1256例动脉静脉内瘘术用于血液透析的临床研究

自１９８５年１月至１９９６年３月 １２５６例慢怀透析患者建立动脉内瘘术产成功地进行血液透析，自体血管内娄１１０１例（鼻烟窝动静脉内瘘５２６例，前臂动脉内瘘５１２例，上臂动脉静脉内瘘３６上肢动脉内瘘１２２例。手术成功率为１００％，１年的通畅率９５．５％，３的的能摔８２．５％，５年通畅率７１．２％，１０年通畅率４８．６％。就制作动静脉内瘘以及对国内外开展各人瘘方法的临床评价和经验进行了讨论。     

喜疗妥软膏延长动静脉内瘘使用寿命

为了延长慢性肾衰维持性血液透析患者动静脉内瘘使用寿命,采用外用喜疗妥软膏保持和治疗２６例患者动静脉内瘘及其并发症。结果内瘘１年通畅率９２．３％,２年通畅率８４．６％,较国内外报道１年通畅率６０％～６５％,２年通畅率５０％～６０％,明显延长。实践证明,外用喜疗妥软膏能够延长动静脉内瘘使用寿命。     

慢性肾衰患者的动静脉内瘘术

血液透析患者要想达到最佳的透析效果，就必须有个成功的动静脉内瘘。动静脉瘘是将人体皮下自身的动静脉血管，直接或通过移植的血管间接吻合成动静脉分流的方法。现将体会介绍如下：１病床资料１．１一般资料：２００１年６月至２００２年６月，我院共做了慢性肾功能衰竭患者的动静脉内瘘手术６例。其中男性３例，女性３例，最大年龄７６岁，最小年龄３２岁，均做了上肢桡动脉与头静脉端侧吻合术。６例当中５例至今通畅良好。１例术后１个月闭塞，手术成功率是８３．３％，但例数少，时间短没有统计学意义。１例手术后血管闭塞的原因是头静…     

应用同种异体血管移植制作动静脉内瘘行血液透析62例体会

应用同种异体血管进行血管移植，制作动静脉内瘘以建立血管通路，在慢性肾功能衰竭病人中成功地进行血液透析，手术成功率为100％，1年的通畅率为96．4％，3年通畅率为90．5％，5年通畅率达86，5％。     

自体动静脉内瘘非血栓性闭塞及狭窄的介入治疗

目的　总结经皮腔内血管成形术(percutaneoustransluminalangioplasty,PTA)治疗自体动静脉内瘘非血栓性闭塞及狭窄临床效果及应用体会.方法　回顾性分 析泸州医学院附属医院血管外科应用球囊扩张术治疗人工血管动静脉瘘狭窄病例的治疗效果,通畅率及近远期并发症.结果　自２０１３年１月－２０１３年１２月共计治疗 ５９例病例,男２７例,女３２例,平均年龄６３．４±１２．３岁.病变部位自体血管吻合口狭窄及吻合口周围２cm处狭窄占６８％ ,瘘体及静脉流出道占２２％,近端中心静脉狭窄 占１０％.球囊扩张技术成功率９５％,６个月通畅率为７２．７％,１２个月通畅率为４９．３％.结论　PTA 是治疗自体动静脉内瘘非血栓性闭塞及狭窄的安全、有效和微创的 方法,能避免患者二次手术、中心静脉置管、且保留足够静脉穿刺长度,但是术后通畅率的提高及假性动脉瘤的发生,有赖于加强术后访视以及更多维护通路新方法的 应用.     

维持性血液透析患者内瘘并发症及护理

内瘘是慢性肾功能衰竭血液透析（血透）患者重要的“生命线”。自１９８７年以来,１６２例维持性血透患者直接动静脉内瘘的通畅率情况：第１年累积通畅率为７８％,第２年累积通畅率为６５％,第３年累积通畅率为６２％,最长内瘘使用期已达１０年以上。其常见并发症：①早期血栓形成吻合口闭塞或狭窄３例,占１８％,需重新手术,但有１例曾作了３次手术,仍未成功。②血流量不足３例,占１８％,表现为静脉侧震颤和杂音减弱,早期出现此情况可试用尿激酶或链激酶吻合口滴入,不能溶解者重新手术。③穿刺部位感染２１例,占１３％,表…     

40例人工动静脉内瘘术的手术体会

目的 探讨与总结自体人工动静脉内瘘术的手术方法和注意事项。方法 对本院40例尿毒症患者采用钛轮钉血管吻合法和外科血管缝合法进行桡动脉和头静脉端端吻合。结果 40例人工内瘘术中，钛轮钉动静脉内瘘吻合法36例（90％），外科血管缝合法4例（10％），吻合成功率100％。1例吻合后血管杂音小，第2天杂音消失，改作长期皮下留置导管进行血透；1例鼻咽窝内瘘因伤口肿胀，术后第2天发生内瘘堵塞，重作前臂内瘘成功；1例切口感染，但血管仍保持通畅，经抗感染治疗后切口愈合良好；术后轻度手背肿胀18例（25％），数天后肿胀自行消失。结论 钛轮钉动静脉内瘘吻合法成功率高，内瘘成熟快，血管通畅率高，不易形成动脉瘤和静脉血管曲张。     

内瘘双瘘重建术等3种术式治疗动静脉内瘘Ⅰ型狭窄的效果比较

目的 比较内瘘双瘘重建术等3种术式治疗动静脉内瘘Ⅰ型狭窄的效果。方法 选取2015年1月至2018年8月浙江大学医学院附属邵逸夫医院收治的80例动静脉内瘘Ⅰ型狭窄患者为研究对象,其中经皮血管腔内血管成形术（PTA）组32例、内瘘重建（实施内瘘切除重建术）组28例和双瘘重建（实施内瘘双瘘重建术）组20例;比较3组患者术后3、6、12个月内瘘通畅率。结果3组患者术后3、6、12个月内瘘通畅率比较,差异均有统计学意义（均P<0.05）;进一步作两两比较发现,双瘘重建组、内瘘重建组术后3、6、12个月内瘘通畅率均明显高于PTA组（均P<0.025）,而内瘘重建组与双瘘重建组术后3、6、12个月内瘘通畅率比较,差异均无统计学意义（均P>0.025）。结论 内瘘双瘘重建术、内瘘切除重建术治疗动静脉内瘘Ⅰ型狭窄的效果明显优于PTA。     

慢性血液透析患者鼻烟窝动静脉内瘘的彩超评价

目的通过对慢性血液透析患者鼻烟窝动静脉内瘘的彩超监测,并与常规前臂动静脉内瘘比较,以评价鼻烟窝动静脉内瘘的应用价值。方法51例慢性血液透析患者按内瘘术式不同分为二组,其中鼻烟窝动静脉内瘘组30例、前臂动静脉内痿组21例,应用彩色多普勒超声监测比较二者手术1年后通畅率、吻合口内径、吻合口平均血流量及并发症发生率。结果鼻烟窝动静脉内瘘组与前臂动静脉内瘘组手术1年后通畅率分别为90．0％（27／30）和90．5％（19／21）;吻合口内径分别为（3．10±0．11）mm和（3．40±0．12）mm;吻合口平均血流量分别为（368．4±6．2）ml／min和（381．2±6．0）mJ／min;并发症发生率分别为10．0％（3／30）和23．8％（5／21）。二者比较在手术1年后通畅率、吻合口内径、吻合17平均血流量及并发症发生率上差异无统计学意义（P〉0．05）。结论鼻烟窝动静脉内瘘与前臂动静脉内瘩比较,在手术1年后通畅率、吻合口内径、吻合口平均血流量及并发症发生率上无明显差异,可做为慢性血液透析患者首选的内瘘术式之一。     

血液透析患者行动静脉内瘘的临床分析

目的 探讨不同内瘘制作方法的优势。方法 总结我院1997—2000年实行的内瘘手术327例，分别采用直接缝合法端侧吻合制作内瘘和饮轮钉端端吻合建立动静脉内瘘。比较分析不同原发病的慢肾衰患者采用两种类型内瘘的成功率和并发症发生率。结果 糖尿病肾病患者直接缝合法1年内瘘通畅率为90．7％，3年内瘘通畅率达88．3％；而钛轮钉吻合1年内瘘通畅率为75．5％，3年内瘘通畅率达65％。非糖尿病肾病患者两种术式比较，1年及3年通畅率无明显差异。结论 糖尿病肾病患者术式选择以直接缝合法建立内瘘效果好，应为建立血管通路的首选。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.