青光眼滤过手术后浅前房的治疗和预防

青光眼滤过手术后浅前房的治疗和预防山东医科大学附属医院（２５００１２）张芳，李运我们统计青光眼滤过手术７２例７６眼．其中原发性青光眼７４眼（急性闭角型青光眼２８眼．慢性闭角型青光眼４４眼．开角型青光眼２眼）．继发青光眼２眼。均在显微镜下行小梁切除术。...     

青光眼小梁切除术后并发浅前房的治疗

青光眼小梁切除术后并发浅前房在临床上比较常见，如不及时处理，会导致滤过泡消失、角膜水肿、虹膜前后粘连、前房角关闭、白内障形成等严重并发症。2000年3月至2003年8月，在我院行青光眼小梁切除术者92例100只眼。其中36眼并发浅前房，经采用相应治疗，恢复良好。现报告如下。     

青光眼小梁切除术后浅前房的原因及治疗

目的探讨青光眼小梁切除术后浅前房的原因及治疗。方法对2003年1月—2008年12月135例(170眼)小梁切除术后浅前房24例(28眼)进行回顾性分析。结果青光眼小梁切除术后浅前房24例(28眼)发生率为18%。发生原因:滤过性强15例,结膜漏8例,脉络膜脱离3例,其中,5眼行手术治疗,其他患者采用加压包扎、散瞳、抗炎、甘露醇静脉滴注保守治疗前房恢复。结论浅前房是青光眼小梁切除术后早期的主要并发症,术前降压、术中操作精细、切口对合准确、术终重建前房,术后密切观察、早发现、及时恢复前方,是手术成功的关键。     

青光眼滤过术后浅前房原因分析

青光眼滤过术后浅前房是一种常见的并发症,如不及时处理可导致角膜水肿、变性,虹膜前后粘连,房角闭塞,白内障、滤过泡消失等并发症。因此,尽早明确青光眼术后浅前房的原因并及时予以治疗十分重要。2000年9月-2005年9月,我们对121例（136眼）青光眼患者行青光眼滤过术．术后发生浅前房35例（37眼,27．21％）,现将发生原因分析并报告如下。     

青光眼术后浅前房原因分析及处理

青光眼滤过手术后引起浅前房是常见的并发症 ,轻者一般 1周左右恢复前房 ,重者出现前房消失 ,严重或长期前房不形成者 ,则会引起角膜内皮失代偿、水肿、白内障、虹膜前粘连、青光眼手术失败等严重的后果。为此 ,我们对 90例 10 0眼青光眼术后发生浅前房的情况及处理措施进行分析 ,现报告如下。一般资料 :本组 90例 10 0眼中 ,男 6 6例 ,女 2 4例 ;年龄30～ 80岁 ,平均为 46 .7岁。原发性闭角型青光眼 6 5眼 ,原发性开角型青光眼 32眼 ,混合型青光眼 1眼 ,继发性青光眼 2眼。 10 0眼中 70眼行小梁切除术 ,10眼术中使用丝裂霉素 C,10眼行小梁…     

检查浅前房对青光眼早期诊断及治疗的临床意义

目的探讨浅前房在临床检查中对青光眼早期干预及治疗的意义。方法采用系列病例研究,对32岁以上浅前房的人群进行眼压、视野、暗光线下的UBM的检查,并进行统计学检验。结果符合入选条件共有97例,包括194只眼,原发性前房角关闭(PAC 20.1%),闭角型青光眼(PACG,14.4%)。结论解剖的窄前房角(ANA)在临床检查中是不容忽视的,对提高人们的生活质量意义重大。     

改良小梁切除术治疗青光眼92例临床观察

目的 观察改良小梁切除术治疗青光眼的临床疗效.方法 将186例青光眼患者随机分为观察组92例(156眼)和对照组94例(160眼),对照组行传统小梁切除术;观察组行改良小梁切除术,手术要点为术中加固巩膜瓣缝合、应用丝裂霉素及可松解缝线.术后随访3个月～1 a,观察两组眼压、前房形成、滤过泡形态及并发症发生情况.结果 术后第1天浅前房发生率观察组和对照组分别为4%、20%(P＜0.05);术后1 a观察组和对照组功能性滤过泡分别占89%、66%,眼压控制在21 mmHg以下者分别为95%、67%,P均＜0.05.结论 改良小梁切除术可减少巩膜瓣瘢痕、主动调节房水过量、促进功能性滤过泡形成,并减少并发症发生,利于提高手术成功率.     

综合疗法治疗儿童外伤性前房积血36例疗效观察

儿童外伤性前房积血临床较常见,少量积血可很快吸收,愈合良好;但大量积血可引起继发性青光眼、角膜血染等并发症,造成视功能损害。2005—2008年,我院采用综合疗法治疗儿童外伤性前房积血36例,疗效较满意。现报告如下。     

青光眼滤过术后浅前房的发生原因及处理方法

回顾分析204例（294只眼）行青光眼滤过性手术后发生浅前房的原因、类型及处理方法。发现其常见原因为房水滤过过畅、结膜瓣渗漏及睫状体脉络膜脱离；大多数浅前房可通过保守疗法治愈。     

青光眼术后浅前房68例临床分析

浅前房是青光眼术后常见的手术并发症,现对1998年1月~2004年12月68例青光眼术后浅前房患者的临床资料分析如下。临床资料:本组68例(86眼)青光眼术后浅前房患者,男29例,女39例;年龄8~72岁,平均58岁。单眼50例,双眼18例;右眼56例,左眼34例。浅前房发生时裂隙灯下Speath分级为Ⅰ级     

Prostanoids in the Therapy of Glaucoma

Elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma, which is a progressive optic neuropathy. Lowering IOP is currently the only therapeutic approach to the therapy of glaucoma. Since the use of pilocarpine eye drops for glaucoma treatment was reported in the late 1870s, academic researchers and pharmaceutical companies attempted to discover new drugs with more potent, prolonged, and safer IOP‐reducing effects. These persistent efforts finally paid off, and prostanoids with FP‐receptor agonist activity were found to be very potent IOP‐lowering agents. To date, three prostanoids (latanoprost, travoprost and bimatoprost) have been launched in many countries, and now a new FP‐receptor agonist, tafluprost, is entering clinical development. All of these prostanoids are superior to the β‐adrenoceptor antagonists in their IOP‐lowering efficacy, and no severe side effects have been reported in their long‐term clinical use. In addition, tafluprost may be expected to improve ocular blood flow. Hence, prostanoids currently occupy center stage among glaucoma medications. It cannot be denied that in terms of efficacy, safety, patient compliance, and medical economy prostanoids are currently the first‐line medicines among ocular antihypertensive drugs.     

Antidepressant Effects of Electroconvulsive Therapy Correlate With Subgenual Anterior Cingulate Activity and Connectivity in Depression

The mechanisms underlying the effects of electroconvulsive therapy (ECT) in major depressive disorder (MDD) are not fully understood. Resting-state functional magnetic resonance imaging (rs-fMRI) is a new tool to study the effects of brain stimulation interventions, particularly ECT. The authors aim to investigate the mechanisms of ECT in MDD by rs-fMRI.They used rs-fMRI to measure functional changes in the brain of first-episode, treatment-naive MDD patients (n = 23) immediately before and then following 8 ECT sessions (brief-pulse square-wave apparatus, bitemporal). They also computed voxel-wise amplitude of low-frequency fluctuation (ALFF) as a measure of regional brain activity and selected the left subgenual anterior cingulate cortex (sgACC) to evaluate functional connectivity between the sgACC and other brain regions.Increased regional brain activity measured by ALFF mainly in the left sgACC following ECT. Functional connectivity of the left sgACC increased in the ipsilateral parahippocampal gyrus, pregenual ACC, contralateral middle temporal pole, and orbitofrontal cortex. Importantly, reduction in depressive symptoms were negatively correlated with increased ALFF in the left sgACC and left hippocampus, and with distant functional connectivity between the left sgACC and contralateral middle temporal pole. That is, across subjects, as depression improved, regional brain activity in sgACC and its functional connectivity increased in the brain.Eight ECT sessions in MDD patients modulated activity in the sgACC and its networks. The antidepressant effects of ECT were negatively correlated with sgACC brain activity and connectivity. These findings suggest that sgACC-associated prefrontal-limbic structures are associated with the therapeutic effects of ECT in MDD.     

An Unusual Complication of Paracentesis

Paracentesis is an important and commonly performed procedure in patients with ascites. It is a safe procedure when carried out in the midline below the umbilicus, with a complication rate of less than 1%. We report an instance in which a large midline varix was entered during paracentesis. The utility of different imaging techniques in detecting such anomalies in the portal hypertensive patient with portal hypertension and ascites is discussed. The approach and management of this complication are outlined.     

Reduced Albumin Dosing During Large-Volume Paracentesis Is Not Associated with Adverse Clinical Outcomes

Digestive Diseases and Sciences - LVP is used to manage diuretic-resistant ascites in cirrhotic patients. Albumin administration prevents complications including acute kidney injury and...     

舒血宁注射液治疗不稳定型心绞痛的临床疗效观察

目的观察舒血宁注射液治疗不稳定型心绞痛（UAP）的临床疗效。方法：80例UAP患者随机分为观察组、对照组。两组患者在入院后均根据病情给予常规治疗,观察组在常规治疗基础上给予舒血宁注射液。观察治疗前后心绞痛发作频率、静息心电图、血压、心率以及心肌耗氧量的变化。结果观察组心绞痛总有效率为90％,心电图疗效总有效率为96％,对照组心绞痛疗效总有效率为73．3％,心电图疗效总有效率为80％。两组比较有统计学意义（P〈0．05）。结论：舒血宁注射液可有效治疗UAP患者,值得推广应用。     

疏肝健脾软坚合剂抗肝纤维化的临床疗效探讨

目的 :探讨中药疏肝健脾软坚合剂对慢性病毒性肝炎所致肝纤维化的临床治疗效果。方法 :将采用放射免疫法 (RIA)测定的血清肝纤维化指标 [透明质酸 (HA)、层黏蛋白 (LN)及Ⅲ型前胶原 (PCⅢ )等 ]明显异常的慢性病毒性肝炎患者 76例 ,随机分为治疗组及对照组。治疗组 3 8例患者服中药疏肝健脾软坚合剂 ,对照组 3 8例患者口服和络舒肝胶囊 ,观察治疗后肝功能及肝纤维化指标的变化。结果 :两组患者血清HA、LN、PCⅢ等肝纤维化指标治疗后均有改善 ,但治疗组恢复程度明显优于对照组 (P <0 0 1) ,而从肝功能比较亦有一定差异性 (P <0 0 5 )。结论 :疏肝健脾软坚合剂抗肝纤维化疗效显著     

Hemorrhagic Complications of Large Volume Abdominal Paracentesis

The incidence of hemorrhagic complications from large volume paracentesis in patients with cirrhosis and portal hypertension is unknown. We have reviewed the cases of 179 outpatients undergoing large volume paracentesis at our institution during a 1-yr period. Of these 179 patients, four developed severe hemorrhagic complications requiring hospital admission and blood transfusion. Three of these patients developed intraperitoneal hemorrhage, one of which was localized to the paracentesis puncture site. One patient experienced an abdominal wall hematoma, localized by ultrasound. The symptoms and signs of hemorrhage became evident anywhere from hours up to 1 wk after completion of the paracentesis procedure. The mechanism of delayed hemorrhage is not known but may relate to the rupture of large intra-abdominal venous collaterals in these patients. The literature does not support a correlation between degree of coagulopathy or thrombocytopenia and risk of bleeding in this setting. To promote early detection of this potentially life-threatening complication, a mechanism should exist for close outpatient follow-up of patients after large volume paracentesis.     

脑脊液置换术治疗蛛网膜下腔出血临床研究

目的探讨脑脊液置换术治疗蛛网膜下腔出血的临床效果。方法将80例蛛网膜下腔出血患者随机分治疗组及对照组,各40例,治疗组在常规治疗的基础上进行脑脊液置换术治疗,对照组使用单纯的常规治疗。结果治疗组治疗的有效例数与对照组比较差异有统计学意义。治疗组中有头痛颈强者21例,持续时间6～12.5d,对照组头痛颈强持续时间14～21d,两组比较差异有统计学意义。治疗组中表现不同意识障碍者6例,经置换2～3次最短在4d内意识恢复正常,对照组意识障碍11例,意识障碍恢复时间6～14d,两组比较有显著差异。蛛网膜下腔出血3大并发症脑血管痉挛、脑积水、脑梗死,治疗组与对照组比较,均有显著差异。结论脑脊液置换术治疗蛛网膜下腔出血,能减少脑血管痉挛、脑积水、脑梗死等并发症,有利于患者恢复,操作简单易行、安全,疗效显著,值得临床推广应用。     

奥美拉唑和泮托拉唑对氯吡格雷抗血小板效应的影响

目的:探讨在中国人群中奥美拉唑、泮托拉唑是否降低氯吡格雷的抗血小板效应.方法:接受择期冠状动脉介入治疗或药物治疗的急性冠状动脉综合征患者在常规氯吡格雷、阿司匹林治疗基础上,将患者随机分为奥美拉唑组(奥美拉唑40 mg/d,n=30)和泮托拉唑组(泮托拉唑40 mg/d,n=30),分别于治疗前及治疗后7天抽血测定血管扩张刺激磷蛋白(VASP)磷酸化水平计算血小板反应性指数(PRI)及二磷酸腺苷诱导的血小板聚集率(ADP-Ag),并观察30天的主要心血管事件.结果:两组一般资料比较差异无统计学意义(P>0.05);奥美拉唑组治疗后第7天与治疗前相比血小板聚集率及血小板反应性指数数值均显著下降,差异有统计学意义(P<0.05～0.01);泮托拉唑组治疗后第7天与治疗前相比血小板聚集率数值显著下降,差异有统计学意义(P<0.01),但血小板反应性指数与治疗前相比差异无统计学意义(P>0.05).两组组间治疗后第7天和治疗前血小板聚集率及血小板反应性指数比较差异均无统计学意义(P>0.05);两组的30天主要不良心血管事件差异无统计学意义(P>0.05).结论:奥美拉唑对双联抗血小板治疗效应无明显影响,但泮托拉唑可能具有抑制氯吡格雷的抗血小板治疗实验室效应.