心脏移植术后肾功能衰竭的围手术期处理(附2例报告)

目的报告2例原位心脏移植术后肾功能衰竭的发生及治疗经过,探讨其围手术期处理的初步经验和要点.方法我院自2000年12月一2002年12月共对4例终末期心脏病患者施行同种异体原位心脏移植术,4例均为男性,采用标准原位心脏移植术,术后应用三联免疫治疗的方法抗排异.结果4例患者均获得手术成功,术后未发现超急性排斥反应或急性排斥反应,2例术后1周左右并发急性肾功能衰竭,应用床边连续肾脏替代(CRRT)治疗后,1例存活22d,1例完全康复,随访半年患者心功能恢复Ⅰ～Ⅱ级(NYHA),生活质量良好.结论心脏移植手术后肾功能损害较常见,围手术期的肾功能保护非常重要,如符合手术指征,及早手术治疗是抢救成功的关键.     

围手术期抗生素的合理应用

近年来,由于抗生素的滥用导致外科术后感染率明显上升,同时,在医院环境诱导了对抗生素耐药菌株的产生或引起细菌或霉菌的二从感染.为了有效地降低术后感染率,减少抗生素药物的副反应,自2001年1月份开始,我们采用围手术期抗生素的合理运用,与以往同期相比,骨科术后感染率明显下降,副反应减少.……     

全肠外营养对老年晚期消化系统恶性肿瘤病人生存期的影响

目的:评估全肠外营养(TPN)对老年晚期消化系统恶性肿瘤病人生存期的影响。方法:回顾性分析121例老年晚期消化系统恶性肿瘤病人TPN治疗后的生存期。结果:TPN治疗后,患者生存期不同程度延长,为9～126天,平均68.1天,多数在两月左右。结论:TPN可延长老年晚期消化系统恶性肿瘤病人的生存期。     

慢性肾功能不全患者行冠状动脉搭桥术围术期处理

目的：探讨慢性肾功能不全患行冠状动脉搭桥术的安全性。方法：回顾性分析1996年6月至2001年6月收治的15例慢性肾功能不全患行冠状动脉搭桥术的临床资料，并复习献。结果：9例患术后早期肾功能指标较术前差；6例患术后早期肾功能技术前无明显变化。围术期腹透4例，血透2例，其中1例行术中血透，肾功能指标均有所改善。全组无术中死亡，1例枚后第三天死于多器官功能衰竭。结论：术前肾功能不全的患，经过积极的术中及围术期处理，大多可以安全渡过肾功能衰竭关，接受冠状动脉搭桥术，达到改善症状延长生命的目的。     

青滕碱对豚鼠心肌动作电位和收缩力的影响

青藤碱2.7μmol/L以上,呈浓度依赖性地降低豚鼠乳头肌收缩力,延长动作电位时程和有效不应期。小剂量时,青藤碱能降低动作电位0相上升最大速率;较大剂量时,动作电位幅度也降低。用TTX处理豚鼠乳头肌所致的慢反应电位,青藤碱能够抑制。此外,青藤碱能对抗乙酰胆碱缩短豚鼠左房肌动作电位时程的作用。结果提示:青藤碱对Na⁺,Ca²⁺和K⁺的跨膜转运均有抑制作用。     

Survival of low birthweight infants in central Queensland

The survival of low birthweight infants £2000g born in the central Queensland area during the years 1979 to 1991 was examined. Five hundred and sixty such infants were either delivered at one of the two Rockhampton obstetric units (Rockhampton Base Hospital and the Mater Misericordiae Hospital) or retrieved from outlying central Queensland areas. Both hospitals had intensive care nurseries capable of ventilation and infants were transferred to tertiary centres only for cardiac or surgical treatment. The study involved all liveborn infants', including those with lethal malformations and all deaths up to the time of discharge. Survival rates were as follows: £500 g 0%, 501 £750 g 30%, 751 £1000 g 51%, 1001 ± 1500 g 79%, 1501 £2000g 93%. The survival of Aboriginal infants and outborn infants were found to be essentially the same as the overall group.     

Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T₃ carcinoma, 15 patients T₄ and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The postoperative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.     

Ten-year stability of cardiovascular responses to laboratory stressors

In this study we examined test-retest stability of cardiovascular stress responses over a decade of the life span. Participants were 55 male college undergraduates. 19 years of age at initial testing, and 29 years of age at follow-up testing Stressors were a foot cold pressor and an aversive reaction time task. Cardiovascular measures included systolic and diastolic blood pressure, heart rate, and preejection period. For cold pressor, the magnitude and pattern of cardiovascular responses remained unchanged at the 10-year follow-up. For the reaction time task, the characteristic cardiovascular response patterns was preserved but with significant attenuation of magnitude. The present findings are consistent with previous observations of temporal stability but over a substantially longer test-retest interval. The long-term stability of stress responses is discussed in the context of stress test methodology, behavioral response demands, and maturation of the physiological systems involved in cardiovascular response expression.     

肿瘤潜隐期二阶段模型

从宫颈癌、大肠癌等病种的自然史抽象出一个具有时变伴随变量的潜隐期二阶段模型。潜隐期以正常状态为起点,疾病为终点;其前阶段可逆,后阶段不可逆;状态间转移速率因病人状况而异。用Markov过程描述并求解此模型,进而给出参数估计和假设检验方法。利用此模型基于江西省靖安县12年6轮宫颈癌筛查资料进行了自然史研究,并讨论了应用前景。