抑肽酶在心内直视手术中的应用

报告体外循环条件下应用大剂量抑肽酶对术后出血、血液各成分及输血量的观察。分为实验组（７例）、对照组（８例）。麻醉后由动脉或静脉放适量自体血，体外循环结束后回输给患者。实验组放血后静脉滴注抑肽酶２００万ｋＩＵ，以后持续用微量泵输入抑肽酶２５万ｋＩＵ／ｈ，直至手术结束；体外循环预充液中加入抑肽酶２００万ｋＩＵ，其余预充液两组相同。结果发现抑肽酶能明显地减少术中及术后出血，实验组术后２４ｈ出血量较对照组减少５６．４％，抑肽酶对血小板数及其它血液成分无明显影响。     

抑肽酶对中性粒细胞CD11b/CD18表达的影响及意义

抑肽酶作为一广谱丝氨酸蛋白抑制剂已广泛应用于心外科手术以减少术后失血 ,但它对炎性反应的作用及剂量关系尚缺乏足够的认识 ;作者对不同剂量抑肽酶对心脏手术期间中性粒细胞 (PMN) CD11b/ CD18表达的影响及意义进行研究。1　对象和方法1.1　对象　双瓣膜替换术患者 32例 ,随机分为 3组 :1对照组 (n=6 ) :不用抑肽酶 ;2小剂量组 (n=13) :体外循环(CPB)前静脉滴注抑肽酶 10 0万 KIU ,预先液中加入 10 0万KIU,术中持续静滴 2 5万 KIU / h,直至关胸结束 ;3大剂量组 (n=13) :抑肽酶用量较小剂量组增加 1倍。1.2　方法　麻醉采用静脉芬…     

利多卡因在胸腔镜肺癌肺叶楔形切除术患者围术期阿片类药物的影响

目的分析术中持续泵入利多卡因对胸腔镜肺叶楔形切除术患者围术期阿片类药物用量及预后的影响。 方法选取2018年5月至2020年5月我院收治的择期胸腔镜肺叶楔形切除术的53例肺癌患者为对象,随机分为观察组28例与对照组25例。对照组经口双腔气管插管后术中行全静脉维持镇痛,观察组经利多卡因1 mg/kg诱导后术中持续泵入利多卡因2 μg/(kg·h)。对比两组围术期相关临床指标,手术时间、术中出血量、麻醉时间、胃肠功能恢复时间、住院时间、重返ICU,对比两组术后不同时点视觉模拟评分(VAS)、阿片类药物使用剂量及用药后不良反应,最后对两组患者行随访,对比两组患者生存率。 结果两组手术时间、术中出血量、麻醉时间及重返ICU发生率(P>0.05);观察组胃肠功能恢复时间、住院时间显著少于对照组(P<0.05)。观察组术后6、12、24、48 h VAS评分显著低于对照组(P<0.05)。观察组舒芬太尼、丙泊酚、雷米芬太尼用药剂量显著少于对照组(P<0.05)。观察组用药后不良反应总发生率7.14%显著低于对照组的32.00%(P<0.05)。观察组存活率91.67%(22/24),对照组90.0%(18/20),两组对比差异(P>0.05)。 结论肺癌患者胸腔镜肺叶楔形切除术中持续泵入利多卡因能够减少阿片类药物用量,降低药物不良反应发生率,可促进患者术后恢复。     

腔镜辅助老年甲状腺微小癌手术应用效果及安全性

目的研究腔镜辅助老年甲状腺微小癌术中应用的效果及安全性。方法老年甲状腺微小癌患者随机分为对照组和观察组各60例。观察组采用腔镜辅助手术,对照组为传统手术。观察两组术中总出血量、术后引流量、手术时间、淋巴结清扫数、声音嘶哑、术后Ca 2+浓度,并随访两组中央区淋巴结复发情况。结果观察组手术时间显著短于对照组(P<0.05);术中出血量显著少于对照组(P<0.01);术后声音嘶哑数显著少于对照组(P<0.05);淋巴结清扫数目显著高于对照组(P<0.01);术后Ca 2+浓度显著高于对照组(P<0.01);术后出血例数两组有统计学差异(P<0.05);区域淋巴结复发两组差异无统计学意义(P>0.05);肿瘤大小是局部淋巴结复发的独立因素。结论老年甲状腺微小癌腹腔镜辅助手术是安全的,术后并发症明显减少。     

大剂量抑肽酶在小儿心脏手术中的临床应用

本文对大剂量抑肽酶在小儿心脏手术中的应用价值作了临床研究。随机选30例小儿复杂先心病,对照组和用药组各15例,观察转流后手术止血时间,术后24小时心包引流量和输血量。证实大剂量抑肽酶应用于小儿心脏手术可大大缩短转流后手术止血时间,减少术后出血和输血量,又无严重毒、副作用,并探讨了抑肽酶的作用机理。     

新辅助化疗在局部晚期非小细胞肺癌外科手术的应用价值

目的探讨新辅助化疗在局部晚期非小细胞肺癌(NSCLC)手术中的临床效果。方法 110例Ⅲ期NSCLC患者随机分为观察组和对照组各55例,观察组患者在接受2个周期的全身化疗后手术,对照组确诊后直接手术。比较两组患者的手术情况和术后生存率。结果观察组的手术切除率为89.1%,显著高于对照组的74.5%(P<0.05);观察组的术中出血量和手术时间显著低于对照组(P<0.05);观察组术后1年、2年、3年生存率分别为85.5%、67.3%、56.4%,对照组分别为69.1%、54.5%、47.3%,两组间比较有统计学差异(P<0.05)。结论术前新辅助化疗可以提高NSCLC的手术切除率,增加患者的术后生存率。     

抑肽酶在恶性梗阻性黄疸患者手术中的应用效果观察

目的观察恶性梗阻性黄疸手术过程中应用抑肽酶对凝血功能状态、术中出血量和血小板功能的影响。方法将21例行手术治疗的恶性梗阻性黄疸患者随机分为观察组11例和对照组10例,两组手术方法和麻醉方法相同,但麻醉诱导后分别静注抑肽酶和生理盐水。诱导前、诱导后1、2、4、8、16、24h分别抽取静脉血,采用Sonoclot凝血和血小板功能分析仪检测凝血功能指标,ELISA法检测纤维蛋白原降解产物（FDP）、D-二聚体（D-D）、颗粒膜蛋白-140（GMP-140）,免疫浊度法检测抗凝血酶-Ⅲ抗原（AT-Ⅲ）及纤维蛋白原（Fig）;记录两组术中出血量。结果观察组术中出血量及血小板功能与对照组相比有显著性差异;凝血指标GMP-140、D-二聚体及FDP均较对照组有明显改善。结论恶性梗阻性黄疸患者手术过程中应用抑肽酶可稳定凝血功能状态,减少术中出血量和保护血小板功能。     

围手术期BPSD干预对老年痴呆髋部骨折患者治疗效果及术后并发症的影响

目的 观察围手术期痴呆伴发精神行为障碍(BPSD)干预对老年痴呆髋部骨折患者治疗效果及术后并发症的影响。方法 选取本院于2018年1月—2020年1月收治的老年痴呆髋部骨折患者80例，参照其干预方案进行均分组，其中对照组40例(围手术期给予常规干预模式),观察组40例(围手术期在常规干预模式基础上给予BPSD干预)。比较两组术前准备时间、手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况，记录两组术前及术后的视觉模拟评分(VAS)的变化，观察两组神经精神科问卷(NPI)评分、简易智能状态检查量表(MMSE)评分的差别。结果 观察组术前准备时间、手术时间、术中出血量、住院时间及骨折愈合时间均短于对照组，住院费用少于对照组，差异有统计学意义(P<0.05)。与术前比较，两组术后1、3、7 d及出院当天的VAS评分下降(P<0.05),观察组术后1、3、7 d及出院当天的VAS评分低于对照组(P<0.05)。与干预前比较，两组MMSE评分升高(P<0.05),NPI评分下降(P<0.05),观察组干预后MMSE评分高于对照组(P<0.05),NP...     

国产及进口抑肽酶在复杂先心病矫正术中的应用

抑肽酶能够通过多种机制减少体外循环心脏直视手术后的失血和输血量 [1] ,该作用在有出血倾向、合并感染性心内膜炎及再手术患者中表现更为突出。我们分别应用国产及进口抑肽酶治疗复杂先天性心脏病患儿 ,并观察其对本病患儿术后出血量的影响 ,同时测定血小板及各项凝血功能指标变化。1　资料与方法1 .1　临床资料　将 60例入院待术的复杂紫绀型先天性心脏病患儿随机分为对照组、国产抑肽酶组和进口抑肽酶组三组 ,每组 2 0例 ,其临床资料见表 1。表 1　三组的临床资料对照组(n=2 0 )国产抑肽酶组(n=2 0 )进口抑肽酶组(n=2 0 )年龄 (岁 )体重…     

无张力疝修补术治疗成人腹股沟疝与传统术式的效果比较

目的探讨对比无张力疝修补术与传统手术治疗成人腹股沟疝的疗效。方法对1999～2008年成人腹股沟疝进行回顾性分析,将行无张力疝修补术166例患者作为观察组,将采取传统手术治疗的178例患者作为对照组,比较两组疗效及术中出血量、术后排气时间、住院时间、术后复发率等。结果观察组术中出血量、术后肛门排气时间和术后住院时间均优于对照组(P=0.001)。观察组术后复发率为0.30%,对照组术后复发率为10.6%,两组比较差异有统计学意义(P0.001)。结论无张力疝修补术治疗成人腹股沟疝与传统手术方法比较,具有出血少、术后恢复快、住院时间短、术后复发率低的特点,适于在基层医院推广应用。     

Survival in adult leukaemia

Summary The evaluation of treatment and outcome in adult leukaemia requires unselected data. Such data is available from one Health Region in the United Kindgom with an adult population of 3.1 million. In the period July 1982 to December 1989, 676 cases of acute myeloid leukaemia (AML), 136 of acute lymphoblastic leukaemia (ALL) and 141 of chronic granulocytic leukaemia (CGL) were registered. The median survival for AML was 21 weeks and 26% of these patients died within 4 weeks of diagnosis. For ALL, the corresponding figures were 81 weeks and 21%. In CGL, the median survival was significantly different for males and females: 113 weeks and 173 weeks respectively. The 5-year survival in AML was 9%, in ALL, 31% and in CGL, 29% (20% for males, 45% for females). Age at presentation was the single most powerful prognostic factor and probably accounts for survival differences between patients referred to tertiary centres and those treated in district general hospitals. (DGH). Survival may be improving overall as supportive care improves.     

Vaccination in adult rheumatology

Patients with rheumatic diseases who are undergoing immunosuppressive therapy have a substantially increased risk of infection compared to the normal population, and are thus candidates for preventive measures. In accordance with the recommendations of the Standing Vaccination Commission of the Robert Koch Institute (St?ndigen Impfkommission, STIKO), these individuals, in analogy with other patients with chronic diseases, belong to a risk group for which vaccination against pneumococci and influenza is recommended. Published studies indicate that a limited immune response is possible for patients undergoing immunosuppressive therapy. Here, methotrexate in particular appears to interfere with the success of vaccination against pneumococci. However, a limited immune response against influenza antigens was observed under immunosuppression with mycophenolate mufti, cyclosporine und azathioprine. Consideration must be given to the fact that a patient under continual immunosuppression has a reduced duration of protective immune response. New studies on tumor necrosis factor (TNF) inhibitors indicate that there should be no interference with pneumococcus infection. The possibly variable vaccination success of patients undergoing TNF inhibitor treatment is qualified by the fact that all published results show that the expected immune response after an influenza vaccination is very good. Vaccination strategies in cases in which the use of rituximab and abatacept is planned are currently unclear.     

Outcome in adult bronchiectasis

The outcome in adult bronchiectasis has not been well described; in particular there has been a lack of long-term prospective studies. Therefore a follow-up study was performed to assess outcome in bronchiectasis in a cohort of adult patients. One hundred-and-one sequential adults, 33 male and 68 female; age 54 +/- 14 years (mean +/- SD) with bronchiectasis had a clinical assessment and spirometry performed. All were non-smokers and 84 were classified as having idiopathic disease. Patients were commenced on a standardized treatment regime and followed up for a minimum period of 2 years. On their last review when patients were clinically stable, a repeat clinical assessment and spirometry was performed and compared with the initial review. The primary endpoints measured were symptoms and FEV1. Subjects were followed up for 8.0 +/- 4.9 years. Clinical review showed that the patients had persistent symptoms that, in the case of dyspnea and sputum volume, were worse on follow-up. Spirometry showed a significant decline in FEV1 over the follow-up period with an average loss of 49 ml per year. This study showed in this group of predominantly female adult patients with bronchiectasis followed up for 8 years, patients had persistent symptoms and an excess loss in FEV1.     

Ebstein's anomaly in adult

Ebstein's anomaly is a rare congenital cardiac disease initially described by Wilhelm Ebstein in 1866. It is defined as the significant apical displacement of the part of the tricuspid valve causing significant tricuspid regurgitation and reduction of the functional right ventricle, right atrial and right ventricular dilatation and atrial and ventricular arrhythmias. Ebstein's anomaly occurs approximately once in 20,000 live births and only 5% of patients survive beyond the fifth decade. We present a case of Ebstein's anomaly in a 69-year-old Italian woman. Also this case is illustrative of Ebstein's anomaly in adult.     

Piloting the older adult financial exploitation measure in adult safeguarding services

Financial abuse is arguably the most complex form of elder abuse as it may occur remote to the older person and it is impacted by issues such as cultural values, perpetrator intent and family expectations. Financial abuse may not be recognised by either the older person or the perpetrator, thus, its prevention, early identification and amelioration are important. The (Irish) National Centre for the Protection of Older People undertook a study to determine the appropriateness of the Older Adult Financial Exploitation Measure for use by the national safeguarding older person services. Findings from a small pilot study involving 16 safeguarding staff’s use of the Older Adult Financial Exploitation Measure with 52 community dwelling older people referred to their service demonstrate a higher suspicion of financial abuse as well as identifying multiple instances of possible financial exploitation in a single individual. Thus, the Older Adult Financial Exploitation Measure is considered appropriate to assist safeguarding personnel’s assessment of older people related to a suspicion of financial abuse.