【摘要】 目的 探讨高原地区桡神经损伤的治疗效果，并总结影响疗效的因素。 方法 回顾性分析2005年6月-2010年6月收治的桡神经损伤并有完整随访资料的54例患者，其中男40例，女14例；年龄8～69岁，平均32.6岁。开放性损伤5例，闭合性损伤49例；左侧26例，右侧28例。受伤原因:刀伤5例，医源性损伤（手术牵拉伤、被钢板挤压伤）10例，肱骨干骨折合并桡神经损伤39例。神经损伤类型:桡神经完全断裂12例；大部分断裂15例；挫伤27例，挫伤长度1.5~4.5 cm。所有患者均有典型的感觉及运动功能障。采用神经吻合修复27 例，神经松解减压27例。骨折均用钢板内固定。 结果 所有患者手术均顺利，术后切口均I期愈合，无手术相关并发症发生。54例均获随访16~24个月，平均18个月。骨折于术后8～14个月达临床愈合。末次随访时根据中华医学会手外科上肢周围神经功能评定标准，神经吻合的27例中，获优14例，良8例，差5例；神经松解减压术治疗的27例均获优。总优良率为91%。 结论 上臂桡神经损伤宜早期手术修复，神经吻合的疗效较神经松解减压术差。【Abstract】 Objective To explore the therapeutic effect on radial nerve injuries in plateau area, and to analyze the influencing factors. Methods The clinical data of 54 patients with radial nerve injuries who were treated between June 2005 and June 2010 were retrospectively analyzed. The patients included 40 males and 14 females and aged 8-69 years (averaged 32.6 years old). Of these 54 patients, 5 were open injuries, 49 were closed injuries; 26 were on the left side, and 28 were on the right sides. Causes of injuries included: 5 direct cut injuries, 10 iatrogenic injuries (including traction injuries and crush injuries by steel plates), and 39 humeral shaft fracture and radial nerve injuries. Types of nerve injuries included: 12 complete radial neurotmesis, 15 partial radial neurotmesis, and 27 radial contusions (with contusion length ranged 1.5-4.5 cm). All patients had radial nerve injuries experienced significant motor dysfunctions. Among these patients, 27 underwent nerve anastomosis, the remaining 27 were treated by nerve decompression; all fractures were treated with internal fixation with steel plates. Results During the average follow-up of 18 months (16-24 months), all 54 patients completely recovered from radial nerve injuries without any complications. The time for fracture healing ranged 8-14 months. According to the evaluation standards for radial nerve functional recovery, developed by the Chinese Medical Association, among the 27 cases treated by nerve anastomosis, 14 were “optimal”, 8 were “fair”, and 5 were “bad”; and all 27 cases treated by nerve decompression were “optimal”. Conclusion It is suggested to have early surgical treatment for the upper arm radical nerve injuries. The nerve decompression had better curative effects than the nerve anastomosis does.
Objective To investigate the influence of hypoxic preconditioning on pulmonary structure of rats exposed to simulated high altitude hypoxia and to explore the role of hypoxia inducible factor-1α（HIF-1α）.Methods Fifty-six Wistar rats were randomly divided into 7 groups(n=8 in each group),ie,a normal control group(N group)，an acute hypoxic control group(H0 group)，an acute hypoxic group(H1 group)，a 3 000 m hypoxic preconditioning group(C3.0 group)，a 3 000 m hypoxic preconditioning + acute hypoxic group (C3.1 group)，a 5 000 m hypoxic preconditioning group(C5.0 group)，and a 5 000 m hypoxic preconditioning + acute hypoxic group(C5.1 group).After treated with hypoxic preconditioning，the animals were exposed to simulated altitude of 6 000 m for 24 hours.Then the protein and mRNA expression of HIF-1α in lung of N，H0，C3.0 and C5.0 groups were assessed by Western blot and RT-PCR，respectively.The lung structure in N，H1，C3.1 and C5.1 groups was observed by light microscope and electron microscope.Results Pulmonary interstitial edema was apparently observed in H1 group，while significantly relieved in two hypoxic preconditioning groups.HIF-1α protein was not detected in rat lungs by Western blot analysis.Compared to N group，the levels of HIF-1α mRNA significantly increased in C3.0 group and C5.0 group(both Plt;0.01).Conclusions Hypoxic preconditioning can relieve hypoxic pulmonary interstitial edema and increase HIF-1α mRNA expression in rat lungs.HIF-1 may be involved in the process of hypoxic preconditioning in rat lungs.
高原性肺水肿(HAPE)是人们由低海拔快速进入高海拔地区（一般3 000 m以上）后2～5 d内发生的非心源性肺水肿，是一种重型急性高原病，起病急、进展快、危害大，若不及时救治，可能危及生命。经过多年努力，对其发病机制及治疗进行了大量研究，取得了一些结果，但仍有许多未明之处，本文综述近年在此领域的研究进展，以期对HAPE的研究具有一定推动作用。
Objective To compare the effects of oxygen therapy and local pressurization in alleviating plateau hypoxia at high altitude. Methods Forty-five healthy male soldiers were investigated at an altitude of 3992 meters. The subjects were randomly divided into three groups, ie. an oxygen inhalation group, a single-soldier oxygen increasing respirator ( SOIR) group and a BiPAP group. The oxygen inhalation group was treated with oxygen inhalation via nasal catheter at 2 L/ min. SOIR was used to assist breath in the SOIR group. The BiPAP group were treated with bi-level positive airway pressure ventilation, with IPAP of 10 cm H2O and EPAP of 4 cmH2 O. PaO2, PaCO2, SpO2 and heart rate were measured before and 30 minutes after the treatment. Results There were continuous increase of PaO2 from ( 53. 30 ±4. 88) mm Hg to( 58. 58 ±5. 05) mm Hg and ( 54. 43 ±3. 01) mm Hg to ( 91. 36 ±10. 99) mm Hg after BiPAP ventilation and oxygen inhalation, respectively ( both P lt; 0. 01) . However, the PaO2 of the SOIR group was decreased from( 56. 00 ±5. 75) mm Hg to ( 50. 82 ±5. 40) mm Hg( P lt; 0. 05 ) . In the other hand, the PaCO2 was increased from ( 30. 41 ±1. 51) mmHg to ( 32. 56 ±2. 98) mm Hg in the oxygen inhalation group ( P lt; 0. 05) , declined from( 28. 74 ±2. 91) mm Hg to ( 25. 82 ±4. 35) mm Hg in the BiPAP group( P lt;0. 05) ,and didn’t change significantly from( 28. 65 ±2. 78) mm Hg to ( 29. 75 ±3. 89) mmHg in the SOIR group ( P gt;0. 05) . Conclusions Both BiPAP ventilation and oxygen inhalation can alleviate plateau hypoxia by improving PaO2 at 3992 meter altitude while SOIR has no significant effect.
Objective To investigate the role of Kv1. 5 in the pathogenesis of pulmonary hypertension simulated by hypobaria and hypoxia, and the effects of dichloroacetate ( DCA) on the Kv1. 5 expression in pulmonary arterial smooth muscle cells ( PASMCs ) and mean pulmonary arterial pressure ( mPAP) . Methods Twenty-four SD rats were randomly divided into a normal group ( N group) , a high altitude group ( HA group) , and a DCA treated group ( DCA group) . The N group were fed in normalconditions, the HA group and DCA group were fed in a hypobaria and hypoxia chamber simulated to an altitude of 5000 meters. In addition, the DCA group rats were gastric gavaged with DCA ( 70 mg · kg - 1 · d - 1 ) .Twenty-one days later, percentage of wall thickness ( WT% ) and percentage of wall area ( WA% ) of the pulmonary arteriole, mPAP, and the ratio of right ventricle / left ventricle and septum ( RV/ LV + S) were evaluated. Real-time PCR, immunohistochemistry and Western blot were carried out to detect the Kv1. 5 expression in PASMCs. Results In the HA group, WT% , and WA% of pulmonary arteriole, mPAP and RV/ ( LV + S) all increased significantly compared with the N group ( P lt;0. 01) . These changes in the DCA group were significantly lower than those in the HA group( P lt; 0. 01) . Furthermore, the protein and mRNA expression of Kv1. 5 in the PASMCs deceased significantly in the HA group compared with the N group( P lt;0. 01) , but recovered in the DCA group ( P lt;0. 01) . Conclusions The expression of Kv1. 5 in PASMCs is tremendously inhibited in rats fed in high altitude, which might be a important role of pulmonaryhypertension. DCA can inhibit the remodeling of pulmonary arterials probably by recovering Kv1. 5 expression.
【Abstract】 Objective To analyze the correlations between the mt5351G and mt6680C genotypes in mitochondrial DNA ( mtDNA) haplogroup M and susceptibility to high altitude pulmonary edema ( HAPE)among the Hans. Methods Specimens from206 Hans cases of HAPE and 144 matched Hans controls were collected. Then PCR-RFLP method was used to determine haplogroup M and N of mtDNA, and PCR-LDR was used to genotype mt5351G and mt6680C in the haplogroup M in these samples. Results The frequencies of haplogroup Mand N were 49. 0% and 51.0% in the HAPE patients, and 47. 2% and 52. 8% in the controls, respectively, with no significant difference between the HAPE patients and the controls. In the haplogroup M, the genotype of mt6680C and mt5351G frequencies in the HAPE patients were both significantly higher than the controls ( both 12. 0% vs. 1. 5% , P = 0. 016) . Conclusion The existence of mt5351G and mt6680C genotypes in the haplogroup Mis a risk factor for HAPE among the Hans.