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21.
体外膜肺联合血液滤过治疗肺肾衰竭的实验研究 总被引:8,自引:0,他引:8
目的 观察体外膜氧合器(ECMO)联合高容量血液滤过(HVHF)对急性呼吸窘迫综合征(ARDS)、急性肾功能衰竭(ARF)的治疗作用。 方法 采用实验犬32只,随机分为A、B、C、D 4组。静脉注射油酸复制ARDS模型及双侧输尿管结扎复制急性肾功能衰竭模型。A组用ARDS呼吸机治疗;B组ARDS用ECMO治疗;C组ARDS+ARF用HVHF治疗;D组ARDS+ARF用ECMO联合HVHF治疗。监测血气、血流动力学以及血生化等指标。 结果 治疗后B组氧分压(PaO2)逐步上升,在治疗4 h后高于A组[(95.58±8.14) 比(82.79±12.37) mm Hg,P < 0.05]; C组PaO2治疗中较成模时无明显改善;D组PaO2呈逐渐上升趋势,在各时间点均高于C组(P < 0.05)。各组血流动力学指标在治疗中保持稳定。C、D组HVHF治疗后Scr、BUN明显降低[C组:Scr (320.89±65.42) 比(655.04±181.22) μmol/L,BUN (20.42±6.65) 比(41.53±10.59)mmol/L;D组:Scr (334.15±45.97)比(697.48±101.66) μmol/L,BUN (19.12±6.39) 比(39.10±11.60) mmol/L,P均< 0.01]。 结论 ECMO可以有效地改善ARDS低氧血症,联合HVHF可以提供肺肾功能联合支持。 相似文献
22.
Fawzi S. AlKhawari Gerry V. Stimson Anthony N. Warrens 《American journal of transplantation》2005,5(6):1326-1331
The worldwide shortage of organs for transplantation makes it important to understand why some oppose donation. Attitudes vary with religion and ethnicity. Accordingly, we undertook a qualitative study of the attitudes of 141 U.K. Muslim Indo-Asians to organ donation. Participants were observed, focus group discussions held and in-depth individual interviews conducted. We identified a high level of alienation from the health care system in general. With respect to organ donation in particular, its importance was generally discounted, often in deference to authority figures within the community who appeared negatively disposed. The culture-specific issues arguing against donation included a sense of the sacredness of the body, a fatalistic approach to illness, a belief that organs took on an independent role as 'witnesses' to an individual's life on Judgement Day and an anxiety that the donor would have no control of the probity of the recipient of an organ. We believe these data suggest a need to improve in a culturally sensitive fashion the provision of health information provided to this community. 相似文献
23.
L. E. Boulware M. U. Troll N. Y. Wang N. R. Powe 《American journal of transplantation》2006,6(11):2774-2785
Attitudes toward monetary and nonmonetary incentives for living (LD) and deceased donation (DD) among the U.S. general public and different racial/ethnic and income groups have not been systematically studied. We studied attitudes via a telephone questionnaire administered to persons aged 18-75 in the continental United States. Among 845 participants (85% of randomized households), less than one-fifth participants were in favor of incentives for DD (range 7-17%). Most persons were in favor of reimbursement of medical costs (91%), paid leave (84%) and priority on the waiting list (59%) for LD. African Americans and Hispanics were more likely than Whites to be in favor of some incentives for DD. African Americans were more likely than Whites to be in favor of monetary incentives for LD. Whites with incomes less than $20 000 were more likely than Whites with greater incomes to be in favor of reimbursement for deceased donors' funeral expenses or medical expenses. The U.S. public is not generally supportive of incentives for DD, but is supportive of limited incentives for LD. Racial/ethnic minorities are more supportive than Whites of some incentives. Persons with low income may be more accepting of certain monetary incentives. 相似文献
24.
目的:评价持续靶控输注异丙酚复合硬膜外阻滞有用于上腹部手术的可行性。方法:30例胃癌手术患者,ASAⅠ~Ⅱ级。随机分成靶控输注异丙酚全麻(T)组15例,靶控异丙酚复合硬膜外阻滞(T+E)组15例。结果:(T+E)组术后躁动、芬太尼、丙泊酚的用量低于(T)组(P<0.05)。异丙酚单位标准化剂量亦较低。两组苏醒时间相似。诱导后两组血压均显著下降(P<0.05),T+E组在诱导后DBP的下降幅度较T组更为显著(P<0.05),T组在探查、术毕、拨管后的SBP、DBP、MAP比(T+E)组显著增高(P<0.05)。两组诱导后至术毕BIS、SEF显著下降,两组间的比较无统计学意义(P>0.05)。结论:靶控输注异丙酚复合硬膜外阻滞用于上腹部手术是可行的,具有异丙酚、芬太尼的用量少、苏醒快、术后躁动少,麻醉深度易于调控,血液动力学较稳定,是一种良好的麻醉方式。 相似文献
25.
The objective was to determine whether vaginal topography accurately predicts the location of the pelvic viscera on fluoroscopy
in women with pelvic organ prolapse. Eighty-nine women undergoing preoperative evaluation for reconstructive pelvic surgery
at a tertiary care referral practice formed the study population. Each woman completed a comprehensive urogynecologic history
and physical examination, which included a quantified (POP-Q) assessment of her vaginal topography, as described by Bump et
al. In addition each woman underwent pelvic floor fluoroscopy (PFF). Visceral sites were selected which corresponded clinically
to the vaginal sites measured by the POP-Q. The most dependent portion of the bladder, small intestine, rectum and urethrovesical
junction was measured. Twenty-five (28%) women had stage II prolapse, 34 (38%) had stage III prolapse, and 28 (32%) had stage
IV prolapse. The remaining 2 women were symptomatic, with stage I prolapse. For the entire study population there was no correlation
between the fluoroscopic position of the small bowel and/or rectum and any apical or posterior wall POP-Q site (C, Ap or Bp).
There was no correlation with the fluoroscopic position of the UVJ at rest or with straining and the corresponding POP-Q site
(Aa). The fluoroscopic position of the most dependent portion of the bladder correlated only modestly with the upper (Ba,ρ=0.51) and lower Aa,ρ=0.68) anterior vaginal wall POP-Q sites. In women without prior surgery (n=33) there was only modest correlation between the fluoroscopic position of the bladder and the corresponding POP-Q site (Aa,ρ=0.71). In this unoperated subpopulation there was no correlation with PFF and any other POP-Q site. In women who had undergone
prior hysterectomy (n=25) or hysterectomy with anterior and/or posterior colporrhaphy (n=17), there was only a modest correlation of the most dependent portion of the bladder and the upper anterior vaginal wall
site (Bb,ρ=0.67 andρ=0.55, respectively). It was concluded that vaginal topography does not reliably predict the position of the associated viscera
on PFF in women with primary or recurrent pelvic organ prolapse.
EDITORIAL COMMENT: The authors seek to evaluate whether physical examination of vaginal prolapse using the POP-Q test correlates
with fluoroscopic findings of visceral position. Surprisingly, little correlation is found, even in previously unoperated
patients. One reason for this lack of correlation between the two modalities of evaluation may lie in the use of two different
fixed points of reference: the POP-Q examination uses the hymen as the fixed point of reference, whereas the investigators
chose to use the posterior edge of the femur as a fixed bony point of reference when evaluating pelvic floor fluoroscopy in
the same patient. The lack of correlation between visual inspection of vaginal wall prolapse and what lies deep to that prolapse
should not be used to invalidate the use of the POP-Q as a means to evaluate pelvic prolapse. Rather, the findings support
the premise behind the ICS/AUGS/SGS committee on pelvic organ prolapse, specifically that clinical pelvic examination of the
vaginal walls looks at surfaces only, and as such cannot determine what, if any, organ lies deep to that surface. 相似文献
26.
选用昆明种小鼠60只,体重18~24克,随机分成三组,每组20只,雌雄各半。通过饮水染毒。一组正常对照,饮自来水,二组饮30ppm含镉水,三组饮300ppm含镉水,染毒时间三个半月。观察指标:体重增长速度、脏器系数、肝肾中镉含量、重点病理形态学改变(光镜和电镜)。结果,30ppm组小鼠肝肾组织有一定病变,300ppm组小鼠的光镜和电镜的病理形态学改变更为明显。提示,小鼠长期摄入镉可引起一定的损害。 相似文献
27.
28.
29.
1986~1992年我院共收治急性发作期慢性肺心病196例,其中因严重肺部感染发生多器官衰竭(MOF)者70例(35.7%),平均受损脏器2.5个,死亡26例,总病死率为37.1%。其中2和3个脏器受损者的病死率分别为20.1%和44.4%,而4和5个脏器受损者则均死亡。血气分析显示pH和PaO2值与受损脏器数目呈负相关,而PaCO2值与受损脏器数目呈正相关。本文讨论了肺心病因肺部感染并发MOF的发病机理,并提出防治的措施。 相似文献
30.
Glutamine and Other Amino Acid Losses During Continuous Venovenous Hemodiafiltration 总被引:2,自引:0,他引:2
I. Novák V. rámek H. Pittrová Z. Ruavý P. Têinský S. Lacigová M. Eiselt L. Kohoutková E. Veselá K. Opatrný Jr. 《Artificial organs》1997,21(5):359-363
Abstract: Serum amino grams and daily losses of glutamine (Gin) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 ± 0.1 g N ) and reached 4.5% of the daily AA substitution. Gln represented 32.7 ± 5.9% of the total AA losses (0.19 ± 0.04 g N ). Serum levels of Gin (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gin in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gin losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gin metabolism and distribution that are reflected by a decrease of serum Gin levels at the institution of this treatment. Therefore, the need for Gin supplementation in ICU patients is even greater in the first days of CVVHDF. 相似文献