带状疱疹后遗神经痛的发病相关因素分析

目的 探讨带状疱疹后遗神经痛发病的相关因素,为临床带状疱疹后遗神经痛的治疗提供依据。 方法 收集浙江省人民医院带状疱疹患者79例作为研究对象,根据是否有后遗神经痛,分为带状疱疹后遗神经痛组29例和非带状疱疹后遗神经痛组50例。对79例患者进行问卷调查,记录并分析带状疱疹类型、就诊时间、皮肤受累面积、有无前驱疼痛与后遗神经痛的关系。 结果 带状疱疹就诊时间和带状疱疹后遗神经痛的发病率有显著相关性(P＜0.05),在5 d内就诊的带状疱疹患者发生带状疱疹后遗神经痛的比例为13.3%,就诊时间超过5 d的带状疱疹患者发生带状疱疹后遗神经痛的比例为42.2%,5 d以上就诊患者带状疱疹后遗神经痛的发生率明显增加;带状疱疹的皮肤受累面积和带状疱疹后遗神经痛的发病率有显著相关性(P＜0.05),带状疱疹皮肤小面积受累时带状疱疹后遗神经痛的发生率为25.0%,带状疱疹皮肤大面积受累时带状疱疹后遗神经痛的发生率为51.4%,带状疱疹受累面积大时后遗神经痛的发生率增加;带状疱疹前驱疼痛和带状疱疹后遗神经痛的发病率有显著相关性(P＜0.05),带状疱疹有前驱疼痛时,带状疱疹后遗神经痛的发生率为47.9%,带状疱疹无前驱疼痛时,带状疱疹后遗神经痛的发生率为19.4%,有前驱疼痛时带状疱疹后遗神经痛的发生率明显高于无前驱疼痛时带状疱疹后遗神经痛的发生率(P＜0.05)。 结论 带状疱疹后遗神经痛的发生率和带状疱疹的类型无关,和带状疱疹的就诊时间、皮肤受累面积和前驱疼痛相关。      

207例带状疱疹临床特征及预后因素分析

目的：探讨带状疱疹的临床特征及预后因素。方法：收集2008年1月—2015年12月住院确诊的207例带状疱疹患者的临床资料,对其发病年龄、性别、基础疾病、发病诱因、数字分级量表（numerical rating scale,NRS)评分、皮损分布与严重程度、实验室检查、治疗与预后进行回顾性分析,进一步利用Logistic回归分析对带状疱疹后遗神经痛的危险因素进行分析。结果：207例住院带状疱疹患者平均发病年龄（63.1±16.0）岁,发病无明显性别差异,17.4%患者合并2种以上基础疾病,51.2%患者发病前有明确诱因,60.4%患者具有前驱期疼痛,21.7%患者病程中伴有发热、皮损,以累及三叉神经眼支者最多,占36.7%;入院时NRS评分和皮损严重程度评分为中度或重度的患者占90%以上。治疗后19例发生带状疱疹后遗神经痛,1例遗留右上肢运动性麻痹。与同期门诊诊治的252例带状疱疹患者相比,住院带状疱疹患者带状疱疹后遗神经痛的发生率明显高于门诊患者（χ2=9.224,P<0.01）。Logistic回归分析显示皮损累及胸神经分布区、NRS评分高是发生带状疱疹后遗神经痛的主要危险因素。结论：临床上应加强识别带状疱疹后遗神经痛的危险因素,早期进行规范与合理治疗。     

带状疱疹86例临床观察

目的分析带状疱疹的发病特点、治疗措施及与疱疹后遗神经痛的相关性。方法回顾性分析86例带状疱疹患者的临床治疗情况。结果病程、带状疱疹后遗神经痛发生与年龄、初诊时间、治疗措施有关。结论带状疱疹患者较早诊治和对症下药,对缩短病程、防止带状疱疹后遗神经痛有积极作用。     

老年带状疱疹后神经痛的因素分析

目的:探讨老年带状疱疹后神经痛的多种因素,为指导临床治疗提供可靠依据。方法:选取2012年7月至2015年7月期间的老年带状疱疹患者127例,将其分为带状疱疹并神经痛组(23例)和非神经痛带状疱疹组(104例),对两组患者临床资料进行比较分析。结果:在患者初治时间、前驱痛及疼痛程度比例方面,非神经痛带状疱疹组低于带状疱疹并神经痛组(P<0.05);在患者发热、性别及受累神经比例方面,两组差异无统计学意义(P>0.05)。结论:老年带状疱疹后神经痛的发生主要与患者初治时间、前驱痛及疼痛程度有关,掌握带状疱疹后神经痛的上述因素,可为临床治疗提供可靠参考。     

优质护理干预对带状疱疹后遗神经痛患者的影响

带状疱疹是由水痘—带状疱疹病毒引起的感染性皮肤病,发生于带状疱疹病毒感染后,10%的患者疼痛时间超过一个月,如得不到及时治疗或治疗不当,疼痛可在疱疹消失后仍然存在,有的病例疼痛甚至超过数十年[1].带状疱疹后遗神经痛与发病年龄有关,小于40岁患者很少发生, 60岁以上患者发生率为50%,70岁以上患者发生率为75%,约有10%-25%的后遗神经痛患者疼痛可持续超过一年,严重影响身心健康[2].优化护理方案能有效缓解患者疼痛、改善其生活质量,意义重大[1-2].本研究对2014年1月-2016年1月在我院住院治疗的带状疱疹后遗神经痛患者进行优质护理干预,效果满意,现报告如下.     

火针配合拔罐治疗带状疱疹后遗神经痛30例

带状疱疹是由水痘-带状疱疹病毒感染引起的一种以沿周围神经分布的群集疱疹和神经痛为特征的病毒性皮肤病,当疱疹消退后仍有部分病毒潜伏在神经节内,导致被侵犯部位发生疼痛,称之为带状疱疹后遗神经痛(Postherpetic neuralgia,PHN),中医学称之为"蛇丹愈后痛".自2000年以来笔者采用火针配合拔罐治疗带状疱疹后遗神经痛取得较好效果,并与皮肤针叩刺治疗进行比较,现报道如下.     

高龄老干部带状疱疹及后遗神经痛49例治疗

目的探讨高龄老干部带状疱疹及后遗神经痛的治疗效果。方法本科2005年1月至2009年12月共收治49例高龄老干部带状疱疹患者,在控制基础疾病的基础上进行有效的抗病毒治疗,应用促进神经功能恢复药物、止痛剂,适当使用免疫增强剂。在做好基础护理的同时重点给予心理护理、神经痛护理、特殊患部护理以及饮食指导。结果全部患者在治疗后其疱疹均结痂,部分痂皮脱落,35例患者未出现疼痛,10例患者存在轻度疼痛,需要应用止痛药,3例患者在服药同时还需要继续理疗,1例后遗神经痛患者在给予常规治疗后其症状未明显好转,再实施神经封闭治疗,后疼痛消失出院。结论对于高龄带状疱疹及后遗神经痛患者实施专科治疗,并且进行有效的护理干预,可显著降低后遗神经痛发生率,缓解患者疼痛状况。     

神经阻滞在中老年带状疱疹治疗中的作用

带状疱疹是由于水痘-带状疱疹病毒引起的沿周围神经分布的群集疱疹和神经痛为特征的病毒性皮肤病.神经痛是本病特征之一,约90%以上的患者会有疼痛,且与其他类型的疼痛相比更具有程度剧烈的特征.神经痛程度轻重与年龄有关,老年患者常疼痛剧烈,且易发展为带状疱疹后遗神经痛(postherpetic neuralgia,PHN).因此,临床治疗中减轻疼痛,减少PHN的发生尤为重要.笔者对神经阻滞减轻中老年带状疱疹患者疼痛的效果进行了观察,现报道如下.     

老年带状疱疹神经痛96例临床观察与护理

目的:探讨老年带状疱疹神经痛的有效护理方法.方法:分析96 例老年带状疱疹患者疼痛的特征及治疗方法,加强心理护理、疱疹局部皮肤护理、神经痛护理、饮食护理及健康指导等.结果:患者皮损痊愈,平均住院15天出院,后遗神经痛的发生明显减少.结论:对老年带状疱疹患者进行合理治疗、配合全方位的综合护理,是缩短病程、减轻神经痛、减少后遗神经痛的关键.     

中西医结合治疗带状疱疹后遗神经痛的疗效分析

目的:分析中西医结合治疗带状疱疹后遗神经痛的疗效。方法:将72例带状疱疹后遗神经痛患者随机分为两组,每组36例,对照组患者给予阿昔洛韦治疗,观察组患者在此基础上加用中药治疗,观察两组患者的疼痛及疱疹消失时间,并对临床疗效进行评价。结果:观察组治疗后的疼痛消失时间及疱疹消失时间均少于对照组,治疗总有效率显著高于对照组,组间差异有统计学意义(P<0.05)。结论:中西医结合治疗带状疱疹后遗神经痛临床疗效好,值得临床进一步推广应用。     

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.