前列地尔在心死亡器官捐献肾移植术后早期肾功能恢复中的应用效果

目的探讨心死亡器官捐献(DCD)肾移植术后应用前列地尔对早期肾功能恢复的影响。方法 44例DCD供体肾移植,26例(前列地尔组)术后当天至14 d连续静脉滴注前列地尔10 g/d,18例(对照组)未应用前列地尔,比较两组术后7 d内的24 h尿量、血肌酐及内生肌酐清除率,术后第7及14天行彩色多普勒超声检查移植肾血流阻力指数,比较两组移植肾功能延迟恢复(DGF)发生率及术后2个月内急性排斥反应发生率。结果术后5 d内,前列地尔组的24 h尿量均明显多于对照组(均<0.05);术后7 d内,前列地尔组血肌酐均明显低于对照组(均<0.05),内生肌酐清除率均明显大于对照组(均<0.05)。术后第7天及第14天,前列地尔组的移植肾血流阻力指数均显著低于对照组(均<0.05)。两组DGF发生率差异有统计学意义(<0.05),急性排斥反应的发生率差异无统计学意义(>0.05)。结论 DCD肾移植术后应用前列地尔可促进移植肾功能早期恢复,减少DGF的发生,但对急性排斥反应的发生率并无明显的作用。     

体质量指数对移植肾功能的影响

目的 研究体质量指数（body mass index,BMI）对肾移植术后移植肾功能的影响。方法 回顾2008年1月-2011年12月本院肾移植受者238例临床资料,根据术前BMI分为3组：BMI〈24.9 kg/m^2（正常组,A组）,BMI 25～29.9 kg/m2（超重组,B组）,BMI≥30 kg/m2（肥胖组,C组）。对比3组术后移植肾功能延迟恢复（delayed graft function,DGF）的发生率、术后1年内急性排斥反应（acute rejection,AR）发生率、血肌酐恢复至正常水平所需时间。结果 肾移植术后DGF发生率A组为20.93%,B组为21.74%,C组为55%（P〈0.01）。急性排斥发生率A组为12.79%,B组为16.30%,C组为43.33%（P=0.088）。血肌酐恢复至正常水平所需时间A组为（7.65±3.23）d,B组为（6.99±5.36）d,C组为（11.45±6.20）d（P〈0.01）。结论 体型肥胖肾移植受者术后DGF的发生率较高,术后血肌酐恢复至正常水平所需时间更长。     

多异体脐血输注诱导产生免疫低反应性的实验与临床研究

目的　探讨多异体脐血输注诱导肾移植受者产生同种免疫低反应的可行性及对移植肾早期排斥反应的影响。方法　对 2 0例肾移植受者术前行多异体脐血输注 ,分别于输血前及输血后 1月、2月、3月 ,检测受者和供者特异性单向混合淋巴细胞反应 ( ML R)等指标的变化 ;并比较肾移植术后早期脐血组与对照组排斥反应的发生情况。结果　脐血输注后受者对供脐血的特异的 ML R显著降低 ( P<0 .0 1) ,对无关成人的 ML R亦有明显下降( P<0 .0 5 )。移植后三月脐血组无一例排斥反应发生。结论　多异体脐血输注能诱导肾移植受者产生同种免疫低反应性。这种低反应性可能对移植肾早期排斥反应的发生有抑制作用。肾移植前多异体脐血输注有望成为临床实用的耐受诱导途径     

供体脾灌注对高度致敏肾移植受者嵌合体形成的影响

目的探讨供体脾灌注对高度致敏肾移植受者稳定期嵌合体形成及移植肾功能的影响。方法对16例高度致敏患者进行配对分组，实验组肾移植术中先予供体脾灌注40min，前瞻性观察脾灌注对患者术后6个月内嵌合体形成、移植肾排斥反应发生及移植肾功能的变化。结果脾灌注后受者外周血中供者来源的有核细胞数量显著增加，受者形成稳定嵌合体的时间较早，例数比对照组更多；肾移植术后脾灌注组排斥反应发生时间较对照组延迟，排斥反应严重程度明显较对照组轻微；术后6个月时，脾灌注组患者血肌酐值低于对照组。结论供体脾灌注可以显著提高高敏肾移植受者外周血中供者来源的有核细胞数量，减轻排斥反应强度，从而促进受者嵌合体的形成，有利于改善稳定期移植肾功能。     

供体脾灌注对高度致敏患者移植肾的免疫保护作用

目的探讨供体脾灌注对高度致敏患者移植肾的保护作用及机理。方法对16例高度致敏患者进行配对分组,实验组肾移植术中先予供体脾灌注。前瞻性观察脾灌注对受者群体反应性抗体（penel reactive antibody,PRA）、补体依赖细胞毒性（complement dependent cytotoxicity,CDC）试验、血清补体溶血活性（CH50）、可溶性人类白细胞抗原Ⅰ（soluble human leucocyte antigen-Ⅰ,sHLA-Ⅰ）以及术后早期移植肾排斥反应和移植肾功能的影响。结果供体脾灌注40min后,患者的PRA、CDC和CH50较灌注前显著降低,血清sHLA-Ⅰ浓度显著增加。对照组肾移植术后发生超急性排斥1例,加速性排斥反应3例,急性排斥反应3例。对照组排斥反应严重程度明显较灌注组高（u=2.54,P〈0.05）;对照组排斥反应发生时间为（3.3±2.6）d（中位数3.0d）,脾灌注组为（10.5±6.2）d（中位数8.5d）,组间比较差异具有统计学意义（t=10.46,P〈0.01）;术后近期血肌酐（serumc reatinine,Scr）值显著高于脾灌注组。结论供体脾灌注可以延缓高度致敏患者术后近期移植肾排斥反应的发生,减轻排斥反应强度,改善移植肾功能;其机制可能与供体脾脏特异性吸附受者毒性抗体,消耗血清补体和分泌s HLA-Ⅰ类抗原有关。     

亲属活体肾移植受者119例临床总结

目的 回顾总结亲属活体肾移植受者围手术期的临床特点.方法 收集119例亲属活体肾移植受者对照同期234例尸体肾移植受者,比较两组供肾热、冷缺血时间、供肾血管长度、植肾手术时间、术后平均住院时间、供受者HLA错配率、术后3 d血肌酐下降速度、DGF发生率、急排发生率、1年人/肾存活率.结果 亲属活体肾移植组供肾血管长度、供肾热、冷缺血时间、术后平均住院时间、HLA六位点法错配率、DGF、急排发生率均明显小于尸体肾移植组(P<0.01),而手术时间、术后3 d血清肌酐下降速度、1年人/肾存活率亲属活体肾移植组均明显大于尸体肾移植组(P<0.01).结论 亲属活体肾移植的近期临床疗效明显优于尸体肾移植,远期(>1年)的临床效果比较有待进一步追踪观察.在有条件、技术成熟的移植中心亲属活体肾移植是患者家族内自救互救的重要途径.     

前列地尔促进肾移植术后早期恢复的临床研究

目的探讨前列地尔能否促进肾移植患者术后康复。方法2003年1月至2006年8月,对298例肾移植受者术中及术后2周内每天静脉滴注前列地尔50μg,与同期内287例未使用前列地尔的肾移植受者进行对比,比较两组术后尿量、血肌酐(SCr)、肌酐清除率(Ccr)、血压、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、B超下移植肾血流阻力指数以及两组肾功能恢复延迟(DGF)和急性排斥反应的发生率。结果应用前列地尔的患者术后尿量和Ccr均明显大于对照组;高血压、ALT和(或)AST异常升高病例发生率明显低于对照组;SCr浓度、移植肾血流阻力指数亦明显低于对照组;前列地尔组DGF发生率为5.56%,显著低于对照组(10.10%)(P<0.01);两组急性排斥反应发生率差异无统计学意义(分别为10.41%、10.77%;P>0.05)。结论肾移植受者术中及术后早期应用前列地尔可促进移植肾功能的恢复,减少高血压和肝功能异常等常见的并发症。前列地尔对肾移植患者术后早期康复具有促进作用。     

应用前列腺素E1改善移植肾早期功能

目的研究前列腺素E1对肾移植后早期肾功能恢复的影响.方法自1999年11月至2003年12月,对267例肾移植受者术中及术后2周内每天应用前列腺素E1(PGE1)90μg,与同期内282例未使用PGE1的肾移植受者进行对比,比较两组术后尿量、血肌酐、内生肌酐清除率、B超下移植肾血流阻力指数以及两组肾功能恢复延迟和急性排斥反应的发生率.结果应用前列腺素E1的患者术后尿量、内生肌酐清除率均明显高于对照组(P＜0.01),而血肌酐、肾血流阻力指数和肾功能恢复延迟的发生率则明显低于对照组(P＜0.01),但两组急性排斥反应发生率无明显差异(P＞0.01).结论肾移植受者术中及术后早期应用前列腺素E1有利于术后移植肾功能的恢复,但不降低急性排斥反应发生率.     

应用CD4+CD25+Treg细胞诱导大鼠肾移植免疫耐受的研究

目的 应用供体抗原特异性CD4 CD25 Treg细胞诱导移植免疫耐受,抑制大鼠肾移植慢性排斥反应.方法 以SD、Wister大鼠分别为供、受体建立同种异体肾移植慢性排斥反应动物模型;受体脾细胞悬液同供体肾组织抗原孵育培养,诱导获得对供体抗原的特异性;采用MACS法分选具有供体抗原特异性的CD4 CD25 T细胞,FACS流式细胞法检测分选的CD4 CD25 T细胞及CD4 CD25 Treg细胞纯度;获得之供体抗原特异性CD4 CD25 Treg细胞于同种异体肾移植术后2、4、6、8、10周,分别经尾静脉注射入受者体内(实验组,n=12),选取未注射组为对照(n=12).观察两组移植肾脏存活时间;术后第10、40、80天MTT法检测比较两组受体脾细胞对供体抗原刺激反应程度;术后第10、20、40、60、80天分别监测各组血肌酐水平.结果 FACS流式细胞法检测分选的CD4 CD25 T细胞得率为4.13%,分离纯度为73.34%;CD4 CD25 Treg细胞纯度为65.22%.所分选之CD4 CD25 Treg细胞成功获得供体抗原特异性,对供体抗原的抑制率(IR)为85.4%.移植肾存活时间:治疗组移植肾存活时间为(98.83±6.66)d,显著长于对照组的(78.25±4.71)d,组间差异有统计学意义(P＜0.05);术后第40、80天治疗组脾细胞对供体抗原刺激反应程度均明显低于对照组,两组间差异有统计学意义(P＜0.05).术后第20、40、60、80天对照组血肌酐指标明显高于治疗组,同治疗组间差异有统计学意义(P＜0.05).结论 供体抗原特异性CD4 CD25 Treg细胞可特异性抑制受体对供体抗原的免疫反应,有效抑制了移植肾慢性排斥反应的发生.     

肾移植术后移植肾功能延迟恢复的原因

目的探讨肾移植术后移植肾功能延迟恢复(DGF)发生的原因及处理方法。方法回顾性总结97例肾移植术后DGF患者的临床资料。结果发生DGF的病因包括急性排斥反应45例(46.4%),急性肾小管坏死39例(40.2%),环孢素A中毒7例(7.2%),髂静脉血栓3例(3.1%),输尿管梗阻3例(3.1%)。76例DGF经治疗后移植肾功能恢复正常,19例血肌酐稳定在200μmol/L左右,1例因应用抗淋巴细胞球蛋白后并发肺部感染死亡,1例应用甲基强的松龙冲击治疗后移植肾功能未好转而恢复血液透析治疗。结论急性排斥反应及急性肾小管坏死是引起肾移植术后DGF的最主要因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.