胆道发育不良患儿的临床病理特点回顾

目的 探讨胆道发育不良患儿的临床表现、病理特点、诊断、治疗及预后,提高对该病的认识.方法 回顾性分析天津市儿童医院外科2010年6月至2016年11月收治的5例胆道发育不良患儿的发病情况、治疗过程,并通过复习国内外文献对胆道发育不良的疾病特点进行总结.结果 5例胆道发育不良患儿均因生后不久出现皮肤、巩膜黄染,内科治疗病情无改善入外科治疗;肝功能检查见胆红素水平升高,以直接胆红素升高为主,伴肝酶不同程度增高;超声检查示胆囊干瘪未充盈或胆囊腔狭小,胆总管显示不清.5例患儿行手术探查,术中造影显示肝内、外胆道通畅,管腔纤细;病理检查见部分汇管区中小叶间胆管缺失,小叶间胆管/汇管区＜0.5,诊断为胆道发育不良,予留置胆囊引流管,术后抗炎、补液、保肝及对症治疗.经2个月～6年门诊随访,5例患儿均存活至今,其中3例黄疸清除,1例皮肤仍黄染并伴有瘙痒,1例未退黄.结论 术前检查提示梗阻性黄疸患儿,术中造影提示胆道纤细,结合病理检查证实小叶间胆管/汇管区比例＜0.5,可以明确胆道发育不良的诊断.     

老年胆道外科疾病100例围手术期护理

目的:探讨老年胆道外科疾病患者的围手术期护理方法。方法:对100例老年胆道外科疾病患者术前做好全面检查,积极治疗伴随疾病,术后密切观察病情,做好管道护理,重视健康指导。结果:本组治愈97例,病情危重自动放弃治疗2例,死亡1例。结论:术前做好充分准备,积极治疗伴随疾病,术后密切观察病情,做好健康指导,是提高手术安全性和减少并发症的关键。     

鸡血藤药材及其不同部位缩合鞣质的含量测定

目的： 建立鸡血藤药材中缩合鞣质的含量测定方法,并对不同批次鸡血藤药材及其不同部位中缩合鞣质的含量进行测定。方法： 优化并建立了采用香草醛-硫酸显色体系测定鸡血藤药材中缩合鞣质含量的方法,反应条件为3 mL 3%香草醛,3 mL 40%浓硫酸,常温反应20 min,测定波长为500 nm。结果： 5个批次鸡血藤药材中缩合鞣质含量为3.99%~8.63%;其中3个批次药材不同部位的缩合鞣质含量测定结果显示,树脂状分泌物中含量最高,为8.14%~11.51%,木质部（5.39%~7.92%）和韧皮部（3.65%~6.90%）含量相对较少。结论： 香草醛-硫酸显色法快速、简便、准确、重复性好, 可用于测定鸡血藤药材中缩合鞣质的含量;缩合鞣质在树脂状分泌物中的含量比其他部位高,为传统的鸡血藤药材质量的判断方法提供了科学依据。     

Immediate effects of manual hyperinflation on cardiorespiratory function and sputum clearance in mechanically ventilated pediatric patients: A randomized crossover trial

Background:In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients.Objective:This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation.Methods:A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4 h provided between interventions.Results:The MHI treatment increased the tidal volume [Vt; 1.2 mL/kg (95% CI, 0.8–1.5)] and static lung compliance [Cstat; 3.7 mL/cmH₂O (95% CI, 2.6–4.8)] immediately post-intervention compared with the baseline (p<0.05). Moreover, the MHI with suction induced higher Vt [1.4 mL/kg (95% CI, 0.8–2.1)] and Cstat [3.4 mL/cmH₂O (95% CI, 2.1–4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7 g (95% CI, 0.6–0.8)] was greater in MHI with suction compared with suction alone (p<0.05). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation (p>0.05) between interventions.Conclusions:MHI can improve Vt, Cstat and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.     

Duloxetine-induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone in a Super-elderly Patient

Duloxetine is widely used for pain control and depressive syndromes. One of its potential side effects is syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Duloxetine-induced SIADH causes hyponatremia, which leads to a variety of symptoms and has previously been reported in the elderly. In the present case, we experienced a case of the rapid onset of SIADH in a super-elderly woman receiving low-dose duloxetine. Elderly patients tend to have lower duloxetine doses and an earlier onset than non-elderly patients. When hyponatremia occurs after duloxetine administration, duloxetine-induced SIADH should be considered, especially in high-risk elderly patients, regardless of the duloxetine dose or duration of treatment.     

三镜联合治疗急性胆源性胰腺炎的体会

目的:探讨腹腔镜、胆道镜、十二指肠镜联合治疗急性胆源性胰腺炎的微创治疗方法及疗效。方法:51例急性胆源性胰腺炎患者均在入院后24小时内行十二指肠镜检查,并予行经内镜鼻胆管引流术(ENBD)。结果:内镜联合手术成功47例,占92.2%;中转开腹4例。术后6个月以上的随访,均健康生活和正常工作,无结石复发。结论:腹腔镜、胆道镜、十二指肠镜联合微创治疗胆源性胰腺炎疗效明确,是完全可靠的方法。