不同灌注速度及方法对大鼠膀胱容量、压力及神经传入电活动测定的影响

目的:探讨不同灌注速度及方法对大鼠膀胱容量、压力及神经传入电活动测定的影响。方法:SD雌性大鼠随机分为2组,分别选用尿道插管法及膀胱顶造瘘法,以50、100、200和400μL/min的速度进行灌注,以尿动力仪观察灌注过程中膀胱容量及压力的变化,以多通道生理记录仪检测灌注过程中膀胱神经传入电活动的变化。结果:采用插管法进行灌注测得最大放电频率,其随速度的升高呈上升趋势;膀胱漏尿点压(BLPP)和最大膀胱排尿压(MVP)随着灌注速度的升高而增大;各灌注速度下膀胱最大容量(MBC)无显著变化。造瘘法以各速度测得最大放电频率均无显著变化;其MBC随速度升高呈下降趋势,且在200及400μL/min灌注时显著降低;其BLPP及MVP无明显变化。2种方法相比,放电频率基线值无显著差异,以100、200和400μL/min进行灌注时造瘘法测得的膀胱最大放电频率均低于插管法;以不同速度灌注,造瘘法测得的MBC均比插管法小;而以50和100μL/min进行灌注时,造瘘法测得的压力比插管法高。结论:插管法以不同速度进行灌注并未对膀胱容量造成明显变化,但其膀胱压力及神经放电频率随速度升高,使用此法应根据研究目的选择灌注速度;采用造瘘法在200及400μL/min的灌注速度时,膀胱容量明显减少,故采用该法时建议以200μL/min的速度进行灌注。     

多孔尿道支架管在尿道成型术中的应用

目的:探讨多孔尿道支架管在尿道下裂患者尿道成型术中的应用.方法:对93例尿道下裂患者行尿道成型术治疗,术中采用多孔尿道支架管引流,不行膀胱造瘘.结果:本组80例患者伤口一期愈合,5例发生尿瘘(5.37%),6月后行尿瘘修补术,尿瘘愈合;8例尿道狭窄(8.6%),接受尿道扩张治疗.所有患者术后阴茎呈正常外观.结论:多孔尿道支架管有效地引流尿道分泌物和尿道积液,避免了对患者行膀胱造瘘术,减少了手术损伤及术后尿瘘、尿道狭窄等并发症的发生率.     

改良蕈样膀胱插管技术在家兔尿生成实验中的应用

目的 应用改良蕈样膀胱插管技术进行家兔尿生成实验,探讨改良蕈样膀胱插管技术的导尿效果。方法 随机抽取10组学生完成家兔改良蕈样膀胱插管,观察静脉注射50%葡萄糖、0.1%呋塞米和0.01%去甲肾上腺素溶液前后家兔尿量的变化。结果 应用改良蕈样膀胱插管技术的家兔导尿尿滴数为（55±16）滴/分,静脉注射50%葡萄糖溶液[（85±17）滴/分]和0.1%呋塞米溶液[（135±22）滴/分]后增加尿量,静脉注射0.01%去甲肾上腺素溶液[（65±20）滴/分]后尿量减少（P<0.01）。结论 改良蕈样膀胱插管技术导尿效果显著,葡萄糖和呋塞米具有明显的利尿作用,而去甲肾上腺素具有抑制尿生成的效果。     

膀胱造瘘术联合改良尿道腔内剜除术治疗老年前列腺增生疗效分析

目的探讨膀胱造瘘术联合改良尿道腔内剜除术(M-PKEP)治疗老年前列腺增生的临床疗效。方法回顾性分析2016年1月至2019年1月河北省沧州中西医结合医院收治的90例老年前列腺增生患者的临床资料,按照手术方案的不同分为4组:A组患者采用经尿道前列腺电切术(TURP),B组患者采用膀胱造瘘术联合TURP,C组患者采用M-PKEP,D组患者采用膀胱造瘘术联合M-PKEP。比较4组患者围手术期及并发症发生情况,记录术前及术后3、6个月的IPSS、残余尿量(RUV)、最大尿流率(Qmax)及生活质量(QOL)评分水平。结果各组患者术中出血量、膀胱冲洗时间及术后住院时间比较,差异有统计学意义(P<0.05),其中D组患者术中出血量、膀胱冲洗时间及术后住院时间均最少;术后3、6个月4组患者IPSS及RUV较术前均明显降低,Qmax较术前明显升高,差异有统计学意义(P<0.05),其中D组患者IPSS、RUV最低,Qmax最高;4组患者并发症发生率比较,差异有统计学意义(P<0.05),其中B组患者并发症发生率最高;术后3、6个月4组患者QOL较术前均明显降低,差异有统计学意义(P<0.05);术后3个月4组患者QOL比较,差异有统计学意义(P<0.05),其中D组患者QOL最低。结论膀胱造瘘术联合M-PKEP治疗前列腺增生可显著提高临床疗效,降低并发症发生率,改善患者生活质量。     

护理干预在前列腺增生患者行尿动力学检查中的应用

尿动力学是借助流体力学及电生理学方法研究尿路输送、贮存、排尿功能的新学科。通过尿动力学检查能客观地评估前列腺增生症（benign prostatic hypertrophy,BPH）时膀胱出口梗阻程度和逼尿肌功能状态,为BPH的诊断、治疗方法选择及疗效评价提供依据。但尿动力学检查是一个有创伤性的操作,而且前列腺增生均为老年患者,所以不可避免会出现患者害怕检查。2010年6月至2010年12月我科对100例前列腺增生行尿动力学检查的患者进行护理干预进行对照观察,达到减轻疼痛的目的。现报告如下。     

输尿管镜联合硅胶尿管在治疗尿道球部损伤中的应用

目的探讨经尿道输尿管镜下行腔内会师术及术后留置硅胶尿管在治疗尿道球部损伤中的临床意义。方法回顾分析2004年1月至2006年9月本院的20例球部尿道损伤患者，采用局麻或腰麻下行输尿管镜腔内会师术及术中、术后放置硅胶尿管2-3周。结果20例中16例经尿道输尿管镜下会师成功，4例会师失败后改行开放性尿道吻合术，留置硅胶尿管，无1例并发局部感染，拔管后排尿通畅。随访3～24月，其中1例开放手术者拔管1周后尿流变细．予行5次尿道扩张后维持正常排尿，1例开放手术者并发阴茎勃起功能障碍。结论输尿管镜下尿道会师术具有手术时间短、操作方便、创伤小的特点，尤其适合于球部尿道部分断裂的患者：而采用硅胶尿管，则更易于插管及可以减少尿路感染及局部瘢痕增生，降低尿道狭窄的发生几率。     

构建糖尿病膀胱病豚鼠模型及其尿动力学评价

背景：糖尿病性膀胱病是糖尿病患者最常见的慢性并发症之一,建立糖尿病膀胱病动物模型为相关研究提供实验动物平台。 目的：建立糖尿病膀胱病豚鼠模型并进行尿动力学评价。 方法：50只英国种短毛雌性豚鼠,实验组(n=42)以单次腹腔注射链脲佐菌素法诱导糖尿病豚鼠,对照组(n=8)注射相应剂量空白枸橼酸缓冲液,分别在9周和12周时行尿动力学检查,确定膀胱功能失代偿豚鼠即糖尿病性膀胱病组和代偿豚鼠即代偿组豚鼠尿动力学特点。 结果与结论：42只豚鼠有20只成功诱导出糖尿病。糖尿病豚鼠中,9周时9只糖尿病组豚鼠,6只膀胱功能代偿,3只失代偿;12周时,另外9只糖尿病组豚鼠,1只膀胱功能代偿,8只失代偿(89%)。糖尿病性膀胱病组豚鼠残余尿量增加(0.72±0.08) mL、最大逼尿肌压下降(0.63±0.05) kPa、膀胱容量增加(2.01±0.05) mL及膀胱顺应性增加(3.47±0.41) mL/kPa,与对照组及代偿组比较,差异均存在显著性意义(P < 0.001)。豚鼠一般可在诱导糖尿病成功后12周发生糖尿病性膀胱病,表现出膀胱残余尿量增加等相应的尿动力学改变。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

前列腺增生病人术前尿动力学检查临床意义

目的:评价尿流动力学检查在BPH病人术前诊治中的意义.方法:对38例BPH患者术前进行尿流动力学检测;根据检测结果选择不同方法进行治疗,其中行前列腺切除术30例,膀胱造瘘术2例,保守治疗6例.结果:38例中有32例存在膀胱出口梗阻,逼尿肌功能严重低下或无力6例,逼尿肌功能不稳定16例,逼尿肌反射亢进1例;术后3个月复查,38例均取得满意疗效.结论:BPH病人术前尿流动力学检测可以明确膀胱出口有无梗阻、逼尿肌顺应性和收缩功能,这对于合理选择术式以提高疗效有重要的临床意义.     

良性前列腺增生患者手术前后尿动力学检查的应用价值

研究良性前列腺增生患者手术前后尿动力学检查的临床应用价值。方法 回顾分析2017年8月~2018年8月在我院进行手术治疗的62例良性前列腺增生患者的临床资料,对比手术前后Qmax、VMCC及PVR,观察预后及疗效。结果 62例患者中伴不稳定性膀胱39例（60.53%）,低顺应性膀胱10例（18.51%）,不稳定膀胱合并低顺应性膀胱7例（11.29%）,逼尿肌收缩受损6例（9.67%）;术后随访1个月,治愈36例（58.06%）,显效18例（29.03%）,无效8例（12.90%）。其中排尿困难5例,尿失禁3例。8例无效患者术后4个月随访,均治愈;术后1个月、5个月患者Qmax、VMCC高于术前,PVR低于术前,差异有统计学意义（P＜0.05）。结论 良性前列腺增生患者手术前后进行尿动力学检查,对术前诊断、术后效果评价具有重要价值,对患者的快速康复具体指导意义。     

女性膀胱癌患者原位回肠和乙状结肠尿流改道效果的比较

背景：原位尿流改道在膀胱癌根治术后具有良好的控尿能力,但针对女性膀胱癌患者行原位回肠重建新膀胱和原位乙状结肠重建新膀胱后疗效及随访方面的研究很少。 目的：比较女性膀胱癌患者原位回肠和乙状结肠尿流改道的临床疗效。 方法：回顾性分析1996至2008年行膀胱癌术后原位回肠尿流改道(回肠组,n=29)和乙状结肠尿流改道(乙状结肠组,n=23)的女性膀胱癌患者的临床资料。比较分析两组患者修复中及修复后的一般情况、尿动力学结果、控尿能力和修复后储尿囊相关并发症等。 结果与结论：平均随访时间回肠组57个月,乙状结肠组55个月。两种修复方式术中失血量、术后控尿效果接近,但两组在手术时间、治疗后下床时间、新膀胱容量等方面差异有显著性意义(P < 0.05)。回肠组治疗后早期及晚期储尿囊相关并发症发生率均高于乙状结肠组。回肠组治疗后储尿囊再发肿瘤2例,乙状结肠组未见发生,说明两种重建方式应用于女性膀胱癌患者疗效均良好。     

A system for measurements of micturition urethral cross-sectional areas and pressures

A system for the measurement of urethral urinary stream cross-sectional areas and pressures is described. The system consists of: (1) A 4 French gauge probe with electrodes for the electrical impedance measurement of cross-sectional areas and side-holes for pressure measurements (2) an electrical field generator and impedance detecting section and (3) a side-hole perfusion and pressure measuring part. Thein vitro performance of the system is: linear cross-sectional area measurement in the range of 0–38 mm², independent of the shape of the lumen and with an axial resolution of approximately 7 mm. Measurement of hydrostatic pressures with a time constant of 0·38 s and of closure pressures with a post-occlusion pressure increase rate of 0·85 kPa s⁻¹.In vivo cross-sectional areas are calibrated in a standard made of PVC. The influence of the electrical shunting of the urethral mucosa is shown to permit this, provided that the impedance of the mucosa in the closed urethra is measured in each patient investigated.     

Estimation of elastic properties in the urethral flow controlling zone by signal analysis of urodynamic pressure/flow data

When urethral flow is treated as a lossless flow through an elastic tube, the relationship between the detrusor pressure and the urinary flow can be related to the elasticity of the flow-controlling zone of the urethra. A recent analytical method of describing urethral elasticity is implemented on a computer. The function p(Q)=p_mo+L_mQ^m is fitted to the recorded pressure/flow data. p(Q) is the detrusor pressure, Q the flow and p_mo, m and L_m parameters. The elastic properties are then obtained as p(A)=p_mo+K_nAⁿ, where p(A) is the static pressure, A the cross-sectional area of the flow-controlling zone and n and K_n calculated parameters. The urodynamic methods used and the computer implementation of the analytical method are described. In obstructed and unobstructed men without neurological symptoms, the elastic properties could be estimated in 94 per cent of the micturitions. The method makes it possible to describe urethral flow properties with Griffiths' model in a standardised way and compare results obtained by different investigators. It is recommended for quantification of urethral obstruction in research and for assessment of borderline cases of obstruction in clinical practice. deceased     

Ultrastructure and morphometry of the urethral glands in normal,castrated, and testosterone-treated castrated male mice

Recent studies of the urethral glands in the male mouse and rat have suggested that they are testosterone-dependent glands that may be potential sites for secretory immunity in the male genital tract. In the present study we describe the ultrastructural features of these glands in normal mice and provide quantitative data on the sizes of the acinar cells and their organelles in sham-, oil-, and testosterone-treated castrated mice. Acinar cells in urethral glands from normal mice contain numerous secretory granules, prominent Golgi complexes, elongated mitochondria, and an abundance of rough endoplasmic reticulum (RER) with large and dilated cisternae, all of which are features characteristic of secretory cells. In some acinar cells the cisternae of the RER were filled with closely packed, unbranched, straight, tubular structures that were oriented parallel to one another, that radiated from aggregates of dense material, or that were randomly attanged. In other acinar cells the cisternae of the RER showed a network of branching and anastomosing vesicular-like structures whose limiting membranes were occasionally seen in continuity with the membranes of the RER. Secretory acini showed large, unbranched tubules in the acinar lumen. When cut at right angles the large tubules exhibited a distinct fuzzy outer coat with fine projections radiating outwards. The ultrastructure of the acinar cells and the presence of tubules in the lumen suggests that they are engaged in secretion of a tubular protein. Morphometric analysis of acinar cells in the urethral glands showed that the mean volumes of nuclei, cytoplasm, secretory granules, vacuoles, and mitochondria were significantly reduced in castrated mice in comparison to either normal or testosterone-treated castrated mice. This confirms earlier observations that the urethral glands are targets of testosterone. © 1993 Wiley-Liss, Inc.     

How to: implement procalcitonin testing in my practice

BackgroundAdding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. However, PCT protocols need to be adapted to clinical settings and patient populations.ObjectivesTo review PCT use in different medical settings and patient populations.SourcesMost recent trials and meta-analyses investigating PCT for antibiotic stewardship were reviewed.ContentSeveral trials found PCT-guided antibiotic stewardship to reduce antibiotic exposure and associated side-effects among patients with respiratory infection and sepsis. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT. In the context of a low pre-test probability for bacterial infections and a low-risk patient, a low PCT level helps to rule out bacterial infection and empiric antibiotic therapy can be avoided. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. Although these concepts have been successful in several respiratory infection and sepsis trials, some studies failed to show an added benefit of PCT due to factors such as low protocol adherence and relying on single rather than repeat PCT measurements.ImplicationAs an adjunct to other clinical and laboratory parameters, PCT provides information about risk for bacterial infection and resolution of infection, and improves antibiotic stewardship decisions, thereby offering more individualized treatment courses with overall reduced antibiotic exposure.     

法舒地尔通过抑制兔尿道成纤维细胞Rho/ROCK通路激活减少尿道损伤后狭窄的发生

目的:研究法舒地尔对创伤后兔尿道狭窄发生的影响及机制,观察兔尿道成纤维细胞活力、迁移以及细胞外基质合成情况。方法:利用显微外科技术建立兔尿道创伤动物模型,分为5组:假手术组,手术组,不同剂量(3 mg/kg、10 mg/kg、30 mg/kg)法舒地尔组,术后3个月逆行尿道造影测量狭窄直径。从兔尿道瘢痕组织提取成纤维细胞进行传代培养,培养液中分别加入TGF-β1(10μg/L)和/或法舒地尔(12.5μmol/L,25μmol/L,50μmol/L)。MTT比色法检测细胞活力;用Transwell小室实验检测细胞迁移能力;Western blot法检测各组Rho相关激酶(ROCK)、α-平滑肌肌动蛋白(α-SMA)以及胶原蛋白Ⅰ和Ⅲ的表达情况。结果:法舒地尔显著减少尿道损伤后狭窄发生(P0.05)。随着法舒地尔浓度的增加,成纤维细胞的活力受到抑制,细胞迁移能力逐渐减弱,ROCK、α-SMA以及胶原蛋白Ⅰ和Ⅲ的表达受到抑制;法舒地尔对兔尿道成纤维细胞外基质及ROCK表达起抑制作用,并呈剂量依赖性(P0.05)。结论:法舒地尔可以通过下调TGF-β1诱导的兔尿道成纤维细胞Rho/ROCK通路,抑制细胞外基质形成,减少尿道损伤后狭窄的发生。     

Knotted urethral catheter in an 80-year-old woman: prevention and management of this unusual complication

Intravesical catheter knotting represents a rare event, especially described in paediatric literature. We report a case of a catheter knot, occurring in an 80-year-old woman, managed by means of sustained traction.     

Permanent catheterization of aorta and pulmonary artery in the dog

Summary A method is presented for permanent catheterization of the aorta and the pulmonary artery in dogs. The preparation of single vessel catheters and double catheters for simultaneous arterial and venous sampling is described. The catheters, made of S-50-HL Tygon tubing, are introduced into the aorta and the pulmonary artery through the omocervical vessels, leaving the cerebral circulation intact. Removal of the catheter by the dog, thrombophlebitis and vascular embolism have not been observed. The catheters have remained functional for up to one year.This work was supported in part by grants from the Netherlands Organization for the Advancement of Pure Research (Z.W.O.) received through the Foundation for Medical Research (Fungo).     

不同公式估测右颈内静脉前路法置管长度准确性比较

目的探讨估测右颈内静脉前路法置管长度最适宜的公式。方法选取2013年1月至2013年6月我科经右颈内静脉留置深静脉导管患者67例,分别用4种公式对置入导管长度进行估测,并与实际置入至正确位置的长度进行比较,分析4种公式的准确性。结果 4种公式估测置入长度的误差百分比均在15%以内。公式1估测长度与实际长度无明显差异(P0.05);其余3种公式的估测长度均明显小于实际长度,有明显差异性(P0.05)。在对不同身高患者置管长度的预测中,公式4的平均绝对误差明显高于公式1,有明显差异性(P0.05);公式2、公式3与公式1的绝对误差平均值比较均无显著性差异(P0.05)。结论4种公式预测长度误差均在15%以内,其中公式1简单、准确、实用、误差小,更适用于右颈内静脉置管前路法长度的估计。     

荷人鼻咽癌裸鼠血内皮抑素的水平变化

目的:探讨不同病期荷人鼻咽癌裸鼠血内皮抑素水平的变化,及其与肿瘤发展的关系。方法:采用BALB/C裸小鼠复制荷人鼻咽癌裸鼠模型,通过EIA方法测定不同病期荷人鼻咽癌裸鼠血内皮抑素的浓度,称取瘤重。结果:荷瘤鼠血中内皮抑素含量在种瘤5d组[(137.61±53.41)μg/L]或10d组[(103.06±17.33)μg/L]与正常裸鼠[(113.56±21.74)μg/L]比较未见明显差异(P>0.05),而种瘤20d组、30d组、40d组[(212.80±85.91)μg/L、(293.63±62.53)μg/L、(271.57±32.45)μg/L]显著高于正常裸鼠(P<0.05)。随着荷瘤时间的延长,瘤宿主血内皮抑素含量逐渐升高,种瘤20d组明显增高,并持续维持在高水平。瘤重与血中内皮抑素含量呈正相关关系(r=0.687)。结论:提示肿瘤的发展与血内皮抑素含量的变化可能有关。