硫普罗宁在大鼠急性坏死性胰腺炎引发肺损伤中抗氧化作用

 目的　探讨硫普罗宁在急性坏死性胰腺炎(ANP)时在肺组织中抗氧化作用。方法　大鼠随机分为A组生理盐水组 ;B组硫普罗宁处理组;C组假手术组。各组大鼠检测肺组织内超氧化物歧化酶(SOD)、丙二醛 (MDA)含量;观察光镜下胰腺组织、电镜下肺组织形态学改变。结果　B组肺组织SOD含量明显低于C组 ,高于A组 ;B组肺组织丙二醛含量均明显高于C组,低于A组;B组胰腺组织及肺组织病理改变较A组减轻,腹水量亦少于A组。结论　ANP时肺组织SOD减少,MDA含量增加明显;在ANP时外源性疏基物质可作为氧自由基清除剂在减轻肺组织氧化应激反应中发挥作用。     

Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial

Blood isotone contrast media is considered to be less toxic to vascular and pancreatic duct endothelium than high-osmolar contrast media. In this study we assessed the impact of a low-osmolar contrast agent compared with a blood isotone product on pancreatic damage induced by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde sphincterotomy (EST). In a prospective trial 42 consecutive ERCP/EST patients were randomized to receive either iopromid, a low-osmolar non-ionic contrast agent (770 mosmol/kg H₂O), or iotrolan, a blood-isotone non-ionic product (320 mosmol/kg H₂O). The endoscopies were performed by two experienced endoscopists. Forty patients were included in the study. Blood samples were collected before and 40 min, 2, 4, 6 and 24 h after the endoscopic procedure. Samples were analysed for pancreatic serum enzymes, acute-phase proteins and blood counts. A clinical pain score was investigated. Post-ERCP pancreatitis was diagnosed in 2 patients in the iopromid group and in 5 patients in the iotrolan group. There was no significant difference between groups in the time course of pancreatic serum enzymes, acute-phase proteins or in the pain score. Due to the small number of patients in this study, only stronger differences caused by the two contrast media could have led to statistically significant results. We did not observe statistically significant differences in comparing iotrolan and iopromid concerning ERCP/EST-induced pancreatic damage. Received: 26 February 1999; Revised: 14 May 1999; Accepted: 9 June 1999     

热休克蛋白70对急性坏死性胰腺炎大鼠肺损伤保护作用的实验研究

目的探讨热休克蛋白70(Hsp70)对急性坏死性胰腺炎(ANP)大鼠肺损伤的保护作用。方法温生理盐水(42~43℃)持续灌洗大鼠腹腔30 m in诱导胰腺组织高表达Hsp70,10 h后诱导大鼠急性胰腺炎(AP),术后6、12 h检测血清和肺组织TNF-α水平,肺湿重系数,肺泡灌洗液中蛋白含量和细胞数,肺组织常规病理评分及Hsp70免疫组化病理改变。结果与ANP组相比,42℃生理盐水腹腔持续灌洗预处理能明显降低SNP术后6 h和12 h的血清和肺组织TNF-α水平(P<0.05),并降低肺湿重系数、肺泡灌洗液中蛋白含量和细胞数水平以及肺组织常规病理评分(P<0.05)。结论Hsp70对SNP肺损伤有明显的保护作用,其机制可能是下调肺组织内TNF-α的表达。     

低氧诱导因子-1在重症急性胰腺炎大鼠脑损伤中的作用

目的观察脑组织低氧诱导因子-1(HIF-1)与重症急性胰腺炎(SAP)大鼠脑损伤的相关性,及生长激素和生长抑制激素联合治疗SAP脑损伤的疗效。方法经胰胆管逆行注射3．5％牛磺胆酸钠(2．5 mL／kg体重)建立大鼠SAP模型,分成SAP模型组、生长抑制激素治疗组、生长激素治疗组、联合治疗组和0．9％氯化钠溶液组;另设假手术对照组。观察各组大鼠的血清炎性介质、内毒素和磷脂酶A2的变化,以及相应的脑组织电子显微镜下表现、脑损伤指标(脑水肿、血脑屏障和细胞凋亡)及脑组织HIF-1表达水平。结果SAP模型组大鼠血清的炎性介质、内毒素和磷脂酶A2表达水平显著高于假手术对照组(P值均<0．01),电子显微镜示脑组织超微结构损伤严重,脑损伤指标亦显著升高(P<0．01);联合治疗组大鼠血清炎性介质和脑组织HIF-1表达水平均较SAP模型组显著降低(P值均<0．01),脑损伤程度亦显著减轻(P<0．01)。结论与假手术对照组相比,SAP模型组炎性介质显著升高,脑组织HIF-1表达过度增强,血脑屏障通透性、脑水肿和脑细胞凋亡均显著升高。生长激素和生长抑制激素联合治疗显著降低SAP大鼠炎性介质和脑组织HIF-1的表达,脑损伤程度亦相应减轻。     

Acute Pancreatitis and Cholecystitis Associated with Postpartum HELLP Syndrome: A Case and Review

We report a case of preeclampsia associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and concomitant nonbiliary acute pancreatitis and cholecystitis in the first postpartum day. A thorough investigation ruled out known etiologies of both pancreatitis and cholecystitis. Following conservative treatment, the patient's HELLP syndrome, pancreatitis, and cholecystitis resolved on the third postpartum day. Preeclampsia is associated with microvascular abnormalities that may involve the splanchnic circulation. These abnormalities may cause not only HELLP syndrome but also pancreatitis and cholecystitis. Recognizing that ischemia can damage not only the liver but also the pancreas and gallbladder, could result in improvements in the diagnosis and management of pancreatitis in patients with preeclampsia.     

重症急性胰腺炎113例病因及预后分析

目的 分析重症急性胰腺炎(SAP)的病因及预后,为防治急性胰腺炎提供依据.方法 回顾性分析113例SAP的病因、性别、年龄、住院天数以及预后情况.结果 113例SAP中,胆源性36例(31.88％)、酒精性48例(42.48％)、特发性10例(8.85％)、高脂血症性13例(11.50％)、混合性6例(8.31％).男∶女=2.65∶1,差异有统计学意义(x2=41.4968,P＜0.01).各类患者年龄分别为:(61.89±11.32)、(45.73±9.70)、(45.20±10.92)、(53.23±8.52)、(56.27±8.53)岁,差异有统计学意义(F=14.6,P＜0.01)；各类患者住院天数分别为:(21.11±11.50)、(19.54±16.57)、(16.00±5.19)、(21.61±8.02)、(10.83 ±9.64)d,差异无统计学意义(P＞0.05)；各组的治愈好转率及病死率之间差异均无统计学意义(均P＞0.05).结论 SAP病因大部分为胆源性及酒精性,而以酒精性为最多；胆源性SAP多为老年患者,酒精性、特发性、高脂血症性SAP患者多为中青年.尽管差异不明显,但酒精性及混合性SAP病死率较高.     

急性胰腺炎早期肠内营养研究进展

急性胰腺炎是临床常见的急危重症,病死率高,恰当的营养支持在机体高代谢及负氮平衡状态下可降低感染率及病死率,是我们一直关注的热点。过去,我们主张通过禁食让胰腺获得休息,从而改善疾病预后。但是,目前越来越多的试验研究表明,相比禁食早期肠内营养让胰腺炎病人获益显著。接下来我将从肠道屏障功能障碍、肠内营养途径、启动时间、营养制剂及营养量的选择等方面就急性胰腺炎早期肠内营养的最新进展作一综述。     

地塞米松治疗重症急性胰腺炎大鼠胰性脑病的研究

【目的】探讨地塞米松治疗重症急性胰腺炎（SAP）大鼠胰性脑病的治疗效果。【方法】将实验用大鼠随机分成3组，采用改良AhoS法制作SAP模型。A组为地塞米松治疗组：SAP制模后3h给予大鼠地塞米松治疗；B组为SAP大鼠空白对照组、C组为假手术组。分别检测各组模型制作成功后24h的血清髓鞘碱性蛋白（MBP），血清淀粉酶（AMS）、白细胞介素-6（IL-6）水平及脑水含量和脑组织细胞超微结构的变化。【结果】B组中大鼠血清AMS、MBP、IL-6、脑水含量水平显著高于C组与A组，且差异均有显著性（P均〈0．05）。C组大鼠脑细胞超微结构正常，无病变；B组大鼠神经元细胞核出现明显的边集现象，线粒体、内质网均出现不同程度的变性；A组大鼠脑细胞线粒体有轻度肿胀，细胞核、内质网无异常。【结论】地塞米松可有效的控制SAP炎症的发生扩散，降低胰性脑病发生率。     

联用灯盏花素选择性动脉介入治疗老年重症急性胰腺炎的临床观察

目的：观察联用灯盏花素选择性动脉介入治疗老年重症急性胰腺炎患者的临床疗效。 方法：将60例老年SAP患者（年龄≥60岁）随机分为观察组（32例）和对照组（28例），对照组采用奥曲肽与抗生素持续性胰腺区域动脉灌注，观察组采用以上灌注药物加用灯盏花素持续性胰腺区域动脉灌注，比较两组治疗效果。 结果：治疗7 d后，两组APACHE II评分均较治疗前降低（均P<0.05），但观察组的APACHE II评分明显低于对照组（P<0.05）；两组血清肿瘤坏死因子α（TNF-α）、白介素6（IL-6）水平均较治疗前明显降低（均P<0.05），但观察组两者的下降程度大于与对照组（均P<0.05）。观察组总并发症发生率明显低于对照组（34.38% vs. 60.71%，P<0.05），观察组中转手术率与病死率均低于对照组（12.5% vs. 21.5%；9.38% vs. 14.29%），但差异无统计学意义（均P>0.05）。 结论：联用灯盏花素选择性动脉介入治疗老年SAP具有良好的疗效。