腰椎穿刺蛛网膜下腔置管持续引流防治脑血管痉挛的初步观察

目的：探讨腰椎蛛网膜下腔置管持续引流对蛛网膜下腔出血（SAH）后脑血管痉挛的预防与治疗效果。方法：对88例颅内动脉瘤性SAH患,在超早期行电解可脱卸弹簧圈（GDC）栓塞术后,实施腰椎蛛网膜下腔置管持续引流,通过临床症状、经颅多普勒超声（TCD）及脑血管造影、ECT判断血管痉挛的发生率及严重程度。结果：11例出现症状性脑血管痉挛,平均随访11个月,恢复良好10例,中度致残1例。无引流相关并发症。结论：腰椎蛛网膜下腔置管持续引流可以清除蛛网膜下腔积血、引流血管收缩物质,预防血管痉挛的发生及缓解痉挛程度。     

Epidural anaesthesia for elective Caesarean section does not influence fetal umbilical artery blood flow indices

This prospective study was completed to determine the influence of epidural anaesthesia on the fetoplacental circulation of normal subjects. Thirty-seven normal pregnant patients at term, undergoing elective Caesarean section, had Doppler measurements of the fetal umbilical artery blood flow velocity before and after epidural anaesthesia using lidocaine 2% without epinephrine. There were no differences in systolic/diastolic, resistance or pulsality indices following epidural anaesthesia. These results suggest that this technique has no adverse effect on fetoplacental circulation in normal non-labouring subjects. Cette étude prospective a pour but de déterminer l’influence de l’anesthésie épidurale sur la circulation foeto-placentaire dans le contexte d’une grossesse normale. Des indices de vélocité du flot de l’artère ombilicale foetale ont été mesurés par Doppler chez trentesept patientes gravides à terme, sans complications, programmées pour une césarienne élective, avant et après une anesthèsie épidurale utilisant la lidocaine 2% sans épinéphrine. Les indices de rapport systole/diastole, de résistance et de pulsatilité sont demeurés inchangés après l’induction de l’anesthésie épidurale. Ces constatations suggèrent que l’anesthésie épidurale n’a pas d’influence sur la circulation foetoplacentaire chez des patientes enceintes normales à terme qui ne sont pas en travail.     

Imbalance between intraperitoneal coagulation and fibrinolysis during peritonitis of CAPD patients: the role of mesothelial cells

We compared peritoneal dialysis effluents from 18 CAPD patientswho had not suffered from peritonitis during the last 6 months(group 1) with the effluents from five patients with acute peritonitis(group 2), measuring activation markers of coagulation and fibrinolysis.These markers included prothrombin fragment F1+2 (F1+2), thrombin-antithrombinIII complex (TAT), fibrin monomer (FM), and fibrin degradationproducts (FbDP). In the dialysate of group 1 we found remarkablyhigh levels of F1+2, TAT and FM concomitant with a high concentrationof FbDP, indicating a high rate of intraperitoneal fibrin turnover.The balance between peritoneal generation and degradation offibrin was disturbed in untreated patients of group 2, who hadsignificantly higher levels of coagulation markers and a higherratio between FM and FbDP. Seven days after treatment with intraperitonealadministration of antibiotics and heparin, F1+2, TAT, FM andFbDP decreased significantly. To evaluate the role of mesothelial cells (MC) in the high peritonealfibrin turnover we investigated the expression of tissue-typeplasminogen activator (t-PA), urokinase-type plasminogen activator(u-PA), plasminogen activator inhibitor type-1 (PAI-1), andtissue factor in cultured human peritoneal MC under basal conditionsand after exposure to tumour necrosis factor (TNF) interleukin-1(IL-1), or bacterial lipopolysaccharide (LPS). The exposureof MC to TNF or to a lesser extent IL-1 or LPS reduced theirfibrinolytic activity by decreasing t-PA production and increasingPAI-1 synthesis. Furthermore the addition of TNF resulted inactivation of the coagulation cascade by the expression of tissuefactor. These in-vitro findings explain the imbalance betweenintraperitoneal coagulation and fibrinolysis during peritonitisof CAPD patients.     

目前下肢被动运动装置存在的问题和改进原则

本文分析了目前下肢ＣＰＭ装置存在的问题,指出在ＣＰＭ每一运动周期,人体下肢与ＣＰＭ支架之间都将产生有害的相对位移和交替牵拉应力,影响关节功能顺利康复。提出下肢ＣＰＭ的正确使用方法和设计原则。     

高频透热撕囊法在白内障手术中的应用

目的:评价在白内障手术中使用高频透热撕囊仪作连续环形撕囊的效果。方法:在30例(34眼)患者进行白内障囊外摘出联合后房型人工晶体植入术中,先向前房注入透明质酸钠,然后使用高频透热撕囊仪作晶体连续环形撕囊术。结果:有3眼术中出现小的晶体前囊放射状撕裂,所有病例术后角膜无水肿,无其他术后合并症,术后一周31眼矫正视力≥0.5,占91.2％。结论:此法操作简便,易于掌握,是一个安全有效的连续环形撕囊的方法。尤其适用于过熟期白内障,儿童先天性白内障和外伤性白内障的截囊。眼科学报1999;15:121—123。     

Crisnatol mesylate: Phase I dose escalation by extending infusion duration

Summary Crisnatol mesylate is a rationally designed cytotoxic arylmethylamino-propanediol with broad spectrum cytotoxic activity. A phase I study with an unconventional escalation scheme was developed using a constant drug infusion rate (mg/m²/hr) and prolonging the infusion duration from 6 to 96 hours. Sixty-five patients received crisnatol at doses from 18 mg/m² in 6 hrs to 3400 mg/m² in 72 hours. The dose-limiting toxicity in two of five patients at 2700 mg/m² and two of three patients at 3400 mg/m² was neurologic and consisted of a syndrome of confusion, agitation, and disorientation. Phlebitis mandated the use of a central line. The mean terminal phase half-life (T_1/2 ) was 3.3 hours with a total body clearance (CL) of 22.8 L/hr/m² and a volume of distribution (Vd_ss) of 53 L/m². The median steady-state peak plasma concentration (C_ss) at 2700 mg/m²/72 hours was 2.7 g/ml and at 3400 mg/m²/72 hours was 3.8 g/ml. No responses were seen. The maximum tolerated dose (MTD) on this schedule is 2700 mg/m²/72 hours in patients with no liver disease and good performance status.     

Long-term observation of chronic subsutaneous administration of lisuride in the treatment of motor fluctuations in parkinson's disease

Summary Twenty-nine patients with advanced Parkinson's disease were treated with subcutaneous lisuride infusion in addition to a basic therapy consisting of levodopa + PDI in all, and deprenyl in some patients. At the time of the report, 13 patients are still receiving lisuride infusion after 5–36 months, while 16 have dropped out after 0.5–30 months one because of psychosis, three because of insufficient efficacy, three due to death unrelated to treatment, three because of difficulties in handling the pump as outpatients, and six for other reasons. Off-periods and parkinsonian disability in off and in on were reduced significantly. These improvements remained constant throughout the observation period. Once the optimal dose regimen is established, only minor adjustments of the doses of lisuride and levodopa are required in the individual case.     

胃癌术后镇痛对肠功能恢复的观察与护理

目的　探讨胃癌手术后硬膜外持续镇痛对患者肠功能的影响。方法　对 6 0例胃癌术后病人进行随机分组 ,PCEA(pa tientcontrolledEpiduralanalgesia)组 :采用硬膜外持续镇痛 (30例 ) ;对照组 :采用间断注射镇痛剂 (30例 ) ,观察肠蠕动、肛门排气时间及不良反应。结果　肠蠕动恢复时间PCEA组 (5 2 1± 4 3)h ,对照组 (5 1 5± 4 4 )h。肛门排气时间PCEA组 (6 5 4±7 5 )h ,对照组 (5 6 1± 9 3)h。PCEA组不良反应明显少于对照组。结论　术后镇痛不影响胃癌术后肠蠕动恢复 ,但应加强术后早期活动的指导     

持续滴注异长春花碱联合异环磷酰胺治疗难治性非霍奇金淋巴瘤

目的：临床研究持续性静脉滴注诺维本(Navelbine，NVB)联合异环磷酰胺(Ifosfamide，IFO)治疗难治性非霍奇金淋巴瘤(NHL)的近期疗效与毒副反应。方法：入组22例经CHOP治疗失败的NHL患，给予持续性静脉滴注NVB联合IFO化疗，至少2个周期，疗效及毒性判定按照WHO标准。结果：完全缓解(CR)6例，部分缓解(PR)13例，稳定(NC)1例，进展(PD)2例，总有效率86．4％。主要毒副作用为骨髓抑制。结论：持续静脉滴注NVB联合IFO治疗难治性NHL有较高的疗效，并较为安全，患可耐受。