放疗联合唑来膦酸治疗骨转移肿瘤疼痛34例临床分析

目的:观察放射治疗联合唑来膦酸治疗骨转移肿瘤疼痛的临床疗效和不良反应。方法:恶性肿瘤骨转移患者67例,随机分为两组,观察组放射治疗联合唑来膦酸34例,对照组单纯放射治疗33例,30Gy/10次。结果:放射治疗骨疼痛有效率72.7%,放射治疗联合唑来膦酸骨疼痛缓解率91.2%(P<0.05),中位缓解期分别为14.5周和22周(P<0.01)。结论:放射治疗联合唑来膦酸治疗骨转移肿瘤疼痛的疗效确切,且止痛持续时间长。     

局部姑息性放疗与口服阿片类药物治疗肿瘤骨转移患者疼痛的疗效比较

目的:比较局部姑息性放疗与口服阿片类药物治疗肿瘤骨转移患者疼痛的临床疗效。方法:选取200例肿瘤骨转移患者作为研究对象,随机分为对照组和观察组,每组各100例。对照组患者使用短效阿片类药物滴定后改成长效缓释阿片类药物口服镇痛治疗;观察组患者进行6MV-X线直线加速器调强放射治疗。结果:治疗后,观察组患者的疼痛完全缓解8例,部分缓解86例,无效6例,总有效率为94%;对照组患者的疼痛完全缓解7例,部分缓解85例,无效8例,总有效率为92%;两组患者临床治疗有效率比较无统计学意义(P>0.05);观察组患者不良反应发生率低于对照组(P<0.05),具有统计学意义。结论:肿瘤骨转移疼痛患者采用局部姑息性放射治疗和口服阿片类药物均具有镇痛的效果,但局部姑息性放射治疗不良反应少,可改善患者生活质量。     

活血止痛酊剂治疗带状疱疹神经痛216例

目的:观察活血止痛酊剂治疗带状疱疹的疗效.方法:216例带状疱疹患者外用活血止痛酊剂治疗31天,观察其疱疹止疱、结痂、脱痂时间及疼痛缓解程度、疼痛开始缓解时间、疼痛持续时间,并进行综合疗效评价.结果:216例患者疼痛缓解程度92.3±4.6%,疼痛开始缓解时间5.6±2.4天,疼痛持续时间17.8±12.7天.综合疗效判定标准:治愈率91.2%,好转率6.9%,总有效率98.1%.结论:活血止痛酊剂抓住了解毒和止痛两个治疗的关键点,药简而效宏,易为广大患者所接受.     

三维适形放疗肺癌的临床分析

目的:探讨三维适形放射治疗肺癌的近期疗效及副反应.方法:16例确诊肺癌患者接受了三维适形放射治疗.结果: 6例肿瘤完全消失,7例肿瘤明显缩小50%以上,3例肿瘤无变化,但CT检查无明显增强;副反应主要为放射性食道炎,不影响进食.结论:三维适形放疗是肺癌治疗中的有效方法.     

19例肿瘤患者合并带状疱疹的护理体会

肿瘤患者接受化疗和放疗后由于机体免疫功能低下,容易并发带状疱疹。带状疱疹以皮肤损害为主造成的疼痛,影响患者的身心状况,如护理不当可能会加重病情,因此,对肿瘤患者合并带状疱疹的治疗与护理是临床工作中的难点。我院肿瘤中心于2005年10月～2008年11月收治此类患者19例,在临床治疗基础上,辅以细致的护理,取得了良好的效果,现报道如下。     

中西医结合治疗带状疱疹后遗神经痛的方法

目的:探讨中西医结合治疗方法对治疗带状疱疹后遗神经痛和促进神经受损恢复的效果。方法:将152例带状疱疹后遗神经痛患者随机分为治疗组76例和对照组76例。两组患者均接受抗病毒治疗、营养神经药物治疗,治疗组在此基础上中草药煎服。结果:治疗组总有效率97%,对照组总有效率63%,治疗组疗效远远高于对照组,差异有统计学意义(P<0.01),中西医结合治疗带状疱疹后遗神经痛,对减轻患者疼痛和神经受损恢复有很好的效果。     

带状疱疹住院患者258例临床分析

目的:分析带状疱疹患者的临床特点、治疗以及后遗神经痛的发生率,为提高临床治疗效果提供参考。方法:对258例住院带状疱疹病例进行回顾性分析。结果:258例患者中有明确诱发因素或者相关的基础疾病者191例,占74.0%;男性患者多于女性;年龄在60岁及以上者122例,占47.3%;后遗神经痛患者29例,占11.2%,多为60岁以上的患者。结论:带状疱疹多数有诱发因素,男性多于女性,后遗神经痛多见于中老年患者,早期诊断和治疗对防止老年患者后遗神经痛的发生具有重要意义。     

生理盐水混合剂含服防治放射性口腔炎的疗效观察

放射性口腔炎是头颈部肿瘤患者接受放射治疗后最常见的并发症。主要表现为口腔粘膜充血、水肿、糜烂、溃疡、白膜形成甚至疼痛、进食困难等。我科采用生理盐水混合剂防治放射性口腔炎 ,效果较好 ,现介绍如下。1　临床资料我们选择鼻咽癌患者 15 9例 ,其中男 10 5例 ,女 5 4例 ,年龄 10～ 78岁 ,所有患者都接受放射治疗 ,剂量DT70GY ,照射面积均在 6cm× 6cm以上。放射治疗后口腔粘膜反应分级 ,轻度 :粘膜红、肿、红斑、充血。中度 :粘膜明显充血、水肿、斑点状白膜、溃疡形成 ,轻度疼痛。重度 :粘膜极度充血、糜烂、出血融合成片状白膜、…     

肿瘤晚期患者的疼痛评估与护理

目的:探究优质护理对肿瘤晚期患者疼痛的有效性。方法:选取67例肿瘤晚期的患者进行护理和疼痛评估,随机分组,试验组39例患者给予优质护理,对照组28例患者采取常规护理,对比其护理效果和疼痛情况。结果:试验组患者轻度疼痛率为82.1%,重度疼痛率为2.6%;对照组患者轻度疼痛率为42.9%,重度疼痛率为25.0,差异有统计学意义(P<0.05)。结论:肿瘤晚期患者接受优质护理,可缓解身体的部分疼痛,缓解悲观情绪,使其得到更多的关怀,避免不必要的护患纠纷。     

局部进展期胰腺癌调强放疗剂量递增临床研究

目的探索调强放射治疗(IMRT)提高进展期胰腺癌局部肿瘤靶区剂量以及减少周围正常组织照射剂量的可能性. 方法21例局部进展期胰腺癌患者接受同期放化疗.放射治疗分第一阶段予常规放射治疗,剂量30Gy/15次/3周;第二阶段强调放射治疗,肿瘤靶区分割剂量3Gy/次,总剂量为21 ～ 30Gy,在2周内分7 ～ 10次完成.总剂量递增水平:51、54、57、60Gy.在放射治疗过程中,每个治疗日5-FU静脉点滴. 结果16例完成治疗计划,分别为51Gy 3例、54Gy 3例、57Gy 3例,60Gy 7例.13例治疗前CA19-9值升高,中位值治疗前后分别为716、255U/ml(P<0.001).14例以疼痛为主的患者至少减少1/3 ～ 1/2的麻醉药品用量,其中5例疼痛症状完全消失.10例患者治疗后卡氏评分有提高. 结论局部进展期胰腺癌患者接受适形调强放疗并同期应用5-Fu化疗增敏,可获得确切的姑息治疗作用,肿瘤剂量60Gy分25次在5周完成,无严重的放射治疗相关的急性毒性反应.     

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.     

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.     

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.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.