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本文作者按照 Fry(1988年)的诊断标准,并参考张时纯所修正的标准,回顾性总结了近五年收治并行手术,治疗较系统的胆石症术后合并 MSOF 21例;全组病例均于术后1~7天,平均2天发生 MSOF;并都伴有不同程度休克,受累器官顺序依次肺、肝、肾、心脏及消化道。发生二衰者15例.病死率40%(死亡6例)二衰者6例,病死率83.3%(死亡5例)。作者以休克致 MSOF 的发生机制,引用单相速发型的概念,分析了本组大多数属于此类型。重点谈了黄疽与肝衰、肾衰的关系;认为梗阻性黄疽病人术后急性肾衰发生率与黄疽程度有密切关系,主张术前、术后尽量设法控制胆质血症。使胆红素降至4.0mg/dL 以下,可降低肾衰的发病率及死亡率。在 MSOF 教治中,主张积极抗休克,大剂量保肝药物应用,同时扩张肾血管,对 ARDS 病人争取早期气管切开。并认为由胆道感染和低血压所致心肌缺血及心律失常的病人及一些术前心动不全的老年人术后可能会发生心衰,故主张除一般强心措施外,重在早期认识和预防。 相似文献
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随着医学技术的不断发展,临床针对胆石症患者应用中西医结合的方案进行治疗,实现了标本兼治的目的,且治疗效果满意。基于此,文章针对胆石症中西医结合治疗作一综述,希望有所帮助。 相似文献
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Prasheeda Chandran Pradeep Garg Chandra S. Pundir 《Indian journal of clinical biochemistry : IJCB》2005,20(2):81-85
Total cholesterol, total bilirubin, calcium, oxalate, inorganic phosphate, magnesium, iron, copper, sodium and potassium were
analyzed quantitatively in gallstones, bile of gall bladder and sera of 200 patients of cholelithiasis (52 cholesterol, 76
mixed and 72 pigment stone patients) and their contents were correlated between calculi and bile and sera and bile in these
three type of stone patients. A significant positive correlation was observed between total cholesterol, total bilirubin of
calculi and bile, copper of bile and sera of cholesterol stone patients, copper of calculi and bile, total bilirubin, oxalate,
magnesium, potassium of sera and bile of pigment stone patients and oxalate and iron of stone and bile, total bilirubin, oxalate,
sodium of sera and bile of mixed stone patients. A significant negative correlation was found between magnesium of serum and
bile of cholesterol stone patients, oxalate of calculi and bile of pigment stone patients and magnesium of serum and bile
of mixed stone patients. 相似文献
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Singh TD Barbhuiya MA Gupta S Shrivastav BR Jalaj V Agarwal N Tiwari PK 《Indian journal of clinical biochemistry : IJCB》2011,26(2):146-153
We have studied the expression of lactate dehydrogenase and its isoforms in gall bladder cancer, cholelithiasis and chronic
cholecystitis. Quantitative and qualitative assays of lactate dehydrogenase and its various isoforms were carried out in the
blood sera of patients and healthy controls along with parallel estimation of various liver function test enzymes. Statistical
analysis was done using the software Graph Pad Prism. Significantly high expression of lactate dehydrogenase along with alkaline
phosphatase and total bilirubin (P ≤ 0.05) was observed in all the three clinical conditions as compared to controls. LDH showed an increasing trend from stage
I to stage IV of GBC indicating a significant positive association with the disease progression. The levels of LDH 3 and 4
isoforms appeared significantly more elevated in GBC than cholelithiasis or chronic cholecystitis. We suggest that a careful
estimation of total LDH and its isoforms 3 and 4 alone or along with alkaline phosphatase and total bilirubin during different
clinical stages, like chronic cholecystitis, cholelithiasis and GBC, may prove to be a potentially useful biomarker in the
prognostic management of gall bladder diseases, specifically GBC. 相似文献
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