经皮氧分压监测在脓毒性休克患者中的临床应用

脓毒症和脓毒性休克是ICU患者最常见的死亡原因之一。液体治疗是治疗脓毒性休克的重要手段之一，如何进行液体治疗仍然存在很大争议，目前普遍以容量反应性来指导液体治疗。但也有学者发现，即使宏观血流动力学恢复，微循环仍可能存在障碍。休克的本质是微循环障碍，如何监测微循环状况及利用微循环监测对脓毒性休克患者进行早期诊断、病情评估，以及指导液体治疗可能是今后研究的方向。经皮氧分压（TcPO₂）监测技术是通过无创方法将皮肤表面电极加热来估测组织氧分压的技术手段。越来越多的学者研究发现TcPO₂在监测脓毒症和脓毒性休克患者局部组织灌注不足、预测患者预后、指导液体治疗等方面有重要的临床价值。因此本文对TcPO₂在脓毒性休克中的应用进行整理和总结。     

Amygdalin improves microcirculatory disturbance and attenuates pancreatic fibrosis by regulating the expression of endothelin-1 and calcitonin gene-related peptide in rats

Background

The pathogenesis of chronic pancreatitis (CP) is a complex process of interaction between tissue injury and repair, which involves microcirculatory disturbance. Amygdalin, an effective component extracted from Semen Persicae (a kind of Chinese herbal medicine), can decrease blood viscosity and improve microcirculation. In this study, we investigated the therapeutic effects of amygdalin on pancreatic fibrosis in rats with CP.

电针对大鼠海马CA1区微循环血流量的影响

目的 研究电针对大鼠海马CA1区微循环血流量的影响。方法 采用激光多普勒微循环血流分析仪，实时监测大鼠双侧海马CA1区微循环血流量，研究电针人中、内关以及曲池、足三里对大鼠海马微循环的影响，并与电针地机、空白组对照。结果 电针人中、内关可使大鼠双侧海马CA1区微循环血流量升高，与同组同侧电针前相比差异具有显著性（P〈0．05）；电针曲池、足三里可使大鼠双侧海马CA1区微循环血流量降低，与同组同侧电针前相比差异具有显著性（P〈0．05）。结论 电针人中、内关可促进大鼠海马CA1区微循环血流量；电针曲池、足三里可降低大鼠海马CA1区微循环血流量。     

颅脑损伤与微循环障碍的实验研究

目的:研究颅脑损伤后的微循环障碍,借以讨论临床某些病人的脑功能紊乱。方法:用两种方法进行研究,一是压迫静脉造成颅内高压模型;另一种是应用荧光素钠作脑血管造影,观察脑外伤后荧光素自脑微血管内向外渗漏的范围。用家兔作实验,通过颅骨窗观察脑软膜的微循环变化。结果:高颅内压时脑微循环停流,当颅内压降低时脑微循环流态正常,无论微血流停流或复流过程均无粒摆流。脑外伤后荧光素自脑微血管中向外渗漏,标识出脑损伤的范围。结论:脑微循环障碍是颅高压的合并症,荧光素自脑微血管向脑组织通道渗漏可显示脑外伤的范围,对脑外伤后某些综合病征和后遗症有诊断价值。     

电针对局灶性脑缺血大鼠脑葡萄糖代谢的影响

目的:探讨电针对局灶性脑缺血大鼠海马微循环和葡萄糖代谢的改善作用。方法:采用线栓法制备局灶性脑缺血模型大鼠,随机分为假手术对照组、模型组、内关组和地机组,电针治疗15天和30天,应用激光多普勒微循环血流仪检测电针对局灶性脑缺血大鼠海马微循环血流量的影响,采用酶化学法测定脑组织葡萄糖、乳酸及丙酮酸的含量研究电针对脑组织葡萄糖代谢的改善作用。结果:针刺治疗后,针刺内关组大鼠海马CA1区微循环血流量显著高于模型组和针刺地机组大鼠(P<0.05),针刺内关组大鼠脑组织内葡萄糖和丙酮酸的含量明显升高,乳酸含量降低,与模型组、针刺地机组有显著性差异(P<0.05),且30天组疗效好于15天组。结论:电针可明显提高MCAO大鼠海马CA1区的微循环血流量,通过微循环的改善进而增加缺血脑组织能量供应,改善缺血后组织细胞的葡萄糖代谢,减轻组织细胞的损伤,促进神经功能的恢复。     

Inducible osteonecrosis in a rabbit serum sickness model: Deposition of immune complexes in bone marrow

We established inducible osteonecrosis in a rabbit serum sickness model. Osteonecrosis with marrow necrosis could be induced by the intravenous injection of horse serum in two doses separated in time by a period of three weeks. In this model, osteonecrosis could be successfully produced in rabbit femoral metaphysis. The incidence of marrow necrosis was 45% (9 of 20 rabbits) and trabecular necrosis occurred in 6 of 20 rabbits (30%) at 7 days after the second injection of the horse serum. In bone marrow of the femoral metaphysis, extravasation of erythrocytes and the formation of microthrombi in arterioles were often observed in an early stage of the present model and both findings correlate well each other (p = 0.0001). Immune complexes could be demonstrated using immunohistochemistry in bone marrow of the femoral metaphysis as well as in glomeruli of the kidney. Extravasation of erythrocytes in bone marrow of the femoral metaphysis was observed in 8 of 12 (67%) cases with immune complex deposition in the sinusoidal space of the femoral metaphysis and in 12 of 21(57%) cases with immune complex deposition in glomeruli of the kidney. Immune complex deposition both in the sinusoidal space of femoral bone marrow (p = 0.0385) and in glomeruli of the kidney (p = 0.0209) closely related to extravasation of erythrocytes and microthrombi in arterioles in the early stage of this model. Early microcirculatory injury (extravasation of erythrocytes and microthrombi in arterioles) adjacent to osteonecrosis could be induced by immune complex deposition in femoral bone marrow and might be predictable characteristics for the inducible osteonecrosis in the present serum sickness model. The important findings in this study were that early microcirculatory injury was closely related to the deposition of immune complexes in femoral bone marrow, and that early microcirculatory injury associated with immune complex deposition was located close to osteonecrotic regions.     

心康胶囊对大鼠血液流变性及实验性微循环障碍的影响

心康胶囊对大鼠血液流变性及实验性微循环障碍的影响刘剑刚＊许秀森＊季颖＊谢雁鸣＊心康胶囊是以温阳活血为治则，由附子、土鳖虫、细辛、桂枝、元胡等中药配制而成的中药复方制剂［１］，其临床用于治疗阴虚血瘀证缓慢性心律失常有较好的临床疗效。为进一步探讨该药的活...     

Ultrastructural changes in the rat spinal cord after temporary occlusion of the thoracic aorta

Summary Occlusion of the aorta of the rat between the fourth and fifth thoracic vertebrae produces focal ischemic lesions of the gray matter of the lumbar spinal cord. Two types of lesions can be distinguished.Type A shows transient parapareses of the hind limbs due to diffuse injury of the lumbar gray matter, consisting of disseminated necrosis of small and middle sized neurons and reactive gliosis.Type B is characterized by irreversible spastic paraparesis due to necrosis of the center of the anterior horn, the zona intermedia and the posterior horn. The astroglia demonstrates characteristic reactions in the developing necrosis of the gray matter: retraction of processes with condensation of the perikaryon and segmentation or rupture of swollen processes leading to disintegration of the neuropil. Microcirculatory disturbances may intensify the tissue reactions in the postischemic period, initiating the focal necrosis of the central gray matter.     

实验性高胆固醇血症家兔血液流变性改变在微循环障碍中的作用

本文利用实验性高胆固醇血症家兔模型,研究了微循环灌流和血液流变性改变间关系。结果表明,微循环流量、流态、流速,微血管形态有明显改变,而这些变化与血清中胆固醇浓度,血浆粘度,全血粘度,红细胞聚集性及红细胞变形有着明显相关性。血液流变性变化构成此模型微循环障碍的基础。