Objective To explore the clinical safety of plasma exchange(PE)combined with early continuous renal replacement therapy(CRRT)and its effects on coagulation and immune functions in patients with polytrauma and hypermyoglobinemia.Methods A non-randomized controlled study was conducted on 60 patients with severe polytrauma and myoglobinemia hospitalized in our department from January 2021 to December 2024.Based on different blood purification,the patients were divided a control group(CRRT)combined with conventional basic treatment,n=30)and an observation group(PE+CRRT and conventional basic treatment,n=30).Biochemical indicators(myoglobin,Mb),inflammation-related indicators,peripheral blood lymphocyte subsets,coagulation indicators,clinical-related indicators,and scores were observed and compared between the 2 groups before and after treatment.Results After 1,2 and 3 d of treatment,the levels of Mb,creatine kinase(CK),creatine kinase-MB isoenzyme(CK-MB),lactate dehydrogenase(LDH),serum creatinine(SCr),blood urea nitrogen(BUN),K+,C-reactive protein(CRP),procalcitonin(PCT),IL-6 and D-dimer(D-D),and white blood cell(WBC)count were significantly decreased in both groups(P<0.05).Among them,the observation group obtained obviously lower levels of all above indicators than the control group at the 3 time points(P<0.05).Additionally,notably shorter average length of total hospital stay,shorter average length of trauma intensive care unit stay,and lower score of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)was observed in the observation group than the control group(P<0.05).There were no statistical differences in coagulation function indicators or T lymphocyte subsets between the 2 groups.No complications occurred.Conclusion For patients with polytrauma and hypermyoglobinemia,early application of PE+CRRT can effectively reduce serum myoglobin level,improve serum biochemical inicators,renal function and inflammatory status,and maintain homeostasis,but shows no effect on immune or coagulation functions.This approach is worthy of promoting in clinical practice.

Objective To observe the effects of different levels of stroke volume variation(SVV) directed fluid therapy on prognosis in elderly surgery patients. Methods One hundred and fifty-six patients (ASA gradeⅠorⅡ) having underwent abdominal surgery were selected, and the patients were divided into 3 groups according to the level of SVV with 52 cases each:low SVV group (SVV 3%-6%), middle SVV group (SVV 7% - 10%) and high SVV group (SVV 11% - 14%). Each group accepted different fluid therapy strategy. The intraoperative index, postoperative recovery index and complications were compared. Results The volume of crystalloid and volume of colloform in low SVV group and middle SVV group were significantly higher than those in high SVV group: (2 365 ± 517) and (2 080 ± 378) ml vs. (1 820 ± 579) ml, (1 105 ± 220) and (898 ± 239) ml vs. (559 ± 166) ml, and those in low SVV group were significantly higher than those in middle SVV group, and there were statistical differences (P<0.05). The urine volume in low SVV group was significantly higher than that in high SVV group:(717.4 ± 289.0) ml vs. (511.8 ± 326.3) ml, and there was statistical difference (P<0.05). The first exhaust time in high SVV group was significantly shorter than that in low SVV group:(81.2 ± 27.5) h vs. (98.9 ± 32.5) h, and there was statistical difference (P<0.05). The first level and above nursing time, postoperative hospital stay and total length of hospital stay in middle SVV group were significantly shorter than those in high SVV group and low SVV group: (4.4 ± 2.8) d vs. (5.3 ± 3.2) and (6.4 ± 3.7) d, (13.8 ± 5.2) d vs. (17.7 ± 8.4) and (19.5 ± 8.9 ) d, (22.7 ± 10.4) d vs. (26.8 ± 13.1) and (30.6 ± 10.3) d, and there were statistical differences (P<0.05). The incidence of stomal leak in high SVV group was significantly higher than that in low SVV group: 17.3% (9/52) vs. 3.8% (2/52), the incidences of postoperative infection in high SVV group and middle SVV group were significantly lower than that in low SVV group: 5.8% (3/52) and 5.8% (3/52) vs. 26.9% (14/52), and there was statistical difference (P<0.05). Conclusions The SVV 3% - 6% in elderly surgery patients may increase the risk of postoperative infection and prolong the time of hospitalization. But the SVV 7% - 10% may have a better postoperative recovery, and this level could be a better goal of perioperative fluid therapy in elderly surgery patients.

Objective To evaluate the two-stage repair in hypospadias cripples.Methods 35 patients with hypospadias cripples underwent two-stage repair.At the first stage,a full-thickness graft of skin or buccal mucosa was used for urethral plate reconstruction after the release of chordee.The second stage was performed 6 months after completion of the first stage.Tubularization of the replaced urethral plate was the preferred technique.Results There was no urethra stricture or “preplaced urethral plate ” atrophy.Fistula developed in 2 of 35 cases.Conclusion The twostaged technique was a useful strategy to deal with the myriad abnormalities encountered in crippled hypospadias.This technique could not only create a neourethra successfully,but also give the penis a near-normal shape and appearance.