不同卧位体外冲击波碎石治疗输尿管下段结石584例

目的：探讨不同卧位体外冲击波碎石（ESWL）治疗输尿管下段结石的效果。方法：根据患者输尿管下段结石的不同位置、患者肥胖程度及下腹部肠气多少分别选择仰卧式或俯卧式体位行ESWL治疗结石584例。结果：患者输尿管下段结石粉碎率达100%；1周后结石排空556例（95.20%）；行第2次ESWL后结石排空22例（3.77%）；行第3次ESWL后结石排空6例（1.03%）。结论：恰当选择I、Ⅱ类输尿管下段结石患者，分别选择两种不同卧位行ESWL治疗，可避免骶椎骨的阻挡及肠气阻断，减少冲击波次数及降低工作电压、结石粉碎率及结石排空率高，且能减少X线对患者的照射量。     

体外冲击波碎石治疗儿童肾结石27例临床分析

2006年4月至2008年10月应用体外冲击波碎石（ESWL）治疗儿童肾结石27例,其中右肾结石11例,左肾结石16例;结石大小5mm×6mm-17mm×22mm,平均9mm×11mm。22例肾结石经1次ESWL治疗结石完全粉碎,1次碎石成功率82％（22／27）;At后7d排净11例,1个月排净8例,随访术后1年排净率96％。ESWL治疗儿童肾结石临床效果好,具有安全、并发症少等优点,特别是对较小肾结石的治疗效果尤为明显。     

钬激光碎石术与体外冲击波碎石术治疗输尿管不同部位结石的临床研究

目的比较钬激光碎石术（LL）与体外冲击波碎石术（ESWL）治疗不同部位输尿管结石的优劣。方法ESWL组66例患者采用体外冲击波术,LL组66例患者采用钬激光碎石术。结果LL组患者上段结石残留率明显高于ESWL组,中下段结石残留率明显低于ESWL组,LL组患者平均治疗时间明显短于ESWL组;LL组患者血尿、膀胱刺激、结石上移、输尿管穿孔发生率明显高于ESEL组,肾绞痛和发热发生率明显低于ESWL组（P〈0．05）。结论上段结石ESWL效果更好,中下段结石LL疗效更佳。     

影响上尿路结石体外冲击波碎石预后的因素

目的 探讨影响上尿路结石体外冲击波碎石(ESWL)预后的因素.方法 回顾性分析ESWL治疗上尿路结石患者366例的临床资料.治疗结果在随访3月时评估,结石完全排出视为治疗成功,未排或有残石为治疗失败.分析患者及结石特征如性别、年龄(年龄段)、身高、体重、体重指数、病程、疼痛、血尿、结石位置、结石侧别、结石长度、结石宽度等因素与治疗成功率的关系.结果 366例碎石成功率63.4%(232/366).应用X2检验及t检验比较两组术前资料,发现病程、结石长度及结石宽度是有意义因素,Logistic多因素回归分析排除了结石宽度和病程,说明结石长度是影响体外冲击波碎石的独立因素.结论 结石大小是影响上尿路结石ESWL预后的最主要因素.     

急诊体外冲击波碎石术治疗输尿管结石嵌顿绞痛疗效分析

目的：探讨应用体外冲击波碎石术急诊治疗输尿管结石嵌顿绞痛的适应症、方法。方法：对我院近3年来共收治的134例输尿管结石嵌顿绞痛病人的临床资料进行回顾性分析。结果：经1次ESWL治疗成功者118例（89．5％），经1次ESWL治疗绞痛缓解者122例（94％），绝大多数患者在ESWL治疗开始后均8～12min（冲击350～550次后）即绞痛缓解，并可在B超定位下见结石影粉碎散开或消失。结论：只要熟练掌握体外冲击波碎石术，并在准确定位的情况下，对急性输尿管结石嵌顿伴绞痛患者采取急诊ESWL将得到良好的疗效。     

造影辅助定位治疗输尿管阴性结石

目的探讨造影辅助定位输尿管阴性结石行体外冲击波碎石（ESWL）治疗的疗效。方法采用顺行造影及逆行造影辅助定位治疗输尿管阴性结石。结果169例患者一次碎石成功119例（70％）,两次成功42例（25％）,8例（5％）不适合ESWL治疗,均改行输尿管镜下弹道碎石术或开放手术。结论输尿管阴性结石采用静脉尿路造影（IVU）及逆行造影定位,行ESWL定位准确,治疗效果好。     

体外碎石治疗肾结石及输尿管结石体会

目的：总结体外冲击波碎石治疗泌尿系结石的体会。方法：回顾性分析2012年2月至2013年2月收治采用体外冲击波碎石疗法（ESWL）治疗的120例肾结石合并输尿管结石的结石患者的临床资料。结果：治疗1次者68例（57%）,治疗2次者35例（29%）,治疗3次者11例（9%）,治疗4次以上者4例（5%）,失败2例。结论：体外冲击波碎石疗法（ESWL）治疗尿路结石创伤小,效果肯定,但对于较大的结石及停留时间较长的结石,需多次碎石,且并发症增多,结石直径与停留时间作为选择ESWL的标准。     

关于输尿管阴性结石应用输尿管插管定位ESWL治疗的疗效观察（附252例报告）

目的探讨输尿管插管造影定位体外冲击波（ESWL）治疗输尿管阴性结石的效果。方法行患侧输尿管插管,逆行造影,用X线定位,明确结石部位后碎石治疗。对ESWL不能定位和ESWL治疗无效者,选用输尿管镜气压弹道碎石、输尿管镜钬激光碎石或输尿管切开取石。结果在252例输尿管结石中有14例输尿管结石未插入输尿管导管或导管脱落者未行ESWL治疗,238例输尿管结石行ESWL治疗,206例经ESWL治愈,有32例其中17例输尿管镜气压弹道碎石,15例输尿管镜钬激光碎石,有14例行输尿管切开取石,252例均随访3~12个月,患者无输尿管结石,肾积水消失或明显减轻。结论输尿管插管造影定位ESWL治疗输尿管阴性结石效果好,不需要麻醉,住院时间短,费用低,对ESWL治疗无效者行输尿管镜气压弹道碎石、输尿管镜钬激光碎石治疗,明显提高了治疗效果,二者配合使用,绝大部分输尿管阴性结石不需要开放手术治疗。     

同侧输尿管内两枚结石的ESWL治疗

目的：探讨同侧输尿管内两枚结石体外冲击波碎石（ESWL）两种碎石方式的疗效。方法：同侧输尿管内两枚结石患者47例行ESWL治疗。A组先碎近端结石，7～14d后再碎远端结石；B组近端结石被粉碎后直接行远端结石ESWL治疗。碎石后复查KUB平片以了解碎石效果。结果：A组29例中18例经2次ESWL碎石后结石排出，碎石成功率为62．1％；B组18例中16例经1次ESWL碎石后结石排出，碎石成功率88．9％。结论：一次性ESWL治疗同侧输尿管内两枚结石可缩短排石时间，疗效满意，是一种较好的碎石方法。     

ESWL治疗复杂性肾结石的护理体会

目的：探讨体外冲击波碎石（ESWL）治疗复杂性肾结石的临床护理效果。方法：对149例复杂性肾结石患者采用ESWL治疗过程中的临床护理体会,进行了回顾性分析。结果：采用分次ESWL粉碎复杂肾结石,充分术前准备、术后心理护理和体位护理,149例中,有142例（96．6％）结石被完全击碎,97例（65．1％）在6个月内结石完全排净,24例（16．1％）基本排净,58例ESWL后形成榆尿管结石,其中45例经综合护理,3个月内结石自行排出;13例再次行ESWL治疗后,结石消除。结论：综合护理是提高单纯ESWL治疗复杂性肾结石碎石和排石成功率的主要因素。     

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.