用血清药理学和流式细胞仪的方法，观察聪圣胶囊含药血清对缺糖缺氧（3h）拟缺血再灌注（0，3，6，18h）损伤神经细胞乳酸脱氢酶（LDH）漏出及神经细胞凋亡率的影响。结果：聪圣胶囊含血清（2，4，8g/kg）可抑制缺糖-缺氧3h再灌（0，3，6和18h）引起的神经细胞内LDH的释放。降低缺糖-缺氧3h再灌18h导致的凋亡细胞率。结论：聪圣胶囊可减轻缺血性脑损伤。     

三乙酰莽草酸对大鼠局灶性脑缺血再灌注过程中血浆血管活性物质量和脑髓过氧化物酶活性的抑制作用(英文)

目的探索血浆内血管活性物质和白细胞浸润在大鼠局灶性脑缺血再灌损伤中是否影响力不同及三乙酰莽草酸(TSA)的保护作用。方法线栓法制备大鼠大脑中动脉缺血90 min再灌注3 ~48 h模型。分别于缺血开始和缺血60 min时给予TSA 50~200 mg·kg-1ig。分别用荧光分光光度法和放射免疫法测定血浆5-羟色胺(5-HT)和血栓烷素B2(TXB2)含量,化学法测定脑皮层中髓过氧化物酶(MPO)活性。结果大鼠脑缺血再灌注3 ~24 h时血浆5-HT和TXB2含量及脑MPO活性呈时间依赖性升高,48 h后5-HT, TXB2含量降至假手术组水平,而MPO活性仍明显高于未缺血侧脑皮层。TSA(100和200 mg·kg-1)可显著抑制缺血90 min再灌注24 h时血浆5-HT和TXB2含量及脑MPO活性增高。结论大鼠局灶性脑缺血再灌注过程中血浆中血管活性物质量和脑组织中MPO活性表现出不同的时相变化,并且对脑损伤影响力不同,TSA可有效保护缺血脑组织。     

经皮二尖瓣球囊成形术在妊娠期妇女中应用（摘要）

经皮二尖瓣球囊成形术在妊娠期妇女中应用（摘要）浙江医科大学附属第一医院心内科陈君柱，朱建华，徐秋萍，黄元伟编者按患风湿性心脏病的中、后期孕妇，心功能Ⅲ级以上，又不肯终止妊娠者，可考虑试用经皮二尖瓣球囊成形术扩张二尖瓣，以改善心功能以保护母婴，但必须认...     

老年患者非体外循环冠脉搭桥术围术期心肌损伤相关指标和心脏功能

目的探讨非体外循环冠脉搭桥术(CABG)应用于老年患者围术期心肌损伤相关指标和心脏功能的变化情况。方法以2011年6月至2012年6月采用非体外循环CABG治疗的30例老年冠心病患者(观察组)为研究对象,观察围术期心肌损伤生化标志物和临床指标,以及心脏功能的变化;同时,回顾性分析同期进行体外循环CABG治疗的30例老年冠心病患者(对照组)的临床资料,对两组的数据进行对比分析。结果 (1)两组患者围术期血肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)的变化趋势基本一致,术后有轻度升高,术后24 h达到最高峰,术后168 h恢复到手术前水平。与体外循环组相比,非体外循环组cTnI及CK-MB含量均明显降低(P<0.01)。(2)术后即刻、术后2、12 h观察组患者的心脏指数(CI)、左室收缩压(LVSP)、左室做功指数(LVSWI)以及右室做功指数(RVSWI)水平均高于对照组(P<0.05)。(3)观察组采用主动脉内球囊反搏(IABP)者与未采用IABP者术后CI及严重并发症的发生情况差异无统计学意义(均P>0.05);观察组患者IABP放置后,CI逐步下降,平均动脉压上升,尿量增多,血管活性药物用量逐渐减少。结论非体外循环CABG对患者围术期心肌损伤和心脏功能不良影响小,与体外循环手术相比,结合IABP更可提高其手术的安全性,值得临床推广应用。     

人参皂苷Rg1联合抗生素治疗小鼠脓毒症急性肺损伤

  目的  观察人参皂苷Rg1联合抗生素亚胺培南对脓毒症急性肺损伤的影响。  方法  C57BL/6雄性小鼠以盲肠穿刺法建立脓毒症模型,将模型小鼠随机分为模型组、亚胺培南组、人参皂苷Rg1组、人参皂苷Rg1+亚胺培南组,每组10只。另取10只C57BL/6小鼠只开腹不穿刺,作为假手术组。各组于术后2 h、26 h、50 h腹腔注射给药。末次给药2 h后（术后52 h）,取小鼠动脉血液测定氧合指数,取肺组织测定肺脏湿/干质量比,HE染色观察肺脏炎症,ELISA测试盒检测肺泡灌洗液白介素（IL）-1β、IL-6、肿瘤坏死因子（TNF）-α及核转录因子（NF）-κB的水平,蛋白印迹及免疫组织化学染色检测肺组织NF-κB p65的表达。  结果  各给药组均能够显著降低脓毒症小鼠的肺脏湿/干质量比,并升高血液中的氧合指数（P<0.01）,降低肺泡灌洗液中IL-1β、IL-6、TNF-α及NF-κB水平（P<0.01）,同时降低肺组织中NF-κB p65的表达（P<0.01）。人参皂苷Rg1合并亚胺培南应用时,与单用人参皂苷Rg1及单用亚胺培南组相比,上述指标更接近对照组水平。HE染色结果显示给药治疗后的各组脓毒症小鼠的肺泡炎细胞浸润减轻,联合用药组的肺脏组织形态与假手术组最为接近。  结论  人参皂苷Rg1单用和联用均能够抑制脓毒症小鼠的肺脏炎症,以抗生素治疗脓毒症时或可考虑联合使用。