无醋酸盐和碳酸氢盐血液透析对外周血细胞因子浓度的影响

研究了无醋酸盐血液透析（ＡＦＨＤ）和碳酸氢盐血液透析（ＢＨＤ）以一些细胞因子和生化参数的影响。结果表明ＡＦＨＤ比ＢＨＤ清除血磷更充分，对影响细胞因子生成的作用更小。     

无醋酸盐透析液的研究进展

无醋酸盐透析液的研究进展季曙明综述黎磊石审校目前，使用的Ｄ－乳酸盐透析液和醋酸盐透析液都是非生理性离子透析液。临床上常常发生一些毒性综合症。动物实验和临床研究发现血中Ｄ－乳酸水平升高大于３ｍｍｏｌ／Ｌ即出现脑功能损害，血中醋酸盐浓度大于７ｍｍｏｌ／Ｌ...     

联机血液滤过透析和无醋酸盐生物滤过的前瞻性交叉研究

目的：通过前瞻性、随机、交叉试验比较联机血液滤过透析（联机HDF）和无醋酸盐生物滤过（AFB）治疗尿毒症的疗效。方法：12例维持性透析患者分别采用联机HDF（包括前稀释和后稀释两种模式）和AFB治疗,每12周为交叉期。结果：两种治疗方法效果均满意。透前血钠、总钙和离子钙、氯、碳酸氢根、尿素无明显变化;联机HDF组血钾有轻度上升;各组血磷、β2－微球蛋白均较透前有下降趋势;AFB组透后血钾水平较联机HDF组低,而碳酸氢根水平较高。动脉血气监测显示,透析中AFB组PO2下降幅度和PCO2上升幅度均低于联机HDF组。和AFB相比,联机HDF可达到较高的一室和二室Kt/V值、较高的尿素和β2－微球蛋白有效清除率、较少的透析间期症状分数。AFB组患者透前平均动脉压低于联机HDF组,透析中血压下降幅度也低于联机HDF组;各组对骨代谢指标的影响无明显差异,血铝水平均下降到透前的1／3左右。前8周各组均发现血浆白蛋白水平下降,随后略有回升,但在研究期末仍低于初始值。结论：联机HDF和AFB均属当今最佳的血液净化疗法之一。联机HDF有较高的大、中、小分子量毒素清除率,较少的透析间期症状。AFB对透析中血气和血流动力学的影响较小。     

高通量血液透析临床应用研究

我院血液净化中心自1998年1月始用高通透性血液滤过器对部分长期血液透析患者进行常规血液透析,称为高通量血液透析（highly permeability dialysis,HPD）,和常规血液透析（CHD）比较,进行了2年的HPD临床观察和前瞻性研究。临床资料和方法1.临床资料:随机选择病例,HPD组26例,男18例,女8例,年龄28～70岁。平均（51.0±12.2）岁,CHD组22例,男18例,女4例,年龄28～70岁,平均（49.0±17.33）岁,两组患者在进入实验性观察以前均规律性血液透析超过8个月。2.治疗方法:两组治疗除了透析器不同外其它条件均同。HPD组用FresenousF60聚砜膜血滤器,面积1.3m2,超滤系数40ml/h.mmHg,复用10～28次;CHD用Fresenous F6聚砜膜血液透析器,面积1.3m2,超滤系数5.5ml/h.mmHg,复用5～8次。透析机均为全电脑控制容积超滤。每周透析1.5～2.5次,每次4.5～5h,血流量（QB）200～250ml/h,透析液流量（QD）500ml/h。两组均为碳酸氢盐透析。     

应用便移式血液透析机进行床边无肝素透析

我们报告应用新型使移式血液透析机进行床边无肝素血液透析的资料与方法，供同道们参考。     

无肝素血液透析的临床观察与护理

血液透析是急、慢性肾衰竭患者得以维持生命的治疗方法之一。常规血液透析需应用肝素抗凝建立体外循环,但肝素在达到充分抗凝时也增加了出血的危险。对于一些合并出血（如消化道出血、脑出血、咯血等）及一些存在严重出血倾向、围手术期的病人一般不使用肝素抗凝,目前临床上应用最广泛的是无肝素透析。无肝素透析的优点是无继发性出血,但易发生凝血［1］。虽然无肝素透析过程中有可能发生透析器或管路凝血而丢失一部分血液,但只要护理人员具有高度的责任心,治疗过程中严密观察,及时发现凝血征象,采取相应的护理措施,可以有效消除和减少凝血发生。我们通过对36例出血患者实施236例次无肝素血液透析治疗的临床观察,采取了一系列的护理措施,使本组患者的血液透析能顺利完成,并取得了满意的效果。现报道如下。     

血液透析中并发症的临床分析

探讨血液透析（HD）中各类并发症与患者的年龄、透析的次数和透析时间的关系，以便更好的预防和治疗各种透析中的并发症。     

联机血液透析滤过治疗尿毒症的临床应用研究

目的：探讨联机血液透析滤过（On-line hemodiafiltration,On-line HDF)对尿毒症患不同分子量物质的清除率、患耐受性及临床疗效。方法：回顾性分析18例伴有血透并发症及不适症状的尿毒症患行后稀释法On-line HDF 231例次，并与23例仍行常规血液透析（HD）治疗的患（887例次）进行比较，观察Kt/V，血清肌酐（Scr)、尿素氮（BUN）、血磷（SP）、β2－微球蛋白（β2－M）下降率及治疗中患血透常见并发症和不良反应发生率。结果：患对联机HDF治疗效果和耐受性显优于HD，透析并发症和不适症状发生率显低于HD（P＜0．01），联机HDF治疗后血清Scr、BUN、SP、β2－M水平显降低，KT／V明显增高。结论：后稀释法联机HDF能有效清除尿毒症患血中大、中、小分子物质，透析效果显提高，患对该法治疗的耐受性明显提高，适用于易出现血透并发症及不适症状的尿毒症患。     

每周两次血液透析患者临床特征分析

目的 研究每周两次血液透析(血透)患者的临床特征.方法 资料来自上海市透析登记网络,1288例于2007年1月登记有透析充分性指标及其他常规生化指标患者纳入本研究.采用回顾性队列研究方法,随访2年.比较每周两次血透与每周3次血透患者的临床特征及其预后情况.结果 与每周3次相比,每周两次血透患者年龄更小,透析龄更短,体表面积更小,单次透析时间更长,单池Kt/V( spKt/V)及血清白蛋白更高,但每周Kt/V显著更低,差异均有统计学意义(P＜0.05).单次透析超滤量两组患者差异无统计学意义.Kaplan Meier生存分析显示两组患者两年生存率相似.多因素Cox回归分析显示年龄、体质量指数、血清白蛋白及每周Kt/V是死亡预测因子.结论 部份患者每周两次血透是可行的,但需要严密监测,并保证其透析充分性与容量平衡.     

Substitution of Acetic Acid for Hydrochloric Acid in the BicarbonateBuffered Dialysate

Abstract: In a multicenter study including 5 dialysis units, blood acetate changes during 4 h dialysis sessions in 141 patients treated with a 4 mM acetate-containing bicarbonate dialysate (ABD) were evaluated and compared to the values of 114 patients using an acetate-free bicarbonate dialysate (AFD). Acetate-free bicarbonate dialysate was delivered by a dialysis machine from the mixing with water for dialysis of a 1/26.2 bicarbonate concentrate, and a 1/35 acid-concentrate in which acetic acid was substituted for hydrochloric acid (Soludia, Fourquevaux, France). This new type of dialysate was routinely in use for 3 years on average (range, from 2 to 5 years). All patients fasted before and during dialysis. Blood samples were withdrawn at the start and at the end of dialysis sessions. The acetate plasma concentration was determined using the acetyl-CoA synthetase enzymatic method (Boehringer, Manheim, Germany). In patients treated with ABD whose predialysis blood acetate levels were in the physiologic range of ≤100 μM (n = 113), the acetate plasma concentration increased from a predialysis mean value of 22 ± 3 μM to a postdialysis mean value of 222 ± 11 μM in 88 patients (78% of patients) whereas the acetate plasma concentration changes remained in the range of physiologic values from 21 ± 6 to 58 ± 7 μM in the other 25 patients. In contrast, patients treated with AFD whose predialysis blood acetate levels were in the physiologic range (n = 108), acetate plasma concentration increased from a predialysis mean value of 49 ± 6 μM to 160 ± 19 μM in only 13 patients (12% of patients) whereas acetate plasma concentration changes remained in the range of physiologic values of 23 ± 2 to 41 ± 3 μM in most of the patients of this group. In this study, a significant number of patients, whether receiving standard or acetate-free bicarbonate dialysates, exhibited an extremely high acetate plasma concentration at the start of the dialysis session. Hyperacetatemia was controlled with AFD in patients whose predialysis acetate plasma concentration of 316 ± 82 decreased to 55 ± 23 μM (n = 6) at the end of the dialysis session whereas the acetate plasma concentration remained high when the predialysis concentration was 580 ± 76 μM, with a postdialysis concentration of 233 ± 39 μM (n = 28). It is concluded that in patients whose predialysis blood acetate levels were in the physiologic range, acetate-containing bicarbonate dialysate induces hyperacetatemia whereas postdialysis blood acetate remains in the normal range in such dialysis patients treated with acetate-free dialysate. Chronic hyperacetatemia, which could be found in dialysis patients, is well controlled by dialysis using an acetate-free dialysate.     

复合树脂修复前牙美学探讨

目的：探讨复合树脂修复前牙缺损的美学效果及注意事项。方法：利用复合树脂具有多种颜色,并可同时灵活使用的优点,对146颗患有缺损的前牙实行充填或充填加贴面修复。结果：修复后的牙齿和谐,逼真。经复查,临床效果满意。随访5年,疗效相对稳定。结论：前牙修复中材料颜色的选择,比色的准确及牙体色素的去除与遮色技术的应用均为影响前牙修复后美学效果的关键。     

CLINICAL EXPERIENCES WITH DIALLYL-NORTOXIFERINE IN CHILDREN

Diallyl-nortoxiferine has been used as a muscle relaxant in321 neonates and children up to 15 years. The neonates appearedto be more sensitive to this relaxant than infants under 1 year,both in regard to the initial dose and the consumption rate.Using a dose of 140 µg/lb (300 µg/kg) body weight,the onset of relaxation was rapid and intubation was easilyperformed after only 1 minute. No evidence of local histaminerelease was found. The average interval between the initialand subsequent dose was 54 minutes in the neonate, 37 minutesin infants under 1 year, 39 minutes in children between 1 and5 years, 43 minutes in children of 5 to 10 years, and 55 minutesin children over 10 years of age. The reversal of the myoneuralblock following neostigmine was excellent provided the intervalbetween the administration of the relaxant and neostigmine exceeded20 minutes. The heart rate was raised in two-thirds of casesfollowing diallyl-nortoxiferine, but this may not be a specificeffect of the drug.     

应用游离股前外侧脂肪筋膜瓣矫治半侧颜面萎缩的临床研究

目的探讨应用股前外侧脂肪筋膜瓣游离移植矫治半侧颜面萎缩的临床效果。方法1997年1月～2006年5月，应用以吻合血管的股前外侧脂肪筋膜瓣游离移植，部分加以Medpor植人及二期手术修整，矫治半侧颜面萎缩患者35例。男11例，女24例；年龄15～47岁。左侧12例，右侧23例。病程4～28年。患者半侧颜面畸形较严重，面颊部凹陷明显。X线片及三维CT重建检查见28例患侧骨骼发育不良。切取脂肪筋膜瓣范围8cm×7cm～20cm×11cm。供区直接缝合。结果术后患者伤口均I期愈合，脂肪筋膜瓣全部成活，供区切口愈合良好，无脂肪液化。35例均获随访6个月～8年。面部轮廓形态满意，双侧基本对称，供区无明显功能障碍。结论吻合血管的股前外侧脂肪筋膜瓣可提供充足的组织量，成活率高，供区隐蔽，不牺牲重要血管，辅以相应的非生物材料及治疗手段，可使半侧颜面萎缩得到满意矫治。     

A CLINICAL INVESTIGATION OF PIRITRAMIDE IN THE TREATMENT OF POSTOPERATIVE PAIN

In a double-blind trial three dosage strengths of piritramide,5, 10 and 20 mg, were compared with morphine 15 mg in the treatmentof postoperative pain. Pain intensity was assessed by the patient,and pain relief and side effects by a nurse-assessor. A iog-doseresponse relationship was established for piritramide. Piritramide20 mg was shown to be equivalent to morphine 15 mg in analgesiceffect. From this and previous studies of piritramide, it appearsthat piritramide has a greater hypnotic effect than an equi-analgesicdose of morphine, but that it has a lesser incidence of otherside effects, particularly nausea and vomiting, and hypotensiveeffects. Piritramide is indicated as a suitable analgesic forpostoperative pain relief.     

CLINICAL INVESTIGATION OF PROLONGED INDUCED HYPOTENSION IN HEAD AND NECK SURGERY

Thirty patients undergoing radical surgery for cancer of thehead and neck were subjected to deliberate hypotension (60–80mm Hg) for an average period of 275 minutes. Ten patients undergoingsurgery of similar magnitude but without controlled hypotensionformed a control group. Hypotensive patients excreted significantlyless urine during surgery. There were no discernible differencesbetween groups in respect of pre- and postoperative haemoglobinlevels, blood volumes, blood urea nitrogen or serum glutamicoxaloacetic transaminase values, electrocardiographic or chestradiographic appearances, or in arterial blood-gas analysismade during surgery. One death occurred in the hypotensive group.The authors conclude that more sensitive indices than thoseutilized are necessary to assess adequacy of perfusion duringdeliberate hypotension. ^*Present address: Department of Anesthesiology, University ofFlorida College of Medicine, Gainesville, Florida. Present address: Department of Otolaryngology, University ofCincinnati, College of Medicine, Cincinnati, Ohio. Present address: 1806 69th Street, Des Moines, lowa.     

胫后动脉筋膜皮支小腿内测皮瓣的临床应用

目的：研究以胫后动脉的分支胫骨滋养动脉所发出的筋膜皮支为蒂的小腿内侧皮瓣在解剖，临床应用的可行性。方法：对６例手足急性外伤性皮肤缺损或疤痕挛缩整形患者以该游离皮瓣进行修复。结果。６例患者均获得了满意疗效。结论：该皮瓣具有皮下脂肪薄，皮肤质量好，避免牺牲胫后动脉主干等优点，适合于修复手足重要功能区域的皮肤缺损。     

ONE-STAGE RECONSTRUCTION OF DEFECTS IN THE HYPOPHARYNGEAL REGION WITH FREE FLAPS

Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed. The complications that required revision (one arterial bleeding, one arterial thrombosis, two fistula formations, one superficial wound dehiscence, one haematoma) occurred mainly in those patients having secondary reconstructions. After primary extensive oncological resection of these tumours reconstruction should be done in one stage. The primary reconstruction should provide sufficient pharyngeal lining, a satisfactory covering of cervical soft-tissue, and adequate functional rehabilitation. We have reviewed our experience and conclusions about the advantages, disadvantages, and current indications for different free flaps in the reconstruction of combined hypopharyngeal, cervico-oesophageal, and cervical skin defects.     

脾转移性肿瘤临床分析(附22例报告)

目的 分析脾转移性肿瘤的临床特点。方法 对22例脾转移性肿瘤临床资料进行回顾性分析。结果 原发灶分别为卵巢癌、肺癌及结肠癌各4例，胃癌3例，乳腺癌及肝癌、胰腺癌分别2例，肾癌1例。4例为单纯脾转移，伴多发脏器转移18例，分别经B超、CT、MRI、选择性脾动脉造影术前诊断，手术切除7例，探查活检10例，5例未手术。目前死亡16例，其中1年内死亡11例。结论 脾转移瘤少见，影像学检查是脾转移瘤主要术前诊断方法，强调以手术中心结合化疗、放疗的综合治疗方案是提高脾转移瘤预后关键。