目的 探讨参附注射液对广西巴马小型猪离体空跳心脏模型的心肌保护作用.方法 将 12 头体重 25～30 kg的健康成年广西巴马小猪随机分成参附组(n=6)和 0.9%氯化钠溶液组(n=6),将灌注了心脏停跳液(HTK液)的心脏与体外循环机连接,常温离体灌注 8h,比较灌注第0 个小时(T0)、第1 个小时(T1)、第2 个小时(T2)、第3个小时(T3)、第 4 个小时(T4)、第 5 个小时(T5)、第 6 个小时(T6)、第 7 个小时(T7)、第 8 个小时(T8)9 个时间点灌注液中肌酸激酶同工酶(CK-MB),乳酸脱氢酶(LDH),α-羟丁酸脱氢酶(α-HBDH)的水平,同时监测 9 个时间点的心率、灌注压和每分钟流量以及T0、T4、T83 个时间点灌注液中IL-6、TNF-α、IL-8的水平;通过透射电镜观察灌注第8 个小时心脏停搏后左心室壁心肌组织的超微结构.结果 2 组灌注液中CK-MB、α-HBDH、LDH的水平随着时间变化显著增加(P<0.05);和 0.9%氯化钠溶液组比较,参附注射液组灌注液中 9 个时间点的CK-MB,α-HBDH,LDH水平明显降低,差异有统计学意义(P<0.05).TNF-α、IL-6、IL-8在灌注液中的浓度随时间显著增加(P<0.05),参附注射液组灌注液中TNF-α、IL-6、IL-8的浓度明显低于0.9%氯化钠溶液组,差异有统计学意义(P<0.05),但2 组心率、灌注压和每分钟流量无明显差异(P>0.05).和 0.9%氯化钠溶液组比较,参附组心肌组织损伤程度较轻.结论 参附注射液对广西巴马小型猪离体空跳心脏的心肌细胞具有保护作用.

1 病例资料 1. 1 病例1 患者32岁,孕1产0.因孕34周,突然胸痛、憋喘1h于2011年12月20日来诊.既往有自发性气胸的类似发病史.1h前用力排便时突然出现右侧胸痛、憋喘.入院检查:T 36. 3℃,P 91 次/min,R 22 次/min,BP 106/60mmHg (1mmHg=0. 133kPa).口唇轻度紫绀,气管轻度右移,左胸呼吸动度减弱,叩呈鼓音,呼吸音消失,右肺及心脏无异常.腹部膨隆,宫底高度30cm,胎位为左枕前位,胎心144/min,无产兆.心电图示:正常心电图;未行X线胸片示检查.诊断为:妊娠并发自发性气胸.来院后立即于胸腔闭式引流(10F),患者呼吸困难明显减轻.同月25日上午患者自觉引流管处疼痛难忍且呼吸困难,请产科医生会诊.会诊认为患者胸腔引流管置管处疼痛明显,妊娠已足35周,为防止出现胎儿缺氧意外,建议行剖宫产术.遂于12月25日下午剖宫产,产1健康男婴(阿氏评分10分) ,同期行胸腔镜肺大疱破裂修补手术.治疗后胸部 CT检查,右肺已完全复张,痊愈出院.

目的 观察巴马小型猪离体心脏非工作模型中灌注液钾离子浓度的变化.方法 选择体重为25 ～30 kg的健康成年广西巴马小猪5头,在全身麻醉下经胸部正中切口通过头臂干插管灌注心脏停跳液(HTK液)使心脏停跳.切取心脏后使用生理盐水灌洗心腔和冠脉系统,尽可能将其中的高钾液冲洗干净,最后连接体外循环机进行心肌灌注建立非工作模型.保存期间未放置左心室引流管.监测离体心脏跳动情况;每隔1h取灌注液进行灌注液中钾离子浓度检测.结果 5例小型猪离体心脏恢复跳动并维持空跳6h,灌注液钾离子浓度相对稳定,各时点钾离子浓度两两比较差异无统计学意义(均P＞0.05).结论 切取心脏后使用生理盐水灌洗心腔和冠脉系统是避免灌注液高钾的关键步骤.保存期间无需放置左心室引流管.

目的 探讨苦参碱(MT)逆转肺癌A549顺铂耐药株活性中的作用及分子机制.方法 对数生长期人肺腺癌耐顺铂细胞株A549/DDP细胞,用不同浓度MT(1,4,16,32μmol·L-1)处理,采用噻唑蓝(MTT)法在24 h检测细胞增殖抑制率.将细胞分为空白对照组及MT组(16μmol·L-1),光学显微镜、Transwell及免疫荧光检测两组细胞的细胞形态、侵袭能力、E-钙粘蛋白(E-cadherin)及波形蛋白(vimentin)细胞免疫荧光变化.另将细胞分为空白对照组、MT组(16μmol·L-1MT)、顺铂(DDP)组(3×10-3μmol·L-1DDP)和MT+DDP组(16μmol·L-1MT+3×10-3μmol·L-1DDP),Western blotting法检测上皮间充质转化(EMT)表型相关标志物E-caherin、vimentin、slug、p-p65等蛋白表达,流式细胞仪检测细胞凋亡率.结果 MT能明显抑制A549/DDP细胞的增殖及侵袭能力,MT处理后细胞呈现上皮细胞样形态及上皮表型.此外,与对照组及DDP组比较,MT+DDP组细胞凋亡率明显升高(P<0.05),E-cadherin蛋白表达水平明显升高(P<0.05),vimentin、slug及p-p65蛋白表达水平明显降低(P<0.05).结论 苦参碱具有逆转肺癌顺铂耐药的作用,其机制与抑制肺癌细胞上皮间质转化及抑制核因子NF-κB信号通路有关.

目的 观察参附注射液对体外循环手术患者肺脏的保护效果.方法 选取广西中医药大学第一附属医院2016年6月至2020年8月择期行体外循环心内直视手术患者50例,按随机数字表法分成观察组与对照组,每组25例.麻醉诱导后,观察组患者静脉输注参附注射液,负荷剂量为1 ml/kg,之后以10 ml/h的速率输注至手术结束;对照组患者给予等容量的0.9％氯化钠注射液.比较2组体外循环前后氧化应激指标[血清超氧化物歧化酶(SOD)和丙二醛]、炎症指标[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-8]、肺损伤指标[血清克拉拉细胞分泌蛋白16(CC16)和表面活性蛋白(SP-D)]水平.结果 体外循环结束时2组血清SOD水平均较体外循环开始前降低,但观察组高于对照组[(66±8)U/L比(56±9)U/L],2组血清丙二醛水平均较体外循环开始前升高,但观察组低于对照组[(9.12±1.33)mmol/L比(12.69±1.38)mmol/L](均P<0.05).体外循环结束时和体外循环结束后1 h 2组IL-6、IL-8及TNF-α水平均明显高于体外循环开始前,但观察组均明显低于对照组(均P<0.05).体外循环结束时2组血清CC16、SP-D水平均较体外循环开始前升高,但观察组均明显低于对照组[(8.08±0.25)μg/L比(12.03±3.06)μg/L、(14.2±3.8)μg/L比(17.9±4.7)μg/L](均P<0.05).结论 参附注射液具有较强的抗氧化应激能力,可以明显降低体外循环手术患者术后炎性细胞因子水平,减轻肺组织损伤,对肺具有一定的保护作用.

There are many methods of minimally invasive surgery for anterior mediastinal diseases. However, the subxiphoid approach thoracoscopic surgery is considered to be the best. For beginners, there are more likely to damage diaphragm and create operative space difficult due to the wrong direction of trocars in the ports of costal arch. In order to let the beginners master this technology efficiently, we improve the technology and elaborate the technology combined with the experience and a case.

目的 探讨青蒿素对大鼠自体移植静脉桥内膜增生的影响.方法 将雄性Sprague-Dawley(SD)大鼠32只建立自体静脉移植模型,随机分为两组:实验组(16只)和对照组(16只).实验组于造模前1 d给予青蒿素100 mg/(kg·d)灌胃直至取材,对照组相同时间给予等体积生理盐水灌胃.两组动物分别于造模后2周和4周取材备检,每个时间点8只.应用图像分析仪计算新生内膜厚度,免疫组织化学方法检测平滑肌22α(SM22α)的表达变化及Western bolt检测SM22α蛋白表达变化情况.结果 实验组术后2周、4周静脉桥新生内膜厚度与同期对照组比较明显减少[(20.79±1.88)μm vs.(35.23±2.66)μm,P<0.01;(37.06±2.22)μm vs.(46.23±2.54)μm,P<0.01].SM22α在静脉桥平滑肌细胞有表达,实验组SM22α蛋白表达阳性率在术后2、4周较同期明显抑制下降[(59.20±5.76)vs.(26.12±3.72),P<0.01;(35.63±4.36)vs.(10.38±2.98),P<0.01].实验组SM22α蛋白含量(SM22α/β-Actin)在术后2、4周较同期明显抑制下调[(0.58±0.1)vs.(0.39±0.06),P<0.01;(0.42±0.06)vs.(0.21±0.05),P<0.01].结论 青蒿素可明显抑制静脉桥内膜增生,原因可能与其抑制血管SM22α的表达下调,从而抑制平滑肌细胞增殖有关.

由于医学论文写作教育的长期缺失,我们对医学论文写作教育的重要性认识不足,以致在现有的教育体制下,培养出来的医学毕业生因为缺乏论文写作能力而不能适应社会的要求.因此,高校进行医学论文写作教育十分必要.然而.目前医学论文写作教育无可以遵循的教学模式、无统一的教材及缺乏师资,所以,开展医学论文写作教育研究尤为重要.在此,该文旨在总结作者开展医学论文写作教育初探的经验.

OBJECTIVE:To investigate the effect of Shenfu (SF) injection on donor heart preservation.METHODS:Twelve pigs were randomly divided into SF group (n=6) and control group (n=6). After eight hours of perfusion, the differences in hemoglobin, the expression of Bcl-2 and BAX, and changes in the myocardial ultrastructure were compared to illustrate the effects of SF injection in heart preservation.RESULTS:The differences in free hemoglobin between the SF group and the control group were statistically significant (P=0.001), and there was significant interaction of groups with times (P=0.019), but the perfusion time may not be associated with the hemoglobin concentration (P=0.616). According to Western blotting analysis, the expression of Bcl-2 was higher in the SF group than in the control group, while the expression of BAX was not different between the two groups. As to ultrastructural changes, both groups exhibited mitochondrial swelling and myofilament lysis, but the degree of damage in the SF group was smaller.CONCLUSION:Our study suggests that the application of SF injection for heart preservation may protect against cardiomyocytes and erythrocytes apoptosis, and Bcl-2 protein may play a role in these physiological processes.

目的 探讨单侧自发性气胸合并双侧肺大疱的理想处理方式.方法 总结16例单侧自发性气胸患者接受胸腔镜手术处理两侧肺大疱的经验.结果 患者于术后3～7d均顺利出院,手术时间为(119.44±6.77)min,术中出血量为(58.85±9.63)mL,术后胸腔引流量为(163.82±97.65) mL,引流时间为(1.96 ±0.48)d,住院时间为(6.06±1.78)d,住院费用为(3.83±1.50)万元.术后出现进行性出血1例.随访1～ 84个月,出现气胸复发1例.结论 在胸腔镜下同期处理两侧肺大疱可以降低患者对侧气胸的发生率,从而避免患者再次手术的痛苦,减少住院费用.

目的 研究广西巴马小型猪心脏解剖特点及其供体心脏的获取方法.方法 选用广西巴马小型猪26头,在全麻体外循环下获取供心,用于供心离体灌注实验.结果 供体心脏获取耗时25～30 min.在26例供心离体灌注实验中,20只(76.9％)自动复跳,6只在人工心脏按压后复跳,均为窦性心律.同时发现广西巴马小型猪的前后腔静脉心包内段比较短,升主动脉也较短,主动脉弓分两支,右肺动脉与左心房常常融合,不容易分离.结论 广西巴马小型猪的心脏有其自身的特点,应根据其特点采用相应的方法获取供体心脏.

Objective The study is to evaluate the clinical application value of custom-made automatic opening specimen retrieval bag in thoracoscopic surgery.Methods Between Jun.2016 and Apr.2017,the samples were taken out use the custom-made automatic opening specimen retrieval bag in a total of 27 patients who underwent thoracoscopic surgery in our hospital.Custom-made automatic opening specimen retrieval bag production,specimen extraction and incision complication were analyzed.Results Among the 27 patients,the custom-made automatic opening specimen retrieval bags were easy to make [(15 ± 5)s],and the samples were also easy to take out [(30 ± 10)s],without incision infections,incision disunions,or tumor implantation.Conclusions The custom-made automatic opening specimen retrieval bag for thoracoscopic surgery is easy to make and use,and could obviously reduce the hospitalization costs and shorten the operation time.

目的 探讨胸腔镜手术低成本切口保护器的简易制作和应用.方法 自制胸腔镜手术切口保护器由2个不锈钢丝弹性环和1只手术手套制作而成.首先将外科手套剪成一个管形套,然后将管形套的一端穿过直径约26 cm的钢丝弹性环并翻转制作成外口,管形套的另一端(有橡皮筋一端)穿过直径约30 cm的不锈钢丝弹性环并翻转制作成内口,这样就制作成了胸腔镜手术切口保护器.使用保护器时,将30 cm环置入胸膜腔,26 cm环放在胸膜腔外.结果 切口保护器制作耗时为5～7 min.共有31例胸腔镜手术患者应用该项技术,全组患者的手术切口无感染、无延期愈合、无肿瘤种植.结论 相对于商用切口保护套,自制胸腔镜手术切口保护器同样有效,且制作简单、成本低廉.

During video-assisted thoracic surgery, incision protectors protect the operating incision, improve the view of the operation, facilitate specimen removal, and reduce the risk of incision infection. Commercialized disposable incision protectors offer many benefits, but are often associated with a high purchase price. Therefore, in the present study, we introduce a custom-made incision protector for thoracoscopic surgery which is more convenient and inexpensive.

Background: Diabetes is a risk factor for vein graft failure after bypass surgery with coronary artery disease (CAD). We first developed a vein grafting model in rats with a type 2 diabetes mellitus-like (T2DM) condition to provide animal models for relevant clinical research. Methods: Sixty male Sprague-Dawley rats were fed high-fat (T2DM group) or normal food (CON group) for one month and then injected (T2DM group) with streptozotocin (35 mg/kg) to induce T2DM. Insulin or glucose tolerance tests were performed to verify the T2DM models. All rats subsequently underwent surgical vein grafting, and the morphology of their grafts at 0, 14, and 28 days was analyzed under microscope. Results: The T2DM group exhibited significantly increased glucose, insulin, free fatty acids, and cholesterol levels (all, P < 0.05), and also exhibited significant hyperglycemic and hyperinsulinemic responses to an intraperitoneal glucose tolerance test compared to that in the CON group. Furthermore, the insulin sensitivity of the T2DM group was significantly reduced as the CON group gained little change according to an insulin tolerance test (P < 0.05). Additionally, the number of cell nuclei of the intima and media on the 14th and 28th day in the T2DM group approximately doubled as compared to that in the CON group (both, P < 0.05). Conclusion: We successfully developed a model of surgical vein grafting in type 2 diabetic rats. This novel rat model may facilitate in vivo mechanistic studies of the increased neointimal formation in type 2 diabetes mellitus-related vein graft failure.

Patients with end-stage renal disease have a higher risk of morbidity and mortality than those without end-stage renal disease in cardiovascular surgery. Poor outcomes are especially found in patients who undergo valve surgery. We report successful mitral valve replacement (MVR) in a dialysis-dependent patient. The patient recovered well at postoperation and had the complication of anticoagulation at follow-up. Based on this successful case, we believe that myocardial protection, prevention of infection, nutritional support, and close monitoring of blood coagulation function are important in dialysis-dependent patients undergoing valve replacement.

目的：探讨中西医结合治疗急性主动脉综合征的临床效果。方法回顾性分析24例中西医结合治疗的急性主动脉综合征病人临床资料。结果24例病人住院期间无死亡，无并发症，全部顺利出院。结论中西医结合治疗可提高急性主动脉综合征的治疗效果。

Objective Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Here, we introduced a method of video-assisted thoracic surgery with no disposable consumables. Methods Between Oct. 2011 and Feb. 2016, a series of 84 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. Results Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage ( P > 0. 05 ), postoperative stay, and recurrence between the two groups [( 16 747. 30 ±2 586.41) yuan vs (21 088.54±6 005.68)yuan,P<0.05] . Conclusions Biportal thoracoscopic bleb ligation for primary spontaneous pneumothorax is a safe, low-cost, simple and reliable procedure.

Background Muscle-sparing thoracotomy (MST) has recently been developed in an attempt to minimize tissue injuries during thoracic operation and postoperative sequelae. However, its potential advantages over traditional posterolateral thoracotomy (PLT) remain to be determined. Here, we performed a meta-analysis on all available studies that compare the pros and cons between the two approaches. Methods A total of 11 relevant studies were found to satisfy our inclusive criteria from three electronic databases. End points included postoperative pain, pulmonary function, postoperative mortality, and perioperative complications. Results Data from seven randomized controlled trials and four observational studies were included (n = 408 and 564, respectively). Compared with PLT group, MST group had a significantly reduced postoperative visual analog scale score on day 1 (weighted mean difference [WMD], -0.79; 95% confidence interval [CI], -1.10 to -0.48), week 1 (WMD, -0.60; 95% CI, -0.98 to -0.22), and month 1 (WMD, -0.73; 95% CI, -1.30 to -0.16). However, no difference between the two approaches was found on postoperative forced vital capacity and forced expiratory volume in 1 second (week 1: standardized mean difference [SMD], 0.44; 95% CI, -0.18 to 1.07 versus SMD, 0.53; 95% CI, -0.13 to 1.18; month 1: SMD 0.26; 95% CI, -0.26 to 0.78 versus SMD, 0.38; 95% CI, -0.25 to 1.00), mortality (odds ratio [OR], 1.23; 95% CI, 0.49 to 3.09), and complications (OR, 0.86; 95% CI, 0.60 to 1.23). Conclusions MST may improve postoperative pain, but shows less effect on other perioperative parameters.

Objective To study the effect of HTK solution and perfadex solution on the function of pulmonary artery endothelium. Methods Fifty-four porcine pulmonary rings (2 mm long) were randomly divided into three groups, including control group (n =18) incubated in Krebs-Henseleit (KH) at 4 ℃ for 4 hours, group A (n =18) incubated in HTK solution and group B (n =18) incubated in perfadex solution at 4 ℃ for 4 hours. The vasoconstriction responses induced by indomethacin (7 μmol/L), N-nitro-L-arginine(300 μmol/L), oxyhemoglobin (20 μmol/L) and prostaglandin F2α (1×10 -7.5 mol/L) were detected. The vasodilator responses induced by bradykinin and non-receptor-mediated calcium ionophore were also detected in three groups. Results The maximum contraction of the vascular ring was caused by prostaglandin F2α. The maximum relaxtion responses of the vascular ring were caused by bradykinin and non-receptor-mediated calcium ionophore. There were no significant differences between three groups (P > 0.05). Conclusion There was no significant difference in endothelium-derived hyperpolarizing factor (EDHF)-mediated relaxation of porcine pulmonary artery between HTK,perfadex and KH solutions.