联合免疫治疗对重症肌无力术后危象发生的影响

【目的】观察术后预防性应用甲基强的松龙，环磷酰胺（CTX）NN~球蛋白联合免疫治疗对重症肌无力患者行胸腺切除术后危象发生的影响。【方法】选择具有高危因素的60例重症肌无力患者并随机分成A（联合免疫治疗）和B（对照）两组，观察两组术后危象的发生情况。【结果】两组的临床基础资料无显著差异（P〉0.05）。A组术后危象发生率（6．7％）明显少于B组的危象发生率（26．7％）（P〈0．05）。发生危象的患者中A组呼吸机使用时间平均为（6．25±6．28）d，B组平均为（24．20±26．38）d．A组患者使用呼吸机时间明显短于B组（P〈0.05）。A组患者平均ICU住院时间为（3．25±2．35）d，B组患者平均ICU住院时间为（9．87±6．56）d，A组患者的ICU住院时间明显短于B组患者（P〈0.05）。【结论】术后预防性的联合免疫疫治疗有助于减少术后危象的发生率和缩短危象的持续时间。     

重症肌无力患者术后肌无力危象发生率及其影响因素

目的研究重症肌无力(MG)患者术后肌无力危象的发生现状,探讨肌无力危象的相关影响因素。方法收集该院2011年2月—2014年2月收治的MG患者236例作为研究对象,对其采用MGFA分型法进行病情的评估,术后将切除组织送病理分析明确胸腺病理类型。结果 MG患者术后肌无力危象发生率为14.41%(34/236);不同性别患者年龄差异无统计学意义(P>0.05);不同性别、年龄段患者肌无力危象发生率差异无统计学意义,P>0.05;MG患者MGFA分型越高,发生肌无力危象的可能性越大(P<0.05);术后感染、胸腺病理类型均是患者肌无力危象发生的影响因素(P<0.05)。结论医务人员应全面评估MG患者胸腺切除术后肌无力危象的发生的风险,术前纠正诱发肌无力危象的相关危险因素,改善预后。     

重症肌无力危象的治疗和预防

目的 :探讨重症肌无力 ( myasthenia gravis,MG)病人围手术期中 MG危象发生的预防和治疗方法。方法 :对已收治的 2 1 0例 MG病人按时间顺序分为常规治疗组 ( A组 )和改良治疗组( B组 )。采用多相监测、选择性预防性气管切开和有效的药物治疗及改进的麻醉方法。结果 :A组病人 MG危象的发生率及死亡率明显高于 B组 ( P<0 .0 1 )。在 B组中应用上述方法及措施 ,降低了围手术期中 MG危象的发生率。结论 :对 MG病人在术前有效的药物治疗非常重要。术中、术后早期应用多相监测 ,及时了解病人生命体征变化 ,为及时治疗提供依据。对较危重的病人行胸腺切除 ,同时予以预防性气管切开和全身麻醉的改进有助于降低术后 MG危象的发生率及死亡率。     

新的重症肌无力外科临床分型和分期的应用

目的:总结作者提出的新的重症肌无力(MG)临床分型和分期方法在外科治疗中的应用价值。方法:收集1998年1月至2007年12月收治的410例MG患者的病历资料,分3组,分别按作者提出的临床分型和分期方法(观察组,280例)、Osserman分型(对照1组,60例)和美国重症肌无力协会临床分型(对照2组,70例)进行术前分型,按所选分型方法指导手术适应证及时机的选择,均行胸腺(瘤)切除并前纵隔脂肪清扫术,比较术后肌无力危象的发生率以及手术死亡率,比较发生肌无力危象患者的术前分型和分期。结果:观察组术后危象的发生率为8.6%,对照1组为20.0%,对照2组为18.6%,与对照1、2组比较,观察组术后危象发生率明显降低(χ2=6.817和5.923,P均<0.05)。观察组发作/进展期患者肌无力危象发生率为23.2%(22/95),远高于稳定/缓解期的1.1%(2/185),差异有统计学意义(χ2=39.037,P<0.001)。3组患者手术死亡率均为0。结论:作者提出的MG临床分型和分期方法可指导手术适应证及时机的选择,有效降低术后肌无力危象的发生率。     

胸腺瘤病理分型与重症肌无力相关性研究

目的探讨胸腺瘤病理分型与重症肌无力（MG）的相关性。方法回顾性分析2005年9月至2015年9月在苏州大学附属第一医院行胸腺瘤切除术的468例患者的病理及临床资料,分析胸腺瘤病理类型与患者性别、年龄、MG和术后肌无力危象的相关性。结果468例胸腺瘤患者伴MG发生率为33.3%;胸腺瘤病理分型为A+AB、B1、B2、B3和C型分别195、86、84、88和15例。胸腺瘤病理分型与性别无明显相关性（P＞0.05）,与年龄呈负相关（r=-0.13,P＜0.05）,与伴发MG明显相关（P＜0.01）。156例胸腺瘤伴发MG患者术后肌无力危象发生率为25.6%,其中A+AB型、B1型、B2型、B3型和C型患者术后肌无力危象发生率比较,差异无统计学意义（P＞0.05）;而B型（包括B1、B2和B3型）术后肌无力危象发生率明显高于A+AB型。结论胸腺瘤病理分型与年龄、MG、术后肌无力危象存在相关性,在提示MG、术后肌无力危象的发生方面具有一定价值。     

重症肌无力围手术期气管切开的危险因素探讨

目的 探讨重症肌无力（MG）病人胸腺切除术围手术期行气管切开的适应症和相关危险因素。方法 回顾性分析我院自1980年4月至1999年8月因MG行胸腺切除术病人174例,44例于围手术期行气管切开,占总数25.3%,38例发生危象、占总数21.8%,分析了重症肌无力临床分型、病期、是否伴有胸腺瘤、术前肺功能情况和术前抗胆碱能药物用量等因素与肌无力危象之间的关系及需要行气管切开术的手术适应症。结果 MG病人病程长、服用抗胆碱能药物剂量大、临床分期为Ⅱb型以上,术前有肺功能损害及合并有胸腺瘤者,特别是伴有侵润型胸腺瘤的患者,术后发生危象较高;需气管切开的比例也相应较高。结论 重症肌无力病人胸腺切除术后发生危象,及时气管切开,人工呼吸器辅助是降低病死率的重要措施;术后立即预防气管切开术后应根据患者的病情严格掌握,不能滥用,以有利于病人恢复。     

术前用强的松降低术后重症肌无力危象的研究

目的 探讨降低胸腺切除术后发生重症肌无力危象的方法。方法 将本院40例胸腺瘤合并重症肌无力的患者进行随机分组,分为实验组20例,对照组20例。实验组术前联合溴吡斯的明及强的松个体化治疗2个月左右,对照组术前用溴吡斯的明治疗2个月左右。两组患者均在重症肌无力症状缓解或明显改善后,再行胸腺切除＋纵隔脂肪清除术治疗。结果 实验组术后出现重症肌无力危象1例（5%）,无死亡病例;对照组术后出现重症肌无力危象9例（45%）,死亡2例,重症肌无力危象的发生率明显下降,两者有显著意义（P=0.0035〈0.05）。结论 胸腺瘤合并重症肌无力的患者术前联合用溴吡斯的明及强的松个体化治疗2个月左右,术后重症肌无力危象的发生率显著降低,并发症少,恢复快。     

58例胸腺瘤合并重症肌无力的围手术期处理

目的探讨胸腺瘤合并重症肌无力(MG)围手术期处理方法。方法回顾分析1970年6月至2007年6月接受手术治疗的58例胸腺瘤合并MG患者的临床资料,包括术前准备、手术路径及术后危象的预防及处理。结果本组发生术后肌无力危象21例,发生率36.2%。术后死亡5例。术后随访47例,肌无力症状消失19例,缓解15例,改善不明显或加重13例。结论术前充分准备,术中置胃管,术中经胸骨正中切口彻底切除胸腺瘤及前纵隔淋巴脂肪组织,术后延长呼吸机辅助通气,合理、及时使用胆碱酶抑制剂及激素,加强呼吸道管理、控制感染等综合措施,是预防及治疗肌无力危象的有效方法。     

术前用强的松降低术后重症肌无力危象的研究

目的探讨降低胸腺切除术后发生重症肌无力危象的方法。方法将本院40例胸腺瘤合并重症肌无力的患者进行随机分组,分为实验组20例,对照组20例。实验组术前联合溴吡斯的明及强的松个体化治疗2个月左右,对照组术前用溴吡斯的明治疗2个月左右。两组患者均在重症肌无力症状缓解或明显改善后,再行胸腺切除 纵隔脂肪清除术治疗。结果实验组术后出现重症肌无力危象1例(5%),无死亡病例;对照组术后出现重症肌无力危象9例(45%),死亡2例,重症肌无力危象的发生率明显下降,两者有显著意义(P=0.0035<0.05)。结论胸腺瘤合并重症肌无力的患者术前联合用溴吡斯的明及强的松个体化治疗2个月左右,术后重症肌无力危象的发生率显著降低,并发症少,恢复快。     

重症肌无力行胸腺切除术后危象的防治(附98例分析)

目的：探讨重症肌无力行胸腺切除术后防治措施的改进，以改善预后。方法：我科1997～2002年因重症肌无力(myasthenia gravis，MG)行胸腺切除术的患者98例，分析其危象易发时间、危险因素及如何采取相应的防治措施。结果：术后发生危象14例，其中死亡1例。MG术后危象主要发生在术后早期，术后危象的发生与年龄、MG临床及病理分型、术前服用抗胆碱酯酶药物剂量、术前是否曾发生危象、肺通气功能和病程长短等危险因素有关，术后呼吸道感染是发生危象的最主要诱因。对于术后可能会发生危象的高危患者，须采用综合性防治措施，包括合理调整抗胆碱酯酶药及激素用量；术后危象发生后及时气管插管或气管切开行机械辅助通气是抢救成功、减少死亡的关键；而加强呼吸道管理、合理应用抗生素防治肺部感染可进一步改善危象的预后。结论：对术后可能发生危象的患者，应根据其危险因素采取相应措施，综合防治，有利于改善预后。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.