超声诊断小儿急性肠系膜淋巴结炎的价值

目的:探讨高频超声诊断在小儿急性肠系膜淋巴结炎中的价值.方法:收集急性腹痛经临床确诊为小儿急性肠系膜淋巴结炎病例72例(腹痛组)和无急性腹痛因其他疾病收住院者52例(无腹痛组),观察两组病例肠系膜淋巴结的数量、大小.结果:急性肠系膜淋巴结炎(腹痛组)较无腹痛组肠系膜淋巴结数量多、体积大.结论:高频超声诊断对小儿急性肠系膜淋巴结炎具有很大的实用价值.     

彩色多普勒超声对乳腺癌转移淋巴结的诊断价值

目的:探讨彩色多普勒超声对乳腺癌转移淋巴结的诊断价值。方法:采用彩色多普勒超声对49例乳腺癌患者进行腋窝淋巴结的形态、大小、数目及血流动力学指标进行观察。结果:病理证实的43例转移淋巴结形态改变,有融合状态。血流信号多位于周边,并随淋巴结的增大血流信号增多,多发性肿大淋巴结较单发血流丰富。结论:转移性淋巴结在二维超声和彩色多普勒上各有其特征性表现,二者结合可提高检出乳腺癌淋巴结转移的准确性。     

留置双J管治疗妊娠期输尿管结石合并急性肾盂肾炎25例分析

目的探讨内支架引流管在治疗妊娠期输尿管结石合并肾盂肾炎治疗中的安全性及有效性。方法对我科2011年1月—2012年12月收治的妊娠合并肾盂肾炎患者,患者取截石位,局部麻醉后,会阴部常规消毒铺洞巾,将斑马导丝放入F5～F6双J管,经尿道置入膀胱镜,将双J管逆行放入患侧输尿管内,留置长度满意后,退出膀胱镜。结果 25例孕妇经过放置内支架引流管后肾盂积水程度得到有效改善,感染得到控制。结论内支架引流管可以用于妊娠期输尿管结石合并肾盂肾炎患者的治疗,有效率及安全性较高。     

A model of experimental acute hematogenous pyelonephritis in the rat

The OBJECTIVE of the study was to create a model of acute hematogenous pyelonephritis in the rat without causing urinary retention by ligation of the ureter. Mixed bacterial suspension containing 1.5 x 10(6) colony-forming units (CFU) of S. aureus and 3.0 x 10(6) CFU of E. coli was inoculated in the caudal vein at a dose of 0.5 ml/kg. Control animals received the same amount of saline solution. Pyelonephritis was confirmed by lab urine tests and histopathological study of the kidneys. Infected animals initially developed sepsis with a significant increase of leukocytes and C-reactive protein in the blood. Originally only bacteriuria was found in the urine of experimental animals, but later, in the course of the development of pyelonephritis (12-18 days), leucocyturia and active leukocytes (glitter cells) were also available in urine. The levels of beta-2 microglobulin in the urine of infected animals (4.02 +/- 0.04 mmol/l on day 16 and 4.18 + 0.07 mmol/l on day 18) were significantly highly increased (p <0.0001) in comparison with the value of the control group (0.088 +/- 0.005 mmol/l). In the early days the histopathological examination of the kidneys established erythrocyte stasis. Later leukocyte infiltrates were observed in the interstitial tissue around the kidney tubules, glomeruli and vascular walls, and inflammatory cell infiltration and degenerative changes were present in the epithelium of the canaliculi. Combined hematogenous infection with S. aureus and E. coli led to the development of pyelonephritis in rats. The pathology in the kidney tubules was confirmed by histopathological study and by the elevated levels of beta-2 microglobulin and the presence of active leukocytes in urine.     

妊娠合并急性肾盂肾炎复发的原因分析和治疗

目的:探讨妊娠合并急性肾盂肾炎复发的原因及治疗。方法:近4年来妊娠合并急性肾盂肾炎复发12例为观察组与同期发病已婚未妊娠妇女急性肾盂肾炎未复发的12例为对照组,回顾对比分析。并且分析治疗方法。结果:妊娠期抗生素使用的限制,抗生素使用时间过短(少于7天),超广谱β-内酰胺酶(ESBLs)的产生,妊娠妇女本身的特点等是妊娠妇女合并急性肾盂肾炎复发的原因。结论:对超广谱β-内酰胺酶菌使用碳青酶烯类及含舒巴坦或他唑巴坦复合制剂是一合适的选择,单独使用青霉素或半合成青霉素(氨苄青霉素)易复发,静脉使用抗生素不低于7天,判断有无产超广谱β-内酰胺酶(ESBLs)细菌的产生。     

Risk factors for quinolone-resistance in women presenting with Escherichia coli acute pyelonephritis

In France, according to the National Epidemiology Observatory of Bacterial Resistance to Antibiotics, 15.3% of outpatient urinary Escherichia coli isolates were fluoroquinolone-resistant in 2010. This puts to question the relevance of empirical fluoroquinolone therapy for community-acquired acute pyelonephritis (APN), potentially severe infections.     

Ⅱ型糖尿病患者彩色多普勒超声肾血流与肾小球滤过率的关系

目的　探讨Ⅱ型糖尿病 (T2 DM)患者彩色多普勒超声肾血流测定能否反映GFR。方法　 134例T2 DM用ECT测定GFR ,按GFR由低到高分为 5组 ,分别是GFR 6 0～ 79、80～ 99、10 0～ 119、12 0～ 139和 >14 0ml/min。再用彩色多普勒超声测定双肾MRA、SRA、IRA和ARA的Vmax及Vmin ,并计算其RI。结果　各级血管的Vmax均与GFR呈正相关 ,P分别 <0 0 2、0 0 5、0 0 5和 0 0 5 ;第 5组各级血管Vmax高于第 1组 ,P分别 <0 0 1、0 0 1、0 0 1和 0 0 5 ;第 5组MRA、SRA和ARA的Vmax高于第 2组 ,P <0 0 5 ;第 1组MRA、SRA的Vmax低于第 2组 ,P <0 0 5。第 1组MRA及ARA上的RI低于第 2组和第 5组 ,P <0 0 5。结论　彩色多普勒超声肾血流测定能够反映T2 DM的GFR ,与ECT测定GFR有相似的结果 ;各级血管Vmax的增高可以作为DM的早期诊断指标 ;Vmax和RI同时降低标志着GFR已低于正常 ,肾功能处于代偿期。     

Pain intensity and imaging at the initial phase of acute pyelonephritis

ObjectiveTo identify predictive factors of urological complication on imaging findings in women with pyelonephritis aged 18 to 65 years.MethodsWe performed an observational, retrospective, single-center study. The medical charts of women diagnosed with pyelonephritis at the emergency department from 2010 to 2015 were reviewed. Only patients who underwent an imaging study at the emergency department and with microbiologically confirmed pyelonephritis were included for analysis. The primary endpoint was the presence of urological complications on imaging findings. The secondary endpoint was treatment changes after imaging diagnosis.ResultsOf the 193 women enrolled, 88 (45.6%) had urological complication(s) on imaging findings. The multivariate analysis revealed that history of urolithiasis (OR = 2.41; P = 0.01) and pain requiring morphine use (OR = 5.29; P = 0.009) were predictive of urological complications on imaging findings. Of the 120 women with uncomplicated pyelonephritis who underwent imaging studies, 45% had urological complication, resulting in a treatment change in 36.7% of patients. The multivariate analysis revealed that age > 40 years (OR = 4.58; P = 0.02) and pain requiring morphine use (OR = 3.78; P = 0.02) were predictive of urological complication(s) on imaging findings and of treatment change based on imaging findings (OR = 6.76; P = 0.005 and OR = 4.19; P = 0.01 respectively) in this subgroup.ConclusionsPain requiring morphine use, age, and history of urolithiasis are independent predictors of urological complications on imaging findings in patients with acute pyelonephritis.     

肾动脉造影与彩色多普勒超声在肾动脉狭窄诊断中的应用价值

目的：对比分析肾动脉造影与彩色多普勒超声在肾动脉狭窄诊断中的应用价值。方法：以肾动脉造影结果为判断标准,对50例肾动脉狭窄的高度疑似患者行彩色多普勒超声检查,评价彩色多普勒超声诊断肾动脉狭窄的准确性。结果：彩色多普勒超声共诊断出狭窄。肾动脉77条,而肾动脉造影共检出狭窄。肾动脉72条,漏诊率为5．00％,误诊率为13．00％。随着血管闭塞程度的加重,多普勒超声诊断结果与肾动脉造影结果的相符率依次升高,,其中重度狭窄组和完全闭塞组的符合率达100％。彩色多普勒超声结果显示,中度狭窄组患者的PSV、EDV及AC均显著高于轻度狭窄组,且重度狭窄组的以上指标均显著高于中度狭窄组,比较差异有统计学意义。结论：彩色多普勒超声在肾动脉狭窄诊断中的准确率较高,可基本达到肾动脉造影诊断的标准,其参数PSV、EDV及AC对判断在患者肾动脉狭窄程度具有重要意义。     

肾动脉多普勒超声在感染性休克患者早期目标导向治疗中的应用

目的探讨肾动脉多普勒超声在感染性休克患者早期目标导向治疗(EGDT)中的应用效果。方法选取2016年1月至2017年5月我院收治的感染性休克患者30例为研究对象,根据患者EGDT 6 h后是否达到复苏目标分为达标组和未达标组,比较两组患者治疗前后的急性肾损伤(AKI)发生情况、Sofa评分,以及28 d生存率、ICU住院天数,EGDT治疗1 h、6 h后采用肾动脉多普勒超声检测肾内血流灌注变化情况,探讨肾内血流灌注变化情况与乳酸水平的相关性。结果 EGDT 6 h后,复苏达标19例,未达标11例。治疗前,两组的AKI发生率及Sofa评分无统计学差异(P>0.05);治疗后,达标组的AKI发生率、ICU住院天数均显著低于未达标组,Sofa评分、28 d生存率显著高于未达标组(P<0.05)。Pearson相关性分析显示,Vmax、Vmin、PI与乳酸水平呈负相关,RI与乳酸水平呈正相关。结论肾动脉多普勒超声在感染性休克患者EGDT中的应用可评估疗效及预后。     

孕妇急性肾盂肾炎病原菌特点及耐药性分析

目的研究妊娠期合并急性肾盂肾炎致病菌及耐药性特点,并为该病的临床治疗方案积累经验,以提高治愈率。方法收集妇产科2009年3月-2013年4月收治的42例妊娠期合并急性肾盂肾炎患者,行细菌培养,采用K-B法测定其耐药性。结果 42例患者中共检出病原菌42株,以大肠埃希菌为主,29株占69.0%,其中有9株为产ESBLs菌株,20株为非产ESBLs菌株,其次为金黄色葡萄球菌、肺炎克雷伯菌、肠球菌属、变形菌属,分别占14.3%、7.1%、4.8%、4.8%;产ESBLs菌株和非产ESBLs菌株对氨苄西林的耐药率最高,分别为100.0%、80.0%,对亚胺培南的耐药性最低,均为0。结论对于妊娠期合并急性肾盂肾炎患者而言,首选头孢菌素进行治疗,对于产ESBLs菌株给予碳青霉烯类及含舒巴坦或他唑巴坦复合制剂较为合适。     

The epidemiology of acute pyelonephritis in South Korea, 1997-1999

Acute pyelonephritis causes significant morbidity, tends to recur, and can be fatal; however, little is known regarding its epidemiology. In this paper, the authors describe the epidemiology of acute pyelonephritis in South Korea by using nationwide heath insurance claims data from 1997 to 1999. The National Health Insurance System of South Korea covers almost the entire population (99%). The overall average annual incidence rate of pyelonephritis in 1997-1999 was 35.7 per 10,000 population (male, 12.6; female, 59.0). Approximately one of every seven patients was hospitalized (incidence per 10,000: inpatients, 5.5; outpatients, 30.1). Incidence varied with age and was higher in the summer season. Following an initial episode, the risk of a second episode within 12 months was 9.2% for females and 5.7% for males; by contrast, the risk of a fifth episode within a year following a fourth episode was 50.0% for females and 53.0% for males. Female sex (hazard ratio = 1.89, 95% confidence interval: 1.60, 2.23), advancing age, outpatient treatments (hazard ratio = 1.35, 95% confidence interval: 1.14, 1.60), and medical aid (hazard ratio = 1.23, 95% confidence interval: 1.08, 1.40) increased the risk of any recurrence. Pyelonephritis has a clear seasonal pattern and high rate of recurrence. The incidence of hospitalization for pyelonephritis in South Korea is similar to that in the United States and Canada.