关于全氟碳化合物应用的新探索

目前关于全氟碳化物（ＰＦＣ）的物理、化学和生物学性能研究已达到了一个新水平，对其应用价值的探索也随之深入。ＰＦＣ的用途由单纯的血液代用品逐渐成为多种需氧治疗的辅助剂，可在心血管系统的广泛应用，对各种肺部疾患疗效显著并可治疗烧伤和用于肿瘤化疗与放疗辅助及细胞培养生物技术，还可作为造影剂和药物释放载体，另外并尝试作为肝酶诱导剂、脂质吸附剂和抗炎剂，在临床各科均有潜在的应用价值。     

全氟丙烷气体长期滞留玻璃体腔对视网膜影响的观察

目的评价全氟丙烷（Ｃ３Ｆ８）长期滞留玻璃体腔对视网膜影响和诱发视网膜细胞凋亡的可能性。方法１３只兔眼进行玻璃体切除和纯Ｃ３Ｆ８注射,通过不同次数再注气,保持玻璃体腔气体８０％以上;应用光学显微镜和ＴＵＮＥＬ技术进行视网膜组织学检查,同时记录暗适应ＥＲＧ。结果１０只注气眼大气泡滞留时间分别是１５,３０,４５和６０天;手术前后ＥＲＧ记录无差异;除６０天１组的视网膜节细胞层有很少数凋亡细胞外,其它时间里无凋亡细胞发现,视网膜结构正常。结论玻璃体切除术后重复注入Ｃ３Ｆ８以长期保持大体积气泡推压视网膜,对视网膜功能和组织不产生有意义影响。     

手术治疗巨大裂孔视网膜脱离的预后分析

目的：探讨不同的手术方法对巨大裂孔视网膜脱离病例的预后影响。方法：回顾１９９５年１月～１９９７年３月间我院住院治疗的巨大裂孔视网膜脱离７２例７３眼。手术方法分为四种。结果：术后随访３月,总视网膜解剖复位率为５７／７３（７８．１％）,其中单纯型为１４／１６（８７．５％）,复杂型为４３／５７（７５．４％）。单纯型与复杂型患眼的术后复位率无统计学差异。环扎加压术后,单纯型患眼的复位率高于复杂型。对于复杂型患眼,玻璃体手术合并环扎加压术与否对其复位率无影响;玻璃体手术中使用Ｃ１０Ｆ１８与否对其复位率无影响。结论：环扎加压术对于治疗单纯型巨大裂孔视网膜脱离,尚属一种有效的方法。Ｃ３Ｆ８气体和全氟碳液是治疗有翻转后瓣的巨大裂孔视网膜脱离的有效手段。部分复杂型巨大裂孔视网膜脱离常用硅油填充。根据患眼的具体情况,选择合适的手术方法至关重要。     

全氟辛酸铵毒性研究进展

著名的杜邦不粘锅特氟龙（Teflon）事件已经结束，确让我们记住了应十分关注的一个化学物质——全氟辛酸铵（perfluorooctanoate，PFOA）。那么，什么是PFOA？ PFOA对动物是否有害？对环境和环境生物的污染状况如何？最重要的是PFOA对人体是否有害，譬如是否有致癌等作用以及在人群血液中的残留情况如何？本文将根据目前的研究情况对上述问题做一综述。     

骨水泥量对椎体成形术疗效和渗漏并发症的影响

目的 探讨椎体成形术中注入的骨水泥量对疗效和渗漏的影响. 方法 对2006年7月至2011年5月广州医学院附属广州市第一人民医院脊柱外科收治的186例腰椎骨质疏松性压缩性骨折患者,行椎体成形术,注入聚甲基异丁烯酸( polymethyl methacrylate,PMMA)治疗,对VAS缓解程度和生活质量进行比较. 结果 术后出现骨水泥渗漏73例.出现渗漏患者注入骨水泥量为(4.05±0.76)ml;未出现渗漏患者注入骨水泥量为(3.03 ±0.82) ml,两者统计学上有显著性差异(P=0.000).注入骨水泥量＜3.5 ml者83例,≥3.5 ml者103例,两组术后VAS、疼痛缓解程度、生活质量,在统计学上均未见显著性差异(P＞0.05). 结论 椎体成形术中,注入骨水泥量对疗效影响不大;注入过多的骨水泥会导致渗漏增多.     

药品与器械信息

眼科手术用全氟萘烷（重水）;全氟辛烷（重水）;全氟化碳填充气体（C3F8）;全氟化碳填充气体（C2F6）;眼底血管病变的口服药物——递法明;     

全氟丙烷气体在复杂性眼外伤前房重建术中的应用

目的探讨全氟丙烷气体(C3F8)在复杂性眼外伤前房重建术中的应用。方法回顾性分析11例(11眼)复杂性眼外伤,行角膜或角巩膜裂伤缝合后,前房注入C3F8气体0.2mL,观察前房气泡大小及消失时间、前房形成情况、眼压,以及眼内积血、角膜内皮和白内障等情况。结果前房内C3F8于术后1～18d消失,平均消失时间为(10.73±6.36)d。术后11例前房均形成良好,1例有虹膜前粘连。2例术前前房大量积血(充满前房),术后仍有少量前房积血。术后角膜水肿,在2周后明显减轻。3例术后早期一过性高眼压,经治疗1周后恢复正常。结论复杂性眼外伤行眼外伤缝合联合前房CF注气术有助于前房形成,减少虹膜前粘连、前房积血、角膜血染等并发症。     

玻璃体视网膜手术联合全氟丙烷气体与硅油填充治疗增殖性糖尿病视网膜病变疗效观察

目的：探讨增殖性糖尿病视网膜病变行玻璃体视网膜手术联合填充硅油或全氟丙烷的临床效果。方法：将36例(40眼)增殖性糖尿病视网膜病变患者分为2组。A组18例(19眼)行玻璃体视网膜手术联合体积分数14％全氟丙烷气体填充治疗,B组18例(21眼)行玻璃体视网膜手术联合硅油填充治疗,术后随访3～12个月,观察2组视网膜复位、视力恢复以及并发症。结果：A组视网膜完全复位15眼(78.95％),矫正视力＞0.1共14眼(73.68％);B组视网膜完全复位17眼(80.95％),矫正视力＞0.1共12眼(57.14％),2组视网膜复位率比较差异无统计学意义(P＞0.05),A组术后视力恢复优于B组(P＜0.05),B组并发症相对较多。结论：增殖性糖尿病视网膜病变患者行玻璃体视网膜手术全氟丙烷气体填充后并发症少,术眼视力恢复良好,视网膜复位率与硅油填充眼接近。     

Reperfusion injury after critical intestinal ischemia and its correction with perfluorochemical emulsion ＂perftoran＂

AIM: To investigate the anti-ischemic properties of perfluorochemical emulsion "perftoran" in mesenteric region. METHODS: Experiments were conducted on 146 nonlinear white male rats weighing 200-350 g. Partial critical intestinal ischemia was induced by thorough atraumatic strangulation of 5-6 cm jejunal loop with its mesentery for 90 min. Global critical intestinal ischemia was made by atraumatic occlusion of the cranial mesenteric artery (CMA) for 90 min also. Perftoran (PF, 0.8-1.0 mL per 100 g) in experimental groups or 0.9% sodium chloride in control groups was injected at 75 min of ischemic period. Mean systemic arterial blood pressure (BPM) registration, intravital microscopy and morphological examination of ischemic intestine and its mesentery were performed in both groups. RESULTS: During 90 min of reperfusion, BPM progressively decreased to 27.3±7.4% after PF administration vs 38.6±8.0% in the control group of rats with partial intestinal ischemia (NS) and to 50.3±6.9% vs 53.1±5.8% in rats after global ischemia (NS). During the reperfusion period, full restoration of microcirculation was never registered; parts with restored blood flow had leukocyte and erythrocyte stasis and intra-vascular clotting, a typical "non-reflow" phenomenon. The reduction of mesenteric 50-400 μm feeding artery diameter was significantly less in the PF group than in the control group (24±5.5% vs 45.2±3.6%, P<0.05) 5 min after partial intestinal ischemia. This decrease progressed but differences between groups minimized at the 90th min of reperfusion (41.5±4.2% and 50.3±2.8%, respectively). In reperfusion of rat's intestine, a significant mucosal alteration was registered. Villous height decreased 2.5-3 times and the quantity of crypts decreased more than twice. In the group of rats administered PF, intestinal mucosal layer was protected from irreversible post-ischemic derangement during reperfusion. Saved cryptal epithelial cells were the source of regeneration of the epithelium, which began to cover renewing intestinal villi after 24 h of blood flow restoration. View of morphological alterations was more heterogeneous in CMA groups. CONCLUSION: Systemic administration of perftoran promotes earlier and more complete structural regeneration during reperfusion in rats after partial and global critical intestinal ischemia.