异丙酚和异氟醚对非体外循环搭桥术患者围术期细胞因子的影响

目的:研究异丙酚和异氟醚对非体外循环搭桥术患者围术期炎性与抗炎性细胞因子平衡的影响。方法:择期非体外循环搭桥患者50例,随机分为2组。异丙酚组微量泵输入剂量为4～6mg·kg-·1h-1,异氟醚组吸入浓度为1%～1.5%。检测诱导前、打开心包、旁路血管开放30min,术后2h、24h血清白细胞介素6(IL-6)、白细胞介素10(IL-10)和肿瘤坏死因子α(TNF-α)的浓度。结果:2组患者旁路血管开放后IL-6浓度较术前升高(P<0.01),术后2h达高峰;术后2h异氟醚组高于异丙酚组(P<0.05)。IL-10浓度变化趋势与IL-6相似,旁路血管开放后、术后2h和24h异丙酚组高于异氟醚组(P<0.05)。2组患者TNF-α水平均无显著变化。结论:异丙酚麻醉促进IL-10的产生,抑制IL-6的产生,控制术中应激反应异丙酚优于异氟醚。     

2 121例老年急性冠脉综合征患者血清脂类浓度的分析

目的分析60岁以上老年人血清脂类水平的参考值,并探讨急性冠脉综合征与血脂指标的相关性.方法将3 766例健康成人分为≤60岁和＞60岁的两个年龄段,采用生物化学的方法测量他们的血脂水平,找出60岁以上老年人的脂类参考值.同时分析2 121例老年急性冠脉综合征病人的脂类指标.结果 60岁以上老年人血脂参考值为:TC 4.65±1.96×1.05mmol/L;TG 1.02±1.96×0.45mmol/L;HDL-C 1.47±1.96×0.40mmol/L;LDL-C 2.98±1.96×0.56mmol/L;ApoA1 1.32±1.96×0.25g/L;ApoB 0.99±1.96×0.35g/L,并且急性心肌梗死和不稳定性心绞痛病人血清脂类各项指标之间没有显著性差异.结论血清LDL-C/HDL-C＞5和TG ≥1.9mmol/L这两项联合指标比其他单独指标与老年人急性冠脉综合征关系更密切.     

便携式多普勒血管探测仪在皮瓣移植中的应用

目的 :研究皮瓣移植前简单、可靠的血管探测的方法。方法 :在皮瓣移植前 ,以 HADECO ES-1 0 0 0 SPM多普勒血管探测仪对皮瓣血管蒂及皮动脉进行探测 ,与术中皮动脉探查结果进行比较 ,考察术前血管探测的准确性和意义。结果 :皮瓣血管蒂及皮动脉术前探测与术中探查结果完全一致。结论 :便携式血管多普勒仪是皮瓣移植前 ,简单、可靠的血管探测的仪器 ,根据探测结果进行皮瓣设计 ,有效地降低了手术失败的风险     

血管内皮细胞受损后急性低氧性肺血管收缩反应减弱

为了探明血管内皮细胞在急性低无性肺动脉高压中的作用进行了本研究。雄性ＳＤ大鼠经２０％乌拉坦麻醉，气管插管，呼吸机通气。动物分为两组：单纯低氧组（ｎ＝１０只）吸１０．５％低氧混合气体５分钟；另一组为肺损伤低无组（ｎ＝７只），ＡＮＴＵｌｍｇ／ｋｇ缓慢注入肺动脉内，再吸入１０．５％低氧混合气体。实验结果表明：大鼠吸入低氧混合气体后肺动脉平均压ＰＰａ）增加２０．４±６．５％，而肺损伤后再吸入低氧气体，ＰＰａ仅增加８．７±３．８％，显著低于单纯低氧组（Ｐ＜０．０１）．结果提示：血管内皮细胞受损后急性低氧性肺血管收缩反应明显减弱。     

慢性低氧大鼠肺动脉内皮素mRNA的表达及定位

目的：探讨慢性低氧大鼠肺动脉内皮素－1基因表达及分布。方法：采用生物素标记cRNA探针，对Wistar大鼠肺动脉进行原位杂交。结果：低氧1周组及低氧2周组大鼠大部分肺动脉内皮细胞ET－1mRNA表达呈阳性信号，而对照组大鼠仅极少数阳性信号（P＜0．01）；低氧1周组大鼠部分显示强阳性信号。低氧1周组及低氧2周组大鼠部分肺动脉平滑肌细胞呈现ET-1mRNA表达阳性信号，而对照组大鼠则无阳性信号表达（P＜0．01及0．05）。结论：慢性低氧对大鼠肺动脉ET－1分泌的影响是在基因转录水平进行，且主要细胞定位在肺动脉内皮细胞，此外还包括肺动脉平滑肌细胞。     

椎动脉型颈椎病的影像学诊断

本文描述了椎动脉型颈椎病的概念及发病机制 ,并对该病的各种影像学检查的主要表现及优缺点进行了综述。     

A prospective analysis of 1400 pulmonary artery catheterizations in patients undergoing cardiac surgery

During 1983 and 1984, 1305 patients underwent 1,400 pulmonary artery (PA) catheterizations. Successful placement was achieved in 1397 (99.6%) of 1,403 attempts. The catheters were inserted via the right internal jugular vein on 1364 occasions. The median duration of monitoring was 28 h with a range from 3 to 220 h. Central venous puncture complications included carotid artery puncture in 67 instances (4.8%) and pneumothorax in one patient. Insertion of the catheters was associated with supraventricular arrhythmias on 11 occasions, ventricular arrhythmias on 930 (66.4%), right bundle branch block on two and a total heart block on one occasion. Eighteen (2.3%) of the 794 cultured catheter tips were positive. An in situ time of more than 72 h was associated with a significantly higher percentage (7.2%) of positive tip cultures compared with an in situ time of less than 72 h (P less than 0.01). Repeated PA catheterization was not associated with significantly more complications than the initial catheterization. The results show that monitoring with a PA catheter in cardiac surgical patients is associated with a low incidence of morbidity.     

Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

Abstract   We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15–2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.