主动脉夹层动脉瘤的超声诊断

目的　探讨主动脉夹层动脉瘤的超声特点。　方法　对 16例临床疑为主动脉夹层的患者进行超声心动图、CT及 MRI检查。　结果　心脏超声检查检出率 92 .3% (14 / 16 ) ,特点为 (1)主动脉壁有分离的回声带 ,真假腔血流速度不同 ;(2 )升主动脉增宽 4 2～ 5 6 m m(13/ 16 ) ;(3)夹层远心端形成血栓 (2 / 16 )。　结论　超声诊断主动脉夹层动脉瘤有重要价值     

降主动脉瘤治疗中主动脉腔内支架隔绝术的应用效果

目的:分析降主动脉瘤治疗中主动脉腔内支架隔绝术的应用效果,旨在提高降主动脉瘤患者的治疗效果。方法:选择收治的stanford B型的主动脉夹层患者52例,真性动脉瘤患者5例,假性动脉瘤患者3例,此外,还有主动脉壁间血肿合并主动脉穿透性溃疡的患者15例,对这些患者实行主动脉腔内支架隔绝手术。结果:75例患者接受主动脉腔内支架隔绝术都比较成功,并发症较轻,2例Ⅰ型内漏但在近端添加cuff之后得到了纠正,有2例Ⅱ型内漏。对69例患者进行1～35个月的随访,每例患者的随访时间平均为(24.3±10.7)个月,并对随访结果记录与整理。结论:在降主动脉治疗中,主动脉腔内支架隔绝术具有广阔的应用前景。     

直视下补片修补急性A型胸主动脉夹层合并的降主动脉内膜破口

目的:探讨合并降主动脉内膜破口的A型胸主动脉夹层的手术新方法.方法:3例急性A型胸主动脉夹层患者在深低温停循环、经上腔静脉逆灌下行升主动脉和半弓置换,同时直视下探查降主动脉近端的内膜破口.用卵圆形毛毡片分别置于裂口处内膜的外侧和内侧,用4-0丙烯线作连续缝合修补破口.结果:3例患者均顺利出院.术后2～3个月行螺旋CT结果显示:3例患者胸部降主动脉夹层均已形成血栓;其中2例假腔消失,另1例假腔明显缩小,但仍有少量血流与真腔相通,可能为降主动脉内膜破口修补处渗漏.结论:对同时合并有降主动脉内膜破口的A型胸主动脉夹层患者行降主动脉内膜破裂口修补具有良好的临床效果,避免了二期降主动脉手术.     

PC-MRA对Stanford B型主动脉夹层血流动力学与顺应性的研究

目的 利用相位对比磁共振血管成像对主动脉夹层(Stanford B型)的血流动力学和顺应性进行研究。 方法 25例诊断Stanford B型主动脉夹层患者,覆膜支架腔内隔绝术前行相位对比磁共振血管成像。分别采集6个主动脉层面:1升主动脉瓣上肺动脉分叉水平;2主动脉弓水平;3降主动脉破口以远2 cm水平;4膈水平;5平较低支肾动脉下1 cm水平;6腹主动脉近髂分叉水平。对图像数据进行定量分析,测量各层面1个心动周期内真腔与假腔的平均横断面积、血流指标(平均血流速度、平均血流量和净流量),并计算真腔与假腔的顺应性。比较真、假腔平均横断面积、血流指标、顺应性的差异及真、假腔顺应性的相关性。相关性应用Pearson 相关分析,差异比较应用Paired t-test统计学方法。结果 在3~6层面水平,所有患者的真腔平均横断面积均小于假腔平均横断面积(P<0.05);真腔内平均血流速度均高于假腔内平均血流速度(P=0.000)。在5、6层面水平,真腔内平均血流量、净流量均高于假腔内平均血流量、净流量(P<0.05)。在3、6层面水平,真腔的顺应性高于假腔的顺应性(P<0.05),并且二者呈明显正相关(r=0.667,P=0.001;r=0.545,P=0.019)。结论 相位对比磁共振血管成像能够定量测定主动脉夹层真腔和假腔的血流动力学指标与真假腔顺应性,为临床Stanford B型主动脉夹层患者提供了一种无创的血流动力学监测手段。     

螺旋CT在主动脉夹层腔内隔绝术前的应用价值

目的 分析螺旋CT在主动脉夹层腔内隔绝术前的应用价值.方法 对拟行主动脉夹层腔内隔绝术的患者,术前全部采用螺旋CT进行评估.结果 65例患者中在术前的螺旋CT评估和手术所见裂口位置相符合60例,相符率92.31%;裂口数量相符合的62例,相符率95.38%;真假腔判断相符合的65例,相符率100%;夹层范围的判断相符合的65例,相符率100%,术前螺旋CT评估降主动脉直径大小为(28.7±6.8)mm,手术所见降主动脉直径大小为(29.8±6.4)mm,差异无统计学意义.结论 术前使用螺旋CT可以对患者的具体情况有一个比较详细的了解,对主动脉夹层腔内隔绝术的成功有重要意义.     

腔内隔绝术后主动脉夹层再发的原因及预防措施

自2000年10月至今共开展主动脉腔内隔绝术31例次,男30例,女1例,夹层动脉瘤26例,StandfordA型4例、StandfordB型22例,其中5例行动脉腔内隔绝术后再次出现主动脉夹层,报告如下。1临床资料5例患者一般资料、复发原因及处理见表1。2讨论主动脉夹层是一种严重威胁人类健康的疾病。65%～70%的患者死于急性期(2周内)。未及时治疗的患者25%死于24h内,1年内病死率达90%,发病年龄的高峰期为50～60岁。DAKE等[1]1994年率先报道以腔内隔绝术治疗13例主动脉夹层及降主动脉瘤获得成功。在我国,有学者1998年报道了国内首例B型主动脉夹层腔内隔绝术。10…     

腔内隔绝术在主动脉瘤治疗中的临床应用（附10例报告）

目的 总结主动脉腔内隔绝术治疗主动脉瘤的临床经验.方法 分析2004年至2008年对10例主动脉瘤患者施行主动脉腔内隔绝术的临床资料.结果 10例病人中腹主动脉瘤4例,降主动脉瘤1例,主动脉夹层Debakey Ⅲ型5例,术后1～6个月复查UCG、CT,显示移植人工支架形态良好,血流通畅,无脑部并发症、无截瘫.结论 主动脉腔内隔绝术治疗主动脉瘤,治疗效果确切,创伤小,并发症少.     

多层螺旋CT血管成像在不典型主动脉夹层中的诊断价值

目的探讨CT血管成像技术在不典型主动脉夹层(AAD)中的表现。方法对12例不典型主动脉夹层病例行多层螺旋CT血管造影检查,结合二维和三维重建技术进行图像分析。结果采用Stanford分类法分型:8例为A型,4例B型。AAD CT表现为:(1)均未见撕裂内膜片和双腔影像;(2)主动脉壁新月形或环状增厚(假腔)达5.0～30 mm;(3)平扫假腔密度高于、等于或低于主动脉真腔者,分别为6例、4例和2例;(4)增强扫描假腔均无强化;(5)83%(10例)病变主动脉无明显受压改变;(6)随诊假腔有变化。二维图像(多平面重建及曲面重建)能较好地显示病变范围、大小及细节,而三维重建(最大密度投影、表面遮盖成像和容积重建)良好显示管壁钙化情况和病变空间关系,模拟内镜可以显示动脉内膜情况。结论多层螺旋CT血管造影结合图像后处理技术,是一种准确、有效诊断不典型主动脉夹层的检查方法。     

覆膜支架腔内修复处理降主动脉破裂的临床体会

目的总结运用胸主动脉覆膜支架腔内修复急诊救治降主动脉破裂的经验和体会。方法回顾分析2013年5月~2017年3月我科收治降主动脉破裂患者16例,其中胸主动脉夹层动脉瘤破裂14例,感染性假性动脉瘤致降主动脉破裂1列,不明原因的食管降主动脉瘘1例。16例患者术前均通过胸腹主动脉计算机断层血管造影(Computed tomography angiography,CTA)明确诊断,均在急诊全麻下经股动脉入路行胸主动脉覆膜支架腔内修复术(Thoracic Endovascular Aortic Repair,TEVAR)。结果 16例患者均顺利完成手术。其中1例患者术后因血流动力学不稳定死亡,1例患者术后急性肾功能衰竭死亡,余14例患者均痊愈出院,未发生截瘫、逆撕、肢体缺血等相关并发症。无术中中转开胸手术。结论胸主动脉覆膜支架腔内修复是急诊救治降主动脉破裂的有效方法,尽早进行急诊手术是抢救的关键。     

带膜血管内支架在治疗胸主动脉夹层中的应用

目的:总结带膜血管内支架置入治疗DebakeyⅢ型主动脉夹层临床经验。方法:胸主动脉夹层8例,男6例,女2例,平均年龄(54.2±10.6)岁。经CT增强扫描或磁共振成像确诊。切开右或左侧股动脉置入带膜血管内支架,封堵原发破口。置入后重复造影检查。随访行胸部X线平片与电子束CT检查。结果:支架置入全部成功,术后即刻造影7例无内漏,1例见少量内漏。降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有不同程度的改善。术后随访:降主动脉及腹主动脉真腔扩大,术后造影1例有内漏者,无加重,其余患者近端夹层动脉瘤消失,夹层近端假腔内均有血栓形成。结论:带膜血管内支架置入治疗胸主动脉夹层近期疗效满意,远期疗效有待于进一步观察。     

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…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

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.