帕金森病苍白球和丘脑毁损术的手术方式选择与疗效关系

目的　总结帕金森病 (PD)苍白球和丘脑毁损术的术式的选择与疗效关系。方法　对 2 13例PD进行了微电极导向立体定向手术治疗 ,其中苍白球腹后部毁损术 (PVP) 171例 ;丘脑腹中间核 (Vim)毁损术 2 1例 ;同期同侧PVP和Vim毁损术 8例 ;同期双侧PVP 5例 ;分期双侧PVP8例。结果　术后UPDRS评分发现上述各种术式在“关”状态下和“开”状态下症状均有明显改善 ,改善率分别为 5 0 .8%～ 6 0 .8%和 2 8.7%～ 36 .6 % ,其中以多靶点毁损术为佳。同期双侧PVP发生明显构音障碍、吞咽困难 1例。结论　根据不同症状选择不同术式 ,同期双侧PVP术后易产生并发症 ,应慎重采用     

微电极导向立体定向手术治疗帕金森病

目的：总结微电极导向立体定向手术治疗帕金森病的临床经验及治疗效果。方法：自1999年4月至2001年2月采用微电极导向立体定向手术治疗帕金森病350例。其中行苍白球腹后部毁损术（PVP）278例,丘脑腹中间核（Vim)毁损术35例,行同期同侧PVP和Vim毁损术15例,行同期双侧PVP11例,分期双侧PVP8例,分期一侧PVP、另一侧Vim毁损术3例。对手术前后的“关”状态和“开”状态进行日常生活量表评分、统一帕金森病评定量表（UPDRS）评分,并进行门诊随访或家访。结果：术后日常生活能力评分“关”状态提高29．8％,“开”状态提高25．9％。UPDRS评分在“关”、“开”状态下,总的症状改善率分别为57．3％和33．4％,其中精神行为情绪改善率为50．8％和28．9％,日常活动改善率为59．1％和35．9％,运动功能改善率为58．2％和34．7％。结:PVP地大多数症状均有效,但对震颤的效果不如Vim毁损术;对震颤明显、无明显僵直的患可选择Vim毁损术;对震颤僵直型患可行同期双侧PVP或同期PVP加Vim毁损术。     

双侧立体定向手术治疗帕金森病的疗效分析

目的：分析帕金森病双侧立体定向手术的术式与疗效，并发症的关系。方法：58例帕金森病患者进行了双侧手术治疗，其中分期双侧苍白球腹后部毁损术（PVP）或腹中间核（Vim)毁损术41例，分期一侧PVP或Vim毁损术，另一侧丘脑底核（STN）或Vim脑深部刺激术（DBS）6例；同期双侧PVP5例，同期双侧STN DBS4例，同期一侧PVP,另一侧STN DBS2例，平均随访6．2个月。:UPDRS结核平分显示双侧术后帕金森病症状均有不同程度改善，但以同期双侧STN DBS效果最佳，无并发症。双侧毁损术并发症较高，尤其是分期双侧Vim毁损术和同期双侧PVP。结论：双侧DBS是具有双侧症状的帕金森病患者立体定向手术治疗的最佳术式，双侧毁损术并发症较高，应慎重采用。     

帕金森病立体定向脑深部刺激术和射频热凝毁损术中脑出血危险因素分析

目的 分析帕金森病立体定向脑深部刺激术(DBS)和射频热凝毁损术中脑出血的危险因素,以降低脑出血并发症发生率.方法 分别对626例帕金森病患者行DBS和射频热凝毁损术治疗,其中DBS 108例,射频热凝毁损术507例,一侧DBS+另一侧射频热凝毁损术11例.共手术治疗靶点774个,其中丘脑底核(STN)DBS术184个,丘脑腹中间核(Vim)DBS术1个,苍白球腹后部毁损术(PVP,行DBS或射频热凝毁损术)474个,Vim射频热凝毁损术115个.结果 术后无症状性脑出血14例,症状性脑出血10例.有高血压病病史者的脑出血发生率为7.5%,显著高于无高血压病病史者的3.1%(χ2=4.77,P<0.05).微电极记录2～4条针道靶点的脑出血发生率为7.1%(12/170),显著高于微电极记录1条针道靶点的2.3%(10/443,χ2=8.19,P<0.01).PVP、Vim射频热凝毁损术的脑出血发生率均明显高于DBS(χ2=4.65、6.81,P值分别<0.05、0.01);Vim射频热凝毁损术的脑出血发生率略高于PVP,但差异无统计学意义(χ2=0.66,P>0.05).结论 高血压病是帕金森病立体定向手术并发脑出血的危险因素.微电极记录针道数与脑出血发生率呈明显正相关,DBS是较射频热凝毁损术更安全的帕金森病外科治疗方法.     

立体定向脑内核团毁损及深部电刺激术治疗帕金森病临床观察

目的探讨立体定向脑内核团毁损术及DBS治疗帕金森病的临床疗效。方法 50例PD患者均在CT/MRI定位下立体定向手术,45例行核团射频毁损术,5例PD DBS均选取STN为手术靶点。术前、术后1月进行UPDRS和ADL的评分,比较手术前后评分的变化和症状改善率。结果射频毁损术及DBS术后短期效果均满意,显效44例(88%),有效6例(12%),总有效率100%。术后1月的UPDRS与ADL评分较术前均明显减少(P<0.05,P<0.01),术后无明显并发症;随诊射频毁损者复发率8例(17.8%),DBS者无复发。结论立体定向脑内核团毁损及DBS术治疗帕金森病疗效显著。     

不同靶点下脑深部电刺激治疗帕金森的疗效对比

目的探讨不同靶点下脑深部电刺激治疗帕金森病(PD)的疗效。方法立体定向微电极植入丘脑底核(STN)与苍白球内侧核(GPi),术后观察PD症状的改善情况,分别计算"关"状态下和"开"状态下肢体症状改善率,分别于术前、术后1月、1年对患者进行UPDRS运动功能及日常生活评分的随访分析,并比较手术前后左旋多巴服用剂量变化情况。结果 DBS对PD症状有效率达到100%,且术后在"关"状态下较"开"状态的改善率更高,效果更明显。术后UPDRS运动功能及日常生活评分较术前显著降低,且STN-DBS术后左旋多巴用量在减轻PD症状的同时可减少术后药物使用量。结论 DBS治疗帕金森病具有显著疗效,其中尤以STN-DBS在保证疗效同时可减少药物用量。     

微电极导向立体定向技术行脑内核团毁损和脑深部电刺激治疗帕金森病的效果观察

目的:观察微电极导向立体定向技术行脑内核团毁损和脑深部电刺激治疗帕金森病的效果.方法:选择我院2008年6月～2010年6月216例帕金森病患者,按照治疗方法不同分为二组,采用微电极导向立体定向技术行脑内核团毁损 180例患者为毁损组,采用脑深部电刺激(DBS)治疗的36例患者为DBS组;所有患者均随访6～12个月,观察二组治疗后症状改善情况及UPDRS运动评分.结果:二组治疗后运动评分症状改善情况显示,毁损组在开状态下,症状改善70例,占38.89%;关状态下,症状改善96例,占63.33%;DBS组在开状态下,症状改善10例,占27.78%;关状态下,症状改善19例,占52.78%;二组比较差异无显著性,无统计学意义P＞0.05.DBS组中23例在1月后症状改善,未调整参数,13例因治疗后症状未完全控制,经再次调整参数后症状完全控制,总有效率100%;毁损组随访6～12个月,显效101例,占56.11%;有效65例,占36.11%;无效14例,占7.78%,总有效率为92.22%,二组比较差异具有显著性,有统计学意义P＜0.05.毁损组中共发生不良反应7例,发生率为3.89%; DBS组无明显不良反应,二组比较差异具有显著性,有统计学意义P＜0.05.结论:脑深部电刺激(DBS)是治疗帕金森病的新技术,术前根据患者的症状合理设置参数,同时在随访过程中可根据患者的症状改善情况进行调节,使临床症状得到有效的控制,且术后并发症少,是治疗帕金森病安全有效的手术方法.     

帕金森病96例给予微电极引导立体定向脑内核团毁损术治疗的临床观察

目的探讨帕金森病采取微电极引导立体定向脑内核团毁损术治疗的临床效果。方法选取我院2012年3月至2014年8月帕金森病患者96例,所有患者均采取微电极引导立体定向脑内核团毁损术治疗,观察其临床治疗效果,并比较治疗前后患者的UPDRS评分之间存在的差异。结果所有患者经过治疗,其治疗总有效率为98.96%,不良反应发生率为93.75%。所有患者在治疗后,其"开"状态和"关"状态的UPDRS评分分别为(24.53±3.52)分和(35.26±6.83)分,与治疗前对比优势明显(P0.05)。结论采用微电极引导立体定向脑内核团毁损术治疗帕金森病患者,能够取得较高的治疗总有效率,而且能够显著改善患者的日常生活能力及运动功能,但需要注意控制毁损灶大小,以免引发患者出现严重不良反应。     

脑深部核团电刺激与毁损术治疗帕金森病疗效比较

目的分别应用脑深部核团电刺激（deep brain stimulation,DBS）和核团射频毁损术治疗原发性帕金森病（Par-kinson＇s disease,PD）,对照研究DBS和射频毁损术对PD患者的肢体僵直、震颤、运动迟缓等症状的疗效。方法应用CT影像学与微电极电生理定位结合的方法进行靶点定位。25例帕金森病患者进行丘脑底核电极植入,其中18例为一侧,7例为双侧同期植入;25例患者进行射频毁损术,其中21例行一侧毁损,4例行分期双侧射频毁损。两组患者术前UPDRS评分差异无统计学意义（P〉0.05）。术后所有患者经过6个月～5年的随访并行UPDRS评分。结果丘脑底核（STN）慢性电刺激及丘脑腹中间核（Vim）或/和苍白球腹后内侧部（Gpi）射频毁损术患者术后的肢体僵直、震颤、运动迟缓等症状均有不同程度的改善。在术后1个月、6个月、1年比较两组患者的UPDRS评分差异无统计学意义（P〉0.05）,而术后2年、3年、5年比较两组的UPDRS评分差异有统计学意义（P〈0.05）。结论目前DBS手术和射频毁损术是治疗PD有效的方法,二者在近期疗效方面差异无统计学意义,但在远期疗效方面DBS较射频毁损术有明显的优势。     

微电极记录技术在手术治疗帕金森病中的作用分析

目的探讨微电极记录技术在手术治疗帕金森中的作用效果,为后续的临床治疗提供参考方法。方法分析采取微电极记录手术治疗的帕金森患者120例患者的相关临床资料,其中苍白球腹后部毁损术(PVP)58例,丘脑腹中间(Vim)毁损术32例,同期同期PVP及Vim患者21例,同期同侧PVP患者5例,分期双侧PVP患者2例,分期一侧PVP或者另一侧Vim术2例。对患者手术前后的"关"和"开"状态进行生活能力以及UPDRS评分,以及观察治疗期间的并发症发生情况。结果经过治疗后患者的生活能力平评分均明显的提高,前后差异显著。结论采取微电极记录方法治疗帕金森,可以明显的提高手术的效果,并有效降低并发症的发生,保证手术的质量。     

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.     

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.