腹部手术中慢性肝功能不全病人罗库溴铵的药效学

目的观察腹部手术中肝功能不全病人罗库溴铵的药效学。方法择期行开腹手术的病人26例,ASAⅠ-Ⅲ级,根据肝功能情况分为2组,Ⅰ组为门脉高压肝硬化病人(肝功能不全组)。Ⅱ组为无肝脏疾病的病人(肝功能正常组),每组13例;监测神经肌肉传导功能,静脉注射诱导剂量罗库溴铵后T1恢复至5%时,持续静脉输注罗库溴铵,初始速率为600μg·kg-1·h-1,每隔5 min以此间隔前速率的10%-20%为标准,调整输入速率,当维持T1=5%的输入速率不发生变化达到1 h以上, 则视为稳态需求量。记录起效时间(注肌松药毕至T1消失的时间)、高峰持续时间(T1由0恢复至5%的时间)、临床有效作用时间(肌松药停止持续输注后T1恢复由5%至25%的时间)和恢复指数(T1 恢复由25%至750%的时间)、持续输注总量、手术时间、瑞芬太尼、异丙酚和咪达唑仑的用量。结果与Ⅱ组比较,Ⅰ组除术前肝功能指标差异有统计学意义外(P<0.05),年龄、性别比、体重、手术时间、瑞芬太尼、异丙酚和咪达唑仑用量差异无统计学意义(P>0.05),罗库溴铵起效时间、高峰持续时间、临床有效作用时间和恢复指数延长(P<0.01)。两组罗库溴铵持续静脉输注的时间相似(P>0.05), 罗库溴铵持续输注总量、平均用量和稳态需求量减少(P<0.05或0.01)。结论罗库溴铵0.6 mg/kg 用于全麻诱导为肝功能不全和肝功能正常病人提供相似的气管插管条件,但在肝功能不全病人中其起效时间、临床作用时间和恢复时间延长,持续输注用量减少。

鸡尾酒疗法治疗合并慢性肝功能不全的急性缺血性卒中

目的以"鸡尾酒"疗法治疗合并慢性肝功能不全的急性缺血性卒中,评价疗效和可能之副作用.方法钙拮抗剂结合脑复康共治疗33例.以未接受鸡尾酒治疗,但接受溶栓和非溶栓治疗者为对照.入院后30分钟、24小时分别按美国国立卫生研究院卒中量表(NIHSS量表)评分.90天时按Barthel指数和修正Rankin量表评分.病情好转率和预后好转率以x2分析进行显著性检验.同时检测血压、谷丙转氨酶、谷氨酰转肽酶、活化部分凝血活酶时间、凝血酶原时间和血小板计数,并以方差分析进行显著性检验.结果处理组病情好转率(42.42%)显著高于非溶栓组(23%,P=0.031),但低于溶栓组(62%,P=0.049);预后良好率处理组(69.70%)和非溶栓组(54%)无显著性差别(P=0.11),但低于溶栓组2(88%,P=0.014).治疗前中后各组血压、谷丙转氨酶、谷氨酰转肽酶、活化部分凝血活酶时间、凝血酶原时间和血小板计数均无显著性差别.结论鸡尾酒疗法可以提高合并慢性肝功能不全急性缺血性卒中的短期疗效,且不影响肝功能和凝血功能,血压下降也可控制在安全范围内.

Real-time shear wave elastography combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease

Objective To observe the value of real-time shear wave elastography(SWE)combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease(CKD).Methods Totally 210 patients with CKD(CKD group)and 64 healthy subjects(control group)were retrospectively enrolled.Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages.SWE parameters of liver and kidney,including mean value,the maximum value and the median value of Young's modulus(EQI mean,EQI max and EQI med)were compared between CKD subgroups and control group.Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage,as well as of liver SWE parameters with biochemical indicators.Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients.Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group(all P≤0.001).Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQI max in CKD4 subgroup were all higher than those in control group(all P<0.003).Kidney SWE parameters in CKD3 subgroup were all higher than those in control group,while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup(all P<0.003).Kidney EQI mean and EQI med in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup,while kidney EQI max in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup(all P<0.003).Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages(r=0.364—0.665,all P<0.001).Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase(ALP)(r=0.229—0.248,all P<0.01).Theγ-glutamyl transferase,ALP and liver EQI max were all independent predictors of liver injury in CKD patients(all P<0.01),with AUC for evaluating liver injury in CKD patients alone of 0.645,0.756 and 0.741,respectively,lower than that of their combination(0.851,all P<0.01).Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages.

肝硬化失代偿期患者大量引流腹水的护理

肝硬化腹水是慢性肝功能不全最常见的严重并发症之一。失代偿期肝硬化大量腹水患者经严格的限水、限钠、使用利尿剂和补充白蛋白等措施治疗无效者称为顽固性腹水。由于肝硬化腹水的易复发性和难治性以及发病年龄的年轻化,不仅给临床治疗带来一定难度,对临床护理也提出了新的挑战,加强对肝硬化腹水患者特别是大量排放腹水后的临床护理和健康指导,能明显加快患者病情的好转以及推迟肝硬化腹水的复发。