异氟醚控制性降压对颅内动脉瘤夹闭术病人脑脊液中S100B蛋白含量的影响

目的 对颅内动脉瘤夹闭术病人采用异氟醚控制性降压,测定动脉瘤夹闭前后脑脊液中S100B蛋白含量,研究异氟醚控制性降压对脑功能的影响。方法 择期颅内动脉瘤夹闭术病人30例,ASA Ⅰ～Ⅱ级,随机分为两组:异氟醚降压组(n=15)和异氟醚非降压组(n=15)。非降压组术中吸入异氟醚维持麻醉,呼气末浓度为1.2％。降压组行异氟醚控制性降压,平均动脉压下降幅度30％～40％,夹闭动脉瘤后降低异氟醚吸入浓度,终止降压。分别于降压前、降压后30 min、动脉瘤夹闭后即刻、停止降压后30 min(非降压组于相应时间)测定循环指标变化;于降压前、动脉瘤夹闭后即刻、2、4 h取脑脊液测定S100B蛋白含量。结果 (1)异氟醚降压后30min平均动脉压由诱导前的(95±12)mm Hg降至(59±5)mm Hg,停止降压后30 min血压回升至(75±8)mm Hg。降压后外周血管阻力及心肌收缩加速度下降,但心率及心输出量均无显著性变化。(2)降压组动脉瘤夹闭后4 h脑脊液中S100B浓度明显高于非降压组(P<0.01),而非降压组脑脊液中S100B浓度轻微升高(P<0.05)。结论 在颅内动脉瘤夹闭术中应用异氟醚控制性降压可能加重了术后脑损伤,不利于病人围麻醉期脑功能的保护。     

异氟醚控制性降压对颅内动脉瘤夹闭术血中S100B含量的影响

目的　测定颅内动脉瘤夹闭前后血中S1 0 0B蛋白含量 ,研究异氟醚控制性降压对脑功能的影响。方法　择期颅内动脉瘤夹闭术病人 30例 ,ASAⅠ～Ⅱ级 ,随机分为两组 :异氟醚降压组 (n=1 5 )和异氟醚非降压组 (n =1 5 )。非降压组术中吸入 1MAC异氟醚维持麻醉。降压组行异氟醚控制性降压 ,平均动脉压下降幅度 30 %～ 4 0 % ,夹闭动脉瘤后降低异氟醚吸入浓度 ,终止降压。分别于切皮前、动脉瘤夹闭后即刻、2、4h、术后第 1、2天取血测定S1 0 0B蛋白含量 ,并于术后 1周随访病人 ,记录有无术后神经系统并发症。结果　 (1 )异氟醚降压后 30min平均动脉压由诱导前的 (95 2± 1 2 3)mmHg降至 (5 8 8± 5 4 )mmHg ,停止降压后 30min血压回升至 (75 1± 8 3)mmHg。降压后外周血管阻力及心肌收缩加速度下降 ,但心率及心输出量均无显著性变化 ;(2 )异氟醚降压组与非降压组间同一时间点血中S1 0 0B蛋白浓度无明显差异。降压组术后第 1天及第 2天血中S1 0 0B蛋白浓度均显著升高 (F =2 94 4 ,P =0 0 1 8)。结论　在颅内动脉瘤夹闭术中应用异氟醚控制性降压可能加重了术后脑损伤 ,不利于病人围麻醉期脑功能的保护     

罂粟碱对颅内动脉瘤手术病人局部脑血流的影响

目的　观察在控制性降压下的颅内动脉瘤夹闭术中罂粟碱浸泡术野对局部脑血流(rCBF)的影响。方法　 2 4例颅内动脉瘤病人随机均分为异氟醚组 (A组 )和尼莫地平组 (B组 )。控制性降压期间 ,A组提高异氟醚吸入浓度至 1 4～ 1 6MAC ;B组尼莫地平 5～ 8μg/kg静注 ,继以 10～ 10 0 μg·kg 1·h 1的速度持续泵入 ,两组均维持MAP在 8 0～ 8 7kPa。动脉瘤夹闭后用罂粟碱浸泡术野 ,用激光多普勒血流仪连续监测rCBF的变化。结果　与动脉瘤夹闭前相比 ,夹闭后A组rCBF明显减少 (P <0 0 1) ,B组rCBF变化不大 (P >0 0 5 ) ;应用罂粟碱后 ,两组rCBF均明显高于用药前水平 (P <0 0 5 ) ,其中A组增加的幅度明显大于B组 (P <0 0 5 ) ;两组rCBF在用药后第 2 0～ 30分钟达到高峰 ,以后逐渐减少。结论　在颅内动脉瘤夹闭术中 ,罂粟碱浸泡术野可增加rCBF ;和异氟醚比较 ,术中用尼莫地平控制性降压rCBF的变化平稳     

持续输注尼莫地平对颅内动脉瘤夹闭术中脑血管痉挛的影响

目的 了解颅内动脉瘤夹闭术中异氟醚麻醉复合输注尼莫地平对脑血管痉挛的影响。方法择期颅内动脉瘤夹闭术患者30例,随机表法分为两组:异氟醚组和尼莫地平组(各15例),异氟醚组术中吸入1个肺泡气最低有效浓度(MAC)异氟醚维持麻醉;尼莫地平组在诱导后输注尼莫地平20 μg·kg-1·h-1至手术结束后,同时吸入1 MAC异氟醚维持麻醉。术中于动脉瘤夹闭前、夹闭后即刻、2 h、4 h取脑脊液采用酶联免疫吸附试验法测定S100B含量;于动脉瘤夹闭前后测定载瘤动脉近心端及远心端血流速度。结果(1)尼莫地平组在动脉瘤夹闭前后脑脊液SIOOB含量无显著变化,而异氟醚组在动脉瘤夹闭后4 h S100B含量显著升高(F=4.11,P<0.05)。(2)尼莫地平组在动脉瘤夹闭前后载瘤动脉近心端血流速度[(15±9)与(19±8)cm／s]显著低于异氟醚组[(24±13)与(26±10)cm／s,t=2.08,P<0.05],而远心端血流速度无显著性差异。结论在颅内动脉瘤夹闭术中持续输注尼莫地平20μg·kg·-1·h-1对脑血管痉挛有一定预防作用。     

中度急性高容量血液稀释联合控制性降压对颅内动脉瘤手术病人血流动力学和脑血流的影响

目的观察中度急性高容量血液稀释(AHH)联合应用控制性降压对颅内动脉瘤夹闭术病人血液动力学和局部脑血流(rCBF)的影响.方法19例颅内动脉瘤病人随机分为异氟醚组(A组,n=10)和尼莫地平组(B组,n＝9).诱导后两组均进行中度AHH(Hct= 25%～30%),监测血流动力学、颅内压(ICP)及动脉瘤跨壁压(TMP)的变化.降压期间,A组提高异氟醚吸入浓度至1.4～1.6MAC;B组尼莫地平5～8μg@kg-1静注,继以10～100μg@kg-1@h-1速率持续泵入,两组均维持MAP在8.0～8.7kPa.用激光多普勒血流仪(LDF)连续监测降压前(T0)、降压中(包括动脉瘤夹闭前T1、夹闭后T2)和升压后(T3)rCBF的变化.结果与AHH前比较,两组在AHH后Hb、Hct和CaO2均显著降低(P<0.01),MAP、CVP、HR、ICP及TMP均无显著性变化(P>0.05);两组在T0～T3期间rCBF和CaO2均无明显变化(P>0.05);T3时A组的HR快于B组(P<0.05).结论在颅内动脉瘤夹闭术中,实施中度AHH能保持血流动力学和TMP稳定,联合应用异氟醚或尼莫地乎控制性降压,不影响rCBF.     

控制性降压对颅内动脉瘤夹闭术中脑氧饱和度和术后神经认知功能的影响

目的研究近红外光谱监测下两种控制性降压方式对颅内动脉瘤夹闭术中脑氧饱和度(rSO_2)和术后神经认知功能的影响。方法选择行颅内动脉瘤夹闭术患者108例,男50例,女58例,年龄30～74岁,ASAⅠ或Ⅱ级,随机分为硝酸甘油降压组(N组)、七氟醚降压组(S组)和非降压组(C组),每组36例。N组和S组在开始剥离动脉瘤时开始控制性降压,于动脉瘤夹闭后停止降压。记录诱导前(T_0)、开始降压时(T_1)、降压后10 min(T_2)、30 min(T_3)、停止降压即刻(动脉瘤夹闭完成,T_4)、停止降压后10 min(T_5)、30 min(T_6)、手术结束时(T_7)和拔管时(T_8)的rSO_2。分别于术前和术后1、3、7 d采用简易精神状态量表(MMSE)和蒙特利尔认知功能评估量表(MoCA)评估患者认知功能。术后3个月随访并记录新发神经系统并发症及重要脏器并发症的情况。结果与T_0时比较,T_2—T_6时N组和S组rSO_2明显降低(P0.05)。T_2—T_6时N组和S组rSO_2明显低于C组(P0.05)。N组和S组不同时点rSO_2差异无统计学意义。三组不同时点MMSE评分及MoCA评分差异无统计学意义。三组术后并发症发生率差异无统计学意义。结论颅内动脉瘤夹闭术中应用七氟醚和硝酸甘油行控制性降压会降低脑氧饱和度,但不影响术后3个月内的神经认知功能。     

异丙酚后处理对颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织抗氧化作用的影响

目的 探讨异丙酚后处理对颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织抗氧化作用的影响.方法 择期拟行颅内动脉瘤夹闭术患者30例,年龄26～64岁,体重53～73 ks,ASA Ⅰ或Ⅱ级,随机分为2组(n=15):对照组(C组)和异丙酚后处理组(P组).C组吸入0.5%～2.0%七氟烷,P组在开放载瘤动脉前吸入0.5%～2.0%七氟烷,开放载瘤动脉即刻靶控输注异丙酚至术毕,血浆靶浓度设为1.2μg/ml,同时下调七氟烷吸人浓度,维持BIS 40～60.于麻醉诱导前即刻(T_0)、阻断载瘤动脉即刻(T_1)、开放载瘤动脉即刻(T_2)、开放载瘤动脉后30min(T_3)、1 h(T_4)及术毕(T_5)时测定脑脊液压力,于T_0、T_3、T_5及术后24 h(T_6)时测定脑脊液F_2-异前列腺素(F_2-IsoPs)、α-生育酚(α-T)及γ-生育酚(γ-T)的浓度.结果 与T_0时比较,L_(4,5)时C组脑脊液压力降低,T_(3～5)时P组脑脊液压力降低,T_(3,5,6)时两组脑脊液α-T及γ-T的浓度降低,F_2-IsoPs浓度升高(P＜0.05);与C组比较,P组T_(3,4)时脑脊液压力降低,T_(3,5,6)时γ-T浓度升高,F_2-IsoPs浓度降低(P＜0.05).结论 异丙酚后处理可增强颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织的抗氧化作用.     

脊柱矫形术患者控制性降压时异氟醚对压力感受反射敏感性的影响

目的观察脊柱矫形术患者控制性降压时异氟醚对压力感受反射敏感性(BRS)的影响,探讨异氟醚控制性降压的机制。方法15例择期行脊柱侧凸矫形术的女性患者,年龄13～16岁, ASAⅠ或Ⅱ级。手术初期用硝酸甘油1μg·kg-1·min-1,速率逐渐升高,控制平均动脉压(MAP)55—65 mm Hg,当心率大于95次/min时,静脉注射艾司洛尔,使心率控制在90次/min以下,随后逐渐升高吸入异氟醚浓度至1.6%,降低硝酸甘油的输注速率直至停用硝酸甘油和艾司洛尔。分别于诱导前即刻、气管插管后即刻、平卧位呼气末异氟醚浓度0.7%时、俯卧位后即刻、呼气来异氟醚浓度1.3%时、停用硝酸甘油和艾司洛尔30 min、俯卧位呼气末异氟醚浓度0.7%时、平卧位后即刻测定BRS。结果当呼气末异氟醚浓度达到1.6%后(54±14)min停用硝酸甘油和艾司洛尔。随着异氟醚呼气末浓度的增加,BRS逐渐降低,停用硝酸甘油和艾司洛尔30 min时BRS最低(P<0.05或0.01)。结论异氟醚达到一定麻醉深度后抑制BRS,此作用是其控制性降压的机制之一。     

控制性降压对颅内动脉瘤夹闭术病人血浆皮质醇醛固酮及血糖的影响

目的和方法：选择４０例在ＮＬＡ麻醉下行控制性降压的颅内动脉瘤夹闭术病人，随机等分为前列腺素Ｅ１组和异氟醚组。两组控制性低血压幅度相似（ＭＡＰ分别降至８．７３±１．５６和８．８３±１．５４ｋＰａ）。结果：降压期间两组病人血浆皮质醇、醛固酮和血糖浓度较降压前明显增高（Ｐ＜０．０５），特别是剥离动脉瘤时皮质醇增高更是明显（Ｐ＜０．０１），手术结束时三者仍轻度增高。结论：在低血压下实施这种手术，只要手术侵袭和降压幅度相仿，所导致的应激反应也相似，并不因应用ＰＧＥ１或异氟醚降压而有所不同。     

尼卡地平控制性降压对局部脑氧饱和度的影响

目的观察颅内动脉瘤夹闭术中控制性降压对局部脑氧饱和度(rScO2)的影响。方法 15例ASAⅠ级的择期颅内动脉瘤夹闭手术患者,丙泊酚-瑞芬太尼全凭静脉麻醉,暴露动脉瘤期间静脉泵注尼卡地平0.5～1μg·kg-1·min-1,逐渐降低术前基础MAP的10%、20%和30%,夹闭动脉瘤后停止降压,观察降压过程中MAP、HR和rScO2的变化趋势。结果尼卡地平控制性降压过程中,随着MAP的逐渐下降,rScO2略有升高,T5时rScO2恢复至T1水平,各时点MAP、HR、PETCO2、BIS和rScO2差异均无统计学意义。结论颅内动脉瘤夹闭术中应用尼卡地平行控制性降压安全可行,不会影响脑氧供需平衡。     

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。     

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。     

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.     

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.     

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.     

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。     

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.     

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.     

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