缺血预处理对高原大鼠肝脏缺血/再灌注损伤早期的影响

目的:了解在高原缺血预处理(IPC)对肝脏缺血/再灌注损伤(I/R)早期保护作用及其机制.方法:SD大鼠45只随机分为3组:假手术组、缺血再灌注组、缺血预处理组.各组恢复血流后分别于1,3,6 h取血液标本,检测血清ALT(nkat/L)、丙二醛(MDA,mmol/L)、NO(μmol/L)的含量.结果:缺血预处理组NO的水平明显高于缺血再灌注组(1 h:95.8±10.1 vs 64.2±6.8,P＜0.01;3 h:91.2±9.7 vs 69.5±7.2,P＜0.01;6 h:77.4±8.6 vs 63.7±6.1,P＜0.01),低于假手术组;而ALT(1 h:2257.1±201.7 vs 2912.2±398.4,P＜0.01;3 h:2465.5±243.4 vs 3637.4±441.8,P＜0.01;2545.5±223.4 vs 4027.5±496.8,P＜0.01)、MDA(1 h:25.1±4.3 vs 38.7±7.6,P＜0.01;3 h:27.5±5.4 vs 45.3±8.8,P＜0.01;34.2±6.7 vs 53.2±10.5,P＜0.01)明显低于缺血再灌注组,高于假手术组.结论:在高原缺氧环境下,缺血预处理对大鼠肝脏缺血再灌注损伤有明显保护作用,其机制可能与缺血与预处理抑制肝脏脂质过氧化物的产生,提高内源性NO的产生,改善肝脏的微循环有关.     

歼击机飞行员高原驻训前后血常规指标调查

目的评价高原环境、飞行环境对静脉血细胞各参数的影响,为高原航空卫勤保障提供依据。方法使用五分类全自动血细胞分析仪,对2013年高原驻训的35例歼击机飞行员及40例地勤人员进行血常规分析,并对16项血细胞参数进行比较。结果歼击机飞行员和地勤人员在进驻高原后红细胞、血红蛋白浓度、红细胞压积均明显升高(P<0.01),红细胞平均血红蛋白浓度、血小板值、血小板压积明显降低(P<0.01)。此外,地勤人员的红细胞平均体积、红细胞体积分布宽度、平均血小板体积、血小板分布宽度高于进驻前(P<0.01),中性粒细胞升高、淋巴细胞下降(P<0.01)。在上述变化中,地勤人员的所有值均在正常范围内,而飞行员血红细胞数、血红蛋白浓度、红细胞压积、血小板压积则超出平原正常人群参考值范围。歼击机飞行因素可对红细胞及血小板的部分指标产生影响,高原环境影响红细胞、血小板及中性粒细胞中的几乎所有参数。结论高原环境、飞行因素均可影响血液中红细胞、白细胞和血小板,从而使得血常规中的各项参数发生变化。     

Early Warning of Acute Altitude Sickness by Physiological Variables and Noninvasive Cardiovascular Indicators

Objective To examine if the variations at sea level would be able to predict subsequent susceptibility to acute altitude sickness in subjects upon a rapid ascent to high altitude.Methods One hundred and six Han nationality male individuals were recruited to this research. Dynamic electrocardiogram, treadmill exercise test, echocardiography, routine blood examination and biochemical analysis were performed when subjects at sea level and entering the plateau respectively. Then multiple regression analysis was performed to construct a multiple linear regression equation using the Lake Louise Score as dependent variable to predict the risk factors at sea level related to acute mountain sickness (AMS).Results Approximately 49.05% of the individuals developed AMS. The tricuspid annular plane systolic excursion (22.0±2.66 vs. 23.2±3.19 mm, t=1.998, P=0.048) was significantly lower in the AMS group at sea level, while count of eosinophil [(0.264±0.393)×10⁹/L vs. (0.126±0.084)×10⁹/L, t=-2.040, P=0.045], percentage of differences exceeding 50 ms between adjacent normal number of intervals (PNN50, 9.66%±5.40% vs. 6.98%±5.66%, t=-2.229, P=0.028) and heart rate variability triangle index (57.1±16.1 vs. 50.6±12.7, t=-2.271, P=0.025) were significantly higher. After acute exposure to high altitude, C-reactive protein (0.098±0.103 vs. 0.062±0.045 g/L, t=-2.132, P=0.037), aspartate aminotransferase (19.7±6.72 vs. 17.3±3.95 U/L, t=-2.231, P=0.028) and creatinine (85.1±12.9 vs. 77.7±11.2 mmol/L, t=-3.162, P=0.002) were significantly higher in the AMS group, while alkaline phosphatase (71.7±18.2 vs. 80.6±20.2 U/L, t=2.389, P=0.019), standard deviation of normal-to-normal RR intervals (126.5±35.9 vs. 143.3±36.4 ms, t=2.320, P=0.022), ejection time (276.9±50.8 vs. 313.8±48.9 ms, t=3.641, P=0.001) and heart rate variability triangle index (37.1±12.9 vs. 41.9±11.1, t=2.020, P=0.047) were significantly lower. Using the Lake Louise Score as the dependent variable, prediction equation were established to estimate AMS: Lake Louise Score=3.783+0.281×eosinophil-0.219×alkaline phosphatase+0.032×PNN50.Conclusions We elucidated the differences of physiological variables as well as noninvasive cardiovascular indicators for subjects after high altitude exposure compared with those at sea level. We also created an acute high altitude reaction early warning equation based on the physiological variables and noninvasive cardiovascular indicators at sea level.     

西藏自治区某医院高原肺水肿住院患者治疗药物结构分析

目的：了解西藏高海拔地区高原肺水肿患者的人群特点和治疗药物结构特点,并分析其规律,为合理配置卫生资源制定科学的疾病治疗措施提供参考。方法：统计西藏自治区某医院2016年1月-2017年6月收治住院的HAPE患者相关信息进行回顾性分析。结果：基于研究医院数据显示,HAPE住院患者中男性明显多于女性,年龄分布集中在20~50岁。在用药种类数方面抗感染药物（17.14%）和中成药（15.71%）种类数较多,但在用药人次数上以消化系统药物（22.64%）、抗感染药物（19.91%）、心血管系统药物（18.56%）、呼吸系统药物（18.09%）为主。HAPE具体治疗药物主要为呋塞米、氨茶碱、地塞米松。结论：基于调查结果,西藏地区HAPE的患病人群和用药结构有一定特点,可为医疗行业在该疾病的治疗措施及药品储备上提供一定参考。     

模拟高原环境导致的低碳酸血症对家兔肺动脉压力的影响

目的 探讨模拟高原环境导致的低碳酸血症对家兔肺动脉压力的影响。方法 选择10只健康雄性家兔行气管插管、肺动脉插管并给予机械通气,通过调整呼吸机参数造成低碳酸血症。按照血气分析结果分为五个阶段,空白对照阶段、无低碳酸血症阶段、轻度低碳酸血症阶段、中度低碳酸血症阶段、重度低碳酸血症阶段。每个时间段先采集动脉和静脉血用于血气分析和血管紧张素Ⅱ（AngⅡ）测定,然后行平均肺动脉压力测定。结果 随着家兔PaCO2逐渐降低,家兔平均肺动脉压力和血清AngⅡ均明显降低,差异有统计学意义（P均〈0.05）。结论 模拟高原环境所导致的低碳酸血症能降低肺动脉压力,可能与血清AngⅡ水平降低有关。     

凋亡相关因子和肿瘤坏死因子-α介导的细胞凋亡及白介素-19、白介素-10在高原慢性肺心病发病中的作用

目的 探讨凋亡相关因子（Fas/Apo-1）和肿瘤坏死因子-α（TNF-α）介导的细胞凋亡及白介素-19（IL-19）、白介素-10（IL-10）在高原慢性阻塞性肺疾病（COPD）合并慢性肺心病（CCP）发病机制中的作用.方法 采用双抗体夹心ABC-ELISA法测定60例高原COPD合并CCP急性加重期患者（急性加重组）和稳定期57例患者（稳定组）血清Fas/Apo-1、TNF-α、IL-19、IL-10浓度;测定1 s用力呼气容积（FEV1％）占预计值百分比（FEV1％pred）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）,并与30例当地健康人（健康组）进行比较.结果 急性加重组和稳定组患者血清Fas/Apo-1、TNF-α、IL-19浓度和PaCO2[分别为（46.89±6.18） pg/ml、（18.37±3.26） ng/ml、（285.52±38.71） pg/ml、（56.36±5.28） mmHg和（37.25±4.82） pg/ml、（13.34±2.5） ng/ml、（166.12±32.45） pg/ml、（43.05±4.43）mmHg]显著高于健康组[分别为（30.44 ±4.16） pg/ml、（9.26±2.01）ng/ml、（86.59±20.91）pg/ml],血清IL-10浓度、FEV1％pred、PaO2[分别为（37.29±6.88） pg/ml、（33.19 ±5.45）、（35.22±5.26） mmHg和（55.36±7.62） pg/ml、（51.33±5.27）、（47.63±5.50） mmHg]显著低于健康组[（30.67±2.91）mmHg、（65.68±7.06） pg/ml、（72.15±5.23）、（68.08±529） mmHg]（均P＜0.01）,急性加重组与稳定组比较亦有非常显著性差异（均P＜0.01）.急性加重组血清Fas/Apo-1、TNF-α、IL-19与FEV1％pred、PaO2显著负相关（分别r=-0.525、-0.498、-0.603和-0.536、-0.528、-0.463,均P＜0.01）,与PaCO2显著正相关（分别r=0.533、0.562、0.498,均P＜0.01）;IL-10与FEV1％pred、PaO2显著正相关（分别r=0.476、0.563,均P＜0.01）,与PaCO2显著负相关（r=-0.525,P＜0.01）.结论 高原COPD合并CCP患者Fas/Apo-1和TNF-α表达上调介导细胞凋亡异常,Fas/Apo-1、TNF-α、IL-19和IL-10可能共同参与了气道慢性炎症反应.     

青海互助高海拔地区土族中学生牙周健康状况调查分析

目的:了解青海互助地区土族青少年人群的牙周健康状况,为今后高原地区少数民族口腔健康保健工作提供数据资料及科学依据。方法:选择双亲均为土族,本人在互助地区出生与生活,分为12、15、18岁3个年龄组的土族中学生1 136人为调查对象,对所有受检人员进行牙石指数(CI)、牙龈出血指数(BI)及牙周探诊深度(PD)检查,结果资料用系统软件SPSS13.0进行t检验、卡方检验等统计分析。结果:12岁组牙石、牙龈出血检出率分别为98.96%、97.92%;15岁组牙石、牙龈出血检出率分别为93.53%、93.13;18岁组牙石、牙龈出血检出率均为97.78%。结论:土族青少年人群牙周健康状况差,应在广大人群中广泛开展口腔卫生保健服务和口腔健康教育。     

Cardiac uses of phosphodiesterase-5 inhibitors

Phosphodiesterase-5 inhibitors (PDE5Is) improve erectile function by enhancing nitric oxide availability in the penis and its supplying vasculature, resulting in vasodilation and increased blood flow. PDE5Is might benefit cardiovascular diseases because phosphodiesterase-5 is also located elsewhere in the body, including the pulmonary and systemic vasculature and in hypertrophied myocardium. PDE5Is are approved for pulmonary arterial hypertension, given that they improved several hemodynamic and clinical parameters in large randomized trials. Initial evidence suggests that PDE5Is benefit patients with congestive heart failure and secondary pulmonary hypertension. PDE5Is seem to improve hemodynamic and clinical parameters in patients with high-altitude pulmonary edema (HAPE) and high-altitude pulmonary hypertension. In climbers with prior episodes of HAPE, PDE5Is prevented HAPE in 2 small randomized trials. In small randomized trials of PDE5Is, patients with Raynaud's phenomenon demonstrated improved blood flow, fewer symptoms and frequency of attacks, and resolution of digital ulcers. In addition to enhancing vasodilation, PDE5Is seem to protect the myocardium through complex pathways that involve nitric oxide, cyclic guanosine monophosphate, protein kinase G, extracellular-signal-regulated kinase, B-cell lymphoma protein-2, and Rho kinase inhibition. In animal models of acute myocardial infarction, PDE5Is consistently reduced infarct size indicating cardioprotection and PDE5Is also promote reverse remodeling and reduce myocardial apoptosis, fibrosis, and hypertrophy. PDE5Is might also benefit patients with treatment-resistant hypertension, preeclampsia, or peripheral arterial disease. This review presents the pathophysiology and trial data with regard to the use of PDE5Is for cardiac diseases.     

不同海拔地区非糖尿病成人糖化血红蛋白水平及影响因素研究

本研究对平均海拔6、2260和2800m三地居住10年以上成年健康居民的红细胞数、血红蛋白、HbA1C水平进行检测,结果显示,2800m海拔地区正常人HbA1C水平较平原地区明显升高(5.80％±0.50％对5.39％ ±0.47％,P＜0.05),诊断和治疗该地区糖尿病时需加以考虑.     

高海拔地区慢性肺心病急性加重期极重度呼吸衰竭并发多器官功能衰竭的救治体会

目的 探讨高海拔地区慢性肺心病急性加重期(HAAECCP)极重度呼吸衰竭并发多器官功能衰竭(MOF)的救治.方法 62例(男37例,女25例,平均年龄59.5岁)HAAECCP极重度呼吸衰竭(PaO2<30 mmHg)并发MOF患者,采用了抗感染、通畅气道、利尿、强心、吸入29～35%氧、呼吸兴奋剂、糖皮质激素、降低血粘度等方法救治.结果 2个、3个、4个、5个及5个以上器官衰竭(OF)者分别为43例、10例、5例和4例,救治成功率分别为100.0%、90.0%、60.0%和0.0%.总救治成功率88.7%,病死率11.3%.结论 HAAECCP极重度呼吸衰竭并发MOF患者救治24 h后,若PaO2能提高到40 mmHg以上,则基本可救治成功,若仍低于30 mmHg,则应尽早行机械通气.