目的:分析本院住院部麻醉药品应用的现状及趋势,并作客观评价。方法:对2005~2008年本院麻醉药品的种类、用量、金额、DDDs等进行归类统计、比较和分析。结果:统计结果表明,本院住院部使用麻醉药品的用量及金额呈上升趋势。临床应用以芬太尼类居首。新型麻醉药品的应用也有上升趋势。结论:本院住院部麻醉药品应用基本合理,但仍存在一些不合理的习惯用法,需进一步提高合理用药水平。
ObjectiveTo investigate the change of cellmediated immunity in gut mucosa after major hepatectomy and to study its relationship with the bacteria translocation.MethodsFortyeight Spraguedawley adult male rats were randomly allocated into two groups, the sham operation group and the operation group. Besides without the hepatectomy, the sham operation group has the same course with the operation group. Seventy percent hepatectomy rats are divided as postoperative 6 h group (n=6)，12 h group (n=6)，24 h group (n=6) and 72 h group (n=6). Sixhour, 12hour, 24hour and 72hour after operation specimens were taken from jejunoileum respectively. Immunohistochemical staining was performed on frozen sections and image pattern analysis was used. We also investigate the change of liver function. ResultsTwentyfour hours and 72 hours after 70% hepatectomy, there was a significant reduction in the number of CD3+，CD4+and CD8+ T lymphocytes in the mucosal lamina propria of the operation group compared with the sham operation group （Plt;0.05）. There was significant difference between these two groups in liver function change （Plt;0.05）.ConclusionThere is an altered pattern of intestinal mucosal T lymphocytes after major hepatectomy, then the local cellmediated immunity was depressed, which may be the cause of translocation of enteric bacteria.
ObjectiveTo investigate the protective effect of SadenosylLmethionine on liver regeneration and liver function in cirrhotic rats after hepatectomy. MethodsCirrhosis was successfully induced by injection of 40% CCl4.Then,partial hepatectomy (about 30%) was performed in all rats. Cirrhotic rats were divided into 3 groups,namely,cirrhotic group (normal saline 5 ml/d,for 15 postoperative days，n=20),treatment group 1 〔S adenosylLmethionine 10 mg/(kg·d),for 15 postoperative days,n=16〕 and treatment group 2 〔SadenosylL methionine 20 mg/(kg·d),15 postoperative days,n=16〕,and normal control group was also established. Animals were sacrificed at the 15th postoperative day and 30th postoperative day to take samples for detection of liver function (Alb,ALT,TB,TBA) and serum TNFα.Liver tissues were also observed under light microscope and electron microscope. ResultsIn two treatment groups,at the time point (15 postoperative days or 30 postoperative days),concentrations of ALT,TB,TBA,Alb and TNFα were decreased significantly as compared with cirrhotic group (P ＜0.01),and concentration of Alb was increased significantly (P＜0.01).In contrast, there were no obvious difference in the same time point of different dosetreatment groups (Pgt;0.05),but the decrease of ALT,TB,TBA,TNFα and the increase of Alb were more significant at the second time point (30th postoperative day) than the first time point (15th postoperative day) when treated with same dose (P＜0.01).At the same time,concentration between TNF α and ALT,TB,TBA showed a positive correlation (P＜0.01),and the concentration between TNFα and Alb showed a negative correlation (P＜0.01).In addition, the histopathology showed SadenosylLmethionine had effects of protecting liver function and enhancing liver regeneration. ConclusionThe study suggests that SadenosylL methionine has the efficacy of enhancing liver regeneration and improving liver function.
目的 探讨纤维胆道镜在肝胆管结石手术术中及术后的操作技巧，提高肝胆管结石的临床治愈率。方法 总结分析180例肝胆管结石病例，在纤维胆道镜下观察，使用取石篮取石、钳咬、抓取、冲洗，行术中、术后经T管窦道取出结石。结果 本组180例中158例行术中取石，结石取净率为94.3%（149/158）； 余22例系术后再次经Ｔ管窦道取石，结石取净率为86.4%（19/22）。术中、术后取净结石共168例，结石取净率93.3%（168/180）。结论 纤维胆道镜能有效治疗肝胆管结石，降低术中、术后残余结石发生率，提高治愈率。
目的 研究环氧合酶-2抑制剂药物的应用状况和发展趋势，为临床合理、有效、经济地选用药物提供科学依据。 方法 采用金额排序和用药频度（DDDs）、日均费用（DDC）方法，对四川大学华西医院2008年－2010年环氧合酶-2抑制剂药物的临床应用情况进行统计分析。 结果 2008年－2010年间，该院环氧合酶-2抑制剂药物的应用数量和销售金额呈逐年上升趋势，其中选择性环氧合酶-2抑制剂药物的用量增幅较大，非选择性环氧合酶-2抑制剂药物用量呈下降趋势。 结论 该院环氧合酶-2抑制剂药物临床应用合理，选择性环氧合酶-2占主导地位，有较好的发展前景。
【Abstract】Objective To evaluate effect of artificial liver support system (ALSS) in liver failure and liver transplantation.Methods Forty-four patients with liver failure (including 12 undergoing liver transplantation) were treated with MARS or plasma exchange. The changes of toxic substances and cytokines in blood were detected before and after treatment. Results ALSS therapy achieved a remarkable improvement in clinical symptoms and physical signs. After ALSS treatment, there was a significant decrease in total bilirubin, total bile acid, alanine aminotransferase, creatinine, urea nitrogen, blood ammonia and endotoxin levels(P＜0.05); the levels of serum NO, TNF-α, IL-4 and IL-6 were significantly decreased(P＜0.05); there was no statistical change in erythrocytes, leukocytes and platelets. The survival rate of 30 liver failure patients caused by severe hepatitis B was 60.0%(18/30). Six patients with acute liver failure were successfully performed liver transplantation. Two patients in 6 with acute liver failure after liver transplantation survived. One patient in 2 with acute liver failure after pancreatoduodenectomy survived. Conclusion ALSS plays a positive role in treatment of liver failure by removing blood toxins, NO and cytokines. ALSS also plays a substitute role for liver failure patients who are waiting for liver transplantation.
ObjectiveTo analyze the clinical and dosimetric impacts on radiation pneumonitis (RP), and provides data for radiotherapy planning. MethodsWe reviewed 59 non-operative esophageal cancer patients who underwent radiotherapy from October 2010 to November 2012 to identify the correlation between the clinical and dosimetric parameters with acute radiation pneumonitis (ARP) and severe acute radiation pneumonitis (SARP) by t-Test, Chi-Square Test and logistic regression analysis. ResultsAmong the 59 patients, 33 (55.9%) developed ARP, in whom 9 (15.3%) developed SARP. Univariate analysis showed that lung infection during radiotherapy, mean lung dose (MLD), and dosimetric parameters are significantly correlated with RP. Multivariate analysis revealed lung infection during radiotherapy, MLD≥13 Gy, and V30≥13% were significantly correlated with the increasing risk RP. ConclusionLung infection during radiotherapy, MLD, and V30 are the influencing factors of RP, which should be seriously considered when formulating radiotherapy plan to avoid RP.
Objective To explore the relationship between acute rejection and expression levels of perforin mRNA in peripheral blood and bile after rat liver transplantation so as to look for a kind of noninvasive method to diagnose acute rejection. Methods Rat orthotopic liver transplantation model with biliary extra-drainage was established. They were divided into 4 groups: blank control group (n=20)， isograft group (n=30)， allograft plus cyclosporine A (CsA) group (n=30) and allograft group (n=30). Semi-quantatative RT-PCR was used to measure the expressions of perforin mRNA in bile and peripheral blood and the pathological changes of the graft were observed on postoperative days of 1, 3, 5, 7 and 10. Results Blank control group and isograft group showed no expression of perforin mRNA in peripheral blood. The expression of perforin mRNA of peripheral blood in allograft group could be detected on day 3 after transplantation and it gradually elevated on day 5 and remained in high level during 7-11 days. In allograft plus CsA group perforin mRNA of peripheral blood continuously expressed in a low level, and the level at the same time points was significantly different compared with allograft group (P＜0.05). The expression of perforin mRNA in peripheral blood was analogous with the severity degree of histologic damage. The expression of perforin mRNA can not be found in bile. Conclusion The expression of perforin mRNA in the peripheral blood offers a sensitive and noninvasive means of monitoring acute rejection.