自体输血对肠肿瘤患者体内免疫球蛋白水平的影响

目的探讨自体输血对肠肿瘤患者免疫球蛋白的影响及不良反应。方法选取需进行肠肿瘤根治术择期手术的患者62例作为研究对象,根据患者意愿及病情、自体输血适应证等情况分为两组,预存式自体输血者27例(观察组),异体输血者35例(对照组),观察两组患者术前、术后免疫球蛋白IgG、IgM、IgA水平及输血不良反应。结果 (1)术前两组IgG、IgM、IgA水平比较无显著性差异(P>0.05);(2)术后两组IgG、IgM、IgA均下降,两组在1 d、7 d时检测指标比较有显著性差异(P<0.05);(3)术后与术前比较,两组在术后1 d时存在显著性差异(P<0.05);术后7 d观察组无显著性差异(P>0.05),对照组存在显著性差异(P<0.05)。(4)两组不良反应发生率存在显著性差异(P<0.05)。结论自体输血对肠肿瘤患者免疫球蛋白影响较小,术后恢复较快,不良反应小,围术期自体输血较异体输血更具有优越性。     

术后早期肠内免疫营养对老年胰腺癌、胃癌患者免疫的影响

目的观察术后早期肠内免疫营养对老年胰腺癌、胃癌患者机体免疫功能的影响.方法采用前瞻性、开放性研究,选择20例胰腺癌、40例胃癌患者分别应用免疫营养制剂(士强,荷兰Nutricia公司产品)(n=30)和对照剂能全力(无锡Nutricia公司产品)(n=30)治疗.均于术后第二天开始等热卡肠内营养支持7 d(30 kcal*kg-1*d-1).检测术前、术后第1天、5天、8天的营养及免疫指标.结果 1.两组病例术后免疫球蛋白(IgG、IgM、IgA)下降(P<0.01),肠内营养支持7 d,两组病例T细胞亚群无显著改变(P>0.05);试验组IgA较术前提高(P<0.05),对照组IgG下降(P<0.05),IgM显著上升(P<0.01).两组病例术后血浆IL-6水平上升(P<0.05),IL-10水平降低(P<0.05).2.术后氮平衡测定肠内营养支持后两组累计氮值为负氮平衡;两组的体重、三角肌皮褶厚度、上臂周径均显著下降(P<0.01);试验组与对照组均出现血清白蛋白、转铁蛋白下降(P<0.05).结论老年胰腺癌、胃癌患者手术后免疫抑制主要表现为血清免疫球蛋白浓度下降;术后早期肠内免疫营养支持可改善患者的体液免疫功能,特别是显著提高血清IgA浓度.     

胸腺肽a1对老年患者腹腔镜胰十二指肠切除术后并发症的影响

目的研究腹腔镜胰十二指肠切除术(LPD)围手术期老年患者的免疫状态与术后感染并发症发生的关系,并探讨胸腺肽a1应用对术后并发症的影响。方法收集2014年6月—2018年6月解放军陆军军医大学第二附属医院收治的43例行LPD的老年患者(66～83岁)的临床资料。随机分成围手术期应用胸腺肽a1组(联合组,n=22)和未使用胸腺肽a1组(对照组,n=21)。观察围手术期患者术前、术后第3天、术后第7天患者的免疫功能指标,包括血清IgG、IgA、IgM、外周血中性粒细胞/淋巴细胞比值(NLP)、CD3~+、CD4~+、CD8~+及CD4~+/CD8~+变化情况,术后感染并发症(肺部感染、胰漏、腹腔感染)发生情况。此外,检测术前、术后第3天、术后第7天患者血清CRP和炎症因子水平(IL-2、IL-10、TNFα、IFNγ)。计量资料2组间比较采用t检验,同一组内不同时间点间比较采用重复测量资料方差分析,进一步两两比较采用Duncan’ s新复极差法;计数资料组间比较采用χ~2检验。结果术后第3天、术后第7天联合组血清IgG、IgA、IgM、CD3~+、CD4~+、CD8~+及CD4~+/CD8~+水平显著高于对照组(P值均0.05),NLR均显著低于对照组(P值均0.05)。术后第7天,对照组血清IgG、IgA、IgM、CD3~+、CD4~+、CD8~+及CD4~+/CD8~+水平较入院时均明显下降(P值均0.05),NLR明显升高(P 0.05)。联合组术后肺部感染、腹腔感染发生率均明显低于对照组(χ~2值分别为144、165,P值均0.05)。与对照组术后第3天、第7天相比,联合组患者血清炎症因子IL-2、IL-10、IFNγ表达显著增高(P值均0.05)。结论手术创伤可导致老年患者免疫功能进一步降低,围手术期应用胸腺肽a1可增强患者免疫功能,并降低术后感染并发症发生率。     

心脏瓣膜置换术后机体免疫功能的变化

目的探讨体外循环心脏瓣膜置换术后机体免疫功能的变化。方法28例风湿性心脏瓣膜病患者,分别于术前第3天、体外循环结束后10 min、术后第1天、术后第3天及术后第7天5个时点取外周静脉血。流式细胞术测定CD3＋、CD4＋、CD8＋,计算CD4＋/CD8＋,采用免疫化学分析系统测定血清IgG、IgA、IgM浓度。结果体外循环后CD3＋、CD4＋、CD8＋及CD4＋/CD8＋均较术前下降（P〈0.05）,血清IgG、IgA、IgM浓度也明显低于术前水平（P均〈0.05）,术后第7天均恢复正常。结论体外循环能导致机体细胞免疫及体液免疫功能下降,至术后第7天基本恢复。     

术后早期经口肠内营养对结直肠癌患者术后免疫和肠黏膜屏障的影响

[目的]探讨术后早期应用肠内营养在结直肠癌手术患者中对免疫功能和肠黏膜屏障功能的影响及价值。[方法]选择我院手术治疗的结直肠癌患者96例采取随机数字表法分为观察组和对照组,对照组给予常规围手术期治疗,观察组在对照组基础上联合早期肠内营养支持,记录2组患者治疗情况。[结果]观察组干预后术后排气时间(48.54±4.23)h,术后发热时间(41.93±3.78)h,住院时间(11.93±1.96)d,术后患者生活质量评分(18.26±2.36)分,术后并发症发生3例;对照组干预后术后排气时间(69.07±10.37)h,术后发热时间(58.65±6.77)h,住院时间(18.79±3.17)d,术后患者生活质量评分(15.64±1.41)分,术后并发症发生11例,差异有统计学意义(P0.05)。观察组术后第7天IgA(1.65±0.78)g/L,IgM(1.26±0.46)g/L,IgG(10.54±1.88)g/L;对照组术后第7天IgA(1.11±0.19)g/L,IgM(0.82±0.14)g/L,IgG(6.92±1.21)g/L,差异有统计学意义(P0.05)。观察组术后第7天CD4~+(39.89±7.65)%,CD4~+/CD8~+(1.56±0.41);对照组术后第7天CD4~+(34.18±4.26)%,CD4~+/CD8~+(1.17±0.11),差异有统计学意义(P0.05)。[结论]术后早期应用肠内营养在结直肠癌手术患者中可以促进患者胃肠道功能恢复,缩短住院时间,提升患者术后免疫功能,改善患者术后的营养状况,值得在临床大力推广使用。     

梗阻性黄疸术后早期肠内营养对T淋巴细胞亚群的影响

目的 探讨手术后早期肠内营养(EEN)对梗阻性黄疸患者T淋巴细胞免疫功能的影响.方法 分别给予梗阻性黄疸术后患者普通静脉输液(对照组)、肠外营养(PN组)及肠内营养(EN组)8 d.术前、术后第1、9天以碱性磷酸酶-抗碱性磷酸酶法测定T淋巴细胞亚群(CD3、CD4、CD8)变化.结果 与对照组比较,PN、EN组体质量下降减少,负氮平衡明显降低,白蛋白、转铁蛋白、前白蛋白升高(P均<0.05).与术前比较,术后第1天三组CD3、CD4阳性细胞数及CD4/CD8比值降低,CD8阳性细胞数升高(P<0.05).术后第9天,EN组CD3、CD4阳性细胞数及CD4/CD8比值恢复至术前水平,且明显高于对照组和PN组(P<0.05),而CD8阳性细胞数低于对照组和PN组(P<0.05).结论 EEN可纠正梗阻性黄疸手术后患者的T淋巴细胞免疫抑制状态,促进其免疫功能恢复.     

术后早期肠内免疫营养对老年胰腺癌、胃癌患者免疫的影响

目的 观察术后早期肠内免疫营养对老年胰腺癌、胃癌患者机体免疫功能的影响。方法采用前瞻性、开放性研究,选择20例胰腺癌、40例胃癌患者分别应用免疫营养制剂(士强,荷兰Nutricia公司产品)(n=30)和对照剂能全力(无锡Nutricia公司产品)(n=30)治疗。均于术后第二天开始等热卡肠内营养支持7d(30keal·kg~(-1)·d~(-1))。检测术前、术后第1天、5天、8天的营养及免疫指标。结果 1.两组病例术后免疫球蛋白(IgG、IgM、IgA)下降(P<0.01),肠内营养支持7d,两组病例T细胞亚群无显著改变(P>0.05);试验组IgA较术前提高(P相似文献   

胸腺肽α1对心脏瓣膜置换术围术期炎症因子及细胞免疫功能的影响

目的 探讨胸腺肽α1对心脏瓣膜置换术围术期炎症因子及细胞免疫功能的影响.方法 入选2010年8月至2011年10月在该院行心脏瓣膜置换术患者40例,根据是否给予胸腺肽α1将患者分为观察组和对照组,每组20例,观察组术前1d开始给予胸腺肽α1 1.6 mg/d肌注,7d为1个疗程,对照组不给任何免疫抑制剂,比较两组患者围术期炎症因子及细胞免疫功能的变化.结果 两组患者手术均顺利完成,手术过程中,两组患者的肿瘤坏死因子(TNF)-α、白介素(IL)-10、IL-2水平均较术前显著升高(P＜0.01);手术后开始下降,至手术后第3天,观察组TNF-α、IL-10、IL-2水平仍高于手术前,但是低于对照组(P＜0.05);至手术第7天,各指标均恢复至术前水平(P＞0.05);两组患者手术中较术前淋巴细胞降低(P＜0.05);术后第7天开始上升,上升速度快于对照组(P＜0.05);两组患者CD4+T和CD4+/CD8+术中较术前均显著降低(P＜0.05),术后恢复速度快于对照组,第3、7天均高于对照组(P＜0.05);CD8+T术中上升,均高于术前(P＜0.05),术后开始下降,速度快于对照组,第3、7天均低于对照组(P＜0.05).结论 胸腺肽α1对心脏瓣膜置换术围术期细胞免疫功能低下有治疗作用,同时可以缓解全身炎性反应.     

围术期生长激素和谷氨酰胺强化的肠内营养对原发性肝癌患者术后营养状况和免疫功能影响的初步研究

目的探讨围术期生长激素和谷氨酰胺强化的肠内营养对原发性肝癌患者术后营养状况和免疫功能的影响。方法将知情同意的原发性肝癌患者48例,随机分为术前谷氨酰胺强化肠内营养组(术前GEEN组)、术后谷氨酰胺强化肠内营养组(术后GEEN组)、胃肠外营养组。术后GEEN组患者在术后12 h间断口服温水,如患者无明显不适,术后24 h开始口服肠内营养液逐渐增加至全量,第4天开始按30 mL/(kg·d)口服至第七天,术后3 d内,不足的能量或水、电解质通过静脉途径补充。同时术后7 d内按4 IU/d皮下注射基因重组人类生长激素(思增)。术前GEEN组在术前3 d按30 mL/(kg·d)开始口服肠内营养液,术后4 d与术后GEEN组的前4 d方案相同,肛门排气后逐渐恢复饮食。同时术前3 d至术后4 d皮下注射基因重组人类生长激素(思增)。胃肠外营养组术后7 d内按胃肠外营养常规支持,肛门排气后逐渐恢复饮食。观察患者临床恢复情况,记录术后并发症(包括伤口感染或脂肪液化、肺部感染等)。营养前或术前1 d和术后8 d清晨采血检测肝功能、NK细胞、T细胞亚群(CD3比例和CD4/CD8比值)、免疫球蛋白(IgM、IgG、IgA)、补体(C3、C5)。结果术前GEEN组和术后GEEN组中各有1例因术后出现明显腹胀不愿意继续口服而退出,其余个别病例出现轻度腹胀等不适,经过调整进食速度和短暂休息后好转,均按计划完成治疗。三组患者在整个研究过程中均无大出血、手术死亡等严重并发症。三组患者发生感染并发症情况比较,术前GEEN组相对较低,但组间差异无统计学意义(P0.05)。营养支持后三组患者蛋白水平比较,术后GEEN组、术前GEEN组总蛋白均比胃肠外营养组高(P=0.00),以术前GEEN组提高更明显(P=0.00),而白蛋白水平无明显变化(P=0.16),肠内营养组需要补充的白蛋白量明显少于对照组(P=0.02)。三组患者营养前T细胞、免疫球蛋白等指标无差异(P0.05)。营养后,术后GEEN组、术前GEEN组CD3比例、CD4/CD8比值均较胃肠外营养组明显升高(P0.05),NK细胞水平提高不明显(P0.05)。在体液免疫方面,术后第八天,术后GEEN组和术前GEEN组的IgM、IgG、IgA、C3、C4接近或已经恢复营养前水平(P0.05),但胃肠外营养组多数指标尚未恢复术前水平,尤其是IgM和IgG,还处于较低水平(P0.05)。营养支持后,术后GEEN组和术前GEEN组总胆红素和转氨酶都有所降低,而胃肠外营养组却有所升高,但这种变化无统计学意义(P0.05)。结论对于原发性肝癌患者,围术期应用生长激素和谷氨酰胺强化的肠内营养方法安全、可行,有效改善机体的营养状况,提高免疫功能。     

肠内营养联合聚乙二醇治疗围术期结直肠癌伴不全肠梗阻患者的效果

目的探讨肠内营养联合聚乙二醇(PEG)对结直肠癌伴不全肠梗阻患者围术期的效果。方法选择接受手术治疗的结直肠癌伴不全肠梗阻患者160例,按照随机数字表法分为观察组83例和对照组77例,观察组给予能全素联合PEG进行围术期肠道准备,对照组给予传统流质饮食和番泻叶。采用欧洲营养风险筛查表NRS-2002进行术前营养评分,对比两组临床相关指标及术后并发症发生情况,并检测两组术前1 d和术后7 dT淋巴细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)和免疫球蛋白(IgG、IgM)水平。结果两组术前营养评分差异无统计学意义(P>0.05)。观察组住院时间、术后耐受固体食物时间、术后肛门排气时间和术后并发症发生率均显著低于对照组(P<0.05)。术前1 d两组免疫指标差异无统计学意义(P>0.05)。对照组术后7 d CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、IgG和IgM水平均较术前1 d降低,且各免疫指标均低于观察组(P<0.05)。结论采用肠内营养联合PEG对结直肠癌伴不全肠梗阻患者进行围术期管理,能够保证患者术中肠道清洁度,改善患者术后营养和免疫力,减少术后并发症的发生。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.