针管抽吸和手法处理起搏器囊袋血肿6例

我们采用针管抽吸加手法处理６例起搏器囊袋血肿,取得了较好的效果,现报告如下。１　资料和方法１－１　１９９１年１０月至１９９７年９月在我院安置ＶＶⅠ永久型起搏器患者共３２例,发生起搏器囊袋中度血肿６例（占１８－７５％）,其中男性４例,女性２例,平均年龄６１岁,安置起搏器原因：病态窦房结综合征２例,三度房室传导阻滞３例,三束支阻滞１例。全部患者都于术后第２～３天发现起搏囊袋中度积血,囊袋上皮肤色泽轻度晦暗,有波动感。术后第７天拆线,见伤口愈合良好,但囊袋血肿无好转。在起搏器伤口及囊袋周围用２％碘酒消…     

安置永久性心脏起搏器术后感染原因及对策

人工心脏起搏器已成为治疗缓慢型心律失常的主要手段。感染是安置埋藏式心脏永久起搏器术后最常见的并发症之一，造成感染有直接的，也有继发的，正确的预防感染是埋藏式起搏器成功的关键。我院从1989年7月-2003年12月共植入心脏起搏器262例，发生感染4例，感染发生率1．5％．现将有关预防起搏器植入术后的伤口感染等并发症处理对策报告如下：     

79例永久起搏器术后并发症临床分析

为了提高安置起搏器的手术水平 ,防止并发症的发生。我们对１９８６年５月～１９９９年６月本院７９例永久起搏器术后并发症进行回顾性分析 ,总结防治对策以供同道参考。同期本院行起搏器植入术６８１例 ,发生永久起搏器术后并发症１１%。７９例中男性４８例 ,女性３１例。年龄３０～７８岁 ,平均５６．２±１８．２岁。心律失常类型 :病态窦房结综合征 (ＳＳＳ)５７例 ,房室传导障碍包括Ⅲ度房室传导阻滞 (Ⅲ度ＡＶＢ)１２例 ,Ⅱ度Ⅱ型房室传导阻滞 (Ⅱ度Ⅱ型ＡＶＢ)８例 ,高度房室传导阻滞 (ＨＤＡＶＢ)１例 ,三分支阻滞 (ＴＦＢ)１例。电…     

49例老年患者起搏器并发症分析

目的：探讨老年患者永久起搏器植入术的并发症及其防治方法。方法：对植入49例老年起搏器发生并发症患者的临床资料进行回顾性分析。分析并发症的发生原因。结果：发生并发症7例,术后常见的并发症分别是囊袋血肿2例（4．1哟、囊袋及切口感染各1例（4．1徇、隔肌痉挛1例,占2．0％;起搏器综合征及充血性心衰2例,占4．1％。结论：充分的术前准备,严密的术中操作,及时有效的处理并发症,老年患者行永久起搏器植入术是安全的。     

植入埋藏式心脏起搏器68例临床报告

目的 探讨在植入埋藏式心脏起搏器所遇到的问题及采取的防治对策。方法 常规采取头静脉切开插入法及有下静脉穿刺法安置电极,选用ＶＶＩ型起搏器,用体外临时起搏器测试电极状态植入起搏器。结果 所有病人临床症状改良,生活质量、劳动力提高。结论 基层医院缺乏起搏器检测仪,用体外临时起搏器亦可安全植入埋藏式起搏器,术后可出现电极脱位、局部部肉抽动、晚期起搏阈值升高等并发症。     

自动阈值夺获型起搏器临床初步应用

目的：评价自动夺获型心室起搏器的功效和安全性。方法：８ 例患者,５ 例三度房室阻滞,２ 例病态窦房结综合征,１ 例慢性心房颤动伴ＲＲ 长间歇。均植入Ｒｅｇｅｎｃｙ ＳＣ＋ ２４０２Ｌ（ＶＶＩ） 起搏器。结果：起搏器植入后随访１ ～６ 个月,起搏器工作良好,ＱＲＳ（Ｒ） 振幅１０－２１ ±３－４１ ｍ Ｖ,ＥＲ 振幅８－４５ ±２－２１ ｍ Ｖ,两者相关系数（ｒ） 为０－２１（ｎ ＝ ６０） 。应用ＶＡＲＩＯ 方法和自动夺获法测定的起搏阈值均为０－９ ～１－５ Ｖ 之间,两者相关系数为０－９２（ｎ ＝ ５１） 。极化电位低于１ ｍ Ｖ 者占全部测定例次的２５ ％ ,高于１ ｍ Ｖ 的极化电位振幅为１－３５ ±０－１５ ｍ Ｖ（ｎ ＝ ４０） 。结论：具有自动夺获功能的起搏器寿命长,起搏安全可靠。     

起搏器安置后的并发症、故障及对策

目的：分析１５６例埋植永久性心脏起搏器产生并发症的原因以减少并发症。方法：１５６例患者，男性８７例，女性６９例，平均年龄５５７岁。植入ＶＶＩ１４７例，ＡＡＩ８例，ＤＤＤ１例。结果：术后各种并发症４５例，发生率为２８８％。并发症的发生与起搏系统质量、术中操作及起搏方式有关，与起搏系统有关的并发症２４例，占５３３％；与手术有关的并发症１５例，占３３３％；与起搏方式有关的并发症６例，占１３３％。结论：并发症的发生应以预防为主，严把手术操作关，合理选用起搏器。     

老年人永久性心脏起搏的临床特点

报告３１３例≥６０岁的老年人植入永久性心脏起博器的临床和１－２２年的远期随访资料。结果表明：Ｓ一组６０－９１岁的老年偿论男女均可植入永久性起搏器。其基础以冠心和退行性传导系统疾病最多，分别占有７５％和２１％，而心肌炎和心肌病明显少于〈６０岁的对照组；心律失常类型以ＳＳＳ和Ａ－ＶＢ为主，且其中合并慢性束支阻滞和心房纤颤的比例高，起搏器类型以ＶＶＩ为主共２５８例，占８２％，但ＤＤＤ起搏器的相对比例罗对     

经皮球囊二尖瓣成形术的并发症分析

目的;总结经皮球囊二尖瓣成形术（ＰＢＭＶ）的并发症及其防治经验。方法：回顾性分析３５０例术中及术后出现的并发症及其处理结果。从心脏的解剖、病理等角度,结合ＰＢＭＶ的机制和操作过程,分析并发症发生的原因。结果：严重下的发生率：心包填塞２．９％;二尖瓣反流９．４％;脑栓塞４％;室颤０．３％;急性心功能不全１．１％,１例合并主动脉狭窄术后因循环衰竭死亡。结论：心包填塞、二尖瓣反流和心律失常是ＰＢＭＶ中主     

程序胸壁试验测试按需起搏器的不应期

随着现代医学的发展，各医院植入起搏器的患者越来越多，对该组人群的监测显得愈来愈重要，尤其是在基层医院，就显得更突出，我们运用程序胸壁刺激仪对起搏器（ＶＶＩ型）的不应期进行了检测，并与程控仪进行比较，现报告如下：１资料与方法１．１一般情况：对我院已植入...     

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…