重组织型纤维酶原激活剂与尿激酶静脉溶栓治疗急性ST段抬高心肌梗死的疗效比较

再灌注治疗是急性ST段抬高心肌梗死最主要的治疗方法,其中静脉溶栓因其方法简单、费用低廉、疗效确切一直备受人们关注.业已证实,粥样斑块破裂基础上血栓形成是急性心肌梗死(AMI)发生的主要病理基础.     

纤维支气管镜床边治疗肺不张的疗效观察

肺不张不是一种独立的疾病，一旦发生可加重原发病，甚至危及病人生命。因此，应迅速消除支气管、肺泡分泌物和阻塞物。经纤维支气管镜（简称纤支镜）吸引治疗由痰栓引起的肺不张可起到立竿见影的效果。纤支镜在直视下进入段支气管甚至亚段支气管，准确清除呼吸道炎性分泌物，解除气道阻塞，促使肺复张，改善肺通气和换气功能，迅速提高氧分压，降低二氧化碳分压，有利于感染的控制及黏膜水肿的消除，目标性强、效率高、损伤少。这种直视下操作最大限度地减少盲目吸引所致的支气管黏膜损伤。我科2003年1月-2005年6月进行床边纤支镜介导治疗急性肺不张病人23例，效果良好。现报告如下。     

^1H-magnetic resonance spectroscopy screening for animals with acute cerebral infraction suitable forthrombolytic therapy

BACKGROUND: As a non-invasive technique which can provide comprehensive biological information, 1H-magnetic resonance spectroscopy (1H-MRS) may provide valuable reference data for irreversible recovery or reversible changes in ischemic tissue after stroke. OBJECTIVE: To monitor and evaluate the effect of the urokinase thrombolytic therapy after experimental acute cerebral ischemia by 1H-MRS technology and investigate its adaptability. DESIGN: Randomly controlled animal study. SETTINGS: Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science. MATERIALS: Eleven healthy adult Sprague-Dawley (SD) rats, weighing 260–300 g and of both genders, were supplied by Experimental Animal Center of Tongji Medical Collage, Huazhong University of Science and Technology [SCXK (e) 2004-007]. 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. METHODS: The experiment was carried out in Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science from August 2003 to December 2005. ① The rats were randomly divided into 30-minute self-thrombo-embolism group (n =6) and 60-minute self-thrombo-embolism group (n =5). Six rats in 30-minute self-thrombo-embolism group were occluded with clot embolus for 30 minutes and 5 rats in 60-minute self-thrombo-embolism group were occluded for 60 minutes. 10 000 U/kg urokinase was dissolved in 2 mL saline and the operation lasted for 5 minutes. ② 1H-MRS was performed before thrombolysis and at 3 hours and 24 hours after successful embolization. The metabolic changes of N-acetyl-L-aspartic acid (NAA)/phosphocreatine (PCr) + creatine (Cr), choline phosphate (Cho)/PCr+Cr and lactic acid (Lac)/PCr+Cr in the region of interests were analyzed. ③ The T2W image was conducted 24 hours after the thrombolytic therapy with TR=500 ms and TE=25 ms. ④ The subjects were sacrificed immediately after 1H-MRS and the brain tissues were cut into pieces and stained with HE method; in addition, pathological changes were observed under optic microscope. MAIN OUTCOME MEASURES: ① Metabolic changes of NAA/PCr+Cr, Cho/PCr+Cr and Lac/PCr+Cr in the region of interests; ② T2W image at 24 hours after the thrombolysis; ③ pathological observation of brain tissue. RESULTS: Eleven rats were all involved in the final analysis. ① Metabolic changes in the region of interests : In 30-minute self-thrombo-embolism group, the Lac peak emerged immediately after the embolism, but the ischemic zone decreased 3 hours after the thrombolytic therapy (0.252±0.01, 0.603±0.01, P < 0.01). Lac/(PCr+Cr) ratio was 0.290±0.01 at 24 hours after thrombolysis, which was higher than that at 3 hours after thrombolysis (P < 0.01). The NAA/ (PCr+Cr) ratio decreased significantly at 3 hours after the thrombolysis as compared with that before thrombolysis (0.922±0.16, 1.196±0.01, P < 0.05). In 60-minute self-thrombo-embolism group, the Lac/(PCr+Cr) ratio was higher at 3 hours after thrombolysis than that before thrombolysis (0.846±0.12, 0.601±0.11, P < 0.05) and the NAA/(PCr+Cr) decreased at 3 hours after the embolism. Fluctuation of NAA/ (PCr+Cr) ranged from 0.68 to 0.75 before thrombolysis and from 0.71 to 0.75 at 3 hours after thrombolysis. ② T2W image: T2W image showed that 2 subjects in 30-minute self-thrombo-embolism group whose Lac/NAA was higher than 0.7 suffered from intracranial hemorrhage. This meant that the subjects with Lac/NAA > 0.7 were more likely to suffer from intracranial hemorrhage. ③ Histological and morphological examinations: Optic microscope demonstrated that interspace surrounding nerve cells was widened at ischemic center; neurons were swelling; nucleus was stained lightly; pyknosis and mesenchymal edema were mainly observed in lateral cortex of brow and vertex and in lateral part of corpus striatum. CONCLUSION: ①Compound parameters in ischemic area before thrombolysis should be regarded as an important predicting marker for thrombolytic therapy, effect evaluation and termination. ② 1H-MRS combining with other imaging technique is a detecting way for screening cases who are suitable for thrombolytic therapy.     

222例肺癌的纤维支气管镜检查分析

经纤支镜检查的222例原发性肺癌中,鳞癌占43.25％,小细胞肺癌占35.13％,腺癌占12.61％。小细胞肺癌(女性患者尤为突出)在我区各类肺癌分布中所占比例较大,是其特点。近五年中,肺癌的检出率及女性肺癌患病数均有上升趋势,其原因值得进一步探讨。     

房颤致急性动脉栓塞并发急性肺水肿1例误诊的分析

患者，女，63岁。“因腰骶部疼痛2d伴双下肢麻木1d”收治骨外科。外院CT提示：L5～S1椎间盘突出。否认高血压、心脏病病史及类似发作史。入院体检：BP100／50mmHg，HR110次／min。双肺呼吸对称，呼吸音粗糙，未闻及干湿哕音。心音尚有力，律不齐，未闻及明显杂音。双下肢肌力Ⅲ级，肌张力减低。皮温两侧对等，皮肤凉，感觉减退。直腿抬高试验阴性。生理反射存在，病理反射未引出。入院诊断：①L5～S1腰椎间盘突出；②椎管内肿瘤并双下肢瘫痪待排。入院后即行甘露醇脱水、镇痛、激素治疗。     

经纤维支气管镜微波治疗儿童咽喉部疾病临床研究

目的：总结纤支镜微波治疗儿童咽喉疾病的疗效。方法：49例咽喉疾病患儿行纤支镜微波治疗，其中下咽乳头状瘤10例，喉部粘连1例，卢带乳头状瘤12例，卢带血管瘤2例，声带多发息肉／小结20例，卢带任克氏水肿1例，会厌囊肿3例。结果：49例患儿均获良好疗效。结论：应用纤支镜微波治疗儿童咽喉疾病，疗效明显优于传统治疗，具有痛苦少，术野清晰，不易复发，成功率高等优点。     

57例糖尿病并肺结核病并存支气管内膜结核分析

糖尿病合并肺结核病患者气道防御机制常减退,加上糖尿结核患者体内结核菌数量大,痰菌阳性率高,多数糖尿病人血糖控制不佳,常常同时并存支气管结核,纤支镜能有效提高检出率。     

稳心颗粒治疗持续性房颤患者的临床观察

心房纤颤是临床上最常见的心律失常之一，起发病率在3％左右。房颤既可以发生于高血压病、冠心病、风湿性心脏病，也可以发生于无器质性心脏病患者，目前治疗房颤的方法很多，包括药物、射频消融、起搏器植人、外科手术等。其中药物治疗仍是我国目前最主要的方法。治疗的主要目的是控制房颤患者的心室率，从而改善患者的生活质量。本研究在探讨稳心颗粒对持续性心房纤颤患者控制心室率的疗效观察和安全性。