目标导向液体治疗联合右美托咪定对创伤性颅脑损伤患者血流动力学、脑氧代谢及炎症因子的影响

目的:探讨目标导向液体(GDFT)治疗联合右美托咪定对创伤性颅脑损伤(TBI)患者血流动力学、脑氧代谢及炎症因子的影响。方法:选取2016年3月~2019年3月期间我院收治的TBI患者142例,根据随机数字表法分为对照组1(n=47,GDFT治疗)、对照组2(n=47,常规液体联合右美托咪定)和研究组(n=48,GDFT联合右美托咪定),比较三组患者围术期指标、血流动力学、脑氧代谢及炎症因子变化情况,记录三组围术期间不良反应状况。结果:三组患者术后12、24 h心率(HR)、呼吸频率(RR)及动脉-颈内静脉血氧含量差(AVDO2)均较术前降低,且研究组低于对照组1、对照组2(P<0.05);三组患者术后12、24 h血氧饱和度(Sjv O2)较术前升高,且研究组高于对照组1、对照组2(P<0.05);三组患者术后12、24 h白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)呈逐渐下降趋势(P<0.05);研究组术后12、24 h的IL-6、TNF-α低于对照组1、对照组2(P<0.05)。对照组2、对照组1、研究组术中总液体量、胶体量、晶体量依次减少(P<0.05),住院天数依次缩短(P<0.05)。三组不良反应发生率对比未见显著差异(P>0.05)。结论:TBI患者手术麻醉过程中给予GDFT联合右美托咪定方案,促进机体HR、RR趋于平稳的同时还可改善脑氧代谢及炎性因子水平,且不增加不良反应发生率。     

右美托咪定对神经外科手术患者围术期血糖、血清TNF-α和IL-6水平的影响

目的:探讨右美托咪定(DEX)对神经外科手术患者围术期血糖、血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平的影响。方法:选取2016年2月-2016年11月我院神经外科收治的患有脑膜瘤拟择期行开颅手术的患者50例,随机分为研究组和对照组各25例。研究组患者于麻醉诱导前10 min以DEX 1.0μg/kg加入0.9%氯化钠注射液中,配成50 mL溶液静脉输注,10 min内输完,而后以0.5μg/kg/h输注DEX。对照组以等速输注等量0.9%氯化钠注射液。记录并对比两组麻醉诱导前10 min(T1)、诱导后(T2)、开皮时(T3)、手术1 h(T4)、手术结束时(T5)心率(HR)、平均动脉压(MAP)及血糖、血清TNF-α和IL-6水平。结果:两组患者HR在T2、T3时间点均高于T1时间点,而研究组患者HR在T2、T3时间点均低于对照组(均P0.05);研究组患者MAP在T3时间点高于T1时间点,对照组患者在T3、T4时间点高于T1时间点,而研究组患者MAP在T3、T4时间点均低于对照组(均P0.05);两组患者在T2、T3、T4、T5时间点血糖均高于T1时间点,而研究组患者在同时间点均低于对照组(P0.05);对照组患者在T2、T3、T4时间点血清TNF-α及IL-6均高于T1时间点(P0.05),研究组患者不同时间点血清TNF-α及IL-6变化无统计学意义(P0.05),且在T2、T3、T4时间点血清TNF-α及IL-6均显著低于对照组(P0.05)。结论:DEX在神经外科手术中有维持患者血流动力学稳定、抗炎、抑制血糖升高的作用,减轻炎症反应和应激反应,从而促进神经外科手术患者术后的恢复。     

右美托咪定对重型颅脑损伤患者术后持续镇静的效果及脑组织的保护作用

目的:探讨右美托咪定对重型颅脑损伤患者术后持续镇静的效果及脑组织的保护作用。方法:将2013年7月至2015年7月医院收治的90例重度颅脑损伤患者按照随机数字表法分为观察组45例和对照组45例,两组患者均常规麻醉后行开颅手术,观察组术后持续输注右美托咪定,对照组术后持续输注芬太尼。比较两组患者手术不同时间点血清S-100β蛋白、MAP、PCO2、Sp O2、HR及脑氧代谢指标变化情况。结果:两组患者术后各时段Sjv O2、Ca-jv DO2、CERO2比较差异无统计学意义,术后各时段两组间Sjv O2、Ca-jv DO2、CERO2比较差异亦无统计学意义(P0.05)。观察组T1~T4时段MAP、HR均显著降低,与T0时段比较比较差异具有统计学意义(P0.05);T1~T4时段观察组MAP、HR显著低于同时段对照组(P0.05)。从T1~T4时段两组患者血清S-100β均呈上升趋势,两组T1~T4时段血清S-100β显著高于T0时段(P0.05);T2~T4时段观察组血清S-100β显著低于同时段对照组(P0.05)。结论:术后持续输注右美托咪定能够对重度颅脑损伤患者能够对患者产生镇静、镇痛作用,且在一定程度上保护了脑组织。     

右美托咪定在体外循环下心内直视手术患儿肺保护、心肌保护的作用及对应激反应的影响

目的:探讨右美托咪定对体外循环(CPB)下心内直视手术患儿肺保护、心肌保护的作用及对应激反应的影响。方法:选取2017年3月～2019年9月期间我院收治的CPB下行室间隔缺损修补术患儿80例,上述患儿根据随机数字表法分为对照组(n=40)和研究组(n=40),麻醉诱导后研究组给予右美托咪定维持至术毕,对照组给予等容量生理盐水。比较两组患儿麻醉诱导前(T1)、停机后6h(T2)、停机后24h(T3)的肺功能[呼吸指数(RI)、氧合指数(OI)和肺顺应性(CL)]、心肌功能[心肌肌钙蛋白I(cTnI)、缺铁修饰白蛋白(IMA)]、炎性因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)]及应激反应[皮质醇(Cor)、血糖(Glu)、去甲肾上腺素(NE)和肾上腺素(E)]情况。结果:两组T2～T3时间点RI呈下降趋势,且研究组低于对照组(P0.05),两组T2～T3时间点OI、CL呈升高趋势,且研究组高于对照组(P0.05)。两组T2～T3时间点cTnI、IMA呈下降趋势,且研究组低于对照组(P0.05)。两组T2～T3时间点Cor、Glu、NE、E呈下降趋势,且研究组低于对照组(P0.05)。两组T2～T3时间点IL-6、TNF-α、IL-1β呈下降趋势,且研究组低于对照组(P0.05)。结论:CPB下心内直视手术患儿术中予以右美托咪定,可有效保护其肺功能、心肌功能,减轻机体应激反应及炎性刺激,有一定的临床应用价值。     

右美托咪定对下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响

目的:探讨右美托咪定对下肢手术患者因止血带诱发肢体缺血-再灌注损伤的影响。方法:选取2015年1月-2016年5月我院行下肢手术治疗的患者90例,按照数字随机法分为观察组及对照组,每组各45例。两组均给予蛛网膜下腔阻滞联合硬膜外麻醉,观察组在穿刺成功15 min内静脉输注1μg/kg的右美托咪定,维持剂量0.5μg/kg·h直至手术结束,对照组患者则给予同等剂量的生理盐水。对比两组止血带前(T0)、止血带充气30 min(T1)、止血带充气1 h(T2)、止血带释放后30 min(T3)、止血带释放后1 h(T4)时的超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、平均动脉压(MAP)、心率(HR)水平以及不良反应发生情况。结果:T3、T4时点观察组SOD水平显著高于对照组,MDA水平显著低于对照组(P0.05)。T1、T2、T3、T4时点观察组TNF-α水平显著低于对照组,T4时点IL-6水平也显著低于对照组(P0.05)。T1、T2时点观察组MAP、HR水平均显著低于对照组(P0.05)。观察组术中止血带疼痛、高血压发生率均显著低于对照组(P0.05)。结论:右美托咪定可显著抑制下肢手术患者止血带诱发氧化应激反应以及炎症反应,进而降低肢体缺血-再灌注损伤,具有较好的安全性。     

右美托咪定对子宫肌瘤切除术患者全麻苏醒期应激反应的影响

目的:探讨盐酸右美托咪定用于全凭静脉麻醉对子宫肌瘤切除术患者应激反应的影响。方法:选择我院收治的择期行子宫肌瘤切除术患者60例,随机分为观察组和对照组,每组30例。两组患者均采用全麻,其中观察组患者在麻醉诱导15 min内静脉输注1 ug/kg盐酸右美托咪定注射液,术中0.3-0.6 ug/(kg×h)维持;而对照组患者采用静脉输注0.9%的Nacl溶液。分别于麻醉前、麻醉后及苏醒期测定并观察两组患者外周静脉血中TNF-α,IL-2和IL-6的浓度变化情况。结果:两组患者麻醉前TNF-α,IL-2和IL-6的浓度无显著性差异(P0.05)。两组患者麻醉后及苏醒期TNF-α,IL-2及IL-6浓度均显著高于麻醉前,差异具有统计学意义(P0.05)。观察组患者麻醉后及苏醒期TNF-α,IL-2及IL-6浓度均显著低于对照组,差异具有统计学意义(P0.05)。结论:右美托咪定用于全凭静脉麻醉对子宫肌瘤切除术患者血清TNF-α、IL-2和IL-6浓度具有调节作用,可缓解或降低手术引起的应激反应。     

右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子及认知功能的影响

目的:探讨右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子以及认知功能的影响,为右美托咪定在腹腔镜下子宫恶性肿瘤手术的临床应用提供参考。方法:选择武汉科技大学附属普仁医院2015年7月至2017年6月收治的100例行腹腔镜下子宫恶性肿瘤手术患者作为研究对象,根据不同麻醉方式分为观察组和对照组两组,各50例,其中观察组患者在给予麻醉诱导前30 min,负荷剂量1.0μg/kg的右美托咪定静脉输注10 min,之后给予患者0.5μg/kg的右美托咪定持续性静脉输注至手术结束前30 min为止,对照组患者按照上述给药方法静脉输注同等容量的生理盐水。然后分别于麻醉诱导前(T0)、手术结束时(T1)、手术结束后4 h(T2)以及手术结束后1天(T3)取患者的外周静脉血,测定比较两组患者各相应时间点的血清C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素(IL-6)等炎症因子水平,外周血皮质醇(cor)、肾上腺素(E)、去甲肾上腺素(NE)等应激水平,MMSE评分、TMT完成时间等认知功能;并分析两组患者术后的不良反应发生情况。结果:两组患者T0时间的血清IL-6、TNF-α、CRP、cor、E、NE水平以及TMT、MMSE认知功能评分差异不具有统计学意义(P0.05),具有可比性;而观察组患者T1、T2、T3各相应时间点的血清IL-6、TNF-α、CRP、cor、E以及NE水平明显低于对照组(P0.05);观察组患者T2、T3各相应时间点的MMSE评分明显高于对照组,TMT评分值明显低于对照组(P0.05);且术后观察组患者的不良反应发生率明显低于对照组(P0.05)。结论:右美托咪定可以明显降低腹腔镜下子宫恶性肿瘤手术患者血清应激反应以及炎症因子水平,改善术后认知功能,减少术后不良反应的发生,效果显著,值得临床推广使用。     

右美托咪定对开胸手术单肺通气患者术中血流动力学和炎性因子的影响

目的:研究右美托咪定对开胸手术单肺通气患者术中血流动力学和炎性因子的影响。方法:选取我院收治的行开胸手术单肺通气的患者50例,通过随机数表法,平均分为对照组(n=25)和实验组(n=25),对照组采取常规麻醉,实验组在常规麻醉中增加Dex的静脉注射。记录2组平均动脉压的血流动力学指标和心率,对比进入手术时刻(T1),注射右美托咪定15分钟时刻(T2)、气管插管后时刻(T3)、切皮时刻(T4)、单肺通气时刻(T5)和术毕时刻(T6)的生命体征,对比T1、T5、T6、T7的外周血TNF-α、IL-6表达水平。结果:对照组的血流动力学指标在T1和T6时刻与实验组相近,差异无统计学意义(p0.05);对照组在T2、T3、T4、T5四个时刻显著高于实验组,差异有统计学意义(p0.05);对照组的TNF-α水平在T1时刻为(33.6±0.7),而实验组为(33.4±0.8),差异无统计学意义(t=0.941,P=0.352);实验组在T5、T6和T7时刻的TNF-α水平均低于对照组,差异有统计学意义(p0.05);对照组的IL-6水平在T1时刻为(8.7±0.6),而实验组为(8.8±0.6),差异无统计学意义(t=0.589,P=0.558);实验组的IL-6水在T5时刻、T6时刻、T7时刻显著高于实验组,差异有统计学意义(p0.05)。结论:右美托咪定不仅可以改善术中和术后的血流状况,同时还可以抑制炎症因子,对机体产生保护作用。     

血必净注射液对重型颅脑损伤患者的神经保护及其机制研究

目的:探讨血必净注射液对重型颅脑损伤患者的神经保护作用及其机制。方法:将2012年1月至2014年12月我院收治的200例重型颅脑损伤患者分为研究组(100例)和对照组(100例),另选取100例同期在我院体检的健康者为正常组。对照组给予常规治疗,研究组在对照组基础上静脉滴注血必净注射液,治疗后第1天、第3天、第5天、第7天时观察各组TNF-α及IL-6水平变化。结果:对照组、研究组各时间点TNF-α及IL-6水平均高于正常组(均P0.05),且研究组的TNF-α及IL-6水平均低于对照组(均P0.05)。结论:血必净注射液对重型颅脑损伤患者的神经具有保护作用,其作用机制可能跟降低炎症反应有关。     

奥曲肽辅助十二指肠镜治疗急性水肿型胆源性胰腺炎疗效及对炎症反应的影响

目的:探讨奥曲肽辅助十二指肠镜治疗急性水肿型胆源性胰腺炎疗效及对炎症反应的影响。方法:选择急性水肿型胆源性胰腺炎患者100例,随机分为研究组与对照组各50例,两组患者均给予禁食、抗感染、营养支持、酶抑制剂治疗,对照组同期给予十二指肠镜治疗,研究组同期给予奥曲肽辅助十二指肠镜治疗,比较两组腹痛缓解时间,白细胞(WBC)、体温恢复正常时间,治疗前(T0)、治疗3d(T1)、治疗7d(T2)血、尿淀粉酶水平与炎症因子CRP、IL-6、TNF-α水平的变化。结果:(1)研究组腹痛缓解时间、WBC、体温恢复正常时间均较对照组明显缩短(P0.05);(2)两组患者T1、T2血、尿淀粉酶水平均较T0明显降低,且T2血、尿淀粉酶水平低于T1(P0.05),研究组T1、T2血、尿淀粉酶水平均低于对照组(P0.05);(3)两组T1、T2血清CRP、IL-6、TNF-α水平均较T0明显降低,且T2低于T1(P0.05),研究组T1、T2时血清CRP、IL-6、TNF-α水平均低于对照组(P0.05)。结论:奥曲肽辅助十二指肠镜治疗急性水肿型胆源性胰腺炎可提高早期治疗效果,减轻炎症反应。     

乙醇与乙醛对心脏的影响及其可能机制的探讨

通过研究乙醇、乙醛对离体心脏和神经干的影响,探讨乙醇、乙醛对心脏作用的可能机制.用不同浓度的乙醇和乙醛处理牛蛙蛙心灌流标本和坐骨神经标本,用BL-420 系统对给药前后心脏的心率和振幅以及神经干最小刺激强度作记录.乙醇和乙醛可以引起神经兴奋性的改变从而影响神经冲动的传导,而且其影响具有明显的量效依赖关系,低浓度的乙醇和乙醛能使神经的兴奋性增加,高浓度则降低;乙醇对心脏的心率和振幅均有抑制作用,低浓度的乙醛对心脏心率和振幅有促进作用,高浓度的乙醛对心脏造成不可恢复的损伤.乙醇、乙醛对心脏的影响效果不同,但两者均可直接影响及通过神经而间接影响心脏的活动.     

Effects of diet on biomarkers of exposure and effects, and on oxidative damage

Modification of DNA is believed to be a key step in carcinogenesis, and therefore DNA adducts have been proposed as predictive biomarkers of human cancer. Smoked and grilled foods are important contributors of PAH-DNA adduct levels, while the consumption of flavonoids and other antioxidants seems to decrease the level of DNA adducts. The aim of this study was to assess the effect of each group of foods and of different dietary profiles on the DNA adducts levels and on oxidative damage to DNA. Occupationally exposed men were recruited in Czech Republic, Slovak Republic and Bulgaria. Non-occupationally exposed subjects were matched on age and gender to PAH-exposed workers. Three hundred and fifty-six subjects who completed the questionnaire for dietary information and had a measurement of DNA adduct levels and oxidative damage to DNA were included in this study. No food item seemed to be individually associated with markers of exposure or DNA damage. Total DNA adducts levels were significantly higher for subjects who had eaten, in the previous 24 h, smoked or fried food. A Principal Components Analysis was performed to identify groups of subjects with similar dietary profiles: no significant differences in biomarker levels were observed among the groups defined according to dietary profiles. In conclusion, this study did not show any significant association between diet and biomarkers of DNA damage, oxidative damage to DNA and chromosomal aberrations, neither when each food was considered separately, nor when the effect of different dietary profiles was tested. The recent consumption of smoked or fried food was associated with an increase in total DNA adducts levels.     

Effects of age and gender on success and death of mountaineers on Mount Everest

Increasing numbers of climbers are attempting Mount Everest, the highest mountain on Earth. We compiled interview data and computed the probabilities of summiting and of dying as a function of climber age and gender (2211 climbers, spring season) for the period of 1990-2005. Men and women had similar odds of summiting and of dying. However, climbers older than 40 years have reduced odds of summiting, and those older than 60 years have increased odds of dying, especially when descending from the summit. On Mount Everest, phenotypic selection appears blind to gender but favours young mountaineers.     

Thoughts on the origin and nature of life and intelligence on earth

Believing, for good reasons, that our Universe engenders the occurrence of Life, it is probable that Life appeared more than once on young planet Earth. The universality of our genetic code indicates though, that only one line produced a population that was cellular, autopoietic, responsive intelligently (i.e., to its advantage) to its environment, and capable of reproduction. Its evolution took time during which other intermediate or incipient forms of life disappeared. Trying to retrace ab initio the preceding chemical evolution on our young planet, we may not repeat the chemistry which led to our line. One can argue that it may be profitable to attempt to construct artificial life forms using the kind of building blocks that we learned to know through studying the chemistry of our life. Independently, computers are being built, or are planned, which possess memory that can be used appropriately (intelligently), and which to some extent can repair and reproduce themselves. Such Life does not depend on our biochemistry. However, these machines do perform as yet only partly along the lines of our human intelligence which is guided by self-awareness and a sense of individual integrity, and are thereby not equipped to search for Understanding and Self-expression.     

放牧对牧草光合作用、呼吸作用和氮、碳吸收与转运的影响

研究放牧对草地植物生理活动的影响,对于揭示草地放牧演替的生理机制有重要意义.大量研究表明,家畜放牧对牧草光合作用、呼吸作用以及C和N吸收与转运的影响,可以分为生理伤害和生理恢复2个阶段.放牧通过改变草地冠层结构影响牧草光合作用,净光合作用速率短期内迅速下降,随着叶面积指数增加又逐渐上升,呼吸作用有相似的变化趋势.牧草放牧后再生长所需的C和N最初主要来自根系和留茬中的贮藏物质,此后随着牧草生长恢复逐渐由同化作用供给,C代谢与土壤N水平负相关.放牧后牧草生理活动变化与牧草遗传特性、种间竞争、家畜放牧特征、非生物环境等因素密切相关.     

Implications of LCA and LCIA choices on interpretation of results and on decision support

The International Journal of Life Cycle Assessment -     

Effect of grafted PEG on liposome size and on compressibility and packing of lipid bilayer

The aim of this study was to elucidate the effect of various mole percentages (0-25 mol%) of 2000 Da polyethylene glycol-disteroylphosphoethanolamine (PEG-DSPE) in the presence or absence of 40 mol% cholesterol and the effect of degree of saturation of phosphatidylcholine (PC) on the size and the lipid bilayer packing of large unilamellar vesicles (LUV). Egg PC (EPC, unsaturated) LUV and fully hydrogenated soy PC (HSPC, saturated) LUV partial specific volume, specific compressibility, size, and packing parameter (PP) of lipids were characterized by measurements of density, ultrasonic velocity, specific turbidity, and dynamic light scattering. Liposome size and specific turbidity decreased with increase in temperature and PEG-DSPE mol%, except at 7+/-2 mol%. At this PEG-DSPE mol%, an anomalous peak in liposome size of 15+/-5 nm was observed. We attribute this effect mainly to the change in the spatial structure of the PEG-DSPE molecule, depending on whether the grafted PEG is in the mushroom or brush configuration. In the mushroom regime, i.e., when the grafted PEG is up to 4 mol% in LUV, the PEG moiety did not affect the additive PP of the lipids in the bilayer, and the PP value of PEG-DSPE is 1.044; while in the brush regime, i.e., when the grafted PEG is higher than 4 mol%, the PP of PEG-DSPE decreases exponentially, reaching the value of 0.487 at 30 mol% of grafted lipopolymer. The specific compressibility and additive PP values for the mixture of matrix lipid (EPC or HSPC), cholesterol, and PEG-DSPE for all liposome compositions investigated reached their maximum at 7+/-2 mol% PEG-DSPE, the concentration of PEG-DSPE at which the highest biological stability of the LUV is achieved.