BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of...BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of hydroxyapatite,which is highly infilt-rative to tissues,thus making complete resection difficult.An adjuvant method to remove or resolve the residual crystals during the operation is necessary.CASE SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions(28 mEq/L)was used as the adjuvant.After resecting calcium phosphate deposits of tumoral calcinosis as much as possible,while filling with the solution,residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field.A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders,bilateral hip joints,and the right foot.A shoulder lesion was resected,but the calcification remained and early re-deposition was observed.Considering the difficulty of a complete rection,we devised a bicarbonate dissolution method and excised the foot lesion.After resection of the calcified material,the residual calcified material was washed away with bicarbonate Ringer’s solution.CONCLUSION The bicarbonate dissolution method is a new,simple,and effective treatment for tumoral calcinosis in hemodialysis patients.展开更多
目的观察碳酸氢钠林格液对高原地区休克伴高乳酸血症患者行乳酸靶向复苏策略的疗效。方法选择2019年1月至2021年5月武威市人民医院急救中心收治的259例休克伴高乳酸血症患者作为研究对象。根据复苏晶体液选择不同将患者分碳酸氢钠林格...目的观察碳酸氢钠林格液对高原地区休克伴高乳酸血症患者行乳酸靶向复苏策略的疗效。方法选择2019年1月至2021年5月武威市人民医院急救中心收治的259例休克伴高乳酸血症患者作为研究对象。根据复苏晶体液选择不同将患者分碳酸氢钠林格液组〔122例,给予碳酸氢钠林格液1500~3000 mL静脉滴注(静滴)〕和常规晶体液组(137例,给予0.9%生理盐水和复方氯化钠溶液1500~3000 mL静滴)。比较两组住院时间、病死率和多器官功能障碍综合征(MODS)发生率的差异,并观察两组治疗前和治疗后6、12、24、48 h pH值、血乳酸(Lac)、剩余碱(BE)、Na^(+)、Cl^(-)、HCO3-、平均动脉压(MAP)、乳酸清除率(LCR)等生理参数的变化。结果碳酸氢钠林格液组住院时间较常规晶体液组明显缩短〔d:6.0(3.0,10.0)比9.0(3.5,15.0),P<0.05〕,病死率较常规晶体液组明显降低〔18.9%(23/122)比29.9%(41/137),P<0.05〕,MODS发生率较常规晶体液组降低〔54.1%(66/122)比64.2%(88/137)〕,但差异无统计学意义(P>0.05)。随治疗时间延长,观察期间两组pH值、BE、MAP、LCR、HCO3-均呈升高趋势,Lac呈降低趋势,各时间点与治疗前比较差异均有统计学意义(均P<0.05),且治疗6 h内和6~12 h变化趋势显著,直至恢复到正常参考值范围。与常规晶体液组比较,碳酸氢钠林格液组治疗后48 h pH值、BE均明显降低〔pH值:7.37±0.11比7.40±0.07,BE(mmol/L):-1.8(-2.5,1.3)比-0.5(-1.9,1.8),均P<0.05〕,治疗后48 h MAP和治疗后6 h LCR均明显升高〔MAP(mmHg,1 mmHg≈0.133 kPa):83.92±4.66比82.07±7.97,LCR(%):50.0(26.1,76.5)比24.3(0.3,24.8)〕,治疗后24 h Na^(+)和治疗后12 h Cl^(-)亦均明显降低〔Na^(+)(mmol/L):140.08±5.13比142.12±5.03,Cl^(-)(mmol/L):99.36±4.46比104.05±11.06,均P<0.05〕。结论采用碳酸氢钠林格液对高原地区休克伴高乳酸血症患者进行扩容治疗,可快速改善酸中毒,更好地维持酸碱平衡;以Lac、LCR为靶向复苏策略,可防止液体矫枉过正或不足,从而为临床治疗提供科学依据,避免造成组织细胞进一步损害,缩短住院时间,降低病死率,且疗效较常规晶体液更显著。展开更多
文摘BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis patients.Calcium phosphate crystals are mainly composed of hydroxyapatite,which is highly infilt-rative to tissues,thus making complete resection difficult.An adjuvant method to remove or resolve the residual crystals during the operation is necessary.CASE SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions(28 mEq/L)was used as the adjuvant.After resecting calcium phosphate deposits of tumoral calcinosis as much as possible,while filling with the solution,residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field.A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders,bilateral hip joints,and the right foot.A shoulder lesion was resected,but the calcification remained and early re-deposition was observed.Considering the difficulty of a complete rection,we devised a bicarbonate dissolution method and excised the foot lesion.After resection of the calcified material,the residual calcified material was washed away with bicarbonate Ringer’s solution.CONCLUSION The bicarbonate dissolution method is a new,simple,and effective treatment for tumoral calcinosis in hemodialysis patients.
文摘目的观察碳酸氢钠林格液对高原地区休克伴高乳酸血症患者行乳酸靶向复苏策略的疗效。方法选择2019年1月至2021年5月武威市人民医院急救中心收治的259例休克伴高乳酸血症患者作为研究对象。根据复苏晶体液选择不同将患者分碳酸氢钠林格液组〔122例,给予碳酸氢钠林格液1500~3000 mL静脉滴注(静滴)〕和常规晶体液组(137例,给予0.9%生理盐水和复方氯化钠溶液1500~3000 mL静滴)。比较两组住院时间、病死率和多器官功能障碍综合征(MODS)发生率的差异,并观察两组治疗前和治疗后6、12、24、48 h pH值、血乳酸(Lac)、剩余碱(BE)、Na^(+)、Cl^(-)、HCO3-、平均动脉压(MAP)、乳酸清除率(LCR)等生理参数的变化。结果碳酸氢钠林格液组住院时间较常规晶体液组明显缩短〔d:6.0(3.0,10.0)比9.0(3.5,15.0),P<0.05〕,病死率较常规晶体液组明显降低〔18.9%(23/122)比29.9%(41/137),P<0.05〕,MODS发生率较常规晶体液组降低〔54.1%(66/122)比64.2%(88/137)〕,但差异无统计学意义(P>0.05)。随治疗时间延长,观察期间两组pH值、BE、MAP、LCR、HCO3-均呈升高趋势,Lac呈降低趋势,各时间点与治疗前比较差异均有统计学意义(均P<0.05),且治疗6 h内和6~12 h变化趋势显著,直至恢复到正常参考值范围。与常规晶体液组比较,碳酸氢钠林格液组治疗后48 h pH值、BE均明显降低〔pH值:7.37±0.11比7.40±0.07,BE(mmol/L):-1.8(-2.5,1.3)比-0.5(-1.9,1.8),均P<0.05〕,治疗后48 h MAP和治疗后6 h LCR均明显升高〔MAP(mmHg,1 mmHg≈0.133 kPa):83.92±4.66比82.07±7.97,LCR(%):50.0(26.1,76.5)比24.3(0.3,24.8)〕,治疗后24 h Na^(+)和治疗后12 h Cl^(-)亦均明显降低〔Na^(+)(mmol/L):140.08±5.13比142.12±5.03,Cl^(-)(mmol/L):99.36±4.46比104.05±11.06,均P<0.05〕。结论采用碳酸氢钠林格液对高原地区休克伴高乳酸血症患者进行扩容治疗,可快速改善酸中毒,更好地维持酸碱平衡;以Lac、LCR为靶向复苏策略,可防止液体矫枉过正或不足,从而为临床治疗提供科学依据,避免造成组织细胞进一步损害,缩短住院时间,降低病死率,且疗效较常规晶体液更显著。
