挥发性麻醉药后处理保护缺血/再灌注心肌的研究进展

缺血后处理（ischemic postconditioning）是近年来提出的一种新的心肌保护方法,即心肌缺血后在长时间的再灌注之前,进行的数次短暂再灌注／缺血的循环。实验证明后处理对缺血心肌确有显著的保护作用。挥发性麻醉药后处理也可以发挥同样的保护效应,其机制比较复杂,远未阐明,现就其保护作用的机制作一综述。     

经颅多谱勒检测兔大脑中动脉微血栓栓子的研究

目的应用经颅多谱勒（TCD）动态检测兔血栓栓塞模型大脑中动脉（MCA）的微栓子信号（MES），观察栓子的负荷量与缺血性脑血管病（ICVD）发生的相关性。方法将实验动物随机分为3组，即A组含3—5个栓子，B组含6-10个栓子，C组为生理盐水对照组。采用自体动脉血微栓子建立兔局灶性脑缺血模型同时TCD监测MES。栓塞后6h进行磁共振成像（MRI）及兔脑组织病理观察。结果A、B组TCD均监测到MES；B组MRI的T1WI、T2WI及病理观察见梗死灶，而A组仅在弥散加权成像（DWI）见可疑小缺血灶。结论TCD实时、动态观察微栓子信号，能预测缺血性脑血管病发生的危险性，为临床及早干预治疗提供科学依据。     

模拟缺血再灌注后心肌细胞的胰岛素抵抗现象

目的准确评价缺血再灌注心肌的胰岛素敏感性及其时相规律，为临床干预提供依据。方法建立成年大鼠心肌细胞模拟缺血60min再灌注模型，应用同位素示踪技术观察不同浓度（0IU／L、0．01IU／L、20IU／L）胰岛素刺激大鼠心肌细胞的葡萄糖摄取效应。结果缺血60min后再灌注15min和60min，心肌细胞活性比率无明显降低（P〉0．05）。胰岛素能促进各组心肌细胞的葡萄糖摄取，并呈剂量依赖性。缺血再灌注15min组和再灌注60min组心肌细胞胰岛素刺激的葡萄糖摄取较对照组均明显降低（P〈0．05）。再灌注60min组心肌细胞胰岛素刺激的葡萄糖摄取较再灌注15min组明显增加（P〈0．05）。结论缺血60min后，再灌注心肌细胞保留了对胰岛素的反应性，同时，再灌注心肌细胞发生明显的急性胰岛素抵抗，再灌注初期尤为严重。急性胰岛素抵抗很可能是缺血再灌注心肌损伤的又一重要机制。     

丙泊酚对大鼠缺血再灌注肾NF-κB、TNF-α表达的影响

目的 研究丙泊酚对大鼠肢体缺血再灌注损伤后肾组织中肿瘤坏死因子-α（tumornecrosisfactor-α,TNF-α）、核因子-κB（nuclear factor-κxB,NF-κB）表达的影响。方法 24只SD雄性大鼠,随机分为假手术对照组（A组）,肢体缺血再灌注组（B组）和丙泊酚干预组（C组）,每组8只。采用免疫组织化学方法检测TNF-α、NF-κB的表达,行图像分析半定量。结果 B组大鼠肾组织中TNF-α、NF-κB的表达明显高于A组（P〈0．05）,C组明显低于B组（P〈0．05）。结论 肢体缺血再灌注后有明显肾损伤,丙泊酚对肢体缺血再灌注肾损伤有一定程度的保护作用,其机制可能与下调大鼠肢体缺血再灌注损伤肾组织中TNF-α、NF-κB的过度表达有关。     

心磷脂与缺血/再灌注损伤

心磷脂（CL）是维持线粒体能量代谢所必需的一种磷脂，参与了众多重要生理过程。此文对CL的结构、合成和转化；在维持线粒体正常功能中的作用；缺血／再灌注（I／R）损伤中的改变以及和线粒体功能的关系等作了逐一阐述，说明CL与I／R损伤导致的细胞死亡关系密切，CL量或性质的改变在细胞凋亡中处于中心地位。     

二氮嗪预处理对肝硬化大鼠肝脏的保护作用

目的探讨采用线粒体ATP敏感性钾通道(mitoKATP通道)选择性开放剂二氮嗪(DE)进行预处理能否模拟缺血预处理(IP)对硬化肝脏缺血再灌注损伤的保护作用及其可能的作用机制。方法雄性肝硬化SD大鼠随机分为5组(每组8只)。IP组以肝缺血5 min作预处理;DE组以静脉注射DE作为预处理;DE 5-HD组是在DE组基础上再予静注mitoKATP通道选择性阻滞剂5-hydroxydecanoate(5-HD)进行预处理;对照组(C组)以静注等量生理盐水作为预处理;上述4组均在预处理后行肝缺血45 min再灌注60 min;缺血方式均为70%肝脏热缺血。假手术组(S组)仅行开腹,不作任何其他处理。完成预定实验操作后分别取血用于血清谷丙转氨酶(ALT)与乳酸脱氢酶(LDH)检测,切取肝组织用于测定ATP酶活力、湿重/干重(W/D)的测定及观察显微、超微结构变化。结果C组ALT,LDH,ATP酶及W/D的水平明显高于S组(P<0.01),肝脏的显微及超微结构损伤明显;IP组与DE组的各项肝组织损伤指标均明显好于C组,ATP酶活性低于C组(P<0.05及P<0.01);而DE 5-HD组的肝损伤指标均差于DE组,ATP酶活性高于DE组(P<0.05及P<0.01)。结论使用DE进行药物预处理能够模拟出IP效应,对肝硬化大鼠肝脏I/R损伤具有保护作用,其作用可能与下调肝组织ATP酶活性,减少ATP大量分解,使肝组织ATP含量升高,改善肝能量代谢,增加能量储备;改善肝组织微循环,减轻肝脏水肿有关。     

展望受体低氧预适应在原位肝移植中的应用

了解原位肝移植过程中无肝期门静脉淤血引起的肠道淤血性缺氧对肝完全缺血再灌注损伤的影响以及肠道缺氧低氧耐受的内源性保护机制。采用文献回顾的方法加以综述。对肝移植受体肠道黏膜屏障功能的保护可减轻移植肝脏再灌注损伤。受体低氧预适应可能为移植肝脏再灌注损伤的保护提供一条全新的途径。     

Incidence of ischemic stroke post-chemotherapy: a retrospective review of 10,963 patients

OBJECTIVE: Vascular occlusion is not an uncommon event in malignancy. However, the frequency of ischemic stroke after chemotherapy has been mentioned only occasionally in clinical studies. A large-scale study is lacking. METHODS: A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, Taiwan, to analyze the incidence of ischemic stroke post-chemotherapy, further, to evaluate a possible causative relationship between the ischemic stroke and the chemotherapy regimen, the interval between the latest chemotherapy session and onset of ischemic stroke and the survival of patients with ischemic stroke post-chemotherapy. The data were retrieved from the Cancer Database from 1993 to 2004. RESULTS: During this period, a total of 10,963 patients, with malignancies were followed-up for 1 month after chemotherapy, underwent 45,294 chemotherapy sessions. Among this group, there were 15 patients experiencing 16 ischemic strokes within the first month after the latest chemotherapy. Among them, 14 patients were followed-up until death and one patient was lost in follow-up after discharge against medical advice. The incidence of post-chemotherapy ischemic stroke was 0.137% and the frequency of chemotherapy cycles complicated by ischemic stroke was 0.035%. Adenocarcinoma was the most common histological type not only in ischemic stroke (40%) but also in overall patients (36.7%). The hemispheric stroke with middle cerebral artery territory involvement was the most common image finding. Platinum compounds, especially cisplatin, were the most commonly used chemotherapeutic agents for ischemic stroke patients. Twelve (75%) of these 16 ischemic strokes occurred within 10 days of the latest chemotherapy session and 10 (62.5%) occurred after the first cycle of chemotherapy. The median survival after ischemic stroke was 4 weeks. CONCLUSION: Our results provide valuable data on the relationship between malignancy, treated with chemotherapy, and ischemic stroke. The risk of ischemic stroke after chemotherapy is predicted by the use of cisplatin-based chemotherapy not cancer histologic type. Infarction usually involves the territorial subtype, causes obvious neurological disabilities and carries a grave prognosis.     

双向局部动脉内溶栓治疗12例急性基底动脉梗塞的临床报告

目的观察并探讨局部动脉内溶栓治疗急性基底动脉梗塞的临床疗效和方法。方法12例临床确诊病人均行DSA全脑血管造影后,在微导丝导引下,将2．7F微导管送至血栓部位,并穿透血栓,总量50～100万U尿激酶分次在血栓的远端和近端注射进行双向溶栓。分别于术前、术后1d、术后14 d和术后28 d行美国国立卫生研究院卒中量表(NIHSS)评分。应用简明统计10．1软件进行单因素重复测量方差分析,并应用Dunnett t(t_D)检验对溶栓后各时间组评分和溶栓前评分进行两两比较。结果分析各时间点NIHSS评分结果发现,术后14 d和28 d组与术前组比较有显著性差异(P＜0．05,P＜0．01)；术后1 d组和术前组比较无显著性差异(P＞0．05)。结论双向局部动脉内溶栓治疗急性基底动脉梗塞是一种安全有效的方法,远期疗效好。     

Functional connectivity between cortical hand motor and language areas during recovery from aphasia

Previous data indicate that in healthy subjects, there is a connectivity between cortical areas for hand movement and language on the left hemisphere. This link is possibly mediated by the so-called mirror neuron system. The present study investigated the functional relationship between linguistic and hand movement processing in patients who were recovering from post-stroke aphasia. The excitability of the right- and left-hand motor cortex during language production in patients who were recovering from post-stroke aphasia and age-matched controls was investigated. As control, phonation was investigated. Hand motor cortex excitability was assessed with Motor Evoked Potentials which were elicited by Transcranial Magnetic Stimulation (TMS). In patients, reading aloud enhanced the excitability of the right hemispheric hand motor cortex, whereas phonation had no effect on hand motor cortex excitability. In the control group, an increased excitability of the left hemispheric hand motor system was found during reading aloud in accordance with previous data. The present data suggest a functional connectivity between regions mediating hand movements and reading. This may indicate that the right hemisphere participates in language processing as far as involved in single word reading in patients recovering from aphasia. The coactivation between cerebral representations of hand movements and language may be used therapeutically for aphasia rehabilitation.