区域动脉灌注联合腹腔镜下腹腔灌洗引流治疗重症急性胰腺炎的护理

目的 探讨区域动脉灌注联合腹腔镜下腹腔灌洗引流治疗重症急性胰腺炎的护理.方法 对15例重症急性胰腺炎患者术前加强健康教育和心理护理,重视术前准备,密切监测术前术后生命体征和病情变化,重点做好动脉置管和腹腔灌洗护理.结果 15例中14例治愈(93%),1例死于晚发性胰性脑病.结论 区域动脉灌注联合腹腔镜下腹腔灌洗引流治疗重症急性胰腺炎可减少并发症,降低死亡率,术前、术后有针对性的护理,以及细致周到的病情观察,对提高疗效起了重要作用.     

早期应用微创技术治疗暴发性急性胰腺炎

目的探讨早期采用微创方法，应用介入技术行区域灌注联合腹腔镜下腹腔灌洗引流治疗暴发性急性胰腺炎（fulminant acute pancreatitis，FAP）。方法回顾分析我院早期采用微创技术治疗暴发性急性胰腺炎5例。患者入院明确诊断后迅速行介入治疗，插管至腹腔动脉持续灌注胰酶抑制剂和抗生素；全麻下行腹腔镜手术，术中尽量吸尽腹腔内积液，冲洗腹腔并适当稀释毒素，于小网膜孔、两侧结肠旁沟和盆腔置多孔引流管，条件允许者打开胃结肠韧带以充分引流。返病房后于小网膜孔引流管用4℃、1．5％的腹膜透析液30滴／min持续潍洗。结果5例患者经联合治疗后72h腹部体征明显改善，腹痛减轻，腹膜炎范围缩小。4例患者7～10天症状全部消失，疗程平均20天；1例急性呼吸窘迫综合征患者并发肺部感染，死于多器官功能衰竭。结论早期应用介入技术行区域灌注联合腹腔镜下腹腔灌洗引流治疗暴发性急性胰腺炎可能是一种较好的方法。     

区域动脉灌注联合腹腔灌洗治疗重症急性胰腺炎临床应用研究

目的 研究不同给药途径治疗重症急性胰腺炎(severe acute pancreatitis SAP)的疗效.方法 将符合入选条件45例SAP患者随机分三组,分别行区域动脉灌注联合腹腔灌洗,即治疗组;常规治疗联合腹腔灌洗,即对照组Ⅰ;一般常规治疗,即对照组Ⅱ.并根据CT 结果,选择不同病变部位置管进行药物灌注治疗,观察腹部症状,血淀粉酶,血常规,并发症率,死亡率等指标.结果 区域动脉灌注联合腹腔灌洗组在腹痛缓解,腹膜刺激征缓解,血氧饱和度恢复,血常规恢复及淀粉酶恢复时间上明显短于对照组Ⅰ和对照Ⅱ,并发症率及死亡率均低于对照组.P<0.05,差异具有显著性.结论 区域动脉灌注联合腹腔灌洗在治疗SAP疗效显著.     

腹腔镜下腹腔灌洗引流治疗重症胰腺炎体会(附6例报告)

目的 探讨急性重症胰腺炎早期治疗方法.方法 针对急性重症胰腺炎早期病理发展过程,在重症胰腺炎发病早期,采用经腹腔镜置管,建立闭式腹腔灌洗系统,用自配的腹腔灌洗液进行腹腔灌洗.结果 本组6例患者,全部治愈.结论 此法治疗重症胰腺炎,效果良好,创伤小,降低了死亡率,是急性重症胰腺炎早期治疗的一种良好手段.     

腹腔灌洗结合生大黄胃肠道灌注治疗非胆源性重症急性胰腺炎的临床研究

目的：探讨腹腔灌洗结合生大黄胃肠道灌洗治疗非胆源性重症急性胰腺炎的方法。方法：60例非胆源性重症急性胰腺炎病人,随机分为腹腔灌洗结合生大黄胃肠道灌注治疗组(n=30)、对照组(n=30)。观察两组治疗后血清淀粉酶的变化,中转手术数,并发症,住院天数和病死率。结果：治疗组能减少并发症,降低病死率,中转手术率低,住院时间缩短,提高机体免疫力。结论：腹腔灌洗结合生大黄胃肠道灌注治疗非胆源性重症急性胰腺炎有较好的临床应用价值。     

早期腹腔灌洗引流治疗急性重症胰腺炎

目的探讨早期腹腔灌洗引流治疗急性重症胰腺炎患者的疗效。方法对28例急性重症胰腺炎行早期手术腹腔持续灌洗引流的治疗进行回顾性总结、分析。结果28例早期手术治疗,经早期腹腔灌洗引流,收到了良好的效果,本组平均住院(23±5)天。本组死亡1例,系因既往有肾病综合征而死于多器官功能衰竭。结论急性重症胰腺炎早期行腹腔持续灌洗引流术可以降低SAP病死率,加速排出酶性有毒渗液,缩短病程,提高疗效。     

急性胆源性胰腺炎微创治疗46例

目的探讨急性胆源性胰腺炎(ABP)的治疗方法。方法回顾性分析该院2000年7月至2008年6月ABP微创治疗46例的临床资料。结果15例轻型非梗阻性ABP非手术治疗缓解后1周行腹腔镜胆囊切除术(LC)手术;26例轻型梗阻性ABP发病早期行鼻胆管引流/内镜下乳头括约肌切开术(ENBD/EST),缓解后1～2周内行LC或LC联合腹腔镜胆总管切开取石;1例重症非梗阻性ABP行微创腹腔置管灌洗,2～4周内延期行LC术;4例重症梗阻性ABP急诊行ENBD/EST,并加微创腹腔置管灌洗,缓解后延期行LC或LC联合腹腔镜胆总管切开取石术。结论ABP微创治疗安全有效,重症ABP早期传统常规治疗的同时联合微创手术治疗值得推广。     

经腹腔镜灌洗引流治疗早期重症急性胰腺炎

目的 探讨经腹腔镜灌洗引流治疗早期重症急性胰腺炎(SAP)的疗效。方法 应用腹腔镜微创外科技术对11例SAP患行胃结肠韧带切开，胰腺被膜切开减压，吸尽胰周渗液及清除坏死组织，并置多管腹腔引流、灌洗。结果 除1例SAP患因术后并发MOF、DIC死亡外，其余10例均痊愈出院，随访半年无复发。结论 腹腔镜灌洗引流治疗早期重症急性胰腺炎方法简单、安全、有效，可以降低SAP死亡率，减少并发症。     

区域动脉灌注治疗重症急性胰腺炎的护理体会

目的:探讨重症急性胰腺炎患者行区域动脉灌注治疗后的预见性护理方法。方法:回顾性分析我院收治的重症急性胰腺炎且进行区域动脉灌注治疗的患者共30例的相关资料,总结对患者采取预见性护理的方法及要点。结果:对患者进行预见性护理需要做好患者的心理护理,加强对穿刺部位护理、导管使用护理以及微型泵注药的使用护理等。密切观察患者治疗过程中出现的并发症或不适症状并及时处理。30例患者经治疗后29例痊愈,1例死亡。结论:采用区域动脉灌注疗法治疗重症急性胰腺炎效果显著,对患者采取预见性护理措施有助于帮助患者早日恢复,提高治愈率。     

B超引导下可调控套管腹腔灌洗治疗重症急性胰腺炎的临床观察

目的 探讨B超引导下可调控套管腹腔灌洗在重症急性胰腺炎治疗的安全性及疗效.方法 对21例重症急性胰腺炎患者除采用常规非手术综合治疗外均行B超引导下可调控套管腹腔灌洗.结果 该组21例患者中,治愈18例,死亡3例,治愈率为85.7%.全组患者均无导管脱落、腹腔空腔脏器损伤等并发症.结论 B超引导下可调控套管腹腔透析液腹腔灌洗治疗重症急性胰腺炎安全有效,为重症急性胰腺炎治疗方法的一种新的探索.     

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.