缺血性脑卒中外科及血管内介入治疗进展

缺血性脑血管病的治疗,是神经内科和神经外科普遍关注的问题之一。近年来,随着影像技术、显微外科技术、介入神经外科学以及神经外科学基础研究的发展和完善,脑血管病的诊断技术进展迅速,使缺血性脑血管病的外科治疗有了很大的发展。文章就颈动脉内膜切除术,血管内介入治疗术进展进行综述。     

我国神经外科血管内治疗的研究进展

笔者在最近召开的中华医学会神经外科学分会血管治疗学组第五届全国神经外科血管内治疗研讨会上了解到,近两年来,我国神经外科血管内治疗领域发展迅速。目前除栓塞材料与国外有差距外,我国在临床神经外科血管内治疗方面,无论是治疗病种、治疗例数,治愈率及治疗水平都达到或接近国际先进水平,而且还在不断拓展治疗范围。除开展脑动脉畸形、脑动脉瘤、动静脉瘘等疾病的血管内治疗外,正不断探索缺血性脑血管疾病的血管内治疗,并取得较好治疗效果,为缺血性脑血管病的治疗开创了新的途径。该领域在我国老一代学术带头人王忠诚、段国升、刘承基等著名专家关怀下,在中青年学术带头人凌锋、李铁林、马廉亭、吴中学等学术带头人的努力下,学术交流日趋繁荣,一支学术严谨、技术精湛的专业技术队伍正在不断壮大,成为我国神经外科学领域的重要学术和技术力量。对于脑血管疾病,无论是缺血性卒中还是出血性卒中,处理的时机至关重要。因此,要树立脑卒中就是“急症”和“时间就是脑”(time is brain)的观念,各科医生都要树立“脑打击观念”(brain attack concept),最大限度地抓紧脑血管病抢救的“时间窗”。各学科要密切配合,协同作战,争取时间尽早实施专科治疗,以赢得脑抢救的最佳机会。     

缺血性脑血管病的治疗进展

近年来随着脑血管发病机制和病理生理的研究深入。缺血性脑血管病治疗发展很快。现对近几年国内外文献报道的急性缺血性脑血管病治疗进展作一综述。     

缺血性脑血管病治疗研究进展

近代科学在医学临床应用有了较大的进展。临床诊断学方面由于采用了精确度高的诊断技术,使缺血性脑血管病的诊断符合率较前明显提高。诊断学的发展大大推动缺血性脑血管病治疗研究,不少学者重新     

支架成形术治疗颅外段颈内动脉狭窄的临床体会

颈内动脉狭窄可导致脑梗死或短暂性脑缺血发作（TIA）,是缺血性脑血管病的主要病因之一。传统保守治疗主要以降压、抗血小板聚集、活血化瘀和降黏降脂为主,近年来由于脑血管介入技术的快速发展,国内许多大型医院已经将颈内动脉支架成形术（CAS）作为常规治疗缺血性脑血管病的重要方法之一。笔者于2010年2月-7月在卫生部直属北京医院神经外科进修学习,累计参与颅外段颈内动脉狭窄支架成形术72例,现总结报告如下。     

急性缺血性脑血管病的治疗现状与评价

近年来，尽管在急性缺血性脑血管病的防治方面取得了进展，但未达到人们所期望的治疗效果，治疗学上仍存在许多争议．本文就急性缺血性脑血管病的治疗现状、有关进展及发展的方向作一综述     

介入神经放射学的现状和发展趋势

介入神经放射学近年发展迅速，已成为微侵袭神经外科的一大重要分支，在颅内动脉瘤、颅内动静脉畸形、硬脑膜动静脉瘘、缺血性脑血管病及脊髓血管病等方面提供了新的治疗手段和途径，特别是在颅内宽颈动 脉瘤栓塞技术的发展及新型栓塞材料的研制中取得了十分可喜的进展，然而从加快发展来看，目前需要进一步加强介入神经放射学基础理论的研究，加强新技术、新材料、新设备的开发，加强专业医生培训，尽快建立治疗操作规范和完善诊断治疗的质量控制体系。     

急性缺血性脑血管病的治疗现状和进展

急性缺血性脑血管病严重威胁人类的健康，病死率和致残率极高，是病残的主要原因，目前元特效治疗方法。该文就近几年来国内外急性缺血性脑血管病治疗现状与进展进行综述，为急性缺血性脑血管病的治疗提供思考与借鉴。     

循证医学在现代神经外科发展中的重要作用

神经外科学是一门古老的学科.自从20世纪70年代以来,随着神经影像技术和显微外科技术的发展和应用,神经外科学迎来了一个日新月异的飞速进展时期.各种新理论、新技术、新的诊疗方法的不断出现,使得神经外科疾病的治疗效果有了很大的提高.     

缺血性脑血管病的影像学研究进展

缺血性脑血管病的病死率和致残率很高,严重危害人类的健康和生存质量。医学影像学技术的发展不仅能提供解剖信息,也能更早和更准确地提供脑血流、代谢等方面的信息,在早期诊断方面提出了新的思路和理论,在缺血性脑血管病的诊断治疗方面的重要性越来越大。准确确定缺血半暗带和评估脑血流量储备能力,将有利于临床治疗决策,影响患者的预后。     

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.