多囊肾去顶减压术改善肾功能的临床研究

目的探索去顶减压术是否有益于多囊肾肾功能的恢复及程度。方法对31例成人型多囊肾患者施行去顶减压术。手术选择传统开放和腹腔镜两种术式。并进行术前术后腰痛、血压、囊肾体积、肾小球滤过率的比较,以了解对肾功能改善的临床意义。随访时间为6个月-5年。结果术后患者临床症状迅速改善,血压下降,囊肾体积减小,肾小球滤过率（Glomerular filtration rate,GFR）升高。结论去顶减压术是治疗成人型多囊肾较好的方法,并有助于肾功能的恢复。     

经腹切口双侧多囊肾去顶术(附15例报告)

目的总结经腹切口行双侧多囊肾去顶减压术的手术经验,探讨其可行性及优点。方法15例患者取腹部正中切口,术侧向上斜卧位,切开结肠旁沟处后腹膜,游离增大的肾脏,由外向内,由浅到深,逐个将所见的囊肿去顶。同法处理对侧。结果手术均获成功。全部病例术后3天、15天Cr和BUN均无显著性改善(P>0.05);血压下降7例,血尿消失1例,腰痛症状缓解8例。结论多囊肾去顶减压术对手术近期改善肾功能的意义不明显,但对缓解血尿、特别是腰痛等症状有一定作用。     

慢性肾功能衰竭引起贫血48例临床探讨

<正>贫血是慢性肾功能衰竭(CRF)最常见的症状之一,其发生机理比较复杂,临床治疗较困难。我院1980～1997年问共收治CRF 48例作如下探讨分析。 1.临床资料 一般资料:男26例,女22例,年龄15～80岁。原发疾病:慢性肾小球肾炎21例,糖尿病肾病5例,狼疮性肾炎2例,高血压肾病2例,慢性肾盂肾炎2例,肾结石2例,诊断不明14例。肾功能衰竭情况:血尿素氮(BUN)7.51～62.7mmol/L(平均26.43±14.46mmol/L),肌酐(Cr)195～2051umol/L(平均610±495umol/L),氮质血症早期(BUN〈28.6mmol/L)28例,尿毒症末期(BUN≥28.6mmol/L)20例。 贫血情况:血红蛋白(Hb)25～106g/L(平均68±30g/L),血红细胞(RBC)0.97～3.85×1012/L(平均2.33     

慢性肾功能不全血液流变学测定

我院对45例男性慢性肾功能不全(CRF)患者的血液流变学进行测定,现报告如下。材料与方法1.病例选择:年龄20～54岁,平均35岁。慢性肾小球肾炎35例(78%),肾病Ⅱ型6例(13%),慢性肾盂肾炎与肾结石各2例(4%)。①氮质血症:血尿素氮(BUN)≥8.9mmol/L,但≤21.4mmol/L;血肌酐(Cr)≥177μmol/L,但≤442μmol/L,共16例;②尿毒症:BUN>21.4mmol/L,Cr>442μmol/L,共29例;③健康对照组55例,经体检及血、尿、便常规检查,心电图、血生化等检查除外心、脑,肾等器质性病变者。2.测定方法:清晨空腹采静脉血4ml,以     

山茛菪碱治疗慢性肾功能衰竭26例观察

我们用山莨菪碱(654—2)治疗26例慢性肾功能衰竭患者,治疗前BUN平均32.2mmol/L,Scr 平均636umol/L。用山莨菪碱静滴治疗3—5个疗程后,多数病人BUN及Scr均有不同程度的下降,临床症状改善。认为山莨菪碱治疗慢性肾功能衰竭有一定效果,值得临床试用。     

聚乙烯吡咯酮治疗慢性肾功能衰竭31例观察

口服聚乙烯吡咯酮(PVP)治疗31例慢性肾功能衰竭(CRF)患者。治疗前BUN22.09±9.54mmol/L,Scr618.28±217.36μmol/L。口服PVP治疗2周BUN和Scr分别下降至16.89±7.87mmol/L和496.71±191.18μmol/L,与治疗前比较有显著差异(P<0.05)。大多数病人症状明显改善,且无明显不良反应。     

腹腔镜肾囊肿去顶减压术治疗多囊肾的临床分析

目的 探讨后腹膜腹腔镜下去顶减压术（retroperitoneallaparoscopic cyst decompression,LRCD）治疗常染色体显性遗传性多囊肾病的方法（autosomal dominant polycystic kidney disease,ADPKD）及疗效。方法 总结后腹膜腹腔镜下去顶减压术治疗ADPKD患者20例,对手术天数、术后平均引流量、手术前后肾功能、及血压情况进行分析。结果 术后随访3～18个月,患者肾功能改善,,血压值kPa改善,手术前后对比有统计学意义（P〈0.05）,B超、CT均未发现囊肿复发。结论 后腹膜腹腔镜下去顶减压术治疗常染色体显性遗传性多囊肾病手术创伤小、术中出血少、术后恢复快、疗效可靠,是一种比较积极可行的手术方法。     

毒鼠强致急性肾功能衰竭一例

1　病例介绍患者男 ,4 7岁 ,因四肢抽搐、少尿 5 d入院。患者入院 5 d前突发四肢抽搐 ,发作时神志不清 ,口吐白沫 ,每次持续约 1min后症状缓解 ,当天发作 2次。尿量也明显减少 ,2 4 h尿量 30 0～4 0 0 ml,当时未到医院诊治。次日四肢抽搐频繁发作 ,神志不清 ,胡言乱语 ,家属送当地医院诊治。检查尿蛋白 ,红细胞 ,透明管型 ,血 BUN15 mmol/ L ,Cr5 0 3μmol/ L ,诊断为“急性肾功能衰竭”。经给予护肾、利尿等治疗 3d,病情无好转 ,尿量逐渐减少 ,2 4 h尿量约 10 0 ml。复查血 BUN2 5 mmol/ L ,Cr90 0 μmol/ L,遂转本院。病后神志不清…     

成人多囊肾后腹腔镜肾囊肿去顶减压术21例

目的观察后腹腔镜肾囊肿去顶减压术治疗成人多囊肾的临床疗效。方法回顾性分析2009年10月至2012年10月期间我院实施后腹腔镜肾囊肿去顶减压术治疗的21例成人多囊肾患者的临床资料,观察和比较术前、术后患者腰腹部胀痛、血压和肾功能情况。结果与术前比较,术后视觉模拟评分（VAS评分）[（3．5±1．5）分vs（5．0±2．0）分】、收缩压[（16．0±1．5）kPa vs（18．5±1．5）kPa]和舒张压[（10．0±0．8）kPa vs（13．5±1．0）kPa],以及肌酐[（215±60）μmol／Lvs（240±70）μmol／L]、尿素氮[（17．0±4．5）mmol／L vs（25．0±5．0）mmol／L】、肾小球滤过率【（61．0±10．0）ml／min vs（65．0±12．0）ml／min]水平均明显降低,差异均有统计学意义（P〈0．05）。结论后腹腔镜肾囊肿去顶减压术治疗成人多囊肾患者能够明显改善其肾功能,有效控制血压,减轻患者痛苦,值得临床推广。     

肾动脉支架置入对缺血性肾病患者肾功能的影响

目的评估支架重建肾动脉血运对缺血性肾病患者肾功能的影响。方法27例严重动脉粥样硬化性肾动脉狭窄伴有肾功能不全的患者进行了肾动脉支架置入术(PTRAS),并随诊6~48个月,观察手术对患者肾功能的影响。结果27例患者中,技术上PTRAS均成功。随诊6、12、24、36个月,患者血肌酐术前为155μmol/L±31μmol/L,术后分别为145μmol/L±22μmmol/L,143μmol/L±22μmol/L,145μmol/L±24μmol/L,140μmol/L±11μmol/L。手术重要并发症可见7例发生急性肾功能不全,4例为可逆性。结论缺血性肾病行肾动脉支架置入术对肾功能有益,但手术并发症较多,远期疗效有待进一步调查。     

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.