应用Child-Pugh评分、吲哚青绿15 min潴留率、去唾液酸糖蛋白受体与肝瞬时弹性值建立肝切除患者肝储备功能定量评估系统的初步研究

目的 联合运用Child-Pugh评分、吲哚青绿（ICG）试验、去唾液酸糖蛋白受体（ASGPR）及肝瞬时弹性值（TE）,建立肝切除患者肝储备功能定量评估系统.方法 对2011年1月至2012年12月在我科行肝切除的104例患者,术前测定Child-Pugh评分、吲哚青绿15 min潴留率（ICGR15）、肝细胞ASGPR荧光强度及TE,并使用术后2周Child-Pugh评分评估肝功能恢复情况.利用多元线性逐步回归分析法筛选影响术后肝功能恢复的指标,以术后肝功能Child-Push评分为因变量（Y值）,以筛选指标为自变量（Xn）,建立肝储备功能评估方程.结果 利用多元线性逐步回归分析法筛选得出ASGPR、Child-Pugh评分、ICGR15与TE是影响术后肝功能恢复的敏感指标,并可建立多元线性回归方程为Y=6.3050-0.0543X1＋0.4980X2＋0.1150X3-0.0637X4,该模型能够解释术后肝功能85.8％变差,而单独使用Child-Pugh评分仅能解释术后肝功能66.0％变差.结论 术前联合应用Child-Pugh评分、ICGR15、ASGPR与TE能够提高Child-Pugh评分评估肝切除患者肝储备功能准确率,具有一定的临床应用价值.     

吲哚氰绿试验联合血栓弹力图补充Child-Pugh分级在评估门脉高压手术患者肝储备功能中的应用

目的:探讨以吲哚氰绿试验(ICG measurement)和血栓弹力图(TEG)补充Child-Pugh分级所形成的新的肝储备评分系统(Ditan 分级)在评估肝硬化门静脉高压症患者肝储备功能中的可行性.方法:对2006年10月至2009年10月间91例肝硬化门静脉高压症接受联合断流术病例,分别于术前和术后以Child-Pugh与Ditan评分系统评估肝储备功能,了解两种方法预测术后肝功能代偿情况的准确率.结果:Child-Pugh分级法和Ditan分级法预测术后肝功能代偿良好准确率分别为57.89%和89.29%(P<0.05);Child-Pugh分级法和Ditan分级法预测术后肝功能代偿轻度不良准确率分别为68.66%和86.21%(P<0.05).结论:Ditan分级系统较Child-Pugh评分能够更全面评价肝硬化门静脉高压症患者围手术期肝储备功能.     

吲哚菁绿排泄试验与肝脏储备功能的相关性评价

目的探讨吲哚菁绿（ICG）排泄试验在肝脏储备功能评估中的临床价值。方法选取2012年1月至2014年5月吉林大学中日联谊医院接受吲哚菁绿排泄试验的肝脏疾病患者119例,分别测定ICG 15分钟滞留率（R15）、血浆清除率（K）、有效肝血流量（EHBF）,并采用Child-Pugh分级、MELD评分及t检验、线性回归分析,比较R15、K值与Child-Pugh分级、MELD评分的关系。结果随着Child-Pugh分级的递增,K值和EHBF下降,而R15升高。Child-Pugh A组R15（12.289±12.754）%,K值（0.172±0.069）/min;Child-Pugh B组R15（41.818±17.202）%,K值（0.063±0.026）/min;两组R15、K值比较存在统计学差异（P〈0.05）。将R15、K值与Child-Pugh分级、MELD评分进行相关性分析,均存在良好相关性,R15为正相关,K值为负相关。结论 R15、K值与Child-Pugh分级关系密切,R15相关性更加显著,提示R15是评估肝脏储备功能的准确、灵敏指标。     

肝体积变化率与肝瞬时弹性值对评估门静脉高压症患者手术前后肝储备功能的价值

目的探讨以肝体积变化率（R）及肝脏瞬时弹性值（FS）补充Child-Pugh评分所形成的新肝储备评价模型在评估肝硬化门脉高压手术患者肝储备功能的可行性。方法对2009年6月至2010年6月113例肝硬化门脉高压接受门奇断流术病例,分别于术前和术后1个月以Child-Pugh评分与新评价模型评估肝储备功能,了解两种方法预测术后肝功能代偿情况的准确率。结果 Child-Pugh评分预测术后肝功能代偿良好准确率为63.33％,新评价模型预测术后肝功能代偿良好准确率为86.49％（P＜0.05）;Child-Pugh评分预测术后肝功能代偿轻度不良准确率为69.87％,新评价模型预测术后肝功能代偿轻度不良准确率为87.67％（P＜0.05）。结论联合肝体积变化率与肝瞬时弹性值的新肝储备评价模型能够提高Child-Pugh评分对肝硬化门脉高压手术患者储备功能评估的准确性。     

脉动色素浓度测定法检测吲哚氰绿清除试验在肝储备功能评估中的应用

目的:探讨脉动色素浓度测定法(pulse dye densito graphanalyzer,PDDG)检测吲哚氰绿(ICG)清除试验在肝炎后肝硬化患者术前肝储备功能评估中的作用。方法:用PDDG法进行ICG清除试验,分析其在104例肝炎后肝硬化患者在术后恢复方面与Child-Pugh评分的相关性。结果:吲哚氰绿15min潴留率(ICGR15)在术后腹水、白蛋白用量、利尿剂用量、黄疸等方面与Child-Pugh评分有较好的一致性;同时ICGR15较Child-Pugh评分在术后并发症及治疗方面相关系数更高,相关性更强。结论:PDDG试验是行ICG清除试验检测肝储备功能实用可行的理想方法,能很好地反映肝炎后肝硬化、门脉高压症患者的肝储备功能,对手术后恢复情况有良好的预计性。     

肝储备功能测定在门静脉高压症手术患者中的临床应用价值

目的探讨肝储备功能测定在门静脉高压症手术患者中的临床应用价值。方法 43例肝硬化门静脉高压症患者术前测定吲哚氰绿(ICG)15min潴留率(ICGR15),并根据结果将患者分为3组,同时对所有患者进行Child-Pugh评分。根据联合断流术后患者肝脏损伤程度及恢复情况将患者分为轻度损伤(M)组和重度损伤(S)组。分析两组术前ICGR15的差异。结果联合断流术后M组与S组术前ICGR15差异有统计学意义[(11.3±6.2)%vs.(27.1±6.4)%,P<0.05]。结论 ICGR15能更准确地评估患者肝储备功能,其临床应用有助于降低门静脉高压症患者手术并发症的发生,降低死亡率。     

R15指标和利用16排CT测评肝储备功能相关性研究

目的 ICG清除试验(DDG分析仪检测法)是测定肝脏储备功能的新方法.本文旨在明确DDG检测在测定肝脏储备功能上的准确性,并讨论和评价基于DDG检测的肝脏储备功能与基于螺旋CT体积测定的半肝切除术后肝脏再生情况与肝脏储备功能的相关性意义.方法 本研究收集了152例原发性肝癌患者的病例及随访资料.对每例患者于规则性半肝切除术前通过ICG清除试验检测测定ICG 15min滞留率(R15),并于术前及术后对其进行16层螺旋CT扫描,并测定肝脏体积、残余肝体积,求出残余肝脏术后1个月增殖率以代表残余肝再生能力.同时比较R15和残余肝术后1个月增殖率的相关性.结果 所有患者均能在6～8min内ICG清除试验检测,检测过程中未发现明显的药物副作用及意外情况.本研究原发性肝癌病例中129例患者合并有不同程度的肝硬化,另22例患者合并慢性肝炎,但无明显肝硬化.合并肝硬化组与未合并肝硬化组间R15值差异均具有统计学意义.经相关性分析得出,R15值与Child-Pugh分级评分之间具有良好相关性.残余左半肝组和残余右半肝组再生增长率与DDG R15值之间均具有相关性.结论 ICG清除试验指标(R15)能很好的反映原发性肝癌患者的肝储备功能;R15的数值与肝脏的再生有一定的相关性.     

门静脉充血指数和血流量与肝储备功能的相关性分析

目的研究肝硬化病程中门静脉充血指数(CI)、血流量(QPV)与肝储备功能的关系。方法将我院138例肝硬化患者,按肝功能Child-Pugh分级分为A、B、C级,对照组健康体检者40例。彩色多普勒超声检测门静脉内径(DSV)、平均血流速度(VSV),计算CI、QPV,对比吲哚菁绿代谢试验ICG15min滞留率(ICGR15),探讨几者关系。结果 CI、QPV与ICGR15对肝储备功能评估相同,Child-Pugh评分越高,CI越高、QPV越增多、ICGR15越高,几者关系呈正相关。结论 CI、QPV明确反映肝储备功能,是对Child-Pugh分级、吲哚菁绿代谢试验的有利补充。     

临床与CT形态和肝容积测量相结合评估肝癌介入患者肝储备功能的价值

目的 探讨将传统的肝储备功能Child-Pugh(C-P)分级方法指标体系与CT肝硬化分级和CT保留肝容积率相结合,形成新的肝储备功能评估方法(改良C-P分级),在评估肝癌介入患者肝储备功能中的价值.方法 对60例行肝动脉化疗栓塞术(TACE)的原发性肝癌患者开展前瞻性研究.分别于术前和术后以C-P与改良C-P评分系统...     

华蟾素胶囊联合介入治疗肝癌临床疗效观察

目的：探讨华蟾素胶囊联合介入治疗肝癌30例的临床疗效。方法：纳入2020年1~12月接诊的60例中晚期原发性肝癌患者作为研究对象，按照随机数字表法分为对照组和观察组，每组30例。对照组行肝动脉化疗栓塞术（TACE）治疗，观察组在对照组基础上加用华蟾素胶囊治疗。比较两组临床疗效，治疗前后Child-Pugh评分、卡氏评分（KPS）变化，及免疫功能指标。结果：观察组治疗总有效率高于对照组（P＜0.05）；观察组治疗后Child-Pugh评分低于对照组，KPS评分高于对照组（P＜0.05）；两组治疗后免疫功能指标均高于同组治疗前（P＜0.05），观察组治疗后免疫功能指标高于对照组（P＜0.05）。结论：华蟾素胶囊能够提高肝癌介入治疗效果，改善患者肝功能储备和生存情况，改善患者的免疫功能。     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

Satisfaction with medical rehabilitation in patients with orthopedic impairment

OBJECTIVE: To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. DESIGN: Retrospective design examining records from facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr). SETTING: Information submitted to UDSmr from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. PARTICIPANTS: The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age +/- standard deviation of 73.07+/-11.81 years, and average length of stay (LOS) of 13.84+/-10.48 days. INTERVENTION: Usual rehabilitation care.Main outcome measures Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM trade mark instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. RESULTS: A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P<.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient's primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity fractures. CONCLUSION: unctional and demographic variables were identified as predictors of satisfaction in patients with orthopedic impairments.     

Persistence with antimuscarinic therapy in patients with overactive bladder

Overactive bladder (OAB) is a chronic condition, which impacts patients' health and quality of life. The primary symptoms of OAB are distressing and may interfere with work, psychosocial and sexual functioning. OAB also is associated with increased risk of urinary tract infections, fractures from falls, skin infections and depression. Patient's concerns about the effects of incontinence on lifestyle highlight the need to restore continence. The mainstay of treatment is antimuscarinic drug therapy, which may often produce only modest reductions in OAB symptoms and may be accompanied by bothersome adverse effects, leading to poor adherence to prescribed medications. Successful treatment of OAB depends on persistence with the prescribed medication, and efficacy and tolerability are key influencers of persistence. New antimuscarinic agents are now available for treating OAB that significantly improve symptoms of incontinence, urgency and frequency with few adverse effects. An improved efficacy and tolerability profile should result in greater patient satisfaction and persistence with therapy during long-term therapy.