Intermittent pneumatic sequential compression of the lower extremities restores the cerebral oxygen saturation during laparoscopic cholecystectomy

Background Pneumoperitoneum causes intracranial pressure elevation and blood stasis at lower extremities. This study investigates cerebral oxygen saturation changes during laparoscopy and the effects of intermittent sequential compression (ISC) of the lower extremities in patients during elective laparoscopic cholecystectomy. Patients and method Sixty patients were randomly divided into two groups according to the application of ISC to the lower extremities. Group I served as control group whereas ISC was applied to group II. Cerebral oxygen saturation, peripheral blood oxygen saturation, heart rate, mean blood pressure, and associated changes have been recorded during the operation. Results Peripheral blood oxygen saturation and mean blood pressure values did not change significantly after pneumoperitoneum. Cerebral oxygen saturation levels of the group II patients were higher in than the group I patients and the difference between the groups was statistically significant (p = 0.0001). The difference became more prominent following the 35^th minute of the operation. Mean heart rate of the patients in group II was lower than the patients in group I and the difference was also statistically significant (p = 0.0001). Conclusion In this study, it was found that the decrease in cerebral oxygen saturation was recovered with ISC application. This simple and reliable technique helps to restore cerebral oxygen saturation levels while increasing blood return from the lower extremities.     

锚定法改良单开门颈椎管成形术配合中药热敷防治术后轴性症状的疗效观察

单开门颈椎管扩大成形术是用于治疗多节段退变的脊髓型颈椎病、颈椎后纵韧带骨化症、无骨折脱位型颈脊髓损伤等颈椎疾患的经典术式,在解除脊髓压迫、改善神经功能方面具有确切而持久的疗效。但也常常伴有术后颈椎总活动度明显减少,同时还常常伴有颈部慢性疼痛、僵硬感、沉重感,亦即轴性症状,而轴性症状与术后颈椎活动度减少呈正相关。笔者应用锚定法改良单开门颈椎管扩大成形术配合中药热敷治疗脊髓型颈椎病、无骨折脱位性颈脊髓损伤等疾患,以防治颈椎管成形术后轴性症状的发生,疗效满意,现报告如下。     

Double-lumen tube for ventilation in severe kyphoscoliosis

The presence of kyphoscoliosis can adversely affect gas exchange because of restriction to gas flow and reduction of lung volume. The effects become more exaggerated during positive-pressure ventilation due to the uneven distribution of ventilation. The use of a double-lumen tube helps to reduce the ventilation perfusion mismatch that occurs because of positive-pressure ventilation. We report a patient with severe kyphoscoliosis who underwent repair of an atrial septal defect, in whom a double-lumen tube was used for ventilation and the conduct of general anesthesia.     

Porcine hepatic phospholipid efflux during reperfusion after cold ischemia

BACKGROUND: Cold preservation produces hepatic injury that is difficult to assess during early reperfusion. The value of reperfusion plasma choline phospholipid in predicting subsequent organ function is documented in these studies. MATERIALS AND METHODS: Livers of female Yorkshire pigs were prepared for transplantation. After 2 h of cold ischemia the reperfusion plasma was evaluated for choline phospholipid and cholesterol. These values were correlated with bile secretion, hepatic hemodynamics, oxygen uptake, and plasma sorbitol dehydrogenase levels. RESULTS: The isolated porcine liver demonstrates a rapid efflux of choline phospholipids into plasma during early reperfusion after cold preservation. After this initial efflux no subsequent plasma increment occurred. These choline-phospholipid increments were isolated in plasma higher density (d > 1.063) lipoproteins and were not accompanied by equivalent increases in cholesterol. Neither biliary reflux nor lecithin cholesterol acyl transferase abnormalities contributed appreciably to the phospholipid increments in reperfusion plasma. Livers with the largest efflux of choline phospholipids had the most impaired circulatory and bile secretory function at 4 h of reperfusion. CONCLUSION: The immediate increase of choline phospholipids, particularly lysophosphatidylcholine, in reperfusion plasma after cold ischemia provides an index of the injury occurring during this interval and correlates with early organ function.     

Interstitial expression of alpha-SMA: an early marker of chronic renal allograft dysfunction.

BACKGROUND: Renal myofibroblast infiltration has been shown to be strongly associated with renal function decline in several chronic renal diseases. The purpose of the present study was to investigate whether early detection of myofibroblast infiltration using alpha-smooth-muscle actin (alpha-SMA) expression in time-zero biopsies predicts renal allograft dysfunction. METHODS: We studied renal tissue from 38 renal transplant patients from whom biopsies had been taken after vascular anastomosis during transplantation to ascertain whether myofibroblasts infiltration predicts renal graft survival. Immunohistochemistry was performed on time-zero biopsies to determine alpha-SMA expression, and this was compared to annual glomerular filtration rate (GFR) variation and other parameters including cold ischaemic time (CIT), donor and recipient age, number of acute rejections, and delayed graft function (DGF). GFR was measured by inulin clearance during of 3 years of follow-up after the transplantation. Progressors were defined as patients with an annual GFR decline >5 ml/min/year. RESULTS: We found a significant correlation between interstitial alpha-SMA expression in time-zero biopsies and GFR evolution during the post-transplantation course (r=0.60, P<0.001). Although progressors had greater interstitial alpha-SMA expression than non progressors (7.9+/-0.7 vs 4.3+/-0.4%), they showed only a tendency towards higher glomerular alpha-SMA expression. In addition, progressors had more interstitial fibrosis in time-zero biopsies than non-progressors. There was no relationship between alpha-SMA expression and CIT, donor and recipient ages, number of acute rejections, and occurrence of DGF. CONCLUSION: This study suggests that alpha-SMA evaluation in time-zero biopsies, especially the combination of alpha-SMA expression and interstitial fibrosis, can strongly predict chronic renal allograft dysfunctions.     

大黄甘草汤联合间断短时静脉-静脉血液滤过对重症急性胰腺炎患者细胞因子的影响

Objective To approach the treatment effect and mechanism of action of intermittent short time veno-venuous hemofiltration(ISVVH)and Rheum Glycyrrhiza Decoction in patients with severe acute pancreatitis(SAP).Methods One hundred and three SAP patients were randomly divided into 3 groups.Rheum Glyeyrrhiza uraleusis fisch Decoction group(A,n=25),ISVVH group(B,n=35)and ISVVH CO-Rheum Glyeyrrhiza uralensis fisch decoction group(C,n=43).A,B and C groups were all treated with conventional therapy.However.the patients in group A were added Rheum Glycyrrhiza uralensis fisch Decoction,the patients in group B added ISVVH while group C were raised ISVVH co-Rheum Glycyrrhiza uralensis fiach Decoction.Finally,we observed three groups of patients with heart rate(HR),respiration(R),blood pressure(BP),liver and kidney function;oxygenation index(PaO2/FiO2),oxygen saturation(SaO2);blood routine,plasma electrolytes,glucose and C-reactive protein;parallel APACHE Ⅱ score;measure level of TNF-α,IL-10 in patients blood serum when they were admitted to hospital,24,48,96 h after treatment respectively.Results After treated 24,48,96 h,C group compared to B group,B group compared to A group,there were significantly improvements in APACHE Ⅱ score(P < 0.05);TNF-alevel decreased(P < 0.05);IL-10 level increased(P < 0.05);three groups after treatment of acute lung injury, thoracic/abdominal effusion,intestinal paralysis/obstruction,sepsis and other complications improved significantly(P < 0.05).Conclusions ISVVH and glycyrrhiza decoction can regulate the liver and renal dysfunctions that followed SAP,raise physical conditions,improve the complications of patients with SAP.     

气道加压对全麻患者右颈内静脉穿刺置管术的影响

目的 探讨气道加压对全麻患者右颈内静脉穿刺置管术的影响.方法 需要进行右颈内静脉穿刺置管的全麻患者125例,随机分为对照组(C组,n=60)和气道加压组(P组,n=65).超声引导下于环状软骨平面,C组在暂停机械通气时、P组手控呼吸维持气道压力20 cm H2O时进行右颈内静脉穿刺置管.暂停机械通气时测定两组右颈内静脉横截面积和穿刺成功后CVP,P组患者气道压力20 cm H2O时测定颈内静脉横截面积和CVP,记录穿刺次数、颈内静脉管壁至皮肤的最短距离、进针深度、进针和退出过程中回抽血液通畅情况,气道加压前测定HR和MAP,并记录气道加压过程中的最低值,观察两组患者的穿刺置管情况.结果 P组气道压力20 cm H2O时颈内静脉横截面积和CVP较气道加压前增加(P＜0.01);与C组比较,P组进针深度降低,1次穿刺成功率、30 s内穿刺成功率、进针过程中回抽血液通畅率升高(P＜0.01),心动过缓、低血压发生率升高(P＜0.05).结论 气道加压有助于超声引导下右颈内静脉穿刺置管术的成功.     

双相气道正压通气治疗急性呼吸窘迫综合征的疗效评价

目的探讨双相气道正压(BIPAP)通气模式治疗急性呼吸窘迫综合征(ARDS)的疗效.方法将20例ARDS患者随机分为BIPAP组和间歇性正压通气(IPPV)组行机械通气治疗,每组10例.观察机械通气期间患者镇静剂和肌肉松弛剂用量,气道力学参数中吸气峰压(PIP)、平台压(Pplate)和呼气末正压(PEEP)的变化以及机械通气的时间.结果15例(75%)治愈出院,5例死亡.BIPAP组机械通气时间[(13±7.5)d]显著低于IPPV组[(21±11.6)d](P<0.05).BIPAP组安定、吗啡和万可松用量显著低于IPPV组(P<0.05);IPPV组PIP、Pplate和PEEP均显著高于BIPAP组(P<0.05).结论BIPAP通气模式人机关系协同性好,缩短了治疗ARDS的机械通气时间.     

体外循环术后并发灌注肺的机械通气治疗

目的回顾性分析6例体外循环心内直视术后并发灌注肺的机械通气治疗经验。方法采用传统的机械通气模式3例,采用肺保护性机械通气方案3例。结果传统的机械通气组死亡1例,肺保护性机械通气组全部存活。结论肺保护性机械通气方案优于传统的机械通气模式,它能有效地防治呼吸机相关性肺损伤,提高灌注肺患者的成活率。     

间歇性与持续性雄激素阻断治疗晚期前列腺癌疗效比较

目的 比较间歇性与持续性雄激素阻断治疗晚期前列腺癌的疗效和副反应。方法 晚期前列腺癌患者69例，分2组。A组34例行间歇性联合雄激素阻断治疗，B组35例行手术去势加抗雄激素药物即持续性雄激素阻断治疗。比较2组患者的疾病进展时间和副反应发生率。结果 A组中位随访31．5（10～60）个月，B组32．6（12～63）个月。A组患者共行60个周期治疗，平均治疗周期13．7个月，其中治疗期6．4个月、间歇期7．3个月。A、B组中位疾病进展时间分别为31、28个月，差异无统计学意义（P=0．446）；骨转移患者中A组中位疾病进展时间24个月，B组为18个月，2组比较差异有统计学意义（P=0．04）。2组副反应发生率分别为：潮热症状A组20．6％（7／34），B组62．9％（22／35）（P〈0．01）；骨质疏松A组11．8％（4／34），B组31．4％（11／35）（P〈0．05）；乳房肿痛A组14．7％（5／34），B组37．1％（13／35）（P〈0．05）。结论 对晚期前列腺癌患者行雄激素阻断治疗应首选间歇性联合雄激素阻断治疗。