胶体硒免疫层析法检测抗-HIV(1+2)抗体的评价

目的 对检测抗-HIV抗体的胶体硒免疫层析法进行评价。方法 用胶体硒免疫层析试剂检测HIV国家参考品、已经确证的临床阴、阳性标本，评价此法的灵敏度、特异性。结果 快速胶体硒法试剂特异性较好，灵敏度尚可，可以满足快速筛查抗-HIV的要求。结论 此法可用于紧急情况下的抗-HIV的筛查，鉴于其灵敏度有待进一步提高，目前尚不能替代酶标法的检测。同时，该法不适用于献血者献血前的筛查。     

Néphrotoxicité des produits de remplissage

Expansion of extracellular volume is a treatment traditionally proposed to correct abnormalities of renal perfusion and prevent ischemic injury. However, vascular filling is not at risk for tissue oxygenation and renal function. The use of synthetic colloids exposes the patient to the risk of developing lesions such as osmotic nephrosis. Hyperoncotic colloids reduce glomerular filtration pressure. The nephrotoxicity of hydroxyethyl starches is now clearly established regardless of their characteristics. Colloids have never demonstrated their superiority as plasma volume expanders, they should be abandoned in favour of crystalloid solutions.     

Volume replacement and microhemodynamic changes in polytrauma

Though fluid administration is one of the most basic concepts in resuscitation, there is ongoing controversy and continuing research on the definition of the ideal fluid for resuscitation of trauma and hemorrhage and for intraoperative volume support. In general, crystalloids and colloids, as well as blood, blood substitutes and oxygen therapeutics, are available. This report briefly revisits the physiological mechanisms underlying resuscitation with crystalloids and colloids, emphasizing colloid-supplemented resuscitation with hypertonic saline. Finally, potential applications of oxygen therapeutics are briefly considered.     

Fluid management in burn patients: results from a European survey-more questions than answers

Many strategies were proposed for fluid management in burn patients with different composition containing saline solution, colloids, or plasma. The actual clinical use of volume replacement regimen in burn patients in Europe was analysed by an international survey. A total of 187 questionnaires consisting of 20 multiple-choice questions were sent to 187 burn units listed by the European Burn Association. The response rate was 43%. The answers came from a total of 20 European countries. Volume replacement is mostly exclusively with crystalloids (always: 58%; often: 28%). The majority still use fixed formulae: 12% always use the traditional Baxter formula, in 50% modifications of this formula are used. The most often used colloid is albumin (always: 17%, often: 38%), followed by HES (always: 4%, often: 34%). Gelatins, dextrans, and hypertonic saline are used only very rarely. Fresh frozen plasma (FFP) is given in 12% of the units as the colloid of choice. Albumin was named most often to be able to improve patients' outcome (64%), followed by HES (53%), and the exclusive use of crystalloids (45%). Central venous pressure (CVP) is most often used to monitor volume therapy (35%), followed by the PiCCO-system (23%), and mixed-venous saturation (ScVO2; 10%). It is concluded that the kind of volume therapy differs widely among European burn units. This survey supported that no generally accepted volume replacement strategy in burn patients exists. New results, e.g. importance of goal-directed therapy or data concerning use of albumin in the critically ill, have not yet influenced strategies of volume replacement in the burn patient.     

99Tcm-SC显像联合蓝染法探测乳腺癌前哨淋巴结

目的　探讨用核素显像联合染料法探测前哨淋巴结 (SLN)及其在乳腺癌外科治疗中的作用。方法　乳腺癌患者 332例 ,均为女性。用99Tcm 硫胶体 (SC)显像联合蓝染料法 ,与单独使用蓝染料法对比 ,进行SLN检出率比较 ,并判断以SLN病理结果推断腋窝淋巴结 (ALN)累及状况的可行性 ;同时对 2 5例患者进行前哨淋巴结活检术 (SLNB)替代全腋窝淋巴结切除术 (ALND)的前瞻性研究。结果　SLNB成功率为 97.8% (32 5 332例 ) ,准确性为 94 .2 % ,假阴性率为 14 .0 % ,其中单纯蓝染料法分别为 96 .7% ,92 .2 %和 2 1.6 % ,联合法分别为 10 0 % ,97.5 %和 4 .8% ,2种方法比较差异均有显著性 (u =1.97和 1.96 5 ,χ2 =7.91,P <0 .0 5 ,0 .0 5和 0 .0 1)。SLNB替代ALND者未发现明显近期术后并发症。结论　联合应用99Tcm SC显像及染料法检出SLN成功率较单独应用染料法高。SLNB替代ALND可提高患者术后生存质量。     

FK506及其纳米粒的房水药代动力学的实验研究

目的探讨FK506及其纳米粒的房水药代动力学特征。方法42只新西兰白兔分为:(1)FK506纳米胶体液滴眼组(18只兔)和注射组(16只兔):双眼结膜囊滴入或结膜下注射10μgFK506的纳米胶体溶液;(2)不含纳米微粒的FK506滴眼组(8只兔):再分为2个亚组,即双眼结膜囊分别滴入20μg和40μg FK506的滴眼液。不同时间点采集房水,酶联免疫法测定房水中FK506含量,计算药代动力学参数。结果含10μg FK506的纳米胶体溶液结膜下注射和滴眼后房水有效药物浓度可分别维持96 h和16 h;结膜下注射后2 h房水浓度为(1.15±0.25)ng/m、l6~96 h房水浓度为(9.62±2.19)~(2.60±0.21)ng/m l,滴眼16 h内房水浓度为(15.50±3.39)~(2.59±0.83)ng/m l;药代动力学参数分别为:达峰时间(Tm ax)(64.00±13.86)h和(1.25±0.50)h,达峰浓度(Cm ax)(10.16±1.37)ng/m l和(15.52±2.37)ng/m l,曲线下面积(AUC0→t)(612.48±54.39)ng.m l-1.h-1和(152.44±16.74)ng.m l-1.h-1,吸收速率常数(Ka)0.040±0.004和3.790±0.730,平均滞留时间(MRT)(58.53±5.42)h和(8.20±1.28)h。房水中FK506质量浓度呈一室模型。不含纳米微粒的FK506(20μg和40μg)液滴眼后房水有效药物浓度维持均≤4 h;其中含20μgFK506液的Tm ax为1 h,Cm ax为(18.93±6.95)ng/m l;含40μg FK506液的Tm ax为2 h;Cm ax为(28.33±1.31)ng/m。l结论采用FK506纳米粒胶体溶液行结膜下注射和滴眼时均可延长FK506药物在房水中的滞留时间,而且结膜下注射能使房水中维持的有效药物浓度相对较低和时间更长     

再议围术期容量管理

背景 围术期液体治疗一直是一个广受争论的临床难题.尽管有较多相关的临床研究和观察,但围术期最佳补液方案仍是临床上悬而未决的难题之一.目的 总结目前液体治疗相关的证据,分析不同液体治疗方案对术后预后的影响.内容 在围术期应考虑到不同患者的个体差异和手术的相关情况,采取目标导向性补液方案,而不是根据固定的补液公式来制定治疗...     

Fluid therapy in trauma

Advances in shock resuscitation have occurred as a result of various military conflicts. Primary objective of trauma care is to minimize or reverse shock, avoiding the lethal triad of hypothermia, acidosis, and coagulopathy. The concept of Damage Control Resuscitation has evolved along with “damage control surgery” which includes hypotensioe and haemostatic resuscitation, where small aliquots of fluid are infused, with hypovolaemia and hypotension tolerated as a necessary evil until definitive haemorrhage control can be achieved. In the initial stages of trauma resuscitation the precise fluid, crystalloid or colloid, used is probably not important as long as an appropriate volume is given. Haemostatic resuscitation includes early use of fresh frozen plasma in a 1:1 ratio with packed red cells with emphasis on whole blood, frequent cryo precipitates and platelets and the use of recombinant Factor VH for control of bleeding.     

呋喃硝胺与胶体铋剂治疗胃溃疡的对比研究

对胃镜诊断的良性胃溃疡55人进行呋喃硝胺与De-Nol单盲、随机治疗试验。味哺硝胺与De-Nol6周治愈率分别是71.4％和70.4％(P>0.05)。两者均未见明显副作用。胃粘膜幽门弯曲菌检出率为96.2％,高于慢性胃炎对照组的76.5％(P<0.05),提示幽门弯曲菌可能与胃溃疡的发病有关。De-Nol组治疗前后幽门弯曲菌检出率为96.3％及65.4％(P<0.01),表明De-Nol有去除胃粘膜幽门弯曲菌的作用。     

Coloides perioperatorios: de la teoría a la práctica

IntroductionFluid administration is the cornerstone in hypovolemic patient's reanimation. Clinical guidelines restrict colloid administration favouring crystalloids. Currently, we don’t know exactly which is the daily clinical practice during the perioperative period. The objective of this study is to describe perioperative use of colloids analysing possible reasons aiming to use them.Material and MethodsProspective, cross-section, national, multicentre observational study. Fluid Day sub-study. We enrolled all patient's older than 18 years old who underwent surgery during the 24 h of the 2-days study (February, 2019, 18th and 20th). We registered demographic data, comorbidities, anaesthetic and surgical procedure data, fluids administered, perioperative bleeding and monitoring type used during the perioperative period.ResultsA total of 5928 cases were analysed and 542 patients (9.1%) received any type of colloids, being hydroxiethyl-starch the most frequently used (5.1%). Patients receiving colloids suffered more longing surgery (150 [90-255] vs. 75 [45-120] min), were urgently operated (13.7 vs. 7.5%) and were more frequent classified as high risk (22 vs. 4.8%). Their recovery was mostly in critical care units (45.1 vs.15.8%). Patients with bleeding less than 500 mL received colloids in a percentage of 5.9 versus 45.9% when this figure was overcome. Patients who received colloids were anaemic more frequently: 29.4 vs. 16.3%. Colloids administration had a higher risk for transfusion (OR 15.7). Advanced monitoring also increased the risk for receiving colloids (OR 9.43).ConclusionsIn our environment with routine clinical practice, colloids administration is limited and close linked to perioperative bleeding.