不同尿激酶溶栓方案对肺栓塞后血液凝血及纤溶系统的影响

目的观察不同尿激酶溶栓方案对肺栓塞后血液凝血及纤溶系统影响。方法收集我院2008年12月～2009年6月尿激酶溶栓方案治疗肺栓塞病例48例的临床资料,遵照知情同意原则将所有患者分为观察组27例和对照组21例,观察组采用2h尿激酶溶栓方案,对照组采用12h尿激酶溶栓方案,比较分析两组患者治疗前后血液凝血及纤溶系统的变化情况。结果治疗前两组的组织型纤溶酶原激活物(tPA)活性、纤溶酶原激活物特异性抑制物(PAI-1)活性和D-二聚体(DD)含量比较,差异均无统计学意义(P0.05);治疗后观察组患者以上指标的改善情况优于对照组,差异有统计学意义(P0.05)。结论 2h尿激酶溶栓方案可以更有效地改善肺栓塞后血液凝血及纤溶系统指标,值得在临床关注。     

不同溶栓方案对急性大面积肺血栓栓塞症的溶栓效果

目的比较不同溶栓方案治疗急性大面积肺血栓栓塞症的溶栓效果和安全性。方法选取2002年6月～2008年6月在笔者所在医院住院的急性大面积肺血栓栓塞症患者35例,随机分为3组:尿激酶12 h溶栓组、尿激酶2 h溶栓组和rt-PA 50 mg溶栓组。结果 (1)3种溶栓方案的临床总有效率均为100%,各组间均未显示有统计学差异;(2)rt-PA治疗组患者在治疗后24 h,呼吸困难的改善较尿激酶2 h组、尿激酶12 h组明显;(3)溶栓后4 h、8 h、12 h各时间点,尿激酶2 h组与尿激酶12 h组D-二聚体比较有显著性差异(P0.05);rt-PA组与尿激酶12 h组比较有显著性差异(P0.05)。结论 (1)三种溶栓方案的疗效(总有效率、病死率)和安全性(主要是出血率)相仿;(2)从溶栓治疗后临床症状的改善,D-二聚体所显示的溶栓速率等方面来看,rt-PA组治疗肺栓塞略优于尿激酶2 h、尿激酶12 h组。     

急性肺动脉栓塞症的溶栓治疗

目的：比较尿激酶2h方案(UK2h)、12h方案(UK12h)及重组组织型纤溶酶原激活剂(rt—PA)溶栓治疗急性肺栓塞的安全性及有效性。方法：选择34例APE患者，分为三组：①UK2h组：尿激酶20000IU／kg，2h内静脉滴入；②UKl2h组：尿激酶首剂4400IU／kg，继而每h 2200IU／kg，静脉滴注12h；③rt—PA组：rt-PA 50mg静脉滴注。结果：uK2h、UK12h、rt—PA组治愈率分别为72．2％、71．4％、77．8％，有效率分别为83.3％、85．7％、88.9％，死亡率分别为5，6％、14．3％、11．1％，三组间差异无统计学意义。主要不良反应为出血，出血率UK12h组高于rt—PA、UK2h组。结论：UK2h、UK12h方案及rt—PA溶栓效果均好，但UK2h、rt—PA方案更安全。     

溶栓干预犬脑栓塞后血浆u-PA和u-PAR水平变化的实验研究

目的观察尿激酶原(pro-UK)和尿激酶(UK)干预犬脑栓塞后血浆尿激酶型纤溶酶原激活剂(u-PA)和尿激酶型纤溶酶原激活剂受体(u-PAR)的变化,及其与溶栓效果的关系。方法自体动脉血凝固制备栓子,使用介入方法建立犬脑栓塞模型。栓塞2h后,分别用pro-UK和UK溶栓,分为A、B 2组,造影观察血管开通情况;实验前(0 h)、治疗后2h和3h时u-PA和u-PAR的变化。结果犬脑栓塞后2 h给予不同溶栓药处理,2 h后造影证实:A组6只中血管开通5只,B组6只中血管开通2只;A组溶栓后2h、3h血浆u-PA值比溶栓前(0h)升高(P<0.01),且2 h比3 h时u-PA值高(P<0.01);B组溶栓后2h、3h与0h时比较u-PA值无明显变化(P>0.05)。2组间2h、3h时u-PA值比较差异有统计学意义(P<0.01)。2组间和2组内不同时间点血浆u-PAR水平差异无统计学意义(P>0.05)。结论血浆u-PA在一定程度上反映了犬脑栓塞溶栓后纤溶系统的变化,血管开通比例较高,血浆u-PA增高明显。血浆u-PAR在pro-UK、UK溶栓后变化不大,与犬血管开通无明确关系。     

瑞替普酶静脉溶栓治疗急性心肌梗死疗效观察

目的观察瑞替普酶(r-PA)静脉溶栓治疗急性心肌梗死(AMI)的临床疗效。方法将符合入院标准行尿激酶原或瑞替普酶溶栓治疗的38例急性心肌梗死患者,随机分为两组,应用瑞替普酶(r-PA)静脉溶栓治疗的22例为观察组,应用尿激酶(UK)静脉溶栓治疗的16例为对照组,观察两组的溶栓再通率、胸痛缓解率及不良反应发生率。结果溶栓后2 h再通率r-PA组为89.47%,尿激酶组为68.42%(P<0.01)。r-PA观察组胸痛症状缓解率较UK对照组显著改善;r-PA观察组出血率并发症明显低于UK对照组。结论 r-PA的溶栓冠脉再通率显著高于UK,瑞替普酶静脉溶栓治疗急性心肌梗死临床疗效好,是一种安全有效的溶栓剂。     

尿激酶溶栓对AMI患者心功能、凝血及纤溶系统的影响

目的:观察尿激酶溶栓治疗对急性心肌梗死(AMI)患者心功能、凝血及纤溶系统指标的影响。方法:选择我院收治的AMI患者39例(观察组),取溶栓前、后患者外周静脉血,检测血浆NT-proBNP水平及相关凝血因子、纤溶指标水平变化,并对治疗前心脏功能进行评价;设立同期来院体检健康者30例为对照组进行对比分析。结果:观察组溶栓治疗前血浆NT-proBNP及血浆Fg、D-D等纤溶指标水平均明显高于对照组(P<0.01);而观察组凝血指标PT、APTT、TT等均明显缩短(P<0.01);观察组溶栓治疗2h后至溶栓治疗48h后者血浆NT-proBNP、D-D水平呈先升高后降低趋势(P<0.01),PT、APTT及TT呈先延长后缩短趋势(P<0.05),于溶栓治疗后4h达到最高值;血浆Fg水平呈先降低后升高趋势(P<0.01),于溶栓治疗4h后达到最小值;观察溶栓治疗期间发生皮肤黏膜出血2例,鼻出血3例,牙龈出血1例,但未见消化道出血及脑出血等严重出血性疾病发生。结论:溶栓治疗能有效降低AMI患者凝血活性,增强纤溶活性,改善患者心脏功能。     

急性肺栓塞犬肺动脉压、血管活性物质变化及尿激酶和氯沙坦的影响

目的研究肺栓塞前后肺动脉压(PAMP)与血浆血管紧张素Ⅱ(AngⅡ)、内皮素(ET)、一氧化氮(NO)水平的变化及尿激酶(UK)和氯沙坦(LOS)的影响。方法犬自体血栓经导管选择性栓塞肺动脉并监测血液动力学,建立急性肺栓塞模型。将模型犬随机分为 UK 组:UK20000U/kg 静脉滴注;LOS 组:LOS 0.5mg/kg 静注,再以0.05mg/(kg·min)静滴;对照组(CTL 组)同期输入等量生理盐水。观察肺栓塞前后及 UK 和 IDS 对 PAMP 的影响。CTL 组、UK 组于栓塞前、模型建立后用药前、用药后1小时、2小时采血放免法测定 AngⅡ、ET,硝酸还原酶法测定 NO 水平。结果三组注栓后 PAMP 均明显升高(P<0.01)。CTL 组 PAMP 模型建立后3小时内无显著变化(P>0.05),UK 组用药0.5小时,LOS 组用药1小时后 PAMP开始下降,3小时后下降更明显(P<0.01)。肺栓塞时,AngⅡ及 NO 各时间点较注栓前均升高(P 分别<0.01、0.05),ET 水平无明显变化。溶栓后3小时,UK 组 AngⅡ较溶栓前明显降低,ET 较注栓前和溶栓前明显升高(P 均<0.01)。结论 AngⅡ、ET、NO 参与肺栓塞时肺血管舒缩反应。UK 能迅速改善肺血流动力学,LOS 在一定程度上降低肺动脉高压,它对肺栓塞治疗可能有益。     

兔急性肺血栓栓塞及溶栓后TXA2?PGI2及ET-1水平的变化与血流动力学相关性研究

目的:探讨兔急性肺动脉血栓栓塞时血清炎症因子血栓素A2(TXA2)、前列环素(PGI2)和肺血管内皮、支气管和肺泡上皮等部位内皮素1(ET-1)变化和血流动力学指标变化及尿激酶(UK)溶栓的影响。方法:24只大耳白兔随机分为对照组、急性肺栓塞(acute pulmonary thromboembolism,APTE)模型组、尿激酶(UK)治疗组,每组8只。采用自体血栓回输法建立动物模型。常规于造模前、造模后1、2、4、8h放免法测定血清TXA2、PGI2,漂浮导管监测血流动力学指标,最后免疫组化法检测肺血管内皮、支气管和肺泡上皮各部位ET-1的表达水平。结果:①放免法测定结果:对照组各时间点无显著差异。模型组1h升高,4h达高峰,其后开始降低,1、2、4h点与对照组比较都有统计学意义(P<0.01)。UK组1h升高,2h达高峰,4h后开始下降,UK组高峰值较模型组低,1、2、4h UK组与模型组两者有统计学意义(P<0.01)。各组术前和8h无统计学差异(P>0.05);②血流动力学监测结果:对照组各时间点肺动脉平均压(PAMP)、中心静脉压(CVP)都无明显变化,模型组及UK组PAMP、CVP栓塞后立即升高...     

重组人尿激酶原与尿激酶对急性心肌梗死患者纤溶系统影响的比较

目的　对比观察注射用重组人尿激酶原(Pro- UK)对全身纤溶系统的影响。方法　将114 例符合溶栓标准的急性心肌梗死患者随机给予不同剂量的Pro UK或尿激酶(UK)进行溶栓。其中Pro -UK 30 mg及40 mg组26 例,50 mg组29例,60 mg组28例;UK组31例。观察溶栓前和溶栓开始后2、24、48 h血浆纤溶酶原(PLG)、D 二聚体(D D)、组织型纤溶酶原激活物(t PA)、纤溶酶原激活物抑制物(PAI)、纤维蛋白原(Fib)的变化以及出血并发症,并于溶栓开始后90 min进行冠状动脉造影,比较Pro UK和UK组溶栓后的血管开通率。结果　各用药组溶栓开始后2 h的PLG及PAI活性较溶栓前显著降低(P<0.01),而D D和t PA活性较溶栓前显著升高(P<0.01);UK组溶栓开始后2 h Fib较溶栓前显著降低(P<0.01),而Pro UK各剂量组Fib降低不明显;以上所有变化在溶栓开始后24 h基本恢复;溶栓开始后2 h Pro UK各剂量组的Fib明显高于UK组(P<0.01),其他时间点各用药组之间的所有观测指标均无显著差异;各用药组之间梗死相关血管开通率和出血并发症均无显著差异;溶栓开始后2 h梗死相关血管开通组的PAI显著低于未开通组(P<0.01),其他指标无显著差异。结论　UK溶栓后对全身纤溶系统激活较明显,与UK比较Pro -UK对全身纤溶系统无明显激活作用。     

不同药物静脉溶栓治疗早期急性脑梗死的效果对比分析

目的对比分析不同药物静脉溶栓治疗早期急性脑梗死的效果。方法选取新乡市第二人民医院2013年4月至2015年3月收治的98例急性脑梗死患者为研究对象,抽签随机分为两组,每组49例。分别进行尿激酶(UK)和重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,并辅以常规诊疗,观察两组凝血指标水平、临床疗效及神经功能缺损评分(NIHSS)情况。结果治疗后两组血小板数量逐渐降低,组间差异无统计学意义(P>0.05);纤维蛋白降解产物与D-二聚体水平均在治疗后2 h明显升高,3 d时下降至治疗前水平,其中,rt-PA组在治疗后2 h时水平明显高于UK组(P<0.05)。治疗后rt-PA组有效率为83.7%,显著高于UK组的65.3%(P<0.05)。与治疗前比较,两组NIHSS评分均显著下降(P<0.05),rt-PA组分数明显低于UK组(P<0.05)。rt-PA组脑血管再发、颅内出血与血管性死亡的总发生率与UK组比较,差异无统计学意义(P>0.05)。结论采用rt-PA对早期急性脑梗死患者进行静脉溶栓治疗可获得较UK更好的疗效,兼具一定的安全性。     

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…