体外循环中血浆内皮素、血管紧张素Ⅱ和前列环素的变化及临床意义

目的:分析体外循环心内直视手术中血浆内皮素、血管紧张 和前列环素的变化及临床意义。 方法 :应用放免法分别于 7个时点测定 30例心内直视手术病人血浆内皮素、血管紧张素 和前列环素 (终产物 6 - keto-PGF1α)水平。结果 :血浆内皮素水平在转机时高于术前 (P <0 .0 5 ) ,转流中逐渐升高 ,停转流时达高峰 (P <0 .0 1) ,术后 2 h及 2 4 h逐渐降低 ,但仍高于术前 (P <0 .0 5 )。血管紧张素 水平在转机时高于术前 (P <0 .0 5 ) ,转流 30 min降低 ,主动脉开放时升高 ,停转流时达高峰 (P <0 .0 1) ,术后 2 4 h呈下降趋势 ,但仍高于术前 (P <0 .0 5 )。 6 - keto- PGF1α在转流即刻显著升高 ,以后各时点降低。结论:体外循环期间血浆内皮素、血管紧张素 水平显著增高 ,6 - keto- PGF1α水平逐渐降低。体外循环期间加入内皮素、血管紧张素 拮抗剂或前列环素合成剂有利于心功能恢复     

前列腺素E1对血管内皮生长因子含量的影响及其与肺小动脉病理分级的关系

目的 研究应用前列腺素E1(PGE1)对先天性心脏病合并肺动脉高压(PH)患者血清血管内皮生长因子(VEGF)含量的影响及其与肺小动脉病理分级的关系. 方法 2002年1月至2003年6月共收治先心病合并PH患者53例(MPAP＞20 mmHg),其中有明显紫绀6例(MPAP＞90 mmHg).入院后静脉滴注PGE1 10～15ng/kg*min,每天用药12小时,连续15天.分别于用药0、5、10和15天晨抽取静脉血,采用酶联免疫吸附法(ELISA)测定血清VEGF含量.做肺组织活检,按Heath和Edwards分类进行病理分级,观察肺小动脉的病理改变. 结果病理分级:Ⅰ级9例,Ⅱ级14例,Ⅲ级19例,Ⅳ级5例,≥Ⅴ级 (紫绀者)6例.应用PGE1前,肺小动脉病理分级Ⅲ级时血清VEGF达到峰值,Ⅳ级、特别是≥Ⅴ级后有明显下降的趋势;应用PGE1后,Ⅰ级血清VEGF与用药前比较差别无显著性意义(P>0.05),Ⅱ、Ⅲ级者血清VEGF明显降低(P<0.01),Ⅳ级者有轻度的降低(P<0.05),而≥Ⅴ级患者无明显变化(P>0.05). 结论 PGE1可降低血清VEGF含量, 其降低幅度与肺小动脉病理改变程度有较密切的关系,可作为术前判断肺小动脉病理分级的一个参考指标.     

不同门奇断流术式对门静脉高压症犬食管下段血管再生的影响

Objective To explore the effect on blood vessel regeneration of distal esophagus in ca-nines of portal hypertension with liver cirrhosis after different procedures with paraesophagastrie devascular-ization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CC14 combined with food restriction. Forty eight model canines were randomly divided into 4 groups: group A, traditional paraesophagastrie devascularization;group B, selective paraesophagastric devascularization;group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with sta-pler;group D,control group. Every group had 12 canines which were randomly divided into A1 ,B1 ,C1 ,D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2, B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemieal methods were used to detect VEGF,CD34 and FVⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expres-sion levels of VEGF and CD34 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation (P <0.05). All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla (P <0.05). The indices in group Cla were lower than those in group C1b (P < 0.05 ). The indices in groups A2 and B2 were higher than those in groups A1 and B1, re-spectively at the 6th month after the operation (P <0.05). They were higer in outer membrane in group C1a than in group C2a (P <0.05). The indices in group C2b were higher than those in group Clb (P<0.05). Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different pro-cedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastrie devascularization and selective paraesophagastrie devascularization, the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after parae-sophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization pins distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.     

经皮血管闭合器在PCL患者中的应用

采用经皮血管闭合器(ANGIO-SEAL)闭合动脉穿刺部位，效果理想、方法可靠。现将应用经验介绍如下。     

外伤性颈内动脉海绵窦瘘的血管内栓塞治疗

外伤性颈内动脉海绵窦瘘(TCCF)的治疗一直是神经外科的棘手问题，手术效果并不令人满意.我院自1998年3月至2002年8月对16例TCCF患者采用血管内栓塞治疗，疗效满意，报道如下.     

血管紧张素原与原发性高血压及其相关研究进展

人类血管紧张素原(angiotensinogen，AGT)是一种主要在肝脏合成的大分子球蛋白，分子量在55000—65000，是仅知的天然肾素底物，与a1-抗胰蛋白酶同源，共属丝氨酸超家族。由于AT是维持肾素一血管紧张索系统功能和调节血压的关键物质，关于AGT的大量相关调查和研究己在不同的人群中展开。本文就AGT的分子生物学特性、调节及其与EH的关系做一介绍。     

介绍一种简单实用的气囊止血带固定带(摘要)

为了减少术中出血,一些四肢部位的手术经常通过患肢捆扎气囊止血带来达到减少术中出血的目的.但经常由于气囊止血带充气后变得坚硬及长时间挤压局部皮肤而使手术结束后此处皮肤有较深压痕或皮肤挤伤出现小水泡等,易增加感染机会,给病人带来痛苦.     

麻醉科毕业实习生教学工作的体会

<正> 毕业实习既是医学生理论认识的深化,又是从理论学习过渡到临床工作的必要途径。因此,不仅需传授现有的临床知识技能,还要培养如何把理论用于实践的能力,以及使学生掌握观察发现问题、分析研究问题和归纳总结问题等一系     

静脉留置针在儿科的临床应用与护理

静脉留置针在临床上已经广泛应用，它具有减少血管损伤，减轻病人痛苦，尤其在儿科，由于季节性强，病人多，护士相对少，家属对静脉穿刺的成功与否非常重视，大部分家属视患孩如掌上明珠，患孩的痛就是父母的痛。采用静脉留置针既可以减少工作量，提高工作效率，又能避免护患纠纷，提高医疗质量，为护理工作的顺利开展打下良好基础。我科于2003年2月至2004年6月对200例住院需静脉输液的患儿使用BD公司研制的单翼族头皮式套管针，经临床应用，操作简单，效果满意。现报告如下：