高渗羟乙基淀粉(200/0.5)氯化钠注射液用于择期颅脑手术麻醉效果探讨

目的 探讨高渗羟乙基淀粉(200/0.5)氯化钠注射液用于择期颅脑手术麻醉对患者血流动力学、电解质酸碱平衡及降低颅内压效果的影响.方法 选取行择期胶质瘤切除手术患者120例,以随机抽样方法分为对照组(60例)和高渗组(60例);分别给予常规羟乙基淀粉和高渗羟乙基淀粉(200/0.5)静脉输注,比较两组患者不同时间点心率(HR),平均动脉压(MAP),中心静脉压(CVP),Na+、K+、Ca2+、pH及颅内压(ICP)等指标水平.结果 两组患者T2、T3及T4时间点HR和CVP指标均较T0时间点明显提高,差异有统计学意义(P＜0.05);两组患者T3和T4时间点MAP指标均较T0时间点显著降低,差异有统计学意义(P＜0.05);而高渗组患者T4时间点HR和MAP指标水平均明显优于对照组,差异有统计学意义(P＜0.05);两组患者T1、T2、T3及T4时间点Na+和K+指标水平与T0时间点比较差异有统计学意义(P＜0.05);两组患者T2、T3及T4时间点ICP水平较T0时间点均显著降低,差异有统计学意义(P＜0.05);高渗组患者T4时间点ICP水平显著低于对照组,差异有统计学意义(P＜0.05).结论 高渗羟乙基淀粉(200/0.5)氯化钠注射液用于行颅脑外科手术治疗患者可有效稳定血流动力学,纠正电解质酸碱平衡平衡紊乱,并抑制颅内压升高.     

血清电解质、CKBB及血乳酸水平与新生儿缺氧缺血性脑病严重程度的相关性分析

分析血清电解质、肌酸激酶同工酶(CKBB)及血乳酸水平与新生儿缺氧缺血性脑病严重程度的相关性。80例缺氧缺血性脑病患儿中轻度患儿27例、中度患儿26例、重度患儿27例。以本院同期健康的足月新生儿60例为对照组。结果显示与对照组新生儿比较,观察组新生儿氯离子及钙离子水平明显降低(P<0.05),CKBB和血乳酸水平明显升高(P<0.05);重度患儿的氯离子及钙离子水平明显低于中度患儿和轻度患儿(P<0.05),CKBB和血乳酸水平明显高于中度患儿和轻度患儿(P<0.05);血清中氯离子和钙离子与缺氧缺血性脑病严重程度呈现负相关性(P<0.05),但CKBB和血乳酸与缺氧缺血性脑病严重程度呈明显的正相关性(P<0.05)。结果说明血清氯离子和钙离子、CKBB及血乳酸水平与新生儿缺氧缺血性脑病严重程度呈明显的相关性。     

Colchicine Overdose-Induced Acute Renal Failure and Electrolyte Imbalance

Colchicine has been used to control gouty arthritis for long time; colchicine overdose, however, causes multiple organ dysfunction. To date, no investigation has revealed the site of kidney lesion or dysfunction. This investigation describes the case of a male with a history of gout who ingested a large amount of colchicine and developed renal, hematopoietic, gastrointestinal, muscular, electrolytic, and hepatic disorder. Glucosuria was noted during hospital days. Colchicine intoxication is shown to induce proximal tubule damage. Severe electrolytes imbalance was noted, including hypomagnesemia, hypophosphatemia, and hypocalcemia. After management, the renal function and serum electrolyte of the patient recovered on the sixth day of hospitalization.     

胃癌患者术前血液中钾、钠、氯、镁、磷的相关性及其对生存预后的影响

目的  探讨胃癌（GC）患者术前血液电解质离子钾、钠、氯、镁、磷的相关性,以及与患者临床资料的相关性和对生存预后的影响。方法  收集该院320例大样本GC手术患者的临床资料,术前检测血液电解质水平,以及进行术后随访（最长随访时间为10年7个月）。统计学分析GC患者术前血液电解质水平的相关性、与侵袭转移的关系以及对患者生存预后的影响。结果  ①电解质离子与GC患者临床资料间的相关性：钾离子水平与癌细胞分化程度相关（P =0.022）,氯离子水平与年龄相关（P =0.042）。②GC患者电解质离子水平之间存在相关性：如氯离子与钠离子相关（r =0.610,P =0.000）,氯离子与钾离子相关（r =0.206,P =0.000）,氯离子与镁离子相关（r =0.115,P =0.047）。③GC患者电解质水平对生存预后的影响：按正常范围分组,钾离子水平在3.5～5.3 mmol/L时患者生存预后最好,>5.3 mmol/L时预后最差（P =0.005）;按中位数分组,磷离子水平≥1.04 mmol/L组预后明显好于≤1.04 mmol/L组（P =0.008）。结论  钾离子水平与GC细胞分化程度相关,并影响患者生存预后。磷离子水平高低也影响患者生存预后。结合临床和影像诊断,GC患者术前检测血液电解质水平作为潜在的预警信号,可以对生存预后进行评估,将有助于制定最佳手术方案、术后放射和化学药物治疗策略,从而尽可能地提高治疗质量及延长生存时间。

     

Effect of large volume replacement with balanced electrolyte solutions on extravascular lung water in surgical patients with sepsis syndrome

We investigated the effect of large volume replacement with balanced electrolyte solutions on extravascular lung water (EVLW) in 16 adult surgical patients with sepsis syndrome. Patients entered the study within the 24 h period following surgical interventions for acute necrotizing pancreatitis, intra-abdominal abscesses, and/or peritonitis. Sequential measurements (n=108) were made at intervals of 6–12 h over a 48 h period. There were no significant differences between initial and final values of thermal-dye EVLW (5.0±1.1 vs. 5.7±1.1 ml/kg), plasma colloid osmotic pressure (COP, 13.3±2.5 vs. 13.2±2.9 mmHg), pulmonary artery wedge pressure (PAWP, 9.2±3.0 vs. 10.8±3.0 mmHg), and COP-PAWP gradient (4.0±3.5 vs. 2.4±3.9 mmHg). All results expressed as (mean±SD). The EVLW did not correlate with plasma COP, PAWP, or COP-PAWP gradient. We conclude that large volume replacement with balanced electrolyte solutions with the secondary decrease in plasma COP and COP-PAWP gradient do not necessarily contribute to a substantial increase in EVLW. This study fails to show any causal relationship between decrease in plasma COP or COP-PAWP gradient and oedema formation in the lung.Supported by the Austrian Govenment, Department of Health     

The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

Eco-Friendly Dye-Sensitized Solar Cells Based on Water-Electrolytes and Chlorophyll

Organic solvents used for electrolytes of dye-sensitized solar cells (DSSCs) are generally not only toxic and explosive but also prone to leakage due to volatility and low surface tension. The representative dyes of DSSCs are ruthenium-complex molecules, which are expensive and require a complicated synthesis process. In this paper, the eco-friendly DSSCs were presented based on water-based electrolytes and a commercially available organic dye. The effect of aging time after the device fabrication and the electrolyte composition on the photovoltaic performance of the eco-friendly DSSCs were investigated. Plasma treatment of TiO₂ was adopted to improve the dye adsorption as well as the wettability of the water-based electrolytes on TiO₂. It turned out that the plasma treatment was an effective way of improving the photovoltaic performance of the eco-friendly DSSCs by increasing the efficiency by 3.4 times. For more eco-friendly DSSCs, the organic-synthetic dye was replaced by chlorophyll extracted from spinach. With the plasma treatment, the efficiency of the eco-friendly DSSCs based on water-electrolytes and chlorophyll was comparable to those of the previously reported chlorophyll-based DSSCs with non-aqueous electrolytes.