四氧化二氮爆炸致冲毒复合伤对家兔血流动力学及病理形态学的影响

目的　复制四氧化二氮 (N2 O4)爆炸致冲毒复合伤模型 ,并研究其对血流动力学及病理形态学的影响。方法　健康成年雄性标准壹级家兔 2 0只 ,体重 2 74± 0 5 9kg。随机分为 :①冲击伤组 (B) ;②N2 O4吸入中毒组 (N) ;③冲毒复合伤组 (BN)。复制冲毒复合伤模型连续监测血流动力学指标并进行前后对照比和同时相组间比。结果　冲击伤后早期 ,心率显著增快 ,平均动脉压 (MAP)、左心室收缩压 (LVSP)、心室内压最大上升、下降速率±dp/dtmax均一过性上升。而四氧化二氮及冲毒复合伤组动物早期心率、MAP、LVSP、dp/dtmax均呈现逐渐下降的趋势 ,伤后 3h～ 6h最低。主要病理形态学改变 :①肺冲击伤以出血明显 ,N2 O4中毒组病变稍轻 ,以肺水肿为著 ,复合伤组肺出血和水肿均加重 ;②心肌纤维断裂 ;③肝浊肿 ,肝细胞灶性及桥接坏死 ;④肾浊肿 ,肾小管坏死 ;⑤脑 :部分神经细胞 /小血管和淋巴管周围空隙增宽 ,脑膜血管扩张充血。结论　四氧化二氮及冲毒复合伤组家兔在 3h～ 6h内血流动力学状态明显恶化 ,而冲毒复合伤组家兔的血流动力学状态恶化程度更为明显。另外 ,三组家兔的主要病理形态学均有改变 ,以冲毒复合伤组的损伤最重 ,提示对冲毒复合伤进行早期救治 (在 3h～ 6h内 )的重要性。     

E-Flow成像技术对原发性高血压患者指端微血管血流动力学变化的评价

目的 探讨原发性高血压患者指端微血管病变的血流动力学变化与高血压程度的相关性.方法 应用E-Flow成像技术观察39例原发性高血压患者右手无名指末节指腹动脉和甲床动脉的收缩期峰值流速(PSV)、舒张期峰值流速(EDV)及阻力指数(RI),并与35例健康人作对照.结果 与彩色及能量多普勒相比,E-Flow能更清晰地显示指端微血管的分布及走行,且随着病程的加重,原发性高血压患者指腹动脉、甲床动脉PSV、EDV的测量值均减低(P＜0.05),RI则升高(P＜0.05).结论 指端微血管血流动力学的变化可作为衡量原发性高血压外周阻力变化的指标.E-Flow成像技术可作为一种新的方法对指端微血管血流动力学进行评价.     

气管插管型喉罩通气道与直接喉镜经口气管插管对血流动力学影响的比较

目的 气管插管型喉罩通气道（ILMA）为气管插管提供了一种新型途径，而且有望减轻气管插管时的心血管应激反应。但是，现有的研究结果并不一致。本研究目的在于：（1）进一步观察气管插管型喉罩通气道（ILMA）经口气管插管对血流动力学的影响；（2）证实经口气管插管时，气管插管型喉罩通气道（ILMA）是否能够比直接喉镜（DLS）产生较轻微的血流动力学反应。方法 择期整形外科手术患者53例，随机分为ILMA组和DLS组，经常规静脉诱导后气管插管。监测麻醉诱导前（基础值）、后，气管插管时和气管插管后5min内的血压（BP、收缩压SBP、舒张压DBP）和心率（HR）的变化。结果 ILMA组的平均气管插管操作时间较DLS组明显延长。气管插管后两组患者血压和心率均比麻醉诱导后明显升高，但血压的最大值未超过麻醉诱导前水平，而心率的最大值较麻醉诱导前明显升高。两组在各对应时问点的血压和心率无明显差异，血压和心率的最大值亦无明显差异。结论 在临床常用的全身麻醉深度下，ILMA和DLS经口气管插管操作引起的血流动力学反应相似。与DES相比较，ILMA引导经口气管插管并不具有减轻心血管反应的优点。     

经颅多普勒超声检测分析椎底动脉供血不足(附540例报告)

目的观察应用ＴＣＤ检测椎－基底动脉供血不足病人颅血流动力学变化的意义。方法仪器为美国ＭｅｄａｓｏｎｉｃｓＴＣＤ仪，探头频率２ＭＨｚ，对５４０例椎－基底动脉供血不足病人按年龄设置３组进行检测。结果ＴＣＤ总异常率为７８．７％，流速异常率为ＶＡ４１．２％、ＢＡ３５．２％、ＩＣＡ３１．９％。其中，高血压、动脉硬化和颈椎病ＴＣＤ异常率分别为９４．０％、８９．４％和８０。０％。全组频谱形态异常率为４７．６％，年龄越大，异常率越高。结论ＴＣＤ对研究椎－基底动脉供血不足血流动力学变化有较大意义。     

急性敌敌畏中毒大鼠的早期心肌损伤

目的 研究急性敌敌畏(dichlorvos,DDVP)中毒导致的早期心肌损伤表现.方法 Sprague Dawley(SD)大鼠24只,随机(随机数字法)分成对照组和中毒组两组,每组12只.采用右侧颈动脉置管术动态监测有创血流动力学指标;测定血清肌钙蛋白T(cardiac troponin T,CTnT)和心房利钠肽(brain natriuretic peptide,BNP)水平;观察心肌组织病理学改变.结果 ①中毒组自身前后对照:中毒1 h内,心率(heart rate,HR)和室内压上升段最大变化率(maximum ascending rates of left ventricular pressure,+dp/dtmax)均有显著下降;室内压下降段最大变化率(maximum descending rates of left ventricular pressure,-dp/dtmax),左室舒张末压(1eft ventricular end diastolic pressure,LVEDP)有显著升高(P＜0.01).其中均以7 min时改变最显著.②中毒组与对照组比,血清CTnT值显著升高(P＜0.01),血清BNP值差异无统计学意义(P＞0.05).③中毒组心肌HE染色存在病理学损害.结论 急性有机磷中毒(acute organophosphorus pesticides poisoning,AOPP)其早期可导致大鼠心肌损伤,血流动力学紊乱,心功能受抑.CTnT可作为早期评价AOPP心肌损伤的指标,而BNP在AOPP诊治中的意义不大.

Abstract：

Objective To investigate the myocardial injury in the early stage of acute dichlorvos poisoning in rats. Method A total of 24 Sprague Dawley rats were randomly (random number) divided into control group(n = 12) and poisoning group(n = 12). Hemodynamic variables were monitored by using an arterial cannula inserted into right arteria carotis communis. Serum levels of cardiac troponin T(CTnT) and brain natriuretic peptide (BNP) were measured. Myocardial tissue was observed with HE stain under microscope. Results The rats of poisoning group showed that the heart rate (HR) and maximum ascending rates of left ventricular pressure(+ dp/dtmax)were significant decreased in an hour after poisoning (P ＜0.01). The maximum descending rates of left ventricular pressure(-dp/dtmax)and left ventricular end diastolic pressure (LVEDP)were markedly increased (P＜0. 01) and reached peak in 7 minutes in the poisoning group. Compared with the control group, cardiac troponin T obviously changed in rats poisoned with dichlorvos in the first hour. BNP was not affected after poisoning(P ＞ 0. 05). Myocardial damage was found in the poisoning rats.Conclusions Myocardial injury and heart failure occurred in the early stage of acute organophosphorus pesticides poisoning(AOPP) in rats. CTnT could play a major role in AOPP while BNP might not be involved in.     

Quality of Life and Adaptation in People With Spinal Cord Injury: Response Shift Effects From 1 to 5 Years Postinjury

Objective

To investigate response shift effects in spinal cord injury (SCI) over 5 years postinjury.

不同部位组合起搏对充血性心力衰竭患者急性血流动力学影响的研究

观察右房左室起搏对充血性心力衰竭 (CHF)患者急性血流动力学的影响。 8例心功能II～IV级CHF患者 ,分别置入右房、右室和左室电极 (经冠状静脉窦 ) ,行不同部位组合起搏的急性血流动力学研究 ,其中 6例获得成功。使用Bitronic公司生产的双腔起搏分析仪 (ERA30 0 )分别行单纯右室心尖部 (RVA)、右房右室 (RA +RV)、右房左室 (RA +LV)、右房双室 (RA +BiV)起搏 ,同时用二维超声心动图测定上述四种起搏状况下的血流动力学参数 ,并进行比较。结果 :右房左室起搏和右房双室起搏血流动力学参数两者间无显著差异 ,但比单纯右室心尖部起搏和右房右室起搏有所改善。结论 :右房左室起搏似可使更多的CHF患者在得益于起搏治疗的同时明显降低医疗费用。     

Editor's Choice: Birth month affects lifetime disease risk: a phenome-wide method

Objective An individual’s birth month has a significant impact on the diseases they develop during their lifetime. Previous studies reveal relationships between birth month and several diseases including atherothrombosis, asthma, attention deficit hyperactivity disorder, and myopia, leaving most diseases completely unexplored. This retrospective population study systematically explores the relationship between seasonal affects at birth and lifetime disease risk for 1688 conditions.Methods We developed a hypothesis-free method that minimizes publication and disease selection biases by systematically investigating disease-birth month patterns across all conditions. Our dataset includes 1 749 400 individuals with records at New York-Presbyterian/Columbia University Medical Center born between 1900 and 2000 inclusive. We modeled associations between birth month and 1688 diseases using logistic regression. Significance was tested using a chi-squared test with multiplicity correction.Results We found 55 diseases that were significantly dependent on birth month. Of these 19 were previously reported in the literature (P < .001), 20 were for conditions with close relationships to those reported, and 16 were previously unreported. We found distinct incidence patterns across disease categories.Conclusions Lifetime disease risk is affected by birth month. Seasonally dependent early developmental mechanisms may play a role in increasing lifetime risk of disease.