低分子肝素钙治疗肺心病并呼吸衰竭的临床价值研究

目的探讨肺源性心脏病(肺心病)并呼吸衰竭患者运用低分子肝素钙进行治疗的临床应用价值。方法72例肺心病并呼吸衰竭患者,应用随机数字表法分为观察组和对照组,每组36例。对照组患者采取常规治疗,观察组患者在对照组上采用低分子肝素钙治疗。对比两组患者治疗前后动脉血气指标[氧分压(PaO2)、二氧化碳分压(PaCO2)及酸碱度(pH)值]及治疗效果。结果治疗前,两组患者的PaO2、PaCO2、pH值水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者的PaO2(9.36±1.02)kPa明显高于对照组的(7.78±0.98)kPa,PaCO2(6.33±0.97)kPa明显低于对照组的(7.65±1.28)kPa,差异均具有统计学意义(P<0.05);两组患者pH值比较差异无统计学意义(P>0.05)。观察组患者总有效率为97.22%,显著高于对照组的83.33%,差异具有统计学意义(P<0.05)。结论针对肺心病并呼吸衰竭患者运用低分子肝素钙进行治疗,可有效改善患者的血气指标,提高治疗效果,具有较高的临床价值。     

Role of Oxalobacter formigenes in preventing calcium oxalate kidney stones

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.     

Optimization of infusional calcium gluconate for prevention of hypocalcemic reactions during therapeutic plasma exchange

We sought to optimize direct intravenous infusion of calcium gluconate (CaGlu) for maintaining plasma ionized calcium concentration ([Ca²⁺]) and preventing hypocalcemic reactions during 34 consecutive 1-volume therapeutic plasma exchanges (TPEs) in eight patients. CaGlu, 2 g in 50 mL of 0.9% NaCl, was prepared by our hospital pharmacy and infused at either 1.0 or 1.6 g/h during alternate TPE. Plasma [Ca²⁺] was monitored at intervals of 20 to 30 minutes. At 1 g/h of CaGlu, plasma [Ca²⁺] fell by 8.35% after 40 to 50 minutes and then plateaued. At 1.6 g/h of CaGlu, plasma [Ca²⁺] fell by 6% after 20 to 30 minutes and then plateaued. The difference at 40 to 50 minutes was significant (P = .015). Hypocalcemic reactions were noted in three patients during 5 of 17 TPE at 1.0 g/h (all after 40 to 60 minutes) but 0 of 17 TPE at 1.6 g/h (P = .044). CaGlu at 1.6 g/h stabilized plasma [Ca²⁺] and appears to prevent hypocalcemic reactions during TPE.     

氢氧化钙糊剂与根管内感染控制

感染控制对根管治疗的成功至关重要。尽管随着器械及设备的进步，对根管的清理及成形取得了很大的进展；然而，由于根管系统解剖结构错综复杂，使得获取清洁根管面临各种问题。例如：机械预备的宽度有限，不能彻底清理感染牙本质；冲洗技术的运用虽然可以去除根管器械预备后形成的玷污层，但对细菌内毒素的清除还是难以达到理想的效果，而残留的微生物、毒素等若得不到清除可能会在根尖周组织形成持续感染。因此，除外机械预备和冲洗，根管封药也是感染根管治疗过程中的重要步骤。氢氧化钙糊剂以其高效的抗菌作用在临床得到广泛使用。文章将对根管封药的必要性、氢氧化钙的作用机制及临床应用做一介绍。