【摘要】 目的 探讨西地兰联合小剂量酒石酸美托洛尔静脉注射治疗二尖瓣狭窄合并急性肺水肿与快速型心房颤动的疗效与安全性。 方法 将2005年1月-2010年2月收治的60例二尖瓣狭窄合并急性肺水肿与快速型心房颤动患者，随机分配至西地兰组与联合用药组，西地兰组以多次静脉注射西地兰控制心率，联合用药组则予以多次静脉注射西地兰与小剂量酒石酸美托洛尔，分别在用药开始时、用药开始后监测收缩压、心率、呼吸频率与手指脉搏血氧饱和度（SpO2），同时观察肺部啰音、呼吸困难，记录肺水肿改善时间。 结果 两组患者在治疗开始时心异率、呼吸频率、收缩压与SpO2均无差异；在治疗整个过程中，两组患者收缩压无差异；治疗开始后60、90及120 min时联合用药组心率均显著低于西地兰组。联合用药组从在治疗开始到肺水肿改善的时间短于西地兰组[(71.37±13.37)、(78.77±14.74) min，P=0.046]。治疗期间无患者出现病情恶化或死亡。联合用药组患者的酒石酸美托洛尔平均总量为4.22 mg/例。 结论 在排除美托洛尔禁忌症的前提下，静脉注射西地兰与小剂量酒石酸美托洛尔可快速、安全、有效地控制二尖瓣狭窄合并急性肺水肿与心房颤动患者的心率，缓解肺水肿。【Abstract】 Objective To observe the effect of intravenous injection with cedilanid and small does of metoprolol tartrate on mitral stenosis complicating with acute pulmonary edema and atrial fibrillation. Methods Sixty patients with mitral stenosis complicating with acute pulmonary edema and atrial fibrillation from January 2005 to February 2010 were randomly divided into cedilanid group and drug combination group, which was administered with cedilanid, or cedilanid and small does metoprolol tartrate by intravenous injection, respectively. Systolic blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO2), dypnea, rales over lung field and the time from beginning of treatment to pulmonary edema improved were monitored as soon as the treatment began. Results There was no significant difference in basic data such as systolic blood pressure, heart rate, respiratory rate and SpO2 at the beginning of treatment between the two groups, and no obvious difference was seen in systolic blood pressure at all the time of treatment between the two groups; while a obvious decrease took place in heart rate between cedilanid group and drug combination group after the treatment began; the time from beginning of treatment to pulmonary edema in drug combination group was much shorter than that in cedilanid group [(71.37±13.37), (78.77±14.74) minutes, P=0.046]. Conclusion Without contraindication of metoprolol, intravenous injection with cedilanid combined with small dose of metoprolol can effectively, quickly and safely treat the patients with mitral stenosis complicating with acute pulmonary edema and atrial fibrillation by controlling the heart rate.
【摘要】 目的 探讨腹水引起的腹内高压对肝硬化小鼠肺组织水通道蛋白1（AQP1）和水通道蛋白5（AQP5）表达的影响。 方法 雄性美国癌症研究所（Institudo of Cancer Reseach，ICR）小鼠50只，随机取10只作正常对照组（腹压0 cm H2O，1 cm H2O=0.098 kPa），其余40只用四氯化碳建立肝硬化小鼠模型，并随机分为4组:肝硬化（腹压0 cm H2O）组、肝硬化（腹压5 cm H2O）组、肝硬化（腹压10 cm H2O）组、肝硬化（腹压20 cm H2O）组，通过腹腔注射不同量的白蛋白生理盐水形成不同的腹压，并维持腹压24 h后取肺组织行病理、免疫组织化学、肺湿/干比值及实时荧光定量PCR检测AQP1和AQP5 mRNA表达量。 结果 与正常对照小鼠相比，肝硬化小鼠肺AQP5、AQP1表达明显下降（Plt;0.05）；肝硬化小鼠随着腹内压的升高，肺湿/干比值升高，AQP5、AQP1表达相应增加（Plt;0.05）。 结论 肝硬化可以影响肺AQP1、AQP5的表达；肝硬化小鼠随着腹内压的升高，AQP1、AQP5表达相应增加，并与肺水肿的严重程度密切相关。【Abstract】 Objective To investigate the role of intra-abdominal hypertension caused by ascites on the expression of Aquaporin (AQP) 1 and AQP 5 in the lung of cirrhotic mice. Methods We randomly chose 10 from 50 male Institude of Cancer Research (ICR) mice to form the control group [intra-abdominal pressure (IAP)=0 cm H2O, 1 cm H2O=0.098 kPa]. The model of cirrhosis were prepared by subcutaneous injection of carbon tetrachloride for the rest 40 mice which were then randomly divided into 4 groups: cirrhosis (IAP=0 cm H2O) group, cirrhosis (IAP=5 cm H2O) group, cirrhosis (IAP=10 cm H2O) group, and cirrhosis (IAP=20 cm H2O) group. Saline with different volume of albumin was injected into the peritoneum of each mouse in order to form different IAP. After 24 hours, analysis of pathology, immunochemistry and wet/dry ratio was done for the lungs of these mice; and the expression of AQP1 and AQP5 at the protein and mRNA levels were analyzed by IHC and qRT-PCR. Results Compared with the normal mice, the expression of AQP1 and AQP5 in lungs of cirrhotic mice were significantly lower (Plt;0.05). Both the lung wet/dry ratio and the expression of AQP1 and AQP5 raised with the increase of IAP. Conclusion Cirrhosis can affect the expression of AQP1 and AQP5 in lungs. The expression of AQP5 and AQP1 in lungs of cirrhotic mice increases with the increase of IAP, which is also closely correlated with the severity of pulmonary edema.
ObjectiveTo discuss the effect ofβ2 adrenoceptor on the alveolar fluid clearance (AFC) of the rats with severe acute pancreatitis (SAP). MethodsSD rats was made to SAP model by injecting taurocholate into biliary-pancreatic duct.These rats were randomly divided into sham operation group and SAP group, the SAP group was divided into subgroups of SAP-4 h and SAP-24 h according to the sampling time after making model.The wet-to-dry ratio, AFC, and AFC affected byβ2 adrenoceptor agonist-terbutaline or inhibitor-propranolol were measured in the bilateral lungs.β2 adrenoceptor mRNA expression in the lungs tissues was measured by real-time-PCR. ResultsCompared with the sham operation group, the wet-to-dry ratio was significantly decreased (P < 0.05) and the AFC was significantly increased in the subgroup of SAP-4 h or SAP-24 h (P < 0.05), β2 adrenoceptor agonist-terbutaline couldn't increase the AFC of the subgroup of SAP-4 h or SAP-24 h (P > 0.05), inhibitor-propranolol could decrease AFC of subgroup of SAP-4 h or SAP-24 h (P < 0.05).β2 adrenoceptor mRNA was decreased in the subgroup of SAP-4 h or SAP-24 h as compared with the sham operation group (P < 0.05). ConclusionsBilateral lung liquid volome induced by SAP is less than the normal lung, AFC is increased in the early period of SAP but decreased in the late period.when the lung injury happens, β2 adrenoceptor might modulate AFC in rats of SAP model.The mechanism of lung injury of SAP is so complex that we need more experiments to be done.
ObjectiveTo evaluate the magnetic resonance imaging (MRI) manifestations, pathological and clinical characteristics, and treatment outcomes of multiple sclerosis (MS) patients with new lesion in medulla oblongata (MO).MethodsPubMed, EBSCO, and Springer databases between January 1st, 2000 and May 1st, 2018 were searched with the combined keywords of " multiple sclerosis” and " medulla oblongata”. Furthermore, the MS patients’ MRI manifestations, pathological and clinical characteristics, and treatment outcomes were summarized.ResultsA total of 18 papers were involved, in which 26 patients were included. The lesions in MO were mainly showed by wedge-shape (9/20), and round or oval-shape (9/20) in axial head MRI. Inflammatory cells infiltration and acute demyelination in the new lesions of MO had been displayed by autopsy reports of two MS patients. The new lesions in MO mainly referred to various types of nystagmus (9/26), left ventricular apical ballooning syndrome (LVABS) (8/26), neurogenic pulmonary edema (NPE) (6/26), and acute heart failure (6/26). Nucleus tracts solitaries (NTS), along with dorsal motor nucleus of the vagus nerve and medial reticular formation (MRF), was related to LVABS and NPE. Intercalatus nucleus, Roller nucleus and/or autonomic nerve structure were related to various types of nystagmus.ConclusionsIn axial head MRI, the new MS lesions in MO were mainly wedge-shape and round or oval-shape. Beyond that, the new MS lesions in MO could involve NTS, dorsal motor nucleus of the vagus nerve, MRF, intercalatus nucleus, Roller nucleus and/or autonomic nerve structure, resulting in special clinical features, such as, nystagmus, LVABS, NPE, and acute heart failure. Corticosteroid is still the main treatment to relieve the clinical manifestations caused by new MS lesions in MO.
Objective To investigate whether sodium tanshinone ⅡA sulphonate ( STS) treatment attenuates pulmonary edema of seawater drowning ( PE-SWD) , and examine the effects of STS on Na-KATPase(NKA) in PE-SWD. Methods Thirty-six rats were randomly divided into there groups, ie. a normal group ( NG) , a seawater group ( SG) , and a STS treatment group ( TG) . The rat model of PE-SWD was established by seawater instillation. PaO2 , histological changes of lungs, lung wet /dry weight ratio ( W/D) ,pulmonary microvascular permeability ( PMVP) , and NKA activity were detected. Western blot were used to test the effects of STS on NKA-α1 expression. Results Seawater instillation decreased PaO2 and the expression of NKA, while increased W/D ratio and PMVP. At 2 h after seawater instillation, the PaO2 in the TG group were significantly higher than those in the SG group, and peaked at 4 h after seawater instillation.Histological examination showed that there were hemorrhage, edema, markedly thickened alveolar wall, and infiltration of inflammatory cells in alveolar spaces in the SG group, but lung injury was significantly alleviated in the TG group. W/D ratio and PMVP in the TG group were significantly lower than those in the SG group. Additionally, NKA activity and NKA-α1 expression were significantly higher in the TG group than those in the SG group. Conclusion STS treatment can attenuate pulmonary edema of seawater drowning which may be related with up-regulating Na-K-ATPase activity and expression.
The high incidence and mortality rates existed in chronic pulmonary thromboembolism(PTE), with considerable misdiagnosis and missed diagnosis rate. The prognosis for patients with chronic thromboembolic pulmonary hypertension was poor with medical therapy. But the pulmonary thromboendarterectomy was well established.The postoperative pulmonary hypertension and reperfusion pulmonary edema are main complications and death causes. The key management after pulmonary thromboendarterectomy is important which decreases pulmonary hypertension , and prevents reperfusion pulmonary edema and re thromboembolism.
ObjectiveTo discuss the change of expression of Na-K-ATPase mRNA in the rats with severe acute pancreatitis (SAP). MethodsTwenty four SPF SD rats were randomly divided into sham group (n=6) and SAP group (n=18), the experiment concluded 3 sub-experiments, and each sub-experiments enrolled 24 rats. After establishment of SAP model successfully, rats of SAP group were randomly divided into SAP-4 h group (n=6), SAP-24 h group (n=6), and SAP-48 h group (n=6). Rats of sham group were only conducted the abdominal exploration. Rats of 4 groups were sacrificed (sham group:4 hours after surgery; SAP-4 h group:4 hours after surgery; SAP-24 h group:24 hours after surgery; SAP-48 h group:48 hours after surgery) to determine the dry/wet ratio, alveolar fluid clearance (AFC), and expressions of Na-K-ATPase mRNA at 2 sides of lung tissues. Results① Dry/wet ratio. Compared with sham group, the dry/wet ratios of SAP-4 h group, SAP-24 h group, and SAP-48 h group were all lower (P < 0.01); compared with SAP-4 h group, the dry/wet ratio of SAP-24 h group was lower (P < 0.01), but dry/wet ratio of SAP-48 h group was higher (P < 0.01); compared with SAP-24 h group, dry/wet ratio of SAP-48 h group was higher (P < 0.01). ② AFC. Compared with sham group, the AFC value of SAP-4 h group and SAP-24 h group were both higher (P < 0.01), but there was no significant difference between sham group and SAP-48 h group (P > 0.05); compared with SAP-4 h group, the AFC value of SAP-24 h group and SAP-48 h group were both lower (P < 0.01); compared with SAP-24 h group, the AFC value of SAP-48 h group was lower (P < 0.01). ③ α1 Na-K-ATPase mRNA. Compared with corresponding side of lung tissue in sham group, the expression level of α1 Na-K-ATPase mRNA at both 2 sides of lung tissues in SAP-4 h group, SAP-24 h group, and SAP-48 h group were higher (P < 0.01); compared with corresponding side of lung tissue in SAP-4 h group, the expression level of α1 Na-K-ATPase mRNA was lower at left lung tissue (P < 0.05) and was higher at right lung tissue (P < 0.01) in SAP-24 h group, and expression level of α1 Na-K-ATPase mRNA at both sides of lung tissues was lower in SAP-48 h group (P < 0.01); compared with corresponding side of lung tissue in SAP-24 h group, the expression level of α1 Na-K-ATPase mRNA at both 2 sides of lung tissues was lower in SAP-48 h group (P < 0.01). There was no significant difference in the expression level of α1 Na-K-ATPase mRNA between left lung tissue and right lung tissue in sham group, SAP-4 h group, and SAP-48 h group (P > 0.05), but the expression level of α1 Na-K-ATPase mRNA at right lung tissue was higher than that of left lung tissue in SAP-24 h group (P < 0.01). ④ β1 Na-K-ATPase. Compared with corresponding side of lung tissue in sham group, the expression level of β1 Na-K-ATPase mRNA at both 2 sides of lung tissues in SAP-4 h group, SAP-24 h group, and SAP-48 h group was higher (P < 0.01); compared with corresponding side of lung tissue in SAP-4 h group, the expres-sion level of β1 Na-K-ATPase mRNA at both 2 sides of lung tissues in SAP-24 h group was higher (P < 0.01), and lower in right lung tissue of SAP-48 h group (P < 0.01); compared with corresponding side of lung tissue in SAP-24 h group, the expression level of β1 Na-K-ATPase mRNA at both 2 sides of lung tissues was lower in SAP-48 h group (P < 0.01). There was no significant difference in the expression level of β1 Na-K-ATPase mRNA between left lung tissue and right lung tissue in sham group and SAP-48 h group (P > 0.05), but the expression level of β1 Na-K-ATPase mRNA at right lung tissue was higher than that of left lung tissue in SAP-4 h and SAP-24 h group (P < 0.05). Conclusionα1 Na-K-ATPase mRNA may be the key factor for AFC, and may involved in the water transformation in lung tissue of SD rat with SAP.