冷冻治疗儿童利特尔区特发性鼻出血的临床观察

鼻出血是儿童常见病症 ,多为鼻中隔利特尔区不明原因的特发性鼻出血[1] ,表现为反复发生鼻腔出血 ,有夜间频发倾向 ,临床治疗方法有多种。我们从 1995～ 1999年间应用液氮接触冷冻方法 ,治疗 70 0余例儿童利特尔区特发性鼻出血 ,随访 5 0 4例 ,效果良好 ,儿童易接受 ,经济方便。资料和方法一、一般资料本组 5 0 4例患者中 ,男性 2 86例 ,女性 2 18例 ,年龄 5～12岁 ,平均年龄 7.5岁 ,病程半个月～ 3年 ,多数患儿可见利特尔区血管曲张或小血管网暴露于粘膜表面。二、治疗方法治疗前做好鼓励和安慰工作 ,以减轻患儿的恐惧心理。用 1%麻黄素、…     

鼻腔镜下难治性鼻出血的治疗研究

目的研究探讨使用鼻腔镜治疗患者难治性鼻出血的有效治疗方法.方法 安抚鼻出血患者的情绪,对有高血压的患者在口服降压药的同时,应用4mg的肾上腺素加上1%地卡因20ml进行鼻腔黏膜麻醉和压迫性,每次3min止血3次,共约10min.用吸引管清除鼻腔内积留的凝血块,再在鼻腔镜下以可疑出血部位为基准,置入2%地卡因(含1:1000肾上腺素)棉片,根据棉片血染的部位进一步的判断出血位置,待鼻腔出血暂时稳定后,在30°鼻内镜引导下查找鼻腔出血点,明确患者出血点后可采用铬酸、单极电凝或微波探头、射频治疗等,进行止血治疗.结果 鼻出血部位与年龄有一定的关系40~49岁年龄组以下鼻道顶部出血最为常见(24/31,77.4%);50~59岁年龄组以下鼻道顶部与鼻中隔部出血较为常见,分别为(13/26,50%)和(11/26,42.3%);出血部位依次为下鼻道顶部(46/75,61.3%)、鼻中隔部(24/75,32%)、中鼻道后上部(5/75,6.7%);术后随访3个月患者恢复良好,均未再出血.结论 鼻内镜下微波、射频或填塞治疗难治性鼻出血有视野清晰、操作准确、止血彻底、患者痛苦小、明显减少并发症等优点,易被患者所接受.     

探讨鼻内镜下治疗鼻腔内不同部位顽固性出血的临床疗效

目的探讨鼻内镜治疗鼻腔内不同部位顽固性出血的临床治疗效果。方法以我院2014年12月至2015年12月收治的248例顽固性鼻出血患者为研究对象,对其临床资料进行回顾性分析,其中:第一组,112例,均为单侧鼻道出血,68例为左侧,44例为右侧;第二组,鼻中隔出血,136例。所有患者均行鼻内镜下微波、电凝止血,随访观察并比较不同部位鼻内镜治疗顽固性鼻出血的临床治疗效果。结果鼻道出血组鼻内镜治疗有效率为92.85%,鼻中隔出血组治疗有效率为97.80%,两组有效率比较无统计学差异(P0.05);但鼻中隔出血组治愈率明显高于鼻道出血组,治愈率比较具有统计学差异(P0.05)。结论鼻内镜下治疗鼻中隔出血和鼻道均有较好的疗效,有效率大致相同,但对鼻内镜治疗鼻中隔出血的治愈率明显高于鼻道出血。故认为鼻内镜适用于治疗鼻腔内不同部位的顽固性出血,尤其是鼻中隔出血。     

鼻内镜下微波治疗鼻出血200例临床疗效观察

目的观察鼻内镜下微波治疗鼻出血的临床疗效。方法 200例鼻出血患者经局部麻醉后,在鼻内镜下查找出血点,利用微波的热效应使蛋白凝固治疗鼻出血。结果 200例鼻出血患者一次治疗痊愈185例,有效12例,无效3例,总有效率达98.50%,治愈率为92.50%;余15例患者经两次微波治疗后痊愈,治愈率达100%.术后不良反应发生率仅为2.00%.结论利用鼻内镜清晰的视野,可窥及鼻腔顶部、深部及后部隐蔽不易窥测的出血部位,在鼻内镜引导下采用微波治疗具有操作简单,无烟、无味,止血效果好,治愈率高,患者无痛苦、乐于接受且无明显不良反应等优点,值得临床推广应用。     

液氮冷冻治疗鼻出血的疗效观察

<正>1995年～1997年间,我们采用液氮治疗鼻出血200例,药物对照治疗90例,均随访2年;两组疗效进行比较,表明液氮冷冻治疗效果较好,现予报道。 1.临床资料 一般资料 选择诊断明确的鼻出血290例,分为液氮冷冻组:200例,男112例,女88例,年龄6～78岁;药物治疗组90例,男48例,女42例;年龄8～70岁;全部患者均系原发于鼻腔病变所致鼻出血,已摒除继发于全身性疾病如高血压、动脉硬化、血液病等所致。病变类型分粘膜病变型:183例,为鼻中隔出血区或鼻甲出血处粘膜充血、干燥、粗糙、炎性变、浅在糜烂、粘膜变薄、中隔穿孔边缘出血。血管病类型:72例,局部毛细血管改变,如单个或多个针帽状静脉囊状曲张突起、网状血管扩张,单个或多个毛细血管瘤,一条或几条血管扩张等。     

鼻内镜下双极电凝治疗难治性鼻出血的临床分析

目的 探讨鼻内镜下双极电凝治疗难治性鼻出血的疗效与安全性,统计难治性鼻出血的常见出血部位、各年龄段性别分布特点。 方法 对2014年11月-2017年12月蚌埠市第三人民医院耳鼻喉科收治的75例难治性鼻出血患者,鼻内镜下一次甚至两次寻找出血点的诊疗过程进行回顾性分析,总结难治性鼻出血的治疗效果,分析并发症的发生情况,统计难治性鼻出血常见出血部位、各年龄段性别分布特点。 结果 鼻内镜下双极电凝治疗难治性鼻出血的治愈率为100%,并发症发生率为2.67%。68例患者在鼻内镜下发现出血点(第一次发现出血点64例),在双极电凝止血后,未再次出血。全部患者为动脉性的单一出血点,大多位于鼻腔隐匿部位,分别为下鼻道(50.67%,38/75),嗅裂鼻中隔面(13.33%,10/75),中鼻道(5.33%,4/75,其中筛泡2例,筛窦前壁1例,上颌窦自然口1例),鼻中隔后端(6.67%,5/75),鼻中隔凹陷(4.00%,3/75),鼻中隔偏曲侧后方(6.67%,5/75),中鼻甲基板、中鼻甲后端、中鼻甲腋部各1例(1.33%,1/75),未找到出血点7例(9.33%,7/75)。7例未发现明显出血点的患者,采用双极电凝方法,处理可疑出血及渗血的黏膜,并鼻腔局部填塞治疗,均未出血。所有患者没有选择蝶腭动脉凝固(结扎)术。鼻出血发病男多于女,40岁以后发病在增加,50岁以后女性发病在增加。 结论 鼻内镜下双极电凝治疗难治性鼻出血疗效好,并发症少,安全性高,符合精准、微创的理念,值得临床推广使用,常见出血部位、各年龄段性别分布特点可指导临床。      

液氮冷冻治疗结节性痒疹39例效果观察

目的:探讨液氮冷冻治疗结节性痒疹的效果。方法:将确诊为结节性痒疹77例患者随机分为两组。观察组39例单纯液氮冷冻治疗,棉签浸蘸液氮后迅速置于结节性痒疹的病变组织,根据皮损的大小、厚度、部位以及局部反应可重复多次冻融;治疗后7~21天复诊,如局部残留结节性皮损可按上述方法重复冷冻。对照组38例外用止痒消炎药水和去炎松尿素软膏治疗。结果:观察组痊愈24例,显效8例,有效32例(82.05%),复发3例(7.7%)。对照组痊愈4例,显效12例,有效16例(42.11%),复发13例(34.2%)。两组有效率和复发率比较差异有统计学意义(P<0.01;P<0.05)。结论:单用液氮冷冻治疗结节性痒疹操作简单安全,效果满意,副作用小,患者易于接受,值得临床应用。     

液氮低温冷冻在鼻出血中的应用

我院耳鼻咽喉科于１９９５～１９９８年在门诊采用液氮低温冷冻直接喷射法和棉签蘸液氮接触法,治疗鼻出血,取得良好效果,现报告如下。１临床资料 鼻出血治疗对象选择为鼻中隔Ｌｉｔｔｌｅ区粘膜糜烂或血管扩张所致静脉性渗血患者,共１１６例。男性７０例,女性４６例,年龄３～７０岁,病程０．５小时～６天。随机分为两组,冷冻组６６例,对照组５０例。冷冻组止血方法为成人用液氮直接喷射出血处,儿童多采用棉签蘸液氮接触出血处。目测冷冻区粘膜色变白或有结霜时为止,约１分钟左右,待其自然复温。此过程为一个冻融周期,每次２～…     

125例鼻出血部位分析及阶梯治疗

鼻出血系耳鼻喉科常见急症 ,本文就我科 1 990年— 1 998年住院治疗的 1 2 5例鼻出血的出血部位统计分析 ,并针对不同的出血部位及病情进行阶梯治疗 ,取得了满意的效果 ,现报道如下。资料与方法1 　 临床资料　本组病例中 ,男性 73例 ,女性 52例 ,年龄 5岁～ 70岁 ,各年龄组鼻出血部位分布为 :黎氏区 51例 ,中隔其它部位 1 5例 ,鼻腔前部 1 3例 ,鼻腔后部 2 0例 ,中鼻道 1 5例 ,多部位 1 1例。2 　阶梯治疗　病人初入院后 ,我们将止血的程序分为五级 ,即 :Ⅰ级为烧灼、冷冻 ;Ⅱ级为鼻腔粘膜下注射50 %葡萄糖或 5%鱼肝油酸钠 ,Ⅲ级为前鼻孔填…     

难治性鼻出血的出血部位及精准治疗

目的探讨难治性鼻出血的出血部位、治疗方法及疗效。方法回顾性分析132例难治性鼻出血患者,分析出血部位与年龄、高血压的关系及疗效。结果鼻出血部位:下鼻道穹隆部56例,嗅裂区鼻中隔面46例,中鼻道后上部25例,不明部位5例。出血部位与年龄有一定的相关性,≤39岁组以下鼻道穹隆部出血最为常见(70.3%),40~59岁组下鼻道穹隆部与嗅裂区鼻中隔面出血比例分别为52.3%(23/44)和31.8%(14/44);而≥60岁组嗅裂区鼻中隔面与中鼻道后上部出血比例分别为58.8%(30/51)和23.5%(12/51)。伴有高血压的鼻出血79例(59.8%),不伴有高血压的鼻出血53例(40.2%),其中嗅裂区鼻中隔面鼻出血患者伴高血压多见(73.9%)。全部病例一次治愈128例(97.0%),二次治愈4例(3.0%),随访3个月均无复发。结论39岁以下患者难治性鼻出血的出血部位以下鼻道穹隆部为主,而60岁以上患者以嗅裂区鼻中隔面为主,高血压是难治性鼻出血常见的合并症,尤其是位于嗅裂区鼻中隔面的鼻出血,鼻内镜下探查难治性鼻出血的出血点并对出血部位进行精准电凝的止血术是行之有效的治疗方法。     

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.