肝移植相关性肾功能衰竭术中危险因素分析

目的探讨肝移植手术过程中引起肝移植相关性肾功能衰竭的危险因素。方法选择术前无明显肾功能损害的肝脏移植手术患者53例,分别于术中及术后抽取血标本进行血肌酐及尿素氮的测定,并根据Rimola等的诊断标准分为肝移植相关性肾功能衰竭组和非肾功能衰竭组。记录手术时间、无肝期时间,术中出血量、输血量,多巴胺、去甲肾上腺素、肾上腺素用量及术中是否发生低血压、是否发生肝缺血再灌注后综合征,对以上数据进行单因素及逐步回归分析,确定术中危险因素。结果术后1周内共有14例发生急性肾功能衰竭,单因素分析表明术中无肝期时间、出血量、血制品输入量、去甲肾上腺素用量以及低血压事件,两组间差异有统计学意义。经单因素及逐步回归分析,无肝期时间长（≥60min）是术后早期发生肝移植相关性肾功能衰竭的独立危险因素。结论肝移植术中无肝期时间≥60min是术后早期肝移植相关性肾功能衰竭的独立危险因素。缩短无肝期、减少术中出血、增加组织灌注压有利于减少肝移植相关性肾功能衰竭的发生,提高手术成功率及患者生存率。     

肝移植术后发生多器官功能不全综合征的预后分析

目的 探讨肝移植术后发生多器官功能不全综合征（multiple organ dysfunction syndrome，MODS）的危险因素。方法 分析46例成人肝移植病例资料，分为MODS组和非MODS组，对合并的多种危险因素进行logistic回归分析。结果 Child分级、术中输液量、术中低血压时间、APACHEⅡ评分、机械通气时间、住ICU时间、血胆红素、血白细胞计数、血肌酐、术后肺部感染等在单因素分析中有统计学意义（P〈0．05）。Logistic回归发现术后肺部感染、术中输液量是肝移植术后MODS的两个独立危险因素。结论 术后积极防治肺部感染和减少肝移植手术中输液量是降低肝移植术后发生MODS的关键。     

心脏瓣膜置换术后肺部感染相关因素分析

目的 探讨瓣膜置换术后肺部感染发生的相关因素.方法 连续观察452例体外循环下行心脏机械瓣膜置换术患者围手术期的临床资料,寻找引起肺部感染的相关因素.结果 术后出现肺部感染31例,占术后感染的75.6%,与其相关的指标有左室射血分数(EF)、再次开胸止血、术后胸骨哆开、呼吸机使用时间、低心排综合征.结论 心脏瓣膜置换术后肺部感染主要与围手术期心功能情况、术后呼吸机使用时间等多种因素有关.     

急性Stanford A型主动脉夹层术后肺部真菌感染危险因素

目的 分析急性Stanford A型主动夹层术后发生肺部真菌感染的危险因素，以针对性地提出干预措施。方法 收集2018年6月至2020年1月河南省胸科医院重症医学科405例急性Stanford A型主动夹层术后患者的临床表现、胸片及细菌学结果，确诊其术后发生肺部真菌感染。对发生肺部真菌感染的可能相关因素进行回顾性调查，使用多因素logistic回归进行分析。结果 53例患者发生肺部真菌感染，占比为13%。相较于同期手术无肺部真菌感染组，肺部真菌感染组的急诊手术患者高于择期手术患者，术后出现急性肾功能不全应用持续血液净化(CRRT)治疗患者高于非CRRT治疗患者；随着呼吸机使用时间的增加，重症监护室时间越长，感染率越高；在使用抗生素方面，使用碳青霉烯类的患者感染率低于使用头孢类的患者感染率，使用碳青霉烯类应用时间<3 d的患者感染率最低。logistic回归结果显示，是否应用CRRT、呼吸机使用时间、手术时间和碳青霉烯类应用时间是急性Stanford A型主动脉夹层术后发生肺部真菌感染的4个危险因素(P<0.05)。结论 呼吸机应用时间和广谱抗生素的应用是急性Stanford...     

肝移植术后病人肺部感染相关因素与护理对策

目的：观察原位肝移植术后病人肺毒感染的相关因素、总结护理经验。方法：回顾分析我院2004年1～12月施行的12例肝移植受体的肺部感染感情况，取病人术前、术后不同叶间采集的痰、咽拭子及支气管灌注液、血液进行常规细菌接种、坚定及抗生素敏感性试验：结果：①肝牡植术后7例（58.22％）病人发生肺部感染；②肺部感染与手术时间长短相关；结论：肺部感染是肝移植术后井废症之一，应采取全环境保护措施；严密观察呼吸年境症状．体枉：加强呼吸机的管理．防止呼吸机相关性肺部感染的发生。     

肝移植受者术后谵妄发病危险因素分析

目的 分析肝移植受者术后谵妄的发病率、发病时机及危险因素。方法 收集2019年1月–2021年12月在中南大学湘雅三医院行肝移植的211例受者的临床资料,调查术后谵妄发病率及发病时间,采用单因素和多因素logistic回归分析谵妄发病的危险因素,并分析谵妄对受者临床结局的影响。结果 肝移植受者术后谵妄的发病率为20.4%(43/211),发病距离肝移植手术的中位时间为19 h。单因素分析显示术前终末期肝病模型(model for end-stage liver disease, MELD)评分≥22、术前住院天数≥7 d、肝癌、术前肝性脑病、术前两个月内感染、术前淋巴细胞值<0.5×10⁹ L^-1、术中大量红细胞输注及使用碳青霉烯类抗生素≥3 d与肝移植受者术后谵妄发生相关。多因素logistic回归分析显示术前两个月内感染[比值比(odds ratio, OR)=2.597,95%置信区间(confidence interval, CI):1.135～5.944,P=0.024],术前MELD评分≥22(OR=2.967,95%CI:...     

肝移植术后急性肺损伤危险因素分析

目的 探讨肝移植术后急性肺损伤(ALI)的相关危险因素.方法 60例肝移植患者术后分ALI组和非ALI组,对11项临床资料进行单因素及多元逐步Logistic回归分析,确定肝移植术后急性肺损伤危险因素.结果 16例患者发生ALI,发生率为26.67%.单因素分析结果表明术前低氧血症、术中无肝期≥60 min、输液量≥8000mL,血制品输入量≥4000mL、气管带管时间≥72 h以及肺部感染,两组间比较差异有统计学意义,多元逐步Logistic回归分析结果表明,术前低氧血症、术中无肝期≥60 min是ALI发生的危险因素.结论 术前低氧血症和无肝期长是发生ALI的相关危险因素.     

冠状动脉旁路移植术后肺部感染的危险因素分析

目的 分析冠状动脉旁路移植术(CABG)后肺部感染发生的危险因素.方法 回顾性分析CABG患者共796例.根据典型的临床症状和体征,胸部X线检查,痰或气管支气管分泌物培养阳性,确诊为肺部感染,对其术前、术中、术后相关因素进行单因素及多因素回归分析.结果 术后肺部感染46例,肺部感染发生率5.78%.术前、术中、术后单因素分析有统计学意义的因素包括年龄、慢性肾功能衰竭史、心律失常病史、术中异体红细胞输注情况、体外循环的使用、术中胺碘酮的使用、手术时间、术后气管插管时间、术后行胸腔闭式引流术.多因素回归分析CABG术后肺部感染的独立危险因素有:胸腔闭式引流术、年龄≥65岁、手术时间≥240 min、术后气管插管时间≥24 h.结论 CABG术后肺部感染与围手术期多种因素有关,其中胸腔闭式引流术、年龄≥65岁、手术时间≥240 min、术后气管插管时间≥24 h是CABG术后肺部感染发生的独立危险因素.     

再次肝移植术的麻醉管理

目的:总结再次肝移植手术的麻醉管理方法.方法:回顾我院20例再次肝移植患者的临床麻醉资料,全组患者采用静吸复合全身麻醉,术中监测有创动脉压(ABP)、心电图(ECG)、中心静脉压(CVP)、肺动脉压(PAP)、肺小动脉楔压(PAWP)、连续心输出量(CCO)、心脏指数(CI)、呼气末二氧化碳分压(PetCO2)、听觉诱发电位指数(AEPI)、中心体温(T)、尿量等;采用脉搏指示连续心输出量(PiCCO)技术监测全心舒张末期容积(GEDV)、胸腔内血容积(ITBV)、血管外肺水(EVLW)、全身血管阻力(SVR)、每搏量变异(SVV)等.统计距离首次肝移植时间、合并腹腔感染或多系统器官衰竭(MOSF)情况、再次手术方式.统计两次手术时间、无肝期时间、出血量、输血量,以及羟乙基淀粉(万汶)、白蛋白、纤维蛋白原、凝血酶原复合物和碳酸氢钠使用量;统计再次移植患者术前凝血酶原时间、国际标准值对照值,术前肌酐、术前胆红素,并与首次移植的相应指标进行比较.结果:20例再次肝移植患者无麻醉死亡,麻醉手术期血流动力学基本平稳,尿量、电解质、酸碱平衡基本稳定.再次移植手术时间明显延长,再次肝移植术中出血量、输血量、纤维蛋白原使用量、凝血酶原复合物使用量、碳酸氢钠使用量明显增多.结论:再次肝移植手术的麻醉管理技术相当复杂, 对病情的充分估计和对手术的了解、术中的细心观察和及时的正确处理是再次肝移植术麻醉管理的重点.     

老年腹部手术患者肺部感染的围手术期危险因素分析及护理对策

目的 探讨老年患者腹部手术后肺部感染的围手术期危险因素及护理对策.方法 收集行腹部手术的107例患者为研究对象,根据患者术后至出院期间是否发生肺部感染分为感染组(19例)和对照组(88例).对可能影响患者术后发生肺部感染的围手术期危险因素进行单因素和多因素Logistic回归分析.结果 107例患者中,发生肺部感染的患者19例(17.76％),未发生肺部感染的患者88例(82.24％).单因素分析提示:感染组患者麻醉时间、手术时间、术中补液量、术中失血量、术后留置鼻胃管时间和上腹部手术比例均大于对照组,差异有统计学意义(P＜0.05).组间急诊手术、术中气管置管、术后静脉置管分布无差异(P＞0.05).多因素Logistic回归分析提示:上腹部手术(OR=5.26,95％CI:1.18～23.48)、手术时间长(OR=10.259,95％CI:2.56～41.04)和置胃管时间长(OR=4.00,95％CI:1.68～9.49)是影响老年腹部肿瘤手术术后肺部感染的独立危险因素;并且均会增加术后肺部感染的风险(P＜0.05).结论 上腹部手术、手术时间长和置胃管时间长可能增加老年腹部手术患者术后肺部感染的风险;采用综合护理措施可降低术后发生肺部感染的风险.     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.