内皮素受体拮抗剂PD142893对梗阻性黄疸大鼠并发肾功能损害的影响

目的：了解梗阻性黄疸（obstructive jaundice，OJ）大鼠模型血浆和肾组织内皮素（endothelin，ET）含量变化对肾功能的影响以及应用ET受体拮抗剂PD142893后的变化。方法：假手术组、OJ组及OJ＋药物组共32只Wistar大鼠分别于术后5、10、15和20d（每组n=8）采用放射免疫法测定血浆和肾匀浆的ET含量，同时测定血清TBIL、肌酐清除率，对肾脏行光镜下病理组织形态学观察。结果：在OJ组和OJ＋药物组中血清TBIL含量、血浆和肾组织匀浆中ET含量随梗阻时间延长而明显增加；OJ组在术后5d即表现为肌酐清除率下降，随梗阻时间延长而加重并伴有肾脏病理形态的进行性改变，而OJ＋药物组对比OJ组相应的改变出现的较晚；在非药物治疗组中，肌酐清除率与血浆和肾组织匀浆中ET含量呈负相关。结论：OJ时的高胆红素血症是导致肾功能损害的原因之一，胆色素对肾脏有直接的毒性作用；OJ引起血浆和肾组织中ET的病理性升高，由其介导的多种生物学效应是最终导致肾功能损害的重要原因；肽类非选择性ET受体拮抗剂PD142893对OJ大鼠的肾脏具有保护作用。     

Ureteroscopic holmium laser lithotripsy in patients with renal impairment

Objectives In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria. Patients and methods Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1–7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure. Results All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%. Conclusions A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.     

暂时性神经综合征的研究进展

暂时性神经综合征是椎管内麻醉所引起的脊神经暂时性功能障碍。其临床表现为术后24h内出现腰背部持续性疼痛,可放射到双侧臀部和下肢。疼痛区痛觉过敏或感觉迟钝。非甾体类抗炎药可缓解症状。疼痛具有白限性,一般可在2d～5d内消退。复原后无永久性运动及感觉神经功能障碍。就其原因可能与局麻药毒性或穿刺过程的机械性损伤有关。     

药物性肾损害53例临床分析

目的总结药物性。肾损害患者53例,旨在提高对该病的认识。方法对本科1995至2005年药物性。肾损害患者的临床资料进行回顾分析。结果53例中40岁以下者17例,40岁以上者36例,其中60岁以上者23例。致病药物中抗菌素32例,中药6例,解热镇痛药、避孕药、造影剂、抗肿瘤药、奥美拉唑、阿昔洛韦、卡托普利共15例。临床表现为急性间质性肾炎综合征21例,急性肾小管坏死11例,急进性。肾炎综合征4例,肾病综合征7例,慢性间质性。肾炎综合征9例,过敏性紫癜性。肾炎1例。死亡3例,转为慢性肾损害10例,其余患者均临床痊愈。结论中老年人为药物性。肾损害的高危人群;抗生素。肾损害特别是头孢类抗生素。肾损害发生率上升到所有药物之首。停用致病药物和支持治疗是公认的治疗方法,而对于少数表现为急进性。肾炎综合征、肾病综合征、过敏性紫癜性。肾炎的患者,甲基泼尼松龙加环磷酰冲击治疗后继以肾上腺皮质激素口服也不失为抢救。肾脏的重要方法。     

梗阻性黄疸大鼠肾细胞凋亡及bcl-2表达的作用

目的探讨梗阻性黄疸引起肾损伤过程中细胞凋亡的意义。方法32只雄性SD大鼠随机均分为2组，假手术组（SO组）只暴露腹腔但不结扎胆管，胆总管结扎组（BDL组）以双重结扎胆管中间离断方法制成梗阻性黄疸大鼠模型。于术后行光镜下肾脏病理学检查，琼脂糖凝胶电泳检测肾细胞DNA的断裂形式，测定血清中D-Bil、TBA、GOT、GPT、Cr和BUN的含量，检测尿β2-微球蛋白，流式细胞术检测肾脏细胞凋亡率，免疫组化法检测肾组织凋亡抑制基因bcl-2蛋白的表达。结果BDL组大鼠肾脏细胞凋亡率明显高于SO组（P〈0．05），出现细胞凋亡特征性DNA梯状带；其肾脏细胞bcl-2蛋白的表达阳性细胞率明显高于SO组（P〈0．01），并于术后7d达高峰，14d时bcl-2表达阳性细胞率开始下降。结论梗阻性黄疸大鼠肾功能损害过程中存在肾脏细胞凋亡，梗阻性黄疸可反馈性启动肾小管上皮细胞凋亡抑制基因bcl-2的表达。     

Reducing delirium and cognitive dysfunction after off-pump coronary bypass: A randomized trial

BackgroundNeuropsychiatric complications of surgical coronary revascularization are inconspicuous but frequent and clinically relevant. So far, attempts to reduce their occurrence, such as the introduction of off-pump coronary artery bypass (OPCAB) grafting method, have not brought the desired results. The aim of this trial was to determine whether using any of the 2 selected modifications of OPCAB could decrease the incidence of these undesired sequelae.MethodsIn this single-center, assessor- and patient-blinded, superiority, randomized controlled trial, 192 patients scheduled for elective isolated OPCAB were randomized to 3 parallel arms. The control arm underwent “conventional” OPCAB with vein grafts. The first study arm underwent anaortic OPCAB (ANA) with total arterial revascularization. The second study arm underwent OPCAB with vein grafts using carbon dioxide surgical field flooding (CO₂FF). Outcomes included the incidence of postoperative delirium (PD) and early postoperative cognitive dysfunction (ePOCD).ResultsThe incidence of PD was 35.9% in the control (OPCAB) arm, 32.8% in the CO₂FF arm, and 12.5% in the ANA arm (χ² [2, N = 191] = 10.17; P = .006). Post hoc tests revealed that the incidence of PD in the ANA arm differed from that in the OPCAB arm (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09-0.68; P = .002). The incidence of ePOCD was 34.4% in the OPCAB arm, 28.1% in the CO₂FF arm, and 9.5% in the ANA arm (χ² [2, N = 191] = 11.58; P = .003). Post hoc tests revealed that the incidence of ePOCD differed between the ANA and OPCAB arms (OR, 0.20; 95% CI, 0.06-0.58; P < .001).ConclusionsPerforming ANA significantly decreases the incidence of PD and ePOCD compared with “conventional” OPCAB with vein grafts, whereas CO₂FF is inconsequential in this regard. These results, which probably reflect decreased delivery of embolic load to the brain in ANA, may have practical applicability in daily practice to improve clinical outcomes.     

血浆同型半胱氨酸水平与血管性认知损害及海马体积的相关性研究

目的 探讨高同型半胱氨酸(Hcy)血症与海马体积及血管性认知功能损害的相关性.方法 采用病例对照研究,纳入脑梗死患者194例,所入选患者均测定血浆Hcy浓度,用脑磁共振三维测量方法测量海马体积,采用蒙特利尔认知评估量表(MoCA)进行认知测定,根据血浆Hcy水平分为正常Hcy组(血浆Hcy＜15 μmol/L,49例);Hcy轻度升高组(血浆Hcy 16～30μmol/L,78例);Hcy中重度升高组(血浆Hcy 31～100μmol/L,52例);Hcy重度升高组(Hcy＞ 100μmol/L,15例).结果 血浆Hcy不同水平组间认知功能MoCA总分差异有统计学意义(P＜0.05),血浆Hcy不同水平组间左、右侧海马体积差异有统计学意义(P＜0.05),血浆Hcy水平与认知功能MoCA总分呈负相关(r=-0.504,P＜0.05),血浆Hcy水平与左、右侧海马体积均呈负相关(r=-0.472,P＜0.05;r=-0.647,P＜0.05).左、右侧海马体积均与认知功能MoCA总分呈正相关(r=0.569,P＜0.05;r=0.671,P＜0.05).结论 高Hcy血症可能与脑梗死患者的海马体积缩小及认知损害相关.     

单唾液酸四己糖神经节苷脂改善脑梗死患者神经功能缺损症状的疗效探讨

目的：探讨单唾液酸四己糖神经节苷脂改善脑梗死患者神经功能缺损症状的疗效,探讨其临床适用性。方法取2014年6月—2015年12月在该院就诊的124例脑梗死患者作为研究对象,随机分为对照组和实验组各62例,对照组给予常规治疗与康复训练,实验组在对照组的基础上给予单唾液酸四己糖神经节苷脂治疗,对比两组患者治疗前后NIHSS评分和治疗后的临床疗效。结果实验组患者治疗后NIHSS评分(10.42±4.33)明显低于对照组(15.11±4.78),差异有统计学意义(P<0.05)。对照组总有效(率)为43(69.35%),明显低于实验组57(91.94%),差异有统计学意义(P<0.05)。结论单唾液酸四己糖神经节苷脂能有效改善脑梗死患者神经功能缺损症状,临床疗效显著,值得临床推广应用。     

针灸配合康复训练治疗脑梗塞后认知功能障碍的疗效评价

目的：探究在脑梗塞治疗中采用针灸配合康复训练的方式对患者认知功能障碍的临床治疗效果。方法随机选择该院在2015年10—11月期间收治的脑梗塞患者100例作为研究对象,采用抽签的方式将其分为对照组和实验组,每50例患者为1组,对照组给予康复训练,而实验组则在此基础上给予针灸治疗,将两组患者的治疗效果进行对比分析。结果经过2个月的治疗,与对照组BBSI评分（7.33±2.18)分及MMSE评分（20.85±2.05)分相比,实验组患者BBSI评分（6.05±2.03)分及MMSE评分（23.80±2.08)分均明显较优,差异均有统计学意义P﹤0.05。结论脑梗塞采用针灸配合康复训练方式进行治疗有明显的效果,可改善患者的认知功能障碍,在临床上值得应用推广。     

不同部位脑出血恢复期记忆损害特点的临床研究

目的：探讨基底节出血及丘脑出血患者出血恢复期的记忆损害特点。方法整群选取内蒙古国际蒙医医院2014年3月＿2016年3月收治的脑出血患者78例(观察组),根据出血部位分为基底节出血41例,丘脑出血37例,另选取同期健康体检者40名作为对照组。采用韦氏记忆量表(WMS)、韦氏成人智力量表(WAIS)、Rey听觉词语学习测验(AVMT)来评价两组患者记忆成分的差异。结果患者在1-100、100-1、累加、视觉再生、视觉再认、图片回忆、触觉记忆、联想学习、词汇测试、倒背、短延迟回忆、长延迟回忆等记得分较正常对照组明显下降。提示基底节出血及丘脑出血恢复期患者均存在记忆受损;基底节出血组患者与丘脑出血组患者在记忆成分中长延迟回忆(2.36±0.95﹚ vs (1.21±0.14﹚方面比较差异有统计学意义(P<0.05﹚。结论脑出血患者因出血部位不同,记忆成分受到不同程度损伤,针对不同部位脑出血及时干预可降低血管性痴呆的发生几率。