兔肝癌组织缺血再灌注后的损伤及凋亡

目的研究肝癌缺血再灌注后的损伤及凋亡。方法超声引导穿刺新西兰兔肝脏左中叶注射VX2肿瘤组织混悬液,建立肝脏肿瘤模型,阻断肿瘤所在的肝左中叶的肝动脉分支60min后去除血管阻断恢复血流,分别再灌注0min、1h、1d、3d和1w。取肿瘤组织、癌周组织和肝脏组织,除测定肿瘤组织和肝脏组织超氧化物歧化酶(SOD)、丙二醛(MDA)的含量外,还对肿瘤组织、癌周组织及肝脏组织进行了HE染色。结果缺血再灌注后肿瘤组织和正常肝组织中的SOD浓度均迅速下降并分别于再灌注1h和0min达最低水平(64.59±4.97,12.38±0.31),其后逐渐恢复(112.83±5.84,25.78±0.56)但至再灌注7d仍低于再灌注前(200.32±26.43,42.00±1.07)。但癌组织中的SOD含量下降更为显著。从缺血再灌注开始至7d肿瘤组织的MDA含量下降(21.59±0.59),而肝脏组织缺血再灌注后0min至7d(29.04±1.43),MDA含量明显升高,均高于缺血再灌注前水平(18.26±0.43)。HE染色显示,肝癌组织缺血再灌注后凋亡细胞明显增多,其中以1d最为显著(23.08%),而癌周和肝组织改变不甚明显(与同时点的癌组织相比P<0.01)。结论缺血再灌注可增强对肝癌组织的损伤并促进细胞凋亡而癌周和正常肝脏组织的改变不明显。     

Coronary Vascular Bed Perfusion with a Polyethylene Glycol-Modified Hemoglobin-Encapsulated Liposome, Neo Red Cell, in Rats

Whether hemoglobin (Hb) encapsulated liposomes have vasoconstrictive activity remains controversial. We therefore examined the vascular activity of a liposome Hb, Neo red cell (NRC), in a simple in vitro model of Langendorff perfusion of the rat heart using Krebs-Henseleit (KH) solution as the perfusate. In the KH solution, NRC (Hb at 1 mg/ml), however, induced an immediate and abnormal increase in perfusion pressure. Histological examinations revealed that embolisms were the likely cause of this disturbance. Inorganic crystals formed by the mixing of NRC with the perfusate were a possible source of the embolisms. We found that the addition of bovine serum albumin to the perfusate was effective in avoiding embolic events. This protocol was used to compare the vasoconstrictive properties of unmodified bovine Hb and NRC. Unmodified bovine Hb (1 mg/ml) caused an increase in perfusion pressure and a decrease in the duration of bradykinin-induced relaxation. In contrast, NRC (Hb at 1 mg/ml) had no such vasoconstrictive effects. These results provide the first information regarding perfusion of the circulatory vascular bed by NRC and further evidence that the encapsulation of Hb into liposomes is an effective approach to modulate Hb-related vasoconstrictive activity.     

Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis

BACKGROUND: Necrotizing fasciitis (NF) is an uncommon but serious infection of fascia and skin associated with considerable morbidity and mortality. One modality proposed for improving the outcome of this condition is hyperbaric oxygen (HBO) therapy. This is a form of medical treatment that involves intermittent inhalation of 100% oxygen under pressures exceeding the atmosphere. The aim of this article is to review current practice and evidence for the use of HBO as adjunctive therapy in the management of NF. METHODS: A survey of published English literature through searches of Medline and PubMed was carried out using the following key words: "necrotizing fasciitis," "Fournier's gangrene," "necrotizing soft tissue infections," "hyperbaric oxygen therapy," "and hyperbaric oxygen chambers." RESULTS: The results of studies on the use of HBO therapy in NF are inconsistent. Some studies have demonstrated that HBO can improve patient survival and decrease the number of debridements required to achieve wound control, whereas others have failed to show any beneficial effect. CONCLUSIONS: Encouraging results have been achieved with the addition of HBO therapy to standard treatment regimes, thus justifying further research in this field. More robust evidence by way of a prospective randomized trial is necessary before widespread and routine use of HBO in the management of NF can be recommended.     

小儿气道异物取出术中及术后发生去氧饱和的危险因素

目的 筛选小儿气道异物取出术中及术后发生去氧饱和的危险因素.方法 选择2007年2月至2008年10月就诊于本院的气道异物患儿301例,年龄5月～12岁,ASA Ⅰ或Ⅱ级,记录患儿术前合并症情况、异物留存时间、异物种类、异物位置、通气方式、置入硬支气管镜时体动反应的发生情况、术后喉痉挛的发生情况、手术时间、拔管时麻醉深度、苏醒时间及术中、术后去氧饱和的发生情况.脉搏血氧饱和度<90%并超过5 S定义为发生去氧饱和.采用logistic回归分析筛选术中及术后发生去氧饱和的危险因素.结果 术中去氧饱和的发生率为20.4%,术后去氧饱和的发生率为12.2%.logistic回归分析结果显示术前合并肺炎、异物种类为植物种子类、手术时间>20 min、保留自主呼吸的通气方式是患儿术中发生去氧饱和的危险因素;异物种类为植物种子类及苏醒时间延长是患儿术后发生去氧饱和的危险因素.结论 术前合并肺炎、异物种类为植物种子类、手术时间>20 min、保留自主呼吸的通气方式是患儿术中发生去氧饱和的危险因素;异物种类为植物种子类及苏醒时间延长是患儿术后发生去氧饱和的危险因素.     

西宁地区严重创伤患者并发成人呼吸窘迫综合征氧动力学变化

目的 探讨西宁地区严重创伤后并发成人呼吸窘迫综合征（ＡＲＤＳ）时氧动力学变化,为治疗提供理论依据。方法 利用Ｓｗａｎ－ Ｇａｎｚ导管及热稀释法心输出量测定技术对２０例ＡＲＤＳ患者进行监测。结果 （保）监测开始１～２ｄ存活组和死亡组的氧输送（ＤＯ２）逐渐上升,氧耗量（ＶＯ２）也随之上升,出现病理性氧供依赖（ｒ＝０．６１７６,Ｐ〈０．０５）,两组间比较无显著性差异。（２）抢救４－５ｄ以后,存活组患者Ｄ     

Oxidative metabolism in the myocardium in normal subjects during dobutamine infusion

To assess the biventricular response of the clearance rate of carbon-11 acetate as an index of myocardial oxidative metabolism to increase in work-load, dynamic positron emission tomography was performed at rest and during dobutamine infusion in 14 normal subjects. The clearance rate constant (K_mono) of the left ventricular (LV) myocardium increased during dobutamine infusion (0.112±0.020 min^–1 vs 0.065±0.015 min^–1 at rest) (P<0.001) in proportion to the increase in the pressure-rate product. K_mono in the right ventricular (RV) myocardium also increased (0.080±0.018 min^–1 vs 0.034±0.013 min^–1 at rest) (P<0.001), with an excellent correlation with the LV K_mono (r=0.920). The fact that the increase in RV Kmono during dobutamine infusion was greater (158%±81%) than that in LV Kmono (79%±39%) (P < 0.005) indicates a greater increase in oxidative metabolism in the RV in response to inotropic stimulation in normal subjects. Correspondence to: N. Tamaki     

Oxygen dynamics at paraspinal muscles during exertion using near-infrared spectroscopy in patients with degenerative lumbar scoliosis

 Oxygen dynamics were measured in both sides of the paraspinal muscles of patients with degenerative lumbar scoliosis. The objective was to investigate the extent of stress by measuring the changes in oxygenation and blood flow volume using near-infrared spectroscopy. There were 44 patients with degenerative lumbar scoliosis (7 men, 37 women) and 11 controls with no scoliosis (2 men, 9 women). The measured recovery time for deoxyhemoglobin indicated the recovery from energy deficit after exercise. The average recovery time of the 11 control subjects was 2.4 ± 0.7 s on the right and 2.4 ± 0.8 s on the left. Among the 44 patients the average recovery time was 3.8 ± 1.8 s on the convex side and 2.1 ± 1.1 s on the concave side. There was a significant difference between the two groups. The recovery time on the concave side in patients was faster than that on the convex side. The results of the current study support the theory that stretching the muscles at the convex side results in chronic increases in the intramuscular compartment and reduced muscular blood flow. Received: May 23, 2002 / Accepted: October 29, 2002 Offprint requests to: M. Miyake, Department of Orthopaedic Surgery, Eiko Hospital, 1381 Takuma, Takuma-cho, Mitoyo-gun, Kagawa 769-1101, Japan     

重症先天性心脏病围术期氧供量和氧耗量的变化

目的了解重症先天性心脏病围术期的氧合状态.方法测定了22例心脏复跳后连续应用多巴酚丁胺或米力农情况下体外循环中、停体外循环后30min、手术结束、术后2h、术后16h的心脏指数(CI)、氧输送量(DO2)、氧耗量(VO2)和氧摄取率(ERO2).结果(1)体外循环中和体外循环结束DO2和VO2有高度正相关性(P＜0.01),相关系数分别为0.861,0.811;(2)体外循环中与体外循环后30min各数据比较CI、DO2、VO2前者明显低于后者(P＜0.05或0.01),ERO2无显著性差异;(3)体外循环结束后各点数据比较,CI能维持在3L@min-1@m-2以上,DO2能维持在550ml@min-1@m-2以上(术后16h最高,明显高于手术结束,P＜0.05),VO2能维持在120ml@min-1@m-2以上术后16h最低,术后2h最高,且明显高于体外循环后30min和术后16h(P＜0.05).结论(1)重症先天性心脏病围术期存在病理性氧供依赖;(2)心脏复跳后应用多巴酚丁胺能改善组织对氧的摄取和利用;(3)体外循环后连续应用多巴酚丁胺或米力农很难进行DO2、VO2、CI的超正常值维护,但CI高于ShoemakerWC提出的在治疗心源性休克所需维护的水平,即应不小于3L@min-1@m-2;(4)手术后16h循环功能尚未完全恢复,仍需继续加强正性肌力药的治疗.     

地氟醚预处理对人脐静脉内皮细胞缺氧/复氧损伤的影响

目的 探讨地氟醚预处理对人脐静脉内皮细胞缺氧/复氧损伤的影响.方法 人脐静脉内皮细胞株接种于培养板或培养皿中,随机分为5组(n=5),正常对照组(C组)不行任何处理;缺氧/复氧组(A/R组)缺氧30 min后,复氧60 min;缺氧/复氧+炎症介质刺激组[A/R+重组人肿瘤坏死因子-α(rhTNF-α)组]在复氧同时加入10 ng/ml rhTNF-α 10 μl;地氟醚预处理+缺氧/复氧组(Des+A/R组)及地氟醚预处理+缺氧/复氧+炎症介质刺激组(Des+A/R+ rhTNF-α组)先给予7.2%地氟醚30 min,洗脱10 min,然后进行缺氧/复氧,复氧同时加入10 ng/ml rhTNF-α 10 μl.采用流式细胞术和原位缺口末端标记法测定细胞凋亡情况,计算细胞凋亡率;应用透射电镜观察细胞凋亡和坏死情况.结果 与C组比较,A/R组和A/R+rhTNF-α组细胞凋亡率升高(P＜0.05);与A/R组比较,Des+A/R组细胞凋亡率降低(P＜0.05);与A/R+rhTNF-α组比较,Des+A/R+rhTNF-α组细胞凋亡率降低(P＜0.05).电镜下,A/R组和A/R+rhTNF-α组可见凋亡和坏死细胞,Des+A/R组和Des+A/R+rhTNF-α组细胞处于增殖和修复状态.结论 7.2%地氟醚预处理30 min可减轻人脐静脉内皮细胞缺氧/复氧损伤.     

高浓度二氧化碳预处理对人脐静脉内皮细胞缺氧复氧损伤的影响

目的 探讨高浓度二氧化碳(CO2)预处理对人脐静脉内皮细胞缺氧复氧损伤的影响.方法 人脐静脉内皮细胞接种于细胞培养板,随机分为6组,每组16孔,对照组(C组)常规培养;缺氧复氧组(MR组)缺氧4 h、复氧24 h;缺氧预处理组(APC组)缺氧10 min、复氧10 min,重复2次后缺氧4 h、复氧24 h;HCA.组、HCA2组和HCA3组分别于50%N-20%02-30%CO2培养箱中行30%CO2预处理10、30、60 min后常规培养10、20、30 min,缺氧4 h、复氧24 h.于复氧24 h时采用MTY法测定人脐静脉内皮细胞活力,采用免疫细胞化学法测定细胞间粘附分子-1(ICAM-1)表达水平.结果 与C组比较,MR组、APC组、HCA1～3组人脐静脉内皮细胞活力降低,ICAM-1表达上调(P＜0.05);与A/R组比较,APC组和HCA2组人脐静脉内皮细胞活力升高,APC组及HCA1,2组ICAM-1表达下调(P＜0.05).结论 高浓度CO2预处理可减轻人脐静脉内皮细胞缺氧复氧损伤.