A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

茯苓化学成分和药理作用研究进展及质量标志物的预测分析

茯苓Poriacocos是我国传统的药食同源中药材,具有利水渗湿、健脾、宁心等功效,在药品、食品及保健品中均有广泛应用。随着对茯苓的深入研究,其三萜类和多糖等主要化学成分、药理作用及应用开发研究备受关注。对茯苓的化学成分、药理作用进行系统综述,根据质量标志物的概念,从亲缘学及化学成分特有性、传统药效、传统药性、化学成分可测性、不同加工方法的影响等几个方面对茯苓质量标志物进行预测分析,为茯苓质量评价研究和产品开发提供科学依据。     

祛风湿药镇痛作用的文献再评价

目的:对祛风湿药药理作用中的镇痛作用进行文献再评价。方法:查阅、归纳、整理2009年以前公开发表的有关祛风湿药镇痛作用的研究文献,根据药物药理作用的评价原则和中药镇痛作用的评定标准,对《中药药理学》教材中具有镇痛作用的祛风湿药进行文献再评价,以明确其镇痛作用。结果:威灵仙镇痛作用确切,独活、木瓜、羌活、青风藤、秦艽、雷公藤实验依据不足,防己、豨莶草、臭梧桐、五加皮无镇痛作用。     

CRRT在心肾联合移植术后的应用及护理

我院于2006年4月28日成功的为1例患者实施了心肾联合移植术,现将护理体会报告如下。1资料与方法1.1一般资料患者男性,29岁,诊断为扩张性心肌病,心功能III级,慢性肾功能不全氮质血症期。于2006年4月28日在全麻体外循环下行心肾联合移植术,术后24h无尿,超声显示肾血管阻力增加,肾     

深低温停循环在主动脉手术中应用-30例报告

目的总结应用深低温停循环技术的主动脉手术30例,探讨深低温停循环中脑保护的方式.方法选取应用深低温停循环的主动脉手术患者30例,标准全身麻醉,降至鼻咽温12～13℃,直肠温17～18℃后,停止循环,恢复循环后,循序升温至鼻咽温37℃、直肠温35℃左右脱离体外循环.其中应用腋动脉顺灌10例,上腔静脉逆灌1例.结果停循环时间8～86(47.6±25.8)min.自动复跳19例,复跳率63%.上腔静脉逆灌1例,时间为26min.腋动脉顺灌10例,时间为35～53(44.2±7.9)min.全部患者无手术死亡,7例患者出现较明显术后并发症,其中神经系统症状3例,肾功能不全1例,声音嘶哑3例,其余患者均于术后24h内清醒.结论深低温停循环是大血管手术的重要辅助手段,其间脑保护方式多种多样各有利弊,其具体的选择和管理等问题尚有待进一步的探讨和研究.     

HPLC法测定不同产地首乌延寿片中2,3,5,4′-四羟基二苯乙烯-2-O-β-D-葡萄糖苷的含量

目的建立HPLC对首乌延寿片定量的分析方法。方法采用HPLC法测定2,3,5,4′-四羟基二苯乙烯-2-O-β-D-葡萄糖苷的含量。结果2,3,5,4′-四羟基二苯乙烯-2-O-β-D-葡萄糖苷对照品线性范围在0.0735～0.441μg,样品平均回收率为95.0%,RSD为2.37%。结论方法简便、准确、专属性强,能有效的控制首乌延寿片的质量。     

益髓颗粒对ITP小鼠脾脏CD4+CD25+Foxp3+Treg细胞及其相关因子影响的研究

目的建立免疫性血小板减少性紫癜（ITP）小鼠动物模型,观察益髓颗粒对模型小鼠脾脏CD4＋CD25＋Foxp3＋Treg细胞（Treg）及血清TGF-β1的影响,探讨益髓颗粒的免疫调节机制。方法 40只Balb/c小鼠随机分为正常组、模型组、泼尼松治疗组、益髓颗粒治疗组,除正常组外,其余各组均隔日一次按100μl/20g腹腔注射1：4豚鼠抗小鼠血小板血清（GP-APS）建立ITP小鼠模型,造模第8天开始各组均按0.2ml/10g·d-1体积灌胃,正常组、模型组灌服生理盐水,益髓颗粒组治疗按0.3g/10g·d-1灌胃,连续8天后眼球取血分离血清,ELISA法检测TGF-β1,取脾制备脾单细胞悬液,用流式细胞仪检测脾Treg。结果模型组小鼠Treg细胞比例、TGF-β1水平明显低于正常组;泼尼松及益髓颗粒治疗组Treg细胞比例及TGF-β1水平均高于模型组,但Treg仍未达到正常水平,与正常组比仍存在差异,而TGF-β1与正常组比差异不明显无统计学意义。结论 ITP小鼠Treg细胞比例减少、TGF-β1水平降低可能与ITP的细胞免疫失调相关,益髓颗粒可通过提高ITP小鼠Treg细胞的比例及血清TGF-β1水平而对ITP的细胞免疫失调起调节作用。     

心内直视手术中七十岁以上患者的体外循环管理

目的 总结分析心内直视手术中七十岁以上患者的体外循环特点和管理方法.方法 2005年3月至2008年7月间7000余例手术中70岁以上患者共有194例,分类进行心内直视手术.体外循环时全部应用进口膜肺,勃脉力A和胶体预充,常规加入白蛋白、激素和乌司他丁;心肌保护采用间断灌注4:1冷含血停搏液,顺灌逆灌和桥灌相结合;常规监测混合静脉氧饱和度和血细胞压积,积极应用超滤技术.结果 术中转流平稳,血流动力学稳定,监测指标均在正常范围,平均体外循环时问和主动脉阻断时间分别为111.5±40.4min和63.6±21.0min.自动复跳率52.6%,平均搭桥数目3.4±0.8支,术后平均气管拔管时间24.0±12.7h,平均ICU时间4.7±3.5d.结论 70岁以上患者以瓣膜和冠状动脉病变为主、病变复杂,体外循环时间和主动脉阻断时间较长,各脏器保护要求高,针对高龄患者的特点,制定相应的体外循环管理方法,是保证手术成功的重要因素.     

1例左心室辅助装置植入术后呼吸衰竭患者应用无创通气联合俯卧位治疗的护理

总结1例终末期扩张型心肌病接受左心室辅助装置植入术、三尖瓣成形术患者术后应用无创通气联合俯卧位治疗的护理。患者在术后拔除气管插管后轻度呼吸困难，继发呼吸衰竭，经过实施无创通气联合俯卧位治疗成功。患者实施俯卧位的前提是合适的镇静，俯卧位过程中，专人固定左心室辅助装置电缆线，同时避免护理过程中出现压力性损伤。