体外冲击波碎石术对兔肝酶活性的影响

采用超微组织化学方法,观察了体外冲击波碎石术(ESWL)对家免肝脏酶活性的影响。实施 ESWL 后,肝细胞的琥珀酸脱氢酶(SDH)和毛细胆管壁上的碱性磷酸酶(ALP)、焦磷酸硫胺素酶(TPPase)反应活性减弱或消失。TPPase 从损伤的肝细胞高尔基体分泌面扁囊、溶酶体样小泡和毛细胆管内溢出,并伴有肝细胞面的质膜上出现了 TPPase 反应产物和形成膜包内凹小泡。结果提示 ESWL 可对肝细胞及毛细胆管的功能和结构有损伤作用。     

ECMO在脓毒症中应用的研究进展

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是一种心肺支持技术,临床上能够为严重、可逆性的心肺衰竭患者提供循环、呼吸支持.近年来,新生儿、儿童和成人脓毒症患者应用ECMO治疗的成功报道日渐增多,掀起了脓毒症患者应用ECMO治疗的热潮.然而,ECMO在脓毒症患者中的临床应用却一直存在争议.大量回顾性研究表明新生儿及儿童脓毒症患者中应用的成功率相对较高,成人脓毒症患者应用ECMO治疗例数较少,但仍可在其他治疗无效的前提下尽早尝试ECMO治疗.     

Out-of-hospital cardiac arrest: the prospect of E-CPR in the Maastricht region

Aim

The current outcome of out-of-hospital cardiac arrest (OHCA) patients in the Maastricht region was analysed with the prospect of implementing extracorporeal cardiopulmonary resuscitation (E-CPR).

Methods

A retrospective analysis of adult patients who were resuscitated for OHCA during a 24-month period was performed.

Results

195 patients (age 66 [57–75] years, 82 % male) were resuscitated for OHCA by the emergency medical services and survived to admission at the emergency department. Survival to hospital discharge was 46.2 %. Notable differences between non-survivors and survivors were observed and included: age (70 [58–79] years) vs. (63 [55–72] years, p = 0.01), chronic heart failure (18 vs. 7 %, p = 0.02), shockable rhythm (67 vs. 99 %, p < 0.01), and return of spontaneous circulation (ROSC) at departure from the site of the arrest (46 vs. 99 %, p < 0.01) and on arrival to the emergency department (43 vs. 98 %, p < 0.01), respectively. Acute coronary syndrome was diagnosed in 32 % of non-survivors vs. 59 % among survivors, p < 0.01. Therapeutic hypothermia was provided in non-survivors (20 %) vs. survivors (43 %), p < 0.01. Percutaneous coronary intervention (PCI) was performed in 14 % of non-survivors while 52 % of survivors received PCI (p < 0.01). No statistical significance was observed in terms of gender, witnessed arrest, bystander CPR, or automated external defibrillator deployed among the cohort. At hospital discharge, moderately severe neurological disability was present in six survivors.

Conclusion

These observations are compatible with the notion that a shockable rhythm, ROSC, and post-arrest care improve survival outcome. Potentially, initiating E-CPR in the resuscitation phase in patients with a shockable rhythm and no ROSC might serve as a bridge to definite treatment and improve survival outcome.     

VCTDSA联合CT 灌乌司他丁联合硝苯地平控释片对ESWL 术后肾功能的保护作用

目的：观察乌司他丁(商品名天普洛安)和硝苯地平控释片(商品名拜新同)对体外冲击波碎石术(ESWL)所致急性肾功能损害 的保护作用。方法：将80 例接受ESWL治疗的肾结石患者,随机分为天普洛安组、拜新同组、天普洛安和拜新同联合组以及对照 组,每组20 例。检测并比较ESWL 前1 d 和后1、3、5 d 患者尿丙二醛(MDA)、N- 乙酰-beta-D- 氨基葡萄糖苷酶/ 肌酐(NAG/Cr)和 24 h尿beta2-微球蛋白(beta2-MG)的变化。结果：EWSL术后第1 天,对照组MDA、NAG/Cr和茁2-MG 水平均明显高于术前(P＜0.05), 且随着术后时间的延长,患者MDA、NAG/Cr 和beta2-MG 水平呈逐渐下降趋势,术后第1、3、5 天治疗组MDA、NAG/Cr 和beta2-MG 数值均明显低于相同时点对照组(P＜0. 05)。术后第1、3 天,联合用药组MDA、NAG/Cr和beta2-MG 水平明显低于单独用药的两组 (乌司他丁组和拜新同组)(P＜0.05),第5 天联合用药组MDA、NAG/Cr 和beta2-MG 水平与单独用药的两组(乌司他丁组和拜新同 组)比较均无明显差异(P＞0.05),单独用药的两组(乌司他丁组和拜新同组)之间在相同时点MDA、NAG/Cr 和beta2-MG 水平无明显 差异。结论：乌司他丁可显著减轻ESWL所致的肾损伤,与钙离子拮抗剂联合用药效果更佳。     

冠状动脉支架植入术后行冠脉旁路移植术

目的:总结15例冠状动脉支架植入术后行冠状动脉旁路移植术的临床经验。方法:回顾分析行冠状动脉支架植入术后行冠状动脉旁路移植术15例患者的资料,男10例,女5例,平均年龄(61±5)岁。行冠状动脉支架植入术后再行冠状动脉旁路移植术时间间隔(24±4)月,冠状动脉内置入支架3-6枚,左室射血分数为43%-64%,其中50%为3例。全组行体外循环下冠状动脉旁路移植术3例,行非体外循环心脏跳动下冠状动脉旁路移植术12例。结果:全组共行动脉桥吻合13支,静脉桥33支;围术期并发低心排综合征3例,肺部感染4例,胸腔内出血行胸腔闭式引流术2例,本组患者无死亡病例。术后平均住院日(13±4)天。结论:对冠状动脉内支架植入术后再狭窄或(和)冠状动脉再血管化不足的病例进行冠状动脉旁路移植治疗,可使冠状动脉达到充分再血管化,提高冠心病患者生活质量及预后。     

体外冲击波联合钻孔减压术对早期股骨头坏死患者关节功能、肌力及生活质量的影响

目的:探讨体外冲击波(ESWT)联合钻孔减压术对早期股骨头坏死患者关节功能、肌力及生活质量的影响。方法:回顾性分析2017年9月~2018年12月期间收治的80例早期股骨头坏死患者的临床资料,依据治疗方式将其分为A组(n=37,钻孔减压治疗)和B组(n=43,钻孔减压联合ESWT治疗),对比两组患者关节功能、肌力、生活质量及并发症情况。结果:两组治疗后3、6、9个月的视觉模拟评分(VAS)评分较治疗前降低(P<0.05),髋关节Harris评分较治疗前升高(P<0.05);B组治疗后3、6、9个月VAS评分低于A组,髋关节Harris评分则高于A组(P<0.05)。两组患者治疗后9个月生理功能、情感职能、躯体疼痛、生理职能、活力、社会功能、总体健康、精神健康这8个维度评分均较治疗前升高,且B组高于A组(P<0.05)。B组患者治疗后9个月肌力3级者少于治疗前及A组同时间点,肌力4级者多于治疗前及A组同时间点(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论:相比于单独采用钻孔减压术,ESWT联合钻孔减压术治疗早期股骨头坏死,可有效减轻患者疼痛症状,改善患者关节功能、肌力及生活质量,且不增加并发症发生率。     

体外与非体外循环冠状动脉旁路移植术再血管化率的系统评价

目的:系统评价采用体外循环与非体外循环下冠状动脉旁路移植术比较,治疗冠状动脉粥样硬化性心脏病的再血管化率。方法:计算机检索MEDLINE(1966～2010.3)、EMbase(1984～2010.3)、Cochrane临床对照试验资料库(2010年第2期)和中国生物医学文献数据库(1979～2010.3),同时手工检索所有纳入试验的参考文献,质量评价后用RevMan 5.0软件进行Meta分析。结果:共纳入2个随机对照试验,包括2276例患者。Meta分析结果显示:体外循环组的再血管化率高于单用非体外循环组,其差异有统计学意义P<0.00001[OR=1.78,95%C(I1.40,2.26)]。结论:当前的证据表明,体外循环下冠状动脉旁路移植术在治疗冠心病时,再血管化率比非体外循环高;评价患者长期预后有一定指导意义。由于纳入研究随访时间较短,上述结论尚需要高质量、大样本、长时间的随机双盲对照试验进一步证实。     

Bone morphogenetic protein activity preservation with extracorporeal irradiation- and liquid nitrogen freezing-treated recycled autografts for biological reconstruction in malignant bone tumor

Recycled autografts have been commonly used in biological reconstruction in conjunction with wide bone resection. Extracorporeal irradiation (ECIR) and freezing are the two major options for pretreating tumor-bearing autografts before transplant. This study, for the first time, compared the effects of these two techniques on bone morphogenetic protein (BMP)-2 activity. Bone tissue extracted from human femoral heads were treated through either ECIR at different doses (5000, 15,000, and 30,000 rad) or liquid nitrogen (LN) freezing for different durations (5, 10, and 15 min). The amount of BMP was analyzed through enzyme-linked immunosorbent assay (ELISA assay). Furthermore, we also used tandem mass spectrometry to analyze change of BMP-2 and BMP-7 expression after high dosage of irradiation (30,000 rad) and long-time of freezing (15 min). To directly evaluate the effect of ECIR or LN freezing treatment on the activity of BMP, commercial recombinant human BMP-2 (rhBMP-2) was added to the culture of human mesenchymal stem cells (hMSCs). The post-treatment activity of rhBMP-2 was quantitated by measuring the osteogenic differentiation of hMSCs with Alizarin Red S staining. Through Western blotting, the activation of the BMP signaling pathway by phospho-Smad antibodies was analyzed. Our results showed that post-treatment levels of BMP did not differ among the ECIR and LN freezing treatments in ELISA assay, but tandem mass spectrometry showed significantly lower expression of BMP-2 after 30,000 rad of irradiation. Both ECIR and freezing lowered the expression of regulatory factors involved in the BMP-activated signaling cascades and similar results were also observed in osteogenic differentiation of hMSCs. However, LN freezing preserved better bioactivity of rhBMP-2 whereas dosage-dependent declination was observed in ECIR groups. In conclusion, considering BMP-2 activity, LN freezing-treated autografts may result in a better osteoinduction outcomes than those treated using ECIR. Further investigation of the factors involved in bone formation is required.     

计算机在体外循环中的应用

计算机在医学领域的应用范围不断扩大,体外循环专业是临床医疗和生物工程紧密合作而产生的,计算机在该领域的应用也有其独特性。在体外循环领域计算机技术不仅直接同一些仪器设备相整合,而且在设备设计,智能化以及质量控制等方面的应用也不断增加。     

坦洛新对输尿管下段结石患者体外冲击波碎石术后排石及血清IL-6，IL-10和CRP水平的影响

目的:探讨输尿管下段结石行体外冲击波碎石术(ESWL)后应用坦洛新辅助排石的临床效果及对患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)水平的影响。方法:选取我院2015年1月～2016年12月收治的122例输尿管下段结石患者,采用随机数字表法均分为两组。于ESWL术后,对照组给予硝苯地平治疗,观察组予以坦洛新治疗。记录比较两组术后排石效果、疼痛情况,治疗前后血清IL-6、IL-10和CRP水平的变化及不良反应的发生情况。结果:治疗后,观察组无石率(91.8%)明显高于对照组(78.7%)(P0.05);观察组排石时间短于对照组,排石直径大于对照组(P0.05);观察组患者血清IL-6,IL-10及CRP水平均显著低于对照组(P0.05)。与对照组相比,观察组肾绞痛发生率、镇痛剂使用率及VAS评分均较低(P0.01)。用药期间,两组均未发生明显不良反应(P0.05)。结论:坦洛新能有效提高输尿管下段结石患者体外冲击波碎石术的排石效果,减轻机体损伤,缓解术后疼痛,并且安全性较高。