经隧道带涤纶套颈内静脉导管在血液透析中的应用

目的:探讨经隧道带涤纶套颈内静脉导管在维持性血液透析患者中的应用价值。方法:为15例维持性血液透析患者留置经隧道带涤纶套颈内静脉导管并作为其血透用血管通路。结果:透析血流量均达200 mL/min以上,导管平均使用时间为(4.87±2.88)个月,最长为11个月,并仍在继续使用。结论:对于无法建立"自体动静脉内瘘"这一传统的长期血管通路的维持性血液透析患者而言,带涤纶套深静脉导管是一个非常有价值的选择。     

中南大学湘雅医院血液透析患者血管通路现状

目的：了解血液透析患者的血管通路现状。方法：回顾性分析中南大学湘雅医院血液透析中心2015年4 月1日至2016年4月1日新导入及维持性血液透析患者的基本资料、血管通路选择和并发症。结果：维持性血液透析 患者258例,采用自体动静脉内瘘(artetiovenous fistula,AVF)的患者占87.60%、带涤纶套带隧道导管占12.40%。新导入 患者61例,首次透析采用无隧道无涤纶套导管的患者占80.33%,AVF占8.19%,带涤纶套带隧道导管占9.84%,动静脉 穿刺占1.64%。AVF选择吻合血管依次为腕桡动脉-头静脉(76.55%)、肱动脉-头静脉(11.06%)、前臂中段桡动脉-头静脉 (7.08%)、肱动脉-肘正中静脉和肱动脉-贵要静脉(5.31%)。AVF发生并发症占总AVF透析人数的 34.07%,其中动脉瘤占 24.34%。结论：维持性血液透析患者绝大多数采用 AVF,而新导入透析患者中使用无隧道无涤纶套导管者比例较大。     

维持性血液透析患者血管通路感染因素分析

血管通路是血液透析患者的生命线,K/DOQI血管通路的临床实践指南建议维持性血液透析患者的血管通路首选动静脉内瘘,其次可选用带涤纶套长期透析导管透析.部分患者由于高龄、糖尿病、心功能差等因素使血管条件受限或无法建立长期动静脉内瘘,导致长期透析导管使用率较高.但血液透析长期导管的导管相关性感染发生率高,一直是临床工作中的常见问题.笔者分析了96例维持性血液透析患者血管通路的感染情况,为进一步的治疗提供指导,现报道如下.     

隧道Cuff导管和自体动-静脉内瘘作为维持性血液透析患者血管通路的疗效比较

对于维持性血液透析(HD)患者而言,建立和维持一个有足够功能的血管通路是保证透析顺利进行和透析充分的关键,因而血管通路被称为HD患者的"生命线".维持性HD患者的血管通路分为:自体动-静脉内瘘、PTFE移植血管瘘、隧道Cuff导管、皮下带孔导管[1].目前国内以自体动-静脉内瘘、隧道Cuff导管应用最多.现笔者通过对近年来收治的维持性HD患者使用自体动-静脉内瘘、隧道Cuff导管作为血管通路的疗效进行比较,以期探讨维持性HD患者理想的血管通路,报道如下.     

维持性血液透析患者动静脉内瘘血栓形成原因及护理体会

良好的血管通路是维持性血液透析患者进行血液透析治疗的基本保证,目前血管通路分为临时性血管通路(直接动静脉穿刺和经皮中心静脉置管)和长期性血管通路(自体动静脉内瘘、移植物人工血管和带隧道带涤纶套双腔导管)。其中自体动静脉内瘘因其使用方便、相对安全、使用寿命长、并发症少等特点,成为维持性血液透析患者首选的血管通路。     

动静脉内瘘和带袖套隧道导管对于血透的充分性和并发症比较

目的：分析动静脉内瘘和带袖套隧道导管对于血透的充分性和并发症。方法本研究选取82例血液透析患者为对象,将其随机分为实验组和对照组,各41例。对照组患者采用动静脉内瘘作为血管通路,实验组患者采用带袖套隧道导管作为血管通路。对比分析2组患者血透充分性和并发症的差异。结果采用尿素清除指数（Kt/V）评价血透充分性,2组Kt/V值均＞1.2,2组血透充分性的差异无统计学意义。对照组并发症发生率为4.88%,实验组并发症发生率为19.51%,实验组并发症发生率显著高于对照组,差异有统计学意义（P＜0.05）。结论动静脉内瘘和带袖套隧道导管作为血管通路均具有良好的血透充分性,其中动静脉内瘘并发症少,具有更大的临床优势,但在血管条件差、无法建立有效的动静脉内瘘时采用带袖套隧道导管作为血管通路也是一种选择。     

自体动静脉内瘘与带隧道带涤纶套导管对维持性血液透析患者微炎症状态及感染的影响

目的:探究自体动静脉内瘘与带隧道带涤纶套导管(TCC)对维持性血液透析(MHD)患者微炎症状态及感染的影响.方法:选取2019年7月—2021年3月于我院接受MHD的174例患者为观察对象,以采用自体动静脉内瘘作血管通路的112例患者为内瘘组,以采用TCC作血管通路的62例患者为导管组.比较两组透析前空腹外周静脉血血常...     

关于以带涤纶套隧道双腔深静脉导管为通路的血液透析患者透析充分性的研究

目的 评价以带涤纶套隧道双腔深静脉导管为通路的血液透析患者透析的充分性情况.方法 选取2017年9月至2019年4月在本院接受血液透析治疗的71例患者作为研究对象,根据血液透析通路的不同分为研究组(n=22)和对照组(n=49).研究组的血透通路为带涤纶套隧道双腔深静脉导管,对照组的血透通路为动静脉内瘘,比较两组透析前后血肌酐(Cr)、血清尿酸(UA)、血清尿素(BUN)水平及透析并发症发生情况.结果 透析前,两组Cr、UA、BUN水平比较差异无统计学意义;透析后,两组肾功能均明显改善,但组间Cr、UA、BUN水平比较差异无统计学意义.两组透析并发症发生率比较差异无统计学意义.结论 以带涤纶套隧道双腔深静脉导管为通路进行血液透析的充分性与患者自身动静脉内瘘相当,且安全性较高,值得临床推广.     

带涤纶套半永久血透导管在血液透析中的应用分析

目的:分析和探讨带涤纶套半永久血透导管在血液透析中临床研究及应用。方法:对2011年5月-2013年5月收治的40例尿毒症患者通过建立皮下隧道及Seldinger技术留置带涤纶套血透导管进行维持性血液透析,观察其置管使用时间及并发症等情况。结果:患者带涤纶套半永久血透导管留置时间最短者4个月,最长者超过2年且至今仍在用,平均18.5个月。与临时导管比较,血流量、尿素清除指数(KT/V)方面比较差异均无统计学意义(P0.05);但带涤纶套半永久血透导管出现感染、血栓形成、脱管等并发症情况更低、使用时间更长(P0.05)。结论:带涤纶套半永久血透导管对于血管条件差、无法建立内瘘,尤其在条件有限基层医院的透析患者提供一条可行的长期血管通路,确保透析继续顺利进行具有重要意义。     

西双版纳州勐海县维持性血液透析患者血管通路分析及护理

目的探讨维持性血液透析患者血管通路的临床应用情况。方法回顾性分析本院自2013年10月开展血液透析以来,在院维持性血液透析(MHD)112例患者的临床资料,分析首次血液透析及维持性血液透析(MHD)患者中不同类型血管通路的分布,针对科内现有的自体动静脉内瘘和深静脉置管的两组患者的使用功能及并发症给予个体化的护理措施。结果新入首次透析患者65例(58%),首次使用各种血管通路的例数及比例为:5例自体动静脉内瘘(AVF)占7.7%,10例带涤纶套的深静脉透析导管(TCC)占15.4%,50例临时透析导管(NCC)占76.9%。112例MHD患者血管通路的比例分别为AVF(85例)75.9%,TCC(17例)15.2%,NCC(10例)8.9%。本组患者AVF并发症的发生率为9.4%,导管相关并发症的发生率55.5%。中途因并发症改变通路的患者为12例,占总数的10.7%。AVF患者糖尿病肾病、高血压肾病、慢性肾小球肾炎三大原发病的比例与TCC患者差异均有统计学意义(均P0.05)。结论深静脉临时置管目前仍是本院首透患者的主要血管通路;MHD患者动静脉内瘘并发症发生率低于深静脉置管患者的并发症,但适应证有一定差,如何根据患者血管条件灵活选择血管通路减少并发症,是临床工作者不断努力探索的问题。     

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.