灌洗引流法治疗慢性骨髓炎灌洗量及灌洗速度的控制

目的 探讨灌洗引流法治疗慢性骨髓炎时灌洗量及灌洗速度的调控.方法 对22例慢性骨髓炎.采用病灶清除灌洗引流术进行治疗,统计其术后的灌洗量及灌洗速度.结果 灌洗量及灌洗速度与其病灶所在部位、病变大小及术后的时间段均有关系.结论 灌洗量及灌洗速度应能保证引流出的液体呈淡红色并且澄清.     

供肾低温灌洗与运送

供肾低温灌洗与运送第一军医大学南方医院肾移植中心（广州，５１０５１５）于立新１常用的器官灌洗液随着器官移植工作的不断发展，器官的灌沫与保存显得越来越重要，人们在不断寻求新的途径来尽量延长器官保存的时间。无论是活体肾或是尸体肾，在移植前必须进行再次灌洗...     

蒸汽吸入性损伤犬支气管肺泡灌洗液的观察

为了探讨吸入性损伤后支气管肺泡灌洗液检测的意义，选用１２条本地健康杂种犬进行自身对照试验。采用蒸汽致伤造成重度吸入性损伤，在伤后１小时和５小时观察支气管肺泡灌洗液（ＢＡＬＦ）中（ＡＣＥ）活性的变化。结果表明，吸入性损伤后肺内大量炎性细胞渗出，脂质过氧化反应水平增高和肺毛细自管内皮细胞损伤。     

人参总皂甙对犬肾自体移植再灌注损伤中钙离子内流？…

目的：为了解人参皂总甙对犬肾移植再灌注中钙离子的内流阻滞作用。方法：采用犬肾移植模型观察再灌注后２４ｈ肾组织细胞中钙离子含量及移植前后不同时期内生肌酐清除值。结果：在肾缺血和再灌注损伤中肾离子含量异常增高。给人参总皂甙后显著减少肾组织细胞中钙离了含量及同时提高内生肌酐清除值。结论：人参总皂地大肾自体移植再灌注损伤中钙离子内流有阻滞作用。减轻肾脏再灌注损伤，保护肾脏功能，并促进肾脏功能早期恢复。     

蒸汽吸入性损伤犬支气管肺泡灌洗液的观察

为了探讨吸入性损伤后支气管肺泡灌洗液检测的意义，选用１２条本地健康杂种犬进行自身对照试验。采用蒸汽致伤造成重度吸入性损伤，在伤后１小时和５小时观察支气管肺泡灌洗液（ＢＡＬＦ）中细胞成份、总蛋白含量、丙二醛（ＭＤＡ）含量、超氧化物歧化酶（ＳＯＤ）活性和血管紧张素转换酶（ＡＣＥ）活性的变化。结果表明，吸入性损伤后肺内大量炎性细胞渗出，脂质过氧化反应水平增高和肺毛细血管内皮细胞损伤     

川芎嗪对犬肾保存的影响

通过犬自体肾移植模型研究了一定浓度的川芎嗪加入ＷＭＯ－１号液对犬肾保存效果的影响。结果表明，单纯ＷＭＯ－１号液保存７２小时和加川芎嗪保存７２小时的肾行自体移植均难存活；加川芎嗪保存４８小时组术后血肌酐的平均值低于单纯ＷＭＯ－１号液保存４８小时组，且血肌酐恢复正常的时间也较单纯ＷＭＯ－１号液组早（Ｐ＜０．０５），说明该实验浓度的川芎嗪不能延长肾保存时间，但有利于移植肾功能的早期恢复。     

蒸汽吸入性损伤犬支气管肺泡灌洗液的观察

为了探讨吸入性损伤后支气管肺泡灌洗液检测的意义,选用12条本地健康杂种犬进行自身对照试验。采用蒸汽致伤造成重度吸入性损伤,在伤后1小时和5小时观察支气管肺泡灌洗液(BALF)中细胞成份、总蛋白含量、丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性和血管紧张素转换酶(ACE)活性的变化。结果表明,吸入性损伤后肺内大量炎性细胞渗出,脂质过氧化反应水平增高和肺毛细血管内皮细胞损伤。     

供犬脾灌注对特异性致敏犬移植肾功能的影响

目的探讨供犬脾灌注对特异性致敏犬移植肾的免疫保护作用。方法雄性家犬作为肾移植的供、受者。首先采用供者淋巴细胞多次输注诱导18只受者致敏后，随机平均将致敏受者分为3组。特异性脾灌注组：用加工过的人用血液透析穿刺管将同一供者的离体脾动、静脉与受者的腹主动脉及下腔静脉连通后开放血流（血流量约18-25ml／min），充盈后轻揉脾脏，灌注40min，然后用同一供肾行肾移植术；非特异性脾灌注组：离体脾灌注以及肾移植的方法与特异性脾灌注组相同，不同的是供脾和供肾均来自于无关供者；对照组：开腹旷置40min后，同法行肾移植。监测脾灌注前、后各组受者微量淋巴细胞毒（CDC）试验和混合淋巴细胞培养（MLC）的变化；观察供者脾灌注对受者移植肾排斥反应发生和肾功能的影响。结果各组受者均在输注淋巴细胞3～4次后诱导致敏成功。特异性脾灌注可以显著降低受者CDC配型水平和MLC淋巴细胞增殖水平，使受者外周血白细胞计数一过性减少，总补体溶血活性（CH50）下降。肾移植术后特异性脾灌注组移植肾肾小球滤过率下降较非特异性脾灌注组和对照组缓慢；病理检查提示术后特异性脾灌注组移植肾排斥反应较非特异性脾灌注组和对照组为轻。结论供者脾灌注可以特异性吸附毒性抗体，使外周血激活淋巴细胞归巢，耗竭血小板，从而延缓特异性致敏受者肾移植后排斥反应的发生，改善移植肾功能。     

小肠移植灌洗的配合

我院 1 999年 5月 2 0日实施 1例血缘关系者活体小肠部分移植术 ,效果满意。现就移植肠灌洗的配合介绍如下。1　临床资料男 ,1 8岁 ,体重 37.5kg,身高 1 83cm,农民。因肠梗阻、肠坏死于 1 998年 9月 1 3日在当地医院行小肠大部分切除术 ,残余近端空肠 30 cm、远端回肠1 0 cm,术后空回肠吻合口出现肠瘘。于 1 998年 9月2 6日转入我院 ,1 1月 2 6日行肠瘘修补术。术后伤口愈合良好 ,但进食后出现腹泻 ,3～ 5次 /d,多时可达1 0次 /d,均为未消化食物。不能维持正常的生理需要 ,不能脱离肠外营养支持 ,诊断为短肠综合征。1 999年 5月 2 0日在全麻…     

独特型网络调节对移植肾的影响

作者对６８例接受同种异体肾移植患者,用淋巴毒抑制和增强试验,测定移植前即刻血清中的抗独特型抗体（Ａｂ２）和抗抗独特型抗体（Ａｂ３）。在测得Ａｂ２的患者组中,６个月内的排斥发生率为６％,明显低于未测到组的２１％（Ｐ＜０．０１）;而测得Ａｂ３患者组中,排斥发生率为６７％,明显高于未测得组（Ｐ＜０．０１）。结果提示：Ａｂ２可使肾移植受体产生一定程度的免疫耐受,而Ａｂ３则易于诱发排斥反应。     

Residual urinary volume is a risk factor for primary nonfunction in kidney transplantation

Primary nonfunction is a severe complication after kidney transplantation. Residual renal function could be a risk factor for this complication in the current era of kidney transplantation from extended criteria donors (ECD). This is a single‐center case–control study. Between 2000 and 2012, 1112 patients received a kidney transplant from a deceased donor. We identified 56 cases of early graft loss (kidney that never recover renal function and/or graft thrombosis <48 h after kidney transplantation). As controls we used patients receiving the contralateral kidney. Donor age was 55 ± 17 years with 57% fulfilling ECD criteria. Among the 56 cases, 14 were due to vascular rejection and 42 to primary nonfunction. Risk factors for early graft loss due to vascular rejection were previous transplant, time on dialysis, and HLA sensitization. Risk factors for primary nonfunction were first transplant, short period on dialysis, mainly peritoneal dialysis, and a residual urinary volume ≥500 ml/24 h. Conditional logistic regression analysis showed that residual urinary volume (OR = 20.01) rather than the dialysis modality was a major risk factor for primary nonfunction. In conclusion, residual urinary volume seems to be a risk factor for primary nonfunction in the current era of kidney transplantation.     

Selection of uremic patients for kidney transplantation

Selection of patients for kidney transplantations is necessary due to the shortage of organs. The process has not been greatly studied. Twelve hypothetical cases were constructed, each with one or several relative contraindications, such as cardiovascular disease, diabetes, old age or a mental disorder. The cases were submitted to 40 nephrologists, chosen to represent the recruitment areas of the four Swedish transplant units. They were asked to declare whether the 'patient' was suitable for transplantation or not, and, independently, whether the patient would be referred to the transplant unit. The same cases were evaluated by 3-4 representatives of each transplant unit. The response rate was 100%. A median of 6 cases was considered suitable (range 3-11). The acceptance rate differed significantly between the four unit areas, from 4 cases (3-7) to 7 (4-11), p=0.014. Nephrologists would accept fewer patients than staff from the transplant units, 5 (3-10) vs. 7 (3-11), p=0.009. Most of the latter difference was compensated for by referral of borderline cases to the unit. Only 5 individual cases were equally judged by at least 75% of the respondents. Discrepancies in view were noted with respect to the significance of old or young age, the patient's determination and severe obesity.     

肾移植对慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响

目的 探讨肾移植对男性慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响.方法 解放军第117医院肾移植中心30例慢性肾功能不全尿毒症期患者于肾移植术前以及术后1个月、3个月和1年应用彩超进行睾丸体积监测,并与20名正常男性的睾丸体积比较.另检测40例尿毒症期和40例肾移植受者的精液,并根据公式[精子密度(×106/mL)×精子活动力×精子正常形态率]计算出生育力指数.结果 慢性肾功能不全尿毒症期患者的睾丸体积术前左侧为(6.82±1.49)mL, 右侧为(7.46±1.89)mL;肾移植术后1个月、3个月和1年左侧分别为(8.25±1.67)mL、(9.31±1.56) mL和(9.80±1.51)mL,右侧分别为(9.18±1.76) mL、(10.41±1.43) mL和(11.09±1.45)mL,肾移植受者术后1个月、3个月和1年的睾丸体积均大于尿毒症期患者,差异有显著性意义(均P<0.01).正常对照组生育力指数为13.03(14.26),肾移植受者的生育力指数为7.19(10.18), 而尿毒症期患者的生育力指数仅为0.23(0.76).尿毒症期患者的生育力指数比肾移植受者和正常对照组均小,差异有显著性意义(均P<0.01). 结论 慢性肾功能不全尿毒症期患者睾丸体积缩小,生育力指数下降, 而成功的肾移植可以明显改善尿毒症期患者的睾丸体积及生育力指数.     

Impact of the ratio of graft kidney volume to recipient body surface area on graft function after live donor kidney transplantation

Functioning nephron mass is a determinant of the graft function of kidney transplant recipients. The graft kidney volume and its weight have been reported to be surrogates of the nephron mass. To investigate the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on the graft function within six months post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery. Ninety-four cases of live donor kidney transplants were included in this study. The graft kidney volume/recipient BSA ratio was correlated with the glomerular filtration rate (GFR) of recipients at one and six months post-transplantation (r = 0.416, p < 0.001 and r = 0.381, p < 0.001, respectively). We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of ≥90.9 mL/m(2) and those with a ratio of <90.9 mL/m(2) (p < 0.001). Multivariate analysis demonstrated that the graft kidney volume/recipient BSA ratio and donor age are independent predictors of recipient GFR at one and six months post-transplantation (p < 0.05). During living donor and recipient matching, both the potential volume of the donated kidney and the body size of recipient should be considered.     

Membranous nephropathy: recurrence after kidney transplantation

BACKGROUND.: It is supposed that about 5% of dialysis patients had membranousnephropathy as a cause for their renal failure. Despite of thisprevalence, only 33 cases of recurrent membranous nephropathyafter kidney transplantation have been reported in the Englishliterature. METHODS.: Among 509 recipients of renal allografts, membranous glomerulonephritiswas the cause of renal failure in five patients, who receivedsix transplants. RESULTS.: Recurrence of the disease was observed in three allografts (50%)in three patients, all of them were on treatment with cyclosporinand low-dose prednisone. Proteinuria appeared at 2, 5 and 19months after grafting. One patient experienced a spontaneousremission after 12 months and he is free from proteinuria andwith good renal function after 5 years. The remaining two patientspresented progressive renal function deterioration and returnedto haemodialysis 24 and 17 months after the appearance of proteinuria.In these patients increasing the immunosuppression did not produceany beneficial effect. One of those patients underwent a secondtransplant; recurrence of the membranous nephropathy has notbeen observed after 3 years of follow-up. CONCLUSIONS.: In this study three new cases of recurrence of membranous nephropathyare reported. One patient experienced a spontaneous remissionof proteinuria. Recurrence of membranous nephropathy in renalallograft was very high in our series. Its appearance was associatedwith poor prognosis of the graft in most patients, althoughspontaneous remission of proteinuria is possible.     

肾移植术后患者应用西罗莫司对他克莫司剂量的影响

观察肾移植术后联合应用西罗莫司(雷帕霉素)对他克莫司(FK506)剂量的影响. 方法 60例肾移植术后患者随机分为两组,研究组30例,免疫抑制方案采用西罗莫司+他克莫司+泼尼松;对照组30例,采用麦考酚吗乙酯(MMF)+他克莫司+泼尼松联合治疗.术后随访2年,比较两组的人、肾存活率,急性排斥反应率,他克莫司用量,肾功能变化和不良事件发生率.结果 研究组、对照组全部如期完成观察,两组的人肾存活率均为100%,研究组、对照组急性排斥反应发生率分别为7%(2/30)、10%(3/30),经肾上腺皮质激素(激素)冲击治疗后逆转;研究组在维持他克莫司血药浓度与对照组相当情况下,其用量低于对照组,比较差异有统计学意义(P<0.05).两组的不良事件发生率相近(60%比70%,P>0.05). 结论 联合西罗莫司+他克莫司+泼尼松方案用作肾移植术后免疫抑制治疗是安全有效的,且能减少他克莫司的剂量.     

每搏变异度指导肝移植术中液体管理对术后腹内压的影响

目的分析每搏变异度(SVV)指导肝移植术中容量管理后液体平衡的情况,评价该措施对术后腹内压的影响。方法回顾性分析本院2012年8月至2013年l2月ICU 52例肝移植患者的临床资料,手术方式均为非转流经典原位肝移植术,前8个月26例患者以传统指标:心率、血压、中心静脉压(CVP)等指导术中容量管理(对照组,n=26),后8个月26例患者采用脉搏轮廓温度稀释连续心排血量监测(picco)行精确的血流动力学监测,获取能较好反映病人容量状况的动态性指标SVV以指导液体管理(实验组,n=26)。结果 1肝移植术中采用不同血流动力学监测方法均能达到患者的早期目标导向性治疗(EDGT)标准;2术中两组液体治疗均为正平衡,对照组所输注总液体量[(8100±1080)ml]、晶体液量[(6000±985)ml]、人工胶体液量(2500±175)ml]均明显高于实验组[分别为(4700±650)m I、(3800±467)ml、(1000±88)m I,P0.05],而红细胞、血浆、血小板、白蛋白等血制品在两组间比较差异无统计学意义;3对照组手术前后腹内压(mm Hg)分别为:5.05±2.70、15.23±4.32(P0.01),实验组手术后IAP分别为:5.42±2.75、11.08±3.56(P0.01),研究表明两组术前腹内压差异无统计学意义,但对照组术后腹内压明显大于实验组,差异有统计学意义。4Pearson相关分析显示:各组液体治疗正平衡量与术后IAP均呈显著正相关(实验组r=0.62,P0.01;对照组r=0.65,P0.01)。结论采用SVV指导肝移植术中容量管理能减少液体正平衡,减轻术后腹内压的升高幅度。     

单肺移植同期行肺减容术纠正移植肺容积不匹配

目的 探讨单肺移植同期行肺减容术纠正移植肺容积不匹配的有效性和安全性.方法 24例次单肺移植的受者中,男性20例,女性4例,年龄(54.6±12.2)岁(28～75岁).原发病为终末期慢性阻塞性肺疾病(COPD)14例,COPD合并上叶毁损肺1例,COPD合并尘肺1例,终末期肺间质纤维化6例,淋巴管血管平滑肌瘤病1例,肺移植术后闭塞性细支气管炎综合征1例.采用右侧单肺移植16例,左侧单肺移植8例.肺减容采用开胸手术,移植肺减容在移植同期的手术视野下操作,自体肺减容采用移植肺对侧的前外侧小切口进胸.术后将受者分为减容组和对照组.减容组有8例受者,其中移植肺减容5例,自体病肺减容2例,移植肺和自体肺共减容1例.将未接受肺减容术的16例受者作为对照组.观察和比较上述两组受者间肺功能等各项临床指标的差异.结果 原发病为COPD的受者中有2例接受了肺减容术,占14.3%(2/14),明显低于其他原发病者接受肺减容术的比例(60%,6/10),二者间差异有统计学意义(P＜0.05).减容组和对照组分别有50.0%和25%的受者术后胸部X线片显示纵隔位置居中,两组比较,差异有统计学意义(P＜0.05).两组间其余各项临床指标的比较,差异均无统计学意义(P＞0.05).但减容组受者的机械通气时间、胸管引流时间、漏气时间、胸管引流量都有增加的趋势,术后胸穿抽液次数和总量都有下降的趋势.有8例未行术后肺功能复查,其余16例次移植肺功能资料齐全,减容组4例,对照组12例,两组间术后第1秒用力呼气容积(FEV1)改善的差异无统计学意义(P＞0.05).结论 单肺移植同期行移植肺或自体肺减容术对纠正移植肺容积不匹配是安全、有效的方法,可以改善移植肺的通气血流比例.     

成人标准肝体积预测公式的初步构建

目的 建立一个预测中国成人标准肝体积的公式.方法 收集2005年3月至2007年12月90例活体肝移植供者的临床资料,包括供者的性别(G)、年龄(Y)、身高(BH)、体重(BW)和术前CT扫描测量的全肝体积(TLV).分析TLV与上述其他指标的相关性,通过多重逐步线性回归得出预测标准肝体积的回归方程.并比较该公式和文献报道的公式预测的标准肝体积(ESLV)之间是否有差异.结果 90例供者的平均体重为(62.4±8.7)kg,平均TLV为(1319.1±167.0)ml,二者成正相关(r=0.655,P<0.01),可用公式TLV(ml)=12.5×BW(kg)+536.4来表示.与已发表文章中的公式相比,ESLV与TLV的差异均有统计学意义(P<0.05).结论 该研究建立了一个简单的更准确的预测中国成人标准肝体积的公式.