真皮下血管网皮瓣血流量与皮瓣成活关系

目的：通过对兔背部真皮下血管网皮瓣断蒂时及断蒂后10d血流量的监测，分析血流量变化与皮瓣成活的关系。探求皮瓣断蒂指征。提出皮瓣成活的客观标准，为临床治疗提供依据。方法：以兔为实验动物，行背部真皮下血管网皮瓣成形术。术后7d断蒂。断蒂前使用激光多普勒血流仪（Laser Doppler flowmetry，LDF）测定皮瓣阻断实验前后皮瓣血流灌注量（Perfuseunit，PU）。并对皮瓣断蒂后10d的PU进行连续监测并与周围正常皮区PU值进行比较。10d后处死动物取皮瓣组织行病理检查。按坏死与否将皮瓣分为两组：成活组与坏死组。分析两组皮瓣血流量变化情况并得出结论。结果：成活组断蒂时阻断试验前后PU比值（阻断比值）明显高于坏死组，且成活组PU值在断蒂后1～10d均显著高于坏死组（P〈0.01）；成活组与坏死组断蒂后10d周边皮区的PU值无统计学差异（P〉0.05）；成活组断蒂后10d皮瓣与周围正常皮区PU比值（瓣周比值）为70．1±11．2。结论：真皮下血管网皮瓣断蒂后皮瓣血流灌注量随皮瓣断蒂时阻断实验前后PU比值增高而增高；皮瓣的最佳断蒂时机为：①皮瓣成形术后7d以上。②肉眼观察皮瓣存活。③LDF测量阻断比值大于44．6％。皮瓣成活的标准为：断蒂术后10d肉眼观察成活且皮瓣与周围正常皮区灌注量比值大于58．9％。     

带真皮下血管网植皮修复手掌皮肤软组织损伤

目的：介绍带真皮下血管网植皮修复手掌皮肤软组织损伤的手术方法、手术适应证和临床应用评价。方法：手掌皮肤组织缺损者行带真皮下血管网游离植皮术;损伤为带蒂皮瓣状者行真皮下血管网薄皮瓣原位植皮术。手掌创面清创,若局部肌腱或掌骨外露,经过软组织转移覆盖后可达到植皮要求。腹部取与创面大小相符的皮瓣,经过修整以保留仅贴在真皮下的血管网脂肪,一期植皮修复创面。如损伤为带蒂皮瓣状,修剪皮瓣中、远端以保留仅贴在真皮下的血管网脂肪,原位植皮修复创面。结果：临床应用56例,其中皮肤软组织缺损26例,创面面积为1．5－6．0cm^2,合并肌腱、掌骨外露7例。损伤为带蒂皮瓣状30例,其中蒂在近端18例,蒂在远端12例,蒂宽度0．5－2．0cm,皮瓣长度2．0－4．5cm。皮片（瓣）全部成活,手掌外形饱满。经过6个月－2年随访,皮片（瓣）的质量、质地感觉满意。结论：该手术方式适用范围广,手术方法简单,临床评价优良。     

手外伤修复中真皮下血管网皮瓣的应用研究

目的探讨真皮下血管网皮瓣修复手外伤创面的手术方法及效果。方法2004年10月～2008年10月,应用胸、腹部带蒂真皮下血管网皮瓣修复手部皮肤软组织缺损创面45例。结果术后43例皮瓣完全成活,仅2例皮瓣远端小部分皮肤坏死,经换药后愈合。术后随访6个月～3年,伤手受区皮肤外形美观、色泽好,功能恢复满意。结论应用胸腹部带蒂真皮下血管网皮瓣修复手部皮肤软组织缺损是一种较理想的修复方法。     

腹部双叶真皮下血管网皮瓣修复手指脱套伤

目的 总结腹部双叶真皮下血管网皮瓣修复手指皮肤软组织脱套伤手术，推广临床应用。方法 临床观察法。伤指彻底清创，去除坏死组织及污染物，多指受伤则缝合形成并指，根据缺损情况，在同侧或对侧腹部设计双叶皮瓣，皮瓣掀起后将远端修成真皮下血管网皮瓣，修复手部创面，供区直接缝合，10-14d断蒂。结果 共修复9例，皮瓣均成活，术后伤指外形及功能恢复良好。结论 腹部双叶真皮下血管网皮瓣断蒂时间早，皮瓣较薄，是修复手指脱套伤的较好方法。     

真皮下血管网皮瓣在手部创面修复的临床应用

<正> 资料和方法 1 手术方法 真皮下血管网皮瓣:按体位及手部创面的面积、形状,在腹部随意设计皮瓣。由皮瓣的远端及两侧切开,在深筋膜下分离,直达皮瓣的蒂部,严密止血。从皮瓣远端开始修剪皮瓣的皮下组织,除皮瓣近蒂部1/3外,其它部分可留脂肪层0.2～0.3cm,透过脂肪层清晰可见完整的真皮下血管网。修剪后真皮下血管网完整,无受损,皮瓣缘同创周缝合后,冲洗皮瓣下,并放橡皮条引流,再行加压包扎。术后24h拔除引流条,加压包扎。术后7d断蒂,14d拆线。     

腹部带蒂含真皮下血管网超薄皮瓣在手部损伤修复中的应用价值

目的：探讨腹部带蒂含真皮下血管网超薄皮瓣在手部损伤修复中的临床效果。方法：对我院接受手部损伤修复的60例患者随机分为实验组和对照组。对照组采用常规腹部带蒂皮瓣方法修复,实验组采用腹部带蒂含真皮下血管网超薄皮瓣修复,比较两组修复效果。结果：实验组12例感觉功能恢复评分为5分,患者感觉功能恢复良好,6例患者评分为4分,修复总有效率为90％（27／30）高于对照组（83．3％）;实验组修复时间为（71．9±12．6）min多于对照组（41．3±10．3）min;实验组修复过程中的出血量为（20．6±5．2）mL、患者修复后住院时间为（2．6±0．4）d,对照组住院时间为（3．5±4）周,实验组住院时间明显优于对照组（P＜0．05）;修复后实验组有1例患者出现并发症（2．5％）低于对照组（P＜0．05）。结论：采用腹部带蒂含真皮下血管网超薄皮瓣在手部损伤修复中效果较好,值得推广应用。     

真皮下血管网皮瓣在手指热压伤修复中的应用

目的 总结真皮下血管网皮瓣修复手指热压伤创面的效果.方法 应用胸腹部真皮下血管网皮瓣修复手指热压伤后皮肤软组织缺损创面48例.结果 术后43例皮瓣成活,5例皮瓣远端小部分坏死,经换药后愈合;术后随访1～3年,受区皮肤平整、外形美观、色泽好、质地软,耐磨性好,功能恢复满意.结论 应用胸腹部真皮下血管网皮瓣修复手指热压伤后皮肤软组织缺损具有术后手外形好、功能恢复快、断蒂后无需二次修整等优点,是比较理想的一种修复方法.     

真皮下血管网薄皮瓣早期修复手部深度烧伤

目的　探讨真皮下血管网薄皮瓣在临床应用的可靠性。方法　选择 2 0例手部深度烧伤住院病人 ,伤后 7d内行侧胸或腹部薄皮瓣带蒂转移修复术 ,供瓣面积最大 8cm× 15cm ,长宽比例 1～ 3∶1,术后 7～ 10d断蒂。结果　平均断蒂时间 8 2d ,除 1例皮瓣远端部分坏死 ,1例术后意外发生撕脱外 ,余 18块皮瓣均完全成活 ,疗效满意。结论　与过去的传统皮瓣比较 ,薄皮瓣断蒂时间明显缩短 ,外形、功能恢复良好 ,不需作二期皮瓣修复术 ,是修复手部深度烧伤较理想的方法之一。     

腹部真皮下血管网皮瓣修复手外伤20例

１９８４年司徒朴等［１］首先成功地将真皮下血管网皮片游离移植改为带蒂移植;杨智义等［２］将真皮下血管网皮瓣设计为窄蒂宽瓣的叶形、梅花形,术后皮瓣成活良好：以其特有的优点受到临床医师重视和广泛应用。近十多年真皮下血管网皮瓣的解剖学基础、断蒂时间、长宽比和成活机理等得到较深入研究［３］。１９９４年以来,我们应用腹部真皮下血管网皮瓣修复各种创伤致手部皮肤软组织缺损共２０例,疗效良好,报告如下。１　临床资料本组共２０例,男１２例,女８例,年龄１６～３５岁,左手６例,右手１４例。手背热压伤切痂术应用８例,…     

真皮下血管网薄皮瓣在皮肤软组织扩张术中的应用

目的 鉴于扩张皮瓣远端常因静脉回流障碍导致皮瓣部分坏死影响治疗效果。探讨是否可以将扩张皮瓣远端修剪成真皮下血管网薄皮瓣以改善其血运。方法 将14例扩张皮瓣远端修剪成真皮下血管网薄皮瓣转移修复缺损。结果 真皮下血管网薄皮瓣处无静脉回流障碍皮瓣成活良好，随访一年，皮肤颜色质地均与近端扩张皮瓣类似。结论 将扩张皮瓣远端修剪成真皮下血管网薄皮瓣，有利于减轻皮瓣静脉回流负担，提高皮瓣成活率。     

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…     

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.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

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.