重症胆源性胰腺炎47例手术治疗分析

目的:探讨重症胆源性胰腺炎的手术时机和方式。方法:重症胆源性胰腺炎47例分为非梗阻型22例和重症梗阻型25例,对其临床治疗进行回顾性分析和总结。结果:重症梗阻型和非梗阻型早期手术并发症的发生率高、平均住院日长,与延期手术比较差异有统计学意义(P<0.05),但重症梗阻型胰腺炎早期手术死亡率明显低于延期手术(P<0.05)。结论:手术时机对重症胆源性胰腺炎患者的预后有重大影响,早期宜行保守治疗,根据患者个体情况选择适当时机进行手术是减少并发症、提高治愈率的关键。     

胆源性重症急性胰腺炎手术时机的临床分析

目的:探讨胆源性重症急性胰腺炎的手术时机。方法:回顾性分析280例胆源性重症急性胰腺炎患者的手术预后。结果:重症非梗阻型胰腺炎患者中,早期手术的住院时间显著短于晚期手术(P<0.01),并发症率和死亡率差异无统计学意义(P>0.05)。重症梗阻型胰腺炎患者中,早期手术的住院时间和死亡率均显著低于晚期手术(P<0.05),并发症率差异无统计学意义(P>0.05)。结论:应该根据病情变化来选择手术时机。对于重症非梗阻型患者,可以先考虑保守治疗;对于重症梗阻型患者,宜早期进行手术。如果患者伴有化脓性胆管炎,则不管是否梗阻,均应早期进行手术。     

胆源性急性胰腺炎手术时机探讨

目的探讨胆源性急性胰腺炎患者合理的手术时机。方法选择该院收治的74例胆源性急性胰腺炎患者,按照手术时机的不同将患者分为早期手术治疗组(发病72 h内)和延期手术治疗组(发病72 h后),每组各37例,观察两组患者的住院时间、ApacheⅡ评分、治愈率、死亡率以及手术并发症发生率。结果早期手术组患者住院时间和治疗后的ApacheⅡ评分分别为(23.6±3.5)d和(4.8±1.4)分,均低于延期手术组患者的(31.7±4.1)d和(14.6±1.9)分,组间差异有统计学意义(P0.05)。早期手术组患者治愈率明显高于延期手术组患者,而死亡率和手术并发症发生率明显低于延期手术组患者,组间差异均有统计学意义(P0.05)。结论在积极保守治疗基础上对胆源性急性胰腺炎实施早期(发病72 h内)手术治疗能够进一步提高临床疗效,改善患者预后。     

急性胆源性胰腺炎的诊疗体会

目的:探讨急性胆源性胰腺炎的诊疗体会。方法:选择急性胆源性胰腺炎患者80例,分为观察组与对照组,对照组患者确诊后2 d内行急诊手术治疗,观察组确诊后先行保守治疗,待症状缓解后行手术治疗,若患者症状严重直接行手术治疗,观察两组的临床治疗效果。结果:观察组治愈率(87.5%)明显高于对照组(62.5%),观察组并发症发生率(12.5%)明显低于对照组(32.5%),观察组死亡率明显低于对照组,两组对比差异有统计学意义(P<0.05)。结论:对于无或者轻度胆道梗阻的急性胆源性胰腺炎患者早期给予非手术的保守治疗,待病情缓解后再行手术治疗,对于重症胆道梗阻的急性胆源性胰腺炎患者,应及时行急诊手术治疗,根据患者的具体情况实行个性化治疗,利于改善患者的预后。     

47例重症胆源性胰腺炎手术治疗时机探讨

目的：探讨重症胆源性胰腺炎的诊断和手术时机。方法：2005年6月至2008年12月收治重症胆源性胰腺炎47例,根据有无胆道梗阻分为两类：重症非梗阻型;重症梗阻型,对其临床治疗结果进行回顾性分析和总结。结果：重症非梗阻型22例,重症梗阻型25例。重症梗阻型和重症非梗阻型早期手术的并发症的发生率高、平均住院日长,与延期手术比较,差异有统计学意义（P〈0.05）,但重症梗阻型胰腺炎早期手术死亡率明显低于延期手术（P〈0.05）。结论：手术时机对重症胆源性胰腺炎患者的预后有重大影响,早期宜行保守治疗,根据患者个体情况选择适当时机进行手术治疗是减少并发症、提高治愈率的关键。     

胆源性急性胰腺炎的手术指征和时机选择探讨

目的探讨胆源性急性胰腺炎的手术指征和时机选择。方法选取我院2003年7月至2011年7月胆源性胰腺炎患者58例分为早期手术组(28例)和延期手术组(30例),观察两组的不同手术方法后的治疗效果。结果早期手术组28例患者中出现并发症21例,发生率为75.00%,死亡2例,死亡率为7.14%,而延期手术组30例患者出现并发症10例,发生率为33.33%,无一例死亡病例。结论手术治疗时机对于胆源性急性胰腺炎患者的预后具有很重大的影响,如果早期进行保守治疗,然后针对患者个体情况来选择适当的时机,治疗效果更好。     

胆源性胰腺炎的手术时机探讨

目的　探讨胆源性胰腺炎的手术时机。方法　对 85例胆源性胰腺炎的临床资料采用统计学方法进行分析总结。结果　早期手术 (72h内 )和延期手术 (6d以后 )胆总管探查率分别为 79.5 %和 5 2 .2 % ,P <0 .0 5 ;胆总管探查阴性率分别为 38.5 %和 1 3.0 % ,P <0 .0 1 ;并发症发生率分别为 1 2 .8%和 4 .3% ,P >0 .0 5 ;病死率分别为 5 .1 %和 0 .0 % ,P<0 .0 1 ;早期手术组胆总管探查率及胆总管探查阴性率明显高于延期手术组。APACHEⅡ≥ 8分的 9例 ,早期手术组 5例 ,并发症发生率 80 % ,病死率 4 0 % ,延期手术组 4例 ,并发症发生率 2 5 % ,病死率为 0 .0 %。结论　对轻症胆源性胰腺炎建议延期手术 ,对重症的胆源性胰腺炎也可考虑延期手术     

胆源性重症急性胰腺炎手术治疗时机分析

目的 探讨胆源性重症急性胰腺炎的最佳手术时机.方法 对2003年1月～2009年9月本院收治的96例胆源性重症胰腺炎(SABP)手术治疗的临床资料进行回顾性分析.结果 96例SABP患者按临床症状和治疗阶段分为手术组和延期手术组.行早期手术62例,治愈52例,占83.8%,死亡10例,占16.1,并发症9例,占14.5%;延期手术组34例,治愈22例,64.7%,死亡12例,占35.3%,并发症9例,占26.4%.结论 对胆源性急性胰腺炎患者的治疗方法和手术时机的选择对预后有重大影响,既不能盲目选择早期手术,更不能轻易认定晚期手术,而应根据临床症状和病情发展变化,恰当选择手术时机,从而有效提高治愈率高,减少并发症和死亡率.     

急性胆源性胰腺炎手术治疗时机的探讨

目的:探讨急性胆源性胰腺炎(GP)病人手术治疗的时机和方法。方法:选择我院确诊的急性胆源性胰腺炎患者60例,随机分为早期手术治疗组和延期手术治疗组各30例,早期手术组在发病24～48h内行手术治疗,延期手术组在病人出院前2～4周行手术治疗。比较两组患者的并发症发生率及病死率差异。结果:无论轻型GP还是重型GP早期手术组并发症发生率及胆总管探查率均较延期手术组明显增加(P<0.05),具有显著性差异(P<0.05)。结论:手术时机对于GP患者的预后有重大影响,早期行保守治疗,针对病人个体情况选择适当时机进行手术治疗是提高治愈率的关键。     

急性重症胆源性胰腺炎65例疗效分析

目的:探讨重症急性胆源性胰腺炎的治疗方法,以提高患者的治愈率,减少并发症和病死率。方法:回顾性分析诊治的65例急性重症胆源性胰腺炎的临床资料。结果:早期手术组27例,其中发生胰周脓肿12例(44.4%),胰腺假性囊肿8例(29.6%),死亡7例(25.9%);延期手术组38例,其中发生胰腺假性囊肿4例(10.5%),胰周脓肿、肠梗阻7例(18.4%),死亡3例(7.9%)。结论:急性重症胆源性胰腺炎延期手术的并发症发生率较早期手术明显降低;治疗宜采用延期手术治疗和个体化治疗方案相结合。     

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.