THE CHANGE OF ARTERIOVENOUS CARBON DIOXIDE AND pH GRADIENTS DURING SEVERE HEMORRHAGIC SHOCK AND RESUSCITATION

Objective. To investigate clinically useful markers for determining the seventy of hemorrhagic shock and adequacy of resuscitation Methods. Prospective study was undertaken in 12 dogs, using an established model for hemorrhagic shock. The anesthetized dogs were bled to a mean arterial pressure of 40 mmHg which was maintained for 3 hours. Then each animal was resuscitated with heperinized whole blood followed by intravenous infusion of dobutamine at a rate of 5 ug. kg-1. min-1 for 10 minutes. Arterial and mixed venous blood gases, arterial lactate concentrations and hemodynamic Parameters were measured throughout the study. Results. A difference in the PCO2 and pH values between arterial and mixed venous blood was observed. Arterial-venous PCO2 and pH difference increased significantly after sustained shock. The arteriovenous carbon dioxide and pH gradients recovered more rapidly than arterial lactate levels after successful resuscitation with blood and dobutamine. Conclusion. Arterial blood gases fail to reflect the acid-base status of tissues during hemorrhagic shock. The differences in PCO2 and pH values between arterial and mixed venous blood could be used as clinical in- dicators for assessing the seventy of shock and efficacy of resuscitation.

Is nitric oxide level affected in postmenopausal women with hypothyroidism?

AIMTo analyze serum levels of nitric oxide （NO）, an indicator of cardiovascular health, in post-menopausal females with and without hypothyroidism. METHODSNO was analyzed colorimetrically in 30 newly diag-nosed hypothyroid postmenopausal females and 30 postmenopausal females with normal thyroid profle. Results were compared and subjected to appropriate statistical analysis. RESULTSThe levels of serum NO were found to be significantlydecreased in postmenopausal females with hypothyroidismas compared to the levels in those with normal thyroidprofile （P value 〈 0.05）. A negative correlation of NOwas observed with thyroid stimulating hormone whereasa positive correlation of NO was observed with free T3 （FT3）, free T4 （FT4）, T3 and T4 though it was statistically signifcant only for FT4 among postmenopausal females with hypothyroidism.CONCLUSIONPostmenopausal hypothyroid females may be at a risk of compromised cardiovascular health as indicated by low NO levels. Regular monitoring and risk assessment is essential for timely intervention.

Effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery

Objective:The aim of this study was to observe the effect of endobronchial blocker tube in the pulmonary carcinoma with video-assisted thoracic surgery.Methods:Forty patients of pulmonary carcinoma with video-assisted thoracic surgery were randomly assigned into two groups with twenty cases each:endobronchial blocker tube group(group 1) and double-lumen endobronchial tube group(group 2).After anesthesia was induced,in group 1,single lumen tube was intubated at first,and then endobronchial blocker tube intubated to left or right primary bronchus under the guidance of fiber-optic bronchoscope according to operational necessary,injected 2-4 mL air to blocker balloon and blocker one lateral primary bronchus for one-lung ventilation necessarily;while in group 2,the position of double-lumen endobronchial tube was confirmed with fiber-optic bronchoscope after intubation.Blood samples were collected before anesthesia induction,double lumen ventilation,at the one-lung ventilation of 5 min,30 min,60 min,120 min and 180 min,SBP,DBP,HR,SpO2,partial pressure of end tidal carbon dioxide(PetCO2),pH,PaO2,PaCO2,PaO2/FiO2 were recorded.Results:Forty cases' intubations were all successful.There were no differences in SBP,DBP,HR,SpO2,PetCO2,pH,PaCO2 between two groups in different points(P > 0.05).Paw in group 1 was lower than group 2,PaO2 and PaO2/FiO2 in group 1 was higher than group 2 in the one lung ventilation of 5 min,30 min,60 min,120 min and 180 min.Conclusion:The endobronchial blocker tube can meet the request of video-assisted thoracic surgery,with the special advantages of simple insertion,lower airway and better oxygenation.Endobronchial blocker tube offer a new way for one-lung ventilation in the pulmonary carcinoma with video-assisted thoracic surgery.

Hepatic encephalopathy complicated with hyponatremia and acid-base disturbance and its prognosis

Objective:To improve the diagnosis and therapeutic effect of occurrence and development of hyponatremia and disorder of acid-base balance among patients with hepatic encephalopathy(HE) by elucidating the regularity and mechanism,as well as its influence on prognosis.Methods:327 HE patients admitted to our hospital from January 1990 to June 2010 were enrolled.Meanwhile 316 patients hospitalized in the medical department of the same hospital were chosen as the control group.Patients in both groups were given the same methods to measure arterial blood gas parameters(pH value,PaCO2,[HCO3-],TCO2,BE and SaO2),blood biochemistry([Na+],[K+],[Cl-]),liver function,kidney function and blood glucose,serum sodium,and thereupon tocalculate the anion gap(AG) and the potential [HCO3-],and acid-base balance disorder.Results:Among the 327 HE patients,hyponatremia was found in 188 cases(57.4%),of whom 132 patients died(70.2%).While among the 316 patients in control group,68 presented with hyponatremia(21.5%),and 19 died(27.9%).The incidence and mortality were significantly different between the two groups(P<0.001).All the 327 patients presented with different degrees of acid-base balance disorder and 178 died(54.4%),in whom 164(50.2%) belonged to simple acid-base balance disorder and 74(45.1%) died,136(41.6%) were dual acid-base balance disorder and 80(58.8%) died,27(8.2%) were triple acid-base disturbance and 24(88.9%) died.Whereas in the control group only 83 patients(26.2%) were recognized as simple and dual acid-base balance disorder,and 18(21.7%) died.There was higher incidence of acid-base balance disorder and mortality rate in HE group than control one(P<0.001).Conclusion:Hyponatremia is valuable to judge HE patients' prognosis.The key parameters in the judgment and evaluation on acid-base balance disorder among HE patients are the change of pH values and serum electrolyte values.When pH value ≤ 7.30 or > 7.55,it generally suggests a poor prognosis.

Effect of Incorporating Free or Encapsulated Ascorbic Acid in Chicken Frankfurters on Physicochemical and Sensory Stability

Sodium erythorbate, antioxidant and curing accelerator, used in meat products, have no vitamin functionality. Ascorbic acid （AA）, in contrast, is a powerful antioxidant, but very unstable. The application of encapsulated AA in frankfurters could allow the incorporation of an antioxidant with vitamin functionality and improved stability. The aim of this study was to evaluate the application ofAA microcapsules in frankfurters and the effects of their application on the product. Different analyses were conducted. The values obtained for mass loss, moisture content, water activity, pH and instrumental color were not significantly different among the treatments. The frankfurters containing the microcapsutes exhibited the lowest hardness value （approximately 5,000 g）, resulting in better scores in the sensory analysis. It was possible to apply the AA microcapsules without compromising the oxidative stability and physicochemical characteristics of the product, providing a promising method for protecting AA and producing fortified frankfurters.

124例178份茶硷血药浓度监测结果分析

目的:回顾124例178份血清茶碱浓度结果,了解不同年龄段、血氧分压、联合激素、β_2受体激动剂对茶碱血清浓度影响。方法:在协议处方下给普通剂型茶碱,治疗过程监测茶碱血药浓度。结果:61～77岁老年人血清茶碱浓度,心血管毒副作用高于14～60岁的病人(P<0.01);血氧分压影响茶碱血药浓度,血氧分压越低,茶碱血清浓度有潴留倾向;联合激素、β_2受体激动剂对茶碱血药浓度无影响。结论:据病情个体化选择茶碱剂量剂型,有条件者注意监测血清茶碱血药浓度。单一的茶碱剂量增加产生毒副作用征象时应联合其它平喘药,以最大限度地降低茶碱毒副反应,产生较佳血药浓度。

Protective effect of ischemic postconditioning on lung ischemia-reperfusion injury in rats and the role of heme oxygenase-1

Objective： To investigate the effect of ischemic postconditioning （1PO） on acute lung ischemia-reperfusion （I/R） injury and the protein expression of haeme oxygenase-1 （HO-1）, a cytoprotective defense against oxidative injury. Methods： After being anesthetized with chloralhydrate, forty-eight healthy SD rats were randomly divided into 6 groups （8 in each）： sham operation group （S group）; I/R group： left lung hilum was clamped for 40 minutes followed by 105 minutes of reperfusion; IPO group： left lung hilum was clamped for40 minutes and postconditioned by 3 cycles of 30 seconds of reperfusion and 30 seconds of reocclusion; Heroin （HM）＋ I/R group： heroin, an inducer of HO-1 was injected intraperitoneally at 40 μmol·kg^-1·day^-1 for two consecutive days prior to 40 minutes clamping of left lung hilum; ZnPPIX＋IPO group： zinc protoporphyrin IX, an inhibitor of HO-1 was injected intraperitoneally at 20 mg·kg^-1 24 hours prior to 40 minutes clamping of left lung hilum; and HM＋S group： HM was administered as in the HM＋I/R group without inducing lung I/R. Arterial partial pressure of oxygen （PaO2） and malondialdehyde （MDA） content in serum were assessed. The left lung was removed for determination of wet/dry lung weight ratio and expression of HO-1 protein by immuno-histochemical technique and for light microscopic examination. Results： The PaO2 was significantly lower in all the experimental groups compared with sham group （90 roan Hg ±11 mmHg）. However, the values of PaO2in IPO （81 mm Hg±7 mm Hg） and HM＋I/R （80 mm Hg±9 mm Hg） were higher than that in I/R （63 mm Hg±9 mm Hg） and ZnPPIX＋IPO （65 mm Hg±8 mm Hg） groups （P〈0.01）. The protein expression of HO- 1 in lung tissue was significantly increased in I/R group compared with S group （P〈0.01）. While the HO-1 protein expression was higher in IPO and HM＋I/R groups as compared with I/R group （P〈0.05, P〈0.01 ）. The lung wet/ dry （W/D） weight ratio and MDA content in serum were significantly increased in I/R group as compared with S or HM＋S groups （P〈0.01）, accompanied by severe lung tissue histological damage, which was attenuated either by IPO or by HM pretreatment （P〈0.01, IPO or HM＋I/R vs. I/R）. The protective effect of IPO was abolished by ZnPPIX. Conclusion： Ischemic postconditioning can attenuate the lung ischemia-reperfusion injury through upregulating the protein expression of HO-I that leads to reduced postischemic oxidative damage.