经尿道选择性绿激光前列腺汽化术治疗高龄高危患者的临床观察

目的 评估经尿道选择性绿激光前列腺汽化术(photoselective vaporization of prostate,PVP)治疗高龄高危患者的安全性及疗效.方法 采用PVP治疗高龄高危良性前列腺增生(benign prostatic hyperplasia,BPH)患者63例,观察平均手术时间、术中出血量、术后留置导尿管时间、手术并发症,记录并计算手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、剩余尿量及尿流率改变等指标的差异.结果 63例患者术后均未有心、肺、脑、肝和肾等系统疾病的加重.其平均手术时间(44.8±6.5)min,术中出血量(85.4±12.4)mL,术后留置尿管时间(3.5±0.5)d.IPSS及QOL评分由术前平均(30.8±4.3)及(6.2±0.6)分别下降至(9.5±1.3)及(2.6±0.4),最大尿流率由术前(6.3±2.1)mL/s增加至术后(17.4±3.6)mL/s,剩余尿量由术前(154.0±20.5)mL下降至术后(29.6±6.8)mL,手术前后比较差异均有统计学意义(P<0.05).结论 PVP是治疗高龄高危BPH的一种安全有效的微创手术,手术操作简单、时间短、出血少、术后恢复快.     

TURP结合TUVP治疗高危重度BPH 36例

目的:探讨经尿道前列腺电汽化术(transurethral electrovaporization of the prostate,TUVP)联合经尿道前列腺电切术(transurethral resection of the prostate,TURP)治疗高危重度良性前列腺增生症(benignprostatic hyperplasia,BPH)的效果。方法:TUVP联合TURP治疗36例BPH。根据sohlege手术危险分类:Ⅱ级26例,Ⅲ级10例。所有患者国际症状评分(IPSS)为26±3,最大尿流率为(3.2±2.4)ml/s,残余尿量100~380 ml。结果:手术时间40~60 min,平均50 min。5例术后输血200 ml,1例先兆前列腺电切综合征发生,平均留置尿管6 d。36例随访6~24个月,平均10个月,IPSS由术前平均26±3下降至术后平均(8±3),最大尿流率由术前平均(3.2±2.4)ml/s升至术后平均(13±2.6)ml/s。术后暂时性尿失禁3例。结论:联合应用TUVP及TURP治疗高危重度BPH疗效满意。     

绿激光前列腺汽化术治疗合并糖尿病的良性前列腺增生

目的 观察经尿道绿激光前列腺汽化术(PVP)治疗合并糖尿病的良性前列腺增生的效果.方法 采用经尿管绿激光前列腺汽化术治疗合并糖尿病的良性前列腺增生32例,观察平均手术时间、术中出血量、术后留置导尿管时间、手术并发症、手术前后的国际前列腺症状评分(IPSS)、生活质量评分(Qol)、剩余尿量及尿流率等指标的差异.结果 32例均安全渡过围手术期,无严重并发症.平均手术时间(40±6.5)mi n,术中出血量(58±6.6)m l.术后留置尿管时间(36±18)h.I P S S及Q ol评分由术前平均(29.8±5.2)及(5.0±0.5)分别下降至(8.6±2.5)及(1.6±0.6).最大尿流率(Qmax)由术前(5.8±2.6)ml/s增至术后(16.8±2.6)ml/s,剩余尿量由术前45-450ml ml下降至术后0-80ml.结论 经尿道绿激光前列腺汽化术是治疗合并糖尿病的良性前列腺增生的一种安全、效果显著的手术方法.     

选择性绿激光汽化术治疗高危良性前列腺增生症的临床研究

目的探讨经尿道选择性绿激光前列腺汽化术(PVP)治疗高危良性前列腺增生(BPH)的有效性和安全性。方法应用PVP治疗高危BPH患者23例,观察术后出血、手术时间、留置尿管时间、手术前后尿流率、国际前列腺症状评分(IPSS)、生活质量评分(QOL)。结果所有患者手术顺利,围手术期未见并发症,手术时间30-105min,平均(38.8±8.5)min,IPSS及QOL评分由术前平均(27.43±2.75)分及(5.10±0.44)分分别下降至(8.3±2.4)分及(1.3±0.6)分,最大尿流率术前(6.76±0.54)ml/s增加至术后(15.8±3.1)mL/s,手术前后比较差异均有统计学意义(P0.05)。结论经尿道选择性绿激光前列腺汽化术(PVP)治疗老年高危前列腺良性增生手术操作简单、出血少、恢复快、安全有效,值得临床推广。     

经尿道等离子双极电切术治疗高危巨大前列腺增生症50例分析

目的探讨经尿道等离子双极电切术（TUPKRP）治疗高危巨大良性前列腺增生症（BPH）的临床疗效及安全性。方法 2003年12月—2010年12月,在我院采用TUPKRP治疗的高危巨大BPH患者共50例,观察其平均手术时间、术中出血量、手术并发症、术后住院天数,记录并计算手术前后的国际前列腺症状评分（IPSS）、残余尿量及尿流率改变等指标的差异。结果 50例均安全渡过围术期,平均手术时间（97±42）min,术中出血量（210±75）ml,切除前列腺质量（140±47）g,IPSS由术前平均31.5±4.6下降至9.4±2.4,最大尿流率由术前（4.5±1.3）ml/s增加至术后（14.6±5.1）ml/s,残余尿量由术前（200.4±52.7）ml下降至术后（32.5±13.5）ml,手术前后比较差异均有统计学意义（P〈0.05）。结论应用TUPKRP治疗高危巨大BPH,疗效确切,完善的围术期处理是确保安全性的重要保证。     

选择性绿激光汽化术治疗良性前列腺增生

目的探讨经尿道选择性绿激光前列腺汽化术(PVP)治疗良性前列腺增生的临床疗效。方法PVP治疗良性前列腺增生(BPH)患者50例。观察平均手术时间,术中出血情况,术后留置尿管时间,记录并计算手术前后国际前列腺症状评分(IPSS),生活质量评分(QOL),尿流率改变等指标的差异。结果平均手术时间(46.0±10.3)min,术后留置尿管时间(38±18.2)h,IPSS及QOL评分术前(25.8±2.0)及(5.1±0.8)分别下降至术后(5.2±1.8)及(1.8±0.8)。最大尿流率术前(5.65±2.2)ml/s增加至术后(18.26±3.2)ml/s。差异有统计学意义(P<0.05),术中出血少。结论PVP是治疗BPH的一种有效的微创手术。操作简单,出血少,恢复快。     

大功率钬激光前列腺剜除术治疗高危前列腺增生(附45例报告)

目的探讨大功率钬激光前列腺剜除(Holmium laser enucleation of the prostate,HoLEP)治疗高危前列腺增生(benign prostatic hyperplasia,BPH)患者的疗效和安全性。方法应用HoLEP治疗45例高危BPH患者。比较治疗前后的国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、剩余尿(PVR)变化,并观察手术安全性。结果 45例患者手术效果满意,术中出血少,无前列腺电切综合征(TURS)。术后随访3～6 个月,Qmax由术前的(6．1±2．8)ml／s升至术后的(20．2±4．3)ml／s,IPSS从术前的(25．6±4．5)分降至术后的 (7.5±2．2)分,PVR 由(136 145)ml降至术后(15±25)ml。结论 HoLEP治疗高危BPH患者疗效确切,安全     

经尿道等离子体双极汽化电切术治疗高危前列腺增生症（附24例报告）

目的:探讨经尿道等离子体双极汽化电切术在治疗高龄、合并慢性内科疾病的高危BPH中的安全性和疗效。方法:采用经尿道等离子体前列腺双极汽化电切术(TUPKVP)治疗高危前列腺增生(BPH)患者28例。结果:24例患者平均手术时间62min,平均失血80ml,切割获取前列腺组织平均重量63g,无水中毒及尿失禁发生,术前国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、剩余尿(PVR)分别为(27.4±5.8)分、(8.6±3.3)ml/s、(153.0±61.3)ml,治疗后2个月分别为(16.2±4.5)分、(15.3±4.2)ml/s、(24.6±11.6)ml,治疗前后IPSS、Qmax、PVR差异有统计学意义。结论:TUPKVP是治疗高龄、合并慢性内科疾病的高危BPH安全有效的方法。     

PVP联合TURP治疗高龄高危且大体积良性前列腺增生的临床分析

目的:探讨经尿道选择性绿激光前列腺汽化术(PVP)与前列腺电切术(TURP)治疗高龄高危且大体积良性前列腺增生的可行性、安全性和有效性。方法:我院2009年10月~2011年10月采用选择性绿激光前列腺汽化术与前列腺电切术相结合的方式治疗大体积高龄高危BPH患者32例,进行术前术后对比分析。结果:本组手术时间为45~100min,平均71.72min;术中无明显出血,无严重手术并发症发生。术后随访3个月,最大尿流率(Qmax)、残余尿量(RUV)、国际前列腺症状评分(IPSS)、生活质量评分(Qmax)均与术前比较有明显的改善。结论:PVP联合TURP治疗高龄高危且大体积BPH,手术时间短、疗效好、并发症少,是安全有效的微创手术方法。     

2μm激光治疗80g以上高龄高危前列腺增生症的近期疗效分析

目的探讨经尿道2μm(铥)激光前列腺汽化切除术(thulium laser vaporesection of prostate,TmL-RP)治疗80 g以上高龄高危前列腺增生症(BPH)的疗效及安全性。方法采用TmLRP治疗高龄高危80 g以上BPH患者36例,观察平均手术时间、术中失血量、并发症及近期疗效等指标。结果 36例均安全度过围手术期,平均手术时间(67.6.8±19.3)min,手术前后Hb改变(6.0±3.9)g/L,术后膀胱冲洗时间平均(0.8±0.4)d。IPSS及QOL评分由术前平均(25.3±4.6)及(5.2±0.7)下降至(8.5±3.6)及(1.4±0.3),最大尿流率由术前(4.1±1.9)mL/s增加至术后(17.0±2.9)mL/s,剩余尿量由术前(130±46)mL下降至术后(26.9±3.4)mL,手术前后比较差异均有统计学意义(P<0.05)。术后近期疗效满意,无严重并发症。结论 TmLRP治疗80 g以上BPH安全有效,操作简单,出血少,尤其适合高龄高危患者。     

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.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.