Clinical observation on chemical damage of nephron and the preventive and therapeutic effects of Baoshen Mixture (保肾合剂) on it

Objective:To observe the change of nephron damaged by chemotherapy and to evaluate the effect of Baoshen Mixture(保肾合剂,BSM) in protecting and treating damaged nephrons.Methods:Four hundred tumor patients with normal renal function and ready to receive chemotherapy were randomly assigned to two groups.Both groups received one cycle of chemotherapy program of 28-30 days with conventional hydratization,alkalization and chloridization.To the 200 cases in the treated group BSM was given orally thrice a day,150 mL every time for 15 successive days and the other 200 cases in the control group were treated by chemotherapy alone.The clinical efficacy was compared after treatment,and the changed condition of damaged nephrons were monitored dynamically and compared at different time points(the 3rd,7th,14th and 21st day after chemotherapy) by measuring the micro-globulin β2(β2-MG),albumin(Alb) and immunoglobulin G(IgG) levels in urine with radioimmunoassay(RIA).Results:(1) The effective rates in the treated group at the 4 time points of observation were all higher than those in the control group respectively(P<0.05 or P<0.01);(2) Less occurrence of abnormal β2-M,Alb and IgG levels on the 14th and 21st day in the treated group took place compared to that in the control group(P<0.01);(3) Urinary levels of β2-MG,Alb and IgG reached the peak on the 7th day in both groups,and then,they came down gradually and returned to the normal level on the 21st day.However,comparison between the two groups showed that all the three parameters in the treated group on day 3,14 and 21 were lower than the respective one at the corresponding time points in the control group(P<0.05 or P<0.01).Conclusion:The chemotherapy damage on nephron is regular in time,and reversible when treated suitably.TCM shows a marked effect in protecting and treating the damage on nephron caused by chemotherapy.     

Effects of choleretics on bile compositions drained from patients with pigment gallstone

Objective: To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone.Methods: Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage (ENBD) were divided equally into three UDA group) and combination of LDL and UDA (the LDL UDA group) through oral intake(7 patients in each group). Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7th day after the treatment started to detect levels of total bile acid (TBA), glycocholic acid (GCA), taurocholic acid (TCA), glycocholic cheno-desoxycholic acid (GCDCA), total bilirubin (TBIL), uncombined bilirubin (UCB), concentration of calcium ion (Ca2 ) as well as the bacterio-genetic and endogenous β-glucuronidase activity for comparing.Results: Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL UDA group after treatment ( P＜0.05), while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment ( P＜0.05). Moreover, levels of Ca2 and endogenous β-glucuronidase activity got significantly lowered (P＜0.05). Conclusion: Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca2 and the activity of endogenous β-glucuronidase in the bile, so as to reduce the possibility of stone formation of bile, and therefore, it could be used to prevent the production of pigment gallstone, especially to prevent post-operative recurrence of stones.     

柴芩承气汤对于重症急性胰腺炎患者基质金属蛋白酶-9的调节作用

Objective： To investigate the effect of Chaiqin Chengqi Decoction （柴芩承气汤, CQCQD） on regulating serum matrix metalloproteinase 9 （MMP-9） in patients with severe acute pancreatitis （SAP）. Methods： Thirty-five SAP patients hospitalized in West China Hospital from September 1, 2008 to February 28, 2009 were randomly assigned to two groups using a computer-derived random number sequence in a ratio of 1：1, treatment group （18 patients） and the placebo control group （17 patients）. The patients in the treatment group were administered with CQCQD by gastric parfusion （50 mL/2 h） and retention enema （200 mL/6 h） for 7 days. The two groups had similar baseline information. The clinical indicators, including the initial Balthazar＇s computed tomography （CT） score, acute physiology and chronic health evaluation I1 （APACHE II） scores on 1st, 3rd, 5th and 7th day, incidences and durations of complications and the serum C-reactive protein （CRP）, levels of MMP-9 on the 1st, 3rd, 5th and 7th day, were recorded and compared between the two groups. Resalts： The serum MMP-9, CRP and the APACHE I1 scores on the 3rd, 5th and 7th day in the treatment group were lower than those in the control group （P〈0.05）. The serum MMP-9 was positively correlated with the APACHE II score on the 1st day （r=0.430, P=0.01）. The durations of acute respiratory distress syndrome （5.4± 2.4 vs. 2.9± 1.3）, acute hepatitis （4.6± 0.8 vs. 1.9 ± 0.6） and acute heart failure （3.9 ± 1.6 vs. 1.3 ± 0.6, P〈0.05） in the control group were longer than those in the treatment group. Conclusion： CQCQD could decrease the serum MMP-9 to relieve the severity of clinical symptoms and prevent the development of multiple organ dysfunction syndrome in patients with SAP.     

Short-term Effect of Combined Therapy with Jinlong Capsule(金龙胶囊)and Transcatheter Arterial Chemoembolization on Patients with Primary Hepatic Carcinoma and Its Influence on Serum Osteopontin Expression

<正>Objective:To observe the clinical combination effect of Jinlong Capsule(金龙胶囊,JLC) and transcatheter arterial chemoembolization(TACE) on the patients with primary hepatic carcinoma(PHC) and JLC's influence on serum osteopontin(OPN) expression and elucidate the correlation between the serum OPN level and curative effect of JLC and TACE.Methods:A total of 98 patients with PHC were observed in a randomized controlled trial(RCT).They were assigned to the Chinese medicine(CM) group(53 patients who were treated with TACE and JLC) and the intervention group(45 patients who were treated with TACE only).The serum OPN levels were measured before and after treatment by quantitative sandwich enzyme-linked immunosorbent assay(ELISA).Forty healthy people were assigned to the control group.The clinical efficacy was observed and Karnofsky score(KPS) was graded.Results:The clinical efficacy of the CM group(60.38%) was better than that of the intervention group(40.00%),and the KPS(84.35±12.19) was higher than the intervention group(69.86±11.58)(P0.05).The serum OPN levels before and after treatment in the patients with PHC were significantly elevated compared with those in the control group(P0.01).After treatment,the OPN levels in CM group(117.69±78.50) were significantly lower compared with those in intervention group(151.09±83.90,P0.05).The OPN levels of responders were remarkably lowered than the non-responders after treatment,and the level of OPN in the CM group was lower than the intervention group(P0.05).Conclusions:The short-term clinical efficacy and the quality of life of patients with PHC can be improved by combining JLC with TACE.The serum OPN levels in PHC patients can reflect the curative effect of treatment and the prognosis of the disease.     

Relationship of anxiety state with lymphocyte subsets and the effect of chinese medical treatment on anxiety in patients with chronic hepatitis B

Objective:To analyze the relationship of anxiety state with CD4~+ level and CD4~+/CD8~+ ratio and to observe the effect of Chinese medicine(CM) treatment on anxiety in chronic hepatitis B(CHB) patients. Methods:The anxiety state of 120 CHB patients was evaluated based on Hamilton Anxiety Scale(HAMA) scoring.According to the scores,63 patients with scores≥14 were classified to anxiety and 57 patients with scores<14 to non-anxiety.The differences in CD4~+ cells and CD4~+/CD8~+ ratio between patients with anxiety and non-anxiety were analyzed.Moreover,63 patients with anxiety were randomized into two groups:31 in the control group were treated with lamivudine(100 mg per day) alone and 32 in the observation group were given equal dosage lamivudine combined with CM treatment depending on syndrome differentiation,all for 12 weeks. The effects of treatment on anxiety state and T-lymphocyte subsets as well as its impact on some CHB-related indices were observed and compared.Results:The anxiety state of CHB patients was negatively correlated with CD4~+ and CD4~+/CD8~+;the level of CD4~+ in patients with anxiety was significantly lower than that in non-anxiety patients(P<0.01 or P<0.05).After treatment,anxiety state in the observation group was significantly improved, with their HAMA scores significantly lowered(P<0.01),and the levels of CD4~+ and CD4~+/CD8~+ were significantly higher than those in the control group(P<0.05 or P<0.01).Moreover,the alanine transaminase recovery rate and the HBV-DNA-negative conversion rate in the observation group were significantly higher than those in the control group,respectively(P<0.05).Conclusions:The anxiety state of CHB patients was related to CD4~+ and CD4~+/CD8~+ levels.CM treatment could improve the anxiety state and showed certain regulatory effect on the patients’ immune system.     

Efficacy and safety of tauroursodeoxycholic acid in the treatment of liver cirrhosis: A double-blind randomized controlled trial

No direct comparison of tauroursodeoxycholic acid (TUDCA) and ursodeoxycholic acid (UDCA) has yet been carried out in the treatment of liver cirrhosis in China. We designed a double-blind randomized trial to evaluate the potential therapeutic efficacy of TUDCA in liver cirrhosis, using UDCA as parallel control. The enrolled 23 patients with liver cirrhosis were randomly divided into TUDCA group (n=12) and UDCA group (n=11), and given TUDCA and UDCA respectively at the daily dose of 750 mg, in a randomly assigned sequence for a 6-month period. Clinical, biochemical and histological features, and liver ultrasonographic findings were evaluated before and after the study. According to the inclusion criteria, 18 patients were included in the final analysis, including 9 cases in both two groups. Serum ALT, AST and ALP levels in TUDCA group and AST levels in UDCA group were significantly reduced as compared with baseline (P<0.05). Serum albumin levels were significantly increased in both TUDCA and UDCA groups (P<0.05). Serum markers for liver fibrosis were slightly decreased with the difference being not significant in either group. Only one patient in TUDCA group had significantly histological relief. Both treatments were well tolerated and no patient complained of side effects. It is suggested that TUDCA therapy is safe and appears to be more effective than UDCA in the treatment of liver cirrhosis, particularly in the improvement of the biochemical expression. However, both drugs exert no effect on the serum markers for liver fibrosis during 6-month treatment.     

Clinical Observation of Shuanghuang Shengbai Granule(双黄升白颗粒) on Prevention and Treatment of Myelosuppression Caused by Chemotherapy in Cancer Patients

Objective: To study the efficacy and safety of Shuanghuang Shengbai Granule(双黄升白颗粒, SSG), a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy. Methods: A total of 330 patients were randomly assigned to the treatment group(220 cases, analysed 209 cases) and the control group(110 cases, analysed 102 cases) with a 2:1 ratio by envelope method. The patients in the treatment group at the first day of chemotherapy started to take SSG for 14 days, while the patients in the control group took Leucogon Tablets. The changes of the blood routine, clinical symptoms and immune function in both groups were observed for safety and efficacy evaluation. Results: At the 7th day of chemotherapy, the white blood cells(WBCs) level in the treatment group was significantly higher than that in the control group(P0.05). After treatment, the WBCs rate in the normal range accounted for 50.2% in the treatment group, the myelosuppression of WBCs and neutrophil were mainly grade Ⅰ, while 8.1% and 5.7% of patients emerged grade Ⅲ and grade Ⅳ myelosuppression, respectively. The incidence of myelosuppression of the treatment group was significantly lower than that of the control group(P0.05). The total effective rate of Chinese medicine syndrome in the treatment group was significantly higher than that in the control group(84.2% vs. 72.5%, P0.05). The immune cell levels in both groups were maintained in the normal range. Compared with that before treatment, the levels of CD3~+ and CD4~+ cells were significantly increased in the treatment group after treatment(P0.05). The discrepancy of CD3~+ and CD4~+ cell activity before and after treatment in both groups were significantly different(P0.05). No obvious adverse event occurred in both groups. Conclusion: SSG had a protection effect on bone marrow suppression, and alleviated the clinical symptoms together with clinical safety.     

Study of Qingre Liyan Decoction (清热利咽汤) in treating and preventing acute radioactive oral mucositis

Objective:To study the effect of Qingre Liyan Decoction(清热利咽汤,QRLYD)in the prevention and treatment of acute radiative oral mucositis(AROM),and to explore the mechanism of QRLYD by detecting epidermal growth factor(EGF)and T lymphocytes(CD3,CD4,and CD8). Methods:Sixty patients conforming with the standard were randomly assigned to two groups,30 patients in each group.Patients in the trial group were treated with QRLYD,and those in the control group were treated with Dobell's solution,both groups receiving conventional radiation treatment.The treatment course for both groups was 6 weeks on average.Blood routine test,CD3,CD4,and CD8 in the peripheral blood and EGF in the saliva were detected one day before and on the 14th and 28th day of radio-therapy.Results:Patients in the trial group were in good condition with normal spirits and intake of food and drinks.The incidence of AROM is lower and the effect in preventing AROM is higher in the trial group than those in the control group(P<0.05).The EGF in saliva,and CD4 and CD8 in the blood of patients in the trial group were higher than those in the control group(P<0.05). Conclusion:QRLYD can cure and prevent AROM.The mechanism may be related with its effects in enhancing body immunity and promoting salivary EGF.     

The role of prourokinase gene in protecting vein grafts from intimal hyperplasia

Objective To study the duration of prourokinase gene expression in vein grafts and the role of the prourokinase gene in protecting vein grafts from neointimal hyperplasia.Methods Fifty-four Wistar rats were used in this study. In each rat, the jugular vein was excised and distended for 30 minutes using a solution containing either Adv5-CMV (control group) or Adv5-CMV/ Pro-UK (treatment group). Next, the jugular vein was reversed and interposed into the divided carotid artery of the same rat. On the 14th day after transfection, vein grafts of the control group were collected in order to perform a fibrinolysis test for prourokinase (Pro-UK) activity. On the 2nd, 7th, 14th, 28th, and 60th day, the vein grafts of the treatment group were likewise collected in order to detect prourokinase activity. On the 28th day, the vein grafts of both groups were explanted to evaluate the 3H-TDR incorporation so that pathologic analysis could be performed.Results Pro-UK activity could not be detected in the control group     

Clinical Study on the Treatment of Knee Osteoarthritis of Shen(肾)-Sui(髓) Insufficiency Syndrome Type by Electroacupuncture

<正>Objective:To study the clinical efficacy of electroacupuncture(EA)on treating knee osteoarthritis (KOA)of Shen(肾)-Sui(髓)insufficiency(SSI)syndrome type.Methods:A total of 245 patients(279 knees)of KOA-SSI were randomly assigned to two groups by lottery:141 knees in the treatment group and 138 knees in the control group.The treatment group was managed with EA at the dominant points of Neixiyan(Ex-LE4) and Waixiyan(Ex-LE5)as well as the conjugate points of Xuanzhong(GB39)and Taixi(KI3)for 30 min,once a day,with 15 days as one course;2 courses were applied with a 5-day interval in between.The control group was treated with intra-articular injection of 2 mL hyaluronic acid into the affected joint every 7 days for 5 times in total.The clinical effects on the patients in different stages were observed,and their symptom scores of knee and contents of cytokines,including interleukin-1(IL-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α), prostaglandin E_(2α)(PGE_(2α)and matrix metalloproteinases-3(MMP-3),in the knee joint fluid were measured before and after treatment.Results:The study was completed in 235 patients(263 knees);four patients(7 knees) in the treatment group and six patients(9 knees)in the control group dropped out.Comparison of therapeutic effects(excellent and effective rates)between the two groups showed insignificant differences(P0.05). Symptom scores of knee and contents of cytokines in the knee fluid after treatment were lowered significantly in the patients of stageⅠ-Ⅲin both groups(P0.05 or P0.01).However,the lowering of the total symptom score of knee in the patients of stageⅢin the treatment group was more significant(P0.05).Conclusions:EA could effectively alleviate the clinical symptoms in KOA patients of stage 1,showing an effect superior to that of hyaluronic acid.EA also shows action in suppressing the secretion of IL-1,IL-6,TNF-α,PGE_(2α)and MMP-3 in the knee fluid.     

恩替卡韦治疗HBeAg阳性慢性乙型肝炎患者96周临床研究

目的 研究恩替卡韦治疗HBeAg阳性的慢性乙型肝炎患者的疗效及安全性.方法 94例初次行抗病毒治疗的HBeAg阳性慢性乙型肝炎患者随机分为两组,恩替卡韦组54例,拉米夫定组40例,分别给予恩替卡韦0.5 mg/d,拉米夫定100 mg/d,疗程96周.评估患者丙氨酸氨基转移酶(ALT)复常率、HBV-DNA转阴率、血清学标志和安全性方面的情况.结果 疗程结束时恩替卡韦组ALT复常率为94.3%,HBV-DNA转阴率(HBV-DNA<1000拷贝/ml)83.0%;拉米夫定组ALT复常率和HBV-DNA转阴率分别为76.3%和60.5%,两组之间比较差异有统计学意义.而HBeAg转阴率和HBeAb阳转率两组之间比较差异无统计学意义.结论 在初治患者中,恩替卡韦治疗96周ALT复常率和HBV-DNA阴转率优于拉米夫定,且安全性良好,耐药发生率低. Abstract： Objective To investigate the efficacy and safety of entecavir in treating patients with HBeAg-positive chronic hepatitis B. Methods Ninety-four cases of HBeAg-positive chronic hepatitis B with no prior history of antiviral therapy were randomly divided into two groups:entecavir group (54 cases) treated with entecavir 0.5 mg/d and cami vudine group (40 cases) treated with lamivudine 100 mg/d.The duration of both therapy were 96 weeks.The ALT normalization rate,HBV-DNA negative conversion rate,HBeAg seroconversion and safty were assessed. Results At the end of the therapy,the ALT normalization rates of entecavir group and lamivudine group were 94.3% and 76.3%,respectively. The HBV-DNA negative conversion rates were 83.0% and 60.5%,respectively.There were significant differences between the two groups.But there was no significant difference in HBeAg negtive conversion rate and HBeAb seroconvesion rate between the two groups. Conclusions The ALT normalization rate and HBV-DNA negative convesion rates of nucleoside naive patients with HBeAg-positive chronic hepatitis B treated by ente cavir for 96 weeks are higher than treated by lamivudine,and the treatment of entecalir is safe and has low incidence of drug resistance.     

慢性乙型肝炎患者合并肝脂肪变性危险因素的病例对照研究

目的探讨慢性乙型肝炎（CHB）肝脂肪变性的危险因素。方法180例经肝活检的CHB患者,其中合并肝脂肪变性患者与无肝脂肪变性患者按照性别相同、年龄±3岁进行1：1匹配,分为病例组（61例,合并肝脂肪变性）与对照组（61例,无脂肪变性）,进行病例对照分析,探讨肝脂肪变性的危险因素。结果病例组体重指数24±3,显著高于对照组22±3（P〈0．01）,而空腹血糖、总胆固醇、甘油三酯、尿酸、丙氨酸氨基转移酶、γ-谷氨酰转肽酶及乙型肝炎病毒（HBV）DNA水平与对照组差异均无统计学意义（均P〉0．05）。经COX模型拟合进行配对资料logistic回归分析,仅体重指数为肝脂肪变性的独立危险因素（OR=1．488,P〈0．01）。结论CHB患者肝脂肪变性与宿主体重指数有关,而与HBVDNA水平无关。     

HCV-cAg与HCV-Ab、HCV-RNA及肝功能之间的关系探讨

目的探讨丙型肝炎病毒核心抗原（hepatitis C virus core antigen,HCV-cAg）与丙型肝炎病毒RNA（hepatitis C virus RNA,HCV-RNA）关系以及丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）水平与HCV-RNA病毒载量之间的相关性。方法选取78例HCV抗体检测阳性的丙型肝炎或疑似丙型肝炎病人作为观察组,另选取同期健康体检者20名作为对照组。采用ELISA法和荧光定量PCR法等对2组血清样本进行HCV-cAg、HCV-RNA和ALT、AST、GGT水平测定,并比较各参数之间的关系。结果观察组HCV-cAg阳性检出率为41.0%（32/78）,HCV-RNA阳性检出率为53.8%（42/78）,差异有统计学意义（P < 0.01）,且二者之间具有较好一致性（κ=0.747）。观察组ALT、AST和GGT水平均明显高于对照组（P < 0.01）,但与HCV-RNA病毒载量均无明显相关性（P>0.05）。结论HCV-cAg和HCV-RNA在检测丙型肝炎方面有较好一致性和相关性,可为丙型肝炎的临床诊断提供有价值的依据。     

四种抗体联合检测在SLE患者中的诊断价值

目的 探讨抗双链DNA(dsDNA)抗体、抗Smith(Sm)抗体、抗核小体抗体(AnuA)、抗组蛋白抗体联合检测在系统性红斑狼疮(SLE)患者中的诊断价值.方法 抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体均采用欧蒙斑点法测定98例SLE患者(分为活动期和稳定期)、90例其他结缔组织病患者及40例健康人血清中的四种自身抗体.结果 98例SLE患者中抗dsDNA抗体、抗Sm抗体、AnuA、抗组蛋白抗体阳性率分别为45.9%、 29.6%、 57.1%、33.6%,特异性分别为100%、99.2%、98.5%、89.2%;抗dsDNA抗体和AnuA在活动期SLE中的敏感性与稳定期相比差异有统计学意义(P<0.05);抗dsDNA抗体和AnuA以及四种抗体联合检测时阳性率分别为70.4%和79.6%,明显高于其中任何单项检测的阳性率,且明显高于疾病对照组,差异有统计学意义(P<0.05).结论 所检测的四种抗体在SLE中都具有很高的特异性和敏感性,其中抗dsDNA抗体和AnuA对活动期SLE具有很好的诊断价值,抗体的联合检测可较大程度提高SLE检测阳性率,四种抗体有明显的互补作用,尤其抗dsDNA抗体和AnuA的联合检测具有很好的组合价值. Abstract： Objective To investigate the diagnostic significance of combined detection of anti-double stranded DNA antibody(anti-dsDNA),anti-Smith antibody(anti-Sm)and antinuclesome antibody(AnuA) and anti-histone antibody in systemic lupus erythematosus(SLE),and evaluate the significance of combined detection of these autoantibodies in the diagnosis of SLE. Methods Ninety-eight cases of SLE patients who were divided into active and stable stage group and 90 disease controls and 40 healthy people were detected with Euro immunoblot assay.Results In the assays mentioned above. The serum positive rates of anti-dsDNA,anti-Sm, AnuA and anti-histone antibody were 45.9%,29.6%,57.1% and 33.1% in SLE, and the specificities were 100%,99.2%,98.5% and 89.2% respectively in patients with SLE.The positive rates of anti-dsDNA and AnuA in active SLE group were 57.5%,65.1%,which was apparently higher than that in the stable stage group;The sensibility of combined detection of anti-dsDNA and AnuA was 70.4%, four autoantibodies combined detection in SLE was 79.6%, which was apparently higher than any single autoantibodies, the difference had statistical significance. Conclusions These four autoantibodies have very high sensibility and specificity respectively, combined detection of four autoantibodies can markedly raise the relevance ratio in SLE, while their specificity didn't have a visual reduction. Especially, the sensibility of combined detection of anti-dsDNA and AnuA can markedly increased in active SLE patients. This compose can raise effectively the diagnosis of active SLE.So the detections of the four antibodies are complementary for the diagnosis of SLE.     

骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响

目的 探讨骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响.方法 择期下腹部、会阴部或下肢手术小儿60例,ASA I或II级.随机分为单纯气管插管组(T组),骶管阻滞复合气管插管组(CT组),骶管阻滞复合喉罩通气组(CL组),每组20例.分别于诱导前(T0)、插管即刻(T1)、手术开始(T2)、手术开始后30 min(T3)、手术开始后60 min(T4)监测心率(HR)、血压、脉搏氧饱和度、呼气末CO2分压,记录平均动脉压(MAP),中心静脉压,丙泊酚、瑞芬太尼的用量及术后不良反应的发生情况.结果 T组、CT组在T1时点MAP、HR明显高于CL组(P<0.05);CL组、CT组丙泊酚及瑞芬太尼的用量明显少于T组;CL组术后不良反应最少.结论 骶管阻滞复合全麻喉罩通气对小儿的血液动力学影响最小,不良反应少. Abstract： Objective To investigate the effects of caudal block with laryngeal mask airway(LMA) ventilation on the hemodynamics of children undergoing elective surgery under general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ children undergoing selective lower abdominal surgery were randomly divided into 3 groups (n=20):Group T:endotracheal intubation. Group CT:caudal block and endotracheal intubatio. Group CL:caudal block and laryngeal mask airway(LMA) ventilation. HR,BP,MAP,CVP,SpO2,PetCO2 were monitored during anesthesia.HR,MAP,CVP were recorded at proinduction (T0),intubation(T1),operation(T2),30 min after operation(T3) and 60 min after operation (T4).Recording the dosage of propofol,remifentanil and adverse reactions of postoperation. Results MAP,HR at T1 were significantly higher in group T and group CT than that in group CL.The dosage of propofol and remifentanil were significantly less in group CT and group CL than that in group T. Conclusions Caudal block with LMA ventilation have little side effects on hemodynamics of the children undergoing slective surgery with general anesthesia.     

压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期35例疗效观察

目的 探讨压缩雾化吸入可必特对慢性阻塞性肺疾病急性加重期的疗效和不良反应.方法 将75例患者随机分为两组,对照组30例采用常规治疗,治疗组35例在常规治疗基础上加用雾化治疗,观察两组治疗效果和解除主要症状、体征的时间和住院时间.结果 治疗组住院时间和喘憋、肺部喘鸣音的持续时间均明显短于对照组(P＜0.05).结论 压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期疗效确切,方法简便,不良反应小,值得推广. Abstract： Objective To explore the effect of compressed nebulized inhalation combivent on chronic obstructive pulmonary disease with acute exacerbation. Mehods Seventy-five patients were randomly divided into two groups,the control group(30 cases) with conventional treatment, the treatment group (35 cases) on the basis of conventional therapy plus treatment with the spray were observed lifting of the main symptoms and signs of the time and hospital stay.Results The treatment group hospitalization time and asthmatic lungs duration of wheezing were significantly shorter than the control group (P<0.01). Conclusions Compression combivent aerosol inhalation treatment of chronic obstructive pulmonary disease with acute exacerbation is simple, side effects are little and are worth promoting.     

超声引导下酒精硬化治疗肝、肾囊肿的并发症及处理方法

目的 探讨超声引导下酒精硬化治疗肝、肾囊肿所发生的并发症及处理方法.方法 回顾性分析近年所施行的肝、肾囊肿介入性酒精硬化治疗患者202例(均以无水酒精为治疗药物),其中出现并发症23例,包括出血、酒精不耐受、注入无水乙醇后无法顺利抽出、术中出现明显疼痛、操作过程中针尖脱出等.结果 22例均经对症处理,成功治疗,1例因针尖脱出,未行酒精硬化治疗,仅抽出囊液.结论 超声引导下酒精硬化治疗肝、肾囊肿是普遍采用的有效方法,但可发生少数并发症,如经早期发现并正确处理均能予以治愈. Abstract： Objective To explore the causes and treatment of the complications of alcohol sclerotherapy for hepatic and renal cysts with ultrasound-guided. Methods In recent 4 years, 202 cases of hepatic and renal cysts were treated by alcohol sclerotherapy with ultrasound-guided,among which complications were found in 23 cases by retrospective analysis. Results 22 cases were treated successfully. In 1 case, the needle was falling off from the cyst cavity, the liquid of cyst was drained out. Conclusions Alcohol sclerotherapy is a generally applied and efficient method for hepatic and renal cysts. But a few complications might occur due to different factors, which could be treated successfully if you found them early.     

低分子量肝素在胸部肿瘤合并高凝血状态病人围术期的临床应用

目的 使用低分子量肝素(LMWH)预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生.方法 对2006年1月至2007年10月我科收治的合并高凝血状态的食管癌、贲门癌、肺癌病人,在围术期皮下注射低分子量肝素,每日1次,从术前3～5 d开始直至病人下床,观察术中出血量及术后胸液量,并统计血栓性疾病发生率.结果 该组病人围术期血栓性疾病发生率得到了明显控制.结论 低分子量肝素对预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生有明显效果,安全可靠. Abstract： Objective To evaluate the efficacy of low molecular weight heparin for preventing thromboembolism disease in perioperative of thoracic tumor with blood hypercoagulabale state. Methods From January 2006 to October 2007, we diagnosed and treated 72 patients with lung cancer and carcinoma of esophagus and cardia. All the patients were treated with LMWH qd from the 3 -5 days before operation until ambulation after operation. To observe the postoperative total amount effusion and to statistic of incidence of thromboembolism disease. Results Incidence of thromboembolism disease decreased more significantly of this group than usual. Conclusions Application of LMWH for preventing thromboembolism disease in periopetive of thoracic tumor with blood hypercoagulabale state is an effective, safe and reliable treatment.     

阿托伐他汀对冠心病合并充血性心力衰竭患者血管内皮功能的影响

目的 研究阿托伐他汀对冠心病(CHD)合并充血性心力衰竭(CHF)患者血浆中一氧化氮(NO)、降钙素基因相关肽(CGRP)和内皮素(ET)的影响.方法 将68例CHD并CHF患者随机分为两组,常规治疗组(地高辛、氢氯噻嗪、硝酸异山梨酯)34例,联用组常规用药加阿托伐他汀34例,另选34例健康体健者为正常对照组.采用Greiss法测定NO水平,放射性免疫法测定治疗前后血中CGRP和ET的水平.结果 CHD并CHF患者中NO和CGRP水平明显低于正常组(P＜0.01),ET显著高于正常组(P＜0.01),治疗后均显著改善(P＜0.01),且以联用组改善更为显著,与常规组治疗后比较差异有统计学意义(P＜0.05).结论 常规用药加阿托伐他汀能显著改善CHD合并CHF患者的NO、CGRP和ET的代谢失衡. Abstract： Objective To study the effect on levels of plasma calcitonin gene-related peptide (CGRP) and endothelin(ET) of atorvastatin in patients with coronary artery heart disease(CHD) complicated with congestive heart failure(CHF). Methods Patients with CHD complicated with CHF were divided into two groups usual medicine group(usual medicine) and atorvastatin group. The plasma CGRP and ET levels were observed before and after treatment. Results The levels of CGRP in patients with CHF were lower than that in normal group before treatment (P＜0.05),and the level of ET was higher (P＜0.05),the improvement of CGRP and ET in atorvastatin group was better than that in the usual medicine group(P＜0.05). Conclusions Atorvastatin had the action of improving the imbalance of CGRP and ET in Patients with CHD complicated with CHF.