以血浆作透析液的血液透析联合高容量血液滤过在高胆红素血症中的初步应用

目的以人体新鲜冰冻血浆作透析液行血液透析(HD-PBD)后继续进行高容量血液滤过(HV-HF),观察其对高胆红素血症的治疗效果。方法7例高胆红素血症患者行HD-PBD治疗6h后,应用同一滤器继续行HVHF治疗24h。另选取6例行MARS治疗6h的高胆红素血症患者作为对照。各组患者治疗前后测定血清胆红素水平,并监测动脉血气分析和电解质浓度的变化。结果HD-PBD对胆红素的清除较HVHF明显(P<0.05),HVHF在纠正电解质和酸碱失衡方面比HD-PBD更显著(P<0.05)。停止HD-PBD后继续行HVHF治疗24h,胆红素仍有所下降(P<0.05);停止MARS治疗后的1～2天内胆红素显著升高(P<0.05)。结论HD-PBD联合HVHF治疗高胆红素血症患者,结合了二者在清除肝源性毒素和调节电解质酸碱平衡紊乱方面的优势,并且安全、简便、易行和成本低廉,值得推广应用。     

以血浆作透析液在肝移植术前的应用

目的以人体新鲜冰冻血浆作透析液行血液透析（PHD）后继续进行连续性静脉-静脉血液滤过（CVVH）,观察其对肝移植术前高胆红素血症及血浆细胞因子水平的影响。方法4例拟行肝移植手术的肝功能衰竭患者行PHD治疗6 h后,应用同一滤器（AV600）继续行CVVH治疗24 h。分别检测治疗前后血清胆红素（TB、DB、IB）、总胆汁酸（TBA）、血氨（BA）及细胞因子TNF-a,IL-6和IL-8的水平。结果PHD治疗6 h后患者总胆红素（TB）、直接胆红素（DB）、间接胆红素（IB）和总胆汁酸（TBA）分别下降（24.38&#177;4.89）%（、26.23&#177;2.67）%（、25.02&#177;0.01）%、（27.38&#177;8.59）%（P〈0.05）;PHD后继续行CVVH治疗24 h,总胆红素（TB）仍有所下降（10.61&#177;0.32）%;CVVH在清除血氨,纠正电解质和酸碱失衡方面比PHD更有效（P〈0.05）;PHD及CVVH治疗后TNF-aI、L 6、IL-8较治疗前明显下降（P〈0.05）。结论对肝功能衰竭患者,PHD联合CVVH治疗能显著降低血清胆红素、总胆汁酸、血氨及炎性细胞因子水平,调节水、电解质和酸碱平衡。     

透析液钾浓度对血液透析患者QT间期及QT离散度的影响

目的探讨透析液钾浓度变化对血液透析患者QT间期及QT离散度的影响。方法选择南通大学附属南通第三医院血液净化中心60例慢性肾衰竭长期维持性血液透析患者先后应用钾浓度为2．0 mmol/L,3．0mmol/L的透析液各进行1次血液透析,分别记录临床及实验室指标,采用12导联同步记录透析中（透析至4h）心电图测量并计算QT间期（QT）及QT离散度（QTd）。结果采用钾浓度3．0mmol/L透析液血液透析时,QT间期由钾浓度2．0mmol/L透析时（595．51±39．01）ms缩短为（540．61±44．63）ms,QTd由（63．27±8．46）ms缩短为（53．46±8．83）ms,两者差异均有统计学意义;心律失常的发生率明显降低（P〈0．01）．差异有统计学意义。采用相同钾浓度透析液透析时透析前血钾浓度〈3．5mmol/L患者QTd较血钾浓度≥3．5mmol/L患者长,差异有统计学意义（P〈0．05）。结论QTd反映心室复极的不均一性和电不稳定性，采用钾浓度3．0mmol/L透析液进行透析可缩短QT间期及QTd,降低心律失常的发生率。防治透析前低血钾也可缩短QTd,减少透析中心律失常的发生率。     

诺和锐应用于胰岛素泵治疗老年糖尿病的临床观察及护理

对28例老年2型糖尿病患者安置胰岛素泵,设置给予24h基础量及三餐前即时皮下注射诺和锐,监测患者空腹及三餐后2h末梢血糖、糖化血红蛋白、血糖控制时间、低血糖事件。结果：持续治疗8周后,患者空腹血糖为（5.12&#177;0.55）mmol/L、餐后2h血糖为（7.48&#177;0.96）mmol/L、糖化血红蛋白（6.54&#177;0.71）%、血糖达标控制时间（8.62&#177;1.89）d,4例次发生轻微低血糖症状,未发生严重低血糖事件及其他不良反应。提示速效胰岛素类似物（诺和锐）可有效、安全的控制老年性糖尿病,且通过糖尿病教育、带泵指导、饮食及运动指导、及时监测等护理措施,可有效提高其治疗效果及治疗依从性。     

双管同步抽注法和全自动换血术治疗新生儿高胆红素血症的效果研究

目的 探讨双管同步抽注法和全自动换血法治疗新生儿高胆红素血症的疗效.方法 分别检测采用双管同步抽注法的10例高胆红素血症新生儿和采用全自动换血法的13例高胆红素血症新生儿换血前后胆红素、血电解质、血常规、血糖、pH值变化.结果 双管同步抽注法组换血前后总胆红素值分别为(391.13&#177;107.62)mmol/L、(193.40&#177;37.86)mmol/L,总胆红素换出率为50.4%.全自动换血组换血前后总胆红素值分别为(430.33&#177;121.92)mmol/L、(216.83&#177;63.66)mmol/L,总胆红素换出率为49.8%.2组换血前后总胆红素值差异均有显著意义(P＜0.01),2组总胆红素换出率无显著性差异(P＞0.05).结论 全自动换血法简便易行,安全有效,是新生儿换血中较理想的方法.     

双管同步抽注法和全自动换血术治疗新生儿高胆红素血症的效果研究

目的探讨双管同步抽注法和全自动换血法治疗新生儿高胆红素血症的疗效。方法分别检测采用双管同步抽注法的10例高胆红素血症新生儿和采用全自动换血法的13例高胆红素血症新生儿换血前后胆红素、血电解质、血常规、血糖、pH值变化。结果双管同步抽注法组换血前后总胆红素值分别为（391．13±107．62）mmol／L、（193．40±37．86）mmol／L，总胆红素换出率为50．4％。全自动换血组换血前后总胆红素值分别为（430．33±121.92）mmol／L、（216．83±63．66）mmol／L，总胆红素换出率为49．8％。2组换血前后总胆红素值差异均有显著意义（P〈0．01），2组总胆红素换出率无显著性差异（P〉0．05）。结论全自动换血法简便易行，安全有效，是新生儿换血中较理想的方法。     

氦-氖激光照射对2型糖尿病合并高血压患者血管内皮功能及血液流变学指标的影响

目的：观察氦-氖激光血管内照射对糖尿病合并高血压及单纯糖尿病患者血液流变学指标及血浆内皮素、一氧化氮水平的影响.方法：①选择2001-04/2002-06解放军第三军医大学大坪医院野战外科研究所内分泌科住院的2型糖尿病患者98例,其中单纯2型糖尿病患者56例（未合并高血压组）,2型糖尿病合并高血压患者42例（合并高血压组）.对实验目的知情同意.②激光血管内照射采用北京产HN800L型氦-氖激光仪,光纤末断输出功率2mV,每天照射1次（45min）,5 d为1个疗程,疗程间隔4 d,观察2个疗程治疗前后患者血浆内皮素、一氧化氮和血液流变学指标变化.③采用全自动血液流变仪测定血液流变学指标.采用放射免疫法测定血浆内皮素水平.按试剂盒说明书配制标准液,血浆2 μL稀释为20 μL,加入显色剂180μL,37℃10 min,酶标仪测定546 nm吸光度（A值）,绘制标准曲线,计算NO2-（μmol/L）浓度,即为一氧化氮水平.④计量资料差异性比较采用t检验.结果：2型糖尿病患者98例均进入结果分析.①合并高血压患者明显,合并高血压组患者空腹血糖、总胆固醇、低密度胆固醇水平明显高于未合并高血压组（P＜0.01）.②未合并高血压组和合并高血压组患者经氦氖激光血管内照射后血浆内皮素水平和红细胞压积明显低于治疗前[治疗后：（44.36&;#177;3.25）mmol/L,（42.94&;#177;3.83）mmol/L,（0.32&;#177;0.03）%,（0.30&;#177;0.04）%;治疗前：（78.22&;#177;5.24）mmol/L,（65.21&;#177;6.17）mmol/L,（0.45&;#177;0.05）%,（0.44&;#177;0.06）%,P＜0.05～0.01];一氧化氮水平和红细胞聚集时间及红细胞变形指数明显高于/长于治疗前[治疗后：（1.91&;#177;0.72）mmol/L,（1.87&;#177;0.68）mmol/L,（7.69&;#177;0.69）s,（7.34&;#177;1.23）s,1.82&;#177;0.10,1.83&;#177;0.08;治疗前：（1.24&;#177;0.32）mmol/L,（1.06&;#177;0.43）mmol/L,（4.84&;#177;1.03）s,（4.79&;#177;1.17）s,0.98&;#177;0.14,1.05&;#177;0.09,P＜0.01].结论：①2 mV剂量氦-氖激光血管内照射能明显改善合并与未合高血压2型糖尿病患者血管内皮功能及血液流变学指标.②合并高血压2型糖尿病患者血脂及血糖代谢紊乱较未合并高血压患者严重.     

胸腹联合伤合并创伤失血性休克的液体复苏治疗

目的探讨延迟与即刻液体复苏对胸腹联合伤并创伤性休克患者的早期救治效果。方法回顾性分析2004年11月至2006年12月来院救治的98例胸腹联合伤并创伤性休克患者资料,所有病例均符合第五版《外科学》休克诊断标准。延迟复苏组（n=51）,在到达手术室彻底止血前,只给予少量的平衡液维持机体基本需求;即刻复苏组（n=47）,入院后快速给予大量等张晶体液和（或）胶体液。用成组t检验、方差分析或χ^2检验分析两种液体复苏方式对血红蛋白含量、血小板计数、红细胞比容、血乳酸含量、碱缺失水平、术前复苏时间及病死率的影响。结果延迟复苏组与即刻复苏组输液量差异具有统计学意义[（1586±346）vs（3520±575）ml,P〈0．01],但两组患者在手术前收缩压却差异无统计学意义[（78±29）mmHgvs（81±24）mmHg,P〉0．05]。术前血红蛋白[（106．21±20．91）g/Lvs（89．10±32．42）g／L]、凝血酶原时间[（11．19±2．03）svs（17．37±2．50）s]、血小板计数[（179．44±52．19）×10^9/Lvs（105．55±50．67）×10^9/L]、红细胞比容[（28．40±2．31）％vs（20．84±2．58）％]、血乳酸[复苏30min：（1．70±0．37）mmol／Lvs（2．44±0．41）mmol／L;复苏60min：（3．16±0．42）mmol／Lvs（5．73±0．68）mmol／L]和碱缺失[复苏30min：（-4．46±1．15）mmol／LVs（-5．78±1．15）mmol／L;复苏60min：（-5．46±1．29）mmol／Lvs（-9．60±2．71）mmol／L],两组间差异具有统计学意义（P〈0．05）。即刻复苏组术前复苏时间（73±29）min、病死率（18．9％）,延迟复苏组术前复苏时间（58±26）min、病死率（11．3％）,组间比较差异有统计学意义（P〈0．05）。结论延迟液体复苏能显著改善胸腹联合伤并创伤失血性休克患者凝血功能、组织和器官的灌注及乳酸酸中毒程度,降低患者的病死率,缩短术前复苏时间,效果优于即刻液体复苏。     

慢性乙型肝炎患者HBV DNA含量与血清生化指标的分析

目的探讨慢性乙型肝炎患者血清中病毒血症水平与病情程度的相关性。方法采用FQ-PCR法检测252例慢性乙型肝炎轻、中、重度患者血清HBVDNA含量及相关生化指标。结果慢性乙型肝炎轻、中、重度组患者HBV DNA含量分别为（4.85±1.0）×10^8-10^7copy/ml、（3.82±0.8）×10^6-10^5copy/ml、（1.8±0.5）×10^5-104copy/ml;血清总胆红素含量分别为（12.64±4.25）μmol/L、（50.18±9.46）μmol/L、（262.96±30.16）μmol/L;白/球比值分别是1.51±0.23、1.61±0.26和0.97±0.25。结论慢性乙型肝炎轻、中、重度各组之间的HBV DNA含量有显著性差异;中、重度组病毒含量与总胆红素水平呈负相关,与白/球比值呈正相关。     

强直性脊柱炎患者的血小板活化功能研究

目的 探讨强直性脊柱炎患者的血小板活化功能.方法 选取2005年11月至2006年10月的35例强直性脊柱炎患者与15例正常人对照,空腹采血2 ml至2%乙二胺四乙酸抗凝试管,行单克隆抗体直接标记,30 min内进行流式细胞仪检测外周血血小板CD62P和CD63的表达,同时免疫比浊法测定C-反应蛋白（CRP）与魏氏法测定血沉（ESR）,血细胞计数仪检测血小板数量.结果 强直性脊柱炎组患者的外周血CD62P表达（13.60±7.64）%明显高于正常对照组（2.78±1.04）%（P＜0.01）;强直性脊柱炎组患者的外周血CD63表达（6.92±4.16）%明显高于正常对照组（4.13±1.85）%（P＜0.05）;CRP（20.18±23.17）mg/L与ESR（36.86.±31.23）mm/h明显高于正常对照组的（3.21±2.18）mg/L与（12.25±5.05）mm/h（均P＜0.01）;强直性脊柱炎患者组血小板计数（259.54±102.59× 109/L）高于正常对照组（197.00±55.70×109/L）（P＜0.05）.结论 强直性脊柱炎患者的血小板活化功能明显高于正常人.     

Feasibility of CT scan-guided Tru-Cut serial liver biopsies to evaluate pharmacodynamic endpoints in patients with liver metastasis treated with experimental drugs

We assessed the feasibility of using computed tomographically guided, Tru-Cut serial liver biopsies to perform pharmacodynamic studies in patients with liver metastasis who had been treated with experimental drugs. Twenty-three patients with liver metastasis were enrolled in two protocols for evaluation of the response to two new biologic drugs: a farnesyltransferase inhibitor and a tyrosine kinase inhibitor of the epidermal growth factor receptor. Computed tomographically guided Tru-Cut biopsies with an 18-gauge needle were performed. The procedure was performed at baseline and 2, 6, and 24 h after starting the administration of the drug. The procedures were scheduled on an outpatient basis. We obtained 271 samples (168 from metastatic lesions and 103 from surrounding normal liver tissue) from 23 patients. Biochemical determination of farnesyltransferase activity and different immunohistochemistry stainings (pEGRF, pMAPK, p27, Ki67, and apoptosis) of the signal transduction pathway were determined in each tissue sample, and all scheduled tissue assays were performed with the tissues obtained. Complete serial biopsies were performed in 20 patients. Three patients were excluded due to minor complications after the first biopsy. The morbidity rate in relation to the number of procedures was 1.1% (three of 271 samples). We found serial liver biopsies using Tru-Cut to be a safe and easy procedure. In our series, we could evaluate samples for molecular changes that influence the optimal dose, sequence, and schedule of the new antineoplastic agents.     

Feasibility of CT scan-guided Tru-Cut serial liver biopsies to evaluate pharmacodynamic endpoints in patients with liver metastasis treated with experimental drugs

We assessed the feasibility of using computed tomographically guided, Tru-Cut serial liver biopsies to perform pharmacodynamic studies in patients with liver metastasis who had been treated with experimental drugs. Twenty-three patients with liver metastasis were enrolled in two protocols for evaluation of the response to two new biologic drugs: a farnesyltransferase inhibitor and a tyrosine kinase inhibitor of the epidermal growth factor receptor. Computed tomographically guided Tru-Cut biopsies with an 18-gauge needle were performed. The procedure was performed at baseline and 2, 6, and 24 h after starting the administration of the drug. The procedures were scheduled on an outpatient basis. We obtained 271 samples (168 from metastatic lesions and 103 from surrounding normal liver tissue) from 23 patients. Biochemical determination of farnesyltransferase activity and different immunohistochemistry stainings (pEGRF, pMAPK, p27, Ki67, and apoptosis) of the signal transduction pathway were determined in each tissue sample, and all scheduled tissue assays were performed with the tissues obtained. Complete serial biopsies were performed in 20 patients. Three patients were excluded due to minor complications after the first biopsy. The morbidity rate in relation to the number of procedures was 1.1% (three of 271 samples). We found serial liver biopsies using Tru-Cut to be a safe and easy procedure. In our series, we could evaluate samples for molecular changes that influence the optimal dose, sequence, and schedule of the new antineoplastic agents.     

Angiographic demonstration of non-occlusive hepatic infarction with scintigraphic and microscopic correlation

The angiographic appearances of histologically proven hepatic infarction without vascular occlusion has not, to our knowledge, been previously described. A case of non-occlusive hepatic infarction in a diabetic patient is presented and correlated with scintigraphic and microscopic findings. It would appear to be the first recorded case of hepatic infarction associated with diabetic ketoacidosis. A follow-up angiogram showed resolution. The literature is briefly reviewed.     

Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients

Background: The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. Methods: Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. Results: After chemotherapy, tumor volume decreased by 50–90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. Conclusions: These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.     

Liver function tests in patients with computed tomography demonstrated hepatic metastases

One hundred patients with computed tomographic (CT) evidence of liver metastases (and confirmation by biopsy or progression of disease) had serum levels of alkaline phosphatase, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase measured within two weeks of scanning. All three enzymes were within the normal range in 33% of patients. Even with advanced involvement (defined as three or more metastatic lesions over 3 cm in diameter), 20% of patients had normal levels of all three liver enzymes. Although liver function tests (LFTs) (enzyme levels) are inexpensive and simple to perform, they failed to detect a significant number of patients with liver metastases.     

Hepatocellular carcinoma with or without cirrhosis: A comparison of CT and angiographic presentations in the United States and Japan

We compared the computed tomographic (CT) and angiographic presentations of hepatocellular carcinoma (HCC) with or without cirrhosis in the United States and Japan. Tumors in the United States were advanced and less frequently associated with liver cirrhosis (association of cirrhosis: United States) 56.2%, Japan 91.0%. In patients with cirrhosis, the size of the tumor tended to be smaller, and nodular tumors (single or multiple) were frequent. In early stage of HCCs with cirrhosis, tumors were hypovascular without a capsule. In advanced stage, tumors were hypervascular and a capsule was frequently observed around the tumor both with CT and angiography. HCCs without cirrhosis were seen in younger patients. These tumors were large at the time of diagnosis. A massive or diffuse mass without a capsule was frequently seen. Most tumors were hypodense on precontrast CT and hypervascular on angiography. Lymph node enlargement was significantly frequent. The radiological characteristics of HCC in both countries were significantly different depending upon associated cirrhosis, as well as the time of the diagnosis.     

肝病患者的血清过氧化氢酶活性测定初探

采用比色法检测了３３７例不同肝病患者的血清ＣＡＴ活性水平。与正常对照组比较，有１２５例血清ＣＡＴ活性增高，占３７．１％（Ｐ＜０．０１）。试验结果表明，血清ＣＡＴ活性测定对不同肝病患者的检出阳性率依次为：肝癌５９．３％（１６／２７），急黄肝５１．７％（１５／２９），肝硬化４１．４％（１２／２９），甲肝３９．３％（２２／５６），慢活肝３９．１％（１８／４６）和乙肝２８．０％（４２／１５０）。     

超声造影评价肝纤维化

目的 评估应用超声造影评价肝纤维化的临床价值.方法 对慢性病毒性肝炎患者32例及健康对照组6名在反相脉冲谐波模式下,经肘静脉注射超声造影剂SonoVue.记录造影剂到达肝动脉时间(HAAT)、到达门静脉时间(PVAT)及到达肝静脉时间(HVAT),计算造影剂到达肝动脉与到达肝静脉间隔时间(VAT)和到达门静脉与到达肝静脉间隔时间(VVT).结果 HVAT、VAT、VVT与肝纤维化程度呈负相关,中度及重度肝纤维化组HVAT、VAT、VVT缩短.以肝纤维化达到S4期为阳性判断标准,HVAT、VAT、VVT的ROC曲线下面积为0.83～0.84.结论 超声造影对重度肝纤维化的诊断具有一定临床价值,但在诊断轻度肝纤维化的准确性方面存在欠缺.     

肝移植病人生存质量及影响因素的研究

目的探讨肝移植对肝癌病人生存质量的影响。方法将58例肝癌病人随机分为肝移植组和肝部分切除术组,在术前和术后1个月、6个月、12个月、18个月、24个月分别采用肝脏疾病生存质量量表(LDQOL)分析病人的生存质量。结果肝移植能有效提高肝癌患者的生存质量,住院次数和费用明显减少(P<0.01),回归社会劳动能力积分显著高于肝部分切除术组(P<0.01或0.05)。结论肝移植能有效改善肝癌患者生存质量。     

Characteristic findings of hepatocellular carcinoma: An evaluation with comparative study of US,CT, and MRI

The sensitivity, specificity, and accuracy of ultrasonography (US), dynamic incremented computed tomography (CT) with delayed phase imaging, and magnetic resonance imaging (MRI) with or without Gd-DTPA were studied for detecting the characteristic appearances of hepatocellular carcinomas (HCC): fibrous capsules, fibrous septa, and mosaic appearances. Results were prospectively evaluated in 30 patients who subsequently underwent hepatic lobectomies or segmentectomies. Pathologic evaluations of the resected liver specimens demonstrated fibrous capsules in 20 tumors (66.7%), fibrous septa in 13 tumors (43.3%), and mosaic appearances in 19 tumors (63.3%). The accuracies for fibrous capsules were 71.4% (20 of 28) for US, 81.5% (22 of 27) for CT, and 92.3% (24 of 26) for MRI. The accuracies for fibrous septa were 57.1% (16 of 28) for US, 59.3% (16 of 27) for CT, and 73.1% (19 of 26) for MRI. The accuracies for mosaic appearances were 71.4% (20 of 28) for US, 51.9% (14 of 27) for CT, and 69.2% (18 of 26) for MRI. Gd-DTPA administrated MRI showed higher accuracies than did conventional MRI for all manifestations. In conclusion, the fibrous capsules of HCCs were readily detected by CT and MRI. Gd-DTPA administration demonstrated an advantage in clarifying fibrous capsules, as well as fibrous septa and mosaic appearances.