重症急性胰腺炎连续性静脉-静脉血液滤过治疗的临床应用

重症急性胰腺炎（acute pancreatitis，AP）是临床常见病程凶险的疾病，患病初期表现全身性炎症反应综合征（SIRS）、水及电解质紊乱，合并各种并发症，严重者出现多器官功能障碍（MODS），死亡率高。近年来，将连续性静脉一静脉血液滤过（CVVH）用于治疗重症AP，充分开拓了替代治疗的新前景，使重症AP的治疗有了新方法，病程趋于平稳，并发症减少、减轻，死亡率降低。本组对重症AP患者病程早期进行CVVH治疗。分析报告如下。     

连续性血液净化治疗心脏术后急性肾衰竭效果及预后观察

目的：观察连续性血液净化（CBP）治疗心脏术后急性肾衰竭（ARF）的临床效果及预后。方法：选择心脏术后ARF21例,其中,合并全身炎症反应综合征（SIRS）10例（A组）,合并多器官功能障碍综合征（MODS）11例（B组）。行连续性静脉静脉血液滤过（CVVH）治疗。比较两组治疗前后氧合指数、心率（HR）、平均动脉压（MAP）、pH、血肌酐（Scr）、中心静脉压（CVP）、血尿素氮（BUN）等指标,以及急性生理功能和慢性健康状况评分（APACHEⅡ）和急性肾小管坏死一个体严重程度指数评分（ATN—ISI）等的变化情况。结果：治疗24h后,两组在氧合指数、BUN、Scr及APACHEⅡ分值等方面,均较治疗前有显著改善（P〈0．05）。A组MAP、pH,治疗前后比较差异显著（P〈0．05）;HR、CVP等指标及ATN-ISI分值,治疗前后比较差异不显著（P〉0．05）。B组MAP、pH、HR、CVP等指标及ATN—ISI分值,治疗前后比较均差异不显著（P〉0．05）。结论：连续性血液净化治疗可有效改善心脏术后ARF患者病情,并维持了酸碱平衡,在一定程度上改善了患者的心肺功能。     

短时血液滤过治疗急性重症胰腺炎15例临床观察

目的探讨短时血液滤过（short time venous hemofdtration SVVH）治疗急性重症胰腺炎（Acute Severe Pancreatitis ASP）的临床疗效。方法在常规治疗的基础上同时加用短时血液滤过治疗，观察治疗前后外周血中C反应蛋白的改变、血液生化指标以及APACHEⅡ积分的改变。结果经短时血液滤过治疗，患者的临床表现明显好转，外周血中细胞因子的浓度明显减少，APACHEⅡ积分明显下降。结论短时血液滤过能有效清除急性重症胰腺炎时体内过度释放的细胞因子，降低APACHEⅡ积分，减轻胰腺组织损害，有效控制全身炎症反应综合征（SIRS）。     

重症急性胰腺炎应用连续性血液净化治疗疗效分析

重症急性胰腺炎（Severeacutepancreatitis,SAP）是临床上常见的急危重症,以严重的全身炎症反应综合征为主要表现。炎症细胞被过度激活并大量释放细胞因子,由此产生的细胞因子级联反应,导致SAP病情加重。该病起病急、病情重、进展快,可迅速出现全身炎症反应综合征（SIRS）,进而发展为多脏器功能衰竭（MODS）而危及患者生命,病死率高达20％～30％^[1]。连续性血液净化（CBP）是治疗重症急性胰腺炎的重要治疗手段之一,具有较好的临床疗效。本院2009。2012年应用床旁连续性静脉一静脉血液透析滤过（CVVHDF）净化方法治疗重症急性胰腺炎26例,疗效满意,现将I临床资料报道如下。     

连续性静脉-静脉血液滤过救治多脏器功能衰竭的护理体会

连续性肾替代治疗（Continuous renal replacement therapy,CRRT）又称连续性血液净化（Continuous blood purification,CBP）是指连续、缓慢清除水分和溶质的治疗方式。1977年,Krammer等首次将连续性动-静脉血液滤过应用于临床，很大程度上克服了传统的间歇性血液透析（IHD）所存在的“非生理性”治疗的缺陷。     

血浆置换加连续性血液净化治疗急性砷化氢中毒并发MODS

目的观察采用血浆置换加连续性血液净化治疗急性砷化氢中毒并发多器官功能综合征（MODS）的疗效。方法对7例确诊为急性砷化氢中毒并发MODS的患者,进行血浆置换加连续性血液净化治疗。结果1例第4天死亡,其余6例患者5天内溶血均停止,1例60天肾功能恢复正常,其余15天内肝功、肾功、心功及胰功均恢复正常。结论我们应用血浆置换加连续性血液净化治疗急性砷化氢中毒并发MODS,取得了明显的效果。     

高容量血液滤过的研究进展

高容量血液滤过（high volume hemofihration，HVHF）是在连续性静脉一静脉血液滤过（CVVH）基础上发展起来的一种治疗模式，它通过增加置换液的输入量从而提高对大中分子溶质的对流清除，目前广泛用于多种危重病的治疗。笔者回顾HVHF的发展及其有关治疗时机与置换量的研究，并就高容量血液滤过冲击治疗模式的应用作一综述。     

连续性血液净化在救治重危病人中的观察与护理

s连续性血液净化，是目前临床上一种新的生命支持技术。它可清除血液中的中、小分子物质、超滤清除体内过多水分，对各种炎症介质的清除作用已在许多研究中得以证实，已成为急救医学的重要部分，对降低重危患者的死亡率有重要意义。现将我们对21例重危病人应用连续性血液净化治疗救治过程中的观察与护理报告如下。     

连续，陛血液净化在救治重危病人中的观察与护理

s连续性血液净化，是目前临床上一种新的生命支持技术。它可清除血液中的中、小分子物质、超滤清除体内过多水分，对各种炎症介质的清除作用已在许多研究中得以证实，已成为急救医学的重要部分，对降低重危患者的死亡率有重要意义。现将我们对21例重危病人应用连续性血液净化治疗救治过程中的观察与护理报告如下。     

预防急性白血病患者化疗期感染强化护理

目的：探讨针对急性白血病患者，在化疗期间对其实施强化护理，观察临床获得的预防效果。方法选取急性白血病住院患者150例。通过随机数表法将所有白血病患者分为A1组（强化护理组75例）与A2组（常规护理组）。 A1组：主要采取强化护理措施、保护性隔离措施以及肠道清除（选择性）等措施；A2组：实施白血病常规护理；对比A1组与A2组白血病患者临床出现感染的概率。结果在临床出现感染的概率方面，A1组与A2组患者之间存在显著差异（ P＜0.05）。结论对于血液病房（缺少层流无菌设备），对其实施强化护理能够显著将临床急性白血病患者出现院内感染的概率降低，在提高临床感染治愈率方面也表现了重要意义。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。