食管癌术后发生呼吸衰竭的危险因素

目的探讨食管癌术后发生呼吸衰竭的危险因素。方法选择新疆医科大学第一附属医院2002年9月至2012年9月食管癌术后发生呼吸衰竭的患者49例(呼吸衰竭组),并随机抽取同期食管癌术后未发生呼吸衰竭患者98例作为对照组,分析食管癌术后发生呼吸衰竭的危险因素。结果单因素分析结果表明食管癌术后发生呼吸衰竭与下列因素有关:最大通气量(MVV)、1 s用力呼气量(FEV1)、最大呼气流量、FEV1/用力肺活量、吸烟指数、手术时间、机械通气时间、术前并发呼吸系统疾病、吻合口位置、术后其他并发症。Logistic回归分析表明:FEV1≤1.5 L、MVV实测值/预测值≤50%、术后其他并发症及手术时间≥3 h为其独立危险因素。结论全面评估及改善术前肺功能,提高手术技巧,尽量减少手术时间,术后严密观察病情减少其他并发症的发生是降低食管癌术后呼吸衰竭的重要因素。     

纵隔留置引流管对治疗食管癌术后胸内吻合口瘘的临床价值

目的探讨食管癌根治术中留置纵隔引流管对发生术后吻合口瘘的治疗作用。方法回顾性分析2012年1月—2016年12月西安交通大学第二附属医院胸外科行食管癌根治性切除手术后发生吻合口瘘的患者45例,采用经左胸(Sweet)或上腹右胸(Ivor-lewis)术式,吻合口均位于胸腔内。其中放置常规胸腔闭式引流管后关胸(对照组)22例,放置常规胸腔闭式引流管后再于食管床放置纵隔引流管(研究组)23例。比较2组患者吻合口瘘确诊时间、术后平均最高体温、平均白细胞计数峰值、治愈时间、心肺并发症、病死率以及预后随访吻合口狭窄等情况。结果研究组术后吻合口瘘确诊时间组早于对照组(t=3.834,P<0.01),且纵隔引流管的引流量约占胸腔总引流量的70%[胸腔总引流量(753.6±136.4)ml,纵隔引流量(536.8±108.3)ml];研究组术后平均最高体温、平均白细胞计数峰值低于对照组(t=8.965、6.185,P<0.01),吻合口瘘治愈时间明显短于对照组,且其之间差异具有统计学意义(t=11.237,P<0.01)。术后对侧胸腔积液行穿刺引流例数少于对照组(χ~2=2.522,P<0.05),术后心肺并发症发生率病死率低于对照组(χ~2=2.741、1.755,P<0.05),但2组患者出院后6个月吻合口狭窄率之间比较,差异无统计学意义(χ~2=0.897,P>0.05)。结论术中放置纵隔引流管有助于早期发现吻合口瘘、更好地通畅术后胸腔引流、降低对侧胸腔积液发生率、减轻术后全身炎性反应症状、减少心肺并发症的发生、缩短吻合口瘘的治愈时间、降低吻合口瘘所致病死率,值得临床推广使用,但对术后出现吻合口狭窄与否无明显影响。     

合并心肺疾患的老年食管癌、贲门癌患者的围手术期处理

目的探讨合并心肺疾患的食管癌、贲门癌患者围手术期处理。方法回顾性分析58例合并心肺疾患的老年食管癌、贲门癌患者术前、术中、术后临床观察治疗,并发症的防治措施。结果58例均行食管癌、贲门癌切除,手术切除率100%,12例术后出现较严重并发症(27%),术后死亡2例。结论合并心肺疾患的老年食管癌、贲门癌患者选用手术治疗时术前充分准备,术中术后加强管理,减少并发症的发生,可提高手术成功率。     

食管癌、贲门癌术后急性呼吸衰竭的危险因素分析

目的:探讨食管癌、贲门癌术后发生急性呼吸衰竭(acute respiratory failure,ARF)的危险因素,为针对性预防其发生提供临床指导依据。方法:将1995年1月~2005年1月期间食管癌、贲门癌术后发生ARF的42例患者临床资料,与按1∶2比例随机抽取的同期手术后未发生ARF的84例食管癌、贲门癌患者的资料做对照,应用Logistic回归分析比较两组患者的年龄、性别、吸烟指数、术前肺功能、术前有无肺部合并症和其它合并症、术前有无低蛋白血症、吻合口位置、手术时间、术后是否镇痛、术后有无其它并发症等与术后发生ARF的相关强度,推测可能导致术后ARF发生的危险因素。结果:患者术前肺功能中重度受损、吸烟指数>400支/年、术前有肺部合并症和手术时间>3h,四个因素与术后ARF发生有显著相关性(P<0.05)。结论:术前改善低肺功能、早期戒烟、积极治疗肺部合并症、提高手术技巧,缩短手术时间是预防和减少术后ARF发生的重要环节之一。     

同期主动脉置换并食管癌切除术的术后早期并发症护理

同期主动脉置换并食管癌切除术的术后早期并发症监测与护理罕有报道。为探讨食管癌侵犯胸主动脉术后并发症的预防,文中分析了26例T4期食管癌侵犯胸主动脉患者术后护理经验。采用回顾性分析研究的方法,总结26例T4期食管癌侵犯胸主动脉患者术后并发症及其护理。26例患者中,12例出现术后并发症,占46.2%,包括心律失常5例,占19.2%,肺不张6例,占23.1%,其中2例老年患者发生呼吸衰竭再次气管插管,占7.7%,乳糜胸1例,占3.8%。所有患者均未出现主动脉瘘、吻合口瘘、截瘫等严重并发症。对上述并发症能及时发现、及时治疗,病情得到控制,26例患者均于术后2周内顺利恢复。对非心肺转流术(cardiopulmonary bypass,CPB)下食管癌侵犯胸主动脉患者术后早期并发症的护理进行分析,有利于术后临床观察,并及时预防,减少术后并发症和手术死亡率,提高手术疗效。     

食管癌术后急性呼吸衰竭的防治体会

为有效地预防及治疗食管癌术后急性呼吸衰竭 ,分析 6 8例食管癌术后急性呼吸衰竭的病因及治疗特点。强调高龄、过度肥胖、长期吸烟、慢性呼吸系统疾病、术前心肺功能差以及术后有胸内并发症者容易发生。多好发于术后 48～72h ,以Ⅱ型呼吸衰竭为多见。术中做好预防至关重要 ,术前正确判断肺功能测试结果 ,充分术前准备 ,手术及麻醉方式的改进。及时辅助通气 ,彻底清除呼吸道内分泌物 ,早期发现并处理并发症 ,积极控制感染     

食管癌术中的器械吻合与手工分层吻合临床特点分析

目的:比较食管癌(EC)术中器械吻合(FLVA)和手工分层吻合(LHS)的临床特点。方法:将230例EC患者分为LHS组(118例)和FLVA组(112例),术中分别接受LHS和FLVA。结果:LHS组吻合口狭窄发生率低于FLVA组(χ2=3.960 2,P<0.05),FLVA组吻合口瘘发生率明显高于LHS组(P<0.05),术后死亡率,FLVA组高于LHS组。LHS组综合费用、手术材料费皆显著低于FLVA组(P<0.01),而两组术后住院费相接近(P>0.05),LHS组手术时间则长于FLVA组(P<0.05)。结论:EC手术中,采用LHS术后严重并发症及术后死亡率低于FLVA,且综合费用、手术材料费皆较低,因此,值得临床广泛推广和应用。     

58例高龄食管癌患者围手术期的护理

目的 探讨高龄食管癌患者的术后护理及预防并发症的发生. 方法 回顾分析58例高龄食管癌患者术前、术后的护理及预防并发症的发生. 结果 58例高龄食管癌患者,手术切除53例飞5例探查,术后出现并发症3例(死亡1例、乳糜胸1例、吻合口瘘 1例).结论 老年人由于全身组织脏器退行性改变,生理储备功能降低,对手术的耐受性明显降低.加之年龄较大、心肺功能差,而食管癌手术的侵袭较大,使手术风险性陡增,所以对70岁以上高龄食管癌根治术后患者重点加强术前心理护理、术后生命体征的观察、饮食的护理以及各种引流管的护理,对减少术后的并发症,提高手术疗效,促进患者早日康复具有重要临床意义.     

食管癌围手术期并发胸膜炎的高危因素分析

目的:探讨高原食管癌患者围手术期并发胸膜炎的相关危险因素,为降低高原食管癌患者围手术期并发症提供依据。方法:回顾性分析收治的327例食管癌患者的临床资料,均行食管癌切除术,患者按照是否并发胸膜炎分为并发胸膜炎组(n=36)及非并发胸膜炎组(n=291),对比分析两组患者临床特征及手术相关因素,采用多因素Logistic回归分析食管癌围手术期患者并发胸膜炎的危险因素。结果:单因素分析显示,高原食管癌患者围手术期并发胸膜炎危险因素包括年龄、术前肺功能、手术时间、过量吸烟、术前合并COPD、手术切口数量、肺结核病史、低蛋白血症、术中出血量、术后其他并发症,差异有统计学意义(P<0.05),多因素Logistic回归分析显示高原食管癌患者围手术期并发胸膜炎独立危险因素为高龄、手术时间越长、肺功能障碍、手术切口数量多、术中出血量多、过量吸烟、术后其他并发症,差异有统计学意义(P<0.05)。结论:高原食管癌患者围手术期并发胸膜炎受多种因素影响,术前评估与及时采取相应措施可降低食管癌患者围手术期胸膜炎发生率,对于高危患者需加强围手术期管理。     

35例食管癌患者术后呼吸功能不全的临床高危因素分析

目的探讨食管癌患者术后发生呼吸功能不全的高危因素。方法采用回顾性病例对照研究,分析食管癌患者术后呼吸功能不全的高危因素。结果经χ2检验,实验组年龄大于65岁,吸烟指数大于400,合并慢性阻塞性肺疾病(COPD),术前肺功能中、重度损害,手术时间大于5h,术后发生肺部并发症者与对照组比较差异有统计学意义。结论年龄大于65岁,吸烟指数大于400,合并COPD,术前肺功能中、重度损害,手术时间大于5h及术后发生肺部并发症是食管癌患者术后呼吸功能不全的高危因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.