依托咪酯与普鲁泊福在困难气管纤维支气管镜引导插管时安全性比较

Objective To investigate the risk factors and anticoagulation parameters in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with deep venous thrombosis (DVT). Methods All of 110 AECOPD patients were divided into two groups according to Doppler examination of lower extremities: DVT group and non-DVT group. The risk factors and anticoagulation parameters were compared. Results Twelve cases (10.9%) were in DVT group,of whom 2 cases (1.8%)had pulmonary embolism. The rate of lying in bed > 3 d, smoke, mechanical ventilation, hospital stays and the levels of PaCO2 were significantly higher in DVT group than those in non-DVT group (P < 0.01 or <0.05 ). In DVT group, the activity of antithrombin Ⅲ and the level of protein S decreased (P < 0.05 ), and the level of D-Dimer increased (P < 0.05). Conclusions Long-term bed, smoke and mechanical ventilation requirement are the main risk factors of DVT in patients with AECOPD. Respiratory failure (type Ⅱ ) is easier to combine with DVT. Abnormality of coagulation and fibrinolytic system exists in AECOPD with DVT.     

慢性阻塞性肺疾病急性加重期合并深静脉血栓形成危险因素及抗凝因子检测

Objective To investigate the risk factors and anticoagulation parameters in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with deep venous thrombosis (DVT). Methods All of 110 AECOPD patients were divided into two groups according to Doppler examination of lower extremities: DVT group and non-DVT group. The risk factors and anticoagulation parameters were compared. Results Twelve cases (10.9%) were in DVT group,of whom 2 cases (1.8%)had pulmonary embolism. The rate of lying in bed > 3 d, smoke, mechanical ventilation, hospital stays and the levels of PaCO2 were significantly higher in DVT group than those in non-DVT group (P < 0.01 or <0.05 ). In DVT group, the activity of antithrombin Ⅲ and the level of protein S decreased (P < 0.05 ), and the level of D-Dimer increased (P < 0.05). Conclusions Long-term bed, smoke and mechanical ventilation requirement are the main risk factors of DVT in patients with AECOPD. Respiratory failure (type Ⅱ ) is easier to combine with DVT. Abnormality of coagulation and fibrinolytic system exists in AECOPD with DVT.     

预注帕瑞昔布用于腹腔镜疝修补术后镇痛的效果

Objective To investigate the effect of pretreatment with parecoxib for postoperative analgesia in patients undergoing laparoscopic hernia repair. Methods Sixty patients undergoing laparoscopic hernia repair were assigned in two groups by random digits table with 30 cases each. The patients in pretreating group received parecoxib 40 mg intravenously before anesthesia, and in control group with the same capacity of normal saline. All patients were anesthetized with combined spinal epidural blockage and tranquilized with pethidine, droperidol and diazepam. Postoperative pain of the abdomen incision was assessed by visual analogue scale (VAS) and the pain of shoulder or back was judged by a 4 grade scale. Side-effects, supplement analgesic, passage of gas by anus 24 h after surgery were observed as well. Results The abdomen incision VAS at 4,8,12,24 h after surgery in pretreating group were lower than those in control group (P ＜ 0.05). And the incidence of pain of shoulder or back was lower in pretreating group (13.3% ,4/30) than that in control group (33.3% ,10/30)(P ＜0.05). While the cases needing supplement analgesic also decreased in pretreating group (13.3% ,4/30) compared with control group (40.0%, 12/30)(P ＜ 0.05). And the side effects and passage of gas by anus 24 h after surgery had no significant difference in two groups. Conclusion Pretreatment with parecoxib in patients undergoing laparoscopic hernia repair may relieve the postoperative incision pain and the pain of shoulder or back while reducing the analgesic supplement without side effects.     

诺维本与顺铂治疗非小细胞肺癌

To evaluate the effect by “standard/chem otherapy with navelbine (NVB) plus cisplatin (PDD) in the treatment of nonsm all cell lung cancer (NSCLC). ”Methods There were 40 NSCLC patients in this study. 38 were male and 2 female. The median age of the patients was 52 years old. Squam ous carcinom a was the most conmon type of malignancy (36 cases).Sixteen patients were inthe stage Ⅲ a and 20 patients in stage Ⅲb-Ⅳ Twenty patients had no prior chemotherapy and 20 received previous chemotherapy. Results Complete response was observed in 4 patients and partial response in 15 patients. The overall response rate was 47.5 %. The response rate of the primary chemothera-py was 60%. The secondary chemotherapy was 35%. The main toxity of NVB was neutropenia which was seen in all treated cases (80.5 % in Grade Ⅱ and Ⅲ) The local venous toxity was observed in 35 % of the patients. Conclusion The so-called standard chemotherapy with NVB plus PDD in the treatment of NSCLC may obtain a higher response rate and lower toxity. It is effective especially for the patients of in an earlier stage.     

下肢动脉旁路移植术后人工血管闭塞的再手术治疗

目的 总结下肢动脉旁路移植术后人工血管闭塞的再手术治疗经验.方法 回顾性分析21例下肢动脉旁路移植术后人工血管闭塞患者再手术的治疗效果.结果 21例患者术后均获随访,随访时间6～36(12±3)个月.肢体存活率71.4%(15/21),截肢率28.6%(6/21),9例最后通过股深动脉供血的患者肢体全部存活.结论 下肢动脉旁路移植术后人工血管闭塞的主要原因是内膜增生或流人道及流出道的狭窄闭塞,再手术前应仔细分析闭塞原因以选择合适的手术方式.股深动脉重建对于人工血管闭塞的再手术治疗非常重要.

Abstract：

Objective To review reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs. Method The treatment effect of 21 patients with reoperation on blood vessel prothesis occlusion after arterial bypass graft in lower limbs was analyzed retrospectively. Results All the cases were followed up 6-36 (12 ±3) months. The limb salvage rate was 71.4%(15/21) ,the amputation rate was 28.6% (6/21). All 9 limbs that underwent revascularization from deep femoral artery reserved. Conclusions Endomembrane hyperplasy, occlusion of the inflow and outflow tracts are the major reasons for the occlusion of blood vessel prosthesis after arterial bypass graft in lower limbs. Appropriate procedures should be based on careful consideration of the occlusion reasons. Profundaplasty is an effective therapy for those who are treated by reoperation on blood vessel prosthesis occlusion in lower limbs.     

髋臼骨折的手术治疗

目的 探讨髋臼骨折的手术方法和疗效.方法 2001年3月至2006年3月共手术治疗髋臼骨折患者41例.按照Letournel-Judet分型,简单型22例,复杂型19例,采用K-L入路31例(其中14例附加大转子截骨)、髂腹股沟入路8例,前后联合入路2例.重建钢板和螺钉固定.结果 随访16～36(24.31±5.31)个月,根据Matta影像学评分标准,解剖复位27例,良好复位8例,差3例,关节轮廓复位3例.根据Merle D'Aubigne临床评定标准:优14例,良18例,一般5例,差4例,优良率78%(32/41).股骨头坏死3例,异位骨化4例,创伤性关节炎3例,坐骨神经损伤4例,股神经损伤1例,神经损伤均在6个月内恢复.下肢深静脉栓塞3例,溶栓后恢复.无死亡病例,无感染、骨折不愈合等并发症.结论 大多数髋臼骨折的手术可以通过单一的K-L入路或髂腹股沟入路完成显露.双钢板或单钢板+拉力螺钉固定牢靠,可以满足髋关节早期功能锻炼的需要.

Abstract：

Objective To investigate the method and curative effect for the operative treatment of acetabular fractures.Methods Forty-one patients with acetabular fractures were treated operatively from March 2001 to March 2006.All fractures were classified according to the Letournel-Judet classification,22cases were simple fractures and 19 cases were complicated fractures.Kocher-Langenbeck (K-L) approach were adopted in 31 cases (14 cases through osteotomy of greater trochanter additionally),ilioinguinal approach were adopted in 8 cases and anterior combined posterior approach were adopted in 2 cases.Different fractures were fixed by reconstructive plates and screws.Results All the patients were followed up for 16-36 (24.31 ± 5.31 ) months.According to the reduction criteria of Matta radiography,there were 27 cases with anatomic reduction,8 cases with satisfactory reduction,3 cases with poor reduction and 3 cases with joint contour reduction.According to the Merle D' Aubigne clinical criteria for joint functions,14 cases showed excellent results,18 cases were good,5 cases were fair and 4 cases were poor,and the excellent-good rate was 78%( 32/41 ).Necrosis of the femoral head was found in 3 cases,heterotopic ossification in 4 cases,traumatic arthritis in 3 cases,sciatic nerve injury in 4 cases,femoral nerve injury in 1 case,all the nerve injury recovered in 6 months.Lower extremity deep venous thrombosis in 3 cases,all of them were recovered by given anticoagulation.No death,infection or nonunion were found.Conclusions K-L approach or ilioinguinal approach are adopted in the most of the operative treatment of acetabular fractures.Dual reconstructive plates or single.reconstructive plate combine lag screws can fix solid.It can make hip to do early exercise.     

112例炎症性肠病患者的营养风险筛查

Objective To assess the nutritional risk of patients with inflammatory bowel disease (IBD).Methods The nutritional status of 112 IBD patients from PUMC Hospital were evaluated by Nutritional Risk Screening 2002 (NRS 2002).Using Chinese standard,a body mass index (BMI) that was lowered than 18.5 kg/m~2 according to clinical material was regarded as malnutrition,and the score was recorded as 3.The se-verity of ulcerative colitis (UC) was evaluated using True-Love criteria as mild,moderate,and severe.Crohn's disease (CD) was evaluated using Harvey-Bradshaw Index as in remission stage (≤4),moderately active stage (4-8),and severely actively stage (≥9).Results All these 112 patients,including 70 UC cases and 42 CD cases,were evaluated by NRS2002.Forty-five patients (40.2%) were judged as at the risk of malnutrition.The incidence of malnutrition was significantly higher in CD patients than in UC patients (52.4% vs.32.9%,P<0.05).It was also significantly correlated with the severity of disease.In patients with severe IBD,the rate of mal-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk.Con-clusions The risk of malnutrition is high in IBD patients.NRS 2002 can be used for nutritional risk screening.     

漂浮电极导管法临时心脏起搏器的围手术期应用

Objective To discuss the application of implantation temporary cardiac pacing by balloon-tipped floating catheter for peroperative period patients. Method Thirty-three patients with severe bradyarrhythmia were received the balloon-tipped floating catheter to RV by Seldinger puncture technique.Meantime, the pacing signals of ECG were observed. The threshold and QRS waves to ensure the electrode position were determined. Result All of 33 cases were successfully punctured and 32 cases get paced, except 1 case had the electro - mechanical dissociation (EMD). Pacing threshold was less than 0. 9V, and mean remaining time was 12.47 ～ 161 (67. 05 ±34. 48) hours. Apical pacing was operated in 23 patients,and right ventricular outflow tract pacing in 10 patients. No severe complications were occurred. Conclusion The implantation method of temporary cardiac pacing by balloon-tipped floating catheter was convenient and safe. It could help the patients get safety in anesthesia and peroperative period.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

血栓前体蛋白在急性缺血性脑血管病早期诊断中的价值

Objective To study the value of thromhus precursor protein(TpP)in early diagnosis of acute ischemic cerebrovascular disease.Methods The patients who showed completely or partly anterior circulation infarcts syndrome and were within 6 hours from onset on admission were observed dynamically.All patients were divided into thrombotic cerebral infarction(TCI)group(40 cases),transient ischemic attack (TIA)group(42 cases), and lacunar infarction(LI)group(37 cases).Concentrations of TpP in plasma obtained from three groups on admission were detected by enzyme linked immunosorbent assay(ELISA),then were compared with each other.The diagnostic value of plasma TpP to TCI within 6 hours from onset was analyzed with ROC curve.Results The level of TpP in TCI,TIA and LI group was(24.43±3.21),(15.51±2.65)and(13.52±5.45)mg/L respectively,and was significantly higher than that of healthy people (3.9±2.5)mg/L(P<0.01).The level of TpP was significantly higher in TCI group than that in TIA and LI group(P<0.01).The level of TpP was significantly higher in TIA group than that in LI group(P<0.01).The area under ROC curve for TpP to diagnose TCI was 0.979±0.013(P<0.01).The level of TpP on optimal cutoff was 19.1 mg/L.When the level of TpP was over 19.1 mg/L,TCI was determined with 95% sensitivity and 96%specificity, sum of which was largest of all.Conclusion The level of TpP can differentiate TCI from TIA and LI within 6 hours from onset.     

急性肢体动脉缺血42例治疗体会

目的探讨急性肢体动脉缺血的临床治疗。方法回顾性分析本院2008年3月～2011年5月收治的42例急性肢体动脉缺血患者的临床资料。30例动脉栓塞急诊行动脉切开Fogarty导管取栓术,11例动脉硬化闭塞症合并血栓形成和1例主动脉夹层行手术联合介入治疗。结果术后肢体存活39例,并发骨筋膜室综合征5例,截肢3例,死亡2例,死亡原因为急性心肌梗死和脑梗死。结论早期诊断、及时选择合理的手术方案和围手术期治疗是降低病死率,预防截肢的关键。     

二维彩色多普勒超声对下肢深静脉血栓的诊断价值

目的：探讨下肢深静脉血栓形成的二维彩色多普勒超声诊断价值。方法：对78例下肢深静脉血栓形成的患者,以实时二维和加压探头观察,彩色血流显示和频谱多普勒检测,观察血栓形成的部位、范围及栓塞程度,并辅以超声诊断性试验。结果：左下肢血栓48例,右下肢血栓24例,双下肢血栓6例。急性下肢静脉血栓54例,慢性下肢静脉血栓24例。结论：彩色多普勒超声对诊断下肢深静脉血栓准确、无创、特异性高,可对血栓的形成及其溶栓治疗过程进行动态观察。     

介入联合静脉溶栓在急性肺栓塞治疗中的应用

目的：探讨介入治疗联合低剂量长时间经静脉溶栓在急性肺栓塞治疗中的效果和安全性。方法对62例急性肺栓塞患者,行肺动脉造影明确栓子部位,应用导管导丝碎栓及团注尿激酶接触性溶栓行介入肺动脉溶栓术。明确有下肢深静脉血栓形成者,介入溶栓术后放置可取出下腔静脉滤器,之后予经上肢浅静脉持续应用尿激酶溶栓治疗3~7 d。观察患者临床症状、肺动脉血栓清除情况、血氧饱和度（SpO2）、动脉血氧分压（PaO2）等指标,术后10 d内行肺动脉CT血管造影（CTA）复查,根据综合情况考虑是否在滤器置入后10~12 d取出滤器。结果本组患者均成功行介入溶栓术及联合静脉溶栓,62例患者治疗后临床症状均明显改善,SpO2及PaO2明显升高;CTA复查肺动脉内血栓完全清除或大部分清除。53例明确有下肢深静脉血栓形成者,介入溶栓术后放置可取出下腔静脉滤器,43例于术后10~12 d取出下腔静脉滤器,无严重手术及溶栓相关并发症。结论介入治疗联合低剂量长时间经静脉溶栓治疗急性肺栓塞是一种安全易行、创伤小、疗效确切的方法。     

Experiences in surgical management of acute arterial occlusions of the lower limb in the course of 20 years

INTRODUCTION: In Hungary surgeons perform every year more then 2000 operations for treatment of acute arterial occlusion. Because of the advanced age and poor general condition of these patients, the postoperative mortality and complication rate is considerable. AIM: Authors analyzed changes in the etiology and therapy of acute arterial occlusions of lower limb in the last 20 years in a retrospective study. PATIENTS AND METHODS: 563 patients were operated on with acute arterial occlusion of lower extremities from 1983 to 2002 by the authors. Patients with vascular surgery in their history were excluded from this study. Student's two-samples "t"-test, chi2- and Fisher's exact test were used in Statistica 6.0 for statistics. RESULTS: Period of 1983-1992 compared to period of 1993-2002 they found increased rate of occlusions caused by thrombosis (35 vs. 46%, p < 0.01) and increased number of acute vascular reconstructions performed with indication of acute thrombosis (17.6 vs. 47.0%, p < 0.001). Mortality was higher in patients operated with embolism than in patients with thrombosis (17.7 vs. 11.6%, p < 0.01), but the ratio of postoperative amputation following embolectomy was lower than following thrombectomy (5.0 vs. 16.0%, p < 0.01). Thrombectomy itself could solve the occlusion caused by thrombosis only in 50% of cases. Results of reoperations following unsuccessful thrombectomies are very poor. Amputation was necessary in 6.8% (in 5 cases of 74 patients) after primary reconstructions, but in 28.6% (in 14 cases of 49 patients) after reoperations. There was no significant difference in postoperative mortality among primary reconstructed, reoperated and conservatively treated groups. CONCLUSIONS: By author's experience, in cases of acute occlusion caused by thrombosis as a complication of chronic obliterative arterial disease, basic cause of occlusion should be searched for and--if conditions are suitable--procedure should be extend to vascular reconstruction.     

急性肠系膜血管闭塞的诊治分析

目的 总结急性肠系膜血管闭塞（AMVO）的诊断与治疗。方法 对1989年5月-2005年5月收治的11例AMVO患者的诊治资料进行回顾性分析。肠系膜上动脉栓塞（MAE）5例，肠系膜上动脉血栓形成（MAT）3例，肠系膜上静脉血栓形成（MVT）2例，非阻塞性肠系膜血管供血不全（NOMI）1例。10例手术，其中坏死肠管切除一期吻合6例，二期吻合3例，1例保守治疗。所有病例均经抗凝、祛聚、扩血管治疗。结果 11例患者最终治愈6例，死亡5例，其中2例死于中毒性休克及多器官功能衰竭，2例死于再发梗死，1例死于短肠综合征，病死率为45．5％。结论 AMVO发病急，进展快，早期易误诊，后期病情凶险，早发现、早治疗及选择合理治疗方案是保证疗效的关键。     

超声导入尿激酶治疗急性下肢深静脉血栓的临床研究

目的评价超声导入尿激酶治疗急性下肢深静脉血栓(DVT)的临床疗效及安全性。方法选择60名急性下肢DVT患者随机分成两组各30例,对照组按常规溶栓治疗,治疗组在常规溶栓基础上加用超声导入尿激酶,比较两组的临床疗效。结果治疗组治愈率明显高于对照组(P<0.05),治疗组缓解患肢的肿胀、疼痛所需时间以及D-Dimer水平达峰值所需时间明显少于对照组(P<0.05)。结论超声导入尿激酶配合常规溶栓治疗急性下肢DVT疗效确切,能明显增强溶栓作用,安全、可靠。     

手术联合腔内治疗合并动脉硬化的急性下肢动脉缺血的临床观察

目的观察手术联合腔内治疗对合并动脉硬化的急性下肢动脉缺血的临床效果。方法回顾性分析20例(24肢)经手术联合腔内治疗的合并动脉硬化的急性下肢动脉缺血患者的临床资料和治疗效果。结果 24肢中,治疗成功20肢,截肢1例,死亡1例。结论采用个体化疗法的手术联合腔内治疗,对合并动脉硬化的急性下肢动脉缺血的高龄患者治疗效果较好,下肢动脉供血的救治率得到提高。     

浅谈气压治疗对预防产妇产后下肢深静脉血栓形成的疗效观察

目的：探讨为预防产妇产后下肢深静脉血栓形成采用空气波压力治疗仪的临床治疗效果。方法：采集本院收治入院的围产期妇女120例,平均分为对照组和观察组,对照组在产妇产后采用常规临床治疗预防下肢深静脉血栓形成,观察组在常规临床治疗基础上给予空气波压力治疗仪治疗。观察两组临床效果。结果：观察组无一例引发下肢深静脉血栓及肺栓塞,有5例出现下肢肿胀、疼痛。对照组下肢深静脉血栓发生率13.33%,下肢疼痛、肿胀发生率31.66%,肺栓塞发生率6.66%,与观察组比较差异均有统计学意义（P〈0.05）。结论：空气波压力治疗仪对下肢静脉血栓有着明显的治疗效果,可有效降低产妇产后引发下肢深静脉血栓的发病率。     

瑞替普酶在急性肺动脉栓塞溶栓治疗的疗效及安全性评价

目的观察瑞替普酶对急性肺动脉栓塞的疗效及安全性。方法观察2006年1月至2011年9月符合溶栓治疗的急性肺动脉栓塞患者100例,随机分为瑞替普酶组50例(研究组)和尿激酶组50例(对照组),观察溶栓前后患者螺旋CT肺动脉造影、肺动脉压、动脉氧分压、血压及出血并发症情况。结果溶栓后研究组肺动脉压、动脉氧分压、血压较对照组明显改善(P<0.05)。研究组溶栓后显效25例,有效20例,无效5例,总有效率90%,对照组显效17例,有效21例,无效11例,总有效率76%,实验组有效率高于对照组(P<0.05))。出血并发症实验组较对照组低,差异有统计学意义(P<0.05)。结论瑞替普酶治疗急性肺动脉栓塞有较好的临床疗效及安全性。     

机械除栓在肺栓塞中的初步临床应用

目的评价机械除栓在肺栓塞中的临床价值。方法18例经CT证实的大面积肺栓塞合并静脉全身溶栓禁忌证的患者,采用7FAmplatz血栓消融器导管、7FHydrolyser溶栓导管、8FOASIS溶栓导管除栓,并结合7F的抽吸导管行血栓抽吸;部分使用尿激酶局部灌注10万~20万U。观察治疗前后临床症状的缓解及并发症、血气改变、治疗前后肺动脉造影情况。结果所有病例的临床症状均缓解,没有严重并发症发生。术前血氧分压为(9.28±1.43)kPa,术后为(11.15±1.29)kPa,差异有统计学意义,P<0.001。术前二氧化碳分压为(4.77±0.70)kPa,术后为(4.92±0.55)kPa,差异无统计学意义,P>0.05。清除血栓前后肺动脉造影评分比较,差异有统计学意义。结论机械除栓技术可以快速清除血栓,改善临床症状,减少溶栓的严重副反应。