微创右腋下直切口与常规胸骨正中切口手术治疗室间隔缺损的效果

目的比较微创右腋下直切口与常规胸骨正中切口手术治疗室间隔缺损的效果。方法将实施室间隔缺损修补术的80例室间隔缺损患儿随机分为2组,各40例。对照组经常规胸骨正中切口手术,观察组实施微创右腋下直切口手术。比较2组的临床效果。结果 2组患者均顺利完成手术,无手术死亡病例。2组术后体外循环时间、呼吸机辅助时间差异无统计学意义(P0.05)。观察组手术时间,术后引流量、住院时间及术后并发症发生率均优于对照组,差异有统计学意义(P0.05)。结论与常规胸骨正中切口比较,应用微创右腋下直切口行室间隔缺损修补手术治疗室间隔缺损,创伤小、术后恢复时间快、并发症少、安全性高。     

胸腔镜下室间隔缺损修补术

目的　探讨胸腔镜下室间隔缺损修补术。　方法　 16例先天性心脏病 (男 10例 ,女 6例 )。年龄 (6～ 2 7)岁。 (14± 7)岁 ,体重 (17～ 6 7)kg ,(38 5± 16 8)kg。采用股动静脉插管 ,在患者右侧第四肋间胸骨旁、第四肋间腋中线、第七肋间腋中线各打一个直径 1cm～ 3cm的孔 ,经第四肋间腋中线插入上腔静脉插管 ,建立体外循环 ,阻闭升主动脉 ,冠脉冷灌 ,心脏停搏 ,切开并悬吊右心房 ,显露三尖瓣及室间隔缺损 ,缝合室间隔缺损 ,缝合右心房切口 ,开放升主动脉。　结果　 16例手术均获成功 ,主动脉阻闭时间 (2 7～ 6 7)min ,(43± 13)min。体外循环时间 (6 6～ 16 8)min ,(95± 33)min。术后心脏杂音消失 ,心脏超声检查示无心内分流。　结论　胸腔镜下可完成室间隔缺损修补术的全部心内操作。也为室间隔缺损修补术提供了另一种选择。     

右外侧小切口剖胸在先天性心脏病手术中的应用

目的　总结经右外侧小切口剖胸在先天性心脏病手术中应用的体会。　方法　 1994年 10月～ 2 0 0 3年 3月 ,共完成经右外侧体外循环下先天性心脏畸形矫治术 12 5 8例。心内畸形包括房间隔缺损 2 93例、室间隔缺损 6 0 4例、室间隔缺损合并房间隔缺损 98例、法乐氏四联症 177例、部分心内膜垫缺损 2 9例及其它畸形 5 7例。合并畸形包括 :动脉导管未闭 ,永存左上腔静脉 ,二尖瓣关闭不全 ,肺静脉畸形引流 ,右室流出道狭窄等。　结果　本组手术死亡 9例 (0 7% ) ,其中 5例因术后低心输出量综合征 ,2例因严重肺感染 ,1例因灌注肺 ,1例因肺高压危象。术后并发症 36例 (2 9% )。体外循环时间 (6 0 3±32 1)分 (15分～ 35 9分 ) ,心肌阻断时间 (37 7± 2 4 6 )分 (3分～ 2 0 5分 )。术后机械通气 (19 7± 34 4 )小时 (1 5小时～ 4 0 1小时 ) ,住院时间 (8 0± 12 1)天 (5天～ 30 0天 )。　结论　右外侧小切口具有损伤小、瘢痕隐蔽、不破坏胸廓连续性、防止术后鸡胸等优点 ,符合微创外科的原则     

经胸骨旁小切口房间隔缺损的微创治疗

目的评价经胸骨旁小切口微创体外循环下房间隔缺损的治疗与经传统开胸手术治疗的优缺点。方法回顾性分析2010年11月至2014年3月华西医院心脏外科行体外循环单纯房间隔缺损修补术55例患者的临床资料,其中男16例、女39例,年龄25.8(9~56)岁。根据术前手术入路不同将患者分为胸部正中切口组(开胸组,15例)和胸骨旁小切口组(小切口组,40例)。术前两组患者年龄、性别、体重、心功能分级(NYHA)、房间隔缺损直径差异无统计学意义(P0.05)。评估两组患者术中、术后数据及随访半年后的疗效。结果全组无术后死亡病例。开胸组1例因术后心功能差延长了住院时间,小切口组1例因肺部感染延长住院时间。小切口组患者的手术时间、体外循环时间更长,且差异有统计学意义(P=0.007,P0.001);住院费用更高,差异也有统计学意义(P=0.040),术中平均出血量、术后第1 d胸腔总引流量均明显减少,差异有统计学意义(P均小于0.001)。两组主动脉阻断时间(P=0.500)和术后平均住院时间差异无统计学意义(P=0.290)。排除学习曲线的干扰,两组患者手术时间(P=0.275)和住院费用(P=0.188)差异无统计学意义,而体外循环时间差异仍有统计学意义(P=0.007)。随访6个月后两组患者均未出现残余分流,无伤口并发症。两组术后3周可从事非重体力活动的比例差异有统计学意义(P0.001)。结论胸骨旁小切口治疗房间隔缺损安全、有效、微创,开展较容易,学习曲线短,可作为房间隔缺损微创整体治疗流程中的重要一环。     

淋巴细胞总量及比例变化在脊柱退变性疾病术后伤口感染早期诊断中的应用

目的 探讨外周血淋巴细胞总量及其比例变化在脊柱退变性疾病术后伤口感染早期诊断中的临床应用价值。方法 回顾性分析我院脊柱外科2015年1月至2020年12月脊柱退变性疾病手术后发生伤口感染的病人20例（其中颈椎手术6例,腰椎手术14例;浅表软组织感染9例,深部感染11例）,设为感染组。同时选取同期术后未感染的病人20例纳入对照组。对比分析病人术前及术后3、7、14 d外周血中的白细胞总数、中性粒细胞总数、淋巴细胞总数、淋巴细胞比例、C反应蛋白（CRP）、红细胞沉降率（ESR）等参数变化。结果 感染组术后3、7、14 d的CRP、ESR、白细胞总数、中性粒细胞总数均较术前显著提高,且随着时间推移逐步下降;同一观察时间点,感染组的数值均明显高于对照组,差异有统计学意义（P＜0.05）;但中性粒细胞总数和ESR在术后3 d和7 d的变化比较,差异无统计学意义（P＞0.05）。感染组术后3、7、14 d的外周血淋巴细胞总数及淋巴细胞比例较术前明显下降,且随着时间推移逐步上升;且感染组术后3、7 d的淋巴细胞总数和术后3、7、14 d的淋巴细胞比例均显著低于对照组,差异有统计学意义（P<0.05）。对照组术前及术后3、7、14 d的外周血淋巴细胞总数及淋巴细胞比例两两比较,差异均无统计学意义（P＞0.05）。感染组病人术后3 d淋巴细胞总数及其比例的ROC曲线下面积（AUC）分别为0.980、1.000,约登指数分别为0.900、1.000,最佳临界值分别为1.545×10⁹/L、0.265;术后7天的AUC分别为0.898、1.000,约登指数分别为0.750、1.000,最佳临界值分别为1.670×10⁹/L、0.280。结论 同CRP、白细胞总数变化一样,术后早期分析外周血中淋巴细胞总数及比例变化同样有助于脊柱手术术后感染的早期诊断,为早期针对性治疗提供可靠依据。     

动态监测PCT、WBC、ESR、hsCRP诊断骨科内固定术后早期切口感染

目的探讨血清降钙素原(PCT)联合血清白细胞(WBC)、红细胞沉降率(ESR)、超敏C反应蛋白(hs CRP)连续监测在骨科内固定术后早期切口感染诊断中的意义。方法观察骨科内固定术后疑似切口感染者54例,分为感染组(21例)和非感染组(33例),术前1 d及术后第1、2、3、5、7天取空腹外周静脉血3 ml检测PCT、WBC、ESR、hs CRP。结果感染组术后第3、5、7天PCT高于非感染组,差异有统计学意义(P0.05)。2组术后各时间点WBC差异无统计学意义(P0.05)。2组术后第1、2、3天ESR、hs CRP差异无统计学意义(P0.05);感染组术后第5、7天ESR、hs CRP明显高于非感染组,差异有统计学意义(P0.05)。结论动态监测PCT、WBC、ESR、hs CRP可以明确骨科内固定术后早期感染的诊断。     

小剂量激素在肺减容手术后的早期应用

目的探讨肺减容术(LVRS)后患者早期应用小剂量、短疗程激素治疗的临床意义。方法2001年4月~2004年3月27例慢性阻塞性肺疾病(COPD)患者在我院胸外科行电视胸腔镜(VATS)辅助小切口单侧肺减容术,术后按是否给予激素治疗分为激素治疗组与非激素治疗组,激素治疗组静脉给予地塞米松10mgtid,连续3d,然后改为强的松5mgqd,连续7d后停药。记录两组的胸腔引流量、拔管时间、漏气时间、发热时间等指标,同时术后第1、3、7和30d测定血气分析、血常规等指标。结果术后两组漏气时间差异无统计学意义(P>0.05);总胸腔引流量激素治疗组明显少于非激素治疗组(700±210mlvs.950±150ml,P=0.001);拔胸腔引流管时间激素治疗组较非激素治疗组早(9±3dvs.12±2d,P=0.005)。在术后1、3d时动脉血氧分压(PaO2)激素治疗组高于非激素治疗组(P<0.05)。在第3、7d时白细胞计数激素治疗组略低于非激素治疗组,两组结果比较差异无统计学意义(P>0.05)。手术后早期两组均无并发感染和死亡患者。结论对肺减容术后患者短期内(本组为10d)使用小剂量激素治疗可以减轻胸膜炎症反应、减少胸腔引流量、缩短拔管时间,而并不增加术后早期并发症的发生,同时对术后动脉血气的改善无明显影响。     

特发性脊柱侧凸后路矫形术后两种引流方式的对比观察

【摘要】 目的：观察特发性脊柱侧凸患者后路矫形术后皮下引流与肌层下引流情况,比较两种引流方式的效果。方法：2005年2月~2007年9月在我院行后路脊柱侧凸矫形同种异体骨植骨融合内固定术患者89例,其中放置皮下引流组（A组）42例,放置肌层下引流组（B组）47例。收集两组患者围手术期数据,包括人口统计学资料（年龄、性别、身高、体重及身体质量指数）、术前侧凸分型与主弯Cobb角、术中资料（手术时间、估计失血量、自体血回输量、输异体红细胞悬液及术中融合节段）、术后切口引流量、术后输血量、术后发热时间与72h体温峰值、术后置管时间及出院时切口愈合等级,对所得数据进行统计学分析。结果：两组患者人口统计学资料、术前主弯Cobb角、主要侧凸类型比例和术中资料差异均无统计学意义（P>0.05）。术后A组平均引流量为26.67±26.61ml（0~90ml）,平均输血量为红细胞悬液0.76±1.34U（0~5U）,平均发热天数为2.14±1.39d（0~6d）,72h体温峰值为37.95±0.53℃（37.3~39.3℃）,平均置管时间为1.86±0.36d（1~2d）;术后B组平均引流量为1343.13±555.41ml（700~2350ml）,平均输血量为红细胞悬液2.44±2.00U（0~5.5U）,平均发热天数为1.75±1.24d（0~4d）,72h体温峰值为37.82±0.44℃（37.3~38.7℃）,平均置管时间为5.13±1.20d（3~7d）。两组术后切口引流量、置管时间及术后输血量差异均有统计学意义（P<0.05）,但两组术后发热天数、72h体温峰值及切口愈合等级差异均无统计学意义（P>0.05）,且均未出现切口感染。结论：特发性脊柱侧凸后路矫形术后放置皮下引流与肌层下引流相比,前者能够减少术后切口引流量、置管时间及术后输血量,同时未增加切口感染率,是一种较为安全的方法,具有一定的临床应用价值。     

经胸小切口封堵房间隔缺损手术效果观察

目的总结经胸小切口封堵房间隔缺损手术经验与疗效。方法2001年5月~2005年9月,我院采用非体外循环经胸小切口治疗房间隔缺损206例,房间隔缺损直径4.8~44.3 mm,其中>30 mm 100例,房间隔缺损伴膨出瘤2例。右侧第4肋间做2~3 cm小切口,显露右心房并在其外侧壁荷包缝合,将双腔推送导管穿刺入右心房,在食管超声引导下经房间隔缺损送入左心房,并释放直径比房间隔缺损最大径大4 mm的镍钛记忆合金封堵器,退出推送导管。结果206例均顺完成手术。手术时间18~32(26±7)m in。无手术死亡,无封堵器脱落。术后5 h拔除气管插管,患者当日即可下床活动。术后3 d复查彩色多普勒,无残余分流。术后住院(4±2)d。186例随访6个月,57例随访3~4.5年,病人恢复良好,彩色多普勒显示均无残余分流,心功能均正常。结论经胸小切口封堵方法治疗房间隔缺损安全可靠,适用于不能介入封堵的房间隔缺损治疗。     

杂交(hybrid)手术在复杂性先天性心脏病治疗中的初步应用

目的探讨结合介入器械和实时影像学的术中"杂交"(hybrid)手术对复杂性先天性心脏病的治疗价值.方法2005年3月～10月,我院行hybrid手术治疗7例复杂性先天性心脏病.球囊扩张组3例均为室间隔完整型肺动脉闭锁(PAIVS)的新生儿.缺损封堵组4例,其中1例右冠状动脉异常起源于肺动脉合并房间隔缺损,1例右侧肺静脉异位引流合并房间隔缺损(ASD),2例多发室间隔缺损(VSD).正中进胸,在超声引导下经右室流出道置入球囊扩张管扩张肺动脉瓣或经右心房植入封堵器.多发室间隔缺损于体外循环下经三尖瓣植入封堵器.合并的其他心脏病变同期常规外科矫正.术后心脏超声随访.结果7例均顺利出院,无一例手术死亡.3例PAIVS术后中位住院时间10 d,余4例均在术后7 d出院.随访1～6个月,7例生长发育良好,人工体肺分流管通畅,未发现中度以上的肺动脉瓣再狭窄,ASD和多发VSD术后均未发现明显残余分流及封堵器移位,均无影响瓣膜功能等并发症发生.结论hybrid手术可以不采用体外循环,减少手术创伤,对于提高复杂性先天性心脏病的疗效具有重要的意义.     

Hemostatic consequences of a non-fresh or reconstituted whole blood small volume cardiopulmonary bypass prime in neonates and infants

Objectives: Despite aggressive measures to miniaturize the cardiopulmonary bypass (CPB) circuit in neonates and infants, the CPB prime volume is often at least as large as the patients’ blood volume. We conducted an observational study to characterize the hemostatic consequences of a CPB prime consisting of either non‐fresh or reconstituted whole blood. Methods: Hematocrit, fibrinogen, platelet count, plasminogen, anti‐thrombin III (AT‐III), and factors (F) II, V, VII, IX, and X of 30 neonates and infants undergoing cardiac surgery with CPB utilizing either a non‐fresh or reconstituted whole blood prime were prospectively evaluated at eight time points. Following protamine administration, microvascular bleeding was treated by protocol. Results: The hemostatic composition of the CPB prime was the same following the use of either non‐fresh or reconstituted whole blood. The CPB prime platelet count (mean ± sd ) was 5.87 ± 2.84 × 10³ μl^?1 when compared to a preoperative platelet count of 298 ± 142 × 10³ μl^?1 (P < 0.0001). Twenty patients received 17.3 ± 9.2 ml·kg^?1 (0.86 ± 0.46 units·kg^?1) of platelets with significant improvement in platelet count. Nine patients received 16.7 ± 13.4 ml·kg^?1 (0.84 ± 0.67 units·kg^?1) of cryoprecipitate with significant improvements in FVIII and fibrinogen. Conclusions: Non‐fresh or reconstituted whole blood as a component of a small volume CPB prime in neonates and infants induces clinically significant dilutional thrombocytopenia in conjunction with less significant reductions in fibrinogen, FII, FV, FVII, FVIII, FIX, FX, plasminogen, and AT‐III.     

Effect of the Neutrophil Elastase Inhibitor Sivelestat on Perioperative Inflammatory Response After Pediatric Heart Surgery With Cardiopulmonary Bypass: A Prospective Randomized Study

Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The neutrophil elastase inhibitor sivelestat is known to suppress this systemic inflammatory response, which can eventually result in acute organ failure. The prophylactic effect of sivelestat on acute lung injury, especially in pediatric cardiac surgery, remains unclear. This prospective double‐blind, randomized study evaluated the perioperative prophylactic effect of sivelestat in patients undergoing elective pediatric open heart surgery with CPB. Thirty consecutive patients, weighing 5–10 kg and undergoing open heart surgery with CPB, were assigned to sivelestat (n = 15) or control (n = 15) groups. From CPB initiation to 24 h after surgery, patients in the sivelestat group received a continuous intravenous infusion of 0.2 mg/kg/h sivelestat, whereas patients in the control group received the same volume of 0.9% saline. Blood samples were collected, and levels of interleukin (IL)‐6, IL‐8, tumor necrosis factor alpha, polymorphonuclear elastase (PMN‐E), C‐reactive protein (CRP), as well as the white blood cell (WBC) count, platelet count, and neutrophil count (NC) were measured. PMN‐E levels, IL‐8 levels, WBC count, NC, and CRP levels were significantly lower, and platelet count was significantly higher in the sivelestat group, according to repeated two‐way analysis of variance. The activated coagulation time was significantly shorter in the sivelestat group, similarly, blood loss was significantly less in the sivelestat group. In conclusion, Sivelestat attenuates perioperative inflammatory response and clinical outcomes in patients undergoing pediatric heart surgery with CPB.     

Larger prostate causes higher frequency of infectious complications in prostate biopsy

INTRODUCTION: Prostate biopsy (PBX) is being performed more often than ever before for the early detection of prostate cancer, but some patients may have febrile infectious complications after biopsy. The risk factors of infectious complications need to be considered. METHODS: We investigated the pre-biopsy risk factors and febrile infectious complications in 120 patients who underwent PBX in our institution. The pre-biopsy risk factors set were prostate volume (> or = 40 ml), transitional zone (TZ) volume (> or = 20 ml), core number of biopsy (> or = 10 cores), and additional performance of TZ biopsy. We analyzed statistically the correlations between these risk factors and C-reactive protein and peripheral white blood cell (WBC) count elevation on day 1 and day 7 after biopsy. RESULTS: Our results showed that a prostate volume > or = 40 ml and a TZ volume > or = 20 ml caused a significantly higher elevation of the C-reactive protein level compared with a prostate volume < 40 ml (p = 0.0055 on day 1 and p = 0.0225 on day 7, respectively) on day 1 and day 7, and a TZ volume < 20 ml (p = 0.0008) on day 1. Regarding WBC count, those patients with a prostate volume > or = 40 ml and a TZ volume > or = 20 ml had a tendency to have an elevated WBC count on day 1 compared with those patients with a prostate volume < 40 ml and a TZ volume < 20 ml, and however these changes were not significant. CONCLUSIONS: This study showed that a larger prostate volume and a larger TZ volume may possibly be risk factors in infectious complications after PBX, although we can perform additional TZ biopsy and increase biopsy core number safely if necessary.     

腹腔镜肾囊肿去顶术不同入路对机体应激反应的影响

目的：探讨经腹腔途径（trans-peritoneal laparoscopy,TPL）和腹膜后途径行腹腔镜（retro-peritoneal laparoscopy,RPL）肾囊肿去顶术对机体应激反应的影响机制。方法：选择肾囊肿患者60例,分别行TPL手术（30例）和RPL手术（30例）。于术前、术终、术后第1、3天分别检测体温、白细胞计数（white blood cell,WBC）、C反应蛋白（C-reactive protein,CRP）、白细胞介素-6（interleukin-6,IL-6）、血糖及皮质醇水平,比较两组应激反应程度。结果：术终及术后第1天体温TPL组高于RPL组（P=0.023、P=0.002）。两组WBC术后第1、3天高于术前（P〈0.05）,且术后第1天TPL组明显高于RPL组（P〈0.01）。两组CRP术后第1、3天明显高于术前（P〈0.01）,TPL组均高于RPL组（P=0.032、P=0.045）。两组血糖和IL-6在术后第1、3天均升高（P〈0.05）,但差异无统计学意义（P〉0.05）。皮质醇在术终及术后第1、3天均升高（P〈0.05）,但差异无统计学意义（P〉0.05）。结论：两种入路的腹腔镜手术患者创伤程度均较小,应激水平较低,但在肾囊肿去顶术中,经后腹腔入路对机体的应激反应小于经腹腔入路。     

Effect of autologous platelet-rich plasma (PRP) in cardiac surgery

Autologous platelet-rich plasma (PRP) was harvested before cardiopulmonary bypass (CPB). After heparin neutralization, it was returned to patients. The purpose of this study was to examine platelet function and the amount of blood loss and blood transfusion after transfusion of PRP. Twenty-eight patients undergoing elective coronary artery bypass grafting and other procedures were divided into three groups: group A; patients undergoing CAGB between May and October 1997 (n = 10), group B; patients undergoing other between May and October 1997 (n = 8), group C; patients undergoing CAGB before May 1997 (n = 10). Blood cell count, platelet aggregation in response to ADP, and platelet adhesion were measured before CPB, just after CPB, after infusion of protamine and PRP, 24 hrs after CPB and 48 hrs after CPB. Blood loss and blood transfusion in group. A and group C were examined after CPB. There was no significant difference in platelet count between group A and group B. There was significant difference in platelet aggregation in group A. There was no significant difference in blood loss after CPB between group A and group C, but there was a significant difference in blood transfusion between group A and group C. These results suggest that PRP was useful to preserve platelet function and to decrease blood loss after CPB in cardiac surgery.     

胃癌术后早期炎症与肠道黏膜通透性的关系

目的探讨肠道黏膜通透性（D-乳酸含量）与外周血中内毒素含量和WBC计数之间的关系。方法胃癌行手术病人62例,检测术前和术后第1、3、7天的外周血中D-乳酸、内毒素、WBC计数水平并进行比较。结果术后第1天、第3天D-乳酸、内毒素及WBC计数均高于术前及第7天（P〈0．05）;术后第1、3、7天血清D-乳酸水平与内毒素之间均呈正相关。结论胃癌手术后第1天开始肠黏膜通透性增加,炎性反应明显,术后第3天达到高峰。肠道菌群易位与炎症反应有关。     

Residual air in the venous cannula increases cerebral embolization at the onset of cardiopulmonary bypass.

OBJECTIVE: When the right atrium (RA) cannula is connected to the venous return line of the cardiopulmonary bypass (CPB) circuit, air is often introduced. Air in the venous cannula may increase cerebral air embolization at initiation of CPB despite the arterial line filter. We measured the volume of air present in the venous cannula after cannulation of the RA. Transcranial Doppler quantified emboli as high-intensity transient-signals (HITS) in both middle-cerebral arteries (MCA) at the beginning of CPB. METHODS: After RA cannulation, the air column in the venous line was measured and the total volume calculated using the known lumen diameter. CPB onset was defined as the instant when the CPB machine started moving the patient's blood from the RA into the venous reservoir. Starting from CPB onset, HITS were counted: (a) until completion of the first minute on CPB (1-min count) and (b) until aortic cross clamping (pre-clamping count). RESULTS: We studied 135 patients during coronary artery bypass surgery operated on by 10 cardiac surgeons. HITS during onset of CPB were detected in 95% of patients. Median counts were 10 HITS (25th, 75th percentiles: 3, 26) at 1-min and 21 HITS (8, 51) during pre-clamping. A significant correlation was found between the volume of air in the venous cannula and the HITS counts (r=0.524, p<0.0001). Absence of retained air was associated with lower HITS counts [3 HITS (1, 11)] compared with any amount of air [13 HITS (4, 29), p=0.002)]. The volume of air in the venous cannula, the MCA mean blood flow velocity and the pre-clamping time were the only independent predictors of the pre-clamping HITS counts (p<0.001). CONCLUSION: Air in the venous cannula can result in HITS in the MCA. Minimizing the volume of air introduced into the venous cannula after cannulation of the RA can decrease cerebral air embolization at the beginning of CPB.     

Leukocytosis after posttraumatic splenectomy: a physiologic event or sign of sepsis?

HYPOTHESIS: Although elevations in white blood cell count (WBC) and platelet count (PC) after splenectomy for trauma constitute a physiologic event, certain WBC and PC patterns help differentiate patients with from those without sepsis. DESIGN: Medical record and trauma registry record retrospective review. SETTING: Academic level I trauma center. PATIENTS: From February 1997 through May 2001, 118 trauma patients underwent splenectomy. Sixty patients developed postoperative sepsis (pneumonia, abdominal infection, septicemia, or severe urinary tract infection) (septic group) and 58 did not (nonseptic group). MAIN OUTCOME MEASURES: White blood cell count, PC, and PC/WBC. RESULTS: After the fifth postoperative day, the WBC of patients with sepsis remained consistently greater than 15 x 10(3)/microL and the PC/WBC remained consistently less than 20. In patients without sepsis, these values remained less than 15 x 10(3)/microL and greater than 20, respectively. Stepwise regression analysis identified 3 independent predictors of sepsis: (1) day 5 PC/WBC less than 20, (2) Injury Severity Score greater than 16, and (3) day 5 WBC greater than 15 x 10(3)/microL. According to a statistical prediction model, the probability of sepsis when all 3 predictors were present was 97.4%; when all 3 were absent, it was 2.5%. CONCLUSIONS: At and after the fifth postoperative day, a WBC greater than 15 x 10(3)/microL and a PC/WBC less than 20 are highly associated with sepsis and should not be considered as part of the physiologic response to splenectomy. In view of the seriousness of postsplenectomy sepsis, these values may be used to increase vigilance and prompt early aggressive treatment.     

肝切除联合脾脏微波消融治疗肝癌合并脾功能亢进的 34 例回顾性分析

目的：探讨肝切除联合脾脏微波消融治疗肝细胞癌（HCC）合并脾功能亢进的安全性和有效性。方法：回顾性分析 34 例因 HCC 合并肝硬化后脾肿大、脾功能亢进而进行部分肝切除联合脾脏微波消融治疗患者的资料,通过手术前后的增强 CT 评估脾脏微波消融体积,通过实验室检查评估手术前后血常规及肝功能改变,并在术后 6 个月定期随访。结果：34例脾脏消融体积平均为（35.3±2.4）%,在随访期内无严重不良事件或手术相关死亡的发生。术后 1 天外周血白细胞水平（12.44±4.45）×109/L 与术前（3.83±1.02）×109/L 相比,其差异显著,具有统计学意义（P<0.01）。外周血小板计数术前平均为（41.04±14.88）×109/L,术后逐渐升高,在术后 2 周达到（113.45±58.33）×109/L。外周血小板计数术前与术后 2 周的差异显著,具有统计学意义（P<0.01）。肝功能 ALT 和 AST 在术后 1 天均升高 , 分别为（564.5±529.8）U/L和（429.1±318.3）U/L,与术前相比,ALT 为（32.8±12.2）U/L,AST 为（34.1±10.7）U/L,其差异均具有统计学意义（P<0.01）;但在术后 7 天 ALT 和 AST 分别恢复至（56.7±43.4）U/L 及（38.8±21.4）U/L,与术前相比,其差异均不具有统计学意义（P>0.05）。术后 1 个月复查 CT 证实所有患者的脾脏损毁体积占术前脾脏总体积的（24.9±4.3）%。结论：肝切除联合脾脏微波消融治疗 HCC 合并肝硬化后脾肿大、脾功能亢进,具有较好的安全性和有效性。     

白细胞滤器对体外循环剩余机血成分及炎性细胞因子影响的随机对照研究

目的 探讨白细胞滤器对体外循环剩余机血成分及炎性细胞因子的影响。 方法 选取2012年12月至2013年2月中国医学科学院阜外心血管病医院体外循环下择期心脏手术患者40例,其中男34例、女6例,年龄16～72岁。将患者随机均分为试验组和对照组。试验组将剩余机血通过白细胞滤器过滤后储存于无菌储血袋中待回输,对照组在体外循环结束后将剩余机血储存于无菌储血袋中待回输。分别采集患者体外循环转机前动脉血（T1）、停机后剩余机血（T2）、室温放置4 h剩余机血（T3）各20 ml,测定血液中成分及血浆中白细胞介素6 （IL-6）、IL-10和肿瘤坏死因子α（TNF-α）的浓度。 结果 T2及T3时试验组白细胞及中性粒细胞计数明显低于对照组（P＜0.05）,红细胞计数、血红蛋白、红细胞压积、游离血红蛋白同时间点组间差异无统计学意义（P＞0.05）。两组患者血浆中IL-6、IL-10和TNF-α浓度各时间点组内差异无统计学意义（P＞0.05）,同时间点组间差异无统计学意义（P＞0.05）。 结论 采用白细胞滤器滤过体外循环剩余机血可以减少余血中的白细胞数量,对剩余机血中其他成分及血浆中炎性细胞因子含量无明显影响。