目的 分析75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的治疗效果和临床经验。 方法回顾性分析山东省潍坊市人民医院和青岛市市立医院自2005年1月至2014年1月109例75岁以上行CABG术患者的临床资料。其中，男63例、女46例，平均年龄（78.1±4.2）岁，均为多支血管病变。术前心功能分级（NYHA） Ⅳ级23例、Ⅲ级57例、Ⅱ级29例。术中行非体外循环CABG （OPCABG） 92例，体外循环下行CABG （on pump CABG）术9例，体外循环辅助心脏不停跳下CABG （on pump beating heart CABG） 术8例。 结果 平均移植血管（2.5±1.4）支，围术期死亡4例，死亡率3.7%。其中，低心排血量综合征死亡1例，心律失常心室颤动死亡1例，肾衰和胃肠道并发症导致多器官衰竭死亡2例。术后主要并发症为心律失常、低心排血量综合征和肺部感染。105例生存患者95例获得随访，随访6～90 （45±26）个月，随访率90.5%。随访期间心源性死亡1例，非心源性死亡4例。患者心功能分级（NYHA）Ⅰ级81例，Ⅱ级18例，Ⅲ级2例，心绞痛消失。 结论 75岁以上冠心病患者行冠状动脉旁路移植术可改善患者症状，缓解心绞痛，提高生活质量，具有良好的近中期效果。
ObjectiveTo investigate the effect of post-conditioning with fospropofol disodium on hepatic ischemiareperfusion (I/R) and its possible mechanism in rats. MethodsForty-eight Sprague-Dawley rats were randomly divided into four groups, including sham group (S), control group (C), propofol group (P) and fospropofol disodium group (F). According to the different periods after reperfusion, each group was further divided into 2-hour and 4-hour reperfusion subgroups respectively (n=6 in each subgroup), named S2h, C2h, P2h, and F2h subgroups and S4h, C4h, P4h, and F4h subgroups. The livers of rats were reperfused after hepatic ischemia for one hour. In the beginning of reperfusion, normal saline was infused intravenously in group S and group C continuously, propofol was infused intravenously in group P continuously, fospropofol disodium was infused continuously in group F. The blood was sampled at the end of ischemia and reperfusion for assay of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The bcl-2 and bax protein contents in liver tissue were detected by immunohistochemical analysis, and liver samples were stained with hematoxylin-eosine for histological observation and damage degree evaluation by counting the proportion of necrosis cells. ResultsThe activity of ALT and AST, the rate of necrosis cells and the amount of bcl-2 and bax protein after reperfusion in group C, group P and group F were higher than those in group S at matched reperfusion time points (P<0.05). The activity of ALT and AST, the proportion of necrosis cells and bax protein contents decreased in group P and group F, compared with group C at the same reperfusion time points, while the contents of bcl-2 protein were significantly increased (P<0.05). ConclusionFospropofol disodium can alleviate hepatic injury induced by ischemia-reperfusion in rats, in which the bcl-2 and bax protein may play important roles.
目的:探讨头颈部数字减影CT血管成像(DSCTA)成像技术的方法。方法:随机选择12例作头颈部脑血管DSCTA病例,通过扫描前训练、缩短扫描时间以减少患者运动,取得增强前后位置一致的横断图像。采用CT机自带的软件进行图像减影处理。采用减影后的图像进行三维后处理。结果:12例患者头颈部血管减影成功,取得了良好血管减影图像。结论:科学的DSCTA检查技术可获得良好的头颈部血管性病变减影图像
Objective To explore the impact of ischemic postconditioning on ischemia-reperfusion injury in isolatedelderly rat hearts and their relation with P-Akt. Methods A total of 30 healthy elderly SD rats (21-23 months old， male or female) with their body weight of 450-500 g were divided into 3 groups: control group， ischemia-reperfusion group， and postconditioning group， with 10 rats in each group. Coronary artery blood flow，myocardial infarction size， phosphorylatedAkt （p-Akt） expression， and changes in myocardium and mitochondria were detected. Results Coronary artery blood flow of the postconditioning group was significantly higher than that of the ischemia-reperfusion group （6.4±1.2 ml/min vs.3.1±1.2 ml/min， P＜0. 01）， and myocardial infarction size of the postconditioning group was significantly smaller thanthat of the ischemia-reperfusion group （35.0%±2.0% vs. 55.7%±3.6%， Plt;0. 05）. The expression of P-Akt was significantlyhigher， and myocardial fibers and mitochondria were preserved better in the postconditioning group than the ischemia-reperfusion group. Conclusion Ischemic postconditioning can protect isolated elderly rat hearts against ischemia-reperfusion injury， which may be related to P-Akt activation.
Objective To study the mechanism of alleviating lung ischemia-reperfusion injury by postischemic treatment with namefene hydrochloride, and explore the optimal timing of drug treatment throughout the disease course. Methods A total of 60 rats were randomly divided into six groups with 10 rats in each group: a sham group, a model group, a nalmefene A (NA) group, a nalmefene B (NB) group, a nalmefene C (NC) group and a nalmefene D (ND) group. The sham group without drug treatment was not treated with ischemia-reperfusion. The lung ischemia-reperfusion model was established by occlusion of the left pulmonary hilum in the model group without drug treatment. After ischemic treatment, the NA, NB, NC and ND groups were respectively injected with nalmefene (15 μg/kg) by the tail vein at 5 min before, 10 min, 30 min and 60 min after pulmonary circulation reperfusion. At the 3rd hour after reperfusion, all rats were sacrificed and the specimens from the upper lobe of the left lung tissue were preserved to observe pulmonary lesions, detect wet/dry weight ratio and the activity of myeloperoxidase (MPO), the expressions of tumor necrosis factor-α (TNF-α), Toll-like receptor 2 (TLR2) mRNA and MyD88 mRNA as well as the expressions of TLR2, MyD88, NF-κB p65 and p-NF-κB p65 in lung tissue. Results There were different degrees of alveolar septal destruction, obvious pulmonary interstitial edema, the infiltration of inflammatory cell, the exudationred of blood cell in the mesenchyme, and the collapse of partial alveolar in the model group and the NA, NB, NC, ND groups. In terms of wet/dry weight ratio, the score of lung tissue injury, the activity of MPO, the expressions of TNF-α, TLR2 mRNA and MyD88 mRNA as well as the expressions of TLR2, MyD88, NF-κB p65 and p-NF-κB p65 in lung tissue, the model group were significantly higher than the sham group (P<0.01); there was no significant difference between the ND group and the model group (P>0.05). The corresponding test values of the nalmefene groups with post-ischemic treatment showed the characteristics of ND group> NC group> NB group> NA group (P<0.01). Conclusion The effect of nammefene on alleviating lung ischemia-reperfusion injury is closely related to the inhibition of TLR2, MyD88, NF-κB p65 and phosphorylation of NF-κB p65 with a characteristic of time-dependent manner.
ObjectivesTo explore the mechanisms by which ischmic preconditioning (IPC), ischemic postconditioning (IPO) and IPCIPO exert influence on ischemic reperfusion injury (IRI) of the graft of SD rat after pancreas transplantation. MethodsAfter the establishment of diabetic SD rats model by using streptozotocin, 24 rats suffered from pancreas transplantation and were randomly averagely divided into four groups: I/R group, IPC group, IPO group, and IPC-IPO group. Six diabetic SD rats suffered with sham operation were served as SO group. The blood glucose level of rats in each group was detected before and after reperfusion, the contents of malonaldehyde (MDA) and super oxide dismutase (SOD) of pancreas allograft were tested at 2 h after reperfusion, and the apoptosis index (AI) of pancreas allograft was monitored by using TUNEL method. ResultsThe blood glucose level of rats in each group was not significantly different (Pgt;0.05). In SO group, the blood glucose level of rats was significantly higher than other groups (Plt;0.01). The blood glucose levels of rats after reperfusion decreased from the levels before reperfusion in I/R group, IPC group, IPO group, and IPC-IPO group (Plt;0.05 or Plt;0.01), furthermore the blood glucose level of rats in I/R group was significantly higher than that in abovementioned three groups (Plt;0.01), although among which the difference was not markedly (Pgt;0.05). When compared with I/R group, the MDA contents of rats after reperfusion in IPC group, IPO group， and IPC-IPO group decreased (Plt;0.01), while the SOD contents of rats after reperfusion increased (Plt;0.01). In rats of SO group, the MDA and SOD contents were significantly higher and lower than other groups, respectively (Plt;0.01). The MDA and SOD contents in IPC group, IPO group, and IPC-IPO group were not different (Pgt;0.05). The AI of pancreas allograft at 2 h after reperfusion in I/R group 〔(47.31±4.52)%〕, IPC group 〔(26.25±3.17)%〕, IPO group 〔(24.73±3.62)%〕, and IPC-IPO group 〔(25.5±4.15)%〕 were higher than that in SO group 〔(3.16±0.53)%〕, Plt;0.01. The AI of pancreas allograft in IPC group, IPO group, and IPC-IPO group were not different (Pgt;0.05), but they were lower than that in I/R group (Plt;0.01). Pathological results showed that injury of pancreas allograft in I/R group was most severe. ConclusionsIPO and IPC are associated with comparable effectiveness to protect graft from IRI during pancreas transplantation. The combined protective effects of IPC and IPO do not appear to be additive, which is equal to IPC or IPO alone.
摘要:目的:探讨16层螺旋CT图像后处理技术对青少年特发性脊柱侧凸的胸椎旋转和椎弓根径线变化特点及临床价值。 方法:收集经临床诊治的青少年特发性脊柱侧凸20例,运用16层螺旋CT扫描及图像后处理技术,进行相关CT数据测量统计。结果:(1)脊柱胸椎侧凸的顶椎及邻近椎体均向凸侧旋转、后份向凹侧旋转,以顶椎旋转最重,且凹侧椎弓根径线小于凸侧,与侧凸程度及方向具有相关性。(2)上、下终椎椎体旋转及椎弓根径线变化则较复杂,其椎体无旋转或向相反方向旋转,椎弓根径线可凸侧小于凹侧,以上终椎明显。结论:16层螺旋CT及图像后处理技术,对显示青少年特发性脊柱侧凸胸椎旋转及椎弓根径线变化特征,可提供临床拟订手术方案的重要影像学依据。