由于肝细胞癌的发生与发展机理复杂,目前还未充分揭示.作为人体基因组中规模最大的转录因子家族,锌指蛋白现已证实在包括肝癌在内的许多癌症中起到了关键性作用,现将对探讨锌指蛋白的构成、类型,以及在肝细胞癌中的作用机制方面进行综述.

目的:探讨天麻素在体外对人胃癌细胞SGC-7901细胞活力和凋亡的影响.方法:培养人胃癌细胞株SGC-7901,随机分为正常组、对照组和实验组,再按不同时间点分为6、12、24、48、72h5个亚组,每个亚组8孔细胞.实验组按2mg/mL加入天麻素,对照组加入等量生理盐水,正常组不作其它处理.运用MTT法检测不同时间点细胞活力,运用TUNEL法检测细胞凋亡情况.结果:天麻素对人胃癌细胞SGC-7901具有增殖抑制和促进凋亡作用,并具有时间依赖关系.正常组、对照组之间细胞活力及凋亡比较均无统计学意义(P＞0.05).在6h、12h、24 h、48 h、72 h时间点,实验组的细胞活性分别为0.41±0.05、0.42± 0.07、0.43± 0.06、0.47± 0.07、0.52± 0.08,对照组分别为0.44± 0.07、0.49±0.12、0.50± 0.09、0.69± 0.11、0.72± 0.12,实验组细胞活力较对照组降低(P＜0.05),实验组的凋亡指数分别为7.12± 0.65、10.48±1.26、15.37± 1.69、17.52± 2.33、33.62± 3.65,对照组的凋亡指数分别为1.08± 0.05、3.41±0.56、6.09± 0.91、9.52±1.14、11.57±1.18,实验组较对照组凋亡显著增加(P＜0.05).结论:天麻素可降低人胃癌SGC-7901细胞的活力并增加细胞的凋亡,可能具有抗肿瘤的作用.

肠缺血再灌注损伤(ischemia reperfusion injury,IR)是外科常见的病理变化,是发生于肠道组织的再灌注损伤,经专家证实其在严重感染、创伤休克的致死性疾病发生与进展中起到重要作用,是创伤休克、严重感染等致死性疾病主要直接致死原因.该研究者从事肠胃工作多年,在这方面具有丰富的工作经验和实践能力,对肠缺血再灌注损伤的具体机有一定的研究,该文针对性提出了疾病防治策略,有助于逆转疾病进程,降低死亡风险,希望能够与同行业的相关技术人员一同分享.

Objective To observe the fibrinogen(FIB)and the platelet(PLT)when the blood transfusion exceeding 3500mL in 24 hours.Methods Chose 25 patients for selecting operation with the blood transfusion is more than 3500mL in 24 hours,monitoring the FIB,PLT,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)before and after transfusion.Results When the blood transfusion surpass 3500mL in 24 hours,the PLT and the FIB are obviously descending(P<0.01).Patients with PLT,PT,APTT,TT extending are extremely(P<0.05).Conclusion After multiplicity blood transfusion,the patients will be easy to emerge dilute plate-reduction and fibrinogenolysis.We should dynamically monitor the thrombin function in time and solve the problem to prevent the severity complications.

目的探讨神经外科手术中使用高渗氯化钠羟乙基淀粉40注射液（以下简称:高渗晶胶液）对患者凝血功能、电解质和血糖的影响。方法选择ASAⅠ-Ⅱ级,神经外科手术患者20例,所有患者均采用静吸复合麻醉。入室后局麻下行桡动脉及颈内静脉穿刺,以5ml/kg输注高渗晶胶液,30-45min内输注完毕,输注后行麻醉诱导。分别在输注高渗晶胶液前（T0）、输注高渗晶胶液完毕即刻（T1）、输注高渗晶胶液后30min（T2）、60min（T3）、术后30min（T4）监测:（1）心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、血氧饱和度（SpO2）等;（2）凝血酶原时间（PT）、部分凝血活酶时间（APTT）;（3）血清K+、Na+、Ca2+、Hct、Hb及血糖。结果与T0时相比,CVPT3时明显升高（P＜0.05）;APTT、PTT1时开始增加（P＜0.05）,T2时达到高峰（P＜0.05）,T3时恢复正常;输注高渗晶胶液后K+浓度降低,Na+浓度升高,T1时改变最为明显（P＜0.05）,T3时基本恢复基础值;Hct、Hb随着输注液体的增加逐渐降低,与T0时相比差异有统计学意义（P＜0.05）;各时点血糖差异无统计学意义（P＞0.05）。结论适量输入高渗晶胶液（5ml/kg）对神经外科手术患者术中凝血功能和电解质、血糖无明显影响。

目的探讨雷米芬太尼复合丙泊酚、七氟醚用于肾上腺皮质腺瘤与嗜铬细胞瘤切除术麻醉的比较。方法24例择期行肾上腺切除术患者,术后病理诊断为肾上腺皮质腺瘤(C组)12例,肾上腺嗜铬细胞瘤(P组)12例。以雷米芬太尼、丙泊酚麻醉诱导,复合七氟醚用于麻醉维持。观察两组诱导前、气管插管前即刻、气管插管、手术开始、探查肿瘤、结扎肿瘤血管、切下肿瘤、手术结束时的收缩压(SBP)、舒张压(DBP)、心率(HR)、自主呼吸恢复及呼之睁眼时间。结果与麻醉诱导前相比,P组SBP探查肿瘤时明显升高,结扎肿瘤血管、切下肿瘤、手术结束时明显下降(P<0.05),DBP气管插管前即刻、气管插管、结扎肿瘤血管、切下肿瘤、手术结束时明显下降(P<0.05),HR在气管插管、手术开始时下降(P<0.05)。C组SBP、DBP在麻醉中除探查肿瘤时,均明显低于麻醉诱导前(P<0.05),HR手术开始时低于麻醉前(P<0.05)。两组间比较,探查肿瘤时,P组SBP明显高于C组(P<0.05),手术开始至肿瘤切下期间,P组HR明显快于C组(P<0.05)。麻醉中P组8/12患者除使用麻黄碱外,需复合其他血管活性药物维持循环稳定,C组3/12患者使用麻黄碱,其他患者未用血管活性药物维持循环稳定。停用雷米芬太尼(9.1±4.2)min自主呼吸恢复,(11.5±5.2)min呼之睁眼。结论雷米芬太尼复合丙泊酚、七氟醚用于肾上腺肿瘤切除术麻醉,对控制血压、心率安全有效,易于调控,诱导过程平稳,气管插管心血管反应发生率低,术中循环功能、麻醉深度的维持可控性好,在肾上腺皮质腺瘤切除术时尤为明显,肾上腺嗜铬细胞瘤切除术时需复合血管活性药物才能维持循环功能的稳定。该三药起效快,消除快,停药后麻醉恢复所需时间短。

Objective To investigate preoperative characteristics of patients with different MELD scores and effects of MELD scores on regulating circulation in liver transplantation.Methods We retrospectively reviewed the records of 124 primary adult liver transplant patients.Patients were divided into low(≤30) and high MELD(>30) score groups.Preoperative characteristics and intraoperative management were compared between the 2 groups.Results There was statistic difference in INR,plsma creatinine,hematocrit,and fibrinogen levels between the 2 groups.Patients with high MELD scores were more likely to require ventilatory and vasopressor support before transplantation.Intraoperative transfusion requirements and use of vasopressors were also significantly increased in patients with high MELD scores.Conclusion Patients with higher MELD scores have more serious condition before operation,more complications during liver transplantation,and require stricter anesthetization surveillance.

目的比较七氟醚静吸复合麻醉与丙泊酚全凭静脉麻醉用于腹腔镜胆囊切除术时循环的变化及术毕的清醒情况。方法选择行腹腔镜胆囊切除术的患者40例,随机分为七氟醚组和丙泊酚组,观察麻醉诱导、气腹前后及术毕的血压、心率变化及手术结束后患者清醒及拔管时间、苏醒期恶心呕吐、烦躁等并发症的发生情况,并比较两组间丙泊酚及瑞芬太尼的用量。结果两组患者在麻醉诱导前后、气腹前、气腹毕及术毕的血压、心率变化差异无统计学意义,气腹后5 min丙泊酚组血压升高、心率增快,与气腹前比较差异有统计学意义;七氟醚组变化不明显,两组间比较差异有统计学意义。术毕停药后两组患者均迅速苏醒、拔管早,定向力恢复快。七氟醚组丙泊酚及瑞芬太尼的用量均明显低于丙泊酚组。结论腹腔镜胆囊切除术中应用七氟醚联合瑞芬太尼、丙泊酚静吸复合麻醉,术中循环平稳,术毕苏醒迅速,并发症少,是值得临床推广应用的一种快通道麻醉方法。

患者,男,28岁,体重55kg,因高温水泥烫伤全身面积多达67%,其中Ⅲ度33%,Ⅱ度34%,合并吸人性损伤入院.于伤后第41天在静吸复合气管内插管麻醉下行头部,双大腿取皮,双上肢,胸腹创面植皮术.

Objective To investigate whether hyponatremia and/or ascites were associated with any changes in the amount of transfusion and vasopress or requirements during orthotopic liver transplantation(OLT).Methods Medical records of 192 OLT patients were retrospectively reviewed.Intraoperative transfusion of red blood cells(RBC) or fresh frozen plasma(FFP) and administration of vasopressors were compared.Results Patients with high MELD score were associated with higher requirements for intraoperative transfusion and vasopressors than those with low MELD score.Patients with or without hyponatremia(Na130 mmol/L) had similar requirements for transfusion and vasopressors.Patients with ascites had significantly higher requirements for both transfusion and vasopressors compared with those without ascites(P0.01).Patients with high MELD plus ascites scores had higher requirements for transfusion and vasopressors compared with patients with low MELD+A scores(P0.01).Conclusion Ascites,but not hyponatremia,is associated with increased intraoperative transfusion and vasopressor requirements during OLT although both hyponatremia and ascites are indicators of liver disease severity.

目的:研究抗自由基药物对休克的治疗作用及机制.方法:采用家兔失血性休克模型,在失血前或再灌注前静脉注入别嘌呤醇,与单纯再灌组比较,通过测定血液及组织中反映氧自由基生成情况的XO活性、氧自由基破坏作用产物 MDA含量;机体抗自由基物质 SOD活性;血液动力学指标: HR,MAP,CO,LVSP,LV dp/dt max.结果:再灌后对照组血液及组织中XO活性、MDA含量较用药组明显升高、 SOD活性降低、用药组别嘌呤醇明显改善休克后血液动力学指标.结论:别嘌呤醇对失血性休克兔治疗有效,其作用机制与抑制黄嘌呤氧化酶,减少自由基生成有关.

Objective To investigate the effects of desflurane on hemodynamics in aged patients.Methods Thirty ASA gradeⅠ Ⅱaged patients,scheduled for elective surgery,were studied. Anesthesia was induced with intravenous thiopentol,succinylcholine and fentanyl.After intubation coesophageal Doppler monitor was performed to measure CO,PV,HR,FTC,CVP,CI,MAP and SVR following inhalation of desflurane at 0 5MAC,1 0MAC,1 5MAC and 2 0MAC respectively.Results Compared with those before inhalation desflurane,MAP and SVR decreased more significantly at 1 0MAC,1 5MAC and 2 0MAC(P0 05 or 0 01), no significant changes occurred in HR and FTC at 0 5MAC(P0 05),HR and FTC increased significantly at 1.0MAC,1.5MAC and 2.0MAC(P0 05 or 0 01),CVP increased significantly at 0.5MAC,1.0MAC,1.5MAC and 2.0MAC(P0 05 or 0 01),no significant changes occurred in CO,PV and CI at any MAC of desflurane. Conclusion The influence of desflurane on cardiovascular system is minor in aged patient but due to the decrease of compensation ,it is necessary to maintain the stablilization of hemodynamics with the concentration of desflurane being more than 1.0 MAC.