自控硬膜外腔镇痛治疗腰椎间盘突出症疗效观察

目的 观察自控硬膜外腔镇痛(PCEA)治疗腰椎间盘突出症的疗效及硬膜外腔注射糖皮质激素对患者血糖的影响.方法 将123例腰椎间盘突出症患者分为两组:PCEA组(n=55),硬膜外腔注射含糖皮质激素镇痛复合液,7d 1次,4次为1个疗程,首次硬膜外腔注射后行PCEA治疗7d;间断注药组(n=68),硬膜外腔注射含糖皮质激素镇痛复合液,7d 1次,4次为1个疗程.观察患者疗效及不良反应.于治疗前、治疗第9天、疗程结束次日监测空腹静脉血糖.结果 治疗第9天及疗程结束次日两组患者视觉模拟量表(VAS)评分均明显降低,PCEA组分别为(3.26±0.41)分、(1.15±0.67)分,间断注药组分别为(4.98±0.66)分、(1.68±0.87)分,较治疗前差异均有统计学意义(P<0.01).治疗第9天PCEA组优良率为76.4%,明显优于间断注药组(55.9%).疗程结束次日PCEA组优良率(89.1%)仍高于间断注药组(82.4%),但差异无统计学意义(P＞0.05).两组患者血糖均较治疗前升高,但仍在正常值范围内.两组患者均无严重不良反应发生.结论 PCEA治疗与间断硬膜外腔注射治疗腰椎间盘突出症临床疗效均较确切.但PCEA治疗在治疗早期能更迅速地缓解患者症状和体征.硬膜外腔注射糖皮质激素可引起患者血糖升高,但仍在正常值范围内.     

持续硬膜外腔注药(PCEA)治疗腰椎间盘突出症的临床研究

目的研究PCEA治疗腰椎间盘突出症的临床效果。方法应用病人自控镇痛泵首次硬膜外推注治疗药液20mL,然后接镇痛泵持续硬膜外腔注药200mL,2ml/min,持续2d。486例腰椎间盘突出症患者分为三组。A组:PCEA组;B组:间断硬膜外腔注药20mL,5~7d1次×3;C组:手术治疗组,常规小开窗半椎板或全椎板椎间盘摘除术。结果A组与B组相比有差异有统计学意义(P<0.05);A组与C组相比差异无统计学意义(P>0.05)。结论PCEA治疗腰椎间盘突出症操作简单、治疗时间短、副作用小、疗效显著,值得推广。     

硬膜外连续与间断注药治疗腰椎间盘突出症的比较

目的比较硬膜外连续与间断注药治疗腰椎间盘突出症的疗效。方法94例行硬膜外注药治疗腰椎间盘突出症的患者,随机分为两组,分别采用硬膜外连续和间断注药治疗方法。结果连续组治疗后7天、30天、90天、180天的治疗优良率分别为100%、95.7%、91.5%、89.3%,与间断组比较有显著性差异(P<0.01)。结论硬膜外连续注药治疗腰椎间盘突出症明显优于间断组,具有疗效好,复发率低,且可以减少激素用量等优点。     

一次正骨推拿法加自控镇痛治疗巨大型腰椎间盘突出症疗效分析

目的:观察一次正骨推拿法加自控镇痛(PCEA)治疗巨大型腰椎间盘突出症临床疗效。方法:将115例患者随机分为治疗组和对照组,治疗组以硬膜外麻醉后一次性正骨推拿联合硬膜外连续自控镇痛法治疗,对照组采用硬膜外麻醉后一次性正骨推拿法治疗。治疗结束后6个月统计疗效。结果:治疗组总有效率93.75%,对照组总有效率86.27%,两组比较临床疗效有显著性差异(P<0.05)。结论:硬膜外麻醉后一次正骨推拿法加自控镇痛治疗巨大型腰椎间盘突出症效果良好,且患者痛苦少。     

PCEA治疗腰椎间盘突出症的临床研究

目的研究 ＰＣＥＡ治疗腰椎间盘突出症的临床效果。方法选择 １９９９年 １１２例腰椎间盘突出症患者随机分为三组：ＰＣＥＡ组（Ａ组）３７例,应用病人自控镇痛泵通过硬膜外腔连续注药治疗２天;硬膜外间断治疗组（Ｂ组）３５例硬膜外腔间断给药,５～７天１次,连续３次;骨盆牵引综合治疗组（Ｃ组）４０例,骨盆牵引重量为体重的４０％±１０ｋｇ,持续３０ ｍｉｎ,每天早上、下午各１次,牵引后配合推拿、按摩,连续１０天,同时辅以消炎镇痛、神经营养等药物治疗。结果 Ａ、Ｂ、Ｃ三组治疗优良率分别为９４．５％、８２．９％、７５．０％,三组互比有显著性差异,Ｐ＜０．０５。结论ＰＣＥＡ治疗腰椎间盘突出症疗程短、疗效显著,值得推广。     

射频热凝术联合硬膜外腔神经阻滞治疗腰椎间盘突出症的临床研究

目的:观察射频热凝术联合硬膜外腔神绎阻滞治疗腰椎间盘突出症(Lumbar interve rtebral disc herniation,LDH)的临床疗效及安全性.方法:102例LDH患者分为两组:射频热凝术联合硬膜外腔神经阻滞治疗组(R组,n=48):硬膜外腔单次注射镇痛复合液,1周后行腰椎间盘射频热凝术;硬膜外腔神经阻滞治疗组(E组,n=54):硬膜外腔注射镇痛复合液.治疗前后进行 VAS评分,观察临床疗效、不良反应.结果:射频热凝术后1d、1周、1月两组患者VAS评分均明显降低,R组分别为3.13±0.99,1.35±0.34,1.05±1.22,E组分别为4.98±0.66、1.98±0.81、1.68±1.03,较治疗前均有显著件差异(P<0.01).射频热凝术后1dR组优良率(75.0%)明显高于E组(53.7%);术后1月R组优良率(83.3%)仍高于E组(74.1%).两组患者均尤严重不良反应的发生.结论:射频热凝术联合硬膜外腔神经阻滞治疗足目前治疗LDH安全、有效的方法.     

腰椎间盘突出症采用自控硬膜外镇痛治疗的护理

目的探讨腰椎间盘突出症采用自控硬膜外镇痛（PCEA）微创治疗的护理技巧和体会。方法回顾性的分析采用自控硬膜外镇痛（PCEA）微创治疗腰椎间盘突出症24例的护理，患者均为L4-5和L5-S1椎间盘突出症，病程2月-3年。结果21例患者达到治愈，3例达到好转。结论通过全面系统的护理可以确保PCEA治疗腰椎间盘突出症的近期及远期的疗效。     

经硬膜外、侧隐窝、骶管注药治疗腰椎间盘突出症的疗效比较

目的比较经硬膜外、侧隐窝、骶管3种方法注药治疗腰椎间盘突出症的疗效。方法将90例腰椎间盘突出症患者随机分为3组,每组30例,即硬膜外组、侧隐窝组与骶管组,3组均7日注药1次,2～4次为1个疗程。结果3组治疗效果的优良率分别为83.2%(25例),84.3(26例),83.3(25例),3组疗效比较差异无统计学意义(P>0.05)。结论经硬膜外、侧隐窝、骶管3种方法注药均是治疗腰椎间盘突出症的有效疗法,但侧隐窝组的不良反应少于硬膜外及骶管组。     

硬膜外腔注药配合手法治疗腰椎间盘突出症临床观察

目的探讨硬膜外腔注药配合手法治疗腰椎间盘突出症的临床疗效。方法对我院2008年12月-2010年12月收治的68例腰椎间盘突出症患者采用硬膜外腔注药配合手法治疗。结果本组68例患者中,治愈43例,好转20例,无效5例,总有效率为92.6%。结论硬膜外腔注药配合手法治疗腰椎间盘突出症的疗效确切,明显减轻了患者的痛苦,患者易于接受,无明显不良反应,是一种治疗腰椎间盘突出症的安全、有效方法。     

硬膜外自控镇痛用于痔瘘手术后临床观察

目的:观察研究硬膜外自控镇痛(PCEA)对痔瘘术后疼痛的疗效等.方法:对102例痔瘘术后患者采用PCEA行术后镇痛治疗.结果:镇痛效果优良率达95.10%,术后生活质量亦明显改善.结论:硬膜外自控镇痛用于痔瘘手术后镇痛效果显著、安全,值得临床推广.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.