心脏超声诊断高血压左室肥厚伴左心力衰竭的临床分析

目的:探讨心脏超声诊断高血压左室肥厚伴左心力衰竭的临床应用价值.方法:将2015年01月-2020年02月本院收治的50例高血压左室肥厚伴左心力衰竭患者作为研究组,另选取同期在本院接受体检的健康者作为对照组,所有受试者均接受心脏超声检查,对两组各项心脏指标进行比较.结果:在左心室后壁厚度(LVPWD)、左房内径(LAD...     

两种气体持续气道正压在单肺通气中对肺内分流与氧合的影响

目的观察氧气与空气在不同持续气道正压(CPAP)水平下对单肺通气氧合与肺内分流的影响.方法随机将14例单肺通气下行开胸手术的病人平均分成组Ⅰ(氧气组)和组Ⅱ(空气组),常规诱导、插入双腔支气管导管后行单肺通气20min后,组Ⅰ利用氧气向无通气侧肺给予5 cmH2O的CPAP,15 min后再给予10 cmH2O的CPAP;而组Ⅱ利用空气向无通气侧肺给予5 cmH2O的CPAP,15 min后再给予10 cmH2O的CPAP.分别记录单肺通气前、单肺通气20min、5 cmH2O的CPAP15 min、10 cmH2O的CPAP15min、术毕恢复双肺通气15min所测得的动脉血pH、PaO2和PaCO2等数据,并计算Qs/Qt值.结果组Ⅰ:5 cmH2O CPAP 15 min比单肺通气20min:PaO2显著增高(P＜0.05)、Qs/Qt显著降低(P＜0.05).10 cmH2O CPAP 15 min比单肺通气20min:PaO2显著增高(P＜0.05)、Qs/Qt显著降低(P＜0.05).10 cmH2O CPAP 15 min比5 cmH2O CPAP 15 min:PaO2显著增高(P＜0.05)、Qs/Qt显著降低(P＜0.05).组Ⅱ:5 cmH2O CPAP 15 min比单肺通气20min:PaO2、Qs/Qt无显著差异(P＞0.05).10 cmH2O CPAP 15 min比单肺通气20min:PaO2显著降低(P＜0.05),Qs/Qt显著增加(P＜0.05).结论氧气提供CPAP可有效改善单肺通气造成的低氧状况,10 cmH2O CPAP比5 cmH2O CPAP对改善Qs/Qt、提高PaO2更有效.用空气提供CPAP不能使单肺通气产生的低氧状况得到改善.     

新斯的明对硬膜外麻醉低血压的影响

目的 :观察新斯的明对硬膜外麻醉血压和心率的影响。方法 :选择 ASA ～ 级的拟行下腹部手术的患者5 0例 ,随机分为对照组 (n=2 5 )和观察组 (n=2 5 )。对照组经硬膜外腔注射 2 %利多卡因 15 ml加生理盐水 1.5 ml,观察组经硬膜外腔注射 2 %利多卡因 15 ml加新斯的明 1.5 mg(1.5 ml) ,观察注药后血压和心率的变化。结果 :麻醉后 ,对照组血压明显降低 ,心率明显减慢 ,观察组血压变化不明显 ,但心率减慢非常明显 ,与对照组相比 ,观察组血压明显高 ,但心率却明显慢。结论 :新斯的明对硬膜外麻醉低血压有预防作用 ,但存在心动过缓的副作用。     

耳针联合硬膜外麻醉对剖宫产产妇肾素-血管紧张素-醛固酮系统的影响

目的观察耳针联合硬膜外麻醉对剖宫产产妇肾素-血管紧张素-醛固酮系统（RAAS）的影响。方法选择择期子宫下段剖宫产产妇30例，随机分为单纯硬膜外麻醉组（单麻组）15例和耳针联合硬膜外麻醉组（联合组）15例。观察2组患者麻醉效果、血流动力学变化和胎儿Apgar评分。同时用放免法测定麻醉前（T0）、切皮后即刻（T1）、胎儿娩出后即刻（T2）和术毕即刻（T3）产妇血清肾素（RE）活性以及血管紧张素-Ⅱ（AT-Ⅱ）和醛固酮（ALD）浓度。结果2组患者麻醉起效时间、麻醉阻滞完善诱导时间、局部麻醉药诱导用量、麻醉平面比较，差异无统计学意义（P〉0．05）。术中联合组出现牵拉反应、需用麻醉辅助药病例数较单麻组少，2组间差异有统计学意义（P〈0．01）。2组患者血流动力学变化、胎儿Apgar评分比较，差异均无统计学意义（P〉0.05）。单麻组RE和AT-Ⅱ浓度在胎儿娩出后即刻（T2）明显高于联合组，差异有统计学意义（P〈0．05或0．01）；单麻组RE浓度在术毕即刻（T1）明显高于联合组，差异有统计学意义（P〈0．05）。结论耳针联合硬膜外麻醉，可以抑制RAAS的应激反应，改善硬膜外麻醉质量。     

VITEK-2 Compact检测鲍氏不动杆菌对阿米卡星药敏结果准确性的探讨

目的 针对VITEK-2 Compact在检测鲍氏不动杆菌对阿米卡星药敏试验中的局限性,利用金标准E-test 法探索不同耐药表型和检测结果的相关性,为临床提供更加准确的结果.方法 运用VITEK-2 Compact ASTGN13药敏卡测定296株鲍氏不动杆菌的药敏试验结果,按耐药表型将所测菌株分为3组即1组仅阿米卡星敏感、2组仅阿米卡星及亚胺培南敏感、3组除阿米卡星及亚胺培南外存在其他被检测药物敏感;每组随机抽取40株用E-test法作为金标准同时进行K-B法测定鲍氏不动杆菌对阿米卡星的敏感性.结果 3组检测鲍氏不动杆菌K-B法和E-test法均一致;1组VITEK-2 Compact结果与K-B法及E-test法结果不一致,2组39株不一致、1株一致,3组2株结果不一致、38株结果一致;同时观察到VITEK-2 Compact AES专家系统显示耐药表型为野生株的29株3种方法结果一致.结论 试验结果证实K-B法及E-test法的结果是一致的,所以VITEK-2Compact用户可以采用K-B法检测鲍氏不动杆菌对阿米卡星的敏感性.     

PCEA防治tuvp后膀胱痉挛289例体会

目的探讨硬膜外自控镇痛（patient controlled epidural analgesia,PCEA）防治经尿道前列腺汽化电切（transurethral electrovaporization of the prostate,TUVP）术后膀胱痉挛的临床应用价值。方法将连续硬膜外麻醉下行TUVP术后的病人289例,随机分成两组,A组（传统镇痛）与B组（PCEA）,记录两组病人并发疼痛、恶心、呕吐、膀胱痉挛、引流不畅的情况。结果 B组术后病人并发疼痛、膀胱痉挛、引流不畅等情况均少于A组,差异有统计学意义（P〈0.05）,且无呼吸抑制等不良反应发生。结论 TUVP术后应用PCEA不仅减轻病人的疼痛,而且有效地降低了TUVP术后膀胱痉挛。     

C／EBPα-Per2信号通路对K562细胞相关基因的调控机制

目的：探索Per2在CCAAT增强子结合蛋白α（C／EBPα）参与调控的慢性粒细胞白血病（CML）发生、发展中的作用。方法通过脂质体介导将真核表达载体pGenesil-3-SiPer2和空载体pGenesil-3-HK转染到pEGFP-C／EBPα-K562细胞,利用新霉素筛选稳定干扰Per2的pEGFP-C／EBPα-K562单克隆细胞株。利用 RT-PCR 和 Western blot 分别检测转染组、空载组、对照组细胞p53、c-myc 、cyclinB1的mRNA及蛋白表达水平的改变。结果成功构建稳定干扰Per2表达的pEGFP-C／EBPα-K562细胞株。与对照组和空载组细胞相比,转染组pGenesil-3-SiPer2-K562细胞的p53 mRNA及蛋白表达水平明显降低,差异有统计学意义（P＜0．01）,而cyclinB1和c-myc基因的mRNA及蛋白表达水平则显著升高,差异有统计学意义（P＜0．01）。结论 Per2基因在C／EBPα参与调控的CML发生发展中起重要作用,该通路的发现对于研究CML的发生及调控机制具有重要意义。     

Impact of CCAAT enhancer binding protein α on the differentiation and apoptosis of acute myeloid leukemia HL60 cells

Objective To investigate the effect of CCAAT enhancer binding protein α(C/EBPα) on differentiation and apoptosis in the acute myeloid leukemia HL60 cells in vitro and in vivo and its possible mechanism. Methods The C/EBPα expression plasmid pEGFP-C/EBPα and empty control plasmid were respectively transfected into HL60 cells with cationic liposome as transfected group and empty plasmid transfected group, and untreated HL60 cells served as control group. The cells stably expressing the C/EBPα gene were obtained by G418 selection. The morphological changes were observed under light microscope following WrightGiemsa staining. MTT assay was employed to evaluate cell proliferation, and flow cytometry(FCM) was performed to analyze cell apoptosis. Meanwhile, the expression of c-myc was respectively detected by RT-PCR and Western blot both at the mRNA and protein level. Twenty BALB/c nude mice were divided into 3 groups in a completely randomized design: 7 mice in transfected group, 7 mice in empty plasmid transfected group and 6 in control group. Three kinds of cells including pEGFP-C/EBPα-HL60 cells, pEGFP -HL60 cells and the control HL60 cells were injected into mice separately through the subcutaneous. The mice were sacrificed at 20 d after injection. The mass and size of subcutaneous xenograft tumors were measured and the cell apoptosis of subcutaneous tumor were detected by TUNEL. Results The pEGFP-C/EBPα-HL60 cell line stably expressing the C/EBPα gene was screened out. Compared to either empty plasmid transfected group or control group, the expression of C/EBPα could promote cellular differentiation of HL60. FCM showed higher apoptotic rate in transfected group[ (21.9±4.5)%,P＜0.05 ] ,while (5.4±1.4)% in control group and (5.0±1.3)% in empty plasmid transfected group. c-myc expression was significantly down-regulated by C/EBPα both at the mRNA and protein level. The mass and size of tumors in transfected group were smaller than those in empty plasmid transfected group and control group [ (5.35±1.12)g and(25±4)mm in control group, (5.12±1.31)g and ( 18±3)mm in empty plasmid transfected group ,while (3.26±0.72)g and ( 11±2)mm in transfected group, all P＜0.05]. More apoptosis cells were found in subcutaneous tumor of transfected group(both P＜0.05). Conclusion C/EBPα can not only inhibit the proliferation, but also induce massive apoptosis of HL60 cells, meanwhile C/EBPα is a tumor suppressor of acute myeloid leukemia.     

膀胱尿路上皮癌CD44v2的表达及临床意义

目的 探讨CD44v2在膀胱尿路上皮癌中的表达及其与临床病理的相关性.方法 应用免疫组织化学技术检测60例膀胱尿路上皮癌和10例正常膀胱黏膜CD44v2蛋白的表达.结果 CD44v2蛋白在正常膀胱粘膜上皮无表达,在60例膀胱尿路上皮癌中阳性表达是25例(41.7％),阳性表达率与肿瘤的病理分级,TNM分期显著相关,而与肿瘤的复发,数量无关.结论 CD44v2可作为判断膀胱尿路上皮癌分级,分期的一个参考指标.