Effects of acute respiratory acidosis on water and electrolyte transport in the human ileum

Abstract. Animal experiments have shown that acute respiratory acidosis stimulates water, Na and C1 absorption and HCO₃ secretion in the ileum. The aim of this study was to investigate whether the human ileum also responds to changes in systemic acid-base balance. Seven healthy volunteers (mean age 24, range 21–29 years) underwent segmental ilea perfusion using a multi-lumen tube assembly with a proximal occluding balloon. A 30 cm test segment was perfused under steady state conditions with a plasma-like electrolyte solution containing PEG as a non-absorb-able volume marker. After a control period, respiratory acidosis (blood pCO₂ 56.2 mmHg, pH 7.29 and [HCO₃] 26.4 mmol 1^-1) was induced by CO₂-breathing over a period of 50 min. Acute respiratory acidosis stimulated net HCO₃ secretion in patients secreting HCO₃ and reduced absorption in patients exhibiting net HCO₃ absorption. These changes were immediate and appeared to be at least partly reversible. Net water, Na, K and CI movement were not affected. The data suggest that HCO₃ transport in the human ileum responds to acute respiratory acidosis.     

结直肠术后患者结肠镜检查前的肠道准备方法探讨

目的改进结直肠术后患者肠道准备方法,提高结肠镜检查质量。方法选择拟行结肠镜检查的结直肠术后患者100例,分为两组,各50例。A组患者(同术前准备方法)结肠镜检查前5 h口服复方聚乙二醇电解质散(SF-PEG)328.8 g(3 000 ml);B组患者结肠镜检查前1日3餐后2 h分别服用SF-PEG27.4 g(250 ml),检查前5 h口服50%硫酸镁(MgSO4)100 ml,再喝温开水1 000 ml,至排泄液似清水样。服药后5 h行结肠镜检查。应用Boston肠道准备量表(BBPS)评分,对肠腔内气泡进行评分,比较两组患者肠道准备有效性、耐受性及安全性。结果 B组的结肠清洁程度BBPS总体评分(8.50±0.35)分,高于A组(7.35±1.25)分;B组进镜时间(3.85±1.20)min和退镜时间(6.25±0.60)min,少于A组进镜时间(5.35±1.75)min和退镜时间(8.20±0.85)min,差异均有统计学意义(P0.05)。B组患者肠道准备接受率、再次肠道准备接受率和总体不良反应评分分别为96.0%、94.0%和(1.35±0.05)分;A组患者分别为86.0%、72.0%和(1.75±0.30)分;差异均有统计学意义(P0.05),B组优于A组。结论结直肠术后患者肠镜检查前的肠道准备,采用间断冲击口服小剂量复方SF-PEG联合MgSO4,效果优于常规剂量。     

Effect of Bovine Parathyroid Hormone 1–34 Fragment on Renal Production and Excretion of Adenosine 3′, 5′ Monophosphate in Man

Abstract. Biologically active bovine parathyroid hormone (b PTH) 1–34 fragment infused over one hour in normal subjects produced an immediate and sharp increase in the excreted fractions of filtered bicarbonate, sodium and potassium, followed by the return to pre-infusion levels as soon as the administration of b PTH was stopped. There was a gradual but steady increase in the excreted fraction of filtered phosphate but a decrease in the excreted fraction of filtered calcium and magnesium. The excreted fractions of these ions were still abnormal 150 minutes after the completion of PTH infusion. The urinary excretion of 3′5′-cyolic AMP increased immediately about one hundred-fold but returned rapidly to pre-infusion levels. Urinary clearance of cyclic AMP approximated glomerular filtration rate in control periods and was twenty to thirty times greater during b PTH infusion. In subjects overloaded with bicarbonate, b PTH brought about a decrease in bicarbonate T_m and the same effects on the urinary excretion of other electrolytes. 3′5′-cyclic AMP excretion was clearly higher in control periods and reached higher levels during b PTH infusion when compared to subjects without an alkaline load. 3′5′-cyclic AMP excretion and fractional clearance were also clearly higher in subjects not given b PTH when control periods were compared to periods with bicarbonate infusion or after acetazolamide administration. During distal blockade obtained by simultaneous administration of chlorothiazide and ethacrynic acid, there was a delay in the rise of 3′5′-cyclic AMP excretion after b PTH administration. It can be concluded from these studies that the pattern of excretion of 3′5′-cyclic AMP is similar to that of bicarbonate, sodium and potassium. The increase of 3′5′-cyclic AMP excretion when urinary pH is above 7 suggests a diffusion trapping mechanism for the secretion into the lumen of this nucleotide. Distal diuretics used in distal blockade did not inhibit 3′5′-cyclic AMP production but delayed its secretion into urine.     

服药时间对结肠镜检查肠道准备效果的影响

目的探讨行结肠镜检查时服药时间对肠道准备效果的影响。方法选取行结肠镜检查的200例患者,分为两组,A组:5:00~7:00,B组:10:00~12:00,于肠镜检查前4 h口服复方聚乙二醇电解质散(PGEP)(恒康正清)139.12 g(2 000 ml)作为清肠剂,内镜医师行Boston肠道准备量表(BBPS)和肠腔内气泡评分,记录患者肠道准备时间,问卷调查患者对肠道准备的耐受性,记录肠道准备过程中的不良反应。结果所有患者均完成肠道准备及全结肠镜检查。A组BBPS总分明显高于B组(P0.05),A组肠腔内气泡评分明显低于B组(P0.05),A组肠道准备时间少于B组(P0.05),A组耐受性高于B组(P0.05),A组不良反应明显低于B组(P0.05)。结论 5:00~7:00服用PGEP行结肠镜检查肠道准备时间短、效果好,方便患者就医,能减少患者空腹等待及不适(头晕、饥饿感)等潜在风险,增加其依从性和耐受性,使肠镜检查顺利进行。     

呼吸机撤机失败的原因分析及探讨

目的统计分析造成呼吸机撤机失败的各种因素。方法对我院及华西医院呼吸内科统计分析影响撤机成败的独立风险因素。结果回归分析提示：机械通气时间、基础肺部疾病、近期肺部感染,APACHEⅡ、血浆白蛋白、电解质紊乱、咳嗽排痰能力7项指标为影响撤机成败的独立危险因素。随着机械通气时间的延长,成功撤机的概率不断下降;有咳嗽排痰能力的患者撤机成功的概率远高于没有咳嗽排痰能力的患者。撤机成败的肺外因素主要有电解质紊乱和血浆白蛋白水平。无电解质紊乱者撤机成功概率是有电解质紊乱者的20．7倍。血浆白蛋白水平正常患者的脱机成功概率远高于血浆白蛋白水平低于正常者,是后者的40倍。结论本研究提示机械通气时间等7项指标为影响撤机失败的独立危险因素。肺外因素也一样决定着撤机的成败,其中营养状态和电解质水平是易于被忽视的两个重要参数。     

肾气丸不同剂量配比对庆大霉素肾损伤大鼠肾功能及电解质影响的研究

目的观察肾气丸不同剂量配比对肾功能损伤大鼠的影响,探索肾气丸治疗肾功能损伤的药物合理配比剂量。方法用正交试验设计方法,选择正交表为L8（27）,将肾气丸方中8种药物分为4个因素,并根据不同剂量组成8个配方。给大鼠腹腔注射庆大霉素制造肾损伤模型,观察肾气丸不同剂量配比对肾功能损伤大鼠的影响。结果肾气丸各因素水平间对尿素氮的影响均无差异（P〉0.05）;在降低肾功能损伤大鼠24h尿蛋白含量方面,干地黄4两、山萸肉4两的配伍比例优于干地黄8两、山萸肉4两的配比;在降低肾功能损伤大鼠血清肌酐（Cr）的含量方面,泽泻3两、牡丹皮2两较优于泽泻3两、牡丹皮3两的剂量配比。在降低大鼠血清钾离子浓度方面,肾气丸方中干地黄8两的用量比例优于干地黄4两的用量比例;在升高肾功能损伤大鼠血清钙离子方面,干地黄4两、山萸肉4两的配比剂量优于干地黄8两、山萸肉4两的配比;肉桂1两、附子1两的配比优于肉桂2两、附子2两的配比。结论肉桂、附子用量以原方比例为佳,干地黄、牡丹皮的用量比例较原方所用比例减少为宜;提示临床肾功能损伤时,用药以小剂量为佳,否则将加重肾脏负担,不利于疾病的治疗。     

高效离子排斥色谱法测定羟乙基淀粉130/0.4电解质注射液中醋酸盐的含量

目的:建立高效离子排斥色谱法测定羟乙基淀粉130/0.4电解质注射液中醋酸盐的含量。方法:采用ICSep ICE-ORH-801(6.5 mm×300 mm,5μm)色谱柱,流动相为0.005 mol·L-1硫酸,流速为1.0 mL·m in-1,柱温为60℃,检测波长210nm。结果:醋酸钠进样量在2.0～16.0μg范围内线性关系良好(r=0.9993);平均回收率(n=9)为99.03%,RSD为0.22%。结论:本分析方法简便、准确,可作为羟乙基淀粉130/0.4电解质注射液中醋酸钠的定量分析方法。     

Deletion of exons 2–4 in the <Emphasis Type="Italic">BSND</Emphasis> gene causes severe antenatal Bartter syndrome

BSND gene mutations usually cause severe forms of antenatal Bartter syndrome and sensorineural deafness (SND). Chronic renal failure and transient hypercalciuria are reported as controversial symptoms of this syndrome. All twelve reported BSND mutations cause SND, whereas only two of the mutations give rise to normal glomerular filtration rate (GFR) and two other mutations cause hypercalciuria. The case we report here, where the patient presented with severe clinical symptoms and deletion on exons 2-4 of the BSND gene, has not been reported previously. Decreased GFR, along with hypercalciuria and difficulties in managing fluid and electrolyte requirements, are the reasons why this patient was brought to attention.     

复方聚乙二醇电解质散用于肠道清洁准备的效果观察

目的:观察复方聚乙二醇电解质散用于肠道清洁准备的效果。方法:178例拟进行肠道清洁准备的患者,随机分成试验组(使用复方聚乙二醇电解质散)与对照组(使用甘露醇),比较2组肠道清洁度、不良反应和依从性。结果:试验组与对照组的肠道清洁度有效率分别为100.0%、94.2%(P>0.0.05),不良反应发生率分别为8.7%、27.9%(P<0.05),完全依从率分别为96.7%、80.2%(P<0.05)。结论:复方聚乙二醇电解质散用于肠道清洁准备效果好,不良反应少,患者依从性高,适合临床推广应用。     

One-Step Polymerizations Enable Facile Construction and Structural Optimization of Graft Copolymer Electrolytes

The development of poly(ethylene oxide) (PEO)-based solid polymer electrolytes (SPEs) is limited by the semi-crystalline nature of PEO and the extremely strong EO-Li⁺ interactions. To promote the rapid migration of Li⁺, a one-step method combining radical polymerization and ring-opening polymerization catalyzed simultaneously by lithium carboxylate is proposed to construct multi-component graft copolymer electrolytes (GCPEs) in this study. Tailored macroinitiator with catalytic and initiated sites (PAALi(OH-Br)) realizes one-step polymerizations of vinyl monomers and cyclic monomers, and provides GCPEs with poly(ethylene glycol) (PEG) and poly(ε-caprolactone) (PCL) side chains. The grafted structure of GCPE greatly facilitates the intra-chain hopping of Li⁺, resulting in excellent ionic conductivity. The introduction of PCL further improves the t_Li+ of GCPE. The three-component graft copolymer electrolyte constructed by polystyrene (PS), PEO, and PCL exhibits high tensile stress (1.62 MPa), a high ionic conductivity (2.4 × 10⁻⁵ S cm⁻¹, 30 °C), and a high t_Li+ of 0.47 and high electrochemical stability.