不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

mito-KATP通道在缺血后处理减轻大鼠肾缺血再灌注损伤中的作用

目的 评价线粒体ATP敏感性钾通道(mito-KATP通道)在缺血后处理减轻大鼠肾缺血再灌注损伤中的作用.方法 健康成年雄性SD大鼠35只,体重250～280 g,随机分为5组(n=7):假手术组(S组)仅分离双侧肾蒂,暴露45 min不夹闭;肾缺血再灌注组(I/R组)夹闭双侧肾蒂缺血45 min,再灌注6 h制备大鼠肾缺血再灌注模型;缺血后处理组(Ipo组)夹闭双侧肾蒂缺血45 min,再灌注10 s,缺血10 s,反复3次,再灌注6 h;mito-KATP通道阻断剂5-羟葵酸+I/R组(5-HD+I/R组)缺血前30 min腹腔注射5-HD 10 mg/kg,余处理同I/R组;缺血后处理+5-HD组(5-HD+Ipo组)缺血前30 min腹腔注射5-HD 10 mg/kg,余处理同Ipo组.于再灌注6 h时采集心脏血样,取肾并分离肾小管上皮细胞,测定血清Cr和BUN的浓度、肾小管上皮细胞线粒体膜电位、细胞内活性氧(ROS)含量和游离Ca2+浓度.结果 与S组比较,I/R组、Ipo组、5-HD+I/R组和5-HD+Ipo组血清Cr和BUN的浓度、肾小管上皮细胞内游离Ca2+浓度和ROS含量升高,线粒体膜电位降低(P＜0.05);与I/R组比较,Ipo组血清Cr和BUN的浓度、肾小管上皮细胞内游离Ca2+浓度和ROS含量降低,线粒体膜电位升高(P＜0.05),5-HD+I/R组和5-HD+Ipo组上述指标差异无统计学意义(P＞0.05);与Ipo组比较,5-HD+I/R组和5-HD+Ipo组血清Cr和BUN浓度、肾小管上皮细胞内游离Ca2+浓度和ROS含量升高,线粒体膜电位降低(P＜0.05).结论 mito-KATP通道的开放参与了缺血后处理减轻大鼠肾缺血再灌注损伤的过程.     

TAT-血红素氧合酶-1融合蛋白对L-02细胞的转导效果

目的 观察TAT-血红素氧合酶-1(HO-1)融合蛋白对L-02细胞的转导能力,细胞毒性和转导后细胞内HO-1活性,评价其转导效果.方法 L-02细胞与FITC标记的TAT-HO-1融合蛋白孵育4 h后,荧光显微镜下观察TAT-HO-1融合蛋白转导入L-02细胞的情况.L-02细胞与TAT-HO-1融合蛋白孵育4 h后,采用CCK-8方法 测定L-02细胞的活力.采用化学法测定HO-1活性.结果 与FITC标记的TAT-HO-1融合蛋白孵育后,L-02细胞内均匀分布绿色荧光;与TAT-HO-1融合蛋白孵育后,L-02细胞活力无明显改变,HO-1活性明显升高.结论 TAT-HO-1融合蛋白可有效地转导人L-02细胞,可明显提高细胞内HO-1活性,且无细胞毒性.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

山莨菪碱对过度训练致急性心肌损伤大鼠caspase-1和IL-18表达的影响

目的 评价山莨菪碱对过度训练致急性心肌损伤大鼠caspase-1和IL-18表达的影响.方法 健康雄性Wistar大鼠48只,体重200～ 220 g,采用随机数字表法,将其随机分为3组:对照组(C组,n=8)、力竭运动组(ES组,n=24)和山莨菪碱组(AD组,n=16).采用游泳力竭法建立过度训练致大鼠急性心肌损伤模型.AD组于力竭运动前20 min腹腔注射山莨菪碱10 mg/kg.ES组于力竭后即刻、6、24 h时,AD组于力竭后6、24 h时分别随机取8只大鼠,采集下腔静脉血样,采用ELISA法检测血清心肌肌钙蛋白I(cTnl)浓度,随后处死大鼠取心肌组织,采用免疫组化法检测caspase-1及IL-18的表达水平,光镜下观察病理学结果.结果 与C组比较,ES组各时点血清cTnI浓度升高,心肌组织caspase-1和IL-18表达上调(P＜0.05);与ES组比较,AD组各时点血清cTnI浓度降低,心肌组织caspase-1和IL-18表达下调(P＜0.05).AD组心肌病理学损伤程度轻于ES组.结论 山莨菪碱可减轻过度训练致大鼠急性心肌损伤,其机制与下调心肌组织caspase-1及IL-18表达有关.     

异丙酚分步效应室靶控输注用于全麻诱导的效果观察

目的 评价异丙酚分步效应室TCI诱导模式在妇科腹腔镜手术患者全麻诱导中应用的效果.方法 选择择期全麻下行妇科腹腔镜手术患者40例,随机分为常规效应室TCI诱导组(Ⅰ组)和分步效应室TCI诱导组(Ⅱ组).分别记录两组患者麻醉诱导开始前(T0)、意识消失时(T1)、气管插管前即刻(T2)及气管插管完成时(T3)患者平均动脉压、心率及麻醉深度状态指数值.记录起效时间(开始输注异丙酚到意识消失时间),异丙酚血浆峰浓度,插管完成时间(开始输注异丙酚到气管插管完成时间),插管完成时异丙酚用量.结果 两组患者不同时间点平均动脉压和心率间差异均有统计学意义(F值分别为30.82和25.69,P＜0.05),与T0时比较两组患者平均动脉压均于T1时出现降低(P＜0.05),T2时达最低值(P＜0.05),T3时恢复至T0水平(P＞0.05); T1、T2时间点组间比较显示Ⅰ组平均动脉压低于Ⅱ组(P＜0.05).与T0时比较两组患者心率均于T1时出现降低(P＜0.05),T3时恢复T0水平(P＞0.05).与Ⅰ组比较,Ⅱ组起效时间、插管完成时间显著延长(P＜0.05),异丙酚血浆峰浓度明显降低(P＜0.05),但两组气管插管完成时异丙酚用量间差异无统计学意义(P＞0.05).结论 异丙酚分步效应室TCI诱导模式对血流动力学的影响较轻,可安全有效地应用于全麻诱导.     

全程心理疏导联合术后镇痛对全身麻醉开胸手术患者苏醒期躁动的影响

目的 评价全程心理疏导联合术后镇痛预防全身麻醉开胸手术患者苏醒期躁动的临床效果.方法 选择全身麻醉下行择期开胸手术患者160例,随机分为4组:常规访视组(A组)、全程心理疏导组(B组)、术后镇痛组(C组)及全程心理疏导联合术后镇痛组(D组),每组40例.记录麻醉前(T0)、手术结束时(T1)、拔出气管导管即刻(T2)、拔出气管导管后5 min(T3)、拔出气管导管后10 min(T4)的平均动脉压(MAP)、心率(HR),观察并记录患者麻醉苏醒期操作配合程度及苏醒期躁动发生率.结果 4组患者术后苏醒时间和拔管时间组间差异无统计学意义(P＞0.05).A、B、C 3组患者T2时MAP水平和HR水平与T0时比较,差异均有统计学意义(P＜0.05).A组苏醒期躁动发生率与B组、C组及D组比较,D组与B组、C组比较,差异均有统计学意义(P＜0.05).结论 开胸手术患者实施全程心理疏导联合术后镇痛的综合性措施,可降低麻醉苏醒期蹂动的发生率,提高患者的安全度与舒适度.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

体外冲击波配合功能锻炼治疗肩周炎的疗效观察

肩周炎为肩关节周围炎的简称,是肩关节囊和关节周围软组织损伤、退变引起的慢性无菌性炎症,以肩关节周围疼痛、功能障碍和肌肉萎缩为主要特征。该病病程较长,可迁延数月至2年,给患者正常生活造成严重影响[1]。目前常用的治疗方法包括局部封闭、物理疗法、针灸疗法、运动疗法等,但其治疗效果并不十分确切。体外冲击波(extracorporealsh ockwave,ESW)是利用声波经由反射器反射后集中成高能量的冲