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11.
目的 探讨腹腔镜下改良Roux-en-Y单纯胃空肠转流术治疗2型糖尿病的临床疗效.方法 回顾性分析11例接受腹腔镜下改良Roux-en-Y单纯胃空肠转流术治疗2型糖尿病患者的临床资料,分析手术前后口服糖耐量及C肽、胰岛素刺激释放试验的变化.结果 术后1个月患者BMI(体重指数)无明显变化,口服糖耐量及C肽、胰岛素刺激释放试验均较术前显著好转(P<0.05),糖化血红蛋白有明显下降趋势,糖尿病症状获得明显缓解.其中2例随访时间超过9个月,3例随访时间超过3个月,术后BMI无明显变化,糖化血红蛋白、空腹血糖及餐后2 h血糖均较术前有显著缓解.结论 腹腔镜下改良Roux-en-Y单纯胃空肠转流术是非肥胖型和轻度肥胖型2犁糖尿病一种有效的治疗方法. 相似文献
12.
目的:研究乌司他丁对婴幼儿体外循环手术中炎性反应的影响及对肺的保护作用.方法:38例诊断为室间隔缺损的婴幼儿患者,随机分为实验组(n=18)和对照组(n=20).实验组乌司他丁按1.2万U/kg 计算用药量,生理盐水溶解稀释至10 ml,主动脉插管前经外周静脉缓慢推注半量,另半量加入预充液中;对照组以等量生理盐水代替,用法同上.于术前和术后1、4、24 h进行血气分析、检测炎性介质(TNF-α、IL-6、IL-8).结果:炎性介质(TNF-α、IL-6、IL-8)术前均无差异,术后明显升高(P<0.05);实验组术后各时点IL-6均明显低于对照组(P<0.01),IL-8术后各时点均明显低于对照组(P<0.05),TNF-α术后4、24 h较对照组低(P<0.05).结论:乌司他丁能抑制IL-6、IL-8的释放,对TNF-α有一定的抑制作用,可减轻婴幼儿体外循环手术中炎性反应,保护肺功能. 相似文献
13.
Tracy J. Cheun Lalithapriya Jayakumar Maureen K. Sheehan Matthew J. Sideman Lori L. Pounds Mark G. Davies 《Journal of vascular surgery》2019,69(1):120-128.e2
Background
Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management.Methods
A database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried. Patients with critical ischemia (tissue loss and rest pain) were identified. Three management groups were identified: no revascularization (None), endovascular revascularization (Endo), and open revascularization by bypass (Bypass). Patients with acute embolism, active vasculitis, end-stage renal disease, ipsilateral dialysis access complications of steal, and ipsilateral trauma were excluded.Results
One hundred eight patients (56% male; average age, 59 years) presented with symptomatic below-the-elbow disease: 93% presented with digital ulceration and the remainder with rest pain. Eighty-one percent had diabetes and 41% had chronic renal insufficiency (not on dialysis). All underwent catheter-based angiography. Fifty-three patients (49%) had no intervention and subsequently were committed to wound care; 26 of these required no further intervention, 10 had an interval palmar sympathectomy, and 17 underwent either a phalanx or digital amputation. Thirty-four patients (31%) underwent an endovascular intervention with a median of 1.5 vessels (ulnar, radial, or interosseous arteries) intervened on. Technical success was achieved in 29 patients (85%). Of the five technical failures, two went on to bypass, one had a focal endarterectomy and patch angioplasty, and one was treated conservatively. Ten patients in the Endo group required either a phalanx or digital amputation. Twenty-one patients (19%) underwent a saphenous vein bypass (reversed or nonreserved) to the radial in 12 and the ulnar in 11 limbs. In follow-up, 11 patients underwent open or endovascular intervention to maintain patency of the bypass. There were nine phalanx or digital amputations in the Bypass group. No below-the-elbow or above-the-elbow amputations were performed within 30 days. The wound healing rate without amputation was 78% (85 of 108). The predictors of wound healing were technical success of the revascularization, intact palmar arch and presence of digital run-off. The presence of an incomplete arch and poor digital run-off were associated with a phalanx or digital amputation.Conclusions
Upper extremity interventions for critical ischemia are associated with a high rate of success. Major amputations are rare and the many can be treated nonoperatively. In appropriately selected patients, both endovascular and open interventions have a high rate of success. 相似文献14.
In patients with aneurysmal subarachnoid hemorrhage (aSAH) unfavorable for endovascular or traditional open surgical techniques, surgical revascularization strategies comprise one of remaining limited options. There is nonetheless a paucity of data on the safety and efficacy of bypass in aSAH. In this study, we aimed to investigate complications and outcomes in a cohort of patients with aSAH treated with bypass. A prospective single-surgeon database of consecutive patients treated for aSAH between 2013 and 2018 was retrospectively analyzed. Complications and functional status at discharge were recorded and analyzed for the patients that underwent bypass surgery. Forty patients with aSAH were treated with bypass surgery (23 extracranial-intracranial; 17 intracranial-intracranial). All-cause perioperative mortality was 13% (6 patients). At discharge and at mean 14-month follow up, respectively, 16/40 (40%) and 16/25 (64%) of patients achieved a Glasgow Outcome Score of 4–5. All-cause, in-hospital complications occurred in 28 patients (70%), of which any ischemic complication occurred in 20 patients (50%), 7 (18%) being open surgical complications. This work represents the largest modern series of bypass for aSAH to date. In cases of aSAH unfavorable for endovascular intervention or traditional open surgical techniques, bypass remains a viable option in this complex group of patients. 相似文献
15.
Andréia Cristina Passaroni Marcos Augusto de Moraes Silva Winston Bonetti Yoshida 《Brazilian Journal Of Cardiovascular Surgery》2015,30(2):235-245
Objective
To provide a brief review of the development of cardiopulmonary bypass.Methods
A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation.Results
The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies.Conclusion
Steady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient''s physiological function. 相似文献16.
目的观察N-乙酰半胱氨酸(N-acetylcysteine,NAC)对心肺转流(cardiopulmonary bypass,CPB)下心脏直视手术患者肺功能参数的影响。方法择期在CPB下行心脏瓣膜置换术的风湿性心脏病患者40例,性别不限,年龄40~65岁,体重45~80kg,ASAⅡ或Ⅲ级,心功能Ⅰ~Ⅲ级,随机均分为NAC组和对照组(C组)。NAC组:麻醉诱导后CPB前静脉输注NAC 100mg/kg,CPB开始后静脉持续输注NAC 40mg/kg至术毕。C组:等剂量用生理盐水作为安慰剂静脉输注。于麻醉诱导后(T0)、开胸后CPB前(T1)、术毕关胸后(T2)、术后5h(T3)、24h(T4)和48h(T5)检测呼吸指数(RI)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)和气道阻力(R)。结果与T0时比较,T2~T4时两组患者RI、A-aDO2明显升高(P0.05)、OI明显降低(P0.05)、T2和T3时两组患者气道阻力明显升高(P0.05)。与C组比较,T2~T4时NAC组RI和A-aDO2明显降低(P0.05)、OI明显升高(P0.05)、T2和T3时NAC组气道阻力明显降低(P0.05)。结论 N-乙酰半胱氨酸可以减轻CPB导致的肺功能损伤,对肺脏可能具有保护作用。 相似文献
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Cristiano Spadaccio Federico De Marco Fabio Di Domenico Raffaella Coccia Mario Lusini Raffaele Barbato Elvio Covino Massimo Chello 《Thrombosis research》2014