A型主动脉夹层发病48h内急诊手术

目的 评价发病48 h内行急诊外科手术的Stanford A型主动脉夹层的效果.方法 2009年9月～2011年5月发病48 h内急诊手术的A型主动脉夹层35例,年龄(43±10)岁.病变均累及主动脉弓,主动脉弓和降主动脉处理采用三分支型主动脉弓覆膜支架行全弓置换+支架象鼻术,升主动脉近端根据情况作相应处理.均采用深低温、选择性低流量脑灌注技术,常规使用甲基强的松龙、改良超滤.结果 全组体外循环时间(195±51 )min,主动脉阻断时间(113±42)min,深低温停循环+选择性脑灌注时间(22±5)min,术后呼吸机辅助时间(95±42)h.围术期死亡1例.随访1～20个月,34例存活患者效果满意.结论 A型主动脉夹层发病48h内急诊手术可以取得良好结果.     

深低温停循环主动脉弓部手术

目的 总结深低温停循环主动脉弓部手术的外科治疗经验.方法 对22例原发疾病主要为主动脉夹层动脉瘤和降主动脉瘤累及弓部患者实施深低温停循环主动脉弓部手术治疗,其中8例行升主动脉+部分主动脉弓替换术,1例行主动脉根部替换术+升主动脉+部分主动脉弓替换术,2例行升主动脉替换+全弓替换术,2例行主动脉瓣替换术+升主动脉替换+部分主动脉弓替换术,8例行升主动脉替换+全弓替换术+象鼻技术(支架象鼻6例),1例行主动脉左半弓+降主动脉置换.4例同时行冠状动脉搭桥手术.结果 围手术期死亡3例,病死率13.6%.死亡原因:1例手术前夹层已经破裂,心脏压塞,急性下壁心肌梗死,心脏停跳,复苏同时手术,手术后严重右心衰,手术后16 h死亡;1例手术后出血+多器官功能衰竭,手术后3 d死亡;1例急性主动脉夹层患者未醒并发肺部感染+多器官功能衰竭,手术后39 d死亡.手术后并发症:出血2次开胸3例;延迟苏醒3例;肾功能衰竭2例.结论 主动脉弓部病变需根据手术前不同的原发病和病变累及的范围制定合理的手术方案,包括半弓、全弓和全弓+象鼻手术;深低温停循环结合选择性脑灌注是一种简便易行的脑保护方法 ,有利于降低主动脉弓部手术死亡率和并发症的发生率.     

Stanford A型主动脉夹层的外科治疗

目的 分析报道Stanford A型主动脉夹层这一凶险复杂疾病的外科治疗方法.方法 2006年6月至2007年9月采用手术治疗Stanford A型主动脉夹层患者24例,经增强血管CT(CTA)、磁共振扫描(MRI)、心脏彩色多普勒(UCG)确诊.无名动脉或右腋动脉 腔房管插管建立体外循环,涉及弓部置换的15例均采用深低温(鼻咽温度16～18 ℃)停循环选择性脑灌注.依据内膜破口位置、夹层累及的部位、有无主动脉瓣关闭不全采用不同的手术方式,其中Wheat术 2例、David 术1例、Bentall术 6例、Bentall术 半弓置换 3例、Bentall术 全弓置换 支架象鼻 5例(其中合并CABG 3例)、升主动脉 全弓置换 支架象鼻 7例.结果 平均体外循环时间(197.3±28.3)min,平均心肌阻断时间(86.1±10.8)min,深低温停循环选择性脑灌注时间(41.2±8.7)min.死亡2例(8.3%),1例患者出现一过性脑功能紊乱,1例出现声音嘶哑.结论 外科手术治疗Stanford A型主动脉夹层明显降低死亡率.消除假腔、置换病变血管、重建分支血管血供是手术原则和治疗思考顺序.手术治疗加血管内支架植入这一杂交技术成为Stanford A型主动脉夹层的经典术式.     

11例DeBakey-Ⅰ型主动脉夹层术后并发症原因及其防治分析

目的总结采用升主动脉及全弓替换加支架＂象鼻＂手术治疗DeBakey-Ⅰ型主动脉夹层术后并发症的方法并分析发生的原因。方法 2005年3月至2009年5月本院收治的11例DeBakey-Ⅰ型主动脉夹层患者,其中急性主动脉夹层2例,慢性夹层9例。均在深低温停循环（DHCA）、低流量选择性脑灌注下手术。实施升主动脉及全弓替换＋支撑型人工血管＂象鼻＂手术3例,主动脉根部替换（Bentall术）及全弓替换＋支撑型人工血管＂象鼻＂手术8例。结果全组平均主动脉阻断时间（102±22）分钟,体外循环时间（159±34）分钟,选择性脑灌注时间（26±12）分钟。无手术死亡病例,手术早期并发症有：2次开胸止血2例,意识障碍2例（1周后恢复）,低氧血症4例,多脏器功能衰竭1例。结论出血、意识障碍以及低氧血症是DeBakey-Ⅰ型主动脉夹层术后早期主要并发症,其主要原因是DHCA造成的凝血机制破坏、脑组织缺氧和肺组织水肿。术中严格的止血操作、选择性脑灌注的使用,术后控制合适的血压水平以及积极的肺部护理是防治的有效手段。     

深低温停循环选择性脑灌注技术在主动脉全弓置换+支架"象鼻"手术中的应用

2004年12月～2008年6月,自治区人民医院应用升主动脉及主动脉全弓置换 支架"象鼻"手术(Elephant trunk procedure)治疗Debakey I型夹层动脉瘤58例,采用深低温停循环(DHCA)选择性脑灌注(ASCP)方法,临床效果满意,现将体外循环(CPB)及经验总结如下.     

Bentall术后并发主动脉弓部夹层动脉瘤再次手术病例报道并文献复习

目的 总结报道1例Bentall术后并发主动脉弓部夹层动脉瘤再手术体会,探讨其发病原因、手术方法 及风险.方法 女,39岁,升主动脉瘤并发Debakey Ⅰ型主动脉夹层动脉瘤,行Bentall术后2年,再发主动脉弓部夹层动脉瘤,在深低温停循环选择性脑灌注下行"主动脉弓全弓置换+支架象鼻术".结果 术后无并发症,2周后康...     

全主动脉弓置换加支架“象鼻”手术治疗DeBakeyⅠ型主动脉夹层临床分析

目的总结升主动脉及全主动脉弓替换加支架＂象鼻＂手术治疗DeBakeyI型主动脉夹层的临床经验。方法对11例DeBakey-I型主动脉夹层患者行升主动脉及全主动脉弓替换加支架＂象鼻＂手术,其中急性主动脉夹层2例,慢性9例。均在深低温停循环、低流量选择性脑灌注下手术。结果 11例患者主动脉阻断时间为（102±22）min,体外循环时间为（159±34）min,选择性脑灌注时间为（26±12）min。均顺利手术,无住院死亡患者。手术后昏迷1例,并发多脏器功能衰竭,患者自动出院;术后出血二次开胸止血2例;意识障碍2例,1周后恢复。结论升主动脉及全主动脉弓替换加支架＂象鼻＂手术是治疗急性与慢性DeBakey I型主动脉夹层安全及有效的方法。     

全弓置换加支架象鼻术治疗Stanford A型主动脉夹层

本文对5例全弓置换加支架象鼻术治疗Stanford A型主动脉夹层手术病例的方法和效果进行探讨,认为全弓替换加支架象鼻手术是治疗急性Stanford A型主动脉夹层安全而有效的方法,值得临床推广.     

DeBakey-Ⅰ型主动脉夹层手术的麻醉及体外循环的处理

目的 总结DeBakey-Ⅰ型主动脉夹层患者手术治疗的麻醉和体外循环管理经验.方法 11例DeBakey-Ⅰ型主动脉夹层患者在全身麻醉深低温停循环+选择性脑灌注技术下行升主动脉及全主动脉弓替换加支架“象鼻”手术,回顾性分析患者临床资料.结果 均麻醉顺利,11例患者主动脉阻断时间为(102±22)min,体外循环时间为(159±34)min,选择性脑灌注时间为(26±12)min.均顺利手术,无住院死亡患者.手术后昏迷1例,且并发多器官功能衰竭,患者自动出院;术后出血二次开胸止血2例;意识障碍2例,1周后恢复.结论 全身麻醉结合深低温停循环+选择性脑灌注等技术可以为主动脉弓置换术提供良好保障.     

保留头臂血管的主动脉弓成形加支架象鼻手术治疗Stanford A型主动脉夹层

目的：探讨保留头臂血管的主动脉弓成形加支架象鼻术治疗Stanford A型主动脉夹层的临床效果。方法采用保留头臂血管的主动脉弓成形加支架象鼻手术治疗23例主动脉夹层Stanford A型的患者,72 h内手术20例,3~14 d内手术3例。结果本组病例住院期间无死亡。全组体外循环时间（209±52）min,升主动脉阻断时间（85±21）min,选择性脑灌注时间为（28±15）min,24 h平均胸引流量为（570±263）mL,术中平均输红细胞悬液量（5.5±3.8）单位,无再次开胸止血病例。23例患者中术后并发急性肾衰竭3例,短暂的神经系统并发症(延迟苏醒)2例,一过性截瘫1例,败血症l例。无永久性神经系统并发症及脏器缺血并发症发生。术后随访6-18个月,均无临床不良事件发生。结论保留头臂血管的主动脉弓成形加支架象鼻术是一种可以选择的主动脉弓部置换的方法,具有安全可行、容易控制出血、简单易于推广的优点。     

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…