不同病理类型的臂丛神经损伤后变性神经中S-100蛋白的变化

目的探讨不同病理类型的臂丛神经损伤后变性神经中Ｓ－１００蛋白的变化规律,为临床进行术中检测与判定提供理论依据,以进一步指导临床,提高臂丛神经损伤的诊治效果。方法建立ＳＤ大鼠不同病理类型的臂丛神经损伤,用免疫组织化学方法分别在损伤后１、２、３和６个月检测变性的远端神经中Ｓ－１００蛋白的分布和含量变化。结果Ｓ－１００蛋白主要沿轴突四周分布,节后组损伤１个月后Ｓ－１００蛋白呈阴性反应,而节前组术后６个月仍有阳性轴突。结论Ｓ－１００蛋白主要分布于雪旺细胞,节前与节后这两种不同病理类型的臂丛神经损伤中神经变性的程度不同,节前损伤远端神经在术后仍能持续保持Ｓ－１００蛋白阳性。     

腕部神经损伤的急诊修复

目的观察腕部神经损伤后经急诊显微修复的效果。方法１９９３年７月～１９９７年１２月对１７例２１条腕部受伤的周围神经进行急诊显微修复,其中正中神经损伤１１例,尺神经损伤２例,两神经同时受损４例。１条为部分断裂,２０条为完全断裂。用７／０～８／０无创缝线作神经外膜缝合１７条,束膜缝合４条。观察神经功能的恢复。结果术后创面Ⅰ期愈合。经６～１８个月随访,所有患者伤手神经功能恢复优良率达到９５．２５％。结论因腕部结构的特殊性,在该部位的神经损伤后经急诊显微修复,有利于再生神经在最短时间内达到感受器和终板,使手内在肌恢复形态和功能,并减少局部粘连。     

Elevated coronary endothelin-1 but not Nitric Oxide in diabetics during CABG

Background. After coronary artery bypass grafting procedures, a higher incidence of morbidity and mortality has been reported in diabetic patients. We tested whether coronary artery bypass grafting in diabetics affects the endothelin-1 and nitric oxide coronary effluent profile during reperfusion.

Methods. Twenty-one consecutive patients (9 with type II diabetes mellitus, 12 non-diabetics) underwent coronary artery bypass grafting by one surgeon. The two groups did not differ in preoperative ejection fraction, Parsonnet score, number of vessels bypassed, or cross-clamp time. Each patient was treated in the same intraoperative manner with single atrial, aortic, and antegrade and retrograde cardioplegia (CPL) cannulas. Cold CPL arrest was by antegrade and retrograde infusion of modified Buckberg CPL solution. Warm CPL solution was infused before reperfusion. Coronary sinus blood samples were obtained for estimation of endothelin-1 and nitrite plus nitrate before CPL arrest and at 1 and 15 minutes after each of 2 reperfusion periods.

Results. In diabetics, endothelin-1 was significantly increased at all reperfusion times as compared with non-diabetics. Nitrite plus nitrate levels were significantly higher in patients with diabetes than in those without, but did not change with time in either of the groups.

Conclusions. Reperfusion after CPL during coronary artery bypass grafting procedure can trigger the release of endothelin-1 in patients with diabetes mellitus. This may favor increased vascular tone or positive inotropic responses after coronary artery bypass grafting and may contribute to significant cardiovascular consequences in diabetic patients.     

Delayed post-traumatic cervical instability

BACKGROUND

Cervical spine instability is a clinical entity whose biomechanical and radiological features have been widely discussed by many authors. On the other hand, the subject of delayed post-traumatic cervical instability is often surrounded by confusion due to its difficult nosologic framing; the aim of this study is to contribute to the matter.

METHODS

A cooperative study was organized by the Study Group for Spinal Surgery of the Italian Society of Neurosurgery to evaluate cervical trauma patients surgically treated more than 20 days after the traumatic event. From a total number of 172 patients, twenty-five were admitted to the study, because neuroradiological investigations performed during the acute phase had shown either an absence of traumatic lesions or only minimal lesions judged to be stable. For this reason these 25 patients had not been treated by either surgery or immobilization in a halo vest. Some time after trauma, this group of patients clearly demonstrated evidence of unstable lesions requiring surgical treatment, following the appearance of new clinical signs or on neuroradiological follow-up.

RESULTS

Re-examination of the neuroradiological investigations performed during the acute phase made it possible to identify elements that might have led us to suspect the presence of ligamental lesions: microfractures, dislocations less than 3 mm, and inversion of physiological lordosis.

CONCLUSIONS

This review clearly indicates that patients with even mild cervical trauma must be scrupulously evaluated during the acute phase and that in some cases it is advisable to perform a more detailed neuroradiological investigation.     

伤后即行切痂对烧伤大鼠心肌损伤的防治作用

目的探讨早期一次性切痂对烧伤后心肌损伤的防治作用。方法建立30% TBSAⅢ度烧伤大鼠立即切痂模型,动物随机分为正常对照组、未切痂组和切痂组,于伤后1,3,6,12和24h 检测血浆肌钙蛋白 T(TnT)和肿瘤坏死因子(TNF)等指际。结果烧伤后3h 血浆 TnT 即显著升高,伤后6h 血浆 TNF 显著高于伤前,心肌组织中 TNF 也在伤后12h 显著升高。未切痂组与切痂组比较,伤后1～3h 未切痂组 TnT、TNF 略低于切痴组,烧伤6h后,未切痂组 TnT 显著高于切痂组,烧伤12h 后,未切痂组 TNF 显著高于切痂组。TNF 与 TnT 存在显著正相关关系。结论 TNF是引起烧伤后心肌损伤的重要因素,且与心肌损伤程度密切相关。伤后即行一次性切痂可以减少炎症介质的生成和释放,这可能是其对烧伤后并发心肌损伤具有防治作用的机理之一。     

神经营养因子对烫伤大鼠不同脑区NO含量的影响

目的观察烫伤大鼠脑损伤时一氧化氮(NO)含量的变化及神经生长因子(NGF)、睫状神经营养因子(CNTF)分别对其不同脑区 NO 含量的影响,以初步探讨神经营养因子对烫伤大鼠脑组织的保护作用及其可能机制。方法 SD 大鼠侧脑室埋管,麻醉后制成30%TBSAⅢ度烫伤。分成非烫伤组、烫伤组、烫伤 神经生长因子组、烫伤 睫状神经营养因子组。伤后3天,取不同脑区匀浆,测定脑组织中 NO 的含量。结果烫伤后脑组织 NO 含量明显升高,给予 NGF、CNTF 后能明显降低不同脑区 NO 的含量。结论烫伤后脑内 NO 升高可能是造成脑损伤的因素之一,NGF、CNTF 对烫伤后脑组织的保护作用可能与其降低脑组织 NO 含量有关。     

硫酸镁对实验性颅脑损伤后线粒体酶活性的影响

探讨硫酸镁对大鼠颅脑损伤后脑线粒体ＡＴＰ酶、超氧化物歧化酶（ＳＯＤ）的活性及线粒体Ｃａ２＋、Ｍｇ２＋及ＭＤＡ含量的影响。方法对自由落体致颅脑损伤的ＳＤ大鼠在致伤同时腹腔注射硫酸镁治疗,伤后２４小时测定线粒体Ｎａ＋－Ｋ＋ＡＴＰ酶、Ｃａ２＋－ＡＴＰ酶、Ｍｇ２＋－ＡＴＰ酶、ＳＯＤ的活性及线粒体Ｃａ２＋、Ｍｇ２＋及ＭＤＡ含量。结果颅脑损伤后大鼠脑线粒体Ｎａ２＋－Ｋ＋ＡＴＰ酶,Ｃａ２＋－ＡＴＰ酶,Ｍｇ２＋－ＡＴＰ酶的活性均明显下降（Ｐ＜０．０５）,线粒体Ｃａ２＋、ＭＤＡ含量增加,Ｍｇ２＋含量及ＳＯＤ活性明显降低（Ｐ＜０．０５）。与创伤组相比,硫酸镁治疗组上述指标均有明显改善（Ｐ＜０．０５）。结论硫酸镁可以改善损伤后脑线粒体酶活性并减轻线粒体钙超载。     

低温对缺血预调心肌保护作用的影响

目的:为确定体外循环心脏直视手术时应用"缺血预调"(IPC)的可能性,分别在两部分实验中研究了(1)IPC对长时间低温缺血心肌的保护作用.(2)IPC期间心肌低温对IPC诱导心肌保护作用的影响.方法:建立离体灌注的大鼠工作心脏模型,稳定后施行不同的预调方案,进而缺血停搏.在预调处理前和缺血再灌注后两次测定工作心脏的主动脉流量(AF).在第一部分研究中,离体心脏在18℃低温条件下缺血60分钟,IPC方案为1b组:5分钟缺血+5分钟再灌注(5×1);1c组:5分钟缺血+5分钟再灌注,反复2次(5×2);1d组:5分钟缺血+5分钟再灌注,反复3次(5×3).1a组为对照组,缺血前不施行预调处理.在第二部分研究中,离体心脏在37℃条件下常温缺血15分钟,实验组(包括6组:Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ和Ⅶ组)的预调方案均为5×1,但IPC期的心肌温度不同,其中:Ⅱ组为37℃,Ⅲ组32℃,Ⅳ组27℃,Ⅴ组22℃,Ⅳ组17℃,Ⅶ组12℃.Ⅰ组为对照组,缺血前不施行预调处理.结果:在第一系列研究中,对照组的主动脉流量(AF)仅恢复到缺血前的2.7%.预调各组的AF恢复程度显著提高,与对照组比较1b组为22%(P＜0.01),1c组为34%(P＜0.0,1d组为14,9%(P＜0.05).5×2的预调方案具有最强的心肌保护作用.在第二系列研究中,预调期温度高于22℃的各组AF恢复程度显著提高.其中Ⅱ组为76%,Ⅲ组70%,Ⅳ组71%,Ⅴ组62%.而对照组AF恢复不足20%(Ⅱ、Ⅲ、Ⅳ、Ⅴ组与对照组比较,P＜0.05),Ⅵ组和Ⅶ组的AF恢复值与对照组比较差异均不显著,表明IPC期心肌温度低于22℃时,无心肌保护作用.结论:无论在常温或低温(＞22℃)条件下进行缺血预调均有显著的心肌保护作用,IPC有可能应用于改进体外循环合并中度低温时心脏手术的心肌保护.     

犬移植肺缺血再灌注实验动物模型的建立

目的为深入研究缺血再灌注对移植肺功能损害的发生机制,克服以往体外肺灌注模型存在的局限性,我们建立了模拟的犬肺自体原位移植模型。方法选用杂种犬１５只,建立左肺原位缺血模型,３小时后（热缺血１小时,冷缺血２小时）,开放左肺动、静脉,结扎对侧肺动脉,监测缺血３小时再灌注６小时过程中动脉血氧分压（ＰａＯ２）、动脉血二氧化碳分压（ＰａＣＯ２）、动脉血氧饱和度（ＳａＯ２）、平均肺动脉压（ＭＰＡＰ）的变化。结果再灌注前后的ＰａＯ２,ＭＰＡＰ有差异（Ｐ＜０．０５）。结论该动物模型能够较好地反映缺血再灌注对犬移植肺功能的损害,并具有一定的可复制性和扩展性     

无骨折脱位颈脊髓损伤的实质探讨

目的 探讨无骨折脱位型颈脊髓损伤的实质。方法 54例无骨折脱位颈脊髓损伤,分析其MRI表现。采取摘除突出椎间盘或/和清除椎管后方致压物、扩大椎管的手术治疗,随访其术后疗效。结果 MRI显示外伤性颈椎间盘突出为主,同一节段黄韧带、棘间和棘上韧带等软组织损伤,导致脊髓压迫、挤压性损害。术后54例病人都有不同程度的康复。结论 外伤引起的颈椎间盘突出挤压脊髓和一过性损伤是无骨折脱位颈脊髓损伤的主要原因。