51例下肢骨折患者围术期微循环状态变化观察

目的：探讨及观察下肢骨折患者围术期微循环状态的变化情况。方法选取2012年12月~2014年5月于本院进行手术治疗的51例下肢骨折患者为观察组,同期的51名健康人员为对照组,将对照组和观察组术前及术后1d、3d、7d、10d的足甲襞微循环积分、管襻形态及其他足甲襞微循环指标进行检测及比较。结果观察组术前及术后1d、3d、7d足甲襞微循环积分、管襻形态及其他足甲襞微循环指标均明显差于对照组,且观察组术后3d的评估结果均差于其他时间段的评估结果,P均＜0.05,而观察组术后10d的评估结果与对照组无明显差异,P均＞0.05。结论下肢骨折患者围术期微循环状态的变化较为明显,呈现较大的波动状态,应针对其这种波动给予针对性的监测与干预。     

尼群地平治疗高血压病人的微循环改变

对３１例高血压病患者服尼群地平治疗前后进行甲襞微循环观察。结果发现，服用中地平后，在血压降低的同时，甲襞微循环管袢数目增多，管袢形态，流态及袢周状态改善。以上结果经统计学处理有显著性差异。提示尼群地平降血压同时可改善微循环状态。     

针刀结合舒筋活络胶囊对神经根型颈椎病患者治疗前后甲襞微循环的影响

目的:观察针刀结合舒筋活络胶囊对神经根型颈椎病患者甲襞微循环的影响。方法:将120例神经根型颈椎病患者随机分为两组,观察组60例,采用针刀结合口服舒筋活络胶囊治疗。对照组60例,采用口服根痛平颗粒治疗,并观察了两组治疗前后甲襞微循环的变化。结果:治疗后两组各项指标与治疗前比较,均有显著性差异(P<0.05～0.01);观察组与对照组后积分比较,可见患者管袢形态、血液流态、袢周积分及总积分均呈下降趋势,但观察组下降幅度更显著,与对照组比较,经统计学处理,有显著性差异(P<0.05)。结论:采用针刀结合舒筋活络胶囊对神经根型颈椎病,可改善患者的微循环,加速局部的血液流通,增加病灶的血氧供应量,且明显优于对照组。     

维生素D与强直性脊柱炎患者甲襞微循环形态的相关性研究

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)患者血清25(OH)D_3与甲襞微循环形态的相关性。方法选择在胜利油田中心医院风湿免疫科就诊的AS患者121例,包括113例男性和8例女性,同时选取年龄、性别相匹配的健康对照80名,所有受试者行甲襞微循环及血清25(OH)D_3检测,同时详细记录AS患者的临床资料,并依据血清25(OH)D_3水平分为VitD不足组和VitD缺乏组。数据间的相关性分析采用Pearson及线性回归分析。结果 (1)AS患者25(OH)D_3水平低于健康对照组;(2)AS甲襞微循环形态存在异常。VitD缺乏组的毛细血管密度、动静脉支管径分别小于与VitD不足组和对照组(P均0.01),管袢直径分别大于VitD不足组和对照组(P均0.01);VitD不足组的毛细血管密度、动静脉支直径均小于对照组(P均0.01),管袢直径大于对照组(P=0.001),毛细血管长度与对照组相比无显著差异(P=0.832);(3)AS患者25(OH)D_3水平与甲襞微循环积分呈显著负相关(r=-0.357,P0.01);25(OH)D_3水平下降是甲襞微循环积分增高的风险因素(β=-0.099,P=0.001)。结论 AS患者存在不同程度的维生素D缺乏,血清25(OH)D_3水平下降与甲襞微循环积分升高显著相关,是AS患者发生微循环障碍的危险因素,详细机制仍需进一步研究。     

硝苯乙吡啶用于嗜铬细胞瘤术前准备的探讨

本文对4例嗜铬细胞瘤患者应用钙阻断剂—硝苯乙吡啶术前扩容进行了观察,对用药剂量、时间及用药后有效指标进行了初步探讨,其临床效果似优于苯苄胺。认为硝苯乙吡啶来源易得,价格便宜且无副作用,不仅适用于嗜铬细胞瘤患者的术前准备,亦可作为恶性嗜铬细胞瘤不能手术切除者长期药物治疗的首选药物。     

中药狼疮定对系统性红斑狼疮外周微循环影响的研究

目的 :研究中药狼疮定对系统性红斑狼疮 (SLE)外周微循环的影响。方法 :临床上筛选 4 5例SLE患者 ,随机分成单用激素组和激素并用狼疮定组 ,利用微循环图像分析仪检测用药前后甲襞微循环情况 ;同时选用 30只小鼠进行实验研究 ,随机分成中药组、西药组和正常组 ,对比观察用药前后耳廓微循环情况变化。结果 :临床研究表明 ,SLE患者的甲襞管襻形态、流速和出血、渗出等方面的总积分值与正常组有显著性差异 (P <0 .0 5 ) ;治疗后激素并用狼疮定组改善程度明显优于单用激素组 (P <0 .0 5 )。实验研究表明 ,治疗后中药组小鼠耳廓细动脉管径呈扩张趋势 ,毛细血管开放数明显增多 ,而西药组相反。结论 :狼疮定能明显减轻SLE外周微循环障碍 ,改善其瘀血病理状态 ,从而有利于提高激素等西药对SLE的疗效 ,减少狼疮性肾炎的发生及其他脏器损害     

嗜铬细胞瘤/副神节瘤的围手术期处理

嗜铬细胞瘤/副神节瘤是由神经嵴起源的嗜铬细胞产生的肿瘤,具有分泌儿茶酚胺的功能,而儿茶酚胺作用于血管、心脏,常常引起血液循环系统及代谢的改变。嗜铬细胞瘤手术前后血液中儿茶酚胺浓度的变化会引起相应血液动力学的改变,若没有充分的术前准备和术后监护,心血管意外事件的发生几率很高。因此,了解嗜铬细胞瘤/副神节瘤的病理学特点,术前进行良好的药物准备,术中轻柔的手术操作及与麻醉师的良好配合,术后ICU的严密监护,是嗜铬细胞瘤围手术期处理的关键,也是嗜铬细胞瘤/副神节瘤成功治疗的基本保障。     

肾上腺嗜铬细胞瘤引起库欣综合征一例报告并文献复习

目的探讨肾上腺嗜铬细胞瘤引起库欣综合征的临床诊断和治疗。 方法结合文献复习,回顾性分析2015年12月我院收治的1例右侧肾上腺嗜铬细胞瘤引起库欣综合征患者的资料。患者女性,45岁,因反复头痛半年,加重伴头晕、多尿、消瘦2个月收入我院内分泌科。术前诊断考虑为肾上腺嗜铬细胞瘤引起库欣综合征,同时按库欣综合征和嗜铬细胞瘤做术前准备,行腹膜后入路腹腔镜右侧肾上腺肿瘤切除术。 结果内分泌检查示促肾上腺皮质激素（ACTH）、皮质醇高于检测值上限,且大、小地塞米松抑制试验不受抑制。血儿茶酚胺三项均升高,以肾上腺素为主,可乐定试验不受抑制。甲氧基肾上腺素及甲氧基去甲肾上腺素均升高。胸部CT平扫及PET-CT未发现可疑异位ACTH来源。肾上腺MR示双侧肾上腺内、外支弥漫性增厚,右侧肾上腺内、外侧支之间可见一类圆形肿块,边界清,考虑肾上腺嗜铬细胞瘤可能。予口服甲吡酮抑制皮质醇生成,常规剂量酚苄明作术前准备,行腹膜后入路腹腔镜右侧肾上腺肿瘤切除术。病理提示右侧肾上腺嗜铬细胞瘤,合并肾上腺皮质区带性增生。免疫组化CgA（+）,ACTH（+）。术后ACTH及皮质醇降至正常范围。术后6个月复查提示患者高血压、糖尿病等表现消失。 结论嗜铬细胞瘤引起库欣综合征是一种罕见疾病,手术切除是有效治疗手段,术前需同时按照嗜铬细胞瘤和库欣综合征完善术前准备。     

异位嗜铬细胞瘤的围术期处理

腹膜后肿瘤来源众多,其中异位嗜铬细胞瘤最为凶险,因为术前易漏诊,且药物、麻醉和手术操作等因素都可诱发儿茶酚胺危象,未经过术前准备的嗜铬细胞瘤病人围术期死亡率高达47%[1]。所以,有必要了解嗜铬细胞瘤的特点和处理。异位嗜铬细胞     

高危嗜铬细胞瘤围手术期处理(附35例报告)

目的：总结高危嗜铬细胞瘤的诊断和治疗经验。方法：回顾性分析35例高危嗜铬细胞瘤患者临床手术治疗资料，总结围手术期的处理方法。结果：27例肿瘤位于肾上腺，8例位于肾上腺外。切除肿瘤33个，平均直径10cm，平均重量350g；2例因切除困难，仅作活检。4例为复发性嗜铬细胞瘤，3例证实为恶性嗜铬细胞瘤。结论：高危嗜铬细胞瘤术前必须有充分的药物准备和明确的定位诊断，术中应严密监测和处理血压波动，术后须注意低血糖现象。     

嗜铬细胞瘤临床功能分级与术前准备标准的探讨

目的　探讨嗜铬细胞瘤临床功能分级与术前准备的标准。方法　我院 1990年 1月至2 0 0 3年 11月手术治疗 172例嗜铬细胞瘤病例 ,根据术前临床症状、2 4h尿儿茶酚胺中去甲肾上腺素、肾上腺素和多巴胺水平将其临床功能分为 4级。功能 0级 2 2例 ,未给予扩容准备 ;功能 1级 17例 ,随机双盲法抽取 10例口服酚苄明 5～ 10mg/d持续 1周 ,其余 7例为对照 ,比较两者围手术期血压的变化 ;功能 2级 12 0例 ,术前口服酚苄明 30～ 2 4 0mg/d充分扩容 4周 ,应用血流动力学指标及微循环图像判断扩容效果 ;功能 3级 13例 ,应用酚苄明及相应的心肺脑复苏措施。全部病例均在全麻下行肿瘤探查切除术。结果　功能 0级者围手术期血压平稳。功能 1级者血压均有波动 (<80mmHg) ,酚苄明治疗者波动幅度 <2 0mmHg ,对照者 >4 0mmHg(χ2 值为 13 12 ,P <0 0 1)。功能 2级和 3级者血压波动幅度 >80mmHg ,术后 2 4h内血流动力学恢复正常 ,无并发症。结论　根据嗜铬细胞瘤功能分级可采取不同的术前准备 ,功能 0级无需扩容 ,功能 1级可口服酚苄明 5～ 10mg/d持续 1周 ,功能 2级必须应用酚苄明 30～ 2 4 0mg/d充分扩容 4周 ,功能 3级必须心肺脑复苏加充分扩容 ,心肺脑功能基本正常后方可手术。血压正常和微循环图像显示微动脉充分扩张是     

椎体终板下微循环障碍直接导致椎间盘退变的实验研究

目的 通过建立椎体终板下微循环障碍动物模型,探讨椎间盘退变发病的可能机制.方法 将24只新西兰白兔随机分为实验组和对照组,实验组采用联合应用内毒素与激素的方法制备典型椎体终板下微循环障碍模型,并通过终板微血栓染色证实;对照组为阴性空白对照,不给予任何药物干扰,仅标准饲料喂养.3个月后分析实验组和对照组动物椎间盘的水含量、生化成分含量和组织形态学,从而评估椎间盘的退变程度.结果 终板微血栓染色证实实验组成功构建椎体终板下微循环障碍模型,3个月后实验组动物椎间盘水含量、生物化学成分含量均低于对照组,椎间盘切片染色可见椎间盘退变的表现.结论 椎体终板下微循环障碍可直接导致椎间盘退变,椎间盘营养供给障碍是椎间盘退变的发病机制之一.     

Laparoscopic adrenalectomy for pheochromocytoma: comparison with open adrenalectomy and comparison of laparoscopic surgery for pheochromocytoma versus other adrenal tumors

OBJECTIVE: To compare the efficacy of laparoscopic adrenalectomy for pheochromocytoma with that of conventional open adrenalectomy for pheochromocytoma and laparoscopic surgery for other adrenal tumors. PATIENTS AND METHODS: Fifty-four patients with adrenal tumors, including 10 cases of pheochromocytoma, 18 cases of Cushing's syndrome, 20 cases of primary aldosteronism, and 6 cases of nonfunctioning tumors, were evaluated. A historical group of 7 consecutive patients who underwent conventional open adrenalectomy for pheochromocytoma was also studied. RESULTS: Laparoscopic adrenalectomy for pheochromocytoma was successful in 9 of the 10 patients. There was no difference in tumor size, operation time, estimated blood loss, or occurrence of hypertensive episodes during surgery between patients treated with laparoscopic procedures and those treated with open surgery. However, the number of days to first postoperative oral feeding and first ambulation, length of hospitalization, and number of patients requiring parenteral analgesics were significantly smaller after laparoscopic surgery than after open surgery. There was no significant difference in operation time, estimated blood loss, incidence of intraoperative complications, or postoperative recovery between patients who underwent laparoscopic adrenalectomy for pheochromocytoma and those who underwent laparoscopic surgery for other adrenal lesions. CONCLUSIONS: Laparoscopic adrenalectomy does not increase the specific risks associated with surgery for pheochromocytoma. It is a minimally invasive alternative to conventional open adrenalectomy.     

腹腔镜肾上腺嗜铬细胞瘤切除术七例报告

目的探讨腹腔镜手术治疗肾上腺嗜铬细胞瘤的可行性及安全性。方法2003年10月至2007年4月，我院行腹腔镜肾上腺嗜铬细胞瘤切除术7例，肿瘤最大径为3．0～6．5cm，平均5．0cm。6例患者术前均有不同程度的高血压。术前常规行降压、扩容处理。采用后腹腔镜入路6例，经腹入路1例，术中术后严密监测血压变化并给予相应处理。结果5例腹腔镜手术成功，2例中转开放手术。手术时间为70-360min，平均163min，术中出血50-600ml，平均300ml。7例患者术中均出现血压波动，无围手术期患者死亡。病理报告证实为嗜铬细胞瘤。随访7～49个月，5例患者术后2个月内血压恢复正常，1例仍需服用降压药物。结论腹腔镜肾上腺嗜铬细胞瘤切除术可行，疗效确切，充分的术前准备和熟练的腹腔镜操作技术是手术安全的保证。     

Viewing the microcirculation through the window: some twenty years experience with the hamster dorsal skinfold chamber

Intravital microscopy represents a sophisticated technique to study the microcirculation in health and disease. While most preparations used for those studies are acute in nature, the use of chamber preparations in the skinfold bear the advantage to allow for chronic studies with repeated analysis of the microcirculation over a prolonged period of time. The skinfold chamber model for microcirculatory analysis has been adapted to mice, rats and hamsters. Although the use of rats and, in particular, the use of mice has the advantage of the availability of species-specific tools, the use of the hamster as the experimental animal may be preferred due to anatomical reasons, which facilitate the microsurgical preparation and improve the quality of microscopic imaging. The use of the hamster dorsal skinfold chamber, firstly described by Endrich and coworkers in 1980, has brought out during the last two decades a considerable number of experimental studies within the fields of microcirculation physiology, inflammation and sepsis, ischemia-reperfusion, angiogenesis, and transplantation, indicating that the model has to be considered a versatile tool to study the microcirculation in health and disease.     

Direct studies on the control of the renal microcirculation

Recent advances in videomicroscopy combined with the development of several innovative in vivo and in vitro preparations now allow for direct study of the renal microcirculation. Blood flow in vasa recta capillaries of the rat can be studied by using video-microscopy, and changes in the flow of red blood cells in the renal cortex and papilla can be continuously monitored by using laser-Doppler flowmetry. All elements of the renal microcirculation can be visualized with the in vitro perfused juxtamedullary nephron or hydronephrotic kidney preparations. Pressures, blood flows, and vascular diameters in individual vessels can be directly measured in these preparations. Renal arterioles can be microdissected from the kidneys of several species and cannulated and pressurized in vitro for the study of pressure-diameter relationships and vascular responses to different agonists. In addition, membrane potentials and intracellular ion concentrations can now be measured in isolated renal arterioles by using microelectrodes and fluorescence microscopy. Thus, it is possible to study the control of renal vascular tone at all levels of integration from signal transduction in isolated cells to direct analysis of the regulation of hemodynamics in different regions of the microcirculation of the kidney in intact animals.     

Associação entre perfusão periférica,microcirculação e mortalidade em sepse: uma revisão sistemática

Although increasing evidence supports the monitoring of peripheral perfusion in septic patients, no systematic review has been undertaken to explore the strength of association between poor perfusion assessed in microcirculation of peripheral tissues and mortality. A search of the most important databases was carried out to find articles published until February 2018 that met the criteria of this study using different keywords: sepsis, mortality, prognosis, microcirculation and peripheral perfusion. The inclusion criteria were studies that assessed association between peripheral perfusion/microcirculation and mortality in sepsis. The exclusion criteria adopted were: review articles, animal/pre‐clinical studies, meta‐analyzes, abstracts, annals of congress, editorials, letters, case‐reports, duplicate and articles that did not present abstracts and/or had no text. In the 26 articles were chosen in which 2465 patients with sepsis were evaluated using at least one recognized method for monitoring peripheral perfusion. The review demonstrated a heterogeneous critically ill group with a mortality‐rate between 3% and 71% (median = 37% [28%–43%]). The most commonly used methods for measurement were Near‐Infrared Spectroscopy (NIRS) (7 articles) and Sidestream Dark‐Field (SDF) imaging (5 articles). The vascular bed most studied was the sublingual/buccal microcirculation (8 articles), followed by fingertip (4 articles). The majority of the studies (23 articles) demonstrated a clear relationship between poor peripheral perfusion and mortality. In conclusion, the diagnosis of hypoperfusion/microcirculatory abnormalities in peripheral non‐vital organs was associated with increased mortality. However, additional studies must be undertaken to verify if this association can be considered a marker of the gravity or a trigger factor for organ failure in sepsis.     

Pheochromocytoma: current status and changing trends

From 1971 through 1980, 106 patients underwent operations for pheochromocytoma. Twelve patients had a pheochromocytoma as a manifestation of the multiple endocrine neoplasia type 2 syndrome. Twenty patients were found to have extra-adrenal paragangliomas. Fifteen patients (14%) had malignant tumors; eight of these tumors were encountered in the group with extra-adrenal lesions. The cumulative survival probability at 5 years was 53%. Determination of urinary metanephrines and vanillylmandelic acid were the most sensitive diagnostic aids, with accuracy rates of 95% and 89%, respectively. In recent years, the measurement of fractionated urinary and plasma catecholamine levels has greatly increased the diagnostic accuracy. Preoperative localization of pheochromocytoma has improved during the last decade. Nephrotomography, selective angiography, and venous sampling have essentially been abandoned in favor of computed tomography. With an accuracy of more than 90%, computed tomography represents the major step forward in the overall management of pheochromocytoma during the past decade.     

膀胱嗜铬细胞瘤的诊断和治疗

目的：提高膀胱嗜铬细胞瘤的诊断与治疗水平。方法：5例膀胱嗜铬细胞瘤患者均通过膀胱镜检查获得定位诊断并均经手术治疗，其中4例行膀胱部分切除，1例行全膀胱切除术。结果：5例获随访，时间2个月～9年。3例痊愈，2例分别于术后2个月、5年死于脑溢血。结论：膀胱镜是最主要的定位检查手段，术前准备与其他部位嗜铬细胞瘤同样重要，术式选择应依据病灶大小及部位。