基于CDASH标准的肿瘤临床试验病例报告表设计

目的:探讨基于临床数据获取协调标准(clinical data acquisition standards harmonization, CDASH)的肿瘤临床试验病例报告表(case report form, CRF)的设计意义、方法及内容。方法:对照CDASH v 2.2,分析肿瘤临床试验数据特点,设计符合肿瘤临床试验实际需求的标准化CRF。结果:将CDASH标准应用到肿瘤临床试验CRF的设计中,规范肿瘤临床试验数据采集,以使肿瘤临床试验CRF设计相对标准化,提升数据质量。结论:执行基于CDASH标准的肿瘤CRF设计,能够促进肿瘤临床研究数据交换、共享,有利于提升肿瘤临床研究结果可靠性。     

CBL教学模式在心血管内科临床见习教学中的应用

以病例为基础的学习(case based learning,CBL)是基于以问题为基础的学习(problem based learning,PBL)发展而来的全新教学模式,它是“以问题为引导、典型病例为中心”的小组讨论式教学法.本文拟以急性心肌梗死教学为例,初步探讨CBL教学模式在心血管内科临床见习教学中的应用.     

难治性Graves病介入治疗的临床研究

Graves病是甲状腺功能亢进(简称甲亢)中最常见的类型,近年来有逐渐增高的趋势。传统的内、外科治疗和131Ⅰ治疗均有部分病例疗效不佳或有可能发生多种并发症。为此,我们对内科治疗效果差的部分病例,采用甲状腺动脉栓塞的治疗方法,进行了临床观察,现报道如下。     

巯甲丙脯酸的多晶型现象

Some properties of captopril have been investigated by XRD, IR, HNMR, DTA and TLC methods. According to the experimental results, two different crystal forms were found. The crystal products consist of high melting form (rap 103～105℃)and low melting form (rap 84～86℃) and the latter form can be transformed into the former form under proper conditions.     

病例报告表的设计及其常见问题分析

病例报告表(Case report form,CRF)是临床试验中收集药物有效性和安全性数据的载体,其设计是否科学严谨直接关系到整个临床试验的成败.本文简介了CRF的设计过程及临床数据采集标准(Clinical data acquisition standards harmonization,CDASH),并对临床试验CRF设计中容易出错的模块和其他常见问题进行分析和说明.     

腹腔镜下脾切除及手助腹腔镜下脾切除的临床研究

目的探讨手助腹腔镜下脾切除术的疗效。方法回顾性分析65例行手助腹腔镜下脾切除治疗患者的临床资料,观察其疗效及并发症情况。结果本组65例患者均顺利完成手术,平均手术时间(156±36)min,平均出血量(216±58)ml,平均住院时间(6.8±2.5)d。无术后并发症,无中转开腹,无死亡病例。结论手助腹腔镜下脾切除术,不但保留了腹腔镜手术的微创特点,而且扩大了手术的适应证,且手术时间短,术后恢复快,是一种安全有效的外科手术方法。     

依达拉奉治疗102例急性脑出血的临床研究

目的分析依达拉奉治疗急性脑出血的价值。方法选取我院保守治疗203例急性脑出血病例作受试对象,随即分成对照组101例(常规治疗)和研究组102例(常规治疗联合依达拉奉),依据Glasgow评分变化对比两组的神经功能改善情况。结果研究组神经功能改善率(84.31%)显著优于对照组(71.29%),P<0.05,数据存在明显差异。结论依达拉奉能够促进急性脑出血患者神经功能恢复,建议推广。     

急性结石性胆囊炎急诊手术与延期手术的疗效比较

Objective Through comparing the curative effects of urgent and delayed laparoscopic cholecystectomy (LC) on acute calculous cholecystitis,evaluating the safety and feasibility of urgent LC for acute calculous cholecystitis.Mthods 109 patients with a clinic diagnosis of acute calculous cholecystitis were randomly assigned to urgent LC (urgent group,n=55) or delayed interval surgery after initial medical treatment (delayed group,n=54,but with some reasons there only 40 patients were treated by delayed surgery).According to the operation time within 72 hours of admission or not,the urgent group was divided into two groups:37 patients in Group Ⅰ (within 72 hours) and 18 patients in Group Ⅱ (beyond 72 hours).The operation time,bile duct injury,conversion to open cholecystectomy,total hospital stay,postoperative complications and mortality of the perioperative period were compared.Results There was no difference between the urgent LC group and delay LC group in the operating time[ (91±26.2 )min versus( 104±34.7 )min],bile duct injury (1 case versus 0 case),conversion to open cholecysteetomy (3case versus 4 case),total hospital stay[ (8±2.7) day versus( 8±1.2 )day]and postoperative complications (2 case versus 1 case).The delay in performing an LC beyond 72 h affected the operating time and conversion to open eholeeystectomy.No death in perioperative period.Conclusion Urgent LC for acute calculous cholecystitis can be performed safely and successfully.Earlier urgent LC has a beneficial impact for patients.     

PBL教学模式与临床病例讨论在病理学教学中的应用体会

病理学是一门联系基础医学和临床医学的桥梁学科。传统的教学模式无法充分调动学生的学习积极性,难以适应本科教学的要求。笔者在教学过程中尝试以问题为基础(problem based learning,PBL)的教学模式与临床病例讨论(clinic case conference,CCC)相结合,以具体典型病例为线索,以学生独立思考解决问题为主、教师引导总结为辅,精心组织编排并实施教学计划。通过积极的师生互动,极大地提高了学生的学习自觉性、培养了学生的探索性思维和归纳总结能力,取得了良好的教学效果,使学生对病理学科产生了浓厚兴趣。     

海捷亚对轻中度原发性高血压疗效和安全性的临床研究

海捷亚(hyzzar)是第一个血管紧张素 受体拮抗剂和利尿剂组成的复方降压制剂,每片含氯沙坦5 0 mg和氢氯噻嗪12 .5 m g,本研究采用福辛普利(fosinopril,蒙诺)作为对照组,初步评价海捷亚对轻中度原发性高血压的降压疗效及安全性。1　资料与方法1.1　病例选择:按1999年世界卫生组织     

阿奇霉素治疗小儿支原体肺炎的临床研究

目的研究阿奇霉素对小儿支原体肺炎的临床治疗效果。方法采用病例对照研究的方法,比较两组在治疗小儿支原体肺炎过程中主要症状消失或缓解的时间、住院时间和治疗效果。结果治疗组咳嗽停止的时间为(6.41±1.52)d,明显少于对照组的(7.72±1.62)d,两组比较差异有统计学意义(P<0.05)。治疗组的住院时间为(6.62±1.34)d,明显少于对照组的(8.41±1.65)d,两组比较差异有统计学意义(P<0.05)。治疗组总有效率为94.44%,明显高于对照组的76.32%,两组比较差异有统计学意义(P<0.05)。对照组不良反应发生率为26.32%,治疗组不良反应发生率为8.33%,二者比较差异有统计学意义(P<0.05)。结论阿奇霉素对治疗小儿支原体肺炎具有较好疗效。     

TWINFIX钛合金带线锚钉修复MCL断裂的临床研究

目的探讨TWINFIX带线锚钉在MCL损伤修复和重建中的临床应用价值。方法回顾性分析我院收治的48例MCL损伤患者病例资料,所有病例均行TWINFIX带线锚钉修复和重建MCL,术后膝关节用石膏托固定于中立位并保证轻度内翻,观察其近期和远期疗效。结果 48例患者术后切口均愈合良好,术后6个月膝关节功能Lysholm评分(95.3±5.8),与术前(27.4±8.4)比较差异有统计学意义(P<0.01);其中优42例,良4例,可2例。术后Lysholm评分各指标均高于术前,差异均有统计学意义(P<0.01)。结论 TWINFIX带线锚钉能显著提高MCL损伤的近期和远期临床疗效,在MCL损伤的修复和重建中具有重要的临床应用价值。     

微创非体外循环下经胸小切口继发孔房间隔缺损封堵术失败后转外科修补手术的临床分析

Objective To assess the therapeutic methods and results of surgical closure of atrial septal defect (ASD) after the failure of occlusion therapy via non-cardiopulmonary bypass (CPB)-minimally invasive intercostal incision (MⅢ). Methods From January 2008 to December 2008, twelve patients from 268 patients underwent occlusion therapy via non-CPB- MⅢ, were performed surgical closure of ASD after the failure of occusion. The causes accounting for the transition consist of introoperative or postoperative dislodgment of occusion device in 6 cases and 1 case respectively, infeasibility in 3 cases, Ⅲ °atrio-ventricular block (AVB) in 1 case and residual shunt in 1 case. All patients underwent the removal of occlusion device and surgical closure of ASD. Results The mean stretched diameter of the ASD (28.6 ± 6.2 mm) was significantly larger ( P ＜ 0.01 ) than that measured by transesophageal echocardiography (TEE) (24.3 ±4.1 mm). The pathological type of ASD was confirmed with the inferior vena cava type in 4 cases of introoperative dislodgment of occusion device, the central tyepe in 2 cases and 1 case of introoperative or postoperative dislodgment repectively, the sieve pore type in 1 cases infeasible to occlusion, and with thin marginal tissue in 1 case with residual shunt. Sinus rhythm was postoperatively observed in all patients. No perioperative mortality and postoperative residual shunt was found. Conclusion Surgical treatment should be performed in time after the failure of occlusion to achieve a good outcome.     

微创非体外循环下经胸小切口继发孔房间隔缺损封堵术失败后转外科修补手术的临床分析

Objective To assess the therapeutic methods and results of surgical closure of atrial septal defect (ASD) after the failure of occlusion therapy via non-cardiopulmonary bypass (CPB)-minimally invasive intercostal incision (MⅢ). Methods From January 2008 to December 2008, twelve patients from 268 patients underwent occlusion therapy via non-CPB- MⅢ, were performed surgical closure of ASD after the failure of occusion. The causes accounting for the transition consist of introoperative or postoperative dislodgment of occusion device in 6 cases and 1 case respectively, infeasibility in 3 cases, Ⅲ °atrio-ventricular block (AVB) in 1 case and residual shunt in 1 case. All patients underwent the removal of occlusion device and surgical closure of ASD. Results The mean stretched diameter of the ASD (28.6 ± 6.2 mm) was significantly larger ( P ＜ 0.01 ) than that measured by transesophageal echocardiography (TEE) (24.3 ±4.1 mm). The pathological type of ASD was confirmed with the inferior vena cava type in 4 cases of introoperative dislodgment of occusion device, the central tyepe in 2 cases and 1 case of introoperative or postoperative dislodgment repectively, the sieve pore type in 1 cases infeasible to occlusion, and with thin marginal tissue in 1 case with residual shunt. Sinus rhythm was postoperatively observed in all patients. No perioperative mortality and postoperative residual shunt was found. Conclusion Surgical treatment should be performed in time after the failure of occlusion to achieve a good outcome.     

急性脑卒中77例临床处理探讨

目的分析急性脑卒中患者临床处理原则与方法。方法采用外科手术治疗及内科保守治疗对不同患者进行治疗,手术方式含开颅血肿清除术、脑室外引流术等;内科治疗方案含脱水降颅压、减轻水肿、控制血压,并采取相应措施并发症。结果本组中痊愈43例(55.8%),有效24例(31.2%),无效2例(2.6%),死亡8例(10.4%)。死亡病例中,出血性卒中6例,多因脑疝、颅内高压;结论随着诊疗技术不断进步与发展,积极有效的临床处理在降低病死率、改善预后中具有重要意义。     

彩超诊断川崎病冠状动脉病变的价值与影像学研究

目的研究分析彩色超声在小儿川崎病冠状动脉病变的诊断及病情监测中的价值与临床意义。方法回顾性分析104例川崎病患儿发病不同阶段的彩色超声诊断,重点分析左右冠状动脉主干。结果初发病例中,发现冠状动脉扩张(CAD)86例(82.69%),冠状动脉瘤(CAA)10例(6.92%),巨大冠状动脉瘤(BCAA)2例(1.92%),冠状动脉血栓或狭窄6例(5.77%),随着病程进展及治疗,CAD和CAA比例逐渐下降,而冠状动脉血栓和狭窄比例逐渐增高。结论利用彩色超声诊断及随访川崎病冠状动脉病变,具有准确、方便、安全的特点,早期诊断和治疗对预后有重要临床研究价值。     

结肠癌伴肝转移28例手术治疗临床研究

目的分析关于结肠癌伴肝转移手术治疗效果。方法回顾我院2010年3月至2014年5月收治的结肠癌同时性肝转移病例28例,分为治疗组与对照组,每组14例,治疗组采用手术治疗,对照组采用保守治疗。结果治疗组采用手术治疗后无死亡病例,而且治疗组1、3、5年累积生存率比对照组采用保守治疗后的累积生存率高,并且生存率和中位生存时间有显著性影响(P<0.05)。结论采用的手术方式治疗结肠癌伴同时性肝转移患者疗效明显,生存时间相对较长,是治疗结肠癌肝转移的重要方案之一。     

纳络酮治疗乙型脑炎的临床研究

我院对1996年7月～1998年8月收治的106例流行性乙型脑炎(乙脑)进行了血浆和脑脊液(ＣＳＦ)中亮氨酸脑啡肽(ｌｅｕ脑啡肽)含量的测定,并对其中56例进行纳络酮治疗,现将结果报告如下。资料与方法一、病例选择　106例病人随机分为两组。纳络酮治疗组56例,男32例,女24例,年龄6个月～12岁,平均39±28岁,轻型7例,普通型39例,重型10例。对照组50例,男26例,女24例,年龄9个月～12岁,平均38±28岁,轻型8例,普通型34例,重型8例。所有病例均符合《传染病学》诊断分型标准。二、治疗方法　纳络酮002ｍｇ·ｋｇ-1·次-1,用10%葡萄糖液或注射用水稀释后静脉…     

龙掌口含液用于感染牙根管消毒的临床研究

用中药酊剂进行根管消毒,能避免原根管消毒剂很多副作用及不足之处[１,２,3］。龙掌口含液原主要用作口腔病消炎止痛的含漱用中药酊剂产品,有较好消炎止痛效果。作者将其用于感染牙根管消毒,经细菌学培养和7年系统临床观察,收到较好的治疗效果,现报导如下。1 材料与方法1.1 实验药物 治疗组为龙掌口含液(贵阳新天药业有限公司出品[黔卫准药字(1996)100090号］),对照组为甲醛甲酚(FC)、樟脑酚(CP)、甲硝唑3种药物。1.2 细菌实验病例 我院牙体科门诊确诊为牙髓坏死或尖周病者48例,男28例,女20例,年龄23～56岁,平均32.4岁。随机…     

激光治疗大隐静脉曲张134例临床分析

目的:评价血管腔内激光治疗大隐静脉曲张(ELVT)的临床疗效.方法:通过2004年9月-2008年3月间腔内激光治疗的134例大隐静脉曲张病例对比以往传统手术(大隐静脉高位结扎+分段剥脱术),比较两组手术时间、术中出血量、术后下床活动时间、住院天数,疼痛程度及术后复发例数等指标.结果:研究组手术时间、术中出血量、术后下床活动时间,平均住院天数均显著低于对照组(P<0.01),疼痛程度亦明显低于对照组;而两组术后复发例数相比差异无统计学意义.结论:血管腔内激光治疗大隐静脉曲张这一新疗法的临床综合疗效明显优于传统手术方法,具有微创、无瘢痕、疼痛轻、复发率低等优点.