难治性上消化道动脉性大出血的急诊栓塞治疗

目的 评价急性上消化道大出血患者介入栓塞治疗的临床效果。方法 对22例经动脉造影检查确诊为急性上消化道大出血的患者予以导管栓塞治疗。结果 治疗后20例完全止血，复发1例，无效1例；有效率90.9％。未见与栓塞相关并发症出现。结论 对急性上消化道大出血患者予以栓塞治疗有效、安全。     

肝癌术后胃Dieulafoy病致上消化道大出血及休克一例

病人男，36岁，主因肝区疼痛不适1周入院。查体：皮肤及巩膜无明显黄染，无肝掌，前胸可见数个蜘蛛痣。腹部饱满，肝脾触诊欠满意，移动性浊音阴性。辅助检查：WBC3．9×100／L，RBC5．41×10^19／L，Hb174g／L, PIT61×10^9／L；HBsAg、HBeAb、HBcAb均阳性；ALT56U／L，胆红素正常。腹部CT：肝硬化、脾大；肝左叶占位。2003年12月3日行肝动脉导管造影及栓塞化疗术，术后给予抑酸、保肝等治疗，恢复顺利。[第一段]     

急性多器官动脉栓塞1例报告

1临床资料患者男,46岁。突发左侧腹痛伴左拇趾发凉、麻木1 d。查体生命体征平稳,急性病容,心肺未闻及异常。腹平,未见胃肠型及蠕动波,左侧腹压痛,以上腹部为著,无反跳痛及肌紧张,未触及包块。叩鼓音,左肾区叩击痛,肠鸣音正常。左拇趾颜色苍白,皮肤温度降低,双侧股动脉、腘动脉及右侧胫后、足背动脉搏动可触及,左侧胫后动脉搏动可触及,右侧足背动脉搏动减弱。腹部彩超未见明显异常。第2 d腹部增强CT显示脾、左肾多发低密度灶(图1~     

急性动脉栓塞致肌病肾病代谢综合征诊断与治疗

目的 总结急性动脉栓塞致肌病肾病代谢综合征的诊治经验.方法 回顾性分析自2002年4月～2009年3月由急性动脉栓塞导致的肌病肾病代谢综合征临床资料.结果 3例存活,3例死亡,1例死于高钾血症引起的心搏骤停,2例死于急性肾功能衰竭.结论 及早恢复血流,减少缺血时间,早期补液扩容、碱化尿液、血液净化治疗是降低肌病肾病代谢综合征发病率,降低病死率、截肢率的关键.     

脾假性动脉瘤破裂致上消化道大出血一例并文献复习

正病例患者,男,57岁,因"黑便10 d"入院,近10天来,患者无明显诱因出现黑便,每天约200 g,未见鲜血,无畏寒、发热,无头晕、黑蒙,无腹痛,腹泻,无恶心、呕吐,无尿频、尿急,无肉眼血尿。门诊行胃镜检查提示(图1):慢性浅表性胃炎伴糜烂,胃底血管瘤。腹部增强CT示(图2):胃血管瘤术后改变,吻合口胃体大弯侧近胃底部胃壁增厚;其旁脾门不规则团块,大小约4 cm,考虑脾假性动脉瘤。查体:神志清,腹     

急性动脉栓塞致肌病肾病代谢综合征诊断与治疗

目的 总结急性动脉栓塞致肌病肾病代谢综合征的诊治经验.方法 回顾性分析自2002年4月～2009年3月由急性动脉栓塞导致的肌病肾病代谢综合征临床资料.结果 3例存活,3例死亡,1例死于高钾血症引起的心搏骤停,2例死于急性肾功能衰竭.结论 及早恢复血流,减少缺血时间,早期补液扩容、碱化尿液、血液净化治疗是降低肌病肾病代谢综合征发病率,降低病死率、截肢率的关键.     

外伤性脾动静脉瘘致上消化道大出血一例

<正>患者女,24岁。因腹胀、腹泻4d,于2009年11月20日入院。2年前因胸腹刀刺伤,行膈肌、胃、胰腺修补和脾动脉干结扎术。查体:体温36.8℃,脉搏86次/min,呼吸20次/min,血压120/80mmHg。神志清,皮肤和     

经导管出血动脉栓塞术对重症急性胰腺炎并发腹腔内大出血诊治体会

目的总结经导管出血动脉栓塞术(transcatheter arterial embolization,TAE)对重症急性胰腺炎(SAP)并发腹腔内大出血的诊治经验。方法回顾性分析本胰腺外科中心2000年1月至2003年1月间19例SAP并发腹腔内大出血病人经TAE诊治的临床资料。结果TAE止血近期成功率89.5%(17/19),再出血发生率36.8%(7/19),再次TAE止血成功率71.4%(5/7)。结论SAP并发腹腔内大出血多为腐蚀性/感染性动脉瘤破裂出血,主要出血血管为脾动脉和胃十二指肠动脉;就紧急止血而言,TAE最有效;对于TAE止血失败或止血后复发出血者手术止血是必要的。     

急性动脉栓塞导致肌病肾病代谢综合征11例的治疗

目的总结急性动脉栓塞致肌病肾病代谢综合征(myonephropathic-metabolic syndrome,MNMS)的诊治经验。方法回顾性分析2005年1月至2006年3月由急性动脉栓塞导致的11例MNMS的临床资料。结果5例存活(保肢4例);2例死于高钾血症引起的心搏骤停,4例死于以急性肾功能衰竭为首发的多器官功能不全综合征。结论急性动脉栓塞一旦确诊,尽早手术。MNMS是急性动脉栓塞的常见、严重并发症,急性动脉栓塞时尽快重建血流、骨筋膜室综合征尽早行筋膜室切开术及坏疽肢体尽早截肢是预防和治疗MNMS的关键。     

左足动静脉畸形栓塞硬化术致足营养动脉栓塞抢救成功1例

患儿女性9岁，左足背部肿物8年余入院。查体：左足肿大。以足前部为甚，其横径大于健侧，于足背和足底分别可见一长5cm的手术切口瘢痕，皮肤颜色正常；触诊左足肿大的部位硬度似骨性肥大，肿物压缩性不明显，足背动脉搏动强于健侧，皮温略高于健侧，无明显震颤。在静脉复合麻醉下行左足血管瘤栓塞硬化术。足背与足跟间扎止血带，防止血栓逆行致全身远位栓塞。穿刺点采用2％利多卡因局部麻醉后穿刺入瘤体，回抽见暗红色静脉血，且无搏动，     

呼吸衰竭并多器官功能障碍综合征68例临床分析

目的探讨呼吸衰竭并多器官功能障碍综合征的临床特点,降低病死率。方法本研究回顾性分析笔者所在医院1990～2010年收治的呼吸衰竭并多器官功能障碍综合征68例患者的临床资料。结果本组呼吸衰竭并多器官功能障碍综合征累及器官为肺、心、脑、胃肠、肾、肝、血液等;器官功能障碍受累器官数目为2个器官39例,3个器官18例,4个及4个以上器官11例;Ⅰ型呼吸衰竭4例,Ⅱ型呼吸衰竭64例;68例中,死亡41例,病死率60.29%,年龄越大、受累器官越多、病死率越高。结论严密监测病情变化、早检查、早诊断、及时的综合治疗是抢救高危患者生命的关键措施。     

Curative effect of acute intermittent peritoneal dialysis in the treatment of infants with multiple organ dysfunction syndrome and acute kidney injury

Objectives To investigate the effect of acute intermittent peritoneal dialysis(AIPD) in multiple organ dysfunction syndrome (MODS) infants with acute kidney injury (AKI) and to assess the effectiveness of the treatment. Methods Twenty-six cases of MODS infants with AKI (Age for 2 months to 3 years) treated with AIPD (AIPD group, n=12) or not (Control group, n=14) in intensive care unit of People’s Hospital of Guizhou Province from September 2006 to May 2014 were retrospectively reviewed. C1inical characteristics including Scr, BUN, CO2CP, serum K+ and C reactive protein (CRP) before and after dialysis, mortality and renal recovery rate within 30 days were analyzed and compared between the two groups. Result After AIPD, the levels of Scr and BUN decreased significantly (P＜0.05), and comparison with control group was the same; serum K+ declined and CO2CP increased obviously (P＜0.05); CRP also decreased but without significant difference as well as comparison with control group. Compared with control group, these infants in AIPD group showed more significant improvement, including congestive heart failure and pneumonedema; both of renal recovery rate(41.67% vs 14.29%, P=0.003) and ventilator weaning rate (58.33% vs 28.57%, P=0.086) remarkablely raised respectively; mortality rate within 30 days significantly reduced (15.4% vs 36.9%, χ2=9.58, P=0.020). Conclusion AIPD is a kind of effective way of renal replacement therapy, which can effectively clean out superfluous water and toxin, as well correct electrolyte imbalance, enhance renal recovery rate and reduce mortality rate, and is effective to MODS infants with AKI.     

Cardiac failure and multiple organ dysfunction syndrome in a patient with endocrine adenomatosis

In this case report, we present the successful therapy of severe cardiac failure in pituitary adrenal insufficiency. A previously healthy 56-year-old-man in pituitary coma due to an atypical variant of multiple endocrine adenomatosis (pituitary adenoma and pheochromocytoma) suffered from cardiac failure resistant to catecholamine and standard hydrocortisone therapy. After two bolus injections of dexamethasone (2 x 24 mg) mean arterial pressure and cardiac function dramatically improved, probably due to restoration of permissive effects on catecholamine action and reversal of pathophysiological mechanisms of cardiac failure. We conclude that in patients with severe cardiovascular failure in pituitary coma the administration of potent glucocorticoids may be more effective in reversing cardiovascular failure than standard dosages of hydrocortisone.     

Nephrogenic acute respiratory distress syndrome: A narrative review on pathophysiology and treatment on pathophysiology and treatment

The kidneys have a close functional relationship with other organs especially the lungs. This connection makes the kidney and the lungs as the most organs involved in the multi-organ failure syndrome. The combination of acute lung injury (ALI) and renal failure results a great clinical significance of 80% mortality rate. Acute kidney injury (AKI) leads to an increase in circulating cytokines, chemokines, activated innate immune cells and diffuse of these agents to other organs such as the lungs. These factors initiate pathological cascade that ultimately leads to ALI and acute respiratory distress syndrome (ARDS). We comprehensively searched the English medical literature focusing on AKI, ALI, organs cross talk, renal failure, multi organ failure and ARDS using the databases of PubMed, Embase, Scopus and directory of open access journals. In this narrative review, we summarized the pathophysiology and treatment of respiratory distress syndrome following AKI. This review promotes knowledge of the link between kidney and lung with mechanisms, diagnostic biomarkers, and treatment involved ARDS induced by AKI.     

Successful management of a giant spinal arteriovenous malformation with multiple communications between primitive arterial and venous structures by embolization: Report of a case

A 47-year-old woman was admitted to our hospital with a giant spinal arteriovenous malformation (AVM) causing heart failure and thoracic myelopathy. Angiography revealed that the spinal AVM had multiple feeding vessels branching from the 5th through 12th intercostal arteries. The drainage vein flowed to the azygos vein and superior vena cava. The AVM destroyed the 7th thoracic vertebra. The cardiac output was 16.7l/min and the shunt ratio was 64% before treatment. Embolization with cyanoacrylate was performed because the operation was considered to be associated with a significant risk of paraplegia and organ ischemia. The cardiac output decreased to 11.6l/min and the shunt ratio was reduced to 32%. After embolization the patient demonstrated no symptoms of either heart failure or sensory deficits. During embolization, provocative tests using sodium amytal and lidocaine with magnetic stimulation were also performed. The above findings suggest that provocative tests and magnetic stimulation are useful to predict paraplegia, which could result from embolization while, in addition, embolization is considered to be a useful treatment for multiple shunt and nidus in this region.     

体外膜肺联合血液滤过治疗肺肾衰竭的实验研究

目的 观察体外膜氧合器（ECMO）联合高容量血液滤过（HVHF）对急性呼吸窘迫综合征（ARDS）、急性肾功能衰竭（ARF）的治疗作用。 方法 采用实验犬32只，随机分为A、B、C、D 4组。静脉注射油酸复制ARDS模型及双侧输尿管结扎复制急性肾功能衰竭模型。A组用ARDS呼吸机治疗；B组ARDS用ECMO治疗；C组ARDS＋ARF用HVHF治疗；D组ARDS＋ARF用ECMO联合HVHF治疗。监测血气、血流动力学以及血生化等指标。 结果 治疗后B组氧分压（PaO2）逐步上升，在治疗4 h后高于A组[（95.58±8.14） 比（82.79±12.37） mm Hg，P < 0.05]； C组PaO2治疗中较成模时无明显改善；D组PaO2呈逐渐上升趋势，在各时间点均高于C组（P < 0.05）。各组血流动力学指标在治疗中保持稳定。C、D组HVHF治疗后Scr、BUN明显降低[C组：Scr (320.89±65.42) 比(655.04±181.22) μmol/L，BUN (20.42±6.65) 比（41.53±10.59）mmol/L；D组：Scr (334.15±45.97)比（697.48±101.66） μmol/L，BUN (19.12±6.39) 比（39.10±11.60） mmol/L，P均< 0.01]。 结论 ECMO可以有效地改善ARDS低氧血症，联合HVHF可以提供肺肾功能联合支持。     

Extended daily veno-venous high-flux haemodialysis in patients with acute renal failure and multiple organ dysfunction syndrome using a single path batch dialysis system.

BACKGROUND: In the treatment of acute renal failure in patients with multiple organ dysfunction syndrome (MODS), continuous renal replacement therapies (CRRT) are increasingly used because of excellent volume control in the presence of improved cardiovascular stability. Patients with MODS, however, are frequently catabolic and have a high urea generation rate requiring either cost-intensive high-volume CRRT or additional intermittent haemodialysis to provide adequate clearance of small-molecular waste products. We tested the closed-loop batch haemodialysis system (called Genius((R))) for the treatment of acute renal failure in patients with MODS in the intensive care unit. METHODS: Blood flow and countercurrent dialysate flow were reduced to 70 ml/min. Thus the 75 l dialysate tank of the Genius((R)) system lasts for 18 h of extended single-path high-flux haemodialysis (18 h-HFD) using polysulphous F60 S((R)) dialysers. Blood pressure, body temperature, and venous blood temperature in the extracorporeal circuit (no heating of the dialysate), ultrafiltration rate, serum urea levels, dialyser urea clearance, and total urea removal were monitored. In addition we tested the bacteriological quality of the spent dialysate at the end of 18-h treatments. RESULTS: Twenty patients with acute renal failure and MODS were investigated. Averaged dialyser urea clearance was 59.8 ml/min (equal to 3.6 l/h or 64.8 l/day). Total removal of urea was 14.1+/-6.5 g/day keeping serum levels of urea below 13 mmol/l. Mean arterial pressure remained stable during the 18-h treatments with a mean ultrafiltration rate of 120 ml/h. The temperature in the venous blood tubing dropped by 5+/-0.5 degrees C during the 18-h treatment (0.28 degrees C/h) in the presence of unchanged core temperature in the patients. There was no bacterial growth in 2.5 l of spent dialysate (<0.0004 colony forming units/ml). CONCLUSIONS: Extended high-flux dialysis using the Genius((R)) system combines the benefits of CRRT (good cardiovascular stability, sterile dialysate) with the advantages of intermittent dialysis (high urea clearance, low treatment costs). High efficiency, simplicity and flexibility of the system offers the unique opportunity to use the same dialysis machine for extended time periods (18 h) as well as for shorter intermittent renal replacement therapy in critically ill patients.     

Pancreaticoduodenectomy complicated by Budd-Chiari syndrome: A case report and review of literature

BACKGROUND Pancreaticoduodenectomy(PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, risk factors, preventive measures, and standardized management of complications. However, some lifethreatening complications remain atypical and undescribed. CASE SUMMARY We report here the case of a 69-year-old patient with Budd-Chiari syndrome that occurred after arterial embolization of postpancreatectomy hemorrhage. Diagnosis was established with biological findings(i.e., acute liver failure) and radiological findings(i.e., compressive hematoma of the retrohepatic vena cava). Emergency surgical revision was performed to evacuate the hematoma. The postoperative course was uneventful, with rapid recovery of liver function. To our knowledge, post-PD Budd-Chiari syndrome has never been described in the literature. CONCLUSION Acute liver failure in early post-PD should prompt investigation to rule out Budd-Chiari syndrome.