Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

X线检查在乳腺癌诊断中的意义及作用

目的 探讨X线检查在乳腺癌诊断中的作用及意义.方法 选取2006年3月至2008年12月于笔者所在医院行乳腺检查的患者共725例,对其中最后经病理诊断确诊为乳腺癌的105例患者,进行回顾性分析,发现确诊的105例患者中的89例均为初期X线诊断中怀疑为乳腺癌患者.结果 早期X线诊断为符合乳腺癌标准的患者89例,占确诊为乳腺癌的105例患者的84.8%,即 X线诊断准确率达84.8%.结论 X线检查在乳腺癌的确诊中具有重要的意义,对早期乳腺癌的发现有积极的意义,值得进一步探讨研究.     

治疗慢性布氏菌病的常用中药的药理作用

布氏菌病(简称布病)是以发热、乏力、自汗、顽固的关节或肌肉疼痛为主要表现的全身性疾病。对慢性布病的治疗,我国在多年的防治实践与科研中积累了丰富的经验。其中,中医药在治疗慢性布病方面发挥了积极的作用[1]。通常对于中药作用的认识都是从中医传统的机理进行分析、归类运用;很少从现代中药药理方面来认识其作用机理,故临床应用时,对药物作用并不十分清晰,运用也很困难。所以要运用中药药理学阐述治疗慢性布病的常用中药的药理作用,使中药作用的认识更清晰、更直观,易于运用。布病的变态反应是引起慢性布病病理改变的重要原因,这一点为…     

试论患者的身体权及其法律保护

由于医疗行为领域侵犯患者身体权的行为具有隐蔽性以及人们对患者身体权的认识不足,导致了医疗行为领域中患者的身体权未得到足够的关注.文章对患者身体权的概念、身体权与健康权的区别与联系,及医学领域侵害患者身体权的几种常见行为方式进行探讨,同时阐述了身体权的法律保护形式及侵害身体权应承担的民事责任.     

"缘对缘"技术在瓣膜成形术中的应用

随着心肌保护、体外循环技术及术后管理的进步，二尖瓣置换的手术成功率及远期疗效均有明显的提高。进行性发展的二尖瓣关闭不全会引起左心房及左心室扩大，左室充盈压升高及左室后负荷减低；若不及时治疗，病变会引起心功能不全，心力衰竭甚至猝死。对于二尖瓣关闭不全，二尖瓣成形术仍是首选的治疗方法。二尖瓣成形能维持心脏的几何形态，保护心室功能，明显降低手术死亡率，降低术后心内膜炎及血栓发生率，具有良好的长期生存率，治疗效果明显优于二尖瓣置换术。     

肾元胶囊对早期糖尿病肾病治疗作用的临床观察

糖尿病肾病（diabetic nephropathy，DN）是糖尿病的主要微血管并发症之一，也是导致慢性肾衰竭的常见原因。其发生首先以微血管的血流动力学变化为起点，继而发生以毛细血管基底膜增厚和系膜基质扩展为特征的肾小球硬化。据欧、美、日本的统计资料表明，目前DN已跃升为终末期肾病（ESRD）的首位原因，占35％左右。近年来，我院应用肾元胶囊对早期糖尿病肾病治疗取得了一定的疗效，现总结报告如下。     

血红素抑制内皮细胞损伤的形态学观察

目的 探讨血红素对人脐静脉内皮细胞氧化应激损伤的保护作用。方法 将培养的人脐静脉内皮细胞进行分组：对照组、损伤组、血红素组。观察各组细胞在光、电镜下形态学的改变。结果 在光镜下，血红素组细胞的生长状态明显优于损伤组；在电镜下，损伤组细胞核固缩，而血红素组细胞核幼稚，核仁明显。结论 在人脐静脉内皮细胞中，血红素对过氧化氢所造成的氧化应激损伤有明显的保护作用。     

甘露醇治疗急性脑血管病并发急性肾衰病人的护理

急性脑血管病并发急性肾功能衰竭(ARF)在临床上比较常见。由于病情危重，病死率高，临床上极为关注，它的转归对急性脑血管病的抢救成功率起着重要作用。分析其发生原因，发现应用脱水剂(甘露醇)，引起肾功能衰竭的比例很大。本将对甘露醇引起ARF原因进行分析并找出相应护理对策。     

试论阿司匹林在防治缺血性心脑血管病中的应用

阿司匹林(Aspirin，ASA)具有抗血小板聚集作用，可预防中风发生，对无症状而有高危因素的患者，应用ASA具有预防作用。通过近几年的临床实践证实，急性缺血性脑卒中发生后即刻给予中等剂量(160～300mg)的ASA治疗，确实能在一定程度上降低早期病死率和非致死性再发卒中。对避免卒中和预防心肌梗塞，用ASA治疗同样可降低发病的危险性，据统计ASA的总疗效可接近12．00％。     

肿瘤浸润淋巴细胞及中药调节其活性的研究进展

肿瘤浸润淋巴细胞 (Ｔｕｍｏｒｉｎｆｉｌｔｒａｉｎｇｌｙｍｐｈｃｙｔｅｓ ,ＴＩＬ)是种渗入到肿瘤组织内的抗肿瘤效应细胞 ,其活性及表型分布与恶性肿瘤发生、发展直接相关 ,具有重要潜在价值。近年 ,随着ＴＩＬ分离制备技术和体外扩增培养方法的建立 ,ＴＩＬ在免疫生物学和功能研究方面进展快速 ,已经从实验研究进入临床应用研究 ,显示了良好前景。1　ＴＩＬ及其抗肿瘤作用1.1　ＴＩＬ表型及其杀伤机制一般认为 ,ＴＩＬ表型有两个特点 :一是异质性 ,一是变化性。ＴＩＬ是以淋巴细胞为主的异质性淋巴细胞群体 ,主要由ＣＤ3+Ｔ细胞组成 ,…