经皮心包穿刺置管引流大量心包积液21例

目的:探讨经皮心包穿刺置管引流大量心包积液的可行性、安全性.方法:分析1999年3月～2004年3月收治的21例大量心包积液临床资料.结果:21例患者均一次引流成功,病因分析;心包转移瘤(8例)、结核性心包炎(5例)、甲状腺功能减退症(2例)、系统性红斑狼疮(1例)、尿毒症(2例)、不明原因(3例).结论:经皮心包穿刺置管引流大量心包积液的可行、安全.     

重用黄芪之经方联用治疗疑难重症举隅

[目的] 介绍重用黄芪之经方联用治疗四则疑难重症的体会。[方法] 通过整理、分析临床治疗心包积液、不明原因单侧上肢肿胀疼痛、湿疹重症、黄汗重症四则验案,总结联合运用经方且重用黄芪,发挥其利水之功效治疗疑难重症的经验。[结果] 黄芪具有益气固表、利水消肿的功效,临床上黄芪用量达80～100 g可发挥其利水之功。结合患者整体临床表现,验案一选用防己黄芪汤、枳实薤白桂枝汤等以温振心阳、化气利水;验案二选用黄芪桂枝五物汤、防己地黄汤等以活血通阳、利水燥湿;验案三选用桂枝加黄芪汤、麻黄连轺赤小豆汤等以祛风散邪、清利湿热;验案四选用芪芍桂酒汤、防己茯苓汤等以通调气血、行水利湿,治疗后临床效果显著。[结论] 临床上遵循“观其脉证,知犯何逆,随证治之”的原则联合应用经方,以疾病症状体征为导向,谨守病因病机遣方用药,能治疗多种疑难重症。     

铜绿假单胞菌注射液治疗恶性胸腔积液和心包积液的临床分析

目的观察铜绿假单胞菌注射液治疗恶性胸腔积液和心包积液的疗效。方法共治疗恶性胸腔积液、心包积液26例。所有患者先行中心静脉导管置管进行积液引流,引流后注入铜绿假单胞菌注射液2～5ml和地塞米松5mg,2%利多卡因10ml,夹闭引流管48h,再开放引流管,根据引流情况连续注药2～3次。结果治疗恶性胸腔积液20例,有效18例（90.0%）;恶性心包积液10例均有效,不良反应为胸痛、气短、发热。结论铜绿假单胞菌注射液应用于恶性胸腔积液、心包积液的治疗,疗效较满意。     

Hepatic hydropericardium

A 41-year-old man with chronic hepatitis C and cirrhosis presented with pericardial effusion and tamponade requiring pericardiocentesis. Nine liters of pericardial fluid was drained with complete resolution of his ascites. He represented with recurrent pericardial effusions despite salt restriction and diuretic therapy. Subsequent radionuclide scans demonstrated a direct connection between the peritoneal and pericardial spaces. A pericardial window was formed but despite this there was recurrence of pericardial effusion and pleural effusion. The patient underwent orthotopic liver transplantation 7 months later and no recurrence of pleural or pericardial effusion was observed following transplantation. We believe this is the first case report of pericardial effusion secondary to cirrhotic ascites and a communication between the peritoneal and pericardial cavities.     

铜绿假单胞菌注射液腔内注入治疗23例恶性心包积液的临床观察

目的:观察铜绿假单胞菌注射液(PA-MSHA)腔内注入治疗恶性心包积液的疗效及安全性。方法:对23例恶性心包积液患者,先心包腔内置入中心静脉导管行持续引流,待积液基本排尽后注入PA-MSHA 2-3ml和地塞米松5mg。夹闭引流管5-7天后复查B超,如效果不佳则再次引流后重复注射上述药物,反之则拔管。结果:共治疗23例,完全缓解14例(60.9%),部分缓解7例(30.4%),总有效率91.3%。心包腔内注药后有5例发热,2例胸痛。结论:PA-MSHA腔内注入治疗恶性心包积液疗效满意,不良反应不大。     

Hydropericardium Hepatitis Syndrome Emerged in Cherry Valley Ducks in China

Since June 2015, a highly pathogenic disease occurred in duck flocks in China, causing pericardial effusion, enlarged discoloured liver, renal enlargement and haemorrhagic lung with a mortality ranging from 5% to 20%. Previous study confirmed that Fowl adenovirus group C (FAdV‐C) and some field FAdVs isolates had been identified as causative agents of hydropericardium hepatitis syndrome (HHS) in chickens and geese world widely. In this study, we firstly report the isolation of FAdV‐C from ducks with HHS. The two isolates, designated as SDSX and SDJX, were separated from liver samples using 9‐day‐old SPF chicken embryos and could cause severe cytopathic effects in duck and chicken embryonic kidney cells. The entire ORF sequences of hexon gene of the two isolates were amplified, sequenced and analysed by restriction fragment length polymorphism. Phylogenetic analysis of loop 1 sequences of hexon gene of FAdVs revealed that the two isolates were closely related to FAdV‐C isolates, which could cause HHS in chickens. Experimental infection indicated that the isolate was high pathogenicity to 20‐day‐old ducks. Our study shows that the recently emerged HHS in ducks was caused by FAdV‐C and may possess a potential risk to other poultry flocks.     

铜绿假单胞菌注射液腔内注入治疗23例恶性心包积液的临床观察

目的：观察铜绿假单胞菌注射液（PA-MSHA）腔内注入治疗恶性心包积液的疗效及安全性。方法：对23例恶性心包积液患者,先心包腔内置入中心静脉导管行持续引流,待积液基本排尽后注入PA-MSHA 2-3ml和地塞米松5mg。夹闭引流管5-7天后复查B超,如效果不佳则再次引流后重复注射上述药物,反之则拔管。结果：共治疗23例,完全缓解14例（60.9%）,部分缓解7例（30.4%）,总有效率91.3%。心包腔内注药后有5例发热,2例胸痛。结论：PA-MSHA腔内注入治疗恶性心包积液疗效满意,不良反应不大。     

白介素-2联合顺铂治疗恶性心包积液的疗效观察

目的:观察白介素-2联合顺铂治疗恶性心包积液的疗效。方法:A组:白介素-2100万单位 顺铂40mg/m2 生理盐水30ml,每周1次。B组:顺铂40mg/m2 生理盐水30ml,每周1次。病人治疗3周期以上后参与疗效评价。结果:治疗30天后CR率A组为93.3%(28/30),B组为80%(24/30);90天后CR率A组为80%(24/30),B组为70%(21/30),两组无显著性差异(P>0.05);180天后CR率A组为76.67%(23/30),B组为50%(15/30),两组显著性差异(P<0.05)。结论:两组短期缓解率无明显差异,但长期完全缓解率有显著差异。     

恩度联合顺铂心包腔内注射治疗恶性心包积液临床研究

目的观察重组人血管内皮抑素（国产,商品名恩度）联合顺铂心包腔内灌注治疗肺癌合并恶性心包积液的疗效和安全性。方法 67例肺癌合并心包积液患者分为Ⅰ、Ⅱ组,分别注入重组人血管内皮抑素及重组人血管内皮抑素加顺铂联用,每周1次,连用3周后评价疗效及生活质量。结果两组治疗心包积液控制总有效率比较无统计学差异（P〉0.05）,与文献报道比较亦无明显差异;但Ⅱ组完全缓解率高于Ⅰ组及文献报道（P〈0.05）。结论恩度联合顺铂治疗肺癌合并恶性心包积液疗效显著,不增加化疗的毒副作用,值得临床推广应用。