微创外科技术在小儿肿瘤中的应用进展

微创外科技术（Minimally Invasive Sugery,MIS）应用于小儿外科疾病的诊治已日益广泛,它具有痛苦少、住院时间短、外形美观等诸多优点。目前在小儿肿瘤外科中的应用主要包括肿瘤组织的活检、分期及可切除性的评估、复发或转移性疾病的诊断以及对肿瘤组织的根治性切除。     

氧化亚氮气腹对新生猪循环、呼吸功能影响的实验研究

目的 建立新生猪气腹模型,观察人工N2O气腹时新生猪血流动力学及呼吸指标的变化规律.方法 乳猪14头,年龄7～14 d,体重2～4 kg.分为2组,对照组(CON组)7头,N2O气腹组(N2O组)7头,监测时间点为麻醉稳定后气腹开始前5 min,气腹开始后15 min、30 min、60min、120min,放气后60min.监测指标为:心率(HR)、每搏输出量指数(SVI)、心输出量指数(CI)、平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、系统血管阻力指数(SVRI)、左室内压变化速率(dP/dtmax)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、血碳酸氢根离子浓度(HCO3-)及血酸碱度(pH).结果 CON组血流动力学及呼吸参数基本维持恒定.与CON组对比,N2O组MPAP(26.29±2.57)及SVRI(2923.00±115.70)增加,差异有统计学意义(P＜0.05);HR(113.57±3.23)、dP/dtmax(432.43±36.61)、MAP(75.00±4.27)、SVI(15.00±0.76)及CI(1.98±0.11)下降,差异有统计学意义(P＜0.05);PaCO2(41.00±2.20)及PaO2(172.14±1.57)升高,差异有统计学意义(P＜0.05).结论 2hN2O气腹对健康新生猪循环功能产生一定影响.

Abstract：

Objective To study the influence of nitric oxide (N2O) pneumoperitoneum on the circulatory and respiratory systems of piglets.Methods Fourteen piglets,which weighted 2-4 kilograms and aged 7-14 days old,were equally and randomly divided into control group and N2O pneumoperitoneum group.On the anesthetized piglets of the N2O group,N2O pneumoperitoneum was induced by inflate the peritoneal cavity with N2O.Monitoring parameters included heart rate (HR),stroke volume index (SVI),cardiac index (CI),mean arterial pressure (MAP),central venous pressure (CVP),mean pulmonary arterial pressure (MPAP),systemic vascular resistance index (SVRI),dP/dtmax,partial pressure of carbon dioxide in arterial blood (PaCO2),partial pressure of oxygen in arterial blood (PaO2),arterial oxygen saturation (SaO2),concentration of HCO3- (HCO3-) in arterial blood and blood pH value (pH).The monitoring parameters were collected 5 minutes before N2O pneumoperitoneum inflation,15,30,60,and 120 min after N2 O pneumoperitoneum inflation and 60 min after pneumoperitoneum deflation.Results Hemodynamic and respiratory parameters of the control piglets were constantly normal.Compared with the control piglets,MPAP (26.29±2.57),PaCO2 (41.00±2.20),PaO2 (172.14± 1.57) and SVRI (2923.00 ± 115.70) of the N2O pneumoperitoneum piglets increased (P＜0.05).HR (113.57 ± 3.23),dP/dtmax (432.43±36.61),MAP (75.00 ± 4.27),SVI ( 15.00±0.76) and CI (1.98±0.11) of N2O pneumoperitoneum piglets decreased (P＜0.05).Conclusions Two hours' N2O pneumoperitoneum changes some circulatory parameters of piglets.     

子宫广泛切除术后尿潴留的预防及护理

目的探讨系统膀胱功能训练对预防子宫广泛切除术后尿潴留的效果及护理方法。方法将74例宫颈癌性子宫广泛切除术患者,随机分为两组,各37例,试验组采用系统膀胱功能训练,对照组采用定期开放尿管预防尿潴留。结果试验组术后排尿困难、残余尿、尿潴留及泌尿系感染发生率均低于对照组(P<0.05),差别有统计学意义。结论对患者进行系统膀胱功能训练,加强心理护理及留置导尿管的护理,可促进术后自主排尿功能的恢复,降低尿潴留的发生。     

怒由肝起，烦从火生

夏季酷暑天气，你是容易暴躁呢还是烦语襞呢？这句看似玩笑的话，实际上与养生和疾病息息相关。暴躁，在中医的症状里对应“易怒”，而烦躁则对应“心烦”，二者在情绪上有相似点，例如“心烦易怒”经常并称；同时二者还可以转归，即易怒又可导致心烦，而这很容易理解的情绪转化背后实际上存在病因病机的种种复杂情况。     

不同气体条件对腹膜形态影响的实验研究

目的 在体实验研究提示,CO2气腹后,腹膜结构出现改变.本实验研究不同气体条件对腹膜形态的影响,探讨CO2气腹对腹腔肿瘤细胞影响的潜在机制.方法 在体实验:乳猪14头,年龄7～14 d,体重2～4 kg.随机分为两组:CO2气腹组(CO2组,n=7),N2O气腹组(N2O组,n=7).分别行100%CO2及100%N2O气腹,气腹时间为4 h,气腹压力为12 mm Hg.实验结束,采集腹膜标本.离体实验:C57BL/6小鼠10只,年龄4周左右,经0.125%胰酶预处理后,通过腹腔灌洗分离培养小鼠腹膜间皮细胞.离体细胞随机分为三组:对照组(5%CO2组).100%CO2组,8 cm H2O压力100%CO2组.细胞培养至连续单层后,将细胞分别暴露于5%CO2、100%CO2及8cmH2O压力100%CO2中4 h.不同气体条件下腹膜及分离培养的间皮细胞行电镜观察.结果 在体实验腹膜电镜结果提示压力12 mm Hg的100%CO2气腹维持4 h,导致腹膜间皮细胞层破坏,基底膜暴露,仅存细胞骨架;相同条件的100%N2O气腹使间皮细胞间隙增大,部分区域基底膜暴露.离体实验观察100%CO2破坏间皮细胞微绒毛,压力下的100%CO2对问皮细胞影响更加明显.结论 100%CO2使在体腹膜及离体间皮细胞超微结构发生明显改变,因此,小鼠模型中发现的CO2气腹后神经母细胞瘤转移增加可能与间皮细胞屏障削弱有关.

Abstract：

Objective Electron microscopic studies have shown significant morphologic changes of peritoneum after CO2 pneumoperitoneum in vivo. This experiment was to assess the effect of different gas on the morphology of peritoneum and the underlying mechanism of CO2 pneumoperitoneum on tumor cells. Methods In vivo, fourteen piglets (2-4 kilogram in weight, 7-14 days of age) were equally divided into the CO2 group(n = 7) and N2O group(n = 7). 100% CO2 or 100% N2O pneumoperitoneum was infused for 4 hours. Pneumoperitoneum pressure was 12 mmHg. At the end of the experiment, the samples of peritoneum were collected. In vitro, primary murine peritoneal mesothelial cells were36 collected by peritoneal lavage from ten C57BL/6 mice (4 weeks of age) after 0. 125% trypsin pretreatment. Isolated cells were divided into three groups: control group (5% CO2),100% CO2 group and 8 cm H2O pressure &. 100% CO2 group. After monolayers of mesothelial cells were established, cells were cultured with 5%CO2, 100% CO2 and 100% CO2 with 8 cm H2O pressure for 4 hours. Peritoneum and isolated mesothelial cells were examined by scanning electron microscopy. Results Scanning electron microscopy investigation suggested in vivo, 12 mmHg 100% CO2 pneumoperitoneum for 4 hours destroyed mesothelial cells layer of peritoneum, exposing the basal lamina. In contrast, 100% N2O pneumoperitoneum leaded to an increase of intercellular gaps and the basal lamina was exposed in part areas under same pressure and duration. In vitro, 100% CO2 exposition was associated with a significant destruction of the microvilli formation of isolated mesothelial cells. 100% CO2 with 8 cm H2O pressure had more significant impact on mesothelial cells. Conclusions The peritoneal mesothelial cells lose their typical cell morphology when exposed to 100% CO2. Thus, the increased neuroblastoma metastasis observed after CO2 pneumoperitoneum in mice might be related to an impaired mesothelial barrier function.     

CO2气腹对新生猪呼吸和循环功能的影响

目的 建立新生猪气腹模型,观察CO2气腹中初生乳猪呼吸和循环功能相关指标的变化规律.方法 乳猪共14头,年龄7～14d,体重2～4kg.分为2组:CO2气腹组7头,对照组7头.麻醉后监测心率、动脉压、中心静脉压、心输出量、每搏输出量,全身血管阻力、左心室内压变化速度、动脉血气.监测时间为麻醉稳定后手术开始前5min,手术开始后15min、60min、120min,关腹后60min.结果 与对照组相比,实验组心率、全身血管阻力及左室内压变化速度增加,差异有统计学意义(P＜0.05).与对照组相比较,气腹后心输出量、每搏输出量下降,差异有统计学意义(P＜0.05).平均动脉压有升高趋势,但统计学意义不大.中心静脉压无明显变化.PaCO2增高(P＜0.05)、伴有pH下降,表现为轻度的呼吸性酸中毒,CO2气腹不引起新生猪血氧分压下降及血氧饱和度下降.结论 健康乳猪在严密监测下可以耐受短时间气腹.     

HPLC法测定慢肝养阴胶囊中五味子醇甲的含量

目的:建立慢肝养阴胶囊中五味子醇甲的含量测定方法。方法:采用高效液相色谱法,色谱条件:色谱柱为Di-amonsil(TM钻石)C18(5μm,4.6mm×250mm);流动相:甲醇-水(13∶7);检测波长:250nm;柱温:25℃;流速:1.0mL/min;理论板数按五味子醇甲峰计算不低于3000。结果:五味子醇甲在0.1516~2.4256μg之间线性关系良好,r=0.9999。五味子醇甲平均回收率为98.8%,RSD=0.58%。结论:该方法准确,重复性好,可用于慢肝养阴胶囊的质量控制。     

二氧化碳对小鼠神经母细胞瘤细胞跨间皮细胞迁移影响的实验研究

目的 本实验研究不同气体条件对神经母细胞瘤细胞跨间皮细胞迁移的影响,探讨CO2气腹对腹腔肿瘤细胞迁移影响的潜在机制.方法 经0.125%胰酶预处理后,通过腹腔灌洗分离培养C57/BL6小鼠腹膜间皮细胞.间皮细胞纯化通过细胞形态学及免疫组化方法(小鼠间皮细胞角蛋白特异性抗体AE1/AE3)鉴定.MTT实验确定细胞活力.使用Transwell系统培养连续间皮细胞层,分别暴露于100%CO2及5%CO2 2 h,经荧光染色后的小鼠神经母细胞瘤细胞(Neuro2a)加入至Transwell系统上室,细胞迁移数目经多功能检测仪进行测定.结果 MTT实验提示,间皮细胞于5%CO2及100%CO2暴露后4 h、6 h、10 h及24 h后两组细胞活力分别为0.82±0.28比0.62±0.22、0.87士0.24比0.62±0.28、0.88±0.69比0.69±0.81及1.05±0.86比0.97±0.25,差别无统计学意义.迁移实验表明,间皮细胞于100%CO2中暴露后,细胞屏障功能下降,Neuro2a迁移数目增加258.56±71.08比77.05±27.89(P＜0.05).结论 100%CO2利于神经母细胞瘤细胞跨间皮细胞迁移.因此,小鼠模型中发现的CO2气腹后神经母细胞瘤转移增加可能与间皮细胞屏障削弱有关.

Abstract：

Objective This study was to assess the effect of CO2 pneumoperitoneum on transepithelial neuroblastoma cell migration. Methods Purification of primary murine peritoneal mesothelial cells was achieved by sequential, peritoneal lavage after 0. 125% trypsin pretreatment. Purity of the mesothelial cell culture was confirmed by cell morphology and immunohistochemical staining for specific cytokeratine (AE1/AE3). In all experiments vitality of the cells was confirmed by MTT assay. Monolayers of mesothelial cells were established on transwell systems. Following incubation with 100% CO2 or 5% CO2 for 2 h, fluorescent stained Neuro2a (neuroblastoma) cells were added to the upper chamber and their migration to the lower chamber was measured by multi - detection reader. Results The conversion of MTT was nearly same 4h, 6 h, 10 h and 24 h after 5% CO2 or 100% CO2 exposition,0. 82 ± 0. 28 VS 0. 62 ± 0. 22,0. 87 ± 0. 24 VS 0. 62 ± 0. 28, 0. 88 ± 0. 69 VS 0. 69 ± 0. 81 and 1. 05 ± 0. 86 VS 0. 97 ± 0. 25 respectively. Migration studies showed that the barrier function of the mesothelial monolayer decreased. A significantly increased migration of neuroblastoma cells was found after 100% CO2 exposure 258. 56 ± 71. 08 VS 77. 05 ± 27. 89 (P＜0. 05). Conclusions 100% CO2 facilitated transepithelial neuroblastoma cell migration. Thus, the increased neuroblastoma metastasis observed after CO2 pneumoperitoneum in mice might be related to an impaired mesothelial barrier function.     

长时间人工气腹对心功能不全新生猪循环功能影响的实验研究

目的 建立新生猪气腹及心功能不全模型,观察长时间CO2及N2O气腹时心功能不全新生猪血流动力学指标的变化规律,比较膨腹气体对有合并症的新生机体进行长时间充填时的优劣.方法 乳猪14头,年龄7～14 d,体重2～4 kg.分为2组,心功能不全CO2气腹组(CO2-HF)7头,心功能不全N2O气腹组(N2O-HF)7头.CO2-HF及N2O-HF组进行4 h气腹,监测时间点为麻醉稳定后气腹开始前5 min,气腹开始后15、60、120、180、240 min,放气后30min.监测指标为:心率(HR)、每搏输出量指数(SVI)、心输出量指数(CI)、平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、系统血管阻力指数(SVRI)、左室内压变化速率(dP/dtmax).结果 与成模前相比,两组成模时HR、SVI及CI降低,差异有统计学意义(P＜0.05);MPAP升高及SVRI增加,差异有统计学意义(P＜0.05);dP/dtmax、MAP及CVP无明显改变.随后两组HR无明显改变,两组CI继续下降,两组MPAP继续升高,两组CVP升高,差异有统计学意义(P＜0.05).CO2-HF组MAP及dP/dtmax下降、SVI继续降低,SVRI继续增加,差异具有统计学差异(P＜0.05).结论 心功能不全新生猪进行长时间气体充填时CO2气腹对心功能影响明显,导致心肌收缩力明显下降及系统血管阻力明显增加;心功能不全新生猪进行长时间N2O气腹充填时心功能无进一步下降趋势.

Abstract：

Objective This experiment established a pneumoperitoneum model and acute cardiac failure model in piglets. It studies changes of hemodynamics of extended artificial pneumoperitoneum with CO2 and N2O in piglets with cardiac dysfunction. Methods Fourteen piglets (2-4 kilogram in weight,7-14 days of age) were divided into two groups: cardiac failure & CO2 group (CO2-HF) and cardiac failure & N2O group (N2O-HF). Both group underwent 4 hours of pneumoperitoneum. Measurements were carried out 5min before anaesthesia, 15,60,120, 180,240 min after establishing pneumoperitoneum and 30 min after deflation. Investigation included heart rete, stroke volume index, cardiac index, mean arterial pressure, central venous pressure, mean pulmonary arterial pressure, systemic vascular resistance index and dP/dtmax. Results In CO2-HF and N2O-HF groups,compared to the preoperative baseline, HR, SVI and CI decreased (P＜0. 05 ), while MPAP and SVRI increased (P＜0. 05). There was no statistical alteration in dP/dtmax, MAP and CVP. Post-operatively, HR were stable in both groups, CI decreased further, MPAP increased further and CVP increased(P＜0. 05). In CO2-HF group, MAP and dP/dtmax decreased,SVI decreased further and SVRI increased further(P＜0. 05). Conclusions Cardiac contractility decreased and systemic vascular resistance index increased significantly during extended CO2 pneumoperitoneum in piglets with compromised heart function. There was no deterioration of heart function with extended N2O pneumoperitoneum in piglets with heart failure.     

克拉霉素(利迈先)治疗小儿呼吸道感染104例临床分析

目的：探讨克拉霉素治疗小儿呼吸道感染的疗效。方法：克拉霉素治疗小儿呼吸道感染的疗效评价。结果：克拉霉素治疗小儿呼吸道感染,临床痊愈率为52．88％,临床有效率为98．08％。结论：克拉霉素治疗小儿呼吸道感染疗效确切,不良反应小。