复方苦参注射液联合盐酸吗啡缓释片治疗中重度癌痛的临床疗效研究

目的：研究复方苦参注射液联合盐酸吗啡缓释片治疗中、重度癌痛的临床疗效。方法：设对照组和治疗组,每组30例,对照组予以盐酸吗啡缓释片,治疗组予以盐酸吗啡缓释片联合复方苦参注射液。观察两组患者疼痛缓解率、不良反应以及生活质量改善情况。结果：两组患者疼痛缓解总有效率比较具有统计学差异（P<0.05）;治疗组疼痛完全缓解和中度缓解优于对照组,具有统计学意义（Z=-1.996）;治疗组便秘反应发生率明显低于对照组（χ2=4.812,P=0.028）。结论：复方苦参注射液具有协同镇痛、缓解便秘和改善患者生活质量的作用。     

小体积肝移植术后门静脉高压状态的意义及其治疗

肝移植的发展至今已有40多年的历史,从早期的动物实验到目前临床上成为治疗终末期肝病的常规性手段,期间经历了许多对相关基础理论和技术上的认识和突破.然而,随着临床上受体数量的不断增加,供体短缺的问题越来越严重,许多受体在等待供肝期间死亡.为了缓解供体不足这一状况,劈裂式肝移植和活体肝移植（LDLT）等技术也应运而生并得到了较快的发展,这在一定程度上增加了供肝的数量[1,2].但与全肝移植相比,以上这两种肝移植方法往往存在移植物体积过小的问题.肝脏体积的缩小会引起肝前门脉入肝血流量的相对或绝对增加及肝后肝静脉系统的流出不畅,从而继发门脉高压状态.短暂或持续的门脉高压状态对供肝来说无疑都是一个机械性损伤因素.移植肝的有效体积不足可引起术后高胆红素血症、难治性腹水、凝血酶原时间国际正常化比值（INR）及凝血酶原时间延长、胃肠道出血、继发感染、肾功能衰竭等严重并发症,临床上称为小体积肝综合征（SFSS）.Ku等早在1995年就认为小体积肝移植后门静脉压力的变化对于手术的预后是一个较大的影响因素,之后越来越多的学者和临床医生逐渐意识到这个问题].作者拟对这一问题作一评述.     

The changes of sphingolipid profiles post ischemia–reperfusion injury in the rat liver

Hepatic ischemia-reperfusion (I/R) injury occurs in many clinical procedures, including liver transplantation, hepatic trauma, and liver resection. The molecular mechanisms responsible for hepatic I/R damage however remain unknown. There is increasing evidence that sphingholipids, in particular ceramide, play a role in stress and death receptor-induced hepatocellular death, contributing to the progression of several liver diseases including liver I/R injury. In order to further define the role of sphingolipids in hepatic I/R, systemic analysis of sphingolipids after reperfusion is necessary. In the present study, we investigated the lipidomic changes of sphingolipids in a rat model of warm hepatic I/R injury, by delayed extraction matrix-assisted laser desorption ionization time-of-flight mass spectrometry (DE MALDI-TOF-MS). The total amounts of ceramide and sphingomyelin and the intensity of most kinds of spingolipids, mainly sphingomyelin, significantly increased 1 hr post-reperfusion (p<0.05) and reached peaks at 6 hrs post-reperfusion (p<0.01) compared to controls. Six new forms of ceramide and sphingomyelins appeared 6 hrs post-reperfusion, (m/z) 537.8, 555.7, 567.7, 583.8, 683.5, 731.4. Interestingly, a ceramide- monohexoside (m/z) 804.4 (CMH[d18:1C22:1+Na]+) also increased post-reperfusion and correlated with extent of liver injury after reperfursion. Three main forms of sphingolipids, ceramide, sphingomyelin and ceramide- monohexoside, are related to hepatic I/R injury and provide a new perspective in understanding the mechanism(s) responsible for hepatic I/R injury.     

与先天性心脏病相关的NUSS术

目的 探讨同期治疗合并先天性心脏病(先心)的漏斗胸及先心术后漏斗胸应用NUSS术的方法及可行性.方法 统计我院2006年7月至2010年6月与先心相关的漏斗胸15例,A组8例合并先心的漏斗胸患儿在同期行心脏手术和NUSS术,其中男5例,女3例,年龄4岁～13岁4个月(平均6岁1个月).其中4例行室间隔缺损经胸伞封术,2例行房间隔缺损经胸伞封术,1例在体外循环下行室间隔缺损修补术,1例在体外循环下行右室双腔矫治及室间隔缺损修补术.B组7例均为先心术后的漏斗胸行NUSS术,其中男5例,女2例,先心手术年龄6个月～3岁10个月(平均1岁9个月),NUSS术年龄4岁7个月～8岁(平均6岁2个月),6例为体外循环下室间隔缺损修补术后,1例为体外循环下法乐四联症矫治术后.术后常规放置有心包纵隔和/或胸腔引流管.结果 所有患儿手术顺利,A组术后5～14 h拔除气管插管,平均(8.8±2.6)h.B组术后4～8 h拔除气管插管,平均(5.9±1.2)h,48～72 h拔除心包纵隔或胸腔引流管.无手术死亡、大出血及胸腔脏器损伤等并发症.术后检查先心矫治效果良好,肺复张良好.术后两组各出现1例切口延期愈合,经治疗后,均顺利出院.随访6个月～4年效果良好.结论 NUSS术用于治疗先心术后漏斗胸以及同期治疗合并先心的漏斗胸安全可行,可有效降低或避免二次手术的难度及风险.

Abstract：

Objective To investigate the clinical outcomes of combining corrective surgery for congenital heart disease (CHD) and NUSS surgery for pectus excavatum (PE) as one-staged operation. Methods From July 2006 to June 2010, 15 children with CHD associated with PE were recruited in this study, and divided into two groups: group A underwent one-staged and group B with twostaged operation. Group A had 8 patients including 5 males and 3 females, aging from 4 to 13.4 years (mean, 6 years and 1 month). Among the 8 patients, 6 with ventricular septal defect (VSD) and 2with atrial septal defect (ASD) underwent interventional or open repair. After the corrective surgery for their CHD, the 8 patients underwent NUSS procedure for pectus excavatum. The group B had 7patients, including 5 males and 2 females. Among them, 6 had VSD and 1 had tetralogy of fallot (TOF). At the first stage, the patients underwent corrective surgery to repair VSD and TOF under CPB. At the second stage, the patients were performed NUSS surgery to correct PE. Their ages at surgery were 4 years and 7 months to 8 years old (mean, 6 years and 2 months). Results All operations were finished successfully. The endotracheal tube was removed 5 to 14 hours after surgery on Group A patients (mean, 8.75 ± 2.59 h), and 4 to 8 hours on Group B patients (mean, 5.86 ±1. 24 h). The drainage tubes of pericardium, mediastinal or chest were removed 48 to 72 h later after surgery. The patients were followed up for 6 months to 4 years. No surgery-related death, hemorrhage, thoracic organ dysfunction and other severe complications were noted. Delayed wound healing was observed on 1 patient in each group. Others recovered from surgery and were discharged from the hospital. Conclusions It is safe to combine corrective surgery for CHD and NUSS procedure for PE as one stage operation.     

重组人红细胞生成素周剂量冲击治疗肿瘤 相关性贫血的临床研究

目的　探讨重组人红细胞生成素(rhEPO)周剂量冲击疗法和常规剂量法对肿瘤相关性贫血的临床疗效及药物不良反应.方法　将４５例肿瘤相关性贫血 患者随机分为对照组(２２例,年龄５６．３２±８．９１岁)和周剂量组(２３例,５７．２２±９．３５岁).对照组采用rhEPO１００００U,皮下注射,３次/周;周剂量组采用rhEPO ５００００U,静脉滴注,１次/周.观察６周,每２周评价１次,评价指标包括血红蛋白(Hb)、有效率、输血率及rhEPO 不良反应.结果　周剂量组Hb从用药第２周开始 升高,对照组Hb从用药第４周开始升高.周剂量组的２、４、６周Hb值均高于对照组(P ＜０．０５);周剂量组的２、４、６周有效率分别为３９．１％、５６．５％、７３．９％明显高于 对照组的９．０％ 、２７．３％ 、４０．９％(P ＜０．０５);２组输血率及不良反应发生率差异无统计学意义(P ＞０．０５).结论　rhEPO 周剂量冲击治疗肿瘤相关性贫血疗效优于 常规剂量,而药物不良反应无明显增加.     

腔镜手术治疗肺隔离症患儿47例

目的: 探讨腔镜手术治疗肺隔离症患儿的可行性。方法: 回顾性分析浙江大学医学院附属儿童医院2015年4月至2017年11月诊治的47例肺隔离症患儿的临床资料。根据手术开展时间,将2015年4月至2016年12月手术的19例患儿归为前期手术组,2017年1月至2017年11月手术的23例患儿归为后期手术组（5例膈肌内肺隔离症患儿由于类型特殊未参与分组）。比较前期手术组和后期手术组手术时间、术中出血量、术后引流管留置天数、术后住院天数和术后并发症的发生率等指标。结果: 47例患儿中,2例中转开胸,其余45例患儿均顺利完成腔镜手术,无手术死亡。后期手术组手术时间较前期手术组缩短（P < 0.05）,术中出血量较前期手术组减少（P < 0.05）,但引流管留置天数和术后住院天数与前期手术组差异无统计学意义（均P>0.05）。14例患儿发生术后并发症（气胸4例、胸腔积液8例,肺部感染1例,膈疝1例）,其中后期手术组术后并发症的发生率为17.4%（4/23）,较前期手术组（8/19,42.1%）降低,但差异无统计学意义（P>0.05）。术后随访2~26个月,所有患儿无复发及胸廓塌陷,剩余肺代偿良好。结论: 腔镜手术治疗肺隔离症患儿创伤小,出血少,术后恢复快,安全可行。     

小体积肝移植的基础研究进展

目的介绍小体积肝移植术后移植物损伤机理及移植物保护措施。方法复习和总结了相关文献资料并作综述。结果小体积肝移植术后过高的门静脉压力导致移植物机械性损伤,并通过改变肝窦微循环状态及激活各类细胞因子使移植物损伤进一步加重。通过手术或药物的方法降低门静脉压力可对移植物起一定的保护作用。结论了解小体积肝移植术后移植物损伤机理对于临床提高活体肝移植的效果具有积极的意义。     

降低内毒素对大鼠肝肺综合征肺损伤的作用

目的:探讨氧氟沙星降低内毒素对大鼠肝肺综合征的肺损伤保护作用。方法:结扎SD大鼠胆总管,建立肝肺综合征(HPS)动物模型。将大鼠分成3组(每组10只),假手术组:分离大鼠胆总管,腹腔注射生理盐水2ml;HPS模型组:结扎大鼠胆总管,腹腔注射生理盐水2ml;氧氟沙星组:结扎大鼠胆总管后腹腔注射左旋氧氟沙星(20mg/kg体重)。6周后检测血清内毒素,血、腹水、胆汁培养需氧或厌氧菌,血气分析,测定门静脉压力,肺干重/湿重比,肺灌洗液和肺组织匀浆中髓过氧物酶含量及丙二醛浓度,并评价肺组织病理变化。结果:与HPS模型组比,氧氟沙星组血浆内毒素浓度显著下降[(59±6.2vs268±35.6)ng/L,P<0.01],门静脉压力[(19.28±2.3vs17.80±2.18)cmH2O,P<0.01]、肺组织肺干重/湿重比(5.1±0.7vs4.9±0.7,P<0.01)、肺髓过氧物酶[(0.40±0.10vs0.24±0.03)U,P<0.01]和丙二醛[(0.32±0.05vs0.22±0.03)μmol/L,P<0.01]含量均有显著降低,肺组织炎症改变明显减轻。结论:降低内毒素可以减轻肝肺综合征的肺损伤。