不同气体吸入对高原缺氧犬脑脊液及动脉血酸碱值的影响

目的:了解氧气( O2 )、二氧化碳气( CO2 )及氧气与二氧化碳混合气( O2 /CO2 )对急性高原病的防治情况。方法:1 5条杂种犬放入减压舱,以3m/s的速度到达45 0 0 m高度,持续减压3d,造成急性高原缺氧模型,然后利用右心漂浮导管法对急性缺氧犬分别吸入O2 、CO2 及O2 + CO2 ,动态观察动脉血及脑脊液酸碱值的变化情况。结果:急性缺氧犬分别吸入O2 、CO2 及O2 + CO2 后,各组自身前后比较,氧气组能提高Sa O2 、PO2 、PCO2 ,但对血液和CSF中p H、HCO3- 的改善不明显;CO2 组能提高血液和CSF中p H、HCO3- 、PCO2 ,但不能提高Sa O2 、PO2 ;CO2 /O2 组则既有益于提高血液和CSF中PO2 、PCO2 、HCO3- ,又能降低p H。结论:CO2 /O2 混合对高原缺氧有一定的协同作用,优于CO2 及O2 的单独使用。

严重循环衰减与动静脉血酸碱差异

酸碱失衡是病人常见的病理改变,临床上常以动脉血气分析监测,晚近发现严重循环衰减时动静脉血酸碱差异增大。本文就正常生理和严重循环衰减时,动静脉血酸碱差异及其发生机理和临床意义进行综述。

无静脉转流肝移植术中患者门静脉和下腔静脉血酸碱及电解质的变化

原位肝移植术创伤大并且机体内环境干扰明显,术中常出现严重的全身电解质和酸碱紊乱[1,2],但门静脉和下腔静脉血的酸碱及电解质变化尚无定论.本研究拟观察无静脉转流经典式原位肝移植术患者新肝血流开放前后门静脉和下腔静脉血酸碱及电解质变化,以了解新肝开放时,门静脉和下腔静脉血再灌注对全身酸碱及电解质的影响,并为术中放血量的估计提供理论依据.

无静脉转流经典式原位肝移植麻醉中血酸碱及电解质的变化

在肝移植术(OLT)的术式中经典式原位肝移植术(SOLT)具有一定的优越性,不做静脉转流的SOLT在断流下行新肝吻合,对外科手术及围麻醉期的管理都提出了更高的要求.

全身炎症反应综合征/多器官功能障碍综合征患者酸碱失衡的分析

目的 提高对全身炎症反应综合征 (SIRS)和多器官功能障碍综合征 (MODS)患者并发酸碱失衡的认识。方法 对 2 5 3 8例SIRS/MODS患者动脉血气参数 (pH、PaO2 、PaCO2 、HCO3 -) ,酸碱平衡紊乱类型与血清电解质结果进行分析。患者至少符合修订后SIRS标准 2项以上 (包括发热、体温过低、心动过速、呼吸急促或PaCO2 下降、白细胞计数异常 ) ;MODS患者则符合各器官功能障碍的诊断标准。结果 2 5 3 8例SIRS患者符合 2项标准者 83 5例 ( 3 2 9%) ,3项者 977例( 3 8 5 %) ,4项者 72 6例 ( 2 8 6%) ;并发MODS者 498例 ( 19 6%) ;全组死亡 2 82例 ( 11 1%) ;病死率随SIRS标准的项数增多和MODS患者器官功能障碍数增加而升高 (P <0 0 5 )。 2 5 3 8例动脉血气分析中 2 12 9例 ( 83 9%)伴有不同类型的酸碱平衡紊乱 ,其中单纯酸碱失衡 12 2 7例 ( 5 7 6%) ,二重酸碱失衡 695 ( 3 2 6%) ,三重酸碱失衡 2 0 7例 ( 9 7%) ;符合SIRS 2项标准者酸碱失衡 5 5 7例 ( 2 6 2 %) ,3项者 65 7例 ( 3 0 9%) ,4项者 482例 ( 2 2 6%) ,MODS者酸碱失衡 43 3例 ( 2 0 3 %)。结论 SIRS/MODS患者原发性疾病常可引起呼碱或呼酸 ,严重者可发生三重酸碱失衡 ,严重的呼碱并代碱、呼酸并代酸可导致重度的碱血症或酸血症 。

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.

Oxymatrine liposome attenuates hepatic fibrosis via targeting hepatic stellate cells

AIM： To investigate the potential mechanism of Arg- Gly-Asp （RGD） peptide-labeled liposome loading oxy- matrine （OM） therapy in CCI4-induced hepatic fibrosis in rats. METHODS： We constructed a rat model of CCh- induced hepatic fibrosis and treated the rats with dif- ferent formulations of OM. To evaluate the antifibrotic effect of OM, we detected levels of alkaline phospha- tase, hepatic histopathology （hematoxylin and eosin stain and Masson staining） and fibrosis-related gene expression of matrix metallopeptidase （MMP）-2, tis- sue inhibitor of metalloproteinase （TIMP）-I as well as type I procollagen via quantitative real-time poly- merase chain reaction. To detect cell viability and apop- tosis of hepatic stellate cells （HSCs）, we performed 3-（4,5）-dimethylthiahiazo（-z-yl）-3,5-diphenytetrazoli- umromide assay and flow cytometry. To reinforce the combination of oxymatrine with HSCs, we constructed fluorescein-isothiocyanate-conjugated Arg-Gly-Asp peptide-labeled liposomes loading OM, and its targeting of HSCs was examined by fluorescent microscopy. RESULTS： OM attenuated CCh-induced hepatic fibro- sis, as defined by reducing serum alkaline phosphatase （344.47± 27.52 U/L vs 550.69 ± 43.78 U/L, P 〈 0.05）, attenuating liver injury and improving collagen deposits （2.36% ± 0.09% vs 7.70% ±0.60%, P 〈 0.05） and downregulating fibrosis-related gene expression, that is, MMP-2, TIMP-1 and type I procollagen （P 〈 0.05）. OM inhibited cell viability and induced apoptosis of HSCs in vitro. RGD promoted OM targeting of HSCs and en- hanced the therapeutic effect of OM in terms of serum alkaline phosphatase （272.51 ± 19.55 U/L vs 344.47 ± 27.52 U/L, P 〈 0.05）, liver injury, collagen deposits （0.26%± 0.09% vs 2.36% ± 0.09%, P 〈 0.05） and downregulating fibrosis-related gene expression, that is, MMP-2, TIMP-1 and type I procollagen （P 〈 0.05）. Moreover, in vitro assay demonstrated that RGD en- hanced the effect of OM on HSC viability and apoptosis. CONCLUSION： OM attenuated hepatic fibrosis by in- hibiting viability and inducing apoptosis of HSCs. The RGD-labeled formulation enhanced the targeting effi- ciency for HSCs and the therapeutic effect.

Correlations Between Serum Uric Acid Level and Disease Activity,Intrathecal Inflammation Reactivity in Patients with Multiple Sclerosis

Objective To explore the correlations between serum uric acid （HA） levels and the clinical and cerebrospinal fluid （CSF） parameters of multiple sclerosis （MS）. Methods The medical reports of 47 MS patients admitted to Peking Union Medical College Hospi- tal during 2008 and 2010 were reviewed. And 49 age- and gender-matched cerebral infarction patients were enrolled as control. The mean serum HA level of the MS patients was compared with that of the control group. The correlations between the HA levels and the clinical parameters including gender, disease duration, relapse rate, and disease disabilities as assessed by the Expanded Disability Status Scale score, were explored. Forty-one patients had CSF examinations. The correlations between the IdA levels and the CSF parameters reflecting inflammation and tissue damage, including CSF protein, white blood cell count, oligoclonal band, 24-hour IgG index, and myelin basic protein, were also investigated. Results The mean serum HA level in the MS patients was lower than that in the control group （247.75 ± 52.59 jamol/L vs. 277.94 ± 74.33 pmol/L, P=0.025） and inversely correlated with the relapse rate （P=0.049）. MS patients with lower serum UA levels tended to have higher white blood cell counts and myelin basic protein level. But there was no correlation between CSF protein levels （r=0.165, P=0.273）, white blood cell counts （r=-0.051, P=0.732）, IgG index （r =0. 045, P=0.802）, or myelin basic protein level （r =-0.248, P=0.145） and the serum UA level, respectively. Conclusion In MS patients, UA levels might partly reflect the extent of disability and inflammation.

Hepatoprotective evaluation of Anogeissus latifolia:In vitro and in vivo studies

AIM： To evaluate the hepatoprotective activity of a hydroalcoholic extract of the bark of Anogeissus latifolia; in vitro in primary rat hepatocyte monolayer culture and in vivo in the liver of Wistar rats intoxicated by carbon tetrachloride （CCl4）. METHODS： In the in vitro study, a primary hepatocyte monolayer culture was treated with CCh and extract of Anogeissus latifolia. Hepatoprotective activity was demonstrated in the CCh damaged primary monolayer culture. In the in vivo study, the hepatoprotective activity of a hydroalcoholic extract ofAnogeissus latifolia was analyzed in liver injured CCh-treated rats. Biochemical parameters including serum transaminases [aspartate aminotransferase （AST） and alanine aminotransferase （ALT）] and alkaline phosphatase （ALP） in serum wereanalyzed. The biochemical findings were supplemented with histopathological examination of rat liver sections. RESULTS： In vitro： primary hepatocyte monolayer cultures were treated with CCh and extract of Anogeissus latifolia. A protective activity could be demonstrated in the CCh damaged primary monolayer cultUre. In vivo： Hydroalcoholic extract of Anogeissus latifolia （300 mg/kg） was found to have protective activity in rats with CCh-induced liver damage as judged from serum marker enzyme activity. CONCLUSION： The above findings lead to the conclusion that the hydroalcoholic extract of Anogeissus latifol/a is hepatoprotective. Hence, we suggest that the inclusion of this plant in the management of liver disorders is justified.

Effect of E. coli coli on Anti-disease Activities of Scailops: Argopecten irradians

The effect of acute E. coli challenge on the anti-disease activity of scallops Argopecten irra-dians is examined. The treatments of scallop from which hemolymph samples were taken for study included (1) control scallops, (2) sham-injected scallops, (3) PSW-injected scallops and (4) E. coli-injected scallops. From the beginning, the anti-disease activities of scallops are deter -mined at 12 hr and 24 hr.The concentrations of circulating hemocytes, the total serum protein concentrations and the activities of alkaline phosphatase, acid phosphatase and superoxide dismutase in the scallops Argopecten irradians are determined.Injection with E. coli results in a significant elevation in the concentration of circulating hemocytes and in the alkaline phosphatase activity and a significant decline in the total serum protein concentration and in the superoxide dismutase activity at 24 hr postchallenge. It shows that metabolism of bay scallop is expedited to adopt the challenge.

Study on acid base disturbance in patients with post traumatic multiple organ dysfunction syndrome

Objective: To investigate the classification and incidence of acid base disturbance (ABD) in the patients with post traumatic multiple organ dysfunction syndrome (MODS). Methods: A total of 119 patients with MODS were examined with arterial blood gas analysis and serum electrolytes detection for 675 times in this study. Results: Different types of ABD existed in 647 times out of 675 times ( 95.9 %) of blood gas analyses. There were 270 times ( 41.7 %) of simple ABD, 271 times ( 41.9 %) of double ABD and 106 times ( 16.4 %) of triple ABD. Among which, 404 times ( 62.4 %) were in respiratory alkalosis (RAL), 332 times ( 51.3 %) in metabolic acidosis (MA), 227 times ( 35.1 %) in metabolic alkalosis (MAL) and 167 times ( 25.8 %) in respiratory acidosis (RA). In this study, 79 cases ( 66.4 %) out of 119 cases with MODS died from these kinds of ABD. Conclusions: It suggests that in the early stage of MODS, RAL with or without hypoxemia may exist, and later on, MA or even triple ABD may occur. In order to detect and correct the primary disorders as early as possible, it is important to keep the balance of hydrolyte. The treatment of primary diseases is also important. Disorders of acid base balance were corrected according to pH standard values, anion gap (AG) and the potential [HCO 3 -] were also calculated simultaneously. When pH was more than 7.50 or lower than 7.20 , it is necessary to give drugs of acidity or alkalinity to the patients with ABD to maintain pH value within a normal range.

Protective effect of Sharbat-e-Deenar against acetaminophen-induced hepatotoxicity in experimental animals

OBJECTIVE: To investigate the effect of Sharbat-e-Deenar(SD) on acetaminophen(APAP)-induced hepatotoxicity in rat model.METHODS: Albino rats were treated with SD at the doses of 1, 2 and 4 mL/kg, p.o. against hepatotoxicity after APAP(2 g/kg, p.o. once only) intoxication.The blood, tissue biochemical parameters and histopathological observation were performed. The RESULTS: APAP exposure in rats significantly increased the level of biochemical parameters such as aspartate aminotransaminase, alanine aminotransaminase, lactate dehydrogenase, serum alkaline phosphatase, bilirubin, urea and creatinine into blood circulation which were reversed towards normal by SD therapy at all doses. The tissue biochemical parameters such as lipid peroxidation, reduced glutathione, adenosine tri-phosphatase and glucose-6-phosphatase were significantly restored after SD treatment against hepatotoxity. Histological analysis confirmed that SD-treated rats significantly alleviated of liver damage and reduced lesions caused by APAP intoxication. The biochemical changes are in good correlation with the histopathological observations.CONCLUSION: On the basis of these results, it can be concluded that SD exerts hepatoprotective activity against APAP-induced liver injury.