不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

颈髓髓内神经鞘瘤1例临床及病理报告

患者女．22岁，因渐起左侧肢体无力伴颈部胀痛7月入院。于1992年9月初无明显诱因出现左足活动不灵，穿鞋易掉，伴夜间阵发性颈部帐痛、咳嗽、打喷嚏时疼痛加剧，继而定上、下肢乏力，左下肢僵硬，迈步发紧，偶有小便失禁，无头鼎，呕吐，于1993年3月17日行X线颈椎摄片，示颈椎生理曲度变直，第3～4颈椎前下缘轻度骨质增生，第5，6颈椎后下缘见骨质增生。头部CT平扫正常．诊断“脑脉管炎”，给予青霉素、地塞米松治疗2周无效。     

氟康唑治疗老年人肺部白色念珠菌感染14例疗效分析

对我院收治的１４例老年肺部白色念珠菌感染患者应用氟康唑（大扶康）治疗，进行疗效分析，并与１６例老年患者应用其他抗真菌药物治疗疗效进行比较。氟康唑组１３例治愈，ｌ例死亡；其他抗真菌药物组９例治愈，７例死亡。氟康唑组病死率（７．１％）明显降低。氟康唑为三唑类第三代抗真菌药物，具有疗效好、副作用轻、使用安全的特点，值得临床上广泛应用。     

老年原发性扩张型心肌病113例临床分析

本文报道老年原发性扩张型心肌病１１３例，占同期扩张型心肌病的２６．２％，８０％患者从事体力劳动。临床特点为起病缓慢，病程较长，心脏扩大明显，全心衰及顽固性心衰发生率较高，各种心律失常多见。住院期病死率为２０．４％，明显高于同期成人病组。对本病的治疗及影响预后因素作了简要讨论。     

颈椎病患者经颅多普勒检查与头颅CT和脑电图的关系

应用多普勒技术对50例确诊为椎动脉型颈椎病的患者进行了检查,结果30例异常。其中25例主要表现为不同程度的双侧颈动脉血流量对称性偏低,管径及头颅CT无异常,脑电图部分改变,主要表现为低幅慢波,经治疗后症状改善,多普勒复查正常,说明CT正常不能否定脑缺性血管病的存在,CT不能代替多普勒检查,另5例主要表现为双侧颈动脉血流量不对称,其中3例为双侧血管经狭窄,CT提示全脑萎缩,脑电图呈低幅慢波;另2例CT提示左颞后顶区,右枕外侧区梗塞,脑电图及脑电地形图表现相应部位慢波灶达6～7级。CT异常者,临床治疗效果欠佳,多普勒检查和脑电图及临床症状变化不大,故多普勒检查对监测脑动力循环有一定意义。     

重庆市某社区城市老年人慢性病现况调查

我们在重庆市沙坪坝区渝培路街道对老年人慢性病患病现况,尤其是高血压患病率、知晓率及治疗率进行调查,以便为老年人预防疾病、促进健康及制定社区老年人的卫生政策提供科学依据。 一、对象和方法 1.对象:2000年3～7月重庆市沙坪坝区渝培路街道共有13440人,对≥60岁以上的老年人1126人(占8.4％)进行基线调查,其中男583人,女543人,男女之比为1.07:1.00,年龄60～92岁,平均(65.3±5.6)岁,受教育程度小学及以下548人,中学477人,大专及以上101人。     

急性高容量血液稀释对深静脉血栓患者凝血功能的影响

目的 探讨急性高容量血液稀释(AHH)对深静脉血栓患者凝血功能的影响.方法 30例股静脉血栓行取栓术患者随机分为三组,入手术室以20 mg·kg <'1>·h<'1>的速度输注6%羟乙基淀粉200/0.5(H组)、琥珀酰明胶(G组)、生理盐水(R组)40 min.观察AHH前后血小板计数(Plt)、血小板聚集功能(PAG)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)变化.结果 AHH后H组Plt明显低于AHH前和G、R组(P<0.05或P<0.01);APTT明显长于AHH前和G、R组(P<0.05或P<0.01);AHH后H组PAG明显低于AHH前和R组(P<0.05);AHH后G组FIB明显低于AHH前和H、R组(P<0.01).结论 AHH后胶体液较晶体液对深静脉血栓患者凝血功能影响明显,可改善患者术中血液高凝状态.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

围手术期超容血液稀释对机体内环境影响

目的:探讨术前用羟乙基淀粉行急性超容血液稀释对胃肠择期手术病人内环境的影响。方法:选择90例ASA~级的择期胃肠手术病人,随机等分成3组:H组(贺斯组)、B组(输血组)和R组(对照组),3组病人均采用静吸复合全麻。H组和B组分别用贺斯、血液术前扩容。结果:13组患者AHH前后,Na 、Ca2 、K 、Cl-均在正常范围之内;H组和R组血液稀释后的pH值较稀释前降低,但实际差别很小,无临床意义。23组患者AHH前后血液动力学MAP,CVP,HR,HCT无明显变化。结论:1急性超容性血液稀释不影响机体内环境的稳定。2本研究证实新一代人工胶体羟乙基淀粉液(贺斯6%HES 200/0.5),扩容效果和维持时间同血液相似,且优于晶体液,能有效维持循环稳定,是一种简单可行、安全有效的血液保护方法,值得临床推广应用。     

磷酸三邻甲苯酯中毒后迟发性脑病（附1例报道）

目的探讨磷酸三邻甲苯酯(TOCP)中毒后迟发性脑病的临床特点。方法详细分析了TOCP中毒患者的临床特征，头颅MRI、脑电图特点以及治疗效果。结果患者误服TOCP后长达13天突发痫性发作，继而浅昏迷、偏瘫，头颅MRI及脑电图均改变。经脱水、保护脑细胞、抗感染及使用激素等治疗后7天患者渐清醒，肌力恢复。结论TOCP易被误服并导致以迟发性脑病为特点的中枢神经系统损害，采取包括用激素在内的综合措施可获得良好治疗效果。