心内直视术后迟发性心脏压塞的观察及护理

我院自1993年以来,共施行心内直视手术230例,发生迟发性心脏压塞4例,占1.7％,就其护理体会如下。 1 临床资料 例1,女,16岁,先天性心脏病,室间隔缺损合并重度肺动脉高压。行室间隔缺损修补术后35天,出现胸闷、心慌、腹胀、呕吐、尿少。检查:面部浮肿,口唇轻度紫绀,心率130次/分,心音低钝而遥远,血压12/10kPa。肝大、肋下5cm,压痛明显,双下肢浮肿。B超示:大量心包积液。即行心包穿刺引流,引流出淡黄色液体1800ml。 例2,男,38岁,风湿性心脏病,二尖瓣狭窄并关闭不全。换瓣术后10天,出现心慌、腹胀、呕吐、尿少、肝大、肋下4cm。B超示心包大量积液,即行剑突下心包穿刺,引流出暗红色不凝血800ml。 例3,女,32岁,风湿性心脏病,二尖瓣狭窄,换瓣术后25天,出院后8天,出现心慌、厌食、呕吐、尿少,并进     

心内直视术后口腔并发症的诊疗

心内直视手术后，因病情需要，常继续保留一段时间的人工辅助呼吸。气管内插管及插管时间较长可导致口腔、咽喉等部位黏膜损伤、细菌感染，同时，由于长时间使用抗生素导致菌群失调，免疫力下降，甚至可出现双重感染。因此，对术后病人勤加观察，做到早发现、早治疗，降低或防止口腔并发症的发生。本文报告心内直视术后几种常见口腔并发症的早期表现和治疗体会。     

体外循环心内直视手术对小儿免疫功能的影响

动态观察了体外循环（ＣＰＢ）心内直视手术患儿外周血Ｔ淋巴细胞亚群睡免疫球蛋白含量。结果证实，ＣＰＢ心内直视术后早期总的Ｔ淋巴细胞（Ｔｔ）和辅助性Ｔ淋巴细胞（Ｔｈ）百分率降低，抑制性Ｔ淋巴细胞（Ｔｓ）百分率增加，Ｔｈ／Ｔｓ比值倒置，免疫球蛋白Ｇ（ＩｇＧ）含量降低。说明ＣＰＢ心内直视手术可使患儿细胞免疫和体液免疫功能降低，应给予相应治疗。     

先天性心脏病右腋下小切口心内直视术围术期的护理

目的:总结右腋下小切口心内直视手术后的监护经验,提高临床护理水平。方法:对78例经右腋下小切口行心脏矫治术患儿进行术前心理护理,术后加强循环系统的监测及呼吸道管理,预防肺部感染及肺不张,重视胸腔引流管的的护理,密切观察引流量、质的变化,做好疼痛护理。结果:本组78例患儿均顺利完成手术,病情稳定,顺利脱离呼吸机。术后未发生肺部感染,出血量少,疼痛明显减轻,切口愈合好,术后6-10天出院,出院时经超声心动图检查均未发现残余漏,未发生因护理不当而致的并发症。结论:右腋下小切口进行心脏矫治手术与传统正中切口手术护理方法不尽相同,术后尤其需要关注胸腔积液及肺不张的发生,加强呼吸道管理,重视引流管的观察与护理,是提高整体护理水平,确保手术安全成功的基础,是术后的护理要点。     

胸骨下部Y形小切口心内直视手术的解剖学基础与临床应用

目的：探讨胸骨下部Ｙ 形小切口心内直视手术的解剖学基础及临床应用。方法：采用胸骨下半部正中劈开,至胸骨角下方２ ｃｍ 处向左上、右上方剪开胸骨,使切口成Ｙ 形,行体外循环心内直视手术２７ 例,观测皮肤切口、胸骨纵切口、显露主动脉、肺动脉、右心及左心范围。结果：患者全部恢复良好,无手术死亡及严重并发症。全组皮肤切口,胸骨纵切口,显露主动脉,显露肺动脉平均长度分别为８ ．８ ±１ ．８ ｃｍ ,８ ．１ ±２ ．２ ｃｍ 、２ ．５ ±０ ．８ ｃｍ 、１ ．５ ±０ ．６ ｃｍ 。全组平均体外循环时间、主动脉阻断时间、手术时间分别为８５ ±４５ ．４ ｍｉｎ 、３９ ．４ ±３０ ．６ ｍｉｎ 、１８０ ．５ ±５１ ．１ ｍｉｎ 。术后平均呼吸机辅助呼吸６ ．１ ±５ ．６ｈ 、术后第１ 天平均出血量１５０ ±７１ｍｌ,平均输血量１５０ ±１４３ｍｌ,术后住院时间９ ．７ ±１ ．５ 天,术后患者无胸骨畸形,切口疤痕小。结论：胸骨下部Ｙ 形小切口心内直视手术显露好,创伤小,出血少,术后恢复快,具有安全性及较好的美容效果。     

肾功能不全的探索

中医药在防治原发性肾脏病中能有效地控制其演化成肾功能不全(CRF).由于中西医对CRF认识上的差异,既谈中西医结合,就应该是有机地结合.虽然全国中西医结合肾脏病学术会议已召开了几届,但尚未引起有关专家学者的重视,故希望有关部门能引起重视并推行CRF中西医结合诊疗标准,以推动国内中西医结合防治CRF的进展.     

糖尿病肾病是早期慢性肾功能不全贫血的加重因素

目的 探讨糖尿病肾病对早期慢性肾功能不全贫血程度的影响.方法 随机抽取本院76例早期慢性肾功能不全患者（血肌酐：141～500μmol/L）分别测定血红细胞计数（RBC），血色素（Hb），红细胞压积（HCT），血肌酐（Scr），血尿素氮（BUN），观察原发病对贫血程度的影响.结果 糖尿病肾病引起的慢性肾功能不全者的贫血程度较非糖尿病肾病者严重.结论 糖尿病肾病是早期慢性肾功能不全贫血的加重因素.     

糖尿病肾病是早期慢性肾功能不全贫血的加重因素

目的：探讨糖尿病肾病对早期慢性肾功能不全贫血程度的影响，方法：B胡机抽取本院76例早期慢性肾功能不全患者（血肌酐；141－500μmol/L)分别测定血红细胞计数（RBC），血色素（Hb)，红细胞压积（HCT），血肌酐（Scr)，血血尿素氮（BUN）,观察原发病对贫血程度的影响。结果：糖尿病引起的慢性肾功能不全者的贫血程度较非糖悄病肾病者严重。结论：糖尿病肾病是早期慢性肾功能不全贫血的加重因素。     

α1—m对慢性肾功能不全患者肾功能的评价

我们观察了正常人及慢性肾功能不全患者血尿β_2-微球蛋白(β_2-m)、α_1-m、Tamm-Horsfall蛋白(THP)、BUN、Cr水平变化,并探讨其临床意义。 材料和方法 一、对象: (一)正常对照组:35例(男17例,女18例),年龄21～71(46.25±14.12)岁,为健康体检者。 (二)慢性肾功能不全组:35例(男28例,女7例),年龄19～72)43.18±16.21)岁。均为本院住院病人。肾功能不全按1985年全国肾脏病学术会议诊断标准确诊。病程1月～20年(平均4.65±0.667)。原发病为:慢性肾小球肾炎17例,隐匿性肾炎9例,糖尿病肾病、肾结核各2例,间质性肾炎、痛风、高血压肾小动脉硬化、肾结石各1例。 二、方法:对受检者采取空腹静脉血,分离血清,置-20℃以下低温冰柜备测。 α_1-m试剂盒由天津九鼎医学生物工程公司提供。β_2-m、THP试剂盒由中国原子能研究所提供。肌酐用苦味酸法、尿素氮用酶法。 三、统计学处理;结果以±S表示,组间比较用t检验。 结果 一、慢性肾功能不全(CRF)患者血清和尿β_2-m、α_1-m较正常组明显升高(p<0.01),THP明显下降(p<0.01)见表1和表2。     

前列腺增生并肾后性肾功能不全的治疗方法

目的：探讨前列腺增生并肾后性肾功能损害的处理方法及手术时机及其术后效果。方法：对30例前列腺增生并肾后性肾功能损害的患者,经留置尿管或耻骨上膀胱穿刺造瘘尿液引流,在肾功能恢复和尿动力检查膀胱逼尿肌功能恢复的前提下行经尿道前列腺电切。结果：经持续尿液引流后肾功均有明显改善,其中22例于1周后成功行前列腺电切,8例行膀胱造瘘后1～2月行前列腺电切术,手术中及术后顺利,均无严重并发症,术后顺访1～2年,排尿通畅满意,肾功能正常。结论：尿液引流是首要处理方法,肾功能恢复及膀胱逼尿肌功能恢复是手术的前提,经尿道前列腺电切是手术的主要方法。     

The role of tumour necrosis factor-alpha in renal dysfunction following mild haemorrhage in rats

Mild haemorrhage occasionally causes delayed death following failure of kidney or multiple organs, but the precise mechanisms have not yet been identified. We investigated the role of tumour necrosis factor-alpha (TNF-alpha), known as a major pro-inflammatory cytokine that leads to multiple organ failure, on the renal damage induced by mild haemorrhage. A mild haemorrhagic state was induced in male anaesthetized rats by bleeding via a common carotid catheter for 20 min at 16.7% of total body blood, 1.09 ml/100 g body weight, without fluid resuscitation. Mean arterial pressure and heart rate decreased soon after haemorrhaging but returned to baseline level up to 5 h after bleeding. TNF-alpha mRNA expression in the kidney and serum TNF-alpha levels were highest at 1 h after bleeding. Intraperitoneal pretreatment with FR167653, an inhibitory compound of TNF-alpha production, as well as of interleukin (IL)-1beta, significantly inhibited the increase in TNF-alpha. The inflammatory cell infiltration and tubular cell injury induced by haemorrhage were suppressed, and the renal dysfunction was dramatically improved by the FR167653 treatment. The morphological changes were also less in the treated group than in those that had not been treated. TNF-alpha has been reported to have striking effects on IL-1beta release and activation of neutrophils, and to play a pivotal role in the expression of the other pro-inflammatory cytokines. Our data show that endogenously-derived TNF-alpha does play a key role in the renal dysfunction during mild haemorrhage. These results should be useful to forensic pathologists to explain the pathogenesis of renal dysfunction induced by a mild haemorrhage and to identify the cause of death where there are no significant morphological changes after mild haemorrhage.     

Monocyte implication in renal allograft dysfunction

Macrophages are involved in the development and progression of kidney fibrosis. The aim of this study was to analyse the phenotype of circulating monocytes and their ability to predict kidney allograft dysfunction in living kidney transplant recipients. Whole blood samples from 25 kidney recipients and 17 donors were collected at five time‐points. Monocyte phenotype was analysed by flow cytometry, and interleukin (IL)‐10 and soluble CD163 by enzyme‐linked immunosorbent assay. One week after transplantation, surface CD163 and IL‐10 levels increased significantly from baseline [2·99 ± 1·38 mean fluorescence intensity (MFI) to 5·18 ± 2·42 MFI for CD163; 4·5 ± 1·46 pg/ml to 6·7 ± 2·5 pg/ml for IL‐10]. This CD163 increase correlated with 4‐month creatinine levels (r = 0·4394, P = 0·04). However, soluble CD163 decreased significantly from baseline at 1 week (797·11 ± 340·45 ng/ml to 576·50 ± 293·60 ng/ml). CD14⁺CD16^– monocytes increased at 4 months and correlated positively with creatinine levels at 12 and 24 months (r = 0·6348, P = 0·002 and r = 0·467, P = 0·028, respectively) and negatively with Modification of Diet in Renal Disease (MDRD) at 12 months (r = 0·6056, P = 0·003). At 4 months, IL‐10 decreased significantly (P = 0·008) and correlated positively with creatinine at 2 years (r = 0·68, P = 0·010) and with CD14⁺CD16^– monocytes at 4 months (r = 0·732, P = 0·004). At 24 h, levels of human leucocyte antigen D‐related declined from 12·12 ± 5·99 to 5·21 ± 3·84 and CD86 expression decreased from 2·76 ± 1·08 to 1·87 ± 0·95. Both markers recovered progressively until 12 months, when they decreased again. These results indicate that monitoring monocytes could be a promising new prognostic tool of graft dysfunction in renal transplant patients.     

Impact of preoperative mild renal dysfunction on short term outcome in isolated Coronary Artery Bypass (CABG) patients

Background and Aim:

It is well known that dialysis dependent renal failure increases the likelihood of poor outcome following cardiac surgery. But the results of CABG in patients with mild renal dysfunction are not clearly established. The aim of the study is to analyze the risk of preoperative mild renal dysfunction on outcome after isolated coronary surgery.

Materials and Methods:

We reviewed prospectively collected data between June 2006-Nov 2006 in 488 patients who underwent isolated CABG. We separated the data into two groups. Control group having normal renal function and study group having mild renal dysfunction (serum creatinine 1.4 mg-2.2 mg%). Among 488 patients, 412 patients were in control group and 76 patients were in the study group.

Results:

Analysis of data showed significant postoperative complications in the mild renal dysfunction group, like increased operative mortality (7.5% vs 1.6%), increased requirement of postoperative renal replacement therapy (10% vs 1.2%), increased incidence of new onset atrial fibrillation (20% vs 4.2%) and prolonged duration of ICU stay. Multivariate analysis adjusting for known risk factors confirmed preoperative mild renal dysfunction (S.creat.1.4-2.2 mg/dl) is an independent risk factor for postoperative morbidity and mortality. (Adj. OR: 4.47; 95% CI: 1.41-14.16; P=0.010).

Conclusion:

Mild renal dysfunction is an important independent predictor of outcome in terms of in-hospital mortality and morbidity in patients undergoing CABG.     

miRNA在宫颈癌早期诊断及预后中的研究进展

微小RNA(miRNA)在宫颈癌的发生、侵袭、转移和复发等过程中扮演重要角色,与其预后密切相关.宫颈癌患者血清中异常表达的miRNA可作为其无创诊断和预后判断的生物标志物,通过研究血清miRNA可以早期诊断宫颈癌,减少肿瘤的转移和复发,寻找治疗靶点,为宫颈癌的诊疗提供突破点.     

连续性肾脏替代治疗介入时机对重症急性肾损伤患者预后影响

目的分析重症急性肾损伤(AKI)行连续性肾脏替代治疗(CRRT)患者临床特点,探讨CRRT介入时机对重症AKI患者预后影响。方法回顾性分析2009年1月1日至2015年12月31日在安徽医科大学第二附属医院重症医学科明确诊断AKI行CRRT患者141例,其中男性89例,女性52例;年龄3~88岁,平均年龄53.93岁。根据改善全球肾脏病预后组织(KDIGO)指南分KDIGO 1、2期和KDIGO 3期两组,比较两组患者一般人口学特征、实验室检查、疾病严重程度及预后情况,并对患者28 d生存率进行Logistic回归分析,从而得出影响重症AKI患者28 d存活率的危险因素。结果基线资料:KDIGO 1期18例,KDIGO 2期32例,KDIGO 3期91例;KDIGO 1、2期血肌酐、尿素氮、尿酸明显低于KDIGO 3期(P<0.001),其余生物化学指标两组间未见明显差异(P>0.05)。两组患者总住院日、重症监护病房(ICU)住院日、合并症(高血压、糖尿病、冠心病、慢性肾脏病)无明显差异(P>0.05)。引起重症AKI诱因组成:脓毒症54例(占38.3%),心脏术后25例(占17.7%),失血性休克22例(占15.6%),为引起AKI诱因的前3位;诱因为心脏术后的KDIGO 1、2期患者明显高于KDIGO 3期(P<0.001)。严重程度和预后比较:KDIGO 1、2期序贯脏器衰竭评估(SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分低于KDIGO 3期,差异有统计学意义(P<0.05);KDIGO 1、2期28 d生存率(70.0%)明显高于KDIGO 3期(46.1%),差异有统计学意义(P<0.01)。经二分类Logistic回归分析,年龄、是否机械通气、白细胞、血肌酐、白蛋白与生存率无关;高SOFA评分、高APACHEⅡ评分、KDIGO 3期为28 d存活率的独立危险因素;女性、ICU入住时间增加是28 d存活率的保护因素。结论基于KDIGO分期的早期CRRT,有望改善重症AKI患者的预后。     

Absence of an impact of emotional distress on the perception of intracardiac shock discharges

The pain of transvenous cardioversion shocks in awake patients is an important clinical problem. It is unknown whether psychological factors modulate any observed variation in pain perception. Thirty-seven patients with chronic atrial fibrillation (AF; mean age 61.9 years, 29 men, 8 women) were consecutively included in the study. Pain perception of a low energy test shock (60V, 0.1J) during internal cardioversion was assessed immediately following the stimulus. Before treatment anxiety, depression, somatization were evaluated. The intracardiac shock was perceived as hypalgesic in 15 (41%) patients, as normalgesic in 10 (27%), and as hyperalgesic in 10 (32%) patients. Pain threshold was significantly lower in patients in which AF was accidentally diagnosed (p < 0.029). Age, sex, and the level of education were equally distributed over the three pain groups. The hyperalgesic pain threshold was not associated with anxiety, depression, or the patients' tendency to amplify benign bodily sensations. This study discloses a wide range of perceived pain intensity caused by a homogenous intracardiac stimulation. Anxiety and depression do not amplify perception of intracardiac shocks. Sensory gating mechanisms may play a more important role in the level of intracardiac shock perception than distressing affective factors.     

The impact of dyslipidemia on early markers of endothelial and renal dysfunction in children

BackgroundDyslipidemia has been associated with endothelial dysfunction in childhood. Impairment of renal function has been demonstrated in dyslipidemic adults.ObjectiveThe aim of this study was to assess markers of early endothelial and renal dysfunction in dyslipidemic children.MethodsThis was a cross-sectional study of 100 children with dyslipidemia and 100 age- and sex-matched control subjects without dyslipidemia aged 7–16 years. Renal dysfunction was assessed by measurement of serum creatinine and cystatin C levels, urinary beta 2-microglobulin levels, urinary albumin to creatinine (Alb:Cr) ratio, and by the estimated glomerular filtration rate (eGFR), based on serum creatinine or cystatin C. Endothelial dysfunction and early vascular changes were evaluated by ultrasound assessment of flow mediated dilation (FMD) of the brachial artery, and carotid intima-media thickness (cIMT), respectively.ResultsThe markers of early renal dysfunction showed no difference between the dyslipidemic children and control subjects except for the urinary Alb:Cr ratio that was higher in the dyslipidemic children (median, 0.007 mg/mg vs 0.005 mg/mg, p = 0.004). The urinary Alb:Cr ratio was positively correlated with the triglyceride to high-density lipoprotein cholesterol ratio (r = 0.28, p = 0.013). FMD values were lower in the dyslipidemic children than in the control subjects (8.504 ± 4.73% vs 10.535 ± 4.35%, p = 0.004), but cIMT did not differ between groups. This decrease in FMD values was evident in children aged ≥10 years. FMD was independently associated with the level of lipoprotein (a) (beta = ?0.29, p = 0.01).ConclusionAmong markers of endothelial and renal dysfunction investigated, FMD was found to be lower and the urinary Alb:Cr ratio higher in children with dyslipidemia.     

复杂肾结石手术治疗体会（附340例报告）

目的探讨复杂肾结石的手术治疗方法。方法回顾性分析340例复杂肾结石手术的临床资料。结果术后经B超或腹平片检查,34例有残留结石,取尽结石率占89%。术中术后大出血8例,其中术中止血困难肾切除2例,术后7d大出血1例经处理无效行肾切除,术后12d大出血1例经再手术止血成功,余4例经处理出血停止。肾切除率8.8%(30/340)。结论肾窦内肾盂切开或联合肾后下部切开取石,出血少、易取尽结石、肾功能影响小,是治疗复杂肾结石的理想术式之一。     

The impact of olfactory dysfunction on interoceptive awareness

This study aimed to investigate how the impairment of the olfactory system influences interoception. Interoception is known as the awareness of one's body or the sense of the condition of the body; more precisely, this construct is defined as the processing, representation, and perception of the internal physical state. Interoceptive sensitivity and chemosensory performance were assessed in 77 subjects, including 43 functional anosmics, 18 hyposmics, and 16 healthy controls. Interoceptive awareness was predicted by odor detection threshold, as well as the duration of olfactory loss in patients who suffered from reduced olfactory function—the longer the olfactory impairment, the worse the perception of bodily signals. The results of this study will significantly contribute to the basic understanding of the multifaceted effects of olfactory alterations.     

Down-regulation of miR-497 is associated with poor prognosis in renal cancer

Introduction: Clear cell renal cell carcinoma (ccRCC) is the most common type of cancer in the adult kidney, and the prognosis of metastatic ccRCC remains poor with high mortality. Recent study indicated that microRNAs (miRNAs) played critical roles in tumor progression. The aim of this study was to investigate the expression, biological role and clinical significance of miR-497 in ccRCC. Methods: Quantitative real-time PCR (qRT-PCR) was performed to detect the expression of miR-497 in renal cancer cell lines and ccRCC tissues. The association between miR-497 expression and overall survival was estimated by the Kaplan-Meier method. Gain of function assays were performed in the 786-O renal cancer cell line. Results: Expression of the miR-497 was significantly decreased in renal cancer cell lines and ccRCC tissues when compared with normal human proximal tubule epithelial cells and adjacent non-tumor tissues. Decreased miR-497 expression was significantly associated with tumor stage, histological grade and lymph node metastases. Significantly shorter overall survival was observed in patients with lower expression of the miR-497. Overexpression of miR-497 significantly inhibited renal cancer cell proliferation, migration and invasion. Conclusions: Our results demonstrated that miR-497 was decreased in ccRCC tissues and may provide a potential prognostic biomarker and a potential target for therapeutic intervention.