护理干预在直肠癌前切除术后并发吻合口瘘的应用及效果

目的：探讨护理干预在直肠癌前切除术后并发吻合口瘘的应用及效果。方法：将179例患者分为对照组和观察组,分别给予 常规护理和综合护理,观察护理干预在直肠癌前切除术后并发吻合口瘘的应用效果。结果：对照组术后3 d内5例患者发生吻合 口瘘,3例患者术后4-7 d发生吻合口瘘;观察组术后3 d内1例患者发生吻合口瘘,1例患者术后4-7 d发生吻合口瘘,两组吻合 口发生率差异有统计学意义（x2=3.880,P＜0.05）。经过护理和治疗后,观察组患者吻合口瘘愈合时间明显短于对照组（t=4.026,P＜ 0.05）。对照组SAS 阳性率69.23%,观察组50.00%,二者之间具有统计学差异（x2=5.186,P＜0.05）;对照组SDS阳性率61.54%,观 察组40.00%,二者之间具有统计学差异（x2=4.978,P＜0.05）。结论：合理有效的综合护理措施可以减少吻合口瘘和医患矛盾的发 生,提高患者对治疗的满意度,促进医患关系的和谐。     

急诊介入栓塞治疗支气管动脉-肺动脉瘘大咯血的效果

目的:观察急诊介入栓塞治疗支气管动脉-肺动脉瘘大咯血患者的疗效,分析栓塞剂的选择及合理应用,为临床研究提供参考。方法:30例支气管动脉-肺动脉瘘大咯血患者采用急诊介入造影检查,使用丙烯酸微球和明胶海绵条对出血动脉行急诊栓塞治疗,对动脉造影表现及治疗结果进行回顾性分析。结果:共找到并成功栓塞42支出血的支气管动脉,28支采用单独丙烯酸微球栓塞治疗,14支行丙烯酸微球与明胶海绵条联合栓塞治疗。栓塞术后随访1年,所有患者栓塞术后均无再次咯血及严重并发症出现。结论:急诊动脉栓塞治疗支气管动脉-肺动脉瘘大咯血是一种安全、有效的微创治疗手段。合理的选择和使用栓塞剂是确保栓塞治疗成功的的关键。     

长江刀鲚不同生态型间的某些形态差异

摘要：为寻找和检验长江刀鲚（Coilia nasus）不同生态型间的形态差异,分析了江苏靖江、上海九段沙、浙江太湖和江西鄱阳湖4个种群906尾样本的脊椎骨数、臀鳍条数和上颌骨长。结果表明,即使是同一种群内的脊椎骨数和臀鳍条数变幅也较大,但均以靖江和九段沙种群的较多,众数分别为81、80和108、109;太湖和鄱阳湖种群...     

Novel insights into interactions between mitochondria and xanthine oxidase in acute cardiac volume overload

Xanthine oxidoreductase (XOR) is increased in the left ventricle (LV) of humans with volume overload (VO), and mitochondrial inhibition of the respiratory chain occurs in animal models of VO. Because mitochondria are both a source and a target of reactive oxygen and nitrogen species, we hypothesized that activation of XOR and mitochondrial dysfunction are interdependent. To test this we used the aortocaval fistula (ACF) rat model of VO and a simulation of the stretch response in isolated adult cardiomyocytes with and without the inhibitor of XOR, allopurinol, or the mitochondrially targeted antioxidant MitoQ. Xanthine oxidase (XO) activity was increased in cardiomyocytes from ACF vs sham rats (24h) without an increase in XO protein. A twofold increase in LV end-diastolic pressure/wall stress and a decrease in LV systolic elastance with ACF were improved when allopurinol treatment (100mg/kg) was started at ACF induction. Subsarcolemmal State 3 mitochondrial respiration was significantly decreased in ACF and normalized by allopurinol. Cardiomyocytes subjected to 3h cyclical stretch resulted in an increase in XO activity and mitochondrial swelling, which was prevented by allopurinol or MitoQ pretreatment. These studies establish an early interplay between cardiomyocyte XO activation and bioenergetic dysfunction that may provide a new target that prevents progression to heart failure in VO.     

Diagnostic and therapeutic approach of congenital solitary coronary artery fistulas in adults: Dutch case series and review of literature

Background

Coronary artery fistulas (CAFs) are infrequent anomalies, coincidentally detected during coronary angiography (CAG).

Aim

To elucidate the currently used diagnostic imaging modalities and applied therapeutic approaches.

Materials and Methods

Five Dutch patients were found to have CAFs. A total of 170 reviewed subjects were subdivided into two comparable groups of 85 each, treated with either percutaneous ‘therapeutic’ embolisation (PTE group) or surgical ligation (SL group).

Results

In our series, the fistulas were visualised with several diagnostic imaging tests using echocardiography, multidetector computed tomography, and CAG. Four fistulas were unilateral and one was bilateral; five originated from the left and one originated from the right coronary artery. Among the reviewed subjects, high success rates were found in both treatment groups (SL: 97% and PTE: 93%). Associated congenital or acquired cardiovascular disorders were frequently present in the SL group (23%). Bilateral fistulas were present in 11% of the SL group versus 1% of the PTE group. The fistula was ligated surgically in one and abolished percutaneously in another. Medical treatment including metoprolol was conducted in two, and watchful waiting follow-up was performed in one.

Conclusions

Several diagnostic imaging techniques are available for assessment of the anatomical and functional characteristics of CAFs.     

覆膜支架封堵治疗食管胃吻合口-胸腔瘘的临床疗效

目的：探讨采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘的,临床价值及其安全性。方法：6例经碘水造影检查证实的食管胃吻合口-胸腔瘘患者,植入覆膜支架后,持续性胸腔引流,抗感染治疗。结果：6例患者共植入7枚支架,支架展开良好,1枚移位。有效率6／7（86％）。置入覆膜支架后,既封堵了瘘口又解决了进食问题,控制了感染。结论：采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘具有较高的临床价值及安全性。     

应用奥曲肽预防胰十二指肠切除术后胰漏作用的研究

目的：预防性使用奥曲肽是否能减少胰十二指肠切除术后胰漏发生率存在着争议。本研究旨在研究奥曲肽在不同胰腺情况下预防胰十二指肠切除术后胰漏发生的作用。方法：本研究将＂软胰腺＂、＂细胰管＂作为术后胰漏发生的高危险因素,将184例胰十二指肠切除术病例分为4组：低危险/非奥曲肽组、低危险/奥曲肽组、高危险/非奥曲肽组、高危险/奥曲肽组。观察术后胰漏等术后并发症情况。结果：共发生术后胰漏35例（19%）,其中高危险组胰漏发生率是低危险组2倍以上（27%versus 10%,P〈0.01）。在胰漏发生低危险胰腺情况下,奥曲肽组与非奥曲肽组术后胰漏发生无显著差别;在胰漏发生高危险胰腺情况下,奥曲肽能显著降低术后胰漏发生率。结论：在胰十二指肠切除术围手术期应根据胰腺的具体情况选择性使用奥曲肽既能有效预防术后胰漏的发生,又能避免不必要的浪费。     

覆膜支架封堵治疗食管胃吻合口- 胸腔瘘的临床疗效

目的:探讨采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘的临床价值及其安全性。方法:6例经碘水造影检查证实的食管胃吻合口-胸腔瘘患者,植入覆膜支架后,持续性胸腔引流,抗感染治疗。结果:6例患者共植入7枚支架,支架展开良好,1枚移位。有效率6/7(86%)。置入覆膜支架后,既封堵了瘘口又解决了进食问题,控制了感染。结论:采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘具有较高的临床价值及安全性。     

重症急性胰腺炎上腹联合侧腹壁切口术后的综合护理探讨

目的:观察上腹联合侧腹壁切口治疗重症急性胰腺炎(severe acute pancreatitis,SAP)术后综合护理的疗效。方法:对我院2006年1月至2010年6月在我科接受上腹和侧腹联合切口手术的46例SAP患者进行回顾性分析。其中26例患者接受综合护理,包括采用造瘘袋辅助护理、使用可调节式伤口保护罩、早期持续冲洗及负压吸引等;20例患者接受常规护理。比较两种护理策略对SAP开放性伤口的预后影响。结果:接受综合护理的患者再次手术率(5/26 vs 10/20,P=0.027),住院周期(26.08±8.48 vs.31.95±8.82,P=0.03)及护士工作满意度(93.15±4.05 vs.87.45±5.90,P<0.01)等方面均优于接受常规护理的患者。综合护理组患者住院期间死亡率(0/26 vs 3/20,P=0.075)及术后肠瘘发生率(1/26 vs 4/20,P=0.08)有降低的趋势。结论:采用综合护理可降低再次手术率,促进伤口愈合,缩短住院周期,可能降低肠瘘发生率及死亡率,提高护理疗效。     

18 例维吾尔族膀胱阴道瘘临床分析

目的:探讨维吾尔族膀胱阴道瘘的病因、诊断及治疗措施。方法:对2006年6月～2011年6月新疆自治区人民医院泌尿外科经美兰试验和膀胱镜检查确诊的18例维吾尔族膀胱阴道瘘患者的病历资料进行回顾性的临床分析。17例患者行瘘修补术,其中12例(70.59%)经腹修补,5例(29.41%)经阴道修补。1例患者行双侧输尿管经皮造瘘术。结果:18例患者中,16例1次修补成功,1例2次修补后成功。术后随访1至12个月无复发。结论:阴道分娩难产在维吾尔族膀胱阴道瘘患者中最为多见,根据患者全身情况、瘘道大小及位置选择合适的手术路径,术前充分准备,术后严格管理,大大提高手术成功率。