双针双极射频消融治疗脱垂型腰椎间盘突出症

目的探讨双针双极射频消融治疗脱垂型腰椎间盘突出症的疗效.方法回顾性分析2009年6月至2012年6月间脱垂型腰椎间盘突出症28例,28个间盘,L4～5椎间盘10例,L5S1椎间盘18例,用18G、20G的射频穿刺针2～3枚在X光定位下穿刺至脱垂的椎间盘组织内,引入电极行双针双极射频消融治疗,治疗温度:42℃～70℃,治疗周期,每个周期120 s,每个间盘2～4周期,术后给预防感染、脱水、活血化瘀、营养神经等治疗.结果手术成功率100%,28例完成随访,随访时间2～24个月.参照改良Macnab方法评价标准判定:优12例,良12例,可2例,差2例,优良率85.7%.结论双针双极射频消融治疗脱垂型腰椎间盘突出症是针对于脱垂的椎间盘组织的消融,术中准确的影像定位,治疗温度自低温逐渐升高,温度可控,消融范围可控,是一种较为安全有效的治疗方法.     

C臂引导下射频靶点热凝联合臭氧消融治疗腰椎间盘突出症的临床研究

目的:观察射频靶点热凝联合臭氧消融用于治疗腰椎间盘突出症的临床疗效。方法:挑选2013年6月至2015年12月我院收治的67例腰椎间盘突出症患者,在C臂引导下,行射频靶点热凝联合臭氧消融治疗,记录患者的临床资料及手术前后的VAS评分,参照改良Macnab法计算治疗有效率。结果:手术前和术后1天、1周、1月、3月的VAS评分依次为6.94±2.74、3.75±3.19、3.12±2.78、2.27±2.37、1.48±1.74,术后较术前明显降低(P0.01)。Macnab法评价术后1周和3个月的治疗有效率分别达到86.6%和89.6%,其中效果显著者分别占50.7%和55.2%。结论:射频靶点热凝联合臭氧消融用于治疗腰椎间盘突出症具有操作简单,安全性高,疗效显著的优点,值得临床推广。     

射频靶点热凝联合臭氧消融治疗腰椎间盘突出症173例疗效观察

目的:观察射频靶点热凝联合臭氧消融术治疗腰椎间盘突出症的临床疗效。方法:173例腰椎间盘突出症患者,在CT引导下,行突出髓核射频热凝治疗,然后向椎间盘内注射臭氧。采用视觉模拟评分法(VAS)和改良Macnab评价法评价疗效。结果:术后1天、1周、1个月、3个月VAS评分值均明显低于术前,差异有统计学意义(P<0.001);术后3个月疗效评定,优良率93.06%,总有效率98.27%,无1例出现严重并发症。结论:射频靶点热凝联合臭氧消融治疗腰椎间盘突出症疗效确切,安全性好,值得临床推广。     

射频热凝术联合臭氧消融术治疗腰椎间盘突出症临床探讨

目的 探讨射频热凝术联合臭氧消融术治疗腰椎间盘突出症的临床效果. 方法 整群选择2014年2月—2015年2月该院收治的88例腰椎间盘突出症患者为研究对象,采用随机数字表法分为观察组和对照组各44例,对照组采用射频热凝术治疗,观察组采用射频热凝术联合臭氧消融术治疗,比较两组患者疼痛程度、直腿抬高角度.结果 观察组VAS评分(2.89±0.76) 明显低于对照组(3.98±0.68)(t=7.909, P<0.05);直腿抬高角度(78.42±4.42)明显高于对照组(71.64±3.98)(t=7.561,P<0.05). 结论 射频热凝术联合臭氧消融术有助于缓解患者疼痛程度,增加直腿抬高角度,提高治疗效果.     

臭氧联合椎间孔胶原酶注射法治疗极外侧型腰椎间盘突出临床疗效观察

目的探讨治疗极外侧型腰椎间盘突出症的治疗方法及疗效。方法在C型臂监视下,对30例极外侧型腰椎间盘突出症患者进行了盘内臭氧联合患侧椎间孔处注射胶原酶治疗方法。结果术后电话随访6～12个月,按改良Macnab评判标准,优：20例,术后疼痛消失,直腿抬高试验〉70,活动无限制,良：6例,偶有非神经根性疼痛,术前体征明显改善,可从事轻体力劳动,不需服用镇痛药。可：3例,症状和体征有些改善,但仍疼痛,直腿抬高试验较前增高,但〈70°,常有疼痛,活动受一定限制,偶有服用镇痛药。差：1例,仍有神经根性疼痛,症状和体征无改善。治疗优良率87%,有效率96.6%。结论在X线监视下,对极外侧突出椎间盘内、椎小关节旁注射臭氧联合患侧椎间孔处注射胶原酶,可有效解除髓核组织对神经根的压迫,位置准确,疗效可靠,是治疗极外侧型腰椎间盘突出症的良好方法。     

CT引导下臭氧消融联合射频热凝治疗腰椎间盘突出症

目的探讨CT引导下臭氧消融联合射频热凝治疗腰椎间盘突出症的临床应用价值。方法 65例经临床、影像检查确诊的腰椎间盘突出症患者在CT引导下先行椎间盘内、外注射臭氧,后行射频热凝治疗。结果 65例患者治疗后随访3~6个月,按改良Macnab疗效评定标准分级。优22例、良33例、可6例、差4例,总有效率93.8%,优良率为84.6%,均未出现并发症。结论 CT引导提高了穿刺的准确性,在严格掌握适应证的情况下,臭氧消融联合射频热凝是治疗腰椎间盘突出症的一种微创、安全、有效的方法。     

中药内服联合射频消融术治疗腰椎间盘突出症的疗效观察

目的:探讨射频消融术加用改良独活寄生汤内服治疗腰椎间盘突出症的疗效。方法:将腰椎间盘突出症患者随机分A、B 2组,每组均28例,A组:采用中药方剂独活寄生汤为基础方加减内服联合射频消融术治疗;B组:单纯射频消融术治疗;术后7d、1个月、6个月、12个月随访评估疗效。统计治疗前后2组患者疼痛及麻木症状、肌力及直腿抬高试验结果等。结果:2组均无不良反应,术前VAS评分组间比较无显著性差异(P>0.05),具有可比性。A组治疗后与治疗前、B组治疗后与治疗前均存在显著性差异(均P<0.01)。2组治疗后各时点比较,A组评分均显著优于B组(均P<0.05)。结论:口服中药改良独活寄生汤联合射频消融术治疗腰椎间盘突出症,临床疗效优于单独射频消融术治疗,可在短时间内消除或缓解患者腰腿部不适症状。     

射频联合臭氧靶点热凝消融治疗腰椎间盘突出症50例疗效观察

目的观察射频联合臭氧靶点热凝消融治疗腰椎间盘突出症的疗效。方法我院自2008年4月-2010年6月,采用射频臭氧联合作用于腰椎间盘突出靶点治疗腰椎间盘突出症50例,均表现为腰痛伴有下肢放射性麻痛,直腿抬高、下肢肌力、反射、浅表感觉均支持腰椎间盘突出症体征,精确定位穿刺点进入射频针靶点分别运行60°30s,70°30s,80°30s,90°200s、92°100s来彻底热凝靶点,然后抽取60Uk/ml臭氧10-20mL,沿射频针缓慢注入盘内。结果本组患者全部得以回访,临床有效率98%。     

经皮穿刺低温等离子消融术治疗腰椎间盘突出症的临床研究

目的探讨经皮穿刺低温等离子射频消融髓核成形术治疗腰椎间盘突出症的可行性及临床疗效。方法回顾分析2009-01～2010-10收治的47例腰椎间盘突出症患者,采用经皮穿刺低温等离子射频消融髓核成形术进行治疗,计算手术时间、出血量、住院时间。在术前、术后1h、1d、2d、3d、3个月、1年时采用疼痛VAS和ODI评分标准进行评定。术后3个月和1年随访临床疗效结果判定参考改良Macnab标准。结果本组患者手术时间（20±10）min,出血量（4±1）ml,住院时间（4±1）d,随访时间（15±2）个月。手术前、后VAS和ODI评分比较差异具有统计学意义（P〈0．05）。结论经皮穿刺低温等离子射频消融髓核成形术治疗腰椎间盘突出症具有操作简便、安全、疗效好的优点。     

射频热凝联合三氧消融术治疗颈腰椎间盘突出症287例疗效观察

目的:观察射频热凝联合三氧消融术治疗颈腰椎间盘突出症的临床疗效。方法:287例颈腰椎间盘突出症患者在C臂引导下,行突出髓核的射频热凝术联合三氧消融术。采用视觉模拟评分法(VAS)及改良的Macnab评价法评价疗效。结果:术后1天、1周、1月、3个月VAS评分值较术前明显降低,差异有统计学意义(P0.05);术后3个月疗效评定,优良率93.37%,总有效率96.86%,无1例出现严重并发症。结论:射频热凝联合三氧消融术治疗颈腰椎间盘突出症操作简便,疗效确切,安全性高。     

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…     

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.     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.