颈髓损伤对心血管系统影响的临床分析

为探讨颈髓损伤对心血管系统的影响。本文观察了４１例颈椎外伤患者血压,心率的变化及颈脊髓损伤平面,脊髓反射恢复前后对血压心率的影响。结果颈髓损伤的患者心率,血压明显降低（Ｐ〈０．０１）;颈４以上比颈４以下损伤的患者心率,血压下降更为明显（Ｐ〈０．０５）;颈髓反射恢复后血压,心率有明显升高（Ｐ〈０．０１）。提示颈髓损伤对心血管系统有明显影响。     

大鼠脊髓蛛风膜下腔注射去氧肾上腺素的升压效应

目的 为阐明脊髓内的α蛹 腺素能受体对心血管活动调节的作用。方法 在完整和颈１横断脊髓的大鼠，脊髓蛛网膜下腔注射（ｉｔｈ）选择性α１受体激动剂去氧肾上腺素后对血压和心率进行观察记录。结果 ①完整大鼠ｉｔｈ去氧肾上腺素引起血压和心率明显升高。②在颈１横断肖髓的大鼠，ｉｔｈ相同剂量的去氧明上腺也引起显著的升高血压效应。③在颈１横断脊髓的大鼠，ｉｔｈα受体阻断剂妥拉苏林可减弱ｉｔｈ去氧肾上腺素的升压效应     

失交感神经支配对周围神经再生影响的实验研究

目的观察失交感神经支配对周围神经损伤后再生的影响。方法切除大鼠一侧颈中交感神经节,切断并吻合双侧正中神经。于手术后1、2、4、8周,分别检测双侧趾浅屈肌复合动作电位(CMAP)、正中神经感觉神经活动电位(SNAP)、吻合口以远的有髓纤维计数和超微结构观察,趾浅屈肌最大肌收缩力及其肌肉湿重等指标,对上述指标进行双侧比较。结果各组动物实验侧的各项指标(19.9μV±2.7μV、11.8mV±1.7mV)均低于对照侧(25.1μV±1.8μV、18.0μV±1.0μV)(均P<0·05)。超微结构观察结果与实验检测指标相符。结论去交感神经支配不利于周围神经损伤后再生,周围神经营养血管的基础紧张被消除导致神经失营养可能是重要原因。交感神经对失神经支配的骨骼肌可能具有营养和保护作用。     

长期大量吸烟者的心血管自主神经反射分析

目的　研究长期大量吸烟对人心血管功能的影响。方法　对吸烟龄为 ( 2 3± 5 )年的 2 0个健康人进行了检测。每一个吸烟者均有一个性别、年龄和体重相近的未吸烟的健康人作为对照。在试验过程中 ,连续记录被检测者的心率和血压。结果　与对照组相比 ,吸烟者具有 :( 1)进行剧烈的Valsalva动作时 ,心率加快较少 (P <0 5 )。 ( 2 )Valsalva动作后动脉血压上升收缩压P <0 .0 1,舒张压P <0 .0 5。 ( 3)Valsalva动作后心率恢复到正常的时间较长 (P <0 .0 1)。 ( 4 )Valsalva动作后血压恢复到正常的时间较长 (P <0 .0 1)。以上结果表明 ,血压反射的减弱是由于长期的外周血管收缩的结果 ,而心跳反射减弱的结果是由于血压反射减弱的结果。这种反射时间的延长可能是副交感压力反射改变的一种表现。结论　长期大量吸烟者可伴有心血管自主神经支配的障碍     

颈4椎体暴裂性骨折并高位截瘫治疗1例

患者 ,男 ,36岁。因颈椎屈曲型损伤伴四肢感觉运动障碍 6h入院。查体 :颈部活动障碍 ,颈 4椎体压痛 ,胸式呼吸消失 ,颈 4皮节以下平面针刺觉减退 ,胸4水平以下痛觉、触觉、温度觉消失。腹壁反射 ,提睾反射及四肢反射消失。四肢病理征阳性。双下肢肌力张力略高、髌阵挛、踝阵挛未引出。四肢肌力 :提肩胛肌双侧Ⅳ级 ,三角肌双侧Ⅳ级 ,肱二头肌双侧Ⅲ级 (术后均恢复Ⅴ级 ) ;肱三头肌双侧Ⅱ级 (术后Ⅳ级 ) ,腕屈肌双侧Ⅰ级 (术后Ⅱ级 ) ;腕伸肌双侧 0级 (术后Ⅱ级 )。髂腰肌、股四头肌、股二头肌、小腿三头肌、胫前肌均为0级术后恢复至Ⅲ至Ⅳ级…     

复方丹参处理对压迫性颈髓损伤减压术后疗效影响的实验研究

探讨复方丹参处理对压迫性颈髓损伤减压后继发性缺血再灌注损伤是否具有保护作用，并研究其作用机制。方法 采用复方丹参在减压术前及术后静脉注射治疗行减压术的兔颈髓压迫损伤动物模型，通过动物的运动功能评分、颈髓组织学检查、细胞凋亡及免疫组化检查与对照组比较，分析复方丹参对压迫性颈髓损伤减压后缺血再灌注损伤的治疗作用及机制。结果 减压第1d及28d时复方丹参处理+减压组后肢运动功能评分分别为(5.33±0.58)及(6.00±0.00)，均显著大于减压组(3.67±0.58)及(5.00±0.00)。组织学检查显示，复方丹参处理+减压组颈髓神经元水肿及神经胶质细胞增生较减压组轻。颈髓组织的免疫组化检测显示在第28d时，复方丹参处理+减压组的血管数为(12.33±2.12)，显著多于压迫组(5.67±2.50)，且多于减压组(9.78±2.17)。细胞凋亡检测显示在减压术后第1d及第28d时，复方丹参处理+减压组颈髓组织的凋亡指数分别为(0.89±0.33)及(0.56±0.53)，显著小于压迫组(2.22±1.56)及(4.00±2.12)及减压组(1.78±0.67)及(1.67±0.50)，与正常对照组(0.78±0.44)及(0.56±0.53)比较无显著性差异。结论 复方丹参处理可改善压迫性颈髓损伤减压术后脊髓的微循环，减轻减压术后的缺血再灌注损伤，增强减压术的疗效，促进术后运动功能的恢复。     

腰椎间盘的应用解剖

对３２ 具（ 男女各１６ 具） 成人尸体的 Ｌ３ － ４ 、 Ｌ４ － ５ 、 Ｌ５ － Ｓ１ 椎间盘和髓核中部横断面的横径、矢径及面积进行了测量,并称量相应髓核的重量。发现 Ｌ５ － Ｓ１ 椎间盘中部横断面积有显著性性别差异; Ｌ３ － ４ 、 Ｌ４ － ５ 髓核的中部横断面积及重量均有显著性性别差异, Ｌ５ － Ｓ１ 髓核的中部横断面积及重量有高度显著性性别差异;同一性别中 Ｌ４ － ５ 与 Ｌ５ － Ｓ１ 髓核重量有高度显著性差异。男性 Ｌ３ － ４ 、 Ｌ４ － ５ 、 Ｌ５ － Ｓ１ 髓核的中部横断面积及重量分别为５４３ ．１ ±６９ ．２７ ｍｍ ２ 、５９６ ．３ ±７３ ．９６ ｍ ｍ２ 、５２３ ．３ ±６１ ．６９ ｍ ｍ２ ,５ ．２ ±０ ．７７ｇ 、５ ．６ ±０ ．８５ ｇ 、４ ．８ ±０ ．７２ ｇ ;女性 Ｌ３ － ４ 、 Ｌ４ － ５ 、 Ｌ５ － Ｓ１ 髓核的中部横断面积及重量分别为４８３ ．８ ±６２ ．８９ ｍ ｍ２ 、５２７ ．０ ±６７ ．４２ ｍｍ ２ 、４５８ ．９±５５ ．０７ ｍｍ ２ ,４ ．６ ±０ ．６９ ｇ 、４ ．９ ±０ ．７５ ｇ 、４ ．１ ±０ ．６３ ｇ 。以上数据可供经皮穿刺椎间盘切除术参考     

导管法测定清醒大白鼠的血压及心率

采用聚乙烯导管直接测定清醒大白鼠的血压,导管在麻醉下插入颈总动脉或股动脉固定,测血压时大鼠在清醒状态下,将该导管连接一导管接于压力换能器上,用多道记录仪记录,纸速为10mm/min与 10mm/s,后一纸速的心跳波形可推算心率。血压按平均动脉压的公式计算。结果30只鼠颈总动脉血压为15.35±0.07lkPa,23只鼠股动脉血压为14.6±0.091kPa,两处血压比较P>0.05。45只鼠的心率为422±1.04次/min。20只鼠的右房压为-0.053±0.012kPa。     

急性应激大鼠的心血管反应与脑内c-fos蛋白表达

目的　观察急性躯体 心理应激对大鼠心血管活动的影响及心血管相关脑区c fos蛋白的表达。　方法　采用足底电击结合噪声的应激模型,检测应激后SD大鼠血压、心率和脑内c fos蛋白表达等变化。　结果　(1)应激即刻引起血压和心率明显增加。收缩压从应激前(10 4 .8±9.4 )mmHg升至(132 .3±10 .7)mmHg ,明显高于对照组[(112 .0±8.0 )mmHg ,(P <0 .0 1) ];应激大鼠心率明显高于应激前和对照组(P <0 .0 1)。应激停止后2～3h ,血压和心率恢复到对照水平。(2 )应激组大鼠杏仁核群c fos蛋白阳性细胞为(2 5 .4±3.8) % ,明显高于对照组[(3.4 1±0 .5 ) % ,(P <0 .0 1) ]。下丘脑室旁核c fos蛋白阳性细胞为(2 1.9±2 .0 ) % ,与对照组(7.1±0 .8) %比较,差异有显著性(P <0 .0 5 ,n =8)。额颞叶皮层c fos蛋白阳性细胞为(5 7.5±3.9) % ,显著高于对照组[(16 .4±2 .5 ) % ,(P <0 .0 1,n =8) ]。　结论　急性躯体 心理应激引起的快速心血管反应可能与下丘脑室旁核、杏仁核群神经元激活有关。     

不横断颈前肌群行甲状腺大部切除术的临床分析

目的评价不横断颈前肌群行甲状腺大部切除术在临床应用中的优缺点。方法回顾性分析192例采用不横断颈前肌群与168例采用横断颈前肌群行甲状腺大部切除术病人作对比分析。结果不横断颈前肌群病人有手术创伤少，手术时间短，术后恢复快，引流血量少，不适症状少，局部美观等优点。结论不横断颈前肌群比横断颈前肌群的损伤小，术后不适症状明显减少，是良性甲状腺疾病行甲状腺大部切除的一种较为适合的手术方法。     

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.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

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.