不同补液方式在创伤合并失血性休克早期急救中的临床应用

目的：研究不同补液方式在创伤合并失血性休克早期急救中的临床应用。方法：选取2013 年6 月到2015 年6 月我院收治的 创伤合并失血性休克患者130 例，按照随机数字表法将患者分为I组和II组，每组65 例，I组给予限制性液体补充，II 组给予充足 液体补充，比较两组输液量、输血量、平均动脉压、心率、死亡率以及并发症。结果：I 组输液量、输血量、心率以及平均动脉压均显 著低于II 组，比较差异具有统计学意义（P＜0.05）；I 组死亡率为18.5％（12/65）显著低于II组的38.5％（25/65），比较差异具有统 计学意义（P＜0.05）；I 组并发症发生率为16.9％（11/65）显著低于II组的36.9％（24/65），比较差异具有统计学意义（P＜0.05）。结 论：限制性液体补液应用于创伤合并失血性休克早期急救效果较好，具有较低的死亡率和并发症发生率。     

Aluminium in tea: SEC-ICP-MS speciation studies of infusions and simulated gastrointestinal digests

Abstract

The speciation of aluminium in tea infusions and in vitro gastrointestinal digests of tea infusions has been investigated using size exclusion chromatography coupled to inductively coupled plasma mass spectrometry (SEC-ICP-MS). At pH 2.5, following simulated gastric treatment, Al from tea eluted at a similar retention volume to that obtained for an aqueous Al standard. At pH 5.5, an aqueous Al standard was eluted from an SEC column in Tris buffer (Al recovery ≈ 100%) only in the presence of a complexing agent (NaF), and at a retention volume corresponding to a molecular mass greater than that expected for an ionic species. Aluminium associated with a tea infusion eluted in two fractions: a higher molecular weight fraction corresponding to Al strongly bound to ligands in the tea, and a lower molecular weight fraction probably comprised of labile Al eluting as Al-F complexes. Simulated gastrointestinal digestion produced three Al-bearing fractions, of which the two at higher molecular mass represented ligand-bound Al. The molarity of the Tris buffer strongly influenced the retention volume of the Al fractions, particularly for the ligand-bound Al. After simulated gastrointestinal digestion, the soluble labile fraction (15% of the Al from the tea infusion) was considered to be potentially available for absorption. The actual proportion of the fraction that might be absorbed would depend upon a number of physiological and nutritional factors.     

The effect of infusion of hypertonic saline on glomerular filtration rate and arginine vasotocin, prolactin and aldosterone in the domestic chicken

Domestic fowl were infused for 60 min with isotonic saline followed by 90 min with hypertonic saline. Plasma electrolyte concentrations, osmolality and haematocrit were measured. Urine electrolyte excretion rates, osmolar output and urine flow rates were also monitored. From these results fractional excretions of electrolytes were calculated. The renal function markers inulin and ρ-amino hippuric acid were infused to enable the measurement of glomerular filtration rate and plasma clearance of ρ-amino hippuric acid, respectively. Plasma samples were also taken to assay for the hormones prolactin, aldosterone and arginine vasotocin. Plasma electrolytes and osmolality, fractional excretion of electrolytes and osmolar output all increased, while haematocrit decreased, throughout the experiment. However, no significant change was found in urine flow rate and little change was seen in glomerular filtration rate. The clearance of ρ-amino hippuric acid, which provides an indication of renal plasma flow, increased during hypertonic saline infusion. Plasma concentrations of aldosterone and prolactin decreased during the experiment and plasma concentrations of arginine vasotocin increased. Infusion of hypertonic saline had no consistent effect on glomerular filtration rate, which may be due to conflicting influences of expansion of the extracellular fluid volume and increased plasma osmolality. Accepted: 19 January 1998     

Analysis of cholesteryl esters and diacylglycerols using lithiated adducts and electrospray ionization-tandem mass spectrometry

Cholesteryl ester (CE) and diacylglycerol (DAG) molecular species are important lipid storage and signaling molecules. Mass spectrometric analyses of these lipids are complicated by the presence of isobaric molecular ions shared by these lipid classes and by relatively poor electrospray ionization, which is a consequence of an inherently weak dipole moment in these lipid classes. The current study demonstrates that lithiated adducts of CE and DAG molecular ions have enhanced ionization and lipid class-specific fragmentation in tandem mass spectrometry (MS/MS) scan modes, thereby allowing the implementation of strategies capable of lipid class-specific detection. Using neutral loss (NL) mode for the loss of cholestane from cholesterol esters (NL 368.5) and specific selected reaction monitoring for DAG molecular species, the response of specific molecular species to that of internal standards was determined. CE and DAG molecular species were quantified in human coronary artery endothelial cells (HCAECs) incubated with both palmitic acid and oleic acid. Furthermore, NL 368.5 spectra revealed the oxidation of the aliphatic fatty acid residues of CE molecular species. Taken together, these studies demonstrate a new analytical approach to assessing CE and DAG molecular species that exploits the utility of lithiated adducts in conjunction with MS/MS approaches.     

腰交感神经节微创介入置管连续给药在糖尿病足治疗中的应用价值

目的:探讨腰交感神经节微创介入置管连续给药在糖尿病足治疗中的应用价值。方法:选取2016年6月-2017年6月期间在我院诊治的40例糖尿病足患者。按随机数字表法分为研究组(n=20)和对照组(n=20)。对照组给予常规治疗,研究组使用腰交感神经节微创介入置管连续给药治疗。对比分析两组视觉模拟评分(VAS)、治疗总有效率、并发症发生情况。结果:两组治疗前VAS评分比较差异无统计学意义(P0.05);两组治疗后VAS评分均下降,且研究组较对照组降低(P0.05)。研究组治疗后的临床总有效率为95.00%(19/20),高于对照组的70.00%(14/20)(P0.05)。治疗后研究组踝肱指数(ABI)和皮温高于对照组,震动感觉阈值(VPT)低于对照组,差异均有统计学意义(P0.05);治疗后研究组患者溃疡愈合时间和住院时间短于对照组,两组比较差异具有统计学意义(P0.05)。两组治疗后并发症发生率比较无统计学差异(P0.05)。结论:使用腰交感神经节微创介入置管连续给药治疗糖尿病足,可显著提高治疗总有效率,减轻患者疼痛,缩短溃疡愈合时间及住院时间,减少截肢率,且安全性较好。     

丙泊酚靶控输注复合瑞芬太尼对腹腔镜直肠癌根治术患者血流动力学及术后认知功能的影响

摘要 目的：探讨丙泊酚靶控输注复合瑞芬太尼对腹腔镜直肠癌根治术患者血流动力学及术后认知功能的影响。方法：选取2017年4月~2019年4月期间我院收治的行腹腔镜直肠癌根治术患者101例,根据随机数字表法将患者分为对照组（n=50,静吸复合麻醉）和研究组（n=51,丙泊酚靶控输注复合瑞芬太尼麻醉）,比较两组围术期指标、血流动力学、术后认知功能及不良反应情况。结果：研究组麻醉诱导时间、拔管时间、清醒时间、自主呼吸恢复时间均较对照组缩短,丙泊酚使用剂量、瑞芬太尼使用剂量均少于对照组（P<0.05）。两组患者麻醉诱导后（T2）~手术结束时（T5）时间点心率(HR)呈先升高再下降的趋势（P<0.05）,平均动脉压(MAP)呈持续升高趋势（P<0.05）;研究组T2时间点HR高于对照组,插管即刻（T3）~手术开始时（T4）时间点HR则低于对照组（P<0.05）;研究组T2~T5时间点MAP均高于对照组（P<0.05）。两组拔管时的简易智能精神状态量表（MMSE）评分均降低,但研究组高于对照组（P<0.05）。两组不良反应发生率比较无统计学差异（P>0.05）。结论：腹腔镜直肠癌根治术中使用丙泊酚靶控输注复合瑞芬太尼麻醉,可有效改善围术期指标,减轻血流动力学波动,对患者术后的认知功能影响较轻。     

Effects of different doses of free 𝛂-linolenic acid infused to the duodenum on the immune function of lactating dairy cows

This study investigated the effect of a duodenal infusion of a C18:3 free fatty acid on the immune function of lactating dairy cows. Four primiparous Chinese Holstein cows fitted with duodenal cannulas received 0, 100, 200, 300, and 400 g/d of α-linolenic acid (LNA) in a two-treatment crossover design. Blood was collected and serum IgA, IgG, IgM, prostaglandin E₂ (PGE₂) and Th1/Th2 cytokines were determined. Results showed that increasing the supply of LNA to the small intestine of dairy cows linearly increased serum IgG and quadratically enhanced interferon-γ (p < 0.05), whereas the concentrations of PGE₂ declined linearly (p < 0.05) and those of interleukin (IL)-4 tended to decrease (p = 0.08). No difference was observed in serum IgA, IgM or other cytokines, such as IL-2, IL-6 and IL-10. This study demonstrated that in dairy cows, a post-ruminal infusion of high doses of LNA has immunomodulatory effects, possibly associated with a predisposition to a Th1-type response.     

Investigations on the influence of duodenal histidine infusion on nitrogen and amino acid turnover of growing German holstein bulls

The effect of a continuous duodenal infusion of L‐histidine (His) (8 g/d) on the retention of nitrogen was investigated in two experiments (I, II), each of which was carried out using two young bulls. In Exps. I and II, the animals (150–250 kg BW) were fitted with a re‐entrant cannula in the proximal duodenum and were fed diets containing 125 g CP/kg DM and 11.5 MJ ME/kg DM. A third experiment (III) using two young bulls (140–200 kg BW) fitted with a simple T‐cannula was carried out infusing 6 g L‐His. The animals were fed a low protein diet (94 g CP/kg DM and 11 MJ ME/kg DM). The study was done to find out whether or not L‐His is the first limiting amino acid (AA) for growing ruminants.

N retention was 28 and 31, 38 and 38, 22 and 24 g/d without L‐His infusion and with L‐His infusion for Exps. I, II and III, respectively. Both in the experiments with a standard protein supply (I, II) and in the experiment with reduced protein supply (III), no significant differences were found between periods with and without infusion of L‐His. The utilisation of duodenal NAN varied between 39% and 50% and was also not significantly influenced by the duodenal infusion of L‐His. No significant effect was observed on the flow of AA into the duodenum. The faecal excretion of AA was also not significantly influenced by the infusion of L‐His. The utilisation of individual amino acids as calculated by the ratio of retained AA to intestinal apparently digested AA, did not differ significantly following the duodenal infusion of L‐His. As expected, the utilisation of His decreased. Of the different essential AA, L‐His was the most utilised (80%) followed by Arg (72%), Met (60%), Leu (45%) and Lys (44%), during periods without supplementation of L‐His.

It is concluded that the intestinal supply of L‐His from the basal diet was sufficient for the potential growth level of animals under these experimental conditions. In all AA present at the proximal duodenum, L‐His could have at first a limiting effect on the performance of growing young bulls with high body gain. Arg and Met, but not Lys, could be second or co‐limiting AA.     

Effect of starch application into the proximal duodenum of ruminants on starch digestibility in the small and total intestine

Four Slovakian Black‐and‐white bulls (LW 410 ± 12 kg; Exp. 1) and four Slovakian Black‐and‐white non lactating dairy cows (LW 475 ± 14 kg; Exp. 2) with permanent ruminal cannulas, duodenal T‐cannulas and ileal re‐entrant cannulas were used in a 4 × 4 Latin square design to determine the postruminal capacity of starch digestion.

In Exp. 1 bulls received 5.4 kg DM from corn silage and 3.6 kg DM from alfalfa hay, in Exp. 2 cows consumed only 2.1 kg DM corn silage and 1.9 kg DM alfalfa hay. Additionally, either 750 or 1500 g (Exp. 1) or resp. 1000 or 2000 g (Exp. 2) gelatinized corn or wheat starch per animal and day were applied as pulse doses or as infusion into the proximal duodenum.

In both experiments the duodenal and ileal nutrient flow, as well as the faecal excretion without starch application, were measured in a pre‐period. After starting starch application ileal digesta and faeces were sampled over 120 h after 9 or 23 days of adaptation respectively. Cr₂O₃ was used as a flow marker.

It was shown, that the capacity of starch utilisation in the small intestine was limited. The effect of different doses of bypass‐starch was more pronounced than the effect of different starch sources. Starch digestibility decreased with increasing amounts of starch in the intestine (Exp. 1: corn starch: from 74.3 to 68.0%, P < 0.001; wheat starch: from 76.7 to 67.4%, P <0.001; Exp. 2: corn starch: from 71.4 to 50.3%, P <0.001; wheat starch: from 73.8 to 53.1%, P <0.001). Corn starch was 0.6 to 2.4% units (P <0.05) and 2.4 to 2.8% units (P < 0.001) less digested than wheat starch in Exp. 1 and Exp. 2, respectively.

The decreased starch digestibility in the small intestine with increasing amounts of starch at the duodenum was not totally compensated in the large intestine. The starch digestibility in the total intestine for the low and high amounts of applied starch was: 83.7 and 81.0% (P < 0.001, corn starch, Exp. 1), 86.0 and 81.7% (P < 0.001, wheat starch, Exp. 1), 95.5 and 79.1% (P < 0.001, corn starch, Exp. 2), 99.8 and 81.7% (P < 0.001, wheat starch, Exp. 2).

Corn starch was 0.7 to 2.3% units (P <0.001) and 2.6 to 4.3% units (P <0.001) less digested than wheat starch in Exp. 1 and Exp. 2, respectively.

Model calculations were used to quantify the efficiency of starch utilisation. The recommended maximal amount of bypass‐starch is supposed to be 1.3 to 1.8 kg per animal and day.