肝功能障碍患者对罗库溴铵药效动力学的影响

目的:探讨不同肝功能分级患者对肌松药罗库溴铵药效动力学的影响。方法:纳入肝功能障碍的手术患者152例,根据肝功能Child-Pugh分级将其分为Child-Pugh A级组62例、Child-Pugh B级组55例、Child-Pugh C级组35例,同时纳入肝功能正常患者60例为对照组。以维库溴铵以动态靶控输注程序控制,0.15~0.2μg/m L之间,维持肌松水平T1/TC在25%以内。对比分析四组间一般情况(包括性别、年龄、体重和BMI指数)、麻醉起效时间、最大阻滞持续时间、T110%恢复时间、T125%恢复时间、T175%恢复时间、恢复指数。结果:Child-Pugh A、B、C组患者的麻醉起效时间逐渐延长,组间差异有统计学意义(P0.05)。Child-Pugh A、B、C三组间患者的麻醉最大阻滞程度逐渐下降,组间差异有统计学意义(P0.05)。Child-Pugh A、B、C三组间患者的麻醉恢复指数逐渐增大,组间差异有统计学意义(P0.05)。Child-Pugh A、B、C和对照组间T110%恢复时间、T125%恢复时间、T175%恢复时间无明显差异(P0.05)。Child-Pugh A级组女性麻醉起效时间明显快于男性,差异有统计学意义(P0.05);男性最大阻滞持续时间小于女性,性别间差异有统计学意义(P0.05)。肝功能Child-Pugh B级组女性麻醉起效时间明显快于男性,差异有统计学意义(P0.05)。肝功能Child-Pugh C级组性别间麻醉起效时间、最大阻滞持续时间、恢复指数差异无统计学意义(P0.05)。结论:肝功能障碍明显影响肌松药罗库溴铵麻醉起效时间,重度肝功能患者使用罗库溴铵时可不考虑性别的影响因素。     

顺式阿曲库铵对阻塞性黄疸患者麻醉的药效学研究

目的:观察非去极化肌松药顺式阿曲库铵用于阻塞性黄疸患者麻醉中的肌松效应和安全性.方法:24例阻塞性黄疸患者行胆总管引流术,随机分为顺式阿曲库铵Ⅰ组(2倍ED95组)、Ⅱ组(3倍ED95组),24例切口部位相近行上腹部手术患者随机分为顺式阿曲库铵Ⅲ组(2倍ED95组)、Ⅳ组(3倍ED95组)作为对照.观察诱导前后生命体征的变化、插管条件、肌松效应.结果:各组患者的血流动力学变化:组间比较无显著性差异(P>0.05);Ⅰ、Ⅲ组插管条件为优的比率明显低于Ⅱ、Ⅳ组(P<0.05);Ⅰ组、Ⅲ组起效时间大于Ⅱ组、Ⅳ组,但是T195%恢复时间、四个成串刺激(TOF)比值恢复到70%的时间明显短于Ⅱ组、Ⅳ组(P<0.05).结论:顺式阿曲库铵可以安全用于阻塞性黄疸患者的麻醉,3ED95剂量的顺式阿曲库铵比2ED95剂量的起效更快,插管条件更好.     

Further Study into Obstructive Jaundice and Ischaemic Renal Damage

Renal ischaemia for one hour in two groups of Gunn rats, one with and the other without bile-duct ligation, produced comparable reversible renal tubular lesions in both groups. Since Gunn rats have an unconjugated hyperbilirubinaemia, which is unaffected by bile-duct ligation, it seems likely that the high levels of bilirubin glucuronide are responsible for sensitizing the renal tubules to ischaemia, possibly by depressing cell respiration.     

Endotoxin and Acute Renal Failure Associated with Obstructive Jaundice

A single dose of endotoxin given to rats with obstructive jaundice produced death with intravascular coagulation. This action was apparently due to delayed clearance of endotoxin from the circulation. The finding is relevant to “hepatorenal failure,” which can be caused by bacteraemia after biliary tract operations.     

Diagnostic Performance of Magnetic Resonance Cholangiopancreatography in Malignant Obstructive Jaundice

Malignant obstructive jaundice is caused by tumors arising from the head of the pancreas and biliary tree, or seen due to secondary metastases in the porta hepatis lymph nodes. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive diagnostic technique that can be used for imaging the entire biliary tree and pancreatic duct system. The objective of this study was to evaluate the accuracy of MRCP in the diagnosis of malignant obstructive jaundice. The methods used involved comparative review of the images obtained by using magnetic resonance imaging and MRCP as well as comparison between MRCP- and pathology-based diagnoses. The accuracy of MRCP-based diagnosis of malignant obstructive jaundice was analyzed. Our data show that the positive rate of anatomical diagnosis and the detection rate of bile ducts on the proximal side of obstruction are 100%. The diagnostic accuracy of malignant obstruction was 82.9%. MRCP was found to have high diagnostic specificity for determining the location and extent of obstruction. We, therefore, concluded that MRCP had significance for clinical diagnosis of malignant obstructive jaundice. The positive rate of localization diagnosis was 100%. Distinguishing the quality of obstruction was also important. The diagnostic accuracy of MRCP for malignant obstructive jaundice was remarkably higher.     

血必净注射液对梗阻性黄疸大鼠血清内毒素及肿瘤坏死因子-alpha水平的影响

目的：探究血必净注射液对梗阻性黄疸大鼠血清内毒素(ETX)及肿瘤坏死因子-alpha(TNF-alpha)水平的影响。方法：选取雄性SD 大 鼠60 只,随机分为假手术(A)组、梗阻性黄疸(B)组、血必净干预(C)组,每组20 只。A组不结扎胆总管,B、C两组结扎胆总管。术后 七天,C 组每日皮下注射血必净4 mL/Kg,A 组、B 组用等量生理盐水替代,持续用药一周。实验两周后,检测和比较各组大鼠血清 ETX、TNF-alpha、总胆红素(TBIL)及直接胆红素(DBIL)水平。结果：术后两周,A组血清TBIL、DBIL 水平显著低于B、C两组;B组血 清TBIL、DBIL 水平显著高于C 组,差异均有统计学意义(P<0.05)。B组血清ETX和TNF-alpha水平显著高于A、C 组,差异均有统计 学意义(P<0.05)。结论：血必净注射液可能通过降低血清ETX和TNF-alpha含量改善梗阻性黄疸。     

梗阻性黄疸MRCP 的循证和临床研究

目的：通过meta、ROC分析以及按病变部位、性质进行的亚组分析分析对目前诊断梗阻性黄疸的非侵入性影像诊断方法（US,Cr和MRCP）进行对比研究。方法：1、采用medline检索。纳入标准为：（a）US、CT和MRCP诊断梗阻性黄疸性疾病的文献（b）病理检查、术中所见或临床、实验室检查结果作为诊断金标准。（c）能够直接或间接获得每个影像方法的真、假阳性数,真、假阴性数。提取数据、文献质量评估通过kappa分析进行一致性检验。统计分析采用漏斗图、SROC分析方法以及协变量分析。2、疑胆胰系疾患接受MRCP检查患者105例,其中同时做US检查者65例。另有同期Cr资料59例,其中同时做US检查者31例。盲法与金标准对比,计算出各诊断方法的真阳性率和假阳性率,ROC分析其诊断效能。同时按病变部位、性质分别计算MR-CP、US及Cr的敏感度、特异度和似然比等指标进行比较分析。结果：1、漏斗图US相关文献分布形状略不规则,CT、MRCP相关文献分布形状类似漏斗形。SROC曲线图MRCP线最靠近左上角,诊断效能高于US和CT、MRCP的Q^＊值（0．9256）高于US（0.8765）和CT（0.8606）。三者间经检验无显著性差别,MRCP和cT问检验Z=0、33,双侧P〉0、25。协变量分析未见对诊断效能有显著性影响因素。2、ROC分析显示,MRCP的曲线最靠近左上角,US次之,Cr在最下面,三者的曲线下面积（Az）分别为0．985,0．981．0、901,均大于0、9,MRCP与Cr间离均差（Z）为0．75,双侧P〉0、25。MRCP、US和Cr诊断胆胰系恶性占位、结石的敏感度分别为100％、83％、82％;92％、71％、76％。经检验,MRCP与US和CT间有显著性差异,P〈0．05。结论：经meta、ROC分析,认为MRCP在诊断梗阻性黄疸疾病中具有优势,诊断效能高于US和Cr。     

Quantification of Superoxide Radical in the Brain of Rats with Experimentally Induced Obstructive Jaundice

The study aimed to directly measure in vivo superoxide radical (O₂⁻) a direct indicator of oxidative stress, in the brain of rats with experimentally induced obstructive jaundice by employing a new quantitative ultrasensitive fluorescent assay requiring minimum sample. O₂⁻ anion is specific for dihydroethidine (DHE) and upon reaction gives a characteristic product, namely 2-OH-ethidium. Ten male rats underwent laparotomy and were divided into two groups: I, sham operated and II bile duct ligation. Ten days later, following injection with DHE (a O₂⁻ trap), all animals were killed and samples from cerebral cortex, midbrain and cerebellum were removed for analysis. It was shown that compared to group I, in group II the O₂⁻ was increased by 67% in the cerebral cortex and by 37% in the midbrain as a consequence of experimental obstructive jaundice, while its levels were unaffected in the cerebellum. The data in this experimental obstructive jaundice model imply a region-specific increase of O₂⁻ formation rate, being higher in cerebral cortex, less so in the midbrain and not at all in cerebellum.     

重组人肝再生增强因子对梗阻性黄疸大鼠肝细胞线粒体DNA的保护作用

目的:初步探讨重组人肝再生增强因子(rhALR)保护及改善梗阻性黄疸大鼠肝细胞线粒体功能及肝功能的机制.方法:144只健康wistar大鼠随机分为SHAM组,BDO-RBF组,BDO-RBF-rhALR组,利用荧光定量PCR方法,对各组大鼠肝细胞总mtDNA、缺失型mtDNA进行相对定量检测.结果:胆道梗阻后,肝细胞线粒体总mtDNA拷贝数出现明显下降(P<0.01).BDO-RBF-rhALR组总mtDNA拷贝数下降程度明显低于BDO-RBF组(P<0.05);对于缺失型mtDNA占总mtDNA的百分比,在SHAM组,未检测出缺失型mtDNA,而在BDO-RBF组及BDO-RBF-rhALR组,均可见缺失型mtDNA,BDO-RBF组的缺失型mtDNA占总mtD-NA的百分比明显高于BDO-RBF-rhALR组(P<0.05);在胆道梗阻解除后,BDO-RBF-rhALR组的总mtDNA的拷贝数及缺失型mtDNA修复速度明显快于BDO-RBF组(P<0.05).结论:rhALR可通过保护及修复梗阻性黄疸大鼠肝细胞受损的mtDNA,达到保护及改善梗阻性黄疸大鼠肝细胞线粒体功能及肝功能的目的.     

S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况影响的临床研究

目的：探讨S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况的影响。方法：选择2010年8月至2012年7月我院肝胆病区收治的90例梗阻性黄疸患者为研究对象,随机分为S-腺苷蛋氨酸治疗组（48例）和对照组（42例）,比较和分析静脉滴注S-腺苷蛋氨酸对梗阻性黄疸患者术后第5d、10d肝功能及营养指标的影响。结果：术后5d、10d,两组患者血总胆红素、直接胆红素、谷丙转氨酶、1．谷氨酰转肽酶、碱性磷酸酶水平较术前1d显著降低,且组内比较差异有统计学意义（P〈0．05）,治疗组以上指标的下降程度较对照组更明显,差异有统计学意义（P〈0．05）。术后第10d,两组患者的血白蛋白、前白蛋白、转铁蛋白水平较术后第5d显著改善（P〈0．05）;术后第5、10d,两组组间血白蛋白、前白蛋白、转铁蛋白水平比较差异有统计学意义（P〈0．05）。结论：梗阻性黄疸患者术后应用腺苷蛋氨酸能促进黄疸消退,加快胆红素的排泄和肝功能的恢复,有利于患者营养状况的改善。