低蛋白饮食对环孢素A肾病大鼠肾间质纤维化的作用

Objective To investigate whether low-protein diet has protective effect on the progression of renal interstitial fibrosis in rats with cyclosporine A (CsA)-induced nephropathy. Methods Eighteen male Sprague-Dawley rats were randomly divided into three groups (6 rats in each group). The rats in control group (C group) received common diet; in model group (M group) low-salt diet; in intervention group (Ⅰ group) low-salt and low-protein diet. After diet adaptation period of one week, the rats in C group received subcutaneous injection of olive oil 1 mg/kg daily for 5 weeks, while M group and Ⅰ group subcutaneous injection of CsA (diluted into 25 g/L with olive oil) 1 ml/kg for 5 weeks. All the rats were sacrificed at the end of the 5th week. The food-intake and body weight were measured daily. The creatinine clearance (Ccr) was examined before rats were sacrificed. The semi-quantitative pathological analysis on kidney sections was performed. The mRNA and protein expression of transforming growth factor-β1 (TGF-βI) and type Ⅰ collagen (Col Ⅰ) in kidney tissue was determined with real time PCR and immunohistochemical staining, respectively. Results The food-intake and body weight of rats in M and I groups were significantly lower than those in C group (P<0.05). Compared with C group, the Ccr levels in M and Ⅰ groups were significantly reduced [(0.65±0.15) ml/min, (0.40+0.13) ml/min vs (1.55±0.29) ml/min, P<0.05], the relative fibrosis areas of kidney interstitium in M and I groups were significantly increased (3.60%±0.46%, 3.26%±0.75% vs 0.44%±0.24%, P<0.05), the mRNA and protein expression of TGF-β1 in M and I group was significantly up-regulated (by 2.6 and 3.1 times in mRNA and by 1.5 and 1.6 times in protein, respectively, P<0.05), and the mRNA and protein expression of Col Ⅰ in M and I groups was also significantly up-regulated (by 3.0 and 3.5 times in mRNA and by 2.3 and 2.1 times in protein, respectively, P<0.05). There were no significant differences between M and I groups in every parameters above-mentioned except the rat body weight and Ccr. Both the body weight and Ccr in Ⅰ group were significantly lower than those in M group (P<0.05). Compared with C group, the urine osmotic pressure in M group and in I group were deceased (for M group, P>0.05; for I group, P<0.05). Compared with C group, the serum cholesterol levels in M and I groups were significantly increased (P<0.05), and the serum phosphorus level in I group was significantly decreased (P<0.05). The levels of serum albumin and serum calcium of all three groups had no statistical differences (P>0.05). Conclusion Low-protein diet has no renoprutective effects on the rat model of cyclosporin A nephropathy, on the contrary, may induce body weight loss.     

低蛋白饮食对环孢素A肾病大鼠肾间质纤维化的作用

Objective To investigate whether low-protein diet has protective effect on the progression of renal interstitial fibrosis in rats with cyclosporine A (CsA)-induced nephropathy. Methods Eighteen male Sprague-Dawley rats were randomly divided into three groups (6 rats in each group). The rats in control group (C group) received common diet; in model group (M group) low-salt diet; in intervention group (Ⅰ group) low-salt and low-protein diet. After diet adaptation period of one week, the rats in C group received subcutaneous injection of olive oil 1 mg/kg daily for 5 weeks, while M group and Ⅰ group subcutaneous injection of CsA (diluted into 25 g/L with olive oil) 1 ml/kg for 5 weeks. All the rats were sacrificed at the end of the 5th week. The food-intake and body weight were measured daily. The creatinine clearance (Ccr) was examined before rats were sacrificed. The semi-quantitative pathological analysis on kidney sections was performed. The mRNA and protein expression of transforming growth factor-β1 (TGF-βI) and type Ⅰ collagen (Col Ⅰ) in kidney tissue was determined with real time PCR and immunohistochemical staining, respectively. Results The food-intake and body weight of rats in M and I groups were significantly lower than those in C group (P<0.05). Compared with C group, the Ccr levels in M and Ⅰ groups were significantly reduced [(0.65±0.15) ml/min, (0.40+0.13) ml/min vs (1.55±0.29) ml/min, P<0.05], the relative fibrosis areas of kidney interstitium in M and I groups were significantly increased (3.60%±0.46%, 3.26%±0.75% vs 0.44%±0.24%, P<0.05), the mRNA and protein expression of TGF-β1 in M and I group was significantly up-regulated (by 2.6 and 3.1 times in mRNA and by 1.5 and 1.6 times in protein, respectively, P<0.05), and the mRNA and protein expression of Col Ⅰ in M and I groups was also significantly up-regulated (by 3.0 and 3.5 times in mRNA and by 2.3 and 2.1 times in protein, respectively, P<0.05). There were no significant differences between M and I groups in every parameters above-mentioned except the rat body weight and Ccr. Both the body weight and Ccr in Ⅰ group were significantly lower than those in M group (P<0.05). Compared with C group, the urine osmotic pressure in M group and in I group were deceased (for M group, P>0.05; for I group, P<0.05). Compared with C group, the serum cholesterol levels in M and I groups were significantly increased (P<0.05), and the serum phosphorus level in I group was significantly decreased (P<0.05). The levels of serum albumin and serum calcium of all three groups had no statistical differences (P>0.05). Conclusion Low-protein diet has no renoprutective effects on the rat model of cyclosporin A nephropathy, on the contrary, may induce body weight loss.     

综合引流治疗复杂的晚期自发性食管破裂（附3例报告）

目的：探讨复杂的晚期自发性食管破裂的处理方法。方法回顾性分析我院胸外科处理的3例复杂的晚期自发性食管破裂患者的临床资料，即及时行食管破裂修补术，并放置食管T管、胸腔引流管、纵隔引流管、双胃肠减压管进行综合引流，术后给予充分营养支持。结果经积极治疗后，3例患者无一例死亡，食管T管拔除后，进食顺利，效果满意。结论多管引流配合T管引流的综合引流方式是治疗复杂的晚期自发性食管破裂的一种安全、有效的方法。     

类风湿关节炎膝关节置换后深静脉血栓发生情况及溶栓效果研究

[目的]探讨类风湿关节炎患者行全膝关节置换术后深静脉血栓的发病率及溶栓效果研究。[方法]2009年2月～2011年5月手术治疗类风湿关节炎24例,其中男性4例,女性20例;年龄29～74岁,平均58.2岁。双膝关节置换术6例(分两次手术),6例行左膝关节置换术,12例行右膝关节置换术。全膝关节置换术后行下肢深静脉造影诊断是否有深静脉血栓形成,术后深静脉血栓形成患者使用系统性溶栓治疗。[结果]深静脉造影术后,类风湿关节炎行全膝置换术后深静脉发生率为26.7%;系统性溶栓后,临床有效率为100%。分别在术后3、6个月随访两次。[结论]类风湿关节炎行全膝关节置换术后深静脉血栓发生率不低,值得在今后的临床工作中注意;下肢深静脉造影是关节置换术后诊断深静脉血栓形成的必要手段。     

高速摩托车祸伤致髌腱及后交叉韧带联合损伤的诊治

目的分析少见的髌腱及后交叉韧带(PCL)联合损伤(断裂或撕脱骨折)的特点。方法对髌腱及PCL联合损伤3例行手术治疗,1例行非手术治疗。结果 3例手术治疗者获随访13~26个月,术后的Insall Salvati比值(髌骨或髌腱长度)恢复至0.8~1.0。所有患者基本恢复至伤前运动水平。结论摩托车高速车祸伤中的屈膝硬物冲击髌腱有可能导致髌腱和PCL的联合损伤,详细的评估可有效的避免漏诊。     

计算机辅助导航与传统全膝关节置换术后下肢深静脉血栓形成的对比研究

背景:大量研究表明计算机辅助导航全膝关节置换(TKA)具有传统手术不可比拟的许多优势,如下肢力线精确、软组织平衡良好、手术创伤小及并发症少等,但对于计算机辅助导航TKA术后下肢深静脉血栓形成(DVT)发生率的研究尚少。目的:比较计算机辅助导航与传统TKA术后下肢DVT发生率的差异。方法:回顾性分析2010年9月至2011年8月行初次TKA的53例58膝。其中导航组,即行计算机辅助导航TKA治疗23 例 26 膝,年龄 42～82 岁,平均 67.3 岁;传统组,即行传统 TKA 治疗 30 例 32 膝,年龄 53～78 岁,平均 67.1 岁。根据术后3～5 d 行下肢深静脉造影检查结果比较两组 DVT 的发生率,并比较两组的手术时间、止血带时间及压力、术中出血量与术后引流量总和的差异。结果:导航组和传统组术后DVT发生率分别为8.7%和36.7%,相比较有统计学意义(P=0.015);导航组和传统组手术时间分别为(146.2±21.3)min和(110.0±18.0)min,相比较有统计学差异(P<0.001);术中出血量与术后引流量总和分别为(987.1±441.9)ml和(1250.0±422.5)ml,相比较有统计学差异(P=0.025);止血带时间分别为(50.3±17.5)min和(45.9±15.4)min,止血带压力分别为(257.7±20.7)mmHg 和(255.9±18.1)mmHg,相比较均无统计学差异(P=0.314 和 0.732)。结论:计算机辅助导航TKA可降低术后下肢DVT的发生率。     

全髋关节置换术后深静脉血栓发生的随机对照研究

目的 通过随机对照研究,探讨全髋关节置换术后深静脉血栓形成的发生率和预防措施.方法 2007年5月至2008年12月行全髋关节置换术的141例患者,男53例,女88例;年龄17～86岁,平均(63.20±13.78)岁.根据是否使用低分子肝素随机分成抗凝组(82例)和非抗凝组(59例),术后均行患肢深静脉顺行性造影,明确血栓发生的部位、大小及数量.诊断标准根据1972年Rabinov和Paulin提出的诊断标准,结合国内吕厚山的相关经验进行统一诊断.根据下肢血栓的部位将血栓分为中央型、周围型和混合性血栓.结果 全髋关节置换术后深静脉血栓形成的发生率为32.62%(46例),其中中央型1例,混合型2例,周围型43例.临床症状有小腿后侧疼痛,沉重或紧张,足和踝关节周围轻度肿胀.临床体征有肌肉压痛、Homans征或Neuhof征阳性.将症状和体征都作为临床依据,其中无临床依据者共34例,占73.9%.抗凝组(82例)和非抗凝组(59例)深静脉血栓形成发生率的差异无统计学意义.结论 采用数字化下肢深静脉造影技术能准确地发现全髋关节置换术后深静脉血栓形成,临床症状与其无直接关联,低分子肝素抗凝后虽能降低深静脉血栓形成的发生率,但差异无统计学意义.     

镇静处理在危重病呼吸衰竭机械通气治疗中的价值

神志清楚的机械通气患者尤其是插管患者往往因为制动、烦躁,导致无谓的氧耗增加,甚至治疗无法进行。本研究旨在客观评价在这些患者中用镇静处理配合机械通气治疗对其精神、神经应激状态、循环和呼吸力学参数的影响。临床资料1.对象:2005年1月~8月收住我院重症监护室的呼吸衰竭危重患者45例,均在急性期接受经口插管机械通气治疗时存在严重的烦躁、躁狂、挣扎、过度通气、频繁人机对抗等不耐受表现,全部患者Ramsay评分≤1,机械通气时间>24小时。45例患者中,男27例,女18例,男女比例1∶0.67,年龄27~64岁,平均年龄53岁。其中急性重症肺炎11例(24…     

不同介入治疗模式对晚期肝癌患者的疗效分析

目的 评价不同介入治疗模式治疗晚期肝癌的临床疗效.方法 不能手术治疗的晚期肝癌患者186例,将186例患者分成3组.A组62例,采取肝动脉栓塞化疗(TACE);B组60例,采取射频消融(RFA)治疗;C组64例,采取TACE联合RFA治疗,比较三组患者介入治疗效果.结果 C组患者肿瘤完全反应率、血清甲胎蛋白(AFP)变化以及介入治疗后1、3年存活率明显高于A、B组,差异有统计学意义(P＜0.05);A、B组间比较差异无统计学意义(P＞0.05).结论 TACE联合RFA治疗肝癌,疗效显著,可提高患者短期生存率.     

碘伏间断冲洗治疗人工关节置换术后早期感染

近年来,人工关节置换术在我国已广泛开展,然而,其术后并发感染的发生率仍有1％～2％之多。目前对人工关节置换术后感染的治疗仍处于困境。本中心自2001年6月起收治4例人工关节术后早期感染的患,采用清创结合碘伏间断冲洗治疗,取得了良好的临床效果,报告如下。