地氟醚与NO预处理对大鼠肺缺血再灌注损伤的保护作用

目的建立在体大鼠肺缺血再灌注(I-R)损伤模型,观察吸入20 ppmNO和/或1.3 MAC地氟醚预处理对大鼠肺I-R损伤的作用.方法 60只SD大鼠随机分为五组,假手术组、I-R组、地氟醚+I-R组、iNO+I-R组及地氟醚+iNO+I-R组.各组在缺血后与再灌注3 h分别处死6只大鼠,检测肺组织IL-10、IL-1β、TNF-α以及ICAM-1表达, MDA、MPO含量和肺组织湿干重比.结果与假手术组相比,肺I-R 后IL-10、IL-1β及TNF-α等细胞因子生成明显增加,ICAM-1呈显著上调,MDA 与MPO显著升高,肺水含量增加.吸入NO和地氟醚均可在一定程度上抑制肺I-R后IL-1β和TNF-α的生成,降低ICAM-1的上调,减少MDA和MPO生成,同时抑制IL-10生成.结论吸入地氟醚和/或NO抑制促炎细胞因子以及黏附分子的表达,同时对抗炎因子也有明显抑制作用,对肺I-R损伤起到保护作用;但两者联合应用并未呈现显著的协同作用.     

氯胺酮对大鼠肺缺血再灌注损伤的影响

[目的]探讨氯胺酮对大鼠肺缺血-再灌注损伤的影响.[方法]成年SD大鼠48只,随机分成4组,分别为假手术对照组(Sham组),缺血再灌注组(Ⅰ-R组),缺血/再灌注 氯胺酮5 mg·kg-1组(KT 1组),缺血/再灌注 氯胺酮10 mg·kg-1组(KT 2组),每组12只,建立大鼠肺缺血-再灌注损伤模型.于再灌注120 min时取大鼠肺组织,观察超氧化物歧化酶(SOD)活性、丙二醛(MDA)浓度、肺组织湿干重比(W/D)的变化,同时测定大鼠血清中炎性细胞因子TNF-α、IL-6和IL-8的含量.[结果]再灌注120 min后,两个KT组大鼠肺组织中的SOD活性高于I-R组(P＜0.01),而MDA含量和W/D值则显著低于I-R组(P＜0.01),同时两个KT组大鼠血清中的TNF-α、IL-6和IL-8浓度均明显低于1-R组(P＜0.01).[结论]氯胺酮可以降低缺血再灌注时肺组织中的氧自由基水平,减轻脂质过氧化反应,同时抑制炎性细胞因子的表达,减轻细胞因子介导的炎性损伤,从而减轻肺组织的损伤,对肺缺血再灌注损伤起一定的保护作用.     

姜黄素预处理对肺缺血再灌注损伤模型大鼠炎性及抗炎性细胞因子的影响

【目的】观察姜黄素预处理对肺缺血再灌注损伤模型大鼠炎性细胞因子肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6),抗炎性细胞因子白细胞介素10(IL-10)水平及髓过氧化物酶(MPO)活性的影响,探讨其作用机制。【方法】将48只健康成年雄性SD大鼠随机分为假手术组。模型组,姜黄素低、高剂量组等4组,每组12只。假手术组大鼠于麻醉前2 h腹腔注射等体积生理盐水,开胸后左肺门不进行夹闭,旷置240 min;模型组大鼠于麻醉前2 h腹腔注射等体积生理盐水,左肺门夹闭,左肺不张60 min再灌注180 min;姜黄素低、高剂量组分别于麻醉前2 h腹腔注射姜黄素50、200 mg/kg,行夹闭左肺门6 min再灌注18 min。造模结束后,采用比色法检测肺组织MPO活性,采用酶联免疫吸附(ELISA)法测定肺组织匀浆液中细胞因子TNF-α、IL-6、IL-10的含量。【结果】与假手术组比较,模型组大鼠MPO活性及TNF-α、IL-6含量升高,IL-10含量降低(均P0.05)。与模型组比较,姜黄素低、高剂量组大鼠MPO活性及TNF-α、IL-6含量降低,IL-10含量升高(P0.05),其中姜黄素高剂量组效果更为明显(P0.05)。【结论】姜黄素预处理可能通过下调炎性细胞因子TNF-α、IL-6水平,上调抗炎性细胞因子IL-10,抑制MPO活性,从而减轻大鼠肺缺血再灌注损伤。     

血红素加氧酶-1的变化对肺缺血再灌注损伤大鼠肺组织细胞因子分泌的影响

目的探讨肺缺血再灌注（I／R）损伤时肺组织中血红素加氧酶-1（HO-1）含量的变化对肺组织中肿瘤坏死因子（TNF-α）、白细胞介素6（IL-6）、白细胞介素10（IL-10）分泌的影响。方法32只健康的SD大鼠随机分成假手术组、缺血再灌注组、HO-1诱导剂组和HO-1抑制剂组。实验结束时取肺组织测湿／干重比（W／D），光镜下计算肺泡损伤数并观察肺组织损伤情况，免疫组织化学法检测肺组织中HO-1蛋白表达，ELISA法测定肺组织匀浆液中细胞因子TNF-α、IL-6、IL-10的含量。结果HO-1诱导剂组HO-1蛋白表达不仅强于假手术组（P〈0．01），而且强于缺血再灌注组和HO-1抑制剂组（均P〈0．01），HO-1抑制剂组表达最弱。HO-1抑制剂组肺组织湿／干重比、肺泡损伤数以及TNF-α、IL-6含量最高，缺血再灌注组次之，HO-1诱导剂组最低；而IL-10含量HO-1诱导剂组〉缺血再灌注组〉HO-1抑制剂组。结论HO-1可以抑制致炎细胞因子TNF-α、IL-6，上调保护性细胞因子IL-10，从而减轻肺缺血再灌注损伤。     

三七总皂甙对大鼠肝缺血再灌注损伤的保护作用

目的探讨三七总皂苷（panaxnonginsengsaponins,PNS）对大鼠肝缺血再灌注损伤的保护作用,并研究其对氧化应激及炎症反应相关因子的影响。方法 30只健康雄性SD大鼠,体质量250～300g,随机分为假手术组（Sham组）、肝缺血再灌注组（HIR组）和三七总皂苷治疗组（PNS组）,各10只。HIR组和PNS组构建肝缺血再灌注模型,PNS组术前1h予50mg/kg PNS生理盐水溶液（5mg/mL）腹腔注射,Sham组及HIR组于术前1h给予相同剂量的生理盐水腹腔注射。预处理3h后处死大鼠,检测并比较三组肝组织丙二醛（MDA）、超氧化物歧化酶（SOD）、髓过氧化物酶（MPO）、细胞间黏附因子-1（ICAM-1）及血清肿瘤坏死因子-α（TNF-α）、白介素-1β（IL-1β）水平。结果 PNS组肝缺血再灌注损伤后肝组织中MDA水平、MPO活性、ICAM-1含量及血清TNF-α、IL-1β低于HIR组（P〈0.05）,SOD活性则高于HIR组（P〈0.05）。结论三七总皂苷可通过减少氧化应激水平和炎症因子表达,减轻肝缺血再灌注损伤,达到肝脏保护作用。     

大鼠肺缺血再灌注损伤前乳化异氟醚预处理

目的:探讨乳化异氟醚(emulsified isoflurane,EI)预处理对大鼠肺缺血再灌注损伤的保护作用。方法:雄性Wistar大鼠160,体重250-300克,随机分为5组,每组32只,对照组(A组)、假手术组(B组)缺血再灌注模型组(C组)、脂肪乳组(D组),乳化异氟醚预处理组(E组)。对照组不作任何处理;假手术组仅开胸游离左肺门后,不进行阻断左肺门,用0.9%生理盐水(5ml/kg/h)输注30min;缺血再灌注组(I/R组):开胸游离左肺门后,用0.9%生理盐水(5ml/kg/h)输注30min后,阻断左肺门45min,后松开血管夹形成再灌注;脂肪乳组用30%浓度的脂肪乳(5ml/kg/h)输注30min后,阻断左肺门45min,后松开血管夹形成再灌注;乳化异氟醚组用6.9%乳化异氟醚(5ml/kg/h)静脉注射30min后,阻断左肺门45min,后松开血管夹形成再灌注。观察各组大鼠肺组织病理学,测定肺组织匀浆MPO、TNF-α水平。结果:肺缺血再灌注可导致严重的肺组织的损伤,表现为肺组织有明显的水肿、渗出和炎性细胞浸润。与A、B组相比,C组肺组织各时间点MPO和TNF-α活性增强(P<0.05、P<0.05)。与C组相比,乳化异氟醚预处理组(E组)肺组织的病理表现及损伤程度明显减轻,肺组织各时间点MPO和TNF-α水平降低(P<0.05、P<0.05)。结论:(1)肺缺血再灌注可引起严重的肺损伤;(2)乳化异氟醚预处理对大鼠肺缺血再灌注损伤的具有保护作用。     

不同脑缺血预处理时相对再次缺血损伤大鼠脑组织中IL-1β、TNF-α、IL-10含量的影响

目的观察脑缺血预处理(CIP)后24、72、120、168h4个不同的时间点再次缺血损伤大鼠脑组织中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)含量的变化趋势,探讨IL-1β、TNF-α、IL-10在脑缺血耐受中的作用。方法将大鼠随机分为6组:假手术组,缺血再灌注损伤组,CIP后24、72、120、168h再次损伤组。CIP各组先短暂阻断双侧颈总动脉10min作为缺血预处理,分别于缺血预处理后24、72、120、168h线栓法阻断大脑中动脉2h作为再次缺血损伤;缺血再灌注损伤组只阻断大脑中动脉2h;采用酶联免疫吸附试验(ELISA)测定各组大鼠脑组织匀浆中IL-1β、TNF-α、IL-10含量。结果与假手术组比较,缺血再灌注损伤组大鼠脑组织中IL-1β、TNF-α和IL-10含量均明显升高(P0.05);与缺血再灌注损伤组比较,CIP后24、72h再次缺血损伤组IL-1β含量明显升高(P0.05),120、168h再次缺血损伤组IL-1β含量逐渐降低;CIP后24、120h再次缺血损伤组TNF-α含量明显升高(P0.05),72、168h再次缺血损伤组TNF-α含量呈降低趋势;CIP后24、72h再次缺血损伤组IL-10含量明显升高(P0.01,P0.05),120h再次缺血损伤组IL-10呈降低趋势,168h再次缺血损伤组IL-10又明显升高(P0.05)。结论在CIP后24h脑组织中细胞因子IL-1β、TNF-α、IL-10水平明显升高能持续到72h(TNF-α除外),表明细胞因子作为触发物质,启动较早,刺激机体产生内源性的保护作用,对抗下次缺血带来的损伤,提高脑缺血耐受。     

大鼠脑缺血再灌注后TNF-α及ICAM-1的相关性分析

目的观察大鼠脑缺血再灌注损伤后细胞间黏附分子-1(ICAM-1)、肿瘤坏死因子-α(TNF-α)在脑缺血再灌注损伤不同时间段的表达规律,探讨ICAM-1、TNF-α在脑缺血再灌注损伤中的关系.方法采用大鼠局灶性脑缺血再灌注损伤模型,大鼠大脑中动脉阻塞2 h,分别再灌注2、6、12、24、48、96h,免疫组织化学法测定ICAM-1、TNF-α表达水平.并设正常组、假手术组及永久缺血组对照.结果ICAM-1的表达永久缺血组、缺血再灌注组ICAM-1明显高于正常对照组和假手术组(P＜0.01);与永久缺血组比较,缺血再灌注组除再灌注2 h时段外,ICAM-1表达明显增高(P＜0.05);脑缺血再灌注2 h组局部脑组织ICAM-1的表达于再灌注48h达到峰值,再灌注96h仍保持较高水平.TNF-α的表达缺血再灌注组大鼠缺血侧半球TNF-α的表达于再灌注2 h开始升高,再灌注12 h,阳性细胞显著增多,24h达到高峰,其后逐渐下降,96h达基础水平;缺血再灌注组TNF-α的表达较正常组、假手术组有显著差异(P＜0.01),比永久缺血组TNF-α阳性细胞低,但无统计学意义(P＞0.05).缺血再灌注组TNF-α的表达与ICAM-1的表达在24、48、96h时间段呈正相关(r分别为0.765、0886、0.787,P＜0.05);TNF-α的表达早于ICAM-1的表达,且TNF-α与ICAM-1表达部位相同.结论大鼠脑缺血再灌注损伤后,ICAM-1、TNF-α参与了脑缺血后的炎症反应,且二者有明显的相关性TNF-α可能诱导了ICAM-1的上调,在神经元迟发性坏死中起着重要作用.     

乌司他丁对胰腺缺血-再灌注损伤大鼠血清炎性因子TNF-α和IL-1β的影响

目的探讨乌司他丁是否能抑制胰腺缺血再灌注损伤大鼠炎性因子的释放.方法SD大鼠72只随机分为假手术组、缺血再灌注组和乌司他丁组.分别检测胰腺缺血再灌注0、6、12h及24h血清中肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）的变化.结果缺血再灌注组的各时点TNF-α含量明显高于假手术组和乌司他丁组（P〈0.05）;缺血再灌注组和乌司他丁组的IL-1β含量在6h、12h、24h较假手术组明显增加（P〈0.05）,但乌司他丁组增高水平明显低于缺血再灌注组（P〈0.05）.结论乌司他丁可以抑制胰腺缺血再灌注损伤大鼠炎性因子的释放,对大鼠胰腺缺血再灌注损伤有保护作用.     

活化蛋白C对大鼠脂肪肝缺血再灌注损伤的影响

目的 探讨大鼠脂肪肝缺血再灌注损伤过程中炎症变化情况以及活化蛋白C (APC)对大鼠脂肪肝缺血再灌注损伤的影响.方法 清洁级健康雄性Wistar大鼠60只,制备成脂肪肝模型后,随机分为假手术组、对照组和APC组.APC组和对照组行部分肝缺血50 min,各组于再灌注6 h和24 h两个时间点,分别对10只大鼠取材,观察各组ALT、AST、TNF-α、肝组织MPO含量、肝组织ICAM-1免疫组化染色和肝脏组织病理学改变等指标.结果 APC组与对照组的ALT、AST、TNF-α、MPO和ICAM-1表达在各个时间点上均明显高于假手术组.再灌注6 h后与对照组比较,APC组ALT、AST、TNF-α水平和MPO含量明显降低,ICAM-1的表达明显减弱.光镜下观察肝形态学变化,对照组损伤甚为明显,APC组和假手术组损伤程度较对照组轻,假手术组更轻.再灌注24 h后,与对照组比较,APC组TNF-α水平明显降低,APC组与对照组其余各项指标间差异无统计学意义.结论 APC通过抗炎和减少内皮细胞损伤,对大鼠脂肪肝缺血再灌注损伤起保护作用.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.