感染性眼内炎的临床特征及治疗

目的:分析感染性眼内炎的临床特征、治疗方法及治疗效果。方法:对2017年1月至2018年5月武汉大学人民医院眼科收治的69例(71眼)感染性眼内炎患者的致病因素、病原学检查、治疗方法及治疗效果进行回顾性分析。结果:内眼手术后眼内炎35例(50. 72%),其中白内障术后27例,小梁切除术后3例,多次球内注药1例,玻璃体切除术后、角膜移植术后各2例;外伤后眼内炎26例(37. 68%),其中眼穿通伤22例,爆炸伤、球内磁性异物各2例;内源性眼内炎8例(11. 59%),其中7例具有全身易感因素。52眼行病原学检查,阳性率为23. 08%。6例(6眼)单纯行眼内注药,56例(58眼)行玻璃体切除手术(其中2眼最终行眼内容剜除术),9例(9眼)行眼内容剜除术,眼球保存率为87. 32%。术后平均视力为(2. 59±1. 41),较术前(1. 75±1. 26)明显提高,差异有统计学意义(t=5. 321,P<0. 001)。结论:内眼手术和眼外伤是感染性眼内炎的主要致病因素,根据病情严重程度,合理选择眼内注药或玻璃体切除手术可以有效控制感染,挽救视功能。     

睫状体扁平部玻璃体切割术治疗感染性眼内炎

睫状体扁平部玻璃体切割术治疗感染性眼内炎徐惠芳，杨巧玲眼内炎是眼外科最严重的并发症［１］。可继发于眼球穿通伤、全身或眼周的感染。眼球穿通伤或眼手术后的眼内炎，虽应用大量抗生素治疗，因血—眼屏障作用，往往难以奏效，常以失明乃至眼球丧失而告终。自从玻璃体...     

感染性眼内炎31例相关致病原因及诊治分析

目的探讨感染性眼内炎的相关致病原因、诊断治疗经过及结果。方法回顾性分析在三门峡市中心医院确诊的感染性眼内炎患者31例,对其致病因素以及治疗方法和结果进行分析。结果外源性及内源性感染性眼内炎均变现为起病急、眼痛伴随视力急剧下降、房水和玻璃体炎性浑浊。外源性感染性眼内炎致病因素多为革兰氏阳性球菌。28例眼内炎均行玻璃体切除术,3例真菌性眼内炎行眼球内容物剜除术。术前术后视力对比,差异有统计学意义(P<0.05)。结论医务人员应重视感染性眼内炎的相关致病因素,及早查找病原菌。玻璃体腔注药和玻璃体视网膜手术是感染性眼内炎重要且有效的治疗手段。     

单核细胞增多性李斯特菌性眼内炎

目的:单核细胞增多性李斯特菌是内源性眼内炎的一种罕见病因,目前关于这种细菌感染的临床进展及预后存在争议。但是,在以往的文献报道中只有少数关于其临床特征的报道。病例报道:患者女性,24岁,3周内发生内源性眼内炎。接受了经睫状体平部玻璃体切割术,检测玻璃体腔内有单核细胞增多性李斯特菌。开始使用大剂量抗生素治疗(局部滴眼、结膜下注射、玻璃体腔注射及全身应用)。到临床治疗结束时,视力由手动提高到0.5,3个月后提高到1.0。无全身性李斯特菌病及肉芽肿形成的迹象。结论:虽然内源性眼内炎往往预后较差,但是本例由李斯特菌感染引起的…     

中国西部真菌性眼内炎临床分析

目的 报道真菌性眼内炎的临床特征、敏感药物、治疗措施和预后。方法 回顾性分析四川大学华西医院2005～2017年真菌培养阳性眼内炎住院患者的临床资料和培养结果。结果 真菌培养阳性眼内炎病例共14例（18眼):外源性6例(6眼),全部为眼球穿通伤所致;内源性8例（12眼）中,其中4例原因不明,2例继发上呼吸道感染,2例继发泌尿系统感染。共培养出4个真菌属:念珠菌属9例,曲霉菌属3例,枝顶孢属1例,粘束孢属1例;内源性眼内炎的主要致病菌为白色念珠菌（75 %）,外源性眼内炎的主要病原体为曲霉菌（33.3 %）。在可测视力的13例患者（17眼）中,内源性眼内炎通过治疗有8眼（66.7 %）视力提高,而外源性眼内炎只有1眼（20 %）视力改善。行玻璃体切除术的患眼,61.5 %有视力提高。5-氟胞嘧啶和两性霉素B的念珠菌敏感率为100 %。结论 外源性真菌眼内炎较内源性预后差。两性霉素B敏感率高。     

玻璃体切除联合硅油填充术治疗内源性眼内炎疗效观察

目的:观察玻璃体切除联合硅油填充术治疗内源性眼内炎的效果。方法:对15例内源性眼内炎患者18只眼的临床资料进行回顾性分析,所有患者均无外伤史和内眼手术史,均进行最佳矫正视力、眼压、裂隙灯显微镜、直接和间接检眼镜及B超检查后确诊。所有患者行玻璃体切除联合硅油填充术,术后随访3~12个月,观察术后眼压、视功能及感染控制情况。结果:18只眼中,术后炎症控制,保留眼球者17眼,这17眼术后视力较术前有不同程度提高,手术后玻璃体再次积脓、眼压不能控制、行眼内容物剜除术者1眼。结论:玻璃体切除联合硅油填充术是治疗内源性眼内炎较为有效的方法。     

内源性眼内炎的临床特征分析

目的 分析内源性眼内炎患眼的临床特征，为临床早期诊断及治疗提供依据。方法 收集内源性眼内炎患者11例(12眼)的临床资料，对其临床特点、易感因素、病原学培养结果、手术方法及预后进行分析研究。结果 本研究纳入患者11例(12眼)，包括单眼10例，双眼1例。主要的眼部体征为结膜充血、角膜水肿及角膜后KP、前房闪辉、前房积脓及玻璃体混浊，眼底均窥不清。首诊误诊为其他疾病的为6例(6眼)，其中5例(5眼)为外院误诊后转入我院明确诊断及治疗，误诊率为50%;伴全身基础疾病10例(11眼)，占91.7%，有明确感染灶6例(7眼)，占58.3%。所有患眼均行眼内液细菌、真菌及厌氧菌培养和药物敏感试验，培养结果阳性者9例(10眼)，占83.3%，其中肺炎克雷伯菌为4例(5眼)，占41.7%。8例(9眼)(72.7%)患者通过玻璃体腔注药术或联合玻璃体切割手术病情得到控制，3例(3眼)(27.3%)患者因炎症未能控制行眼内容物剜出手术。末次随访时，视力较前提高的5只眼，占41.7%，视力无明显改变2只眼，占16.7%，较前下降2只眼，占16.7%，但视力均较差，在光感～0.15之间。结论 内源性眼内炎早...     

感染性眼内炎转归至眼球摘除或眼内容剜除术的危险因素分析

目的分析感染性眼内炎最终转归至眼球摘除或眼内容剜除术的危险因素。方法收集感染性眼内炎住院患者121例的临床资料,分为眼摘组(包括眼球摘除和眼内容剜除)24例和未眼摘组97例。从年龄、性别、用药史、既往病史、临床表现、白细胞计数、治疗过程等方面进行回顾性分析。结果有24例眼(19.8%)接受了眼球摘除或眼内容剜除术。眼摘组中角膜溃疡性眼内炎所占比例(33.3%)和内源性眼内炎所占比例(25.0%)大于未眼摘组(1.0%、4.1%)(P<0.001)。眼摘组的平均年龄高于未眼摘组的平均年龄(P<0.05);眼摘组的入院视力(2.9±0.2)LogMAR差于未眼摘组(2.3±0.5)LogMAR(P<0.001);并且眼摘组的延误治疗时间(15.8 d)也长于未眼摘组(4.6 d)(P<0.05)。眼摘组的白细胞计数[(12.8±5.6)×10~9/L]高于未眼摘组[(9.1±3.3)×10~9/L](P<0.005)。经Logistic回归分析,角膜溃疡相关眼内炎、内源性眼内炎、入院视力差、白细胞计数增高以及治疗时间延误是眼球摘除或眼内容剜除的风险因素(OR=...     

玻璃体切除联合玻璃体注射药治疗眼内炎的护理

化脓性眼内炎是穿透性眼外伤后严重并发症,一旦发生,若不及时采取有效措施,可引起视力丧失和眼球萎缩,甚至无法保留眼球.近年来由于玻璃体切除技术的开展及手术技术的日趋完善,预后有了很大的改善.现将本科近年采用玻璃体切除联合玻璃体内注药治疗28例(28眼)的疗效及护理报告如下.     

全身应用抗生素预防支气管扩张继发内源性眼内炎的失败经验

目的:报道1例罕见的支气管扩张女性患者继发绿脓杆菌感染的双侧内源性眼内炎。设计:干预性病例报道。方法:1例69岁女性患者,患支气管扩张,虽然持续3周静脉使用头孢他啶抗生素,最后仍发展为先右眼、继而左眼绿脓杆菌性内源性眼内炎。结果:右眼内源性眼内炎发现太晚,最后视力为手动。左眼发现相对较早,通过早期行玻璃体切割术及玻璃体内注入抗生素等抗感染治疗,1年后视力稳定在20/40。结论:全身抗生素治疗未能根除支气管扩张患者的绿脓杆菌感染原发灶。异常的眼部红痛可能是内源性眼内炎的特征性表现,对于治疗像绿脓杆菌一样毒力强的病原体感…     

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…