复杂性颅内动脉瘤的介入治疗

目的 总结血管内栓塞治疗165例颅内复杂性动脉瘤患者的体会，探讨颅内复杂性动脉瘤介入治疗方法、技术操作要点、存在问题及临床应用前景。方法 165例颅内动脉瘤患者中139例为破裂动脉瘤，按Hunt—Hess分级：I级49例，Ⅱ级55例，Ⅲ级48例，Ⅳ级13例。采用双弯塑形、横向成篮、分部填塞及篮外填塞等方法治疗101例，瘤颈重塑形技术2例，血管内支架结合GDC62例。结果 栓塞程度：致密栓塞139例(84．2％)，90％以上20例(12．1％)，90％以下7例(4．2％)。术中出血3例(1．8％)，死亡2例(1．2％)。结论 GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。采用双弯塑形、横向成篮、分部填塞、篮外填塞及Remodelling技术等方法，可以明显提高宽颈动脉瘤的致密栓塞率，血管内支架结合GDC是治疗颅内梭形及宽颈动脉瘤的有效方法，支架覆盖的主要分支血管血流不受支架影响，长期疗效有待于进一步随访观察。     

外伤性颈内动脉海绵窦段假性动脉瘤血管内栓塞治疗

目的：探讨外伤性颈内动脉海绵窦段假性动脉瘤血管内栓塞治疗的方法和疗效。方法：5例颈内动脉海绵窦段假性动脉瘤，其中的4例宽颈假性动脉瘤先植入冠脉孔支架覆盖动脉颈，再将微导管通过支架网孔超选进入动脉瘤腔，填塞电解可脱卸弹簧圈（GDC）；另1例窄颈假性动脉瘤单纯行GDC填塞。结果：所有动脉瘤均成功治疗，动脉瘤填塞均在95％以上，1例宽颈假性动脉瘤行支架结合GDC治疗后复发，经再次填塞GDC后治愈，1随访5－18个月，载瘤动脉通畅，临床效果优良。结论：从本组资料看，窄颈和宽颈假性动脉瘤可分别采用GDC栓塞和血管内支架结合GDC栓塞治疗，血管内支架结合GDC栓塞治疗颈内动脉假性动脉瘤是安全、有效的方法，长期疗效有待进一步随访。     

血管内支架结合电解可脱卸弹簧圈治疗颅内椎动脉宽颈动脉瘤

目的：总结血管内支架结合电解可脱卸弹簧圈治疗颅内椎动脉宽颈动脉瘤的初步经验。方法：通过股动脉途径，采用将血管内支架跨动脉瘤颈放置，通过其网孔将微导管送入动脉瘤腔后填塞GDC的技术治疗6例椎动脉颅内段宽颈动脉瘤。结果：1例支架置入术失败，其余5例支架均准确到位。4动脉瘤达到致密填塞，1例大部填塞，载瘤动脉通畅。1例采用弹簧圈同时闭塞动脉瘤及载瘤动脉，无手术并发症，患均恢复良好。结论：血管内支架联合微弹簧圈是治疗颅内宽颈动脉瘤的有效方法，但仍需要远期随访。     

血管内支架结合弹簧圈治疗颅内宽颈动脉瘤

目的：探讨应用血管内支架结合电解脱弹簧圈(GDC)栓塞治疗颅内宽颈动脉瘤的临床疗效。 方法：30例颅内宽颈动脉瘤（瘤颈宽度2.0~6.5 mm，体/颈比≤2）患者，采用血管内支架结合GDC对动脉瘤进行栓塞治疗,并与30例传统方法栓塞的宽颈动脉瘤患者做对比。 结果：25例患者应用血管内支架结合GDC使动脉瘤成功栓塞；5例患者仅行支架封堵动脉瘤开口，其中1例于术后2周因动脉瘤再次破裂出血而死亡。29例临床随访3~20个月，无再出血及血栓栓塞症状。对照组30例患者中10例因动脉瘤颈过于宽阔，弹簧圈无法在瘤腔内停留而致栓塞失败；另20例患者术后6个月，5例动脉瘤颈部复发，1例因动脉瘤再次破裂致蛛网膜下腔出血。 结论：血管内支架结合GDC治疗颅内宽颈动脉瘤效果优于传统方法栓塞，是一种安全有效的方法，值得临床推广与深入研究。     

球囊再塑形联合三维电解可脱弹簧圈治疗颅内宽颈动脉瘤4例

目的:探讨球囊再塑形联合三维电解可脱弹簧圈(3D-GDC)治疗颅内宽颈动脉瘤的体会。方法:采用球囊再塑形联合3D-GDC对4个颅内宽颈动脉瘤进行栓塞治疗。其中后交通动脉瘤(PcomA)3个,脉络膜前动脉瘤1个。其中3例动脉瘤瘤颈>4mm,1例颈体比>0.7,而<1,均使用HyperForm球囊辅助3D-GDC、GDC治疗。球囊辅助技术采用双导管,微导管送入动脉瘤腔前1/3,再将不可脱球囊置于瘤颈,充盈将瘤颈覆盖,再将GDC填塞动脉瘤。结果:所有动脉瘤全部致密填塞,无任何并发症,随访3个月至2年,经DSA复查,均无动脉瘤复发,载瘤动脉通畅。结论:球囊再塑形联合3D-GDC治疗颅内宽颈动脉瘤是处理颅内宽颈动脉瘤安全、有效的方法。采用球囊保护技术栓塞动脉瘤的效果优于单纯采用弹簧圈栓塞的效果,并且球囊保护技术复杂程度较低。     

瘤颈再塑形技术在颅内宽颈动脉瘤血管内治疗中的应用

目的探讨运用瘤颈再塑形技术治疗颅内宽颈动脉瘤的适应证、技术要点、安全性及临床应用前景。方法对23例不同部位的宽颈动脉瘤运用瘤颈再塑形技术治疗,其中14例采用neuroform支架置入瘤颈再塑形结合电解可脱弹簧圈栓塞,9例采用球囊辅助瘤颈再塑形结合电解可脱弹簧圈栓塞。术后6、12个月常规复查脑血管造影,并用改良Rankin量表进行预后评价。结果23例患者的颅内动脉瘤均成功栓塞,其中100％致密栓塞15例,95％栓塞6例,90％栓塞2例;治疗后1年时生活不能自理或死亡者占17.3％;未发现动脉瘤再破裂出血者。结论应用血管内自膨式支架neuroform置入及球囊辅助瘤颈再塑形技术结合电解可脱弹簧圈栓塞是治疗宽颈动脉瘤的有效方法,有较好的临床应用前景。     

26例支架辅助栓塞颅内宽颈动脉瘤的疗效分析

目的探讨血管内支架辅助弹簧圈治疗颅内宽颈动脉瘤的经验和疗效.方法对26例行血管内支架辅助弹簧圈治疗的颅内宽颈动脉瘤患者的临床资料、栓塞方式、治疗结果及临床、影像学随访结果进行回顾性分析.26例含28枚宽颈动脉瘤,动脉瘤位于前交通动脉瘤3枚,后交通动脉瘤15枚,颈内动脉眼动脉段6枚,大脑中动脉4枚.结果采用支架28个辅助弹簧圈栓塞28枚颅内宽颈动脉瘤,所有病例均成功释放支架(100%);手术相关并发症发生3例,其中死亡1例.动脉瘤即刻栓塞结果按Raymond分级:Ⅰ级:18枚(64.3%),Ⅱ级:6枚(21.4%),Ⅲ级:4枚(14.3%).随访25例,时间6~51个月,(平均15个月),均无新增神经功能障碍及再出血.出院后3个月m RS评分:m RS:0~1分22例(84.0%);m RS:1~2分3例.结论支架辅助弹簧圈栓塞颅内宽颈动脉瘤,可以提高致密栓塞率,降低动脉瘤复发的可能,是一种安全有效的治疗方法.     

GDC栓塞治疗47例颅内动脉瘤的疗效

目的 探讨应用电解可脱性铂金弹簧圈(GDC)栓塞治疗颅内动脉瘤的疗效和经验。方法 47例颅内动脉瘤患者(48个动脉瘤)，其中43例行单纯GDC栓塞术，3例宽颈动脉瘤行支架结合GDC栓塞，1例宽颈动脉瘤应用球囊瘤颈塑型GDC栓塞术．术前、术后造影对比，术后随访1～58个月。结果 47例颅内动脉瘤患者，行GDC栓塞47个，其中36个100％栓塞(76．5％)，6个90％柃塞(12．8％)，2个80％栓塞(4．3％)，1个50％栓塞(2．1％)，2个栓塞失败(4．3％)，1个多发动脉瘤未作处理，4例应用瘤颈辅助技术手术顺利，效果满意。术后随访无蛛网膜下腔出血发生。结论 GDC适合大多数颅内动脉瘤的栓塞治疗，安全可靠。     

血管内支架结合电解可脱卸弹簧圈治疗宽颈后交通动脉瘤

目的：总结血管内支架结合电解可脱卸弹簧圈（Guglielmi detachable coil,GDC)治疗宽颈后交通动脉瘤的临床体会，对其指征、操作要点及主要并发症进行初步探讨。方法：24例宽颈后交通动脉瘤，植入球囊膨胀型网孔冠脉支架覆盖动脉瘤颈，再将微导通过支架网孔超选进入动脉瘤腔内行GDC填塞。结果：完全填塞19例，90％以上填塞3例，60％－70％填塞2例，载瘤动脉通畅，平均随访6．8个月，所有患未出现神经功能障碍。结论：血管内支架结合GDC是治疗宽颈后交通动脉瘤的有效方法，长期疗效有待进一步随访。     

Neuroform自膨式支架结合弹簧圈栓塞颅内宽颈动脉瘤

目的报道采用Neuroform自膨式支架结合弹簧图治疗颅内宽颈动脉瘤，探讨该支架的特点及使用该支架的安全性、术中并发症、短中期疗效和应用前景。方法采用Neuroform支架结合弹簧圈栓塞治疗30例31枚颅内宽颈动脉瘤。颈内动脉海绵窦段3枚，眼动脉3枚，后交通动脉20枚，前交通动脉2枚，大脑中动脉M1段1枚，大脑中动脉分叉部1枚．基底动脉干1枚，其中1例患者为多发动脉瘤，绝对宽颈（瘤颈〉4mm）动脉瘤26枚，相对宽颈5枚，瘤颈瘤体闭均〉0．7。结果4枚采用NeuroformⅡ代自膨式支架结合弹簧圈栓塞治疗，其余均采用NeuroformⅢ代支架结合弹簧圈栓塞治疗。30例31枚支架均成功到位释放，1例多发动脉瘤患者置入2枚支架。9枚动脉瘤完全栓塞（100％），11枚几乎完全栓塞（95％～99％），11枚不完全栓塞（95％以下）。2例术中出血；2例术中支架内血栓形成，其中1例术后遗留肢体偏瘫，另1例死亡；1例术中弹簧圈尾端从支架网孔突入颈内动脉，术后出现一过性脑缺血表现，其余患者均恢复良好出院。临床随访28例，随访期1～32个月，平均11个月，6例术后6～12个月血管造影随访，其中1例后交通动脉瘤患者同侧大脑前动脉闭塞，大脑中动脉主干血栓形成；另5例原有瘤颈残留者无变化。结论在栓塞颅内宽颈动脉瘤时应用Neuroform自膨式支架结合弹簧圈技术，使弹簧圈无法突入载瘤动脉，可提高栓塞致密度，安全疗效好。     

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…