足三里注射新斯的明治疗术后腹胀

术后病人腹胀为手术后的常见症状，一般经下床活动，禁食等治疗措施，腹胀大部分能好转或消失，但有部分病人，持续腹胀，影响刀口愈合，甚至导致刀口裂开。     

新斯的明足三里穴位注射治疗麻醉止痛后腹胀168例

2000年5月至2002年5月,我们采用新斯的明足三里穴位注射治疗麻醉止痛后腹胀168例,效果显著。     

术后硬膜外注射新斯的明镇痛对心率的影响

硬膜外注射新斯的明（ＮＥＯ）是一较新的术后镇痛方法［１］。ＮＥＯ为一胆碱酯酶抑制剂,它可作用于心脏Ｍ受体而减慢心率。为此,作者对术后疼痛期患者硬膜外注射ＮＥＯ,观察其对心率和血压的影响。１对象和方法１．１对象选择ＡＳＡⅠ～Ⅱ的妇产科手术患者３０例,年...     

足三里注射新斯的明对急性重症脑梗死患者自主排便功能影响的疗效观察

目的:评估足三里注射新斯的明对急性重症脑梗死患者自主排便功能影响.方法:回顾性分析2018年9月～2019年8月我院血管外科监护室收治的急性重症脑梗死患者63例,对照组30例患者予开塞露、灌肠人工辅助排便措施,治疗组33例患者予足三里注射新斯的明,观察2组患者治疗前后患者肠鸣音,治疗后24 h内自主排便次数、便血、大便...     

新斯的明联合大黄灌肠对重症急性胰腺炎腹内高压患者的作用

目的 探讨新斯的明联合大黄灌肠治疗SAP患者腹内高压(IAH)的疗效。 方法 回顾性分析2018年1月至2022年6月间河北北方学院附属第一医院重症监护室(ICU)收治的89例行持续性肾脏替代疗法(CRRT)的SAP患者临床资料。根据治疗方式分为对照组(44例)和研究组(45例),对照组患者给予大黄灌肠＋芒硝盐外敷,2次/d,持续7 d;研究组患者在对照组治疗的基础上,加用肌肉注射新斯的明0.5 mg,2次/d,持续7 d。监测腹内压,记录两组患者急性生理和慢性健康评估(APACHE)Ⅱ、改善肾脏整体预后分级(KDIGO)和肺损伤(LIS)评分及治疗前后血清白细胞、CRP、降钙素原(PCT)、IL-6、IL-8和肿瘤坏死因子(TNF)-ɑ水平。主要研究终点为24 h腹内压变化量,次要终点包括治疗后1~7 d粪便增加量、新出现腹腔间隔室综合征(ACS)、新出现器官功能障碍、血管并发症、ICU住院时间、总住院时间、存活率及治疗结束6个月后的治疗干预和并发症的发生。 结果 研究组和对照组腹内压均于治疗后9 h开始下降,与治疗前相比,两组治疗7 d后腹内压下降显著,且研究组7 d内下降幅度显著高于对照组,差异均有统计学意义( P值均<0.05)。较治疗前,对照组和研究组治疗后APACHEⅡ、KDIGO和LIS评分均显著下降,但研究组比对照组下降更明显。治疗后研究组患者血清WBC计数及炎症因子CRP、PCT、IL-6、IL-8、TNF-ɑ水平均显著低于对照组,差异均有统计学意义( P值均<0.05)。与对照组比较,研究组在治疗24 h后腹内压变化量显著增加,在治疗1、2、3、5、7 d后粪便量也显著增加( P值均<0.05),但两组患者腹内压加重、新出现ACS、新出现的器官功能衰竭、血管并发症、ICU住院和总住院时间及存活率比较差异均无统计学意义。随访6个月后,胰腺炎再发及其治疗干预比较差异也无统计学意义。 结论 新斯的明的协助治疗可降低SAP患者腹内压和增加排便量,改善SAP的病情,其可能与炎症因子的释放减少有关。     

新斯的明联合大黄灌肠对重症急性胰腺炎腹内高压患者的作用

目的探讨新斯的明联合大黄灌肠治疗SAP患者腹内高压(IAH)的疗效。方法回顾性分析2018年1月至2022年6月间河北北方学院附属第一医院重症监护室(ICU)收治的89例行持续性肾脏替代疗法(CRRT)的SAP患者临床资料。根据治疗方式分为对照组(44例)和研究组(45例), 对照组患者给予大黄灌肠+芒硝盐外敷, 2次/d, 持续7 d;研究组患者在对照组治疗的基础上, 加用肌肉注射新斯的明0.5 mg, 2次/d, 持续7 d。监测腹内压, 记录两组患者急性生理和慢性健康评估(APACHE)Ⅱ、改善肾脏整体预后分级(KDIGO)和肺损伤(LIS)评分及治疗前后血清白细胞、CRP、降钙素原(PCT)、IL-6、IL-8和肿瘤坏死因子(TNF)-ɑ水平。主要研究终点为24 h腹内压变化量, 次要终点包括治疗后1～7 d粪便增加量、新出现腹腔间隔室综合征(ACS)、新出现器官功能障碍、血管并发症、ICU住院时间、总住院时间、存活率及治疗结束6个月后的治疗干预和并发症的发生。结果研究组和对照组腹内压均于治疗后9 h开始下降, 与治疗前相比, 两组治疗7 d后腹内压下降显著, 且研究组7 d内...     

肝移植围手术期并发症的处理

目的探讨肝移植围手术期并发症的发生规律及处理方法。方法回顾性分析44例肝移植病例的并发症及处理。结果32例发生肺部细菌性感染(72％),其中13例合并真菌感染(29．5％)．死亡2例(15．3％);急性肾功能不全(ARF)9例(20．4％),7例须连续肾脏替代(CRRT)治疗,死亡3例(33．3％);大量胸腔积液14例(31．8％),无死亡;急性排斥反应5例(11．3％),无死亡;腹腔内出血5例(11．3％)．死亡2例(40％);胸腔内出血2例(4．5％),无死亡;T管脱出2例(4．5％)．死亡1例(50％)。结论肝移植围手术期死亡主要与并发症有关．早期诊断与处理并发症,是提高肝移植存活率的重要措施。     

肝移植患者术中凝血功能的变化及影响因素

目的:探讨不同肝移植术式术中凝血功能变化的规律及相关的影响因素.方法:将2006-06/2007-05我院15例亲体肝移植患者及29例原位肝移植患者,分为肝癌组,肝硬化和急性肝衰组.综合评估患者术前状态,于患者术前及术中(无肝前期、无肝期、再灌注期30 min、再灌注期1 h)检测凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、血小板计数(PLT)、血红蛋白量(HB)、白蛋白(ALB)及CO_2结合力(TCO_2),观察不同肝移植术式术中各组患者凝血功能及酸碱失衡的变化规律及特点,分析术前和术中可能存在的影响因素及与凝血功能的相关性.结果:肝硬化患者组术前凝血状态介于肝癌组与急性肝衰组之间.术前PLT明显减少,与其他两组相比差异显著(P<0.05).无肝期各项指标进一步恶化.再灌注30 min PT,APTT,INR值达到峰值,FIB水平于无肝期达到最低点(亲体移植:0.68±0.17 g/L vs 0.93±0.37 g/L,0.77±0.19 g/L,0.83±0.27 g/L,0.72±0.31 g/L;原位肝移植:0.65±0.14 g/L vs 0.89±0.10 g/L,0.71±0.26 g/L,0.69±0.16 g/L,0.70±0.23 g/L,P<0.05).肝癌组各指标术前基本正常,术中变化幅度均较前两组小(P<0.05).急性肝衰组患者术前PT、APTT、INR延长最为显著,凝血状态最差(P<0.05),但术中恢复较快.除无肝期外,FIB较其他两组明显减少(P<0.05).应用Pearson相关分析术中出血量与围手术期因素的相关关系,发现MELD评分与术中出血量具有相关性(r=0.619,P<0.05).与原位肝移植相比,亲体肝移植术中凝血功能及代谢紊乱的变化较大,尤以无肝前期及无肝期恶化明显.再灌注后各项凝血指标恢复迅速(P<0.05).结论:应根据具体情况个性化治疗肝移植患者.     

原位肝移植患者围手术期成分输血探讨

目的:探讨原位肝移植围手术期成分输血疗效及手术前血液成分的准备,总结成分输血经验,降低用血量,减少输血反应。方法:44例肝移植患者来自不同的地区,其中1例来自韩国的患者,1例蒙古族患者;2例行肝肾联合移植的患者。部分受体与供体之间有血缘关系,ABO、RH血型相合。将44例肝移植患者按照病情诊断,分为肝硬化组18例(40.1%),男13例、女5例;肝恶性肿瘤组26例(59.1%),男24例、女2例。根据患者手术中、手术后的不同出血情况,给予不同的血液成分治疗,所用红细胞悬液均进行白细胞过滤。结果:肝硬化组成分用血量大于肝恶性肿瘤组(肝癌)。不同病情的肝移植患者需要的血液成分差异很大。讨论:术前明确患者的诊断及病程,探讨患者围手术期的出血量,提供安全、合理、有效的成分输血治疗,应用白细胞过滤技术,减少输血反应,降低输血总量是保障原位肝移植手术取得成功的关键环节。     

肝移植术时凝血功能障碍的处理

目的:探索同种原位肝移植术(OLT)时凝血功能障碍的诊断与治疗.方法:回顾性分析我院23例次OLT术前和术中凝血功能、术中出血量与输注凝血因子、血小板和红细胞悬液的关系.结果:术前69.6%、56.5%、30.4%肝病患者分别有凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)延长·中位延长时间分别为6.3、21.8、6.8 s;纤维蛋白原(Fg)和血小板计数(BPC)中位值分别为1.38g/L和47×109/L.术中100%、91.3%、65.2%患者PT、aPTT、TT分别较对照延长,中位延长时间分别为10.3、55.2、18.8 s;Fg和BPC的中位值分别为1.26 g/L和27×109/L.术前凝血功能正常或纠正充分者16例次,术中血制品用量明显减少,红细胞悬液中位用量4600 ml;而术前凝血功能纠正不充分者7例,术中出血量增多,血制品用量也明显增加,红细胞悬液中位用量9000 ml.结论:肝移植术加重术中凝血功能障碍;充分的术前准备和动态监测凝血功能并酌情补充血液成分可减少术中出血和输血,以保障手术顺利进行.     

肝后腔静脉成形术行原位肝移植103例

目的:探讨肝移植新术式肝后腔静脉成形术在人原位肝移植中的应用价值.方法:应用改良肝移植新术式肝后腔静脉成形术行原位肝移植103例,观察其手术所用时间、无肝期、术中出血量及并发症等.结果:本组无1例发生围手术期死亡.肝后腔静脉成形术手术所用时间及无肝期(6.8±0.8 h,52.6±14.5 min)显著短于同期报告资料经典式肝移植(7.4±0.6 h,86.5±7.1 min)以及改良背驮式肝移植(7.9±0.6 h,78.4±7.94 min).术中出血量(2960±1120 mL)也显著少于改良背驮式(4662±913 mL)和经典式肝移植(4441±1072 mL).肝后腔静脉成形术术后肾功能不全发生率为29.1%(30/103),与经典式肝移植相近,比改良背驮式高,但均能在术后3-4 wk内恢复正常.结论:肝移植新术式肝后腔静脉成形术能简化病肝切除和新肝植入的手术操作,缩短手术时间,减少术中出血,值得临床进一步推广应用.     

Conventional Care of Fulminant Hepatic Failure: Medical and Surgical Aspects

Abstract: Fulminant hepatic failure (FHF) is a clinical syndrome with a poor outcome. Survival rates are between 10% and 40% depending on the etiology of hepatic necrosis. Multiple supportive modalities have been tried to improve patient outcome. However, orthotopic liver transplantation has been shown to be the most effective therapy at improving survival. Management of these patients requires invasive monitoring, mechanical ventilation, and infection prophylaxis, all of which are conducted most efficiently in specialized units. The goal is to allow the native liver to regenerate and to prevent the development of complications while maintaining the patient in a condition suitable for orthotopic liver transplantation. Therapeutic plasma exchange improves survival in patients with sufficient residual capacity for regeneration. It is effective in restoring hemostasis, improving neurological function, and prolonging biochemical stability of patients awaiting liver transplantation. Hepatoprotective and hepatotrophic substances are still in the experimental stage. Auxiliary liver grafting and artificial liver support devices have proved to be an adjunct or a bridge to transplantation; however, they are not yet widely available.     

肝移植术后三种主要并发症患者的肝生化指标变化特点分析

目的探讨肝移植术后三种主要并发症患者的肝功能指标变化规律及其与临床病理表现的对应关系,了解其在肝移植术后并发症鉴别诊断中的意义。方法收集209例肝移植术后病理诊断为急性排斥反应（AR）、缺血再灌注损伤（IRI）及胆道狭窄（BDS）患者的临床资料,选取肝穿刺前5d和肝穿刺后3d期间共9个时段的血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（γ-GT）、直接胆红素（DBil）和总胆红素（TBil）5项肝功能指标检测结果,与病理诊断结果进行配对分析。结果IRI组的AST及γ-GT的波动幅度显著高于AR组（P〈0.05）,而ALT的波动幅度显著高于BDS组（P〈0.05）;BDS组的DBil及TBil波动幅度显著高于其他两组（P〈0.05）。结论原位肝移植术后患者的肝功能指标变化能反映AR、IRI和BDS等并发症的基本病理生理特点,将这些特点与肝穿刺病理检查相结合,有助于对AR、IRI和BDS的发生和发展进程以及治疗转归做出客观评估。     

Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma： Report of an initial experience

AIM: To report a retrospective analysis of preliminary results of 36 patients who received sirolimus (SRL, Rapa-mune, rapamycin) in a consecutive cohort of 248 liver allograft recipients. METHODS: Thirty-six liver transplant patients with he-patocellular carcinoma (HCC) who were switched to SRL-based immunosuppression therapy from tacrolimus were enrolled in this study. The patients who were diagnosed as advanced HCC before orthotopic liver transplantation (OLT) were divided into group A (n = 11), those who were found to have HCC recurrence and/or metastasis after OLT were assigned to group B (n=18), and those who developed renal insufficiency caused by calcineurin inhibitor (CNI) were assigned to group C (n = 7) after OLT. RESULTS: The patients were followed up for a median of 10.4 mo (range, 3.8-19.1 mo) after conversion to SRL therapy and 12.3 mo (range, 5.1-34.4 mo) after OLT. Three patients developed mild acute cellular rejection 2 wk after initiating SRL therapy, which was fully reversed after prednisolone pulse therapy. In group A, only 1 patient was found to have HCC recurrence and metastasis 12 mo after OLT. In group B, 66.7% (12/18) patients (2 with progressive tumor, 7 with stable tumor and 3 without tumor) were still alive due to conversing to SRL and/ or resection for HCC recurrence at the end of a median follow-up of 6.8 mo post conversion and 10.7 mo post-transplant. In group C, no HCC recurrence was demonstrated in 7 patients, and renal function became normal after SRL therapy. Thrombocytopenia (n = 2), anemia (n = 8), and oral aphthous ulcers (n = 7) found in our cohort were easily manageable. CONCLUSION: The conversion to SRL-based immuno-suppression may inhibit the recurrence and metastasis of HCC and improve CNI-induced renal insufficiency in OLT patients with HCC.     

Surveillance for hepatocellular carcinoma in patients with cirrhosis improves outcome

Objective

Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation.

Methods

A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n = 172) (group 1); substandard surveillance (n = 48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n = 59) (group 3).

Results

Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P <.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P <.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P <.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests.

Conclusion

The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.