腔内血管成形术对老年人下肢动脉硬化闭塞症的疗效分析

〔摘 要〕 目的：比较腔内血管成形术与下肢人工血管旁路移植术治疗老年人下肢动脉硬化闭塞症（ASO）的临床疗效。 方法：将 2015 年 1 月至 2017 年 1 月在福建医科大学附属南平市第一医院治疗的 84 例老年 ASO 患者随机分为两组开展治疗, 对照组使用下肢人工血管旁路移植术,观察组使用腔内血管成形术,比较两组患者的手术效果、踝 – 肱血压指数（ABI）变 化、足背动脉血流动力学变化。 结果：两组患者的 6 个月通畅率、保肢率、病死率、再狭窄率比较,差异均无统计学意义 （P ＞ 0.05）,但观察组 3 年通畅率、并发症发生率明显低于对照组,差异具有统计学意义（P ＜ 0.05）;两组患者术前、 术后 1 个月、3 个月、6 个月的 ABI 比较,差异均无统计学意义（P ＞ 0.05）;术后 1 个月,两组患者的足背动脉的内径、 血流峰速、血流量比较,差异均无统计学意义（P ＞ 0.05）。 结论：腔内血管成形术与下肢人工血管旁路移植术治疗老年 人 ASO 的近期通畅率相当,腔内血管成形术创伤小、并发症发生率低、安全性高、具有可重复性,但下肢人工血管旁路移 植术的远期通畅率更高,临床应根据患者的具体情况选择适宜的手术方式。     

术前访视与宣教对患者术前睡眠及不良情绪的影响

目的:探讨对手术患者给予手术室护理术前访视与宣教后对睡眠、不良情绪产生的影响。方法:选取2016年7月至2019年8月福建省医科大学附属南平市第一医院收治的手术患者96例作为研究对象,按照数字奇偶法分为观察组和对照组,每组48例;观察组采用常规术前访视+互动式术前访视与宣教方法展开对应护理;对照组采用常规术前访视展开对应护理;就组间PSQI评分、SAS评分以及SDS评分数据展开比较。结果:入院时,观察组手术患者PSQI评分与对照组差异无统计学意义,护理后,观察组手术患者PSQI评分低于对照组(P<0.05);入院时,观察组手术患者SAS、SDS评分数据与对照组比较差异无统计学意义(P>0.05);护理后,观察组SAS、SDS评分数据均低于对照组(P<0.05)。结论:手术室护理术前访视与宣教对预期手术患者睡眠质量、焦虑抑郁情绪均可予以减轻,有利于优化其手术效果,促进身体早日康复。     

过氧化物酶体增殖物激活受体δ对同型半胱氨酸诱导人脐静脉内皮细胞MCP-1 mRNA表达的影响及机制

目的: 观察过氧化物酶体增殖物激活受体δ(PPARδ)激活后对同型半胱氨酸(Hcy)诱导的人脐静脉内皮细胞(HUVECs)单核细胞趋化蛋白-1(MCP-1)mRNA表达的影响及机制。方法: 胶原酶消化法获取和体外培养HUVECs;实验分组:空白对照组、Hcy组、GW0742(PPARδ特异激动剂)组和二亚苯基碘鎓(DPI,NADPH氧化酶特异抑制剂)组,RT-PCR检测MCP-1和PPARδ mRNA表达,Western blotting测PPARδ蛋白水平,2',7’-二氯荧光素二乙酸酯(DCFH-DA)染色测定细胞内活性氧(ROS)。结果: 与空白对照组相比,Hcy呈浓度依赖性 促进人血管内皮细胞MCP-1 mRNA的表达,抑制细胞PPARδ mRNA表达,当Hcy浓度为10^-5 mol/L时,MCP-1 mRNA表达显著增加,PPARδ mRNA明显降低(P<0.01);与Hcy组相比,GW0742组细胞MCP-1 mRNA的表达下降(P<0.01);与空白对照组相比,Hcy组细胞内ROS明显增强;GW0742显著抑制Hcy诱导的细胞内ROS水平。结论: PPARδ激活可抑制Hcy诱导人血管内皮细胞MCP-1 mRNA的表达,其机制可能与抑制ROS信号通路有关。     

急性脑梗死患者血压变异性与认知功能障碍的关系

目的：分析急性脑梗死（ACI）患者血压变异性与认知功能障碍的关系。方法：回顾性分析2018年6月至2021年6月福建医科大学附属南平第一医院收治的80例ACI患者的临床资料,按照蒙特利尔认知评估量表（MoCA）评分分为认知功能障碍组（评分<26分）、非认知功能障碍组（评分≥26分）。统计患者基线资料,分析ACI患者血压变异性指标[24 h舒张压变异系数（24h DCV）、24 h收缩压变异系数（24h SCV）、24 h舒张压标准差（24h DSD）、24 h收缩压标准差（24h SSD）]与认知功能障碍的关系。结果：80例ACI患者经MoCA量表评估,发生认知功能障碍31例,发生率为38.75%;多因素logistic回归分析结果显示,血压变异性指标均是ACI患者认知功能障碍的危险因素（OR均> 1,P均<0.05）;受试者工作曲线（ROC）结果显示,24h DCV、24h SCV、24h SSD、24h DSD水平预测ACI患者认知功能障碍发生的曲线下面积（AUC）均> 0.70,有一定预测价值,其中联合检测价值最高。结论：ACI患者的血压变异性与认知功能障...     

Intramuscular hematoma in rhabdomyolysis patients treated with low-molecular-weight heparin: Report of two cases

BACKGROUNDRhabdomyolysis is a serious complication of heat stroke. Unlike that in acute kidney injury, the risk of muscle bleeding in rhabdomyolysis is often ignored and can substantially increase via the widespread use of anticoagulants, leading to the formation of intramuscular hematoma.CASE SUMMARYDuring the summer, a middle-aged man and an elderly man were diagnosed with heat stroke, rhabdomyolysis, and acute renal impairment. Low-dose enoxaparin sodium was initiated for prophylaxis of deep vein thrombosis after the disease was stabilized with continuous renal replacement therapy. After that, the patients'' hemoglobin decreased progressively, and no obvious intracranial, thoracic, digestive, or skin bleeding tendency was found. However, one of the patients had hip muscle pain, and computed tomography and color ultrasound confirmed that the patients separately had lumbar back and hip intermuscular hematoma. After discontinuation of anticoagulant drugs and monitoring of the steady increase in hemoglobin, the intermuscular hematomas were gradually absorbed. Following the use of prophylactic anticoagulation therapy, the patients'' hemoglobin showed a progressive downward trend. Hematoma formation in the lumbosacral and buttock muscles was confirmed after excluding bleeding in typical regions (such as the digestive tract, thoracic cavity, and abdominal cavity). Anticoagulant drugs were discontinued immediately, and nutritional support was increased. Subsequently, the hemoglobin levels gradually increased, and the hematoma volumes gradually decreased.CONCLUSIONPatients with rhabdomyolysis have a risk of muscle bleeding, and inappropriate use of anticoagulants may lead to an increased risk or even to the formation of an intermuscular hematoma. When continuous blood loss is found in the body, the possibility of bleeding in the muscles and more typical sites should be considered.     

精细化护理对甲状腺手术患者术后负性情绪及睡眠的影响

目的:探析精细化护理用于甲状腺手术患者术后改善负性情绪和睡眠的效果.方法:选取2017年3 月至2019 年2月福建医科大学附属南平第一医院收治的甲状腺手术患者92例作为研究对象,根据数字随机法分为对照组和观察组,每组46例.对照组进行常规护理干预,观察组在对照组的基础上进行精细化护理干预.比较与观察2 组患者护理前后的负性情绪和睡眠质量评分.结果:护理后观察组的负性情绪及睡眠质量评分显著低于对照组,差异有统计学意义(P<0.05).结论:精细化护理可有效地改善甲状腺手术患者的负性情绪,提高睡眠质量,从而促进患者术后恢复,值得在临床应用.     

Intermediate to Long-Term Clinical Outcomes of Percutaneous Cryoablation for Renal Masses

PurposeThe purpose of this study was to evaluate the effectiveness and adverse outcomes of percutaneous cryoablation (CA) for treatment of renal masses in a large cohort of patients.Materials and MethodsThis retrospective analysis included 299 CA procedures (297 masses in 277 patients) performed between July 2007 and May 2018 at a single institution. The mean patient age was 66.1 years (range, 30–93 years) with 65.8% being male. A total of 234 (78.8%) masses were biopsy-proven renal cell carcinoma (RCC). The mean maximal tumor diameter was 2.5 cm (range, 0.7–6.6 cm). Efficacy was assessed only for ablations of biopsy-proven RCC, whereas the evaluation of adverse events and renal function included all masses. Complications were graded according to the Society of International Radiology classification.ResultsMajor complications occurred in 3.0% of procedures (n = 9), none of which resulted in death or permanent disability. The mean imaging follow-up period was 27.4 months (range, 1–115) for the 199 RCC patients (204 ablated tumors) with follow-up imaging available. Complete response on initial follow-up imaging at mean 4.2 months (range, 0.3–75.6) was achieved in 195 of 204 tumors (95.6%) after a single session and in 200 of 204 tumors (98.0%) after 1 or 2 sessions. Of the RCC patients achieving complete response initially, local recurrence during the follow-up period occurred in 3 of 200 tumors (1.5%). Metastatic progression occurred in 10 of 193 (5.2%) RCC patients without prior metastatic disease during follow-up.ConclusionsCA for renal masses is safe and remains efficacious through intermediate- and long-term follow-up.     

HIV感染者外周血PBMC中NF-κB/iNOS表达及其免疫调节机制

目的探讨不同分期艾滋病病毒(HIV)感染者外周血单个核细胞(PBMC)中NF-κB和iNOS的表达的免疫调控作用。方法纳入150例HIV感染者,根据世界卫生组织临床分期标准分Ⅳ期,设Ⅰ期组、Ⅱ期组、Ⅲ期组、Ⅳ期组,无HIV感染者30例为健康对照组。吖啶橙/溴化乙啶染色观察各组PBMC的凋亡情况;采用Western Blot检测NF-κB抑制剂PDTC干预PBMC前后NF-κB、iNOS蛋白的表达水平;酶联免疫吸附试验法检测PDTC干预PBMC前后血清中NO水平。结果Ⅱ期组、Ⅲ期组、Ⅳ期组经过PDTC干预后细胞凋亡率进行性下降[Ⅱ期组:(9.91±2.31)、(8.01±1.87)、(6.34±1.28)、(4.37±1.11),Ⅲ期组:(15.89±3.85)、(12.98±3.38)、(10.05±2.16)、(8.36±2.01),Ⅳ期组:(28.47±6.98)、(25.75±6.14)、(18.75±4.23)、(10.97±2.12)],组间比较差异有统计学意义(P均<0.05)。PDTC干预前后四组NF-κB、iNOS的蛋白和基因表达水平较对照组差异均有统计学意义(P均<0.05);四组经过PDTC干预前后NF-κB、iNOS蛋白和基因表达存在差异,两两比较有统计学意义(P均<0.05)。PDTC干预前后四组NO表达水平与对照组比较升高,差异有统计学意义(P均<0.05)。激光共聚焦显微镜观察NF-κB的显像变化,随着病程的延长NF-κB定位显像逐渐显著。结论NF-κB-iNOS-NO可能介导HIV感染者免疫调控过程。     

棘突椎板复合体回植联合空心螺钉固定在胸腰椎椎管内肿瘤切除术中的应用

目的 :探讨椎管内肿瘤切除术中应用棘突椎板复合体回植+空心钉重建脊柱后柱结构的临床疗效。方法:2011年2月~2015年10月,对31例原发性椎管内肿瘤患者行肿瘤切除术,并应用棘突椎板复合体回植联合空心钉置入重建脊柱后柱结构。其中26例患者获得随访,男11例,女15例,年龄29~76岁(46.5±8.4岁)。所有随访的患者均行X线、CT检查观察脊柱稳定性及椎管成形情况,MRI检查评价肿瘤的切除情况,术后采用日本骨科学会(Japanese orthopaedic association,JOA)评定法进行效果评定。结果:成功置入64枚空心螺钉,手术时间为75~148min(96±21min),术中出血量为170~305ml(225±32ml),4例出现脑脊液漏,未出现脊髓损伤、感染等相关并发症。随访6~28个月(13.5±2.1个月),术后动力位X线片提示脊柱活动度基本得以保留,无椎体失稳或滑脱;末次随访CT评估发现2个节段的空心螺钉累及关节突关节,没有观察到螺钉断裂或位移现象,20例(76.9%)患者达到骨性愈合;MRI示肿瘤无复发;腰椎JOA评分从术前11.2±2.1分升至末次随访时的24.6±2.8分,差异有统计学意义(P0.05),优良率达80.8%。结论:原发性椎管内肿瘤切除术中应用空心钉固定棘突椎板复合体可以有效重建脊柱后柱结构,固定可靠,能有效避免术后医源性椎管狭窄,是治疗椎管内肿瘤的有效术式。     

临床药师在消化科开展药学服务的实践与体会

目的:总结临床药师在消化科开展药学服务的内容与体会。方法:回顾典型案例,详细叙述了临床药师在消化科开展药学服务的内容。结果:临床药师能针对临床各方面发挥自身药学专长,在消化科开展药学服务取得初步成效。结论:临床药师应在临床工作中不断地总结和探索,为患者的用药安全提供有力保障。