AKI肾穿刺活检术后肾周血肿与术前透析干预相关性研究

目的〖KG*2〗探讨急性肾损伤（acute kidney injury,AKI）肾穿刺活检术后肾周血肿与术前透析干预相关性。 〖HTH〗方法〖KG*2〗回顾性分析行肾穿刺活检术AKI患者180例的临床资料,根据术前有无接受透析干预和术后有无出现肾周血肿分组,比较不同组基线临床特征资料和术后出血指标,采用Logistic回归法分析肾穿刺活检术后肾周血肿的危险因素。 〖HTH〗结果〖KG*2〗透析组AKI 2~3期比例、肌酐及尿素氮水平均显著高于未透析组（P＜0.05）;透析组血红蛋白水平显著低于未透析组（P＜0.05）;入选患者术后24 h肾脏超声证实出现肾周血肿108例,占比为60.0%,其中透析组46例,未透析组62例;透析组和未透析组术后肾周血肿发生率比较差异无统计学意义（P＞0.05）;透析组术后血红蛋白水平显著低于未透析组（P＜0.05）;肾周血肿组和非肾周血肿组基线临床特征资料比较差异无统计学意义（P＞0.05）;Pearson法评估结果显示,肾穿刺活检术后肾周血肿发生与术前血液透析治疗无相关性（r=0.34,P=0.26）;多因素分析结果显示,肾穿刺活检术术后肾周血肿直径≥5 cm风险与术前血液透析治疗亦无相关性（r=0.27,P=0.35）。 〖HTH〗结论〖KG*2〗肾穿刺术前透析干预难以有效降低或避免肾穿刺活检术后出血风险。     

西藏地区肾穿刺活检术后出血风险分析

目的: 观察我国西藏地区肾穿刺活检术(percutaneous renal biopsy,PRB)术后出血情况,分析总结与高原地区患者出血相关的危险因素,提高手术安全性。方法: 选择西藏自治区人民医院肾脏内科2016年5月至2018年5月收治的经皮肾穿刺活检术患者临床资料进行回顾性研究,分析诸因素(性别、年龄、血压、血红蛋白、血小板、血肌酐、凝血酶原时间和活化部分凝血酶原时间)与术后出血事件的相关性。结果: 共收集病例150例,平均年龄(41.2±15.6)岁,其中男性比例为58.7%(88/150),女性为41.3%(62/150),术后出血12例(男、女各6例),出血比例8.0%(12/150)。出血组平均年龄与无出血组相比,有偏高趋势[(48.3±20.0)岁vs. (40.6±15.1)岁,P=0.099]。出血组较无出血组高血压发生率、血红蛋白增多症发生率、尿素氮、凝血酶原时间差异均无统计学意义(P>0.05)。出血组血肌酐水平有高于无出血组趋势(P=0.090),出血组较无出血组活化部分凝血酶原时间有延长趋势(P=0.069)。出血组血小板计数明显低于无出血组(P<0.05)。多因素Logistic回归分析发现,活化部分凝血酶原时间延长和较低的血小板计数具有相对较高的出血风险,差异有统计学意义(P=0.079,P=0.082)。结论: 高原地区行PRB总体上是安全、可靠的;高龄、低血小板、肾功能下降、活化部分凝血酶原时间延长与PRB术后出血相关,高血红蛋白不是高原地区PRB术后出血的危险因素。     

自发性脑内血肿扩大的影响因素

本文对 384例自发性脑出血 (SCH)患者进行 2次以上脑CT扫描 ,血压观察 ,血小板计数及肝功能检查。结果 :自发性脑出血的血肿扩大与性别、年龄、血压、血肿形态、谷丙转氨酶、血小板计数等因素有关 ,而与出血部位无关。     

输尿管结石致尿脓毒血症患者发生严重脓毒症或脓毒性休克的危险因素分析

目的：探讨输尿管结石导致尿脓毒血症患者进展为严重脓毒症或脓毒性休克的相关危险因素,为临床识别高危患者提供参考。方法：回顾性收集我院2016年1月至2017年12月由急诊接诊的输尿管结石伴尿脓毒血症患者的临床资料,根据是否进展为严重脓毒症或脓毒性休克分为病例组和对照组,分别对性别、年龄、体质指数（body mass index,BMI）、糖尿病、既往结石手术史、结石部位、结石大小、肾积水程度、外周血白细胞计数、血小板计数、血清白蛋白水平、肌酐、C-反应蛋白（C-reactive protein,CRP）、降钙素原（procalcitonin,PCT）、尿培养、血培养等影响因素进行单因素分析,并对显著相关性危险因素进行Logistic回归分析。结果：单因素分析结果显示,2组间性别、年龄、合并糖尿病、外周血白细胞计数、血小板计数、血清肌酐值、CRP、PCT,差异有统计学意义（P<0.05）;BMI、既往结石手术史、结石大小、结石部位、肾积水程度、血清白蛋白水平、尿培养、血培养,差异无统计学意义（P＞0.05）。多因素分析显示,与尿脓毒血症进展最相关的因素为年龄、外周血白细胞计数、血小板计数及CRP。结论：输尿管结石致尿脓毒血症患者中,年龄、外周血白细胞计数、血小板计数及CRP是其进展为严重脓毒症或脓毒性休克的危险因素,对于此类患者应积极处理。     

超声引导下经皮肾穿刺活检术并发症的危险因素研究

目的探讨超声引导下经皮肾穿刺活检术并发症的风险因素。方法回顾性分析在我院行超声引导下经皮肾穿刺活检术的200例患者临床资料,观察患者并发症发生情况,并对其危险因素进行研究分析。结果肾穿刺活检术成功率100%,术后21例并发症(肉眼血尿12例,动静脉瘘4例,腰痛3例,包膜下血肿2例),发生率10.5%;并发症组与无并发症组患者肾功能、术前是否呼吸配合训练、穿刺长度、穿刺次数、年龄等比较有统计学意义(P0.05)。结论病种、是否配合呼吸训练、穿刺次数、长度、高龄等为超声引导下经皮肾穿刺活检术后并发症的危险因素,通过术前综合评估、呼吸训练能够降低并发症发生率。     

2型糖尿病患者24h尿微量白蛋白相关因素分析及临床意义

目的:筛查2型糖尿病患者(T2DM)24 h尿微量白蛋白(24 h UMA)相关因素,以期进一步指导2型糖尿病患者肾病预防和治疗。方法:测定住院的2型糖尿病患者的体重,血生化如肾功能、血脂等,尿生化如24 h尿微量白蛋白等,计算BMI,肾小球滤过率、肌酐清除率,晨尿微量白蛋白/肌酐。结果:24 h尿微量白蛋白与体重、BMI、血肌酐、血尿素氮、24 h尿总蛋白、24 h尿肌酐、晨尿微量白蛋白、微量白蛋白/肌酐、TC、LDL、收缩压均有相关性,与HbA1c、FMN无相关性。结论:24 h尿微量白蛋白反映糖尿病肾脏病变,控制肾病要作好体重、血脂、收缩压的控制,血糖控制不宜过严。     

超声引导下肾穿刺出血的危险因素分析

目的探讨超声引导下肾穿刺出血的相关危险因素。方法选取2016年1月至2017年12月我院收治的90例进行肾穿刺的患者作为研究对象,对患者资料进行回顾性分析。所有患者均在超声引导下进行肾穿刺操作,根据并发症发生情况,分为无严重并发症组(83例)与严重并发症组(7例),对比两组基线资料、各项指标变化,分析肾穿刺出血的危险因素。结果无严重并发症组与严重并发症组年龄、性别构成比、高血压病史、肝脏病史、穿刺次数>2次发生率、术前收缩压与舒张压、血清肌酐血小板计数、肾小球滤过率差异均有显著性(P<0.05)。单因素分析结果显示,男性,年龄较大,有高血压病史,穿刺次数>2次,术前收缩压与舒张压、血清肌酐偏高,血小板计数及肾小球滤过率偏低是肾穿刺出血的危险因素。多因素Logistic回归分析发现,穿刺次数、术前舒张压、血小板计数及肾小球滤过率是肾穿刺出血的危险因素。结论针对超声引导下肾穿刺患者,临床应加强危险因素评估,以便及时采取干预措施,改善预后。     

瞬时弹性成像实施受控衰减参数的影响因素分析

目的 探讨影响体检成人肝脏受控衰减参数变化的相关因素,为进一步提高无创定量检测肝脂肪变的准确性提供科学依据.方法 对1738例成人健康体检者应用瞬时弹性成像(FibroScan)检测记录实施受控衰减参数(CAP),同时登记年龄、性别、体质指数(BMI)及检测血清学(肝功能、血脂、血糖、尿酸、肌酐、血小板等)指标.采用多元线性回归分析进行统计分析,筛选有意义的相关因素.结果 多元线性回归结果显示BMI、γ-谷氨酰转移酶、白蛋白、丙氨酸氨基转移酶、三酰甘油、肌酐、年龄、B超结论 词、低密度脂蛋白、血糖与总胆固醇的偏回归系数均小于0.05,有统计学意义;对CAP影响最大者为BMI,其余依次为B超结论词、三酰甘油、年龄、白蛋白、丙氨酸氨基转移酶、肌酐,其他因素未进入回归方程.结论体检成人肝脏CAP值受BMI、B超结论词、三酰甘油、年龄、白蛋白、丙氨酸氨基转移酶、肌酐的影响.     

采用胸腹腔漏出液进行体外循环心肺转流1例报告

目的：探讨采用胸、腹腔漏出液作为心肺机预充液进行体外循环的临床可行性。方法：对1例体外循环心肺转流患者体外转流前和转流期间分次抽取胸、腹腔漏出液3900ml经孔径40цm滤网过滤后分别进入体外循环。于手术前、转流停机后及手术后24天，测定血浆总蛋白、白蛋白、尿素氮、肌酐、血细胞比容、血红蛋白、血小板计数、凝血酶原时间、血浆电解质含量和血气分析及体温变化观测。结果：体外转流停机时超滤出水分2900ml，尿量900ml；血浆总蛋白回升至54g/L，白蛋白至32g/L以上。尿素氮、肌酐正常，血细胞比容、血红蛋白变化不明显，血浆电解质、血气分析在正常范围。患者术后无发热、感染、精神障碍及心衰、肺水肿。     

福辛普利对IgA肾病患者PDGF－D表达的作用

目的研究血小板源性生长因子（PDGF—D）在IgA肾病患者肾小球中的表达及福辛普利对PDGF—D的作用。方法32例经肾活检证实为IgA肾病的患者,服用福辛普利9个月后重复肾活检。应用酶联免疫吸附（ELISA）和免疫组化法检测PDGF—D在治疗前后肾组织、血液及尿液中的表达。同时检测治疗前后24h尿蛋白定量、血浆白蛋白（ALB）及血尿素氮（BUN）、肌酐（Cr）水平。结果IgA肾病患者肾组织PDGF—D有较高的表达,同时患者血、尿中PDGF－D的水平也较高。经过福辛普利治疗后,PDGF—D在肾组织中的表达下降（P〈0．01）,同时血、尿中的浓度也减少。治疗前后24h尿蛋白定量、血浆白蛋白（ALB）及血尿素氮（BUN）、肌酐（Cr）水平没有显著的变化。结论福辛普利能显著抑制IgA肾病患者肾脏PDGF－D表达。     

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.