连续性高容量血液滤过对重症急性肾功能衰竭患者外周血细胞因子的影响

目的 研究连续性高容量血液滤过(CHVHF)对重症急性肾衰患者外周血TNF-α、IL-1β、IL-2R、IL-4、IL-6、IL-8、IL-l0的影响。方法 18例重症急性肾衰(ARF)患者使用Baxter BM25机器及F40型聚砜膜滤器行CHVHF治疗9—10h／d。置换液流量为400-500m1／h，均以前稀释方式输入。在治疗前和治疗后2、4、6、8和10h(或结束时)取血检测TNF-α、IL-1β、IL-2、IL-2R、IL-4、IL-6、IL-8、IL-l0的浓度。结果 18例重症ARF患者存活13例，其中10例肾功能完全恢复。治疗后血浆促炎细胞因子TNF-α、IL-1β、IL-2、IL-2R以及IL-8水平均逐渐降低，并以治疗后6—8h降低最为显著。然而．在CHVHF治疗8—10h，均有不同程度地回升，但仍均显著低于CHVHF治疗前水平。血浆抗炎细胞因子IL-4、IL-6及IL-l0在CHVHF治疗后也逐步降低，以治疗后2—4h降低最显著，随后均逐渐升高，并维持至治疗后10h。结论 使用60型血滤器行CHVHF可清除多种细胞因子，其清除作用具有饱和效应，适时更换血滤器可能有助于增加这些炎性细胞因子的清除。     

真伪利石素经验鉴别

利石素是一种较好的化结石药物，对肾、胆、膀胱等结石，如果症状未致严重，结石较小的，该药能起溶解结石作用，使结石从小便排出。目前，我们在对市面上的利石素进行检查中发现了多种假冒伪劣药品，现将真、伪利石素的主要区别分述于下，以供参考．1．真品利石素；1．1真利石素多为椭圆形深棕红色透明胶囊，外观均匀。新近亦有从西德进口的利石素为圆形的深红棕色透明胶丸。本品的内容物滴于白色滤纸上可见红棕色油状液体，有较强烈的松节油及硫磺的特臭。1．2在外包装上．包装盒瓶及说明书上英文字母清析工整说明书上影印的粉红色利石素…     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.     

溶血性贫血患者的护理

溶血性贫血是指红细胞破坏加速,超过骨髓造血功能的代偿能力而发生的贫血。因为红细胞膜先天性异常所致的溶血性贫血,包括遗传性球形红细胞增多症、遗传性椭圆形红细胞增多症等;因为红细胞酶异常所致溶血性贫血,     

神经外科患者术后颅内感染预防及护理的研究进展

<正>颅内感染(Intracranial infection,ICI)是神经外科颅脑术后严重并发症之一,直接影响患者的预后效果和康复质量。国外报道颅脑术后感染率为2%~9%~([1])。其国内发生率约为1.40%~3.71%~([2-3])。神经外科是医院感染的高发科室之一,由于患者病情重、侵入性操作多、手术复杂、住院时间长等原因,导致患者术后易发生颅内感染。针对术后发生的颅内感染的因素,临床干预手法较单一,但文献回顾发现,     

HPLC法测定富马酸替诺福韦二吡呋酯原料药和胶囊中的有关物质

目的:建立测定富马酸替诺福韦二吡呋酯原料药和胶囊中有关物质的方法。方法:采用高效液相色谱法。色谱柱为Eclipse XDB-C18,流动相为甲醇-0.05%磷酸溶液(40∶60,V/V)和甲醇(梯度洗脱),检测波长为260 nm,流速为1.0 ml/min,柱温为40℃,进样量为20μl。结果:已知杂质替诺福韦单吡呋酯浓度在2.515~20.120μg/ml范围内与峰面积呈良好的线性关系(r=0.999 9);检测限为3.75μg/ml,定量限为12.50 ng/ml;精密度、稳定性、重复性试验的RSD分别为0.42%、2.00%、2.67%。按自身对照法测得替诺福韦单吡呋酯含量的结果偏高。结论:该方法操作简便、专属性强、灵敏度高,可用于富马酸替诺福韦二吡呋酯原料药和胶囊中有关物质的测定。     

超声诊断乳腺肿块的价值

目的 探讨超声诊断乳腺肿块的应用价值.方法 对101例乳腺良性肿块及恶性肿瘤患者分别进行常规二维超声及彩色多普勒检查,并与手术病理检查对照,分析两者不同的声像改变.结果 乳腺良性肿块较恶性在形态、边缘、包膜、声晕、后方回声等声像特征比较差异有统计学意义(P＜0.05),尤其是恶性肿块的微小钙化点检出率50.0%(32/64)与Ⅰ级以上血流信号93.8%(60/64),后方衰减43.7%(28/64),高回声晕31.2%(20/64),较良性肿块的微小钙化点检出率10.8%(4/37)与Ⅰ级以上血流信号27.0%(10/37),后方衰减18.9%(7/37)为高,且差异有统计学意义(P＜0.01).结论 常规二维超声结合彩色多普勒超声检查对乳腺肿瘤的早期检出具有重要价值.     

轮状病毒肠炎并心肌损害102例临床分析

目的探讨轮状病毒（rotavirus,RV）肠炎致心肌损伤的临床特点,指导其诊断和治疗。方法回顾分析2007年2月～2011年12月在本院治疗的轮状病毒肠炎患儿265例,均做心电图、心肌酶谱检测。结果 102例患儿心肌酶增高,心电图有异常,心肌损伤病例占同期轮状病毒肠炎患儿的38.5%。其心肌酶的增高与脱水的程度和病情轻重相关。结论轮状病毒肠炎并心肌损害多属于潜在性和亚临床型心肌损害,在临床表现上并无特殊性,有面色苍白、精神萎靡症状及合并脱水、酸中毒的患儿更易发生心肌损害,诊断上依靠心肌酶及心电图检查,只要做到早期发现、早期治疗,轮状病毒肠炎并心肌损害预后较好。     

循坐骨神经穴位针刺联合分阶段康复训练法对老年股骨颈骨折髋关节置换术后患者的疗效

目的：探讨循坐骨神经穴位针刺联合分阶段康复训练法对老年股骨颈骨折（FNF）髋关节置换术后患者的疗效。方法：选取2019年6月—2021年6月来上海市第五康复医院就诊并符合纳入标准的老年FNF患者86例,参照随机数字表法分入观察组与对照组,每组43例。两组均进行常规全髋关节置换术及术后常规干预措施;对照组采取分阶段康复训练法干预;观察组在对照组的基础上行循坐骨神经穴位针刺干预。两组连续观察3个月。比较两组髋关节Harris评分、骨折愈合时间、骨密度、临床疗效及并发症。结果：术后3个月,观察组患者的Harris评分明显高于对照组,而骨折愈合时间显著短于对照组（P <0.01）;术后3个月,两组腰椎正位（L2-4）、右跟骨、股骨颈的骨密度明显升高,且观察组明显高于对照组（P <0.01）;末次随访当日,观察组的髋关节功能优良率较对照组提升更加显著（90.70%vs 69.77%,P <0.05）;观察组患者中下肢深静脉血栓与假体松动发生率显著低于对照组（4.66%vs 23.26%,P <0.05）。结论：于西医常规干预基础上,循坐骨神经穴位针刺联合分阶段康复训练法对...