双重滤过血浆置换在治疗神经免疫性疾病中的安全性分析

目的 探讨双重滤过血浆置换(DFPP)在治疗神经系统免疫性疾病中的不良事件及有效处理措施,保障治疗的安全性.方法 回顾性分析西部战区总医院神经内科72例(185例次)使用DFPP治疗的住院患者,其中包括重型吉兰巴雷综合征(GBS)患者35例(110例次),重症肌无力危象22例(45例次),自身免疫性脑炎15例(30例次).患者在接受常规药物治疗的同时联用DFPP,分析其在DFPP治疗过程中及治疗前后出现的不良事件.结果 与治疗前相比,DFPP治疗后患者血浆白蛋白、球蛋白及前白蛋白均有下降,差异有统计学意义(P<0.05),3 d后复查肝功,上述指标均有明显恢复,但未恢复治疗前水平,与治疗前后相比差异均有统计学意义(P<0.05).凝血功能检查发现,患者凝血功能均有明显下降(P<0.05),尤其纤维蛋白原下降率达65.77％,但3d后上述指标均有明显恢复.其余不良事件有低血压、穿刺局部出血或血肿、感染、过敏及变态反应、血流量不足、静脉压高、溶血、破膜、跨膜压及血浆入口压过高等,这些不良事件反应均较轻,总发生率为7.57％.结论 DFPP在治疗神经免疫性疾病中不良事件发生率低,经适当处理后均能顺利完成治疗,未出现严重不良事件,安全性较好.     

大剂量免疫球蛋白治疗Guillain-Barre综合征14例疗效观察

目的观察大剂量静脉滴注免疫球蛋白(IVIG)治疗Guillain-Barre综合征(GBS)的疗效。方法将29例GBS患者随机分为IVIG治疗组(IVIG组)和对照组,IVIG组给人免疫球蛋白0.4 g/(kg·d)静脉滴注,连用5 d;对照组用甲基强的松龙500 mg/d,连用5 d;治疗3周评定临床疗效。结果IVIG组治愈率35.7%,有效率92.8%明显高于对照组(13.3%,73.3%)(均P<0.05),呼吸肌麻痹四肢肌力开始恢复时间明显早与对照组(均P<0.01)。结论大剂量IVIG治疗GBS有显著疗效。     

静脉注射免疫球蛋白治疗多发性硬化急性期疗效观察

目的 探讨静脉注射大剂量免疫球蛋白(IVIG)治疗缓解复发型多发性硬化(MS)急性复发的疗效.方法 选择2003年2月至2007年4月住院的缓解复发型MS病例中第1次复发的病例58例,其中用IVIG治疗组28例,选同期未用IVIG治疗病例30例作为对照,两组其他治疗均相同.观察两组治疗前后的残疾状态扩展评分(EDSS)及再次复发情况.结果 IVIG治疗组的治疗后15天及21天的EDSS评分均明显优于对照组,且治疗后2年内的再次复发率明显低于对照组.结论 静脉注射大剂量免疫球蛋白对于缓解复发型MS急性复发的患者有确切疗效,且能降低再次复发几率.     

双重血浆置换治疗吉兰巴雷综合征

目的：观察双重血浆置换(double filtration plasmapheresis，DFPP)对吉兰巴雷综合征(Guillain—Barre syndrome，GBS)的治疗效果．方法：6例吉兰巴雷综合征患进行双重血浆置换治疗，治疗前后观察神经功能改善状况，检测置换前后血液免疫系列、补体系列及置换后弃浆液的免疫系列、补体系列．结果：2例痊愈，3例好转、患血液中的补体及免疫球蛋白治疗后均明显下降、弃浆液补体及免疫球蛋白明显高于血液．结论：双重血浆置换是治疗重症吉兰巴雷综合征较为有效的方法、可能与降低血液中免疫球蛋白及补体有关．     

大剂量人血丙种球蛋白联合地塞米松治疗GBS的临床观察

目的:观察静脉注射大剂量丙种球蛋白(IVIG)联合地塞米松治疗格林-巴利综合征(GBS)的临床疗效。方法:自2000年-2006年我院收治GBS60例,其中30例为观察组,应用大剂量丙种球蛋白联合地塞米松治疗,另30例为对照组,仅用静脉注射丙种球蛋白治疗,观察两组疗法在改善呼吸肌及颅神经麻痹、肌力恢复方面的效果。结果:观察组的肌力恢复明显优于对照组(P<0.01),平均住院天数较对照组明显缩短(P<0.01),观察组并发感染的机会并未增加,气管切开例数和死亡率无显著性差别。结论:应用IVIG联合地塞米松治疗GBS在肌力恢复、缩短平均住院天数方面明显优于单纯静脉注射丙种球蛋白疗法。     

GBS临床病例观察与诊疗研究

目的:研究格林-巴利综合征(GBS)的临床特征、神经电生理特点及治疗方法。方法:对23例患者均按常规方法检测运动、感觉神经传导、F波、H反射及肌电图(EMG)检查,观察患者神经电生理改变;全部患者采用静脉注射免疫球蛋白(IVIG)、血浆置换(PE)和(或)激素治疗。结果:12例患者MCV减慢,13例患者DML延长,20例患者远端CMAP下降,16例和7例患者分别存在部分传导阻滞和可能传导阻滞/波形离散(CB/TD),治疗后症状得到缓解。结论:神经电生理学检查对于变异型GBS的诊断与鉴别诊断有着重要意义。     

甲泼尼龙+环磷酰胺冲击治疗联合双重血浆置换在重症紫癜性肾炎患儿中的应用观察

目的探究甲泼尼龙+环磷酰胺冲击治疗联合双重血浆置换(DFPP)在重症紫癜性肾炎(HSPN)患儿中的应用效果。方法将于新乡市中心医院就诊的65例重症HSPN患儿随机分为对照组32例(采用甲泼尼龙+环磷酰胺冲击治疗)和观察组33例(在对照组基础上联用DFPP治疗),比较治疗前和治疗24周后两组患儿肾功能[血肌酐(SCr)、血尿素氮(BUN)、24 h尿蛋白定量(24 hUTP)、尿白蛋白(mALB)、尿β2-微球蛋白(尿β2-MG)]、免疫功能[血清免疫球蛋白A (IgA)、免疫球蛋白M (IgM)、免疫球蛋白G (IgG)、β1C-球蛋白(C3)、β1E-球蛋白(C4)],比较两组治疗24周期间药物不良反应发生情况。结果治疗24周后,两组SCr、BUN、24 h UTP、mALB、尿β2-MG、IgA、IgM、IgG、C3、C4均较治疗前均显著降低,且观察组显著低于对照组(P0.05);治疗24周期间,两组各项药物不良反应发生情况均无显著性差异(P0.05)。结论甲泼尼龙+环磷酰胺冲击治疗联合DFPP可有效改善重症HSPN患儿肾功能以及免疫功能,该疗法安全性较好,适宜于在临床推广应用。     

双重血浆置换治疗多发性硬化的疗效观察

目的:分析双重血浆置换(DFPP)治疗急性多发性硬化(MS)的临床疗效。方法:随机将29例多发性硬化患者分为两组,其中观察组14例和对照组15例,观察组采用双重血浆置换,对照组采用常规治疗,比较两组治疗后第7天、21天后的Kurtzke神经功能障碍量表(EDSS)评分情况,并比较两组患者血清IgG水平。结果:两组患者治疗后第7天、第21天观察组的EDSS评分均优于对照组(P<0.05)。观察组治疗后第7天的血清IgG水平与对照组及观察组治疗前比较明显降低,差异有统计学意义(P<0.05)。结论:双重血浆置换是治疗多发性硬化症的一项新技术,其机制可能与选择性去除血液中大分子免疫球蛋白相关,具有安全、有效的特点。     

护理服务在自身免疫性疾病患者行双重血浆置换治疗中的应用

目的:观察围治疗期护理在自身免疫性疾病患者行双重血浆置换(DFPP)治疗中的应用效果。方法:选取自身免疫性疾病患者68例作为观察对象,按照随机数字表法将患者分为观察组与对照组各34例。两组均给予双重血浆置换治疗,对照组给予常规护理,观察组在对照组基础上给予围治疗期护理。比较两组DFPP顺利完成率和并发症发生情况。结果:观察组DFPP顺利完成率明显高于对照组,并发症发生率明显低于对照组,差异均具有统计学意义(P<0.05)。结论:在自身免疫性疾病患者行双重血浆置换治疗中引入围治疗期护理,能够提高DFPP完成率,降低并发症发生率。     

双重滤过血浆置换治疗难治性类风湿关节炎的疗效观察

目的 探讨双重滤过血浆置换(DFPP)治疗难治性类风湿关节炎的疗效.方法 36例患者均给予双重滤过血浆置换治疗,每次间隔7d,连续3次.同时患者既往应用药物激素或非甾体抗炎药和(或)免疫抑制剂在双重滤过血浆置换治疗1次后视病情逐渐减量.结果 显效:14例,有效:20例,无效:2例,临床总有效率:94.45%.类风湿因子、血沉、C-反应蛋白治疗后均明显下降.结论 双重滤过血浆置换治疗难治性类风湿关节炎临床疗效肯定.     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.