子宫内膜异位症诊治困局与思考

子宫内膜异位症（Endometriosis,EM）是一种雌激素依赖性神经炎症性疾病,其导致的慢性盆腔痛、卵巢子宫内膜异位囊肿、不孕严重影响女性的生活质量。本文从中西医角度综述了EM发病机制,并对EM中西医诊治存在的问题进行了深入的探讨;并对EM中西医诊治提出策略性建议。笔者强调,EM是一种慢性疾病,需要长期的管理。在EM诊治过程中要重视临床诊断,避免诊断延迟;同时要重视中医药的规范化治疗,尽早介入、尽早使用;要积极提高中医药在EM治疗中的地位和临床使用率。     

药物治疗子宫内膜异位症临床体会

子宫内膜异位症（EM）是女性生育年龄的常见病，据报道其发病率高达10％-15％，80％的患者合并有明显的痛经，50％的患者合并不孕，严重影响着中青年妇女的健康和生活质量。目前多数学者认为手术是治疗EM的首要措施，但EM易复发，显微镜下的病灶肉眼无法看到而成为复发的来源，于是药物与手术联合治疗成为人们探讨的问题，我科采用中西医结合药物治疗，取得较好的临床效果，现总结分析如下。     

阿奇霉素治疗成人支原体肺炎的临床效果观察

目的:对使用阿奇霉素(Azithromycin,AZM)治疗成人的支原体肺炎(Mycoplasma pneumonia,MP)的临床效果进行观察分析。方法:将42例成人MP患者分为AZM组和红霉素组(EM组),分别给予患者AZM和EM,均辅以化痰止咳常规治疗和相应护理。通过对两组患者在退热、咳喘停止等时间和疗效情况进行比较,探讨AZM应用于成人MP治疗的应用情况。结果:AZM组患者的退热、咳喘停止时间及治疗住院的时间均明显地短于EM组患者(P<0.05),且AZM组患者在治愈率(CR)、总体有效率(TRR)上均明显更高(P<0.05),治疗成人MP总体效果更佳。结论:与EM相比,AZM能更快更有效地改善患者发热炎症、呼吸困难等症状,显著提高治愈率和治疗总体有效率。     

急诊医疗系统送达与自行就诊的ST段抬高型心肌梗死患者的死亡率模式比较——来自渥太华医院前瞻性STEMI登记资料

急诊医疗系统(EM S)在ST段抬高型心肌梗死(STEM I)的识别和治疗中起着关键性作用。作者试图确定当前STEM I患者对EM S的应用以及EM S应用与治疗、患病率和死亡率模式的相关性。将由EM S送达的患者与那些自行就诊的患者进行比较。401例患者中,59.9%由EM S送达,40.1%为自行就诊。     

多发性硬化症患者的疲劳与残疾、抑郁和生活质量相关

多发性硬化症患者的疲劳是一种常见的废用性症状,干扰患者的日常生活功能。本研究旨在证实疲劳与残疾、病程、抑郁和生活质量之间的关系。采用法国有效版的疲劳影响量表(EM IF-SEP)、Beck抑郁量表简表(13项)和SF-36,对312例临床确诊为多发性硬化症患者(EDSS≤6.5分)中的237例进行检测。EM IF-SEP包括4个方面(认知、体格、社会作用和心理状况),并允许多方面评估。采用多变量分析,EM IF-SEP的体格总评分和社会作用亚评分与EDSS得分高度相关(P<0.0001),而EM IF-SEP的认知和心理方面评分与EDSS得分无关,校正ED SS后,EM IF-…     

巨噬细胞在子宫内膜异位症中的作用研究进展

子宫内膜异位症(endometriosis,EM)是指具有生长功能的子宫内膜组织出现在子宫腔以外的身体其他部位并种植生长而发生的病变.EM的发病率在育龄妇女中为10%～15%,且有上升趋势,在不孕妇女中发病率约占50%.EM患者常伴有痛经、性交疼痛、腹腔疼痛、月经不调、不孕等症状,严重影响患者的生活质量.     

子宫内膜异位症的治疗现状与展望

子宫内膜异位症（endometriosis简称EM）是指具有生长功能的子宫内膜组织，出现在子宫腔被覆粘膜以外的身体其他部位所造成的一种病变。以继发性痛经、进行性加重、性交痛、腰骶痛、月经失调、肛门坠胀、不孕、局部有触痛结节或包块等为其主要临床表现。是生育年龄妇女的常见病，近年来发病率升高，主要症状是疼痛和不孕，严重影响患者的生活质量。目前除根治性手术外尚无很好的治疗方法。笔者现就EM的治疗现状综述如下。     

左炔诺孕酮T形宫内节育器治疗子宫内膜异位症33例分析

目的探讨左炔诺孕酮宫内缓解系统（L N G-I U S）治疗子宫内膜异位症（E M）及子宫腺肌病(A M)的临床效果和不良反应。方法对33例诊断为AM或EM的已育妇女,选择月经周期4-6天放置LNG-IUS,观察其月经量,血红蛋白和痛经,子宫体积指标的变化。结果放置LNG-IUS的相比,33例患者放置3个月、12个月后月经量,较放置前明显减少（P<0.01）。血红蛋白较放置前显著升高（P<0.05）。痛经较放置前明显减轻（P<0.01）。子宫体积较放置前明显缩小（P<0.05）。随访12个月后,其中3例有月经间期出血。结论LNG-IUS对于AM及EM患者的临床症状有显著的治疗作用,提高了患者的生活质量,有很好的临床应用价值。     

子宫内膜异位症复发因素临床研究

目的:分析子宫内膜异位症(EM)患者复发的影响因素。方法:收集363例EM患者临床资料,根据治疗结果将其分为复发组和未复发组两组,比较复发组与未复发组之间不同的临床特征,用Logistic回归法统计分析EM患者复发的相关因素。结果:EM患者术后2年复发率15.43%。EM复发组和EM未复发组初发平均年龄分别为32.42+6.32岁和34.67+7.88岁,两组比较有统计学差异。EM复发组中合并子宫腺肌症的比例显著高于EM未复发组(8/14.29%vs 5/4.89%),有统计学差异。EM复发组中出现后穹窿触痛结节、多发病灶症状的患者显著高于EM未复发组(242/78.83%vs 32/57.14%,22/39.29%vs58/18.89%),两组之间比较有统计学差异。复发组EM患者未用药患者比例显著高于未复发组(23/41.07%vs41/13.35%)。未复发组EM患者术后妊娠率显著高于EM复发组患者(92/29.97%vs5/8.93%)。多因素非条件Logistic回归分析表明,盆腔炎病史、合并子宫腺肌症、后穹窿触痛结节、手术分期为EM患者复发的危险因素,发病年龄、术后药物治疗和术后妊娠情况为EM患者复发的保护因素。结论:子宫内膜异位症患者术后治疗后复发因素主要有具有盆腔炎病史、合并子宫腺肌症、后穹窿触痛结节、手术分期较晚等,针对危险因素的患者应积极药物治疗并加强随访,对于有生育要求的患者应积极促进妊娠。     

子宫内膜异位症的治疗现状与展望

子宫内膜异位症 (endom etriosis简称 EM)是指具有生长功能的子宫内膜组织 ,出现在子宫腔被覆粘膜以外的身体其他部位所造成的一种病变 [1 ] 。是生育年龄妇女的常见病 ,近年来发病率升高 ,主要症状是疼痛和不孕 ,严重影响患者的生活质量 ,目前除根治性手术外尚无很好的治疗方法。但根治性手术妇女有被阉割的感觉 ,且术后易出现绝经期的一系列症状 ,病人不易接受。目前 EM治疗的目的主要是缓解疼痛 ,祛除内膜异位病灶 ,恢复盆腔内生殖器正常解剖结构、生育功能和防止复发。选择治疗的方法应根据患者年龄、生育要求、症状的严重程度以及病…     

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…