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。     

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.     

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。     

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。     

57例老年人甲状腺机能亢进症临床分析

５７例老年人甲状腺机能亢进症临床分析第一医院老年科曾凡荣，蒲霞，刘永碧，马厚勋中图分类号Ｒ５８１．１老年人甲状腺机能亢进证（甲亢）临床表现常不够典型，误诊率亦较高￣［１，２］。本文就我院１９８３年３月至１９９２年２月共收治住院甲亢１００６例，对其中５...     

732例离退休干部健康体检情况分析

为探讨老年人健康状况,做好离退休干部医疗保健工作,寻找危害老年人健康及生命的高危因素,制定相应的防治措施,我们于1992~1993年对重庆市部份     

阿苯达唑治疗多发性细粒棘球蚴病1例

<正> 最近,我们用阿苯达唑治疗1例多发性肺包虫病患者,取得了较好的疗效,现报道如下. 患者男性,37岁,农场工人,住院号122456,因咳嗽,痰中反复带血7mo(月),于1984年8月3日入院.1yr前患者在修建房屋时,从2M高屋顶跳下,30min后出现寒颤,发热,出汗等,患者卧床休息约30min后恢复.7mo前开始反复小量略血与痰中带血,并有咳嗽.在当地医院摄胸片,发现双肺有多个乒乓球大小的块影,拟诊为转移性肺癌而来我院就诊.病后患者一般情况较好,无消瘦或食欲减退,