气管切开术的应用解剖学基础

目的:为气管切开术提供应用解剖学资料。方法:经甲醛固定的成人颈部尸体标本32具,解剖观察气管颈段的位置、形态及其毗邻关系。结果:(1)气管颈段长度(65.2±2.0)mm,横径(17.4±3.0)mm,矢状径(16.6±2.6)mm。(2)甲状腺峡位于第2～4气管软骨环前方占93.8%(2例峡部缺如)。(3)甲状腺最下动脉出现率为9.38%。结论:切口应选择在环状软骨下方2cm～3cm处正中线上,位置不可过高或过低,气管切开时忌太深或用力过猛,尤应重视甲状腺最下动脉的出现,以防止出血及损伤毗邻器官出现并发症。     

成人四肢常用骨牵引部位骨的形态及其毗邻关系

目的 :为创伤骨科提供四肢常用骨牵引部位的形态学依据。方法 :对 10 0例成人尸体四肢骨标本 ,3 0例成人尸体四肢标本进行解剖 ,观察骨的不同方位毗邻的血管和神经。结果 :股骨下端内上髁上方 2 0mm处 ,矢状径为 ( 2 0 0 6± 2 5 2 )mm ,冠状径 ( 4 2 96± 2 66)mm ;股骨粗隆最突部矢状径为 ( 3 4 4 6± 2 91)mm ,冠状径 ( 5 4 4 3± 3 82 )mm ;胫骨粗隆最突部矢状径为 ( 4 1 3 6± 3 5 4 )mm ;冠状径 ( 3 5 90± 3 66)mm ;尺骨冠突部矢状径为 ( 3 1 69± 2 3 1)mm ;冠状径为 ( 2 1 18± 2 2 7)mm ;跟骨距后下缘的前上方 2 0mm处 ,冠状径为 ( 2 1 18± 2 2 7)mm。这些部位骨剖面的结构表层均为薄层骨皮质 ,内为较密骨松质 ,在骨的不同方位毗邻重要的血管和神经。结论 :临床上可根据牵引部位的形态特点注意选择适当的骨牵引器具、牵引穿针部位和方向 ,以防止骨牵引术所致的并发症     

喉上与喉返神经的临床应用解剖学研究

目的　为甲状腺手术避免神经损伤提供应用解剖学资料。方法　解剖观测 12 0例 (左右各 60例 )成人防腐固定标本。结果　喉上神经外支在平甲状软骨上缘与甲状腺侧叶上极上方约 1 2cm处之间 ,两者距离很近 ,其横径为 0 6± 0 2mm。喉返神经与甲状腺下动脉交叉处横径为 1 4± 0 4mm ,其入喉点至环甲关节 (甲状软骨下角尖 )的距离为 5 2± 1 6mm。喉返神经行于甲状腺下动脉前方者右侧稍多于左侧。左侧沿气管食管沟上行 ,右侧与气管食管沟之夹角为 17 8°± 8 2°。结论　喉上神经外支与甲状腺上动脉关系密切 ,喉返神经与甲状腺下动脉呈交叉或交织关系 ,显露神经的术式 ,术中以气管食管沟、甲状软骨下角等为标志 ,是显露喉返神经简便、安全、实用的方法     

颅骨卵圆孔的应用解剖

目的　为三叉神经节阻滞术提供解剖学依据。方法　对 10 0个成人颅骨卵圆孔及其有关结构进行了观察与测量。结果　卵圆孔长径为 7.55± 0 .13( 4 .0～ 11.2 )mm ,宽径为 3.97± 0 .0 6( 2 .0～ 7.1)mm。卵圆孔位于两颞骨关节结节连线之前者 10 1侧 ( 50 .5%± 3.54% ) ,位于该线者 87侧 ( 4 3.5%± 3.51% ) ,位于该线之后者 12侧 ( 6.0 %± 2 .30 % )。卵圆孔距颞骨关节结节 35.11± 0 .16( 2 8.2～4 0 .0 )mm ,至棘孔的距离为 3.65± 0 .10 ( 0 .6～ 8.6)mm。结论　颅骨卵圆孔是三叉神经节阻滞术的重要骨性标志 ,穿刺时应避免损伤脑膜中动脉等结构。     

椎动脉的解剖学研究及其临床意义

目的为椎动脉的重建术提供解剖学依据。方法在 2 2具 4 4侧经防腐处理的成人尸体标本上 ,观察椎动脉颅外部各段的走行、分支情况 ,测量各段起点的外径、长度。结果椎动脉第 1段起点的外径左侧为 4 .35± 0 .78mm ,右侧为 3.97± 0 .5 6mm ,长度左侧为 4 0 .1± 5 .8mm ,右侧为 39.6± 9.3;第 2段起点外径左侧为 3.5 6± 0 .6 7mm ,右侧为 3.0 4± 0 .82mm ,长度左侧为 5 9.8± 7.3mm ,右侧为 6 0 .2±6 .9mm ;第 3段起点外径左侧为 3.0 3± 0 .4 8mm ,右侧为 2 .98± 0 .75mm ,长度左侧为 38.7± 2 .5mm ,右侧为 39.2± 3.1mm。结论椎动脉颅外部各段测量结果对椎动脉重建术有重要参考价值     

视交叉及其周围结构的测量

目的 :为视交叉及其周围区病损机制和手术治疗提供解剖学依据。方法 :在 37例成人颅脑视交叉及其周围区 ,对具有临床意义的数据进行解剖学测量。结果 :视神经颅内段长度为 :左 ( 9.5± 0 .2 )mm ,右 ( 9.6± 0 .3)mm ;垂直径 :左 ( 3.5± 0 .1 )mm ,右 ( 3.6± 0 .1 )mm ;横径 :左 ( 5 .3± 0 .2 )mm ,右 ( 5 .5± 0 .3)mm。视交叉后缘至鞍背的距离 :前置位 ( 3.5± 1 .1 )mm ;后置位 ( 3.0± 1 .5 )mm。视交叉的前后径、垂直径、横径分别为 ( 8.5± 0 .9)mm ,( 3.2± 0 .1 2 )mm ,( 1 1 .9± 0 .5 )mm。视神经管间距为 ( 1 1± 1 .2 )mm。视交叉的前角角度为 ( 65 .5± 5 .6)度。结论 :①视交叉与垂体的位置关系的不同 ,垂体瘤压迫视交叉的部位就不同。②视交叉前角的角度一般小于直角 ,其大小与视神经管间距及视神经颅内段长度有关。③视交叉并不与鞍隔接连 ,故垂体肿瘤增大向上穿破鞍隔后 ,在一定时间内 ,尚不致压迫视交叉。④鞍隔的厚度 ,鞍隔孔的类型和大小与肿瘤扩散的难易和扩展方向有重要关系。     

腰神经后支卡压的应用解剖学研究

目的 :观测腰神经后支骨纤维孔与腰神经后支卡压的关系。方法 :在 2 0具成人尸体标本上 ,观察腰神经后支与腰神经后支骨纤维孔的解剖学关系 ;测量该孔的纵横径及其体表定位。结果 :腰神经后支先穿过腰神经后支骨纤维孔后再分为内侧支和外侧支等 ;该孔L3 的纵、横径为 5 6± 0 9mm、 3 4± 0 5mm ,而L5的纵、横径为 3 5± 0 3mm、 2 1± 0 2mm ;L4、5横突间韧带的厚度分别为 1 5± 0 7mm、 2 0± 0 8mm ;体表定位在相对应的各腰椎平面距后正中线外侧约 30～ 40mm处。结论 :腰神经后支骨纤维孔的结构特点是造成腰神经后支卡压的形态学基础 ,并为临床治疗腰背痛提供解剖学依据     

新生儿气管插管及支气管镜检的应用解剖

对37例经福尔马林固定5～10d的新生儿尸体呼吸道进行了解剖学观察,为气管插管及支气管镜检提供了有关的应用解剖数据。测得鼻孔至声门处的距离为68.6±1.54mm;至气管起始处的距离为115.70±1.60mm;上牙槽突前正中处至声门的距离为56.72±1.10mm。还对呼吸道各处的口径进行了测量,提出在气管后壁膜性部靠隆突处有一三角形膜性部位,是气管的最薄弱部位。     

咽旁间隙及咽旁结构的断层解剖学定量研究

目的　为咽旁间隙疾病的CT等影像诊断提供解剖学资料。方法　选用 2 0例成人尸体头颈部横断标本 ,在咽隐窝层面上 ,用游标卡尺和关联方格测定咽旁间隙及咽旁结构的宽度和面积。结果　咽旁间隙的面积为 447.6± 2 .1 8mm2 (左 )和 446 .4± 2 .1 0mm2 (右 )。腭帆张肌的宽度和面积为 2 3 .60± 0 .84mm(左 )、2 2 .1 6± 0 .90mm(右 )和 45 .8± 1 .36mm2 (左 )、45 .0± 1 .42mm2 (右 ) ,翼内肌的宽度和面积为 2 2 .98± 0 .86mm(左 )、2 2 .60± 0 .64mm(右 )和75 .2± 1 .34mm2 (左 )、74.6± 1 .2 0mm2 (右 )。两侧咽旁间隙及咽旁结构的宽度和面积均无显著性差异 (P >0 .0 5) ,椎前间隙和翼肌筋膜间脂肪存在率分别为 75 .0 %和 60 .0 %。结论　咽旁间隙及咽旁结构的断层解剖学定量研究对咽旁间隙疾病的CT等影像诊断具有重要的指导作用     

颈1-2椎间隙侧方解剖观测及临床应用

目的　通过颈 1- 2椎间隙侧方解剖观测 ,为临床开展颈椎侧方穿刺提供解剖学依据。方法　对 2 0具成人尸体共 4 0侧颈 1- 2椎间隙的相关数据进行解剖学观测。结果　乳突尖至颈 1- 2椎间隙中点的距离为(1.2 6± 0 .16 )cm ,乳突尖至颈 1下缘的距离为 (1.0 5± 0 .16 )cm ,乳突尖至颈 2上缘的距离为 (1.4 7± 0 .14 )cm ,颈 1- 2椎间隙中点至颈 1后弓的距离为 (0 .96± 0 .0 5 )cm。结论　国人颈椎侧方穿刺的前方穿刺部位在乳突尖下方 (1.0 5± 1.4 7)cm之间 ,穿刺的中点在乳突尖下 1.2 6cm ;后方穿刺部位则在前方穿刺部位背侧(0 96± 0 .0 5 )cm处。     

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…