氧化亚氮联合利多卡因行无痛人工流产术280例临床分析

目的: 探讨吸入 50%氧化亚氮 (N2O) 与 50%氧气 (O2 ) 的混合气体联合宫颈注射 2%利多卡因进行无痛人工流产术 (人流术) 的有效性和安全性。方法: 将人流术 580例分为A、B两组。其中A组 280例吸入 50%氧化亚氮 (N2O)与 50%氧气的混合气体联合宫颈注射 2%利多卡因进行无痛人流术, 称为联合组; B组 300例, 不用任何药物, 为对照组, 分析比较两组手术中镇痛效果, 宫口松弛情况, 手术出血量, 人流综合反应。结果: 联合组镇痛完全, 有效率达 97 5%。宫口完全松弛率 97 9%。两组比较有显著性差异 (P<0 05)。结论: 吸入氧化亚氮联合宫颈注射利多卡因进行无痛人流术, 镇痛效果确定, 人流时受术者意识处于朦胧状态, 安静, 无痛苦, 不良反应少, 苏醒快等。     

重症急性胰腺炎持续血液净化治疗观察

目的探讨持续性血液净化技术在重症急性胰腺炎治疗中的效果。方法23例患者接受传统临床药物治疗,23患者在此基础上加上持续性血液净化技术,对比两组患者炎性因子等指标改善的情况。结果治疗24h后,观察组IL-1、IL-6、IL-8、TNF-α分别为（246．52±31．84）pg／ml、（15．12±1．07）pg／ml、（16．05±1．08）pg／ml、（1．42±0．31）ng／L,治疗48h后,观察组IL-1、IL-6、IL-8、TNF-α分别为（190．46±27．65）pg／ml、（11．07±1．87）pg／ml、（11．04±1．57）pg／ml、（0．68±0．34）ng／L,均显著低于治疗前,差异有统计学意义（P〈0．05）,且观察组指标明显低于对照组。治疗24h后,观察组Ang-Ⅰ、Ang-Ⅱ、E、ALD分别为（1．34±1．17）ng／L、（0．72±5．37）ng／L、（1．05±0．21）ng／ml、（145．27±15．34）pg／ml,治疗48h后,观察组Ang-Ⅰ、Ang-Ⅱ、E、ALD分别为（9．28±1．16）ng／L、（48．42±4．10）ng／L、（0．63±0．11）ng／ml、（99．31±11．16）pg／ml,均显著低于治疗前,差异有统计学意义（P〈0．05）,且观察组指标明显低于对照组。结论CBP可以明显缓解SAP病情,促进炎性因子和RAAS系统的改善。     

益心泰丸对慢性心衰大鼠血浆PRA、AngⅡALD含量影响

目的：观察益心泰丸对慢性心力衰竭大鼠血浆中PRA、AngⅡ、ALD含量影响。方法：采用腹主动脉缩窄法建立慢性心力衰竭的动物模型。将造模成功的大鼠随机分为五组：模空组、益心泰丸高剂量组、益心泰丸中剂量组、益心泰丸低剂量组和科素亚对照组,每组10只：另设一组正常对照组10只。对各组动物分别用药4周后（除正常对照组）测定血浆中PRA、AngⅡ、ALD含量。结果：益心泰丸和科素亚组与模型组比较,血浆中PRA、AngⅡ、ALD含量均低于模型组（P〈0．01）。结论：益心泰丸通过抑制RAAS的过度激活,而调节心力衰竭时神经内分泌系统的变化,以保护心肌细胞,改善心功能．治疗心力衰竭。     

Autonomic nervous system mediates the cardiovascular effects of Rhodiola sacra radix in rats

ETHNOPHARMACOLOGICAL RELEVANCE: Rhodiola sacra (Crassulaceae) exhibits cardiovascular bioactivities and is used in Tibetan medicine for promoting circulation and preventing hypertension. However, the underlying mechanisms of its cardiovascular effects are poorly understood. AIM OF THE STUDY: The aim of this study was therefore to evaluate the cardiovascular activity of water-soluble fraction (WtF) and n-butanol-soluble fraction (BtF) of Rhodiola sacra radix and to explore its mechanism of action in propofol anesthetized Sprague-Dawley rats. MATERIALS AND METHODS: The changes of blood pressure, heart rate and cardiac contractility after systemic administration of the extracts (10-75mg/kg) were examined for at least 40min. Different antagonists were used to evaluate the mechanisms of cardiovascular effects of the extracts. RESULTS: Intravenous injection of the WtF (10, 25, 35, 50 or 75mg/kg) exhibited dose-dependent hypotension and increases in heart rate and cardiac contractility. In contrast, mild alterations in the same cardiovascular parameters were detected only at high dose (75mg/kg) BtF. The WtF-induced hypotensive, positive inotropic and chronotropic effects were significantly abolished by pretreatment with hexamethonium (30mg/kg, i.v.) or reserpine (5mg/kg, i.v.), whereas the hypotensive, but not the positive inotropic or chronotropic effect was potentiated by captopril (2.5mg/kg, i.v.). Pretreatment with methylatropine (1mg/kg, i.v.), on the other hand, reversed the positive inotropic and chronotropic but not the hypotensive effects of WtF. The WtF-induced cardiovascular responses were not affected in rats pretreated with N(G)-nitro-l-arginine methyl ester (20mg/kg, i.v.). CONCLUSIONS: We conclude that systemic administration of the WtF of Rhodiola sacra radix elicited a potent hypotensive effect that was mediated by the withdrawal of sympathetic vasomotor tone and interaction with the circulatory angiotensin system. The positive inotropic and chronotropic effects of WtF may result from a direct vagal inhibition on the heart.     

ACS合并AHF患者治疗中RAAS抑制剂对CI-AKI发病的影响

目的 探讨肾素血管紧张素醛固酮系统（RAAS）抑制剂在急性冠状动脉综合征（ACS）合并急性心力衰竭（AHF）患者经皮冠状动脉介入术（PCI）中对比剂致急性肾损伤（CI-AKI）中的作用。方法 回顾性分析成功行PCI手术ACS合并AHF患者504例,并于术后24～48 h内复查肾功能。分别按照有无CI-AKI及有无应用RAAS抑制剂进行分组,对比相关观察指标,并将差异有统计学意义的观察指标进行Logistics回归分析。结果 504例患者中144例（28.6%）患者发生CI-AKI。CI-AKI组RAAS抑制剂使用比例、高血压、糖尿病患病率与非CI-AKI组比较,差异有统计学意义（P?<0.05）。CI-AKI组反映心脏功能超声指标LVEF、LVEDD、PAP、NT-proBNP、hs-CRP及Hcy水平与非CI-AKI组比较,差异有统计学意义（P?<0.05）。将上述指标引入Logistic回归分析发现,应用RAAS抑制剂对CI-AKI影响消失。而高血压、NT-proBNP、Hcy、hs-CRP、LVEF、PAP仍为心力衰竭患者CI-AKI发生高危因素。结论 对ACS合并AHF患者需行PCI治疗患者,常规应用RAAS抑制剂并不增加CI-AKI发生风险。     

Mechanism of adrenocortical toxicity induced by quinocetone and its bidesoxy-quinocetone metabolite in porcine adrenocortical cells in vitro

Quinocetone (QCT) is a new feeding antibacterial agent in the QdNOs family. The mechanism of its adrenal toxicity is far from clear. This study was conducted to estimate the adrenal cell damage induced by QCT and its bidesoxy-quinocetone (B-QCT) metabolite and to further investigate their mechanisms. Following doses of QCT increasing from 5 to 50 μM, cell apoptosis and necrosis, mitochondrial dysfunction and redox imbalance were observed in porcine adrenocortical cells. The mRNA levels of the six components of intermediary enzymes and the adrenal renin-angiotensin-aldosterone system (RAAS) displayed a dysregulation induced by QCT, indicating that QCT might influence aldosterone secretion not only through the upstream of the production but also through the downstream of the adrenal RAAS pathway. In contrast, B-QCT had few toxic effects on the cell apoptosis, mitochondrial dysfunction and redox imbalance. Moreover, LCMS-IT-TOF analysis showed that no desoxy metabolites of QCT were found in either cell lysate or supernatant samples. In conclusion, we reported on the cytotoxicity in porcine adrenocortical cells exposed to QCT via oxidative stress, which raised awareness that its toxic effects resulted from N→O groups, and its toxic mechanism might involve the interference of the steroid hormone biosynthesis pathway.     

COVID-19 and the heart: An update for clinicians

SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Some therapeutics under investigation for COVID-19 may also have adverse cardiac effects. The involvement of the RAAS system in viral entry makes it pertinent to consider the effects of medications that modulate the system. Comprehensive knowledge of peculiar cardiovascular manifestations of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is needed for optimal patient management.