优选精制蛇毒酶凝胶剂基质组成及制备工艺

目的室温条件下优选精制蛇毒酶凝胶剂基质组成及制备工艺。方法以凝胶剂的稳定性及外观性状为考察指标,以卡波姆-940、氮酮、丙三醇-丙二醇和吐温-80为可变因素,选用L9(34)表进行正交实验。结果最优的基质组成是:卡波姆-940 2.0g,氮酮1.0g,丙三醇-丙二醇为7g∶3g,吐温-80 1.5g。结论按该法制备的凝胶剂符合中国药典2005年版软膏剂的有关规定。     

部分脾栓塞术治疗肝硬化性脾功能亢进15例临床分析

目的　探讨部分脾栓塞术对治疗肝硬化性脾功能亢进的疗效及临床价值。方法　对 15例肝硬化性脾功能亢进患者进行了部分脾栓塞治疗 ;观察术前术后外周血象的变化、腹水消退及并发症发生情况。结果　 15例术后外周血象较术前明显改善。 5例有腹水者 ,腹水消失 4例 ,腹水减少 1例。术后并发症主要有左上腹疼痛 (15例 )、发热 (10例 )、左侧少量胸水 (3例 )。结论　部分脾栓塞术对治疗肝硬化性脾功能亢进症有明显疗效和重要的临床价值。选择合适的病人和严格的操作技术能避免严重并发症的发生     

130例外伤性脾破裂的治疗分析

目的:探讨不同程度外伤性脾破裂的各种治疗方式.方法:总结分析130例外伤性脾破裂的各种处置方式及治疗效果.结果:129例痊愈,1例死亡.结论:Ⅰ级脾破裂不合并空腔脏器破裂者采用非手术保守治疗,Ⅱ～Ⅲ级及部分Ⅳ级脾破裂者采用PSE及脾脏可吸收网套捆扎治疗,部分Ⅳ级脾破裂和(或)合并严重休克者,或合并空腔脏器破裂者及Ⅳ级以上脾破裂者应在积极抗休克的同时行脾切除术,条件许可的情况下可加做自体脾片大网膜移植术.     

Quantification of the Electroencephalographic Theta/Alpha Ratio for the Assessment of Portal-Systemic Encephalopathy Following Implantation of Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS)

The aim of the study was the quantification of metabolically caused electroencephalographic changes of portal-systemic encephalopathy, a prototype of hepatic encephalopathy. We examined 12 patients with liver cirrhosis before and after implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS) by means of quantitative digital electroencephalography (EEG). One month after TIPSS implantation, all patients showed an increase in the power of the theta frequency band as well as a decrease in the power of the alpha frequency band. To reduce the error variance, we formed the quotient of the relative power of the theta and alpha frequency band. Theta/alpha quotient values over 0.7 indicate a general change of the EEG with a sensitivity of 93% and a specificity of 87%. The results we have to hand indicate a correlation between the albumin concentration and the theta/alpha quotient 1 and 3 months after TIPSS. No significant correlation was revealed with regard to the Child-Pugh score or the liver function parameters cholinesterase, bilirubin, and prothrombin time. Neither the arterial ammonia concentration nor the performance in the psychometric test showed significance in relation to the theta/alpha quotient. Substances with a high albumin bond and potential neurotoxicity may—in the case of lower albumin levels—be absorbed with increased frequency in the CNS and may be responsible for the observed EEG change.     

双介入法治疗肝硬化门脉高压症的护理

目的探讨经皮肝穿食道胃底曲张静脉栓塞和部分脾动脉栓塞治疗肝硬化门脉高压症的护理。材料与方法本组12例,平均年龄51.7岁,均为肝硬化门脉高压症惠者,同时行部分性脾动脉栓塞和经皮肝穿胃冠状静脉栓塞治疗。结果12例患者均手术成功,术中门静脉压力平均降低3.76mmHg,随访2～6个月无1例再出血,脾亢症状明显改善。食道钡餐见2例曲张静脉消失,7例病人由Ⅲ度静脉曲张变成Ⅱ度曲张,3例无变化。结论术前心理护理,术中止痛、止血、止吐、镇静,密切观察病情变化,术后输液抗炎,注意并发症的发生等是手术成功的重要环节。     

Elevated Serum Levels of Astroglial S100β in Patients with Liver Cirrhosis Indicate Early and Subclinical Portal-Systemic Encephalopathy

Portal-systemic encephalopathy is the prototype among the neuropsychiatric disorders that fall under the term Hepatic Encephalopathies. Ammonia toxicity is central to the pathophysiology of Portal-systemic encephalopathy, and neuronal ammonia toxicity is modulated by activated astrocytes. The calcium-binding astroglial key protein S100 is released in response to glial activation, and its measurement in serum only recently became possible. Serum S100 was determined by an ultrasensitive ELISA in patients (n=36) with liver cirrhosis and transjugular intrahepatic portosystemic stent-shunt. Subclinical portal-systemic encephalopathy and overt portal-systemic encephalopathy were determined by age-adjusted psychometric tests and clinical staging, respectively. Serum S100 was specifically elevated in the presence of subclinical or early portal-systemic encephalopathy, but not arterial ammonia. S100 levels elevated above a reference value (S100 110pg/ml) or the cut off value determined in our group of patients (112pg/ml) predicted subclinical portal-systemic encephalopathy with a specificity and sensitivity of 100 and 56.5%, respectively. Serum S100 was significantly dependent on liver dysfunction (Child-Pugh score), but was more closely related to cognitive impairments than the score. Serum S100 seems to be a promising biochemical surrogate marker for mild cognitive impairments due to portal-systemic encephalopathy.     

脾功能亢进的介入放射学治疗——部分性脾动脉栓塞

目的研究部分性脾动脉栓塞对脾功能亢进的介入性放射学治疗,以致改善脾功能亢进的外周血象.材料与方法对14例临床诊断为脾功能亢进的患者,经股动脉穿刺行部分性脾动脉栓塞术,栓塞剂为0号医用丝线,剪成2cm～3cm长的线段,部分辅以明胶海绵条.结果14例患者PSE术后均有程度不同的发热、腹痛、恶心、呕吐等栓塞后综合症,经对症治疗后均缓解、消失,24小时～1周开始白细胞,血小板计数明显升高.结论栓塞面积控制在40%～70%之间可较好的改善脾功能亢进患者的外周血象,减少栓塞后严重并发症的发生,是脾功能亢进的首选治疗手段.     

Partial splenic artery embolization in portal hypertension patients with hypersplenism: Two interval-spaced sessions’ technique

Purpose

To evaluate the ability of interval spaced sessions of transcatheter partial splenic artery embolization (PSE) to avoid the potential post procedure major complications, in portal hypertension patients with hypersplenism.

Material and methods

The study included 50 patients (39 male and 11 females). All patients had liver cirrhosis and portal hypertension with hypersplenism and hyperactive bone marrow. All patients underwent PSE in two sessions separated at least by 1 month interval. Immediate, short and intermediate term follow-up for 1 year were done.

Results

We had no post procedure mortality. None of the patients developed septic shock, splenic abscess or needed emergency surgery. Ten of our patients developed subcapsular collections which were treated conservatively. All of our patients showed significant increase in the thrombocyte count after the first session which becomes remarkable after the second session and remained at appropriate levels during the follow up period.

Conclusion

PSE using two (interval-spaced) sessions with careful pre- and post procedure medications and care; is really effective non surgical minimally invasive procedure in avoiding the potential post procedure complications while achieving remarkable hematologic response on controlling hypersplenism in cirrhotic patients with portal hypertension.