Objective To observe the protective effects of unfractionated heparin (UFH) on high-mobility group box-1 protein (HMGB1) induced increased permeability of endothelial cells, and investigate the protective mechanism of UFH on HMGB1 induced defective expression of zonula occludens-1 (ZO-1). Methods Human umbilical vascular endothelial cells (HUVECs) were culturedin vitro and divided into 4 groups (n=5), namely a control group, a HMGB1 group (100 ng/ml), a heparin group (UFH 10 U/ml), a HMGB1/heparin group (100 ng/ml HMGB1 + UFH 10 U/ml). Endothelial cell viability was measured by methyl thiazolyl tetrazolium (MTT) colorimetric method. Endothelial permeability was determination by Transwell chamber method. Immunofluorescence and laser confocal microscopy were used to assess the distribution of ZO-1. The protein expressions of tight junction protein ZO-1 and nuclear factor kappa B (NF-κB) were detected by Western blot. Results HMGB1 (100 ng/ml) had no inhibitory effect on endothelial cell viability (P＞0.05). UFH pretreatment could reduce the permeability increment of endothelial cells induced by HMGB1. UFH pretreatment could reduce the close loop reduction and damage of ZO-1 induced by HMGB1, enhance the fluorescence intensity and expression of ZO-1, and decrease the NF-κB translocation. Conclusions UFH can protect HMGB1-mediated defect of ZO-1 expression and increased permeability of the endothelial cells. The mechanism may be related to the decreased nuclear translocation of NF-κB.
目的 探討腹腔鏡膽囊切除術（laparoscopic cholecystectomy，LC）中不同CO2氣腹壓力對患者肝功能、動脈血氣及對頸、肩痛的影響。方法 選擇行擇期LC術患者120例，采用隨機數字表法，按住院先后順序對應入組，隨機均分為氣腹壓力10mmHg （1 mm Hg=0.133kPa）組、12mmHg組及14mmHg組3組；對比分析3組患者手術后肝功能、血氣指標以及術后當天、第1和第2天惡心、嘔吐及頸肩部疼痛的發生率。結果 3組患者術前各參數組間比較差異均無統計學意義（P＞0.05）。術后肝功能及血氣分析指標的改變3組間的差異有統計學意義（P＜0.05），氣腹壓力越大，其術后AST、ALT及TBIL水平升高越明顯，而pH及PO2的下降越明顯，PCO2的升高也越明顯；術后患者頸、肩痛及惡心嘔吐發生率3組間比較差異也有統計學意義（P＜0.05），氣腹壓力越大，術后頸、肩痛及惡心嘔吐發生率越高。結論 CO2氣腹壓力對術后肝功能及動脈血氣指標的改變以及術后頸、肩痛和惡心嘔吐發生率有明顯影響。
目的總結困難腹腔鏡膽囊切除術（LC）中造成操作困難的原因，探討各種情況下的手術技巧。 方法回顧性分析2004年12月至2013年12月期間我院為128例LC術中遇有操作困難的患者施行手術的臨床資料。 結果128例患者中113完成LC，住院時間為5～7 d（平均5.50 d）；15例中轉開腹完成，住院時間為7～9 d（平均7.46 d）。術后發生膽汁漏1例，經保守治療治愈，余術中、術后均未發生嚴重并發癥。128例患者術后隨訪3個月～2年（平均19.4個月），無并發癥發生。 結論術中仔細解剖，謹慎操作，采用適當的手術技巧，多數困難LC能順利完成，遇復雜情況果斷中轉開腹是避免LC嚴重并發癥的關鍵措施。