尼莫地平复方丹参注射液治疗新生儿缺氧缺血性脑病疗效观察

目的观察尼莫地平联合复方丹参注射液治疗新生儿缺氧缺血性脑病(HIE)的疗效.方法 128例HIE患儿随机分为复方丹参注射液组32例,尼莫地平组,尼莫地平加复方丹参注射液,与对照组.结果复方丹参注射液组、尼莫地平组、尼莫地平加复方丹参注射液治疗组总有效率分别为81.3%(26/32)、80.0%(24/30)、97.1%(34/35),对照组总有效率为51.6%(16/31),P＜0.05.结论尼莫地平与复方丹参注射液在治疗HIE时有协同作用,疗效显著,未见副作用发生.     

先天性心脏病患儿肺动脉,上腔静脉血一氧化氮含量检测及意义

目的:探讨一氧化氮(NO)与先天性心脏病(CHD)引起的肺动脉高压(PH)发病间的关系。方法:应用NO试剂盒检测了CHD患儿肺动脉及上腔静脉血浆中NO含量。结果;(1)伴PH组肺动脉血浆NO含量明显高于不伴肺动脉高压组(37.58±9.99μmol/L:19.03±15.25μmol/L,P<0.01);(2)在PH组中,肺动脉血浆NO含量明显高于上腔静脉血(P<0.01);而不伴PH组,肺动脉和上腔静脉血浆NO含量无显著性差异(P>0.05)。结论:(1)伴PH的先心患儿肺动脉血浆NO含量升高;(2)NO可能介入了CHD引起的PH发病过程。     

Permissive Hypercapnia and Intravascular Oxygenator in the Treatment of Patients with ARDS

Abstract: This open clinical study was aimed at testing the hypothesis that an intravascular oxygenator (IVOX) may help to perform permissive hypoventilation in 10 patients with severe ARDS. After initial evaluation, we tried to reduce ventilator settings before and after IVOX implantation. Before IVOX, poor clinical tolerance and worsening oxygenation did not allow for a significant decrease in ventilator settings. With IVOX, peak inspiratory pressure (PIP) was reduced from 47 to 39 cm H₂O (p = 0. 005) and minute ventilation from 13 ± 3. 5 to 11 ± 3 L/min. CO₂ removal by IVOX allowed a significant decrease in Paco₂ from 66 ± 15 to 59 ± 13 mm Hg. Improvement of oxygenation with IVOX was not signify cant. Furthermore, interruption of oxygen flow through IVOX did not change oxygenation variables. Tolerance of the IVOX device was good, but insertion of the device was followed by a significant decrease in both cardiac index and pulmonary wedge pressure. In conclusion, IVOX improves tolerance of hypoventilation by limiting hypercapnia in ARDS patients. These preliminary results must be confirmed by a randomized controlled study     

血浆纤维连接蛋白含量对肺性脑病预后判断的临床价值

采用火箭电泳法对６４例（８０例次）肺性病患者进行血浆纤维连接蛋白（Ｆｎ）测定。合并肺性脑病１９例，并与１０６例健康人及１０４例其他呼吸疾患进行对比．结果表明：正常组、肺性病缓解组、急性发作组、肺性脑病组血浆Ｆｎ水平分别为３４．２７±６．３６ｍｇ／ｄｌ，２９．６１±４．２５ｍｓ／ｄｌ，１５．２１±５．２０ｍｇ／ｄｌ，１１．８２±５．６７ｍｇ／ｄｌ．肺性脑病患者血浆Ｆｎ显著降低，并随病情恶化而进一步下降。同时，其含量变化与ｐＨ值和ＰａＯ２呈正相关，与ＰａＣＯ２，呈负相关。因此动态观察肺性脑病患者血浆Ｆｎ含量可作为判断顶后一项较为可靠的指标。     

Comparison of Sputum and Serum Eosinophil Cationic Protein (ECP) Levels in Nonatopic Asthma and Chronic Obstructive Pulmonary Disease

The aim of the present study was to investigate whether sputum eosinophil cationic protein (ECP) concentrations could be a useful marker in the differential diagnosis between intrinsic asthma and chronic obstructive pulmonary disease (COPD). For this purpose total blood eosinophil counts were obtained and concentrations of serum and sputum ECP from 10 nonatopic asthmatics with a mild attack and 9 COPD patients with acute exacerbation were measured by radioimmunoassay. Mean serum ECP concentration was 54.3 ± 23.0 g/L in the asthmatic group and 83.3 ± 79.2 g/L in the COPD group (p: n.s.). In the group of asthmatics mean sputum ECP level was 984.5 ± 1245.5 mg/L/g sputum and in the COPD group it was 417.5 ± 363.5 mg/L/g sputum. There was no significant difference in sputum ECP levels between patients with asthma and COPD. We conclude that neither sputum nor serum ECP levels are useful markers in differential diagnosis of asthma attack and acute exacerbation of COPD.     

The role of the chest X-ray in the evaluation of chronic severe heart failure: things are not always as they appear

The chest x-ray has become a standard clinical test to aid in the evaluation of patients with chronic severe heart failure. To evaluate just how useful this tool is in the routine assessment of pulmonary venous hypertension secondary to heart failure, we compared the radiologist's interpretation of the chest x-ray with hemodynamic data obtained from right heart catheterization in a group of patients undergoing protocol evaluation of an experimental treatment for heart failure. Of 23 patients with pulmonary venous hypertension (pulmonary capillary wedge pressure greater than 20 mmHg) and a complete data base, only 11 had chest x-rays showing evidence of pulmonary venous congestion or interstitial or alveolar edema. The sensitivity of the chest x-ray in selecting patients with a pulmonary capillary wedge pressure over 20 mmHg in this setting was only 48%. In other studies, where the radiologist was aware that his or her reading was being compared to hemodynamic assessments, the sensitivity of the chest film has approached 85%. We feel our analysis more closely parallels routine clinical practice. Clinicians should be aware that the chest x-ray may not be a very sensitive tool for the assessment of pulmonary hemodynamics in patients with severe heart failure.     

缺氧叠加三氯化铁大鼠肺动脉高压模型肺血管内皮细胞的病理变化

目的 :观察大鼠缺氧叠加静注FeCl3 致肺动脉高压模型肺动脉内皮细胞的病理变化。方法 :常规病理组织学和透射电子显微镜及多功能显微镜观察肺动脉内皮细胞的变化。结果 :缺氧叠加静注FeCl3 2周、4周时肺动脉平滑肌肥厚 ,肺间质有大量炎细胞浸润 ,血小板聚集 ,微血栓形成 ,血管内皮剥脱 ,内膜下组织暴露 ,内膜下及弹力纤维变形 ,内皮细胞成片脱落为循环内皮细胞。结论 :缺氧叠加静注FeCl3 引起的肺动脉内皮细胞脱落 ,内膜下组织暴露 ,微血栓形成和平滑肌肥厚是肺动脉高压形成的病理学基础     

肺癌组织中血管内皮生长因子受体Flt1及KDR的表达及其与肿瘤转移和预后的关系

①目的　探讨肺癌中血管内皮生长因子受体Flt1、KDR的表达与其转移及预后的关系。②方法　应用免疫组织化学PowerVisionTM PV90 0 0法 ,测定 75例肺癌标本中Flt1、KDR的表达。③结果　肺癌组织中Flt1、KDR的表达较为广泛 ,主要位于肿瘤细胞胞浆及胞膜上 ,纤维母细胞和血管内皮细胞胞浆中亦有表达。Flt1、KDR在肿瘤细胞中的阳性率均显著高于在间质纤维母细胞中的表达 (χ2 =6 .0 7、5 .88,P <0 .0 5 )。肿瘤细胞及纤维母细胞中该两种受体的阳性率在不同年龄、不同性别及不同病理类型、不同病理分级之间差异均无显著性 (χ2 =0 .0 1～4 .84 ,P >0 .0 5 ;P =0 .2 9～ 0 .79)。肿瘤细胞中Flt1、KDR的阳性表达率在 3组不同大小的肿瘤间差异均有显著性(χ2 =1 0 .35、7.2 9,P <0 .0 5 ) ,而纤维母细胞中差异均无显著性 (χ2 =2 .86、2 .5 6 ,P >0 .0 5 ) ;肿瘤细胞及纤维母细胞中Flt1、KDR的阳性率在淋巴结有、无转移两组间的差异均有显著性 (χ2 =4 .72～ 9.32 ,P <0 .0 5 ) ,在 3组不同术后生存时间病人间亦均有显著性差异 (χ2 =8.81～ 1 9.1 9,P <0 .0 5 )。肿瘤细胞中Flt1、KDR的表达呈极显著性正相关 (r =0 .4 4 ,P <0 .0 1 )。④结论　肺癌的生长主要依赖自分泌机制 ,联合检测Flt1、KDR可能对肺癌转移     

舒利迭加无创通气治疗稳定期慢性阻塞性肺疾病的临床研究

目的探讨舒利迭(吸入型肾上腺皮质激素与长效β2-受体激动剂的预混制剂)联合双水平气道正压通气(B iPAP)对稳定期慢性阻塞性肺疾病(COPD)的治疗作用。方法稳定期COPD病人52例,舒利迭TM50/250,1吸/次,2次/d;B iPAP,吸气压力(IPAP)10~20cm H2O,呼气压力(EPAP,也称PEEP)3~6cm H2O,吸氧浓度(FiO2)3L/m in,每天夜间通气6~8h。观察治疗前、治疗后12周病人临床症状、生活质量、健康状态和肺功能。结果治疗前、治疗后12周病人的临床症状、急性加重次数及严重程度、健康状态和生活质量、肺功能等指标比较差异有统计学意义(P<0.05)。结论舒利迭联合B iPAP治疗稳定期COPD病人能够明显改善其症状,提高生活质量,有一定的临床应用价值,对减缓COPD病人肺功能下降有积极意义。     

Structural and metabolic changes in the ventricular myocardium in experimental massive pulmonary embolism

N. I. Pirogov Second Moscow Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. S. Savel'ev.) Translated from Byulleten' Ékperimental'noi Biologii i Meditsiny, Vol. 113, No. 3, pp. 327–329, March, 1992.