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超声引导下两种神经阻滞方式对胸腔镜下肺叶切除术患者炎症反应及免疫功能的影响 被引量:6
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作者 张磊 袁海军 +3 位作者 乐新会 张宇帆 王晨 赵栋 《中国内镜杂志》 2022年第11期8-14,共7页
目的比较超声引导下两种神经阻滞方式对胸腔镜下肺叶切除术患者炎症及免疫功能的影响,以期为该类患者的镇痛治疗提供参考。方法选择2020年1月-2021年7月该院114例行胸腔镜下肺叶切除术的患者,排除1例脱落病例,最终纳入113例患者,根据麻... 目的比较超声引导下两种神经阻滞方式对胸腔镜下肺叶切除术患者炎症及免疫功能的影响,以期为该类患者的镇痛治疗提供参考。方法选择2020年1月-2021年7月该院114例行胸腔镜下肺叶切除术的患者,排除1例脱落病例,最终纳入113例患者,根据麻醉方式的不同,将其分为A组(n=57)和B组(n=56)。两组患者均在超声引导下进行阻滞,A组采用胸椎旁神经阻滞,B组采用竖脊肌平面阻滞。比较两组患者围手术期情况、炎症反应、应激反应和免疫反应相关指标,以及不良反应发生率。结果两组患者围手术期相关指标比较,差异均无统计学意义(P>0.05);两组患者术毕(T_(1))和术后24 h(T_(2))白细胞介素-10(IL-10)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、皮质醇(Cor)、去甲肾上腺素(NE)及CD8+水平均较术前(T_(0))明显升高(P<0.05);两组患者CD3+、CD4+及CD4+/CD8+水平较T_(0)时点明显降低(P<0.05),且A组明显高于B组(P<0.05);A组不良反应发生率明显低于B组(P<0.05)。结论胸腔镜下肺叶切除术患者采用超声引导下胸椎旁神经阻滞,有助于减轻机体应激及炎症反应,对患者免疫功能的影响较轻,安全性较高。 展开更多
关键词 胸椎旁神经阻滞 竖脊肌平面阻滞 胸腔镜下肺叶切除术 炎症反应 免疫功能
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Abdominal paracentesis drainage ameliorates severe acute pancreatitis in rats by regulating the polarization of peritoneal macrophages 被引量:20
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作者 Ruo-Hong Liu Yi Wen +7 位作者 Hong-Yu Sun Chun-Yu Liu yu-fan zhang Yi Yang Qi-Lin Huang Jia-Jia Tang Can-Chen Huang Li-Jun Tang 《World Journal of Gastroenterology》 SCIE CAS 2018年第45期5131-5143,共13页
AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate r... AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.CONCLUSION These findings suggest that APD treatment exerts antiinflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect. 展开更多
关键词 ABDOMINAL PARACENTESIS drainage PERITONEAL MACROPHAGES POLARIZATION Severe acute PANCREATITIS
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超声引导竖脊肌平面阻滞对胸腔镜肺叶切除患者术后镇痛和细胞免疫功能的影响 被引量:12
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作者 张宇帆 赵栋 +2 位作者 许多嘉 蓝志坚 彭文勇 《中国内镜杂志》 2020年第9期41-48,共8页
目的观察超声引导下竖脊肌平面(ESP)阻滞对胸腔镜下肺叶切除患者术后镇痛和细胞免疫功能的影响。方法选择择期胸腔镜下肺叶切除术患者90例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级。随机分为单纯静脉全麻组(C组)、椎旁神经阻滞+静脉全麻组(P... 目的观察超声引导下竖脊肌平面(ESP)阻滞对胸腔镜下肺叶切除患者术后镇痛和细胞免疫功能的影响。方法选择择期胸腔镜下肺叶切除术患者90例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级。随机分为单纯静脉全麻组(C组)、椎旁神经阻滞+静脉全麻组(P组)和ESP阻滞+静脉全麻组(E组)。E组和P组分别在全麻诱导前行超声引导下ESP阻滞和椎旁神经阻滞,20 min后测定阻滞范围和效果,术毕3组均采用静脉自控镇痛(PCIA)。记录入手术室(T0)、麻醉诱导前(T1)、切皮即刻(T2)和术毕(T3)3组患者平均动脉压(MAP)和心率(HR);记录术后2 h(T4)、8 h(T5)、12 h(T6)、24 h(T7)和48 h(T8)静态数字疼痛评分[NRS(R)]和动态NRS评分[NRS(M)];并于T0、T3、T7和T8抽取静脉血5 mL,检测血液自然杀伤(NK)细胞数目和Th1/Th2比值;记录术后镇痛泵按压次数、药物输注总量、曲马多给药次数和术后不良反应发生情况。结果与T0比较,P组患者在T1时点MAP降低、HR增快(P<0.05),C组患者T2和T3时点MAP增高、HR增快(P<0.05);P组和E组患者T2和T3时点MAP低于C组、HR慢于C组(P<0.05);C组和E组患者T1时点MAP高于P组、HR慢于P组(P<0.05);P组和E组患者术后T4~T6时点的NRS(R)低于C组(P<0.05),E组患者术后T7时点NRS(R)低于C组(P<0.05);P组和E组患者术后T4~T6时点的NRS(M)低于C组(P<0.05);P组和E组各时点NRS比较,差异无统计学意义(P>0.05)。各组患者在T3、T7和T8时点NK细胞数目、Th1/Th2比值均较T0降低,E组和P组在T3、T7和T8时点NK细胞数目、Th1/Th2比值高于C组(P<0.05),E组和P组比较,差异无统计学意义(P>0.05);E组和P组术中瑞芬太尼用量、镇痛泵按压次数、药物输注总量和曲马多给药次数均明显少于C组(P<0.05),E组与P组比较,差异无统计学意义。P组术后低血压发生率高于C组和E组(P<0.05)、C组术后恶心呕吐发生率高于P组和E组(P<0.05)。结论超声引导下ESP阻滞,对胸腔镜下肺叶切除患者术后疼痛和免疫功能的影响与椎旁神经阻滞相当,但对患者循环影响更小。 展开更多
关键词 胸腔镜 肺叶切除 竖脊肌平面阻滞 术后镇痛 细胞免疫
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肺内压力监测联合开胸前肺萎陷技术用于胸腔镜手术的效果 被引量:3
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作者 赵栋 熊畅 +3 位作者 张宇帆 乐新会 许多嘉 蓝志坚 《中国内镜杂志》 2021年第9期37-43,共7页
目的评价肺内压力监测(IPM)联合开胸前肺萎陷技术(PTLCT)用于胸腔镜手术的效果。方法选择择期行胸腔镜左肺叶楔形切除术的患者96例,性别不限,年龄30~79岁,体重指数(BMI)<30 kg/m^(2),美国麻醉医师协会分级(ASA)为Ⅰ级或Ⅱ级,采用随... 目的评价肺内压力监测(IPM)联合开胸前肺萎陷技术(PTLCT)用于胸腔镜手术的效果。方法选择择期行胸腔镜左肺叶楔形切除术的患者96例,性别不限,年龄30~79岁,体重指数(BMI)<30 kg/m^(2),美国麻醉医师协会分级(ASA)为Ⅰ级或Ⅱ级,采用随机数表法分为4组(n=24):PTLCT组(C组)、-5~5 mmHg IPM联合PTLCT组(P_(1)组)、-15~-6 mmHg IPM联合PTLCT组(P_(2)组)、<-15 mmHg IPM联合PTLCT组(P_(3)组)。PTLCT采用双肺纯氧通气并在侧卧位前封堵术侧支气管,单肺通气10 min后打开胸膜并胸腔镜进胸。P_(1)组、P_(2)组、P_(3)组分别在PTLCT的基础上,在IPM达到相应压力段时打开胸膜并胸腔镜进胸。记录每组侧卧位即时(T_0)和打开胸膜前(T_1)的心率(HR)、收缩压(SBP)、舒张压(DBP)、经皮动脉血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))和动脉血二氧化碳分压(PaCO_(2)),并且到时间点后即刻进胸,胸腔镜直视下观察肺萎陷情况。结果P_(1)组有8例患者在达到肺内压力段时未能完成进胸前准备;P_(2)组有2例患者未能达到所需肺内压力段;P_(3)组有1例患者在进胸前的单肺通气期间发生低氧血症(SpO_(2)<90%),2例患者未能达到所需肺内压力段。与C组比较,P_(1)组患者肺萎陷评分(LCS)下降(P<0.05),P_(2)组、P_(3)组患者LCS差异无统计学意义(P>0.05)。在T_1时,与P_(1)组比较,P_(3)组SpO_(2)降低(P<0.05);与C组比较,P_(1)组PaO_(2)升高(P<0.05);与P_(1)组比较,P_(2)组、P_(3)组PaO_(2)降低(P<0.05);与P_(2)组比较,P_(3)组PaO_(2)降低(P<0.05)。结论IPM联合PTLCT可以避免肺组织损伤;在-15~-6 mmHg肺内压力段时进胸,既可以达到良好的开胸前肺萎陷效果,又可以保持良好的SpO_(2),适合作为胸腔镜进胸时机。 展开更多
关键词 肺内压 肺萎陷 胸腔镜手术 支气管封堵器 单肺通气
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Fast Fabrication and Judgement of Tip-Enhanced Raman Spectroscopy-Active Tips
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作者 Xian-Biao zhang yu-fan zhang +6 位作者 Hang Li Jie Cui Song Jiang Ben Yang Yang zhang Yao zhang Zhen-Chao Dong 《Chinese Journal of Chemical Physics》 SCIE EI CAS CSCD 2022年第5期713-719,I0011,共8页
The quality of the scanning tip is crucial for tip-enhanced Raman spectroscopy(TERS)experiments towards large signal enhancement and high spatial resolution.In this work,we report a controllable fabrication method to ... The quality of the scanning tip is crucial for tip-enhanced Raman spectroscopy(TERS)experiments towards large signal enhancement and high spatial resolution.In this work,we report a controllable fabrication method to prepare TERS-active tips by modifying the tip apex at the atomic scale,and propose two important criteria to in-situ judge the tip’s TERS activity for tip-enhanced Raman measurements.One criterion is based on the downshift of the first image potential state to monitor the coupling between the far-field incident laser and near-field plasmon;the other is based on the appearance of the low-wavenumber Raman peaks associated with an atomistic protrusion at the tip apex to judge the coupling efficiency of emissions from the near field to the far field.This work provides an effective method to quickly fabricate and judge TERS-active tips before real TERS experiments on target molecules and other materials,which is believed to be instrumental for the development of TERS and other tip-enhanced spectroscopic techniques. 展开更多
关键词 Tip-enhanced Raman spectroscopy Tip-enhanced Raman spectroscopy-active tip Atomistic protrusion Image potential state
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Site-Dependent TERS Study of a Porphyrin Molecule on Ag(100) at 7 K
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作者 Ben Yang Yun-jie Yu +5 位作者 yu-fan zhang Xian-biao zhang Gong Chen Yao zhang Yang zhang Zhen-chao Dong 《Chinese Journal of Chemical Physics》 SCIE CAS CSCD 2019年第3期287-291,I0001,共6页
Single-molecule tip-enhanced Raman spectroscopy(TERS)has emerged as an important technique for structural analysis at sub-molecular scale.Here in this work,we report a TERS study of an isolated free-base porphyrin mol... Single-molecule tip-enhanced Raman spectroscopy(TERS)has emerged as an important technique for structural analysis at sub-molecular scale.Here in this work,we report a TERS study of an isolated free-base porphyrin molecule adsorbed on the Ag(100)surface at cryogenic temperature(~7 K).Site-dependent TERS spectra reveal distinct local vibrational information for the chemical constituents within a single molecule.Moreover,distinct spatial features among different Raman peaks can be resolved from the TERS mapping images.These images are found to associate with related vibrational modes,enabling to resolve the mode associated with N-H bonds at the sub-nanometer level.This study will provide deep insights into the symmetry of adsorption configurations and local vibrational information within a single molecule. 展开更多
关键词 Tip-enhanced Raman spectroscopy Spatial mapping Adsorption configuration PORPHYRIN
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