宫腔镜电切术治疗黏膜下子宫肌瘤的疗效

目的探讨宫腔镜电切术治疗黏膜下子宫肌瘤的疗效。方法采集2017年1月12日至2018年8月10日收治的86例黏膜下子宫肌瘤患者随机数字表分组。开腹组进行开腹手术,宫腔镜组进行宫腔镜电切术。分析效果;黏膜下子宫肌瘤手术相关指标;施术前后患者血清钠、血红蛋白;并发症。结果宫腔镜组效果、血清钠、血红蛋白、黏膜下子宫肌瘤手术相关指标、并发症和开腹组比较有优势,P <0.05。结论黏膜下子宫肌瘤患者行宫腔镜电切术效果确切。     

微通道经皮肾镜术中灌注液吸收对血浆渗透压的影响

微通道经皮肾镜取石术（mPNL）是在传统经皮肾镜取石术的基础上发展起来的一项新技术。它具有创伤小、恢复快，等优点。经皮肾镜术中为保持视野清晰，需以一定的压力和速度持续使用灌注液进行肾盂内灌注，大量的灌注液吸收可能会引起血流动力学和血生化的改变。2004～2007年我院通过检测51例上尿路结石患者mPNL术前及术后的血浆渗透压及血清钠的变化，探讨mPNL术中灌注液吸收对血浆渗透压及血清钠浓度的影响，报告如下。     

甘露醇在汽化电切手术中预防水中毒的临床应用

目的探讨在前列腺汽化电切手术中,加入甘露醇灌洗液对预防水中毒的作用。方法采用随机分组．54例前列腺汽化电切患者分为观察组（5％葡萄糖＋5％甘露醇灌洗液）和对照组（5％葡萄糖灌洗液）,对术前、术后电解质、血糖进行检测。结果观察组和对照组术前电解质、血糖无显著性差异（P〉0．05）,术后比较差异有统计学意义（P〈0．01）。结论 在前列腺汽化电切手术中,甘露醇加入灌洗液有减轻和缓解水中毒的作用。     

静脉补液结合消化道补水治疗高渗高血糖状态的疗效观察

目的探讨静脉补液结合消化道补水在治疗高渗高血糖状态（HHS）中的作用。方法33例HHS患者纳入本研究。在静脉补液的同时，匀速进行消化道补水，观察治疗前后血钠、血钾、血糖、有效血浆渗透压等变化及补液、补钾量和预后。结果经静脉补液和消化道补水，血糖、有效血浆渗透压平稳下降，治疗头12h血糖及有效血浆渗透压下降速度不超过3mmol·L^-1·h^-1；治疗48h后，除2例死亡外，其余患者血钠、血钾和血浆渗透压恢复正常，血糖为（10．8±5，2）mmol／L。结论静脉补液结合消化道补水能平稳降低血糖、有效血浆渗透压，降低HHS病死率。     

胸腔灌洗对海水浸泡胸部开放伤高渗状态的疗效

目的研究胸腔灌洗对海水浸泡胸部开放伤高渗状态的疗效。方法实验组(胸腔灌洗组)和对照组(常规救治组)每组10只犬,制成海水浸泡胸部开放伤动物模型。对照组采用常规救治,实验组在常规救治的基础上给予胸腔灌洗。测定两组血清电解质及生化指标,计算血浆晶体渗透压。结果海水浸泡胸部开放伤后,两组血清钠及血浆渗透压明显升高,经过治疗血清钠及血浆渗透压均降低,其中胸腔灌洗组的改善更明显,结论胸腔灌洗是纠正海水浸泡胸部开放伤所致高渗状态的有效方法。     

滤过钠排泄分数对高血糖高渗综合征的预测价值

目的研究尿钠排泄在渗透压调节中的意义,探讨滤过钠排泄分数对高血糖高渗综合征的预测价值。方法糖尿病患者血糖控制平稳后行馒头餐试验时留取空腹及餐后2 h静脉血与随机中段尿,测定血糖、血钠、血钾、血肌酐、血尿素氮、尿钠、尿肌酐。按照空腹渗透压将研究对象分为研究组(10例)和对照组(22例),比较其年龄、体重指数、尿白蛋白排泄率、HbA1c、餐后2 h渗透压、空腹及餐后2 h血糖、血钠浓度、滤过钠排泄分数等。结果进餐后2 h两组血渗透压分别为:(290.22±4.54)mmol·L-1(对照组)(,302.47±5.02)mmol·L-1(观察组);血钠浓度分别为:(133.45±2.09)mmol·L-1(对照组)(,137.10±1.52)mmol·L-1(观察组);滤过钠排泄分数分别为:(0.89±0.36)(对照组)(,0.56±0.38)(观察组),统计学分析,差异均有显著性(P<0.05)。结论血糖升高导致血浆渗透压升高时,代偿性尿钠排泄增加降低血钠浓度是血渗透压维持正常的机制之一,测定滤过钠排泄分数可以反映机体对渗透压调节能力,预测高血糖高渗综合征(HHS)的发生。     

腹部手术与血电解质变化的关系

目的：讨论腹部手术后血电解质的变化及早期补钾的必要性,方法：选择腹部手术病人40例,测定其术前,术后血钾,钠,氯,尿素氮值,并进行统计学处理。结果：手术后血钾浓度明显低于手术前（P＜0．01）,并呈进行性下降,血清钠,氯及尿素氮,肌酐浓度无明显改变,结论：术后应早期补钾,根据尿量及检验结果调整补充量。     

经尿道前列腺汽化电切综合征发生原因和治疗体会

前列腺增生症(BPH)是老年男性的常见病,经尿道前列腺汽化电切术(TUVP)具有损伤小、出血少、术后恢复快等优点[1-2].但老年人常有心血管和肺部疾患,是麻醉的潜在危险因素;手术本身因非电解质冲洗液的吸收,导致循环超负荷、低血钠、体液渗透压降低即经尿道前列腺汽化电切综合征(TURS),增加了麻醉手术风险.     

高渗氯化钠及利尿剂在预防TURS中的疗效分析

目的总结经尿道前列腺汽化电切术中应用利尿剂,预防TURS(电切综合症)的临床疗效。方法回顾性分析治疗TUVP治疗中、重度BPH患者40例,前列腺电切术开始时静脉滴注3%氯化钠注射液,手术进行1小时静脉注射速尿20mg。术前测血糖及血清钠,术后再次测血糖及血清钠。对比术前、术后血糖、血清钠变化幅度。结果 40例手术过程顺利,均未发生TURS,术后血糖值平均6.5mmol/L(5.0～7.48mmol/L),较术前平均升高1.8mmol/L,血清钠平均值血清钠平均值135.2mmol/L(133～137.5mmol/L),较术前平均减低1.7mmol/L。结论高渗氯化钠及利尿剂在中、重度前列腺增生电切术中,对防止TURS是一种有效的治疗方法。     

宫腔镜手术前后患者血糖、电解质及生命体征的变化研究

目的 探讨宫腔镜手术对患者血糖、电解质及生命体征变化的影响.方法 选取2012年4月～2014年4月本院收治的患者70例,均采用宫腔镜手术进行治疗,比较患者术前术后的平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)等生命体征指标及血糖、血钾(K+)、血钠(Na+)、血氯(Cl-)等参数变化.结果 患者手术后的MAP、HR和CVP等生命体征指标及血糖,K+、Na+、Cl-等电解质含量,较术前均无明显变化,差异无统计学意义(P＞0.05).结论 宫腔镜手术作为一种创伤小、手术时间较短、安全系数较高的妇科手术,可明显减轻患者的经济负担,治疗效果较好,对临床具有指导意义,值得临床推广.     

Indicators of dehydration and haemoconcentration are associated with the prevalence and severity of coronary artery disease

1. The vascular endothelium is injured by blood flow abnormalities exacerbated by different risk factors, including markers of haemoconcentration. The aim of the present study was to assess the association between markers of haemoconcentration and dehydration and the prevalence and severity of coronary artery disease (CAD). 2. Subjects in the present study (189 men and 126 women) were classified as either CAD cases or controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions on coronary arteries. Serum electrolytes, osmolality and haematological parameters were measured. 3. Compared with control subjects, patient with CAD had increased levels of serum osmolality, calculated osmolality, tonicity, sodium, glucose and blood urea nitrogen (BUN). Significant differences were also observed in the haematocrit and haemoglobin concentration, but not in erythrocyte counts and total serum protein. On multiple logistic regression analysis adjusting for major risk factors, serum osmolality, glucose and BUN exhibited significant associations with CAD, but the correlations were lessened by diabetes. Analysis using anova showed a significant correlation between serum osmolality, sodium, glucose and BUN and the severity of CAD. The area under the receiver operating characteristic curves, as a relative measure of the test's efficiency, was the highest and significant for serum osmolality, BUN and glucose. 4. The results indicate that some of the markers of dehydration and haemoconcentration are associated significantly with the prevalence and severity of CAD, but the independence of these correlations is questioned. These markers may play a role in the pathogenesis of atherosclerosis.     

Effects of propofol and midazolam on lipids, glucose, and plasma osmolality during and in the early postoperative period following coronary artery bypass graft surgery: a randomized trial

It is not clear how levels of serum lipids and glucose and plasma osmolality change during propofol infusion in the pre- and postoperative period of coronary artery bypass graft surgery (CABG). This prospective, randomized, controlled trial evaluated changes in these parameters during propofol or midazolam infusion during and in the early postoperative period following surgery. Twenty patients undergoing CABG were randomized preoperatively into two groups: 10 patients received propofol (induction 1.5 mg/kg, maintenance 1.5 mg kg(-1) h(-1)) and 10 patients received midazolam (induction 0.5 mg/kg, maintenance 0.1 mg kg(-1) h(-1)). Both groups also received fentanyl (induction 20 mug/kg, maintenance 10 microg kg(-1)). Serum lipids, glucose, and plasma osmolality were measured preinduction, precardiopulmonary bypass, at the end of cardiopulmonary bypass, at the end of surgery, and 4 and 24 h postoperatively. In the propofol group, we observed a significant increase in triglycerides and very low-density lipoprotein levels 4 h postoperatively. In the midazolam group, we observed a significant decrease in low-density lipoprotein, cholesterol at the end of cardiopulmonary bypass, end of surgery, and 4 and 24 h postoperatively and significant increase in osmolality at the end of cardiovascular bypass. Changes in glucose levels did not differ significantly different between the two groups. In patients with normal serum lipids, glucose, and plasma osmolality undergoing CABG, propofol infusion for maintenance anesthesia is not associated with dangerous changes in serum lipids, glucose, and plasma osmolality compared with midazolam. A propofol infusion technique for maintenance of anesthesia for cardiac surgery where serum lipids and glucose may be of concern could be recommended as an alternative to midazolam.     

Diuretic and natriuretic effects of sorbinil, an aldose reductase inhibitor

The renal effects of sorbinil, an aldose reductase inhibitor that interferes with the conversion of glucose to sorbitol, were studied in rats and rabbits before and after fluid deprivation. The intracellular osmolar solute, sorbitol, is found in increasing concentrations from cortex to medulla in the kidney and may be involved in the urinary concentrating mechanism. Oral administration of sorbinil in the rabbit resulted in significant increases in urine flow rate and sodium excretion with a tendency toward decreased urine osmolality and increased potassium excretion both before and after water deprivation. When fluid intake was controlled in the rat study, significant increases in urine flow rate and sodium and potassium excretion and a significant decrease in urine osmolality occurred only in response to fluid deprivation. Thus, sorbinil has diuretic and natriuretic properties and may prevent the normal concentration of urine in the antidiuretic animal.     

Dose-dependent serum biochemical alterations in Wistar albino rats after Palamneus gravimanus (Indian black scorpion) envenomation

Palamneus gravimanus envenomated rats showed dose-dependent alterations in serum biochemical parameters. Sub lethal doses of 100, 200, and 400 microg/kg of P. gravimanus venom were injected intramuscularly into rats. Blood samples were collected by heart puncture before and 4 h after crude venom administration. Serum was analyzed for glucose, blood urea nitrogen (BUN), uric acid, total protein, cholesterol, sodium, potassium, inorganic phosphorus, alkaline phosphatase, aspartate aminotransferase (AST-SGOT), alanine amino-transferase (ALT-SGPT), lactate dehydrogenase (LDH), and creatinine phosphokinase (CPK). Statistically significant increases in serum levels of glucose, creatinine, AST, ALT, BUN, CPK, and LDH and significant decreases in serum levels of total protein, uric acid, cholesterol, calcium, and potassium 4 h after venom administration could be due to the toxic action of P. gravimanus venom on certain organs in rats.     

Effects of an isotonic oral rehydration solution, enriched with glutamine, on fluid and sodium absorption in patients with short-bowel syndrome

Aim : To compare the effects of a standard oral rehydration solution with a polymeric glucose isotonic solution enriched with glutamine on water and sodium absorption in the short bowel.
Methods : Six patients with high jejunostomy were tested in a random order on 2 consecutive days with the standard solution (20 g/L glucose, 94 mmol/L sodium, 292 mOsm/kg osmolality) and a solution containing maltodextrins (18 g/L Glucidex 12; hydrolysis of 18 g of Glucidex 12 yields 20 g glucose) enriched with 14.6 g/L of glutamine (94 mmol/L sodium, 282 mOsm/kg osmolality). Solutions were administered via a naso-gastric tube at a rate of 2 mL/min. Jejunal effluent for each solution was collected during an 8-h period, after a 14-h equilibrium period.
Results : The net 8-h fluid absorption was not significantly different between the standard solution and the solution with glutamine (333 ± 195 and 213 ± 251 mL, respectively (mean ± S.E.M.)). Net sodium absorption was higher for the standard solution than for the solution with glutamine (15 ± 15 vs. 2 ± 20 mmol, P  < 0.05). The rate of glucose absorption was not different between the solutions.
Conclusion : The replacement of glucose by maltodextrins and the addition of glutamine to the standard oral rehydration solution, without changing its sodium content or osmolality, results in a reduction of sodium absorption in the short-bowel syndrome.     

Single-dose effects of ibopamine hydrochloride on renal function in patients with congestive heart failure.

To examine the renal effects of ibopamine HCl we evaluated 15 patients with New York Heart Association Class II-III congestive heart failure and mild renal insufficiency (creatinine clearance [CLcr] = 45-85 ml min-1). Diuretics and vasodilators were withheld and a sodium (Na+)-restricted diet was initiated. All patients exhibited positive Na+ balance at the time of evaluation. Hourly urine volumes, urine chemistries, serum chemistries, PAH and inulin/iothalamate clearances were determined 2 h pre and 4 h post a single 200 mg oral dose of ibopamine. Effective renal plasma flow, creatinine clearance, filtration fraction, and the fractional excretion of sodium and potassium were not significantly altered postdose. A significant increase in urine output and decrease in urine osmolality were seen at all time points postdose. A significant reduction in serum potassium (2 and 3 h) and blood urea nitrogen (1, 3 and 4 h) concentrations occurred. Measurements of glomerular filtration rate by inulin or [125I]-iothalamate produced differing results in the patient groups studied. We conclude that a single dose of ibopamine does not produce significant improvements in renal function in patients with congestive heart failure, mild renal insufficiency and positive sodium balance.     

输尿管镜术治疗婴幼儿急性梗阻性双侧输尿管结石的评价

目的：探讨输尿管镜腔内治疗婴幼儿急性梗阻性双侧输尿管结石的有效性及安全性。方法回顾性分析2011年9月至2013年9月新疆维吾尔自治区人民医院收治的16例双侧输尿管结石婴幼儿,行一期U-100激光碎石或逆行置管引流治疗。输尿管上段结石9侧,输尿管下段结石23侧,合并肾结石5例,结石直径6～14 mm,平均（7．4±1．9） mm。术前检查血尿素氮25～49 mmol/L,血肌酐270～835μmol/L,血尿酸623．7～1640．5μmol/L,血钾4．5～6．8 mmol/L。观察手术前后尿量、血尿素氮、血肌酐、血尿酸、血钾变化。结果输尿管镜下U-100一期双侧输尿管成功碎石8例,7例逆行置入输尿管支架管引流,双侧置管4例,单侧置管3例,1例逆行置管失败改开放手术。6例二期手术碎石,治愈15例,死亡1例。平均手术时间（45±7）min,平均住院时间（9．1±2．3）d。术后第3天血尿素氮1．9～5．9 mmol/L,血肌酐45～76μmol/L,血尿酸125．6～296．7μmol/L,血钾3．2～4．8 mmol/L。结论输尿管镜联合U-100激光碎石或逆行置入输尿管支架管引流治疗婴幼儿急性梗阻性双侧输尿管结石临床有效,创伤小,治疗效果理想。     

Efficacy of a standard United Kingdom oral rehydration solution (ORS) and a hypotonic ORS assessed by human intestinal perfusion

Human triple-lumen intestinal perfusion was used to compare water and solute absorption from the oral rehydration solution (ORS) most widely used in the United Kingdom and a new experimental hypotonic ORS (HYPO-ORS). HYPO-ORS (osmolality 210 mOsm/kg) promoted significantly greater water absorption than UK-ORS (7.03 +/- 1.1 vs 2.73 +/- 1.0 ml cm-1 h-1; P less than 0.01). HYPO-ORS produced net sodium and chloride absorption whereas the low sodium UK-ORS produced a net secretion of these ions. Bicarbonate absorption was also greater from HYPO-ORS although potassium and glucose absorption were similar from both solutions. This study suggests that UK-ORS may not promote optimal water and solute absorption and that clinical studies with HYPO-ORS are indicated.     

小儿胸腔镜手术中应用碳酸氢钠纠正代谢性酸中毒时稀释液的选择

目的:探讨碳酸氢钠纠正小儿代谢性酸中毒所用葡萄糖注射液稀释的适宜浓度。方法:选择接受胸腔镜肺叶切除术的 患儿为研究对象,采用不同浓度的葡萄糖注射液稀释5%碳酸氢钠注射液来纠正代谢性酸中毒,比较各组患儿不同时间点动脉 血pH、血液渗透压、阴离子间隙、标准碱剩余以及血糖水平的变化。结果:2.5% 和5% 的葡萄糖注射液稀释碳酸氢钠纠正代谢 性酸中毒时,不同时间点两组动脉血pH、血液渗透压、阴离子间隙和标准碱剩余水平比较差异无统计学意义,2.5% 葡萄糖组在 各时间点的血糖水平低于5%葡萄糖组,而且血糖波动较小。结论:小儿胸腔镜手术中采用2.5% 葡萄糖注射液稀释碳酸氢钠 纠正代谢性酸中毒是一种较好的方法。