第十期走向世界医药卫生科技新进展讲座简介(续)

《经颈静脉肝内门腔静脉内支架分流术治疗肝硬变门静脉高压的应用研究》由中国医科大学第一临床学院放射线科徐克主讲。经颈静脉肝内门腔静脉内支架分流术(TIPSS)原理是,经右颈内静脉入路,采用特殊穿刺装置和普通球囊导管及血管内支架(stent),在较大的肝静脉和肝内门静脉之间建立分流通道,以降低门静脉压力,控制和防止食管及胃底静脉曲张破裂出血,并促进腹水吸收,为治疗肝硬变门静脉高压(CPH)的介入放射学最新技     

经颈静脉肝内门腔静脉分流术的护理体会

经颈静脉肝内门腔静脉分流术的护理体会经颈静脉肝内门腔静脉分流术（简称ＴＩＰＳＳ）是利用一根记忆性金属支架，使门静脉与肝静脉沟通，降低门静脉压力。这种方法具有创伤小，术程短，出血少，术后并发症少及易于护理等优点。该技术国内开展较少，我科为７名患者成功地...     

采用Fluency、Viatorr覆膜支架行TIPS治疗乙型肝炎肝硬化门静脉高压的临床分析

目的 回顾Fluency、Viatorr覆膜支架行颈静脉肝内门体分流术（TIPS）治疗乙肝肝硬化并发门静脉高压症患者的临床资料，比较两者的临床疗效及转归。方法 选取2015年6月—2021年1月北海市人民医院收治并采用Fluency、Viatorr覆膜支架行TIPS治疗的乙肝肝硬化并发门静脉高压症患者110例。其中，男性77例，女性33例，年龄37～74岁。根据支架类型分为Fluency组、Viatorr组，分别有77例和33例。比较两组患者一般资料、支架狭窄、支架闭塞及再次施行TIPS手术间隔时间及TIPS治疗前后门静脉压力，随访后比较两组患者并发症、病死原因。结果 患者中临床症状为门静脉高压症引起上消化道出血95例（86.4%）、顽固性腹水15例（13.6%）。治疗结束后，110例患者中26例（23.6%）出现支架狭窄、23例出现闭塞（20.9%）。其中Fluency组肝静脉端15例（19.5%）、门静脉端血栓形成8例（10.4%）、肝静脉端6例（7.8%）、门静脉端迂曲打折5例（6.5%）;Viatorr组肝静脉端3例（9.1%）、门静脉端血栓形成1例（3.0%）、肝静脉端迂曲打...     

经颈静脉肝内门一腔静脉分流术的护理与观察

经颈静脉肝内门-腔静脉分流术(简称TIPSS)是由颈内静脉插管经上腔静脉、右心房、下腔静脉、肝静脉，再经肝静脉分支穿入门静脉分支在肝内门静脉及肝静脉间置入网状金属支架形成人工管道达到分流，从而降低门静脉压力的治疗方法。我院对21例患者采用TIPSS治疗肝硬化门脉高压合并食道胃底静脉曲张破裂出血，近期效果显著，现将护理观察体会报告如下。     

经颈静脉肝内门腔静脉内支架分流术治疗肝硬变门脉高压症

经颈静脉肝内门腔静脉内支架分流术治疗肝硬变门脉高压症袁克文，王志铭，陈宇军，姜学林（附属第一医院放射线科）安鼎伟，赵桂芹（附属第一医院消化科）刘瑶（锦州市太和区医院）经颈静脉肝内门腔静脉内支架分流术（ＴｒａｎｓｊｇｕｌａｒＩｎｔｎａｈａｐａｔｉｃｐｏ...     

TIPS临床应用现状

经颈静脉肝内门体分流术（transjugular intra hepatic portasystemic shunt，TIPS）是由Rosch首先提出并实验，1982年Cohpinto等将肝内门体分流术应用于临床，1988年Richter等将金属支架成功地应用于临床．其后被逐渐广泛应用于防治肝硬化门脉高压及其并发症。主要操作步骤是先经颈静脉插管至肝右或肝中静脉，再经肝静脉穿刺门静脉。置导丝于门静脉内并扩张肝内通道。然后将支架装置安放于肝实质内通道中，气囊扩张通道并用支架维持通道开放。从而在肝实质内建立肝静脉和门静脉主要分支之间的分流通道，用以降低门静脉压力。控制和预防门脉高压及其并发症。有经验的介入科医师可以很容易地放置这类支架．死亡率低于1％-2％。     

肝硬化门脉高压症超声血流参数对门静脉压力的影响

目的:研究肝硬化门脉高压症多个超声参数对门静脉压力的影响.方法:观察25例患者(门体压差大于或等于5 mmHg18例为试验组,小于5 mmHg 7例为对照组)的腔静脉、门静脉、脾静脉及肠系膜上静脉的超声血流参数,对照经颈内静脉肝内门体分流术(TIPS)导管测量的门静脉压力,利用多元逐步回归分析来研究门静脉内径(x1)、...     

经颈静脉肝内门腔静脉内支架分流术治疗门脉高压症

经颈静脉肝内门腔静脉内支架分流术治疗门脉高压症南昌三三四医院外一科（３３００２４）阎洪经颈静脉肝内门腔静脉内支架分流术（下简称ＴＩＰＳＳ）是９０年代应用于临床的新技术。由于其创伤小，降低门脉压及对食管曲张静脉破裂急诊出血疗效可靠，受到了国内外医学界的...     

经颈静脉肝内门体分流术中超声引导监视的应用

本文报道自1993年11月以来为8例门脉高压并发食管胃底静脉曲张出血患者,行B超引导下颈静脉肝内门体分流术(TIPSS),技术操作成功,出血停止。TIPSS后门静脉压力平均下降13.6mmHg,腹水减轻或消失,经短期随访无再出血发生。该术式对门脉高压病人降低门静脉压力是一比较简单、安全、可靠的方法。     

经颈静脉肝内门腔静脉内支架分流术治疗肝硬变门脉高压症

目的:探讨经颈静脉肝内门腔静脉内支架分流术(TIPS)治疗肝硬变门脉高压症的技术操作、并发症及其疗效。方法:采用经颈静脉肝内门腔静脉内支架分流术,治疗5例肝炎后肝硬变门脉高压症患者,分流通道直径为10mm。结果:4例成功,术后平均门脉压力由4.46kPa(45.50 cmH_2O)降为2.13 kPa(21.75 cmH_2O),消化道出血得到控制,胸腹水明显吸收,食管静脉曲张减轻或消失,临床症状得到改善。结论:TIPS 具有创伤小、疗效确切、合并症少、适应范围广等优点,是治疗门脉高压食管、胃底静脉曲张破裂出血的一种安全、有效的方法,其长期疗效有待进一步观察。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.