经纤维支气管镜氩等离子体凝固治疗气道狭窄

目的:评价经纤维支气管镜(纤支镜)氩等离子体凝固(argen plasma coagulation,APC)治疗在气道狭窄中的应用价值.方法:应用ERBE 300型APC治疗器经纤支镜对18例气道狭窄患者进行治疗,包括10例支气管肺鳞癌,5例支气管结核,1例肺胚母细胞癌,1例支气管囊腺癌和1例支气管淀粉样变;其中4例为气管或支气管支架置入后再狭窄.从狭窄再通疗效和气促评分情况进行评价.结果:18例患者进行了26次APC治疗(12例1次,4例2次,2例3次).完全有效8例(44.4%),部分有效5例(27.8%),轻度有效4例(22.2%),无效1例(5.6%).4例气管或支气管支架置入后再狭窄患者治疗均为完全有效,且APC对镍钛记忆合金支架无损伤.结论: 经纤支镜APC治疗气道狭窄是安全有效的.     

支气管结核57例误诊原因分析

支气管结核(bronchical tuberculosis)又称支气管内膜结核(endobronchical tuberculosis,EBTB)是指结核杆菌侵袭气管支气管黏膜、黏膜下层或进一步深入损坏肌层、软骨,最终瘢痕愈合导致气管、支气管管腔狭窄或管壁软化的疾病[1].EBTB临床表现和胸部X线片缺乏特异性,误诊、漏诊率较高.     

支架置入术在气管支气管狭窄中的应用

目的:探讨支气管镜直视下安置镍钛合金支架对气管、支气管狭窄及支气管食道瘘的治疗效果及不良反应。方法:对107例不同原因引起的气管、主支气管狭窄患者在支气管镜直视下施行气道镍钛记忆合金支架置入,其中14例合并支气管食道瘘患者置入带膜支架,对其中39例气道再狭窄患者给予微波治疗。结果:所有患者术后呼吸困难均立即明显缓解。14例合并气管食道瘘患者在置入带膜气管支架后进食呛咳消失。39例气道再狭窄患者予微波治疗后未再出现肉芽组织增生。其中4例患者术后1个月内出现纵隔感染,积极给予抗感染及食管内支架置入治疗后好转。结论:纤支镜直视下安置镍钛合金支架是治疗中心气道狭窄安全而有效的方法之一,带膜支架置入是治疗气管食道瘘的有效手段,微波治疗可对支气管腔内肿瘤生长起到有效控制作用。     

球囊扩张及支架置入治疗瘢痕性气道狭窄26例

目的探讨球囊扩张及支架置入在瘢痕性气道狭窄治疗中的作用及安全性.方法对26例不同原因引起的气管、主支气管瘢痕性狭窄或闭塞在支气管镜直视下施行了球囊扩张及镍钛记忆合金支架置入,观察了气促指数、血氧饱和度及肺部影像的变化,并随访了3～56个月.结果 26例瘢痕性气道狭窄患者均施行了球囊扩张,共置入气道支架27个,球囊扩张及支架置入后气道内径由(3.2±1.7)mm扩大至(11.5±1.8)mm,(P《0.01)呼吸困难立即缓解,气促指数由(2.8±0.6)下降至(0.6±0.5),(P《0.01),血氧饱和度由(88±2)%提高至(92±1)%,(P《0.01).术后气道肉芽组织增生4例(15.4%),经高频电凝后未再反复出现肉芽组织增生.瘢痕导致再狭窄1例(3.8%),需反复球囊扩张;并发气胸1例(3.8%),支架断裂1例(3.8%).结论支气管镜直视下球囊扩张及支架置入对瘢痕性气道狭窄治疗效果确切,并发症少.     

经支气管镜安置支架治疗气道狭窄及气管食道瘘21例分析

目的探讨支气管镜直视下安置镍钛合金支架对气管、支气管狭窄及支气管食道瘘的治疗效果及不良反应.方法对21例不同原因引起的气管、主支气管狭窄在支气管镜直视下施行了气道镍钛记忆合金支架置入,其中2例合并支气管食道瘘患者置入的为带膜支架,对其中4例严重气道狭窄患者在安置支架前进行了气道球囊扩张,对其中3例主支气管内肿瘤患者在支架上捆绑 125I粒子.结果所有患者术后呼吸困难均立即明显缓解.2例合并气管食道瘘患者在置入带膜气管支架后进食呛咳消失.4例严重气道狭窄患者在进行球囊扩张后均顺利置入气管支架.3例在支架上捆绑 125I粒子的支气管内肿瘤患者1个月后肿瘤组织明显减少.术后出现痰带血2例,肉芽组织增生2例.结论纤支镜直视下安置镍钛合金支架是治疗中心气道狭窄安全而有效的方法之一,支气管球囊扩张可使支架置入更加顺利,带膜支架置入是治疗气管食道瘘的有效手段,支架上捆绑 125I粒子可对支气管腔内肿瘤起到有效控制作用.     

经支气管镜置入金属支架治疗气道狭窄的临床研究

： 目的 探讨经支气管镜高频电刀烧灼并置入金属支架治疗气道狭窄的有效性及安全性。方法 23例患者因肿瘤增生致气管狭窄,或结核肉芽、瘢痕组织致气管、主支气管狭窄,经支气管镜高频电刀烧灼肿瘤或增生组织,扩大管腔后置入金属支架。结果 全部患者气道通畅,气促缓解,气道管径扩大,随后管腔再次狭窄,甚至阻塞。反复电刀烧灼后恢复畅通,短期内无明显不良反应。结论 经支气管镜高频电刀烧灼并置入金属支架治疗气道狭窄是一种有效且安全的治疗方法,治疗后短期疗效确切,对恶性肿瘤所致气道狭窄可优先选择;但对良性增生所致气道狭窄的治疗,由于患者寿命相对较长,支架置入后远期可能产生肉芽增生及支架断裂等并发症,应慎重选择。     

依据CT图像特点预测支气管内膜结核肺不张手术治疗后患者转归的初步研究

目的 探讨多层螺旋CT(multisilice spiral computered tomography,MSCT)对支气管内膜结核(Endobronchial tuberculosis,EBTB)肺不张阶段患者术前指导价值.方法 回顾性分析2006年4月2011年3月就诊于沈阳市胸科医院患有肺段或肺叶不张的EBTB患者共38例(男13例,女25例),平均年龄49岁,年龄14～65岁.均行胸部MSCT检查及肺复张手术治疗,包括球囊扩张术(24例),支架植入术(10例),以及外科支气管成形术(4例).由2名专业胸部放射科医师对狭窄气道的位置、狭窄程度、病变长度、受累肺组织肺不张程度、病变管壁钙化以及病变支气管扩张做出单盲分析.结果 57.9%(22/38)的肺不张患者行手术治疗成功,然而病变支气管壁钙化(16例)的患者手术成功率仅37.5%;病变支气管扩张(10例)的患者手术成功率为30%;病变长度＞3mm(16例)的患者手术成功率为22.7%,而病变长度≥3mm(22例)的患者手术成功率为77.3%.气道的狭窄程度以及受累肺组织肺不张的程度并不影响本次研究结果(P＞0.05).肺复张治疗成功患者的平均年龄明显低于治疗失败的患者的平均年龄(P=0.037),女性患者EBTB支气管狭窄导致的肺不张的发生率较高(P<0.05).25例左侧支气管受累,13例右侧支气管受累.结论 病变支气管管壁钙化、管腔扩张及病变长度会影响介入或外科手术治疗EBTB后遗症-支气管狭窄的疗效,而病变支气管的狭窄程度及肺不张程度对手术疗效并无显著影响.因此可以通过分析、总结CT图像特点选择手术疗法或保守疗法,以避免不必要的治疗措施,提高手术成功率.     

纤支镜下腔内球囊扩张治疗结核性支气管狭窄235例

目的:评价结核性支气管狭窄经纤支镜下腔内球囊扩张的疗效.方法:235例结核性支气管狭窄患者应用纤支镜介导下球囊扩张治疗,并观察所有患者治疗前后气道直径、气促评分的变化.其中107例患者检测了FEVI.结果:235例分别接受高压球囊扩张术1～9次.平均(2.9±1.7)次.狭窄支气管的直径由治疗前的(2.31±1.49)mm增加到(6.38±1.56)n吼,气促评分由术前的2.15±0.76,减少到0.61±0.48,FEVl由术前(1.2±0.5)L,术后升至(1.9±1.1)L,治疗前后差异均有统计学意义(P相似文献   

纤维支气管镜引导下气管支气管支架置入术治疗肺癌并气道梗阻的临床分析

目的观察纤维支气管镜引导下气管支气管置入术治疗肺癌并气道梗阻的近期疗效。方法选择18例肺癌并呼吸道梗阻患者18例,在病房床旁纤维支气管镜引导下行气管支气管支架置入术,观察气管支气管支架置入前、后患者气促症状、PaO2、PaCO2变化。结果18例患者成功放置,气管支气管支架放置后呼吸困难症状立即缓解,置入前、后患者气促评级、PaO2、PaCO2间差异均有显著性意义。结论纤维支气管镜引导下气管支气管置入术对肺癌并气道梗阻患者安全有效,可明显改善患者的近期生存质量。     

镍钛记忆合金支架在老年恶性气管狭窄患者中的应用

目的 观察纤维支气管镜引导下气管、支气管支架置入治疗老年恶性气管狭窄的效果.方法 对27例老恶性气管狭窄患者行气管支气管支架置入术,观察置入前后患者的近期和远期效果.结果 27例患者均成功置入.置入后气促症状立即缓解,血气分析明显改善.结论 气管支气管支架置入对老年恶性气管狭窄患者安全有效,能改善患者的生活质量.     

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…