低温体外保存对血小板活化和凋亡的影响

目的 观察保存温度对血小板活化和凋亡的影响,评估低温体外保存血小板的效果.方法 取20份单采血小板,一分为三,一份于(22±2)℃振荡保存(对照组),另两份悬浮于血小板添加液(65％)与自体血浆(35％)的混合液中分别静置于10℃储血冰箱(实验Ⅰ组)和(22±2)℃振荡仪(实验Ⅱ组),于1、3、4、5、7d检测血小板计数(platelet count,PLT)、血小板P选择素(cluster of differentiation 62 platelet,CD62p)表达率、血小板线粒体跨膜电位(mitochondrial transmembrane potentia,△Ψm).结果 随着时间延长,3组PLT比较平稳,在组间、时点间以及组间·时点间交互作用差异均无统计学意义(P＞0.05);随着时间延长CD62p逐渐升高,而△Ψm％逐渐下降,3组CD62p、△Ψm在组间、时点间以及组间·时点间交互作用差异均有统计学意义(P＜0.01).结论 血小板添加液混合血浆10℃低温保存比(22±2)℃保存血小板的活化和凋亡程度均较低.     

Predicting long-term outcomes after cardiac arrest by using serum neutrophil gelatinase-associated lipocalin

Objectives

Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival.

心脏骤停亚低温治疗脑保护策略

脑损伤被认为是导致心脏骤停自主循环恢复患者死亡的重要原因,挽救、阻止神经细胞损伤,恢复神经功能对 于改善复苏预后意义重大。作为心脏骤停患者诊疗中的重要一环,亚低温治疗已经体现出其在神经功能保护方面的 优势,但最终使患者获益的不仅仅是体温的降低,还取决于亚低温治疗策略的制定与实施、器官功能的连续评估与监 测、必要的辅助支持治疗等集束化诊疗策略的执行。     

Maintenance of integrity and function of isolated hepatocytes during extended suspension culture at 25°C

Abstract: Isolated hepatocytes in suspension provide a number of advantages for use in bioartificial liver device, however, poor stability of this cell preparation at physiological temperatures is an apparent barrier preventing their use. We therefore investigated the integrity and differentiated function of isolated rat hepatocytes under conditions of mild hypothermia. Isolated hepatocytes were suspended in a bicarbonate buffered saline medium, supplemented with glucose and bovine serum albumin (BSA), and maintained for 48 h at 25 °C on a rotary shaker under an atmosphere of 95% O₂ and 5% CO₂. Under these conditions there was no significant decline in cell viability and good preservation of cellular morphology on transmission electron microscopy for at least 24 h. Isolated hepatocytes in suspension at 25 °C were also able to maintain normal Na ⁺ and K ⁺ ion gradients. The cellular energy status ([ATP], ATP/ADP ratio, cytoplasmic and mitochondrial redox potentials), metabolic function (urea synthesis and ammonia removal), albumin synthesis and phase I and phase II drug detoxification activity of these cells were also maintained for at least 24 h post isolation. These observations demonstrate the robust nature of mildly hypothermic isolated hepatocytes in suspension and encourage further studies re‐examining the feasibility of using this cell preparation in bioartificial livers.     

Two cases of asystolic cardiac arrests managed with therapeutic hypothermia

Poor neurological outcome is a common sequel of prolonged cardiac arrest. Although Therapeutic Hypothermia (TH) for neuroprotection has been a subject for research for over Half a century, its use has been limited because of many controversies and lack of clear guidelines. However for over two decades there has been a revival of interest in mild therapeutic hypothermia (32-34°C) for neuroprotection. However its use after primary asystolic cardiac arrest has been questioned.Herein presenting two cases of prolonged asystolic arrest (39 minutes and 25 minutes); where therapeutic hypothermia was successfully used in following prolonged cardio pulmonary resuscitation. On patients who were in deep coma after resuscitation, TH was applied for 24 hours as per institutional protocol with full neurological recovery in both the cases. Therapeutic hypothermia might have a potential role in even in non-shockable arrests and should be considered in every successful cardiopulmonary resuscitation with poor neurological status.     

长时程亚低温治疗对重度颅脑损伤患者脑损伤标志物及氧化应激指标的影响

目的:探讨长时程亚低温治疗对重度颅脑损伤患者脑损伤标志物及氧化应激指标的影响。方法:62例重度颅脑损伤患者根据治疗方式不同将其分为短时程（2 d）亚低温治疗组（对照组, n=30）和长时程（5 d）亚低温治疗组（观察组, n=32）,治疗后第6天时比较两组患者凝血功能指标、脑损伤标志物、氧化应激指标、并发症发生情况,随访期间观察患者昏迷时间及30 d致残率与30 d病死率。结果:治疗后第6天时,观察组血清凝血酶原时间、凝血酶时间、活化部分凝血酶原时间水平高于对照组（P<0.05）,观察组血清D-二聚体水平低于对照组（P<0.05）。治疗后第6天时,观察组患者血清髓鞘碱蛋白、神经元特异性烯醇化酶、S100蛋白、丙二醛、超氧化物歧化酶水平均低于对照组（P<0.05）。两组患者颅内血肿、胃肠动力减弱、泌尿系感染、肺部感染、应激性溃疡发生率无统计学差异（P>0.05）。观察组患者昏迷时间较对照组缩短（P<0.05）;观察组患者30 d致残率及30 d病死率均低于对照组,但两组间差异无统计学意义（P>0.05）。结论:长时程亚低温治疗有利于改善重度颅脑损伤患者凝血功能,降低脑损伤标志物水平及氧化应激损伤,缩短昏迷时间,且不增加并发症发生风险。     

成人危重患者低体温复温管理的证据总结

目的 总结成人危重低体温患者复温管理的相关证据,为临床实践提供指导。方法 根据循证护理方法确立循证问题,根据证据的“6S”模型,从“证据金字塔”上层开始检索国内外有关成人危重患者低体温复温管理的相关证据,证据资源类型包括临床决策、推荐实践、证据总结、指南、专家共识。由2名研究人员独立进行文献质量评价,并对符合质量标准的文献进行证据内容提取。结果 共纳入8篇文献,包括2篇临床决策,1篇推荐意见,3篇证据总结,2篇专家共识。共提取出涉及体温监测（3条证据）、复温目标（2条证据）、复温措施选择（5条证据）、复温风险管理（7条证据）、复温并发症监测（5条证据）的22条证据,证据等级1~5级。结论 本研究从5个维度汇总了成人危重患者低体温复温管理证据,为临床实践提供了理论指导。但本研究汇总的证据来源多为国外研究,建议研究者在使用本次汇总的证据时,要充分评估每条证据在临床的可行性、适宜性、临床意义和有效性,并评估证据在临床应用的障碍与促进因素,以确保证据在临床的顺利应用。     

亚低温在蛛网膜下腔出血急性期的脑保护作用

亚低温对脑动脉瘤性蛛网膜下腔出血急性期脑损伤保护作用的研究报道较少。在动脉瘤性蛛网膜下腔出血急性期,有多种脑损伤机制参与脑损伤的发生。亚低温在脑梗死早期能对抗多种脑损害因素,应用于动脉瘤性蛛网膜下腔出血急性期,有可能发挥脑保护作用。     

No difference in mortality between men and women after out-of-hospital cardiac arrest

AimComparing the outcome after out-of-hospital cardiac arrest (OHCA) in men and women and to determine whether sex modifies the effect of targeted temperature management (TTM) at 33 or 36 °C.MethodsThe TTM trial randomized 950 patients to TTM at 33 or 36 °C for 24 h. This predefined sub-study of the TTM trial assessed survival and neurological outcome defined as Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using female sex as main predictor of outcome, in relation to level of TTM and other confounding factors.ResultsCompared to men, women more often had OHCA at home, p = 0.04 and less often had bystander defibrillation, p = 0.01. No other differences in arrest circumstances were found. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) <24 h after ROSC was less often performed in women, both: p = 0.02.Female sex was associated with higher mortality in univariate analysis, hazard ratio (HR) = 1.29, CI = 1.04–1.61, p = 0.02 compared to men. Adjusting for demographic factors (age and comorbidity), arrest circumstances, pre-hospital findings, inclusion sites, treatments and status at admission reduced this: HR = 1.11, CI = 0. 87–1.41, p = 0.42, and sex was no longer an independent risk factor for death.The effect of sex did not modify the effect of TTM at 33 and 36 °C, p_interaction = 0.73.ConclusionFemale sex seems associated with adverse outcome, but this association is largely explained by differences in arrest circumstances and in-hospital treatment. Our data shows no interaction between sex and the effect of targeting 33 vs. 36 °C.