食管癌术后并发肺部感染57例分析

目的:探讨食管癌患者术后肺部感染的原因与预防.方法:对2001～2005年间57例食管癌病例进行回顾性分析.结果:其中1例患者因误吸导致死亡,1例出现吻合口瘘,3例因出现成人呼吸窘迫综合征(ARDS)行气管切开、呼吸机辅助通气,52例出现不同程度的肺部感染.结论:食管癌患者术后并发肺部感染的因素较多,其中喉返神经损伤是引起肺部感染的主要因素,预防喉返神经损伤可有效地减少肺部感染并发症的发生.     

三切口食管癌手术中喉返神经损伤原因的分析

目的：探讨280例中上段食管癌患者采取三切口手术后,并发喉返神经损伤的原因及防治。方法：手术采取全麻双腔气管插管,右胸、上腹、左颈部切口,行胃顶部与食管断端吻合,术后采用十二指肠营养管管饲,左颈、右胸腔置引流管。结果：280例患者中喉返神经损伤21例;其中死亡2例,肺部炎症及感染9例,经抗炎及营养支持治疗后痊愈,10例患者恢复顺利。结论：食管癌三切口手术治疗中喉返神经的损伤原因是可以注意和预防的,必要时可以选择综合治疗方法。     

食管癌术后肺部感染的影响因素探讨

目的:分析研究引起食管癌患者手术后发生肺部感染的相关因素。方法:对2009年1月至2011年12月期间我院收治386例食管癌患者的临床资料进行了回顾性分析研究,探讨导致患者术后发生肺部感染的相关因素。结果:386例患者中发生术后感染的患者共30例,占到了全部手术患者的7.77%,其中60岁及以上的患者共占83.33%(25例),年龄在60岁以下的患者共占16.67%(5例),存在长期吸烟史的患者共占86.67%(26例),无长期吸烟史的患者共占13.33%(4例)。引发肺部感染的患者中,术后反流,共占26.67%(8例),管理不善,共占23.33%(7例),因喉返神经损伤导致的肺部感染占10.00%(3例)。其中无通气功能障碍以及轻度通气功能障碍患者共占16.67%(5例),中度以及重度慢性阻塞性通气功能障碍的患者共占83.33%(25例)。30例患者中共有20.00%(6例)的患者因肺部感染严重而引发呼吸衰竭,2例的患者因治疗无效死亡,死亡率为6.67%。讨论:导致食管癌患者发生术后肺部感染的主要因素包括患者的年龄大小、是否存在吸烟史、进行手术前是否存在通气功能障碍、手术过程中对于呼吸道的管理是否科学规范、术后是否发生胃食反流以及手术过程中是否出现喉返神经损伤等几个方面,因此医护人员应当特别加强对以上方面的管理,降低和避免术后肺部感染的发生,提高患者的整体治愈率。     

解剖保护预防复发性结节性甲状腺肿术中喉返神经损伤的研究

目的探讨复发性结节性甲状腺肿术中如何预防喉返神经的损伤。方法回顾性分析2002年11月至2012年11月于该院就诊的52例复发性结节性甲状腺肿患者,其中对38例患者在术中进行喉返神经的解剖保护,14例患者在术中未进行喉返神经保护。结果行喉返神经解剖术后无1例发生喉返神经损伤,未行喉返神经解剖的术后有4例出现喉返神经损伤,前者较后者术后出现神经损伤的概率较低,差异有统计学意义(P<0.01)。结论复发性结节性甲状腺肿术中解剖和保护喉返神经能够有效地预防术后喉返神经的损伤。     

食管癌术后并发肺部感染的危险因素分析

目的探讨食管癌术后并发肺部感染的危险因素,以降低食管癌术后肺部感染的发生率。方法收集2010年1月~2013年1月我院治疗的食管癌患者80例,发生肺部感染10例,未发生肺部感染70例,对两组患者的相关因素,包括年龄、性别、吸烟史、吸烟时间、合并基础疾病、手术方法、手术时间、术前血红蛋白、术前放疗与否、术中喉返神经损伤与否、术前血清白蛋白、术中是否使用自控硬膜外镇痛(PCEA)情况进行对比分析。结果年龄≥60岁、合并基础疾病、术前营养不良(术前血红蛋白≤100g/L、白蛋白≤30g/L)、术前未进行化疗、行开胸手术、未使用PCEA、有吸烟史、吸烟时间≥20年的食管癌患者肺部感染发生率较高(P<0.05或P<0.01)。将上述单因素进行多因素非条件Logistic回归分析:年龄≥60岁、合并基础疾病、术前营养不良(术前血红蛋白≤100g/L、白蛋白≤30 g/L)、吸烟史、吸烟时间≥20年、术中喉返神经损伤是食管癌并发肺部感染的危险因素(P<0.05)。结论食管癌术后并发肺部感染的危险因素较多,在治疗食管癌的手术中应引起广大医生的重视,从而采取积极的措施进行预防和治疗。     

胸腹腔镜联合治疗食管癌术后护理体会

目的：：探讨胸、腹腔镜联合治疗食管癌手术护理方法。方法：回顾性分析胸、腹腔镜联合治疗150例食管癌手术患者的护理经过。结果：术后35(23.3%)例发生并发症,其中肺部感染14(9.3%)例,颈部吻合口瘘20(13.3%)例,喉返神经损伤8(5.3%)例,经精心治疗护理,150例患者均痊愈出院。结论：在传统开胸食管癌根治术常规护理的基础上,术前术后采取有针对性的心理护理、皮肤护理、切口护理、引流管护理、呼吸道护理、活动护理和并发症的观察与预防等护理措施,更能提高手术成功率,减低并发症。     

甲状腺手术中喉返神经的显露与保护分析及个性化治疗

目的:通过在甲状腺手术中采取主动解剖显露喉返神经的保护措施及个性化治疗,达到减少和预防喉返神经损伤的目的。方法:选择甲状腺手术患者200例,其中100例采取主动解剖显露喉返神经的保护措施,另100例行常规手术,对比两种术式治疗效果。结果:观察组患者中有1例发生单侧喉返神经损伤,且在术后3个月内声嘶消失,术中喉返神经损伤率为1%;对照组术后有8例发生声嘶,术中喉返神经损伤率为8%,观察组与对照组术中喉返神经损伤经统计学检验有显著差异。结论:甲状腺手术中采取主动解剖显露喉返神经的措施能大大降低术中对喉返神经的损伤,术中采取个体化的方案对降低喉返神经损伤率尤为重要,同时要避免将神经周围完全分离,这样既可减少神经误伤,又可减少术后神经因局部水肿或缺血导致声嘶甚至呼吸困难的问题。     

腔镜微创食管癌根治术与传统开放性食管癌根治术治疗食管癌的效果比较

目的对比研究腔镜微创食管癌根治术与传统开放性食管癌根治术治疗食管癌的临床效果。方法选取2015年1月至2017年1月温县人民医院收治的拟行手术治疗的食管癌患者40例,将其随机分为对照组与观察组,各20例。对照组接受开放性食管癌根治术治疗,观察组接受腔镜微创食管癌根治术治疗,观察对比两组患者淋巴清扫效果和术后并发症(肺部感染、吻合口瘘、心律失常、喉返神经损伤发生率)发生情况。结果两组患者的淋巴结清扫效果比较,差异无统计学意义(P>0.05);观察组术后肺部感染、吻合口瘘、心律失常、喉返神经损伤发生率均低于对照组,差异有统计学意义(P>0.05)。结论腔镜微创食管癌根治术与传统开放性食管癌根治术治疗食管癌均具有较好的临床效果,腔镜食管癌根治术能有效降低患者术后并发症发生风险,值得推广应用。     

甲状腺手术中喉返神经损伤原因分析及预防(附642例报告)

目的:探讨、总结642例甲状腺手术中喉返神经损伤的原因及预防措施。方法:对我院2014—2016年共642例甲状腺手术中喉返神经损伤进行回顾性分析,总结损伤原因,提出预防喉返神经损伤措施。结果:642例甲状腺手术中,喉返神经损伤共11例,发生率为1. 71%,其中声音嘶哑术后1周恢复1例,术后3个月余恢复3例,术后6个月恢复7例,术后永久嘶哑0例。结论:熟悉喉返神经的局部解剖及变异,术中精细化操作是预防喉返神经损伤的关键。     

甲状腺手术中是否常规暴露喉返神经的分析

目的：探讨常规暴露喉返神经在甲状腺手术中预防喉返神经损伤中的应用价值。方法从我院2012年1月-2013年12月接诊的甲状腺肿瘤患者中选取54例，随机分为2组，常规暴露组29例，非常规暴露组25例，对比2组术后喉返神经损伤的相关情况。结果术前患者均无声音嘶哑症状，经电子喉镜检查声带活动正常。术后常规暴露组患者中出现4例声音嘶哑，发生率为13.79%；非常规暴露组患者中出现6例声音嘶哑，发生率为24.0%。对10例喉返神经损伤患者提供治疗，3个月后，常规暴露组4例患者完全恢复，非常规暴露组5例患者完全恢复；另1例患者经诊断发现因血肿压迫导致无法恢复，故行2次手术，行血肿清除后恢复正常。结论在甲状腺手术操作过程中，通过常规暴露能够提高手术视野，避免手术引起的喉返神经损伤，同时在促进喉返神经损伤患者的恢复上也具有重要作用。     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…