缬沙坦对肝硬化门脉高压作用及机制研究

目的研究缬沙坦对肝硬化门脉血流动力学的影响并探讨其作用机制。方法肝硬化患者观察组和对照组各24例,分别给予口服缬沙坦80 mg/d的一周和常规治疗。用药前后应用彩色多普勒超声仪检测门静脉和脾静脉内径并计算其平均流速和血流量。同时放免法测定血浆肾素活性和血管紧张素Ⅱ。结果服用缬沙坦后门静脉和脾静脉内径缩小,与用药前相比P<0.05;它们的平均流速和血流量均有降低,与用药前相比P<0.05。用药后血浆肾素活性和血管紧张素Ⅱ较用药前则明显升高(P<0.05)。结论缬沙坦可以使肝硬化患者门脉压力降低,可能与调控肾素血管紧张素醛固酮系统有关。     

缬沙坦治疗肝硬化门静脉高压症的临床分析

目的 该实验通过观察缬沙坦对肝硬化患者血流动力学及肝肾功能等指标的影响,探讨其降门静脉压的作用及其安全性.方法 选取40例肝硬化患者,将其随机分为对照组和治疗组各20例,对照组给予常规治疗,治疗组在常规治疗基础上加用缬沙坦80 mg/d口服,疗程为1个月.治疗前后应用彩色多普勒超声仪检测门、脾静脉的内径与流速,整个用药过程中观察患者的血压和心率,监测血常规和肝、肾功能.结果 治疗组患者门、脾静脉的内径减小,流速增快,差异有统计学意义(P＜0.05),而对照组治疗前后上述指标虽有变化,但差异无统计学意义.应用缬沙坦后,患者的血压和心率无明显变化,血常规和肝、肾功能无明显损害(P＞0.05).结论 缬沙坦可通过减小门脾静脉内径,提高血流速度,从而起到降低门静脉压力的作用.同时对血压和心率无明显影响,对血常规和肝、肾功能也无明显损害.     

肝硬化患者血浆内皮素-1和降钙素基因相关肽水平变化及意义

目的 探讨肝硬化患者血浆内皮素-1(ET-1)和降钙素基因相关肤(CGRP)水平的改变及其与肝功能损害和门脉血流动力学的关系.方法 用彩色多普勒超声测定42例肝硬化患者和20例对照组门静脉及脾静脉的直径、流速和血流量.用放射免疫分析法测定空腹血浆ET-1和CGRP水平.结果 肝硬化患者门脉系统存在血流动力学异常,血浆ET-1和CGRP水平显著高于对照组.按肝功能Child-Pugh分级将肝硬化患者分为A,B,C 3组,各组血浆ET-1和CGRP水平依次升高.合并腹水的肝硬化患者血浆ET-1和CGRP水平显著高于未合并腹水者.血浆ET-1和CGRP水平与门静脉和脾静脉的直径以及脾静脉的流量呈显著正相关.结论 肝硬化患者血浆ET-1及CGRP水平升高反映了肝功能损害的严重程度,同时在门静脉高压的形成和发展过程中起着重要的作用.     

缬沙坦降低肝硬化门静脉高压的疗效观察

目的探讨两种不同剂量缬沙坦降低肝硬化门静脉高压的疗效。方法将肝硬化门脉高压患者40例随机分为两组,每组20例。一组口服缬沙坦40m g/d,另一组口服缬沙坦80m g/d,疗程2周。治疗前后应用彩色多谱勒超声仪分别测量门、脾静脉内径和最大血流速度。结果治疗后两组患者门、脾静脉的内径下降,血流速度增快,用药前后比较,差异有统计学意义（P〈0.01）。而治疗后两组上述指标比较,差异无统计学意义（P〉0.05）。结论两种不同剂量缬沙坦降低肝硬化门静脉高压的疗效相同。     

彩色多普勒对肝硬化门脉系统血流动力学改变的意义

目的观察肝硬化患者门静脉系统血流动力学改变并探讨其对预后的影响.方法用彩色多普勒测量肝硬化腹水、无腹水及上消化道出血患者门静脉和脾静脉内径、血流速度及血流量,同时检测肝功能,并设正常对照组.结果肝硬化患者门静脉、脾静脉内径及血流量大于正常对照组(P＜0.01),门静脉血流速度小于正常对照组(P＜0.01).肝硬化消化道出血组门静脉血流速度小于腹水组和无腹水组(P＜0.05),肝硬化腹水组和消化道出血组门静脉血流量小于无腹水组(P＜0.05),肝硬化消化道出血组脾静脉血流速度大于无腹水组及腹水组(P＜0.01).结论脾静脉血流量的增多是导致门静脉高压的重要原因之一,并导致肝功能预后不良,脾静脉血流速度增快的肝硬化患者容易并发上消化道出血.     

超声检查在肝硬化门静脉高压诊断中的临床应用

目的分析超声检查在肝硬化门静脉高压诊断中的应用价值。方法 2016年1月至2017年6月前来我院就诊的74例肝硬化门静脉高压症病患作为研究对象归为研究组,选取同期于我院行健康检查的78例民众作为对照组,组织所有参选对象行超声检查,比较两组受检者门静脉内径、门静脉血流量、脾静脉内径和脾静脉血流量。结果研究组患者门静脉内径、门静脉血流量、脾静脉内径和脾静脉血流量等指标均高于对照组健康民众,差异有统计学意义(P0.05)。结论超声检查可快速准确的帮助肝硬化门静脉高压症病患诊断病情,便于医者根据检查结果设计治疗方案,推动临床医疗工作顺利开展。     

前列地尔脂微球注射液对肝硬化腹腔积液患者血流动力学的影响及临床疗效观察

目的：观察前列地尔脂微球注射液治疗肝硬化合并腹水的疗效及治疗前后门静脉脾静脉血流动力学、肾功能、白蛋白的改变。方法选取肝硬化腹腔积液患者100例,随机分为治疗组和对照组各50例。对照组采用传统的综合治疗,治疗组在此基础上加用前列地尔脂微球注射液10μg 静脉滴注,1次／d,疗程为21d。观察2组治疗前后白蛋白、肾功能、24h 尿量、B 型超声腹腔积液定量、门静脉内径、脾静脉内径、门静脉平均血流速度、脾静脉平均血流速度、门静脉血流量、脾静脉血流量。结果治疗组的肾功能及腹腔积液较对照组明显改善（P ＜0.05）,白蛋白较对照组明显升高（P ＜0.05）,临床疗效优于对照组（P ＜0.05）。治疗组治疗后门静脉内径、脾静脉内径较对照组明显缩小（P ＜0.05）,门静脉平均血流速度、脾静脉平均血流速度较对照组明显加快（P ＜0.05）。治疗组与对照组治疗前后门静脉血流量、脾静脉血流量均无明显变化（P ＞0.05）。结论前列地尔脂微球注射液可通过降低肝脏血流阻力而降低肝硬化门脉高压,但不影响门静脉血流量,可提高血浆白蛋白浓度及改善肾功能,从而使尿量明显增加,腹腔积液明显消退。     

彩超对肝硬化门、脾静脉血流量检测与电子胃镜食管胃底静脉曲张相关性的观察

目的 探讨彩超对肝硬化门、脾静脉血流量检测与电子胃镜食管胃底静脉曲张的关系.方法 76例肝硬化患者均在行彩超检测前后1周内行电子胃镜检查.结果 根据门、脾静脉血流量的超声测值结果将肝硬化患者分为两组:A组为门静脉血流量大于脾静脉血流量,B组为门静脉血流量小于脾静脉血流量.电子胃镜检查B组食管胃底静脉曲张及破裂出血发生率...     

超声预测肝硬化脾切除联合脾肾静脉分流术后吻合口闭塞的初步研究

目的：利用超声技术预测肝硬化脾切除联合脾肾静脉分流术后吻合口闭塞。方法：回顾性分析肝硬化门 静脉高压行脾切除联合脾肾静脉分流术患者53例,依据门静脉系统CT对脾肾静脉吻合口通畅性的检查结果,将患者 分为通畅组39例和闭塞组14例。比较两组门静脉和脾静脉内径、血流速度及血流量、血栓形成情况、血流方向等超 声指标,分析预测脾肾静脉吻合口闭塞的影响因素。结果：与通畅组比较,闭塞组门静脉内径增宽,脾静脉内径变 窄、血栓形成、血流速度降低、血流量减少、血流呈向肝性改变,差异有统计学意义(均P<0.05)。结论：门静脉内 径增宽,脾静脉内径变窄、血栓形成、血流速度降低、血流量减少、血流呈向肝性改变等超声指标是预测肝硬化 脾切除联合脾肾静脉分流术后脾肾静脉吻合口闭塞的影响因素。     

门脉高压症患者门静脉系统血流动力学的变化

目的探讨肝硬化门脉高压患者门脉系统血流动力学参数变化及其临床意义。方法应用多普勒超声检测50例肝硬化门脉高压症患者门脉系统血流动力学参数,并以18例正常体检患者对照研究。分析两组间门脉系统相关血管血流动力学参数差异。结果病例组门静脉、脾静脉和脾动脉血管内径及其血流量较对照组均呈显著性增大（P〈0.01）,血流速度亦有增加,但无统计学显著意义（P〉0.05）。病例组脾静脉血流量/门静脉血流量（Qp/Qsv）为82.4%（1360.60/1650.57）,而对照组脾静脉血流量/门静脉血流量（Qp/Qsv）仅为37.7%（364.31/965.69）,两组间比较具有统计学显著性意义（P〈0.01）。结论门静脉高压患者存在门静脉系统血流动力学变化。提示其在门静脉高压症的发病机制中起重要作用。     

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…