CPB诱发犬急性肺损伤时肺组织转化生长因子β1 mRNA表达的变化

Objective To observe the changes in the transforming growth factor-beta 1 (TGF-β1 ) mRNA expression in the lung in a dog model of cardiopulmonary bypass(CPB)-induced acute lung injury. Methods Thirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into control group and CPB group ( n = 18 each) . Lung injury was produced by CPB according to the method described by Williams. Six animals were killed at each of the following time points: before CPB (T0 ) and 30 and 60 min after termination of CPB (T1 , T2) in each group. Lung specimens were obtained for microscopic examination and determination of TGF-β1 mRNA expression (by RT-PCR) and MDA content. The lungs were lavaged and the protein concentration in the brancho-alveolar lavage fluid (BALF) was determined and pulmonary permeability index (PPI) was calculated. Results Microscopic examination showed massive inflammatory cell infiltration, alveolar capillary dilatation, congestion, widened alveolar septum, massive RBC in the alveolar space and focal atelectasis in the lung in CPB group. The TGF-β1 mRNA expression and MDA content and PPI were significantly higher in CPB group than in control group. The TGF-β1 mRNA expression and MDA was positively correlated to PPI (MDA: r = 0.867, P < 0.01; PPI: r = 0.821, P < 0.01) . Conclusion TGF-β1 mRNA expression in the lung is significantly up-regulated after CPB and is an important factor contributing to CPB-induced acute lung injury.     

CPB诱发犬急性肺损伤时肺组织转化生长因子β1 mRNA表达的变化

目的 观察CPB诱发犬急性肺损伤时肺组织转化生长因子β1(TGF-β1)mRNA表达的变化.方法 成年健康杂种犬36只,体重15～16 kg,随机分为2组(n=18):对照组(C组)和CPB组.CPB组制备CPB诱发急性肺损伤模型,C组除不进行CPB外,其余操作同CPB组.分别于CPB前(T0)、CPB停机后30 min(T1)、60 min(T2)时各处死6只犬,取肺组织,光镜下观察肺组织病理学结果,计算肺通透性指数(PPI),测定肺组织TGF-β1 mRNA表达和MDA含量.结果 C组肺组织结构清晰,未见炎性细胞浸润,肺泡壁光滑、完整,肺泡腔及间质无出血和渗出;CPB组肺泡腔内可见水肿液和中性粒细胞浸润,并可见大量的红细胞,肺泡隔增宽,局灶性肺不张.与C组比较,CPB组TGF-β1 mRNA表达上调,MDA含量和PPI升高(P<0.05或0.01).CPB组TGF-β1 mRNA表达水平与MDA含量和PPI呈正相关(MDA:r=0.867,P<0.01;PPI:r=0.821,P<0.01).结论 犬CPB后肺组织TGF-β1 mRNA 表达上调,可能是CPB诱发急性肺损伤发生发展的重要因素之一.     

瑞芬太尼复合氯胺酮在小儿手术麻醉中的效果分析

目的探讨瑞芬太尼复合氯胺酮在小儿手术麻醉中的效果。方法将78例手术患儿随机分为两组,A组单纯给予氯胺酮麻醉,B组给予瑞芬太尼复合氯胺酮麻醉,对比分析两组麻醉效果。结果两组术前、术中血氧饱和度、无创血压、心率等比较差异无统计学意义（P〉0.05）;两组术中血氧饱和度、无创血压差异无统计学意义（P〉0.05）;B组术中心率低于A组,氯胺酮总用量少于A组,苏醒时间短于A组（P〈0.05）。结论对小儿手术患者采用瑞芬太尼复合氯胺酮麻醉,可减慢心率,减少氯胺酮的用量,缩短苏醒时间。     

超声引导下颈内静脉置管术在肥胖患者中的应用

传统的颈内静脉穿刺主要依靠可见的或可触及的解剖标志，穿刺成功与否取决于操作者的技术与经验。肥胖患者颈部多粗短，不易准确定位，其操作难度明显提高。为提高穿刺置管的成功率和安全性，我们采用超声引导下对肥胖患者行颈内静脉穿刺置管术，收到良好效果，现报道如下。     

支撑喉镜下声带手术的麻醉体会

支撑喉镜下声带显微手术时间短 ,麻醉要求甚高 ,麻醉处理有一定特殊性。我院近几年顺利完成此类手术 82例 ,效果满意 ,现报告如下。1　资料与方法1 .1　一般资料 :全组男 3 4例 ,女 4 8例 ,年龄 1 9～ 3 5岁 ,体重4 2～ 78ｋｇ,ＡＳＡⅠ～Ⅱ级。病种 :声带息肉 55例 ,声带小结2 4例 ,声带囊肿 3例。1 .2　麻醉方法 :术前 3 0ｍｉｎ肌注苯巴比妥钠 2ｍｇ·ｋｇ- 1,阿托品 0 .0 1ｍｇ·ｋｇ- 1。入室后开放静脉 ,静注地塞米松 1 0ｍｇ,静滴平衡液 6～ 8ｍｌ·ｋｇ- 1·ｈ- 1,麻醉诱导为芬太尼 4～ 6μｇ·ｋｇ- 1,利多卡因 1～ 1 .5ｍｇ·ｋｇ…     

靶控输注异丙酚在无痛肠镜检查中的应用

目的:观察异丙酚靶控输注(TCI)技术应用于门诊无痛肠镜检查中的临床效果.方法:60例患者分为靶控输注组(T组)和手控输注组(M组),两组均先静脉注射芬太尼0.8～1 μg/kg,T组用TCI泵输注异丙酚,效应室浓度从2.5μg/mL开始,以0.5μg/mL递增,镜检过程中浓度维持在2.5～4.0μg/mL,M组用输液泵输注异丙酚60mg/(kg·h)的速率诱导,然后以6mg/(kg·h)的速率维持,两组术中根据体动反应、MAP及SpO<,2>变化情况调整异丙酚输注速率.观察记录异丙酚诱导量和总量、诱导时间、镜检持续时间、苏醒时间、术中呼吸循环的变化及不良反应.结果:与M组相比T组的麻醉诱导时间、苏醒时间、诱导所需的异丙酚用量均明显少于M组(P<0.05),术中不良反应率低于M组(P<0.5),术中血压下降幅度及低血压发生率比较差异有显著性(P<0.05),异丙酚总量及镜检时间两组差异无显著性.结论:靶控输注异丙酚应用于门诊无痛肠镜检查能达到满意的麻醉效果,稳定的血流动力学,较少的不良反应发生率,但在体弱或老年患者异丙酚TCI应从较低靶控浓度开始诱导.     

CPB诱发犬急性肺损伤时肺组织转化生长因子β1 mRNA表达的变化

Objective To observe the changes in the transforming growth factor-beta 1 (TGF-β1 ) mRNA expression in the lung in a dog model of cardiopulmonary bypass(CPB)-induced acute lung injury. Methods Thirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into control group and CPB group ( n = 18 each) . Lung injury was produced by CPB according to the method described by Williams. Six animals were killed at each of the following time points: before CPB (T0 ) and 30 and 60 min after termination of CPB (T1 , T2) in each group. Lung specimens were obtained for microscopic examination and determination of TGF-β1 mRNA expression (by RT-PCR) and MDA content. The lungs were lavaged and the protein concentration in the brancho-alveolar lavage fluid (BALF) was determined and pulmonary permeability index (PPI) was calculated. Results Microscopic examination showed massive inflammatory cell infiltration, alveolar capillary dilatation, congestion, widened alveolar septum, massive RBC in the alveolar space and focal atelectasis in the lung in CPB group. The TGF-β1 mRNA expression and MDA content and PPI were significantly higher in CPB group than in control group. The TGF-β1 mRNA expression and MDA was positively correlated to PPI (MDA: r = 0.867, P < 0.01; PPI: r = 0.821, P < 0.01) . Conclusion TGF-β1 mRNA expression in the lung is significantly up-regulated after CPB and is an important factor contributing to CPB-induced acute lung injury.     

超声与心电图对心肌梗塞定位的诊断及临床价值

心电图是最早用于诊断冠心病心肌梗塞和冠状动脉供血不足的检查方法。近年来发展了许多新的检查技术和方法,彩色多普勒就是其中之一。本文应用彩色多普勒超色(CDFI)与心 电图(ECG)对心肌梗塞定位性诊断进行了对比研究,目的在于客观评价二种检查方法在临床 中的意义。 1　资料与方法 　　研究对象为1997～1999年我院心肌梗塞住院患者。男33例,女4例,年龄42～78岁,平均55. 7岁,其中急性心肌梗塞20例,陈旧性心肌梗塞17例。为便于对比研究,将 Ⅱ、Ⅲ、avF导联有坏死性Q波者归为下壁心梗组,将V1－V4导联具有坏死 型Q波者归为前壁心梗组。同天进行心电图及彩色多普勒超声检查者24例,一周内完成者13 例。     

乌司他丁对术中自体血回输患者血浆TNF-α、IL-6、IL-8的影响

目的 观察乌司他丁对术中自体血回输患者血浆TNF-α、IL-6、IL-8水平的影响.方法 术中自体血回输患者30例,男性16例,女性14例,年龄25～63岁,ASAⅠ～Ⅲ级,体量指数20～24kg/m2,随机分为两组(n=15):乌司他丁组（U组）,于麻醉后、手术开始前将乌司他丁(Ulinastatin)20万U溶于2...     

N-乙酰半胱氨酸对体外循环诱发犬肺损伤的影响

目的 探讨N-乙酰半胱氨酸对体外循环(CPB)诱发犬肺损伤的影响.方法 成年犬36只,雌雄不拘,体重15 ～ 16 kg,采用随机数字表法,将其随机分为2组(n=18):CPB组(C组)和N-乙酰半胱氨酸组(N组).右锁骨下动脉和右心房分别插管,制备CPB模型,N组于CPB前即刻静脉注射N-乙酰半胱氨酸150mg/kg,然后以20 mg·kg-1·h-1速率静脉输注至CPB结束后60 min;C组给予等容量生理盐水.分别于CPB前、CPB结束后30、60 min时采集动脉血样,进行动脉血气分析,计算呼吸指数和氧合指数;然后处死动物,取肺组织,测定MDA含量、SOD活性和转化生长因子-β1( TGF-β1) mRNA表达;光镜和电镜下观察肺组织病理学结果.结果 与C组比较,N组呼吸指数和肺组织MDA含量降低,氧合指数和肺组织SOD活性升高,TGF-β1 mRNA表达下调(P＜0.05或0.01),肺组织病理学损伤程度明显减轻.结论 N-乙酰半胱氨酸可减轻CPB诱发犬肺损伤,其机制与减轻脂质过氧化反应,下调肺组织TGF-β1表达有关.