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目的比较国内与国际诊断标准对新生儿缺氧缺血性脑病(HIE)的诊断价值。方法2002-01—2004-06,对山东曹县人民医院以国内标准诊断的126例HIE重新以国际标准进行回顾诊断,并加以比较。结果126例中按国际标准,诊断符合率为80.16%(P<0.01),胎龄≥37周和<37周HIE诊断符合率分别为86.13%(P<0.01)和57.14%(P<0.01),日龄≤3d,～7d及>7d诊断符合率分别为75.00%(P<0.01)、84.38%(P<0.05)及94.44%(P>0.05),病情轻度、中度及重度诊断符合率分别为73.44%(P<0.01)、87.18%(P<0.05)及95.65%(P>0.05)。结论国内标准太偏松,易使HIE诊断扩大化,国际标准太严,易使HIE诊断发生漏诊,二者相结合,更科学合理,更适于国情。     

Separating the direct effect of hypoxia from the indirect effect of changes in cardiac output on the maximum pressure difference across the tricuspid valve in healthy humans

In healthy humans, changes in cardiac output are commonly accommodated with minimal change in pulmonary artery pressure. Conversely, exposure to hypoxia is associated with substantial increases in pulmonary artery pressure. In this study we used non-invasive measurement of an index of pulmonary artery pressure, the maximum systolic pressure difference across the tricuspid valve (P_max), to examine the pulmonary vascular response to changes in blood flow during both air breathing and hypoxia. We used Doppler echocardiography in 33 resting healthy humans breathing air over 6–24 h to measure spontaneous diurnal variations in P_max and cardiac output. Cardiac output varied by up to ~2.5 l/min; P_max varied little with cardiac output [0.61±0.74 (SD) mmHg min l^–1]. Eight of the volunteers were also exposed to eucapnic hypoxia (end-tidal ) for 8 h. In this group P_max rose progressively from 21 mmHg to 37 mmHg over 8 h. By comparing diurnal variations in P_max during air breathing with changes in P_max during hypoxia in the same eight individuals, we concluded that only approximately 5% of the changes in P_max during hypoxia could be attributed to concurrent changes in cardiac output. The low sensitivity of P_max to changes in cardiac output makes it a useful index of hypoxic pulmonary vasoconstriction in healthy humans.     

Oxygen consumption of the chicken embryo: interaction between temperature and oxygenation

We measured the effects of hypoxia and changes in ambient temperature (T) on the oxygen consumption (VO2) of chicken embryos at embryonic days 11, 16 and 20 (E11, E16 and E20, respectively), and post-hatching day 1 (H1). Between 30 and 39 degrees C, at E11 and E16, VO2 changed linearly with T, as in ectothermic animals, with a Q10 of about 2.1. At E20, VO2 did not significantly change with T, indicating the onset of endothermy. At H1, a drop in T increased VO2, a clear thermogenic response. Hypoxia (11% O2 for 30 min) decreased VO2, by an amount that varied with T and age. At H1, hypoxia lowered VO2 especially at low T. At E20, hypoxic hypometabolism was similar at all T. At E11 and E16, hypoxia lowered VO2 only at the higher T. In fact, at E11, with T=39 degrees C even a modest hypoxia (15-18% O2) decreased VO2. Upon return to normoxia after 40 min of 11% O2, VO2 did not rise above the pre-hypoxic level, indicating that the hypometabolism during hypoxia did not generate an O2 debt. At E11, during modest hypoxia (16% O2) at 36 degrees C, the drop in VO2 was lifted by raising the T to 39 degrees C, suggesting that the hypoxic hypometabolism at 36 degrees C was not due to O2-supply limitation. In conclusion, the hypometabolic effects of hypoxia on the chicken embryo's VO2 depend on the development of the thermogenic ability, occurring predominantly at high T during the early (ectothermic phase) and at low T during the late (endothermic) phase. At E11, both low T and low oxygen force VO2 to drop. However, at a near-normal T, modest hypoxia promotes a hypometabolic response with the characteristics of regulated O2 conformism.     

音乐疗法对幼儿缺氧缺血性脑病恢复期听力影响的疗效观察

目的观察音乐疗法治疗幼儿缺氧缺血性脑病恢复期听力的疗效。方法 2013年6月至2015年6月钟祥市妇幼保健计划生育服务中心儿科收治的缺氧缺血性脑病正处于恢复期有明显听力障碍的患儿228例,随机分为观察组和对照组各114例。对照组采用高压氧联合肌内注射单唾液酸四己糖神经节苷脂进行治疗,观察组对照组治疗基础上加入音乐疗法,每天听音乐4次,每次20min,治疗1个月对比两组患儿听力改善情况。结果观察组治疗总有效率为92.1%(105/114),显著高于对照组69.3%(79/114),差异有统计学意义(P0.05)。在音乐治疗过程中所有患儿无任何反抗、排斥、痛苦等不良反应。结论与常规治疗方式相比,联合使用音乐疗法能够显著提升缺氧缺血性脑病恢复期有听力障碍患儿的听力恢复效果,且治疗方式简单易行、治疗内容柔和、易于被幼儿接受、无副反应。     

低氧预处理通过激活低氧诱导因子1α增强老年人骨髓间充质干细胞促血管新生能力

目的 探讨低氧预处理对老年人骨髓间充质干细胞(hBMSCs)促血管新生能力的影响,为改善老年患者自体干细胞移植治疗缺血性心肌损伤疗效提供支持.方法 老年hBMSCs经过低氧预处理后,倒置相差显微镜下摄片观察细胞形态,流式细胞术检测细胞表面标志物,并进行成骨、成脂诱导分化检测其分化潜能.随后收集青年hBMSCs常氧培养基...     

三七皂苷单体R1 抑制低氧高二氧化碳诱导的肺动脉平滑肌细胞p38 MAPK信号通路的活化

目的: 探讨三七皂苷单体R₁(R₁)减轻低氧高二氧化碳(CO₂)性肺动脉收缩的作用及其与p38 MAPK信号通路的关系。方法: 原代培养雄性SD大鼠肺动脉平滑肌细胞(PASMCs),取第2至5代对数生长期细胞至低氧高CO₂(1% O₂, 6% CO₂)条件下继续培养,并分别用8、40、100 mg/L R₁ 孵育24 h后收集细胞,采用免疫印迹法测定p38 MAPK磷酸化蛋白表达,半定量RT-PCR检测p38 MAPK mRNA的表达。结果: Western blotting和RT-PCR结果显示,低氧高CO₂组p-p38 MAPK蛋白和p38 MAPK mRNA表达明显高于对照组(N)组(P<0.01)。与低氧高CO₂组相比,R₁(8、40、100 mg/L)不同程度抑制了p-p38 MAPK蛋白和p38 MAPK mRNA的表达(P<0.01),并呈剂量依赖关系。结论: 低氧高CO₂诱导PASMCs p38 MAPK活化,三七皂苷单体R₁可能通过抑制p38 MAPK通路减轻低氧高CO₂性肺动脉收缩。     

核转录因子-κB在缺氧预处理抑制心肌细胞凋亡中的作用

目的 :研究缺氧预处理 (hypoxicpreconditioning ,HPC)对于心肌细胞蛋白激酶C(PKC)和核转录因子κB (NF κB)表达的影响 ,及其在缺氧复氧诱导心肌细胞凋亡中的作用。方法 :在培养的SD乳鼠心肌细胞制作缺氧 /复氧 (H/R)模型 ,以荧光素染料Hoechst3 3 2 5 8测定心肌细胞凋亡率 ;制备心肌细胞蛋白提取物 ,以新PKCε亚型 (nPKCε)特异性抗体测定nPKCε相对蛋白含量 ;以抗NF κB抗体检测NF κB的表达 ;并以PKC抑制剂H7与心肌细胞预孵育后 ,观察H7对于HPC诱导的PKC和NF κB表达上调以及心肌细胞保护作用的影响。结果 :缺氧复氧造成心肌细胞凋亡 ,HPC可以降低心肌细胞H/R后凋亡率 ,并诱导nPKCε和NF κB表达上调 ;PKC抑制剂H7可以消除HPC诱导的PKC、NF κB表达上调和心肌细胞保护作用。结论 :HPC可以提高乳鼠心肌细胞对于H/R的耐受性 ,其机制涉及PKC介导的NF κB表达上调。     

Simultaneous recording of ATP-sensitive K+ current and intracellular Ca2+ in anoxic rat ventricular myocytes. Effects of glibenclamide

We investigated the temporal relationship between the adenosine triphosphate-sensitive K current (K _ATP current), hypoxic shortening and Ca accumulation in cardiomyocytes exposed to anoxia or metabolic inhibition. Whole-cell, patch-clamp experiments were performed with nonstimulated isolated rat heart ventricular muscle cells loaded with the Ca-sensitive fluorescent dye 1-[2-(5-carboxyoxazol-2-yl)-6-aminobenzofuran-5-oxy]-2-(2′-amino-5′-methylphenoxy) ethane-N,N,N′,N′-tetraacetic acid (fura-2) via the patch pipette. After approximately 8 min anoxia, the K _ATP current started to rise and reached a maximum of 21.3 ± 3.7 nA (n = 5, recorded at 0 mV clamp potential) within 1–3 min. At that time hypoxic contracture also occurred. Resting cytoplasmic free calcium (Ca_i) did not change significantly before hypoxic shortening. After hypoxic contracture, the K _ATP current decreased and Ca_i started to rise, reaching about 1 μmol/l. The presence of glibenclamide (10 μmol/l) in the bath reduced the anoxia-induced K _ATP current by more than 50%, but did not significantly influence the time dependence of current, hypoxic shortening and Ca_i, or the magnitude of Ca_i. Metabolic inhibition with 1.5 mmol/l CN resulted in K _ATP current increase and hypoxic shortening, occurring somewhat earlier than under anoxia, but all other parameters were comparable. In non-patch-clamped cells loaded with fura-2 AM ester and field-stimulated with 1 Hz, 1 μmol/l glibenclamide had no significant effect on the magnitude of the Ca_i increase caused by exposure of the cells to 1.5 mmol/l CN⁻. After CN⁻ wash-out in non-patch-clamped cells, Ca_i declined, oscillated and finally returned to control values. It can be concluded that glibenclamide inhibits anoxia-induced K _ATP currents only partially and has no significant effect on anoxia-induced rise in resting Ca_i. Received: 3 November 1995/Received after revision: 9 January 1996/Accepted: 16 January 1996