Objective To observe the effect of ischemic postconditioning(IPC) on alleviating lung ischemia-reperfusion(IR) injury in rats and to explore its mechanism.Methods A total of 24 rats were randomly divided into 3 groups,8 in each: Sham-operation group(SO group),ischemia-reperfusion group(IR group),and ischemic postconditioning group(IPC group).In SO group,continuous infusion for 105 min;in IR group(as control group),45 min of ischemia,reperfusion for 60 min;in IPC group,ischemia for 45 min,infusion for 1 min,then ischemia for 1 min,repeating 5 times,and after that full restoration of perfusion for 50 min.The rats were killed to obtain the lung tissue.Malondialdehyde(MDA),superoxide dismutase(SOD),myeloperoxidase(MPO) level,lung wet / dry weight ratio(W/D) were detected by lung histomorphological examination.Results In IPC group,the alveolar exudates,red blood cells and white blood cells were fewer than those in IR group,which were observed under light microscope;and the polymorphonuclear leukocyte infiltration in lung interstitium was less.Compared with IR group,MDA,MPO levels and W/D in IPC group decreased,but SOD increased(all P0.05);compared with SO group,MDA,MPO levels and W/D in IPC and IR groups were all increased,SOD decreased(all P0.01).Conclusion The ischemic postconditioning has the effect of alleviating lung ischemia-reperfusion injury in rats and its mechanism is related to excessive production of oxygen free radicals after suppression of reperfusion.

目的 评价外科手术治疗先天性多囊肺的临床效果.方法 回顾性分析68例先天性多囊肺患者的临床资料.结果 29例(42.6%)行肺叶切除,25例(36.8%)行全肺切除,术中发现隔离肺3例,术后病理证实伴发腺癌1例,鳞癌1例.本组无手术死亡,长期随访均无严重并发症和复发,患者生活质量明显改善.结论 先天性多囊肺一经诊断应尽早择期行病肺切除术,肺部感染反复发作、病史长者手术较困难,并有恶变倾向,应注意定期随访.

急性肺损伤(ALI)的发病原因比较复杂,花生四烯酸(AA)及其代谢产物前列腺素(PG)、白三烯(LT)和血小板激活因子(PAF)等参与了ALI发生发展的病理过程.磷酸脂酶A2(PLA2)以卵磷脂、磷脂酰丝氨酸等为底物,将其sn-2位上的脂肪酸降解,产生溶血卵磷脂和游离脂肪酸.由于磷脂sn-2位大多是不饱和脂肪酸,其中50%以上是AA,其代谢产物PG、LT、TXA2(血栓素A2)、脂氧素(LX)以及PAF等具有强烈的生物活性,而PLA2是所有这些脂质介质的一个限速酶,可见PLA2在ALI发生发展中起着非常重要的作用.现就PLA2在ALI的作用综述如下.

目的:缺血后处理即在全面恢复再灌注前反复短暂多次预再灌、停灌,探讨缺血后处理对在体大鼠肺缺血再灌注损伤的脂质过氧化反应的影响.方法:实验于2004-05/06在汕头大学医学院附属肿瘤医院中心实验室完成.通过阻断左肺门建立大鼠在体左肺缺血再灌注模型,将24只健康雌性SD大鼠随机分为①假手术组8只:持续灌注105 min.②缺血再灌注组8只:缺血45 min,再灌注60 min.③缺血后处理组8只:缺血45 min后,短暂再灌注1 min,缺血1 min,反复5次,然后再全面恢复灌注60min.试验结束后处死动物,切取新鲜肺左叶组织制成100g/L组织匀浆,测定丙二醛含量用硫代巴比妥酸比色法,测定超氧化物歧化酶活性用黄嘌呤氧化酶法(羟胺法).结果:3组24只动物均进入结果分析.①肺组织丙二醛含量测定结果:假手术组为(0.934±0.086)μmol/g,对照组为(1.230±0.169)μmol/g,缺血后处理组为(1.064±0.090)μmol/g,缺血后处理组与对照组相比明显降低(P＜0.05).②超氧化物歧化酶活性测定结果:假手术组为(2.838±0.509)μkat/g,对照组为(1.183±0.222)μkat/g,缺血后处理组为(2.008±0.298)μkat/g,缺血后处理组与对照组相比显著升高(P＜0.01).结论:对照组与假手术组相比,肺组织经历45 min缺血60 min再灌注后丙二醛含量明显升高,抗自由基酶类超氧化物歧化酶活性显著下降,说明再灌注期肺组织脂质过氧化反应增强,抗氧化能力降低.缺血后处理组较对照组肺组织中脂质代谢产物丙二醛含量下降,抗自由基酶超氧化物歧化酶活性增加,表明缺血后处理可减轻在体大鼠肺缺血再灌注损伤的脂质过氧化反应而产生肺保护作用.

1 病例报告 男,43岁.因反复咳嗽、咯痰3 a,加重伴胸闷1 a入院.3 a前无诱因开始出现咳嗽、咯少量白色黏痰,无咯血,无低热、盗汗,在外院诊断为粟粒型肺结核,给予HRZ方案抗结核治疗1 a,效果不佳,病情反复.1 a来咳嗽加重并伴有胸闷,在外院行X线胸片及CT检查,诊断为右侧胸腔积液、肺泡细胞癌,并多次行胸腔穿刺抽液等对症治疗以缓解呼吸困难症状.