目的探讨对于多发骨折的患者，行股骨干内固定手术的时机与术后机体炎性变化及临床结果间的关系。方法进行前瞻性非随机队列研究。按入选标准选取2005年4月至2007年8月78例患者。分为多发骨折伴有股骨干开放骨折组26例（A组）、多发骨...目的探讨对于多发骨折的患者，行股骨干内固定手术的时机与术后机体炎性变化及临床结果间的关系。方法进行前瞻性非随机队列研究。按入选标准选取2005年4月至2007年8月78例患者。分为多发骨折伴有股骨干开放骨折组26例（A组）、多发骨折伴股骨干闭合骨折组23例（B组）、单纯股骨干闭合骨折组29例（C组）。A组实施伤害控制骨科学（damage control orthopaedics，DCO）处理行分期手术，B、C组均早期行骨折确定性内固定术（〈24h）。各组患者术前、术后血液IL-6、TNF-α浓度作为炎性反应水平的指标，PaO2／FiO2、总胆红素、肌酐等项目作为了解各器官功能损害的指标，并统计各组术后并发症的发生率。对各组患者术前、术后炎性反应程度的变化以及多器官功能损害情况和术后并发症率进行比较分析。结果A组二期术后IL-6平均升高了59ng／L，TNF-α平均升高了85ng／L，而B组分别平均升高了154ng／L和250ng／L，两组之间IL-6、TNF-α升高的值均有显著差异（P〈0．01）。A组一期术后、C组术后IL-6、TNF-α平均升高的程度也均明显小于B组（P〈0．01）。相应的，B组术后中出现PaO2／FiO2〈250mmHg（1mmHg=0．133kPa）的比例、总胆红素出现异常的比例、肌酐出现异常的比例均大于A组两期手术术后（P〈0．05），在人工通气时间、ICU时间、正性体液平衡时期上也均高于A组二期术后（P〈0．01）。与A组一期手术比较，B组术后人工通气时间略高（P〈0．05），而ICU时间、正性体液平衡时期无明显差异（P〉0．05）。C组术后在以上各个项目上也均小于B组（P〈0．01）。术后统计栓塞和MODS的发生率，A组（11．5％）与B组（13．0％）比较无明显差异，但均高于C组（P〈0．01）。结论多发骨折股骨干早期髓内钉固定，可引起机体炎性反应的显著变化，并引起各器官亚临床的改变，而晚展开更多
Objective: To investigate effects of Shenfu injection on the concentrations of plasma tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), activity of Nuclear Factor kappa B (NF-κB) and heart tissue ultrast...Objective: To investigate effects of Shenfu injection on the concentrations of plasma tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), activity of Nuclear Factor kappa B (NF-κB) and heart tissue ultrastructure during myocardial ischemia/reperfusion (I/R) injury in rats and its potential mechanism.Methods: Myocardial ischemia/reperfusion (I/R) was produced by ligation and release of the left anterior descending coronary artery. Ischemia lasted for 30 min and reperfusion for 60 min. Twenty-four healthy male SD rats weighing 230-280 g were randomly divided into three groups (n=8, each): Group I (Sham-operation group); Group II (I/R group); Group III (Shenfu group), in which Shenfu injection (10 ml/kg) was intraperitoneally injected 30 min before ischemia in animals with I/R. The plasma concentrations of IL-6 and TNF-α were measured by ELISA, and the heart was harvested for determination of NF-κB levels by Ecl-western blot analysis. Electron microscopy was used to study its ultrastructure.Results: After reperfusion, NF-κB binding activity in myocardial nuclei and the plasma concentrations of IL-6 and TNF-α were significantly increased in Group II, compared with Group I (P< 0.01), and they were markedly reduced in Group III, compared with Group II (P< 0.01). In addition, electron microscopic examination showed more serious injury of the myocardium ultrastructure in Group II, while in Group III the myocardial ultrastructure was similar to normal state.Conclusions: Shenfu injection inhibits NF-κB activity in I/R myocardium and leads to down-regulation of proinflammatory cytokine expression, which might be one of the molecular mechanisms of Shenfu injection in cardioprotection.展开更多
文摘目的探讨对于多发骨折的患者，行股骨干内固定手术的时机与术后机体炎性变化及临床结果间的关系。方法进行前瞻性非随机队列研究。按入选标准选取2005年4月至2007年8月78例患者。分为多发骨折伴有股骨干开放骨折组26例（A组）、多发骨折伴股骨干闭合骨折组23例（B组）、单纯股骨干闭合骨折组29例（C组）。A组实施伤害控制骨科学（damage control orthopaedics，DCO）处理行分期手术，B、C组均早期行骨折确定性内固定术（〈24h）。各组患者术前、术后血液IL-6、TNF-α浓度作为炎性反应水平的指标，PaO2／FiO2、总胆红素、肌酐等项目作为了解各器官功能损害的指标，并统计各组术后并发症的发生率。对各组患者术前、术后炎性反应程度的变化以及多器官功能损害情况和术后并发症率进行比较分析。结果A组二期术后IL-6平均升高了59ng／L，TNF-α平均升高了85ng／L，而B组分别平均升高了154ng／L和250ng／L，两组之间IL-6、TNF-α升高的值均有显著差异（P〈0．01）。A组一期术后、C组术后IL-6、TNF-α平均升高的程度也均明显小于B组（P〈0．01）。相应的，B组术后中出现PaO2／FiO2〈250mmHg（1mmHg=0．133kPa）的比例、总胆红素出现异常的比例、肌酐出现异常的比例均大于A组两期手术术后（P〈0．05），在人工通气时间、ICU时间、正性体液平衡时期上也均高于A组二期术后（P〈0．01）。与A组一期手术比较，B组术后人工通气时间略高（P〈0．05），而ICU时间、正性体液平衡时期无明显差异（P〉0．05）。C组术后在以上各个项目上也均小于B组（P〈0．01）。术后统计栓塞和MODS的发生率，A组（11．5％）与B组（13．0％）比较无明显差异，但均高于C组（P〈0．01）。结论多发骨折股骨干早期髓内钉固定，可引起机体炎性反应的显著变化，并引起各器官亚临床的改变，而晚
文摘Objective: To investigate effects of Shenfu injection on the concentrations of plasma tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), activity of Nuclear Factor kappa B (NF-κB) and heart tissue ultrastructure during myocardial ischemia/reperfusion (I/R) injury in rats and its potential mechanism.Methods: Myocardial ischemia/reperfusion (I/R) was produced by ligation and release of the left anterior descending coronary artery. Ischemia lasted for 30 min and reperfusion for 60 min. Twenty-four healthy male SD rats weighing 230-280 g were randomly divided into three groups (n=8, each): Group I (Sham-operation group); Group II (I/R group); Group III (Shenfu group), in which Shenfu injection (10 ml/kg) was intraperitoneally injected 30 min before ischemia in animals with I/R. The plasma concentrations of IL-6 and TNF-α were measured by ELISA, and the heart was harvested for determination of NF-κB levels by Ecl-western blot analysis. Electron microscopy was used to study its ultrastructure.Results: After reperfusion, NF-κB binding activity in myocardial nuclei and the plasma concentrations of IL-6 and TNF-α were significantly increased in Group II, compared with Group I (P< 0.01), and they were markedly reduced in Group III, compared with Group II (P< 0.01). In addition, electron microscopic examination showed more serious injury of the myocardium ultrastructure in Group II, while in Group III the myocardial ultrastructure was similar to normal state.Conclusions: Shenfu injection inhibits NF-κB activity in I/R myocardium and leads to down-regulation of proinflammatory cytokine expression, which might be one of the molecular mechanisms of Shenfu injection in cardioprotection.
