中药保留灌肠与口服序贯治疗子宫内膜异位症36例

目的：观察中药保留灌肠与口服序贯对子宫内膜异位症盆腔疼痛缓解的情况。方法：36例病例采用以活血化瘀、解毒止痛为主中药保留灌肠与口服序贯治疗,治疗前后进行疼痛症状评分。结果：治疗3个月后盆腔疼痛缓解情况与治疗前比较明显减轻（P〈0．05）。结论：中药保留灌肠与口服序贯治疗子宫内膜异位症盆腔疼痛有确切镇痛疗效。     

活血化瘀法治疗子宫内膜异位症慢性盆腔痛67例临床观察

[目的]观察活血化瘀法治疗子宫内膜异位症慢性盆腔痛的临床疗效。[方法]选择67例子宫内膜异位症慢性盆腔痛患者,以活血化瘀法为基本治则随证加减,中药汤剂口服配合保留灌肠及阴道穹窿上药,3个月为1疗程,观察患者慢性盆腔痛症状及体征变化,采用积分比法评价疗效。[结果]临床痊愈6例,显效25例,有效28例,无效8例,总有效率88.06%,且疗效与疗程成正比。[结论]活血化瘀法治疗子宫内膜异位症慢性盆腔痛疗效显著,值得临床推广。     

蔡氏内异Ⅰ号方治疗子宫内膜异位症

目的:观察蔡氏内异Ⅰ号方治疗子宫内膜异位症气滞血瘀证患者的临床疗效。方法:60例气滞血瘀型子宫内膜异位症患者采用随机数字表法平均分为治疗组(给予蔡氏内异Ⅰ号方)与对照组(给予安慰剂),两组均连续治疗3个月经周期。治疗后比较两组患者治疗前后痛经症状评分、中医证候评分、盆腔包块大小、血清CA125水平及两组患者临床疗效。结果:治疗组有效率(83.33%)显著优于对照组(43.33%),差异有统计学意义(P<0.05)。治疗组与对照组痛经有效率分别为86.67%、40.00%,两组治疗后痛经症状评分、视觉模拟评分、疼痛分级指数及现时疼痛强度评分均低于治疗前(P<0.01),且治疗组优于对照组(P<0.05)。治疗组与对照组中医证候有效率分别为83.33%、46.67%,差异有统计学意义(P<0.01)。治疗后,治疗组卵巢囊肿直径明显小于治疗前(P<0.01),血清CA125水平明显低于治疗前(P<0.05)。结论:蔡氏内异Ⅰ号方治疗气滞血瘀型子宫内膜异位症患者疗效显著,可显著降低患者痛经程度和血清CA125水平,改善中医证候相关症状,缩小卵巢囊肿。     

手术辅以米非司酮治疗子宫内膜异位症的临床观察

目的 探讨手术后辅以米非司酮治疗盆腔子宫内膜异位症的疗效.方法 将2004年10月~2005年2月笔者所在医院行腹腔镜下手术的40例盆腔子宫内膜异位症患者随机分成两组,研究组20例术后辅以口服米非司酮12.5 mg/次,每天1次,连续服用3~6个月.对照组20例为单纯手术治疗.结果 两组患者痛经症状均得到不同程度的缓解,研究组有效缓解率为85.0%,高于对照组的55.0%(P<0.05);研究组复发率为5.0%,明显低于对照组的15.0%(P<0.05).结论 盆腔子宫内膜异位症术后辅以米非司酮治疗是必要的,能有效控制临床症状,降低复发率.     

米非司酮治疗更年期盆腔子宫内膜异位症47例疗效分析

目的:探讨米非司酮治疗更年期盆腔子宫内膜异位症的疗效。方法:选择更年期盆腔子宫内膜异位症患者47例,应用米非司酮口服3个月,观察月经改变,痛经程度及血清激素水平变化等。结果:47例患者在用药期间全部闭经,停药后有35例月经未复潮直接进入绝经期,有8例月经恢复,有4例月经稀发。所有月经恢复,月经量均较服药前明显减少。所有患者痛经程度有所下降。用药后血清FSH、LH、E2、P水平均有所下降,差异有显著性(P<0.01)。结论:米非司酮治疗更年期盆腔子宫内膜异位症有较好疗效,不良反应少,复发率低,不易诱发其他激素依赖性疾病,可明显减轻临床症状,是一种安全、经济、方便、较理想的治疗方法。     

左炔诺孕酮宫内缓释系统对中重度子宫内膜异位症保守性手术后巩固治疗的临床观察

目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS,曼月乐)治疗中重度子宫内膜异位症保守性手术后的临床疗效。方法对32例中重度子宫内膜异位症术后的患者,宫内放置LNG-IUS,观察痛经程度、月经变化、盆腔结节改变等情况。结果治疗后观察3—18个月经周期,治疗组症状完全消失率94%,总临床症状缓解率100%,症状完全消失率显著高于对照组(67%),差异有统计学意义(P<0.05)。复发率6%,明显低于对照组27%(P<0.05)。结论左炔诺孕酮宫内缓释系统中重度子宫内膜异位症保守性手术后巩固治疗,疗效好,再次复发率低,依存性高。     

消异方治疗子宫内膜异位症痛经疗效观察

目的：观察消异方治疗子宫内膜异位症痛经的临床疗效。方法子宫内膜异位症痛经患者60例,随机分为两组,治疗组30例给予消异方胶囊治疗,对照组30例给予散结镇痛胶囊治疗,疗程均为3个月经周期。观察治疗前、后两组患者痛经疼痛视觉模拟评分（VAS）、血清神经生长因子（NGF）、子宫动脉血流阻力指数（RI）情况。结果治疗后两组VAS疼痛评分均低于治疗前（P＜0．05）,但两组疗效、VAS疼痛评分比较,差异无统计学意义（P＞0．05）;两组治疗后血清NGF、子宫动脉血流的阻力指数均低于治疗前（P＜0．05）,治疗组患者血清NGF水平下降更明显（P＜0．05）。结论应用消异方治疗子宫内膜异位症痛经与散结镇痛胶囊疗效相当,其作用机制可能是与降低血清NGF水平、改善盆腔微循环有关。     

温通法治疗子宫内膜异位症及子宫肌腺症疼痛临床研究

目的:观察温通法治疗子宫内膜异位症、子宫肌腺症痛经、盆腔痛的临床疗效及对血性激素水平的影响。方法:60例患者,将其中50例有疼痛症状的患者随机分成两组,治疗组30例采用温阳祛痛中药复方治疗,对照组20例给予少腹逐瘀汤治疗,3个月为1疗程。另设一组无疼痛症状的子宫内膜异位症患者10例作为无痛对照组,不用药治疗。观察治疗前后患者临床疗效、疼痛症状及血性激素水平的变化。结果:治疗组、对照组临床总有效率分别为90%(27/30)、70%(14/20),两组比较无显著性差异(P>0.05)。但治疗组在改善痛经、形寒肢冷、神疲乏力、气短症状方面疗效优于对照组(P<0.05)。治疗前有疼痛症状患者的血雌二醇(E2)水平高于无痛组(P<0.05),孕酮(P)水平低于无痛组(P<0.05);治疗后患者血E2水平升高,血P水平下降(P<0.05),但组间比较无显著性差异(P>0.05)。结论:温通法治疗子宫内膜异位症及子宫腺肌病盆腔痛,具有良好的临床疗效,可能是通过调节患者失衡的雌孕激素水平发挥作用。     

补肾温阳化瘀法治疗子宫内膜异位症的临床研究

目的 探讨补肾温阳化瘀法对子宫内膜异位症患者生活质量及痛经的影响.方法 将46例子宫内膜异位症表现为痛经的患者随机分为中药组23例和西药组23例,中药组给予补肾温阳化瘀中药口服,对照组给予孕三烯酮口服,共治疗3个月经周期.观察治疗后两组患者的生活质量及痛经情况.结果 治疗后中药组患者生理领域、心理领域、独立性领域、社会关系领域评分[分别为:(17.5±1.2)、(16.4±2.6)、(14.6±1.6)、(17.8±2.6)分]与西药组[分别为:(15.3±1.4)、(12.6±1.2)、(12.4±2.2)、(11.8±1.5)分]比较差异均有统计学意义(P<0.05).严重痛经患者服用中药后痛经程度评分[(2.5±0.7)分]与服用西药者[(1.4±0.1)分]比较差异有统计学意义(P<0.05).结论 补肾温阳化瘀法对子宫内膜异位症患者的生活质量及痛经情况的改善程度优于西药治疗,且无闭经发生.     

腹腔镜术后联合曲普瑞林治疗子宫内膜异位症疗效分析

目的：探讨腹腔镜术后联合曲普瑞林治疗子宫内膜异位症疗效。方法整群收集2011年6月—2015年6月长春市妇产医院妇科一疗区收治确诊的134例子宫内膜异位症患者,随机分为观察组（联合曲普瑞林）和对照组（不用药）各74例,比较盆腔痛、痛经VAS评分和复发率。结果观察组盆腔痛VAS评分为（1.27±0.24）分、痛经VAS评分为（1.31±0.13）分,复发率为4.1%,优于对照组盆腔痛VAS评分（3.58±0.26）分、痛经VAS评分（3.66±0.21）分,复发率22.9%（P<0.05）羌率有统计学意义。结论腹腔镜术后联合曲普瑞林治疗子宫内膜异位症疗效满意,明显降低复发率。     

甲状腺术后切口皮内缝合和负压引流的临床观察

各种手术的切口,是否能按预期的时间拆线,达到满意的愈合效果,也是临床手术技巧操作的关键,配合适宜的引流管放置,持续负压吸引,就可减少血肿,减少感染率,提高愈合率。我科自1995年以来应用甲状腺手术的皮内缝合方法,并放置输血器管代替橡皮引流管获得良好的效果,无一例感染或血肿出现,值得临床广泛推广使用。1对象和方法我院自1995年6月至2005年6月共行甲状腺手术(甲亢、甲瘤、甲癌、结节性甲状腺肿)2 200例,年龄12岁78岁,中位年龄36岁,放置引流管甲状腺创面,由胸骨柄上窝引出,如双侧甲状腺手术要放双侧各一引流管,一般术后第2天拔除引流管…     

支付能力对停药前用药时间影响的观察

目的:观察医疗费用支付能力在精神分裂症治疗中对停药前服药时间的影响。方法:将精神分裂症按支付能力分为公费组、自费组,自费组再分为支付能力好组、支付能力差组,观察各组在两年内停药、服药情况,倾向评分均衡化处理后比较各组停药前用药时间。结果:公费组与自费组在维持用药时间无差别,但自费组中支付能力差组较其它组别有更短的维持服药时间。结论:应用停药前服药时间应考虑费用支付能力的影响,对支付能力差的患者给予一定的经济支持有可能改善停药前用药时间。     

The relationship between socio-demographic characteristics of patients and diagnostic delay in acute pulmonary thromboembolism

Abstract

Background. In pulmonary thromboembolism (PE), delay to diagnosis is very common. In this study, we examined the role of patients and the socio-demographic characteristics in delayed diagnosis of PE.

Patients and methods. We evaluated 156 PE patients for the dates of symptom onset, the dates of first visit to a health institution and diagnosis, signs and symptoms, and the socio-demographic characteristics. Delays were analyzed using the Mann-Whitney U test, and the predictors were analyzed using logistic regression analysis.

Results. Of the patients, 60.3% visited a health institution within the first day of the symptoms. Mean time from symptoms to the first admission to a health institution (patient delay) was 2.04 ± 3.89 days (median 0 day, range 0–30). Current smoking, a high level of education, and co-morbidity were associated with longer patient delays. The time interval from first symptom to the diagnosis (total delay) was 7.93 ± 10.05 (median 4 days, range 0–45) days. While hypotension, syncope, and previous surgery/trauma were significantly associated with a shorter total delay, a previous visit to any health institution was associated with longer total delay.

Conclusion. In conclusion, although some socio-demographic characteristics of patients such as smoking, educational status, and co-morbid diseases were found to be associated with delayed visit to any health institution, our results showed that physician or health system delays were more prominent in delayed diagnosis of PE.     

医师的行医权与告知义务

医师的行医权和履行医师的告知义务紧密联系、不可分割的。行医权的行使必须以履行法定义务为前提,只有在充分履行告知义务的基础上,行医权才能有保障。文章通过以下几个方面来浅析一下医疗活动中医师的行医权与告知义务：（1）行医权的概念及法律保障。（2）医师的告知义务。（3）医疗服务中的行医权与告知义务的履行。其目的是明确医师的权利和义务,提高医务人员依法行医,切实履行告知义务,才能恰当实施行医权。维护医患双方合法权益,构建和谐的医患关系。     

The relationship between socio-demographic characteristics of patients and diagnostic delay in acute pulmonary thromboembolism

Background

In pulmonary thromboembolism (PE), delay to diagnosis is very common. In this study, we examined the role of patients and the socio-demographic characteristics in delayed diagnosis of PE.

Patients and methods

We evaluated 156 PE patients for the dates of symptom onset, the dates of first visit to a health institution and diagnosis, signs and symptoms, and the socio-demographic characteristics. Delays were analyzed using the Mann-Whitney U test, and the predictors were analyzed using logistic regression analysis.

Results

Of the patients, 60.3% visited a health institution within the first day of the symptoms. Mean time from symptoms to the first admission to a health institution (patient delay) was 2.04 ± 3.89 days (median 0 day, range 0–30). Current smoking, a high level of education, and co-morbidity were associated with longer patient delays. The time interval from first symptom to the diagnosis (total delay) was 7.93 ± 10.05 (median 4 days, range 0–45) days. While hypotension, syncope, and previous surgery/trauma were significantly associated with a shorter total delay, a previous visit to any health institution was associated with longer total delay.

Conclusion

In conclusion, although some socio-demographic characteristics of patients such as smoking, educational status, and co-morbid diseases were found to be associated with delayed visit to any health institution, our results showed that physician or health system delays were more prominent in delayed diagnosis of PE.     

应用依达拉奉联合参芎葡萄糖注射液治疗前部缺血性视神经病变的临床研究

目的:探讨应用依达拉奉联合参芎葡萄糖注射液治疗缺血性视神经病变的疗效。方法:将40例缺血性视神经病变患者随机分为对照组和治疗组,2组均给予激素、B族维生素药物等基础治疗,治疗组加用依达拉奉与参芎葡萄糖注射液,共14天,观察2组治疗前及治疗后神经功能缺损程度、临床疗效、视觉诱发电位指标变化。结果:治疗组患者神经功能恢复明显优于对照组。2组治疗后视神经功能评分、视觉诱发电位比较,差异有统计学意义(P<0.05)。结论:依达拉奉联合参芎葡萄糖注射液治疗缺血性视神经病变安全有效。     

328例动静脉内瘘术的临床分析

目的探讨头静脉、桡动脉三种不同吻合方式动静脉内瘘术的优缺点及其并发症的原因。方法回顾性分析328例动静脉内瘘术患者术中采取端侧、端端、侧侧手术方式的成功率、内瘘并发症,并做相关数据的统计学处理。结果动静脉内瘘手术成功率92.9%,均能达到维持性血液透析标准,端端吻合术组与侧侧吻合术组吻合口口径比较,差异无统计学意义（P〉0.05）,端端吻合术组与端侧吻合术组吻合口口径比较,差异有统计学意义（P〈0.05）,端侧吻合术组吻合口血流量与其他两组间比较,差异有统计学意义（P〈0.05）。发生内瘘堵塞23例（7%）,血栓形成是动静脉内瘘阻塞的主要原因,高血压组和（或）糖尿病组与其他组比较,其内瘘失败率明显增高（10.6%和3.5%）,两组间比较具有统计学意义（P〈0.05）。结论头静脉桡动脉端侧吻合内瘘手术连续缝合操作简便,成功率高,并发症少,应作为建立长期血液透析通路的首选。血栓形成仍是动静脉内瘘堵塞的主要原因,应注意防范。高血压肾病组及糖尿病肾病组手术成功率相对较低,应把握手术技巧,并于术前充分评估。     

运用三焦升降学说理论治疗癃闭

运用三焦升降学说治疗癃闭，补肺降气浚上焦，益脾升清启中焦，温肾化气畅下焦。     

封闭式负压引流技术在手足外伤手术中的临床应用价值

目的:探讨封闭式负压引流(VSD)技术在手足外伤手术中的临床应用价值。方法:采集我院2010年1月至2011年1月的50例的手足外伤手术的临床资料分成观察组(N=25)及对照组(N=25)两组,其中观察组给予封闭式负压引流技术进行修复和重建,对照组仅给予常规的传统方法修复,对两组进行比较对照分析。结果:给予封闭式负压引流技术进行修复和重建的观察组取得了比传统方法治疗复杂创面无法达到的良好效果。结论:本课题的研究为VSD为探讨和分析手足外伤手术创面的治疗提供了一定的理论依据和临床实践指导价值。     

Return to play after spondylolysis: An overview

Spondylolysis is increasingly associated with specific sports, timely and effective management of which underpins successful return to sports. Hence, the main purpose of this systematic review of reviews [RoR] is to summarize data from published reviews exploring the return to play in athletes with spondylolysis managed conservatively or surgically, thereby providing for recommendations for future practice and research.A systematic review of review of articles published in English and since 2015 was conducted online using PubMed and Google Scholar, as per Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines. Predefined eligibility criteria were applied, and the data thus compiled were analyzed. Study quality was assessed using the AMSTAR-2 checklist.A total of 7 systematic reviews and meta-analysis consisting of 51 primary studies were included in the review. The result of this RoR highlights the knowledge gap and limitations in RTP research post spondylolysis with existing heterogeneity in methods and reporting amid other factors within primary studies. Further quality of the study was found to be of low to critically low confidence based on the AMSTAR-2 scale, suggesting that the results should be interpreted with great caution.Though both conservative and surgical approaches increase the percentage of athletes returning to play, the evidence remains largely limited and inconclusive as to which is better. However, it appears that surgical interventions give those who failed a trial of conservative approach, a better shot at return to play. There is a need for further high-quality, appropriately powered, well-designed, multicentered studies, and also for consensus regarding “returning to play” definition and outcome measures.