钾通道阻滞剂对大鼠支气管平滑肌细胞增殖的影响

目的探讨电压依赖性延迟整流钾通道(K_V)、Ca²⁺激活钾通道(K_Ca)和ATP敏感性钾通道(K_ATP)对大鼠支气管平滑肌细胞(BSMC)增殖的影响。 方法应用免疫细胞化学、MTT微量比色分析法及流式细胞术,观察K_V,K_Ca和K_ATP对培养中大鼠BSMC增殖的影响。结果K_V阻断剂4-氨基吡啶(4-AP)显著促进大鼠BSMC增殖细胞核抗原的表达,提高BSMC吸光度值,使S+G₂M期细胞数显著增多,并显著提高基础状态下BSMC内Ca²⁺浓度,而K_Ca阻断剂四乙铵(TEA)和K_ATP阻断剂格列本脲(Glib)均无此效应。 结论大鼠BSMC K_V活性的抑制,可提高细胞内Ca²⁺浓度,促进细胞的增殖,而K_Ca和K_ATP对BSMC的增殖均无明显影响。     

声反射技术在测量正常人咽腔中的应用

目的 探讨正常人咽腔大小与阻塞性睡眠呼吸暂停病人发病机理的相互关系。方法 用声反射测量技术对24名健康志愿者的咽腔进行测量,咽腔面积测量是测量持续的缓慢呼气终末的肺总容量(Total Lung Capacity,TLC)和残余量(Residual Volume,RV),比较咽腔横断面积在男女成人肺容量的三个方面的表现:TLC,50％VC(50％ of vital Capacity)和RV。结果 男性咽腔面积在TLC6.4±1.3cm2,在50％VC5.4±0.9cm2和RV4.1±0.8cm2。女性咽腔面积在TLC4.8±0.6cm2,50％VC4.2±0.5cm2和RV3.7±0.6cm2。男女间不同的咽腔面积在TLC和50％VC中有显著的统计学意义,而在RV中无统计学意义。结论 (1)不同性别的咽腔面积与身体的尺寸大小有关。(2)在男女成人中显示咽腔面积随着肺容量的变化有相似的变化。(3)男性成人的咽腔面积随着年龄的增长而减小。     

肺炎克雷伯菌引起大鼠小气道上皮细胞损伤及与肺内α肿瘤坏死因子关系的探讨

目的探讨肺炎克雷伯菌引起大鼠小气道上皮细胞损伤及机制。方法将Wistar大鼠随机分为两组:对照组和感染组采用光镜动态观察小气道上皮细胞损伤改变。以免疫组化及原位分子杂交分析方法,检测小气道上皮细胞α肿瘤坏死因子(TNF-α)蛋白和TNF-αmRNA表达的变化。并用放射免疫分析法测定肺组织中TNF-α含量。结果显示感染组大鼠小气道上皮细胞病理改变明显。感染第2周起至第4周小气道壁各种炎症细胞增加,可见上皮细胞部分脱落坏死,损伤明显加重。感染组在2～4周TNF-αmRNA表达与对照组比较显著增强(P <0 .0 1)。在第4周TNF α蛋白明显增高(P <0 .0 1)。从第1周起肺组织中TNF-α含量增加并保持到第8周。结论肺炎克雷伯菌在体内可引起小气道上皮细胞损伤,肺内TNF-α水平升高与气道上皮细胞损伤程度平行。并且TNF-α蛋白和TNF-αmRNA表达上调在加重上皮细胞损伤中又具有重要作用     

鼻塞持续气道正压通气治疗新生儿呼吸衰竭临床观察

目的观察经鼻塞持续气道正压通气(N-CPAP)治疗新生儿呼吸衰竭的效果。方法应用STEPHANN-CPAP小儿呼吸机对30例危重新生儿进行经鼻塞持续气道正压通气呼吸支持治疗,观察治疗前后临床症状和血气变化。结果治疗有效25例,无效5例。治疗有效患儿使用N-CPAP时间12~96h,平均(32±4)h。并发症为鼻黏膜损伤,共12例。全部病例均治愈出院。结论N-CPAP治疗新生儿肺炎并呼吸衰竭及早产儿原发性呼吸暂停效果显著,是新生儿科一种简便易行、无创安全、疗效显著的呼吸支持设备。     

隐孔菌发酵物对脾虚证哮喘小鼠气道高反应性及炎症的影响

目的建立脾虚证哮喘小鼠模型,观察隐孔菌发酵物(CVFS)对脾虚证哮喘小鼠气道高反应性及炎症的影响。方法以卵白蛋白(OVA)致敏 饮食不节 劳倦过度伤脾法建立脾虚证哮喘小鼠模型;测定小鼠的肺阻力(RL)和支气管-肺泡灌洗液(BALF)中的炎症细胞,观察肺组织和免疫器官脾脏的病理变化。结果脾虚证哮喘小鼠的气道高反应性、BALF中的嗜酸性粒细胞数目,肺组织嗜酸性粒细胞炎性病理变化以及脾脏指数与单纯哮喘小鼠比较有明显差异(P<0.05)。CVFS能明显改善单纯哮喘小鼠和脾虚证哮喘小鼠由乙酰甲胆碱(MCH)诱导的气道高反应性,减少BALF中的嗜酸性粒细胞数目,以及改善肺组织嗜酸性粒细胞炎性病理变化,而对脾虚证哮喘小鼠作用更为明显。CVFS能明显增加脾虚证哮喘小鼠脾脏指数,而对单纯哮喘小鼠的脾脏指数无明显影响。结论OVA致敏 饮食不节 劳倦过度伤脾法可建立脾虚证哮喘小鼠模型;CVFS可明显改善脾虚症状,抑制脾虚证哮喘小鼠的气道高反应性和炎症反应,提示CVFS可用于临床脾虚证哮喘的治疗。     

A literature review of the prehospital use of neuromuscular blocking agents by air medical personnel to facilitate endotracheal intubation

Air medical personnel in the United States have used neuromuscular blocking agents to facilitate endotracheal intubation in the field for more than a decade. This literature review examines 15 studies to investigate their experience and explores the following specific areas: the intubation success rate in patients who did or did not receive these agents, the intubation success rate of air medical personnel before and after they incorporated these agents into their practice, the neuromuscular blocking agents and adjunct medications used by air medical personnel, and the disposition of patients who could not be intubated after an agent was given. The data suggest that, overall, air medical personnel use these agents safely and effectively. Suggestions are offered for future studies, including examining ground time when agents are used to facilitate intubation, complications of their use in this setting, and the use of simulators to train personnel in the administration of these medications.     

Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion

In a double-blind randomised study, we compared conditions during insertion of the laryngeal mask airway in 150 patients who received either fentanyl 1 microg.kg-1, mivacurium 0.04 mg.kg-1 or normal saline, before induction of anaesthesia with propofol 2 mg.kg-1. Insertion conditions, including mouth opening, swallowing, gagging or coughing, head or limb movement and ease of insertion, were each graded using a three-point scale. The median (interquartile range) summed insertion scores were more favourable with the use of fentanyl [8.0 (7.0-9.0)] and mivacurium [7.5 (6.8-8.3)] than with normal saline [9.0 (7.8-10.3); p < 0.01]. Fentanyl and mivacurium decreased swallowing and head or limb movement, and mivacurium improved mouth opening. Insertion conditions were similar between fentanyl and mivacurium, while both prolonged apnoea. Fentanyl and mivacurium are equally effective in facilitating insertion of the laryngeal mask airway following anaesthetic induction with propofol.     

Quantitative computer‐assisted digital‐imaging upper airway analysis for obstructive sleep apnoea*

This was a prospective study of a new objective method which quantitatively analyses the upper airways in patients with obstructive sleep apnoea (OSA). Video‐nasopharyngoscopic examinations of the upper airways of 45 patients were carried out with an endoscopic calibrator. Images of the upper airway during quiet respiration and Mueller's manoeuvre in erect and supine positions were digitized by computer to generate the actual dimensions of obstructive sites. Measurements by the new method were validated by comparing 90 pairs of videoendoscopic images with upper airway magnetic resonance imaging (MRI) measurements at two identical levels. Quantitative precision is 100% for the retropalatal level and 95.6% for the retrolingual level with a tolerance of 0.5 cm² between the two methods. The absolute mean of the difference between the two methods of measurement is 0.08 cm² at the retropalatal level and 0.18 cm² at the retrolingual level. The agreement between the digital‐imaging videoendoscopic and MRI measurements was 93.3% for the retropalatal level and 95.6% for the retrolingual level. Quantitative computer‐assisted digital imaging is a reliable, cost‐effective clinical method of upper airway evaluation in OSA patients. This method allows us to examine the dynamic and static morphology objectively, measure surgical outcomes of upper airway, opening up new avenues for OSA management.     

Influence of Danshen Injection on airway inflammation and CD4^＋CD25^＋ regulatory T cells of asthmatic rats

Objective： To investigate the influence of Danshen Injection on airway inflammation and CD4^＋CD25^＋ regulatory T cells（CD4^＋CD25^＋ Tr） of asthmatic rats, and elucidate the possible mechanism of Danshen Injection in treatment of asthma. Methods： 30 Wister rats were randomly divided into control group, asthma group and Danshen Injection treated group. Bronchoalveolar lavage fluids （BALF） were collected, and cytology studies were conducted. Lung tissues were obtained and pathologic analyses were done with hematoxylin and eosin stain （HE）. Flow cytometry was used to detect the CD4^＋CD25^＋ Tr ratio in peripheral blood mononuclear cells （PBMCs）. Results： Total cell, the percentage of lymphocytes, neutrophils and eosinophils （Eos） in BALF of Danshen Injection-treated group were lower than that in asthma group （P〈0.05, P〈0.01）. Compared with asthma group, less infiltration of inflammatory cells in lung tissues was observed in Danshen Injection-treated group. CD4^＋CD25^＋ Tr of asthma group was lower than that of control and Danshen Injection treated group （P〈0.05）. Conclusion： Danshen Injection can suppress airway inflammation of asthmatic rats, probably by increasing the number of CD4^＋CD25^＋ Tr.     

大剂量盐酸氨溴索联合新型鼻罩持续呼吸道正压通气治疗新生儿呼吸窘迫综合征

目的探讨大剂量盐酸氨溴索(沐舒坦)联合新型鼻罩持续呼吸道正压通气治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法选择NRDS患儿114例,随机分成治疗组(n=58)和对照组(n=56),两组在相同综合治疗的基础上,对照组予头罩吸氧(氧流量4~6 L/min),治疗组予大剂量沐舒坦30 mg/(kg.d),分2次用5%葡萄糖注射液20 mL稀释后静脉滴注,并联合新型鼻罩持续呼吸道正压通气(NCPAP),其参数设定为流量6~8 L/min,吸入氧浓度(FiO2)0.4~0.6,压力为5~8 cm H2O,观察两组治疗后12及48 h的临床表现及血气变化,比较pa(O2)及pa(CO2)及pa(O2)/FiO2的变化。结果治疗组44例经治疗12 h及48h后,呼吸困难和呻吟明显减轻或消失,血pa(O2)升高,pa(CO2)下降,氧合参数明显增加,其中以胸片RDS分级Ⅰ及Ⅱ级效果较佳,Ⅲ及Ⅳ级效果较差;治疗组总有效率75.8%,而对照组为26.7%,两组疗效及血气、氧合指数比较均有显著性差异。结论大剂量沐舒坦联合新型鼻罩持续呼吸道正压通气能改善通气及氧合,对新生儿RDS有较好的疗效,尤其对胸片RDS分级Ⅰ级及Ⅱ级的患儿,早期应用可避免气管插管,减少机械通气率。