目的：分析肝移植术后持续性血小板减少的危险因素，探索减少该疾病发生的有效治疗手段。方法：回顾性分析在浙江大学医学院附属第一医院肝胆胰外科2009年1月—2012年6月期间接受肝移植手术并符合纳入标准的128例患者资料，对移植前脾...目的：分析肝移植术后持续性血小板减少的危险因素，探索减少该疾病发生的有效治疗手段。方法：回顾性分析在浙江大学医学院附属第一医院肝胆胰外科2009年1月—2012年6月期间接受肝移植手术并符合纳入标准的128例患者资料，对移植前脾脏体积、术前门静脉直径、术前胃左静脉直径、术前和术后血小板、术前和术后白细胞、术前总胆红素水平及终末期肝病模型评分等指标进行统计分析，筛选术后持续性血小板减少的独立危险因素。并且对在2012—2013年期间部分术前存在危险因素的患者行肝移植同期脾动脉缩窄术，分析其术后持续性血小板减少的发生率。结果：患者肝移植术前脾脏体积大于500 ml （ P＝0.012， OR＝2.789，95％可信区间：1.249～6.227）以及门静脉直径大于15 mm （ P ＝0.017， OR＝3.124，95％可信区间：1.230～7.933）为术后持续性血小板减少的独立危险因素。行肝移植同期脾动脉缩窄术的6例患者中仅1例（16.7％）在术后表现为持续性血小板减少，而对照组48例中32例（66.7％）术后存在持续性血小板减少，两者间差异有统计学意义（ P＜0.05）。结论：患者肝移植术前脾脏体积大于500 ml以及门静脉直径大于15 mm可以作为肝移植术后持续性血小板减少的独立危险因素。肝移植手术同期行脾动脉缩窄术以控制脾脏体积作为肝移植术后持续性血小板减少的预防方法具有一定的临床效果。展开更多
Evaluating and managing circulatory failure is one of the most challenging tasks for medical practitioners involved in critical care medicine.Understanding the applicability of some of the basic but,at the same time,c...Evaluating and managing circulatory failure is one of the most challenging tasks for medical practitioners involved in critical care medicine.Understanding the applicability of some of the basic but,at the same time,complex physiological processes occurring during a state of illness is sometimes neglected and/or presented to the practitioners as point-of-care protocols to follow.Furthermore,managing hemodynamic shock has shown us that the human body is designed to fight to sustain life and that the compensatory mechanisms within organ systems are extraordinary.In this review article,we have created a minimalistic guide to the clinical information relevant when assessing critically ill patients with failing circulation.Measures such as organ blood flow,circulating volume,and hemodynamic biomarkers of shock are described.In addition,we will describe historical scientific events that led to some of our current medical practices and its validation for clinical decision making,and we present clinical advice for patient care and medical training.展开更多
To validate the accuracy and consistency of respiratory inductive plethysmography (RIP) in measuring tidal volume after an overnight sleep, tidal volumes of 18 patients with suspected sleep disordered breathing and 8...To validate the accuracy and consistency of respiratory inductive plethysmography (RIP) in measuring tidal volume after an overnight sleep, tidal volumes of 18 patients with suspected sleep disordered breathing and 8 normal volunteers were measured simultaneously with RIP (V TRIP ) and with an ultrasonic airflow meter (V TUFM ) before and after an unstrained overnight sleep on supine and lateral decubitus. The bias of the V TRIP was expressed as (V TRIP V TUFM )/ V TUFM ·100 %, limits of agreement between V TRIP and V TUFM was measured by averaged bias ±2 s . Results showed that in normal subjects, the bias of RIP before and after overnight sleep was precise and consistent in both supine (0.7 % and -1.6 %) and lateral decubitus (3.7 % and -0.56 %). In these patients, the bias of RIP before and after sleep in supine also remained small (1.9 % and 1.7 %), but it became larger in lateral decubitus (24.5 % and 20.4 %) and 11.5 % exceeded the limits of agreement observed in the evening. The patients′ body mass indices (BMI) were higher than those of normal subjects (median 34.2 vs. 27.8 kg/m 2). Pooled data showed that the bias of V TRIP in the morning on lateral decubitus but not on supine was correlated to BMI (Spearman R=0.32, n =52, P =0.02). Thus, we were led to conclude that the accuracy of V TRIP overnight was precise and consistent in normal subjects, but the deviation of V TRIP measured on lateral decubitus in patients especially in those with excessive obesity was greater, thus, the method should not be used for quantitative determination.展开更多
Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory h...Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory health in childhood and adolescence mainly in terms of asthma occurrence. Additionally, there is a mounting body of evidence that overweight/obesity may also affect lung function in non-asthmatic subjects. The aim of this review was to present and discuss the studies that investigated this issue in non-asthmatic children and adolescents. Only a few studies have evaluated the impact of excess weight on static volumes and their results point towards an inverse relationship between overweight/obesity and functional residual capacity. More studies have been conducted on the impact of excess weight on dynamic lung volumes with inconsistent, however, results. Nevertheless, a relatively consistent finding was that the ratio of forced expiratory volume in 1 s/forced vital capacity was significantly lower among overweight/obese children compared to their counterparts with normal weight. The underlying mechanisms of these observations have not been adequately elucidated but it is believed to result from complex interaction of mechanical, developmental, and metabolic causes. There is a need for more welldesigned studies in order to clarify the impact of excess weight on lung function in non-asthmatic subjects, as well as to explore the contribution of factors such as duration and degree of obesity, and fat distribution. Despite the absence of conclusive data, there are stillconvincing evidence to be communicated to the children and their families as part of the arguments to encourage them to adopt a healthier lifestyle.展开更多
文摘目的：分析肝移植术后持续性血小板减少的危险因素，探索减少该疾病发生的有效治疗手段。方法：回顾性分析在浙江大学医学院附属第一医院肝胆胰外科2009年1月—2012年6月期间接受肝移植手术并符合纳入标准的128例患者资料，对移植前脾脏体积、术前门静脉直径、术前胃左静脉直径、术前和术后血小板、术前和术后白细胞、术前总胆红素水平及终末期肝病模型评分等指标进行统计分析，筛选术后持续性血小板减少的独立危险因素。并且对在2012—2013年期间部分术前存在危险因素的患者行肝移植同期脾动脉缩窄术，分析其术后持续性血小板减少的发生率。结果：患者肝移植术前脾脏体积大于500 ml （ P＝0.012， OR＝2.789，95％可信区间：1.249～6.227）以及门静脉直径大于15 mm （ P ＝0.017， OR＝3.124，95％可信区间：1.230～7.933）为术后持续性血小板减少的独立危险因素。行肝移植同期脾动脉缩窄术的6例患者中仅1例（16.7％）在术后表现为持续性血小板减少，而对照组48例中32例（66.7％）术后存在持续性血小板减少，两者间差异有统计学意义（ P＜0.05）。结论：患者肝移植术前脾脏体积大于500 ml以及门静脉直径大于15 mm可以作为肝移植术后持续性血小板减少的独立危险因素。肝移植手术同期行脾动脉缩窄术以控制脾脏体积作为肝移植术后持续性血小板减少的预防方法具有一定的临床效果。
文摘Evaluating and managing circulatory failure is one of the most challenging tasks for medical practitioners involved in critical care medicine.Understanding the applicability of some of the basic but,at the same time,complex physiological processes occurring during a state of illness is sometimes neglected and/or presented to the practitioners as point-of-care protocols to follow.Furthermore,managing hemodynamic shock has shown us that the human body is designed to fight to sustain life and that the compensatory mechanisms within organ systems are extraordinary.In this review article,we have created a minimalistic guide to the clinical information relevant when assessing critically ill patients with failing circulation.Measures such as organ blood flow,circulating volume,and hemodynamic biomarkers of shock are described.In addition,we will describe historical scientific events that led to some of our current medical practices and its validation for clinical decision making,and we present clinical advice for patient care and medical training.
文摘To validate the accuracy and consistency of respiratory inductive plethysmography (RIP) in measuring tidal volume after an overnight sleep, tidal volumes of 18 patients with suspected sleep disordered breathing and 8 normal volunteers were measured simultaneously with RIP (V TRIP ) and with an ultrasonic airflow meter (V TUFM ) before and after an unstrained overnight sleep on supine and lateral decubitus. The bias of the V TRIP was expressed as (V TRIP V TUFM )/ V TUFM ·100 %, limits of agreement between V TRIP and V TUFM was measured by averaged bias ±2 s . Results showed that in normal subjects, the bias of RIP before and after overnight sleep was precise and consistent in both supine (0.7 % and -1.6 %) and lateral decubitus (3.7 % and -0.56 %). In these patients, the bias of RIP before and after sleep in supine also remained small (1.9 % and 1.7 %), but it became larger in lateral decubitus (24.5 % and 20.4 %) and 11.5 % exceeded the limits of agreement observed in the evening. The patients′ body mass indices (BMI) were higher than those of normal subjects (median 34.2 vs. 27.8 kg/m 2). Pooled data showed that the bias of V TRIP in the morning on lateral decubitus but not on supine was correlated to BMI (Spearman R=0.32, n =52, P =0.02). Thus, we were led to conclude that the accuracy of V TRIP overnight was precise and consistent in normal subjects, but the deviation of V TRIP measured on lateral decubitus in patients especially in those with excessive obesity was greater, thus, the method should not be used for quantitative determination.
文摘Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory health in childhood and adolescence mainly in terms of asthma occurrence. Additionally, there is a mounting body of evidence that overweight/obesity may also affect lung function in non-asthmatic subjects. The aim of this review was to present and discuss the studies that investigated this issue in non-asthmatic children and adolescents. Only a few studies have evaluated the impact of excess weight on static volumes and their results point towards an inverse relationship between overweight/obesity and functional residual capacity. More studies have been conducted on the impact of excess weight on dynamic lung volumes with inconsistent, however, results. Nevertheless, a relatively consistent finding was that the ratio of forced expiratory volume in 1 s/forced vital capacity was significantly lower among overweight/obese children compared to their counterparts with normal weight. The underlying mechanisms of these observations have not been adequately elucidated but it is believed to result from complex interaction of mechanical, developmental, and metabolic causes. There is a need for more welldesigned studies in order to clarify the impact of excess weight on lung function in non-asthmatic subjects, as well as to explore the contribution of factors such as duration and degree of obesity, and fat distribution. Despite the absence of conclusive data, there are stillconvincing evidence to be communicated to the children and their families as part of the arguments to encourage them to adopt a healthier lifestyle.
