缺氧,缺血及再灌注山羊血浆对血管内皮细胞和中性粒细胞的影响

为了探讨缺氧，缺血及再灌注损伤的发生的机制，我们分别观察了缺氧（模拟海拔４０００ｍ高原）２４ｈ山羊血浆（ＨＰ），缺血１ｈ（在上述条件下于缺氧２４ｈ末放血使血压维持在６．０ｋＰａ１ｈ）山羊血浆（ＩＰ）和再灌注回输放出血液后２４ｈ）山羊血浆（ＲＰ）对中性粒细胞（ＰＭＮ）及培养的肺动脉内皮细胞（ＰＡＥＣ）的作用，ＰＭＮ在分别含ＨＰ、ＩＰ和ＲＰ的培养中温育１ｈ末，细胞活力明显升高（Ｐ〈０．００１），其升高     

肺切除术影响围手术期右心功能

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.     

低氧诱导成肌纤维细胞形成在低氧性肺血管重塑中的作用

目的:探讨低氧性肺动脉高压(HPH)无肌性肺动脉肌化的细胞来源。方法:雄性Wistar大鼠40只,分为对照组和低氧3、7、14、21d组,每组8只,低氧组复制HPH大鼠模型。测定各组平均肺动脉压(mPAP),右心室肥大指数(RVHI),肺小动脉病理及其形态计量学;细胞培养实验观察人胚肺成纤维细胞表型转化,透射电镜观察微血管的超微结构改变。结果:(1)低氧7d起大鼠mPAP、管壁面积/管总面积、管腔面积/管总面积分别为(18.41±0.37)mmHg、(52.2±0.8)%、(47.8±0.8)%与对照组(14.02±0.41)mmHg、(64.5±1.3)%、(35.5±1.3)%比较差异有显著性(P<0.05),低氧14d起稳定于高水平;低氧14d RVHI为(25.0±1.8)%,与对照组(23.6±0.5)%比较差异也有显著性(P<0.05)。(2)细胞培养显示低氧72h部分人胚肺成纤维细胞表达α-平滑肌肌动力蛋白。(3)透射电镜观察21d组增厚的重塑血管壁,位于内外弹性膜之间的细胞为成肌纤维细胞表型,外层具有与它紧密联系的成纤维细胞。结论:成纤维细胞转化为成肌纤维细胞是低氧性肺血管重塑的重要原因之一。     

老年患者术后谵妄危险因素分析

目的探讨老年患者术后发生谵妄的影响因素。方法统计我院169例老年手术患者的年龄、性别以及低氧血症、术后疼痛、睡眠时间减少等的发生情况,对资料进行2χ检验、单因素分析及多因素Logistic回归分析,判定老年患者术后发生谵妄的危险因素。结果169例老年患者术后发生谵妄20例,发生率为11.8%。≥70岁的高龄患者、术中与术后发生低氧血症者、术后疼痛与睡眠时间减少与谵妄发生有关(P<0.01)。高龄患者、术中与术后发生低氧血症者、术后疼痛是谵妄发生的重要影响因素。结论应给予高龄患者特别注意,围术期预防低氧血症,良好的术后镇痛及睡眠对预防术后谵妄有积极意义。     

无创机械通气在肺栓塞低氧血症中的应用

目的探讨经口鼻面罩无创机械通气治疗肺栓塞的临床价值。方法52例肺栓塞伴低氧血症患者,随机分为两组,对照组24例给予抗凝、解痉及抗感染等对症处理,治疗组在此基础上采用无创机械通气治疗,比较两组的治疗效果。结果无创通气治疗后患者的pH值、PaO2、PaCO2、呼吸频率和心率与治疗前比较差异均有统计学意义(P<0.01);与对照组比较差异亦均有统计学意义(P<0.05)。结论无创机械通气应用于肺栓塞可明显纠正低氧血症和酸碱平衡紊乱,减少心肺并发症的发生。     

无创机械通气治疗AAMI并低氧血症对BNP及预后的影响

目的：探讨对急性前壁心肌梗死（AAMI）并低氧血症患者行无创机械通气治疗后患者脑利钠肽（BNP）动态变化,左室射血分数（LVEF）和预后的改善。方法：回顾性分析2011年3月-2013年10月期间收住院的60例 AAMI并低氧血症患者的资料,患者被随机分为无创通气组（28例）与常规治疗组（32例）,观察并比较两组患者BNP的动态变化及 LVEF情况。结果：两组治疗后BNP水平及 LVEF均有明显改善（P均＜0.05）,与常规治疗组比较,无创通气组治疗后 BNP水平[24h：（263.6±23.3）μmol/L比（126.2±21.9）μmol/L]显著降低、LVEF [（40.6±13.1）％比（47.3±14.7）％]显著上升（P均＜0.01）,随访30d后无创通气组较常规治疗组6 min步行距离（426-550m）者比例为75.0％比59.3％、LVEF [（49.4±12.5）％比（41.1±11.7）％]、存活率（96.4％比90.6％）明显增加,再次住院率（7.1％比12.5％）显著降低（P均＜0.01）。结论：急性前壁心肌梗死并低氧血症患者早期行无创机械通气治疗能明显改善患者的心功能,提高患者的运动耐量和存活率。     

The metabolic function of the lung

Whereas the respiratory function of the lung has been studied extensively, there are only scarce data available concerning the lung's drug clearance capabilities in man. Its metabolic function in hormonally active agents has been documented in animals. To gain insight in this non-respiratory function of the lung knowledge of the architecture of the alveolar-capillary unit and the histochemistry of its different cell types is necessary. Some examples of studies with drugs are presented to illustrate the methods that have been used in metabolic and uptake studies of the lung.     

急性A型主动脉夹层术前低氧血症相关因素分析

目的 分析急性A型主动脉夹层术前低氧血症的临床相关因素.方法 2011年1月至6月,随机采集54例急性A型主动脉夹层患者临床资料.男42例,女12例;年龄28 ～ 73岁;发病到就诊时间0.4 ～14.0天.收集患者年龄、性别、发病时间、体重指数、高血压史、糖尿病史、吸烟史、饮酒史、心脏射血分数、凝血酶原时间、纤维蛋白原定量、纤维蛋白原降解产物、D-二聚体定量、C-反应蛋白、降钙素原测定结果、ICU时间和住院时间.低氧血症定义为静态未吸氧情况下,氧分压(PaO2)＜(100～年龄×0.33 ±5)mm Hg(1 mm Hg =0.133 kPa).结果 患者中无低氧血症组14例,其中2例未手术者死亡,手术12例无死亡;低氧血症组40例,其中7例未手术者均死亡,手术33例,死亡2例.两组患者年龄、性别、发病时间、高血压史、糖尿病史、吸烟史、饮酒史、心脏射血分数、凝血酶原时间和纤维蛋白原定量差异无统计学意义,P＞0.05;体重指数、纤维蛋白原降解产物、D-二聚体定量、C-反应蛋白、钙素原测定、ICU停留时间和住院时间差异有统计学意义,P＜0.05.结论 急性A型主动脉夹层患者术前伴有低氧血症与肥胖、凝血纤维溶解系统被激活和炎症反应过度有关.     

肺栓塞的首诊思路

目的 通过对肺栓塞临床特点的分析与总结,寻找肺栓塞的首诊思路.方法 对23例肺栓塞患者的高危因素、临床表现及常见辅助检查结果进行分析.结果 91.30％(21/23)肺栓塞患者有高危因素.常见症状为呼吸困难(91.30％,21/23)和胸闷(69.57％,16/23),肺栓塞三联征仅见13.04％(3/23),其他表现包括心悸、胸痛、咯血、晕厥等.血气分析见低氧血症、低碳酸血症.D-二聚体阳性率为91.30％(21/23).91.30％(21/23)心电图和86.96％(20/23)超声心动图异常.结论 合适的首诊思路有助于及早诊断可疑肺栓塞患者,同时可以排除其他常见心肺疾病.     

老年患者冠状动脉搭桥术后早期低氧血症的临床分析及护理

目的分析老年患者冠状动脉搭桥术(coronary artery bypass grafting,CABG)后早期发生低氧血症的危险因素。方法回顾性分析55例老年患者行CABG的病历资料,分析术后72h内发生低氧血症的危险因素。结果 23例(41.82%)老年患者术后72h内发生低氧血症;与未发生低氧血症的老年患者比较,术前肺部疾病或其他原因引起的胸片异常、体外循环时间以及手术时间、术中失血量差异有统计学意义(P<0.05)。结论对术前有肺部疾患或患有影响呼吸功能其他疾病、体外循环时间和手术时间长、术中失血量较大的患者,要早期预见低氧血症发生的可能,积极采取相应措施。