老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

高血糖与重型颅脑损伤预后关系的临床研究

重型颅脑损伤多伴有高血糖，伤情越重血糖升高越明显，预后越差。本文通过分析68例GCS〈8分的重型颅脑损伤患者血糖变化的特点及对预后的影响，以探讨血糖变化与颅脑损伤严重程度的关系，现报道如下。     

PFNA内固定与人工股骨头置换治疗老年股骨粗隆间骨折的临床效果分析

目的比较股骨近端防旋髓内钉(PFNA)内固定与人工股骨头置换对老年股骨粗隆间骨折患者临床效果。方法选取2016年1月至2020年2月就诊于该院的股骨粗隆间骨折患者100例,根据手术方式将其分为PFNA组(53例)与人工股骨头置换组(47例),分别从手术时间、术中出血量、术后下床时间、术后住院时间、围术期并发症、术后疼痛视觉模拟评分(VAS)及髋关节Harris功能评分进行对比分析。结果与人工股骨头置换组相比,PFNA组手术时间、术中出血量明显缩短或减少,差异有统计学意义(P<0.05);PFNA组术后下床时间、术后住院时间较人工股骨头置换组增加,差异有统计学意义(P<0.05);两组术后1个月VAS评分比较,差异无统计学意义(P>0.05)。PFNA组术后2周、1个月时髋关节Harris功能评分明显低于人工股骨头置换组,差异有统计学意义(P<0.05);PFNA组患者术后6个月髋关节Harris功能评分术后并发症发生率较人工股骨头置换组明显升高,差异有统计学意义(P<0.05)。结论股骨粗隆间骨折无论是采用PFNA内固定还是人工股骨头置换,均具有良好的手术效果,PFNA内固定可以减少手术时间,降低术中出血量,对于患者远期临床效果较好。人工股骨头置换可以帮助患者早期进行下床功能锻炼,减少卧床并发症的发生,但是手术创伤较大,术中出血量较多,远期临床效果并未优于PFNA内固定,因此在临床中应该根据患者的具体情况选择合适的手术方式。     

复方肝素口服结肠靶向胶囊对溃疡性结肠炎大鼠的治疗作用

 目的 考察复方肝素口服结肠靶向胶囊对大鼠溃疡性结肠炎（ulcerative colitis, UC）的治疗作用。方法 将大鼠随机分为模型组,正常对照组,阳性对照组,辅料对照组,复方肝素高、低剂量组共6组。其中除正常对照组外,其余5组均采用三硝基苯磺酸造模。连续灌胃给药12 d后,从组织损伤评分、髓过氧化物酶(myeloperioxidase, MPO)活性、肠道微生态的变化3方面对复方制剂的药效进行考察。结果 与模型组相比,复方肝素高剂量组结肠部位炎性损伤明显好转（P<0.01）,MPO水平明显降低（P<0.01）,肠道有益菌显著增加,有害菌明显降低。结论 复方肝素口服结肠靶向制剂对大鼠溃疡性结肠炎有较好的抗炎及改善肠道微生态的作用。     

156例颅颌面骨折治疗的临床分析

目的回顾性研究颅颌面骨折患者的治疗方法。 方法选取佛山市中医院口腔颌面外科2017年1月至2019年12月收治的156例颅颌面骨折患者,经过急诊CT确诊有颅脑外伤并颌面部骨折患者为纳入标准。首先于脑外科处理颅脑外伤,给予护脑、抗炎、脱水等对症处理,病情稳定后手术治疗行颌面部骨折切开复位内固定术,术中麻醉注意保持血压稳定,术后继续脑外科及口腔科专科对症治疗,并康复治疗3 ~ 6个月。 结果156例颅颌面骨折损伤患者中,16例患者张口受限,9例有面瘫症状,其余患者康复满意。 结论颅颌面骨折患者治疗应评估好手术时机择期手术,围手术期应密切观察患者颅脑病情变化。     

单支与多支移植肾动脉的移植效果观察

目的 比较单支与多支移植肾供肾动脉的移植效果.方法 根据供肾动脉的支数将患者分为3组,A组为单支肾动脉组(251例);B组为2支肾动脉组(12例),但有1支动脉直径<2 mm或估计供血区域<10%.将该动脉结扎(上极动脉);C组为2支或2支以上肾动脉组(35例).分别观察记录3组患者的手术时间、术中失血量、术后并发症以及术后肾功能情况.结果 A、B两组的手术时间较C组短,但差异无统计学意义(均P>0.05).3组的失血最差异无统计学意义(均P>0.05).3组患者术后的肌酐差异无统计学意义(均P>0.05).A组有7.6%(19/251)出现术后并发症;B组有2例出现肾功延迟恢复,无其他并发症,并发症发生率为16.7%(2/12);C组有11.4%(4/35)出现并发症.术后各组1年人/肾存活率差异无统计学意义(P>0.05).结论 单支与多支移植肾供肾动脉组之间比较,除手术时间略长外,在术中失血量、术后并发症、术后肾功能情况、术后急性排斥反应发生率、术后1年人/肾存活率方面均无明显差异.提高血管重建吻合技术是减少多支供肾动脉术后并发症,提高移植肾存活率的关键.     

原发性肾病综合征并发急性肾衰竭19例临床观察

急性肾衰竭(acute renal failure,ARF)为原发性肾病综合征(primary nephrotic syndrome,PNS)最严重的并发症.一些有大量蛋白尿的PNS患者并无低血容量、药物或感染因素存在,而出现ARF.     

静脉补铁治疗血液透析患者肾性贫血的疗效观察

目的 评价静脉用铁剂蔗糖铁(森铁能)、口服铁剂琥珀酸亚铁片(速力菲)分别与基因重组红细胞生成素(rHuEPO)联合应用,治疗伴有缺铁的维持性血液透析(MHD)患者肾性贫血的有效性和安全性.方法 72例MHD患者,随机分为静脉组和口服组,每组36例,分别采用静脉注射蔗糖铁及口服琥珀酸亚铁片进行补铁治疗,治疗时间为5周,观察时间共8周.治疗前,两组患者男女性别比例、年龄、维持血液透析时间、血红蛋白(Hb)、血细胞比容、血清铁蛋白(SF)和转铁蛋白饱和度(TSAT)等均无显著性差异.全部病例都合并使用同等剂量rHuEPO治疗.观察并比较两组患者治疗贫血的效果、铁代谢指标变化及不良反应发生情况.结果 治疗8周时,静脉组Hb和口服组Hb均较治疗前明显提高(P＜0.01,P＜0.05),而静脉组Hb上升幅度明显高于口服组(P＜0.01);两组SF和TSAT均较治疗前明显提高(P＜0.01,P＜0.05),而静脉组上升幅度明显高于口服组(P＜0.01);总有效率静脉组明显高于口服组(P＜0.01);静脉组不良反应发生率(0/36,0%)明显低于口服组(15/36,41.7%).结论 静脉注射蔗糖铁可有效纠正维持血液透析患者的铁缺乏、提高铁利用率及rHuEPO的治疗效果,不良反应发生率低,安全性好.     

射频消融在肺癌治疗中的应用进展

外科手术是根治早期非小细胞肺癌的有效手段。然而不幸的是,肺癌患者往往因为确诊时已属晚期,或者因为心肺功能差而不能耐受手术。另外,从历史角度来看,常规单纯的化疗和放射治疗效果也很有限。射频消融是治疗肺肿瘤的一种微创技术,已有的临床研究表明射频消融治疗肺癌具有较高的完全缓解率和可接受的并发症发生率;对于非小细胞肺癌或肺转移癌的患者,射频消融可以作为一种选择治疗方法或补充治疗方法。本文就肺癌的射频消融原理以及它与其它治疗方法的临床联合应用作一综述。