系统性毛细血管渗漏综合征

系统性毛细血管渗漏综合征（systemic capillary leak syndrome,SCLS）的特点为不明原因反复发作的全身性水肿、严重的低血容量性低血压、低蛋白血症,伴随毛细血管的高渗状态,最早由Clarkson等报道.[第一段]     

毛细血管渗漏综合征中内皮祖细胞的作用

体外循环后毛细血管渗漏综合征的血管修复对该病的恢复起到至关重要的作用。外周血中存在着能分化为血管内皮细胞的内皮祖细胞,能够促进损伤血管修复和生后血管再生。血浆中的血管内皮生长因子（VEGF）、促红细胞生成素（EPO）等因子通过刺激血管内皮祖细胞的动员、迁移、黏附和分化,促进血管修复和再生。现对体外循环后血管内皮祖细胞的数量和功能情况及其与血浆相关因子的相互作用进行综述,旨在为毛细血管渗漏综合征的治疗和预防提供新的思路.     

重症急性胰腺炎并发毛细血管渗漏综合征的研究进展

重症急性胰腺炎(SAP)起病急、临床表现凶险、病死率高,在急性反应期常发生毛细血管渗漏综合征(CLS),CLS的出现又加快了重症急性胰腺炎病情恶化。目前针对重症急性胰腺炎诱发的毛细血管渗漏综合征的研究较少,在临床治疗上易被忽视,就重症急性胰腺炎诱发毛细血管渗漏综合征的发病机制、临床诊断及治疗等方面做一综述。     

危重患者毛细血管渗漏综合征的护理

目的 探讨危重患者毛细血管渗漏综合征(CLs)的护理方法.方法 对5例CLS患者在补液、机械通气和镇静等治疗的同时采取针对性护理措施,包括密切观察病情、呼吸道护理、镇静剂护理及基础护理.结果 所有患者治疗5～7d水肿减轻,均成功脱机,住院(14.5±5.7)d痊愈出院.结论 对CLS患者做好病情观察、及时清理呼吸道、做好呼吸机护理极为重要.     

羟乙基淀粉对低血容量性休克兔毛细血管渗漏的影响

目的通过正交实验设计,观察6%羟乙基淀粉(6%HES)、复方氯化钠实验研究和生理盐水在低血容量性休克不同阶段的治疗作用及对毛细血管渗漏的影响。方法确立实验因素为液体种类、给液剂量和给液时机,实验水平数为三水平,由此选用L9(34)正交表。随机选择27只健康新西兰大白兔,根据正交表顺序建立失血性休克模型,在不同时机输入相应的液体。输液后,由颈内静脉注入伊文思蓝(EB),观察3h后处死,(1)取右肺中叶0.5g组织,计算含水率;(2)用EB标准品测出EB标准曲线,计算出伊文思蓝含量回归方程;(3)取右肺中叶0.1~0.3g组织,碾碎后用甲酰胺萃取EB,离心后用分光光度仪测EB吸光度,根据EB回归方程计算出EB含量;(4)观察肺病理变化。结果肺含水率和EB含量方差分析结果均表明A(液体种类)、B(给液剂量)和C(给液时机)三个因素均有统计学意义,A为主要因素,其次为B,再次为C。病理结果A1B3C2组肺损伤最轻,其他由轻到重依次为A1B2C2、A3B3C2、A1B3C3、A3B2C1、、A2B2C3、含B1的三组,A2B3C1肺损伤最重。结论选择中分子羟乙基淀粉(200/0.5)20ml/kg于休克代偿期输入,可降低肺毛细血管通透性,减轻肺水肿及肺损伤,对低血容量性休克时肺毛细血管渗漏可能有治疗作用。     

院前长途转运危重患者处理毛细血管渗漏综合征体会

目的:总结长途转运危重患者,用甘露醇处理毛细血管渗漏综合征(cls)的疗效.方法:随机抽样845例,分甘露醇实验组376例和甘露醇对照组469两组,甘露醇组按4-6小时给20%甘露醇250毫升,加压静滴;非甘露醇组给维护生命体征液体,无特殊的利尿脱水治疗.结果:甘露醇组Glasgow评分提高、心衰和呼吸衰竭得到改善;治疗前后呼吸、心率、血氧饱有显著性差异存在;死亡率19.9%较非甘露醇组33.3%低.     

胸外术后毛细血管渗漏综合征补液治疗策略的临床研究

目的探讨胸外术后毛细血管渗漏综合征(CLS)补液治疗策略。方法 29例胸外术后CLS患者按预后分为痊愈组和死亡组,按CLS病程分别统计术后早期(1~4天)和术后晚期(5~7天)患者日均平均动脉压(MAP)、中心静脉压(CVP)、血浆白蛋白(ALB)含量、尿量和胸液引流量作为疗效判断指标,统计日均晶体液、白蛋白、人工胶体和新鲜冰冻血浆使用,并分析两组补液策略差异。结果两组患者术后早期均存在低血容量和低白蛋白血症;治疗后痊愈组在术后晚期症状改善而死亡组继续恶化,其日均MAP、CVP、ALB、尿量均低于痊愈组,日均胸液引流量较高。痊愈组术后早期白蛋白和人工胶体使用量高于死亡组(P0.05),而晶体液和血浆使用量比较,差异无统计学意义(P0.05);术后晚期痊愈组白蛋白、人工胶体、血浆和晶体液使用量均低于死亡组(P0.05)。结论胸外术后CLS补液治疗策略需根据病程分期进行,在术后早期充分补充白蛋白和人工胶体能够有效避免CLS持续进展。     

救治特重度烧伤并发多器官功能障碍综合征一例

笔单位收治1例烧伤面积为90％TBSA、合并冲击伤和吸入性损伤的患，伤后相继并发脑、肺、心、肾、肝脏、血液、胃肠道及代谢系统等8个器官系统功能障碍，经治疗痊愈出院。现报告如下。     

肾病综合征的中西医护理现状

肾病综合征是肾小球基底膜通透性异常，导致尿中丢失大量蛋白为主要病变的临床综合征，其临床表现为大量蛋白尿、低蛋白血症、水肿、高脂血症，属中医水肿范畴。中医学认为病因多与感受风、寒、湿、疮毒、饮食内伤以及情志不和有关，病机主要三焦气化功能失调，尤以脾虚土不制水，肾虚水无所主有关。由于该病病程长、易复发、合并症多及治疗困难等特点，导致患者及家属心理压力大，因此，合理治疗和护理显得非常重要。现结合文献，将我国中西医护理现状综述如下。     

早期限制性容量复苏治疗创伤性休克合并急性肾衰竭30例

创伤性休克合并急性肾衰竭是由于机体遭受各种致伤因子急剧打击,循环功能障碍,引起有效循环血量急剧减少,出现有效血容量不足,脏器的灌注受到影响,伴随肾脏受损和肾功能减退,导致急性肾衰竭发生,严重者可因合并严重并发症,进而导致患者死亡。目前,创伤性休克合并急性肾衰竭的早期容量复苏,临床上常用两种方法：传统液体复苏及限制性液体复苏,研究表明：采取早期限制性容量复苏措施及时干预,可能避免加重肾功能损伤,但其具体机制不清,本研究拟观察我院创伤性休克合并急性肾衰竭患者中早期限制性容量复苏的疗效,进一步探讨其治疗机制。     

Abdominal Compartment Syndrome Associated With Capillary Leak Syndrome After Liver Transplantation

Orthotopic liver transplantation was performed in a 49-year-old man with metastatic liver sarcoma. After surgery, both abdominal compartment syndrome (ACS) and capillary leak syndrome (CLS) developed. Exploratory laparotomy and colon exteriorization were performed. Five days later, a diagnosis of severe CLS was established, and hydroxyethyl starch was infused to prevent leakage of albumin. The patient gradually recovered over 3 weeks. Awareness of ACS and CLS is important to improve outcome because early diagnosis and immediate therapy are essential. Bladder pressure is a key factor in diagnosing ACS, and pressure of 35 mm Hg is an indication for decompressive laparotomy. During the early stage of CLS, hydroxyethyl starch but not albumin should be used to alleviate edema and hypoalbuminemia.     

危重患者毛细血管渗漏综合征的护理

目的探讨危重患者毛细血管渗漏综合征（cLs）的护理方法。方法对5例CLS患者在补液、机械通气和镇静等治疗的同时采取针对性护理措施，包括密切观察病情、呼吸道护理、镇静剂护理及基础护理。结果所有患者治疗5～7d水肿减轻，均成功脱机，住院（14.5士5.7）d痊愈出院。结论对CLS患者做好病情观察、及时清理呼吸道、做好呼吸机护理极为重要。     

A Case Report of Idiopathic Systemic Capillary Leak Syndrome That Occurred During the Postoperative Period of Abdominoperineal Resection for Colorectal Cancer

A 57-year-old woman without any past medical history underwent abdominoperineal resection for rectal cancer in our department. On postoperative day 15, the patient complained of sudden abdominal pain, and high fever was noted in addition to the appearance of erythema around the stoma. The diagnosis of phlegmon was made, and antibiotic infusion was started. However, a few days later, the patient developed hypovolemic shock with hypoalbuminemia and hemoconcentration. Fasciotomy was performed to exclude the necrotizing fasciitis, though all cultures were negative. Upon exclusion of the differential diagnoses, idiopathic systemic capillary leak syndrome (ISCLS) was diagnosed. She was successfully treated with massive fluid infusion under ventilation and continuous hemodiafiltration. Here, we report the first case of ISCLS that occurred during the postoperative period of colorectal surgery.Key words: Idiopathic systemic capillary leak syndrome (ISCLS), Surgery, Abdominoperineal resectionIdiopathic systemic capillary leak syndrome (ISCLS) is a rare disease characterized by severe hyperpermeability of unknown cause, followed by hemoconcentration and hypoalbuminemia. During such episodes, approximately 70% of the plasma acutely shifts from the intravascular area into the interstitial space causing severe hypovolemic shock. The first case of ISCLS was described by Clarkson et al in 1960. Since then approximately 150 cases of ISCLS have been reported worldwide. To the best of our knowledge, this is the first report of a case of ISCLS that occurred during the postoperative period of colorectal surgery.     

股神经嵌压症的诊断与治疗（附7例报告）

目的：进一步确定股神经嵌压症的诊断以及手术治疗的效果。方法：对7例被诊断为急慢性股神经嵌压症进行临床分析,右侧5例,左侧2例,急性4例,慢性3例。结果：术后随访3个月－2年,平均10个月,均经手术减压松解后症状消失。结论：手术对早期治疗本病,可以取得满意的临床效果。     

下腰椎手术失败综合征146例报告

目的：了解下腰椎手术失败综合征的原因及预防治疗。方法：通过对１４６例下腰椎手术失败综合征病人分析，找出ＦＢＳＳ′的病因，预防及治疗措施。结果：详细讨论了ＦＢＳＳ病因及确切的治疗方法。结论：由于复发原因较多，需要仔细检查，对症治疗。不能盲目再手术。     

Larsen's Syndrome: Report of Three Cases in the One Family, Mother and Two Offspring

Three cases are presented of the very rare Larson's syndrome, being only the second report in the literature of concomitant involvement of parent (the mother in this instance) and offspring (two children) (see also Haberman et al. 1976).

The only therapeutic procedure that is applicable, i.e., surgery, has given only mediocre results over an evolutive period of 8 to 9 years (in case C).

We have not been able to demonstrate analytical or histological abnormalities that might provide a diagnostic clue, so that the aetiopathogeny of the disorder remains unknown.     

Larsen's Syndrome: Report of Three Cases in the One Family,Mother and Two Offspring

Three cases are presented of the very rare Larson's syndrome, being only the second report in the literature of concomitant involvement of parent (the mother in this instance) and offspring (two children) (see also Haberman et al. 1976).

The only therapeutic procedure that is applicable, i.e., surgery, has given only mediocre results over an evolutive period of 8 to 9 years (in case C).

We have not been able to demonstrate analytical or histological abnormalities that might provide a diagnostic clue, so that the aetiopathogeny of the disorder remains unknown.     

骨样骨瘤7例报告

目的：分析7例骨样骨瘤的临床及影像学特点，总结诊断经验。方法：病变位于长骨干4例，跟骨，髋臼，胫骨下端各1例，对所有患都进行了局灶切除及病理检查，结果：术后7例症状均消失，长骨干4例术前诊断与病理报告相符，其余3例术前均未得到正确诊断。结论：松质骨骨样骨瘤其X线表现不典型是诊断困难的重要原因，X片骨硬化和病人疼痛症状应为诊断的重要线索，必要时拍断层照片或CT检查，有助于明确诊断。