目的 探讨p38丝裂原活化蛋白激酶(p38 MAPK)抑制剂SB203580对慢性阻塞性肺疾病(COPD)大鼠气道黏液高分泌的影响及可能机制.方法 将大鼠随机分为空白对照组(NS组)、SB203580对照组(SB组)、COPD模型组(COPD组)以及SB203580干预组(COPD+ SB组).采用气道内滴入脂多糖联合香烟烟雾熏吸法制备COPD大鼠模型.于造模当天开始每天给药,SB组及COPD+ SB组给予SB203580(3 mg/kg)腹腔注射,NS组及COPD组给予等量生理盐水,于实验第29天处死各组大鼠,行苏木精-伊红(HE)染色,观察大鼠肺组织病理变化,应用免疫组化和免疫电泳法分别测定大鼠肺组织中黏蛋白(MUC5AC)、基质金属蛋白酶-9(MMP-9)及磷酸化的p38 MAPK(p-p38 MAPK)蛋白的含量.结果 COPD组大鼠肺组织符合典型的COPD气道黏液高分泌表现,证明造模成功.与NS组比较,COPD组大鼠肺组织MUC5AC、MMP-9、p-p38 MAPK表达明显增高(F=3.23～6.95,P＜0.01);与COPD组比较,COPD+ SB组肺组织MUCSAC、MMP-9、p-p38 MAPK表达明显降低(F=3.53～8.36,P＜0.01).结论 p38 MAPK抑制剂SB203580可减轻COPD大鼠气道黏液分泌,其机制可能通过调控MMP-9的表达,从而下调MUC5AC的表达来实现.

目的探讨呼吸衰竭患者紧急情况下应用气管镜引导进行气管插管的配合与护理方法。方法对50例呼吸衰竭患者采用气管镜引导气管插管，同时给予熟练护理配合，正确采取体位，掌握操作中常见并发症及处理措施，严密观察患者反应，给予心电监护，向家属做好解释及心理护理，备齐抢救用物，预防各种不良反应等。结果采用气管镜引导行气管插管本组患者50例全部插管成功，其中48例接呼吸机辅助呼吸后病情好转，另2例插管后循环衰竭死亡。结论气管镜引导进行气管插管作为急、慢呼吸衰竭患者抢救生命的一种方法，在临床上不断发展成熟，特别对于困难气管插管患者[1]，能有效缩短抢救时间，挽救患者生命。临床需护士严格把握适应症、进行熟练配合、严密监护和积极防治各种并发症，以保证在最短时间内抢救成功，保证患者安全。

Objective To study the influence of low-molecular-weight heparin(LMWH) on the expressions of hypoxia inducible factor-1α(HIF-1α),heme oxygenase-1(HO-1) and vascular endothelial growth factor(VEGF) in lung tissue of rats with chronic obstructive pulmonary disease(COPD).Methods Sixty Wistar rats were randomized to control group,COPD model group and LMWH-treated group.A COPD model in rats was created by intratracheal instillation of 1ipopolysaccharides and exposed to cigarette smoking.Subcutaneous injection of LMWH was given to the rats in LMWH group immediately upon completion of the model.The pathology of lung tissue of the rats in the three groups were observed,and the expressions of HIF-1α,HO-1 and VEGF were detected using immunohistochemical method.Results Compared with the control group,the expressions of HIF-α,VEGF and HO-1 were significantly elevated(F=58.97-88.12;q=6.70-18.65;P0.01).Compared with COPD model group,the pathological change of the lung tissue in LMWH treated group was milder,the expressions of HIF-α,VEGF and HO-1 significantly decreased(q=8.64-11.19,P0.01).Conclusion HIF-1α,VEGF and HO-1 may involve in the development of COPD,airway inflammation and remodeling.LMWH can alleviate the inflammation and remodeling process of the airway.

Objective To determine whether steroidogenic enzyme expression is associated with the steroid secretory pattern of subclinical Cushing's syndrome(SCS) by investigating the expression of CYP17 and CYP11B1 in SCS adenomas,normal adrenal cortices(NA),non-functional adrenal adenomas(NFA) and cortisol-producing adenomas(CPA).Methods Total RNA and protein were extracted from 20 CPA,6 SCS,15 NFA,and 8 NA.Real-time quantitative polymerase chain reaction(PCR),western blotting and immunohistochemistry analysis were performed to determine the mRNA and protein expression of CYP17 and CYP11B1 in different tissues.Expressions of CYP17 and CYP11B1 in the adrenocortical tumors were compared in NA.Results Expressions of both CYP11B1 and CYP17 mRNA and protein were detected in all samples tested.Expressions of CYP11B1 mRNA and protein were significantly higher in CPA group than the others,and were slightly higher in SCS samples than that in NA and NFA samples(P0.05).Expressions of CYP17 mRNA and protein in different tissues were similar to that of CYP11B1.They showed positive correlations with plasma cortisol and negative correlations with adrenocorticotrophin levels(P0.05).Conclusion CYP11B1 and CYP17 were over-expressed in subclinical CPA,and their over-expressions were caused by the increased production of cortisol in CPA.