支架辅助弹簧圈栓塞治疗急性期颅内破裂动脉瘤的围手术期危险因素分析

目的 探讨支架辅助弹簧圈栓塞（SAC）治疗急性期（≤28 d）颅内破裂动脉瘤（RIA）围手术期技术相关并发症及临床预后的影响因素。方法 回顾性连续纳入2012年1月至2018年6月在海军军医大学（第二军医大学）长海医院接受SAC治疗的急性期RIA患者,对其临床及影像学资料进行单因素分析及多因素logistic回归分析,筛选可能存在的围手术期技术相关并发症及预后的危险因素。结果 最终接受SAC治疗并完成30 d随访的急性期RIA患者共509例,其中男170例、女339例。28例（5.5%）患者围手术期发生缺血并发症,多因素分析结果显示动脉瘤位于血管分叉处是SAC治疗急性期RIA患者围手术期发生缺血并发症的独立危险因素[比值比（OR）=4.108,P=0.001]。25例（4.9%）患者围手术期发生出血并发症,多因素分析结果显示年龄<60岁是SAC治疗急性期RIA患者围手术期发生出血并发症的独立危险因素（OR=3.574,P=0.014）。出院改良Rankin量表（mRS）评分为3～5分的患者81例（15.9%）,死亡（mRS评分为6分）27例（5.3%）,预后不良（mRS评分>2分）率为21.2%（108/509）;多因素分析结果显示年龄≥80岁、入院时高Hunt-Hess分级（3～5级）、围手术期发生缺血并发症、围手术期发生出血并发症、入院格拉斯哥昏迷量表（GCS）评分差是急性期RIA患者SAC治疗后预后不良的独立危险因素（P均<0.01）。结论 对于SAC治疗的急性期RIA患者,动脉瘤位于血管分叉处是围手术期发生缺血并发症的独立危险因素;年龄<60岁是围手术期发生出血并发症的独立危险因素;入院时GCS评分较差的患者出院时临床预后较差,围手术期发生缺血及出血并发症是预后不良的独立危险因素。     

快速康复外科理念应用于老年进展期胃癌患者围术期的回顾性对照研究

目的 探讨快速康复外科（fast-track surgery,FTS）理念在老年人进展期胃癌患者术后康复的安全性和有效性。方法 回顾性纳入2013年1月~2016年6月间河南科技大学第一附属医院胃肠肿瘤外科收治的122例老年（年龄 ≥ 60岁）进展期胃癌患者,其中围术期按照快速康复外科理念管理65例,按照传统管理57例。比较两组手术情况、术后恢复情况及应激程度。结果 FTS组较对照组术中麻醉时间、输液量均减少、术后通气时间提前、术后住院时间缩短、住院费用降低（P<0.05）且白细胞计数和C反应蛋白等应激指标均降低（P<0.05）,两组的手术时间、术中出血量、清扫的淋巴结数和肠梗阻、感染、吻合口瘘等术后并发症率差异无统计学意义（P>0.05）。结论 FTS用于老年进展期胃癌患者围术期管理方法安全可行,值得临床推广。     

全腹腔镜全胃切除Uncut Roux-en-Y吻合与π形吻合的对比分析

目的 探讨全腹腔镜全胃切除的安全性、可行性,对比全腹腔镜下全胃切除食管空肠吻合应用Uncut Roux-en-Y吻合与π形吻合两种不同消化道重建方式的围手术期情况及术后疗效。方法 回顾性分析2016年1月至2019年6月大连医科大学附属第二医院胃肠外科所有接受全腹腔镜根治性全胃切除75例胃癌患者的临床资料。根据消化道重建方式的不同,分为Uncut RY组（39例,52%）和π形吻合组（36例,48%）。比较两组患者的围手术期指标及术后并发症的发生情况。结果 两组患者均顺利完成全腹腔镜下全胃切除手术,无中转开腹,无二次手术,无围手术期死亡。Uncut RY组与π形吻合组患者的手术时间分别为（215.10±35.71）min和（191.58±36.43）min,术后首次进食时间分别为3（2,4）d和4（3,6）d,上述两组数据比较,差异均有统计学意义（P<0.05）;两组患者术中出血量、术后住院时间、住院费用等差异均无统计学意义（P>0.05）。Uncut RY组和π形吻合组Roux滞留综合征分别发生2例和8例,差异具有统计学意义（P<0.05）;两组患者在吻合口漏、肺炎或胸腔积液、腹腔出血、切口感染、反流性食管炎、倾倒综合征、吻合口溃疡等术后并发症的发生方面,差异均无统计学意义（P>0.05）。结论 全腹腔镜下全胃切除手术安全可行。应用π形吻合手术时间更短,应用Uncut Roux-en-Y吻合进食更早,Roux滞留综合征发生率更低。     

加速康复护理清单在胸腰椎骨折患者围手术期的应用效果

目的 探讨加速康复护理清单在胸腰椎骨折患者围手术期中的应用效果。方法 选取2019年6月至2020年1月安徽医科大学第一附属医院60例胸腰椎骨折手术患者为研究对象,按随机数字表法分为对照组与观察组,每组30例。对照组采取常规围手术期护理,观察组在常规护理的基础上按照自行设计的围手术期加速康复护理清单实施护理。比较两组患者疼痛程度、腰椎功能评分、并发症发生率、平均住院时间及护理满意度的差异。结果 两组患者疼痛评分组别×时间存在交互效应（F=4.268,P=0.019）,观察组患者术前、术后第1天、第3天疼痛评分均低于对照组（F=8.956,P=0.006）,随着住院时间的延长,两组患者的疼痛评分逐渐下降（F=652.492,P<0.001）;两组患者腰椎功能组别×时间存在交互效应（F=17.589,P<0.001）,观察组患者术前、术后1周、1个月腰椎功能得分均高于对照组（F=8.956,P=0.006）,随着时间的延长,两组患者的腰椎功能得分逐渐上升（F=652.492,P<0.001）。观察组患者住院时间短于对照组,并发症发生率低于对照组,护理满意度高于对照组,差异均有统计学意义（P<0.05）。结论 围手术期应用加速康复护理清单可减轻胸腰椎骨折患者疼痛,减少并发症发生率、缩短住院时间,提高患者护理满意度。     

先天性食管闭锁术后患儿短期预后的分析

目的 通过回顾性分析先天性食管闭锁接受手术治疗的患儿临床资料,了解影响其短期预后的因素,以改善食管闭锁手术患儿的预后。方法 收集并分析笔者医院2008年1月～2014年12月接受过手术治疗的46例先天性食管闭锁患儿的临床资料。结果 46例患儿中3例术中因食管闭锁两盲端距离过大放弃。43例患儿完成手术治疗,其中转院2例。26例治愈出院的患儿,出生体重2976.0±554.6g;15例死亡患儿,出生体重2337.3±498.1g;这41例患儿,足月儿有31例,死亡7例,早产儿10例,死亡8例。较大的出生体重（P=0.008）和较长的胎龄（P=0.002）有助于患儿术后生存;发生术后吻合口瘘14例,发生率为34.15%,其中死亡10例,治愈4例,吻合口瘘患儿病死率高于无该并发症患儿（P=0.001）;Ⅲa型20例,发生吻合口瘘6例,Ⅲb型21例,吻合口瘘8例,吻合口瘘发生与疾病分型无关（P>0.05）。结论 小胎龄、低体重以及术后吻合口瘘是先天性食管闭锁术后患儿短期预后不良的主要因素,加强护理,减少吻合口瘘的发生将可能助于改善患儿预后。近端食管肌层环形切开延伸术,可以减少吻合口张力,减少吻合口瘘的发生。     

冠状动脉旁路移植术患者术前相关因素与术后并发症相关性分析

目的 探讨冠状动脉旁路移植术（coronary artery by pass grafting,简称CABG手术）患者术前相关因素与术后并发症的关系。方法 按照预设的纳入标准,入选2011年6月~2013年6月于华中科技大学同济医学院附属协和医院行CABG治疗的患者416例,收集患者术前的相关临床资料,统计患者术后并发症,并通过病历资料、门诊、住院或电话随访至2014年7月30日。通过Logistic回归分析CABG患者发生全因死亡的相关危险因素。结果 416例患者,住院期间3例死亡,其他并发症74例。Logistic回归分析表明高龄（OR=1.17,95% CI：1.06~1.42,P=0.034）、糖尿病（OR=1.56,95% CI：1.21~2.08,P=0.009）、心肌梗死（OR=4.52,95% CI：2.65~7.39,P=0.000）、心功能Ⅲ级或Ⅳ级（OR=1.22,95% CI：1.17~1.40,P=0.000）、LVEF<40%（OR=2.34,95% CI：1.53~3.58,P=0.028）是患者发生术后并发症的独立危险因素。平均随访时间2.1年,共有48例患者发生了联合终点事件,Logistic回归分析表明,高龄（OR=1.26,95% CI：1.17~1.51,P=0.029）、糖尿病（OR=1.37,95% CI：1.12~1.76,P=0.012）、不稳定型心绞痛（OR=1.53,95% CI：1.39~2.68,P=0.011）、心肌梗死（OR=3.48,95% CI：1.64~5.09,P=0.000）、心功能Ⅲ级或Ⅳ级（OR=1.22,95% CI：1.03~1.78,P=0.026）、LVEF<40%（OR=1.82,95% CI：1.25~2.72,P=0.000）和术后并发症（OR=2.56,95% CI：1.92~3.59,P=0.000）均是患者发生联合终点事件的独立危险因素。结论 高龄、糖尿病、心肌梗死、心功能Ⅲ级或Ⅳ级、LVEF<40%是患者发生术后并发症的独立危险因素,高龄、糖尿病、不稳定型心绞痛、心肌梗死、心功能Ⅲ级或Ⅳ级、LVEF<40%和术后并发症均是患者发生联合终点事件的独立危险因素。     

3D腹腔镜与2D腹腔镜辅助在胃癌根治术中的应用效果比较

目的 比较3D腹腔镜与2D腹腔镜辅助在胃癌根治术围手术期临床资料，探讨3D腹腔镜在胃癌根治手术中的临床应用效果。方法 选择六安市第二人民医院2014年11月至2017年10月收治的72例腹腔镜胃癌D₂根治术（根治性全胃切除术和根治性远端胃大部分切除术）患者，根据患者选择的腹腔镜操作系统不同，分为观察组（32例）与对照组（40例）。观察组采用3D腹腔镜操作系统，对照组采用2D腹腔镜操作系统。比较两组患者手术方式、手术时间、术中出血量、术后排气时间、淋巴结清扫数量及术后并发症等指标。结果 两组患者的手术时间、术中出血量的差异有统计学意义（P<0.05），而淋巴结清扫数量、术后排气时间、术后并发症发生率及严重并发症（≥Ⅲ级）发生率的差异均无统计学意义（P>0.05）。结论 与2D腹腔镜操作系统相比较，3D腹腔镜辅助下胃癌根治术能一定程度缩短手术操作时间、术中损伤小、出血量减少，更有助于淋巴结清扫，在手术近期效果方面有一定的优势。     

Ivor-Lewis式对食管癌术后早期DGE的相关因素分析

目的 探究影响微创Ivor-Lewis食管癌切除术后早期胃排空障碍（delayed gastric emptying,DGE）的相关因素。方法 选取2015年1月~2016年10月就诊于笔者医院经纤维内窥镜检查诊断为食管癌的患者156例,根据胃排空障碍诊断标准判断术后早期（1周内）患者是否出现DGE,出现DGE者纳入DGE组,未出现DGE者纳入对照组,统计食管癌患者的基线资料,对DGE组与对照组可能的危险因素进行单因素分析,将差异有统计学意义的指标进行多因素Logistic回归分析,进一步判断该因素对术后早期DGE发生的影响程度,ROC曲线分析上述因素对预测术后早期DGE发生的能力高低情况。结果 食管癌患者的一般情况显示,微创Ivor-Lewis式食管癌切除术的术后并发症中胃排空障碍的发生率较高,而其他并发症相对较少。单因素分析显示,DGE组和对照组中年龄、术中失血量、胸腔引流时间、焦虑评分、镇痛泵的使用、围术期白蛋白水平、术后至肠内营养时间间隔以及术后补液量比较,差异均有统计学意义（P<0.05）。Logistic回归分析显示,年龄（OR=1.851,P=0.039）、焦虑评分（OR=2.017,P=0.033）、围术期白蛋白水平（OR=0.430,P=0.041）,和术后补液量（OR=2.588,P=0.034）对胃排空障碍的发生均有显著影响,差异有统计学意义（P<0.05）。ROC曲线分析显示,术后补液量和围术期白蛋白水平在DGE组和对照组曲线下面积分别为0.774、0.758。结论 高龄、术后焦虑、围术期低蛋白血症以及术后过度补液均能增加术后胃排空障碍发病概率,影响患者的术后生活质量。     

McKeown食管癌术后呼吸衰竭的危险因素分析及预测模型建立

目的 探讨McKeown食管癌术后呼吸衰竭发生的危险因素,建立临床预测模型,为早期临床干预提供依据。方法 回顾性分析2020年1~12月在安徽省肿瘤医院胸外科行McKeown食管癌手术的261例患者的临床资料,其中男性患者203例,女性患者58例。结果 261例患者中有13.00%(34/261)的患者发生术后呼吸衰竭。logistic回归分析显示,年龄(OR=1.078,P=0.015)、术中补液量(OR=1.001,P=0.032)、术后低蛋白血症(OR=4.501,P=0.001)、吻合口瘘(OR=7.101,P<0.001)、胸腔广泛粘连(OR=2.785,P=0.031)是McKeown食管癌术后呼吸衰竭发生的独立危险因素。并建立Nomogram预测模型。受试者工作特征曲线下面积为0.848(95% CI:0.772~0.925,P＜0.001)。结论 对于McKeown食管癌手术的患者,年龄越大、术中补液量越多、胸腔广泛粘连、伴有术后低蛋白血症及吻合口瘘,术后发生呼吸功能衰竭的风险越高。     

不同年龄段老年直肠癌的临床特征及术后并发症的危险因素分析

目的 探讨不同年龄段老年直肠癌患者的临床特征以及术后并发症发生的危险因素。方法 回顾性分析江苏大学附属武进医院普外科2011年5月至2016年5月行直肠癌根治术的272例老年直肠癌患者临床资料。根据年龄,分为普通组（65~74岁）146例,高龄组（≥ 75岁）126例,比较两组的临床特征及术后并发症。应用单因素以及多因素分析法分析术后并发症发生的相关因素。结果 与普通组相比,高龄组的麻醉风险评分（ASA）和Charlson合并症指数（CCI）评分更高,输血以及既往腹部手术史更多。术前合并症中,高龄组的慢性阻塞性肺疾病（COPD）、贫血和消化性溃疡更多、营养情况更差。高龄组的术后伤口感染、肺部感染、尿潴留和营养相关并发症发生率较普通组高,差异均有统计学意义（P<0.05）。单因素分析显示年龄、BMI、ASA评分、CCI评分、贫血、小野寺预后营养指数、高血压和COPD可能与患者术后并发症有关。多因素logistic回归分析显示CCI评分（OR=8.140,P=0.000）和贫血（OR=2.424,P=0.013）是术后并发症发生的独立危险因素。小野寺预后营养指数（OR=0.225,P=0.000）是术后并发症发生的独立保护因素。结论 随着年龄上升,直肠癌患者术前合并症增加、营养状况变差,进而导致术后并发症增加。CCI评分和贫血是术后并发症发生的独立危险因素。     

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.