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The protective effects of heat-shock response on the retinae of rats after retinal ischemic reperfusion injury

Objective To analyze the protective effects of heat-shock response on the retinae of the rats after retinal ischemic reperfusion injury.Method Twenty Wistar rats (20 eyes) were divided into 4 groups: intracameral perfusion group (group P), intracameral perfusion after quercetin injection group (group P+Q), intracameral perfusion after heat shock group (group P+H), and in tracameral perfusion after quercetin injection and heat shock group (group P+Q+H ). According to the standard program established by International Society for Clinical Visual Electrophysiology, we recorded the results of the dark-adapted electroretinogram (D-ERG ),oscillatory potentials (OPs),and light-adapted ERG (L-ERG) of the rats with intraocular hypertension after induced by heat shock response. The expressions of HSP 70 of the rats in all groups were observed by Western blotting.Results The expression of HSP 70 of the rats in group P+H was the highest in all groups, but the expressions of HSP70 in group P+Q and P+Q+H were inhibited significantly. The amplitudes of a and b wave of ERG and O2 wave of OPs decreased, and the delitescence of them were delayed significantly in rats after intracameral perfusion. The amplitude of b wave of D-ERG and O2 wave of OPs in group P+H were higher than which in group P. Zero hour after perfusion, the amplitudes of all waves in group P+H increased significantly (Plt;0.05). Twenty-four hours after perfusion, the retinal functional resumption of the rats in group P+H was better than which in group P. In group P+Q and P+Q+H, the delitescences of all waves of ERG and O2 wave of OPs were the longest and the amplitudes were the lowest, and some waves even disappeared.Conclusions The heat-shock response may improve the recovery ability of the retinal cells after injury of ischemic reperfusion.(Chin J Ocul Fundus Dis，2003，19：117-120)

早期乳酸清除率对重症感染患者预后的评估研究

目的 分析早期乳酸清除率对重症感染患者预后的临床评估价值。方法 选取2009 年1 月至2011 年12 月收治的248 例重症感染患者为研究对象进行回顾性分析。根据患者转归分为生存组和死亡组, 比较两组一般资料、APACHEⅡ 评分、脓毒症休克发生率、初始血乳酸浓度和治疗 6 h的乳酸清除率差异。根据乳酸清除率水平分为高乳酸清除率组和低乳酸清除率组, 比较两组一般资料、APACHEⅡ评分、脓毒症休克发生率、初始血乳酸浓度和病死率的差异。结果 生存组和死亡组患者的一般资料、APACHEⅡ评分、初始血乳酸浓度间的差异均无统计学意义( P gt;0. 05) 。生存组乳酸清除率明显高于死亡组[ ( 32. 6 ±11. 3) % 比( 15. 2 ±10. 1) % , P = 0. 024] , 而脓毒症休克发生率明显低于死亡组( 30. 9% 比87. 5% , P = 0. 019) 。高乳酸清除率组的脓毒症休克发生率( 34. 6% 比 53. 7%) 及死亡率( 25. 5% 比61. 1% ) 明显低于低乳酸清除率组( P 均lt;0. 05) 。结论 早期乳酸清除率可用于早期评估重度感染患者的预后转归。

The Impact of Norepinephrine on Pulmonary Vein in Treating Septic Shock

热休克蛋白90抑制剂治疗新生血管性眼病的研究现状

热休克蛋白90（HSP90）作为一种广泛存在的分子伴侣，在新生血管性疾病的发生发展中起重要作用。HSP90抑制剂能抑制HSP90活性，引起与细胞增生、细胞周期调节、细胞凋亡有关的重要信号蛋白选择性降解，并通过与磷脂酰肌醇-3激酶/蛋白激酶B和类风湿性关节炎因子/蛋氨酸脑啡肽/促分裂原活化蛋白激酶等信号通路中的多种HSP90客户蛋白分子相互作用，降低血管生成因子的表达，从而抑制血管内皮细胞的增生和存活。研发特异性的HSP90抑制剂药物已经成为治疗肿瘤及相关新生血管性疾病的新选择。其可能成为治疗新生血管性眼病的全新靶点。

脓毒症休克患者免疫细胞变化与疾病演变及预后关系的研究

目的 评价脓毒症休克患者外周血中性粒细胞、单核细胞、淋巴细胞计数与多器官功能衰竭及预后的关系。方法 记录患者被诊断为脓毒症休克后第1、3、5、7 d 中性粒细胞、单核细胞、淋巴细胞的变化, 同时进行脓毒症相关性器官衰竭评分( SOFA) 。根据院内预后分为存活组和死亡组。结果 100 例持续存在7 d 以上脓毒症休克的患者中, 50 例存活,50 例死亡。死亡组单核细胞计数、SOFA 评分在第5、7 d 明显升高, 并显著高于存活组的对应值( P lt;0. 05) 。死亡组淋巴细胞计数在第5、7 d 明显降低, 并低于存活组的对应值( P lt;0. 05) 。两组外周血中性粒细胞计数均未发生明显变化( P gt;0. 05) 。结论 脓毒症休克时, 单核细胞凋亡可能是机体的保护机制, 而淋巴细胞计数呈下降趋势预示患者预后不良。将SOFA 评分与淋巴细胞计数的变化相结合观察脓毒症休克的病情, 对患者的治疗及预后的评价有指导意义。

Clinical Analysis of Xuebijing Injection in Treating Severe Burn Patients with Sepsis during Shock Stage

目的:探讨应用血必净注射液对严重烧伤患者休克期并发脓毒症的治疗效果。方法:依据脓毒症感染诊断标准,对44例严重烧伤患者休克期并发脓毒症的患者,随机分为2组,对照组22例给予常规治疗,治疗组22例,加用血必净注射液,疗程7日。分别观察2组患者治疗前后体温(T)、心率(HR)、白细胞计数(WBC)、中性粒细胞率、血小板记数(PLT)及病死率。结果:血必净注射液治疗后,治疗组的HR、WBC、PLT与对照组比较有显曹改善(Plt;005);病死率较对照组显著降低(Plt;001)。结论:烧伤后早期应用血必净注射液是防治休克期烧伤脓毒症的重要措施,对烧伤脓毒症起到早期保护组织、防治MODS的作用。

Effect of Limited Fluid Resuscitation on Intestinal Injury of Hemorrhagic Shock in Rats

ObjectiveTo determine the effects of different volume fluid resuscitation on intestinal injury and the permeability of intestine in hemorrhagic shock rats. MethodsSprague-Dawley male rats(n=72) were randomly equally divided into 4 groups after the model establishment of blood pressure-controlled hemorrhage, 45, 30, and 15 mL/(kg·h) of fluid resuscitation were performed in high dosage of resuscitation(HLR), moderate dosage of resuscitation(MLR), and low dosage of resuscitation(LLR) group respectively, but rats of Sham group didn't accept fluid resuscitation. After resuscitation, ten centimeters ileum was harvested for testing intestinal permeability. Then 6 rats of each group were sacrificed at 24, 48, and 72 hours after fluid resuscitation respectively. Over the specified time interval, blood was collected for testing levels of lactic acid and plasma tumor necrosis factor-α(TNF-α). The ileums of 3 resuscitation groups were obtained for testing the ratio of wet weight to dry weight and observing the histological changes. ResultsAfter resuscitation, the intestinal permeability was higher in HLR group(P<0.05). At 3-8 hours after resuscitation, rats of Sham group were all died, and the other rats of 3 groups were all alive. The level of plasma lactic acid was lower in LLR group than those of other 2 groups at 24 hours(P<0.05). The levels of TNF-α were higher in HLR group than those of other 2 groups at 24, 48, and 72 hours(P<0.05), and at 48 hours, level of TNF-α in LLR group was lower than MLR group(P<0.05). At 24 hours after resuscitation, ratio of intestinal wet weight to dry weight in LLR group was the lowest, and HLR group was the highest(P<0.05). According to the histopathology, intestinal injuries of the 3 groups were tend to be remission with the time, and at 48 and 72 hours after resuscitation, intestinal villus of LLR group appeared to be normal. ConclusionLimited fluid resuscitation of 15 mL/(kg·h) could not only decrease the levels of lactic acid and TNF-α, but also moderate the intestinal permeability and the intestinal injury in early stage after shock and surgery.

Veno-arterial extracorporeal membrane oxygenation in salvage of cardiogenic shock

Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.

Effect of different resuscitation fluids on interleukin-8 and tumor necrosis factor-α in rats with traumatic hemorrhagic shock

Objective To investigate effect of different resuscitation liquids and different resuscitation methods on contents of interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in early resuscitation process of rats with traumatic hemorrhagic shock. Methods Sixty-four healthy SD rats (450–550 g) were chosen and divided into 4 groups randomly and averagely: crystal liquid limited resuscitation group, colloidal liquid limited resuscitation group, 7.5% NaCl limited resuscitation group, and colloidal liquid non-limited resuscitation group. There were 16 rats in each group. All the experimental rats were weighed before intraperitoneal injection of pentobarbital sodium anesthesia. Animal model was established via Chaudry’s method. The rats were killed and the abdominal aorta bloods were drew on hour 2, 6, 12, and 24 after recovering from anesthesia. The contents of IL-8 and TNF-α in plasmas were detected by enzyme linked immunosorbent assay. Results The contents of IL-8 and TNF-α among three kinds of limited resuscitation groups on hour 6 after resuscitation were significantly higher than those on hour 2 after resuscitation (P<0.05) and reached the peaks, then began to decrease. On hour 12 after resuscitation, the contents of IL-8 and TNF-α were decreased continuously among three kinds of limited resuscitation groups (P<0.05). The contents of IL-8 and TNF-α in the colloidal liquid non-limited resuscitation group at each point time were significantly higher than those among three kinds of limited resuscitation groups (P<0.05), which in the crystal liquid resuscitation group were significantly lower than those in the other limited liquid resuscitation groups (P<0.05). Conclusions In process of liquid resuscitation of rats with traumatic hemorrhagic shock, limited resuscitation method is better than that of non-limited resuscitation method. Among three kinds of limited resuscitation methods, crystal resuscitation liquid is more effective than the other two resuscitation liquids in prohibiting releases of IL-8 and TNF-α in rats with traumatic hemorrhagic shock.

全身多处刀砍伤失血性休克后视网膜出血一例