腹腔镜术中体位对呼吸循环功能的影响

目的观察腹腔镜手术期间体位对患者呼吸循环功能的影响。方法A组,女性腹腔镜胆囊切除术患者30例,术中取反向特伦伯格卧位;B组,女性卵巢囊肿切除术患者30例,术中取特伦伯格卧位,监测气腹前(T0)、气腹后体位改变前(T1)、体位改变后15 min(T2)、30 min(T3)、术毕气管导管拨出后10 min(T4)时的MAP、HR、SpO2、肺胸顺应性(Comp)、气道阻力(Raw)、气道峰压(Ppeak)、PETCO2。结果T1、T2、T3时与T0时比较两组HR、MAP、Ppeak、Raw、PETCO2明显升高,Comp降低(P<0.05);T2时点后A组Raw、Ppeak、PETCO2明显低于B组,Comp高于B组(P<0.05),T4时B组患者HR、MAP明显高于A组。结论气腹与体位均使患者循环动力学发生改变,通气功能下降,其中以特伦伯格卧位下降更为明显。     

选择性肺叶隔离通气用于COPD老年患者开胸手术时的通气效果

目的 评价选择性肺叶隔离通气用于慢性阻塞性肺病(COPD)老年患者开胸手术时的通气效果.方法 择期拟行食管癌根治术合并COPD的老年患者30例,年龄65～80岁,体重指数16～ 28 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=15):单肺通气组(OLV组)和选择性肺叶隔离通气组(SLC组).OLV组患者采用双腔气管导管实施单肺通气,SLC组患者使用支气管堵塞器堵塞肺叶支气管,实施选择性肺叶隔离通气.于平卧位双肺通气10 min(T0)、侧卧位单肺通气或选择性肺叶隔离通气5 min(T1)、45 min(T2)、90 min(T3)、术毕侧卧位双肺通气10 min(T4)时测定气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)和动态肺顺应性(Cd).于T0、T3、T4时采集动脉血样,行血气分析,计算氧合指数(OI)、肺泡-动脉血氧分压差[P(A-a)Q2]和呼吸指数(RI).结果 与OLV组比较,SLC组T2～4时Peak、Pplat及Raw降低,T1～4时Cd升高,T3,4时0I升高、P(A-a)O2和RI降低(P＜ 0.05或0.01).结论 COPD老年患者胸科手术时,单肺通气和选择性肺叶隔离通气均可安全完成手术,实施肺叶隔离通气能改善氧合,具有更好的通气效果.     

双腔管肺通气时判定选择性单肺通气的声学监测方法

气管内插管最常见的并发症是置入一侧支气管（单肺插管）（OLI）。对此，目前尚无有效的早期监测方法。在本研究中我们探讨使用声学分析的方法来判定单肺插管。11例需要使用双腔气管导管的胸外科手术患者纳入研究。麻醉诱导后及确认双腔气管导管位置正确后，于手术前记录每侧肺的通气数据。使用3个压电扩音器来记录肺呼吸音，其中每侧胸壁各一个，第3个置于右前臂用于记录背景噪音。采集到的声音经过滤后，计算信号的能量包，并将呼吸及其间歇分为小片段。根据单肺能量信号的比率，呼吸被分成以下三类：双侧通气、选择性的右肺通气以及选择性的左肺通气。右肺通气时11例患者中有10例可以通过此项技术确认，在左肺通气时确认率达到100％。研究提示声学监测能有效地监测选择性单肺通气，并可用于早期诊断OLI。     

肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响

目的 评价肺叶支气管填塞通气对食管癌根治术患者肺内分流的影响。方法 择期行食管癌根治术患者24例，随机分为2组（n=12）：A组为双腔支气管导管组。B组为肺叶支气管填塞气囊组。麻醉诱导后，A组插入双腔支气管导管，B组先插入单腔气管导管，再在纤维支气管镜引导下插入支气管填塞气囊。两组均先行双肺通气30min，再行肺隔离通气至少30min，A组为单肺通气。B组为肺叶支气管填塞通气。术中监测气道压。分别于清醒仰卧位自主呼吸空气时（L）、侧卧位双肺通气30min（T1）和肺隔离通气30min（T2），抽取桡动脉血和中心静脉血标本，测定血气和血红蛋白，计算肺内分流率（Qs／Qt），采用放免法测定动脉血浆血栓素B2（TXB2）和6-酮-前列腺素F1α（6-k-PGF1α）浓度。结果 与A组比较。仅T2时B组PaO2升高，气道压、Qs／Qt及TXB2浓度均降低（P〈0．05）。与Tn比较，T1时两组Qs／Qt均升高（P〈0．05），TXB2浓度变化无统计学意义（P〉0．05）；与T1比较，R时A组Qs／Qt和TXB2浓度升高（P〈0．05），而B组变化无统计学意义（P〉0．05）。两组6-k-PGF1α浓度组内及组间比较差异均无统计学意义（P〉0．05）。结论 肺叶支气管填塞通气可以通过降低开胸手术期间的肺内分流来提高机体的氧合功能。     

结构性心理干预对乳癌围术期患者心理状态的影响

目的 研究体位交替更换对心脏术后气管插管患者生命体征的影响，了解其可行性，以确保体位护理在此类患者中的有效实施。方法 对35例气管插管时间＞24h的心脏手术后患者于清醒后实施半卧位，左、右侧卧位各1h交替及晨、晚问仰卧位各1h的体位护理，比较不同体位HR、SBP、SaO2值及不适情况。结果 不同体位对HR、SBP无显著影响（均P＞0.01）；半卧位，左、右侧卧位即刻及30min时SaO2值均比仰卧位高（均P＜0.05）：半卧位和左、右侧卧位不同时间SaO2值比较，差异无显著性意义（均P〉0.05）。不适症状除腰痛外，伤口胀痛、胸闷和紧张发生率仰卧位均显著高于其他卧位（均P〈0.05）。结论 体位改变对患者的生命体征无负面影响，可促进肺氧合功能，增加患者舒适度。     

全麻诱导插管牙齿脱落误入气管一例

患者,男,68岁,ASAⅡ级,诊断为右上肺癌,拟在全麻下行肺癌根治术.入手术室后连接监护仪,建立静脉通道后开始麻醉诱导,静注咪达唑仑6 mg、舒芬太尼0.03 mg、依托咪酯20 mg、顺式阿曲库铵10 mg,气管内插入左侧双腔37号导管,胸部听诊导管进入右侧支气管内,左肺通气差.经调整导管位置多次仍未达到理想效果,为避免意外损伤,将双腔管退至主气管.患者左侧卧位后气道压明显升高,潮气量减小,需手控呼吸将气体压进肺内.换单腔气管插管改平卧位,加深麻醉,插入8号单腔导管,通气好,气道压23mm Hg,呼吸压力容量环近正常,再次左侧卧位.数分钟后再次出现气道压明显升高达40 mm Hg以上,潮气量减小,需手控呼吸.     

压力控制容量保证通气模式对全麻患者呼吸力学的影响

目的观察压力控制容量保证(PC-VG)通气模式对全麻患者呼吸力学的影响。方法择期行平卧位下腹部和盆腔剖腹手术全麻患者40例,随机分为两组,分别采用PC-VG模式(P组)和容量控制通气(VCV)模式(V组)行机械通气。记录气管插管后5min(T0)、15min(T1)、30min(T2)、60min(T3)、120min(T4)气道峰压(Ppeak)、气道平均压(Pmean)、气道平台压(Pplant)及肺顺应性(CL)和气道阻力(Raw)。结果与T0时比较,T1~T4时V组中Ppeak、Pmean、Pplant、Raw明显升高(P0.05或P0.01),两组CL均明显降低(P0.01),P组Raw明显升高(P0.05)。与V组比较,P组T1~T4时Ppeak、Pplant明显降低(P0.05),T4时P组CL明显升高(P0.05)。结论 PC-VG模式对全麻患者呼吸力学影响较小。     

右肺下叶切除术中癌栓脱落阻塞气道一例

患者,男,52岁,体重58kg。因反复咳痰1年,咯血伴右侧胸痛半年入院纤维支气管镜检查诊断为右下叶支气管息肉样新生物。拟行右肺下叶切除术麻醉诱导后,插入39Fr左双腔支气管导管,听诊双肺呼吸音分隔、对位良好。左侧卧位下行右侧开胸,开胸后改左侧单肺通气机控呼吸,潮气量8ml/kg,呼吸频率16/min,气道压19cmH2O,SpO2维持在100%,单肺通气历时1h。在使用支气管残端闭合器切除右中、下肺叶,检查支气管残端有无漏气时,发现导管右侧支气管腔完全堵塞,吸痰管不能通过将双腔管退至总气管,右肺上叶膨胀良好,行双肺通气。约10min后脉搏、氧饱和度不明原…     

开胸术病人不同参数单肺通气的效果

目的评价开胸术病人不同参数单肺通气（OLV）的效果。方法择期行开胸术病人28例，ASAⅡ或Ⅲ级，麻醉诱导后双腔支气管插管，双肺通气（TLV）30min，设定潮气量（VT）为10ml／kg,呼吸频率（RR）12次／min。OLV时在保持分钟通气量不变的情况下，所有病人均先采用OLV1（VT10ml／kg，RR12次／min）30min，后改为OLV2（VT8ml／kg，RR15次／min）30min，最后改为OLV3（VT6ml／kg，RR20次／min）30min，分别于，ITLV前及OLV时每次调整VT后30min行动脉血气分析，同时监测气道峰压（Ppeak）、气道阻力（Raw）及血液动力学变化，计算每种通气方式的高气道压发生率。结果与TLV时比较，OLV时动脉血氧分压均明显下降，其中OLV3时动脉血二氧化碳分压上升（P〈0．01）；OLV时Ppeak及Raw均增高，其中OLV1时增高明显（P〈0．05）。OLV。时高气道压发生率达53．6％，高于OLV2及OLV3时（P〈0．01）。结论开胸术病人单肺通气时，VT8ml／kg及RR为15次／min通气效果较好。     

开胸手术患者进胸前非通气侧肺通气量的测定

目的 研究开胸手术患者进胸前非通气侧肺通气量的大小.方法 采用旁气流(SSS)技术对50例择期开胸手术患者开胸前非通气侧肺通气量进行监测.观察患者平卧位、侧卧位非通气侧肺阻力环(F-V环)、通气流率(PEF)、I:E、RR等参数的变化.结果 平卧位时观察到非通气侧肺的F-V环为锯齿状封闭的环,环的上下较对称.整个呼吸周期PEF不恒定,为(3.89±0.69)L/min,VT为(72.56±17.27)ml,I:E和通气侧相反,但观察结果 不稳定,RR与对侧RR一致;侧卧位时,非通气侧肺F-V环变大,环上锯齿相对平卧位时少,上下较对称.PEF不恒定,为(5.24±0.61) L/min,VT为(158.67±17.79)ml,I:E观察结果 也不稳定,RR与对侧RR一致.与平卧位相比,侧卧位时非通气侧肺PEF、VT增加(P＜0.05).开胸后,F-V环、PEF逐渐变小,消失.结论 单肺通气时非通气侧肺在双肺完全隔离的条件下存在低潮气量通气,采用SSS技术能很好地对非通气侧肺进行连续监测,能动态测定患者非通气侧肺PEF、VT等通气指标.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.