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Objective@#To investigate the effects of remifentanil combined with propofol on hemodynamics, inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.@*Methods@#From June 2017 to August 2018, 112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table, with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0), 0.5h(T1), 1h(T2) and awake(T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response, stress response and immune function indicators at T0, T2 and T3 were recorded.@*Results@#Compared with T0, T1 and T2, the MAP of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.834, 4.484, 5.378, tobservation group=6.420, 7.006, 6.152, all P<0.05). Compared with T0, the HR of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=5.943, tobservation group=7.722, all P<0.05). Compared with T1 and T2, CO of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.276, 2.262, tobservation group=6.318, 5.132, all P<0.05). There were no statistically significant differences in MAP, HR and CO between the two groups at T0, T1, T2 and T3(all P>0.05). The doses of norepinephrine in the observation group and the control group were (1 587.7±287.5)μg and (1 937.9±397.6)μg, respectively, and the difference was statistically significant(t=5.341, P<0.05). The serum levels of C reactive protein(CRP), tumor necrosis factor alpha(TNF-α) and interleukin 6(IL-6) increased with time in the two groups, and the differences were statistically significant(tcontrol group=17.06, 36.13, 19.07, 3.822, 9.466, 2.874, 14.18, 26.87, 16.21, tobservation group=11.72, 20.79, 11.01, 2.810, 6.559, 3.716, 10.52, 24.56, 17.64, all P<0.05). At T2 and T3, the serum levels of CRP, TNF-α and IL-6 in the observation group[T2: CRP (89.63±17.65)mg/L, TNF-α (51.16±10.16)ng/L, IL-6 (34.26±6.25)ng/L, T3: CRP (136.15±26.25)mg/L, TNF-α (58.64±11.12)ng/L, IL-6 (67.56±12.67)ng/L]were lower than those in the control group[T2: CRP (112.15±22.34)mg/L, TNF-α (59.56±11.58)ng/L, IL-6 (42.65±8.37)ng/L, T3: CRP (175.16±34.75)mg/L, TNF-α (65.79±11.35)ng/L, IL-6 (79.02±14.56)ng/L], the differences were statistically significant(t=5.919, 6.703, 4.080, 3.367, 6.010, 4.443, all P<0.05). Compared with T0, serum levels of epinephrine(E), cortisol(Cor) increased in two groups at T2 and T3, and the differences were statistically significant(tcontrol group=10.03, 8.096, 8.679, 7.029, tobservation group=6.473, 4.728, 6.330, 4.727, all P<0.05). Compared with T2, serum levels of E and Cor in two groups at T3 were decreased, and the differences were statistically significant(tcontrol group=2.400, 2.638, tobservation group=2.260, 2.162, all P<0.05). At T2 and T3, the serum levels of E, Cor in the observation group[T2: E (286.36±41.02)ng/L, Cor (262.52±29.89)μg/L, T3: E (270.35±33.59)ng/L, Cor (253.23±30.28)μg/L]were lower than those in the control group[T2: E (312.56±38.75)ng/L, Cor (287.56±38.76)μg/L, T3: E (295.79±35.12)ng/L, Cor (270.25±30.15)μg/L], the differences were statistically significant (t=3.457, 3.917, 3.828, 2.981, all P<0.05). At T0, T2 and T3, there were no statistically significant differences in CD3+, CD4+, CD8+ and CD4+/CD8+ between the two groups(all P>0.05).@*Conclusion@#Remifentanil combined with propofol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock, and can alleviate inflammation and stress response.
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Objective To investigate the effects of remifentanil combined with propofol on hemodynamics,inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.Methods From June 2017 to August 2018,112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table,with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0),0.5h(T1),1h (T2) and awake (T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response,stress response and immune function indicators at T0,T2 and T3 were recorded.Results Compared with T0,T1 and T2,the MAP of the two groups was higher at T3,and the differences were statistically significant(tcontrol group =4.834,4.484,5.378,tobservation group =6.420,7.006,6.152,all P ＜0.05).Compared with T0,the HR of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =5.943,tobservation group =7.722,all P ＜ 0.05).Compared with T1 and T2,CO of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =4.276,2.262,tobservation group =6.318,5.132,all P ＜ 0.05).There were no statistically significant differences in MAP,HR and CO between the two groups at T0,T1,T2 and T3 (all P ＞0.05).The doses of norepinephrine in the observation group and the control group were (1 587.7 ± 287.5) μg and (1 937.9 ±397.6) μg,respectively,and the difference was statistically significant(t =5.341,P ＜0.05).The serum levels of C reactive protein(CRP),tumor necrosis factor alpha(TNF-α) and interleukin 6 (IL-6) increased with time in the two groups,and the differences were statistically significant(tcontrol group =17.06,36.13,19.07,3.822,9.466,2.874,14.18,26.87,16.21,tobservation group =11.72,20.79,11.01,2.810,6.559,3.716,10.52,24.56,17.64,all P ＜ 0.05).At T2 and T3,the serum levels of CRP,TNF-α and IL-6 in the observation group [T2:CRP (89.63 ±17.65) mg/L,TNF-α (51.16 ± 10.16) ng/L,IL-6 (34.26 ± 6.25) ng/L,T3:CRP (136.15 ±26.25) mg/L,TNF-α (58.64 ± 11.12)ng/L,IL-6 (67.56 ± 12.67)ng/L] were lower than those in the control group[T2:CRP (112.15 ±22.34) mg/L,TNF-α (59.56 ± 11.58) ng/L,IL-6 (42.65 ± 8.37) ng/L,T3:CRP (175.16 ±34.75) mg/L,TNF-α (65.79 ± 11.35) ng/L,IL-6 (79.02 ± 14.56) ng/L],the differences were statistically significant (t =5.919,6.703,4.080,3.367,6.010,4.443,all P ＜ 0.05).Compared with T0,serum levels of epinephrine(E),cortisol(Cor) increased in two groups at T2 and T3,and the differences were statistically significant(tcontrol group =10.03,8.096,8.679,7.029,tobservation group =6.473,4.728,6.330,4.727,all P ＜ 0.05).Compared with T2,serum levels of E and Cor in two groups at T3 were decreased,and the differences were statistically significant (tcontrol group =2.400,2.638,tobservation group =2.260,2.162,all P ＜ 0.05).At T2 and T3,the serum levels of E,Cor in the observation group [T2:E (286.36 ± 41.02) ng/L,Cor (262.52 ± 29.89) μg/L,T3:E (270.35 ±33.59)ng/L,Cor (253.23 ±30.28)μg/L]were lower than those in the control group[T2:E (312.56 ±38.75)ng/L,Cor (287.56 ± 38.76) μg/L,T3:E (295.79 ± 35.12) ng/L,Cor (270.25 ± 30.15) μg/L],the differences were statistically significant (t =3.457,3.917,3.828,2.981,all P ＜ 0.05).At To,T2 and T3,there were no statistically significant differences in CD3+,CD4+,CD8+ and CD4+/CD8+ between the two groups (all P ＞ 0.05).Conclusion Remifentanil combined with propefol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock,and can alleviate inflammation and stress response.
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Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.
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Objective To evaluate the efficacy and safety of sunitinib as post-operative adjuvant therapy in patients with high-risk renal cell carcinoma (RCC).Methods A total of 60 patients with resected,histologically confirmed clear cell RCC were enrolled in this study.Patients received orally sunitinib either at a dose of 50 mg on treatment schedule (once daily for 4 weeks followed by 2 weeks off) or at a dose of 37.5 mg once daily for three 6-week cycles from 1 month after surgery.Results All the 60 patients tolerated Sunitinib treatment well and no patient discontinued treatment due to adverse events.Most adverse events were grade Ⅰ to Ⅱ.The most frequently reported adverse events were neutropenia (56.7％),thrombocytopenia (53.3％),leucopenia (48.3％),hand-foot syndrome (46.7％) and hypertension (36.7％).The most frequently reported grade 3 or 4 toxicities were thrombocytopenia (25.0％),neutropenia (15.0％),hand-foot syndrome (11.7％) and leucopenia (8.3％).The majority of adverse events occurred within the first 1-2 cycles of sunitinib treatment,and was ameliorated 1 month after 3 cycles finished.No irreversible adverse event was observed.As of April 5,2012,no recurrence occurred in patients except one death due to cerebrovascular accident unrelated to treatment,with both 6-month and 9-month disease-free survival rate of 100％.Conclusions Myelosuppression occurred less frequently in high-risk RCC patients treated with sunitinib as operative adjuvant therapy than in advanced RCC patients,with a better benefit trend.However,long-term follow-up data are needed to further confirm the efficacy of sunitinib in the adjuvant setting.
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OBJECTIVE To explore the relationship between urinary tract infection(UTI) and urological surgical site infections(SSI).METHODS The surgical site infections of 115 patients underwent urological operations were observed.Patients were screened for the presence of UTI before the operation and subcutaneous swabs for culture were collected at the end of the operation by brushing with a sterile cotton-swab just before skin closure.The resistance and similarity of the isolates were analyzed by antimicrobial susceptibility test and pulsed field gel electrophoresis(PFGE).RESULTS Surgical site infection occurred in 14 of 115 patients.The isolates from infected surgical sites showed higher resistance to antimicrobial agents than those from non-infected surgical sites(P
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Objective To investigate the effectiveness of three-drug (Relingqing, Prostant and Antibiotic) therapy to chronic prostatitis. Methods One hundred and twenty patients were randomly divided into 2 groups: three-drug treatment group (n=80) and antibiotic only group (n=40). After treated for 12 weeks, 120 cases of chronic prostatitis were evaluated with the pre- and post-massage test (PPMT) and chronic prostatitis symptom index (CPSI). Results In three-drug treatment group, 15 patients in 21 patients of type Ⅱ and 41 patients in 59 patients of type ⅢA were normal evaluated by PPMT. From the results of CPSI, the cure rate was 13.8% (11 cases), the symptoms of 48 patients (60.0%) were improved significantly whose CPSI decreased more than 15, and only 16 patients(20.0%)felt a little better whose CPSI decreased from 5 to 15, and the symptoms of 5 patients were not improved. There was statistical difference among three-drug treatment group and antibiotic only group. Conclusion The three-drug treatment is more effective in treating chronic prostatitis than the therapy of antibiotic only.
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<p><b>OBJECTIVE</b>To deepen the understanding of patients with complete necrosis of the ureter after renal transplantation for early diagnosis and treatment.</p><p><b>METHODS</b>Of 5 patients with complete necrosis of the ureter after renal transplantatioin between January 1991 and April 2001 in our hospital, 4 were male and 1 was female (mean age, 35 years). Seven to 12 days after renal transplantation, native pyeloureterestomy was performed for 1 patient, and the remaining 4 patients received the cutting of the diatal necrosis ureter and vesicoureterostomy because of urine leakage. Six to seven weeks later when the ureter stents were pull out, native pyeloureterestomy or pyeloureteroplasty was performed for the 4 patients because of uropenia and hydronephrosis.</p><p><b>RESULTS</b>Five patients showed normal function of the kidney postopcreation (follow up: 6 - 12 months) without hydronephrosis.</p><p><b>CONCLUSIONS</b>When distal necrosis of the ureter is observed after renal transplantation, complete necrosis of the ureter may occur. Native pyeloureterostomy or pyeloureteroplasty is an effective treatment.</p>
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cadáver , Transplante de Rim , Necrose , Complicações Pós-Operatórias , Ureter , Patologia , Cirurgia GeralRESUMO
Objective To evaluate the prevalence,management and risk factors of post transplantation anemia (PTA) in a group of Chinese kidney transplant recipients after a long-term follow-up. Methods The clinical data of 154 adult kidney transplant recipients,who were followed up for at least 5 years,were retrospectively studied,including yearly hemoglobin (Hb) level,the prevalence and treatment of anemia,state of renal function,use of immunosuppressive agents and other medications. Patients were divided as anemic and non-anemic groups,and comparison of clinical data was carried out between the groups. The incidence of anemia was calculated and management of anemia was recorded. Monofactorial correlation analysis was used to determine the factors associated with Hb level,and multi-variation logistic regression was used to identify the factors related to the onset of anemia at 1 and 5 years post-transplant. Results The annual incidence of PTA at the current year of and 1 to 5 years after transplantation was 45.5%,10.7%,9.6%,14.8%,13.5% and 19.5%,respectively. About 38.3% of the patients suffered from anemia at least once during the 5 years of follow-up period,and 42% of these patients developed anemia recurrently. Correlation analyses indicated that Hb levels were associated with graft function (P0.05). Logistic regression model showed that serum creatinine and blood urea nitrogen levels were associated with the diagnosis of anemia in the 1st year after transplantation (P