慢性乙型肝炎肝脏微循环障碍的诊断方法研究

目的 探讨低氧诱导因子-1α(HIF-1α)、血栓烷素B2( TXB2)、6-酮-前列腺素F1α(6-Keto-PGF1α)及透明质酸(HA)联合检测在慢性乙型肝炎(CHB)肝脏微循环障碍诊断和监测中的意义.方法 对81例CHB患者和5例健康志愿者留取血清作HA化学发光法检测,抗凝血浆作TXB2和6-Keto-PGF1α放射免疫法检测,同时肝穿取标本进行HIF-1α免疫组化染色,并用透射电镜观察肝组织超微结构的变化.结果 随着CHB分级的加重,HIF-1α在肝组织中的表达强度和范围逐渐加大,HA、TXB2逐渐上升(均P＜0.05),6-Keto-PGF1α逐渐下降.电镜示肝窦腔内红细胞聚集,肝窦阻塞和狭窄明显,狄氏腔中胶原纤维沉积及基底膜形成率逐步加重.结论 HIF-1α、HA、TXB2及6-Keto-PGF1α联合检测能较好地反映肝脏微循环状况.     

Late Outcome of Spinal Cord Stimulation for Unreconstructable and Limb-threatening Lower Limb Ischemia

OBJECTIVES: To determine whether the initial benefits of spinal cord stimulation (SCS) treatment for critical limb ischemia (CLI) persist over years. DESIGN: Analysis of data prospectively collected for every CLI patient receiving permanent SCS. Follow-up range 12 to 98 months (mean 46+/-23, median 50 months). POPULATION: 87 patients (28% stage III, 72%stage IV) with unreconstructable CLI due (83%) or not (17%) to atherosclerosis and with an initial sitting/supine transcutaneous pO2 gradient >15 mmHg. METHODS: Assessment of actuarial patient survival (PS), limb salvage (LS) and amputation-free patient survival (AFPS). Analysis of the impact of 15 risk factors on long-term outcomes using the Fischer's exact test for categorical variables and the t test for continuous variables. RESULTS: Follow-up was complete for patient and limb survival. A single non-atherosclerotic patient died during follow-up. Among atherosclerotic patients PS decreased from 88% at 1y, to 76% at 3y, 64% at 5y and 57% at 7y. LS reached 84% at 1y, 78% at 2y, 75% at 3y and remained stable thereafter. Diabetes was found to affect LS (p<0.05) and heart disease to reduce PS (p<0.01). AFPS was reduced in heart patients (p<0.01), diabetics (p<0.05) and in patients with previous stroke (p<0.05). CONCLUSIONS: In CLI patients the beneficial effects of SCS persist far beyond the first year of treatment and major amputation becomes infrequent after the second year.     

莨菪类药物治疗重症手足口病微循环障碍65例分析

目的 分析莨菪类药物治疗重症手足口病微循环障碍的临床疗效,探讨治疗重症手足口病微循环障碍的有效方法。方法 采用回顾l生分析的方法对笔者所在医院收治的重症手足口病微循环障碍的65例患儿的相关信息进行分析。结果 重症手足口病微循环障碍临床发生率高,严重影响患儿预后。及时应用莨菪类药物治疗能迅速改善微循环,缓解病情,改善预后,达到良好临床效果。结论 莨菪类药物治疗重症手足口病微循环障碍临床疗效显著,不良反应轻微,能显著提高治愈率,降低病死率。     

微循环阻力指数对2型糖尿病患者冠状动脉微循环障碍的评价作用

目的:探讨微循环阻力指数(index of microcirculatory resistance,IMR)在评价2型糖尿病患者冠状动脉微循环障碍中的作用。方法:选择2型糖尿病、非糖尿病患者各30例,设为糖尿病组和非糖尿病组。检测2组患者的血浆高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP),并采用压力导丝检测其冠状动脉(左前降支)IMR值。结果:糖尿病组hs-CRP、充血状态下冠状动脉IMR值明显高于非糖尿病组(P0.01)。2组患者的hs-CRP与IMR呈正相关(r=0.657,P0.01)。结论:糖尿病患者较非糖尿病患者更易出现冠状动脉微循环障碍,可能与糖尿病患者更易发生炎性反应有关。压力导丝测定IMR能较准确、敏感地反映2型糖尿病患者的冠状动脉微循环情况。     

川芎嗪改善宫颈微循环治疗宫颈糜烂

川芎嗪改善宫颈微循环治疗宫颈糜烂艾旭＊郭萍＊张俊霞子宫颈糜烂与宫颈癌的发生有关，故对其治疗广受重视。我们采用活血化瘀的方法改善宫颈局部微循环，并佐以消炎的药物治疗宫颈糜烂取得较满意的效果。１资料与方法临床资料：９０例患者为妇科门诊病人，生育年龄。有生...     

胰腺微循环的解剖和生理

目的:揭示胰腺微循环的解剖学特征、动力学特点及相关的机能和临床意义.方法:采用保留动态和组织信息于静态样本的微循环光镜和扫描电镜研究法、FITC红细胞标记胰腺微循环活体荧光显微观察法,对猴、狗、鼠、兔胰腺微循环通道的构筑特征、胰腺活体微循环的动力学特点进行了研究.结果:①胰腺小叶内动脉与小叶内静脉之间包括了胰腺内分泌部和外分泌部两极毛细血管床;②胰腺门脉循环流向是由内分泌部流向外分泌部;③胰腺小叶多由独支的小叶内动脉供血,相邻小叶内动脉及其分支间无吻合存在,属终末动脉;④生理状态下胰腺微循环表现为稳定的毛细血管灌注形式,灌流量约1.18±0.05nl/min;急性胰腺炎早期出现FITC-RBC流量减少、微循环灌流不足和机能毛细血管密度减少.结论:胰腺小叶为胰腺微循环形态与机能的基本单位:胰岛-腺泡门脉循环是胰腺微循环的基本特征;胰腺小叶内动脉具终末动脉的特性,是急性胰腺炎局部微循环紊乱的解剖学基础.     

糖尿病大鼠肺脏微循环通透性的变化及其意义

目的观察实验性糖尿病大鼠肺脏微血管通透性的变化,为临床提供糖尿病肺病的形态学依据。方法雄性SD大鼠共60只,体重(220±20)g,按65 mg/kg的剂量一次性腹腔注射链脲菌素(STZ)来制备糖尿病大鼠模型,在成模即刻(0周)、成模后2、4、8、12周时分别随机抽取12只,通过干湿重法、尾静脉注入伊文思蓝(EB)并心脏灌注后在分光光度计下测肺组织OD值以及荧光显微镜下测其荧光量来了解肺脏微血管的通透性。另随机抽取12只大鼠作为正常组。结果①与正常组比较,0周组、2周组糖尿病大鼠肺组织的干湿重稍有增加,但差异无统计学意义(P>0.05)。而4周组、8周组和12周组糖尿病大鼠出现了组织干湿重明显增加,差异有统计学意义(P<0.05)。②与正常组相比较,0周组、2周组糖尿病大鼠肺组织EB含量稍有增加,但差异无统计学意义(P>0.05)。从4周开始,糖尿病大鼠出现肺组织EB含量明显增加,差异有统计学意义(P<0.05)。③荧光显微镜下观察肺腑组织荧光量可见4、8、12周组大鼠肺脏组织出现较强的红色荧光。结论糖尿病导致大鼠肺脏微血管通透性发生了变化。     

D-dimer as marker for microcirculatory failure: correlation with LOD and APACHE II scores

The relevance of plasma d-dimer levels as marker for morbidity and organ dysfunction in severely ill patients is largely unknown. In a prospective study we determined d-dimer plasma levels of 800 unselected patients at admission to our intensive care unit. In 91% of the patients' samples d-dimer levels were elevated, in some patients up to several hundredfold as compared to normal values. The highest mean d-dimer values were present in the patient group with thromboembolic diseases, and particularly in non-survivors of pulmonary embolism. In patients with circulatory impairment (r=0.794) and in patients with infections (r=0.487) a statistically significant correlation was present between d-dimer levels and the APACHE II score (P<0.001). The logistic organ dysfunction score (LOD, P<0.001) correlated with d-dimer levels only in patients with circulatory impairment (r=0.474). On the contrary, patients without circulatory impairment demonstrated no correlation of d-dimer levels to the APACHE II or LOD score. Taking all patients together, no correlations of d-dimer levels with single organ failure or with indicators of infection could be detected. In conclusion, d-dimer plasma levels strongly correlated with the severity of the disease and organ dysfunction in patients with circulatory impairment or infections suggesting that elevated d-dimer levels may reflect the extent of microcirculatory failure. Thus, a therapeutic strategy to improve the microcirculation in such patients may be monitored using d-dimer plasma levels.     

复方脑栓1号对血细胞解聚效应的实验研究

选用金黄地鼠，从足背静脉注射大分子右旋糖酐的方法，复制以血 细胞聚集为基础的微循环障碍动物模型，然后注射“复方脑桂１号”和“维脑路通”。 通过显微电视录像系统将图像放大约８００倍，观测体内与体外血细胞聚集－解聚 动态变化过程，并作定性定量分析．纶果表明：“复方脑栓１号”对体内外血细胞有 明显的解聚作用（治疗作用）和抑制血细胞的聚集效应（预防作用）且均优于常用 药“维脑路通”．