糖尿病患者睡眠期周期性肢体运动障碍相关的心率变化特点

目的：探讨糖尿病（DM ）患者睡眠期周期性肢体运动障碍（PLMS）相关的心率变化特点。方法纳入20例PLMS患者,根据病史和多导睡眠图（PSG）检查分为DM 伴发 PLMS组（病例组）和原发性PLMS组（对照组）,标记受试者PLMS相关的心率开始增快及回归基线的时间,测量PLMS发生前5次（T －5～－1）、发生时（Onset）和发生后15次（T＋1～＋15）心率的R－R间期,计算不同时间位点心率较基线增高的幅度,并对组间心率变化幅度进行比较。结果纳入病例组5例（PLMS次数为488次）、对照组6例（PLMS次数为479次）。两组心率均在T －2位点开始升高,病例组于T＋13位点回归基线,对照组于T＋9～＋10位点间回归基线。与对照组相比,病例组在T＋1～＋4、T＋11～＋14时间位点的心率变化幅度较小,且差异有统计学意义（P ＜0．05）。结论 PLMS患者会出现反映心脏活化的心动过速,与非DM患者相比,DM患者的心率变化幅度较小、回归基线时间延迟且并未出现明显的心动过缓。     

缺血预适应对肢体缺血再灌注大鼠肝脏的保护效应

目的 观察缺血预适应(IPC)对大鼠肢体缺血再灌注后肝脏损伤的影响,以进一步探讨IPC对肢体缺血再灌注后肝脏功能的保护作用。方法 实验用雄性Wistar大鼠18只,随机分为对照(Control)组,缺血再灌注(IR)组和缺血预处理(IPC IR)组．每组6只。分别测定血浆谷草转氧酶(ALT)、谷丙转氨酶(AST)、乳酸脱氢酶(LDH)．血浆和肝组织超氧化物歧化酶(SOD)、黄嘌呤氧化酶(XOD)、丙二醛(MDA)的含量变化及肝组织的湿/干重比值(W／D)、髓过氧化物酶含量(MPO)及DNA双链百分率(Ratio of DNA Chain％)。结果 发现IPC减轻了肢体IR后引起的ALT、AST、LDH、XOD、MDA、MPO、W／D含量的升高．并且增加了SOD以及肝组织中DNA双链百分率。结论 IPC对肢体IR继发的肝脏功能损伤具有保护作用。     

Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia

Aim: To examine the influence of diabetes mellitus (DM) on the outcome of infrainguinal bypass operations performed for critical foot ischaemia in Chinese patients. Methods: A prospective audit of 265 consecutive infrainguinal bypass operations. Results: Diabetic patients suffered more frequently from ischaemic heart disease (48%vs 25%, P= 0.001) and tissue loss (90%vs 79%, P = 0.01) at presentation. Cigarette smoking was more prevalent in the non‐diabetic (NDM) group (72%vs 51%, P = 0.001). Arterial segments distal to the common femoral artery were more often used as inflow to bypass graft in DM patients (36%vs 22%, P = 0.02). Operative mortality (seven DM vs one NDM, P = 0.19). Early graft failure (7% in DM group vs 10% in NDM group, P = 0.24), wound infection rate (24% in DM group vs 17% in NDM group, P = 0.21), early limb loss (9% in DM group vs 6% in NDM group, P = 0.66) were comparable. However, hospital mortality was higher in DM patients (8%vs 1%, P = 0.04). DM patients more frequently required further surgical debridement postoperatively (20%vs 9%, P = 0.04). Long‐term, patient survival was inferior in the DM group (43% NDM vs 33% DM at 5 years, P = 0.03). Primary graft patency (46% DM vs 34% NDM at 4 years P = 0.19), secondary graft patency (57% DM vs 47% NDM at 4 years P = 0.14) and limb salvage rate (78%vs 81% at 5 years, P = 0.79) were comparable. Conclusion: Diabetes mellitus adversely affects hospital mortality and long‐term survival. Graft patency and limb salvage are not compromised by the presence of DM.     

Therapeutic option for managing lung injury induced by infrarenal aortic cross-clamping

Background

Operations on the infrarenal aorta can cause ischemic-reperfusion (IR) injury in local tissues, which could result in remote organ (e.g., lung) damage. Treatment of such injuries remains an unresolved problem.

Objectives

Our aim was to reduce remote lung damage after lower limb IR by means of postconditioning.

Materials and methods

Male Wistar rats were divided into three groups: Sham-operated, IR, and Postconditioned (PostC). In the latter two groups rats underwent 180 min of exclusion of the infrarenal aorta. The reperfusion time was 4 h. Serum-free radical levels, tumor necrosis factor-α and interleukin-6 concentrations, histologic changes in the lung, wet/dry-ratio, myeloperoxidase activity, heat shock protein 72 level and blood gas changes were investigated.

Results

Postconditioning reduced histological damage in the lung (P < 0.05). Free radical levels and tumor necrosis factor-α concentrations were significantly lower in the PostC group than in the IR group (P < 0.05 and P < 0.01, respectively). Interleukin-6 concentrations did not significantly differ in the PostC group. Compared with the IR group, lung myeloperoxidase activity was lower in the PostC group. Decreased pulmonary heat shock protein 72 level was observed in the PostC group compared with the IR group and the wet/dry-ratio was also significantly lower in the PostC group (P < 0.05). A noticeably higher arterial pO₂ level was manifest in the PostC group after 2 and 4 h of reperfusion (P < 0.05).

Conclusions

Postconditioning reduced lung damage under experimental conditions, in the early period of reperfusion after lower limb IR injury.     

肌电图定位定量电刺激治疗上肢周围神经损伤的临床分析

目的 探讨肌电图定位定量电刺激治疗上肢周围神经损伤的临床疗效。方法 选取2013年1月～2015年1月于本院接受治疗的100例上肢周围神经损伤患者,按照(0,1)随机分布分为2组; 患者入院后均采用基础药物治疗,实施常规康复训练,对照组进行低频电刺激治疗,观察组在肌电图监测下给予定位定量电刺激,时间为6个月,比较2组的治疗效果。结果 2组患者治疗期间均无严重不良反应发生。对照组的临床显效率为63.8%,低于观察组(77.6%)(P<0.05)。治疗前2组患者的各项检测数据无显著差异; 治疗后检测指标均得到改善,2组桡神经和正中神经肌电图的波幅、运动电位潜伏期与MCV以及尺神经的运动电位潜伏期均有显著差异,观察组优于对照组(P<0.05)。结论 采用肌电图辅助治疗有助于电刺激位置的准确定位以及刺激参数的科学设置,可以明显改善电刺激治疗上肢周围神经损伤的临床疗效,提高患者的生存质量。     

Limb lengthening over plate

Background:

The limb lengthening over plate eliminates the associated risk of infection with limb lengthening over intramedullary nail. We present our experience of limb lengthening in 15 patients with a plate fixed on the proximal segment, followed by corticotomy and application of external fixator.

Materials and Methods:

15 patients (7 females, 8 males) were included in this consecutive series. The average age was 18.1 years (range 8–35 years). Fifteen tibiae and one femur were lengthened in 15 patients. Lengthening was achieved at 1 mm/day followed by distal segment fixation with three or four screws on reaching the target length.

Results:

The preoperative target length was successfully achieved in all patients at a mean of 4.1 cm (range 1.8–6.5 cm). The mean duration of external fixation was 75.3 days (range 33–116 days) with the mean external fixation index at 19.2 days/cm (range 10.0–38.3 days/cm). One patient suffered deep infection up to the plate, three patients had mild procurvatum deformities, and one patient developed mild tendo achilles contracture.

Conclusion:

Lengthening over a plate allows early removal of external fixator and eliminates the risk of creating deep intramedullary infection as with lengthening over nail. Lengthening over plate is also applicable to children with open physis.     

69例急性下肢缺血的诊治分析

目的探讨急性下肢缺血的治疗方法及预后。方法回顾性分析我科2007年1月～2012年1月治疗69例急性下肢缺血患者的临床资料,其中急性动脉栓塞14例,动脉硬化闭塞基础上继发急性血栓形成50例,血栓闭塞性脉管炎3例,不明原因2例。根据病情采用:动脉切开Fogarty导管取栓8例,人工血管旁路17例;球囊扩张成形/支架置入15例;置管溶栓后进一步行腔内治疗12例;低位静脉动脉化2例;单纯药物治疗9例;I期截肢6例。结果 12例(17.4%)治疗成功,50例(72.5%)治疗好转,1例(1.4%)治疗无效。57例(82.6%)患者获得随访,随访时间3～62(平均26.4)个月,42例症状不同程度改善,7例Ⅱ期截肢,5例死于心、肺疾病。结论急性下肢缺血早期诊断与及时采用合适的治疗方法是治疗成功的关键。     

微波腔内治疗下肢静脉曲张的研究

目的:探讨微波腔内闭合大隐静脉治疗静脉曲张的临床疗效。方法:将陕西省咸阳市第一人民医院普外科收治的36例病人(40条肢体)行微波腔内闭合曲张静脉;50例(60条肢体)行传统剥脱术的病人为对照组。比较两组病人手术时间、术中出血量、住院时间及术后恢复情况。结果:两种治疗均可有效治疗下肢静脉曲张,但微波治疗组比对照组具有更短的手术时间、更少的术中出血量及更少的手术切口,且病人术后住院时间亦明显缩短,微波治疗具有更低的术后下肢瘀血发生率;且其下肢麻木发生率亦低于对照组组,但无统计学差异(P=0.13)。结论:微波腔内闭合术治疗下肢静脉曲张具有安全、操作简捷、创伤小、恢复快等优点。