张学文教授运用古方治疗疑难病症举隅

张学文教授从医55年,积累了丰富的临床经验,尤擅治脑病及杂病,善用古方。本文介绍其治疗疑难病症的医案三则,以窥其经验之一斑。     

高血压视网膜病变与血压和血小板参数的关系研究

[目的]探讨血压和血小板参数在预测高血压视网膜病变中的作用.[方法]比较高血压伴视网膜病变组和无视网膜病变组的血压及血小板参数,统计学分析比较其差异.[结果]视网膜病变组的收缩压、舒张压均显著高于无视网膜变组(P<0.05).视网膜病变组的PLT低于无视网膜病变组,而MPV、 PDW均高于无视网膜病变组,差异有统计学意义(P<0.05).[结论]血压和血小板参数可作为预测高血压视网膜病变的指标之一.     

羊膜移植在眼表疾病的临床应用

目的 探讨和评估新鲜羊膜移植治疗眼表疾病的疗效.方法 对结膜肿物,睑球粘连,碱烧伤,酸烧伤,热灼伤共24例(28眼)施行新鲜羊膜移植术,术后观察眼表重建情况,羊膜植片情况,术后视力情况,随访4-18个月.结果 24例(28眼)均未发生新鲜羊膜植片的排斥反应.2 5眼一次羊膜移植术后结膜、角膜上皮化痊愈,眼表重建成功.睑球粘连的患者第三眼位复视消失.1眼发生睑球粘连,2眼角膜部分上皮缺损,再次行羊膜覆盖术,术后随访完成上皮化,术后视力不同程度提高.结论 新鲜羊膜移植能有效的促进上皮细胞的分化移行、抑制局部的炎症反应、阻止新生血管和瘢痕的形成、阻止烧伤的病理发展,是治疗眼表疾病的一种积极有效的治疗方法.     

术中持续输注不同浓度尼莫地平对颅内动脉瘤夹闭术患者内皮素的影响

目的 通过对颅内动脉瘤夹闭术中持续泵注不同浓度的尼莫地平,观察内皮素(endothelin,ET)的变化情况,寻求预防和治疗脑血管痉挛的最佳方案.方法 45例择期行颅内动脉瘤夹闭术患者随机分为3组:对照组、观察1组、观察2组,每组15例.全麻快速诱导用咪唑安定0.1 mg/kg,维库溴铵0.1 mg/kg,芬太尼4 μg/kg,异丙酚2 mg/kg.术中麻醉维持:用微量泵泵入异丙酚4～8 mg/(kg·h),维库溴铵80～100 μg/(kg·h),吸异氟醚1 MAC,必要时追加芬太尼2～3 μg/(kg·次).麻醉诱导后, 对照组未使用尼莫地平,观察1组采用尼莫地平7.5 μg/(kg·h),观察2组采用尼莫地平15 μg/(kg·h),均使用微量泵开始匀速输注至手术结束.三组患者均在麻醉诱导前(T0)、切开硬脑膜时(T1)、动脉瘤夹闭后即刻(T2)、夹闭动脉瘤后30 min(T3)抽血测定ET水平,同时记录各时点的平均动脉压(MAP).结果 观察1、2组T2 ET水平均较T0明显降低(P＜0.05),观察2组T3 ET水平较T0明显下降(P＜0.05).观察2组T3 ET水平与对照组同时点ET比较差异有统计学意义(P＜0.05).三组T1、T2 MAP值均较T0明显降低(P＜0.05).结论 在颅内动脉瘤夹闭术中持续输注15 μg/(kg·h)尼莫地平明显地降低ET,可起到早期预防和治疗术中及术后脑血管痉挛作用.     

肿瘤坏死因子-α在心力衰竭中表达的研究进展

心力衰竭是常见的临床综合征,肿瘤坏死因子–α(TNF-α)在心力衰竭中起重要作用.本文对近年心力衰竭时TNF-α升高机制、TNF-α在心力衰竭时发挥的作用及针对抗TNF-α临床治疗心衰研究进行综述.     

改良式B-Lynch缝合术在治疗剖宫产产后出血中的应用价值

目的:对应用改良B-Lynch缝合术对患有剖宫产产后出血的患者进行治疗的临床效果进行研究分析。方法:抽取104例剖宫产产后出血患者病例,将其分为对照组和治疗组,平均每组52例。对照组采用临床常规方法进行治疗;治疗组采用改良B-Lynch缝合术进行治疗。结果:治疗组患者的手术时间明显短于对照组;术中出血量明显少于对照组;手术成功率明显高于对照组。结论:应用改良B-Lynch缝合术对患有剖宫产产后出血的患者进行治疗的临床效果非常明显。     

温泉浴联合中药熏蒸治疗关节病型银屑病的护理

总结了48例温泉浴联合中药熏蒸治疗关节病型银屑病的护理经验。包括基础护理、中药熏蒸治疗的护理、运动疗法及护理、音乐疗法及护理、心理治疗及护理。认为中药熏蒸联合温泉浴治疗关节病型银屑病安全有效,精心护理能缩短疗程,促进患者早日康复出院。     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.     

四种抗体交叉配血的试验方法结果比较

为确保临床输血安全，避免因不完全抗体引起的输血反应。不完全抗体配血法已逐步应用于临床配血实验中，目前不完全抗体测定方法和试剂较多，为寻找快捷、安全、灵敏的配血方法．本文就凝聚胺法、胶体促凝剂法、菠萝酶法、抗人球蛋白法等4种不完全抗体检测方法的灵敏度进行了实验比较。现将结果报道如下：