Influence of volume replacement with different HES–solutions on microcirculatory blood flow in cardiac surgery

A variety of hydroxyethyl starch (HES) preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found. A 5th group without ANH served as a control (10 patients in each group). In addition to systemic haemodynamics and various laboratory parameters, skin capillary blood flow was measured by laser Doppler flowmetry. Laser Doppler flow (LDF) was monitored simultaneously at the patient's forehead and forearm. Changes in systemic haemodynamics were similar in all ANH–patients. Systemic vascular resistance (SVR) was lowest after infusion of HES 200/0.5. The most pronounced increase in plasma viscosity was in patients of group 1 (450/0.7) (P<0.05) and plasma viscosity remained highest during the entire investigation period in these patients. After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. + 18%). Group 3 (200/0.62) showed the highest decrease in forehead–LDF. During CPB, forehead–LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5). At the end of the operation, LDF was most reduced in groups 1 (– 32%) and 3 (– 33%). Forearm–LDF increased in all ANH–patients. Immediately after ANH this increase was lowest in group 3 (200/0.62). In the further course of the investigation, no more differences were seen in any HES patients. The different HES preparations showed a different microcirculatory response. 6% HES 200/0.5 seems to be overall most suitable for volume replacement in cardiac surgery patients undergoing acute normovolemic haemodilution (ANH) due to the best effects on microcirculatory skin perfusion assessed by laser Doppler flow. HES 6% 200/0.62 showed the overall least positive effects with regard to skin capillary blood flow in this situation.     

脑瘤手术中吸入异氟醚或异丙酚麻醉对血流动力学及应激反应的影响

目的　研究两种麻醉方法对血流动力学和应激反应的影响。方法　行脑瘤手术的 38例病人随机分为两组 ,醚组和酚组 ,醚组 (2 0例 ,咪唑安定、芬太尼、万可松诱导 ;维持麻醉为吸入异氟醚 1MAC ,30min后 1.5MAC ,30min。间断静注芬太尼、万可松 ) ;酚组 (18例 ,诱导同醚组 ,维持麻醉为全凭异丙酚静脉泵入 6mg·kg 1 ·h 1 ,30min后 12mg·kg 1 ·h 1 ,30min。间断静注芬太尼、万可松 )。快速补液。两组分别于诱导前 (T1 )、插管后即刻 (T2 )、麻醉维持 30min(T3)和 6 0min(T4 ) 4个时动脉血测定血糖浓度。同时监测血流动力学。结果　 (1)血流动力学变化　醚组 :MAP值在T3、T4 时点非常显著降低 (P <0 .0 1) ,且显著低于酚组同时点值 (P<0 .0 5 )。HR值各时点无统计学差异 (P <0 .0 5 ) ;酚组 :MAP值在T4 时点显著降低 (P <0 .0 5 )。HR值在T3、T4 时点显著降低 (P<0 .0 5 ) ,并低于醚组同时点值 (P <0 .0 5 )。 (2 )动脉血血糖浓度的变化　异丙酚组各时点血糖无变化 ;异氟醚组血糖浓度在麻醉后 30及 6 0min显著升高 (P <0 .0 5 ,P <0 .0 1)。结论　酚组的麻醉方式可适当控制应激反应 ,术中平稳 ,更利于脑瘤手术     

细小病毒H－1对正常仓鼠肝细胞DNA周期动力学的影响

健康成年金黄仓鼠腹腔内接种ＰＶＨ－１（５×１０６ｐｆｕ），ＦＣＭ动态检测肝细胞ＤＮＡ周期动力学变化，结果显示：ＰＶＨ－１接种后处于Ｇ０＋Ｇ１期的肝细胞与对照组动物相比无显著差异。Ｓ期肝细胞在第３天显著高于对照组动物（Ｐ＜０．０５），且在第７天时仍呈上升趋势，第１４天到３０天趋于正常水平。Ｇ２＋Ｍ期肝细胞在ＰＶＨ－１接种后第３０天升高（Ｐ＜０．０５）。结果提示，动物在ＰＶＨ－１接种后第３到第７天是病毒在肝细胞中的复制高峰，并阻滞仓鼠处于Ｓ期肝细胞分裂进入Ｇ２＋Ｍ期，但是这种阻滞作用较短暂、并可逆，在ＰＶＨ－１接种后１４～３０天自然消失。     

西洋参茎叶皂甙单体Rb_3对大鼠血流动力学及单钙通道活动的影响

单体皂甙Ｒｂ３自西洋参茎叶皂甙中提取。Ｒｂ３３０ｍｇ·ｋｇ－１可使麻醉大鼠在体心脏的ＭＡＰ，±ｄＰ／ｄｔｍａｘ和ＬＶＳＰ减少。用斑片钳的连细胞电压钳法证明．Ｒｂ３３００ｍｇ·Ｌ－１使Ｌ、Ｂ、Ｔ型钙通道的开放时间缩短、开放概率减少，其作用与异搏定３７．５ｍｇ·Ｌ－１相似，与ＢａｙＫ８６１１５μｍｏｌ·Ｌ－１作用相反。确切地证明Ｒｂ３对钙通道有阻滞作用。     

DNA flow-cytometric analysis in colorectal cancer: A comparison of metastasizing and non-metastasizing tumours

The most common cause of death in patients with colorectal cancer is metastatic liver disease. In order to identify patients at a high risk of developing hepatic secondaries from colorectal cancers, DNA content was measured in metastasizing colorectal primaries (Group I, n= 32) as well as in their subsequently resected liver secondaries and in sections of non-metastasizing colorectal cancers (Group II, n= 25). A modified interpretation system involving both a DNA index and percentage of cycling cells (those in S and G2 + M phases) was developed. DNA content was measured in paraffin-embedded sections by flow cytometry using internal controls (human peripheral blood mononuclear cells) and non-malignant tissue controls (19 patients with diverticular disease). In Group I there were significantly more tumours with both abnormal ploidy (aneuploid or abnormal tetraploid peak) and > 15% cycling cells compared with Group II (Chi-squared; P= 0.034). The combination of abnormal ploidy and > 15% cycling cells was superior to Dukes’ classification for identifying metastasizing tumours (Logistic Regression; P= 0.047). However, it was not possible to discriminate between the two groups using either DNA ploidy or the percentage of cycling cells alone. The metastasizing colorectal cancers exhibited similar DNA ploidy characteristics and had a similar percentage of cycling cells compared with their liver metastases. These results suggest that tumour DNA ploidy plus the percentage of cycling cells may predict the development of liver metastases and thus survival in patients with colorectal cancer.     

Brain MR imaging in patients with hepatic cirrhosis: relationship between high intensity signal in basal ganglia on T1-weighted images and elemental concentrations in brain

In patients with hepatic cirrhosis, the globus pallidus and putamen show high intensity on T1-weighted MRI. While the causes of this high signal have been thought to include paramagnetic substances, especially manganese, no evidence for this has been presented. Autopsy in four cases of hepatic cirrhosis permitted measurement of metal concentrations in brain and histopathological examination. In three cases the globus pallidus showed high intensity on T1-weighted images. Mean manganese concentrations in globus pallidus, putamen and frontal white matter were 3.03 ± 0.38, 2.12 ± 0.37, and 1.38 ± 0.24 (μg/g wet weight), respectively, being approximately four- to almost ten-fold the normal values. Copper concentrations in globus pallidus and putamen were also high, 50 % more than normal. Calcium, iron, zinc and magnesium concentrations were all normal. The fourth case showed no abnormal intensity in the basal ganglia and brain metal concentrations were all normal. Histopathologically, cases with showing high signal remarkable atrophy, necrosis, and deciduation of nerve cells and proliferation of glial cells and microglia in globus pallidus. These findings were similar to those in chronic manganese poisoning. On T1-weighted images, copper deposition shows no abnormal intensity. It is therefore inferred that deposition of highly concentrations of manganese may caused high signal on T1-weighted images and nerve cell death in the globus pallidus. Received: 12 August 1996 Accepted: 17 December 1996     

脑立体定向术临床应用

目的：探讨以脑立体定向术治疗震颤麻痹、癫痫、癌性疼痛、慢性精神病及颅内金属异物的方法和疗效。方法：用多功能脑立体定向仪对不同疾病毁损其不同的核团。结果：震颤麻痹１６６例共１８２次手术中治愈１３例次，显效１４５例次，有效１１例次，无效１２例次，死亡１例，有效率达９２９％；癫痫１８例，显效１１例，有效４例，无效３例，有效率达８３３％；癌性痛疼５例均显效；精神病３例，显效２例，有效１例；颅内异物２例均治愈。结论：脑立体定向术对以上疾病均取得了较为满意及良好的疗效，总有效率达９２４％，并且比传统开颅术简便安全     

大鼠肝抑素样提取物的生物效应初探

从大鼠肝分离出小分子蛋白质,注入肝大部切除的大鼠体内。术后24h制备肝细胞悬液及骨髓细胞悬液,用流式细胞计测定细胞DNA含量。结果:①实验组大鼠每克体重注入肝提取物10～300μg,一致呈现4n肝细胞DNA复制受阻于G_1期,各类肝细胞数与正常大鼠的相似;②对照组大鼠,4n肝细胞由正常的68.1％降至30.9％,8n肝细胞由6.3％骤增至25.3％,并出现16.8％的4n～8n间8期肝细胞;③两组大鼠的骨髓细胞DNA含量均无变化。表明肝提取物中含有肝抑素样物质,它特异性地使再生肝的4n肝细胞增殖周期阻滞于G_1期及S早期。     

血清甘氨胆酸测定对肝硬化患者预后的评价

本文报告50例肝硬化患者SCG含量的临床意义.结果表明,SCG测定诊断肝硬化的阳性率为92％,明显高于SGPT(53％)及ADA(78.6％)的阳性率.Child-pugh肝功能分级中A、B、C级SCG值分别为10.14±6.03,23.55±11.27和54.66±24.47μmol/L(P<0.01).相关分析表明,SCG与血清白蛋白含量呈负相关(r=-0.5018.P<0.01),与胆红素含量呈正相关(r=0.6964,P<0.01).并发肝性脑病和原发性肝癌者及死亡病例,其SCG升高更为明显.我们认为肝硬化患者SCG值大于40μmol/L预示病情危重,预后不良.     

产褥期脑病62例临床分析

目的研究产褥期脑病的临床特征、治疗方法及预后。方法选择62例产褥期突发精神症状并有全脑受累体征病人的临床资料进行回顾性分析。结果发现产褥期脑病的临床表现酷似病毒性脑炎,但病前无明显感染灶,病程较长,疗效和预后较差。结论对产褥期精神异常病人应进行神经病学方面检查,尽早诊治。病初要控制和缩短脑水肿期,防止和减轻脑细胞的变性和脱鞘;恢复期要耐心而持久地进行各种康复治疗,以便病人恢复到最佳健康水平。