经颅多普勒对人工心瓣膜患者脑动脉微栓子的监测

目的 监测人工心瓣膜患者脑动脉微栓子(MES)情况。方法 采用Multi-DopX4经颅多普勒超声(TCD)监测20例人工心瓣膜患者脑动脉微栓子。结果 微栓子阳性14例，阳性率为70％，出现频率为0～319个／30min，相对强度为11～42(均数为22．9)dB，时间延迟为0．9～35(均数为11.6)ms。结论 TCD是监测人工心瓣膜患者脑动脉微栓子的较可靠的方法。     

经颅多普勒对人工心瓣膜患者脑动脉微栓子的监测

目的监测人工心瓣膜患者脑动脉微栓子(MES)情况.方法采用Multi-DopX4经颅多普勒超声(TCD)监测20例人工心瓣膜患者脑动脉微栓子.结果微栓子阳性14例,阳性率为70%,出现频率为0～319个/30min,相对强度为11～42(均数为22.9)dB,时间延迟为0.9～35(均数为11.6)ms.结论TCD是监测人工心瓣膜患者脑动脉微栓子的较可靠的方法.     

双门经颅多普勒检测机械心瓣膜患者微栓子信号的研究

目的 :研究脑动脉微栓子信号 (MES)的基本特征。方法 :采用双门深经颅多普勒 (TCD)检测了 2 1例机械心瓣膜患者的脑动脉 MES。结果 :MES阳性发现率为 80 .95 % (17/ 2 1) ,MES出现频率为 0～ 40 4(中位数 40 )个 /小时 ,MES相对强度为11～ 38(2 3.6 3± 5 .13) d B。84.89%的 MES在二个取样深度依次显示 ,时间延迟为 0 .4～ 2 8.4(中位数 6 .0 ) m s,15 .11% MES仅见于近端通道 ,而在远端通道未能显示。结论 :双门深 TCD是研究 MES基本特征的有效方法     

双门深经颅多普勒超声对脑动脉微栓子信号检测的敏感性和特异性研究

目的 :研究双门深经颅多普勒超声对微栓子信号 (MES)检测的敏感性和特异性。方法 :采用双门深TCD对 30例人工心瓣膜患者进行脑动脉微栓子检测 ,并与在线状态下有经验医师的人工判断 (作为黄金标准 )相比较。结果 :双门深TCD检测MES的敏感性为 6 0 2 % ,特异性为 6 7 8%。结论 :双门深TCD为识别、检测MES提供了新方法 ,但在线状态下的人工判断仍然是必要的。MES相对强度阈值对双门深TCD检测MES敏感性和特异性的影响值得进一步研究。     

双通道经颅多普勒超声检测机械心瓣膜患者微栓子信号

目的观察脑动脉微栓子信号(MES)的基本特征,结合TCD-8软件分析检测MES的敏感性和特异性.方法采用双通道TCD和TCD-8软件检测4例机械心瓣膜患者的脑动脉MES.结果2例发现MES信号,MES相对强度为14～34(26.5士4.9)dB,时间延迟为0.5～20.3(中位数为5.3)ms,TCD-8软件检测MES的敏感性为64.20%,特异性为69.33%.结论双通道TCD不仅是研究MES基本特征的有效方法,也为识别、检测MES提供了新方法,但在线状态下人工判断仍是必需的.     

双门深经颅多普勒检测机械心瓣膜患者微栓子信号的研究

目的:研究脑动脉微栓子信号(MES)的基本特征.方法:采用双门深经颅多普勒(TCD)检测了21例机械心瓣膜患者的脑动脉MES.结果:MES阳性发现率为80.95%(17/21),MES出现频率为0～404(中位数40)个/小时,MES相对强度为11～38(23.63±5.13)dB.84.89%的MES在二个取样深度依次显示,时间延迟为0.4～28.4(中位数6.0)ms,15.11%MES仅见于近端通道,而在远端通道未能显示.结论:双门深TCD是研究MES基本特征的有效方法.     

经颅多普勒监测缺血性卒中患者脑动脉微栓子

目的　了解缺血性卒中患者微栓子的发生率及其可能发病机制。方法　采用德国EMETC 4 0 4 0型经颅多普勒 (TCD)检测仪 ,用soundtrack 2 .4版本的软件对 61例缺血性卒中患者双侧大脑中动脉 (MCA)进行微栓子监测。监测时间不少于 3 0min ,监测前常规行颈动脉B超检查。结果　 6例发现了微栓子 (占 9.83 % ) ,其中 3例为心脏机械瓣膜修复术后患者 ( 1例合并脑栓塞 ,另 2例神经功能正常 ) ,另 3例为非心源性脑梗死患者(占 5 8例非心源性脑梗死患者中 5 .17% )。 3例颅外颈动脉狭窄的患者中 1例微栓子阳性。在非心源性脑梗死患者中 ,仅于患侧MCA处监测到微栓子 ,而在心脏人工瓣膜修复术后患者中 ,双侧MCA均可监测到微栓子。结论　非心源性脑梗死急性期微栓子阳性率低 ,可能与颅外颈动脉狭窄程度有关。     

机械心脏瓣膜置换术后远期抗凝状态临床观察及意义

目的:机械心脏瓣膜置换术后远期INR与并发症的关系,最佳抗凝强度范围及意义。方法:对机械心脏瓣膜置换术后出院半年以上的患者在门诊检查四项凝血指标(PT,PTR,INR,Fbg,APTT)224例次,按照INR结果不同分为三组:I组INR<1.5,II组INR1.5～2.5,III组INR>2.5。结果:I组26例/次,华发林服用量3.55±1.03mg,INR1.39±0.10,出现脑栓4例/次,并发症15.3%;II组176例/次,华发林服用量3.44±1.02mg,INR2.13±0.11,出现鼻出血、血尿5例/次,并发症2.8%;III组22例/次,华发林服用量2.96±1.07,INR2.91±0.62,出现鼻出血、皮下出血4例/次,并发症18%。结论:II组的例/次占总数的77.8%,INR在1.5～2.5之间并发症最低,说明INR在1.5～2.5之间是安全可靠的,是本地区最佳抗凝强度范围。机械心脏瓣膜置换术后抗凝强度是动态的,术后远期更应高度关注抗凝状态。     

动力型微泡清除器在体外循环冠状动脉旁路移植术中的初步应用

目的　明确动力型微泡清除器 (DBT)在冠脉搭桥患者体外循环 (CPB)全过程中减少动脉灌注管道和大脑中动脉内微气泡的效果及其对血细胞和凝血机能的影响。方法　 2 0例患者随机分组 ,DBT组在动脉滤器与主动脉插管之间接入DBT。检测DBT前、后的动脉灌注管内和对照组相应位置的微气泡量和患者双侧大脑中动脉内微栓信号 (MES)量。术前、CPB停止和术后 6h分别测定血浆游离血红蛋白 (PFH)、乳酸脱氢酶 (LDH)、血小板计数、纤维蛋白原、凝血因子Ⅱ活性、抗凝血酶Ⅲ(ATⅢ )活性。结果　DBT组动脉灌注管内不同直径微气栓的清除率分别为 6 8%～ 74 % (10～ 12 0 μm) ,79%～ 81% (2 0～ 12 0 μm)和 88%～ 96 % (40～ 12 0 μm )。整个CPB期间大脑中动脉内MES总值 ,DBT组 (178± 12 2 )比对照组 (197± 137)有减少的趋势 ,但差异无显著意义。血细胞破坏和凝血机能各指标在两组间差异无显著意义。结论　DBT能高效清除体外循环动脉灌注管内微气泡并且不加重血细胞的破坏或凝血抗凝机制的紊乱。要最大程度消除入脑气体微栓须采取综合临床措施 ,而DBT是有效手段之一。     

脑振荡患者的凝血酶原等检验指标的变化

目的　研究脑振荡患者凝血酶原时间 (PT) ,凝血酶原时间国际标准化比值 (INR) ,活化的部分凝血活酶时间 (APTT)和纤维蛋白原含量 (FIB)等凝血因子的变化以及白细胞 (WBC) ,血小板 (PLT) ,平均血小板体积 (MPV)和血钾 (K)的变化。方法　空腹时抽取脑振荡患者全血 2 .7mL ,选取 4 0例无溶血 ,无黄疸、无脂血者 ,男 2 0例 ,女 2 0例。年龄 4 3～ 89岁。用 0 .3mL枸橼酸钠抗凝 ,摇匀 ,30 0 0r/min转速离心 15min分离血浆 ,并在 2h内用COAT -GATE凝血分析仪检测 4 0例脑振荡患者的PT ,APTT ,FIB及INR ,并同时以 4 0例健康体检者 (无溶血、无黄疸、无脂血者 ,男 2 0例 ,女 2 0例。年龄 4 3～ 89岁。无肝脏、心血管、血液系统及神经系统疾病 ,其他血液生化指标均在参考范围内 )作对照组。检测试剂采用欧加农试剂。同时用欧加农室内定值质控品做质控 ,质控在控制范围。再抽取全血 3mL ,肝素抗凝 ,离心取血浆检测K+ ;取全血加EDTA抗凝 ,测WBC ,PLT及MPV。结果　脑振荡患者组及对照组PT分别为 (15 .5± 1.6 )s ,(14 .8± 1.2 )s,经t检验 ,P <0 .0 1,2组间有显著性差异 ;脑振荡患者组及对照组INR分别为 1.1± 0 .4 9,0 .98± 0 .2 0 ,经t检验 ,P<0 .0 1,2组间有显著性差异 ;脑振荡患者组及对照组FIB分别为 (3.17±     

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…